Monday, March 30, 2020

Coronavirus incubation could be longer than 14 days; global infection numbers rise

Feb 23. 2020
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By The Washington Post · Anna Fifield, Simon Denyer, Chico Harlan, Miriam Berger, Marisa Iati · NATIONAL, WORLD, THE-AMERICAS, ASIA-PACIFIC, EUROPE, MIDDLE-EAST 

BEIJING - Scientists were studying a case in China that suggested the incubation period for coronavirus could be longer than 14 days, potentially casting doubt on current quarantine criteria even as the epidemic moved into new regions.

The potential for a longer incubation period was linked to a patient in China's Hubei province, where the virus was first detected in December. A 70-year-old man was infected with coronavirus but did not show symptoms until 27 days later, the local government reported. 

South Korea and Japan both reported a sharp spike in cases Saturday, while an additional 109 people died of the virus in China and a sixth person died in Iran. Italian authorities on Saturday said the country was seeing a sudden rise in coronavirus cases, with at least 58 confirmed in the past two days - an outbreak that represents the largest yet across Europe. 

Meanwhile, scientists in China reported indications that the virus might be transmissible through urine. 

World Health Organization Director General Tedros Adhanom Ghebreyesus said Saturday that WHO experts were due to arrive that day in Wuhan, China, the center of the coronavirus outbreak. The team has visited three Chinese provinces this week, Tedros said in a speech in Geneva.

Outside China, Tedros said the WHO is concerned about the number of cases without a clear epidemiological link, such as recent travel to China or contact with a person known to be infected. 

The WHO also has been sending medical supplies to Africa and training the continent's health-care workers to prepare them for the virus's possible arrival there, Tedros said. The only confirmed case of the coronavirus in Africa is in Egypt. 

"Our biggest concern continues to be the potential for covid-19 to spread in countries with weaker health systems," Tedros said. 

Chinese leader Xi Jinping, who has not visited Wuhan since the outbreak began, was briefed that the situation in the city and in surrounding Hubei province "remains grim and complex," according to a report by the official Xinhua News Agency published Saturday.

"The nationwide inflection point of the epidemic has not yet arrived," the report said after a meeting of Communist Party leaders.

China's National Health Commission reported Saturday that 397 new cases of coronavirus had been diagnosed Friday, taking the total to more than 76,000. The rate of infection outside Hubei appears to have slowed markedly, although there has been a great deal of confusion about the statistics this week as officials have repeatedly changed the criteria for confirming cases.

Among the new cases discovered Friday were a 70-year-old man in Hubei who was confirmed as infected after 27 days in isolation, while a man in Jiangxi province tested positive after 14 days of centralized quarantine and five days of isolation at home. On Thursday, authorities reported that a man in Hubei had tested positive for coronavirus after what appeared to be a 38-day incubation period with no symptoms.

The United States is also struggling with domestic fallout from its responses to the virus. The California city of Costa Mesta has sued the federal government over its plan to transfer quarantined coronavirus patients from the Travis Air Force Base near Sacramento to the former Fairview Developmental Center as early as this weekend. The city said that the area in question is surrounded by residential neighborhoods and that placing patients with a highly contagious disease so close by could pose a risk to public health. 

A federal judge granted Costa Mesa's request Friday, temporarily blocking the transfer of up to 50 patients. The restraining order prohibits state and federal government authorities from transporting anyone infected with coronavirus or who has been exposed to the disease to Costa Mesa before a hearing at 2 p.m. Monday at the Santa Ana federal courthouse, according to the Los Angeles Times.

The State Department, meanwhile, is battling thousands of Russian-linked social-media accounts promoting baseless theories that the United States created the coronavirus outbreak, according to the AFP. The accounts post "almost near identical" messages at similar times in five languages, the report says.

"Russia's intent is to sow discord and undermine U.S. institutions and alliances from within, including through covert and coercive malign influence campaigns," Philip Reeker, the acting assistant secretary of state for Europe and Eurasia, told the AFP.

Misinformation about the coronavirus outbreak has proliferated - mostly on social media - since the first cases were reported in December. 

