CORONA Main Coronavirus thread

mudlogger

mudlogger

Veteran Member
Kathy in WV said:
Our Sam's had holes also in the rice and beans. Some canned foods. I got strange looks for buying all that cheap Vodka but I got 9 people who need their elderberry. Hubby and son both work in the hospital.
Click to expand...
I hit Sam's, Wally and Aldi's in SW Va today, and all were good. Rice had been down, was fully stocked. Beans at Wally were restocked. La la la. You just look at people and know their train is about to derail.

I did ask an Asian woman in the Sam's bathroom--hey, don't you all talk to folks in the loo? and asked if she still talked to folks back in the Philippines, yes, what do they think about the virus, THEY ARE ALL SCARED and wearing masks.
 
S

Squid

Veteran Member
And
Zagdid said:
centennialcitizen.net

Project C.U.R.E. sends shipments to China: Centennial organization, its partners send suits, masks to help with novel coronavirus efforts in Nanjing

The rapidly changing situation around the novel coronavirus spread is something Project C.U.R.E. and its partners have been monitoring closely, and the Centennial-based organization has sent two …
centennialcitizen.net centennialcitizen.net

Project C.U.R.E. sends shipments to China
Centennial organization, its partners send suits, masks to help with novel coronavirus efforts in Nanjing
Posted Friday, February 14, 2020 10:33 am fair use

Staff report
The rapidly changing situation around the novel coronavirus spread is something Project C.U.R.E. and its partners have been monitoring closely, and the Centennial-based organization has sent two shipments of equipment to help.

The first shipment, sponsored by the International Ministries, contained 4,200 Dupont Tychem suits and 21,000 N95 masks, and they will be delivered to Amity China in Nanjing. The second shipment, sponsored by Cheniere Energy headquartered out of Houston, contains 118,020 N95 masks, which equates to 562 cases. Both shipments will be distributed throughout Wuhan and surrounding areas.

International Ministries and the Chinese government are still in need and looking for more masks and protective medical equipment.

“What China urgently needs at present are medical masks, protective suits, and safety goggles,” foreign ministry spokeswoman Hua Chunying said in a press briefing, according to a news release.

Since 1987, Project C.U.R.E has been delivering life-saving medical equipment and supplies to hospitals and clinics throughout the under-resourced world. The programs are funded by grants from the U.S. government, non-governmental organizations and by philanthropic foundations, corporate partners and individual donors. Learn more at Project C.U.R.E. Home | Project C.U.R.E.
Click to expand...

And if the outbreak hits us in 10-14 days all the masks and med eqt sent to China will not be available for US
 
S

shane

Has No Life - Lives on TB
mudlogger said:
I hit Sam's, Wally and Aldi's in SW Va today, and all were good. Rice had been down, was fully stocked. Beans at Wally were restocked. La la la. You just look at people and know their train is about to derail.

I did ask an Asian woman in the Sam's bathroom--hey, don't you all talk to folks in the loo? and asked if she still talked to folks back in the Philippines, yes, what do they think about the virus, THEY ARE ALL SCARED and wearing masks.
Click to expand...
Sam's two hours ago in San Marcos, TX...
IMG_3918.jpegIMG_3918.jpeg
 
jward

jward

passin' thru
jward

jward

passin' thru
gather round kiddos, it's story time

Tracking coronavirus: Map, data and timeline


The tables below show confirmed cases of coronavirus (2019-nCoV, officially known as SARS-CoV-2 or COVID-19) in China and other countries. To see a distribution map and a timeline, scroll down. There are currently 66,887 confirmed cases worldwide, including 1,523 fatalities.

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Join us on Patreon or support us with a one-time donation on PayPal.

