Fears of a global pandemic are rising as authorities in China struggle to contain the spread of a pneumonia-like illness with a travel lockdown widening to include a dozen cities in central China.
Fifteen new deaths were announced by health officials in Hubei province on January 25, the start of the Lunar New Year holiday, raising the death toll to 56. All but three of the victims of the newly identified coronavirus perished in Wuhan, the central Chinese city of 11 million at the epicenter of the outbreak.
Though more than 20 cases of the virus have been identified elsewhere in Asia and as far afield as Europe and the United States, fatalities have thus far been confined to China. There is no vaccine or specific treatment for the Wuhan coronavirus, though China has confirmed it can be transmitted through human contact.
The majority of fatal cases, according to the World Health Organization (WHO), are among the elderly with pre-existing chronic conditions that would increase their susceptibility to infectious diseases.
Symptoms of the illness include fever, difficulty in breathing, coughing and fatigue. Much, however, remains unknown about the deadly new strain of coronavirus, including the extent of its lethality and how easily it spreads through human-to-human transmission.
But the outbreak is rapidly expanding with newly confirmed cases in China.
“We’re beginning to see information about the transmissibility [of the coronavirus] which seems to be fairly high,” said William Aldis, a former senior WHO official and country representative for Thailand. “As far as becoming a pandemic, the virus has to be lethal in a high proportion of affected cases, and we don’t know that yet.”
Analysis of the full genome sequence of the new virus strain had led scientists to conclude that it belongs to the same family of coronaviruses as SARS (Severe Acute Respiratory Syndrome), which killed 774 and infected over 8,000 after initially emerging in China and quickly spreading to 37 countries in a deadly outbreak from 2002 to 2003.
SARS was eventually contained and there have been no known cases of it reported anywhere in the world since 2004. Medical experts are divided over whether the Wuhan coronavirus outbreak poses a greater threat than SARS. Measuring the case fatality rate – the number of people who die after being infected – is key to determining its risk.
At present, it remains unclear how many people are infected. Further complicating efforts to detect and contain the contagion is the fact that health officials in China believe that the incubation period for the coronavirus is around 14 days, meaning those infected may not show symptoms of the disease until two weeks later.
“If you look at the worldwide reporting of deaths and divide it by the number of cases, we might suspect that the lethality of this virus is relatively low. But, we don’t have enough of a numerator and denominator to draw a conclusion,” Aldis, who coordinated WHO’s response to avian influenza in Thailand in the 2000s, told Asia Times.
The WHO has thus far declared the new coronavirus an “emergency in China” but has stopped short of designating the outbreak a “public health emergency of international concern” (PHEIC), a formal declaration that would legally require countries to initiate preparedness plans and step up their response to prevent a wider epidemic.
Aldis told Asia Times that the international public health agency is “on the brink” of issuing such a declaration, but it must first determine the “pandemic potential” of the previously unknown contagion. “There is still not enough epidemiologic data. Until we know its lethality, we should avoid pressing too many panic buttons,” he said.
Twenty-nine of China’s 31 provinces and regions have confirmed cases of the coronavirus and a travel lockdown has been imposed upon some 56 million people ahead of the Lunar New Year holiday, which ordinarily sees hundreds of millions of citizens traversing the country to attend family reunions in their hometowns.
Fears persist that the infection rate could accelerate as masses of people return to their communities and millions travel abroad during the holiday. Local authorities in Wuhan, a major travel hub within China, have been criticized for not being quick enough to initiate efforts to stem the flow of outbound Lunar New Year travelers.
“There will be people right now in transit, people already on the move who are already infected,” said Aldis, referring to individuals who departed from Wuhan while the virus was still in the incubation stage. “The disease has already escaped many specific geographic boundaries. What happens next depends on how lethal this virus is.”
According to the US Centers for Disease Control and Prevention (CDC), the source of the virus can be traced to a human-to-animal contact at a seafood and poultry market in Wuhan known to trade in illegal wildlife. Authorities quickly disinfected the market, a move that experts say complicates efforts to trace and control the source of the contagion.
As the death toll rises, Beijing’s handling of the worst major public health crisis it has faced since SARS is under scrutiny. The Chinese government was roundly criticized for a slow and ineffective response to that earlier deadly outbreak 18 years ago. Many had then accused it of attempting to downplay the severity and cover up the scale of the epidemic.
With Beijing’s unprecedented decision to seal off a region with a population nearly equivalent to Canada’s, many have acknowledged the Chinese response as being robust. WHO earlier this month said the rapid identification of the new virus strain demonstrated China’s “increased capacity to manage new outbreaks.”
Medical personnel with the People’s Liberation Army (PLA) have been deployed to Wuhan, and local authorities have begun constructing a 1,000-bed hospital for the infected. While Beijing demonstrates a capacity to marshal resources to manage the crisis, tight control of information flows by authorities have given some observers cause for concern.
“China’s containment effort has been proactive but opaque,” said Zi Yang, a senior analyst with the China Program at the S Rajaratnam School of International Studies (RSIS) in Singapore, in a recent commentary. “Yet despite the quick response […] transparency remains a major issue that could undermine international containment effort.”
While China’s approach to the ongoing outbreak has differed from its handling of SARS, the academic claimed there has been “severe underreporting” of the number of infected persons. Though international partners and agencies are being kept informed of developments, the legacy of the SARS outbreak “still shadows responses of today,” Zi said.