The death toll in China from the coronavirus (2019-nCoV) is now at 427, killing more people there in a matter of weeks than the 9-month severe acute respiratory syndrome (SARS) outbreak in 2002 and 2003. (SARS took 349 lives and infected 5,327 people in China.) As of issue, there have been 20,000 confirmed cases around the world and the first death reported outside China this weekend; in the Philippines. A second death outside mainland China was reported in Hong Kong this morning.
In just one month, information on 2019-nCoV has changed almost as quickly as the disease has spread. When 2019-nCoV was first identified on December 31, 2019, in Wuhan City, China, animal-to-human transmission from a Wuhan-based meat market was confirmed and believed to be the only form of infection. Quickly thereafter, the significant spread of cases outside that area indicated human-to-human transmission was present. On January 26, China’s Health Minister Ma Xiaowei announced that the virus can be spread before a person exhibits symptoms, meaning people can be contagious before they are sick, (as is the case with the flu) and infected patients could be unknowingly spreading the virus as they go about their lives.
On January 26, China’s Health Minister Ma Xiaowei announced that the virus can be spread before a person exhibits symptoms, meaning people can be contagious before they are sick, (as is the case with the flu) and infected patients could be unknowingly spreading the virus as they go about their lives. On Thursday, January 30, the New England Journal of Medicine reported a case of a 2019-nCoV infection from an asymptomatic person, thereby validating Xiaowei’s claims and suggesting “a reassessment of transmission dynamics of the current outbreak.” In this case, a Shanghai resident traveled to Germany for business and showed no signs of infection during the two-day trip. She became ill on her flight home and tested positive for 2019-nCoV upon arrival. Her otherwise healthy German business partner got sick two days after contact with her but had felt better by the time the company was notified of the Shanghai woman infection. Immediate mandatory testing showed that the German business partner had the virus, as did three other co-workers. All four German patients were isolated in hospitals and do not appear to be severe and/or have since recovered.
The German case is critical as it illustrates two generations of cases, meaning the person who contracted the virus then passed it on to others. This is a notable development in the research of 2019-nCoV, and the CDC and WHO have yet to publicly confirm this type of transmission. It is likely that more information on this case will be forthcoming from those institutions. In the US, 3 more cases were reported in California yesterday, bringing the total number of American cases to 11. The day after the WHO declared the global outbreak a Public Health Emergency of International Concern last week, US health officials announced a public health emergency, enabling the government to temporarily ban foreign nationals who have traveled to China in the last two weeks who are not immediate family members of US citizens or permanent residents.
From VIGILINT Emergency Physician, Eric W. Ossmann, MD, FACEP:
“Over this last weekend, unprecedented travel restrictions and quarantine orders were enacted in the US. Similar actions occurred in multiple locations throughout the globe, and modifications to these restrictions and orders will be occurring on a regular basis. Maintaining situational awareness on the current location and travel itineraries of your global workforce is absolutely critical. Additionally, constant monitoring of current, and institutionally relevant, travel restrictions and quarantine orders is an essential component of an emergency action plan for 2019-nCoV.”