Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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February 7, 2020

EPI UPDATES China’s National Health Commission reported 31,161 total cases of 2019-nCoV in China, including 636 deaths. So far, 1,540 patients have been discharged. Another 26,359 suspect cases remain, and 186,045 individuals are being monitored. The NHC also reported 50 cases in Hong Kong, 10 in Macau, and 16 in Taiwan.

The WHO Situation Report for February 6 reports 216 cases across 24 countries outside of China. A total of 25 new international cases were reported in the past 24 hours, but notably, no new countries reported cases. The regional and global risk assessments remain as “high.”

“WHISTLEBLOWER” DEATH One of 8 clinicians in Wuhan who were reprimanded by local police after sharing information about the emerging 2019-nCoV epidemic in late December died from 2019-nCoV infection. Dr. Li Wenliang , an opthamologist in Wuhan, reportedly shared information with some colleagues after isolating several patients linked to a local animal market. When a screenshot of the chat conversation was made public, hospital officials and local police reprimanded him for allegedly spreading misinformation and “disrupting social order.” Looking back, Dr. Li’s warning was one of the earliest signs of the ongoing epidemic. Dr. Li is believed to have contracted the infection while treating a patient for an unrelated condition who was later diagnosed with 2019-nCoV, and he developed symptoms on January 12. The China People’s Supreme Court reportedly sided with the 8 “whistleblowers” in a recent decision on the case, noting that the early warning could have provided the public an opportunity to implement protective actions to reduce the risk of transmission.

Several media outlets are reporting that Dr. Li’s death has prompted a significant response from the Chinese public . The doctor’s death and the circumstances surrounding his reprimand by the government for speaking out about the early cases in the epidemic are trending topics on several Chinese social media platforms, including Weibo and WeChat.

ACCELERATING RESEARCH The WHO will convene a “ global research and innovation forum ” to facilitate advanced research and development on topics to include vaccines and therapeutic products. The meeting will be held February 11-12 in Geneva, Switzerland, and participants will include a broad scope of international experts, representing public health agencies and leading human and animal health scientists from around the world. One of the primary aims of the meeting is to “produce a global research agenda for the new coronavirus” which will establish “priorities and frameworks that can guide which projects are undertaken first.” Pre-identified research priorities include diagnostic tests, vaccines, and therapeutics, but other topics will include genomic study and identifying the source of the virus.

US DIAGNOSTIC AVAILABILITY The US CDC announced that shipping has commenced to distribute 2019-nCoV diagnostic test kits nationwide. The kits are real-time reverse transcriptase PCR (RT-PCR) tests that use a testing instrument commonly used for seasonal influenza. The tests are designed to be used on both upper and lower respiratory specimens, and they can provide results in 4 hours from initial specimen processing. The initial shipments will distribute approximately 200 test kits to domestic laboratories, and additional kits will be shipped to “select international laboratories” as well. Each test kit can process 700-800 specimens. The test kits are not FDA-approved, so they will be utilized under an Emergency Use Authorization.

INTERNATIONAL REFERENCE LABORATORIES In its February 6 Situation Report, the WHO announced 15 reference laboratories have been designated to support the 2019-nCoV response. The list includes 1 laboratory each in the US, UK, Russia, Australia, and China as well as 5 more in Asia, 3 in Europe, and 2 in Africa. The WHO “has made 250,000 tests available to the WHO Regional Offices national laboratories” and is working to further increase availability around the world. The WHO is also leveraging specimen shipping capacity from the Global Influenza Surveillance and Response System to transport specimens for testing to the international reference laboratories.

PROTECTING FRONT-LINE RESPONDERS China’s State Council published a notice directing governments at all levels to provide additional support for healthcare workers and other responders . The notice focuses on several different types of support, providing for basic needs, such as food and sleep; providing mental health support, including through the psychological hotline described below; establishing communication between responders and their families to provide emotional support; and allocating personal protective equipment and other supplies to promote responders’ safety during response activities.

PSYCHOLOGICAL SUPPORT China CDC announced updated guidance for implementing psychological support hotlines in response to the emerging coronavirus epidemic. The new guidance provides additional detail on setting up and operating the hotlines, including requirements for staffing and equipment in order to ensure effective 24-hour operations. Additionally, the guidance delineates professional requirements for the hotline consultants and management as well as ethical principles for operation, including objectivity and informed consent. These hotlines aim to provide mental health support for affected members of the public as well as front-line responders.

QUARANTINED CRUISE SHIPS Several cruise ships around the world, including several in Southeast Asia, have been quarantined after passengers tested positive for 2019-nCoV. The Diamond Princess —currently quarantined in Yokohama, Japan—has reported that 41 additional passengers tested positive. Princess Cruises announced the nationalities of the newly identified cases: 21 from Japan, 8 from the United States, 5 from Canada, 5 from Australia, 1 from Argentina, and 1 from the United Kingdom. In the first round of testing, 10 passengers and crew were identified: 3 passengers from Japan, 3 from Hong Kong, 2 from Australia, and 1 from the United States as well as 1 crew member from the Philippines. Various reports indicate that 10 passengers and crew were identified initially, and 51 have tested positive since the screening began on February 4, bringing the total to 61. Passengers onboard are largely confined to their rooms, but the ship has provisions for those with interior rooms to have limited time outdoors. Princess Cruises has also increased entertainment options available to the passengers and arranged to deliver meals directly to their rooms, in an effort to keep the passengers comfortable. The quarantine end date is currently set as February 19.

Multiple media outlets are reporting that the Holland America cruise ship Westerdam has been denied entry by the Philippines and Japan as a result of recent port visits to Hong Kong and Taiwan. The ship was scheduled to visit Manila, but the Philippines government prevented the ship from entering port under travel restrictions on the entry of non-citizens traveling from China, Hong Kong and Macau. The ship was scheduled to visit several Japanese ports in the coming days and then depart for its next cruise from Yokohama, but the Japanese government notified the cruise line that it would be denied entry to any Japanese ports. Notably, Holland America reports that there are no suspect or confirmed cases onboard the Westerdam. Holland America has cancelled the ship’s next cruise, and they are working to identify a solution for its current passengers. 

Multiple media outlets are reporting that several passengers on a cruise ship currently in port in New Jersey have been taken to the hospital to be tested for 2019-nCoV. The 4 passengers are Chinese citizens, but none have recently travelled to Wuhan. The Royal Caribbean cruise ship Anthem of the Seas is currently in port in Bayonne, New Jersey (USA), just outside New York City. The cruise began 12 days ago, and the ship visited several ports in the Caribbean. An additional 23 Chinese nationals were screened in New Jersey, and they are scheduled to fly back to China today. The media reports indicate that the cruise line is participating in enhanced screening, much like airlines, but that the ship is scheduled to continue on its itinerary, departing this afternoon.