2019–20 outbreak of novel coronavirus (2019-nCoV)

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2019–20 outbreak of novel coronavirus
2019–20 outbreak of novel coronavirus (2019-nCoV) is located in China
2019–20 outbreak of novel coronavirus (2019-nCoV)
Location of Wuhan, China, the epicentre of the outbreak.
Date12 December 2019 – present
LocationOrigin: China Wuhan, Hubei, China
Casualties
Cases as of 23 January 2020
Country or region Confirmed cases Deaths Ref.
China China (mainland) 633 17[1]
Thailand Thailand 4 0[2]
Hong Kong Hong Kong 3 0[3]
Macau Macau 2 0[4]
Vietnam Vietnam 2 0[5]
Japan Japan 1 0[6]
Saudi Arabia Saudi Arabia 1 0[7]
Singapore Singapore 1 0[8]
South Korea South Korea 1 0[6]
 Taiwan 1 0[9]
United States United States 1 0[10]
Total 650 17

An outbreak of novel coronavirus 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, which was linked primarily to stallholders who worked at the Huanan Seafood Market (华南海鲜市场), which also sold live animals. Chinese scientists subsequently isolated a new strain of the coronavirus, designated 2019-nCoV, 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. Whether this virus is of the same severity or lethality as SARS is unclear.[11][12][13][14]

On 20 January 2020, Chinese premier Li Keqiang urged decisive and effective efforts to prevent and control the pneumonia epidemic caused by a novel coronavirus.[15] As of 23 January 2020, 25 deaths have occurred, all in China, and there is evidence of human-to-human transmission. Extensive testing has revealed over 600 confirmed cases, some of whom are healthcare workers.[16][17][18] Confirmed cases have also been reported in Thailand, South Korea, Japan, Taiwan, Macau, Hong Kong, the United States,[17] and Singapore.[8]

Whether the situation constitutes a public health emergency of international concern under International Health Regulations was discussed on 22 January 2020 by an emergency committee organised by the World Health Organization (WHO).[19] The decision was postponed due to lack of information.[20] The WHO had warned that a wider outbreak was possible,[21] and there were concerns of further transmission during China's peak travel season around the Chinese New Year.[13][22] The sudden increase in occurrences of the disease has raised questions relating to wildlife trade, uncertainties surrounding the virus’s ability to spread and cause harm,[23] whether the virus has been circulating for longer than previously thought, its origin and the possibility of the outbreak being a super-spreader event.[14][19][22][24][25]

The first suspected cases were reported on 31 December 2019,[26] with the first instances of symptomatic illness appearing just over three weeks earlier on 8 December 2019.[27] The market was closed off on 1 January 2020, and people who showed signs and symptoms of the coronavirus infection were isolated.[26] Over 700 people, including more than 400 healthcare workers who came into close contact with possibly infected individuals, were initially monitored.[28] 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,[11][29] of which two were later reported to be a married couple, one of whom had not been present in the marketplace, and another three who were members of the same family that worked at the marketplace's seafood stalls.[30][31] The first confirmed death from the coronavirus infection occurred on 9 January 2020.[32]

On 23 January 2020, Wuhan was placed under quarantine, in which all public transport in and out of Wuhan have been suspended.[33] The cities of Huanggang and Ezhou, adjacent to Wuhan, will also be placed under a similar quarantine from 24 January 2020 onwards.[34][35]

Context[edit]

Replication cycle of a coronavirus

As the cluster of cases with "pneumonia of unknown cause" had centred around 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), where bushmeat are sold, it led to the suspicion that the cause may be a novel coronavirus from an animal source.[12][36][37][38]

Coronaviruses mainly circulate among animals, but have been known to evolve and infect humans, as has been seen with SARS, MERS and four other coronaviruses found in humans which cause mild respiratory symptoms like in the common cold. All six can spread from human to human.[39][40] In 2002, with an origin in civet cats 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.[39][41][42] At the time, China was criticised by the WHO for its handling of the epidemic.[43] Ten years after the onset of SARS, the dromedary-camel-related coronavirus, MERS, resulted in 750 deaths in over 27 countries.[39] The Wuhan outbreak's association with a large seafood and animal market, which sells animals for consumption, has led to the possibility of the illness having an animal source.[40] This has resulted in the fear that it would be similar to the previous SARS outbreak,[41][44] a concern exacerbated by the expectation of a high numbers of travelers for Chinese New Year, which begins on 25 January 2020.[45]