Last update: 14 February 2020 at 6:10 p.m. ET

MAINLAND CHINACasesDeathsNotesLinks
Hubei province
(includes Wuhan)		54,4061,4578,276 serious, 1,876 criticalSource
Guangdong province1,261272 serious, 37 criticalSource
Henan province1,1841149 serious, 34 criticalSource
Zhejiang province1,155051 serious, 30 criticalSource
Hunan province988255 seriousSource
Anhui province934611 criticalSource
Jiangxi province900157 seriousSource
Jiangsu province59306 serious, 4 criticalSource
Chongqing532527 serious, 24 criticalSource
Shandong province523216 serious, 10 criticalSource
Sichuan province463117 criticalSource
Heilongjiang province4181161 seriousSource
Beijing3723Source
Shanghai318111 serious, 6 criticalSource
Tianjin1203Source
Other regions2,11215Source
TOTAL66,2791,52010,730 serious
7,635 recovered
10,109 suspected

REGIONSCasesDeathsNotesLinks
Hong Kong5615 critical, 2 serious, 1 recoveredSource
Taiwan1801 recoveredSource
Macau1001 recoveredSource
TOTAL8417 serious

INTERNATIONALCasesDeathsNotesLinks
Japan259*19 serious, 4 recoveredSource
Singapore6706 critical, 17 recoveredSource
Thailand3301 serious, 12 recoveredSource
South Korea2807 recoveredSource
Malaysia1907 recoveredSource
Australia15010 recoveredSource
Germany1601 recoveredSource
Vietnam1607 recoveredSource
United States1503 recoveredSource
France1101 serious, 2 recoveredSource
United Kingdom901 recoveredSource
Canada801 recoveredSource
UAE801 serious, 1 recoveredSource
Philippines312 recoveredSource
India301 recoveredSource
Italy302 seriousSource
Russia202 recoveredSource
Spain20Source
Nepal101 recoveredSource
Cambodia101 recoveredSource
Sri Lanka101 recoveredSource
Finland101 recoveredSource
Sweden10Source
Belgium10Source
Egypt10Source
TOTAL524220 serious/critical
Notes


  • Hubei province, China: The numbers include clinically-diagnosed cases, which means they were not confirmed by laboratory testing.
  • Japan: The total includes 4 asymptomatic cases, which are not included in the government’s official count.
  • Japan: The total includes 218 people from the “Diamond Princess” cruise ship. They are not included in the government’s official count.
  • North Korea: Unconfirmed reports about 1, 5, or 7 cases in North Korea cannot be verified. If cases are confirmed by the North Korean government, they will be added to this list.
bnonews.com

Tracking coronavirus: Map, data and timeline

The table below shows cases of coronavirus (officially known as SARS-CoV-2, COVID-19, or 2019-nCoV) around the world. Each figure is verified by our team through local health departments or local media. A distribution map and a timeline with a list of recent updates can be found below the table...
bnonews.com bnonews.com
 
jward

jward

passin' thru
part two

Timeline (GMT)
14 February

  • 23:10: 2,420 new cases and 139 new deaths in Hubei province, China. (Source)
  • 21:10: 1 new presumptive confirmed case in BC, Canada. (Source)
  • 17:00: First case in Egypt. (Source)
  • 14:03: 1 new case in Japan. (Source)
  • 14:00: 1 new case in Japan. (Source)
  • 13:54: 1 new case in Japan. (Source)
  • 13:50: 1 new case in Japan. (Source)
  • 11:05: 9 new cases in Singapore. (Source)
  • 10:09: 2 new cases in Japan. (Source)
  • 09:15: 3 new cases in Hong Kong. (Source)
  • 08:47: 3 new cases and 1 new death in Chongqing, China. (Source)
  • 08:02: 4 new cases in Shandong province, China. (Source)
  • 07:51: 1 new case in Japan. (Source)
  • 03:25: China’s National Health Commission reports 267 new cases and 5 new deaths on the mainland, excluding Hubei province. Hubei Province deducted 108 prior deaths from the death toll due to double counting. (Source)
  • 00:43: 1 new case in Japan. (Source)
13 February

  • 23:45: 4,823 new cases and 116 new deaths in Hubei province, China. 1,043 cases which were previously reported were deducted from the government’s figures. (Source)
  • 14:50: 3 new cases in Hong Kong. (Source)
  • 15:10: 1 new case in the United States. First in Texas. (Source)
  • 12:40: 1 new case in Japan. (Source)
  • 11:55: 1 new case, a fatality, in Japan. This is the first death in Japan. (Source 1)
  • 11:36: 8 new cases in Singapore. (Source)
  • 11:15: 1 new case in Japan. (Source)
  • 10:13: 1 new case in Malaysia. (Source)
  • 09:05: 1 new case in Japan. (Source)
  • 08:15: China’s National Health Commission reports 312 new cases and 12 new deaths on the mainland, excluding Hubei province. (Source)
  • 05:15: 1 new case in Vietnam. (Source)
  • 03:10: 44 new cases in Japan. They were found on the “Diamond Princess” cruise ship off Yokohama, raising the ship’s total to 218. (Source)
  • 00:25: 1 new case in California, United States. (Source)
12 February

