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2019–20 Wuhan coronavirus outbreak

Location of Wuhan, the epicentre of the outbreak, in China.
Date	12 December 2019 – present
Location	Origin: Wuhan, Hubei, China
Casualties
Cases as of 25 January 2020 Country or region Confirmed cases Deaths Ref. China (mainland) 1096 41  Hong Kong 5 0  Thailand 5 0  Singapore 3 0  Taiwan 3 0  France 3 0  Macau 2 0  Japan 2 0  South Korea 2 0  United States 2 0  Vietnam 2 0    Nepal 1 0 Total 1126 41

An outbreak of a 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. The outbreak was linked primarily to stallholders who worked at the Huanan Seafood Wholesale Market, which also sold live animals. Chinese scientists isolated a new strain of coronavirus – given the initial designation of 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.

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. As of 24 January 2020, 41 deaths have occurred, all in China, and there is evidence of human-to-human transmission. Extensive testing has revealed over 1,000 confirmed cases in China, some of whom are healthcare workers. Confirmed cases have also been reported in Thailand, South Korea, Japan, Taiwan, Macau, Hong Kong, the United States, Singapore, Vietnam , France and Nepal.

On 23 January 2020, the WHO decided against declaring the outbreak a public health emergency of international concern. The WHO had previously warned that a wider outbreak was possible, and there were concerns of further transmission during China's peak travel season around the Chinese New Year. Many New Year events have been closed over fear of transmission, including the Forbidden City in Beijing, traditional temple fairs, and other celebratory gatherings. The sudden increase in occurrences of the disease has raised questions relating to its origin, wildlife trade, uncertainties surrounding the virus's ability to spread and cause harm, whether the virus has been circulating for longer than previously thought, and the possibility of the outbreak being a super-spreader event.

The first suspected cases were notified to WHO on 31 December 2019, with the first instances of symptomatic illness appearing just over three weeks earlier on 8 December 2019. The market was closed off on 1 January 2020, and people who showed signs and symptoms of the coronavirus infection were isolated. Over 700 people, including more than 400 healthcare workers who came into close contact with possibly infected individuals, were initially monitored. 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. Of those 41 people, two were later reported to be a married couple, one of whom had not been present in the marketplace, and another three were members of the same family that worked at the marketplace's seafood stalls. The first confirmed death from the coronavirus infection occurred on 9 January 2020.

On 23 January 2020, Wuhan was placed under quarantine, in which all public transport in and out of Wuhan has been suspended. The nearby cities of Huanggang, Ezhou, Chibi, Jingzhou, and Zhijiang were also placed under quarantine from 24 January.

Context

In Wuhan, during December 2019, an inaugural cluster of cases displaying the symptoms of a "pneumonia of unknown cause" was linked to 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), i.e. bushmeat, the immediate hypothesis was that this was a novel coronavirus from an animal source (a zoonosis).

Coronaviruses mainly circulate among animals, but have been known to evolve and infect humans in the past as has been seen with SARS, MERS together with four further coronaviruses found in humans that cause mild respiratory symptoms like the common cold.

All six of those already known coronaviruses can spread from human to human. In 2002, with an origin in horseshoe bats, then via civets 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. At the time, China was criticised by the WHO for its handling of the epidemic. Ten years after the onset of SARS, the dromedary-camel-related coronavirus, MERS, has resulted in more than 850 deaths in 27 countries. The Wuhan outbreak's association with a large seafood and animal market has led to the presumption of the illness having an animal source. This has resulted in the fear that it would be similar to the previous SARS outbreak, a concern exacerbated by the expectation of a high numbers of travellers for Chinese New Year, which begins on 25 January 2020.

