COVID-19 pandemic

2019–20 Wuhan coronavirus outbreak

Location of Wuhan, the epicentre of the outbreak, in China
Date	8 December 2019 – ongoing (4 years, 8 months, 1 week and 3 days)
Location	Origin: Wuhan, Hubei, China
Casualties
Cases as of 26 January 2020: Country or region Confirmed cases Deaths Ref. China (mainland) 2,455 80 Hong Kong 8 0 Thailand 8 0 Macau 5 0 United States 5 0 Australia 4 0 Japan 4 0 Malaysia 4 0 Singapore 4 0 Taiwan 4 0 France 3 0 South Korea 3 0 Vietnam 2 0 Canada 1 0 Nepal 1 0 Total 2,503 80

2019-nCoV cases in Mainland China, Hong Kong, Macau, and Taiwan

  Suspected

  Confirmed 1–9

  Confirmed 10–99

  Confirmed 100–999

  Confirmed ≥1000

Infected people in China according to the National Health Commission daily reports
2020-01-16			45
2020-01-17			62
2020-01-18			121
2020-01-19			198
2020-01-20			291
2020-01-21			440
2020-01-22			571
2020-01-23			830
2020-01-24			1287
2020-01-25			1975

People queueing outside a Wuhan drug store to buy face masks and medical supplies

A new coronavirus, designated 2019-nCoV (and also called Wuhan coronavirus), was identified in Wuhan, Hubei province of China, after people developed pneumonia without a clear cause and for which existing vaccines or treatments were not effective. The virus has shown evidence of human-to-human transmission and its transmission rate (rate of infection) appeared to escalate in mid-January, with several countries other than China reporting cases. The incubation period (time from exposure to developing symptoms) of the virus, which can be fatal, is up to two weeks. Symptoms include fever, coughing and breathing difficulties. Chinese Health Minister, Ma Xiaowei, has said that people can spread the virus before they display any symptoms.

Wuhan has been placed under quarantine, in which all public transport in and out has been suspended. Thereafter, transportation in at least 15 other cities in Hubei province have also been halted in a similar fashion. Many New Year events have been closed over fear of transmission, including the Forbidden City in Beijing, traditional temple fairs, and other celebratory gatherings. Hong Kong has also raised their infectious disease response level to the highest level and declared an emergency, closed its schools until mid-February and cancelled its New Year celebrations.

A number of countries have put out travel advisories warning against travel to Wuhan and/or Hubei province in China. Travelers who have visited Mainland China have been requested to monitor their health for at least two weeks and contact their healthcare provider to report any symptoms of the virus. Anyone who suspects themselves to carry the virus are advised to wear a surgical mask and seek medical advice by calling a doctor rather than directly visiting the clinic in person. The travel sector has been providing refunds and no-fee cancellation for reservations in Mainland China or by people from Mainland China. Airports and train stations have implemented temperature checks, health declarations and information signage in an attempt to identify carriers of the virus.

Chinese scientists were able to isolate a strain of the new coronavirus quickly, with the genetic sequence being made available for laboratories across the world to independently develop PCR tests that can confirm infection in a person. Of the first 41 people confirmed by real-time RT-PCR and next-generation sequencing to have been infected, two-thirds were found to have a link with the Huanan Seafood Wholesale Market, which also sold live animals. The seventh member of the coronavirus family to infect humans, 2019-nCoV's genome sequence has been reported to be 75- to 80-percent identical to SARS-CoV, and more than 85-percent similar to several bat coronaviruses. Whether this virus is of the same severity or lethality as SARS is unclear.

After the development of a diagnostic PCR test for detecting the infection, the presence of 2019-nCoV was confirmed in 41 people in the original Wuhan cluster. Of those 41 people, two were later reported to be a married couple, one of whom had not been present in the marketplace, and another three were members of the same family that worked at the marketplace's seafood stalls. Extensive testing thereafter revealed over 2,000 confirmed cases in China, some of whom were working in healthcare. Confirmed cases have also been reported in Thailand, South Korea, Japan, Taiwan, Macau, Hong Kong, the United States, Singapore, Vietnam, France, Nepal, Australia, Malaysia and Canada. The first confirmed death from the coronavirus infection occurred on 9 January 2020. By 25 January, the number of deaths due to 2019-nCoV stood at 56, all in China.

