The Wall St.Journal 28Feb2020

A8| Friday, February 28, 2020 ** THE WALL STREET JOURNAL.

WORLD NEWS

mission of experts for the

WHO to China last week.

“Have you got 100 beds where

you can isolate people if you

haveto?Haveyougotawing

of a hospital that you’re going

to close off?” he said.

While a lockdown in Hubei

province in China has likely

slowed the spread of the virus,

millions of people left before it

was imposed, and people who

were infected and not diag-

nosed could have spread the vi-

rus elsewhere, experts say. Offi-

cials say the epidemic in China

peaked a few weeks ago and

new cases are on the decline.

“Pandemic” is defined by the

WHO as widespread transmis-

sion globally of a new disease,

taking a toll on society. The

term has been applied to only a

few diseases in history—a

deadly flu in 1918, the H1N1 flu

in 2009 and HIV/AIDS among

them. The WHO’s director-gen-

eral, Tedros Adhanom Ghe-

breyesus, warned earlier this

week that while the new virus

didn’t yet qualify as a pan-

demic, it “absolutely” could be-

come one.

The WHO is helping African

nations and other countries

prepare by sending out diag-

nostic test kits and other sup-

plies, and training health work-

ers. The agency is urging

countries to be ready and says

a pandemic can still be averted.

The U.S. government said

this week that it was operating

on the assumption that the new

coronavirus would spread in

the country, and urged Ameri-

cans to prepare for “social dis-

tancing measures” such as clos-

ing schools and canceling large-

scale events.

Italian measures

Italy had moved aggressively

to prevent a Covid-19 outbreak,

initially screening travelers and

then banning direct flights

from China—the only country

in the European Union to do so.

Authorities had also quickly

isolated two Chinese tourists

who fell ill.

However, hospitals were told

to test only patients who

showed symptoms and who had

been to China or in contact

with other infected people.

When a 38-year-old man

from Codogno, a town south of

Milan, developed a cough and a

fever on Feb. 15, it didn’t seem

possible that he might be in-

fected with the new coronavi-

rus. The man, whose first name

is Mattia and whose surname

can’t be published under Italian

privacy laws, had never been to

China. He hadn’t had contact

with people who showed symp-

toms of infection either, Italian

health officials later said.

On. Feb. 18, Mattia, who

works at a local research and

development unit of Unilever,

felt sicker and went to his local

hospital. Doctors gave him anti-

biotics and he went home.

The next day he was admit-

ted to the hospital in critical

condition. Doctors tested him

for the coronavirus after his

wife told them he had met with

a friend who had recently re-

turned from China. On Feb. 20,

health authorities confirmed

Mattia had Covid-19.

Italian authorities moved

quickly to track down and test

people who had come into con-

tact with Mattia or with his

friend. Residents of Codogno

and surrounding towns were

told to stay at home.

It was too late. Tests showed

the virus had spread. The in-

fected included his pregnant

wife and six members of his

amateur soccer team. Medical

staff and other patients at the

hospital in Codogno had also

been infected. However, the

friend who had returned from

China tested negative.

So far 650 people have

tested positive for the virus in

Italy, of whom 17 have died, ac-

cording to government data.

Italian authorities are still

trying to figure out how Mattia

got infected. They suspect that

one or more people with mild

symptoms were unknowingly

transmitting it for some time,

according to Massimo Galli,

head of the infectious-diseases

department at Milan’s Sacco

hospital.

Ten towns in the Lombardy

region and one in neighboring

Veneto have been quarantined,

with armed forces manning

checkpoints; supermarkets and

pharmacies are the only stores

open. The government has shut

down schools and cinemas

across northern Italy. Some 27

million people live in areas af-

fected by the restrictions.

“I was expecting the corona-

virus to arrive in a big city, not

in a small town,” says Leyla

Bicer, a 35-year-old pharmacist

from the quarantined town of

Casalpusterlengo who serves

customers through an 8-inch

opening in the front door.

The current government pol-

icy is to test only people who

show symptoms. Those who are

infected are either admitted to

a hospital or told to stay at

home, provided they can be

kept in isolation.

More cases linked to the

Lombardy outbreak have

emerged elsewhere in Europe—

from Sicily to Switzerland to

Spain’s Canary Islands—raising

fears it might be too late to

stop it from spreading across

the continent. A 56-year-old

Italian woman vacationing in

Austria died on Tuesday night.

Italy’s European neighbors

have said that they will keep

borders open and continue to

allow Italians to travel. But

checks and other precautions

have proliferated, as well as

pressure to cancel events.

The European Commission

has called for member states to

review their pandemic plans,

including procedures for trac-

ing the movements of patients.

In Europe, the job of respond-

ing to epidemics rests with in-

dividual states. That along with

social factors would make it

difficult for Europe to replicate

Note: Data begins when Johns Hopkins and the World Health Organization began publishing daily global case numbers.

China first reported a pneumonia cluster in Wuhan in early December 2019.

Sources: Johns Hopkins Center for Systems Science and Engineering; Italian government

*Cruise ship docked in Japan

Cumulativedailyreportedinfections,asofFeb.27,6p.m.ET

GlobalSpread

Locations ordered by date of first reported infection.

