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2019–20 novel coronavirus outbreak
Wuhan, China
Date12 December 2019 – present
LocationOrigin: China Wuhan, Hubei, China
Casualties
Cases
Country/Region Confirmed Cases Deaths Ref
China Mainland China 323 6[1]
Thailand Thailand 2 0[2]
Japan Japan 1 0[2]
South Korea South Korea 1 0[2]
Taiwan Taiwan 1 0[3]
United States United States 1 0[4]
Total 329 6
As of 21 January 2020
Cases distribution map

The 2019–20 novel coronavirus outbreak, also known as the Wuhan coronavirus, the China pneumonia outbreak or the Wuhan pneumonia (simplified Chinese: 武汉肺炎; traditional Chinese: 武漢肺炎; pinyin: Wǔhàn fèiyán) began in mid-December 2019 in the city of Wuhan on the Yangtze River in central China, as an emerging cluster of people with pneumonia of unknown cause, linked primarily to stallholders who worked at the Huanan Seafood Market (華南海鮮市場), which also sold live animals. Chinese scientists subsequently isolated a new coronavirus, the 2019-nCoV, which has been found to be at least 70% similar in gene sequence to SARS-CoV.[5][6][7][8] As of 21 January 2020, increased testing has shown near to 300 confirmed cases, including some in healthcare workers and some outside China.[9] Six deaths have occured and there is evidence of human-to-human spread. It has not yet however, shown to be of the same severity or as deadly as SARS. Questions raised include whether the virus has been circulating for longer than previously thought, whether Wuhan really is the center of the outbreak or simply the place it was first identified with ongoing surveillance and testing, and could there be a possibility that Wuhan is a superspreader event.[8][10][11][12] Whether the situation constitutes a public health emergency of international concern under International Health Regulations will be discussed on 22 January 2020 by an emergency committee arranged by the World Health Organization (WHO).[11]

2019-nCoV does not currently have an effective medicine treatment or vaccine, though efforts to develop some are underway.[13][14] Its symptoms include, among others, fever, breathing difficulties and coughing[15], which have been described as "flu-like"[16]. 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)."[17][18] 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.[19] Some countries require people to report flu-like symptoms to their doctor, especially if they have visited mainland China.[20]

The first suspected cases were reported on 31 December 2019,[21] with the first symptoms appearing just over three weeks earlier on 8 December 2019.[22] The market was closed off on 1 January 2020 and people with the symptoms were isolated.[21] Over 700 people, including more than 400 healthcare workers, who came into close contact with suspected cases were initially monitored.[23] With 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,[5][24] of which two were later reported to be a married couple, one of whom had not been to the market, and another three who were members of the same family that worked at the market's seafood stalls.[25][26] The outbreak resulted in initial deaths on 9 January 2020[27] and 16 January 2020, both in men over 60,[28][29][30] a third on 19 January 2020,[31][32] and three more on 21 January 2020.[10][33]

China's National Health Commission confirmed on 20 January 2020 that the new strain of coronavirus can be transmitted between humans.[34] At the time, a number of healthcare workers had also been infected.[11] The WHO had warned that a wider outbreak was possible,[35] and there were concerns of further spreading during China's peak travel season around Chinese New Year.[7]

Confirmed cases outside of mainland China include two women in Thailand, one man in Japan, one woman in South Korea and one woman in Taiwan. [2][36][37][38] Based on these developments and assumptions such as international travel statistics, British scientists on 17 January estimated that the true number of infections could be around 1,700.[39][40] On 20 January, China reported a sharp rise in cases with nearly 140 new patients, including two people in Beijing and one in Shenzhen.[41] As of 21 January, the number of laboratory-confirmed cases stands at 318, including 312 in mainland China, two in Thailand, one in Japan, one in South Korea, one in Taiwan and one in the United States.[4][42][43][44][45][46]

Overview

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 1000 stalls selling chickens, cats, pheasants, bats, marmots, venomous snakes, spotted deer and the organs of rabbits and other wild animals, it led to the suspicion that the cause may be a novel coronavirus from an animal source.[6][47][48][49]

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.[50][51] 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.[50][52][53] At the time, China was criticised by the WHO for its handling of the epidemic.[54] Ten years after the onset of SARS, the dromedary-camel-related coronavirus, MERS, resulted in 750 deaths in over 27 countries.[50] 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.[51] This has resulted in the fear that it would be similar to the previous SARS outbreak,[52][55] a concern exacerbated by the expectation of a high numbers of travellers for Chinese New Year, which begins on 25 January 2020.[56]

