COVID-19 pandemic

2019–20 Wuhan coronavirus outbreak

Location of Wuhan, the epicentre of the outbreak, in China
Date	12 December 2019 – ongoing
Location	Origin: Wuhan, Hubei, China
Casualties
Cases as of 25 January 2020: Country or region Confirmed cases Deaths Ref. China 1,409 42 Thailand 7 0 Hong Kong 5 0 Australia 4 0 Malaysia 4 0 Singapore 4 0 France 3 0 Japan 3 0 Taiwan 3 0 Macau 2 0 South Korea 2 0 United States 2 0 Vietnam 2 0 Nepal 1 0 Total 1,451 42

Number of cases in Greater China

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

An outbreak of a novel coronavirus, given the designation of 2019-nCoV, was initially identified during mid-December 2019 in the city of Wuhan in central China, as an emerging cluster of people with pneumonia with no clear cause. A majority of the earliest cases were directly associated with stallholders who worked at the Huanan Seafood Wholesale Market, which also sold live animals and game meat, though the exact origin of the virus has not been concluded. Chinese scientists isolated a new strain of coronavirus which has been found to be at least 70 percent similar in genome sequence to SARS-CoV. With the development of a specific diagnostic PCR test for detecting the infection, a number of cases were confirmed in people directly linked to the market and in those who were not directly associated with it. There is evidence of human-to-human transmission. Whether this virus is of the same severity or lethality as SARS is unclear.

On 23 January 2020, the World Health Organization (WHO) decided against declaring the outbreak a public health emergency of international concern, but said that their emergency committee would quickly reconvene to review the decision if necessary. The WHO had previously warned that a wider outbreak was possible, and there were concerns of further transmission during China's peak travel season around the Chinese New Year (Chunyun). Many New Year events have been closed over fear of transmission, including the Forbidden City in Beijing, traditional temple fairs, and other celebratory gatherings. The sudden increase in occurrences of the disease has raised questions relating to its origin, wildlife trade, uncertainties surrounding the virus's ability to spread and cause harm, whether the virus has been circulating for longer than previously thought, and the possibility of the outbreak being a super-spreader event. Chinese premier Li Keqiang has urged decisive and effective efforts to prevent and control the epidemic.

The first suspected cases were notified to WHO on 31 December 2019, with the first instances of symptomatic illness appearing just over three weeks earlier on 8 December 2019. The Huanan Seafood Wholesale Market was closed off on 1 January 2020, and people who showed signs and symptoms of the coronavirus infection were isolated. Over 700 people, including more than 400 healthcare workers who came into close contact with possibly infected individuals, were initially monitored. After the development of a specific diagnostic PCR test for detecting the infection, the presence of 2019-nCoV was subsequently 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 1,300 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 and Malaysia. 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 42, all in China.

On 23 January 2020, Wuhan was placed under quarantine, in which all public transport in and out of Wuhan has been suspended. Since then, transportation in at least 12 other cities in Hubei province have also been halted in a similar way.

Context

See also: Severe acute respiratory syndrome and Timeline of the SARS outbreak

Replication cycle of a coronavirus

Wuhan is a major railway hub.

In Wuhan, during December 2019, an inaugural cluster of cases displaying the symptoms of a "pneumonia of unknown cause" was linked to a wholesale animal and fish market, which had a thousand stalls selling 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 numbers of travellers for Chinese New Year, which begins 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

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. Its RNA sequence is approximately 30 kbp in length.

Epidemiology

Basic reproduction number for the human-to-human transmission of the virus was estimated as between 2 and 4. 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.

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. 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.

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.

There are reports of cases of asymptomatic patients. However, it has not been determined how infectious asymptomatic patients are.

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

Transmission

The first 59 suspected cases at the end of December 2019 and early January 2020 were admitted to Jin Yin-tan 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 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 18th 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 1,402, including 1,363 in Mainland China, six in Thailand, five in Hong Kong, four in Australia, three in France, three in Japan, three in Malaysia, three in Singapore, three in Taiwan, two in Macau, two in South Korea, two in the United States, two in Vietnam, and one in Nepal.

Chronology

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

Reported cases and responses

Map of the 2019–20 Wuhan coronavirus outbreak (as of 24 January 2020):

  Country of origin (Mainland China)

  Confirmed cases reported

  Suspected cases reported

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.

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.

