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Discussion Thread I - 2019-nCov (new coronavirus)

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  • alert
    replied
    Neither exposed case has a really strong exposure history. The Thai case visited a market, but not the one linked to this outbreak. Unless she had some bizarre stray contact with a still-undiagnosed vendor who supplied multiple markets, say, it would seem she was infected by an animal source. The case in Japan had contact with a pneumonia patient, but it's not clear that it is one of 41 confirmed cases. He had onset on January 3, making for a likely exposure in late December.

    Hopefully, authorities in Wuhan are working backward from both exported cases to ensure that no other cases are missed.

    I can't help but wonder if this virus might not be foodborne as well, particularly if proper cooking procedures aren't followed.

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  • Laidback Al
    replied
    Two confirmed cases of the Wuhan novel coronavirus have now been identified outside of China, one in Thailand and one in Japan. Neither country has reported additional cases. We need to be concerned about transmission risks from any new coronavirus.

    The 2015 MERSCoV outbreak in the Republic of Korea originated with a single individual arriving from the Middle East. This individual along with five superspreaders infected a total of 186 individuals, 38 of whom died. The epidemic lasted two months. See: Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea

    With a coronavirus that is capable of human-to-human transmission, even a single infected patient can cause an epidemic.

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  • Shiloh
    replied
    Thought it helpful to pull this info from media reports of the 1/15/2020 Hong Kong Press Conference (post on page 14 & 15 https://flutrackers.com/forum/forum/...-observation):

    * 70% of patients work long hours in the South China Seafood Market in Wuhan. The relevant merchants mainly sell aquatic products, not game. However, it was revealed that in addition to aquatic products and birds, the market involved also includes bamboo rats, snakes, crickets, hedgehogs, etc. Game, but the quantity of game sold is unknown.

    * pointed out that the local staff did not collect only near the aquatic stalls, but the virus was only found in the aquatic stalls. As for the survival time of the virus, it is still to be studied. Because it is not an animal sample, the health committee failed to pinpoint the source of the virus.

    * Zhang Zhujun said that of the 41 patients in Wuhan, seven adults had visited the South China Seafood Market, which is believed to be the source of the disease. The remaining patients reported that they had not been there or were "too serious to ask", and most of the patients appeared on the market for sale. The area of ​​aquatic seafood is not for those who sell game.

    * a couple infected by the mainland has not been identified. It is said that his wife became ill after he brought home items from the market and polluted the environment. She also pointed out that in addition to the couple's case, there was also a case of a three-person group in which the patients were a father and son and a son-in-law.

    *Zhang Zhujun pointed out that environmental samples from the South China seafood market, including the ground, table tops, and gloves, were positive for the new coronavirus, and the samples came from areas where aquatic products were sold. She said that although human-to-human cases of infected couples could not be ruled out at this stage, it is also possible that the husband brought home the virus-carrying items from the market, which polluted the home environment and infected his wife.

    * A couple who was defined as a family group case, Zhang Zhujun initially only said that her husband developed the disease first, and his wife developed the disease "every few days". After questioning, she said that "there was no question to be clear". It is believed that the conversation between the mainland personnel occurred about 5 days apart. She also did not ask whether the condition of the wife, who was later affected, was more severe or milder than that of her husband.

    * One group is two couples. Mr. worked in the South China seafood market where many cases were found and took the lead. His wife had never been to the market and became ill after 5 days. The infection was transmitted to his wife from the onset of the husband, so there may be a case of human-to-human transmission, but the underground, tabletop and glove samples of the market involved have detected the new coronavirus. Zhang Zhujun acknowledged that the possibility of transmitting the virus through contaminated objects could not be ruled out.

    *The Chairman of the Infectious Diseases Advisory Committee of the Hong Kong Medical Association, Liang Zichao, believes that the apparent evidence of the two couples points to human transmission, but it may also be transmitted through articles, such as the wife's handling of her husband's contaminated clothing. . He went on to point out that according to the information published in the Mainland, only one of the 41 confirmed cases is human-to-human, which means that the transmission coefficient of the virus, that is, the efficiency of transmitting to other people is low, and it means that the chance of large-scale spread of the virus in the community is low. .