Wuhan is the capital of Hubei province and is the seventh-largest city in China, with a population of more than 11 million people. It is a major transportation hub of the country, long known as the "Nine Provinces' Thoroughfare" (九省通衢). It is approximately 1,100 km (700 miles) south of Beijing, 800 km (500 miles) west of Shanghai, and 970 km (600 miles) north of Hong Kong. It is considered today as the political, economic, financial, commercial, cultural and educational centre of Central China. Direct flights from Wuhan also connect with Europe: six flights weekly to Paris, three weekly to London, and five weekly to Rome.

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

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). Like SARS-CoV, it is a member of Beta-CoV lineage B.

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. Its RNA sequence is approximately 30 kbp in length.

Transmission

The natural wildlife reservoir of the 2019‐nCoV and intermediate host that transmitted the 2019-nCoV to humans has not been confirmed. On 22 January 2020, scientists from Peking University, Guangxi Traditional Chinese Medical University, Ningbo University and Wuhan Biology Engineering College published an article, which after looking at "humans, bats, chickens, hedgehogs, pangolins, and two species of snakes", concluded that the "2019‐nCoV appears to be a recombinant virus between the bat coronavirus and an origin‐unknown coronavirus" ... and ... "snake is the most probable wildlife animal reservoir for the 2019‐nCoV" which then transmitted to humans. Others have also suggested the 2019-nCoV developed as a result of "viruses from bats and snakes combining". Some have disputed the paper from Peking and argued that the reservoir must be bats and the intermediate host, bird or mammal, not snakes.

An updated preprint paper published 23 January 2020 on bioRxiv from members of the Wuhan Institute of Virology, Wuhan Jinyintan hospital, University of Chinese Academy of Sciences and the Hubei Provincial Center for Disease Control and Prevention suggest that the 2019 novel coronavirus has possible bat origins, as their analysis shows that nCoV-2019 is 96% identical at the whole genome level to a bat coronavirus.

Studies have confirmed that the 2019-nCoV enters humans via ACE 2 receptors, as is the case with the SARS virus.

Epidemiology

Confirmed cases outside of mainland China include four women and one man in Thailand, one man in Japan, one woman in South Korea, one woman and two men in Taiwan, two men in Hong Kong, two men in Vietnam, two men and one woman in Singapore, one man and one woman in the United States, and one man in Macau. The figures are supported by experts including Michael Osterholm.

On 17 January, an Imperial College group in the UK published a Fermi 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", which has since been confirmed as happening. 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". A Hong Kong University group has reached a similar conclusion as the earlier study, with additional detail on transport within China.

On 20 January, China reported a sharp rise in cases with nearly 140 new patients, including two people in Beijing and one in Shenzhen. As of 24 January, the number of laboratory-confirmed cases stands at 911, including 889 in Mainland China, 5 in Thailand, 3 in Singapore, 3 in Taiwan, 2 in Hong Kong, 2 in Macau, 2 in Vietnam, 2 in Japan, 2 in South Korea and one in the United States.

Chronology

Global: reported cases and responses

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

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.

Confirmed cases

France

The first confirmed case in France and in Europe was reported in Bordeaux, and two more in Paris, all of them on 24 January. The first two passengers had travelled through Schiphol Airport on their way to France. The French Health Minister Agnès Buzyn, stated in a press conference that it is likely other cases would arise in the country.

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. In the first week of 2020, 30 unwell travelers from Wuhan were tested. Most were found to be positive for other respiratory viruses.

On 22 January 2020, a mainlander man, age 39, who travelled 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 Mary Hospital in Hong Kong Island. 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.

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. The Hong Kong Tourism Board canceled the Lunar New Year Cup and a four-day Lunar New Year carnival, citing concerns over the virus outbreak.

On 24 January 2020, Hong Kong health authorities confirmed a fifth case of the coronavirus in Hong Kong.

Japan

A 30-year-old Chinese national who had previously travelled 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.

Japan has been taking extra precautions from 2019-nCoV due to the upcoming 2020 Summer Olympics being held in Tokyo.

Macau

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.

