The World Health Organization is seeking more information from China about the large numbers of health workers falling sick because of the coronavirus after it was revealed 1,760 of them have tested positive and six have died.
This is the first time China has included the specific numbers for healthcare professionals in the data it has provided on the spread of the epidemic. “This is a critical piece of information because health workers are the glue that holds the health system and the outbreak response together,” said the WHO’s director general, Dr Tedros Adhanom Ghebreyesus.
What is the virus causing the illness that started Wuhan?
The virus is officially called Sars-CoV-2 and this causes the disease Covid-19. It is a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. Many of those initially infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city.
What other coronaviruses have there been?
New and troubling viruses usually originate in animal hosts. Ebola and flu are other examples – severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals.
What are the symptoms of the coronavirus?
The virus can cause pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. If people are admitted to hospital, they may get support for their lungs and other organs as well as fluids. Recovery will depend on the strength of their immune system. Many of those who have died were already in poor health.
Is the virus being transmitted from one person to another?
China’s national health commission has confirmed human-to-human transmission, and there have been such transmissions elsewhere. As of 12 February there are now 45,182 confirmed cases and 1,115 deaths. There are cases in 28 other countries outside China, with deaths recorded in one case in Hong Kong, and one case in the Philippines. The number of people to have contracted the virus overall could be far higher, as people with mild symptoms may not have been detected.
The number of confirmed cases of coronavirus in the UK has doubled from four to eight after four more people in Brighton were diagnosed with the infection over the weekend.
There are nine cases of the virus in the UK. Four were located in Brighton, one in London. At Arrowe Park Hospital in Merseyside 83 people in quarantine were told they would be allowed to leave on Thursday after they all tested negative. Of the 1,750 tests carried out so far in the UK, more than 99% had been negative.
Why is this worse than normal influenza, and how worried are the experts?
We don’t yet know how dangerous the new coronavirus is, and we won’t know until more data comes in. The mortality rate is around 2%. However, this is likely to be an overestimate since many more people are likely to have been infected by the virus but not suffered severe enough symptoms to attend hospital, and so have not been counted. For comparison, seasonal flu typically has a mortality rate below 1% and is thought to cause about 400,000 deaths each year globally. Sars had a death rate of more than 10%.
Should I go to the doctor if I have a cough?
Unless you have recently travelled to China or been in contact with someone infected with the virus, then you should treat any cough or cold symptoms as normal. The NHS advises that people should call 111 instead of visiting the GP’s surgery as there is a risk they may infect others.
Is this a pandemic and should we panic?
Health experts are starting to say it could become a pandemic, but right now it falls short of what the WHO would consider to be one. A pandemic, in WHO terms, is “the worldwide spread of a disease”. Coronavirus cases have been confirmed in about 25 countries outside China, but by no means in all 195 on the WHO’s list.
There is no need to panic. The spread of the virus outside China is worrying but not an unexpected development. The WHO has declared the outbreak to be a public health emergency of international concern, and says there is a “window of opportunity” to halt the spread of the disease. The key issues are how transmissible this new coronavirus is between people and what proportion become severely ill and end up in hospital. Often viruses that spread easily tend to have a milder impact.
“We need to know more about these figures, including the time period and circumstances in which the health workers became sick.”
On the same day, Egypt reported a case, making it the first country in Africa to do so. The country’s health ministry said the affected person was a foreigner who had been put into isolation at hospital, adding that the WHO had been immediately informed and that all necessary preventative measures had been taken. It did not give the nationality of the affected person or any other details.
Earlier this month the WHO said it was particularly concerned about high-risk nations with weaker health systems that may lack the facilities to identify cases.
Doctors and nurses in China are having to adopt makeshift measures to try to protect themselves in the face of dire shortages of protective gowns, gloves and masks, according to the New York Times. Eyewitnesses told of health professionals patching up damaged protective masks with tape and reusing goggles meant to be used once and thrown away. They are wrapping their shoes in plastic bags because they have no protective covers for them.