    *The other group of 3 people, father, son, and uncle, lived together and ran the shop together. The time of onset of the three people was very close, and there was a chance to be "common exposure.

    * Lai Weiwen pointed out that 7 to 8 of them were in serious condition, severe patients were aged 40 to 78, and had kidney and liver failure at the same time, and 2 patients needed external life support treatment.


    *a specific rapid test was developed locally, and viruses were found in throat secretion, sputum and blood. The overall number of white blood cells in patients with pneumonia is normal or low, and the lymphocytes are lower than normal. This phenomenon has occurred in other pneumonia. In addition, the lungs of local pneumonia patients will be filled with inflammatory secretions.

    Patients are treated locally with supportive care, including oxygen and intravenous injections. Early treatment with Tamiflu was used locally, but it was discontinued after it was found not to be flu. Local preaching has a certain degree of utility. No local ribavirin or protease was used.

    * Two of them needed ECMO (artificial heart and lung) treatment.

    Lai Weiwen pointed out that the discharge conditions for pneumonia patients in Wuhan were more than 10 days of fever reduction, and two samples that were 48 hours apart were negative for the virus.

    * Lai Weiwen, chief infection control director of the Hospital Authority, pointed out that 7 to 8 patients with pneumonia in Wuhan were severe, including one who died. The patients were mild to moderate pneumonia. The severe cases were 40 to 78 years old. Renal and liver failure occurred. Two of the severe patients needed an external life support device. At least one patient had more than one virus. Other patients have bacterial infections, and it is believed that high-risk people have long-term patients, older people, and obese people...


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  • Laidback Al
    replied
    Current status of the “viral pneumonia” outbreak in Wuhan China.

    Key points from the Hong Kong Centre for Health Protection (CHP) announcement on January 11, 2020 from post #151 in the News Thread on this outbreak.

    1. After preliminary determination, the pathogen of "viral pneumonia with unknown cause" is a novel coronavirus.

    2. As of yesterday (January 10), 41 patients in Wuhan have been diagnosed to have been infected with the novel coronavirus. These patients are mainly business operators at a market called "Hua Nan Seafood Wholesale Market" in Wuhan, which has been closed since January 1. (note: other reports have placed the number of confirmed cases in Wuhan at 59 [News Thread #145]).

    3. There have been no new cases in Wuhan since January 3.

    4. Among the 41 confirmed patients, two patients have been discharged, seven patients are in serious condition and one died, while the remaining patients are in stable condition.

    5. 739 close contacts including 419 healthcare workers have been monitoring and none have yet exhibited symptoms.

    6. According to the mainland health officials there is no definite evidence of human-to-human transmission. (note: it is not clear the all infections among the 41[59] patients in Wuhan were a result of animal-to-human transmission in the market).

    No confirmed cases of this novel coronavirus have yet been reported outside of Hubei Province in China.

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  • JJackson
    replied
    Information seems to be beginning to flow. It looks like the causative agent is a CoV and is speculated to be a BetaCoV, although I do not know on what basis, if it is then bats should become the focus of the investigation for a host reservoir. Reports seem to indicate that the virus has been identified in 15 patients and that its very large genome has been fully sequenced but I have not seen any reports of sequence release or confirmation even that it is a BetaCov, both would be very helpful at this stage. Going forward we will hopefully get some information on the S gene whose protein host the receptor binding domain (as HA does in flu) and the ability to compare this the other BetaCoVs. If the outbreak persist and H2H becomes a factor then sequence changes indicating host adaption would become the research target. Just my thoughts - very possibly entirely erroneous - so caveat emptor.

