CORONAVIRUS TRACKING – Jonathan M. Metsch, Dr.P.H. PARTS 1-5. February 12, 2020

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)

A.China Identifies New Virus Causing Pneumonialike Illness, by Sui-Lee Wee and Donald G. McNeil Jr.,

B.Phylogenetic Analysis Shows Novel Wuhan Coronavirus Clusters with SARS,

C.Deadly Coronavirus in China Raises Fears of Outbreak as Human Transmission Confirmed, by ELLIOT HANNON,

D.6 people dead, 300 infected as China confirms Wuhan virus can be spread by humans, by James Griffiths and Nectar Gan,

E.China confirms new coronavirus can spread between humans, by Nectar Gan, Yong Xiong and Eliza Mackintosh,

F.Japan and Thailand Confirm New Cases of Chinese Coronavirus, by Sui-Lee Wee,

G.British tourist feared to be victim of deadly new Chinese coronavirus, by Jackie Salo,

H.Three U.S. Airports to Check Passengers for a Deadly Chinese Coronavirus, by Denise Grady,

I.Coronavirus outbreak in China sparks ‘super-spreader’ fears as pneumonia-like illness sickens hundreds, by Madeline Farber,

J.First US case of deadly coronavirus reported in Washington state, CDC says, by John Bacon,

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PART 2. January 29, 2020

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)



C.New coronavirus ‘not spreading’ in the US, CDC says, by Erin Schumaker,

D.Health experts call for calm as coronavirus cases rise, by Holly Ellyatt,

E.New York Braces for Coronavirus: ‘It’s Inevitable’, by Joseph Goldstein and Jeffrey E. Singer,

F.New York colleges on coronavirus alert as classes begin, by Melissa Klein,

G.Response To 1st Coronavirus Case In Washington State Draws On Lessons From Measles, by WILL STONE,

H.After coronavirus false alarm, see how one N.J. hospital is preparing for the real thing, by Spencer Kent

I.Wuhan virus: China building 1,000-bed hospital over the weekend to treat coronavirus patients,

J.Coronavirus: How can China build a hospital so quickly?, by Sophie Williams,

K.Experts Warn of Possible Sustained Global, by Helen Branswell,

L.Author: Protect yourself against coronavirus infection with one simple step, by Olivia Balsamo,

M.US evacuees from China land at California military base as coronavirus outbreak grows, by Eliott C. McLaughlin and Faith Karimi, to look ‘pretty intense’: N.Former CDC head who led U.S. SARS response speaks about coronavirus, by Erika Edwards,

O.How to Avoid the Coronavirus? Wash Your Hands, by Elisabeth Rosenthal,

P.WHO officials say coronavirus spread outside of China is of ‘grave concern’, Berkeley Lovelace Jr.,

(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)

PART 3. February 3, 2020

“The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

The prospect is daunting. A pandemic — an ongoing epidemic on two or more continents — may well have global consequences, despite the extraordinary travel restrictions and quarantines now imposed by China and other countries, including the United States.

Scientists do not yet know how lethal the new coronavirus is, however, so there is uncertainty about how much damage a pandemic might cause. But there is growing consensus that the pathogen is readily transmitted between humans.

The Wuhan coronavirus is spreading more like influenza, which is highly transmissible, than like its slow-moving viral cousins, SARS and MERS, scientists have found.

“It’s very, very transmissible, and it almost certainly is going to be a pandemic,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease.

“But will it be catastrophic? I don’t know.”

In the last three weeks, the number of lab-confirmed cases has soared from about 50 in China to more than 17,000 in at least 23 countries; there have been more than 360 deaths.

But various epidemiological models estimate that the real number of cases is 100,000 or even more. While that expansion is not as rapid as that of flu or measles, it is an enormous leap beyond what virologists saw when SARS and MERS emerged.” (A)

“The World Health Organization declared a global health emergency on Thursday as the coronavirus outbreak spread well beyond China, where it emerged last month.

The move reversed the organization’s decision just a week ago to hold off such a declaration. Since then, there have been thousands of new cases in China and clear evidence of human-to-human transmission in several other countries, including the United States.

All of which warranted a reconsideration by the W.H.O.’s emergency committee, officials said.

The declaration “is not a vote of no confidence in China,” said Tedros Adhanom Ghebreyesus, the W.H.O.’s director-general. “On the contrary, the W.H.O. continues to have confidence in China’s capacity to control the outbreak.”

The declaration comes now, he said, because of fears that the coronavirus may reach countries with weak health care systems, where it could run amok, potentially infecting millions of people and killing thousands.” (B)

“The Donald Trump administration declared the coronavirus outbreak to be a public health emergency in the United States on Friday, setting quarantines of Americans who have recently been to certain parts of China.

Centers for Disease Control and Prevention officials said it was the first quarantine order issued by the federal government in over 50 years. Marty Cetron, director of CDC’s Division of Global Migration and Quarantine, said the last time a quarantine was used was in the 1960s for smallpox…

U.S. citizens who have been in China’s Hubei province during the past 14 days and are returning to the U.S. States will undergo health screenings and be monitored during mandatory quarantines of up to 14 days, officials said.

Azar also announced a temporary suspension of entry into the United States of foreign nationals who pose a risk for the transmission of the coronavirus.

As a precaution, any U.S. citizen who has been anywhere else in mainland China beyond Hubei province will be screened when they return for evidence of coronavirus symptoms. They will also be subject to self-quarantines of up to 14 days and monitored by local health officials.

All flights from China to the U.S. will be funneled to one of seven airports that are designated ports of entry: New York, San Francisco, Seattle, Honolulu, Los Angeles, Chicago and Atlanta.” (C)

“The United States has taken decisive action to protect Americans from the threat of a fast-moving coronavirus while offering help to China, President Donald Trump said on Sunday, but a key adviser said Beijing had not accepted the offers of assistance.

Trump appeared to downplay concerns about the flu-like virus that has killed more than 300 people in China and spread to more than two dozen countries, telling Fox television in an interview, “We’re gonna see what happens, but we did shut it down, yes.” (D)

“People showing no symptoms appear to be able to spread the novel coronavirus that has caused an outbreak in China and led world health authorities to declare a global emergency, researchers reported Thursday in the New England Journal of Medicine. If confirmed, the finding will make it much harder to contain the virus.

The case described — from Germany — could help resolve one of the major unknowns about the virus, which as of Thursday night had infected nearly 9,700 people in China and killed 213. About 100 more infections have been reported in 18 other countries, but no deaths.

Some viruses, including SARS, which is another coronavirus, can only be passed when a person is showing symptoms. Others, like the flu, can be spread a day or two before the onset of symptoms. If people are contagious before they become sick, they can be unknowingly spreading the virus as they go shopping or to work or to the movies. Trying to snuff out the virus in that case is a much more difficult task.

What’s also concerning is that the spread from an asymptomatic person appeared to lead to two generations of cases, meaning the person who contracted the virus then passed it on to others.” (E)

“Close to 10,000 people have contracted the new coronavirus that originated in Wuhan, China—more cases than SARS in 2003. So far, 213 people have died. The preliminary fatality rate for 2019-nCoV hovers around 3%—which is low, but still concerning because of the number of cases accumulating.

But that fatality rate is likely to be higher in older adults. Unofficial open-source data from researchers based in the UK and China show that out of 41 deaths, 39 were in people over 50. Bloomberg reports similar figures. While that’s not unexpected, it indicates the need for effective therapies targeted at this population. And as the proportion of adults over 50 continues to increase globally, future pandemics could be deadlier than they’ve been in the past…

There are two reasons older adults are more susceptible to infections. First, seniors are more likely to have other chronic health conditions, like diabetes or chronic obstructive pulmonary disease, that make it harder for their bodies to cope with damage caused by a new pathogen. Every year, the majority of flu deaths are seen in people 65 or older.

Second, the immune system changes with age—particularly in its ability to respond to coronaviruses. Unlike the flu virus, which does most of the damage to your body on its own, most of the symptoms from coronavirus infections actually come from the body’s immune response, Menachery says. Although he and his lab team are still characterizing these reactions, it seems like coronaviruses encourage older immune systems to kick in with extra inflammation, which can have a cascading effect.” (F)

“Two more Americans, a husband and wife, were confirmed to have the coronavirus late Sunday in the second person-to-person transmission in the U.S. and the 10th and 11th cases in the country, respectively.

