BBC Focus 02.2020

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REVIEW REALITY CHECK

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WHEN DID THE OUTBREAK START?
On 31 December 2019, China contacted the World Health
Organization (WHO) to inform them of an outbreak of
‘pneumonia of unknown cause’ in Wuhan, a city in the
country’s central Hubei province.
A week later, on 7 January 2020, the Chinese authorities
investigating the outbreak confirmed that a previously
unknown strain of coronavirus was to blame. It was
believed to have originated in one of Wuhan’s animal
markets, where it had jumped species from an as-yet-
unidentified animal into humans.
By 11 January the coronavirus, temporarily designated
2019-nCoV, had claimed its first life. Over the next 10
days, the news broke that human-to-human transmission
of 2019-nCoV was possible. The virus killed two more
people, and cases of it turned up in Thailand, Japan, South
Korea, Vietnam and the US. WHO met to determine
whether the situation constituted a global emergency.
As of Monday 27 January, less than a month after the
initial alert, 10 cities in Hubei are in a state of lockdown
and airports around the globe are screening passengers
arriving from Wuhan. The virus has reached Australia
and France, the number of confirmed cases is up to
almost 3,000 and rising.

BUT HOW SERIOUS IS IT?
The 2019-nCoV virus presents with flu-like symptoms but
is capable of causing respiratory distress, pneumonia and
potentially death. Furthermore, it’s contagious before the
symptoms show.
“It’s a serious situation. We’re approaching it with
caution but I don’t think alarm,” says Prof Mark Fielder, a
medical microbiologist at Kingston University. “What we
need to remember is that most of the cases – in fact, I’m
going to say all of the cases as things stand now – have
come from people with direct links to Wuhan or other
local cities where the virus is known to be present.”
According to Fielder, the virus hasn’t moved into people
without direct links to Wuhan – it will be more
concerning if that happens. Many people, once they are
given supportive care, seem to fight the virus off and get
better. “A number of the patients who unfortunately lost

“Most of the cases have come from people with


direct links to Wuhan or other local cities where


the virus is known to be present”


LEFT
Colourful
lanterns
decorate a
Beijing park,
but the Lunar
New Year
festivities
were
cancelled to
reduce risk of
infection
ABOVE In
Zhongnan
Hospital,
Wuhan, a
doctor and a
patient bid
each other
greetings
for the Lunar
New Year

their lives have also had other diseases, so they’ve perhaps
not been quite so fit in the first place,” says Fielder.
At the time of writing, the coronavirus is still spreading.
But despite the seemingly steep rise in the number of cases,
the outbreak remains within estimates of its expected
incidence. WHO has put the total number of expected cases at
4,000, with a margin for error from 1,000 to 9,700.
“[The reason] we’ve seen a rise in the number of cases is, I
think, a conglomeration of factors. If it did emerge from this
market, which does seem likely, then obviously quite a lot of
people attended that market, especially as people were
probably getting provisions for the New Year celebrations in
China,” explains Fielder. “But we can’t tell how many people
were in that market and where they went afterwards or where
they’d come from before. Also, it takes about five days for the
symptoms to appear, so there would have been a delay from
exposure to symptom formation. And perhaps we’re now
seeing relatives of those infected, and people who have been
caring for them, succumbing themselves.” The length of
2019-nCoV’s incubation period explains the sudden jump in
the number of confirmed cases. Transmission may be slowing
but cases will continue to appear due to the time it takes for
the infection to present. Ensuring China has sufficient
capacity to deal with the cases that are still to appear is why
it’s currently rushing to build new hospitals.

WHY IS THERE SUCH A WIDE MARGIN OF ERROR?
The wide margin for error associated with WHO’s estimate 2

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