How coronavirus went from a Wuhan food market to a national emergency — and what we can learn from China’s early mistakes

On Wednesday, WHO said coronavirus has become a pandemic.

WHO had previously characterized the illness late last year as a series of epidemics. An epidemic is a disease that infects regions or a community, such as SARS (2002-3) or Ebola outbreak in West Africa (2014-15). Governments around the world have been unable to stop the spread of COVID-19, the disease caused by the new coronavirus SARS-CoV-2.

An outbreak is deemed to have become a pandemic when it has spread from human-to-human on several continents around the world, such as the 1918-19 “Spanish flu” or, one of the most extreme pandemics ever recorded, the Black Death (1347-51).

Coronavirus had infected 145,369 people globally and killed 5,429 as of Friday evening, according to data the latest rally from the database of Johns Hopkins University’s Center for Systems Science and Engineering; the database also reported 71,694 recoveries. The U.S. has had at least 2,174 confirmed coronavirus cases and 47 deaths.

Also see: ‘Hundreds of people fled south, storming the night trains’: Italians struggle to adjust to the New Normal amid coronavirus lockdown

As COVID-19 continues its silent and sometimes deadly march across the world, what can be learned from those uncertain, early days when it first made an appearance at a food market in Wuhan, China? People, understandably, have questions: Will you get coronavirus? Will it kill you? Why has the Centers for Disease Control and Prevention and the U.S. government taken so long to issue testing kits so people who are asymptomatic and/or have mild systems can get tested?

The first known person was reported to have contracted the virus on Dec. 1 in China, according to an article in The Lancet.

There are infection clusters in Iran, and South Korea and Italy; Italy announced a nationwide lockdown, effectively quarantining the entire country. Ongoing outbreaks in Iran, Italy and South Korea are the “greatest concern,” said Dr. Tedros Adhanom Ghebreyesus, the World Health Organization’s director-general, while the rate of infections in China is slowing.

Silence and misinformation helped the virus spread

Amid the fear and confusion surrounding the initial days of the virus in China, some families there have voiced concern and frustration that their relatives’ cause of death was marked as “severe pneumonia” or “viral pneumonia” on their death certificates, the Wall Street Journal reported.

Such practices may have delayed news and/or awareness of the outbreak, which is why the media and public-health authorities are ramping up efforts to encourage people to wash their hands for 20 seconds and cover their mouth if they sneeze and cough.

“COVID-19 rapidly spread from a single city to the entire country in just 30 days,” a Feb. 24 paper on the fatality rates of the disease in the peer-reviewed medical journal JAMA found. “The sheer speed of both the geographical expansion and the sudden increase in numbers of cases surprised and quickly overwhelmed health and public-health services in China.” In China, 50% of men smoke versus 2% of women, making them more susceptible to dying from the disease, it added.

The virus appeared during a cold winter in China, Europe and Western Asia, which may soon spell trouble for countries in the southern hemisphere. “It’s not surprising that it happened in the winter season,” said Jeff Goad, a professor and chair of the Department of Pharmacy Practice at Chapman University, a private university in Orange, Calif. “Illnesses that are respiratory in nature tend to spread faster in colder environments. People are indoors more often and they congregate more.”

China did not appear to take early, preemptive actions. Coronavirus is believed to have originated at a food market in Wuhan, China. In January, Zhou Xianwang, the mayor of Wuhan, said 5 million people left the city before travel restrictions were imposed ahead of the Lunar New Year. As authorities struggled to cope with the speed of the virus’s spread, they pledged to re-open the Xiaotangshan Hospital on the outskirts of Beijing, built during the 2002 to 2003 SARS epidemic.

Some critics have said that the Chinese government could have done more in those early days to alert authorities to both the existence of the virus and confirm that human-to-human transmission was likely, especially when hospitals in Wuhan were seeing more and more people arriving at their doors, complaining about the same symptoms. WHO’s China Country Office was informed of cases of pneumonia of unknown etiology (or cause) on Dec. 31.