  • 23:48: 14,840 new cases, including clinically diagnosed cases, and 242 new deaths in Hubei province, China. (Source)
  • 18:53: 1 new case in the United Kingdom. (Source)
  • 08:24: 1 new case in Hong Kong. (Source)
  • 07:00: 3 new cases in Singapore. (Source)
  • 02:53: 1 new case in Japan. It is one of the quarantine officers who was working on board the “Diamond Princess” cruise ship off Yokohama. This case is not included in the total for the ship’s passengers and crew. (Source)
  • 02:14: China’s National Health Commission reports 377 new cases and 3 new deaths across the mainland, excluding Hubei province. The deaths were in Henan province, Hunan province, and Chongqing. (Source)
11 February

  • 23:55: 39 new cases in Japan. They were found on the “Diamond Princess” cruise ship off Yokohama, raising the ship’s total to 174. (Source)
  • 22:17: 1,638 new cases and 94 new deaths in Hubei province, China. (Source)
  • 21:01: 1 new case in Thailand. (Source)
  • 19:25: 2 new cases in Germany. (Source)
  • 16:10: 7 new cases in Hong Kong. (Source)
  • 14:59: 2 new cases in Singapore. (Source)
  • 06:57: 2 new cases in Japan. (Source)
  • 02:37: 1 new case in Vietnam. (Source)
  • 01:14: 1 new case in California, United States. (Source)
  • 01:00: 1 new case in South Korea. (Source)
  • 00:13: China’s National Health Commission reports 370 new cases and 5 new deaths on the mainland. Of the deaths, one each in: Beijing, Tianjin, Heilongjiang province, Anhui province, and Henan province. (Source)
10 February

  • 22:10: 2,097 new cases and 103 new deaths in Hubei province, China. (Source)
  • 17:56: 1 new case in the United Arab Emirates. (Source)
  • 16:00: 4 new cases in Hong Kong. (Source)
  • 14:20: 2 new cases in Hong Kong. (Source)
  • 12:30: 2 new cases in Singapore. (Source)
  • 09:46: 4 new cases in the United Kingdom. (Source)
  • 05:13: 65 new cases in Japan. They were found on the “Diamond Princess” cruise ship off Yokohama, raising the ship’s total to 135. (Source)
  • 01:01: 1 new case in Malaysia. (Source)
For the full timeline, click here.
Chart
 
Doomer Doug

Doomer Doug

TB Fanatic
Mark D said:
I had a PT appointment last night (still recovering from a car accident), and during a lull in the leg torture, the PT asked if I had heard about "that virus in China". I said yes, and asked what she had heard. She stated that all the hospital staff had been in a meeting about it that morning (Thursday), and that: "they still didn't know enough about it to establish
Click to expand...
 
marsh

marsh

On TB every waking moment
www.medrxiv.org

Tobacco-use disparity in gene expression of ACE2, the receptor of 2019-nCov

In current severe global emergency situation of 2019-nCov outbreak, it is imperative to identify vulnerable and susceptible groups for effective protection and care. Recently, studies found that 2019-nCov and SARS-nCov share the same receptor, ACE2. In this study, we analyzed four large-scale...
www.medrxiv.org www.medrxiv.org

Tobacco-use disparity in gene expression of ACE2, the receptor of 2019-nCov
Guoshuai Cai
doi: Tobacco-use disparity in gene expression of ACE2, the receptor of 2019-nCov
This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

Abstract
In current severe global emergency situation of 2019-nCov outbreak, it is imperative to identify vulnerable and susceptible groups for effective protection and care. Recently, studies found that 2019-nCov and SARS-nCov share the same receptor, ACE2. In this study, we analyzed four large-scale datasets of normal lung tissue to investigate the disparities related to race, age, gender and smoking status in ACE2 gene expression. No significant disparities in ACE2 gene expression were found between racial groups (Asian vs Caucasian), age groups (>60 vs <60) or gender groups (male vs female). However, we observed significantly higher ACE2 gene expression in smoker samples compared to non-smoker samples. This indicates the smokers may be more susceptible to 2019-nCov and thus smoking history should be considered in identifying susceptible population and standardizing treatment regimen.

Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
None
 
Doomer Doug

Doomer Doug

TB Fanatic
I guess it I'd good I bought two 50 caplets bottles of Advil, with a two year expire date. This is what I am talking about here. A week ago when I bought both of them at the same time, there were no holes in the shelf, and no signs talking about supply issues. I am going to Target and see if the Sheeple are mooooooooving faster.
 
Cascadians

Cascadians

Leska Emerald Adams
psychgirl

psychgirl

Has No Life - Lives on TB
shane said:
Sam's two hours ago in San Marcos, TX...
View attachment 182776View attachment 182776
Click to expand...


...on that note....my local Kroger is stocked normally. All isles.
I did buy extra Kroger Tylenol, Kroger brand Ibuprofen, Kroger Aspirin, and antihistamine/with chest congestion formula that are on sale. Also on sale are large bottles of Peroxide for 1.00$ and alcohol for .50. Bought two of each for now.


I know there are a ton more I need but I always keep extra anyway....I'' but more OTC this weekend.
A co worker has been out since I sent her home Wednesday morning, she was vomiting for an hour straight in the bathroom....she just sent all of us a text, tonight, w/photo shot of her letter from hospital stating that she has tested pos for regular flu...

KEEP THAT CRAP AWAY FROM THE REST OF US! She is not allowed to come back to work until temp is normal.
 
jward

jward

passin' thru
keep that crap away from t he rest of us:

this is where maybe we can squeal loud enough to be heard, demanding en masse that policies change in our companies, organizations, and communities. So much trouble would be adverted if those infected folks would just stay the heck away.
 
jward

jward

passin' thru

Corona virus (2019-nCoV/COVID-19) watcher
@2019nCoVwatcher

New study led by
@mlipsitch
: ''We found that the ability to detect imported cases among high surveillance countries is 40%, among intermediate surveillance countries it is 37%, and among low surveillance countries it is 11%'.

https://twitter.com/i/web/status/1228468363892002816
View: https://twitter.com/2019nCoVwatcher/status/1228468363892002816?s=20


UNDerdetection of internationally imported COVID-19 cases
View ORCID ProfilePablo M De Salazar, View ORCID ProfileRene Niehus, View ORCID ProfileAimee Taylor, View ORCID ProfileMarc Lipsitch

doi: Estimating underdetection of internationally imported COVID-19 cases
This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.




Abstract
Risk of COVID-19 infection in Wuhan has been estimated using imported case counts of international travelers, often under the assumption that all cases in travelers are ascertained. Recent work indicates variation among countries in detection capacity for imported cases.
Singapore has historically had very strong epidemiological surveillance and contact-tracing capacity and has shown in the COVID-19 epidemic evidence of a high sensitivity of case detection. We therefore used a Bayesian modeling approach to estimate the relative imported case detection efficiency for other countries compared to that of Singapore. We estimate that the global ability to detect imported cases is 38% (95% HPDI 22% - 64%) of Singapore′s capacity.
Equivalently, an estimate of 2.8 (95% HPDI 1.5 - 4.4) times the current number of imported cases, could have been detected, given all countries had the same detection capacity as Singapore. Using the second component of the Global Health Security index to stratify country likely detection capacities, we found that the ability to detect imported cases among high surveillance countries is 40% (95% HPDI 22% - 67%), among intermediate surveillance countries it is 37% (95% HPDI 18% - 68%), and among low surveillance countries it is 11% (95% HPDI 0% - 42%).

We conclude that estimates of case counts in Wuhan based on assumptions of perfect detection in travelers may be underestimated by several fold, and severity correspondingly overestimated by several fold. Undetected cases are likely in countries around the world, with greater risk in countries of low detection capacity and high connectivity to the epicenter of the outbreak.

Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
This work was supported by Award Number U54GM088558 from the US National Institute Of General Medical Sciences. P.M.D was supported by the Fellowship Foundation Ramon Areces. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute Of General Medical Sciences or the National Institutes of Health.
Author Declarations
All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.
Yes
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
Yes
 
marsh

marsh

On TB every waking moment
www.who.int

WHO Director-General's remarks at the media briefing on COVID-2019 outbreak on 14 February 2020

www.who.int www.who.int

WHO Director-General's remarks at the media briefing on COVID-2019 outbreak on 14 February 2020

14 February 2020

Good afternoon everyone. I am speaking to you from Kinshasa, Democratic Republic of the Congo, where I have met with President Tshisekedi, ministers, UN colleagues and other partners – to review the impressive progress that has been made toward ending the Ebola outbreak, and to talk about future plans to ensure that everyone in the DRC can access quality health services going forward.

I have been impressed with the commitment of President Tshisekedi and his government to ending the outbreak in eastern DRC and I would like to urge the whole world to recommit to getting to zero Ebola cases. But it is also vitally important that resources and attention focus on strengthening the country’s health system and bolstering preparedness.
Whether it’s Ebola or COVID-19, investing in preparedness is the smartest way to ensure disease outbreaks are identified and stopped quickly.

I am glad to say that countries around the world are in a better state of preparedness for COVID-19 than they were just a week ago, and WHO’s efforts to help countries boost their lab capacity continue.

Now the latest numbers on the COVID-19 outbreak.

As you know, China has changed the way it reports data from Hubei province.
There are now a total of 47,505 laboratory-confirmed cases in China, and 16,427 cases that have been clinically-confirmed in Hubei province.

While it’s not uncommon in outbreaks for case definitions to change over time as more information becomes available, we are seeking further clarity on how clinical diagnosis is being made, to ensure other respiratory illnesses including influenza are not getting mixed into the COVID-19 data.

In total, there have been 1,381 deaths in China, including 121 reported today.

Outside China, there have been 505 cases in 24 countries and two deaths.

The vice minister of the national health commission has said that as of Tuesday 1716 health care workers have been infected, and six have died.

This is a critical piece of information, because health workers are the glue that holds the health system and outbreak response together. But we need to know more about this figure, including the time period and circumstances in which the health workers became sick.
WHO guidelines have been developed for health workers taking care of hospitalised adults and paediatric patients with acute infections. These guidelines have been made available to all countries.

As I said the other day, we have been in regular contact with suppliers, asking them to prioritize production and distribution of personal protective equipment to health workers on the front lines. We are also in touch with Member States on this important issue.

I’m glad to say that the WHO-led Joint Mission with China on COVID-19is moving forward. We expect the full team to touch down over the weekend.

The mission consists of 12 international and WHO experts and a similar number of national expert counterparts from the People’s Republic of China.

The Joint Mission will include in-depth workshops, a data review with the principal ministries, a series of meetings with key national-level institutions and field visits in three provinces to understand the application and impact of response activities at provincial and county levels, including urban and rural settings.

The goal of the joint mission is to rapidly inform the next steps in the COVID-19 response and preparedness activities in China and globally.

Particular attention will be paid to understanding the transmission of the virus, the severity of disease, and the impact of ongoing response measures.

Furthermore, it will be important to review which type of information is needed so that the world can use this window of opportunity to prepare health systems and workers for possible outbreaks.

Clearly this is an evolving picture. Health workers and responders in China are working with virtually no sleep in difficult conditions. But we need to ensure that we’re getting the most accurate data, as quickly as possible, to assist China and support the global response.
We’re working with our Chinese counterparts on these issues, and this is also part of the scope of work for the WHO-led joint mission with China.

Finally, I wish to thank Cambodia for demonstrating to the world the meaning of solidarity.
While other countries turned away the Westerdam cruise ship, Cambodia allowed it to dock.
Today hundreds of passengers are disembarking and are en route to their home countries.
20 passengers who reported signs of illness have tested negative for the COVID-19 virus.
I hope that other countries will follow Cambodia’s lead.

