Feature

Coronavirus: What we know so far


Matt Woodley


24/01/2020 3:25:47 PM

A rising death toll, millions in lockdown and multiple cases in Australia, with local authorities saying it is highly likely more will emerge.

Coronavirus
The rapidly evolving situation has prompted Chinese authorities to place three cities with a combined population of more than 18 million people into lockdown.

UPDATED

Four cases of the deadly coronavirus have been confirmed in Australia: three in New South Wales and one in Victoria.

Less than a month after China first informed the World Health Organization (WHO) of a number of pneumonia-like cases in Wuhan, novel coronavirus 2019 (2019-nCoV) has spread to 11 countries, infected close to 3000 people and led to 80 deaths.

More than 56 million people are currently in lockdown in mainland China, while Hong Kong has also declared a state of emergency.
 
As the situation continues to evolve, newsGP recaps what is already known, and what the future may hold.
 
Australia
Four cases of the deadly virus have been confirmed in Australia: three in NSW and one in Victoria.

Three men in NSW tested positive on Saturday after visiting Wuhan. A case was confirmed in a man in Victoria earlier on Saturday.

Victorian Health Minister Jenny Mikakos said on Saturday morning the man returned from China last week. He reportedly displayed no symptoms on the flight to Melbourne.

A Chinese national in his 50s, the man reportedly visited a GP on Thursday and the Monash Medical Centre at Clayton on Friday, where he was put into isolation. He has pneumonia and is in a stable condition.

‘There is no reason for alarm in the general community,’ Minister Mikakos said.

The man arrived in Melbourne on the morning of 19 January on a China Southern flight from Guangzhou. According to Victoria’s Acting Chief Health Officer Dr Angie Bone, border screening would not have detected the virus.

All passengers will be contacted as a precaution.

‘He did not show any symptoms whilst he was on the fight so it’s possible he wasn’t contagious, but there’s a lot we don’t know about this virus at this point,’ Minister Mikakos said.

The risk to the broader community is said to have been minimised by the fact the man had been staying with family and had not been in contact with many people, Minister Mikakos added. However, the case has led to concerns that more people with the virus may have arrived in Australia before Wuhan was locked down.

‘Given the number of cases that have been found outside of China and the significant traffic from Wuhan city in the past to Australia it was not unexpected that we would get some cases,‘ Australia's Chief Medical Officer Professor Brendan Murphy said.

‘The risk to Australia I think is more in those people who travelled in the week up to last Thursday when the travel ban was put in place. There are potentially others like this person who have travelled to Australia who were well when they arrived who may develop the disease.’

A total of 18 people have been tested for the virus in NSW, with 12 having been cleared; nine people in Queensland have been tested, with all returned negative results for coronavirus, though authorities are awaiting results from another potential case; four people in South Australia were being tested, but authorities believe they are unlikely to have the virus; one man has been checked in a Hobart hospital.
 
Professor Murphy has said testing processes for the virus have matured and results should become available within 24 hours.
 
A flight from Wuhan to Sydney that arrived on Thursday was one of the last to leave the central Chinese city before it was placed on lockdown, prompting mass screening of passengers by Australian health authorities and biosecurity personnel. Passengers and crew wore face masks and those who flagged concerns about their health had their temperature taken.

Passengers arriving on all flights into Australia from China are now being stopped and provided with health information, including what to do if they become unwell.

The Australian Government has raised the travel alert level to ‘do not travel’ for the city of Wuhan and the entire Hubei province. It has also ordered one million additional P2 facemasks.
 
Meanwhile, GPs have expressed concern regarding health department advice directing potential carriers to local clinics, and University of Queensland researchers have joined the quest to develop a new vaccine.
 
Crossbench senator Rex Patrick and RACGP President Dr Harry Nespolon have previoulsy called for all direct flights from China to be screened by biosecurity staff.
 
Global state of play
Singapore and Vietnam have become the latest countries outside of China with confirmed cases of the virus, joining Thailand, South Korea, Japan, Taiwan and the US.

Reports indicate Europe's first cases have been confirmed in France, with two patients hospitalised in Paris and the other in the south-western city of Bordeaux.
 
None of the 41 deaths have occurred outside of China, but authorities in Hebei province – around 900 km from the outbreak’s epicentre – have confirmed the first death to occur outside of Wuhan.

The World Health Organization (WHO) has declared the coronavirus an ‘emergency in China’, but has not declared it an international concern.
 