A timeline of events in the early stages of the COVID-19 outbreak

Dec. 1: The first known patient to have contracted the virus is identified in Wuhan, according to a boots-on-the-ground investigation by a group of Chinese researchers published in the medical journal The Lancet. “None of his family members developed fever or any respiratory symptoms. No epidemiological link was found between the first patient and later cases,” they wrote.

Dec. 18: Ai Fen, the head of the emergency department at Wuhan Central Hospital, says shenoticed an elderly man with a lung infection, high fever and flu-like symptoms.

Late December: A Wuhan doctor posts in a WeChat group that there were seven cases of what he describes as SARS connected to the food market. At the behest of the local Communist party office, he later signs a document at a local police station saying he made an error.

Dec. 31: Authorities inform the WHO China Country Office of cases of pneumonia of unknown etiology (unknown cause) detected in Wuhan.

Jan. 1: The food market in Wuhan, the epicenter of the coronavirus outbreak, closes for environmental sanitation and disinfection. WHO requests further information from China.

Jan. 7: Chinese scientists say they’ve identified a new virus that, like SARS and the common cold, belongs to the coronavirus family. Chinese President Xi Jinping issues orders to contain the new coronavirus, according to Qiushi, the official Communist party magazine; previous reporting by Chinese state media gave Jan. 20 as the date the president issued those orders.

Jan. 11: China announces the first known death from the coronavirus: a 61-year-old man who had bought food at the Wuhan market. WHO receives “detailed information” from Chinese authorities that there is “no clear evidence of human-to-human transmission” linked to coronavirus cases found.

Jan. 15: Wuhan’s health commission releases a statement: “The possibility of limited human-to-human transmission cannot be ruled out.”

Jan. 18: An annual potluck banquet is held for 40,000 families from a city precinct in Wuhan.

Jan. 20: Chinese officials say the coronavirus, which initially spread from an animal or animals to people, can be transmitted through human-to-human contact.

Jan. 23: Public transport on buses, trains and ferries in Wuhan are suspended from 10 a.m. local time to help prevent the spread of the virus.

Jan. 24: WHO says it’s too early to declare a “public-health emergency of international concern,” its highest alert. Coronavirus makes its first official appearance in Europe, with French authorities confirming three cases of the virus. Australia confirms four people with the virus.

Jan. 25: Pared-down Lunar New Year celebrations begin with many of the festivities canceled.

Jan. 29: The New England Journal of Medicine says: “There is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019.”

Jan. 30: As the virus spreads internationally, the WHO’s Tedros declares the coronavirus a public-health emergency of international concern.

Feb. 2: The first official death from COVID-19 outside of China is reported in the Philippines: a 44-year-old Chinese man who arrived in Manila from Wuhan.

Feb. 7: Dr. Li Wenliang, 34, the doctor who first sounded the alarm on the virus in an online chat group with other doctors, dies. The hospital where he worked makes the announcement.

Does China have more power than the U.S. to control the virus?

“It was an unfortunate time,” Jeff Goad told MarketWatch. “It’s hard to speculate whether they had a poor response or acted the best they could. China can shut down entire cities, which we can’t do.”

The early spread of the disease was likely helped by preparations for China’s Lunar New Year holiday, when people traveled to visit relatives. Wuhan mayor Zhou Xianwang said 5 million people had left the city before travel restrictions were imposed ahead of the Lunar New Year.

In an effort to stem the spread of the virus, transport bans were instituted in more than a dozen Chinese cities in January with a combined population of more than 50 million people. Officials in Wuhan, a city with a year-round population of 11 million people, said they had temporarily closed the area’s outgoing airport and railway stations, and suspended all public transport. Photographs of empty streets taken of the city in recent weeks depicts something akin to a 21st-century ghost town.

