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Wednesday 11 March 2020

CORONAVIRUS: SMALL BEGINNINGS. Background situation from Jan-Feb 2020


Germany - March 2020
Image source (article) Mail Online


Archived on: https://www.worldometers.info/coronavirus/

Timeline:
  • On February 3, two new cases were reported in Germany, one is the children of a family already infected with the virus.
  • On February 2, doctors in Thailand said they discovered medical treatment that cured a patient of coronavirus ‘in 48 Hours’
  • On February 2, a death in the Philippines marked the first death occurring outside of China. It was a 44-year-old Chinese man from Wuhan who was admitted to the hospital on Jan. 25 with fever, cough, and sore throat, developed severe pneumonia but in the last few days “was stable and showed signs of improvement; however, the condition of the patient deteriorated within his last 24 hours resulting in his demise." reported the Philippine Department of Health.
  • On February 2, China shut down another major city as it closed roads and restricted the movement of residents in Wenzhou, a city with a population of 9 million that is located 800 km away from Wuhan, in Hubei province. The Zhejiang province, where Wenzhou is located, has the highest number of confirmed cases outside the Hubei province.
  • On February 1, the 8th case in the United States was reported (a male in his 20s, in Boston, MA).
  • On January 31, the first 2 novel coronavirus cases in the UK, [18] the first 2 cases in Russia, [20] and the first case in Sweden and in Spain were reported. Canada reported its 4th case.
  • On Jan. 31, the United States
  • declared Coronavirus a Public Health Emergency
  • issued 14 days quarantine rules for US citizens entering the US from China (mandatory if entering from the Hubei province).
  • issued an order to deny entry to foreigners who have traveled to China within the past two weeks.
  • On January 30, the novel coronavirus total case count surpassed that for SARS (which affected 8,096 people worldwide).
  • On January 30, the World Health Organization declared the coronavirus outbreak a Global Public Health Emergency.
  • On January 30 CDC confirmed the first US case of human to human transmission[17].

Germany, Japan, Vietnam and the United States have reported cases in patients who didn't personally visit China, but contracted the virus from someone else who had visited Wuhan, China[15]. These cases of human to human transmission are the most worrisome, according to the WHO[16].

Wuhan (the city where the virus originated) is the largest city in Central China, with a population of over 11 million people. The city, on January 23, shut down transport links. Following Wuhan lock down, the city of Huanggang was also placed in quarantine, and the city of Ezhou closed its train stations. This means than 18 million people have been placed in isolation. The World Health Organization (WHO) said cutting off a city as large as Wuhan is "unprecedented in public health history."[12] and praised China for its incredible commitment to isolate the virus and minimize the spread to other countries.


How dangerous is the virus?

There are three parameters to understand in order to assess the magnitude of the risk posed by this novel coronavirus:

The attack rate or transmissibility (how rapidly the disease spreads) of a virus is indicated by its reproductive number (Ro, pronounced R-nought or r-zero), which represents the average number of people to which a single infected person will transmit the virus.

WHO's estimated (on Jan. 23) Ro to be between 1.4 and 2.5. [13]

Other studies have estimated a Ro between 3.6 and 4.0, and between 2.24 to 3.58. [23].

Preliminary studies had estimated Ro to be between 1.5 and 3.5. [5][6][7]

An outbreak with a reproductive number of below 1 will gradually disappear.

For comparison, the Ro for the common flu is 1.3 and for SARS it was 2.0.
Fatality Rate (case fatality ratio or CFR) of the Wuhan Coronavirus

See full details: Wuhan Coronavirus Fatality Rate

The novel coronavirus' case fatality rate has been estimated at around 2%, in the WHO press conference held on January 29, 2020 [16] . However, it noted that, without knowing how many were infected, it was too early to be able to put a percentage on the mortality rate figure.

A prior estimate [9] had put that number at 3%.

Fatality rate can change as a virus can mutate, according to epidemiologists.

For comparison, the case fatality rate for SARS was 10%, and for MERS 34%.
Incubation Period (how long it takes for symptoms to appear)

See full details: COVID-19 Coronavirus Incubation Period

Symptoms of the novel coronavirus (2019-nCoV) may appear in as few as 2 days or as long as 14 (estimated ranges vary from 2-10 days, 2-14 days, and 10-14 days, see details), during which the virus is contagious but the patient does not display any symptom (asymptomatic transmission).
Age and conditions of Coronavirus cases

See latest findings: Age, Sex, Demographics of COVID-19 Cases and Deaths

According to China's National Health Commission (NHC), about 80% of those who died were over the age of 60 and 75% of them had pre-existing health conditions such as cardiovascular diseases and diabetes.[24]

According to the WHO Situation Report no. 7 issued on Jan. 27:
The median age of cases detected outside of China is 45 years, ranging from 2 to 74 years.
71% of cases were male.