Countries and regions with confirmed cases

Australia

The first confirmed case in Australia was announced on 25 January by Victorian Health Minister Jenny Mikakos. The case was of a man in his 50s, who had travelled from Guangzhou to Melbourne on 19 January via China Southern Airlines flight CZ321. He is currently receiving treatment at Monash Medical Centre in Melbourne's south-east. On 25 January, it was announced that three patients have tested positive for the coronavirus in New South Wales. Within the same day, six people in New South Wales were held under observation and confirmed to undergo hospital testing after having recently returned from Wuhan. Out of the six patients, two are suspected to have probable cases of the virus and were quarantined. The remaining four are potentially suspected to have contracted the virus.

Australia's chief medical officer, Brendan Murphy, said biosecurity officials would begin screening passengers arriving on the three weekly flights to Sydney from Wuhan starting on 23 January. Passengers would also be given an information pamphlet and asked to present themselves if they had a fever or suspected they might have the disease.

France

The first confirmed case in France and in Europe was reported in Bordeaux, and two more in Paris, all of them on 24 January.

Hong Kong

'Hong Kong confirms two new cases of pneumonia' – video news report from China News Service, 24 January 2020.

Hong Kong's Centre for Health Protection (CHP) added the term "unidentified pneumonia" to their list of notifiable diseases to expand their authority on quarantine. The Hong Kong government also shortened hospital visits and made it a requirement for visitors to wear face masks. Screening was tightened at airports and train stations with connections to Wuhan. In the first week of 2020, 30 unwell travellers from Wuhan were tested. Most were found to be positive for other respiratory viruses.

On 22 January, a mainland man, age 39, who travelled from Shenzhen developed symptoms of pneumonia. he had been to Wuhan in the previous month. He tested positive and was hospitalised in Queen Mary Hospital, Hong Kong Island. A 56-year old man from Ma On Shan, who had visited Wuhan, had also tested positive, raising the number of confirmed cases to two.

The Hong Kong government designated the Lady MacLehose Holiday Village in Sai Kung as a quarantine centre. On 23 January, three people who had come into close contact with the two aforementioned cases were quarantined, including two medical workers and a visitor from Australia. The Hong Kong Tourism Board canceled the Lunar New Year Cup and a four-day Lunar New Year carnival, citing concerns over the virus outbreak.

On 24 January, health authorities confirmed a fifth case.

Japan

A 30-year-old Chinese national who had previously travelled to Wuhan developed a fever on 3 January and subsequently returned to Japan on 6 January. He tested positive for 2019-nCoV during a hospital admission between 10 and 15 January. He had not visited the Huanan Seafood Market, but possibly had close contact with an affected person in Wuhan. On 25 January, the third case of the virus was confirmed.

Japan has been taking extra precautions, due to the upcoming 2020 Summer Olympics being held in Tokyo.

Macau

As of 22 January, Macau had confirmed two cases, in a 52-year-old woman and a 66-year-old man, both from Wuhan.

Mainland China

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

Malaysia

Eight Chinese nationals were quarantined at a hotel in Johor on 24 January after coming into contact with an infected person in neighbouring Singapore. Despite early reports of them tested negative for the virus, three of them were confirmed to be infected on 25 January.

The director general of the Ministry of Health, Noor Hisham Abdullah, said thermal scanners were being used to screen travellers at border points, and that the Malaysian health authorities were placed on high alert.

Nepal

A Nepali student who had returned from Wuhan and was quarantined in Kathmandu became the first confirmed case of the country and South Asia on on 24 January, after a sample sent to WHO Collaborating Centre Hong Kong. He was discharged after his condition improved.

Singapore

Singapore's Ministry of Health (MOH) issued a health advisory on 2 January, and implemented temperature checks for passengers arriving in Changi Airport from Wuhan the following day. On 20 January, temperature screening at Changi Airport was extended to all travellers coming from China. In addition, individuals with pneumonia who had travelled to Wuhan within 14 days before the onset of symptoms will be isolated in hospital. MOH also issued a reminder to hospitals and general practitioners to be vigilant for such cases. On 22 January, quarantine measures were extended to travellers who arrived from China and displayed symptoms, with the first seven suspected cases tested negative. On the same day, three more suspected cases were detected, causing the MOH to form a multi-ministry taskforce to tackle the virus. The MOH advised against non-essential trips to Wuhan and expanded the travel advisory the following day to all of Hubei.

