Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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February 9, 2020

EPI UPDATES China’s National Health Commission (NHC) reports a total of 37,198 confirmed cases, the lowest daily increase in more than a week. The number of deaths reported is 811, and 2,649 patients have been cured and discharged. The NHC also reported 26 cases (including 1 death) in Hong Kong, 10 cases in Macau, and 17 cases in Taiwan. The NHC is now tentatively referring to the disease as “ Novel Coronavirus Pneumonia ” or NCP.

The World Health Organization reports that outside of mainland China there are 288 cases in 24 countries. The number of confirmed cases in the United States remains at 12.

SPREAD OUTSIDE CHINA France’s Ministry of Health reported secondary spread from a confirmed case recently returned from Singapore. Five of 11 people who had shared a ski chalet with the index case, all British nationals, were diagnosed with 2019-nCoV. Taiwan announced  its 17th confirmed case, a man who passed through the Hong Kong airport while travelling to and from Europe. In Singapore , seven new cases were diagnosed, five of which were linked to previously identified cases. None of the new cases has a travel history to China. Of the 40 cumulative cases recognized in Singapore, four (10%) are in critical condition. [Editor’s note: We commend the Singapore Ministry of  Health for their exemplary situation reports, which are timely and  highly detailed.]

SOUTH KOREAN RESPONSE The Ministry of Health in South Korea announced that rapid testing will soon be available at private medical facilities. Testing capacity will expand to 10,000 tests per day, up from the current capacity of 3,000 daily. Travelers who have visited Hubei Province in the last two weeks are prohibited from entering the country, as of Feb 3. For people undergoing follow-up, the Ministry is using a mobile phone app. Additional, extensive details about the country’s response are available in a recent press release .

RAPID EMERGENCY HOSPITAL CONSTRUCTION The emergency construction of a hospital to house 2019-nCoV patients was expected to begin accepting patients on February 8. The Leishenshan Hospital will provide an additional 1,600 beds, bringing the total in Wuhan to more than 10,000. At least 1,000 beds are designated for severe coronavirus patients, and 3 public facilities have been converted to temporary hospital facilities, which provide 4,250 beds for patients with milder symptoms (expected to increase to 5,400 beds in the future). CGTN reports that the Leishenshan facility includes an ICU, a negative pressure room, surgery rooms, and CT equipment.

China’s NHC published draft guidelines for the construction of emergency hospitals/treatment centers to support the 2019-nCoV response. The guidance specifies requirements for facility layout, including clean areas, patient care areas, and buffer rooms/anterooms; air handling and airflow considerations, including negative pressure rooms; and workflow and patient movement guidance for operations within the facilities as well as references to the relevant national standards for construction and infrastructure (eg, water, electricity, waste handling). The guidance explicitly indicates a preference for using prefabricated or modular units in the construction of emergency hospitals, a technique which has already been demonstrated for the first to emergency facilities in Wuhan.

CLINICAL CASE SERIES A new paper describing the clinical characteristics of 138 hospitalized patients in Wuhan was published on Friday in the Journal of the American Medical Association. Key findings include: (1) 41% of patients were infected in the hospital, including 40 healthcare workers; (2) 26% of patients in the case series were admitted to the ICU; (3) although 46% had underlying medical conditions, the most common condition was hypertension; (4) the median time from symptom onset to ICU admission was 10 days, suggesting a long clinical course is common. This paper is the first indication that healthcare workers are frequently infected. A second paper describing 13 mild nCoV patients in Beijing was also recently published in JAMA.

ACCURACY OF DIAGNOSTIC TESTS Caixin , reporting on an interview with a Chinese Academy of Medical Sciences expert, suggests that nucleic acid testing often results in false negatives, particularly early in the course of illness; the sensitivity of the test may only be 30-50%. China’s Novel Coronavirus Pneumonia Diagnosis and Treatment program document previously required a positive PCR test to be considered a confirmed case. However, the guidance changed in the recently-released fourth edition of the program to allow for diagnosis based on clinical presentation, but only in Hubei province. 

MODELING UPDATES Refined estimates of the effectiveness of airport screening, published recently in Eurosurveillance , find that only half of infected travelers would be identified through entry and exit screening. The authors, based at the London School of Hygiene and Tropical Medicine, have also published an interactive tool to allow users to explore different scenarios. Another modeling study , also by researchers at LSHTM, estimates that the outbreak may peak in Wuhan in mid to late February. They also find that, "once more than three infections have been introduced into a new location, there is an over 50% chance that an outbreak will occur.”  Both modeling studies emphasize that there is substantial uncertainty in their results.

CARE FOR PREGNANT WOMEN, NEW MOTHERS & NEWBORNS China’s Department of Maternal and Child Health published new guidance for caring for mothers and children during the 2019-nCoV epidemic. The guidance includes recommendations to establish dedicated entrances and patient care areas at healthcare facilities for obstetrics, to reduce the risk of exposure to 2019-nCoV and to increase the use of telemedicine (eg, through social media like WeChat, phone, videoconference) for pregnant women to support self-monitoring at home. Obstetrics and midwifery facilities should also implement screening and triage protocols to identify potential 2019-nCoV patients during patient intake. Newborns who exhibit clinical manifestations of 2019-nCoV infection (eg, fever, dyspnea) should be immediately transferred to a designated treatment facility capable of treating infants.

UPDATES ON CHINA’S RESPONSE Many municipalities are poised to return to work tomorrow after the Lunar New Year holiday was extended. However, some restrictions and recommendations to reduce transmission are still in effect. The Beijing municipal government will implement unspecified driving restrictions based on license numbers beginning Monday. The Beijing Foreign Affairs office published guidance on protective measures when going back to work , including temperature and symptom checks before leaving home, avoiding public transit when possible, and wearing a mask at work and reducing face-to-face meetings. The Beijing Municipal Economic and Information Technology Bureau announced a series of measures to support local businesses during the epidemic response, including rent subsidies for small businesses, reducing interest rates and mitigating the impact of credit-related issues stemming from the epidemic, and subsidies for small businesses to purchase and implement online services. Additionally, Beijing will implement a competition and establish a “Special Zone for Epidemic Prevention and Control” to promote innovation and research and development for pharmaceuticals and other products to support the 2019-nCoV response. Locations of communities with cases and hospitals treating cases has also been published.

In other news, Wuhan, the epicenter of the 2019-nCoV epidemic, is implementing enhanced surveillance citywide . According to Xinhua , health officials will “comb communities to ensure every confirmed or suspected patient is located and attended to.” Additionally, the article reports that “a senior official vowed to nail any official deserter ‘to history's pillar of shame,’” potentially indicating repercussions for those attempting to hide or conceal patients.

LIFE AND DEATH IN A WUHAN ICU The Straits Times newspaper published a lengthy interview with a physician on the frontlines of a Wuhan coronavirus ICU. We recommend that our subscribers read the piece in full on the Straits Times website .