The husband, from San Benito County, California, recently traveled to Wuhan, China, the center of the virus’ outbreak, and apparently passed the disease to his wife, who did not go to China. Both 57, neither has been hospitalized, but they have also not left their home.

The couple’s diagnosis brings the total number of positive cases in the United States to 11. The ninth case in the country, in Santa Clara County, California, was announced Sunday afternoon. The other human-to-human transmission was also between a husband and wife and was announced last week in Illinois.” (G)

“Stopping the spread of a rapidly emerging disease takes masterful medical detective work, including tracing the people who have been infected and figuring out their web of contacts, steps that are vital to understanding how it’s being transmitted. US public health officials are following those trails to quickly detect new cases of the Wuhan coronavirus, including the report on Thursday of a sixth US infection—the husband of a woman who became ill after traveling from China back home to Chicago—which was followed by a seventh, in California, on Friday.

Yet there’s a potential wildcard, a deviation that throws off the most careful calculations. For reasons that are still unclear, some people, known as super-spreaders, transmit disease much more readily than others, and to many more people. Like an infectious grenade, they can set off a sudden cluster of illnesses. “These super-spreader events are very unique and fall out of the world of averages,” says Michael Osterholm, an infectious disease expert and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Yet super-spreading can shape the trajectory of an outbreak in unexpected ways, making it more difficult to control. Instead of infecting just a few people who are close to them, a super-spreader may inadvertently infect dozens—who go on to spread the disease elsewhere.” (H)

“Can wearing a medical face mask protect you against the new coronavirus? It’s a question many people, including pet owners who are putting canine face masks on their dogs, are asking.

If it’s a regular surgical face mask, the answer is “no,” Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University in Tennessee, told Live Science.

A more specialized mask, known as an N95 respirator, can protect against the new coronavirus, also called 2019-nCoV. The respirator is thicker than a surgical mask, but Schaffner doesn’t recommend it for public use, at least not at this point.” (I)

“New York City health officials announced on Saturday that a patient at Bellevue Hospital Center might have the new coronavirus and that samples were being sent to the federal authorities for laboratory testing. If confirmed, it would be the first known instance of the virus in New York City.

Based on the patient’s symptoms and travel history from China, city officials were taking the potential case seriously. This was the first time city officials had sent a sample to the Centers for Disease Control and Prevention for testing.

Another reason the health authorities suspect it might be the new coronavirus: They had tested the patient for influenza and other common illnesses, and those tests came back negative, health officials said.

They said they did not expect to receive results from the C.D.C. for 36 to 48 hours, or possibly longer.

“An individual with a travel history to China felt unwell and sought help from a medical provider who promptly contacted the Health Department,” the health commissioner, Dr. Oxiris Barbot, said in a statement.” (J)

“China completed building on Sunday a massive, makeshift hospital in Wuhan that will serve as the frontline in battling the coronavirus epidemic, according to a report.

Huoshenshan Hospital was built in less than two weeks to treat patients at the epicenter of the virus that has killed more than 300 people, BBC reported.

The hospital, which has 1,000 beds, started construction Jan. 23 and will begin admitting patients on Monday, according to Chinese state media China Global Television Network.

Around 40 million people tuned into livestreams of the construction on YouTube and Periscope, while workers rushed to complete one of two hospitals that will specialize in treating the virus.

Chinese officials are still working to build the second emergency hospital, Leishenshan Hospital, which is expected to open Wednesday around 25 miles away from the newest site, CGTN reported.” (K)

“The 195 Americans who flew from China to California were first told they must clear medical tests that could take 72 hours or many days. Now they are all being quarantined for two weeks…

This makeshift community on a military base in Riverside, Calif., is made up of evacuees from Wuhan, the city in China that is the epicenter of the coronavirus outbreak. The 195 people, including diplomats, infants, a football player and a theme-park designer, are among Americans who have managed to leave Wuhan since a quarantine was imposed.

Now they find themselves stuck in place in the United States. The federal government on Friday imposed a 14-day quarantine, retroactive to when the plane left Wuhan. The patients were initially told they had to wait at least 72 hours for medical testing to be completed.” (L)

“The BlueDot algorithm scours news reports and airline ticketing data to predict the spread of diseases like those linked to the flu outbreak in China.

On January 9, the World Health Organization notified the public of a flu-like outbreak in China: a cluster of pneumonia cases had been reported in Wuhan, possibly from vendors’ exposure to live animals at the Huanan Seafood Market. The US Centers for Disease Control and Prevention had gotten the word out a few days earlier, on January 6. But a Canadian health monitoring platform had beaten them both to the punch, sending word of the outbreak to its customers on December 31.

BlueDot uses an AI-driven algorithm that scours foreign-language news reports, animal and plant disease networks, and official proclamations to give its clients advance warning to avoid danger zones like Wuhan.

Speed matters during an outbreak, and tight-lipped Chinese officials do not have a good track record of sharing information about diseases, air pollution, or natural disasters. But public health officials at WHO and the CDC have to rely on these very same health officials for their own disease monitoring. So maybe an AI can get there faster. “We know that governments may not be relied upon to provide information in a timely fashion,” says Kamran Khan, BlueDot’s founder and CEO. “We can pick up news of possible outbreaks, little murmurs or forums or blogs of indications of some kind of unusual events going on.” (M)

““The outbreak is probably a lot bigger than one the public health officials have confirmation of,” says James Lawler, an infectious disease specialist at the University of Nebraska Medical Center, who treated quarantined Ebola patients in 2017 and 2018. “Just using a back-of-the-envelope calculation on how many travelers there are from China in a given week, and percentage than might have been affected, it’s a lot.”

An area containing eight cities and 35 million people have now been quarantined in China, The New York Times reported Friday, while The Wall Street Journal reports that hospitals in the epicenter of Wuhan are turning away patients and medical supplies such as masks and sanitizers have run out.

Lawler and others say that the coronavirus outbreak will continue to spread as travelers from China to other nations exhibit symptoms of infection. He says we still don’t know how many people will get sick, and how many of those will die before the outbreak recedes.

To stop the spread of disease, public health officials will need to tell the truth and tell it quickly. But in the meantime, it might be worth deputizing an AI-driven epidemiologist.” (N)

As the coronavirus outbreak continues to spread across China, a flurry of early research is drawing a clearer picture of how the pathogen behaves and the key factors that will determine whether it can be contained.

How contagious is the virus?

It seems moderately infectious, similar to SARS.

How deadly is the virus?

It’s hard to know yet. But the fatality rate is probably less than 3 percent, much less than SARS.

How long does it take to show symptoms?

Possibly between 2 to 14 days, allowing the illness to go undetected.

How much have infected people traveled?

The virus spread quickly because it started in a transportation hub.

How effective will the response be?” (O)

“The World Health Organization has declared the growing coronavirus outbreak in China to be a global health emergency. It’s a recognition that the outbreak — now with nearly 10,000 cases — may continue to spread beyond China, and that the nations of the world should lend their assistance and be prepared.

Just a month ago, this virus, called 2019-nCoV, was unknown to science. Now, health officials are working furiously to understand it, trying to prevent a pandemic (a larger global spread of an infection).

These are still early days. Critical questions about the virus — namely how it spreads, and how deadly it is — remain to be firmly answered. But it’s not too soon to wonder: How does this outbreak end?

Right now, infectious disease experts are outlining three broad scenarios for the future of this outbreak. Keep in mind there’s a lot of uncertainty about how this will unfold.

1) The spread of the virus gets under control through public health interventions

This is the best-case scenario, and essentially what happened with the SARS (severe acute respiratory syndrome) outbreak in 2003…

2) The virus burns itself out after it infects all or most of the people most susceptible to it

Disease outbreaks are a bit like fires. The virus is the flame. Susceptible people are the fuel. Eventually, a fire burns itself out if it runs out of kindling. A virus outbreak will end when it stops finding susceptible people to infect.

3) Coronavirus becomes yet another common virus

There’s a third scenario about how this outbreak ends. That it doesn’t.

