Coronavirus outbreak 'just beginning' outside China, says expert

Killer coronavirus outbreak is ‘just getting started’ outside of China and will strike EVERY country on the planet, warns infectious diseases expert

Dale Fisher, a WHO official, said he’s confident every country will have infections
Chinese health bosses claim disease may be completely gone in China by April
Mr Fisher said that’s possible, but outbreak is just beginning in other nations
Flu-like virus has killed more than 1,100 people and infected nearly 46,000
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Every country in the world can expect to have cases of coronavirus because the epidemic is ‘only just getting started’ outside of China, an experts has warned.

Chinese health bosses claim the disease may be completely eradicated by April, after the country reported its lowest number of new cases in nearly two weeks.

But a World Health Organization (WHO) official has said while the epidemic may be reaching its peak in China, it would continue to get worse for the rest of the world.

Dale Fisher, chair of the Global Outbreak Alert Response Network at the WHO, said: ‘It has spread to other places where it’s the beginning of the outbreak. In Singapore, we are at the beginning of the outbreak. I’d be pretty confident though that eventually every country will have a case.’

The flu-like virus has killed more than 1,100 people and infected nearly 46,000, mostly in China.

A member of staff checks the temperature of people entering a building at the Central Business District (CBD) in Singapore to screen them for coronavirus

Singapore has reported 50 coronavirus cases, one of the highest tallies outside China, including mounting evidence of local transmission.

Asked why there were so many cases in Singapore, Mr Fisher said there were comparatively more tests being conducted on the island.

‘We have a very low index of suspicion for testing people so…we do have higher ascertainment,’ he said, but added that there was a lot about transmission of the virus yet to be understood.

Mr Fisher’s warning comes after the WHO described the outbreak as the ‘worst enemy you can ever imagine’ and more of a threat to humanity than terrorism.

WHO’s director general, Dr Tedros Ghebreyesus, said the epidemic could rumble on for more than a year and warned a vaccine could take at least 18 months to develop.

He added: ‘To be honest, a virus is more powerful in creating political, social and economic upheaval than any terrorist attack. It’s the worst enemy you can imagine.’

Yesterday a top Hong Kong medical official predicted the coronavirus could infect more than 60 per cent of the global population if containment methods fail.

Professor Gabriel Leung, chair of public health medicine in the city, said on Tuesday even if the coronavirus kills just 1 per cent of sufferers, it could still wipe out as many as 45million people.

But WHO’s director general, Dr Tedros Ghebreyesus, said the epidemic – which has struck down 46,000 (shown) – could rumble on for more than a year

China hopes the killer virus, which has claim claimed more than 1,000 lives (shown) will be curbed by April

The WHO has long believed that a new disease pandemic could rapidly race around the world and destabilise society, due to modern air travel.

Dr Ghebreyesus’ stark warning was a more broad statement about new unknown viruses, not specifically the Chinese coronavirus.

It comes after the United Nations health agency gave the illness its official name, COVID-19.

CO stands for corona, VI for virus, D for disease and 19 for the year it emerged, Dr Ghebreyesus explained on Tuesday when it was revealed.

WHO bosses said they avoided referring to a geographical location, animal or group of people so it would not cause any prejudice.

The virus, which has had various names from simply coronavirus to Wuhan coronavirus, Chinese coronavirus or even snake flu, needs its own moniker because it is just one type of coronavirus.

The word refers to a group of viruses which contains those that cause SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome).

Dr Tedros Ghebreyesus, the director-general of the World Health Organization, said: ‘To be honest, a virus is more powerful in creating political, social and economic upheaval than any terrorist attack. It’s the worst enemy you can imagine’

The deadly coronavirus outbreak is the ‘worst enemy you can ever imagine’, according to the World Health Organisation. Medics in hazmat suits transfer a patient into the isolation ward in a hospital in Wuhan

HOW MANY CASES HAVE BEEN RECORDED ACROSS THE WORLD?

COUNTRY

CHINA

JAPAN

SINGAPORE

HONG KONG

THAILAND

SOUTH KOREA

TAIWAN

MALAYSIA

AUSTRALIA

VIETNAM

GERMANY

FRANCE

MACAU

UAE

CANADA

INDIA

PHILIPPINES

ITALY

RUSSIA

SPAIN

BELGIUM

SWEDEN

FINLAND

NEPAL

SRI LANKA

CAMBODIA

WORLD TOTAL

CASES

42,667

161

43,132

The number of new cases reported in China each day has begun to level off, steadily declining in the last six days.

But scientists tackling the crisis warn the true toll will be much higher than figures show because thousands of patients have only mild symptoms or are asymptomatic.

Most experts believe that each infected person has gone on to transmit the virus to around 2.5 people, giving an ‘attack rate’ of 60 to 80 per cent.

The death rate, however, is thought to be much lower. Hong Kong’s Professor Leung expects it to be around one per cent once milder cases, that have not been diagnosed, are taken into account.

‘Is 60 to 80 per cent of the world’s population going to get infected?,’ he told The Guardian during a trip to London this week,

‘Maybe not. Maybe this virus will come in waves. Maybe the virus is going to attenuate its lethality because it certainly doesn’t help it if it kills everybody in its path, because it will get killed as well.’