Context

Replication cycle of a coronavirus

Wuhan as a railway hub, one of the four most important railway hubs in China

See also: Severe acute respiratory syndrome, Timeline of the SARS outbreak, and Timeline of the 2019–20 Wuhan coronavirus outbreak

In Wuhan, during December 2019, an inaugural cluster of cases displaying the symptoms of a "pneumonia of unknown cause" was linked to Huanan Seafood Wholesale Market, which had a thousand stalls selling fish, chickens, pheasants, bats, marmots, venomous snakes, spotted deer and the organs of rabbits and other wild animals (ye wei), i.e. bushmeat. The immediate hypothesis was that this was a novel coronavirus from an animal source (a zoonosis).

Coronaviruses mainly circulate among animals, but have been known to evolve and infect humans in the past as has been seen with SARS, MERS together with four further coronaviruses found in humans that cause mild respiratory symptoms like the common cold.

All six of those already known coronaviruses can spread from human to human. In 2002, with an origin in horseshoe bats, then via civets from live animal markets, an outbreak of SARS started in mainland China, and with the help of a few super-spreaders and international air travel, reached as far as Canada and the United States, resulting in over 700 deaths worldwide. The last case occurred in 2004. At the time, China was criticised by the WHO for its handling of the epidemic. Ten years after the onset of SARS, the dromedary-camel-related coronavirus, MERS, has resulted in more than 850 deaths in 27 countries. The Wuhan outbreak's association with a large seafood and animal market has led to the presumption of the illness having an animal source. This has resulted in the fear that it would be similar to the previous SARS outbreak, a concern exacerbated by the expectation of a high number of travellers for Chinese New Year, which began on 25 January 2020.

Wuhan is the capital of Hubei province and is the seventh-largest city in China, with a population of more than 11 million people. It is a major transportation hub of the country, long known as the "Nine Provinces' Thoroughfare" (九省通衢). It is approximately 1,100 km (700 mi) south of Beijing, 800 km (500 mi) west of Shanghai, and 970 km (600 mi) north of Hong Kong. It is considered today as the political, economic, financial, commercial, cultural and educational centre of Central China. Direct flights from Wuhan also connect with Europe: six flights weekly to Paris, three weekly to London, and five weekly to Rome.

Since 2000, the World Health Organization has coordinated international reactions against several new diseases such as MERS, SARS (2003–2004), 2009 swine flu, and others.

Phylogenetics

Genomic information

Genome organisation (click to enlarge)
NCBI genome ID	MN908947
Genome size	30473 bp
Year of completion	2020

In this case phylogenetics is the study of the virus's evolutionary history and relationships among other organisms.

The seventh member of the family of coronaviruses that can infect humans, the 2019-nCoV's genome sequence has been reported to be 75 to 80% identical to the SARS-CoV and have more similarities to several bat coronaviruses.

Sequences of Wuhan betacoronavirus show similarities to betacoronaviruses found in bats; however, the virus is genetically distinct from other coronaviruses such as Severe acute respiratory syndrome-related coronavirus (SARS) and Middle East respiratory syndrome-related coronavirus (MERS). Like SARS-CoV, it is a member of Beta-CoV lineage B.

Five genomes of the novel coronavirus have been isolated and reported, including:

• BetaCoV/Wuhan/IVDC-HB-01/2019,
• BetaCoV/Wuhan/IVDC-HB-04/2020,
• BetaCoV/Wuhan/IVDC-HB-05/2019,
• BetaCoV/Wuhan/WIV04/2019, and
• BetaCoV/Wuhan/IPBCAMS-WH-01/2019

— from the China CDC National Institute for Viral Disease Control and Prevention, Institute of Pathogen Biology, and Wuhan Jinyintan Hospital.

The genome's RNA sequence is approximately 30 kbp in length.

