Novel coronavirus cases surge in China as disease investigations continue. Highest risk in Wuhan. Maintain basic health precautions.

Severity: Warning Alert

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This alert began 23 Jan 2020 21:52 GMT and is scheduled to expire 31 Mar 2020 23:59 GMT.

  • Incident: Novel Coronavirus
  • Location(s): Nationwide; primarily eastern provinces, especially Wuhan (map)
  • Period: December 2019-January 2020
  • Cases (Confirmed): 644 (644)

Summary
Chinese authorities report additional cases of 2019 Novel Coronavirus (2019-nCoV) Jan. 23, for a total of 644 confirmed cases. Most cases have occurred in Wuhan, Hubei Province (444 cases), with travel-related cases reported in 25 Chinese provinces (autonomous regions and municipalities). Sustained transmission of 2019-nCoV has not been confirmed outside Wuhan, though the true extent of this outbreak is likely larger than officially recognized.

All cases presenting with severe pneumonia have been hospitalized for treatment in isolation. Strict basic health precautions, respiratory hygiene, and diligent handwashing remain the best way to avoid infection. Additional cases will likely be identified in the coming days and weeks in this rapidly evolving situation.

On Jan. 23, the US CDC issued a "Warning-Level 3" travel health notice due to the ongoing outbreak of 2019 Novel Coronavirus (2019-nCoV) in Wuhan. This is the highest of three notice levels, indicating the US CDC recommends avoidance of any non-essential travel to Wuhan. Chinese authorities have shut down transportation in and out of Wuhan, as well as some other municipalities in Hubei Province. Older adults and people with chronic medical conditions or suppressed immune systems are at increased risk of severe symptoms from this respiratory illness.

Background and Analysis
Older individuals and those with chronic illness are more susceptible to infection and are at increased risk for severe complications. Human-to-human transmission has been confirmed by Chinese health authorities, though it remains unclear how easily the virus spreads between people. Some reports suggest conjunctivitis (reddening associated with infection or irritation of the eye) may be an early symptom of 2019-nCoV, and that respiratory droplets from infected individuals may infect others via contact with the mucous membrane of the eye. Investigations into transmission and disease modeling are ongoing. The reported clinical signs and symptoms of 2019-nCoV infection are primarily fever, chills, and difficulty breathing.

This outbreak was first reported Dec. 31, 2019, as suspected Severe Acute Respiratory Syndrome (SARS) cases. However, by Jan. 7, 2020 the pathogen was isolated and identified as a new type of coronavirus (2019 Novel Coronavirus, or 2019-nCoV), ruling out any other respiratory pathogens such as influenza, avian influenza, adenovirus, SARS, and Middle East Respiratory Syndrome coronavirus (MERS-CoV), as the cause. Evidence suggests that the primary outbreak is associated with exposures in the Huanan Seafood Wholesale Market and most of these cases were frequent visitors to the market or individuals who handled the seafood. Authorities closed the market Jan. 1, 2020. Animal-to-human transmission via domestic poultry, snakes, or contamination of food or surfaces by bats are more likely methods of such transmission.

The US CDC maintains a "Watch-Level 1" travel health notice due to 2019 Novel Coronavirus (2019-nCoV) activity in China, where cases imported from Wuhan have been reported throughout the country. This level of notice advises travelers to practice usual precautions: washing hands regularly with soap; avoid contact with sick individuals; and avoid animals (alive or dead), animal markets, and products that come from animals (especially uncooked meat).

Advice
Emphasize basic health precautions, especially frequent handwashing with soap and water, or an alcohol-based hand sanitizer if soap and water are unavailable. Avoid crowded areas and obviously ill people. Consider respiratory facemasks and protective eyewear. There is no evidence that influenza vaccine, antibiotics, or antiviral medications will prevent this disease, highlighting the importance of diligent basic health precautions.

Resources
WHO advice for international travel and trade

WHO Coronavirus knowledge base

US CDC "Warning-Level 3" travel health notice for Wuhan

US CDC "Watch-Level 1" travel health notice for China