PART 2. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART 1 FOLLOWED BY NEW PART 2

PART 1. January 21, 2020

“The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

“Chinese researchers say they have identified a new virus behind an illness that has infected dozens of people across Asia, setting off fears in a region that was struck by a deadly epidemic 17 years ago.

There is no evidence that the new virus is readily spread by humans, which would make it particularly dangerous, and it has not been tied to any deaths. But health officials in China and elsewhere are watching it carefully to ensure that the outbreak does not develop into something more severe.

Researchers in China have “initially identified” the new virus, a coronavirus, as the pathogen behind a mysterious, pneumonialike illness that has sickened 59 people in the city of Wuhan and caused a panic in the central Chinese region, the state broadcaster, China Central Television, said on Thursday. They detected this virus in 15 of the people who fell ill, the report said.

The new coronavirus “is different from previous human coronaviruses that were previously discovered, and more scientific research is needed for further understanding,” the report said.” (A)

“China released the genetic sequence of a new coronavirus believed to be responsible for a cluster 0f unusual pneumonia cases in Wuhan. Phylogenetic analysis shows the coronavirus to be closely related to SARS CoV, the virus responsible for the SARS pandemic which began in China in 2003.

Further analysis is necessary, but this preliminary analysis shows the virus is also quite similar to other SARS-related coronaviruses which appear to be endemic to the area. Prior EcoHealth Alliance research has found evidence that these viruses are spilling into human populations. We are also conducting behavioral analysis with the goal of reducing risk for this spillover.

The virus responsible for the current outbreak in Wuhan has so far killed one person; fortunately it’s not currently believed that the virus has the ability to spread human-to-human. Our work has shown that there is a large diversity of coronaviruses that are endemic to China.” (B)

“Chinese officials confirmed Tuesday that six people have died from a pneumonialike coronavirus, while raising the number of confirmed cases of the illness to 300, sparking fears of an outbreak in the country. The virus, which was first confirmed on Dec. 31 in the city of Wuhan, is believed to have been transmitted from animals to humans, but Chinese health officials now say they have evidence that human-to-human transmission is also possible, potentially via saliva. The World Health Organization says the symptoms of the virus are fever, cough, and respiratory difficulties such as shortness of breath, all of which can, in serious cases, lead to pneumonia, kidney failure, and, in the most severe cases, death.” (C)

“Officials in China are racing to contain the spread of a new virus that has left at least six people dead and sickened more than 300, after it was confirmed the infection can spread between humans.

Wuhan, the central Chinese city where the coronavirus was first detected, announced a series of new measures Tuesday, including the cancellation of upcoming Lunar New Year celebrations, expected to attract hundreds of thousands of people.

Tour agencies have been banned from taking groups out of Wuhan and the number of thermal monitors and screening areas in public spaces will be increased. Traffic police will also conduct spot checks on private vehicles coming in and out of the city to look for live poultry or wild animals, after the virus was linked to a seafood and live animal market, according to a report by state media outlet the People’s Daily, citing Wuhan’s Municipal Health Commission.

The new measures come after Chinese President Xi Jinping ordered “resolute efforts to curb the spread” of the virus Monday.

There are now fears, however, that efforts to contain it are coming too late, hampered by a slow-moving Chinese bureaucracy which failed to put sufficient measures in place in time.

In the coming days, hundreds of millions of Chinese are expected to begin traveling across the country and overseas as the annual Lunar New Year break gets fully underway, compounding concerns of a further spike in cases.

Though infections were first detected in Wuhan in mid-December, infrared temperature screening areas were not installed in the city’s airports and stations until January 14, according to state media.

On Tuesday, China’s National Health Commission announced that it had received 291 confirmed cases of the Wuhan coronavirus, with 77 new cases reported on January 20.” (D)

“Earlier on Monday, Chinese authorities reported that the number of cases had tripled over the weekend to 218. The outbreak has spread to Beijing, Shanghai and Shenzen, hundreds of miles from Wuhan, where the virus first surfaced last month.” (E)

“Thailand and Japan each reported new cases of a coronavirus that has left two people dead and at least 40 sick in China, adding to concerns about the spread of the virus beyond Chinese borders ahead of a major holiday.