Transmission

Before the 2019-20 outbreak, a study from 2015 published in Nature warned about potential risk of SARS-CoV re-emergence from viruses circulating in Chinese bat populations. Using the SARS-CoV reverse genetics system, Ralph Baric team generated and characterized a chimeric virus expressing the spike of bat coronavirus SHC014 in a mouse-adapted SARS-CoV backbone. Both monoclonal antibody and vaccine approaches failed to neutralize and protect from infection with this CoVs using the novel spike protein.

Basic reproduction number

The transmissibility of the virus between human-to-human has been variable, with some affected people not transmitting the virus to others while others have been able to spread the infection to several people. The Basic reproduction number for the human-to-human transmission of the virus has been estimated as between 1.4 and 3.8 by a several research groups. The number describes to how many people a newly infected person is likely to pass the virus in human population. The new coronavirus has been reportedly able to transmit down a chain of up to four people so far.

Reservoir and transmitting host

The natural wildlife reservoir of the 2019‐nCoV and intermediate host that transmitted the 2019-nCoV to humans has not been confirmed, and results of animal sampling from the market are not yet available. However, it is likely that the primary reservoir for the virus is bats.

An updated preprint paper published 23 January 2020 on bioRxiv from members of the Wuhan Institute of Virology, Wuhan Jinyintan hospital, University of Chinese Academy of Sciences and the Hubei Provincial Center for Disease Control and Prevention suggest that the 2019 novel coronavirus has possible bat origins, as their analysis shows that nCoV-2019 is 96% identical at the whole genome level to a bat coronavirus.

On 22 January 2020, scientists from Peking University, Guangxi Traditional Chinese Medical University, Ningbo University and Wuhan Biology Engineering College published an article, which after looking at "humans, bats, chickens, hedgehogs, pangolins, and two species of snakes", concluded that the "2019‐nCoV appears to be a recombinant virus between the bat coronavirus and an origin‐unknown coronavirus" ... and ... "snake is the most probable wildlife animal reservoir for the 2019‐nCoV" which then transmitted to humans. Others have also suggested the 2019-nCoV developed as a result of "viruses from bats and snakes combining". Some have disputed the paper from Peking and argued that the reservoir must be bats and the intermediate host, bird or mammal, not snakes (as snakes, unlike humans, are poikilotherms).

ACE 2 receptors

Studies have confirmed that the 2019-nCoV enters humans via ACE 2 receptors, as is the case with the SARS virus.

Epidemiology

In this case epidemiology is the study and analysis of the distribution (who, when, and where), and the patterns of the spread of the virus.

The first 59 suspected cases at the end of December 2019 and early January 2020 were admitted to Jinyintan Hospital, specially designated to isolate them. 41 of the 59 were confirmed with the 2019-nCoV infection. Of these 41 cases, there was one group of family members, 30 (73%) were men and the average age was 49 years. Almost a third (32%) had an underlying medical condition including eight with diabetes, six with high blood pressure and six with heart disease. Two thirds had a history of exposure to the Huanan Seafood Wholesale Market. The most frequently reported symptoms were 40 (98%) with fever, 31 (76%) with cough, and 18 (44%) with muscle aches and tiredness. Less frequent symptoms included coughing sputum or blood, headache and diarrhoea. Around half of the cluster had shortness of breath and 13 were admitted to intensive care. CT scans of all 41 people revealed pneumonia. Complications included 12 with acute respiratory distress syndrome, six with RNAemia, five with acute cardiac injury and four with secondary infection.

On 17 January, an Imperial College group in the UK published a Fermi estimate that there had been 1,723 cases (95% confidence interval, 427–4,471) with onset of symptoms by 12 January 2020. This was based on the pattern of the initial spread to Thailand and Japan. They also concluded that "self-sustaining human-to-human transmission should not be ruled out", which has since been confirmed as happening. As further cases came to light, they later recalculated that "4,000 cases of 2019-nCoV in Wuhan City... had onset of symptoms by 18 January 2020". A Hong Kong University group has reached a similar conclusion as the earlier study, with additional detail on transport within China.