It comes after two British prisoners await results after being tested for coronavirus in Oxfordshire – one of whom had recently been transferred from a jail in Thailand.

Mark Rumble, 31, from Oxfordshire, was sent back to the UK to face charges of a conspiracy to supply class A drugs.

Rumble reportedly collapsed in his cell at HMP Bullingdon, close to Bicester on Monday, while a second inmate developed flu-like symptoms and a third other is also being tested for the illness.

A total of 33 cases of the coronavirus, have been diagnosed in Thailand and it was the first country outside of China to declare cases, on January 13.

Meanwhile Brighton is at the centre of Britain’s coronavirus crisis, with six of the UK’s eight confirmed cases diagnosed in the city.

‘Super-spreader’ businessman Steve Walsh picked up the virus in Singapore on a work trip and brought it back to the UK following a ski trip in France. He is feared to have infected at least 11 others in the UK, France and Spain.

Mr Walsh broke his silence after discovering he was the source of an extraordinary web of cases stretching across the UK and Europe.

Speaking from an NHS isolation room, the sales executive yesterday revealed he had ‘fully recovered’ and insisted he acted as quickly as possible once he realised the threat he posed.

Yesterday, authorities were still tracking the contacts of Mr Walsh and his five associates – including two GPs – who have also tested positive in the Brighton area over the last few days.

One of the two infected GPs also worked at the A&E unit at Worthing Hospital in West Sussex, which was last night contacting patients and staff to tell them what precautions they should take.

The doctor, who has not been identified, treated a ‘small number’ of patients at the hospital on February 4 and 5 before they became unwell and ‘self-isolated’.

WHAT DO WE KNOW ABOUT THE DEADLY CORONAVIRUS IN CHINA?

Someone who is infected with the coronavirus can spread it with just a simple cough or a sneeze, scientists say.

At least 1,116 people with the virus are now confirmed to have died and more than 45,200 have been infected in at least 28 countries and regions. But experts predict the true number of people with the disease could be 100,000, or even as high as 350,000 in Wuhan alone, as they warn it may kill as many as two in 100 cases. Here’s what we know so far:

What is the coronavirus?

A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.

The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.

Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.

The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.

Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals.

‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses).

‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’

The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.

By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.

The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000.

Just a week after that, there had been more than 800 confirmed cases and those same scientists estimated that some 4,000 – possibly 9,700 – were infected in Wuhan alone. By that point, 26 people had died.

By January 27, more than 2,800 people were confirmed to have been infected, 81 had died, and estimates of the total number of cases ranged from 100,000 to 350,000 in Wuhan alone.

By January 29, the number of deaths had risen to 132 and cases were in excess of 6,000.

By February 5, there were more than 24,000 cases and 492 deaths.

By February 11, this had risen to more than 43,000 cases and 1,000 deaths.

Where does the virus come from?

According to scientists, the virus has almost certainly come from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.

The first cases of COVID-19 came from people visiting or working in a live animal market in the city, which has since been closed down for investigation.

Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat.

A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent similar to a coronavirus they found in bats.

However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.

Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.

‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’

So far the fatalities are quite low. Why are health experts so worried about it?

Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.

It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs.

Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.

Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.

‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’

If the death rate is truly two per cent, that means two out of every 100 patients who get it will die.

‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.

‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’

How does the virus spread?

The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.

It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky.

Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person.

There is now evidence that it can spread third hand – to someone from a person who caught it from another person.

What does the virus do to you? What are the symptoms?

Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.

If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients – at least 97 per cent, based on available data – will recover from these without any issues or medical help.

In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.

What have genetic tests revealed about the virus?

Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world.

This allows others to study them, develop tests and potentially look into treating the illness they cause.

Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.

However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.

This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.

More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.

How dangerous is the virus?

The virus has so far killed 1,116 people out of a total of at least 45,207 officially confirmed cases – a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.

However, experts say the true number of patients is likely considerably higher and therefore the death rate considerably lower. Imperial College London researchers estimate that there were 4,000 (up to 9,700) cases in Wuhan city alone up to January 18 – officially there were only 444 there to that date. If cases are in fact 100 times more common than the official figures, the virus may be far less dangerous than currently believed, but also far more widespread.

Experts say it is likely only the most seriously ill patients are seeking help and are therefore recorded – the vast majority will have only mild, cold-like symptoms. For those whose conditions do become more severe, there is a risk of developing pneumonia which can destroy the lungs and kill you.

Can the virus be cured?

The COVID-19 virus cannot currently be cured and it is proving difficult to contain.

Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.

No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.

The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.

Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.

People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.

And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).

However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.

Is this outbreak an epidemic or a pandemic?

The outbreak is an epidemic, which is when a disease takes hold of one community such as a country or region.

Although it has spread to dozens of countries, the outbreak is not yet classed as a pandemic, which is defined by the World Health Organization as the ‘worldwide spread of a new disease’.

The head of WHO’s global infectious hazard preparedness, Dr Sylvie Briand, said: ‘Currently we are not in a pandemic. We are at the phase where it is an epidemic with multiple foci, and we try to extinguish the transmission in each of these foci,’ the Guardian reported.

She said that most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.

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