0 20k 40k 60k+

Jan. 26 Feb. 2 Feb. 9 Feb. 17 Feb. 24

Mainland China

Thailand

Japan

Hong Kong

Taiwan

United States

Macau

South Korea

Singapore

Vietnam

Australia

France

Malaysia

Nepal

Canada

Cambodia

Germany

Sri Lanka

Finland

U.A.E.

India

Italy

Philippines

Russia

Spain

Sweden

United Kingdom

Belgium

DiamondPrincess*

Egypt

Iran

Israel

Lebanon

Afghanistan

Bahrain

Iraq

Kuwait

Oman

Algeria

Austria

Croatia

Switzerland

Brazil

Georgia

Greece

North Macedonia

Norway

Pakistan

Romania

Denmark

Estonia

SouthKorea

1 , 766 infections

LargestoutbreakoutsideofChina

SouthKorea

1,766 infections

Largest outbreak outside of China

Italy

650 infections

OutbreakcenteredinruralareasoutsideMilan

Italy

650 infections

Outbreak centered in rural areas outside Milan

Iran

245 infections

Deputy health minister among those who have tested positive

for how the disease was trans-
mitted.
Increased travel and trade
over the past couple of de-
cades have significantly accel-
erated the risk of global
spread of disease. Airline pas-
senger traffic has more than
doubled since 2003, when
there was an epidemic of an-
other coronavirus, severe
acute respiratory syndrome
(SARS), which infected nearly
8,100 people, killing 774. Inter-
national trade rose to $19.
trillion in 2018 from $7.59 tril-
lion in 2003, according to the
World Trade Organization.
All told, there have been
nearly 82,300 cases of the dis-
ease, called Covid-19, in 46
countries, with 2,804 deaths,
since the virus was identified
almost two months ago, ac-
cording to the WHO. Reports of
deaths and the confirmation of
new infections in seemingly
random places—a case was
even confirmed this week
above the Arctic Circle—have
raised the prospect of a world-
wide contagion.
Yet how big an impact the
virus ultimately has depends
partly on how transmissible
and deadly it turns out to be—
factors that aren’t yet fully un-
derstood. In some ways, as the
stock-market tumble suggests,
that uncertainty is driving
concern.
Right now, cases of infection
are falling through the cracks
as the virus speeds around the
world faster than screening
measures are implemented or
updated. The new virus is par-
ticularly challenging for public-
health officials because people
who are infected and transmit-
ting to others might have only
mild flulike symptoms, or no
symptoms at all, making them
difficult to identify. That is
what makes this virus such a
threat: It spreads more easily
and is milder for most than
SARS or Ebola, yet at least for
now appears deadlier than
some other highly contagious
diseases, such as seasonal flu.
The outbreaks in Italy, South
Korea and Iran all started with
a few cases and expanded
quickly, suggesting that many
mild cases contributed unseen
to the spread, said Nils Daul-
aire, a visiting scholar at the
Harvard T.H. Chan School of
Public Health and Arctic Uni-
versity of Norway, and a former
assistant secretary for global
affairs at the U.S. Department
of Health and Human Services.
“It is now a near certainty
that it will spread to all corners
of the globe and affect every
country,” Dr. Daulaire said.
“The horse is most decidedly
out of the barn.”
Public-health systems
around the world have im-
proved their ability to detect
and battle new emerging dis-
eases, applying lessons learned
from SARS, flu epidemics and a
devastating Ebola epidemic in
West Africa in 2014. Govern-
ments and other funders have
also invested in new technolo-
gies to speed the development
of medicines and vaccines.
But the new coronavirus epi-
demic shows that major gaps
remain. Many countries still
don’t have the staff or labora-
tory technologies to detect out-
breaks quickly. Problems with
diagnostic tests and protocols
for the new coronavirus mean
many infected people likely
aren’t being tested. Few coun-
tries, including the U.S. and Eu-
ropean nations, have extra sup-
plies of hospital beds,
ventilators or other equipment
to handle an influx of patients
with pneumonia caused by the
new coronavirus.
“There has to be a shift in
mind-sets,” said Bruce Ayl-
ward, a veteran epidemiologist
who headed an international

ContinuedfromPageOne

measures that China imposed,

such as large-scale lockdowns,

experts say.

Jeremy Farrar, director of

the Wellcome Trust, a medical-

research charity, said the key is

keeping containment efforts

going as long as possible, to re-

duce overlap with flu season.

The continent’s health systems

are already under pressure, he

said: “There isn’t a huge

amount of spare capacity in the

European health systems.”

In Iran, the confirmed cases

include Iraj Harirchi, the coun-

try’s deputy health minister

and head of its coronavirus task

force. He appeared feverish,

mopping his face during a press

conference this week, with a

government spokesman stand-

ing next to him.

Iran has close ties with

China, and Iranian authorities

have said the virus was most

likely introduced to the country

directly from there. One reason

that Iran now suffers from a

shortage of masks is that Teh-

ran donated a million of them

earlier this month to China.

Current U.S. sanctions have

hampered imports of certain

supplies and medicines.