On 20 January 2020, China reported a sharp rise in cases with nearly 140 new patients, including two people in Beijing and one in Shenzhen. On 25 January 2020, the number of laboratory-confirmed cases stood at 2,062, including 2,016 in Mainland China, seven in Thailand, six in Hong Kong, five in Macau, four in Australia, four in Malaysia, four in Singapore, three in France, three in Japan, three in South Korea, three in Taiwan, three in the United States, three in Vietnam, and one in Nepal.

Super-spreaders were suspected multiple times by different experts and media. A widely-believed super-spreader patient was reported to have infected 14 different members of medical staff. On 25 January, Gao Fu, the head of China's CDC denied such claims and "dismissed a media report" claiming this, according to an announcement made to the official Xinhua News Agency. Earlier the same day, however, China Newsweek (operated by another official news agency, China News Service), citing an expert from Peking University, claimed that the aforementioned patient could be considered a super-spreader already, and criticised the hospitals involved for not having properly protected the staff who came in contact with the patient. China Newsweek also criticised the government's censorship, saying all doctors and nurses, except those in the fever clinic, have "basically nothing but a mask" to protect themselves.

Chronology

Main article: Timeline of the 2019–20 Wuhan coronavirus outbreak

Map of the 2019–20 Wuhan coronavirus outbreak (as of 25 January 2020):

  Region of origin (Mainland China)

  Confirmed cases reported

  Suspected cases reported

Countries with confirmed and suspected cases and country prevention

Main article: 2019–20 Wuhan coronavirus outbreak countries

The virus is spreading widely on the planet. The unknown cases may be 10 times the number of confirmed cases. With children and young adults being less strongly affected than elders, they may be carriers of the disease. Countries have invoked measures to screen incoming passengers from China.

Identification

Signs and symptoms

A doctor in a protective bunny suit sees a patient in a Wuhan hospital

Reported symptoms have included fever in 90% of cases, fatigue and a dry cough in 80%, and shortness of breath in 20%, with respiratory distress in 15%. Chest x-rays have revealed signs in both lungs. Vital signs were generally stable at the time of admission of those hospitalised. Blood tests have commonly shown low white blood cell counts (leucopenia and lymphopenia).

Testing protocol

On 15 January 2020, the WHO published a protocol on diagnostic testing for 2019-nCoV, developed by a virology team from Charité Hospital in Germany.

Concerns of underreporting

There are concerns on whether adequate medical personnel and equipment are available in regions affected by the outbreak for hospitals to correctly identify coronavirus cases instead of mis-diagnosing suspected cases as "severe pneumonia". Many of those experiencing symptoms may decide to self-quarantine at home instead of going to a hospital due to long wait-times and cramped conditions.

Estimates

Based on cases reported and assuming a 10-day delay between infection and detection, researchers at Northeastern University and Imperial College London estimated that the number of actual infections may be 10 times higher than those confirmed at the time of reporting. Imperial College estimated 4,000 cases with 440 confirmed by 21 January 2020, Northeastern University estimated 12,700 infections with 1,320 cases confirmed by 24 January 2020.

Prevention and management

Infrared cameras were installed in Wuhan railway station to check passengers' body temperature before they board the trains.

2019-nCoV does not have an effective medicine treatment or vaccine, though efforts to develop some are underway. Its symptoms include, among others, fever, breathing difficulties and coughing, which have been described as "flu-like". To prevent infection, the WHO recommends "regular hand washing, covering mouth and nose when coughing and sneezing… [and] avoid[ing] close contact with anyone showing symptoms of respiratory illness (such as coughing and sneezing)."

Though there are no specific treatments for general human coronaviruses, the U.S. CDC provides generic advice that an infected person can relieve their symptoms by taking regular flu medications, drinking fluids and resting. Some countries require people to report flu-like symptoms to their doctor, especially if they have visited mainland China.

Domestic responses

'Aerial photography of roads after motor vehicles are banned in central urban areas of Wuhan: few vehicle traces' - Video news from China News Service

On 20 January, Chinese President Xi Jinping made his first public remark on the outbreak and "spoke of the need for the timely release of information," according to state-run News Agency. One day later, the Central Political and Legal Affairs Commission of the CPC, the most powerful political organ in China overseeing legal enforcements and the police, wrote "self-deception will only make the epidemic worse and turn a natural disaster that was controllable into a man-made disaster at great cost," and "only openness can minimise panic to the greatest extent." The commission then added, "anyone who deliberately delays and hides the reporting of cases out of self-interest will be nailed on a pillar of shame for eternity."

