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Situation Update - Coronavirus Outbreak, China

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ONGOING OUTBREAK OF 2019 NOVEL CORONAVIRUS (2019-NCOV)

  • The World Health Organisation (WHO) states that while the outbreak of 2019-nCOV was an emergency for China, it was not yet a global health emergency.

  • In December 2019, The World Health Organisation was notified of a new cluster of pneumonia cases in Wuhan City, Hubei Province of China.

  • Wholesale fish and animal market in Wuhan believed to be the source of the virus.

  • Identified on 7 January by Chinese authorities as the novel coronavirus (2019-nCoV).

  • China confirms 2,744 cases of 2019-nCoV and 81 deaths (27th January).

  • Confirmed cases across Asia, Australia, Europe and North America found to have travelled to China recently.

  • Guidance issued by UK’s Foreign and Commonwealth Office advising against all travel to Hubei province and calling on anyone already in the area to leave.

  • Passenger screening in place for ex-Wuhan travellers to Australia, Japan, Hong Kong, Singapore, Thailand, South Korea, Italy, UAE, UK and US.

  • Heavy population movements during upcoming Chinese New Year increases risk of transmission outside of Wuhan.

  • The national new year holiday has been extended by three days to Sunday, 2 February.

China coronavirus 2

Situation

On 31st December 2019, the World Health Organisation was notified of a new cluster of pneumonia cases in Wuhan City, China’s central Hubei Province. The outbreak has been linked to a wholesale fish and animal market in the city. Chinese authorities later identified a novel coronavirus (2019-nCoV) as the causative virus.

Following the discovery that the majority of patients can be linked to the Wuhan South China Seafood City (also called the South China Seafood Wholesale Market and the Hua Nan Seafood Market), the Chinese authorities have now implemented a nationwide ban on the sale of wildlife in markets, restaurants and e-commerce platforms. This specific market had also been closed for cleaning and disinfection since 1 January 2020 by Chinese health officials.

As of the 27th January, the total number of 2019-nCoV cases in China has reached 2,744, with 81 deaths (76 of which in Hubei Province) in the country. According to the European Centre for Disease Prevention and Control (2020), a further global spread is likely, with confirmed cases of the virus already reported in several countries in Asia, Australia, Europe, and North America. At least 44 cases have been confirmed abroad, including in Thailand, the United States, and Australia. There have been no deaths outside China. Those cases reported outside of China have recently travelled to the country prior to the onset of symptoms, and the majority of these individuals are reportedly in a stable condition.

Chinese authorities have initiated containment measures in outbreak areas, alongside inter-city travel restrictions, disrupting connections between infection areas. Flights into and out of Wuhan, the epicentre of the outbreak are suspended. Furthermore, Wuhan authorities have closed all transport hubs including airports, railway and bus stations, and inter-province shuttle buses have been suspended in cities including Beijing, Tianjin and across the Shadong and Heibei provinces. The local government in Wuhan said that no-one from the city had left China in the past four days. Some 4,096 tourists from Wuhan are still out of the country.

The US, France and Japan are in the process of organising the evacuation of their citizens from Wuhan; which has now been placed under quarantine.

The Coalition for Epidemic Preparedness Innovations has stated that financial backing has been received for three research programs to begin developing potential vaccines. Scientists are hoping to test the first batch in three months’ time.

Analysis

Coronaviruses, a large family of viruses, cause illnesses ranging in severity from the common cold to more severe disease such as Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Early symptoms include fever, fatigue and a dry cough.

As a zoonotic disease, transmission is from animals to humans. However, there has been recent evidence that there is also person-to-person transmission; for example, a traveller arriving in Japan had not visited the market but did have close contact with unspecified pneumonia patients. Furthermore, despite reports of medical staff becoming infected after treating patients, the WHO and the Chinese authorities have confirmed that there is limited transmission between people. However, there are concerns that persons may become infectious prior to presenting symptoms, making containment extremely difficult, which differs from the SARS outbreak.

Public Health England state that “other coronaviruses are mainly transmitted by large respiratory droplets and direct or indirect contact with infected secretions…Under certain circumstances, airborne transmission of other coronaviruses is thought to have occurred via unprotected exposure to aerosols of respiratory secretions and sometimes faecal material”. Therefore, basic hand and personal hygiene is of paramount importance to reduce the potential spread of the virus.

Clinical features and symptoms include fever, a dry cough and fatigue during the early infection and later respiratory difficulties include bilateral lung infiltrates on chest x-ray, a feature of other types of viral pneumonia. If symptoms develop within 14 days of travelling to Wuhan, seek medical advice/attention. Ring ahead before arrival and ensure they are aware of your recent travel history.

Clinical features and symptoms include fever, a dry cough and fatigue during the early infection and later respiratory difficulties include bilateral lung infiltrates on chest x-ray, a feature of other types of viral pneumonia. If symptoms develop within 14 days of travelling to Wuhan, seek medical advice/attention. Ring ahead before arrival and ensure they are aware of your recent travel history.

Implications

Australia, Japan, Hong Kong, Singapore, Thailand, South Korea, Italy, UAE, UK and the US have implemented passenger screening for those travelling from Wuhan. Further screening measures are likely to be implemented in other countries should the virus spread.

Further to the effective lockdown of Wuhan, travel restrictions have been implemented in nearby Huanggang, Ezhou, and Chibi. It has been announced that traffic will be suspended in Huanggang City and Ezhou City. Officials Beijing and Shanghai have also asked residents who return from affected areas to stay at home for 14 days to prevent the spread of the virus. In Shanghai, the government has stopped businesses from returning to work until 10 February. The ban applies to all companies apart from utilities, medical firms, medical suppliers, and supermarkets.

Tourist destinations within Hong Kong have been closed; along with several destinations in Chinese cities including Sanya, Beijing and Shanghai. Taiwan has tightened restrictions on travellers from China; suspending the majority of them, with business travellers and spouses of those living within the country an exception. The Mongolian authorities have reportedly closed all border crossings between the country and China until at least the 2 March. Furthermore, India has urged its citizens to avoid all non-essential travel to the country and the UK’s Foreign and Commonwealth Office has issued new guidance advising against all travel to Hubei province and calling on anyone already in the area to leave.

The national new year holiday has been extended by three days to Sunday, 2 February, these celebrations will result in a significant increase in global travel volume and within China itself, hence increasing the risk of virus transmission. The period during the Lunar holidays is described as the largest annual human migration on Earth, with almost 7 million Chinese tourists travelling abroad during the 2019 Lunar New Year according to state media. However, as a result of the outbreak, Lunar New Year celebrations have been cancelled in cities across mainland China and beyond; including in France, Macao and Hong Kong. All public gatherings in Mongolia have also been cancelled as a precaution.

Despite China’s National Health Commission stating on Sunday (26th January) that the ability of the new coronavirus to spread is strengthening and infections could continue to rise, the WHO has stated that the virus is not considered as a global health emergency. The outbreak remains an evolving, dynamic situation and is being continuously monitored.