The first case was confirmed on 23 January, involving a 66-year-old Chinese national from Wuhan who flew from Guangzhou via China Southern Airlines flight CZ351 with 9 companions and stayed at Shangri-La's Rasa Sentosa Resort and Spa. Contact tracing subsequently commenced. Two more cases were confirmed the next day, involving a 37-year-old son of the first imported case and a 53-year-old Chinese woman who arrived on 21 January by flight and showed preliminary positive results previously. Another 28 suspected cases were detected as a result of enhanced testing. Border control measures were enhanced and extended to land and sea checkpoints on 24 January and the Immigration and Checkpoints Authority started temperature checks from noon of that day.

On 25 January, MOH confirmed the fourth case of Wuhan coronavirus in Singapore involving a 36 year-old from Wuhan who stayed at Village Hotel Sentosa. He subsequently went to Sengkang General Hospital, where infection was confirmed.

South Korea

A suspected case was reported in South Korea on 8 January, and the person isolated. There have been four suspected cases since then, and confirmed cases on 20 and 24 January.

Taiwan

On 21 January, the first case in Taiwan was confirmed in a 50-year-old woman who just returned to Taoyuan International Airport from her teaching job in Wuhan. She reported her signs on her own initiative and was hospitalised without formal domestic entry and is being treated in quarantine. As of 24 January, there are three confirmed cases.

Thailand

In Thailand, screening of passengers arriving from Wuhan at four airports; Suvarnabhumi International Airport, Don Mueang International Airport, Phuket International Airport and Chiang Mai International Airport, began on 3 January, and a number of suspected cases have been found to have other common respiratory conditions.

On 13 January, Thailand had its first case, also the first outside China. The affected individual was a 61-year-old Chinese woman who is a resident of Wuhan; she had not visited the Huanan Seafood Market, but was noted to have been to other markets. She developed a sore throat, fever, chills and a headache on 5 January, flew directly with her family and a tour group from Wuhan to Suvarnabhumi airport in Bangkok on 8 January, where she was detected using thermal surveillance and was hospitalised that same day. Four days later, using RT-PCR, she tested positive.

Thailand's second case occurred in a 74-year-old woman who arrived in Bangkok on a flight from Wuhan on 17 January. On 21 January, Nakornping Hospital reported on a suspected case of a 18-year-old male patient who arrived in Chiang Mai from Wuhan with a high fever, his blood samples were sent to King Chulalongkorn Memorial Hospital in Bangkok for further analysis.

On 22 January, the Thai Ministry of Public Health announced a report for two additional confirmed cases of infection found in Thailand. The third was a 68-year-old man, a Chinese tourist like previous cases. The fourth case was the first case for a Thai citizen; a 73-year-old Thai woman hospitalised at Nakhon Pathom Hospital in Nakhon Pathom Province, arriving from Wuhan.

The fifth case was confirmed on 24 January in a 33-year-old Chinese woman arriving from Wuhan with her 7 year-old daughter who was not infected. She reported herself to Rajvithi Hospital, where she was hospitalised, 3 days after her arrival in Bangkok on 21 January.

On 25 January, Government of Hua Hin District in Prachuap Khiri Khan Province reported a case for 73-year-old chinese woman patient traveled from Wuhan since 19 January then entered a private hospital in Hua Hin at 23 January. The first blood test showed a positive result. However, They are awaiting a result from another lab for confirmation.

United States

Map of the outbreak in the United States (as of 24 January 2020):

  Confirmed cases reported

  Suspected cases reported

The Centers for Disease Control and Prevention (CDC) announced the first confirmed case of the new coronavirus in the United States, in a man in his 30s from Snohomish County, Washington, on 21 January 2020. The man had traveled from Wuhan to Seattle–Tacoma International Airport on 15 January and reported four days later to the Providence Regional Medical Center in Everett, Washington, after feeling ill with symptoms of pneumonia. A second case was confirmed in Chicago, Illinois, on 24 January, a woman in her 60s. 43 persons who had contact with the first man diagnosed are being monitored.

On 24 January, US health officials reported that they are monitoring 63 other potential cases within the US. The cases being monitored in the U.S. stretch across 22 different states, including the first patient in Washington state and the second case in Illinois.

Between 60,000 and 65,000 people travel from Wuhan to the United States every year, with January being a peak. At San Francisco International Airport, Los Angeles International Airport, and John F. Kennedy International Airport in New York City, arriving passengers began to be screened for symptoms of the virus ahead of the Chinese New Year peak travel season. As the number of cases started to increase, O'Hare International Airport in Chicago and Hartsfield–Jackson Atlanta International Airport have also started screening arriving passengers.