Authorities across China announced school closures and delayed the spring semester, which normally begins in late February and early March. All schools ranging from kindergartens to universities in the whole of Hubei province will have their winter break prolonged and the exact date of the new semester will be announced later, according to a statement made on 24 January. China's Ministry of Education also asked all schools to halt public assemblies and delay major exams. Some universities with open campuses also banned the public from visiting. Education department in Hunan province, which neighbours the centre of the outbreak Hubei province, stressed on the official newspaper Hunan Daily on 23 January, claiming it will strictly ban off-school tutors and restrict unapproved student gatherings, which are all common practices in China for students to get better grades. Education departments in Shanghai and Shenzhen also imposed bans on off-school tutoring and ask schools to track and report students who have been to Wuhan or Hubei province during the winter break. Several universities, including China's top-ranking Peking University and Tsinghua University announced the spring semesters will be delayed on 26 January. The semi-autonomous regions Hong Kong and Macau also announced adjustments on schooling schedules. Hong Kong's Chief Executive Carrie Lam Cheng Yuet-ngor declared an emergency at a press conference on 25 January, saying the government will close primary and secondary schools for two more weeks on top of the previously scheduled Lunar New Year holiday, pushing the date for school reopenings to 17 February. Macau closed several museums and libraries, and prolonged the Lunar New Year holiday break to 11 February for higher education institutions and 10 February for others. The University of Macau said they will track the physical conditions of students who have been to Wuhan during the Lunar New Year break.

After the Chinese Lunar New Year on 25 January, there would be another peak of people travelling back from their hometowns to workplaces as a part of Chunyun. Several provinces and cities started to encourage people to stay in their hometowns and not travel back. Eastern city Suzhou also encouraged remote working via the internet and further prolonged the spring festival break.

The Civil Aviation Administration of China and the China State Railway Group, which regulates China's civil aviation and operates rail services, announced on 24 January that passengers could have full refunds for their plane and train tickets without any additional surcharges, regardless of whether their flight or train will go through Wuhan or not. Some hotel chains and online travel agencies also allowed more flexibility in cancellations and changes. China's Ministry of Culture and Tourism ordered travel agencies and online tourism firms to suspend package tours and stop offering "flight+hotel" bundles.

More provinces and cities outside the most contaminated Hubei started to restrict travel. Beijing suspended all intercity bus coaches on 25 January, with several others follow suit. Shanghai, Tianjin, Shandong, Xi'an, and Sanya all announced suspension of intercity or interprovince bus services on 26 January.

On the evening of 25 January, the authorities banned the use of private vehicles in Wuhan. Only vehicles which are transporting critical supplies or emergency response vehicles are allowed to move within the city.

International responses

The situation in Wuhan is being monitored with respect to the forthcoming third round of the 2020 AFC Women's Olympic Qualifying Tournament, some of which is due to be played there over the course of the tournament's span from 3 February 2020 to 9 February 2020. On 22 January 2020, the AFC announced that it would be moving the Group A matches previously scheduled to be played in Wuhan—which included the respective squads from Australia, China PR, Taiwan and Thailand—to Nanjing instead due to the coronavirus outbreak. A few days later, the AFC announced that together with Football Federation Australia they would be moving the matches to Sydney, Australia.

Since 31 December 2019, some regions and countries near China tightened their screening of selected travellers. The US Centers for Disease Control and Prevention (CDC) later issued a Level 1 travel watch. Guidances and risk assessments were shortly posted by others including the European Centre for Disease Prevention and Control and Public Health England. In China, airports, railway stations and coach stations installed infrared thermometers. People with fevers are subsequently taken to medical institutions after being registered and given masks. Real time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test was used to confirm new cases of coronavirus infection.

