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    China coronavirus: Death toll rises as disease spreads

    January 25, 2020

    The death toll from a newly-discovered coronavirus in China has risen to 41 on the day of the Lunar New Year.Another 15 deaths in the Hubei province, where the outbreak began, were announced on Saturday.Health officials are struggling to contain the outbreak as millions of people travel for the new year festival, one of the most important dates in its calendar.There are now more than 1,200 confirmed cases in China.

    The virus has also now spread to Europe, with three cases confirmed in France. The UK is investigating a number of suspected cases, while officials there are trying to trace around 2,000 people who have recently flown to the UK from Hubei province.Australia has also confirmed several cases in Melbourne and Sydney, joining a handful of countries treating patients.In China, many events to celebrate the Lunar New Year have been cancelled.What does the virus do?
    The coronavirus, previously unknown to science, causes severe acute respiratory infection with symptoms including a fever and cough. There is no specific cure or vaccine.Based on an earlier report of the fatalities, when just 17 were dead, most of the victims appeared to be older people, many with pre-existing medical conditions.But one of the dead in the most recent update was a doctor at a hospital in Hubei, China Global Television Network reported.

    Pharmacy have been wearing protective clothes and masks serve customers in WuhanSymptoms seem to start with a fever, followed by a dry cough and then, after a week, lead to shortness of breath and some patients needing hospital treatment.About a quarter of cases are thought to be severe.Wuhan, where the outbreak began, is effectively on lockdown: all bus, metro and ferry services have been suspended, and all outbound planes and trains cancelled.The People's Daily newspaper reports that from Sunday, only special vehicles will be allowed on roads in Wuhan's downtown area.A new hospital is being built in the city, for patients. Chinese media outlets said the new 1,000-bed hospital could be ready within six days.Pharmacies in the city have begun to run out of supplies and hospitals have been filled with nervous members of the public.Residents have been advised not to leave, and roadblocks have been reported.Ezhou, a smaller city in Hubei, shut its railway station. The city of Enshi has suspended all bus services.
    City officials in the capital, Beijing, and Shanghai have asked residents who return from affected areas to stay at home for 14 days to prevent the spread of the virus, local media report.Have you been affected? Get in touch: This email address is being protected from spambots. You need JavaScript enabled to view it.
    Authorities have also shut major tourist sites including the Forbidden City in Beijing and a section of the Great Wall, and cancelled major public events in other parts of the country, including:
    Shanghai's Disney Resort is temporarily closing, as are McDonald's restaurants in five cities.On Thursday, a coronavirus patient died in northern Hebei province - making it the first death outside Hubei.nother death was later confirmed in north-east Heilongjiang province, more than 2,000km (1,200 miles) from Wuhan.Earlier, when the death toll was 17, information from China's National Health Commission said the youngest person who died from the virus was 48 and the oldest was 89.But 15 of the 17 were over 60, and more than half suffered from other chronic diseases including Parkinson's and diabetes. Just four were women.
    French Health Minister Agnès Buzyn said one of the French cases, a 48-year-old man of Chinese origin who had been visiting Wuhan, had been hospitalised in Bordeaux. Little was known about the second case, in hospital in Paris, except that the patient had been travelling in China.It was likely other cases would occur in Europe, Ms Buzyn added.She confirmed a third case, in Paris, later on Friday evening.On Saturday, Australia reported its first case, a patient who is in hospital in Melbourne, after arriving from China last weekend. That was quickly followed by the announcement of three cases in Sydney, in the neighbouring state of New South Wales.Earlier on Friday a case was confirmed in Chicago, the second in the US.Singapore confirmed its third case, known to be the son of another patient, also on Friday. Nepal recorded its first case on the same day.Thailand has five cases confirmed; Japan three; Vietnam and South Korea two each; and one in Taiwan.Wuhan: The London-sized city where the virus beganFourteen people in UK tested for new strain
    Other nations are investigating suspected cases, including the UK, US, and Canada.Media captionWHO regional director says China now has "stronger capacity" to deal with infectious outbreaks
    The World Health Organization has not classed the virus as an "international emergency", partly because of the low number of overseas cases."It may yet become one," said the WHO's director-general, Dr Tedros Adhanom Ghebreyesus.
    How worried should we be?
    By James Gallagher
    Health and science correspondent
    24 January 2020
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    Related TopicsCoronavirus outbreak
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    The outbreak occurred in the city of Wuhan, south of Beijing
    A virus - previously unknown to science - is causing severe lung disease in China and has also been detected in other countries.

    At least 41 people are known to have died from the virus, which appeared in the Chinese city of Wuhan in December.

    There are already hundreds of confirmed cases, and experts expect the number will keep rising.

    A new virus arriving on the scene, leaving patients with pneumonia, is always a worry and health officials around the world are on high alert.