Health officials in Thailand on Friday said they had found a second case of the mysterious pneumonialike coronavirus in that country, in a 74-year-old Chinese woman. The woman is in good and stable condition, said a spokesman for Thailand’s public health ministry, Rungrueng Kitphati.

The woman entered Thailand through Bangkok via a flight from the central Chinese city of Wuhan, the epicenter of the outbreak. Investigators were still trying to gather information from the woman but have been hindered by a language barrier, Mr. Rungrueng said.

On Thursday, Japan’s Health Ministry said that a Chinese man in his 30s tested positive for the coronavirus. The man, a resident of Kanagawa Prefecture, just south of Tokyo, returned to Japan on Jan. 6 after traveling to Wuhan. The man, who came down with a fever on Jan. 3, was hospitalized on Friday but was discharged five days later because he had recovered, according to the Health Ministry.” (F)

“A British tourist is feared to have contracted the mysterious coronavirus that’s sweeping Asia after he was hospitalized on a trip to Thailand, according to a report.

Ash Shorley, 32, was admitted in critical condition to a Phuket hospital, where he’s being treated for pneumonia-like lung infections, the Sun reported.

Doctors believe his symptoms are consistent with the new Chinese coronavirus, which has killed three patients and infected hundreds of others.

“They think he is the first Western victim of the Chinese flu,” his father, Chris, told the outlet. “We are waiting on tests.”” (G)

 “Airports in New York, San Francisco and Los Angeles will begin screening passengers arriving from Wuhan, China, for infection with a mysterious respiratory virus that has killed two people and sickened at least 45 overseas, the Centers for Disease Control and Prevention announced on Friday.” (H)

“Officials this week also confirmed that the new coronavirus, which is linked to a seafood and animal market in Wuhan, is transmissible between humans. This ultimately sparked fears that a person infected with the virus and experiencing the most severe stage of infection could be a super-spreader —  someone who transmits the virus to a considerable more amount of people than the average infected person, the South China Morning Post reported…

In response to the outbreak, the World Health Organization (WHO) is holding an emergency meeting on Wednesday to determine whether or not it should be considered an international public health emergency, according to the South China Morning Post…

Australia is taking similar measures, with officials there announcing Tuesday that the country will also begin screening passengers who are arriving from Wuhan, according to The New York Times. Japan and South Korea also announced increased airport screenings.

But even with screening measures, “You cannot absolutely prevent entry into the country of a disease like this,” Brendan Murphy, the chief medical officer for the Australian government, said, according to the newspaper. Some people who are infected may not show symptoms, he explained.” (I)

“The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.

The CDC and Washington state officials said the man, in his 30s, was in good condition at Providence Regional Medical Center in Everett. The symptoms presented Sunday and the diagnosis was confirmed Monday.

Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, called the news “concerning.”

“We’re still in the early days of this investigation,” Messonnier said.” (J)

PREQUELS

“A SEVERE FLU PANDEMIC… could kill more than 33 million people worldwide in just 250 days.” – “Boy, do we not have our act together.” — Bill Gates”. (J)

ASSIGNMENT: Does your community have a seasonal flu EMERGENCY RESPONSE PLAN? Do your community’s hospitals have SURGE CAPACITY  and RAPID RESPONSE TEAMS? If not, develop a plan!

EBOLA. PART 13. Ebola Treatment Centers are having difficulty maintaining their ability to respond to Ebola cases that may come again to the U.S.

ASSIGNMENT: As Ebola spreads from Congo to contiguous countries In Africa, is the United States prepared for Ebola and other known and unknown emerging viruses?

PART 4. CANDIDA AURIS. “.. nursing facilities, and long-term hospitals, are…continuously cycling infected patients, or those who carry the germ, into hospitals and back again.”

Tomorrow morning’s Emergency Preparedness meeting (just scheduled for 8AM, http://doctordidyouwashyourhands.com/2018/10/tomorrow-mornings-emergency-preparedness-meeting-just-scheduled-for-8am/

“we are not finished with Zika… It very well could come back.” Are we ready?