Wuhan is the seventh-largest city in China, with a population of more than 11 million people. It is a major transportation hub in central China, approximately 700 miles (1,100 km) south of Beijing,[46] 500 miles (800 km) west of Shanghai, and 600 miles (970 km) north of Hong Kong.[47] Direct flights from Wuhan also connect with Europe: six flights weekly to Paris, three weekly to London, and five weekly to Rome.[48]

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[edit]

Genomic information
NCBI genome IDMN908947
Genome size30473 bp
Year of completion2020

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).[49] Like SARS-CoV, it is a member of Beta-CoV lineage B.[50]

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.[49][51][52] Its RNA sequence is approximately 30 kbp in length.[49]

Epidemiology[edit]

Confirmed cases outside of mainland China include three women and one man in Thailand, one man in Japan, one woman in South Korea, one woman in Taiwan, two men in Hong Kong, two men in Vietnam, one nurse in Saudi Arabia, one man in Singapore, one man in Macau and one man in the United States.[6][53][54][55][19]

On 17 January, an Imperial College group in the UK published an 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".[56][57] 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".[16][18] A Hong Kong University group has reached a similar conclusion as the earlier study, with additional detail on transport within China.[58]

On 20 January, China reported a sharp rise in cases with nearly 140 new patients, including two people in Beijing and one in Shenzhen.[59] As of 23 January, the number of laboratory-confirmed cases stands at 650, including 633 in Mainland China, 4 in Thailand, 3 in Hong Kong, 2 in Macau, 2 in Vietnam, one in Japan, one in South Korea, one in Taiwan, one in Saudi Arabia, one in Singapore and one in the United States. [10][60][61][62][63][64]

Chronology[edit]

Novel coronavirus in China[65][66]
Date
CST		 Cases Deaths Quarantine Source
Suspected Confirmed Quarantined Released Cumulative
2019.12.31 27 [67]
2020.01.03 44 121 [68]
2020.01.05 59 163 [69]
2020.01.10 41 1 [70]
2020.01.11 41 1 717 46 763 [71]
2020.01.12 41 1 687 76 763 [72]
2020.01.13 41 1 576 187 763 [73]
2020.01.15 2 119 644 763 [74]
2020.01.16 45 98 665 763 [75]
2020.01.17 62 2 82 681 763 [76]
2020.01.18 121
2020.01.19 198 3 90 727 817 [77]
2020.01.20 291 6 922 817 1739 [78][79]
2020.01.21 440 9 1394 765 2197 [80]
2020.01.22 571 17 4928 969 5897 [81]
2020.01.23 633 17
Novel coronavirus in Wuhan
Novel coronavirus in China
Date when first case in province was confirmed:
  11 Jan 2020
  20 Jan 2020
  21 Jan 2020
  22 Jan 2020
  23 Jan 2020
Novel coronavirus cases globally

30 December 2019: An "urgent notice on the treatment of pneumonia of unknown cause" was issued by the Medical Administration and Medical Administration of Wuhan Municipal Health Committee.[82]

31 December 2019: 27 people with pneumonia of unknown cause were reported to the WHO. Most were stallholders from the Wuhan South China Seafood Market. Seven were in a serious, life-threatening state. As a result, Hong Kong, Macau and Taiwan tightened their inbound screening process.[12][83]

1 January 2020: The fish and animal market suspected of being linked to the pneumonia cases was closed for cleaning and disinfection.[12]

3 January 2020: Thailand began screening passengers arriving from Wuhan at four different airports.[84][85][86] On the same day, Singapore started screening passengers at Changi Airport.[87]

5 January 2020: Early investigations into the cause of the pneumonia ruled out seasonal flu, SARS, MERS and bird flu.[11][36] The number of suspected cases reached 59 with seven in a critical condition. All were quarantined and 163 contacts commenced monitoring. At this time, there were no reported cases of human-to-human transmission or presentations in healthcare workers.[88][89]

6 January 2020: The US Centers for Disease Control and Prevention (CDC) issued a travel watch at level 1, with recommendations on washing hands and the advice to avoid animals, animal markets, and contact with unwell people if traveling to Wuhan.[88][36]

9 January 2020: The WHO confirmed that a novel coronavirus had been isolated from one person who was hospitalised.[90][91] On the same day, the European Centre for Disease Prevention and Control posted its first risk assessment.[92] The WHO also reported that Chinese authorities had acted swiftly,[90] identifying the novel coronavirus within weeks of the onset of the outbreak, with the total number of positively tested people being 41.[93] The first death from the virus occurred in a 61-year-old man who was a regular customer at the market. He had a number of significant medical conditions, including chronic liver disease and he died from heart failure and pneumonia. The incident was reported in China by the health commission via Chinese state media on 11 January.[28][32][48][94]