This has happened before. In 2009, a new strain of the H1N1 flu virus encircled the globe in a pandemic. But, “after a while it became a part of our normal repertoire of what might come up each flu season,” Mina says.” (P)

“Each new crisis follows a familiar playbook, as scientists, epidemiologists, health-care workers, and politicians race to characterize and contain the new threat. Each epidemic is also different, and each is a mirror that reflects the society it affects. In the new coronavirus, we see a world that is more connected than ever by international travel, but that has also succumbed to growing isolationism and xenophobia. We see a time when scientific research and the demand for news, the spread of misinformation and the spread of a virus, all happen at a relentless, blistering pace. The new crisis is very much the kind of epidemic we should expect, given the state of the world in 2020. “It’s almost as if the content is the same but the amplitude is different,” Bhadelia said. “There’s just a greater frenzy, and is that a function of the disease, or a function of the changed world? It’s unclear.”

And there will be a next epidemic. A new disease was always going to rear its head to test the world’s mettle, and more almost certainly will in the future. As I argued in 2018, the world isn’t ready. There has assuredly been progress—vaccines can be produced faster, global cooperation is tighter, basic research is nimbler—but supply chains are stretched, misinformation is rife, and investments in preparedness always fall into neglect once panic subsides. “Every year, things get more and more connected,” Inglesby says. “Epidemics like this show that all of it can be relatively quickly put at risk.” (Q)

A.Wuhan Coronavirus Looks Increasingly Like a Pandemic, Experts Say, by Donald G. McNeil Jr.,

B.W.H.O. Declares Global Emergency as Wuhan Coronavirus Spreads, by Sui-Lee Wee, Donald G. McNeil Jr. and Javier C. Hernández,

C.Trump administration declares coronavirus emergency, orders first quarantine in 50 years, by David Jackson,

D.Trump says U.S. has ‘shut down’ coronavirus threat; China shuns U.S. help, by Doina Chiacu, Andrea Shalal,

E.Study documents first case of coronavirus spread by a person showing no symptoms, by Andrew Joseph/

F.Coronaviruses hit seniors the hardest, by Katherine Ellen Foley,

G.2nd person-to-person transmission of coronavirus reported in US; 1st death confirmed outside China, by Christina Carrega,

H.Wuhan Coronavirus ‘Super-Spreaders’ Could Be Wildcards, by MICHELE COHEN MARILL,

I.Can wearing a face mask protect you from the new coronavirus?, by Laura Geggel,

J.New York City Eyes First Suspected Case of Coronavirus, by Joseph Goldstein,

K.China completes emergency coronavirus hospital in just days, by Jackie Salo,

L.Inside the California Military Base a Coronavirus Evacuee Tried to Flee, by Miriam Jordan,

M.An AI Epidemiologist Sent the First Warnings of the Wuhan Virus, by ERIC NIILER,

N.An AI Epidemiologist Sent the First Warnings of the Wuhan Virus, by ERIC NIILER,

O.How Bad Will the Coronavirus Outbreak Get? Here Are 6 Key Factors, by Knvul Sheikh, Derek Watkins, Jin Wu and Mika Gröndah,

P.Coronavirus: How does this outbreak end?, by Brian Resnick,

Q.The New Coronavirus Is a Truly Modern Epidemic, by ED YONG,

PART 4. February 9, 2020

 “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

“Five health care workers at Good Samaritan Hospital in San Jose were exposed to the new coronavirus while treating a patient there and have been sent home and told to remain isolated until Feb. 11, according to Santa Clara County public health officials…

The workers are being kept at home “to protect the public’s health and limit any potential spread of the virus,” Santa Clara County public health officials said in a statement.” (A)

“During SARS, patients were sent to nine hospitals all over Hong Kong so that no one hospital had to bear the full burden of the outbreak. Despite this effort to spread the load, the outbreak overwhelmed the city’s health-care system. The Tuen Mun public hospital in the northwest of the city was one of the treatment facilities. The toll on the hospital was steep. Staff had to work long hours with the threat of a deadly virus looming over them. Non-emergency patients were turned away. Entire wards were turned into isolation zones. And the first of many casualties among health-care workers in Hong Kong occurred at Tuen Mun on April 26, 2003…

During SARS much of the spread was happening in hospitals. Once that became clear, public health officials put in place rigid infection control measures in medical settings; the outbreaks in Hong Kong, China, Toronto and elsewhere were brought under control. Cowling says transmission of this new coronavirus is quite different from SARS…

Public health officials don’t yet know what it will take to stop the new Wuhan coronavirus, but Seto says fanatically enforcing hand washing — at home and in hospitals — will probably be one of the keys.” (B)

“Most transmission appears to be occurring in the community,” he says. “We’ve seen a small number of infections of health-care workers, but nothing like SARS where one third of the cases were health-care workers. For the new coronavirus it’s a much smaller fraction in hospitals, and probably most transmission occurring in the general community. And that’s much, much more difficult for public health measures to deal with.”

Infectious disease specialists and scientists say the new coronavirus that’s shuttering companies across mainland China may be more contagious than current data shows.

Emerging in Wuhan, China, about a month ago, the virus has spread from about 300 people as of Jan. 21 to close to 21,000 and killed more than 420 — with the number of new cases growing by the thousands every day.

“The rapid acceleration of cases is of concern,” Dr. Mike Ryan, executive director of the World Health Organization’s emergencies program, said at a news conference last week before the agency declared a global health emergency.

Chinese scientists worry the respiratory illness, which world health officials say likely came from a fish market, has mutated to adapt to its new human hosts far more quickly than SARS. Data on the virus is changing by the day, and some infectious disease specialists say it will take weeks before they can see just how contagious it is. What they’re seeing so far is concerning and leading U.S. and international scientists to believe the virus is more contagious than the current data shows, according to interviews with epidemiologists, scientists and infectious disease specialists.” (C)

“The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe, according to many of the world’s leading infectious disease experts.

The prospect is daunting. A pandemic — an ongoing epidemic on two or more continents — may well have global consequences, despite the extraordinary travel restrictions and quarantines now imposed by China and other countries, including the United States.

Scientists do not yet know how lethal the new coronavirus is, however, so there is uncertainty about how much damage a pandemic might cause. But there is growing consensus that the pathogen is readily transmitted between humans.

The Wuhan coronavirus is spreading more like influenza, which is highly transmissible, than like its slow-moving viral cousins, SARS and MERS, scientists have found.

“It’s very, very transmissible, and it almost certainly is going to be a pandemic,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease.” (D)

“When the H1N1 flu began spreading a decade ago, U.S. hospitals were flooded with patients. The pandemic, which was declared over in 2010, left nearly 275,000 hospitalized, as health officials fretted whether they would have enough beds, enough medical supplies, or enough protective gear…

Hospitals across the country are convening near-daily meetings to check in on their emergency preparedness plans. And they’ve called all hands on deck. Nearly everyone — from physicians and nurses to public affairs representatives and the employees responsible for ordering supplies and keeping the hospital clean — is involved in making sure a hospital’s existing emergency plans are up to date.

 “But as we project outward with the potential for this to be a much longer situation, one of the things that we’re actively working on is projecting the long-term needs for our health care system,” Dr. Nancy Messonnier, director of Center for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, told reporters on Wednesday…

Much of that work revolves around hospitals planning for what Biddinger called the “four S’s” of a surge in patients amid an outbreak: supplies, staff, space, and the system that governs all of them.

They need to review their inventory of supplies, including ventilators, oxygen tanks, and the respirator masks that health workers might need to wear to care for infected patients. They need to plan for how to protect other patients in the hospital, particularly those with weak immune systems. They need to review screening procedures and the proper way to put on protective gear. And they need to educate everyone — from the front desk employees in the ER to the workers who take out the trash in patient rooms — in those protocols.” (E)

“Given the unknowns about 2019-nCoV, in the coming days and weeks, we’re in for some twists and turns. For now, many experts believe this outbreak could get a lot worse: burdening the Chinese health system, spreading in poorer countries with weaker health systems, and sickening and killing thousands more people along the way. Alternatively, it could get much better, with new cases and deaths steadily dropping. Here are the key factors that will determine which way it goes.