Hospitals are developing their own Zika preparedness models. Compare the Central Florida and Johns Hopkins approaches! Which template makes more sense? http://doctordidyouwashyourhands.com/2016/09/hospitals-are-developing-their-own-zika-preparedness-models-compare-the-central-florida-and-johns-hopkins-approaches-which-template-makes-more-sense/

We don’t know what we don’t know” (1) The challenge to emergency preparedness….., http://doctordidyouwashyourhands.com/2017/08/we-dont-know-what-we-dont-know-1-the-challenge-to-emergency-preparedness/

Doctor, Did You Wash Your Hands?® There is a sign in my primary care provider’s examination room:

http://doctordidyouwashyourhands.com/wp-admin/post.php?post=9909&action=edit

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NEW PART 2. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

In July of 2009 the Mayor of Hoboken asked me to initiate a H1N1 “Swine Flu” Task Force. We started with a set of questions based on reports from communities that had already experienced a Swine Flu surge:

Health Officer: Where vaccination sites should be established? Is there a special plan to monitor restaurants and food shops where flu-related safety guidelines need to be strictly enforced? Who will start preparing a Community Education plan?

Hospital: What is the back-up plan if hospital becomes “contaminated” and is closed to admissions, or if nursing staff is depleted by flu-related absenteeism, etc.? ICU triage? Availability of respirators?

OEM:  off-site screening centers if hospital ER is on overload

Hoboken Volunteer Ambulance Corps:  “mutual assist” plan

Hoboken Police Department & Hoboken Fire Department: back-up plan if the ranks get depleted by the flu

BOE: criteria in deciding whether or not to close schools

Stevens Institute of Technology: surveillance and plan for (college) students

“Field Manual” for the Mayor

Interestingly Swine Flu never flourished in the Hoboken area probably due to herd immunity acquired from the Swine Flu in 2008 in New York City, where many Hobokenites work and visit.

Acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003 and the illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak was contained. According to the World Health Organization (WHO), a total of 8,098 people worldwide became sick with SARS during the 2003 outbreak. Of these, 774 died. In the United States, only eight people had laboratory evidence of SARS-CoV infection. All of these people had traveled to other parts of the world with SARS.” (A)

With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

The Hospital was in a small town at the intersection of many major highways. It could be easily secured since it had no immediately contiguous neighbors. It had a helicopter pad. Its patients could be easily transferred. And it could be managed by the Public Health Service or military medicine if necessary.

It didn’t happen!

“We understand that many people in the Unites States are worried about this virus,” said Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases (part of the Centers for Disease Control and Prevention).

“At this time, in the U.S., the virus is not spreading in the community,” she added. “For that reason we continue to believe that the immediate health risk from the new virus to the general public is low at this time.”

In the U.S., 110 individuals from 26 states are being investigated to determine whether they have coronavirus. Of those individuals, 32 have tested negative, five have tested positive, and the remaining test results are pending.

No new coronavirus cases have been diagnosed overnight, according to the CDC, and all five cases were in people who had traveled to China. Two of those five cases are in Southern California and Chicago, Washington state and Arizona have each reported one coronavirus case…

Five U.S. airports, in New York, San Francisco, Los Angeles, Chicago and Atlanta, continue to screen passengers from Wuhan for pneumonia-like symptoms, such as fever and respiratory problems. So far, airports have screened about 2,400 passengers, with screenings declining following strict travel bans and a quarantine in Wuhan…

The CDC is in the process of developing a real-time diagnostic test to identify the virus and is hoping to quickly roll that test out to states. For now, all samples are being sent to the CDC in Atlanta, a process which takes about a day, from the time clinicians and the CDC agree to test a patient for coronavirus until results come back from Atlanta. Other countries are doing similar centralized testing, Messonnier explained. While speed is important, accurate testing is the agency’s priority.

