January 24, 2020

CDC on Friday announced that it has confirmed a Chicago woman who recently traveled to Wuhan, China, is infected with the new coronavirus that's been spreading throughout China and other countries, marking the second case of the virus confirmed in the United States.

The news comes as U.S. providers work to screen patients for possible infection from the new coronavirus, and as the Department of State and CDC issued a travel advisory urging Americans who visit China to "exercise increased caution" and avoid nonessential travel to Wuhan, where the outbreak of the virus originated.

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 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 Thursday said they have confirmed more than 800 cases of the virus. Reported cases involve patients in China, Japan, Korea, Thailand, Vietnam, and the United States. They include patients who have not visited Wuhan or had contact with animals.

Officials on Thursday said there have been 26 reported deaths linked to the virus. China's health commission 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. 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 China's health commission.

W. Ian Lipkin, an epidemiologist at Columbia University who advised the Chinese government and WHO during the SARS outbreak, said that information is somewhat reassuring because it indicates that 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 in China 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.

Wuhan has said it will add 3,400 beds to hospitals that are able to treat the virus, which would bring the total number of such beds to 5,400. In addition, construction workers are scrambling to build "a makeshift quarantine and treatment facility on the outskirts of Wuhan," NPR's "Goats and Soda" reports. The facility will house 1,000 beds, according to "Goats and Soda."

Meanwhile, hospitals in Wuhan are asking the public to donate protective supplies, including masks and suits, as the facilities' supply stocks are running low. Shortages are worsening as the number of cases of the virus grows and distributers, manufacturers, and suppliers of the protective gear close due to the Lunar New Year holiday.

Chinese authorities also have shut down public transportation within Wuhan and 12 nearby cities, and have restricted travel both into and out of some affected areas. The restrictions have essentially quarantined an estimated 35 million people, the New York Times reports.

WHO on Thursday said the outbreak constitutes a public health emergency in China, but delayed its decision on whether to classify the outbreak as a global public health emergency, saying it needs more information on the virus. Tedros Adhanom Ghebreyesus, WHO's director general, said, "Make no mistake. This is an emergency in China, but it has not yet become a global health emergency."

US government issues advisories to public, providers as 2nd US case is confirmed

In the United States, CDC on Friday announced that testing has confirmed a 60-year-old Chicago woman who returned to the United States from Wuhan on Jan. 13 is infected with the virus. Allison Arwady, commissioner of Chicago's Department of Public Health, said the woman began experiencing symptoms of the infection a few days after her return, and she called her doctor. Providers admitted the woman to a hospital and placed her in isolation.

Arwady said the woman is "clinically doing well and in stable condition." Arwady added that the woman did not have much contact with anyone outside of her home. The woman did not attend any large, public gatherings or use public transportation, Arwady said.

Nancy Messonnier, director of CDC's National Center for Immunization and Respiratory Diseases, has said risk of widespread transmission of the virus in the United States is low, though she expects more cases of infection will be confirmed in the country in coming days. According to CNBC, Messonnier said U.S. public health officials are monitoring 61 potential cases across 22 states.

For example, health officials in Texas on Thursday announced they are isolating a Texas A&M student who recently traveled to Wuhan to determine whether he is infected with the virus. Texas A&M in a statement said immediate risk of transmission to people on the university's College Station campus is considered low, and Kathy Lofy, the state's health officer, separately said the state has begun investigating whether there might be other cases of infected people in the state.

The Department of State and CDC on Thursday issued a travel advisory urging Americans who visit China to "exercise increased caution" and avoid nonessential travel to Wuhan. In addition, the agencies urged people who feel sick after traveling to areas affected by the outbreak to seek immediate medical care. The agencies recommended that such patients notify providers about their recent travel and any symptoms before visiting health care facilities, so providers can be prepared to screen and isolate the patients if needed.

And throughout the country, hospitals have prepared to screen and treat patients potentially infected with the new 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. Other hospitals have incorporated coronavirus-specific question into their electronic health records systems.

Hospitals also are taking steps to contain the virus' spread and protect immunocompromised patients who are more susceptible to contracting coronaviruses. Some hospitals have established routines to help safely guide patients through facilities and avoid transmitting the virus. At the University of California, San Francisco (UCSF), patients who providers suspect are infected with the virus could be isolated in a room specifically designed for people with an emerging pathogen—which the facility established in light of the 2014-2016 West African Ebola outbreak.

But experts have noted that identifying potential cases of the virus might be difficult for several reasons. For one, symptoms of patients infected with the new virus often have symptoms that resemble the flu, which has been spreading throughout the United States.

In addition, the process of confirming a patient's infection with the new virus can be slow, as states currently must send a nasal swab, samples of phlegm from a patient's lungs, and blood serum to CDC to confirm cases of the virus. CDC on Thursday said it is asking FDA for special emergency authorization to allow states to use a CDC-developed diagnostic test to identify cases of the virus  (Chakradhaar/Joseph, STAT News, 1/24; Weixel, The Hill, 1/23; Weixel, The Hill, 1/23; Coleman, The Hill, 1/23; Sibi Joseph, Reuters, 1/23; Weixel, The Hill, 1/23; Baker, New York Times, 1/23; Steenhuysen, Reuters, 1/23; Xu et al., Reuters, 1/24; Feng/Neuman, "Goats and Soda," NPR, 1/24; Hua/Cadell, Reuters, 1/22; Young, Wall Street Journal, 1/24; New York Times, 1/24; Lovelace, CNBC, 1/24; Miller, USA Today, 1/24).

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