Wednesday, January 22, 2020

Taiwan CDC Update On Novel Coronavirus Cases & Preparedness



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With new reports coming in literally by the hour, it is impossible to dedicate a blog post for each case count or location update.  The most current consolidated case count  I've found comes from Taiwan's CDC, which lists  440 cases in mainland China, of which 9 have died, and another 9 cases confirmed outside of China.
These number represent lab-confirmed cases that were sick enough, or lucky enough, to be hospitalized and tested. 
Given the (still unknown, but estimated) incubation period of 7 to 14 days, with often as long as a week of illness before seeking medical help and being tested, there is likely at least a 2 week lag time between when many of these cases became infected, and when they were reported.

And while the number of mild, or even subclinical infections with nCoV2019 is unknown at this time, our experience with MERS-CoV suggests they could represent a substantial number of cases flying under the radar..

The point being that these numbers are useful in determining the geographic spread of the virus, and the trajectory in the number of new cases being reported, but they don't really tell us much about how many people have really been infected. 

In response to the outbreak of pneumonia in Wuhan, Mainland China, the command center continued to coordinate the resources and manpower of all ministries and departments to fully guard the domestic epidemic prevention security

Release Date: 2020-01-22
In response to the first domestic case of severe special infectious pneumonia returning from Wuhan, Mainland China, the Central Epidemic Epidemic Command Center continued to coordinate the manpower of various ministries, strengthen port quarantine measures and public risk communication and health education to reduce public panic; Pre-planning and rehearsing for infection control in medical institutions to reduce the impact of the epidemic on the country, fully protect the domestic epidemic prevention security and ensure the health of the people.
The command center said that the number of masks is sufficient, and people do not need to panic and snap up. From today, the Department of Disease Control will distribute surgical masks to Chaoshang's designated logistics center, which will then be sold by Chaoshang. One million each will be released from January 22 and January 23, and another one million will be released every week from January 30 to March 20, subject to flexible adjustments based on actual conditions.
The command center stated that according to the information reported by the Chinese Centers for Disease Control and Prevention on this (22) day, 440 cases have been confirmed in mainland China, of which 9 have died, including 258 in Wuhan, 12 in Huanggang, 17 in Guangdong, and 6 in Shanghai.
There were 10 cases in Beijing, 5 cases in Zhejiang Province, 5 cases in Chongqing City, 2 cases each in Tianjin, Sichuan Province, and Jiangxi Province, and 1 case each in Henan Province, Yunnan Province, Shandong Province, and Hunan Province. The remaining cases have not been announced in the provinces.
There are currently 9 cases in other countries and regions, including 4 in Thailand, 1 in Taiwan, Japan, South Korea, the United States, and Macau, all of which have Wuhan tourism history. 
In response to the outbreak of pneumonia in Wuhan in mainland China, the command center continued to strengthen the surveillance of outbreaks and border control measures, and comprehensively inquired Wuhan's travel history and conducted health assessments for incoming fever travelers from international and small three-way ports. Since December 31, 2019, boarding and quarantine of direct flights from Wuhan has been launched. 37 flights have been carried out and 4,469 passengers and crew members have been quarantined. There are no new evacuation cases. 
There are 9 cases of severe special infectious pneumonia in China listed as pre-notifications of statutory infectious diseases, all of which have been ruled out; 21 suspected cases have been reported as of statutory infectious diseases as of yesterday (21), 8 have been ruled out, and 12 are in isolation. 1 The confirmed diagnosis was the first overseas transfer case announced yesterday. It is currently being treated in the negative pressure isolation ward of the hospital. Except for one contact person who had a slight cough without fever, the rest were normal.
The command center once again urged that the tourist outbreak recommendation in Wuhan, Mainland China has been raised to a third level warning, reminding the public to avoid going to the area unless necessary. If you need to go, you should implement personal hygiene measures such as washing your hands frequently with soap, wearing a mask for coughing, avoiding contact with wildlife and patients with acute respiratory infections, and avoid entering and exiting traditional markets and medical institutions. When returning to China from Wuhan and its adjacent areas, if you have fever, cough, or shortness of breath, whether you take antipyretics or cough medicine, please report to the quarantine staff at the airport or at the port to receive a health assessment. Within 14 days of returning to China If you have fever or respiratory symptoms, please call the toll-free epidemic prevention line 1922 or (0800-001922) and follow the instructions to wear a mask as soon as possible to seek medical treatment. When you seek medical treatment, please inform the doctor of your travel history, occupation, contact history, and whether you are in a group ( TOCC), timely diagnosis notification. For more information on "Severe Special Infectious Pneumonia", please refer to the website of the Department of Health (https://www.cdc.gov.tw).