Estimates of the mortality rate sit at around 4% – higher than Spanish Flu but lower than SARS – while 25% of the confirmed cases are reported to be severe. Despite the increasing death toll and spread of carriers, the WHO has resisted declaring a Public Health Emergency of International Concern (PHEIC) given 2019-nCoV’s ‘restrictive and binary nature’.
 
However, the 15-member Emergency Committee convened by WHO Director-General Dr Tedros Adhanom Ghebreyesus was divided in its finding and resolved to reconvene in around 10 days’ time to reassess the situation.

China-coronavirus-article.jpg
The virus first emerged in the central Chinese city of Wuhan in mid-December, where it was linked to a seafood market that also sold live chickens, bats and other mammals.

What comes next?
The 2019-nCoV outbreak has occurred on the eve of Chinese Lunar New Year, the world’s largest annual human migration event in which hundreds of millions of people are expected to make around three billion trips over the next 16 days.
 
Airports, train stations and long-haul bus depots across China have installed temperature monitoring facilities for travellers, while major cities such as Beijing have cancelled all large-scale gatherings and events.
 
But regardless of safeguards, there are questions over the effectiveness of quarantining megacities, with reports already emerging of people deliberately trying to avoid 2019-nCoV checks. Meanwhile, according to the Washington Post, a now-deleted post from Wuhan Railway said 300,000 people travelled by train out of Wuhan on 15 January.
 
There are also fears the official total vastly underestimates the scale of the outbreak, with some experts suggesting it may already have spread to 4000 people.
 
Officials are testing 14 potential carriers in the UK, while the results from a second potential case in the US are waiting to be confirmed. The first person diagnosed with 2019-nCoV in the US is currently being treated by a few medical workers and a robot at the Providence Regional Medical Center in Everett, Washington.
 
Inside Wuhan there are plans to construct a hospital specifically for 2019-nCoV patients within six days, while China’s Ministry of Finance has said it will allocate 1 billion yuan ($210 million) to officials in Hubei province to fight the outbreak.
 
Despite this, one of the virologists who helped identify the SARS virus, Guan Yi of the University of Hong Kong’s State Key Laboratory of Emerging Infectious Diseases, has reportedly been disappointed with the response so far after visiting Wuhan earlier in the week.
 
‘Even though the central authorities have said in the past two days they were attaching a high degree of importance, local health protections had not been upgraded at all,’ he said.
 
‘At the time I thought this was going to be a “state of war”. Why hadn’t the alarm been sounded?
 
‘I’ve experienced a lot and I’ve never felt scared, most of these [viruses] are controllable … but this time I’m scared.’

With AAP
 
The RACGP has more information on coronavirus available on its website.
 
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Dr Umberto Boffa   26/01/2020 1:44:42 PM

The older I get, the more cynical - everyone knows 10 times as many people in China are infected than the "official number" of 1700 - some say 160,000. Hence, the mortality rate is actually ten times less than currently proclaimed. Another funding drive for public health?
Bert Boffa


Dr Kingsley John Mudd   26/01/2020 5:57:22 PM

What makes you think that the Chinese are not under-reporting the death rate even more than they are under-reporting the number of cases? And what's the problem with putting funds into public health?


Dr Xiong Tan   26/01/2020 10:52:51 PM

Please read The Lancet "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext

With limited data, 41 hospitalized patients, 6 death, 15% (SARS 10%, MERS 35%).


Dr Peter James Strickland   27/01/2020 12:08:20 PM

What we do know now is that Health authorities are starting to blame GPs for their own serious mistakes. It is NOT the GPs who have allowed this coronavirus to enter Australia, but the government health officials, and any cases now confirmed in Australia are directly due to those Australian health officials who have NOT taken the hardline of not allowing passengers from affected countries (esp. China) from travelling to Australia. Now they are talking about bringing back to Australia children from Wuhan Province in the near future -- it is unbelievable to be bringing a further threat of bringing this virus into Australia, and thus causing potential deaths here as well as overseas! GPs treat thousands of these infection types daily --is every respiratory patient now going to be tested for coronavirus?


Dr Kingsley John Mudd   27/01/2020 1:01:09 PM

Thanks for the reference, Xiong, but I'm not sure how it really helps us. It really just tells that we know very little - to quote the article : "Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies."
The study can't tell us how many are infected overall, and the sample size is not large enough to provide a reliable estimate of the death rate.
Ah well, I guess only time will tell. In the meantime ... "alert but not alarmed", as they say.