    But is this a brief here-today-gone-tomorrow outbreak, or the first sign of something far more dangerous?

    Coronavirus: Your questions answered
    Wuhan: The London-sized city where the virus began
    China coronavirus: What we know so far
    What is this virus?
    Officials in China have confirmed the cases are caused by a coronavirus.

    These are a broad family of viruses, but only six (the new one would make it seven) are known to infect people.

    Severe acute respiratory syndrome (Sars), which is caused by a coronavirus, killed 774 of the 8,098 people infected in an outbreak that started in China in 2002.

    "There is a strong memory of Sars, that's where a lot of fear comes from, but we're a lot more prepared to deal with those types of diseases," says Dr Josie Golding, from the Wellcome Trust.

    How severe are the symptoms?
    It seems to start with a fever, followed by a dry cough and then, after a week, leads to shortness of breath and some patients needing hospital treatment.

    Around one-in-four cases are thought to be severe.

    The coronavirus family itself can cause symptoms ranging from a mild cold all the way through to death.

    "When we see a new coronavirus, we want to know how severe are the symptoms. This is more than cold-like symptoms and that is a concern but it is not as severe as Sars," says Prof Mark Woolhouse, from the University of Edinburgh.

    The World Health Organization (WHO) is considering declaring an international public health emergency - as it did with swine flu and Ebola.

    How deadly is it?
    Forty-one people are known to have died from the virus - but while the ratio of deaths to known cases appears low, the figures are unreliable.

    But the infection seems to take a while to kill, so more of those patients may yet die.

    And it is unclear how many unreported cases there are.

    Where has it come from?
    New viruses are detected all the time.

    They jump from one species, where they went unnoticed, into humans.

    "If we think about outbreaks in the past, if it is a new coronavirus, it will have come from an animal reservoir," says Prof Jonathan Ball, a virologist at the University of Nottingham.

    Sars started off in bats and then infected the civet cat, which in turn passed it on to humans.

    And Middle East respiratory syndrome (Mers), which has killed 858 out of the 2,494 recorded cases since it emerged in 2012, regularly makes the jump from the dromedary camel.

    Which animal?
    Once the animal reservoir (where the virus normally camps out) is detected, then the problem becomes much easier to deal with.

    The coronavirus cases have been linked to the South China Seafood Wholesale Market, in Wuhan.

    But while some sea-going mammals can carry coronaviruses (such as the Beluga whale), the market also has live wild animals, including chickens, bats, rabbits, snakes, which are more likely to be the source.

    Researchers say the new virus is closely related to one found in Chinese horseshoe bats.

    Why China?
    Prof Woolhouse says it is because of the size and density of the population and close contact with animals harbouring viruses.

    "No-one is surprised the next outbreak is in China or that part of the world," he says.

    How easily does it spread between people?
    At the beginning of the outbreak, the Chinese authorities said the virus was not spreading between people - but now, such cases have been identified.

    Scientists have now revealed each infected person is passing the virus on to between 1.4 and 2.5 people.

    This figure is called the virus' basic reproduction number - anything higher than 1 means it's self-sustaining.

    We now know this is not a virus that will burn out on its own and disappear.

    Only the decisions being made in China - including shutting down cities - can stop it spreading.

    While those figures are early estimates, they put coronavirus in roughly the same league as Sars.

    There are also concerns that people with no symptoms could be spreading the virus.

    Prof Kwok-Yung Yuen from the University of Hong Kong-Shenzhen Hospital said "asymptomatic infection appears possible".

    How often or easily this happens is far from clear, but it could make the virus far harder to contain.

    How fast is it spreading?
    It might appear as though cases have soared, from 40 to more than 800 in around a week. But this is misleading.

    Most of the "new" cases were already out there but have only just been detected as China steps up its surveillance.

    There is actually very little information on the "growth rate" of the outbreak.

    But experts say the number of people becoming sick is likely to be far higher than the reported figures.

    A report by the MRC Centre for Global Infectious Disease Analysis at Imperial College London said: "It is likely that the Wuhan outbreak of a novel coronavirus has caused substantially more cases of moderate or severe respiratory illness than currently reported."

    Skip Twitter post by @MRC_Outbreak
    UPDATE: Report estimates 4000 cases #coronavirus #2019nCoV

    Our estimate at 4,000 cases is more than double the past estimate due to increase of number of cases outside China. This should not be interpreted as implying the outbreak has doubled in size.


    — MRC Centre for Global Infectious Disease Analysis (@MRC_Outbreak) January 22, 2020
    End of Twitter post by @MRC_Outbreak
    While the outbreak is centred on Wuhan, there have been cases in Thailand, Japan, South Korea, Vietnam, France, Singapore, Taiwan, Nepal and the US.