An analysis of air travel patterns was used to map out and predict patterns of spread, and was published in the Journal of Travel Medicine in mid-January 2020. Based on information from the International Air Transport Association (2018), Bangkok, Hong Kong, Tokyo, and Taipei had the largest volume of travellers from Wuhan. Dubai in the United Arab Emirates and Sydney and Melbourne in Australia were also reported as popular destinations for people travelling from Wuhan. Using the validated tool, the Infectious Disease Vulnerability Index (IDVI), to assess ability of managing a disease threat, Bali was reported as least able in preparedness, while cities in Australia were most able.

National reporting advice

National reporting advice

Polity	Advice	Authority	Last Updated	Link
Mainland China	"Seek prompt medical attention if you have symptoms of fever and respiratory infection".	National Health Commission	21 January 2020
Hong Kong	"When travelling outside Hong Kong, do not touch animals; do not eat game meat; and avoid visiting wet markets, live poultry markets or farms. After returning to Hong Kong, if you have a fever or other symptoms, wear a surgical mask, consult a doctor promptly and reveal your recent travel history".	Centre for Health Protection	23 January 2020
United States	"CDC recommends that travelers avoid all nonessential travel to Hubei Province, China, including Wuhan". Travellers who have been to Hubei province and "and feel sick with fever, cough, or difficulty breathing'" should "Seek medical care right away. Before you go to a doctor's office or emergency room, call ahead and tell them about your recent travel and your symptoms".	Center for Disease Control and Prevention	23 January 2020
United Kingdom	"Individuals should seek medical attention if they develop respiratory symptoms within 14 days of visiting Wuhan, either in China or on their return to the UK. They should phone ahead before attending any health services and mention their recent travel to the city".	Public Health England	22 January 2020
Australia	"If you become unwell and suspect you may have symptoms of coronavirus, you must seek medical attention. Please ring ahead of time to book your appointment. This will help make your doctor aware of your symptoms and your travel history. Call 000 if you need urgent medical help".	Australian Government Department of Health	25 January 2020
Malaysia	"The Ministry of Health Malaysia urges every Malaysian that wants to visit Wuhan, China to postpone their trip except for those with very important matters that cannot be avoided".	Ministry of Health	23 January 2020
Singapore	"Singaporeans are advised not to travel to the whole of Hubei Province"., "Wear a mask if you have respiratory symptoms such as a cough or runny nose;"" All travellers should monitor their health closely for two weeks upon return to Singapore and seek medical attention promptly if they feel unwell.  Travellers should inform their doctor of their travel history. If travellers have a fever or respiratory symptoms (e.g. cough, shortness of breath), they should wear a mask and call the clinic ahead of the visit".	Ministry of Health	24 January 2020
India	Travellers are advised to report "the illness to the nearest health facility and also inform the treating doctor regarding your travel history".	National Centre for Disease Control	11 January 2020
Israel	"Israelis are advised to avoid non-urgent travels to China".	Ministry Of Health	26 January 2020

City-wide quarantine measures

On 23 January 2020, a quarantine on travel in and out of Wuhan was imposed in an effort to stop the spread of the virus out of Wuhan. Flights and trains in and out of Wuhan, public buses, the metro system and long-distances coaches were suspended until further notice. Large-scale gatherings and group tours were also required to be suspended. By 24 January 2020, a total of 15 cities, including Wuhan, in Hubei, were placed under similar quarantine measures.

Due to the unprecedented quarantine measures, residents rushed to stockpile on essential goods, food and fuel. The prices of goods were also significantly increased. Medical staff faced difficulties in commuting to their hospitals, as they were now limited to walking and private cars. Taxis and private hire vehicles would shun them upon knowing the destination.

Residents of Wuhan donning masks rushed out to nearby markets on 23 January.

Guan Yi, an epidemiologist and SARS virologist with teams consisting of medical specialists who just flew back to Hong Kong after their one-day inspection in Wuhan told correspondents that "the Wuhan outbreak is at least 10 times larger than that of SARS, calling people to stay away from Wuhan as soon as possible."