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The State Department on Saturday heightened its travel advisories from Level 1 to Level 2 for South Korea and Japan, urging Americans to "exercise increased caution" when traveling to those countries due to the rising number of coronavirus cases there. Older adults and people with chronic conditions, who might be at higher risk of contracting the virus, should consider postponing unnecessary travel to those countries, the department said.

In Seoul, the Korea Centers for Disease Control and Prevention (KCDC) reported Saturday that 229 additional cases of the coronavirus had been detected, taking the total to 433, more than doubling in the space of a day and making South Korea the most affected country outside China.

"Apart from the Diamond Princess cruise ship, [South] Korea now has the most cases outside China, and we're working closely with the government to fully understand the transmission dynamics that led to this increase," Tedros said.

The majority of the new cases have been traced to existing clusters at a church in the southern city of Daegu and a hospital in nearby Cheongdo County, according to the KCDC.

More than half of South Korea's cases are connected to the Daegu branch of the Shincheonji Church of Jesus the Temple of the Tabernacle of the Testimony.

Since members of the church attended a funeral at nearby Cheongdo Daenam hospital, 111 coronavirus cases have been reported there, including two patients who died of the virus.

The mass infection at the hospital is centered on its locked psychiatric ward, where a confined environment could have aggravated transmissions, said Jung Eun-Kyeong, director of the KCDC.

A man in his 40s was found dead at his home in the city of Gyeongju, east of Daegu, after becoming infected with the virus. He is the third person in South Korea to die of the virus.

In Japan, the number of coronavirus cases rose to 121 on Saturday, more than tripling in a week. That number excludes the 634 people on board the Diamond Princess who contracted the virus.

One of the latest cases was a teacher in her 60s at a public junior high school east of Tokyo, who complained of nausea while working. The mayor of Chiba city said the school will be closed until Wednesday, public broadcaster NHK reported. 

The teacher had not traveled abroad in the past two weeks and has no record of having been in contact with a known infected person, underlining the fact that the virus is now spreading almost invisibly throughout the country, experts say.

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As numbers suddenly rose in Italy, the government has scrambled to contain the new outbreak, asking some 50,000 people to stay indoors and suspending all public events - including religious ceremonies and school - in 10 small towns to the south of Milan. 

Until a few days ago, Italy had seen only three confirmed infections, including a pair of Chinese tourists. 

"There is quite an evident contagion, a very strong one," said Giulio Gallera, health chief of the northern Lombardy region, which has seen the majority of the cases.

Italian officials on Friday attributed the country's first death to the coronavirus, and on Saturday said that a 77-year-old woman had also tested positive for the virus after being found dead in her home. But Italian authorities said the woman suffered from other health conditions, and were unsure whether it was the virus that had killed her. 

The cases in Italy appeared concentrated in the prosperous Lombardy region, which includes the country's financial hub, Milan, and other areas nearby. 

According to Italian media reports, one of the first people to come down with the virus was a 38-year-old who'd had dinner with somebody who had just come back from China. But some three weeks passed between that dinner and the time the man came down with a fever. In between, he ran a half-marathon, played soccer and traveled to several towns, according to La Repubblica, a major Italian daily.

Meanwhile, the number of confirmed cases of the virus in Iran has risen to 28. 

The outbreak there has so far been centered on the holy Shiite city of Qom, where on Wednesday authorities suspended schools and religious gatherings as a precaution. On Saturday, Iranian authorities also closed schools in the capital, Tehran, and issued a temporary ban on cinemas and art-related events across the country, state-run Fars News Agency reported. 

Other countries in the region have also reacted with alarm, particularly after Lebanon's first coronavirus case Friday was found to be a woman who had just traveled from Qom. 

In the past few days, Iraq and Kuwait suspended direct flights to Iran, while Iraq temporarily halted new visas for Iranian nationals and, along with Turkey, imposed restrictions on travelers who had recently arrived from Iran. Kuwait Airways said Saturday that it would be chartering special flights to evacuate citizens from Mashhad, Iran. 

