Unprecedented Stage in Fight Against Coronavirus With Disease Rapidly Spreading

RIO DE JANEIRO, BRAZIL – A month has passed, and it feels like a century. On January 22nd, China went to sleep thinking that Wuhan, the capital of Hubei, had a problem with a few infections from the new coronavirus. On the 23rd it awoke to a quarantined city; another fifteen would meet the same fate, with approximately 60 million inhabitants.

Today, the outbreak is an epidemic that limits the displacement of hundreds of millions of people within China, has multiple outbreaks in several countries and is threatening to turn into a global pandemic. Doctors do not know if it will eventually disappear, as in the case of SARS, or become endemic like the HIV/AIDS infection. The cases have spread to two dozen other countries, three of which – South Korea, Iran, and Italy – have experienced a sudden increase in infections within their borders over the past four days.

Chinese President Xi Jinping said on Sunday that the Covid-19 epidemic, the disease caused by the new coronavirus, represents “China’s most critical health emergency” since the founding of its current political system in 1949. The president spoke at an extraordinary meeting: a videoconference in which the almost 200 members of the Central Committee and their substitutes (the largest governing body of the Communist Party), the main military leaders and the main regional authorities in the country took part.

The spread of coronavirus outbreaks draws a new scenario that is about to explode if it has not done so already, the pillar of the fight against the disease on which the World Health Organization (WHO) has been working since the discovery of SARS-CoV-2: the containment within the Chinese borders through draconian quarantines of the source of the epidemic in Hubei and the swift detection and control of cases that have emerged in other countries.

South Korea, which now has 602 infected individuals, has led the first major increase in internal contagion. It was immediately followed by Italy, which since Friday has recorded three deaths and approximately 130 cases. WHO and experts are particularly concerned about Iran, a country that until last Tuesday claimed not to have any infections in its territory, but on Sunday reported 15 new cases, bringing the number of infections to 43 and eight deaths.

The reason for the alert? Four people who were diagnosed with coronavirus – two in the United Arab Emirates, one in Lebanon and one in Canada –  recently landed from a flight from Iran. When a country starts exporting cases, experts say, it means that the virus has been circulating among its population for days, something that the Iranian authorities have not been able to detect in time and failed to report earlier.

China and WHO had as their strategy, after declaring the global alert on January 30th, a focus on preventing the outbreak from settling in other countries.This bought time, as the experts say. But in statements on Saturday, WHO Director-General Tedros Adhanom Ghebreyesus reiterated what he had said on Friday: “The time to act is running out” in order to control the disease before it becomes a global problem. And he voiced his concern about cases where the source of contagion is unclear: people who have not traveled to China and have not come into contact with another sick person. Singapore now has at least seven such cases, and Japan has a similar problem. Italy has also yet to determine the source of contagion from its so-called “patient zero”.

During this month, the virus – the incubation period of which has been established at 14 days even though some studies have raised it to 24 – has proved to be highly contagious. In addition to the outbreaks mentioned, it infected over 500 people in five Chinese prisons, apparently in only one week.

The Diamond Princess cruise ship, which the Japanese bureaucracy decided to quarantine in the port of Yokohama on February 3rd with 3,700 people on board, ultimately resulted in over 600 infections. And if South Korea now has more than 600 cases, this is due to a 61-year-old “supercontaminator“, linked to a Christian sect and related to half of the country’s positive cases. There is also another outbreak in a nearby county hospital, Cheongdo.

“What is not known is whether it is a virus that will become endemic and attack populations at risk around the world, or not,” says David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and former executive director of the WHO’s Contagious Diseases group. For the expert, it is a “serious disease” because, as it is new, humans have never been exposed to it and therefore have no defenses.

WHO has corroborated Chinese studies among thousands of patients – in China almost 77,000 people have been infected, and more than 2,400 have died – which found that 80 percent of infections are mild; 20 percent are severe and very severe, and two percent result in death. The majority of fatalities are of elderly people who suffered from other conditions (diabetes, coronary diseases, respiratory issues), while the virus seems to attack children less.

As Heymann says, the most severe problem occurs when the virus weakens the protective cells of airways and other opportunistic infections occur. “It is a very serious disease in humans, but no more dramatic than other lung diseases. People die when the opportunity arises for another bacterial disease,” he says.

A WHO delegation, which is in China this week and has already visited Beijing, Canton and the Sichuan province, was due to arrive Saturday in Wuhan, the city where the first cases originated and where most of the almost 77,000 infections are found in China. But although the latest data in the country seem to point to the start of a remission – on Saturday, the number of new infections has not reached 400, while the previous day it was almost 900 – the WHO asks for caution. “It is too early to make estimates about the outbreak,” the director-general warned in statements made on Saturday at a meeting with African officials.

“Our greatest concern is still the potential for the Covid-19 to spread to countries with weaker health care systems,” said Tedros, who specifically referred to countries on the African continent: “We are working hard to prepare these nations for the potential arrival of the virus.

In total, 1,200 cases have been detected in 26 countries besides China, as stated by the WHO official. Eight of them ended in death, including one case in Egypt, the first on the African continent. In the Middle East, the United Arab Emirates also declared a contagion.

A second wave in China?

In China, where the disease has emerged, hundreds of millions of people have been living for weeks in a semi-quarantine situation, with restricted freedom of movement. In several cities in Hubei, including Wuhan, the restriction is harsh: after the central government has declared a “people’s war” against the virus, no one is allowed to leave their homes unless to go to a doctor or provide essential services.

Economic activity is virtually stalled and many small and medium-sized businesses fear for their survival. Buses, trains, and airlines are suspended. Approximately 200 million people who were outside their homes when the containment measures were announced could not return.

One of the concerns of Chinese authorities is exactly what may happen when people outside their homes return; how to deal with a second wave of contagion after recent progressive declines. Heymann does not rule out this chance: “We must be prepared in case this should occur,” he says.

Source: El Pais