Vietnam

Prime Minister of Vietnam Nguyễn Xuân Phúc has ordered relevant ministries, including Health, Transport, Foreign Affairs, Public Security, Defence, Information and Communications, Culture, Sports and Tourism, Labour, Invalids and Social Affairs, Agriculture and Rural Development, to deploy measures to prevent and counter the spread of the disease into Vietnam, as well as to warn Vietnamese citizens not to visit the epidemic areas. Deputy minister Đỗ Xuân Tuyên said that Vietnam is considering closing the border with China as a necessary countermeasure. Saigon Tourist announced that it has cancelled all tours to or transit in Wuhan. On 24 January, the Civil Aviation Administration of Vietnam ordered the cancellation of all flights from and to Wuhan.

The first two cases of confirmed infected were hospitalised on 22 January and treated at Cho Ray Hospital, Ho Chi Minh City. One case is a Chinese man travelling from Wuhan to Hanoi to visit his son living in Vietnam. The second is the man's son who is believed to have contracted the disease from his father. After the confirmation, the acting Minister of Health Vũ Đức Đam has ordered the activation of the ministry's Emergency Epidemic Prevention Center.

Countries with suspected cases

Canada

On 23 January, Minister of Health Patty Hajdu said that five or six people were being monitored for signs of coronavirus, including at least one in Quebec and another in Vancouver.

The Canada Border Services Agency (CBSA) has implemented signage in Toronto, Vancouver, and Montreal airports to raise awareness of the virus and has added a health screening question to the electronic kiosks for passengers arriving from central China; however, there are no direct flights from Wuhan to Canada.

India

The Government of India issued a travel advisory to its citizens, particularly for Wuhan, where about 500 Indian medical students study.

It was announced that passengers arriving at Chhatrapati Shivaji International Airport from China would undergo thermal screening. Later, the procedures were extended to six other major international airports.

On 24 January, it was reported that two suspected cases of the coronavirus had been detected in the Indian city of Mumbai. Both cases were isolated and the appropriate precautions were taken at the hospital they are being treated in.

Italy

On 23 January, one suspected case in the city of Bari where an Italian singer, after returning home from an Asian tour that also included the city of Wuhan, was hospitalized after feeling ill. Tests for the virus that infected the singer reported that it is not 2019-nCoV.

Mexico

Mexican President Andrés Manuel López Obrador said on 22 January that authorities were investigating one potential case of coronavirus in the northern border state of Tamaulipas, and that a second had been ruled out. The case has since been attributed to a common cold. On 23 January, the Secretariat of Health reported that the case in Tamaulipas and two cases in Mexico City had been ruled out. However, three possible cases in Jalisco, one in Michoacán and one in Mexico City were being investigated.

Philippines

One suspected case involved a five-year old child from Wuhan who had arrived in Cebu City on 12 January. Samples from the child were sent to the Research Institute for Tropical Medicine in Muntinlupa for testing. The case tested positive for a "non-specific pancorona virus", although it has yet to be determined if the pathogen is the 2019-nCoV. Samples from the child had been sent to a laboratory in Australia for further testing and the authorities are awaiting the results. Three other travellers from China were checked by authorities at another airport, but they did not show relevant symptoms. Another case is that of a 35-year old man in Tacloban who had worked in Wuhan.

The outbreak has prompted urging from at least a member of the House of Representatives. Muntinlupa representative Ruffy Biazon sent a letter on 22 January calling on the Civil Aviation Authority of the Philippines (CAAP) to suspend flights from Wuhan to the Philippines. Royal Air Charter Service operates direct flights from Wuhan to Kalibo in Aklan.

Portugal

On 25 January, a traveller from Wuhan with symptoms of the virus was admitted to the Hospital Curry Cabral in Lisbon. Results from medical tests are pending.

Sri Lanka

As of 20 January, the Ministry of Health in Sri Lanka had instructed the Quarantine Unit at Bandaranaike International Airport to screen passengers for symptoms. Additionally, the ministry warned that infants, children, pregnant mothers, elderly and people who suffer from chronic diseases among other issues should avoid visiting crowded places when possible.