10 January 2020: The gene sequencing data of the isolated Wuhan coronavirus, a virus from the same family as the SARS coronavirus, was posted on Virological.org by researchers from Fudan University, Shanghai. A further three sequences from the Chinese Center for Disease Control and Prevention, one from the Chinese Academy of Medical Sciences, and one from Jinyintan Hospital in Wuhan were posted to the Global Initiative on Sharing All Influenza Data (GISAID) portal.[28][95][84][96] The same day, Public Health England issued its guidance.[92]

11 January 2020: In China, more than 700 close contacts of the 41 confirmed cases, including more than 400 healthcare workers, had been monitored, with no new cases reported in China since 5 January.[88][36][28][97] The WHO published initial guidance on travel advice, testing in the laboratory and medical investigation.[28]

13 January 2020: The CDC announced that the genome had been posted on the NIH genetic sequence database, GenBank.[40] On the same day, Thailand witnessed the first confirmed case of 2019-nCoV, the first outside China.[55] The affected 61-year-old Chinese woman, who is a resident of Wuhan, had not visited the Huanan Seafood Market, but was noted to have been to other markets. She had arrived in Bangkok on 8 January.[27]

14 January 2020: Two of the 41 confirmed cases in Wuhan were reported to include a married couple, raising the possibility of human-to-human transmission.[27][98]

15 January 2020: A second death occurred in a 69 year old man in China.[99][100]

The WHO published a protocol on diagnostic testing for 2019-nCoV, developed by a virology team from Charité Hospital.[99]

16 January 2020: The WHO was alerted by Japan's Ministry of Health, Labour and Welfare that a 30-year-old male Chinese national had tested positive to 2019-nCoV during a hospital stay between 10 and 15 January. He had not visited the Huanan Seafood Market, but possibly had close contact with an affected person in Wuhan.[54][101]

17 January 2020: Thailand's second confirmed case was reported in a 74 year old woman who arrived in Bangkok on a flight from Wuhan.[53][102] The number of laboratory-confirmed cases rose to 45 in China.[103]

18 January 2020: China reported 17 additional laboratory-confirmed cases, with three cases in critical condition. The number of laboratory-confirmed cases rose to 62 in China, with the ages ranging from 30 to 79, of which 19 were discharged and eight remain critical.[60]

19 January 2020: First confirmed cases reported in China, outside Wuhan, one in the southern province of Guangdong and two in Beijing.[62] Wuhan reported 136 additional laboratory-confirmed cases, bringing the total number of laboratory-confirmed cases in China to 201. A new death was also reported in Wuhan, bringing the total number of fatalities in China to three.[104][105]

20 January 2020: First confirmed case reported in South Korea.[106] Beijing and Guangdong reported an additional three and thirteen laboratory-confirmed cases respectively. Shanghai confirms its first case, bringing the total number of laboratory-confirmed cases in China to 218.[64][107] The investigation team from China's National Health Commission confirmed that the coronavirus can be transmitted between humans. At least two people had become infected whilst living hundreds of miles from Wuhan.[24]

21 January 2020: The World Health Organization announced that it will hold an emergency meeting on the virus the following day to determine if the virus is a "public health emergency of international concern".[108]

Confirmed cases were reported in several new locations in China. Zhejiang province and Tianjin reported 5 and 2 laboratory-confirmed cases respectively.[109][110] Guangdong reported 3 additional laboratory-confirmed cases.[111] Shanghai and Henan province reported an additional 4 and 1 laboratory-confirmed cases respectively.[112] One laboratory-confirmed case was reported in Sichuan province, and Chongqing reported 5 laboratory-confirmed cases.[113][114] Shandong, Hunan and Yunnan all reported one laboratory-confirmed case each.[115][116][117] Jiangxi reported 2 laboratory-confirmed cases.[118] In all, the total number of laboratory-confirmed cases in China increased to 312 and the death toll to 6.[119][120][114]

15 Wuhan medical staff infections were reported, of which 14 were from a suspected super-spreader.[121][122]

New cases were also reported outside of mainland China. Taiwan reported its first laboratory-confirmed case,[123] and the first confirmed case in North America was reported in the state of Washington.[10][124]