Some have used their own money to buy protective gear if they could find it for sale, or begged from friends. Others told of avoiding eating and drinking for long stretches because going to the toilet meant removing and discarding safety gowns that they would not be able to replace.
Tedros pointed out that the WHO had disseminated its guidelines for protecting health workers to China and other countries with Covid-19 cases, but the critical problem in coronavirus-hit Chinese hospitals appears to be obtaining protective gear.
On Friday, Doctors Without Borders/Médecins Sans Frontières (MSF) said that it would send 3.5 tonnes of medical protective equipment to Wuhan Jinyintan hospital— one of the hospitals at the forefront of treating patients with the virus.
The lockdown in China’s cities is intended to stop the virus travelling but has impeded the production and delivery of essential supplies of personal protective equipment (PPE) and masks and glove, while donations have not always got through to where they are most needed.
WHO is already seeking more information from the Chinese government about the change in the way doctors are now diagnosing Covid-19, which led to a big surge in diagnoses numbers on Thursday. An extra 15,000 cases were reported from the centre of the outbreak, Hubei province, who had all been diagnosed by a CT scan of their lungs and not a lab test.
On Friday, the latest figures were 47,500 lab-confirmed cases in China and 16,457 clinical diagnoses reported by doctors after scans, bringing the total to more than 63,000. Tedros said they needed to know doctors were not misdiagnosing other infections as the coronavirus.
“While it is not uncommon in outbreaks for clinical definitions to change over time as more information becomes available, we are seeking further clarification on how the clinical diagnosis is being made, to ensure that other respiratory illnesses including influenza are not getting mixed into the Covid-19 data,” he said.
US experts will be part of an international team that will arrive in China at the weekend to hold talks with their counterparts, the WHO said. The confirmation followed calls from a senior White House official for Beijing to be more transparent over its handling of the outbreak and its change in the reported data, as Chinese authorities expanded “wartime” measures to limit its spread.
“We’re a little disappointed in the lack of transparency coming from the Chinese,” said Larry Kudlow, the director of the US National Economic Council.
China’s national health commission’s vice-director, Zeng Yixina, confirmed that more than 1,700 Chinese medical workers had been infected and six had died, adding that the commission was “highly concerned about this issue” and had issued guidelines for the prevention and control of infection within medical institutions.
Healthcare workers accounted for about 3.8% of confirmed cases as of three days ago, Zeng said.
The death toll stands at 1,383. Three deaths were outside of mainland China: in Hong Kong, Japan and the Philippines.
Singapore confirmed nine new cases on Friday, bringing its total to 67, while in Japan, the health ministry said 11 elderly passengers on the quarantined cruise ship Diamond Princess were allowed to leave the vessel after they tested negative.
While public health experts have greeted the change in reporting positively, others say it raises more questions about the data. The change in diagnostic criteria has been applied only to Hubei province.
“Is the politburo really being honest with us?” Kudlow asked, referring to communist China’s top leadership body. Kudlow said President Xi Jinping had assured Donald Trump that Beijing would accept US help, but “they won’t let us”.
“I don’t know what their motives are. I do know that apparently more and more people are suffering over there,” he said.
At a meeting of senior leaders in Beijing on Thursday, officials called for other areas to “adopt quarantine and rescue measures equal to that of Wuhan”, which has been under lockdown for the past three weeks. The meeting, chaired by the Chinese premier, Li Keqiang, called on Wuhan to speed up classifying and quarantining residents suspected or confirmed of contracting the virus.
In Huanggang, one of the worst-hit areas outside of Wuhan with more than 2,000 cases and at least 59 deaths, authorities issued emergency measures for 14 days, “fully sealing” all residential areas and banning vehicles, except those for emergency, medical or official purposes.
Checkpoints would be set up and public security deployed to enforce the measures. Local district committees are to organise residents’ food and supplies. “All residents must not enter or leave their communities without authorisation,” the notice said.
Additional reporting by Pei Wu Lin