Lastly, I want to say again, from my heart, that this is the time for solidarity, not stigma. There are worrying signs that the world is not hearing the call for unity and standing in unison with those at the epicenter in China who are saving lives and alleviating suffering.
I thank you.
 
marsh

marsh

On TB every waking moment

Overview of U.S.?Domestic?Response to the 2019 Novel Coronavirus (2019-nCoV) - FluTrackers News and Information

Overview of U.S. Domestic Response to the 2019 Novel Coronavirus (2019-nCoV) February 10, 2020 (R46219) Contents Background (https://www.everycrsreport.com/reports/R46219.html#_Toc32317708) 2019 Novel Coronavirus (2019-nCoV) (https://www.everycrsreport.com/reports/R46219.html#_Toc32317709)...
flutrackers.com
Overview of U.S. Domestic Response to the 2019 Novel Coronavirus (2019-nCoV)
Today, 01:13 PM

Overview of U.S. Domestic Response to the 2019 Novel Coronavirus (2019-nCoV)

February 10, 2020 (R46219)Contents

 
marsh

marsh

On TB every waking moment
www.scmp.com

US will test people with flu symptoms for coronavirus

Testing will initially be carried out by labs in Los Angeles, San Francisco, Seattle, Chicago and New York, but more sites are planned, CDC says.
www.scmp.com www.scmp.com
Coronavirus: US will test people with flu symptoms, in expansion of government response
  • Testing will initially be carried out by labs in Los Angeles, San Francisco, Seattle, Chicago and New York, but more sites are planned, CDC says
Bhavan Jaipragas

Bhavan Jaipragas
Published: 2:31am, 15 Feb, 2020

US health authorities on Friday said they are ready to institute “mitigation” measures to minimise the harm caused by transmission of the novel coronavirus even as they significantly expanded efforts to contain the outbreak from becoming widespread in the country.

In a telephone briefing with reporters, Nancy Messonnier of the Centres for Diseases Control and Prevention (CDC) said that the US would begin to test individuals for the coronavirus if they have been identified by local health authorities as having flu-like symptoms.

The heightened measures – a major expansion of Washington’s effort to contain the outbreak – will see the CDC work with public health labs in Los Angeles and San Francisco in California; Seattle, Washington; Chicago, Illinois; and New York City. More sites are planned, she said.
Messonnier, the director of the CDC’s Centre for Immunisation and Respiratory Diseases, also addressed a rising debate among health officials and epidemiologists on whether to pivot from “containment” of the outbreak – through measures such as contact tracing and isolating those who come into contact with infected people – to mitigation strategies.

Those advocating for mitigation say that the latest data prove the virus has a high transmissibility that almost certainly dooms containment efforts. In a scenario where the virus reaches pandemic levels, a policy of mitigation would mean those with mild symptoms would be asked to seek outpatient medical treatment and rest at home.

Only those with acute symptoms would be hospitalised, while a policy of “social distancing” that would include school and workplace closures may also be instituted.

Messonnier stressed that the two strategies were not mutually exclusive. While the possibility of widespread transmission of the coronavirus in the US would trigger a “change in our response strategy”, Messonnier said, mitigation and containment measures could be employed at the same time.

“There are times when those components merge together across the United States, potentially at different locations in the United States,” she said.

For now, she said, the CDC remained focused on keeping the number of confirmed coronavirus cases in the US – currently at 15 – as low as possible.

Messonnier said that mitigation would entail a reduction in the current practice in the US and elsewhere of tracing and isolating every person who comes into contact with infected people.

Instead, efforts to disrupt the virus would happen at the community level through “social distancing” measures that would include telecommuting, teleschooling and telemedicine.


Messonnier said that given the lack of other countermeasures – there is no antiviral or vaccine available for the virus yet – these “nonpharmaceutical” interventions were the methods available to authorities.

Such measures would “decrease the burden, the morbidity, mortality [and] do everything to help at the societal level,” she said.

To be sure, the US has shown no signs of a major coronavirus outbreak, but public health officials have repeatedly said they need to be prepared for community transmission in the US.
Moreover, several experts have advocated for governments to prepare to pivot to a mitigation strategy, including Tom Inglesby, the director of the Centre for Health Security of the Johns Hopkins Bloomberg School of Public Health and Hitoshi Oshitani, a professor of virology at Tohoku University in Japan.

In a commentary for Singapore’s state news agency CNA, Oshitani argued that there was an urgent need for countries to make the transition so that health care systems are not overwhelmed when there is a sudden surge in “transmission chains” – which may occur given the virus’s high transmissibility.

Officials in Singapore, among the areas worst hit by the virus outside China, have said a shift to mitigation was among the approaches they were considering but have approached that stance cautiously.

“We have to calibrate and judge as we go on each step, what is the most prudent thing to do. Err on the side of caution, but make a sensible judgment. And that’s what we're trying,” Singapore’s Prime Minister Lee Hsien Loong said on Friday.

