2019 Novel Coronavirus Update

Written by WorldClinic

February 24, 2020

2019 Novel Coronavirus Update

Updated: Mar 30, 2020

Reports last week that the SARS-CoV-2 epidemic had started to turn the corner appear to have been premature as they were a result of the change in accounting by the Chinese government. The epidemic in China is not peaking. From Friday through midday yesterday, there were 1,400 new cases reported and 192 deaths. The epicenter is still, by far, Wuhan and the Hubei Province in general. Of the 192 deaths over the weekend, only single digits were outside of Hubei. Actual case numbers in China, however, cannot be trusted because even within China, the case definition for reporting purposes is not standardized and international experts increasingly believe that the magnitude of the epidemic in China is much larger and much broader geographically than officially acknowledged.

Efforts to minimize infections across borders have been fairly successful, despite the increasing evidence that there is some unknown degree of transmission from people who are not yet or may never become, symptomatic. This has important implications for international trade and business as China will be increasingly isolated until they can “bend the curve” on case growth. The success in decreasing the rate of case importation will also mean that quarantine provisions will likely increase to include anyone at risk based on travel or exposure history, not just those who are ill. Over the weekend, only 3 additional imported cases of the disease have been noted (one each in Japan, Singapore, and the US) and in the last week only 6 new imported cases. Unfortunately, locally acquired cases have increased, especially in South Korea, with over 390 cases including 4 deaths (most linked to a single “super-spreader” in a megachurch that did not practice any infection control). Travelers are strongly advised to avoid Daegu, the country’s fourth-largest city, where the largest concentration of these cases is located. So far, it appears that South Korean health authorities have reasonable control of the situation, but this bears close monitoring. There are new reports today of a large group of cases in Italy, but details on this are not yet clear.

Note that in many cases, initial reports may be inaccurate, with the real situation usually, but not always, much more controlled than initially indicated.

The characteristic that continues to raise the most concern, is when there are cases that represent local transmission without any identifiable link to an imported case. This implies there are infectivity sources in the community that are uncontrolled (most likely because they had only mild symptoms that they thought were a typical seasonal viral infection). So far, outside of China, this has happened only in South Korea, Hong Kong, and Japan. In each of these countries, the absolute numbers are relatively small, but the implications for control are important. This may be occurring in other countries that do not have robust public health programs, especially in Africa and South America, where there are significant Chinese investments in both money and human capital, including the movement of Chinese to and from China during the Chinese New Year earlier this month. Multiple companies are attempting to develop a vaccine, including some smaller companies that claim to have a candidate vaccine ready to test. Larger well-funded and experienced companies, such as Sanofi, which has developed other coronavirus vaccines, believe that an investigational-use vaccine (first step to use in humans) is at least a year away with fully licensed use measured in multiple years. Note that many countries are imposing mandatory quarantines (some in quarantine facilities and some via self-quarantine) for travelers arriving from countries with sustained evidence of locally acquired cases not directly attributable to a Chinese case.

This is a situation that changes by the day. Please contact us with your specific travel plans and we can provide more detailed information and recommendations.

As an example, Israel is mandating a 14-day home-quarantine (with daily inspections) for all travelers from China, Japan, South Korea, Hong Kong, Macau, Singapore, and Thailand. Anyone considering travel to any country with local transmission should be aware that administrative restrictions (or reductions in air travel options) may affect travelers with little or no notice while in-country or on return to their home country. If currently traveling to a country with the local transmission that is not linked to a known imported case, consider returning home as soon as possible. We will pass along additional updates as they become available.

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