4 ways this outbreak could take a turn for the worse

1) China can’t contain the new coronavirus

2) The new coronavirus spreads in countries with weak health systems

3) The virus is actually deadlier than it seems right now

4) Travel bans isolate countries, spread xenophobia — and exacerbate outbreaks

4 things that could unfold that would prevent a pandemic

1) China contains the virus

2) Local clusters of the disease in other countries don’t grow

3) The virus can’t spread in poorer countries with hotter climates

4) We learn the virus is not as deadly as it seems (F)

“Princess Cruises late Tuesday said nine passengers and a crew member on one of its ships in Japan had tested positive for the new coronavirus from China, prompting local authorities to order a multiweek quarantine of the vessel.

The Santa Clarita, California-based line said more than 2,600 passengers and 1,044 crew on the Diamond Princess would remain quarantined on the ship for at least 14 days.

The 10 people who have tested positive for the virus are being taken off the ship, which is in the harbor of Yokohama, Japan — the port for Tokyo. They’ll be transferred to local hospitals…

Early Wednesday, another cruise vessel arriving in a major Asian port was quarantined until passengers could undergo screening for coronavirus. The quarantine of the 3,376-passenger World Dream, in Hong Kong, was ordered after three passengers from a previous sailing tested positive for the virus. World Dream is operated by Dream Cruises, an Asia-based cruise company that caters to Asian travelers.//

Princess said Diamond Princess would head out to sea to perform normal marine operations including, but not limited to, the production of fresh water and ballast operations, before returning to Yokohama and docking at the city’s port. Food and other supplies needed for the extended quarantine of the vessel will be brought onboard.

Passengers have been confined to their cabins for the duration of the quarantine, and many shipboard services have been shut down. Food is being delivered to cabins at regular intervals. Passengers have access to complimentary internet and telephone service to stay in contact with their families and other loved ones.”  (G)

“A southern New Jersey military installation is on a list of potential coronavirus quarantine locations should the need arise.

The Department of Health and Human Services has requested the support of the Department of Defense to provide space if primary and secondary facilities become full.

The Department of Defense identified 11 locations near major airports, including Joint Base McGuire-Dix-Lakehurst, which spans through portions of Burlington and Ocean counties, according to a news release issued Thursday.

The military involvement would be limited to providing housing support for up to 20 people as they undergo a period of quarantined observation, the Department of Defense release said. Military personnel will not be in direct contact with quarantined people and will minimize contact with personnel supporting the evacuees, officials said…

There are currently 12 confirmed cases in the United States, CNN reported Thursday. The news network report said that “planeloads” of Americans fleeing the outbreak in China are arriving at military bases across the United States.” (H)

“Current efforts to contain the coronavirus differ in many ways from those inflicted on lepers in the past century. Americans who may have been exposed to the virus in China are quarantined for 14 days and are not sentenced to life in isolation. The medical treatment is significantly improved and the chances of recovery are good. However, the corona virus is far more contagious than leprosy, against which 95% of people are naturally immune. Precautions are certainly useful.

But this recent outbreak raises questions similar to the health authorities that struggled with decades ago. Are quarantine and isolation the most effective way to contain a disease? Do you hesitate to identify yourself as a potential victim?

“It fails because people are headed for the hills,” said Wendy Parmet, a professor of health law at Northeastern University, Rob Stein from the NPR. “People don’t call and look for medical care … and medical care providers are afraid to treat patients because they don’t want to be quarantined.”

There are other questions as well.

Will the US decision to close its borders for foreigners who have recently visited China do more harm than good? The World Health Organization believes that such travel bans may and warns of panic and anxiety measures.

Perhaps more importantly, how are those who are believed to be potential carriers of the virus treated by those around them? NPR’s Maria Godoy reports that some Asian Americans are already experiencing a setback. A student was told to leave a cafe and “take the corona virus with her.”” (I)

“The Centers for Disease Control and Prevention has shipped the diagnostic test for the novel coronavirus to more than 100 public health labs nationwide, allowing states to test for coronavirus cases themselves and receive results quicker.

Why it matters: The FDA bypassed usual regulatory channels to distribute the test under an Emergency Use Authorization, which has been used in life-threatening situations like MERS, Ebola and the Zika virus.

Before, specimens from all over the country had to be shipped to Atlanta to have their suspected cases validated.

“This continues to be an evolving situation and the ability to distribute this diagnostic test to qualified labs is a critical step forward in protecting the public health,” FDA Commissioner Stephen Hahn said.” (J)

“CDC created this interim guidance to provide US public health authorities and other partners with a framework for assessing and managing risk of potential exposures to 2019-nCoV and implementing public health actions based on a person’s risk level and clinical presentation. Public health actions may include active monitoring or supervision of self-monitoring by public health authorities, or the application of movement restrictions, including isolation and quarantine, when needed to prevent the possible spread of 2019-nCoV in US communities. The recommendations in this guidance apply to US-bound travelers and people located in the United States who may have been exposed to 2019-nCoV. CDC acknowledges that state and local jurisdictions may make risk management decisions that differ from those recommended here. However, a harmonized national approach will facilitate smooth coordination and minimize confusion. The guidance may be updated based on the evolving circumstances of the outbreak.” (K)

“Infection control procedures including administrative rules and engineering controls, environmental hygiene, correct work practices, and appropriate use of personal protective equipment (PPE) are all necessary to prevent infections from spreading during healthcare delivery. Prompt detection and effective triage and isolation of potentially infectious patients are essential to prevent unnecessary exposures among patients, healthcare personnel, and visitors at the facility. All healthcare facilities must ensure that their personnel are correctly trained and capable of implementing infection control procedures; individual healthcare personnel should ensure they understand and can adhere to infection control requirements.

This guidance is based on the currently limited information available about 2019-nCoV related to disease severity, transmission efficiency, and shedding duration. This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States. This guidance is applicable to all U.S. healthcare settings. This guidance is not intended for non-healthcare settings (e.g., schools) OR to persons outside of healthcare settings. For recommendations regarding clinical management, air or ground medical transport, or laboratory settings, refer to the main CDC 2019-nCoV website.” (L)

“Whether it’s an influx of coronavirus carriers or another Superstorm Sandy, a new nonprofit report finds New Jersey is in a relatively good position to handle the next public health emergency.

An annual survey released Wednesday by The Trust for America’s Health shows that New Jersey is among a top tier of 17 states considered to have the best health care and emergency response systems, along with the training and capacity to protect residents against communicable diseases, natural disasters and other calamities.

Officials at the Trust — a national research and advocacy group focused on public health and injury prevention — said the Garden State has ranked in the top third of states for the last several years, a significant improvement from 2013, when it came in as one of the seven lowest-scoring states.” (M)

“Gov. Phil Murphy on Monday launched a task force to make sure New Jersey is prepared for any threat from the surging coronavirus.

Murphy also noted that Newark Liberty International Airport is one of 11 major U.S. airports that receive flights from China requiring enhanced screening for the virus.

There are no confirmed cases of coronavirus in New Jersey, but Murphy said it’s “critical” the state has “strong preparedness protocols in place.”

“By establishing the Coronavirus Task Force, we are bringing together experts across state agencies, health officials, and federal partners to ensure that we are working collaboratively to protect the health and safety of all New Jerseyans,” the governor added.

According to an executive order Murphy signed Monday, the task force will coordinate all state efforts to “prepare for and respond to the public health hazard posed” by coronavirus.

The task force is chaired by state Health Commissioner Judith Persichilli and will include members of the state’s human services, law and public safety, education, and homeland security departments, as well as the State Police.” (N)

““I have to emphasize that the risk right now, certainly to the United States but definitely to the residents of New Jersey, is still low,” said state health commissioner Judith Persichilli, whom Murphy named as the chair of a new Coronavirus Task Force…

Authorities also said that Newark Liberty International Airport is one of 11 airports in the nation where flights from China will be allowed to land, and passengers on those flights will be screened and, if necessary, quarantined.

“We’ve been very proactive, we have teams in place ready to go,” Persichilli said. “There will be screening at the Newark Airport. We are prepared to handle quarantine of any person that comes in.”

Also represented on the task force are the State Police, the Office of Homeland Security, the attorney general and the Department of Education. The group will coordinate with hospitals and other health care facilities as well as federal authorities and the Port Authority, which runs Newark Airport.