Globally there have been almost 1,400 deaths – all but three in China, where the virus is believed to have originated in Wuhan, Hubei province, and where nearly 64,000 people have fallen ill.

The US has enacted a temporary travel ban on foreign nationals who have recently visited China, and quarantine measures for its own citizens returning from Hubei province.
 

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marsh

marsh

On TB every waking moment

The Lancet:
COVID-19: what is next for public health?
The WHO Scientific and Technical Advisory Group for Infectious Hazards (STAG-IH), working with the WHO secretariat, reviewed available information about the outbreaks of 2019 novel coronavirus disease (COVID-19) on Feb 7, 2020, in Geneva, Switzerland, and concluded that the continuing strategy of containment for elimination should continue, and that the coming 2–3 weeks through to the end of February, 2020, will be crucial to monitor the situation of community transmission to update WHO public health recommendations if required.
Genetic analysis early in the outbreak of COVID-19 in China revealed that the virus was similar to, but distinct from, severe acute respiratory syndrome coronavirus (SARS-CoV), but the closest genetic similarity was found in a coronavirus that had been isolated from bats.
1
As there was in early January, 2020, scarce information available about the outbreak, knowledge from outbreaks caused by the SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV) formed the basis for WHO public health recommendations in mid-January.
2
However, the availability of more evidence in the past month has shown major differences between the outbreaks and characteristics of COVID-19 compared with those of SARS-CoV.

• View related content for this article

Recognising the Wuhan-focused and nationwide outbreak responses in China, WHO has encouraged countries with heavy air travel exchange with Wuhan to take precautionary public health measures
2
and, if there is imported infection, to undertake activities that could lead to the elimination of the virus in human populations as occurred during the 2003 SARS outbreak.
3
After the SARS outbreak, a few follow-on outbreaks occurred, including accidents in laboratories researching SARS-CoV.
4
SARS-CoV is thought to have been eliminated from human populations during 2003, and there have been no reports in the medical literature about SARS-CoV circulation in human populations since then.
The 2003 SARS outbreaks are thought to have originated from the spillover of a mutated coronavirus from animals sold in a live animal market in Guangdong province in China to a few humans, and it then surfaced as a large cluster of pneumonia in health-care settings in Guangdong province.
5
Although the causative agent was then unknown, an infected medical doctor who had been treating patients in Guangdong province travelled to Hong Kong when he became ill and became an index case for hospital-associated and community outbreaks in Hong Kong and in three countries outside of China. The causative agent was later identified as a coronavirus and named SARS-CoV. The SARS outbreaks were at times characterised by several superspreading events—eg, hotel-based transmission from one infected hotel guest to others who travelled to Canada, Singapore, and Vietnam.
6
One large apartment complex-based outbreak of SARS was later found to be caused by aerosolisation of virus contaminated sewage.
6
COVID-19 is thought to have been introduced to human populations from the animal kingdom in November or December, 2019, as suggested by the phylogeny of genomic sequences obtained from early cases.
7
The genetic epidemiology suggests that from the beginning of December, 2019, when the first cases were retrospectively traced in Wuhan, the spread of infection has been almost entirely driven by human-to-human transmission, not the result of continued spillover. There was massive transmission in a matter of weeks in Wuhan, and people in the resulting chains of transmission spread infection by national and international travel during the Chinese New Year holidays.

COVID-19 seems to have different epidemiological characteristics from SARS-CoV. COVID-19 replicates efficiently in the upper respiratory tract and appears to cause less abrupt onset of symptoms, similar to conventional human coronaviruses that are a major cause of common colds in the winter season.
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Infected individuals produce a large quantity of virus in the upper respiratory tract during a prodrome period, are mobile, and carry on usual activities, contributing to the spread of infection. By contrast, transmission of SARS-CoV did not readily occur during the prodromal period when those infected were mildly ill, and most transmission is thought to have occurred when infected individuals presented with severe illness, thus possibly making it easier to contain the outbreaks SARS-CoV caused, unlike the current outbreaks with COVID-19.
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COVID-19 also has affinity for cells in the lower respiratory tract and can replicate there, causing radiological evidence of lower respiratory tract lesions in patients who do not present with clinical pneumonia.
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There seem to be three major patterns of the clinical course of infection: mild illness with upper respiratory tract presenting symptoms; non-life-threatening pneumonia; and severe pneumonia with acute respiratory distress syndrome (ARDS) that begins with mild symptoms for 7–8 days and then progresses to rapid deterioration and ARDS requiring advanced life support (WHO EDCARN clinical telephone conference on COVID-19, personal communication with Myoung-don Oh [Seoul National University Hospital] and Yinzhong Shen [Shanghai Public Health Clinical Center])