While a report in the Lancet, published Jan. 24, suggested that people who contract coronavirus might be able spread the disease before they develop symptoms, Messonnier maintained that the CDC has “no clear evidence” of patients’ being infectious before symptom onset. For now, the virus’ incubation period is believed to be between two and 14 days..

The World Health Organization did not declare a public health emergency of international concern last week, after deliberating for two days over the decision.” (C)

“It appears to be very well contained,” Mark Parrish, regional medical director of Northern Europe at International SOS, told CNBC Tuesday.

“The Chinese have done some extraordinary things, identifying the virus and its molecular structures and then instigating those quarantine measures in China where they have shut down these huge cities and stopped all movement. It’s come at a really bad time of the year … It’s likely to have moved around China.”

“It appears though that the death rate remains at about 2% to 3%, it seems to be very well contained at the moment,” he said.

“Putting it into perspective, 100 deaths or so, so far, all in elderly people and those that have other co-existing diseases unfortunately. And those are the ones that are most likely to be affected by this as their respiratory systems find it difficult to deal with these things.”..

Global media organizations have fixated on whether the outbreak will be declared a “global health emergency” by the World Health Organization (WHO). Currently, the WHO has the virus at a “high risk” level after admitting on Monday its error in initially stating (last week) that the global risk was “moderate.”

Christian Lindmeier, spokesperson for the WHO, told CNBC Tuesday that the assessment was done by a group of independent experts and that the situation would be re-evaluated “very soon.”

He said there was definitely a crisis in China “but declaring this a public health emergency of international concern is another step. It means that internationally this is spreading and is transmitting from human to human internationally.

“So not only a traveler carrying it from China into another country and it being contained there, but it spreading onward from there and this is something we’ve not yet seen, let’s be very clear about this,” he said.

Although it has not happened yet, Lindmeier said it would not be surprising if the virus spread further. He said health systems should closely monitor the situation and “be aware that this is what could come to their shores.”..

“The jury’s still out just how bad it will be, but when you think that the number of cases has doubled in one day, that’s very worrisome,” he said.” (D)

“With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.

As a result, hospitals have been on the lookout for patients with recent travel involving Wuhan, the Chinese city where the coronavirus is believed to have originated. And they have urged those who recently traveled there — or who have been in contact with someone who has — to quickly seek medical care if they have any respiratory or flulike symptoms.

“It’s inevitable that we will have someone who is positive with coronavirus,” New York City’s health commissioner, Dr. Oxiris Barbot, said Sunday.

Some of the last passengers to arrive at Kennedy International Airport on the last direct flights from Wuhan before they were canceled were quarantining themselves at home. One man told of how he had confined himself to his house in Queens, as friends left special Lunar New Year meals on his doorstep.

So far, state officials have sought testing for nine patients who were deemed potential cases of the new coronavirus, sending samples to the Centers for Disease Control and Prevention for testing.

Four of those patients were found not to have the virus, and the tests involving the other five are still pending, Gov. Andrew M. Cuomo said Monday in a statement.

When the first case does arrive, health officials said, that patient may end up in a biocontainment unit in Bellevue Hospital or sent home to ride out the illness in his or her bedroom. That will depend largely on how sick they are, public health officials say…

By and large, the message to the public has been one of reassurance. “We are encouraging New Yorkers to go about their everyday lives and suggest practicing everyday precautions that we do through the flu season,” Dr. Barbot said.

But there is considerable anxiety and debate over the proper precautions within the city’s Chinatowns. That has only grown in the past few days as more alarming news has emerged out of Wuhan about the virus’s spread. So far more than 4,500 people have been sickened and more than 100 people have died.” (E)

“New York’s colleges, which enroll some 50,000 students from China, put out warnings to be on alert for symptoms of the deadly coronavirus as classes started up again for the spring semester.

Most of the Chinese students in the state are studying in the New York City area, according to the Institute for International Education’s most recent report.

New York University, which has upwards of 19,000 international students — more than any other college in the country — said it reached out to students from China’s Wuhan region, where the virus originated, and “provided them with information about the symptoms, instructed them to check in with us if they are experiencing those symptoms, reminded them about the availability of NYU health services.”

