Experts Question If New Coronavirus Can Be Contained In Wake Of WHO Emergency Announcement

In the wake of a World Health Organization declaration Thursday of an international public health emergency, there is growing uncertainty among disease control experts over whether even the drastic measures now being taken will be too little too late to contain the outbreak.

The concerns came as the reported case count of 9811 exceeded that of the 2002-03 SARS outbreak, and the fatalities rose to 213 dead. The United States and eight other countries issued stiff advisories against travel to China, while other countries and territories closed or restricted border entries, suspended visa authorizations, and cancelled flights.

However, such measures seemed to pale in the face of reports such as one published Friday by researchers from the University of Hong Kong, in The Lancet, which estimated that up to 75,800 individuals could be infected with the virus in the epicentre of Wuhan, a city of 10 million where the 2019-nCoV coronavirus first emerged in December 2019.

A medical team from Beijing’s Tsinghua (清华) University is sent to Wuhan to help fight the outbreak.

“In a manner of 3-5 weeks, countries around the world are going to be seeing outbreaks not that dissimilar to what we’ve been seeing in China,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP), told Health Policy Watch.

He warned that the dynamics of the outbreak were moving into “uncharted territory,” with the virus looking as infectious as the seasonal flu, and the current case-fatality approaching the alarming death rate seen in the 1918 Spanish Flu pandemic, which killed an estimated 50 million people worldwide.

The virus is also spreading silently among people with asymptomatic or mild infections who may not require or seek medical attention, reported the New England Journal of Medicine, in a letter Thursday. The letter, signed by over a dozen doctors from Munich’s University Hospital described the case of a 33-year old German businessman who fell ill with the virus and infected three other co-workers, shortly after meeting a Chinese business partner from Shanghai – who appeared healthy at the time, but became ill on her return flight home.

“The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak,” said the authors. Osterholm added that although it’s suspected asymptomatic patient are less infectious than those showing symptoms, experts are still determining how often asymptomatic transmission happens.

Although WHO’s Director General Dr Tedros Adhanom Ghebreyesus had said Thursday, during his announcement of the international public health emergency (PHEIC) that WHO did not recommend restrictions in trade or travel – which can cause “more harm than good” by hindering information-sharing and medical supply chains – his advice was being widely ignored.

The United States State Department Thursday issued a level-4 “do not travel” advisory for China – the highest level of travel restriction advisory. Canada, The United Kingdom, France, India, New Zealand, Finland, Australia, and Germany also have recommended against travel to China and particularly Hubei Province.

Egypt, Hong Kong, Russia, Malaysia, and Singapore took even more drastic measures to limit travel to and from China – including cutting flights, temporarily suspending visas, and even closing borders to the mainland – especially targeting travelers to and from Hubei.

On Friday, the Chinese Mission to the United Nations protested the increased travel restrictions in a Twitter post that said: “There is no reason for measures that unnecessarily interfere with international travel and trade. WHO doesn’t recommend limiting trade and movement.”

As for other measures governments should be taking to protect against 2019-nCoV, Osterholm told HPW that countries should be “preparing their health systems as much as they can” with an eye towards “protecting their healthcare workers.”

“Many hospitals in China that are reporting cases in healthcare workers do not have adequate protective equipment because they’ve run out,” said Osterholm.

He added that other countries should prepare for “a major increase in patients with respiratory disease like this who are not only going to need a bed, but some form of isolation so that they don’t transmit the virus to others. And that includes protecting healthcare workers.”

China Blamed For Cracking Down On Medical Reports Of New Virus in Early December

While the WHO Director General repeatedly praised China for its fast and efficient response, other media reports criticized the Chinese government for covering up details of the new virus in its early days in December – and hauling doctors who reported the initial emergence of the novel infections before police for punishment.

“In late Dec a Wuhan doctor said in a WeChat group that there were 7 cases of SARS connected to the seafood market. He was then scolded by the party disciplinary office, and made to sign a “I’m wrong” statement with police. He’s still in critical condition [from the disease],” reported Yaxue Cao, founder and editor of the respected ChinaChange.org website, which reports on Chinese civil society and the rule of law, in a Twitter thread that was circulating widely among Chinese and abroad.

“From the same report, we learned that Wuhan health authorities were having overnight meetings about the new “SARS” at end of Dec. Earlier today the Wuhan mayor said he was not “authorized” to publicize the epidemic until Jan 20. Q[uestion] is, “what went on during the 3 weeks in between?” said Cao.

Li Wenliang, doctor at Central Hospital of Wuhan, was one of the 8 people reprimanded by police for spreading “rumors” about the new viral disease.

“The first known coronavirus infections in the city of Wuhan presented symptoms beginning on December 1 and by 8 December, there was alarm in Wuhan’s medical circles. That would have been the moment for the authorities to act decisively. And act decisively they did – not against the virus but against whistle-blowers who were trying to call attention to the public health threat,” said New York Times journalist Nicholas Kristof, in an 30 January Op-Ed that related the authorities’ detention of a group of Wuhan medical doctors’ who had reported the emergence of an unidentified SARS-like virus on WeChat social media. One doctor who was among the group detained in January later posted his story and photo online, and is currently recovering from the disease himself.