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,[57] 500 miles (800 km) west of Shanghai, and 600 miles (970 km) north of Hong Kong.[58] Direct flights from Wuhan also connect with Europe: six flights weekly to Paris, three weekly to London, and five weekly to Rome.[59]

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".[39][40]

Phylogenetics

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).[17] Like SARS-CoV, it is a member of Beta-CoV lineage B.[60]

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.[17][61][62] Its RNA sequence is approximately 30 kbp in length.[17]

Epidemiology

Chronology

Novel coronavirus in China[63][64]
Date Cases Deaths Quarantine Source
Suspected Confirmed Quarantined Released Cumulative
31 December 2019 27
3 January 2020 44 121
5 January 2020 59 163
10 January 2020 41 1
11 January 2020 41 1 717 46 763
12 January 2020 41 1 687 76 763
13 January 2020 41 1 576 187 763
15 January 2020 2 119 644 763
16 January 2020 45 98 665 763
17 January 2020 62 2 82 681 763
18 January 2020 121
19 January 2020 198 3 90 727 817
20 January 2020 291 6 922 817 1739 [65][66]
21 January 2020 312 6
Novel coronavirus in Wuhan
Novel coronavirus in China
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.[67]

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.[6][68]

1 January 2020: The fish and animal market suspected of being linked to the pneumonia cases was closed for cleaning and disinfection.[6]

3 January 2020: Thailand began screening passengers arriving from Wuhan at four different airports.[69][70][71] On the same day, Singapore started screening passengers at Changi Airport.[72]

5 January 2020: Early investigations into the cause of the pneumonia ruled out seasonal flu, SARS, MERS and bird flu.[5][47] 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.[73][74]

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 travelling to Wuhan.[73][47]

9 January 2020: The WHO confirmed that a novel coronavirus had been isolated from one person who was hospitalised.[75][76] On the same day, the European Centre for Disease Prevention and Control posted its first risk assessment.[77] The WHO also reported that Chinese authorities had acted swiftly,[75] identifying the novel coronavirus within weeks of the onset of the outbreak, with the total number of positively tested people being 41.[78] 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.[23][27][59][79]

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.[23][80][69][81] The same day, Public Health England issued its guidance.[77]

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.[73][47][23][82] The WHO published initial guidance on travel advice, testing in the laboratory and medical investigation.[23]

13 January 2020: The CDC announced that the genome had been posted on the NIH genetic sequence database, GenBank.[51] On the same day, Thailand witnessed the first confirmed case of 2019-nCoV, the first outside China.[38] 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.[22]

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.[22][83]

15 January 2020: A second death occurred in a 69 year old man in China.[28][84]

The WHO published a protocol on diagnostic testing for 2019-nCoV, developed by a virology team from Charité Hospital.[28]

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.[37][85]

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.[36][86] The number of laboratory-confirmed cases rose to 45 in China.[87]

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.[42]

19 January 2020: First confirmed cases reported in China, outside Wuhan, one in the southern province of Guangdong and two in Beijing.[44] 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 fatality in China to three.[88][32]

20 January 2020: First confirmed case reported in South Korea.[89] 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.[90][91] 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.[34]

21 January 2020: The World Health Organisation 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".[92]

Confirmed cases were reported in several new locations in China. Zhejiang province and Tianjin reported 5 and 2 laboratory-confirmed cases respectively.[93][94] Guangdong reported 3 additional laboratory-confirmed cases.[95] Shanghai and Henan province reported an additional 4 and 1 laboratory-confirmed cases respectively.[96] In Sichuan province, Chongqing reported 5 laboratory-confirmed cases and Chengdu reported its first laboratory-confirmed case.[97][98] In all, the total number of laboratory-confirmed cases in China increased to 312 and the death toll to 6.[33][9][98]

New cases were also reported outside of mainland China. Taiwan reported its first laboratory-confirmed case,[99] and the first confirmed case in North America was reported in the state of Washington.[4][100]

Global: Reported cases and responses

Since 31 December 2019, some regions and countries near China tightened their screening of selected travellers.[68] The US Centers for Disease Control and Prevention (CDC) later issued a Level 1 travel watch.[73][47] Guidances and risk assessments were shortly posted by others including the European Centre for Disease Prevention and Control and Public Health England.[77] 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.[42]

File:Top 20 flight routes from Wuhan with data on IDVI for each country.jpeg
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 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.[22][101][102]

Australia

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.[103] 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. Queensland Health are running tests to see whether the man is carrying the virus.[104]

Bangladesh

Enhanced screening measures have been set up at Shahjalal International Airport in Bangladesh.[105]

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 Novel coronavirus (2019-nCoV)

The thermal scanners are operated by the quarantine service personnel sent by the Ministry of Health. Currently, no entry of it has been detected yet but they're working closely with the World Heath Organization to prevent its spread.