Spring semester classes begin Monday at NYU. A college spokesman would not say how many students come from the Wuhan area.” (F)

“The first U.S. patient, an unidentified man in his 30s, had traveled to the Wuhan area at the end of last year. He fell ill shortly after flying back to the U.S., where he lives north of Seattle.

In Washington state, health agencies have identified more than 60 people who came in close contact with the infected man before he was hospitalized in Everett, a city in Snohomish County outside Seattle.

The case quickly grabbed headlines, but it didn’t rattle local health clinic workers who had recently geared up to handle another infectious disease.

“The measles really kind of enlightened everybody about ‘Wow, there are a lot of things out there that can be really contagious and can get you really sick, really fast,’ ” says Tove Skaftun, the chief nursing officer for the Community Health Center of Snohomish County.

Skaftun says she’s glad that last year’s outbreak forced them to improve how they approach these situations.

“We’ve recently grown our infection-control program so it’s kind of at the forefront of a lot of what we do,” says Skaftun.

She says that effort focused on educating staff about the correct precautions to take when faced with different kinds of infectious diseases — including wearing protective air-purifying respirators when in contact with patients who may be infected…

The patient in Seattle first went to a local health clinic when he started showing symptoms. Once it became clear he was at risk for coronavirus, he was transported to Providence Regional Medical Center in Everett, a hospital north of Seattle, where he was treated in isolation. He remains in “satisfactory” condition, according to the Washington State Department of Health.

Dr. Amy Compton-Phillips, the chief clinical officer at Providence St. Joseph Health, which runs that hospital, says it was set up to handle high-level infectious pathogens during the Ebola scare of 2014.

“All types of infrastructure had been put in place to ensure that when something came around we’d be ready,” says Compton-Phillips.

Those include specialized gurneys to keep patients isolated while they’re wheeled around the hospital, robots that can listen to patients’ lungs and take blood pressure, and rooms with negative-pressure air flow so germs aren’t circulated throughout the rest of the hospital…

She says staff have practiced getting ready for an infectious outbreak pretty recently. Last year, Clark County, Wash., which is part of suburban Portland, Ore., had an alarming outbreak of 71 cases of measles, mostly among unvaccinated children…

“There are a lot of unknowns,” says Janet Baseman, professor of epidemiology at the University of Washington. “The best thing public health can do now is assume that it will be similar to other coronavirus outbreaks we have seen in recent years until proven otherwise.”

“Being overprepared is the name of the game,” she says.” (G)

“The emergency call was made to Hackensack University Medical Center late Thursday night.

A doctor’s office was sending a woman in her mid-20s to the emergency room, according to reports, with a suspected case of coronavirus, the deadly novel virus sweeping through China and much of Asia.

The alert turned out to be a false alarm: The patient did not have the coronavirus. Although a relief, it was a scenario hospitals across the state have been bracing for as fears mount that this new, mysterious virus will spread to New Jersey.

Emergency rooms throughout the Garden State are ramping up their procedures in preparation for the time when a patient does arrive with the deadly virus.

“The key is to recognize it early so you can isolate early, and that prevents the likelihood of spreading in our facility and to other patients and employees,” Dr. Jerry Zuckerman, vice president of infection prevention and control at Hackensack Meridian Health System, told NJ Advance Media…

Experts determined the patient who entered the Hackensack emergency room Thursday night was not infected with the virus after an evaluation, a spokeswoman for Hackensack Meridian Health said. Zuckerman declined to discuss the patient, but shed some light on how such a virus is contained in an emergency room.

The protocols are anything but high-tech. But they work, Zuckerman said.

Interview the patient. Mask the patient. Isolate the patient.

That’s it.

It may sound rudimentary, but that is all that stands between the virus spreading or being contained.

First, patients are interviewed to determine whether they’ve visited the outbreak’s place of origin. Then patients are masked and isolated, before being placed in an airborne infection isolation room — also called a negative pressure room. These rooms isolate pathogens.

If medical personnel must enter an isolation room, they have to wear respirator masks, gloves and goggles — think of the protective gear worn in the 1995 Dustin Hoffman film, “Outbreak.”..