Also Monday, Princeton University has told students who recently returned from China to “self-quarantine” for 14 days from the time they were last in China, a step the university said was being taken as a precaution. The number of students affected by the order is more than 100, according to various news reports.

The precaution matches a general advisory issued for travelers by state public health officials.

“If you’ve traveled to China and return from that travel, we would urge residents to monitor their symptoms for 14 days,” said Dr. Lisa McHugh, program coordinator for infectious disease epidemiology for the state health department. “If you develop symptoms, again we would urge you to contact your health care provider, and we’ll work through them to determine if the individual should be tested at the Centers for Disease Control.”” (O)

“China on Thursday finished building a second new hospital to isolate and treat patients of a virus that has killed more than 560 people and continues to spread, disrupting travel and people’s lives and fueling economic fears.

A first group of patients was expected to start testing a new antiviral drug, as China also moved people with milder symptoms into makeshift hospitals at sports centers, exhibition halls and other public spaces.

Other treatment centers had tight rows of simple cots lining cavernous rooms where patients with milder symptoms would be cared for. And Wuhan had another 132 quarantine sites with more than 12,500 beds, according to the official Xinhua News Agency.” (P)

“United States citizen died from the coronavirus in Wuhan, China, American officials said on Saturday. It was the first known American death from the illness, and was likely to add to diplomatic friction over Beijing’s response to the epidemic.” (Q)

“A study published Friday in the medical journal JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.

This is big news. In plain English, it means that nearly half of the initial infections in this hospital appear to have been spread within the hospital itself. This is called nosocomial transmission. (Doctors use big words to hide bad things: Nosocomial means caught it in the hospital.)

What’s more, most spread doesn’t appear to have been the result of a so-called “super-spreader event,” in which a single patient transmits infection to many other people. In these events, a procedure such as bronchoscopy — where a doctor inserts a tube into the patient’s lungs — can result in many infections.

This would be a concern, but not nearly as much as what appears to have happened: Many health care workers and many patients got infected in many parts of the hospital. What’s more, since there’s a broad spectrum of infection and only patients who were sick were tested, it’s quite likely that there was even more transmission in the hospital.

So, like SARS and MERS — other coronaviruses — before it, the Wuhan coronavirus is spreading in hospitals.” (R)

“The World Health Organization’s director-general cautioned Saturday that transmission of the new coronavirus outside of China may increase and countries should prepare for that possibility.

 “It’s slow now, but it may accelerate,” Tedros Adhanom Ghebreyesus said during a press conference in Geneva. “So while it’s still slow there is a window of opportunity that we should use to the maximum in order to have a better outcome, and further decrease the progress and stop it.”

Tedros’s warning came after health authorities in Singapore announced they had diagnosed the infection in a man with no travel history to China and no known link to other cases in Singapore…

Infectious diseases expert Michael Osterholm warned that it is unwise to conclude that just because the world hasn’t yet seen outbreaks in other countries they won’t happen. It takes several generations of transmission — an imported case passed on to two others, who then infect two others and so on — before an outbreak takes off, he said.”

“What we’re watching is the public health community trying to catch up to the speed of the virus,” said Osterholm, who is the director of the University of Minnesota’s Center for Infectious Diseases Research and Policy.” (S)

“With an intense flu season in full swing, hundreds of thousands of coughing and feverish patients have already overwhelmed emergency rooms around the United States. Now, hospitals are bracing for the potential spread of coronavirus that could bring another surge of patients.

So far, only a dozen people in the United States have become infected with the novel coronavirus, but an outbreak could severely strain the nation’s hospitals.

“We’re talking about the possibility of a double flu pandemic,” where a second wave starts before the first is over, said Dr. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security.

Public health experts are also closely watching reserves of vital medical supplies and medications, many of which are made in China. Some hospitals in the United States are already “critically low” on respirator masks, according to Premier Inc., which secures medical supplies and equipment on behalf of hospitals and health systems. And China is the dominant supplier of the raw ingredients needed for penicillin, ibuprofen and even aspirin — drugs taken daily by millions of Americans and dispensed routinely to hospital patients.

“All the hospitals are taxed with a large flu season and other bugs,” said Dr. Mark Jarrett, the chief quality officer for Northwell Health, which operates 23 hospitals across Long Island and elsewhere in New York. About 400 patients are coming to its emergency rooms each day with flulike symptoms.

“Everybody is at maximum capacity,” Dr. Jarrett said…

“Many of us are holding our breath to see the downstream effect on pharmaceuticals and other medical supplies because of this outbreak in China,” said Dr. Paul Biddinger, who helps oversee emergency preparedness for Partners Healthcare, the Boston hospital group that includes Massachusetts General.

Experts like Dr. Toner say supplies could easily become depleted, especially at smaller hospitals that tend to have less inventory of basic items like masks, gowns and gloves. Hospitals have long struggled with shortages of injectable medications and staples like saline. In 2017, Hurricane Maria knocked out power to several pharmaceutical factories in Puerto Rico, leading to a shortage of saline bags…

Because the nature of the virus is still unknown, public health officials said it’s unclear what future challenges hospitals will face if the coronavirus spreads into an epidemic in the United States. While the current government guidelines call for patients to be treated in specialized isolation rooms, experts say it is unlikely that there will be enough isolation rooms at individual facilities.” (T)

“The number of deaths from novel coronavirus in mainland China increased to 811 Sunday, health officials with China’s National Health Commission said.

This exceeds the number of deaths reported from the SARS outbreak in 2003, which killed 774 people, according to the World Health Organization.

Outside of China, two people died from the disease in the last two week, one in the Philippines and one in Hong Kong, bringing total number of global deaths to at least 813.

As of Sunday, more than 37,198 confirmed cases have been reported on mainland China…

Six more people aboard a cruise ship quarantined in Japan have tested positive for novel coronavirus, bringing the total on the Diamond Princess to 70, Japan’s health ministry said Sunday.

The ministry said one of the six confirmed cases is a woman in her 70s who has Hong Kong residency, but is also a U.S. citizen. That brings the total number of American passengers who were confirmed to have the virus to 14.” (U)

“Four passengers on Friday were taken to a hospital after their cruise ship arrived in New Jersey for evaluation of coronavirus..

The CDC has confirmed just 12 cases in the United States, mostly in California; there have been no cases in New Jersey or New York

Four passengers traveling on a cruise ship that returned to New Jersey have tested negative for the new virus that has sickened tens of thousands in mainland China and killed more than 800.

Governor Phil Murphy said all passengers tested negative and “New Jersey currently has no confirmed cases of novel coronavirus and the risk to residents remains low.” (V)

(A)          Five San Jose hospital workers sent home after exposure to coronavirus, by  Deanne Fitzmauric,

(B)          How Hong Kong Beat SARS: Lessons Learned, by Jason Beaubien,

(C)          Wuhan Coronavirus Looks Increasingly Like a Pandemic, Experts Say, by Donald G. McNeil Jr.,

(D)          Researchers say the coronavirus may be more contagious than current data shows, by Berkeley Lovelace, Jr.,

(E)          ‘We need everyone for this’: U.S. hospitals harnessing resources to brace for any spike in coronavirus cases, by MEGAN THIELKING,

(F)          What happens next in the coronavirus outbreak? We mapped 8 scenarios, by Julia Belluz,

(G)         Nearly 4,000 people quarantined on cruise ship for 14 days after coronavirus confirmed onboard, by Gene Sloan,

(H)          N.J. military base is among potential coronavirus quarantine locations, by Justin Auciello,

(I)           Will Corona Virus Quarantines Help or Harm? A look back at leprosy, by Gwen Olson,

(J)           FDA allows states to test for coronavirus for faster results, by Marisa Fernandez,

(K)          Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential 2019 Novel Coronavirus (2019-nCoV) Exposure in Travel-associated or Community Settings,

(L)           Interim Infection Prevention and Control Recommendations for Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) or Persons Under Investigation for 2019-nCoV in Healthcare Settings,

(M)        How Ready Is NJ to Handle Public Health Emergencies? The Latest Results, by LILO H. STAINTON,

(N)         Gov. Murphy launches task force to protect N.J. from coronavirus, by Brent Johnson,

(O)         Murphy Sets Up Coronavirus Task Force, State Health Officials Say Risk in NJ ‘Is Still Low’, by Joanna Gagis,

(P)          China finishes second new hospital built for coronavirus patients,

(Q)         First American Dies of Coronavirus, Raising Questions About U.S. Response, by Raymond Zhong and Edward Wong,

(R)          New study an eye-opener on how coronavirus is spreading and how little we know, by Dr. Tom Frieden,

(S)          WHO cautions that transmission of the new coronavirus outside of China could increase, by HELEN BRANSWELL,

(T)          Hospitals are currently making preparations for a possible outbreak of the new coronavirus, by Reed Abelson and Katie Thomas,

(U)         Coronavirus updates: 14 Americans aboard quarantined cruise ship now confirmed to have coronavirus,

(V)          Royal Caribbean Passengers Test Negative for Coronavirus,

PART 5. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

“Nearly six weeks after China announced the coronavirus outbreak, there’s still a surprising amount we don’t know about this newly discovered disease. But one thing is becoming clear: China’s silence in the earliest days of the crisis may have made it worse.