    Could the virus mutate?
    Yes, you would expect viruses to mutate and evolve all the time. But what this means is harder to tell.

    The novel coronavirus has jumped from one species to another. It could mutate to become easier to spread from one person to another or to have more severe symptoms.

    This is something scientists will be watching closely.

    How can the virus be stopped?
    We now know the virus will not stop on its own; only the actions of the Chinese authorities can bring this epidemic to an end.

    There is also no vaccine to give people immunity to the virus.

    The only option is to prevent people who have become infected from spreading the virus to others.

    That means:

    Limiting people's movement
    Encouraging hand-washing
    Treating patients in isolation with healthcare workers wearing protective gear
    A massive feat of detective work will also be needed to identify people whom patients have come into contact with to see if they have the virus.

    How have Chinese authorities responded?
    Image copyrightGETTY IMAGES
    Image caption
    Temperature screening can help identify people who have been infected
    China has done something unprecedented anywhere in the world - by effectively putting Wuhan into quarantine.

    Travel restrictions have also been imposed on a dozen other cities with 36 million people affected.

    Some mass gatherings have been banned and tourists sites, including part of the Great Wall, have been closed.

    Wuhan - the centre of the outbreak - is building a new hospital with a beds for 1,000 patients.

    How is the world responding?
    Most Asian countries have stepped up screenings of travellers from Wuhan and the WHO has warned hospitals worldwide a wider outbreak is possible.

    Singapore and Hong Kong have been screening air passengers from Wuhan and authorities in the US and the UK have announced similar measures.

    However, questions remain about the effectiveness of such measures.

    If it takes five days for symptoms to appear, then someone could easily be halfway round the world and have passed through any screening checks before starting to feel ill.

    How worried are the experts?
    Dr Golding says: "At the moment, until we have more information, it's really hard to know how worried we should be.

    "Until we have confirmation of the source, that's always going to make us uneasy."

    Prof Ball says: "We should be worried about any virus that explores humans for the first time, because it's overcome the first major barrier.

    "Once inside a [human] cell and replicating, it can start to generate mutations that could allow it to spread more efficiently and become more dangerous.

    "You don't want to give the virus the opportunity."

    Are there any vaccines or treatments?

    However, the work to develop them is already under way. It is hoped that research into developing a vaccine for Mers, which is also a coronavirus, will make this an easier job.

    How can China build a hospital so quickly?
    By Sophie Williams
    BBC News
    9 hours ago
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    Constuction on the site in Wuhan has already begun with staff hoping it will be completed within six days
    The Chinese city of Wuhan is set to build a hospital in six days in order to treat patients suspected of contracting the coronavirus.

    There are currently 830 confirmed cases in China, 41 of whom have died.

    The outbreak began in Wuhan, home to around 11 million people. Hospitals in the city have been flooded with concerned residents and pharmacies are running out of medicine.

    According to state media, the new hospital will contain about 1,000 beds.

    Video footage posted online by Chinese state media shows diggers already at the site, which has an area of 25,000 square metres (269,000 square feet).

    It is based on a similar hospital set up in Beijing to help tackle the Sars virus in 2003.

    "It's basically a quarantined hospital where they send people with infectious diseases so it has the safety and protective gear in place," said Joan Kaufman, lecturer in global health and social medicine at Harvard Medical School.

    How is China able to build a hospital in six days?
    "China has a record of getting things done fast even for monumental projects like this," says Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.

    He points out that the hospital in Beijing in 2003 was built in seven days so the construction team is probably attempting to beat that record. Just like the hospital in Beijing, the Wuhan centre will be made out of prefabricated buildings.

    "This authoritarian country relies on this top down mobilisation approach. They can overcome bureaucratic nature and financial constraints and are able to mobilise all of the resources."

    China coronavirus: A visual guide
    China marks Lunar New Year in shadow of virus
    Mr Huang said that engineers would be brought in from across the country in order to complete construction in time.

    "The engineering work is what China is good at. They have records of building skyscrapers at speed. This is very hard for westerners to imagine. It can be done," he added.

    In terms of medical supplies, Wuhan can either take supplies from other hospitals or can easily order them from factories.

    On Friday, the Global Times confirmed 150 medical personnel from the People's Liberation Army had arrived in Wuhan. However it did not confirm if they would be working in the new hospital once it has been built.

    What happened during the Sars outbreak?
    In 2003, the Xiaotangshan Hospital was built in Beijing in order to accommodate the number of patients showing symptoms of Sars. It was constructed in seven days, allegedly breaking the world record for the fastest construction of a hospital.

    About 4,000 people worked to build the hospital, working throughout the day and night in order to meet the deadline, said.

    Inside, it had an X-ray room, CT room, intensive-care unit and laboratory. Each ward was equipped with its own bathrooms.