 “Although this novel virus in understandably a cause for concern, it is important for New Jersey residents to know that the risk to the public remains low,” Health Commissioner Judith Persichilli said in the Department of Health statement.

“The New Jersey Department of Health works with hospitals and local health departments throughout respiratory virus and flu season on hundreds of disease outbreaks each year and we are prepared — along with our partners — to respond to potential novel coronavirus cases.”” (H)

“The Chinese city of Wuhan is rapidly building a new 1,000-bed hospital to treat victims of a new coronavirus, mobilising machinery to get it ready by early next week, state media said…

The new hospital is being built around a holiday complex originally intended for local workers, set in gardens by a lake on the outskirts of the city, the official Changjiang Daily reported on Friday. Prefabricated buildings which will have 1,000 beds will be put up, it said.

Building machinery, including 35 diggers and 10 bulldozers, arrived at the site on Thursday night, with the aim to get the new facility ready by Monday, the paper added.

“The construction of this project is to solve the shortage of existing medical resources” the report said.

“Because it will be prefabricated buildings, it will not only be built fast but it also won’t cost much.”” (I)

“How is China able to build a hospital in six days?

“China has a record of getting things done fast even for monumental projects like this,” says Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.

He points out that the hospital in Beijing in 2003 was built in seven days so the construction team is probably attempting to beat that record. Just like the hospital in Beijing, the Wuhan centre will be made out of prefabricated buildings.

“This authoritarian country relies on this top down mobilisation approach. They can overcome bureaucratic nature and financial constraints and are able to mobilise all of the resources.”

Mr Huang said that engineers would be brought in from across the country in order to complete construction in time.

“The engineering work is what China is good at. They have records of building skyscrapers at speed. This is very hard for westerners to imagine. It can be done,” he added.

In terms of medical supplies, Wuhan can either take supplies from other hospitals or can easily order them from factories.

On Friday, the Global Times confirmed 150 medical personnel from the People’s Liberation Army had arrived in Wuhan. However it did not confirm if they would be working in the new hospital once it has been built.”  (J)

“Some infectious disease experts are warning that it may no longer be feasible to contain the new coronavirus circulating in China. Failure to stop it there could see the virus spread in a sustained way around the world and even perhaps join the ranks of respiratory viruses that regularly infect people.

“The more we learn about it, the greater the possibility is that transmission will not be able to be controlled with public health measures,” said Dr. Allison McGeer, a Toronto-based infectious disease specialist who contracted SARS in 2003 and who helped Saudi Arabia control several hospital-based outbreaks of MERS.

If that’s the case, she said, “we’re living with a new human virus, and we’re going to find out if it will spread around the globe.” McGeer cautioned that because the true severity of the outbreak isn’t yet known, it’s impossible to predict what the impact of that spread would be, though she noted it would likely pose significant challenges to health care facilities.

The pessimistic assessment comes from both researchers studying the dynamics of the outbreak—the rate at which cases are rising in and emerging from China—and infectious diseases experts who are parsing the first published studies describing cases to see if public health tools such as isolation and quarantine could as effective in this outbreak as they were in the 2003 SARS epidemic…

China’s health minister, Ma Xiaowei, warned Sunday that the virus seems to be becoming more transmissible and the country—which has taken unprecedentedly draconian steps to control the virus—was entering a “crucial stage.”..

Dr. Nancy Messonnier, director of National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, said the agency knows transmission of the virus within the United States may be on the horizon.

“We’re leaning far forward. And we have been every step of the way with an aggressive stance to everything we can do in the U.S.,” she told STAT. “And yet those of us who have been around long enough know that everything we do might not be enough to stop this from spreading in the U.S.”

