The Washington Post - 17.02.2020

A12 eZ su the washington post.friday, february 21 , 2020

The Coronavirus Outbreak

BY GERRY SHIH

AND MIRIAM BERGER

BEIJING — Authorities in Hubei
province reported good news
Thursday: There were only 349
new coronavirus cases the previ-
ous d ay, the l owest t ally in weeks.
The bad — and puzzling —
news? Wuhan, the capital of Hu-
bei, reported 615 new cases all by
itself.
As Chinese leaders and state
media strike a coordinated note
this week on the government’s
ability to contain the outbreak,
inconsistencies and sudden
changes in o fficial data are leaving
experts — and journalists — strug-
gling t o plot meaningful trends, or
even place any confidence in the
figures coming from government.
early friday, China’s national
Health Commission reported n ew
infections increased again to 889.
There are now a cumulative total

of 75,465 infections and 2,

deaths, mostly in Hubei province,

the a gency said.

Hubei authorities have

changed their criteria for count-

ing cases twice in the past week.

An earlier change that interna-

tional researchers applauded led

to a sudden s pike in c ase n umbers

on feb. 12. A nd the l atest shift, the

sixth time t hat national guidelines

have been edited since Jan. 15,

caused an overnight drop in new

cases from 1 ,693 t o 349.

Jonathan read, an epidemiolo-

gist at england’s Lancaster Uni-

versity, s aid case d efinitions some-

times do need to be edited as au-

thorities come to grips with how a

novel pathogen manifests itself.

“That said, it is very unhelpful

for surveillance purposes to

change how you define a case too

often,” he said.

The latest inconsistency — un-

der which one city appeared to

have more cases than the total in

the province — apparently arose

because Hubei province deducted

cases that have not been confirmed

through genetic tests from a total

reported case number, which in-

cludes all diagnoses made by phy-

sicians using other methods.

At best, the constant changes

have f rustrated scholars. A t worst,

they have raised suspicions.

“sloppiness of c heating the c ase

# is getting to level of ridiculous,”

eric feigl-Ding, a visiting scientist

at t he H arvard T.H. C han school o f

Public Health, said on Twitter.

There is no smoking gun sug-

gesting that Chinese officials fabri-

cate numbers — at least not since

late January. But many researchers

say the official figures probably un-

derestimate the true numbers be-

cause of limited testing capacity

and the prevalence of cases with

mild or no symptoms. That is why

having case numbers c ollected w ith

consistent methodology would

help scholars c hart the general con-

tours, if not the precise values, of

how t he epidemic is unfolding.

When cases spiked feb. 12,

which coincided with China’s rul-

ing Communist Party n aming sev-

eral new officials to oversee Hubei

and Wuhan provinces, Chinese

political observers predicted that

the move allowed the new regime

to wipe the slate clean and be able

to show progress. That prediction

has b een largely borne out.

The party b oss of Wuhan, Wang

Zhonglin, has ordered a citywide

sweep to find all remaining cases

of coronavirus infections so the

city would have “baseline” statis-

tics to work with. At the same

time, he issued a warning to local

party cadres: If one more case

were to be found in a household,

he said, that district’s party secre-

tary would be held accountable.

Politics aside, innate limita-

tions in scientific modeling also

pose challenges for the coronavi-

rus count.

Covid-19’s fatality rate is around

2 percent, according to prelimi-

nary numbers. But that figure

could be skewed in multiple ways,

said Caitlin rivers, a senior schol-

ar at t he Johns Hopkins Center for

Health security. It’s often difficult

to determine whether c oronavirus

was t he c entral cause of death or a

contributor. Along with c ases d oc-

tors don’t yet know about, there

are also recently infected patients

whose survival remains uncer-

tain. fatality rates differ signifi-

cantly across d emographics.

While public health authorities

are releasing primary medical

data, scientists around the world

are also poring over secondary

sources and publishing studies

based on them. rivers said these

sources are helpful for experts but

cautioned they can be confusing

for a public that doesn’t know

how to interpret the literature.

Knowing the severity of a dis-

ease is critical for modeling who

might die and w hat demographics

are most likely to burden a health

system. for now, said John Allen

Paulos, a professor of mathemat-

ics at Temple University, t here’s an

innate level of u ncertainty a round

coronavirus figures.

The numbers are “nebulous

and unclear,” he said. “We don’t

know and for the time being we

need to take whatever precautions

might w ork.”

[email protected]

[email protected]

berger reported from washington.

China’s counting methods cause confusion as numbers keep fluctuating

Criteria changes make it

difficult for experts to

plot meaningful trends

Kevin Frayer/agence France-presse/getty images

Members of a neighborhood group check a resident’s temperature

Wednesday in Beijing, part of an effort to avoid the coronavirus.

athit perawongmetha/reuters

A bus arrives sunday in Yokohama, Japan, outside the Diamond Princess cruise ship, where the coronavirus had e xploded into a shipwide epidemic. it is a Princess luxury liner.

He r ecorded a video and sent it

to his brother to share with his

family in case he was hospital-

ized and unable to communicate,

or even died. “mom, Dad, I love

you, I miss you. I’m sure every-

thing will be okay,” he recalled

saying.

five days after the ship

reached port, the CDC wrote a

letter to the American passengers

saying that “remaining in your

room is the safest option to mini-

mize your risk of infection,” and

adding, “We acknowledge that

this situation is difficult.”

for nearly two weeks, the only

way off the Diamond Princess

was through illness, and a ride by

ambulance to further isolation in

a hospital.