Nepal

A suspected case was reported in Nepal on 16 January 2020. A Nepali student who had returned from Wuhan and was quarantined in Kathmandu. This became first confirmed case of the country and South Asia after a sample sent to WHO Collaborating Center Hong Kong came back ‘positive’ for the virus on 24 January 2020.

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. On 20 January 2020, temperature screening at Changi Airport was extended 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. On 22 January 2020, quarantine measures were extended to travellers who arrived from China and display symptoms. On the same day, three more suspected cases were detected, causing the MOH to form a multi-ministry taskforce to tackle the virus. The MOH also advised against non-essential trips to Wuhan and later expanded the travel advisory the following day to the whole of Hubei.

The first case was confirmed on 23 January 2020 involving a 66-year-old Chinese national from Wuhan who flew from Guangzhou via China Southern Airlines flight CZ351 with 9 companions and stayed at Shangri-La's Rasa Sentosa Resort and Spa. Contact tracing subsequently commenced. Preliminary tests also showed positive results for a 53-year-old. The 37-year-old son of the first imported case in Singapore, as announced by MOH on 23 January 2020, was confirmed to have the virus, bringing the total number of confirmed cases to three. Another 28 suspected cases were detected as a result of enhanced testing. Border control measures were enhanced and extended to land and sea checkpoints on 24 January 2020 and the Immigration and Checkpoints Authority started temperature checks since noon.

South Korea

A suspected case was reported in South Korea on 8 January 2020, with the person isolated as a result. There have been four suspected cases since then, and confirmed cases on 20 January 2020 and 24 January 2020.

Taiwan

As of 24 January 2020, there are 3 confirmed cases. 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. 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.

Thailand

In Thailand, screening of passengers arriving from Wuhan at four airports; Suvarnabhumi International Airport, Don Mueang International Airport, Phuket International Airport and Chiang Mai International Airport, began on 3 January 2020, and a number of suspected cases have been found to have other common respiratory conditions.

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.

Thailand's second case occurred in a 74-year-old woman who arrived in Bangkok on a flight from Wuhan on 17 January 2020.

On 21 January 2020, Nakornping Hospital reported on a suspected case of a 18-year-old male patient who arrived in Chiang Mai from Wuhan with a high fever, his blood samples were sent to King Chulalongkorn Memorial Hospital in Bangkok for further analysis.

On 22 January 2020, the Thai Ministry of Public Health announced a report for two additional confirmed cases of infection found in Thailand. The third was a 68-year-old man, a Chinese tourist like previous cases. The fourth case was the first case for a Thai citizen; a 73-year-old Thai woman hospitalised at Nakhon Pathom Hospital in Nakhon Pathom Province, arriving from Wuhan.

The fifth case was confirmed on 24 January 2020; in a 33-year-old Chinese woman arriving from Wuhan with her 7 year-old daughter; who was not infected. She reported herself to Rajvithi Hospital, where she was hospitalised, 3 days after her arrival in Bangkok on 21 January 2020.

United States

CDC announced the first confirmed case of the new coronavirus in the United States, in a man in his 30s from Snohomish County, Washington, on 21 January 2020. The man had travelled 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. A second case was confirmed in Chicago on 24 January, a woman in her 60s.

Vietnam

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. Deputy minister Đỗ Xuân Tuyên said that Vietnam is considering closing the border with China as a necessary countermeasure. Saigon Tourist announced that it has cancelled all tours to or transit in Wuhan. On 24 January, the Civil Aviation Administration of Vietnam ordered the cancellation of all flights from and to Wuhan.

The first two cases of confirmed infected were hospitalised on 22 January and treated at Cho Ray Hospital, Ho Chi Minh City. One case is a Chinese man travelling from Wuhan to Hanoi to visit his son living in Vietnam. The second is the man's son who is believed to have contracted the disease from his father. After the confirmation, the acting Minister of Health Vũ Đức Đam has ordered the activation of the ministry's Emergency Epidemic Prevention Center.

Suspected cases

Canada

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.

