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EPIDEMICS
WHO chief sees chance to stop virus, warns of 'grave' threat
By Laurent Thomet and Jing Xuan Teng
Beijing (AFP) Feb 11, 2020

How coronavirus spreads outside China
Paris (AFP) Feb 11, 2020 - For WHO chief Tedros Adhanom Ghebreyesus, the key question in the battle against the novel coronavirus is how quickly it is spreading beyond China.

"The detection of a small number of cases may indicate more widespread transmission in other countries; in short, we may only be seeing the tip of the iceberg," he warned in a recent tweet.

Here are some of the key issues:

- How the virus transmits -

It is a respiratory virus, spreading through contact with an infected person: their coughs, sneezes or droplets of saliva or discharge from the nose.

Scientists think a person needs to be within a metre of an infected person to risk catching it.

Health officials stress basic precautionary measures: washing hands frequently, covering up coughing or sneezing. And if you are infected, wear a mask to protect others.

Diarrhoea may be a secondary mode of transmission, according to one team of researchers.

And Chinese scientists writing in the New England Journal of Medicine suggested every person infected would, on average, infect another 2.2 individuals.

That is a higher rate than winter flu (1.3), lower than an infectious disease such as measles (more than 12) and comparable to SARS (3) -- the last major virus that broke out in China, in 2002-03.

- When it becomes contagious -

Scientists initially thought the virus became contagious several days after symptoms started to appear, as happened with SARS, Arnaud Fontanet of the Institut Pasteur told AFP.

They now think it could be infectious earlier than that.

"Today, everybody agrees that the contagious period starts as soon as symptoms appear," said Fontanet, a specialist in tracking emerging diseases.

There had even been a few cases of transmission from people who showed no symptoms, he added.

One reason these cases are rare is that coughing is a major means of transmission -- and a symptomless carrier does not cough.

Even so, transmission by symptomless carriers makes it harder to contain the virus because they are harder to spot.

- Spread outside China -

The concern expressed by Ghebreyesus about the spread of the virus beyond China came as news broke of a British national infected in Singapore.

He went on to infect several other Britons during a stay at a French Alpine ski resort, before finally being diagnosed back home in England.

By then, he had infected at least 11 people, including a nine-year-old child.

"What is concerning is the source of these infections, which appears to have been a conference in Singapore attended by some participants from China," said Nathalie MacDermott of Imperial College London.

Some of the 90 other people there might also have taken the virus back to their home countries, said MacDermott, a specialist in paediatric infectious diseases.

Every time health officials identify an infected person, they have to track down those they might have infected to ensure they, in turn, are not passing it on, she said.

She and other experts are already worried about "the potential for this epidemic to develop into a pandemic".

- Catching it in hospital -

On Friday, Chinese researchers published a study of 138 coronavirus patients at a hospital in Wuhan, the epicentre of the outbreak.

In their paper, published in the Journal of the American Medical Association, they noted that more than 40 percent of these patients -- 57 -- caught it in hospital.

Seventeen were already in hospital for other reasons and the other 40 were health professionals.

This was already a problem during the outbreak of SARS and the Middle East Respiratory Syndrome coronavirus (MERS), two other deadly outbreaks featuring different types of coronavirus.

The death toll in China from the new coronavirus epidemic jumped on Wednesday, as the chief of the World Health Organization urged countries to work together against the "grave threat" posed by the outbreak.

The WHO is holding a conference in Geneva on combating the virus, which has killed more than 1,100 people in China and spread to dozens of countries around the world.

WHO chief Tedros Adhanom Ghebreyesus said viruses could have "more powerful consequences than any terrorist action".

Although 99 percent of the infections are in China, where it remains "very much an emergency", it also "holds a very grave threat for the rest of the world", Tedros said at the conference, where the virus was officially named "COVID-19".

The case of a British man who passed on the virus to at least 11 other people -- without having been in China -- has raised fears of a new phase of contagion abroad.

"We have to use the current window of opportunity to hit hard and stand in unison to fight this virus in every corner," Tedros said, warning that a failure to act would lead to far more cases in the future.

WHO sent an advance team to China this week for an international mission to examine the epidemic, where more than 44,000 people have now been infected.

Chinese authorities have locked down millions of people in a number of cities, but another 94 deaths were reported on Wednesday in the hardest-hit province of Hubei, the central province where around 56 million people are under lockdown.

The mortality rate remains relatively low at around 2 percent.

- 'Bigger fire' -

Several governments have banned arrivals from China and major airlines suspended flights in a bid to keep the disease away from their shores.

Most cases overseas have involved people who had been in Wuhan, the quarantined central Chinese city where the virus emerged late last year, or people infected by others who had been at the epicentre.

The Briton caught the virus while attending a conference in Singapore and then passed it on to several compatriots while on holiday in the French Alps, before finally being diagnosed back in Britain.

The 53-year-old said Tuesday he had fully recovered, but remained in isolation in a central London hospital.

"The detection of this small number of cases could be the spark that becomes a bigger fire," Tedros said on Monday.

- 'I'm scared' -

The biggest cluster of cases outside China is aboard the Diamond Princess cruise ship moored off Japan, where 135 people have been diagnosed.

The ship has been in quarantine since arriving off the Japanese coast early last week after the virus was detected in a former passenger who had disembarked in Hong Kong.

More than 100 people were evacuated from a 35-storey Hong Kong housing block Tuesday after two residents in different apartments tested positive for the virus.

People were forced to leave as health officials in masks and white overalls scrambled to work out whether the virus had spread through the complex of about 3,000 people.

"Of course I'm scared," a 59-year-old resident, who gave her surname as Chan, told AFP.

The United States said Tuesday it had authorised non-essential consulate staff to leave Hong Kong "out of an abundance of caution" linked to the virus.

- Torrent of criticism -

Chinese authorities dismissed two senior health officials from Hubei and tightened restrictions in the capital Wuhan, forbidding people with fever from visiting hospitals outside of their home districts and sealing off residential compounds.

Local authorities both in Wuhan -- where the virus is thought to have emerged in a market selling wild animals -- and Hubei have faced a torrent of criticism for hiding the extent of the outbreak in early January.

The death of a whistleblowing doctor from Wuhan has sparked calls for political reform in China.

Most deaths and cases are in Hubei.

"The problem of human-to-human transmission has still not been solved in Wuhan," the official Xinhua news agency quoted Zhong Nanshan, a renowned scientist, as saying.

"I believe that with enough venues, enough doctors, better protective gear and our various support teams, the situation in Wuhan should improve quickly, but it is still at a rather difficult stage," he said, forecasting a mid- to late-February peak in the outbreak.

Toward the end of January, Zhong had expected a peak in a week to 10 days.

President Xi Jinping has largely kept out of the public eye since the outbreak spread across the country.

But he emerged on Monday, pictured wearing a mask and having his temperature taken at a hospital in Beijing.

Xi called the situation in Hubei "still very grave" and urged "more decisive measures" to contain the spread of the virus.


Related Links
Epidemics on Earth - Bird Flu, HIV/AIDS, Ebola


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EPIDEMICS
WHO warns overseas virus spread may be 'tip of the iceberg'
Geneva (AFP) Feb 10, 2020
The head of the World Health Organization has warned that confirmed cases of coronavirus being transmitted by people who have never travelled to China could be the "tip of the iceberg". Tedros Adhanom Ghebreyesus' remarks come as members of a WHO-led "international expert mission" flew to China on Monday to help coordinate a response to the outbreak that has so far infected more than 40,000 people and killed 908 in the country. "There've been some concerning instances of onward #2019nCoV spread ... read more

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