Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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January 28, 2020 - Afternoon Update

EPI UPDATE The Johns Hopkins University Center for Systems Science and Engineering estimates 4,690 confirmed cases and 106 deaths as of 2:24pm EST. In addition to China, cases have been confirmed in 14 other countries. This estimate is based on a compilation of data across a variety of official and unofficial sources . Official updates from China’s National Health Commission are not expected until this evening.

Taiwan CDC announced its first case of domestic transmission of 2019-nCoV. The patient is a 50-year-old male who lives with a previously-confirmed imported cases. Taiwan health officials have determined that the infection was a result of household transmission. Taiwan has identified 8 confirmed cases and 578 suspected cases.

Japan’s National Institute of Infectious Disease reported a case of 2019-nCoV in a 40-year-old male with no history of travel to Wuhan. The man is a bus driver, and he reportedly came into contact with tourists from Wuhan between January 8-16. The man developed symptoms on January 14 and sought care on January 17, but he was not diagnosed at that time. His symptoms worsened on January 22, and he sought care again on January 25. Samples were submitted for diagnostic testing on January 26. This appears to be the first instance of domestic transmission of 2019-nCoV infection in Japan.

INTERNATIONAL EXPERTS The WHO announced today that China is collaborating with international experts to assist in efforts to research and characterize the 2019-nCoV virus and disease, with a particular focus on transmissibility and severity. This announcement came while US health officials (Alex Azar, Secretary of Health & Human Services; Robert Redfield, Director of the US CDC; Nancy Messonnier, Director of the National Center for Immunization and Respiratory Disease; and Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases) held a press conference , during which they emphasized the importance of having US experts on the ground in China in order to support ongoing disease control efforts and gain better insight into the disease and transmission characteristics.

DISEASE TIMELINE AND TRANSMISSION In a recent study , the travel histories of 34 cases detected outside Wuhan but with relevant travel to Wuhan were analyzed. Based on the timelines for the patients’ travel and symptom onset, the researchers estimated an incubation period of 2-11 days and a mean value of 5.7-5.9 days. The researchers also estimated that symptoms would present in 95% of cases by approximately 10.3-12.6 days. These estimates are fairly similar to the estimated incubation periods for SARS and MERS, and they support current estimates used by the WHO and US CDC. In other news, phylogenetic analyses continue to identify late November or early December as the likely dates for the emergence of 2019-nCoV in humans.

MEDICAL COUNTERMEASURES The US FDA announced steps aimed to facilitate the development of medical countermeasures (MCMs) for 2019-nCoV. Notably, the FDA launched a website dedicated to its activities around the novel coronavirus, including information on MCM development. The site contains links for sponsors of investigational diagnostics and therapeutics to contact FDA directly and submit relevant information for Emergency Use Authorization and/or Investigational New Drug programs. Additionally, the site includes a section to provide information on the current status of relevant diagnostics, vaccines, and therapeutics (NOTE: currently there are no FDA-approved products in any of these categories).

TRAVEL RESTRICTIONS A number of new travel-related restrictions have been implemented for China. Travel by high-speed rail, ferry, and tour bus between mainland China and Hong Kong will be suspended beginning January 30; flights will also be reduced by half. Russian regions that share a border with China will close that border, joining Mongolia and Kyrgyzstan as countries that have closed land borders. In Macau , around 150 residents of Hubei Province were deported, and more deportations are expected. Macau is also implementing new travel restrictions, requiring a medical certification for visitors originating from Hubei Province.

COMMUNITY RESPONSES Reports of how communities are handling life under cordon sanitaire find that basic necessities like food availability and trash removal are largely unaffected; however, there are growing concerns about stigma and social strain for affected populations. For example, there are some reports of villages managing the movement of people in and out of their community or implementing unofficial contact tracing.

WHO SITUATION REPORT The World Health Organization published its eighth situation report today. Among the updates: (1) a new Global 2019-nCoV Clinical Data Platform will allow Member States to contribute anonymized clinical patient data; (2) approximately 20% of cases are severe, which aligns reasonably with the previous data; and (3) the assessed risk to China remains very high. Regional and global risk is assessed as high.

TRAVEL WARNINGS & GUIDANCE The US CDC and State Department have both issued Level 3 travel warnings for China, recommending that travelers “reconsider travel” (State Department) or “avoid non-essential travel” (CDC). Included in the State Department’s Level 3 travel warning is a short note that there is an additional Level 4 travel warning (ie, “do not travel”) specifically for Hubei Province. Interestingly, the main State Department list of travel advisories shows China as having a Level 3 advisory, but it does not mention that a Level 4 warning exists for Hubei Province. The US Embassy & Consulates in China website has a dedicated page for the Hubei-specific Level 4 travel warning . Previously, the US CDC had separate travel alerts for China and Wuhan/Hubei, but these appear to have merged into a single Level 3 warning for the entire country. Note: This newsletter previously reported on these changes, but we are covering them again for further clarity.

CHINA CDC RISK ASSESSMENT China’s CDC released [pdf] an updated risk assessment, which includes some epidemiological information. Notably, the age range for confirmed cases is 9 months to 96 years, but only 0.6% of confirmed cases are under the age of 15. The incubation period is thought to be 10 days (1-14 days). Older patients and those with underlying health conditions have been shown to be at higher risk of severe disease and death. The observed overall proportion of severe cases is 16.8%. The report estimates the mortality to be less than 3%, based on the available data. The primary routes of transmission are listed as respiratory droplets and close contact, and there is “reliable evidence...that the disease is contagious during the incubation period.” The estimated R0 at this point is between 2 and 3.

HUBEI PROVINCE RESPONSE Health officials from China’s National Health Commission held a press conference to discuss response activities currently ongoing in Hubei Province , including the deployment of medical teams to support coronavirus response operations. More than 4,130 personnel from 30 medical response teams have been deployed to Wuhan. These teams include civilian and military clinicians and experts in respiratory and infectious diseases, including both traditional Chinese and Western medicine. Another 13 teams—an additional 1,800 personnel—are expected to deploy today, bringing the total to nearly 6,000 total responders deployed to Hubei Province. In addition to Wuhan, these responders are working in several other cities in Hubei Province, including Huanggang, Xianning, Xiaogan, Xiantao, Tianmen, and Qianjiang. The officials also reported that 20 designated small- and medium-sized hospitals in Hubei Province have the capacity for 5,311 beds, and additional beds are being added gradually. Additionally, the 2 new rapid-construction hospitals are expected to be operational in the next week, adding 2,000-2,300 beds.