Q & A: Pneumonia Outbreak in Wuhan City, China

Daniel Lucey M.D. MPH, is an infectious diseases physician and adjunct professor of infectious diseases at Georgetown University Medical Center, a senior scholar at the Georgetown University O’Neil Institute, Anthropology Research Associate, Smithsonian Museum of Natural History and a member of the Infectious Diseases Society of America Global Health Committee.He has served as a volunteer medical responder to outbreaks that included the West Africa Ebola crisis. He has collected information on outbreaks starting in 2001 with Anthrax, and including smallpox vaccination 2002, SARS 2003, H5N1 Flu 2004, MERS in 2013, and Ebola in April, 2014, He has gathered, and is updating information on the current outbreak of pneumonia in Wuhan City in the Hubei province of China.

When did the outbreak begin and when was the most recent case?

The first case was December 12, 2019. The most recent case was December 29. (according to the January 5 report from the Wuhan Municipal Health Commission and Health Committee’s Report on Unexplained Viral Pneumonia.)

When was the outbreak first made public?

December 31, 2019. (Chinese health authorities reported 27 patients with 7 in critical condition, according to the Wuhan Municipal Health Commission on its Weibo social media account (12/31/19 Reuters  “Chinese officials investigate cause of pneumonia outbreak in Wuhan”)

What are the clinical findings?

Findings include fever with some patients describing “difficulty breathing.” Some describe as an “Atypical Pneumonia” with bilateral infiltrates in lungs on chest x-ray. (Jan. 5, 2020, World Health Organization, Disease Outbreak News, “Pneumonia of unknown cause – China”)

What is the cause? Has SARS-coronavirus (Co-V) been ruled out?

Yes, SARS Co-V has been ruled out, as has MERS-CoV, (known) avian and human influenzas and adenovirus; however, the cause is still unknown (according to Wuhan Municipal Health Commission and Health Committee’s Jan. 5 report).

What are the latest case numbers, and number of contacts in quarantine?

As of Jan. 5-6, a total of 59 patients and 163 contacts have been reported (per Wuhan Municipal Health Commission).

Have there been deaths?

So far Chinese authorities report no deaths. Of 59 patients, “7 critically ill”. (per Wuhan Municipal Health Commission).

Has there been person-to-person spread, or health workers infected?

No, so far WHO (Jan. 5) reports “no evidence of significant human-to-human transmission and no health care worker infections reported”.

Is there an epidemiological link (epi-link) for the patients?

Yes, patients have been linked to a seafood market in Wuhan, that also sold multiple animals (e.g., pheasants, rams, rabbits, snakes, birds, and perhaps other species). This market was closed on January 1st, 2020. (See Science Jan. 3,2020 by Dennis Normile, Novel human virus pneumonia cases linked to seafood market in China stir concern) WHO (Jan. 5) stated: “The reported link to a wholesale fish and live animal market could indicate an exposure link to animals”.

There have not been public comments about whether specimens from animals and seafood were obtained and tested before January 1st. This part of the investigation would be essential to confirming if there is a zoonotic source and why the outbreak occurred now (i.e., the “One Health” approach to outbreaks).

How has Hong Kong responded?

Immediately on Dec. 31 and comprehensively seven days a week since, with resources that include a public dedicated webpage with multiple key documents and daily updates, via their Department of Health “Centre for Health Protection (CHP)”.

Is this outbreak an example of what the WHO in 2018 termed a “Disease X”?

Yes.