As fears mounted, Israel announced Saturday that nine South Koreans who had recently returned home from a tour in Israel tested positive for the virus. Israeli and Palestinian authorities on Saturday urged anyone who may have interacted with the group visiting from Feb. 8 to 15 to self-quarantine as they work to trace who may have had contact with the tourists, who visited major cities including Jerusalem.

Israel's ambassador to China, Zvi Heifetz, was among those who self-quarantined, The Jerusalem Post reported, citing Israel's foreign ministry. Heifetz took the same flight to Seoul as the South Korean tourists and is quarantined in Beijing, the report says.

About 200 students and teachers who came into contact with the South Koreans have also self-quarantined, according to The Times of Israel.

A spokeswoman for Israel's Population and Immigration Authority said Saturday that all non-Israeli citizens arriving on a direct flight from Seoul to Tel Aviv that evening would be denied entry. Israel's Health Ministry has ordered Israelis returning from South Korea to self-quarantine. 

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Meanwhile, tests are continuing on the crew members on board the Diamond Princess. At least 74 crew members have so far been found to have the virus.

All of the passengers have now been tested and almost all have left the ship, either to go home if they tested negative, to local hospitals or government facilities if they have the virus, or back to their home countries.

Some passengers were asked to stay aboard to serve an additional quarantine if their cabin mate contracted the virus, but they are also disembarking Saturday to serve out the rest of their quarantine in a government facility, local media reported.

More than 200 port calls in Japan by international cruise ships have been canceled this month due to the coronavirus outbreak, a Kyodo News survey showed Saturday, with the lost revenue from passengers coming ashore dealing another blow to Japan's weakening economy.

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The 83-year-old woman who tested positive for the coronavirus when she arrived at Kuala Lumpur airport after disembarking in Cambodia from the MS Westerdam cruise ship has recovered, Malaysia health authorities said Saturday.

The woman "is showing good improvement and signs of recovery, however, she is still being monitored and managed in hospital for a slight cough," Malaysia's director general of health, Noor Hisham Abdullah, said in a statement.

The woman repeatedly tested negative while on board the ship and when she disembarked in Sihanoukville, then twice tested positive while transiting in Kuala Lumpur airport on Feb. 15. That set off a global scramble to track the hundreds of other passengers who had also disembarked then boarded planes bound for home. 

The woman was taken to a hospital and given antiviral treatment and supplementary oxygen, and she showed improvement after 72 hours of treatment initiation, Abdullah said. Two more tests, conducted 24 hours apart, both came back negative for coronavirus.

But the U.S. Centers for Disease Control and Prevention cast doubt on whether the woman was ever infected, saying she "never had coronavirus to our knowledge."

Cambodia's Ministry of Health had previously cleared the 747 crew members who were still on board the Westerdam and the 781 passengers who were still in the country of coronavirus infection.

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Separately, scientists in China are continuing to study how the virus is transmitted.

A research team led by renowned Chinese pulmonologist Zhong Nanshan had isolated live coronavirus strains in urine samples from infected patients, Zhao Jincun, a respiratory expert at the State Key Laboratory, told reporters in Guangdong on Saturday.

The team of scientists had previously said the virus, in addition to being carried in respiratory droplets, appeared to be transmissible through fecal matter, underscoring the need to practice good hand washing as a preventive measure.

Zhao did not directly say that the virus could be transmitted through urine, simply noting that the strains had been isolated and that this had implications for public health control. They are continuing to work on isolating the virus and on a cure, the Guangzhou Daily reported.

But he said people should pay more attention to personal and family hygiene to prevent the spread of the virus and recommended frequently washing hands, closing the toilet lid before flushing and making sure bathroom drains are not blocked.

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Denyer reported from Tokyo, Harlan from Rome, and Berger and Iati from Washington. The Washington Post's Lyric Li in Beijing, Akiko Kashiwagi in Tokyo, Min Joo Kim in Seoul, Stefano Pitrelli in Rome, Ruth Eglash in Jerusalem, and Yasmeen Abutaleb and Carol Morello in Washington contributed reporting.

 

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