As of 22 January, six people were put under observation in Quebec after showing signs of a respiratory virus since recently returning from China. On the following day, the Minister of Health Patty Hajdu said that five or six people were being monitored for signs of coronavirus, including at least one person in Quebec and another in Vancouver.

On 24 January, all six people that were put under observation in Quebec tested negative for coronavirus.

India

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

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

On 24 January, it was reported that two suspected cases of the coronavirus had been detected in the Indian city of Mumbai. Both cases were isolated and the appropriate precautions were taken at the hospital they are being treated in.

Malaysia

One patient, a tourist from China, has been placed in isolation ward at Queen Elizabeth Hospital in Sabah for suspected infection of the virus. The patient including three other suspected patients comprising one from Sabah and two from Selangor were later tested negative for the virus. Further eight Chinese nationals were quarantined at a hotel in Johor after coming into contact with an infected person in neighbouring Singapore.

Mexico

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. The case has since been attributed to a common cold after testing negative for the coronavirus . On 23 January, the Secretariat of Health reported that the case in Tamaulipas and two cases in Mexico City had been ruled out. However, three possible cases in Jalisco, one in Michoacán and one in Mexico City are now being investigated.

Philippines

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.

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. Another two suspected cases tested negative for the virus, and were allowed to return home.

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.

United Kingdom

Four suspected cases underwent testing in Scotland on 23 January: three in Edinburgh and one in Glasgow. All had recently been to Wuhan. 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. On 24 January 14 people were tested for the virus with all coming back negative. Since then, the British government have been tracing up to 2,000 people who came in on flights from Wuhan.

United States

On 24 January, US health officials reported that they are currently monitoring 63 other potential cases within the US. The cases currently being monitored in the U.S. stretch across 22 different states, including the first patient in Washington state and the new case in Illinois.

Prevention in other countries

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. 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.

Bangladesh

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

Brazil

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. The case was later dismissed as tests came back negative for the virus. After this case, in the State of São Paulo, the Health Secretary of the state announces a response and monitoring plan for new suspected infections. The main referral hospitals will be trained to detect and report cases of Wuhan coronavirus. Professionals are advised to observe fever, cough and difficulty in breathing associated with people who have traveled to outbreak areas in China. Also issued that suspect patients must be isolated, and make use of personal protective equipment.

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 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.

Italy

On 23 January, one suspected case in the city of Bari where an Italian singer, after returning home from an Asian tour that also included the city of Wuhan, was hospitalized after feeling ill. Tests for the virus that infected the singer reported that it is not 2019-ncov.

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.

Malta

Maltese local authorities has taken preventive measures, and advised the public and health workers to uphold sanitary regulation to not spread illnesses. The Superintendent of Public Health has cautioned for adequate measures but sees no risk of arriving and spreading within the country as of yet.

Netherlands

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. Both confirmed European cases of coronavirus have entered the EU via this airport.

North Korea

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.

Panama

The Panamanian government has enhanced its sanitary control and screening measures at all ports of entry, in order to prevent the spread of the virus, isolating and testing potential cases.

Serbia

Minister of Health Zlatibor Lončar announced the Belgrade Nikola Tesla Airport would introduce new measures that include screening passengers arriving at the airport with thermal cameras, adding that Serbia is ready to quarantine anybody believed to be carrying the virus.

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.

Turkey

The Ministry of Health announced that Turkey has arranged quarantine rooms, inspection centres and thermal cameras for screening at the airports as added precautions, even though the World Health Organization does not consider them necessary for the country.

United Arab Emirates

On 23 January 2020, Dubai International Airport announced that travellers arriving directly from China would have their temperatures screened.

United States

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

Symptoms at clinical presentation

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

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.

Prevention and management

2019-nCoV does not currently have an effective medicine treatment or vaccine, though efforts to develop some are underway. Its symptoms include, among others, fever, breathing difficulties and coughing, which have been described as "flu-like". To prevent infection, the WHO recommends "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)."