Some posts on Weibo showed that hospitals in Wuhan have already been overloaded with thousands of people with fever and were highly critical of the reliability of the figures from the Chinese government although such posts are now deleted due to unknown reasons.

On 26 January, the city of Shantou in Guangdong declared a partial lockdown, though this was quickly reversed only two hours later. This created chaos as residents rushed to supermarkets to stock food as soon as the lockdown was declared, and the surge of stockpiling didn't come to an end until the authorities reversed their decision. Caixin said the wording of Shantou's initial declaration was "unprecedentedly strict" and will severely affect residents' lives if implemented as is. Shantou's department for outbreak control later clarified they will not restrict travelling and all they would do is to sterilise vehicles used for transportation.

Local authorities of the capital Beijing and several other major cities, including Hangzhou, Guangzhou, and Shenzhen announced 26 January that, these cities will not suffer from a lockdown similar to those of Hubei province's. Rumors of these lockdowns had already spread widely before the official announcements. A spokesperson of Beijing's municipal transportation commission claimed that the expressways and highways, as well as subways and buses, are operating normally. In an effort to ease residents' panic, Hangzhou's government stressed the city will not be locked down from the outside world, and both cities said that they will introduce precautions against potential risks.

Hubei cities under transportation ban

City	Date quarantined	Estimated population	Source
Wuhan	23 January 2020	11,081,000
Huanggang	23 January 2020	6,630,000
Ezhou	23 January 2020	1,077,700
Chibi	24 January 2020	490,900
Jingzhou	24 January 2020	5,590,200
Zhijiang	24 January 2020	497,600
Yichang	24 January 2020	4,135,900
Qianjiang	24 January 2020	966,000
Xiantao	24 January 2020	1,140,500
Xianning	24 January 2020	2,543,300
Huangshi	24 January 2020	2,470,700
Dangyang	24 January 2020	469,600
Enshi	24 January 2020	777,000
Xiaogan	24 January 2020	4,915,000
Jingmen	24 January 2020	2,896,500
Total		41,546,000

Specialty hospitals

Construction site of Huoshenshan Hospital as it appeared on 24 January

File:Wuhan Jinyintan Hospital (Medical treatment Center)-VOA.jpg

Jinyintan Hospital had initially been tasked with treating those with the coronavirus.

A specialty hospital named Huoshenshan Hospital has been under construction as a countermeasure against the outbreak and to better quarantine the patients. Wuhan City government had demanded that a state-owned enterprise fabricate such an accommodation "at the fastest speed" comparable to that of the SARS outbreak in 2003.

On 24 January, Wuhan authorities specified its planning, saying they planned to have the hospital built within six days of the announcement and it will be ready to use on 3 February. The specialty hospital will have 1,000 beds and it will take up 25,000 square metres. The hospital is modelled after the Xiaotangshan Hospital which was fabricated for the SARS outbreak of 2003, itself built in only seven days. State media praised the construction workers for their hard-working, said there will be 1,500 workers and nearly 300 construction machineries on the site at peak, and another backup team of 2,000 workers has already gathered. The construction will go non-stop on the Chinese Lunar New Year's Eve and the New Year, which are 24 and 25 January. This means the workers will have to give up their holidays and report said these workers were paid twice as much as average.

Authorities announced plans for a second specialty hospital on 25 January. The new one will be named Leishenshan Hospital (雷神山医院), with a capacity of 1,300 beds; completion is planned within "half a month." Some people voiced their concerns through social media services, saying the authorities' decision to build yet another hospital in such little time showed the severity of the outbreak could be a lot worse than expected.

Evacuation of foreign diplomats and citizens from Wuhan

The United States Department of State announced on January 25 that it was taking measures to evacuate diplomats and officials at the U.S. Consulate General in Wuhan, as well as any American citizens affected by the lock down. It is estimated that approximately 1,000 U.S. citizens live within Hubei province. An evacuation flight is expected to depart Wuhan Tianhe International Airport on 28 January, bound for San Francisco International Airport.

The government of Thailand is also planning to evacuate 64 Thai nationals. Four C-130 aircraft equipped with medical teams have been placed on standby, with a more complete plan for evacuation expected to be known by 27 January.

