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January 26, 2020 - Update
EPI UPDATE China’s National Health Commission reports 1,975 confirmed cases and 56 deaths as of Jan 25. Of those, 324 (16%) are reported to be severe. At least 23 travel-related cases have been found in 9 other countries, according to the WHO. Unofficial sources report 37 cases across 11 countries.
The WHO also reported two instances of secondary spread outside of China. Vietnam and Australia have each identified one infection in close contacts of a travel-related case. Unconfirmed news from Malaysia reports three secondary cases with close contact to a confirmed, travel-related case. No official statement regarding this possible cluster could be found at the time of this writing.
The United States has confirmed a third case in Orange County, California. The case has a travel history to Wuhan. Canada reported a ‘presumptive’ case in Toronto on Saturday.
POSSIBILITY OF PRE- OR ASYMPTOMATIC TRANSMISSION The transcript from an official press conference, available on China’s National Health Commission website, reports that pre- or asymptomatic transmission may be possible. A report in state media describes a case: “We encountered a patient who came to Hangzhou from Wuhan to attend a conference. When he arrived in Hangzhou, he did not have any symptoms. He did not have the typical symptoms of cough and fever. But it didn't take long for a few colleagues he had contacted to be infected. Symptoms appeared one after another. But at this time, he still did not have the disease himself. After returning to Wuhan at the end of the meeting, he did not get the disease after another two days.” If confirmed, that transmission dynamic would complicate efforts to control the virus. Detailed epidemiological information is urgently needed to fully assess this risk.
CHINA REPORTS LIMITED PPE The press conference described in item 2 also outlined challenges in producing and distributing personal protective equipment. Production capacity is reported to be at 40% due to the Spring Festival holiday. Hubei Province, the focal point of the outbreak, reports a demand of 100,000 pieces of PPE per day and 3 million pieces per month. However, production capacity currently stands at either 13,000 or 30,000 units [editor’s note: both values were reported in the press conference. It is unclear if this is an issue of machine-translation]. There are an additional 50,000 units currently produced for exportation “but without the Chinese standard license, it will take a little time to switch to domestic sales.”
TRAVEL RESTRICTIONS REDUCE MOVEMENT Transportation volume in China has decreased markedly over the same period last year: “Railways have decreased by 41.5%, road transport has decreased by 25%, and civil aviation has decreased by 41.6%.” The impact of control measures will not be apparent for at least one incubation period. The incubation period is not yet well described, but it is thought to be less than 14 days. The incubation of SARS was around 4-6 days.
ECDC RISK ASSESSMENT The European Centre for Disease Control has published an updated risk assessment. They find (excerpted): the potential impact of 2019-nCoV outbreaks is high; further global spread is likely; the impact of the late detection of an imported case in an EU/EEA country without the application of appropriate infection prevention and control measures would be high, therefore in such a scenario the risk of secondary transmission in the community setting is estimated to be very high. WHO's risk assessment remains at "very high in China, high at the regional level and moderate at the global level."