China MOA: 5th Recent Outbreak Of HPAI H5N6 (in Swans) in Western Xinjiang Province


Xinjiang Uygur autonomous region
Photo Credit- Wikipedia


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While avian flu outbreaks (in poultry and in humans) have been greatly subdued in China for the past couple of years, since the first of the year we've been following a revival of sorts, of HPAI H5N6 outbreaks in swan in the western province of Xinjiang (see here, here, and here).
The Asia strain of HPAI H5N6 has been the most successful avian H5 virus affecting humans in China, with roughly 2 dozen known (and often fatal) infections since 2014.



HPAI H5N6 continues to evolve, and while it hasn't spread as far and wide as its HPAI H5N1 and HPAI H5N8 cousins, last November - in EID Journal: Genetic Characterization of Avian Influenza A(H5N6) Virus Clade 2.3.4.4, Russia, 2018 - we saw the details of last winter's first detection of China's HPAI H5N6 virus in Western Russia.

Today's report (announced yesterday by the MOA), is the 5th outbreak reported since January 8th.

Swans in the Ma Division of the Eighth Division of the Xinjiang Production and Construction Corps H5N6 subtype highly pathogenic avian influenza epidemic

Date: 2020-01-21 16:38 Author: Source: Ministry of Agriculture and Rural Press Office 
 The Information Office of the Ministry of Agriculture and Rural Affairs announced on January 21 that a wild swan H5N6 subtype highly pathogenic bird flu outbreak occurred in the Ma Division of the Eighth Division of the Xinjiang Production and Construction Corps.
On January 21, the Ministry of Agriculture and Rural Affairs received a report from the China Animal Epidemic Prevention and Control Center. After confirmed by the National Avian Influenza Reference Laboratory, the wild swan H5N6 subtype of the wild swan in the Daquangou Reservoir of the Eighth Division of the Xinjiang Production and Construction Corps was diagnosed. Bird flu outbreak. More than 150 swans perched in the area, 19 were ill and 19 died. After the outbreak, a local person has been sent to pay close attention to the swans in the area and disinfect the surrounding environment. All sick and dead birds have been harmlessly treated.

 

Thailand MOH Reports 4th Confirmed Coronavirus Case - Macao Reports 1st Case


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One of the realities of blogging during an ongoing event is you have to sleep sometime, and while I caught about six hours of badly needed rack time, the case counts in China have continued to mount, Thailand has announced two more imported cases, and Macao has announced their first case.
Thankfully, I got a brief late night skype update from Sharon Sanders at FluTrackers, where their global network of volunteer newshounds are able to cover extended events like this even on a 24/7 basis. 
First this (translated) statement from Thailand's Ministry of Health

Ministry of Public Health raises surveillance levels for new species of coronary viruses during the Chinese New Year festival.
22 January 2020
Deputy Prime Minister and Minister of Public Health teleconferencing for all medical facilities Comply with the highest standards Raise surveillance levels Prevention and control of new strains of coronary virus during the Chinese New Year, coordinating the Ministry of Foreign Affairs. Ministry of Tourism Notify tour companies for surveillance Take care of tourists who come to Thailand
Today (22 January 2020) at the Ministry of Public Health, Nonthaburi Province, Mr. Anutin Charnwirakul, Deputy Prime Minister and Minister of Public Health Together with Dr. Sukhum Kanjanaphimai, Permanent Secretary of the Ministry of Public Health, have a remote conference on the case of "New species of coronary pneumonia 2019" with provincial public health doctors and hospital directors nationwide
Mr Anutin gave an interview that During the Lunar New Year, all hospitals will upgrade surveillance measures. Prevent disease control According to the highest standards used for emerging infectious diseases Ready to upgrade the emergency operation center to respond to the situation to level 3, as well as add quick and efficient screening systems in all 5 airports, monitor patients at both public and private hospitals, have a system for screening diseases and patients quickly Organize a team of doctors, nurses and personnel who are trained in diagnosing diseases. Laboratory results are known in 24 hours. Provide treatment guidelines according to international standards. Ready to coordinate the Ministry of Foreign Affairs And the Ministry of Tourism and Sports Notify tour companies, watch out for tourists Both traveling in Thailand and Thai people traveling abroad
For Thailand situation From 3 - 21 January 2020, screening 123 flights from Wuhan City. A total of 19,480 passengers and crew, with 2 Chinese tourists confirmed. The doctor provided treatment and returned the country. This week, another 2 patients were found. The first was a Thai woman with a history of traveling to Wuhan. Get treatment at Nakhon Pathom Hospital At this time, symptoms have improved. The second person is a Chinese tourist who is a man. Was screened for high fever at Suvarnabhumi Airport on January 19, currently undergoing treatment at the Bamrasnaradura Institute. Results of the detection of a new strain of the corona virus
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Next, we have this brief announcement from Macao's government website. (Note : one of the idiosyncrasies of translating Chinese to English is that the symbol for Macao translates to `Australia'.)