Chinese authorities delayed informing the world about the severity of a deadly disease spreading within the country’s borders — even trying to muzzle whistleblowers, like the late Dr. Li Wenliang. Now hailed as a national hero, Li was forced on January 3 by police to sign a letter saying he spread “untrue speech” for warning colleagues about the virus that eventually took his life.

With more than 40,500 people infected and 910 deaths, China’s missteps early on seem increasingly fateful. The fact that the international community has not acknowledged those missteps is also consequential…

But the reality is this: China’s mishandling and the ensuing silence from the international community is emblematic of how the global system governing the international response to pandemics fails to work, half a dozen global health experts told Vox.

Though we have global health laws — in particular, the International Health Regulations, or IHR — meant to guide countries dealing with outbreaks, they’re not actually enforceable. “You can’t penalize [countries that] don’t follow it,” said Devi Sridhar, the chair in global public health at the University of Edinburgh. Instead, the international community has to rely on “soft law and norms” — or “disease diplomacy.”..

The revised IHR asks countries to build out their disease surveillance capacities and report public health crises immediately. It also asks nations not yet affected by a new pathogen to avoid punishing those that are through travel and trade restrictions. “These revisions were all about trying to get countries to sacrifice their short-term interests for the long-term well-being of all countries,” said Sridhar…

 “The IHR operates on mutual trust largely, and it is a mutual trust,” said Eccleston-Turner. “That mutual trust has been eroded over a number of outbreaks where member states have ignored the recommendations from WHO.”” (A)

“Human intervention, or lack thereof, may also have been a factor. More than half a dozen doctors first discussed the threat of a potential coronavirus outbreak in early December only to be silenced by the local Communist Party, according to some critics of the government.

Yaxue Cao, founder and editor of the political pressure group, said a Wuhan doctor posted in a WeChat group to say there were seven cases of SARS connected to the seafood market. He was then scolded by the party disciplinary office, and forced to retract that, Cao said.

“From the same report, we learned that Wuhan health authorities were having overnight meetings about the new ‘SARS’ at end of December,” Cao posted on Jan. 27. “Earlier today. the Wuhan mayor said he was not ‘authorized’ to publicize the epidemic until Jan. 20.”…

The spread was likely helped by China’s Lunar New Year holiday last month. Wuhan mayor Zhou Xianwang said 5 million people had left the city before travel restrictions were imposed ahead of the Chinese New Year.

“People unfamiliar with China have trouble understanding the immense travel phenomenon that occurs during Lunar New Year, when, over a one-month period, some 3 billion people are on the move, many returning to their home towns and regions but others vacationing,” Tanner Brown, a Beijing-based journalist, wrote for MarketWatch last month. “Peak travel occurs this week.”..

People also may not know they’re carrying the virus. Symptoms of common human coronaviruses include a runny nose, headache, cough, sore throat, fever and a general feeling of being unwell, according to the CDC. Symptoms of the new coronavirus can include fever, cough and shortness of breath…

But it was weeks since the virus was first discovered before flights were curtailed, and the global travel industry is ideal for many viruses to travel long distances.

In an attempt to remain competitive, airlines have decreased their turnaround times in recent years. Many budget airlines have reduced turnaround times to 25 minutes by removing the seat pockets. Other airlines have managed to have long-haul turnaround times of 90 minutes. Not only do planes get a new plane load of passengers, they often get a completely different crew.

Deep cleans are not always possible during such turnarounds. Charles Gerba, a microbiologist at the University of Arizona, recommends using hand sanitizers or disinfectant wipes, particularly when traveling and/or at the office, where people may be reluctant to stay home if they’re sick.” (B)

“China’s new coronavirus may peter out. Or it might join the flu on the roster of the world’s winter illnesses — a bug that will be routinely vaccinated against. Or it might become a global pandemic, killing millions of people.

Experts don’t have enough information to predict which of these very different scenarios will come to pass. So for now, they are cautious.

“The issue is, we don’t know. And any sort of prediction would be ill-advised,” said the director of National Institute of Allergy And Infectious Disease, Anthony Fauci, at a Friday briefing by the presidential task force on coronavirus. “You really do prepare for the worst possible scenario.”

Scenario 1: The virus stays mostly in China

WHO officials this week still expressed hope that the Chinese government will largely contain the coronavirus through unprecedented travel restrictions and quarantine in Hubei province and elsewhere that most closely resemble martial law enacted over tens of millions of people. The quarantines began two weeks ago, and the coronavirus is thought to have an incubation period of up to 14 days, which is leading to questions about how well the measures have worked, especially after China locked down Guangzhou City, population 14 million, just this Friday…

Scenario 2: Another seasonal flu

If the coronavirus does manage to spread widely outside of China, it isn’t necessarily catastrophic. It could turn out to have seasonal behavior, flaring up in winter like the flu. That pattern has been seen in at least two of the common coronaviruses that affect people. If that’s the case for this new one, said Fauci, “when you start getting into the spring weather of April, May, and June, it almost certainly would start to turn around.”

On the downside, that means it would just come back next winter. That happened with the 1918 Spanish flu pandemic that hit the world in two seasonal waves.

Still, the extra time wouldn’t hurt, allowing for clinical trials to test the effectiveness of antiviral drugs used on an emergency basis in the outbreak. China has started two randomized clinical trials of a promising drug called remdesivir, overseen by respiratory disease expert Cao Bin at Beijing’s China–Japan Friendship Hospital. (One of the 12 US patients with the coronavirus tried the drug and recovered a day later.)..

Scenario 3: Deadly global pandemic

Then there’s the worst-case scenario: The relatively few cases popping up in dozens of countries flare up worldwide in the coming months with deadly consequences. It happened in 1957, when a flu pandemic killed 1.1 million people worldwide, and again in 1968, when another flu strain killed about 1 million people….

…That means the new coronavirus might have already skirted containment efforts and might be worse than reported in Hubei province, where some news reports have come of elderly people dying without ever being tested by hospitals. China’s nationwide travel ban, and reports of one province offering a $140 bounty to people who turn in recent arrivals from Wuhan, said Fisman, “are not things you do when you are winning against an outbreak.”…

The one caution about all predictions early in past outbreaks is that they don’t tend to match up with the outcome,” said Fisman, acknowledging his own expectations have worsened as the outbreak has continued. “We still don’t know a lot.”(C)

“As it continues to spread around the world, bringing panic with it, scientists are striving to develop ways of fighting this previously unknown threat. Sophisticated computer modelling is being used to track and predict its transmission, while virologists are attempting to engineer a vaccine. Others are seeking drug treatments that can help those who fall ill with the infection.

But this is not the first coronavirus scientists have encountered, and defeating them is harder than you might think. Even after decades of trying, coronaviruses are formidable foes…

In order to get a reliable model of how the disease spreads, Donnelly says, there are a few things we need to know about the virus. First, how long someone might be infected by it before developing symptoms. This is called the incubation period. Second, we need to know how long someone with the virus remains infectious for, and in cases where patients do not recover, how quickly the virus can cause death. “That helps us estimate the case fatality rate,” says Donnelly.