Other reports have also confirmed that China was busy cracking down on journalists and social media about the virus in early and mid-January – at a time when more information might have strengthened the early response effort.  A Hong Kong news station said its reporters were approached by police during an interview in a Wuhan hospital in mid-January, and forced to delete their interviews and photographs.

Shanghai sources reached by Health Policy Watch also confirmed that the “government told Chinese citizens not to talk about the outbreak on social media” a couple of weeks ago.

Virus May Have Spread Too Far To Be Squashed Like SARS – Africa At Risk

Speculation was now growing over whether the virus could in fact be contained and effectively eliminated, as was the case with SARS in the 2002-2003 outbreak, or if it might enter permanently into the global chain of viral transmission – at least until a vaccine could be developed.

Already, the number of reported cases has outnumbered those of SARS, which reached 8,000, and also appears to be more insidiously infectious – although SARS still had a higher fatality rate.

And that is not including the asymptomatic cases, which may number as high as 75,000 in Wuhan alone, according to a study published Friday in The Lancet.

African countries, which have a deep and embedded network of links with China may be particularly at risk. Even though so far, no cases had been reported on the continent, several individuals suspected of infections had been quarantined. And asymptomatic cases could be slipping through borders undetected, experts feared.

It was the need to bolster response in low-income countries with weaker health systems and fewer resources was a key consideration in the WHO declaration of a PHEIC on Thursday, Dr Tedros repeatedly emphasized.

Already earlier this week, senior officials from African Union (AU) said screening and surveillance was being enhanced across the continent.

John Nkengasong, the director of African Centre for Diseases Control and Prevention warned that the continent stood at “risk” given its existing links with China at the moment.

“It is very possible that we have cases, but not recognised,” Nkengasong told reporters at the African Union (AU) headquarters in Addis Ababa.

Airports across the continent have increased screening for passengers, even as carriers announced flight cancellations. Kenya Airways halted flights to Guangzhou, backtracking on earlier statements that it would continue to monitor the situation. Ethiopian Airlines has also suspended its flights.

Some African countries were considering evacuating their citizens from the Chinese province – although only Morocco said it would actually evacuate 100 nationals. An estimated 4,600 African students are residing in Hubei Province, ground zero for the rapidly spreading virus.

As the virus struck just before the Chinese Lunar New Year, some students had already travelled back home to Africa before Wuhan and the Hubei region were placed under lockdown. But a large number of students still remain trapped in Hubei.

However so far, no cases have been reported among the returning students. Kenya’s Health Cabinet Secretary, Cecily Kariuki, Ministry of Health confirmed that a student who had been quarantined at Kenyatta National Hospital in Nairobi after returning to Kenya from Wuhan on 28 January was virus-free. Zweli Mkhize, South Africa’s Minister for Health said the country had screened 55 frequent travelers to China at points of entry, all who were found to be virus-free.

“We have remained vigilant on the development regarding the movement and behaviour of the viral infection across the world and we continue to engage with the international academic fraternity to better understand how the virus behaves,” Mkhize told News24.

However, with the climbing reports of confirmed cases, models suggesting tens of thousands more in China, and reports of asymptomatic carriers able to infect others within days, the chances of any country remaining virus-free for much longer were rapidly diminishing.

“Trying to control transmission of a virus like this, an influenza-like virus, is virtually impossible. So you can try to keep it out or minimize its arrival into your area into a very limited degree, but generally it’s going to make its way,” Osterholm told Health Policy Watch.

“In terms of what actions countries and governments can take right now, it’s really preparing their health systems as much as they can. And one of the things to prepare in fact is protection for their healthcare workers.”

Further Actions To Speed Vaccine Trials Announced

Meanwhile, as public health experts looked towards a new vaccine as a potential solution, the Oslo-based Coalition for Epidemic Preparedness (CEPI), announced its fifth collaboration in just a few weeks – to accelerate development of a vaccine against the new coronavirus.

CEPI said that it had signed a collaboration with CureVac AG, a biopharmaceutical company pioneering the field of mRNA-based drugs, aims to “safely advance vaccine candidates into clinical testing as quickly as possible, and would include US $8.3 million from CEPI to fund accelerated vaccine development, manufacturing and clinical tests,” according to a press release.

Rendering of the novel coronavirus, 2019-nCoV, created by the US CDC.

The coronavirus is made up of a single RNA chain enclosed in a spiky, spherical envelope.

Yesterday CEPI also launched a new call for proposals to rapidly develop and manufacture already proven vaccine technology that can be used against the new coronavirus. The call is rolling and open for two weeks.

CEPI also has three other collaborations underway with the Pharma company Inovio, The University of Queensland (Australia) as well as a third partnership involving Moderna, Inc. and the US National Institute of Allergy and Infectious diseases.

Grace Ren and Fredrick Nzwili contributed to this story

Image Credits: Twitter: @Tsinghua_Uni, Nandu News, US Centers for Disease Control and Prevention.