To date, at least 14 countries and territories outside of mainland China have reported nearly 60 cases. There have been no reports yet of unchecked spreading from those imported cases to others…

 “If it’s not contained shortly, I think we are looking at a pandemic,” Bedford said, though he cautioned that it’s impossible to know at this point how severe that type of event would be…

 “I’m not making a prediction that it’s going to happen,” Inglesby said, though he noted the mathematical modeling, the statements from Chinese authorities, and the sharply rising infection numbers make a case for this possible outcome. “I think just based on those pieces of limited information, it’s important for us to begin some planning around the possibility that this won’t be contained.”” (K)

“Laurie Garrett, a Pulitzer Prize-winning science writer, told Yahoo Finance that despite swelling panic over the spread of coronavirus, people should be “realistic” about the infection and the protections they employ against it.

“One of the smart ways to approach thinking about ‘how do you protect yourself,’ is to ask, well, when somebody here in the office has a common cold, and they’re sneezing all over the place, how do you make yourself not get the cold?” asked Garrett, the author of “The Coming Plague,” a book about emerging deadly diseases.

“Social distancing; that’s step number one. Keep your distance from other people” in order to avoid contracting or spreading an infection, Garrett told “The Final Round.” Cleanliness and personal hygiene is also of utmost concern, she added.

“For yourself, think of your hands as your number one problem: anything you touch that’s a common surface,” the author said, explaining that the same principle governs why people are discouraged from sharing utensils or cups.

“Here, in New York City, we think about the subways, we think about how we move around in the city; the answer, if you’re nervous, is wear gloves. Then take your gloves and wash them at night,” Garrett said. “If it’s socially required to shake hands, wash your hands afterwards.”…

Garrett said that “…unlike SARS, which only is contagious when you have a fever, this one seems to be contagious when you don’t even know that you’ve been infected, and the incubation time is much longer.”

While SARS only took three to five days to incubate, the coronavirus “is going out ten days. That means that, potentially, individuals are contagious to others for ten days, without knowing it, traveling about and doing whatever they do with their daily life and infecting so many other people.”

The author also argued that official numbers are “grossly underestimating” the true toll of infections.

“They have a lag time in testing people; they don’t have enough test kits; they have lines around the block, in Wuhan, of people trying to get tested,” says Garrett. “It’s wholly backed up.”” (L)

“A flight carrying about 200 American evacuees landed Wednesday at a US military base in Southern California after leaving the epicenter of the deadly coronavirus outbreak in China.

The flight — operated by Kalitta Air out of Ypsilanti Township, Michigan — was seen taxiing down the runway shortly after 8 a.m. (11 a.m. ET). Several law enforcement vehicles greeted it on the tarmac, their lights flashing…

The US Defense Department will work with the US Department of Health and Human Services, which includes the CDC, to provide housing and, if any individuals are ill, care at a local civilian hospital, Defense Department spokeswoman Alyssa Fara said.

In Alaska, officials conducted two health screenings after prior screenings in China. The CDC cleared all passengers to continue on to California, Alaska officials said.

Passengers were screened in an isolated area of the Anchorage airport’s north terminal, which handles international flights, and had no impact on general travel, airport manager Jim Szczesniak said.

The CDC will work with airport officials to clean the terminal, and there are no international flights scheduled at the airport until May, he said…

Precautions were taken to separate the crew on the plane’s upper level from the passengers on the plane’s lower level, she said, and the crew did not disembark in China.

“These individuals will be screened before they take off; monitored during the duration of the flight by medical personnel on board; screened again on landing to refuel in Anchorage, Alaska; monitored on the last leg of the flight by medical personnel on board; evaluated upon arrival at March Air Reserve Base … and then monitored for symptoms post-arrival,” the CDC said.

The passengers may be forced to stay in isolation between three days and two weeks, an official said.

Priority was given to US citizens at risk

The passengers include US diplomats and their families. The State Department said US citizens could board on a reimbursable basis if space was available.

While there are about 1,000 Americans living in Wuhan, priority was given to US citizens who are “most at risk for contracting coronavirus” if they stay in the city, the State Department said.” (M)

“How would you describe the rate of spread?

Honestly, we don’t know, and part of the reason that it’s continuing at this point in time is because testing is just becoming available. So, while we’re seeing a big bolus [large number] of diagnosed cases, we don’t yet know when they were actually infected.

