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The WHO says that in China, human-to-human transmission of the virus occurred largely within households. Photo: AFP

Beware of coronavirus outbreaks coming back to life, WHO warns

  • Scientists still to determine the intermediate host of the disease, raising risk of recurrence
  • Study by Hong Kong and mainland China researchers finds that more than half of the patients did not have a fever when admitted to hospital
Health experts have highlighted challenges with the coronavirus epidemic, with the WHO warning of the risk of outbreaks coming back to life and researchers in mainland China and Hong Kong pointing out a major difficulty with diagnosis.
The alerts came on Friday as the World Health Organisation declared that the risk of global spread of the coronavirus epidemic had become “very high” – though the UN health agency stopped short of calling it a pandemic.

In a joint study published in the New England Journal of Medicine, researchers from mainland China and Hong Kong reviewed the cases of 1,099 coronavirus patients from 552 hospitals in 30 provinces.

They found that more than half the patients did not have a fever when they went into hospital, making diagnosis more difficult. But 88.7 per cent of them did develop one after admission.

“Some patients with Covid-19 do not have fever or radiologic abnormalities on initial presentation, which has complicated the diagnosis,” the study said, referring to the disease caused by the coronavirus.

The study was co-authored by dozens of medical experts, including Zhong Nanshan, director of China’s State Key Laboratory of Respiratory Diseases, and Chinese University of Hong Kong respiratory medicine expert Professor David Hui Shu-cheong.

So far, the epidemic has killed 2,835 people on the mainland, with 47 more fatalities on Saturday. Mainland China has 79,251 infections, with 39,002 patients recovered.

More cases have also been reported in South Korea, Italy and Iran, prompting the US Centres for Disease Control and Prevention to raise its travel advisory for Italy and Iran, recommending travellers avoid all non-essential trips to those countries due to “limited access to adequate medical care in affected areas”.

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In a report, also released on Friday, the WHO said it was convinced that China’s containment measures were effective as the number of new cases had continued to fall.

It also said that epidemiologists were convinced that the coronavirus that caused the disease now known as Covid-19 was caused by an organism spread from animals. Bats appeared to be the reservoir of the virus, but the intermediate host had not yet been identified.

Without identifying that animal chain, there was a risk that outbreaks could recur in areas where they had receded, the UN health agency warned.

The report was compiled by a team of more than two dozen specialists from China and overseas who were part of a nine-day WHO trip to Beijing, and Guangdong, Sichuan and Hubei provinces from February 16.

It gave an overview of the trip, assessed the response to the epidemic and identified next steps for China and other countries to take.

The team concluded that in China, human-to-human transmission of the virus occurred largely within households. Among 344 clusters in southern China’s Guangdong province and Sichuan in the southwest, 78 to 85 per cent occurred within families.

Though transmission also occurred in hospitals and other closed settings, transmission in these places did not appear to be a major feature of the virus in China, it said.

As of February 20, there were 2,055 confirmed cases among health workers from 476 hospitals across the country, 88 per cent of which were in Hubei province.

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But most of the cases among medical workers were identified early in the outbreak in Wuhan when supplies and experience were lower. In some later cases, medical workers may have been infected within the household rather than in a health care setting, it said.

Quoting from the Guangdong Provincial Centre for Disease Control and Prevention, the study said that as of February 20, the coronavirus could be detected in upper respiratory samples one or two days before symptoms.

It said that so far the best prevention measure was to keep a safe distance from other people, minimising close contact in public places, but the risk of more cases was rising as work resumed and movement restrictions were lifted.

Amid criticism that Chinese authorities were slow to respond to the health crisis, Communist Party journal Qiushi published on Saturday a speech by Chinese President Xi Jinping dated February 5.

In it, Xi lashes out at some local governments for their failure to impose adequate prevention and control efforts.

Xi said party committees and governments at all levels actively carried out prevention and control work under the central government’s leadership, but some local governments took inappropriate measures and changed policies frequently.

“In some places, there were even crimes that seriously impeded prevention and control work, and the public is dissatisfied with that,” he said, adding that containment efforts were at a critical moment.

As part of its response, the defence ministry said it would suspend some major military exercises.

“Since the outbreak of the novel coronavirus, the military has been focused on epidemic prevention and control while also … seeking to minimise the impact to our military training,” ministry spokesman Wu Qian said, giving no details of the affected exercises.

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Hui, one of the co-authors of the joint study, also called for more tests to be conducted in private and public clinics to enable early detection and isolation of suspected cases.

The virus has so far infected 94 people in Hong Kong, killing two. However, no new infections were reported on Saturday.

Hui, who sits on a Covid-19 government advisory panel reporting directly to the city’s leader, said that even though the patients’ mortality rate was lower than the 2-3 per cent mortality rate of patients with flu infections, the figure was still significant. “The virus is highly contagious, so a 1.4 per cent mortality rate still means a substantial number of deaths.”

More countries have started imposing preventive measures such as school closures and cancellation of public gatherings. South Korea urged citizens to stay indoors on Saturday after the number of confirmed cases rose rapidly.

Additional reporting by Victor Ting

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This article appeared in the South China Morning Post print edition as: battle against virus faces more hurdles, experts warn
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