The SAR Government Is Fully Prepared to Deal with New Coronavirus
Source: Information Service (GCS)
Release Date: January 22, 2020 14:53
In response to the outbreak of the first new coronavirus infection in Macau, the government has launched and deployed the anti-epidemic work in an all-round way, and taken necessary measures including conducting heat exploration and filling in entry declaration forms at ports to fully cope with and prevent the epidemic.
A female passenger from Wuhan came to Australia via Gongbei Port on the 19th. She went to Renjue General Hospital for medical treatment on the 21st and was diagnosed as a new coronavirus infection. The patient is currently in stable condition and receiving isolated treatment. In this regard, the "New Coronavirus Infection Response Coordination Center" held its first meeting to fully launch and deploy the anti-epidemic work to deal with and prevent the epidemic.

Tuesday, January 21, 2020

CDC Activates its Emergency Response System - Novel Coronavirus Update Jan 21st


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While the ultimate impact of China's novel coronavirus outbreak is far from certain, the United States, and many other countries around the world, are gearing up to deal with whatever might come.
Tomorrow the WHO will hold a meeting of their IHR Emergency Committee to discuss the spread of the virus in China, and to decide whether it constitutes a PHEIC (Public Health Emergency of International Concern). 
While the risk to the general public in the United States is currently considered LOW - today, in addition to their press conference on the 1st US case, and an updated travel advisory - the CDC has updated their dedicated Novel Coronavirus page with the latest developments and current risk assessment.   You'll find a link, and excerpts from, today's update below.

2019 Novel Coronavirus (2019-nCoV), Wuhan, China

This is an emerging, rapidly evolving situation and CDC will provide updated information as it becomes available, in addition to updated guidance.
On This Page
Situation Summary Risk AssessmentWhat to ExpectCDC ResponseOther Available Resources
Updated January 21, 2020
Situation Summary