What we’re waiting for from the World Health Organization is the “epi curve,” which is the graph that shows, by date, the number of new cases and the date of onset of their symptoms. It may be that we’ve been seeing 200 cases a day over 10 days, or it may be that we saw 3 cases, and then we saw 15 and then we saw 100 and then we saw 500 and now a thousand.

We just don’t understand yet whether the case count is due to accelerating spread, or is that just kind of an artificial understanding because of the way the tests are being deployed and the diagnoses are coming in…

How should health officials communicate with the public?

In any frightening new situation, trust is the most important thing. And when you don’t have all of the facts and you’re not sure about what’s going on, maintaining your credibility and your trust are of paramount importance. If you’re going to try to influence what people do or how they decide to manage themselves in a situation like this, you have a lot better chance of helping them decide to do the right thing if they trust you.

So that means first and foremost, telling them the truth. Tell them what you know is going on, tell them what you wish you knew but don’t. Then it’s important to tell them what you’re doing to get answers and, above all, that you promise that when you have new information, you will share it in a timely manner.

If you can keep that cadence going in an outbreak, people will trust you because you do what you say, and they will come to rely upon you as a credible source of updated information.” “(N)

Here are my main takeaways from that experience for ordinary people on the ground:

1. Wash your hands frequently.

2. Don’t go to the office when you are sick. Don’t send your kids to school or day care when they are ill, either.

Notice I didn’t say anything about masks. Having a mask with you as a precaution makes sense if you are in the midst of an outbreak, as I was when out reporting in the field during those months. But wearing it constantly is another matter. I donned a mask when visiting hospitals where SARS patients had been housed. I wore it in the markets where wild animals that were the suspected source of the outbreak were being butchered, blood droplets flying. I wore it in crowded enclosed spaces that I couldn’t avoid, like airplanes and trains, as I traveled to cities involved in the outbreak, like Guangzhou and Hong Kong. You never know if the guy coughing and sneezing two rows ahead of you is ill or just has an allergy.

But outdoors, infections don’t spread well through the air. Those photos of people walking down streets in China wearing masks are dramatic but uninformed. And remember if a mask has, perchance, intercepted viruses that would have otherwise ended up in your body, then the mask is contaminated. So, in theory, to be protected maybe you should use a new one for each outing.

The simple masks are better than nothing, but not all that effective, since they don’t seal well. For anyone tempted to go out and buy the gold standard, N95 respirators, note that they are uncomfortable. Breathing is more work. It’s hard to talk to people. On one long flight at the height of the outbreak, on which my few fellow passengers were mostly epidemiologists trying to solve the SARS puzzle, many of us (including me) wore our masks for the first couple of hours on the flight. Then the food and beverage carts came.”  (O)

“The spread of a fast-moving virus outside of China is of “grave concern” and has prompted the World Health Organization to reconvene an emergency meeting this week to decide whether it’s become a global health emergency, WHO officials said Wednesday.

The coronavirus has spread to a handful of people through human-to-human contact outside of China, Dr. Mike Ryan, executive director of the WHO’s health emergencies program, said at a news conference at the organization’s Geneva headquarters Wednesday.

“These developments in terms of the evolution of the outbreak and further development of transmission, these are of grave concern and has spurred countries into action,” Ryan said, adding that he just returned from China on Wednesday. “What we know at this stage, this is still obviously a very active outbreak and information is being updated and changing by the hour.”” (P)

(The old B.S. Pollak Hospital, part of the old Jersey City Medical Center, was constructed with federal funds during the Great Depression. The building is now privately owned.

“The Pollak Hospital facility was formerly the site of a three-story building constructed in 1918 for the Jersey City School for Crippled Children. It was taken over as the Infectious Disease Hospital and in 1934 received a loan of $2,996,000 by the Reconstruction Finance Corporation for a new county tuberculosis hospital. The 250-bed facility was eventually named for Dr. B.S. Pollak and became noted for the treatment of chest diseases. When completed in 1936, the 22-floor hospital, at 320 feet, was the tallest building in Jersey City until 1989 with the construction of Exchange Place Center at 490 feet.”) (B)

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