WHO joint mission shares China experience; COVID-19 escalates in Europe, Mideast

Wuhan map
Wuhan map

dk_photos / iStock

Three more European countries reported their first COVID-19 cases today, mostly linked to Italy's outbreak, and more newly affected Middle East countries confirmed more illnesses linked to an outbreak in Iran.

In other developments regarding the novel coronavirus, the leader of the World Health Organization (WHO) joint mission to China gave a detailed report on the group's findings in China, and case numbers grew in other affected Asian countries, mainly in South Korea and Japan.

WHO joint mission observations

The WHO-led international joint mission wrapped up its visit to China yesterday, and Bruce Aylward, MD, MPH, who led the 25-member group, today briefed reporters on the team's experiences and findings. He said that, without a drug or vaccine available to battle the new virus, the country used standard public health tools such as case finding and contact tracing with rigor and innovation "on a scale that we have never seen in history."

Though Wuhan and Hubei province are the epicenter, the outbreak evolved differently as the virus spread to other provinces, and though the central government enforced rules, provincial health officials had the flexibility they needed to tailor the response to their situations.

The team also observed how China "repurposed the machinery of government" to battle the outbreak and used big data tools, including artificial intelligence, to manage a massive amount of information, such as contact tracing.

Aylward also said the team observed an agile, science-driven response, during which the government updated its clinical guidance six times as it learned more about the virus and illness.

China's stringent measures, such as sealing off towns and ordering people to stay in their homes, changed the course of the outbreak, with a decline that is now occurring sooner than expected, Aylward said. Team members had multiple ways of getting a sense of the decline, such as talking to doctors in Wuhan who spoke of open hospital beds and no more waiting lines for testing at fever clinics.

Because of the decline in cases, Chinese researchers report slower-than-expected enrollment of patients in drug treatment trials. China today reported 508 new cases, up from 409 reported yesterday, for a total of 77,658. The death toll is at 2,663, and there are 9,126 serious cases, according the National Health Commission.

Aylward urged countries that are bracing for outbreaks to shift their mindset. "The world is not ready, but can get ready fast," he said, emphasizing that countries can indeed affect the course of the disease with aggressive and tough programs, noting that key steps should include planning for a heavy demand on hospitals and respiratory support, such as ventilators, staffing for contact tracing, and getting the public on board.

A big question that still remains unanswered is how many mild cases go undetected, a metric that is key for getting a better handle on the disease's severity and fatality rate. Aylward said the group saw bits of information, such as testing of samples from China's flu surveillance system and testing of convenience samples, that hint the number of milder cases may not be great. However, he said that over the last few days China approved two serology tests, which will help answer the question.

He said though asymptomatic transmission might play some role, household exposure seems to be the main driver of the outbreak. And he noted that many health workers who got sick were exposed in the community.

Regarding the clinical spectrum, Aylward said about 88% of patients remember having a fever and 68% had a dry cough. Only about 12% had a runny nose, hinting that COVID-19 might not have much upper respiratory involvement. Some patients reported a prodrome that consisted of fatigue, muscle pain, and a vague feeling of being unwell.

In those who have symptoms, 80% have mild disease, 13% have severe illness, and 6% are critically ill, the group found.

When pressed on whether countries outside China—especially those without strong central governments—could replicate China's experience, Aylward said countries can be masters of their own fate. "Can that be replicated? Why not?"

Italy's total tops 300 as 3 new countries affected

Since yesterday, Italy's health ministry reported 93 more cases and 4 more deaths, raising the case total to 322, including 10 deaths. Though the outbreak is centered in northern Italy near Lombardy, the country today reported the first cases in more regions, including Tuscany, Sicily, Liguria, Bolzano province.

Also, Italy's health ministry said officials from the WHO and the European Centre for Disease Prevention and Control will meet with Italian health officials in Rome to discuss the next steps for managing Italy's outbreak.

In other European developments, three countries—Austria, Croatia, and Switzerland—reported their first COVID-19 cases.

  • Austria's health ministry reported two confirmed cases. According to a media report, the patients are isolated in a hospital in Innsbruck, and one is from Lombardy, the epicenter of Italy's outbreak.
  • Croatia today reported the country's first case, which involves a man who had recently traveled from Italy, Agence France-Presse reported, citing a health ministry official who said the man has mild symptoms and had visited Milan.
  • Switzerland today reported its first case, which was detected in Ticino canton near the border with Italy, according to a Swiss media report that cited the country's public health office. The patient is a man in his 70s who had visited the Milan region.

Meanwhile, France and Spain—two earlier affected countries—reported more infections today. France reported two new cases, one involving a Chinese woman who recently returned from China and one involving a man who had recently traveled to Lombardy region in Italy, France24 reported today, citing French health officials. France now has 14 cases.

Spain today reported as many as three new patients. Two are a male traveler from Italy and his companion who were staying on the Canary Islands' resort island of Tenerife, where the hotel they are staying is on lockdown, CNN reported. The other is an Italian woman living in Barcelona who had recently visited northern Italy, including Bergamo and Milan, according to in Italian media report that cited Catalonia regional health officials.

Iran total nears 100; four regional countries reports more cases

Iran's health ministry today reported 34 more cases and 3 more deaths today, raising its case total to 95, which includes 15 deaths. In another development, the country's deputy health minister, who appeared to be suffering from symptoms while addressing reporters, and a member of parliament are among the confirmed cases, the BBC reported today.

Meanwhile, four countries in the Middle East that reported their first cases yesterday (Iraq, Bahrain, Oman, and Kuwait)—all linked to Iran travel—reported, more today.

  • Iraq's health ministry reported 4 more cases, bringing its total to 5, Reuters reported today. The patients are members of an Iraqi family who had traveled to Iran.
  • Bahrain since yesterday has reported 22 more cases, raising its total to 23, the health ministry announced today. It said the 6 more recent patients had traveled from Iran.
  • Oman's health ministry today reported 2 more cases, lifting its total to 4. Both involved Iran travelers.
  • Kuwait's health ministry reported 1 more case, involving a woman who was in quarantine with a group of Iran travelers, putting its total at 9 so far, Kuwait News Agency

Korea's cases approach 1,000

South Korea's Centers for Disease Control and Prevention today in three updates reported (60, 130, and 84 ) 274 new cases, down from 438 yesterday, raising its total to 977. It also reported 2 more deaths, lifting the fatality count to 10.

Daegu and Gyeongbuk are still the main hot spots, and the Shincheonji Church of Jesus cluster and a large hospital cluster make up 68.8% of cases.

In a related development yesterday, the US Centers for Disease Control and Prevention raised it travel advisory for South Korea to his highest warning level, urging people to avoid nonessential travel due to widespread community transmission.

In Japan, the health ministry today reported 8 more cases, plus 1 more asymptomatic carrier, raising its total to 147, though it notes 164 overall cases that include 17 asymptomatic carriers.

The latest cases are from Nagano prefecture, Kumamoto, Sapporo, Ishikawa prefecture, Nagoya, and Tokushima prefecture.

Also, Japan reported another death in a passenger from the Diamond Princess cruise ship, a man in his 80s from Tokyo.

Elsewhere in Asia, Thailand reported two new cases, one a woman who had traveled to China and the other a driver who had served Chinese tourists, the Bangkok Post reported today. The country's case total is now at 37. And Singapore reported one more case, linked to an earlier patient, raising its total to 91.

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