WHO seeks to answer nCoV unknowns as more local spread noted outside of China

Plane landing in Munich
Plane landing in Munich

mustafasen / iStock

Following a meeting with Chinese government officials, including the country's president, the World Health Organization (WHO) today announced an agreement to send a WHO-led international expert team to China to get a better grasp of the novel coronavirus (2019-nCoV) outbreak, as China's cases surged past 4,000 and two new countries—Germany and Sri Lanka—reported their first cases.

In other developments, three countries, including Germany, reported instances of local spread, with more reporting additional travel-linked cases.

WHO expert team to probe key questions

A WHO delegation, led by Director-General Tedros Adhanom Ghebreyesus, PhD, arrived in Beijing yesterday and met with a group that included China's President Xi Jinping and its health minister Ma Xiaowei, MD.

In a statement, the WHO said discussions centered around China's strong capacity to manage respiratory disease outbreaks, collaboration on containment measures in Wuhan, further studies to gauge disease severity and transmission, and the need for China to continue sharing data and virus materials.

The WHO will send the international expert team to China as soon as possible. In the past, the WHO had sent similar international joint teams to gather more information on other outbreaks, such as MERS-CoV (Middle East respiratory syndrome coronavirus) in Saudi Arabia and South Korea.

"We appreciate the seriousness with which China is taking this outbreak, especially the commitment from top leadership, and the transparency they have demonstrated, including sharing data and genetic sequence of the virus," Tedros said.

Though there are still many unknowns about the outbreak, including the source of the virus and extent of its spread, most reported cases have been mild, with about 20% of patients experiencing severe disease, the WHO said. It added that the number of cases in and outside of China is deeply concerning, and that a better understanding of transmissibility and severity is urgently needed to guide response steps.

The WHO said it continues to monitor developments and could reconvene its emergency committee on short notice to consider again if the situation warrants a public health emergency of international concern under International Health Regulations.

News of the joint meeting broke during a media briefing today with top US health officials. At the event, US Health and Human Services (HHS) Secretary Alex Azar, said the US had offered to send experts separately or as part of a WHO group and that he was delighted to hear the news (see separate CIDRAP News story).

China tops 4,000 cases, 100 deaths

China today reported 1,771 new cases today, the largest daily number since the outbreak began, boosting the overall total to 4,515 cases.

The latest illnesses were reported from 30 of China's 33 provinces and administrative regions. But about 1,300 of the cases are in Hubei province, where Wuhan is located, according to the latest Hubei province update translated and posted by FluTrackers, an infectious disease news message board.

The number of people with severe infections rose to 976, and 26 more people died, raising the fatality count to 106.

Short incubation period in Vietnam

Last week Vietnam was the first country to report local transmission, and today a team from Vietnam published details about the event in an early online report in the New England Journal of Medicine.

The report said Vietnam's local case is part of a family cluster, involving the 27-year-old son whose parents flew to Hanoi from the Wuhan area earlier this month. The man's 65-year-old father, who had underlying health conditions, became ill a few days later and was hospitalized.

His son, who lives in Long An province in Vietnam, had not traveled to any area where the virus was spreading and had shared a hotel room with his parents for 3 days after they arrived in Vietnam. A few days later, he began experiencing a dry cough, fever, vomiting, and loose stools. The authors of the report said the son's clinical course suggests the incubation period could have been 3 days or less.

The report also noted that the family traveled across four cities in Vietnam, using planes, trains, and taxis. So far no other illnesses have been detected in 28 contacts who are under monitoring.

Local spread in 3 more nations

Also today, Germany reported its first 2019-nCoV case, involving a 33-year-old Bavarian man who is thought to have been infected by a colleague from China while attending company training last week in Bavarian state, Deutsche Welle, a newspaper based in Germany, reported, citing Bavarian health officials.

The colleague, a woman from Shanghai, started feeling sick on the flight back to China on Jan 23. The woman's parents, who live near Wuhan, had recently visited her in Shanghai.

The Bavarian man recovered from his illness enough to return to work, but when the Shanghai colleague was diagnosed as having 2019-nCoV, the company urged its employees to report symptoms, which prompted the man to get tested.

Later today, Bavaria's health ministry reported three more similar cases in employees who worked for the same company, according to a government statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. The health ministry said a few other contacts are being tested and added that about 40 employees who are considered close contacts will be tested as a precaution.

Japan reported three more cases today, one of which involves local spread, raising its number of 2019-nCoV cases to seven. The locally acquired case involves a man in his 60s from Nara prefecture who had contact with a visitor from Wuhan. Media reports said the man is a tour bus driver who drove two groups of Chinese tourists from Wuhan earlier this month.

Japan's other cases reported today, which bring its total to seven, involve a woman and man in their 40s, both from Wuhan. Neither had not visited the outbreak market.

Meanwhile, Taiwan today in reporting its eighth case said the patient is a man in his 50s from central Taiwan who contracted the virus from his wife, whose illness was recently detected when she got sick after returning from working in China, Reuters reported today. Taiwan officials said the man's illness marked its first locally acquired case.

Imported cases in Thailand, Canada, France

Thailand today reported six more patients with imported infections, five of them members of the same family who had traveled from hard-hit Hubei province, according to a separate Reuters report. The sixth was from the city of Chongqing, another of China's hot spots. The detections demonstrate that infected travelers will be coming from a range of affected Chinese areas.

The country has now reported 14 imported cases, the most of any area outside the mainland. According to the report, Thai officials today announced plans to screen all travelers from China.

Canada today announced its third case, involving a British Columbia man from the Vancouver area in his 40s who arrived back from Wuhan last week, according to a provincial government statement. He regularly travels to China for work and contacted local health authorities last week when he got sick after returning from Wuhan. He is in home isolation, and health officials are monitoring his contacts.

France reported its fourth case, in an elderly Chinese man who was visiting the country from Hubei province, Agence France-Presse (AFP) reported. The man is in serious condition in a Paris hospital.

So far, 16 locations outside of mainland China have reported about 78 2019-nCoV cases.

See also:

Jan 28 WHO press release

Jan 28 WHO situation report

Jan 27 China CDC daily update

Jan 27 FluTrackers post on Hubei province cases

Jan 28 N Engl J Med report

Jan 28 Deutsche Welle story

Jan 28 AFD post

Jan 28 Japanese health ministry statement on local case

Jan 28 Kyodo news story

Jan 28 Japanese health ministry statements on fifth and sixth cases

Jan 28 Taiwan CDC report

Jan 28 Reuters story on Taiwan's local case

Jan 28 Reuters story on new Thai cases

Jan 28 British Columbia government statement

Jan 28 AFP story

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