Complaint to a congressman

tips the balance

for some, the difficult situa-

tion became dire. By the score,

people tested positive. some

200 passengers were over the age

of 80, at much higher risk of

complications from the virus.

The crew members, meanwhile,

were forced to stay at their jobs.

“obviously, the situation on the

ground changed, and clearly

there’s been more transmission

than expected on the ship,” said

michael ryan, a WHo executive

director for health emergencies.

“It’s very easy in retrospect to

make judgments on public health

decisions made a t a certain p oint.”

see virus on A

spencer fehrenbacher, 29, an

American studying for his mas-

ter’s degree in China, signed up

for the cruise with friends as a

break between semesters. Just a

couple of days in, they became

alarmed about reports of the

virus spreading in China.

In Vietnam, he came down

with a fever. It lasted only

24 hours, but he feared he might

have the virus. He decided not to

get off at the next two stops, in

Ta ipei and okinawa, because he

was afraid he’d wind up quaran-

tined.

T he ship sped back to Yokoha-

ma and docked feb. 3. Japanese

authorities told passengers they

could not leave.

The next day, they mingled

onboard. many ate a buffet din-

ner, but the casino was closed and

the evening show canceled. That

night, the captain ordered pas-

sengers to return to their cabins

and stay there until quarantine

officers came to see them.

over the next several days, test

results trickled in: Dozens had

become infected. fehrenbacher

kept fearing the worst.

“I was sitting there all day

waiting for what I call the knock

of doom on the door,” he said.

fehrenbacher stayed in his

room — e very day, a ll day. H e had a

balcony and that was good

enough. He started using t he word

“optimistic” when he spoke to

friends and family, because “posi-

tive” c arried a bad connotation.

an average of slightly more than

two additional people. The dis-

ease has been fatal in roughly two

out of 100 confirmed cases.

T ravelers have already spread

it to more than two dozen coun-

tries, where it has infected more

than 75,000 people and killed

more than 2,000.

‘The knock of doom’

T he Diamond Princess left Yo-

kohama for a 15-day cruise on

Jan. 20. one man from Hong

Kong left the ship when it docked

there five days later, and checked

into a hospital. on feb. 1, officials

confirmed he was infected with

the coronavirus.

the Westerdam, who were greet-

ed by the Cambodian prime min-

ister with handshakes and flow-

ers, and who later traveled wide-

ly. only later did news come that

one of the Westerdam passengers

had tested positive for the virus.

That situation spurred fears

that Westerdam passengers

would spread the virus around

the world. But no additional pas-

sengers have tested positive, and

so far, no evidence has emerged

they have widely seeded the virus.

The coronavirus (officially,

sArs-CoV-2) is extremely conta-

gious. experts estimate that with-

out protective measures, every

infected person will spread it to

case scenario, covid-19, a flulike

respiratory infection, could be-

come a full-blown global pan-

demic.

navigating the crisis has re-

quired delicate medical and polit-

ical judgments. The decision to

evacuate the Americans from the

Diamond Princess came only af-

ter infections on the cruise ship

spiked and passengers revealed

their grim living conditions.

one lesson from that debacle is

that cruise ships are like petri

dishes. Thousands live in close

quarters on a vessel never de-

signed for quarantines. The crew

continued to deliver food, and

health workers moved through-

out the ship. more than 600 of the

3,700 passengers and crew mem-

bers have now tested positive for

the virus and two older Japanese

passengers have died.

With Japanese authorities iso-

lating the passengers for weeks

off the coast, the ship, operated

by Princess Cruises, quickly de-

veloped the second-largest num-

ber of coronavirus cases on the

planet outside of China — more

than in Japan, singapore, Thai-

land, the United states or all of

europe. Avoiding “another Chi-

na” has been the goal of the World

Health organization for weeks,

and then it happened anyway, in

Yokohama harbor.

The treatment of the Diamond

Princess passengers stands in

stark contrast to what happened

to those on another cruise ship,

wanted to forge ahead. The in-
fected passengers had no symp-
toms and could be segregated on
the p lane in a plastic-lined e nclo-
sure. But officials at the Centers
for Disease Control and Preven-
tion disagreed, contending they
could still spread the virus. The
CDC believed the 14 should not
be flown back with uninfected
passengers.
“It was like the worst night-
mare,” said a senior U.s. official
involved in the decision, speak-
ing on the condition of anonymi-
ty to describe private conversa-
tions. “Quite frankly, the alterna-
tive could have been pulling
grandma out in the pouring rain,
and that would have been bad,
too.”
The state Department won the
argument. But unhappy CDC offi-
cials demanded to be left out of
the news release that explained
that infected people were being
flown back to the United states —
a move that would nearly double
the number of known coronavi-
rus cases in this country.
The tarmac decision was a
pivotal moment for U.s. officials
improvising their response to a
crisis with few precedents and
extraordinarily high stakes. ef-
forts to prevent the new patho-
gen from spreading have revealed
the limits of the world’s r eadiness
for an unprecedented public
health emergency. In the worst-

virus from A

Against the CDC’s advice, infected Americans flown home

spencer Fehrenbacher

spencer Fehrenbacher, 29, takes a photo on a state Department-

chartered airplane from Tokyo to the united states.

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