UAE MOH Announces 2 More Novel Coronavirus Cases (n=7)

#14,831

Ten days ago the UAE announced their first detection of the novel coronavirus in a 4 members of a family arriving from the Chinese city of Wuhan.'  Overnight they are reporting two new cases - bringing the nation's total to 7 - although details on exactly how and where they may have been infected are not provided.

The announcement was made via the UAE's Ministry of Health & Prevention Facebook page and twitter account.

First the statement, then I'll return with a postscript.

Ministry of Health & Prevention

The UAE Ministry of Health and Prevention, MoHAP, announced today two new cases of coronavirus, bringing the total number of cases to seven in the country.

The patients were identified through the continuous periodic screening being conducted in accordance with the standards of the World Health Organisation, WHO, for people with symptoms of the new coronavirus.

In a statement, the Ministry said that the new cases, who are of Chinese and Filipino nationalities, are under observation and necessary medical care according to the highest health standards applicable in the country, stressing the effectiveness of the online reporting system.

The Ministry added that all health facilities will continue to report any new cases suspected to have coronavirus.

The Ministry also said it works in coordination with all departments and concerned authorities in the country to take all precautionary and preventive measures and ensure the safety and security of the UAE’s citizens and residents.

#mohap_uae

#coronavirus

While we watch the numbers of cases reported both inside and outside of Mainland China closely, the reality is we don't know how much of the picture we are really seeing.  So far, the worst of the 2019-nCoV epidemic appears centered in Hubei Province, and to a far lesser extent, the rest of the Chinese Mainland.

What we don't know - with any certainty - is how accurate China's surveillance and testing really is.  Whether the daily numbers they provide reflect the actual number of infected showing up at hospitals, or simply the number they are able to test (or perhaps can admit for treatment).  

How many mild or moderate cases are turned away by hospitals, or who never seek medical care, is unknown.  And anyone who dies - either at home or in a hospital - before being tested and admitted to an isolation ward, is likely not counted in the death toll. 

Even if one assumes the best of intentions on the part of the Chinese government, it would be unrealistic to expect their daily numbers to accurately reflect the situation on the ground.  As it is, I take everything they report - including the recent stabilization of case numbers - with a very large grain of salt. 

Elsewhere in the world, surveillance and reporting are equally suspect, although not necessarily for the same reasons. 

Medically sophisticated places - like Hong Kong and Singapore - who already have a good deal of experience dealing with SARS, MERS-CoV, and Avian flu surveillance, are struggling to identify and isolate community acquired cases (see Singapore Reports 7 New Locally Acquired Coronavirus Cases).

Singapore - which has been doing a remarkable job of contact tracing and reporting cases - continues to find new locally acquired cases related to exposures that occurred more than two weeks ago.  At the same time, the South Korea, Malaysia, France, and the UK have all reported exported cases from Singapore. 

What we aren't hearing very much from are the developing countries of Africa, the Indian Subcontinent,  Central Asia, South America, and much of the Middle East. 

Countries where financial resources are often limited, public health infrastructure may be already stressed or unprepared to test cases, and where additional cases of pneumonia would not be immediately recognized as signifying an outbreak.

By the time they recognize they have a coronavirus problem, it is likely to already be a very big problem. 

While containment of this virus seems increasingly unlikely, that doesn't mean that a `classic pandemic' is imminent or even assured.  We may see rolling regional epidemics instead, or - if the virus can be contained outside of China - we might see a reprieve until next fall.

It's even possible - if China manages to contain their outbreak - that this virus will become endemic, and become part of our annual respiratory virus season, along with influenza, parainfluenza, adenoviruses, and other human coronaviruses. 

While there seems to be no end to the number of estimates of the viruses severity and transmissibility, both of these numbers are notoriously difficult to pin down during the start of an epidemic, and both can be highly variable over time.  Academics still debate these numbers for the last 4 pandemics.

The point of all of this is, we don't know what the next few months will bring, so we need to be prepared for a wide range of scenarios.   

And to expect to see some twists and turns along the way.