On December 31, 2019, China reported to the World Health Organization (WHO) a number of pneumonia cases with unknown origin. The next day, a seafood market in the city of Wuhan was shut down as a result of evidence linking these initial cases to the market. In the days that followed, a team of Chinese and international scientists were able to isolate the virus responsible for this sickness and provide its genetic sequence, their work confirming the existence of a new coronavirus, dubbed 2019-nCoV.
Despite the initial rapid response, the virus has continued to spread with more than 17,000 cases and over 300 deaths reported in mainland China as of February 3, 2020. In addition to China, cases have been confirmed in 27 other countries as of February 3, including eleven in the US. Prior to February 2, all of the deaths related to this coronavirus outbreak had occurred in China; however, the first death outside of China was reported in the Philippines on February 2.
Even as the disease continues to spread, health experts are encouraged by the number of patients who have recovered. Additionally, WHO has praised China’s response to the outbreak; the WHO Director-General Dr. Tedros Ghebreyesus said, “[China’s] actions actually helped prevent the spread of coronavirus to other countries.” As of February 3, only 151 cases have been reported outside of China. However, even as China has received praise from WHO, other groups have raised concerns, such as the decision about how to record cases and China’s transparency in addressing the outbreak, and have suggested that China did not do enough to stop the spread of the virus within its own country.
Coronaviruses are a broad family of viruses that can cause a number of different illnesses, such as the common cold or some cases of bronchitis. Coronaviruses are zoonotic diseases, which means they can spread between humans and animals.
Because of the zoonotic nature of coronaviruses, new outbreaks can occur when a virus that only infected animals mutates and becomes capable of infecting humans. This occurred in 2002, leading to an outbreak of severe acute respiratory syndrome (SARS), as well as in 2012 with the outbreak of middle east respiratory syndrome (MERS). Because it also occurred in China, SARS is particularly important as it offers a comparison for the ongoing response efforts.
"I think that the world has just gotten much better at coordinating response"
Dr. Anne W. Rimoin, UCLA Professor of Epidemiology
The first cases of SARS were detected in November 2002; however, China did not report the outbreak until February 2003, a sharp contrast to China’s quick reporting of the current outbreak. By the time WHO declared that SARS had been contained worldwide, over 8,000 people had been infected and nearly 800 had died, mostly in China. At the time, China faced criticism for its outbreak response, including their attempts to downplay the scale of the outbreak.
Following the 2002 outbreak of SARS, China has expended considerable effort in improving the Chinese Centers for Disease Control and Prevention, a process which some experts have credited with improving China’s response capabilities. In addition to China, the global community as a whole has become better at responding to outbreaks. As Dr. Anne W. Rimoin, an epidemiology professor at the University of California, Los Angeles, has said, “Since the SARS outbreak, we’ve seen several other outbreaks. We’ve had MERS, we’ve had the H1N1, that’s swine flu; we’ve had chikungunya, we’ve had Zika, and we’ve had several Ebola outbreaks since that time. So I think that the world has just gotten much better at coordinating response.”
China’s initial response to the outbreak has been fairly quick in comparison to the SARS response. The WHO was alerted of the new disease on December 31, 2019, less than a month after the earliest symptoms appeared on December 8. On January 1, Chinese authorities shut down a fish market in Wuhan based on epidemiological information indicating the market was the likely origin of the outbreak. By January 12, scientists working on the outbreak had been able to isolate and genetically sequence the new virus, a major step for developing screening and treatment methods. In the following weeks, China has implemented a number of measures to stop the spread of 2019-nCoV, including quarantining affected cities, extending the Lunar New Year holiday so people do not have to work, and delaying the start of the academic semester.
|“[China’s] actions actually helped prevent the spread of coronavirus to other countries”
Dr. Tedros Ghebreyesus, Director-General of WHO
While China has responded much faster this time than they did for the 2002 SARS outbreak, they have still faced criticism for apparent attempts to downplay or hide the extent of the outbreak. Additionally, at least one study has suggested that the early outbreak stages occurred much differently than reported by China. Yanzhong Huang, a Council on Foreign Relations fellow that studies China, stated “There was no action in Wuhan from the local health department to alert people to the threat.”
Outside China, countries have continued to ramp up their response to the outbreak with increased airport screenings and restrictions on travel and border crossings. On January 30, the WHO declared the 2019-nCoV outbreak a global health emergency, a declaration which can increase international funding and allows WHO to respond more rapidly. The US followed suit the next day. Meanwhile, the WHO is preparing to send a team of health experts to China to assist with the outbreak response. China has also agreed to allow a US team to join the WHO efforts, an offer the US initially made weeks earlier.
In the US, several steps have been taken to curb the spread of the outbreak. In mid-January, the US Centers for Disease Control (CDC) and Department of Homeland Security (DHS) began health screenings at three airports for passengers on direct or connecting flights from Wuhan. By the end of January, the Trump Administration had announced the formation of a coronavirus task force; in addition, both the CDC and the State Department had issued travel warnings advising against all nonessential travel to China and had begun coordinating the return of US citizens in Wuhan to the US, where they have subsequently been quarantined. On January 31, US Health and Human Services (HHS) Secretary Alex Azar announced that all US citizens returning from Hubei province, where the outbreak began, would be quarantined. Additionally, Azar stated that foreign nationals who had travelled to China in the past two weeks would be banned from entering the US. In his statement, Azar added, “The risk of infection for Americans remains low and with these, and our previous, actions we are working to keep the risk low.”
"the risk of infection for Americans remains low"
Alex Azar, US Secretary of Health
In the midst of the US response to the outbreak, public health experts have argued against travel bans, like the one announced by Alex Azar, and insisted that border screenings are sufficient. The US is not alone in restricting travel. To date, fourteen countries have imposed some form of travel ban on foreign nationals or flights. Dr. Tedros, the head of WHO, said “Travel restrictions can cause more harm than good by hindering info-sharing, medical supply chains, and harming economies.” Additionally, travel bans can “discourage transparency, both in this outbreak and in the future,” according to Dr. Catherine Worsnop, a University of Maryland professor who studies international cooperation during global health emergencies.
In addition to hindering cooperation, travel bans can be expensive to implement and use valuable resources that could be spent elsewhere. The CDC has already had to use $105 million in funds Congress set aside last year for agencies to use during public health emergencies. Meanwhile, HHS has notified Congress it may need to move as much as $136 million in funds from other department agencies in order to support efforts at the CDC.
Lead Policy Analyst @ SciPol.org
While China may have acted too slow to stop the spread of this new coronavirus within China, they seem to have acted quickly enough to limit the global spread of the outbreak. Additionally, as the global community has faced an increasing number of outbreaks, such as Ebola and Zika in previous years, it has become better prepared to handle health emergencies. Encouragingly, while this new virus may spread faster than the previous outbreak of SARS, it’s mortality rate is believed to be below 3%, much better than the nearly 10% mortality rate seen with SARS. Importantly, the number of patients who have recovered continues to increase and there are early indications that a mixture of antiviral drugs may treat the disease, although a vaccine is likely a long way off.
At the moment, there is little risk within the US with only 11 reported cases, all associated with individuals who travelled to China or their spouses. Continued screening and quarantining, as needed, of travelers is likely sufficient to prevent a sustained spread of the virus within the US.