The Centers for Disease Control and Prevention (CDC) is closely monitoring an outbreak caused by a novel (new) coronavirus in Wuhan, Hubei Province, China. Chinese authorities first identified the new coronavirus, which has resulted in close to 300 confirmed human infections in China with several deaths reported. A number of countries, including the United States, have been actively screening incoming travelers from Wuhan and exported human infections with the novel coronavirus have been confirmed in Thailand, Japan, and The Republic of Koreae.
The United States announced their first infection with 2019-nCoV detected in a traveler returning from Wuhan.
Chinese health authorities posted the full genome of the so-called “2019 novel coronavirus” or “2019-nCoV” in GenBankexternal icon, the NIH genetic sequence database, and in the Global Initiative on Sharing All Influenza Data (GISAIDexternal icon) portal.
Coronaviruses are a large family of viruses, some causing illness in people and others that circulate among animals, including camels, cats and bats. Rarely, animal coronaviruses can evolve and infect people and then spread between people such as has been seen with MERS and SARS. Past MERS and SARS outbreaks have been complex, requiring comprehensive public health responses.
Early on, many of the patients in the outbreak in Wuhan, China reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread. However, a growing number of patients reportedly have not had exposure to animal markets, suggesting limited person-to-person spread is occurring, though it’s unclear how easily or sustainably this virus is spreading between people. Both MERS and SARS have been known to cause severe illness in people. The situation with regard to 2019-nCoV is still unclear. While severe illness, including illness resulting in four deaths, has been reported in China, other patients have had milder illness and been discharged.
There are ongoing investigations to learn more. This is a rapidly evolving situation and information will be updated as it becomes available.
Risk Assessment
Outbreaks of novel virus infections among people are always of public health concern. The risk from these outbreaks depends on characteristics of the virus, including whether and how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (for example, vaccine or treatment medications).
There is much more to learn about how the 2019-nCoV virus spreads, severity of associated illness, and other features of the virus. Investigations are ongoing. While CDC considers this is a serious public health concern, based on current information, the immediate health risk from 2019-nCoV to the general American public is considered low at this time. Nevertheless, CDC is taking proactive preparedness precautions.
What to Expect
Access to the full genetic sequence of 2019-nCoV will help identify infections with this virus going forward. More cases may be identified in the coming days, including more in countries outside China, including possibly more cases in the United States. Given what has occurred previously with MERS and SARS, it’s likely that some limited person-to-person spread will continue to occur.
CDC Response
  • CDC is closely monitoring this situation and is working with WHO.
  • CDC established a 2019-nCoV Incident Management Structure on January 7, 2020. On January 21, 2020, CDC activated its Emergency Response System to better provide ongoing support to the 2019-nCoV response.
  • On January 21, 2020, CDC again updated its interim travel health notice for this destination to provide information to people who may be traveling to Wuhan City and who may get sick. The travel notice was raised from Level 1; Practice Usual Precautions, to a Level 2: Practice Enhanced Precautions advising travelers that preliminary information suggests that older adults with underlying health conditions may be at increased risk for severe disease.
  • CDC began entry screening of passengers on direct and connecting flights from Wuhan China to the three main ports of entry in the United States on January 17, 2020 and will to expand that screening to Atlanta and Chicago in the coming days. CDC, working with DHS, also will funnel all travelers from Wuhan, China to the five airports conducting entry health screening. Together, the five airports will cover all travelers arriving in the United States whose travel originated from Wuhan, China.
  • CDC issued an updated interim Health Alert Notice (HAN) Advisory to inform state and local health departments and health care providers about this outbreak on January 17, 2020.
  • A CDC team has deployed a team to support the ongoing investigation in the state of Washington in response to the first reported case of 2019-nCoV in the United States, including potentially tracing close contacts to determine if anyone else has become ill.
  • CDC has developed a real time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test that can diagnose 2019-nCoV. Currently, testing for this virus must take place at CDC, but in the coming days and weeks, CDC will share these tests with domestic and international partners through the agency’s International Reagent Resourceexternal icon.
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Coronavirus: CDC Elevates China Travel Advisory To Level 2 - Practice Enhanced Precautions







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On January 6th, before we even knew that China's pneumonia outbreak was due to an emerging coronavirus, the CDC Issued a Level 1 (Watch) Travel Notice For Unidentified Pneumonia - Wuhan, China.

Today, with cases spreading across China, the CDC has released a revised Travel Advisory advising enhanced precautions for travelers.

Novel Coronavirus in ChinaWarning - Level 3, Avoid Nonessential Travel
Alert - Level 2, Practice Enhanced PrecautionsWatch - Level 1, Practice Usual Precautions
Key Points
  • There is an ongoing outbreak of pneumonia first identified in Wuhan, China, caused by a novel (new) coronavirus.
  • Person-to-person spread is occurring, although it’s unclear how easily the virus spreads between people.
  • Preliminary information suggests that older adults and people with underlying health conditions may be at increased risk for severe disease from this virus.
  • Travelers to Wuhan, China, should avoid contact with sick people, animals (alive or dead), and animal markets.
  • Travelers from Wuhan to the United States, and other countries, may be asked questions about their health and travel history upon arrival.
  • The situation is evolving. This notice will be updated as more information becomes available.
What is the current situation?
A novel (new) coronavirus is causing an outbreak of pneumonia illness in the city of Wuhan, Hubei Province, China. This outbreak began in early December 2019 and continues to expand in scope and magnitude. Global surveillance is in the early stages and we expect more cases to be confirmed in China and beyond its borders. Signs and symptoms of this illness include fever, cough, and difficulty breathing. Initially some patients were linked to the Wuhan South China Seafood City (also called the South China Seafood Wholesale Market and the Hua Nan Seafood Market). However, since closing the market on January 1, 2020, more cases have been identified suggesting that some person-to-person spread is occurring though it’s unclear how easily this virus is spreading between people.
Coronaviruses are a large family of viruses. There are several known coronaviruses that infect people and usually only cause mild respiratory disease, such as the common cold. However, at least two previously identified coronaviruses have caused severe disease — severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). SARS-CoV and MERS-CoV have been ruled out as the cause of the current outbreak.
Chinese health officials have reported hundreds of cases in the city of Wuhan and severe illness has been reported, including deaths. Cases have also been identified in travelers from Wuhan to other parts of China and other countries. This novel coronavirus has the potential to cause severe disease and death. Preliminary information suggests this is especially true among the elderly and those people with underlying health problems or compromised immune systems. Many characteristics of this novel coronavirus and how it may affect people are still unclear.
In response to this outbreak, Chinese officials have started exit screening for travelers leaving the city of Wuhan and several countries and territories in the region are reported to have implemented health screening of travelers arriving from Wuhan.
On arrival to the United States, travelers from Wuhan may undergo health screening, including having their temperature taken and filling out a symptom questionnaire.
Travelers with signs and symptoms of illness (fever, cough, or difficulty breathing) will have an additional health assessment.
What can travelers do to protect themselves and others?
Travelers to Wuhan should
  • Avoid contact with sick people.
  • Avoid animals (alive or dead), animal markets, and products that come from animals (such as uncooked meat).
  • Wash hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
  • Older travelers and those with underlying health issues may be at risk for more severe disease and should discuss travel to Wuhan with their healthcare provider.
  • If you traveled to Wuhan and feel sick with fever, cough, or difficulty breathing, you should
  • Seek medical care right away. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel and your symptoms.
  • Avoid contact with others.
  • Not travel while sick.
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
  • Wash hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
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WHO Novel Coronavirus (2019-nCoV) SITUATION REPORT - 1