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. Some countries require people to report flu-like symptoms to their doctor, especially if they have visited mainland China.

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. 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.

Quarantines

A quarantine on travel in and out of Wuhan was imposed from 23 January 2020, 10:00 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. Various logistic issues have occurred after the quarantine, including rising food prices and difficulty for medical staff commuting to the hospital. In Wuhan, the roads remain open, but police are checking all incoming vehicles.

On 23 January 2020, 11 pm (UTC+8), the Chinese government announced a lockdown on Chibi City effective at 00:00 on 24 January, preceded by the prefecture-level cities of Huanggang, Ezhou, and Wuhan.

Since the city of Wuhan has been closed down, residents are scrambling to nearby stores to stockpile on essential goods. There have been numerous reports of long lines at supermarkets, pharmacies, and gas stations — residents are flocking to gas stations because of a false rumour about fuel reserves running out. Following the quarantine, prices of goods have significantly increased in Wuhan.

By 23 January at least 3 cities had been "locked down" by Chinese authorities, with a combined population of over 18 million. By the 24th this had increased to 10 cities in Hubei.

An epidemiologist and SARS virologist with teams consisting of medical specialists who just flew back to Hong Kong after their one-day inspection in Wuhan told correspondents that "the Wuhan outbreak is at least 10 times larger than that of SARS, calling people to stay away from Wuhan as soon as possible."

Some posts on Weibo showed that hospitals in Wuhan have already been overloaded with thousands of people with fever and were highly critical of the reliability of the figures from the Chinese government although such posts are now deleted due to unknown reasons.

Affected cities

Specialty hospital

A specialty hospital named "Huoshenshan Hospital" has been under construction as a countermeasure against the outbreak and to better quarantine the patients. Wuhan City government has demanded a state-owned enterprise to re-construct an accommodation in Wuhan into a Virus Therapy Center "at the fastest speed" comparable to that during the SARS outbreak in 2003.

On 24 January, Wuhan authorities specified its planning, saying they planned to have the hospital built within 6 days of the announcement and it will be ready to use on 3 February. The specialty hospital will have 1,000 beds using cargo containers, and it will take up 25,000 square meters. The hospital was intended to emulate the "Xiaotangshan Hospital" during 2003's SARS outbreak, which was built within 7 days, located on the outskirts of Beijing for treating the surge of SARS patients only.

See also

• 2009 flu pandemic
• Acute respiratory distress syndrome
• Emerging infectious disease
• Middle East respiratory syndrome
• Rousettus bat coronavirus HKU9
• Severe acute respiratory syndrome (SARS)

References

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External links

Mainland China and Hong Kong

• Wuhan unexplained viral pneumonia epidemic The pathogen was initially identified as a new type of coronavirus. CCTV, (9 January 2020). Template:Link language
• Wuhan Municipal Health Commission Template:Link language
• Statutory Reporting of Severe Respiratory Disease associated with a Novel Infectious Agent. CHP, Hong Kong, (7 January 2020)

WHO

• Surveillance case definitions for human infection with novel coronavirus (nCoV). WHO, (11 January 2020)
• Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases. WHO (15 January 2020)

Europe

• "Cluster of pneumonia cases caused by a novel coronavirus, Wuhan, China". ECDP (17 January 2020)
• Wuhan novel coronavirus and avian flu: advice for travel to China. PHE, UK, (10 January 2020).
• Threat level remains LOW but authorities raise alertness to symptoms MSN (22 January 2020)

• Current events from January 2020
• 2010s medical outbreaks
• 2019 disasters in Asia
• 2019 health disasters
• 2020 disasters in Asia
• 2020 health disasters
• 2020s medical outbreaks
• 21st-century epidemics
• Atypical pneumonias
• Coronaviridae
• December 2019 events in China
• Health disasters in China
• History of Wuhan
• January 2020 events in China