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  • Treyfish
    replied
    ,,,When asked if the Hong Kong government decided not to send staff to Wuhan to learn about the epidemic situation or the mainland did not allow it, Chen Zhaoshi did not respond positively, saying only that Wuhan was busy dealing with the epidemic situation. When is it appropriate? " This newspaper was informed that a team of scientists in Hong Kong had offered to go to Wuhan or Beijing to assist the local government, but so far they have not been invited by the Mainland.,,,https://news.mingpao.com/pns/%e8%a6%...8e%a5%e8%b5%b0

    Taiwan also asked to send people
    The Office of Disease Control also sent a letter to the CCP officials, asking to go and learn about the epidemic.
    Director of the Department of Epidemic Center for Disease Control Liuding Ping : "That the current Chinese Communist Party official to say it is not yet obvious situation of human transmission."


    In addition, the CDC also sent a letter to the "National Health and Health Commission of China", hoping to send people to mainland China to understand the epidemic situation. However, the other party only stated that it had received the letter and did not respond to further arrangements..https://www.ntdtv.com/b5/2020/01/07/a102747288.html
    Last edited by Treyfish; January 7, 2020, 05:04 PM.

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  • Treyfish
    replied
    not sure if people will want to go to a dr if they may be forced to isolate at a hospital, and maybe should have to isolate at home?

    Quarantine order execution process


    2020-01-08
    ◆ Patients seek medical treatment from public / private hospitals or private clinics

    ◆ Whether the doctor's diagnosis and treatment meet the two major requirements of isolation:

     1. Have been to Wuhan within 14 days before the onset of illness;

     2. Symptoms of fever, pneumonia, and upper respiratory tract infection

    ◆ If so, the doctor must fill in the report form and call the CHP to report

    ◆ After analysis by the Centre for Health Protection, an isolation order will be issued by the Director of Health when necessary to force patients to isolate

    ◆ Patients must be sent to a public hospital for medical treatment. If the quarantine order is violated, the maximum fine is 5,000 yuan and the prison is 6 months.
    http://paper.wenweipo.com/2020/01/08/HK2001080006.htm

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  • sharon sanders
    replied
    I think we do not know about human to human transmission. Since there is no test for this illness there could be many people who have mild cases. We just don't know anything at this stage. We don't know how many - really - are/were infected, for how long, where, what.....nothing. We are watching people with symptoms who test negative for known human pathogens.

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  • alert
    replied
    The international media, along with several well known virologists, are now suspecting this is a novel virus. It might be, but there are a lot of things that could still explain this that haven't been ruled out:

    - Legionella. This one is almost too obvious. ProMED moderators have mentioned this twice, and it's the first thing I thought of too when I read the first posts a week ago. It's so obvious that you'd think they would have ruled it out by now, but no one has said that. There are also a few testing issues with this bacteria, and let's not forget that in 1976 Philadelphia, it took two months to realize the outbreak of Legionella was not due to a virus.

    - Several known zoonotic bacteria, including tularemia, Q fever, and the one that caused the atypical pneumonia outbreak in South Korea last year.

    - Hantavirus, perhaps one imported from another part of the world. The CFR of zero to this point is a little low for hantavirus, but with no reported recoveries so far, it's unclear that all patients will survive.

    - Anthrax or plague, particularly if widespread antibiotic use is involved. Again, the known CFR is low, but there might be explanations for that.

    I hope the labs in Wuhan are continuing to test for and rule out known options. With the exception of plague, everything I mentioned above transmits H2H very poorly or not at all, which is consistent with what is being reported.

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  • Pathfinder
    replied
    Translation Google

    China Daily Online Review: Wuhan Viral Pneumonia Prevention and Control Orderly Information Transparency Wins International Recognition

    Source: China Daily2020-01-07 11:29 

    Since the end of December 2019, the Wuhan Municipal Health Commission has conducted surveillance of respiratory diseases and related diseases and found several cases of viral pneumonia of unknown cause. As of 8:00 on January 5, 2020, the city has reported 59 such cases. It is somewhat gratifying that the incident did not trigger a large-scale panic. The reason is that the government has ensured open and transparent information.