Canada

The Canada Border Services Agency (CBSA) said it will not implement extra screening measures, but plans "to implement signage" in Toronto, Vancouver and Montreal airports to raise awareness of the virus. There are no direct flights from Wuhan to Canada.[106]

Hong Kong

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 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.[53] In the first week of 2020, 30 unwell travellers from Wuhan were tested. Most were found to be positive for other respiratory viruses.[73][82]

India

The Government of India issued a travel advisory to its citizens, particularly for Wuhan, where about 500 Indian medical students study.[107]

It was announced that passengers arriving at Chhatrapati Shivaji International Airport from China would undergo thermal screening.[108] Later, the procedures were extended to six other major international airports.[109]

Japan

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.[37][85]

Malaysia

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 following the global outbreaks.[110]

Nepal

A suspected case was reported in Nepal on 16 January 2020. The Chinese national had returned from Wuhan and was quarantined in Kathmandu.[111]

Philippines

One suspected case involving a five-year old child was reported in Cebu City. While the child had tested positive for a virus, authorities in Manila say they are not sure if it 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 symptoms that corresponded with the warning issued by the World Health Organization about the virus from Wuhan. [112]

Singapore

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.[72] The 2019-nCoV was ruled out in all seven suspected cases so far.[113] On 20 January 2020, MOH announced an extension of temperature screening at Changi Airport 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 cases with pneumonia who have recently travelled to Wuhan.[114][115] A day later, MOH also announced the extension of quarantine measures to travellers who arrived from China and display symptoms from the next day onwards.[113]

South Korea

A suspected case was reported in South Korea on 8 January 2020, with the person isolated as a result.[80] There have been four suspected cases since then, and a confirmed case on 20 January 2020.[89]

Sri Lanka

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.[116]

Taiwan

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.[3] She reported her signs to the patrols on her own initiative and was then sent hospitalized upon arrival without formal domestic entry and is being treated in quarantine.[3]

Among the 4 suspected cases reported, 3 have been tested negative in the initial screenings.[117][73][47]

Thailand

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.[38][69][118]

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.[22][119][120][121]

Thailand's second case occurred in a 74-year-old woman who arrived in Bangkok on a flight from Wuhan on 17 January.[36]

United Arab Emirates

No confirmed cases. According to the Ministry of Health and Prevention, it does not pose any risk to UAE residents as of now.[122]

United States

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. The man had traveled from Wuhan to Seattle–Tacoma International Airport and reported to the Providence Regional Medical Center in Everett, Washington, after feeling ill.[123][124]

Between 60,000 and 65,000 people travel from Wuhan to the United States every year, with January being a peak.[87] At San Francisco International, Los Angeles International, and John F. Kennedy International Airport in New York, the three US airports with direct flights from Wuhan, arriving passengers began to be screened for symptoms of the virus ahead of the Chinese New Year peak travel season.[125][126]

Vietnam

Two suspected cases of pneumonia were detected on 14 January 2020 after two Chinese tourists arrived in Vietnam through Danang International Airport with a fever. The tourists were quarantined, and later released after having tested negative for the virus.[127]

Clinical presentation

Reported symptoms have included fever in 90% of cases,[5] fatigue and a dry cough in 80%,[5][128] and shortness of breath in 20%, with respiratory distress in 15%.[73][47][128] Chest x-rays have revealed signs in both lungs.[73][47] Vital signs were generally stable at the time of admission of those hospitalised.[128] Blood tests have commonly shown low white blood cell counts (leucopenia and lymphopenia).[5]

Testing

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.[28]

Prevention

Recommended prevention measures per the WHO are "regular hand washing, covering mouth and nose when coughing and sneezing... avoid close contact with anyone showing symptoms of respiratory illness (such as coughing and sneezing)."[17][18]

See also

References

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Look up Wuhan pneumonia in Wiktionary, the free dictionary.

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