WHO declares public health emergency Jan. 30. Coronavirus cases surge in China as investigations continue. Use basic health precautions.

This alert affects China

This alert began 30 Jan 2020 21:27 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): 12,167 (8,163)

Summary
On Jan. 30, the WHO declared the ongoing coronavirus outbreak a Public Health Emergency of International Concern (PHEIC). This indicates that the outbreak requires a coordinated international response, primarily due to the potential for the virus to spread to countries with weaker health systems that would be ill-equipped to contain it. So far, every country that has identified imported cases has contained them appropriately. In a press statement after the announcement, the WHO stressed that there should be no restrictions on travel or trade and that it remains supportive of China's work to address the outbreak.

Chinese authorities continue to identify new cases of 2019 Novel Coronavirus (2019-nCoV) as elevated disease surveillance continues. Authorities have identified a total of 12,167 suspected cases nationwide, including 8,163 confirmed, according to data through Jan. 30. Most cases have occurred in Hubei Province (4,903 cases), approximately 2,260 of which were reported in Wuhan.

The true extent of this outbreak is likely larger than officially recognized. 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, the average being 3-7 days until symptoms appear. Infected individuals are contagious to others before displaying symptoms. These symptoms include fever, fatigue, cough, difficulty breathing, sometimes worsening to diarrhea, 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 China. This is the highest of three notice levels, indicating the US CDC recommends avoidance of any non-essential travel to China. Limited access to adequate medical care in affected areas has been reported. This level of notice also advises travelers to practice enhanced precautions: washing hands regularly with soap; avoid contact with sick individuals; and avoid animals (alive or dead), wet 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 close contact with animals (dead or alive), especially at wet markets. Practice good coughing/sneezing etiquette (i.e., covering coughs and sneezes with a disposable tissue, maintaining distance from others, and washing hands). There is no evidence that the 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 China