Yaxue Cao, the founder of the political pressure group ChinaChange.org, wrote on Twitter

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 that a Wuhan doctor had posted in a WeChat group to say there were seven cases of SARS connected to the food market. He was 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 the end of December,” Cao posted on Jan. 27.

How COVID-19 is transmitted

Shortly after Cao sent those tweets, Dr. Li Wenliang, 34, the doctor who first sounded the alarm about a potentially new virus on that WeChat group, died. “Our hospital’s ophthalmologist Li Wenliang was unfortunately infected with coronavirus during his work in the fight against the coronavirus epidemic,” the hospital in Wuhan said. “He died at 2:58 a.m. on Feb. 7 after attempts to resuscitate were unsuccessful.”

“Globally, about 3.4% of reported COVID-19 cases have died,” Tedros said at a press briefing in Geneva on Tuesday. That’s more than previous estimates that hovered around 2%, and the influenza fatality rate of less than 1%. Tedros last week estimated a fatality rate of between 2% and 4% in Wuhan; outside of Wuhan, he estimated one of 0.7%, although other estimates put it at closer to 2%.

The WHO fatality rate estimate could be related to officials underestimating the number of actual cases. If infections are actually higher globally, the fatality rate would obviously fall. The more time asymptomatic people spend going about their daily lives, the more people can become infected. Writing in Slate, Jeremy Samuel Faust, an emergency physician at Brigham and Women’s Hospital and an instructor at Harvard Medical School, said, “These frightening numbers are unlikely to hold.”

The virus has an incubation period of up to 14 days, during which it can be contagious, said Ma Xiaowei, the director of China’s National Health Commission. That, medical professionals say, allows the virus to be passed from person to person. The more time asymptomatic people spend going about their daily lives, the more people can become infected. (SARS has an average incubation rate of 2 to 7 days, according to the Centers of Disease Control and Prevention.)

W. Ian Lipkin, an epidemiologist at Columbia University’s Mailman School of Public Health in New York City, returned from Wuhan before the city was effectively closed off from the outside world. He quarantined himself in the basement of his Manhattan home for 14 days.

Lipkin had an advantage over many of the people who first became infected in China in December and January: He was acutely aware of the virus’s existence and the need to self-isolate to prevent further contagion.

Research has shown that the virus has even been found in human feces, although it’s not yet known how long it can survive outside the human host. “How long is it in feces?” Lipkin told the latest issue of The New Yorker. “How long is it in the mouth and the nose? How long is it on surfaces? On buckles, seat belts, doorknobs, touch screens, or the TV remote in a hotel room, which, by the way, never gets cleaned and is one of the filthiest things on the planet.”

Some airlines have canceled flights to the most severely affected areas, but the WHO suggests concerns about risks of contracting the virus on an airplane may be overplayed. “Research has shown that there is very little risk of any communicable disease being transmitted on board an aircraft,” WHO says. “Transmission of infection may occur between passengers who are seated in the same area of an aircraft, usually as a result of the infected individual coughing or sneezing or by touch.”

Also see: Influenza kills more people than the flu so everyone is overreacting, right? Wrong — here’s why

Lipkin, who wears gloves while traveling on the New York subway, told The New Yorker: “On airplanes, I wipe everything down. I stay away from bowls of mixed nuts or candy.” With that said, the WHO says most commercial aircraft recycle up to 50% of cabin air. “The recirculated air is usually passed through HEPA — high-efficiency particulate air — filters, of the type used in hospital operating theatres and intensive care units, which trap dust particles, bacteria, fungi and viruses,” it adds.

The bigger risk, others say, lies in infected people taking work trips and vacations. “Unfortunately, the virus is very effective, just like the influenza virus,” Goad said, adding that respiratory viruses thrive in the winter months. “The challenge we have is that, very soon, the southern hemisphere will move into winter, when we move to summer,” he said. “If we have some of the travel restrictions in place in the summer months, it may hopefully curb some of the spread between hemispheres.”

“It may slow it down,” he added, “but it’s unlikely to stop it.”

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