Confirmed cases of the novel Wuhan coronavirus have gone from 62 detected in Wuhan (and 3 exports that we knew of then) to over 200 after a jump of 136 new cases in a single report from the Wuhan Municipal Commission of Health (WMCH). Also, disease now includes “‘mild” pneumonia cases as well as severe and critical. And there have been 2 cases in Beijing and 1 in Shenzhen as well as a new case in South Korea (onset Jan 18). This isn’t great news.
Photo by chuttersnap on Unsplash
On January 17th Wuhan reported 17 new cases,[2] but their next report includes cases for Jan 18th – in which 59 new cases have been added with 1 new death and Jan 19th with 77 new cases.[1] Four deaths have now occurred.
136 new cases in two days
Of the 136 new cases, 66 were male and 70 were female. This is a significant change from the male-dominated figures we’d seen to date. The youngest case was 25 years old and the oldest was 89 years old. The onset of illness continues to creep up – cases are likely to be being acquired in an ongoing fashion – from where we still don’t know. The latest batch has onset dates which include up to the 18th of January.
It seems that all cases still had pneumonia but the severity of it has now been ranked. The 136 cases are spread across 100 mild cases, 33 severe cases, and 3 critical cases.
A burden on hospitals
The total number of novel Wuhan coronavirus-associated pneumonia cases in Wuhan now stands at 198 (201 worldwide). 25 Wuhan cases have recovered (12.6%) and 3 been discharged (1.5%). 170 (85.8%) of cases are still in isolation in a hospital so there is a very real burden to healthcare services. Of these, 126 cases (74.1% of those hospitalised) are described as mild pneumonia, 35 (20.6%) as severe, and 9 (5.3%) cases as critically ill.[1]
We are of course all assuming this is a new burden but we have no evidence yet to support that. This may be part of a previous burden of pneumonia that went undetected because there was no seafood market to identify it as a cluster of unusual activity. Virus age remains a question.
Contact conundrum – to watch or to test (test!)
There are now 817 close contacts in Wuhan of which 727 “medical observations have been lifted, and 90 medical observations are still underway”. This says not testing, just observing, to me. I’d love WMCH to clarify this in their next FAQ/Q&A
This is a common procedure in the early days of an emerging virus. I’ve seen it frequently, even in my short times in this field. Medical Doctors choose to watch for symptoms over testing for the virus. Test take time to develop so this is a quick way to look for obvious spread of disease. But it does not monitor the spread of the virus . Eventually, this will be done but time is lost while using a relatively incentive tool to learn about a new virus.
Tests take some time – but something highly sensitive and specific can be available within a week of having a virus’s sequence. A new assay’s component sequences can be shared at that time for everyone’s benefit. In this event, the first specific assays developed were by an external group in Germany and now a second group from Hong Kong;[3] no sequences or details about the assay(s) in use within Wuhan or by the Chinese CDC have been published yet, despite their declaration and mass production of some sort of “nucleic acid” kit having been rolled out at “all levels”.[4].
From that moment on, it would be better practice to test respiratory samples form contacts, close and otherwise. Cost is not an issue when seeking to stop the emergence of a respiratory disease and its cause because the cost that accrues after its escape will be exponentially higher. There are only excuses for not testing and old medical habits to overcome.
No related cases were found among the close contacts but as far as I can tell from these reports, they haven’t been tested with a nucleic-acid based test. An antibody detecting test – if suitably specific – is also essential. But they take longer to develop for multiple reasons.
What will tomorrow bring? More testing I hope and with it, more answers.
References
- Wuhan Municipal Commission of Health and Health on pneumonia of new coronavirus infection | Published: 2020-01-20 02:42:40
http://wjw.wuhan.gov.cn/front/web/showDetail/2020012009077 - Wuhan Municipal Commission of Health and Health on pneumonia of new coronavirus infection | Published: 2020-01-19 00:43:34 http://wjw.wuhan.gov.cn/front/web/showDetail/2020011909074
- World Health Organization Technical Documents for Novel Coronavirus | Laboratory guidance
https://www.who.int/health-topics/coronavirus/laboratory-diagnostics-for-novel-coronavirus - New advances in prevention and control of new coronaviruses
https://m.nbd.com.cn/articles/2020-01-15/1400572.html
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Diagnostics in China for this new coronavirus has been developed with the assistance of a specialist Military operation team and a private firm (where ‘private’ means with local or centralized permissions/participation). To test all people in China is not feasible (1,1 bln of people), and close contacts that remained not symptomatic could be exempted, at least until a third generation infection arises in contacts’ contacts. Blood samples may be collected for further serology when this will be available / feasible. As margin note, I would suggest FluBlogia to being less eager to see ‘official reports’ from local / national health & family planning commissions. Sina / Xinhua / CCTV / People’s Daily / Youth Daily are ‘official’ source of information, since in China there are not ‘independent’ media outlets. Careful analysis of these source ‘messages’ will reveals all things the rulers want to disclose.
Have you noticed that moderation delete ‘duplicate comments’ even when there are no duplicatons? It’s a pity when one reaches 500 chars reaction to a post, only to see them voided by the system.