A study of 138 hospitalized patients with NCIP found that the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men.[25]

The WHO, in its Myth busters FAQs, addresses the question: "Does the new coronavirus affect older people, or are younger people also susceptible?" by answering that:
  • People of all ages can be infected by the new coronavirus (2019-nCoV).
  • Older people, and people with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus.
  • Patient who died in the Philippines was a 44-year old maleThe patient who died in the Philippines on February 2, in what was the first death occurring outside of China, was a 44-year-old Chinese man from Wuhan who was admitted on Jan. 25 after experiencing fever, cough, and sore throat, before developing severe pneumonia. In the last few days, “the patient was stable and showed signs of improvement, however, the condition of the patient deteriorated within his last 24 hours resulting in his demise." according to the Philippine Department of Health.
  • Serious Cases of 30 year old patients in France

As of Jan. 29, according to French authorities, the conditions of the two earliest Paris cases had worsened and the patients were being treated in intensive care, according to French authorities. The patients have been described as a young couple aged 30 and 31 years old, both Chinese citizens from Wuhan who were asymptomatic when they arrived in Paris on January 18 [19].
Age and Sex of the first deaths as reported by the China National Health Commission (NHC)

The NHC reported the details of the first 17 deaths up to 24 pm on January 22, 2020. The deaths included 13 males and 4 females. The median age of the deaths was 75 (range 48-89) years.[21]
WHO Risk Assessment: Global Emergency

See full details: WHO coronavirus updates

On January 30, the World Health Organization declared the coronavirus outbreak a Global Public Health Emergency.

For more information from the WHO regarding novel coronavirus:
WHO page on Novel Coronavirus (2019-nCoV)


Comparisons:
  • Every year an estimated 290,000 to 650,000 people die in the world due to complications from seasonal influenza (flu) viruses. This figure corresponds to 795 to 1,781 deaths per day due to the seasonal flu.
  • SARS (November 2002 to July 2003): was a coronavirus that originated from Beijing, China, spread to 29 countries, and resulted in 8,096 people infected with 774 deaths (fatality rate of 9.6%). Considering that SARS ended up infecting 5,237 people in mainland China, Wuhan Coronavirus surpassed SARS on January 29, 2020, when Chinese officials confirmed 5,974 cases of the novel coronavirus (2019-nCoV). One day later, on January 30, 2020 the novel coronavirus cases surpassed even the 8,096 cases worldwide which were the final SARS count in 2003.
  • MERS (in 2012) killed 858 people out of the 2,494 infected (fatality rate of 34.4%).

Coronavirus Worldometer Sections:
Coronavirus Update
Cases
Deaths
Mortality Rate
Transmission Rate
Incubation Period
Age, Sex, Demographics
Symptoms
Countries with cases: basic list - detailed list
Expert Opinions
Cases in the US

More information

Novel coronavirus outbreak may reach peak in one week or about 10 days: expert - Xinhua, Jan. 28, 2020
China’s Xi Jinping pledges to overcome ‘devil’ coronavirus - Financial Times, Jan. 28, 2020
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China - The Lancet, Jan. 24, 2020
The Age, Sex and Symptoms of China’s Coronavirus Victims - Bloomberg, Jan. 23, 2020
Sources

Novel Coronavirus (2019-nCoV) situation reports - World Health Organization (WHO)
2019 Novel Coronavirus (2019-nCoV) in the U.S. -. U.S. Centers for Disease Control and Prevention (CDC)
Outbreak Notification - National Health Commission (NHC) of the People’s Republic of China
Novel coronavirus (2019-nCoV) - Australian Government Department of Health
Novel coronavirus 2019-nCoV: early estimation of epidemiological parameters and epidemic prediction - Jonathan M. Read et al, Jan. 23,2020.
Early Transmissibility Assessment of a Novel Coronavirus in Wuhan, China - Maimuna Majumder and Kenneth D. Mandl, Harvard University - Computational Health Informatics Program - Posted: 24 Jan 2020 Last revised: 27 Jan 2020
Report 3: Transmissibility of 2019-nCoV - 25 January 2020 - Imperial College London‌
Case fatality risk of influenza A(H1N1pdm09): a systematic review - Epidemiology. Nov. 24, 2013
A novel coronavirus outbreak of global health concern - Chen Want et al. The Lancet. January 24, 2020
Symptoms of Novel Coronavirus (2019-nCoV) - CDC
China's National Health Commission news conference on coronavirus - Al Jazeera. January 26, 2020
Wuhan lockdown 'unprecedented', shows commitment to contain virus: WHO representative in China - Reuters. January 23, 2020
Statement on the meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) - WHO, January 23, 2020
International Health Regulations Emergency Committee on novel coronavirus in China - WHO, January 30, 2020
Human-to-human transmission of Wuhan virus outside of China, confirmed in Germany, Japan and Vietnam - The Online Citizen, Jan. 29, 2020
Who: "Live from Geneva on the new #coronavirus outbreak"
CDC Confirms Person-to-Person Spread of New Coronavirus in the United States - CDC Press Release, Jan. 30, 2020
CMO confirms cases of coronavirus in England - CMO, UK, Jan. 31, 2020
Coronavirus in France: what you need to know - The Local France, Jan. 31, 2020
First two persons infected with coronavirus identified in Russia - Tass, Jan. 31, 2020
Updated understanding of the outbreak of 2019 novel coronavirus (2019nCoV) in Wuhan, China - Journal of Medical Virology, Jan. 29, 2020
Estimating the effective reproduction number of the 2019-nCoV in China - Zhidong Cao et al., Jan. 29, 2020
Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak - Jan. 30, 2020
Coronavirus: Window of opportunity to act, World Health Organization says - BBC, Feb,\. 4, 2020
Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China - Wang et. al, JAMA, Feb. 7, 2020




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