22 January 2020: WHO's emergency committee was unable to reach a consensus on whether the outbreak should be classified as PHEIC due to lack of information. The committee will resume discussion the next day.[20]

Macau and Hong Kong report their first laboratory-confirmed cases.[125][4] Beijing reports an additional 5 laboratory-confirmed cases, while Guangdong reports an additional 9 laboratory-confirmed cases. Shanghai reports an additional 5 laboratory-confirmed cases, while Tianjin reports an additional 2 laboratory-confirmed cases. Zhejiang and Jiangxi report an additional 5 and 1 laboratory-confirmed cases respectively.[126] Liaoning reports its first 2 laboratory-confirmed cases.[127] Guizhou, Fujian, Anhui, Shanxi and Ningxia report one laboratory-confirmed case each.[128][129][130][131][132] Hainan reports 4 laboratory-confirmed cases.[133] Hunan reports 3 additional laboratory-confirmed cases.[134] Guangxi reports 2 laboratory-confirmed cases.[135] In all, the total number of laboratory-confirmed cases in China increased to 571 and the death toll to 17. In response, the government announced a quarantine until further notice, cancelling outgoing flights and trains from Wuhan, and suspending public transportation in Wuhan, effective 10:00 (02:00 UTC, UTC+08:00) on 23 January.[136]

2 more laboratory-confirmed cases were reported in Thailand, raising the total number of laboratory-confirmed cases in Thailand to 4.[137]

On the evening of 22 January 2020, Hong Kong reported its second laboratory-confirmed case.[138]

New data shows the current rapid spread of the disease, and an increase in the rate of transmission.[139][140]

23 January 2020: Jiangsu reports its first laboratory-confirmed case.[141] Heilongjiang reports its first 2 laboratory-confirmed cases. [142] Both Fujian and Guangxi report an additional 3 laboratory-confirmed cases each. [143][144] Shanghai reports an additional 7 laboratory-confirmed cases.[145] In all, the total number of laboratory-confirmed cases in China increased to 628 while the death toll remained at 17. Wuhan suspended all public transportation from 10am onwards, including all bus, metro and ferry lines. In addition, all outbound trains and flights were halted.[146] Macau also reports its second laboratory-confirmed case, another 66-year old man from Wuhan.[147] Singapore reports its first laboratory-confirmed case, a 66-year-old man from China.[8] Saudi Arabia confirms its first case of an Indian nurse working at the Al Hayat National Hospital in Abha.[148] Vietnam confirms its first laboratory-confirmed case, a 66-year-old father and 28-year-old son from China.[5]

Global: reported cases and responses[edit]

Number of cases in Greater China
Map of the 2019-nCoV outbreak (as of 23 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 travelers.[83] The US Centers for Disease Control and Prevention (CDC) later issued a Level 1 travel watch.[36][88] Guidances and risk assessments were shortly posted by others including the European Centre for Disease Prevention and Control and Public Health England.[92] 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.[60]

Top 20 flight routes from Wuhan with data on the Infectious Disease Vulnerability Index for each country

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 travelers from Wuhan. Dubai in the United Arab Emirates and Sydney and Melbourne in Australia were also reported as popular destinations for people traveling 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.[27][149][105]

Confirmed cases[edit]

Hong Kong[edit]

Reported suspected cases of novel coronavirus in Hong Kong

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.[42] In the first week of 2020, 30 unwell travelers from Wuhan were tested. Most were found to be positive for other respiratory viruses.[88][97] On 22 January 2020, a mainlander man, age 39, who traveled from Shenzhen developed symptoms of pneumonia. The man had been to Wuhan in the previous month. He tested positive for 2019-nCoV and was hospitalised in the Queen Elizabeth Hospital in Kowloon. A 56-year old man from Ma On Shan, who had visited Wuhan, had also tested positive for 2019-nCoV, raising the number of confirmed cases to two.[3][150]

The Hong Kong government designated the Lady MacLehose Holiday Village in Sai Kung as a quarantine centre. On 23 January 2020, three people who had come into close contact with the two aforementioned cases were quarantined, including two medical workers and a visitor from Australia.[151]

Japan[edit]

A 30-year-old Chinese national who had previously traveled to Wuhan developed a fever on 3 January 2020 and subsequently returned to Japan on 6 January. He tested positive for 2019-nCoV during a hospital admission between 10 and 15 January 2020. He had not visited the Huanan Seafood Market, but possibly had close contact with an affected person in Wuhan.[54][101]

Macau[edit]