There were around 85 Sri Lankan students in Hubei Province, most of whom returned to Sri Lanka before the lockdown in Wuhan. The Sri Lankan embassy in Beijing estimates that 30 Sri Lankans are currently in Hubei province as of 25 January.

On 24 and 25 January, a Chinese woman and a Sri Lankan female medical student who studied in Wuhan were admitted to the special treatment unit of the Infectious Diseases Hospital (IDH) in Colombo on suspicion of coronavirus infection. It has not yet been ascertained whether their symptoms are caused by the coronavirus.

Turkey

The Ministry of Health announced that Turkey has arranged quarantine rooms, inspection centres and thermal cameras for screening at the airports as added precautions, even though the World Health Organization does not consider them necessary for the country. A Chinese patient who showed symptoms of the disease and who arrived in Istanbul recently from Wuhan was appointed to a hospital in Büyükçekmece district and was isolated and kept in check for 36 hours before being sent back to China. Around 20 people including medical personnel who have been in contact with the patient have been isolated. Exact diagnosis is expected to be reported within 3 days.

On 25 January, a Chinese tourist has been hospitalized and placed under quarantine in Konya.

United Kingdom

Four suspected cases underwent testing in Scotland on 23 January: three in Edinburgh and one in Glasgow. All had recently been to Wuhan. Heathrow Airport has tightened surveillance of the three direct flights that it receives from Wuhan every week; each will be met by a Port Health team. In addition, all airports in the UK will have written guidance (in English, Mandarin, and Cantonese) available for unwell travellers. The British government have been tracing up to 2,000 people who came in on flights from Wuhan. By 25 January, 31 suspected cases had been tested, with all coming back negative.

Bangladesh

Enhanced screening measures have been set up at Shahjalal International Airport in Bangladesh.

Brazil

The Health Secretary of the state of State of São Paulo announced a response and monitoring plan for new suspected infections. The main referral hospitals will be trained to detect and report cases of Wuhan coronavirus. Professionals are advised to observe fever, cough and difficulty in breathing associated with people who have travelled to outbreak areas in China. Also issued that suspect patients must be isolated, and make use of personal protective equipment.

Cambodia

The Cambodian Ministry of Health has taken preventive measures by installing thermal scanners at Phnom Penh International Airport, Siem Reap International Airport and Sihanouk International Airport to prevent the entry of the novel coronavirus (2019-nCoV). The thermal scanners are operated by the quarantine service personnel sent by the Ministry of Health. Currently, no case has been detected yet.

Germany

The German health minister Jens Spahn approves of China's actions against the further spread of the virus. Especially in regards to the SARS-outbreak, he praises China's transparency. Because of that, no concrete measures are taken, but daily checks by Germany's centre for disease control.

Indonesia

A total of 135 airport gates have been installed with thermal scanners by the Ministry of Health.

Kazakhstan

On 24 January, Almaty Airport staff and Almaty medical brigades had a medical exercise. The situation where a plane arrives from China with an infected passenger was simulated. Also, disinformation was spreading through messengers about infected people in Almaty. It was disproved by the Minister of Healthcare.

Currently, 98 Kazakhstani students are in Wuhan, but none of them are infected with the coronavirus.

Malta

Maltese local authorities have taken preventive measures, and advised the public and health workers to uphold sanitary regulation to not spread illnesses. The Superintendent of Public Health has cautioned for adequate measures but sees no risk of arriving and spreading within the country as of yet.

Netherlands

Airlines and the main international airport Schiphol are, as of 22 January, not taking extra measures yet against the spread of the virus, stating the lack of direct flights from or to Wuhan.

North Korea

As a precaution against the virus, North Korea is to temporarily ban foreign tourists until the government feels that the virus is well under control.

Panama

The Panamanian government has enhanced its sanitary control and screening measures at all ports of entry, in order to prevent the spread of the virus, isolating and testing potential cases.

Russia

The Russian consumer health watchdog Rospotrebnadzor advised tourists to refrain from visiting Wuhan and to stay away from Chinese zoos and markets selling animals and seafood. The agency also said that development of a vaccine against the virus was underway, relying on the WHO's recommendations. The Russian city of Blagoveshchensk, near the Chinese border, limited access to the country. Cultural exchange and official visits to China were cancelled. The Governors of the Amur Region Vasily Orlov, and of the Penza Oblast Ivan Belozertsev, called on residents to abandon trips to China altogether. Residents of large cities have been told to avoid contact with tourists from China.

