Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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February 19, 2020

EPI UPDATES The National Health Commission of China reported 1,749 new confirmed cases across the country, 1,185 suspected cases, and 136 new deaths. In total, there are 74,185 confirmed cases and 2,004 deaths. Of those, 1,693 cases are in Hubei province. The National Health Commission also report that a joint expert team from China and WHO have begun field inspections in Beijing, Guangdong province and Sichuan province.  

South China Morning Post reported that a 70 year old local in Hong Kong has died from COVID-19, becoming the second person in Hong Kong to die from the virus. There are a total of 63 cases in Hong Kong. Japan announced 6 new cases of COVID-19 and one possible asymptomatic carrier, bringing the total to 53 patients and 13 asymptomatic carriers. Singapore reported a total of 84 confirmed cases, and 34 cases discharged. Reuters reported 20 new cases in South Korea, with 14 patients traced back to multiple church services in the city of Daegu, bringing the total number of cases there to 51. 

NEW CASE DEFINITIONS, THERAPEUTICS, DISCHARGE CRITERIA FROM CHINA China’s National Health Commission has released new guidance for the epidemiological and clinical management of COVID-19. In the previous edition, it was announced that cases without diagnostic testing could be recorded as ‘confirmed’ in Hubei province. In the new edition, this was cancelled. There are now three categories: (1) suspected, with an epidemiological history and two clinical symptoms; (2) suspected, without a clear epidemiological history and three clinical symptoms; (3) confirmed by RT-PCR or gene sequencing. The guidance also now recommends several therapeutics, including chloroquine phosphate, Abidol, ribavirin, and others. Finally new criteria for discharge and de-isolation include: (1) normal body temperature for more than three days; (2) improvement of respiratory symptoms; (3) improved pulmonary imaging; (4) two negative PCR tests, at least 1 day apart. We note that these changes to the case definition will likely be reflected in the number of new cases reported in the coming days, and that this change should be considered when considering the epidemic’s trajectory.

IRAN CONFIRMS FIRST CASES According to the New York Times , Iranian authorities have confirmed two cases of COVID-19, becoming the first two cases identified in the country. Other cases have been reported in other Middle Eastern countries including the United Arab Emirates, and Egypt. 

DIAMOND PRINCESS US Centers for Disease Control released a statement regarding 100 Americans who remain aboard the Diamond Princess will be required to undergo an additional 14 days of quarantine in Japan after disembarking before they are permitted to reenter the United States. Passengers have begun disembarking from the cruise ship as the 14 day quarantine period for the passengers has ended. Passengers will disembark over a 3 day period, however, those who shared cabins with infected passengers will be required to remain onboard. Over 621 people have been infected while aboard the ship, with a total of 79 new cases reported yesterday, indicating that a substantial proportion will not be able to leave yet. The experiences with the Diamond Princess and other cruise ships have taken a financial toll on parent company, Carnival. Elsewhere in the cruise industry , “More than 50 cruises have been cancelled, seven ports closed and thousands of holidaymakers’ plans disrupted.”

CALL FOR DISTINCT VIRUS NAME A paper published in The Lancet is calling for a distinct name for the virus causing the ongoing COVID-19 outbreak. Originally the Coronavirus Study Group of the International Committee on Virus Taxonomy suggested the name SARS-CoV-2, based on phylogenetic characteristics of the virus. The paper states that having the virus name SARS-CoV-2 which is unrelated to the disease name COVID-19 is misleading and calls for a unique name to be given to the virus. This will enable better and more clear communication and avoid unnecessary confusion. The paper suggests renaming the virus from SARS-CoV-2 to human coronavirus 2019 (HCoV-19). 

AMERICANS RELEASED FROM US QUARANTINE A total of 346 Americans who were quarantined for 14 days upon returning from Wuhan have been released from the designated quarantine sites, Travis Air Force Base and Marine Corps Air Station. Among those who entered the quarantine, one person has been confirmed to be infected and is under care at a local hospital.