    Within two months, it admitted one-seventh of the Sars patients in the country and was hailed as a "miracle in the history of medicine" by the country's media.A woman becomes one of the last patients to leave Xiaotangshan hospital after being treated for Sars
    Ms Kaufman explained: "It was ordered by the ministry of health and seconded nurses and other doctors from existing health facilities to man the hospitals. They had protocols from the ministry of health that talked about how to handle infectious diseases and the critical path of identification and isolation that was specific for Sars."

    She added that during the Sars epidemic, the organisation and costs were covered by local areas but there were a lot of subsidies from the state that flowed down through the system from the costs of staff salaries to building.I can't imagine that the burden of this is going to be on the Wuhan government because it's high priority," said Ms Kaufman.According to Mr Huang, the hospital was "quietly abandoned after the epidemic ended".

    Chinese diasporas on edge over coronavirus
    By Zhaoyin Feng
    BBC Chinese Service, Washington
    9 hours ago
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    China marks lunar New Year in the shadow of virus outbreak
    Hours after the first case of coronavirus was confirmed in the US, surgical masks began selling out at the pharmacies in Seattle, where a resident recently returned from China had fallen ill.

    "I immediately ordered a box of masks online after I heard of the first US case," said Tina Liu, a Chinese student at the University of Washington, not far from the city.

    Since 8 December 2019, when the first cases of the mysterious coronavirus lung illness were reported in Wuhan, China, more than 500 residents there have been infected.

    On the eve of the lunar New Year holiday on Saturday, billions of people are on edge - but not just in China.

    Though only two cases have so far been reported in the US, and a handful in other countries outside of China, the anxiety sparked among Chinese overseas is palpable.

    'We've been advised not to leave our rooms'
    'We've got enough food to last 10 days'
    How is China coping with the Coronavirus outbreak?
    The outbreak of the most serious epidemic in Asia since 2003 has brought unwelcome memories of the Sars emergency, as well as new anxieties in the age of social media and increased global travel.

    Since the Sars outbreak of 2003, China has undergone a massive transformation.

    Nearly 150 million Chinese travelled abroad in 2018, compared to 20.2 million in 2003.

    Some 360,000 Chinese students study in the US and travel between the two countries frequently.

    Hundreds of millions of Chinese have gained access to social media, which did not exist during the Sars outbreak.

    From thousands of miles away, members of the Chinese diaspora are worrying for their families from afar, or fretting over getting sick themselves.

    Image copyrightGETTY IMAGES
    "It's hard not to worry, as you're based overseas and can't do much about it," said Rui Zhong, a Chinese-American living in Maryland with family in Wuhan, where millions of residents are under quarantine.

    Thousands of miles apart, Ms Zhong and her family are constantly exchanging information about the outbreak on WeChat, a Chinese messaging platform.

    In Seattle, many Chinese residents are on high alert, Ms Liu told BBC. Some 65,000 Chinese travellers visit the US each year, and the two confirmed cases in the US are individuals who fell ill after recently returning from China.

    Although she had not seen many people wearing masks in Seattle, Ms Liu decided to wear one as a precautionary measure. "It's better to be safe than sorry," she said.


    Media captionWhat's life like in quarantined Wuhan?
    Amid the health emergency, the Chinese government has loosened its censorship controls and sought to apply lessons learnt from the Sars epidemic to prevent a repeat of the 2003 disaster.

    Whereas information about the outbreak was tightly controlled in previous weeks, coverage of the outbreak has been liberalised in China, and news from Wuhan now circulates more freely on Chinese social media platforms.

    Compared to the Sars epidemic, the Chinese government has been "more open" to sharing information, according to Amesh Adalja, an expert at the Johns Hopkins University Center for Health Security.

    In the 2003 epidemic, China was criticised by the international community for concealing the scale of the outbreak, which led to the virus spreading to 26 countries and killing nearly 800 people.

    With coronavirus, "China has provided more timely updates about case counts and made the virus sequence public early", Dr Adalja said.

    That has helped the world take more proactive measures to tackle the outbreak, he said.

    China's travel industry counts cost of coronavirus
    Has China learned lessons since deadly Sars epidemic‎?

    Media captionWHO regional director says China now has "stronger capacity" to deal with infectious outbreaks
    Modern technology and the larger global Chinese community means the diaspora is reacting differently, too.

    Overseas Chinese have used social media to launch crowdfunding campaigns to send medical supplies to Wuhan, for examples.

    Muyi Xiao, a Wuhan native who currently lives in New York City, was the first to warn her family about the virus after reading reports in the international media.

    She alerted her family in Wuhan to take precautionary measures in late December 2019. "They didn't think it was a big deal back then," she told BBC.

    But now, she has urged them to cancel their Lunar New Year dinner, even though it is their most important meal of the year. "The feast can wait. The family's health is of the utmost importance," she said.





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