China reports gush of retrospective COVID-19 cases

China today reported 13,332 retrospective COVID-19 cases from Hubei province, based on clinical diagnosis rather than testing, because of the demands of managing an onslaught of pneumonia cases, as the United States reported two more cases in Hubei province evacuees.

In other developments, Japan reported the second death from the new coronavirus disease outside of China, along with several more confirmed infections on the quarantined cruise ship, as other countries such as Singapore and Vietnam reported more local cases.

And in research news, a monkey study shows promise for an antiviral drug against a related coronavirus.

China cases near 60,000 with new criteria

In a statement today, China's National Health Commission (NHC) said a different category for reporting cases has been added only for Hubei province, which is the outbreak's epicenter. It said the classification has allowed doctors to get patients with suspected infections, based on pneumonia findings on radiographic imaging, into appropriate treatment faster.

Subtracting the retrospective cases, the NHC's report today reflects 1,820 lab-confirmed cases, down from 2,015 new cases reported yesterday, for an overall total of 59,804 illnesses. For severe cases, 174 were subtracted from the total, putting the current number at 8,030. And 254 more deaths were reported, lifting the outbreak's fatality count to 1,367.

So far, 5,911 people have been discharged from the hospital.

At a media briefing today, Mike Ryan, MD, director of the WHO's health emergencies program, emphasized that the addition of the clinically diagnosed illnesses doesn't reflect a surge of new cases. He said the clinical case definition for Hubei province allowed doctors to report cases, initiate patient care, and start the public health response more quickly, without having to wait for lab confirmation.

He said the WHO is waiting for details on how the cases were spread across the earlier outbreak weeks and that it will continue to track both lab-confirmed and clinically confirmed cases.

Tests positive for 2 more US evacuees

Elsewhere, the US Centers for Disease Control and Prevention (CDC) has reported two more COVID-19 infections in quarantined evacuees from Hubei province, raising the nation's total to 15.

Last night, the CDC said it confirmed a COVID-19 illness in a person who is part of a quarantined group that arrived in California on Feb 7, the second to be confirmed at Marine Corps Air Station Miramar. It said the two patients arrived on different planes and were housed in separate facilities, and there are no epidemiologic links between them.

Chris Braden, MD, who leads the CDC's on-site team, said in a statement that there is no sign of human-to-human spread at the facility, but the CDC will conduct contact tracing as part of its response.

Today, the CDC confirmed another similar case, but involving a person quarantined at JBSA-Lackland Air Force Base in Texas after returning on a charter flight on Feb 7. The individual is the first to experience symptoms at the Texas facility and has been isolated and is receiving care at a nearby designated hospital.

The CDC warned that it expects more cases in the coming days and weeks, including those among people who recently returned from Wuhan, the city in Hubei province that has been hit the hardest. An earlier group of 195 evacuees completed their quarantine period and have returned to their communities, but 600 are still in federal quarantine and are being closely monitored.

Japan reports death, 44 sick on cruise ship

Elsewhere, Japan reported a death in one of four newly reported local cases, marking the second death outside of China. The health ministry said in a statement that the woman who died is in her 80s and is from Kanagawa prefecture. She first sought care on Jan 28 and was hospitalized when her condition worsened.

One of the other local cases today involves a 70-year-old man who works as a taxi driver in Tokyo, and an investigation into the source of his illness is under way. The others include a man in his 50s from Wakayama prefecture and a man in his 20s from Chiba prefecture. Japan now has 30 COVID-19 cases.

Also today the country reported that 44 more COVID-19 cases have been confirmed on the Diamond Princess cruise ship, bringing the overall total to 218. The boat has been quarantined in Yokohama port since Feb 3.

Westerdam cruise ship arrives in Cambodia

Meanwhile, the Westerdam cruise ship today arrived in Cambodia, after it was turned away by four countries over fears of COVID-19.

At today's WHO media briefing, Ryan said some of the passengers had mild upper respiratory symptoms and were still on board for testing.

Later in the day, WHO's Director-General Tedros Adhanom Ghebreyesus, PhD, said on Twitter that 20 passengers tested negative for the virus, and he thanked Cambodia's health ministry and government for their act of global solidarity.

The boat was carrying 2,257 people, which included 802 crew members.

More local spread in Singapore, Vietnam

Singapore's health ministry confirmed 8 more cases today, lifting its total to 58. Four of the patients are linked to a church cluster, 2 are Bangladeshi citizens linked to a work cluster, 1 is a family member of an earlier confirmed patient, and the exposure for another is still under investigation.

Vietnam's health ministry today reported 1 more case, which involves the father of a previously confirmed case. The country has now confirmed 16 COVID-19 infections.

The WHO said in its latest daily situation report that over the past 24 hours it has receive reports of 6 more cases outside of China, raising the total to 447 from 24 countries.

Promising remdesivir findings in monkeys

A preclinical trial of remdesivir, meanwhile, an antiviral drug being studied in China's outbreak that has been used on a compassionate basis for some COVID-19 patients, showed promising results in rhesus monkeys against a related coronavirus, a team from the US National Institute for Allergy and Infectious Diseases (NIAID) reported today in the Proceedings of the National Academies of Sciences (PNAS).

Scientists experimentally infected the treatment-group monkeys with Middle East respiratory syndrome coronavirus (MERS-CoV), which is closely related to the virus that causes COVID-19.

The drug prevented disease when given before infection and improved the conditions of monkeys who received it after infection, when compared with the untreated control group. After receiving the drug either 24 hours before infection or 12 hours after infection, the animals were observed for 6 days.

All control animals who didn't receive remdesivir showed signs of disease. Those treated before infection had no symptoms and lower virus replication levels in the lungs. For monkey treated after infection, illnesses were less severe than controls, lung levels of virus were lower, and lung damage wasn't as severe.

The team concluded that the findings support further clinical trials for both MERS-CoV and COVID-19.

Made by Gilead, remdesivir showed in vitro and in vivo activity against other coronaviruses such as SARS (severe acute respiratory syndrome) virus and MERS-CoV. Though not licensed or approved, Gilead has provided it for emergency use in a few COVID-19 patients, including at least one in the United States.

See also:

Feb 13 China NHC statement

Feb 12 CDC statement on 14th case

Feb 13 CDC statement on 15th case

Feb 13 Japanese health ministry statement on ship infections

Feb 13 Japanese health ministry statement on fatal case

Feb 13 Japanese health ministry statement on Tokyo taxi driver case

Feb 13 Japanese health ministry statement on Wakayama prefecture case

Feb 13 Japanese health ministry statement on Chiba prefecture case

Feb 13 Tedros tweet

Feb 13 Singapore health ministry statement

Feb 13 Vietnamese health ministry information

Feb 13 PNAS study

Feb 13 NIAID press release on the study

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