The case fatality ratio with COVID-19 has been difficult to estimate. The initial case definition in China included pneumonia but was recently adjusted to include people with milder clinical presentation and the current estimate is thought to be about 1–2%, which is lower than that for SARS (10%).
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The actual case fatality ratio of infection with COVID-19 will eventually be based on all clinical illness and at the time of writing information on subclinical infection is not available and awaits the development of serological tests and serosurveys.

Presently COVID-19 seems to spread from person to person by the same mechanism as other common cold or influenza viruses—ie, face to face contact with a sneeze or cough, or from contact with secretions of people who are infected. The role of faecal–oral transmission is yet to be determined in COVID-19 but was found to occur during the SARS outbreak.
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The lock-down of Wuhan City seems to have slowed international spread of COVID-19; however, the effect is expected to be short-lived (WHO modelling group). Efforts are currently underway in China, in the 24 countries to which infected persons have travelled, and in public conveyances, such as cruise ships, to interrupt transmission of all existing and potential chains of transmission, with elimination of COVID-19 in human populations as the final goal. This WHO-recommended strategy is regularly assessed each week by STAG-IH on the basis of daily risk assessments by WHO as information becomes available from outbreak sites.

A plausible scenario based on the available evidence now is that the newly identified COVID-19 is causing, like seasonal influenza, mild and self-limiting disease in most people who are infected, with severe disease more likely among older people or those with comorbidities, such as diabetes, pulmonary disease, and other chronic conditions. Health workers and carers are at high risk of infection, and health-care-associated amplification of transmission is of concern as is always the case for emerging infections. People in long-term care facilities are also at risk of severe health consequences if they become infected.

Non-pharmaceutical interventions remain central for management of COVID-19 because there are no licensed vaccines or coronavirus antivirals. If the situation changes towards much wider community transmission with multiple international foci, the WHO strategy of containment for elimination could need to be adjusted to include mitigation strategies combined with the following activities currently recommended by STAG-IH on the WHO website.

First, close monitoring is needed of changes in epidemiology and of the effectiveness of public health strategies and their social acceptance.

Second, continued evolution is needed of enhanced communication strategies that provide general populations and vulnerable populations most at risk with actionable information for self-protection, including identification of symptoms, and clear guidance for treatment seeking.

Third, continued intensive source control is needed in the epicentre in China—ie, isolation of patients and persons testing positive for COVID-19, contact tracing and health monitoring, strict health facility infection prevention and control, and use of other active public health control interventions with continued active surveillance and containment activities at all other sites where outbreaks are occurring in China.

Fourth, continued containment activities are needed around sites outside China where there are infected people and transmission among contacts, with intensive study to provide information on transmissibility, means of transmission, and natural history of infection, with regular reporting to WHO and sharing of data.

Fifth, intensified active surveillance is needed for possible infections in all countries using the WHO-recommended surveillance case definition.
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Sixth, preparation for resilience of health systems in all countries is needed, as is done at the time of seasonal influenza, anticipating severe infections and course of disease in older people and other populations identified to be at risk of severe disease.

Seventh, if widespread community transmission is established, there should then be consideration of a transition to include mitigation activities, especially if contact tracing becomes ineffective or overwhelming and an inefficient use of resources. Examples of mitigation activities include cancelling public gatherings, school closure, remote working, home isolation, observation of the health of symptomatic individuals supported by telephone or online health consultation, and provision of essential life support such as oxygen supplies, mechanical ventilators and extracorporeal membrane oxygenation (ECMO) equipment.

Eighth, serological tests need to be developed that can estimate current and previous infections in general populations.

Finally, continued research is important to understand the source of the outbreak by study of animals and animal handlers in markets to provide evidence necessary for prevention of future coronavirus outbreaks.

We declare no competing interests.
 
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