    On December 31, 2019, the Wuhan Municipal Health and Health Commission informed that some medical institutions recently found that many cases of pneumonia associated with South China Seafood City were consulted by experts and were diagnosed with viral pneumonia. As soon as the news came out, people asked whether the SARS epidemic had made a comeback. Between 2002 and 2003, SARS invaded most of China and even Asia.

    The Wuhan Municipal Government did not respond immediately, but conducted a thorough investigation and research. On January 5, the Wuhan Municipal Health and Health Commission reported that respiratory pathogens such as influenza, bird flu, SARS and the Middle East Respiratory Syndrome (MERS) had been ruled out.

    As government departments ensure that information is open and transparent, public confidence has doubled. This is obvious on social media and there is no sign of panic among netizens. In addition, Wuhan's passenger traffic has not been affected. Without panic, the masses will not relocate on a large scale and help the government effectively control the spread of the disease.

    The Wuhan Municipal Health and Health Commission's approach has also received the attention and recognition of the international community. On January 5, the World Health Organization (WHO) notified a recent case of unexplained pneumonia in Wuhan and stated that "based on the information currently available, it is not recommended to impose any travel or trade restrictions on China."

    It turns out that in major or unexpected events, transparent information can prevent the spread of rumors and public panic. Blocking or selectively disclosing information makes it easier to panic. Authoritative information cannot be made public in the first place, and all kinds of gossips will appear in the room; if the public's security protection strategy cannot be informed, individual self-rescue will start out of order and mass panic will spread. Obviously, open and transparent information is an effective way to dispel public panic. (Editor: Yan Yujie and Wang Hui)

    2019年12月底以来,武汉市卫健委开展呼吸道疾病及相关疾病监测,发现若干起不明原因的病毒性肺炎病例。截至2020年1月5日8时,全市共报告此类病例59起。令人稍感欣慰的是,此事没有引发恐慌。究其原因,是政府确保了信息的公开透明。

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  • sharon sanders
    replied
    This action is significant because if the CDC knew what this disease was they would be issuing statements to calm down the situation. This statement confirms that probably no one outside China knows what this pathogen is, or how to treat it. They are also asking medical personel to wear 95 masks when evaluating people for this illness which indicates the CDC thinks it could be airborne human to human. Not for sure...but they are leaving open the possibilty and want healthcare personnel to err on the side of caution.

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  • sharon sanders
    replied
    US CDC Issues a "Watch" on the Pneumonia of Unknown Cause in China - January 6, 2020

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  • sharon sanders
    replied
    I am sure it is a coincidence that there have been no updates to the African swine fever outbreaks on the Ministry of Agriculture's site since December 24, 2019.




    A screen shot taken a few minutes ago:

    Click image for larger version  Name:	chinamoapage.PNG Views:	0 Size:	112.9 KB ID:	822190

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  • alert
    replied
    Most of the people identified in Hong Kong have tested positive for common pathogens such as influenza, which has been excluded as the cause of the main outbreak. Singapore has also isolated one suspected case, but she tested positive for RSV. There is apparently a lot of background noise here. because Wuhan is in the middle of a pretty bad flu season.

    Most of the testing over the past few days has been related to SARS. Now that SARS is ruled out, they need to look elsewhere. I can think of at least half a dozen diagnoses (although none of them viral) that might explain this outbreak. I'd think most of them should have been tested for earlier, but we have no way to know what else has been excluded. I think the jump to "novel virus" is a bit premature, at least in the absence of H2H spread.

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  • Laidback Al
    replied
    Once more we should be concerned that China is not being forth coming about this unidentified outbreak. The Centre for Health Protection in Hong Kong has identified perhaps as many 16 people exhibiting symptoms among people travelling back and forth between Wuhan and Hong Kong. Wuhan has a population of 11 million people. Many of these people must visit other places in China besides Hong Kong. I find it surprising that only Wuhan visitors to Hong Kong are exhibiting symptoms.

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