As of 22 January 2020, Macau has confirmed two cases of 2019-nCoV, that of a 52-year-old woman, and a 66-year-old man, both from Wuhan.[4]

Singapore[edit]

Singapore's Ministry of Health (MOH) issued a health advisory on the pneumonia outbreak on 2 January 2020, and implemented temperature checks for passengers arriving in Changi Airport from Wuhan the following day.[87] On 20 January 2020, temperature screening at Changi Airport was extended to all travelers coming from China. In addition, individuals with pneumonia who had traveled 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 cases with pneumonia who have recently traveled to Wuhan.[152][153] On 22 January, quarantine measures were extended to travelers who arrived from China and display symptoms.[154] Three more suspected cases were detected on 22 January 2020. At the same time, the MOH began to form a multi-ministry taskforce to tackle the virus. The MOH also advised against non-essential trips to Wuhan as the situation worsens.[155]

The first case was confirmed on 23 January 2020 involving a 66-year-old China national, with preliminary tests showing positive results for a 53-year-old. Another 28 suspected cases were detected as a result of enhanced testing. Border control measures will be tightened, with measures extended to land and sea checkpoints from the next day.[8]

South Korea[edit]

A suspected case was reported in South Korea on 8 January 2020, with the person isolated as a result.[95] There have been four suspected cases since then, and a confirmed case on 20 January 2020.

Taiwan[edit]

On 21 January 2020, 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.[9] She reported her signs to the patrols on her own initiative and was then sent hospitalised upon arrival without formal domestic entry and is being treated in quarantine.[9]

Among the 4 suspected cases reported, 3 have been tested negative in the initial screenings.[36][88][156]

Thailand[edit]

In Thailand, screening passengers arriving from Wuhan at four different airports began on 3 January 2020, and a number of suspected cases have been found to have other common respiratory conditions.[55][84][157]

On 13 January 2020, Thailand witnessed the first confirmed case of 2019-nCoV 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 for the new coronavirus.[27][158][159][158]

Thailand's second case occurred in a 74-year-old woman who arrived in Bangkok on a flight from Wuhan on 17 January.[53]

On 21 January 2020, an 18-year-old male who arrived in Chiang Mai from Wuhan was hospitalized with a high fever. The local director of the Chiang Mai disease control department later confirmed that he was infected with the coronavirus via a press conference. Blood samples were sent to Bangkok for further analysis.[160][161]

On 22 January 2020, the Thai Ministry of Public Health announced a report for the third and fourth cases of infection found in Thailand. The third was a Chinese tourist like previous cases. The fourth was a 73-year-old Thai woman, who had returned from Wuhan, the first case in a Thai national.[162]

United States[edit]

The first confirmed case of the new coronavirus in the United States, a man in his 30s from Snohomish County, Washington, was announced by the CDC on 21 January 2020.[163] 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.[10][164][165]

Between 60,000 and 65,000 people travel from Wuhan to the United States every year, with January being a peak.[103] 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.[166][167]

Vietnam[edit]

Two suspected cases of pneumonia were detected on 14 January 2020 after two Chinese tourists arrived in Vietnam through Da Nang International Airport with a fever. The tourists were quarantined, and later released after having tested negative for the virus.[168]

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.[169] Deputy minister Đỗ Xuân Tuyên said that Vietnam is considering to close border with China as a necessary countermeasure.[170] Saigon Tourist announced that it has canceled all tours to or transit in Wuhan.[171]

The first two cases of confirmed infected was hospitalized on 22 January and treated at Cho Ray Hospital, Ho Chi Minh City. One is the Chinese father travel from Wuhan to Hanoi to visit his son living in Vietnam; he had transmited the disease to his son.[172]

Suspected cases[edit]

As of 22 January, Vietnam, Nepal, Hong Kong and Taiwan were monitoring suspected cases, per the ECDC.