RUSSIA WIDENS TRAVEL RESTRICTIONS FROM CHINA The Associated Press reported that Russia will now indefinitely ban all Chinese nationals from entering the country. Russia, which has three reported cases, halted air traffic, closed its land borders, and stopped issuing work visas with China. Russia may also begin deportations of foreigners infected with the virus. 

MEDICAL COUNTERMEASURES The Biomedical Advanced Research and Development Authority is partnering with pharmaceutical company Janssen to make therapeutics to target SARS-CoV-2. Researchers at Janssen and the Belgian Rega Institute for Medical Research will conduct high throughput screening of a library of already approved as well as investigational therapeutics. 

MEDICAL SUPPLIES FDA has not been able to inspect any Chinese factories this year, and officials have warned that the outbreak "will likely impact the medical product supply chain, including potential disruptions to supply or shortages of critical medical products in the U.S." 

An American factory capable of expanding mask production is not doing so , because expanding in a previous outbreak nearly destroyed the company: “Everybody said they’d stay with us. The day after the pandemic they forgot who we were. We nearly went out of business … I can’t do that. I can’t put our company — I can’t fire 100 people again.” 

In other news, 16 tons of medical supplies donated from the US have arrived in China, but that the Chinese government is awaiting a  $100 million donation that the US government has previously pledged. 

IMPACT ON HIV PATIENTS UNAIDS announced today it is working with Chinese officials and community partners to ensure that people with HIV in the country have access to the medication amidst the expanding COVID-19 epidemic. Access to treatment has been affected due to travel restrictions and supply chain constraints with HIV antiretroviral therapies. The Chinese National Center for AIDS/STD Control and Prevention has directed authorities to ensure that people with HIV can receive treatments regardless of their location and has disseminated lists of clinics providing antiretroviral therapies. UNAIDS also said it was donating PPE to facilitate care of individuals with HIV and COVID-19 coinfection. 

RACISM AND STIGMA Reports of increased racism and bias towards people of  Chinese nationality and Asian descent highlights a troubling impact of the ongoing COVID-19 outbreak. Anecdotal reports of people being told to leave public places and social media posts warning against visiting establishment owners by Chinese people is becoming a more common reality as the outbreak continues. Additionally, in Europe, there has been stigmatization of infected travelers returning from affected countries. Racism, fear, and social backlash are serving as social contagions during the outbreak. 

ECONOMIC IMPACTS Central Beijing is busier as some shops reopen and activity resumes. However, the Washington Post reports that “Xicheng district, one of Beijing’s most central locales and the site of the Chinese government’s central headquarters, is tightening restrictions and increasing tests…” In other news, shipping along the Yangtze River Channel is down 90%.

ASYMPTOMATIC TRANSMISSION A study published in the Journal of Infectious Diseases reports on the epidemiological features of four patients in a familial cluster in Shanghai. Notably, the study found that an 88 year old male, whose only exposure was to family members who were purportedly asymptomatic, was infected. The suggest this as evidence of potential transmissibility of the virus during the incubation period. A report in the New England Journal of Medicine describes 114 individuals evacuated from Wuhan City to Germany. Of the evacuees who were negative on symptom screening, 2 tested positive by RT-PCR for SARS-CoV-2. The study asserts that based on this evidence, symptom based screening alone is not effective for detecting all potential cases of SARS-CoV-2. 

PATHOLOGICAL FINDINGS Lancet Respiratory Medicine reports on the results of autopsy in a patient who died from infection with SARS-CoV-2. Biopsies from heart, lung, and liver tissues show pathological features consistent with those seen in patients infected with SARS-CoV and MERS-CoV. The examination found a lack of substantial damage to heart tissues. Based on lung pathology, including pulmonary edema and hyaline membrane formation, use of corticosteroids along with mechanical ventilation should be considered to prevent the development of acute respiratory distress syndrome.