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

Severity: Warning Alert

This alert began 27 Jan 2020 20:32 GMT and is scheduled to expire 31 Mar 2020 23:59 GMT.

  • Incident: Novel coronavirus outbreak
  • Location(s): Nationwide; primarily Hubei Province (map)
  • Period: December 2019-January 2020
  • Cases (Confirmed): 5,794 (2,858)

Summary
Chinese authorities continue to identify new cases of 2019 Novel Coronavirus (2019-nCoV) as elevated disease surveillance continues nationwide. Authorities have identified a total of 5,794 suspected cases, including 2,858 confirmed, according to data through Jan. 27. Most cases have occurred in Hubei Province (1,423 cases), approximately 700 of which were reported in Wuhan. Cases in other provinces were all imported from Wuhan, or other locations within Hubei Province, prior to the travel ban.

Sustained community transmission of 2019-nCoV within China has not been confirmed outside Hubei Province, though the true extent of this outbreak is likely larger than officially recognized.

All cases presenting 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 weeks in this rapidly evolving situation.

Background and Analysis
Older individuals and those with chronic illness are more susceptible to infection and are at increased risk for severe complications. Most people who are becoming ill, and nearly all who have died, were older with underlying medical conditions. Preliminary investigations indicate the course of illness is not as severe as seasonal influenza, nor as contagious. Clusters of disease transmission among families have been reported, as well as transmission in hospitals between patients and healthcare workers. Investigations into transmission and disease modeling are ongoing.

The incubation period of 2019-nCoV is approximately 1-14 days after exposure, with the average being 10 days until symptoms appear. Infected individuals are likely contagious to others before displaying symptoms. These symptoms include fever, fatigue, and cough, sometimes worsening to diarrhea, difficulty breathing, kidney failure, and pneumonia - especially in those with underlying medical conditions.

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 or bats are more likely methods of such transmission. Temporary bans on wildlife trade have been implemented to help curb this outbreak.

The US CDC maintains a "Warning-Level 3" travel health notice due to 2019 Novel Coronavirus activity in Hubei Province. This is the highest of three notice levels, indicating the US CDC recommends avoidance of any non-essential travel to Hubei Province. The US CDC also maintains an "Alert-Level 2" travel health notice for China, where cases imported from Wuhan have been reported throughout the country. This level of notice advises travelers to practice enhanced 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

WHO Coronavirus knowledge base

US CDC "Warning-Level 3" travel health notice for Hubei Province

US CDC "Alert-Level 2" travel health notice for China