The governments of Russia, France, India, Japan, and Australia are considering similar measures.

Criticism

Chinese authorities faced initial criticism on mishandling the outbreak, including insufficient medical supplies, lack of transparency to the press and censorship of social media. On 1 January 2020 the Wuhan police interviewed eight residents for spreading false information (referring to the new infection as a reappearance of SARS) with none ultimately being detained or punished.

For over a month from 8 December 2019 to 17 January 2020, all the confirmed cases in mainland China were from the sole city of Wuhan, yet meanwhile, there were already confirmed cases in Japan and Thailand. Some people suggested via Chinese social media that the authorities must be concealing the actual numbers, as Wuhan definitely isn't better connected to other countries than to other parts of China. People jokingly called this virus a "patriot" as it "only infects other countries but not ourselves."

Several Hong Kong media correspondents were detained by the police for over an hour when they were interviewing in Wuhan's Jinyintan Hospital on 14 January. Reports said the police brought the correspondents to a police station, where the police checked their travel documents and belongings, then asked them to delete video footage taken in the hospital before releasing them.

Vaccines and antivirals

Several organizations around the world are working on a vaccine. U.S. National Institutes of Health (NIH) is hoping for human trials of a vaccine in three months. The Chinese Center for Disease Control and Prevention (CCDC) has started developing vaccines against the novel coronavirus and is testing existing drug effectiveness for pneumonia. The Coalition for Epidemic Preparedness Innovations CEPI is funding three vaccine projects and hopes to have a vaccine in trials by June 2020 and approved and ready in a year. The University of Queensland in Australia has received $10.6 million in funding from CEPI to develop a "molecular clamp" vaccine platform. Moderna is developing a mRNA vaccine with funding from CEPI. Inovio Pharmaceuticals received a grant from CEPI and designed a vaccine in two hours after receiving the gene sequence. The vaccine is being manufactured so that it can be first tested on animals.

San Francisco based Vir Biotechnology is evaluating if previously identified monoclonal antibodies (mAbs) are effective against the virus.

Gilead Sciences is in active discussions with researchers and clinicians in the United States and China regarding the ongoing Wuhan coronavirus outbreak and the potential use of remdesivir as an investigational treatment.

See also

• 2009 flu pandemic
• Acute respiratory distress syndrome (ARDS)
• Emerging infectious disease
• Rousettus bat coronavirus HKU9
• Severe Acute Respiratory Syndrome (SARS)

Further reading

Mainland China and Hong Kong

• Wuhan unexplained viral pneumonia epidemic The pathogen was initially identified as a new type of coronavirus. CCTV, (9 January 2020). (in Chinese)
• Wuhan Municipal Health Commission (in Chinese)
• Statutory Reporting of Severe Respiratory Disease associated with a Novel Infectious Agent. CHP, Hong Kong, (7 January 2020)

WHO

• World Health Organization (2020). "Surveillance case definitions for human infection with novel coronavirus (nCoV)‎: interim guidance v1, January 2020". World Health Organization. hdl:10665/330376. WHO/2019-nCoV/Surveillance/v2020.1.
• World Health Organization (2020). "Laboratory testing of human suspected cases of novel coronavirus (nCoV)‎ infection: interim guidance, 10 January 2020". World Health Organization. hdl:10665/330374. WHO/2019-nCoV/laboratory/2020.1.

Europe

• "Cluster of pneumonia cases caused by a novel coronavirus, Wuhan, China". ECDP (17 January 2020)
• Wuhan novel coronavirus and avian flu: advice for travel to China. PHE, UK, (10 January 2020).
• Threat level remains LOW but authorities raise alertness to symptoms MSN (22 January 2020)

External links

• Realtime interactive global map of Wuhan novel coronavirus (2019-nCOV) spread by Johns Hopkins University
• "Coronavirus". Centers for Disease Control and Prevention (CDC).
• "Statement on the meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus 2019 (n-CoV) on 23 January 2020". World Health Organization (WHO).
• Ver.2020 Jan 27th the Change of Total Number of Novel coronavirus (2019-nCoV) Cases for each Country on YouTube