Serbia

Minister of Health Zlatibor Lončar announced the Belgrade Nikola Tesla Airport would introduce new measures that include screening passengers arriving at the airport with thermal cameras, adding that Serbia is ready to quarantine anybody believed to be carrying the virus.

United Arab Emirates

On 23 January 2020, Abu Dhabi International Airport and Dubai International Airport announced that travellers arriving directly from China would have their temperatures screened.

Identification

Symptoms at clinical presentation

A doctor with special protective suit seeing a patient in 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

Due to a lack of medical personnel and equipment in regions affected by the outbreak, many hospitals have failed to identify coronavirus cases while many patients with coronavirus-like symptoms are labeled as having "severe pneumonia" instead. Incidentally, many of those experiencing symptoms decide to stay home instead of going to a hospital due to long wait-times and cramped conditions. Because of this, researchers at Northeastern University and Imperial College London estimate that the number of cases may be five or 10 times higher than what has been reported.

Additional concerns have been raised due to China's past handling of the 2003 SARS Epidemic, where the Chinese government hid infected patients from WHO inspectors and underreported the number of SARS cases.

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 currently 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.

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.

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. China's Ministry of Education also asked all schools to halt public assemblies and delay major exams. Some universities with open campuses also banned public visits. Hunan provincial education department stressed on 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. 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.

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
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

Quarantines

A quarantine on travel in and out of Wuhan was imposed from 23 January 2020, 10:00 onwards. Flights and trains in and out of Wuhan, public buses, the metro system and long-distances coaches were suspended until further notice. The move is an effort to stop the spread of the virus out of Wuhan, and to ensure the health and safety of the people, according to China's Xinhua News Agency. Large-scale gatherings and group tours were also required to be suspended. Various logistic issues have occurred after the quarantine, including rising food prices and difficulty for medical staff commuting to the hospital. In Wuhan, the roads remain open, but police are checking all incoming vehicles.

On 23 January 2020, 11 pm (UTC+8), the Chinese government announced a lockdown on Chibi City effective at 00:00 on 24 January, preceded by the prefecture-level cities of Huanggang, Ezhou, and Wuhan.

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

Since the city of Wuhan has been closed down, residents are scrambling to nearby stores to stockpile on essential goods. There have been numerous reports of long lines at supermarkets, pharmacies, and gas stations — residents are flocking to gas stations because of a false rumour about fuel reserves running out. Following the quarantine, prices of goods have significantly increased in Wuhan.

By 23 January at least 3 cities had been "locked down" by Chinese authorities, with a combined population of over 18 million. By the 24th this had increased to 10 cities in Hubei.

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.

Chinese cities under transportation ban

City	Date quarantined	Population
Wuhan	23 January 2020	11,081,000
Huanggang	24 January 2020	6,162,069
Ezhou	24 January 2020	1,048,672
Chibi	24 January 2020	478,410
Jingzhou	24 January 2020	5,691,707
Zhijiang	24 January 2020	495,995
Yichang	24 January 2020	4,059,686
Qianjiang	24 January 2020	946,277
Xiantao	24 January 2020	1,175,085
Xianning	24 January 2020	2,462,583
Huangshi	24 January 2020	2,429,318
Total		32,500,329

Specialty hospitals

Construction site of Huoshenshan Hospital as it appeared on 24 January

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

Initially Jinyintan Hospital was tasked with treating those with the coronavirus.

A specialty hospital named Huoshenshan Hospital (Chinese: 火神山医院) 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.

Authorities announced plans for a second specialty hospital on 25 January. The new one will be named Leishenshan Hospital (Chinese: 雷神山医院), with a capacity of 1,300 beds; completion is planned within "half a month." Some people voiced their concerns on social media sites, 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.

See also

• 2009 flu pandemic
• Acute respiratory distress syndrome (ARDS)
• Emerging infectious disease
• Middle East respiratory syndrome (MERS)
• 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" (Document). World Health Organization. hdl:10665/330376. WHO/2019-nCoV/Surveillance/v2020.1. License: CC BY-NC-SA 3.0 IGO.
• World Health Organization (2020). "Laboratory testing of human suspected cases of novel coronavirus (nCoV)‎ infection: interim guidance, 10 January 2020" (Document). World Health Organization. hdl:10665/330374. WHO/2019-nCoV/laboratory/2020.1. License: CC BY-NC-SA 3.0 IGO.

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

• "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).