Holy city

The city of Qom, which offi-

cials have pinned as the epicen-

ter of the outbreak in the Is-

lamic Republic, is one of the

holiest cities in Shia Islam and

attracts thousands of visitors

every year. Religious rituals in

the city include kissing and

touching the shrines, and

crowds praying together inside

mosques.

Despite orders from the Ira-

nian government to close

shrines and mosques in Qom,

clerics in the city resisted for

days after the first Covid-

case was announced on Feb. 19.

Even after Iranian authorities

canceled a three-day religious

festival known as I’tikaf, sched-

uled for early March, Qom resi-

dents have openly defied orders

from the governor’s security

council to keep shrines closed.

Iraq, Kuwait, Oman and Af-

ghanistan reported their first

cases this week, linking them to

Iran. Pakistan reported its first

two cases and said both had

traveled to Qom.

In South Korea, officials are

reporting more new cases with

no ties to a megachurch where

the country’s outbreak began.

Around half of South Korea’s

2,022 confirmed patients have

ties to the Shincheonji Church

of Jesus. New clusters of infec-

tion have been reported at

other churches, while one new

cluster of potential infections is

being examined at a hospital in

northwest Seoul.

Citizens and physicians

groups have criticized Presi-

dent Moon Jae-in’s administra-

tion for not banning the entry

of Chinese nationals. On

Wednesday, South Korea’s

Health Minister Park Neung-

hoo said 2,000 Chinese enter

the country every day and

quarantining them would be

impossible. Mr. Park said the

culprits for the country’s coro-

navirus cases were South Kore-

ans who had traveled to China.

Health officials say they ex-

pect the number of confirmed

patients to keep growing. The

Seoul government has capped

exports of surgical masks

through the end of April amid

short supply. It moved the

prime minister to the hard-hit

city of Daegu to run an anti-

disaster headquarters. Individu-

als who refuse to be tested for

coronavirus can be fined as

much as 3 million South Korean

won, or around $2,500.

Dr. Tedros, the WHO direc-

tor-general, warned that using

the term “pandemic” unless the

disease was truly widespread

globally could amplify fear and

stigma and hamper efforts to

stop it. Still, he said, “All coun-

tries, whether they have cases

or not, must prepare for a po-

tential pandemic.”

—Denise Roland, Sune Engel

Rasmussen, Aresu Eqbali,

Timothy W. Martin, Saeed

Shah and Drew Hinshaw

contributed to this article.

Behind the

Virus’s

Fast Move

HONG KONG—The coronavi-
rus outbreak in South Korea is
now spreading faster than the
epidemic in China, where the
virus first emerged, daily gov-
ernment data indicated, under-
scoring the difficulties in con-
taining the spread of a disease
that some observers already
believe to be a pandemic.
South Korea, the country
worst-hit by the coronavirus
apart from China, has 2,

cases, according to its latest

figures released on Friday. Over

the 24-hour period ended

Thursday afternoon, South Ko-

rea’s 505 new coronavirus in-

fections exceeded the 327 new

cases that China logged over

the whole of Thursday.

It was the first time that

South Korea has reported a

larger daily increase than

China. It was also the lowest

daily total of new cases in

China since Jan. 23, when offi-

cials imposed a quarantine

over Wuhan, a city of 11 million

people where the outbreak ap-

parently began.

Other outbreaks of the

Covid-19 disease caused by the

coronavirus have also widened,

adding to a global death toll

that now exceeds 2,800 people.

South Korea on Thursday af-

ternoon reported one additional

death over the preceding 24-

hour period, for a total death

count of 13. China, meanwhile,

recorded 44 deaths on Thursday,

lifting its toll to nearly 2,800.

The World Health Organiza-

tion has acknowledged that

Covid-19 appears to be cur-

rently widening faster outside

China than within it, but urged

against declaring a pandemic—

a term that connotes the

world-wide spread of a new

disease.

The disease’s rapid spread in

South Korea, which a week ago

had reported just 104 cases, led

the country to inject about $

billion in emergency funds to

stoke economic activity that

has nosedived.

The crisis has stirred up

public criticism of President

Moon Jae-in. Opposition politi-

cians have faulted his adminis-

tration for not imposing a blan-

ket entry ban on travelers from

China, and accused Mr. Moon—

who has sought warmer ties

with Beijing—of prioritizing his

diplomatic agenda over the in-

terests of South Koreans.

Seoul has blocked entry to

travelers arriving from China’s

central Hubei province, where

the coronavirus was first de-

tected. A Moon administration

spokesman, Kang Min-seok,

said the measure is being im-

plemented effectively.

Mr. Kang defended the pol-

icy as being in line with WHO

guidance on epidemic controls,

which doesn’t advise restric-

tions on international travel.

He said the number of Chinese

nationals entering South Korea

isn’t large.

—Dasl Yoon

contributed to this article.

BYCHUNHANWONG

South Korea Overtakes China in New Infections

A diner wore a mask at a restaurant in Milan on Monday. Cases linked to Italy’s outbreak have emerged elsewhere in Europe.

VALERIA FERRARO/SOPA IMAGES/ZUMA PRESS