Super spreaders shed far larger numbers of the virus particles than other patients, increasing the chance they will infect someone else

Another important factor is the reproduction number, which is how many other people someone with the disease will infect. Donnelly and her colleagues have estimated the new coronavirus to have a reproduction number of about 2.6. “If that number is greater than one, then you expect there to be an outbreak,” she says….

Even if it can be diagnosed quickly, finding an effective treatment for a virus like this is famously difficult…

The speed at which coronaviruses mutate and so change their characteristics makes them hard to vaccinate against. Vaccines tend to train the immune system to target a particular feature, such as a protein structure on the shell of the virus. But by continually altering its appearance, our immune systems find it hard to recognise different infections. It is partly why the common cold has been so difficult to develop a vaccine against…

But it is still an open question as to whether a treatment or a vaccine will be found within a matter of months or if it will take years. Until then, says Donnelly, all that can be done is to continue to monitor the virus and try to stop it spreading.” (D)

“What do we most need to know next? For epidemiologists who track infectious diseases, the most pressing concerns are how to estimate the lethality of the disease and who is susceptible; getting detailed information on how it spreads; and evaluating the success of control measures so far.

No. 1 is the “clinical iceberg” question: How much of it is hidden below the surface? Because the outbreak is still evolving, we can’t yet see the totality of those infected. Out of view is some proportion of mildly infected people, with minor symptoms or no symptoms, who no one knows are infected…

In 2003, during the early days of the SARS outbreak, the medical community got the math wrong. At first, we believed that case fatality hovered between 2 percent and 3 percent. It took two pages of longhand algebra, written in Oxford, England, coded into a computer in London and then applied to data from Hong Kong, to get it right. The actual case fatality for Hong Kong was staggering: 17 percent…

Knowing the number of people likely to die, or who get seriously sick or have zero symptoms, will help health authorities determine the strength of the response required. They can better estimate how many isolation beds, heart-lung machines and medicines, among other things, are needed…

Along with getting a grasp on the level of severity is figuring out susceptibility, or who is most at risk for infection. The data so far indicates that this would include older adults, the obese and people with underlying medical conditions. There are few reports of children becoming infected. But are they not showing symptoms, or are they immune? And could they infect others as silent carriers?..

Returning to the big picture, we must also refine what we know about how the new coronavirus is passed between people. Even as the outbreak appears to keep escalating, we believe the rapid — sometimes necessarily draconian — response of governments and health authorities has made a dent in transmission. In another recent study, we estimated how many people could get infected if there were no drastic public health interventions. Our goal with this report was to sound the alarm over what could be, so that it wouldn’t be…

The goal is to stay at least a couple of steps ahead of the epidemic curve. Scientists must prepare health authorities to catch any subsequent waves of infections and prepare for the possibility that this particular virus could reappear seasonally — and maybe one day it could be only as bad as the common cold.

I’ve seen record-breaking outbreaks before and witnessed the world rally. If we all play our roles and remain on guard, then chances are we will defeat the new coronavirus, too…” (E)

“Even as U.S. authorities have taken the drastic steps of quarantining residents returning from China and temporarily banning foreign visitors who recently traveled to affected Chinese regions, they have urged the vast majority of U.S. residents to go about their regular activities.

But there are exceptions. People who returned from China on or after Feb. 3 have been formally quarantined or asked to stay home. And behind the scenes, local public health officials have launched painstaking efforts to reach “close contacts” of people with confirmed cases of the virus, dubbed 2019-nCoV, asking them to self-quarantine and submit to ongoing monitoring.

So what exactly is a ‘close contact’?..

For the new coronavirus, guidelines from the federal U.S. Centers for Disease Control and Prevention define “close contact” as anyone who has been within 6 feet of a person infected with the virus for a “prolonged period of time,” as well as those who have had direct contact with the infected person’s secretions. These guidelines are then interpreted by local public health departments…

In the US, health officials continue to stress low risk of coronavirus..

There is some case-by-case decision-making in assessing risk, Rudman said. Whether a health professional was wearing gloves, a mask or other protective equipment, and what kind of interaction they had with the patient, all factor in.

And because they work with people who are sick and may be at higher risk from infection, health care workers may be asked to take more extreme precautions. Santa Clara County’s public health department asked at least five people to go on two weeks of paid leave after a man who visited the hospital where they worked later tested positive for the virus.

Earlier cases were not so straightforward. One factor that has made the investigations particularly challenging is confusion over whether the virus can be spread by an infected person who is not showing symptoms. Health departments say that, given the uncertainty, they are taking a cautious approach and looking for any contacts going back three days before symptoms started. “Fortunately, we have so few cases, so we can do that,” Rudman said.

Rudman declined to say how many people are being monitored in Santa Clara but noted that having so few cases has meant she and her colleagues have had time to be methodical about who might be at risk. She hopes that will provide comfort to others in the community.” (F)

“A new report into the range of symptoms experienced by coronavirus patients suggests that around one in 10 suffer from diarrhea and nausea for a few days before developing breathing difficulties, leading to suggestions that the pathogen may be transmitted via feces. While this route of transmission has not been confirmed, the new data does raise the possibility that doctors may have missed some key early warning signs by focusing only on cases involving respiratory symptoms.

It has already been established that the virus is primarily passed on by droplets in an infected person’s cough, and the new study – which features in the Journal of the American Medical Association (JAMA) – found that the majority of coronavirus patients at a hospital in Wuhan, China, suffered from symptoms such as fever, muscle pain, and shortness of breath at the onset of the illness.

However, of the 138 patients observed by the study authors, 14 initially presented with diarrhea or nausea, developing more classic coronavirus symptoms a day or two later. According to Chinese media reports, doctors found traces of viral nucleic acids in the stool of patients who exhibited these atypical digestive symptoms.

The first US patient to be diagnosed with coronavirus is also said to have experienced diarrhea for a few days, and the virus was also found to be present in his feces.

While this doesn’t mean that fecal matter is responsible for the spread of the illness, it does provide evidence for another similarity between coronavirus and SARS, to which it is related. Back in 2003, hundreds of people in a Hong Kong housing estate became infected with SARS thanks to a plume of warm air emanating from a bathroom that had been used by an infected person…

Significantly, 41 percent of patients in the study became infected in hospital, with both healthcare workers and patients who had been hospitalized for other reasons catching coronavirus. Regardless of the transmission route, therefore, it seems that hospitals are a potential breeding ground for the virus, suggesting that improved hygiene may be necessary to prevent its spread.” (G)

“The coronavirus epidemic could grip about two-thirds of the world’s population if the deadly bug is not controlled, a top public health official said — as another expert predicted that cases in China could peak this month and fade away by April.

Professor Gabriel Leung, chair of public health medicine at Hong Kong University, told the Guardian he was examining the implications of the World Health Organization’s Monday warning that cases of coronavirus spreading outside China are the “tip of the iceberg.”

Most experts believe that each person infected can go on to transmit coronavirus to about 2.5 other people — creating an “attack rate” of 60 to 80 percent, Leung told the paper.

“Sixty percent of the world’s population is an awfully big number,” he said.

Even with a general fatality rate as low as 1 percent — a possibility once milder cases are taken into account — there could still be a massive global death toll, he added.

Meanwhile, experts are attempting to map out the likely course of the illness, Leung told the Guardian.

“Is 60 to 80 percent of the world’s population going to get infected?” he said. “Maybe not. Maybe this will come in waves. Maybe the virus is going to attenuate its lethality because it certainly doesn’t help it if it kills everybody in its path, because it will get killed as well.”

Health officials are also attempting to determine whether restrictions put in place in Wuhan — the epicenter of the outbreak — as well as other cities, have made a positive impact.

“Have these massive public health interventions, social distancing, and mobility restrictions worked in China?” Leung asked. “If so, how can we roll them out, or is it not possible?” “(H)

“The disease caused by the new coronavirus that’s sickened more than 42,000 people in China now has an official name: COVID-19. It stands for the coronavirus disease that was discovered in 2019.

The World Health Organization announced the name Tuesday, saying it was careful to find a name without stigma.