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The World Health Organization has just published their first 2019-nCoV SitRep; a 5 page PDF which provides a timeline and summary of outbreaks to date.
As events are moving so fast, this first SitRep doesn't include the Taiwan or U.S. imported cases, and the case counts listed have already grown.   
I've only reproduced a portion of the document, so follow the link to download it and read it in its entirety. 


Novel Coronavirus (2019-nCoV)  SITUATION REPORT - 1
Data as reported by: 20 January 2020
SUMMARY
Event highlights from 31 December 2019 to 20 January 2020:
 
  • On 31 December 2019, the WHO China Country Office was informed of cases of pneumonia unknown etiology (unknown cause) detected in Wuhan City, Hubei Province of China. From 31 December 2019 through 3 January 2020, a total of 44 case-patients with pneumonia of unknown etiology were reported to WHO by the national authorities in China. During this reported period, the causal agent was not identified.
  • On 11 and 12 January 2020, WHO received further detailed information from the National Health Commission China that the outbreak is associated with exposures in one seafood market in Wuhan City.
  • The Chinese authorities identified a new type of coronavirus, which was isolated on 7 January 2020.
  • On 12 January 2020, China shared the genetic sequence of the novel coronavirus for countries to use in developing specific diagnostic kits.
  • On 13 January 2020, the Ministry of Public Health, Thailand reported the first imported case of lab-confirmed novel coronavirus (2019-nCoV) from Wuhan, Hubei Province, China.
  • On 15 January 2020, the Ministry of Health, Labour and Welfare, Japan (MHLW) reported an imported case of laboratory-confirmed 2019-novel coronavirus (2019-nCoV) from Wuhan, Hubei Province, China.
  • On 20 January 2020, National IHR Focal Point (NFP) for Republic of Korea reported the first case of novel coronavirus in the Republic of Korea.



(SNIP)
PREPAREDNESS AND RESPONSE:
WHO:
• WHO has been in regular and direct contact with Chinese as well as Japanese, Korean and Thai authorities since the reporting of these cases. The three countries have shared information with WHO under the International Health Regulations. WHO is also informing other countries about the situation and providing support as requested;
 • On 2 January, the incident management system was activated across the three levels of WHO (country office, regional office and headquarters); 
• Developed the surveillance case definitions for human infection with 2019-nCoV and is updating it as per the new information becomes available; 
• Developed interim guidance for laboratory diagnosis, clinical management, infection prevention and control in health care settings, home care for mild patients, risk communication and community engagement; 
• Prepared disease commodity package for supplies necessary in identification and management of confirmed patients; 
• Provided recommendations to reduce risk of transmission from animals to humans; 
• Updated the travel advice for international travel in health in relation to the outbreak of pneumonia caused by a new coronavirus in China; 
• Utilizing global expert networks and partnerships for laboratory, infection prevention and control, clinical management and mathematical modelling; 
• Activation of R&D blueprint to accelerate diagnostics, vaccines, and therapeutics; 
• WHO is working with our networks of researchers and other experts to coordinate global work on surveillance, epidemiology, modelling, diagnostics, clinical care and treatment, and other ways to identify, manage the disease and limit onward transmission. WHO has issued interim guidance for countries, updated to take into account the current situation.
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