Wuhan City in the Hubei Province of the People’s Republic of China is on the Yangtze River and is the most populous city in central China. A major transportation hub, it is where a cluster of pneumonia cases began in December, with the first patient reported on Dec. 12. Dr. Daniel Lucey, who has responded to, and monitored information on outbreaks since 2001 updates information on the outbreak here. The following are Dr. Lucey’s Jan. 10 and Jan 12 updates to his initial answers to frequently asked questions posting on the outbreak Jan. 7.
Frequently Asked Questions on Cluster of Pneumonia Cases in Wuhan: Update #2, Jan. 12, 2020
How many patients have laboratory-confirmed infection with this novel coronavirus?
41 patients. One patient has died, seven remain severely ill, and six have been discharged, according to the Jan. 12 update from WHO.
Has person-to-person transmission occurred, or infection of any health care workers?
No. None reported so far. Of the 739 close contacts of patients, including 419 medical staff, none have developed evidence of infection, according to the latest update from Wuhan on January 11. (Translate page)
Are there any FDA-approved antivirals, antibodies, or vaccines for the 3 coronaviruses known to cause pneumonia in humans: (1) SARS, (2) MERS, and (3) nCoV in Wuhan?
No. And since more novel coronaviruses causing disease in humans should not be a surprise in the 2020s, then a high-level initiative to create a Universal Coronavirus Vaccine is warranted.
Are there any reported new infections since the market was closed January 1?
No. The incubation period is unknown; however, currently there is no evidence of new infections after this market was closed. Dates of illness onset for the 41 patients linked to the Market were between December 8, 2019 and January 2, 2020.
Has China shared the genetic sequence of this virus?
Yes. WHO confirmed on Jan. 12. Specific diagnostic tests can now be developed world-wide.
Has an animal source of this novel coronavirus been found?
Not yet. If animal species from this one Wuhan Market are found to have this virus, then testing in other markets inside and outside Wuhan will occur quickly. Once antibody tests are developed in the months ahead, then serosurveys of animals and humans will occur.
What is the latest US CDC guidance?
See Saturday, Jan. 11 CDC Summary, Risk Assessment, and Responses . CDC states: ”Clinicians should use WHO guidance until CDC guidance is updated in the coming days.” WHO resources and guidance for travelers, case definitions, infection prevention and control is at: https://www.who.int/health-topics/coronavirus.
Have infections with this novel virus been reported in Hong Kong or anywhere else?
No. As of Jan 12 Hong Kong has tested 67 hospitalized patients with travel from Wuhan, none of whom have an epidemiological (epi) link to the market. Most patients have other viral infections identified. In a Jan. 11 letter to Doctors, the Hong Kong Department of Health Centre for Health Protection stated that their Public Health Laboratory “is conducting molecular testing for a number of coronaviruses and the current test is able to detect the novel coronavirus based on sequence comparison but not yet evaluated due to unavailability of the novel coronavirus.” According to a Jan. 11 press release from Hong Kong, from Jan. 13-14 a team from Hong Kong will be Wuhan to learn about the outbreak, “prevention and control measures and case management.”
Frequently Asked Questions on Cluster of Pneumonia Cases in Wuhan: Update # 1 Jan. 9, 2020
Has a new virus been found in the Wuhan pneumonia outbreak?
Yes, a novel coronavirus was reported Jan. 9, 2020 on the World Health Organization (WHO) website. It is a preliminary finding and not yet proof that this new virus is the cause of the pneumonia cluster.
How many patients have tested positive for this new virus?
On Jan. 9 it was also reported that “molecular testing of 15 cases returned positive results for the novel coronavirus, and the virus was also isolated from a sample of a case”, according to the China National Health Commission Mainland expert group and communicated to the Hong Kong Centre for Health Protection (CHP) of the Department of Health.
Is a diagnostic test available yet for this new coronavirus?
Not yet, except in Wuhan where the whole genome sequence of the virus was determined this week and an assay developed to detect the nucleic acid of the new virus. Hong Kong CHP “has already contacted the National Health Commission (NHC) …and expressed the wish to obtain relevant information of the virus, including its genetic sequence, so as to provide accurate testing for the novel coronavirus.”
Are there any proven cases outside of Wuhan?
No. In an admirable example of how to respond to such an outbreak, Hong Kong publishes a daily list of ill patients arriving from Wuhan who have been hospitalized and what viruses have been found on testing i.e., seasonal influenza, parainfluenza, rhinovirus, metapneumovirus, adenovirus, RSV, more.
The new virus-specific diagnostic test to detect nucleic acid of this new coronavirus developed in Mainland China this week, however, is only available there.
Has the new coronavirus been found in any animals?
No. Testing of animals from the seafood/live animal market in Wuhan before it was closed and disinfected January 1st should be feasible now that a diagnostic test is available for the new coronavirus. If animal samples are positive for the virus, then such animals in other markets in Wuhan and far from Wuhan will be tested. Perhaps this outbreak is not the first one due to this virus, but only the first one that has been recognized (“discovered”).
Testing animals and the marketplace itself would be essential to confirming if there is a zoonotic source and why the outbreak occurred now in Wuhan (i.e., the “One Health” approach to outbreaks).
Has anything changed since the initial FAQs this week in terms of the case count of 59 persons, the lack of deaths, lack of person-to-person spread, lack of health worker infections?
No, nothing has changed; it always could, however in the near future.
What is the latest guidance from the U.S. Centers for Disease Control and Prevention?
On January 8 the US CDC issued their latest in a series of health advisories through its Health Alert Network. Infectious diseases specialists, clinicians and other health providers are urged to read this entire CDC guidance. It concludes with the following three detailed “Recommendations for Health Care Providers:
- Providers should consider pneumonia related to the cluster for patients with severe respiratory symptoms who traveled to Wuhan since December 1, 2019 and had onset of illness within two weeks of returning, andwho do not have another known diagnosis that would explain their illness. Providers should notify infection control personnel and local and state health departments immediately if any patients meet these criteria. State health departments should notify CDC after identifying a case under investigation by calling CDC’s Emergency Operations Center at (770) 488-7100.
- Multiple respiratory tract specimens should be collected from persons with infections suspected to be associated with this cluster, including nasopharyngeal, nasal, and throat swabs. Patients with severe respiratory disease also should have lower respiratory tract specimens collected, if possible. Consider saving urine, stool, serum, and respiratory pathology specimens if available.
- Although the etiology and transmissibility have yet to be determined, and to date, no human-to-human transmission has been reported and no health care providers have been reported ill, CDC currently recommends a cautious approach to symptomatic patients with a history of travel to Wuhan City. Such patients should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed. Personnel entering the room to evaluate the patient should use contact precautions and wear an N95 disposable facepiece respirator. For patients admitted for inpatient care, contact and airborne isolation precautions, in addition to standard precautions, are recommended until further information becomes available. For additional information see: https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html.”
Daniel Lucey, M.D. MPH, FIDSA, FACP, 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.