“We had to find a name that did not refer to a geographical location, an animal, or an individual or group of people,” WHO Director-General Tedros Adhanom Ghebreyesus said in a call with reporters.” (I)

“Time will tell if the new coronavirus ends up being less or more dangerous than the flu; we don’t fully know yet how bad it is. Usually, the diseases that stick around tend to become less lethal. Only live hosts can continue to make more viruses. Influenza is also pretty devious in how it mutates its surface molecules from year to year to evade immune system detection. If 2019-nCoV is not able to do that, people’s immunity to it could gradually improve.

But therein lies the paradox. The outcome that has public health officials really concerned is that 2019-nCoV will turn into something like a disease that we have a tough time making you worry about right now.

Every year physicians and public health officials try to get you to immunize yourselves against the flu, and far too many of you don’t. We beg you to practice proper precautions and hygiene — and, still, tens of thousands of people die, and too few worry enough.

Governments and employers could help by making it easier for sick people to stay home from work. Many Americans without paid sick leave go to work despite feeling ill, and many of those work at restaurants, schools and hospitals, where disease is easily spread.

The most significant defense the United States has to prevent pandemics is a solid public health infrastructure. The public has to trust it. The system also needs to be properly prepared and have the resources to handle a widespread infection. (The system is currently stretched thin and underfunded.) It’s critical to make sure there are enough medical supplies available, as well as necessities like food, to get a community through an outbreak.” (J)

“The Centers for Disease Control and Prevention is preparing for the coronavirus, named COVID-19, to “take a foothold in the U.S.,” Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters. “At some point, we are likely to see community spread in the U.S. or in other countries,” said Messonnier. “This will trigger a change in our response strategy.” (K)

“An apartment building in Hong Kong, its units linked by pipes. A department store in the eastern Chinese city of Tianjin, where more than 11,000 shoppers and employees mingled. A ski chalet in France, home base for a group of British citizens on vacation.

These sites, scattered around the world, have become linked by a grim commonality: They are places where pockets of new coronavirus cases have emerged in recent days, raising fears about the virus’s ability to spread quickly and far beyond its origins in central China.” (L)

“Right now scientists are trying to accomplish something that was inconceivable a decade ago: create a vaccine against a previously unknown virus rapidly enough to help end an outbreak of that virus. In this case, they’re trying to stop the spread of the new coronavirus that has already infected tens of thousands of people, mainly in China, and given rise to a respiratory condition now known as COVID-19.

Typically, making a new vaccine takes a decade or longer. But new genetic technologies and new strategies make researchers optimistic that they can shorten that timetable to months, and possibly weeks — and have a tool by the fall that can slow the spread of infection.” (M)

“As the new coronavirus continued to spread unabated within the city of Wuhan, China, government officials last week imposed draconian measures.

Workers in protective gear were instructed to go to every home in the city, removing infected residents to immense isolation wards built hastily in a sports stadium, an exhibition center and a building complex…

Many experts are skeptical that isolating thousands of patients in shelters can stanch the spread of the coronavirus. There are more than 40,000 cases in China now, in every province, although the wide majority are in Hubei Province.

“This is a bit like closing the barn door after the horses are already out,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville…

Wuhan’s makeshift shelters may yet become breeding grounds for infection, especially if patients are not properly screened, Dr. Markel and other experts said.

The patients already are in a weakened state, and facilities like these make it easy for viruses and bacteria to travel — not just the coronavirus, but also any of the dozens of pathogens that may thrive when people gather in tight quarters.

“Whenever we put people in facilities together, even during a hurricane, we are concerned about them getting infectious diseases,” said Nicole A. Errett, a researcher at the University of Washington who is a co-director of the Collaborative on Extreme Event Resilience.” (N)

“CMS sent a memo to state survey agency directors urging them to double down on compliance with basic infection control practices.

The memo includes information and links to resources to combat the illness caused by the novel coronavirus. It also states that healthcare staff and surveyors, including federal, state and local contractors are expected to adhere to standard infection control practices, such as CDC recommendations on standard hand hygiene practices.

In 2020 surveys, CMS and accrediting organization acute care surveyors will be especially alert to hand hygiene practices, including the use of alcohol-based hand rub/hand sanitizer, the preferred method of hand hygiene in clinical settings, the memo says.

“We know that adherence to basic infection control and prevention practices such as hand hygiene can help reduce the risk of infectious disease spread in all healthcare settings,” the memo reads.” (O)

“Successful outbreak control works like this: Patients report their symptoms to health-care workers. Those health-care workers then report unusual cases to local public-health officials who investigate the illness. Those officials may isolate ailing patients, identify others with whom they have come into contact, and monitor those individuals. The results of these investigations are reported to government officials, who communicate reliable information about the outbreak and its causes to the public and the press. That information enables those who are not sick to take measures, such as hand washing and avoiding crowds, to prevent themselves from getting infected and spreading the outbreak. The promise of reliable information and competent, supportive medical care convinces others who are suffering symptoms to come forward so that new cases are identified, tracked, and treated. This cycle continues until the virus stops infecting new people, the people already infected get well or perish, and the outbreak burns out.  

In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections like severe-acute respiratory syndrome and the Ebola virus. However, in many countries without responsive governments, open press, and rudimentary health-care systems, controlling an infection becomes much harder. Officials in repressive societies are more apt to rely on counterproductive censorship and quarantine measures that unduly interfere with citizens’ rights and spread distrust.” (P)

“Further increasing the danger of outbreaks and epidemics is another by-product of better health: complacency. In 2013, less than 0.5 percent of international health aid was devoted to preventing infectious-disease outbreaks, and the portion of the World Health Organization budget funded by dues from 194 member countries had dwindled to less than the budget of the New York City Department of Health. Starved of funds, the international system intended to control outbreaks like Ebola failed miserably in West Africa.

After that episode, the Obama administration established a White House–based directorate to respond to outbreaks and dedicated $1 billion to help poor countries build the basic capabilities to prevent, detect, and respond to pandemic threats. The Trump administration has assisted in the international response to Ebola in Congo and offered China help in the current coronavirus crisis, but it also dismantled the White House directorate on pandemic preparedness and urged that U.S. funding for global health security return to pre-2014 levels.” (Q)

(A)          The tricky business of disease diplomacy, by Julia Bellu,

(B)          As coronavirus infections exceed 37,000, here’s how it spread so rapidly, by QUENTIN FOTTRELL,

(C)          Three Scenarios For The Coronavirus, by Dan Vergano,

(D)          In just a couple of months the new coronavirus that emerged from the Chinese city of Wuhan has spread around the world, sparking a race to find treatments and vaccines against it, by Abigail Beall,

(E)          The Urgent Questions Scientists Are Asking About Coronavirus, by  Gabriel Leung,

(F)          US health officials are seeking ‘close contacts’ of coronavirus. Here’s what that means, Anna Maria Barry,

(G)         Coronavirus May Be Transmitted Via Poop As Well As Coughing, Scientists Suggest, by Ben Taub,

(H)          Expert warns coronavirus could infect 60% of world’s population, by Amanda Woods,

(I)           Coronavirus gets official name from WHO: COVID-19, by Erika Edwards,

(J)           Lessons That Go Beyond the Coronavirus Outbreak, by Aaron E. Carroll,

(K)          CDC prepares for community outbreaks in US,

(L)           A Store, a Chalet, an Unsealed Pipe: Coronavirus Hot Spots Flare Far From Wuhan, by Viviann Wang, Austin Ramzy and Megan Specia,

(M)        Timetable For A Vaccine Against The New Coronavirus? Maybe This Fall, by JOE PALCA,

(N)         Huge Shelters for Coronavirus Patients Pose New Risks, Experts Fear, by Roni Caryn Rabin,

(O)         Don’t slip on infection control basics amid coronavirus outbreak, CMS warns, by Anuja Vaidya,

(P)          Coronavirus likely now ‘gathering steam’, by Alvin Powell,

(Q)         Coronavirus Is Spreading Because Humans Are Healthier, by Thomas J. Bollyky,


“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)

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.

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,

“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?

We don’t know what we don’t know” (1) The challenge to emergency preparedness…..,

You are Chief Preparedness Officer at Chiang Rai Region General Hospital in Thailand waiting for the twelve boys and their coach trapped in a cave

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

“Raw” Curated Contemporaneous Case Study Methodology by Jonathan M. Metsch, DR.P.H.

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