Australia[edit]

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 2020. 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.[173] On 21 January 2020, Australian authorities confirmed that a man in Brisbane was in isolation at his home after showing symptoms of a SARS-like illness. The man was later released after samples sent to a laboratory came back negative for 2019-nCoV. [174][175]

Brazil[edit]

The Health Secretary of the state of Minas Gerais reported on 22 January a suspected case from a 35 year old Brazilian woman who arrived in Belo Horizonte on 18 January from Shanghai, who self-reportedly did not visit Wuhan. Medical tests are underway to confirm the case.[176][177]

Canada[edit]

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.[178][179]

As of 22 January, six people were put under observation in Quebec after showing signs of a respiratory virus since recently returning from China.[180]

Mexico[edit]

Mexican President Andrés Manuel López Obrador said on 22 January that authorities are investigating one potential case of coronavirus in the northern border state of Tamaulipas. He added that a second potential case of the infection in Mexico had been ruled out. [181]

Nepal[edit]

A suspected case was reported in Nepal on 16 January 2020. The Nepali national had returned from Wuhan and was quarantined in Kathmandu.[182]

Philippines[edit]

One suspected case involved a five-year old child from Wuhan who had arrived in Cebu City on 12 January 2020. 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.[183]

Samples from the child had been sent to a laboratory in Australia for further testing and the authorities are awaiting the results. Three other travelers from China were checked by authorities at another airport, but they did not show symptoms that corresponded with the warning issued by the World Health Organization about the virus from Wuhan.[184] Another two suspected cases tested negative for the virus, and were allowed to return home.[185]

The outbreak has prompted urging from at least a member of the House of Representatives. Muntinlupa representative Ruffy Biazon sent a letter dated on 22 January 2020 to the Civil Aviation Authority of the Philippines (CAAP) to suspend flights from Wuhan to any part of the Philippines. Royal Air Charter Service operates direct flights from Wuhan to Kalibo in Aklan.[186]

Russia[edit]

On 22 January 2020, a 23 year old Russian man arriving in Pulkovo Airport, St. Petersburg from Shanghai was hospitalised.[187]

No cases[edit]

Bangladesh[edit]

Enhanced screening measures have been set up at Shahjalal International Airport in Bangladesh.[188]

Cambodia[edit]

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.[189]

India[edit]

The Government of India issued a travel advisory to its citizens, particularly for Wuhan, where about 500 Indian medical students study.[190]

It was announced that passengers arriving at Chhatrapati Shivaji International Airport from China would undergo thermal screening.[191] Later, the procedures were extended to six other major international airports.[192]

Malaysia[edit]

The director general of the Ministry of Health, Noor Hisham Abdullah, said thermal scanners were being used to screen travelers at border points, and that the Malaysian health authorities were placed on high alert following the global outbreaks.[193]

Netherlands[edit]

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.[194]

North Korea[edit]

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.[195]

Panama[edit]

The Panamanian government has enhanced its sanitary control measures at all ports of entry, in preparation for the arrival of the virus.[196]

Sri Lanka[edit]

The Ministry of Health in Sri Lanka informed 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.[197]

United Arab Emirates[edit]

On 23 January 2020, Dubai Airport announced that travelers arriving directly from China would've their temperatures screened.[198]

United Kingdom[edit]

Heathrow Airport has tightened surveillance of the three direct flights that it receives from Wuhan every week. Each of these flights will be met by a Port Health team, comprising principal port medical inspector, port health doctor, administrative support, and team leader. In addition, all airports in the UK will have written guidance available for unwell travellers.[199]

Clinical presentation[edit]

Reported symptoms have included fever in 90% of cases,[11] fatigue and a dry cough in 80%,[11][200] and shortness of breath in 20%, with respiratory distress in 15%.[88][36][200] Chest x-rays have revealed signs in both lungs.[88][36] Vital signs were generally stable at the time of admission of those hospitalised.[200] Blood tests have commonly shown low white blood cell counts (leucopenia and lymphopenia).[11]

Testing[edit]

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.[99] On 22 January 2020, scientists from Peking University, Guangxi Traditional Chinese Medical University, Ningbo University and Wuhan Biology Engineering College published an article, stating "the newly identified coronavirus may boost cross‐species transmission from snake to human".[201]

Prevention and management[edit]

Airport screening

2019-nCoV does not currently have an effective medicine treatment or vaccine, though efforts to develop some are underway.[202][203] Its symptoms include, among others, fever, breathing difficulties and coughing,[204] which have been described as "flu-like".[205] 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)."[49] 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.[206] Some countries require people to report flu-like symptoms to their doctor, especially if they have visited mainland China.[207]

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.[208] 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.[209]

An effective quarantine on travel in and out of Wuhan was imposed from 23 January 2020, 10 am 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.[210] Various logistic issues have occurred after the quarantine, including rising food prices[211] and difficulty for medical staff commuting to the hospital.[212]

See also[edit]

References[edit]

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External links[edit]

Mainland China[edit]

Hong Kong[edit]

UK[edit]

WHO[edit]

European Centre for Disease Prevention[edit]

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