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January 23, 2020

'A state of war': Officials quarantine Chinese cities as cases of new coronavirus soar

Daily Briefing

    Chinese authorities on Thursday shut down public transportation and began sealing off roadways in Wuhan and two neighboring cities as part of efforts to combat the growing number of cases of a new coronavirus—prompting some experts to question whether the United States is prepared to handle a similar outbreak.

    How the outbreak started

    Reports of the infection first surfaced in early December 2019 among people in Wuhan, which is the capital of China's Hubei province. Chinese state media earlier this month announced that the cause of the illness "is believed to be a new type of coronavirus," and said "more scientific research is needed for further understanding."

    The World Health Organization (WHO) in a statement explained that "[c]oronaviruses are a large family of viruses that range from the common cold to SARS." The organization said, "Some cause less-severe disease, some more severe. Some transmit easily from person to person, while others don't." According to WHO, the main symptoms of infection from the Wuhan coronavirus, called 2019-nCoV, are fever and lesions in both lungs. Some patients also have reported difficulty breathing, WHO said.

    The Chinese outbreak's origin has been connected to a now-closed live seafood market that also sold exotic animals. Researchers who examined the virus' genetic code now believe the disease initially infected humans through exposure to snakes sold at the market, and then was spread via human-to-human transmission. The researchers said they still are unsure how the virus adapted to survive in both cold-blooded and warm-blooded hosts.

    Number of cases soars—though experts question current count

    Reported cases of the virus have climbed quickly and extended beyond Wuhan. The Chinese health commission on Wednesday evening said they have confirmed more than 570 cases of the virus, with an additional 393 suspected cases of infection. Reported cases involve patients in China—including the first case in Hong Kong, which authorities confirmed Wednesday—Japan, Korea, Thailand, and the United States. They include patients who have not visited Wuhan or had contact with animals.

    Officials on Wednesday said there have been 17 reported deaths linked to the virus, including 13 men and four women. China's health commission on Thursday said the deaths largely occurred among older men, many of whom had underlying health conditions, such as cirrhosis of the liver, diabetes, hypertension, and Parkinson's disease, the New York Times reports. Most of the patients who died had gone to the hospital with a fever and cough, but at least three of them did not have fevers when they were admitted to the hospital, according to the health commission's statement.

    W. Ian Lipkin, an epidemiologist at Columbia University who advised the Chinese government and WHO during the SARS outbreak, said the information is somewhat reassuring because it indicates the infection does not appear to be killing young and otherwise healthy people.

    However, observers have raised concerns about Chinese authorities underreporting cases of and deaths related to the virus. A London Imperial College study published Wednesday estimated that at least 4,000 people should be infected with the new coronavirus based on previous outbreaks of similar viruses.

    Part of the reason why cases and related deaths might be underreported is because hospitals do not have the necessary resources to screen all of the potential cases. For example, relatives of some patients have said hospitals with limited resources, which cannot handle the influx of patients, have turned away patients and refused to test them for the virus, the Washington Post reports.

    According to NPR, Wuhan has said it will add 3,400 beds to hospitals that are able to treat the virus. That will bring the total number of such beds to 5,400, NPR reports.

    Further, Hong Kong's Hospital Authority on Tuesday expanded surveillance of pneumonia cases to include patients with a history of traveling to all of mainland China.

    Chinese authorities restrict travel in three cities

    As part of efforts to curb the virus' spread, Chinese authorities on Thursday shut down public transportation within Wuhan and two neighboring cities, Ezhou and Huanggang.

    According to the Times, authorities on Thursday morning largely closed off access to Wuhan, suspending buses, subways, and ferries within the city and cancelling flights and trains leaving the city. In addition, NPR reports that officials as of Thursday afternoon "began sealing off highways entering" Wuhan. While cars still were able to exit Wuhan as of early Thursday afternoon, authorities said they were screening all passengers entering and leaving Wuhan for symptoms of the coronavirus, as well as for the illegal transport of wild animals.

    Authorities also said they are planning to impose travel restrictions in Chibi and Zhijiang, and several regional airlines, trains, ferries, and busses on Thursday announced plans to suspend travel services to Wuhan. MTR, the private company maintaining railways in Hong Kong, said it would not make stops in Wuhan.

    Wuhan's public health authorities said they are in a "state of war" against the virus, as they attempt to quarantine the city to curb its spread. A committee of Wuhan's top officials said the city must "[s]trictly implement emergency response requirements, enter into a state of war, and implement wartime measures to resolutely curb the spread of this epidemic." They added, "Homes must be segregated, neighbors must be watched."

    Is the US prepared for a coronavirus outbreak?

    News earlier this week of the first confirmed case of the virus in the United States has raised questions regarding whether the country is prepared to handle an outbreak of the new coronavirus.

    Experts and reports evaluating U.S. responses to previous public health crises—including the 2001 anthrax scare, the 2003 SARS crisis, the 2014 MERS outbreak, and the 2016 West African Ebola epidemic—suggest the United States is more prepared to handle such an outbreak than it was in the past. For example, Thomas Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, said the United States two decades ago had fewer programs and resources dedicated to respond to an outbreak, but now, agencies like HHS' Office of the Assistant Secretary for Preparedness and Response, the Department of Defense, and the Department of Homeland Security have tested, trained, and coordinated with U.S. health care facilities to prepare.

    Hospitals throughout the country are taking steps to screen and treat patients for the virus. For example, at Emory University and UCLA hospitals, as well as Vanderbilt University Medical Center, health care workers are asking patients questions about their travel histories.

    Alexandra Phelan, a faculty research instructor at Georgetown University's Department of Microbiology and Immunology, said, "Well-trained and resourced health-care workers will be the key to detecting new cases, implementing infection control procedures—including isolating suspected ill individuals—and treating those who are ill."

    However, the United States might not be as prepared for the outbreak as needed. Tom Frieden, a former CDC director who oversaw the United States' Ebola response during the 2016 outbreak, said, "The big picture is that we're better prepared than we were before, but not nearly as prepared as we need to be." Frieden noted that the country's stockpiles of drugs and equipment have increased, but he said a lack of information about the new virus could impede efforts to respond. "Large parts of the world have really bad diseases spreading that could bite us tomorrow and we don't know about it," Frieden said.

    But another factor working in the United States' favor is that the science to respond to outbreaks has advanced rapidly. For example, William Schaffner, an infectious disease specialist at Vanderbilt School of Medicine, and other officials said Chinese officials sequenced the virus' genome and distributed the information around the world within weeks. In comparison, it took months to identify the SARS virus in 2003.

    In addition, CDC was able to test specimens from the first U.S. patient with the new coronavirus and confirmed his diagnosis within 24 hours. Meanwhile, NIH and other agencies already are working to develop a vaccine and treatments for the virus.

    Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, on Wednesday said human trials for a vaccine against the new coronavirus could start within three months.

    Fauci noted that NIH also is collaborating with WHO and CDC to gather information on how to help physicians across the world identify the infection's symptoms (New York Times, 1/23; Klar, The Hill, 1/22; Bowden, The Hill, 1/22; Ramzy, New York Times, 1/23; Bernstein/Sun, Washington Post, 1/22; Feng/Cheng, NPR, 1/23; Qin/Wang, New York Times, 1/22; Fifield, Washington Post, 1/22; Guo et al., The Conversation/CNN, 1/23; Budryk, The Hill, 1/23).

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