China Investigates SARS Like Pneumonia Disease

http://www.thebigwobble.org/2020/01/chinese-mystery-disease-update-no-3-139.html

The Big Wobble is trying to get a grip on this story.
(N-SARS New-Severe Acute Respitory Syndrome ?)

https://www.globaltimes.cn/content/1177345.shtml;

There have been suspected cases in Vietnam and Singapore, and 90 suspected cases have been reported in China's Hong Kong Special Administrative Region.
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In the early moments of SARS, there was concealment in China. This must not be repeated.

The new epidemic in Wuhan is not as horrible as SARS. We sincerely hope Chinese society can be more successful in preventing and controlling the pneumonia, and move a big step forward in terms of medicine, social management and public opinion compared with 2003.

Hi Albert. Its been a while

You mention Ferguson's estimates. How accurate are they? Is there anywhere I can see the modelling or raw data?

[This is the clinical recommendations of the WHO for suspected cases.

It should show us what to expect]

Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected:

Interim Guidance

1 Clinical management of severe acute respiratory infection when novelcoronavirus (nCoV)infection is suspected Interim guidance 12January 2020WHO/nCoV/Clinical/2020.

1 Introduction This is the first edition of this document for novel coronavirus, an adaption of WHO Clinical management of severe acute respiratory infection when MERS-CoVinfection is suspected publication (2019). This document is intended for clinicians taking care of hospitalised adult and paediatric patients with severe acute respiratory infection (SARI) when a nCoV infectionis suspected. It is not meant to replace clinical judgmentor specialist consultation but rather to strengthen clinical management of these patients and provide to up-to-date guidance.   Best practices for SARI including IPC and optimized supportive care for severely ill patients are essential.   This document is organized into the following sections:

1.Triage: recognize and sort patients with SARI

2.   Immediate implementation of appropriate infection prevention and control (IPC)measures

3.Early supportive therapy and monitoring

4.Collection of specimens for laboratory diagnosis

5. Management of hypoxemic respiratory failure and acute respiratory distress syndrome (ARDS)

6.Management of septic shock

7.Prevention of complications

8.Specific anti-nCoV treatments

9.Special considerations for pregnant patients. These symbols are used to flag interventions:

Do: the intervention is beneficial(strong recommendation) OR the intervention is a best practice statement

Don’t: the intervention is known to be harmful.

Consider: the intervention may bebeneficial in selected patients (conditional recommendation) OR be careful when considering this intervention.

This document aims to provide clinicians with updated interim guidance on timely, effective, and safe supportive management of patients with nCoV and SARI, particularly those with critical illness. The recommendations in this document are derived from WHO publications.   1-4   Where WHO guidance is not available, we refer to evidence-based guidelines. Members of a WHO global network of clinicians, and clinicians who have treated SARS, MERS or severe influenza patients have reviewed the recommendations (see Acknowledgements).   

For queries, please email outbreak@who.intwith ‘nCoVclinical question’ in the subject line.

[Technophobe: This is obviously a hasty first draft and (up until now) I have attempted to correct the lack of spaces, paragraphs and punctuation. But I can't keep it up! I'm dyslexic and proof reading is enormously hard for me. So appologies, the rest is in part as it is in the PDF, I just added about 200 spaces between words, so it would all fit on one page,]

Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance 21.

Triage: early recognition of patients with SARI associated with nCoV infection Triage: recognize and sort all patients with SARI at first point of contact with health care system (such as the emergency department). Consider nCOV as a possible etiology of SARI under certain conditions (see Table 1). Triage patients and start emergency treatments based based on disease severity. Remarks: nCoV may present with mild ,moderate, or severe illness; the latter includes severe pneumonia, ARDS, sepsis and septic shock. Early recognition of suspected patients allows for timely initiation of IPC (see Table 2). Early identification of those with severe manifestations (see Table 2) allows for immediate optimized supportive care treatments and safe, rapid admission (or referral)to intensive care unit according to institutional or national protocols. For those with mild illness, hospitalization may not be required unless there is concern for rapid deterioration. All patients discharged home should be instructed to return to hospital if they develop any worsening of illness. Table 1. Definitions of patients with SARI, suspected of nCoV* SARI. An ARI with history of fever or measured temperature ≥38 C° and cough; onset within the last ~10 days; and requiring hospitalization.

5 However, the absence of fever does NOT exclude viral infection.

6 Surveillance case definitions for nCoV*

1. Severe acute respiratory infection (SARI) in a person, with history of fever and cough requiring admission to hospital, with no other etiology that fully explains the clinical presentation

1(clinicians should also be alert to the possibility of atypical presentations in patients who are immunocompromised); AND any of the following: a)A history of travel to Wuhan, Hubei Province China in the 14 days prior to symptomon set; or b) the disease occurs in a healthcare worker who has been working in an environment where patients with severe acute respiratory infections are being cared for, without regard to place of residence or history of travel; or c) the person develops an unusual or unexpected clinical course, especially sudden deterioration despite appropriate treatment, without regard to place of residence or history of travel, even if another etiology has been identified that fully explains the clinical presentation.

2. A person with acute respiratory illness of any degree of severity who, within 14 days before onset of illness, had any of the following exposures: a) close physical contact 2 with a confirmed case of nCoV infection, while that patient was symptomatic; or b) a healthcare facility in a country where hospital-associated nCoV infections have been reported; *see https://www.who.int/health-topics/coronavirus for latest case definitions 1 Testing should be according to local guidance for management of community-acquired pneumonia. Examples of other etiologies include Streptococcus pneumoniae, Haemophilus influenzae type B, Legionella pneumophila, other recognized primary bacterial pneumonias, influenzaviruses, and respiratory syncytial virus.

2 Close contact’ is defined as:-Health care associated exposure, including providing direct care for nCoVpatients, working with health care workers infected with nCoV, visiting patients or staying in the same close environment of a nCoVpatient. - Working together in close proximity or sharing the same classroom environment with a with nCoVpatient-Traveling together with nCoVpatient in any kind of conveyance-Living in the same household as a nCoVpatientThe epidemiological link may have occurred within a 14-day period before or after the onset of illness in the case under consideration.

Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance3Table 2. Clinical syndromes associated with nCoV infectionUncomplicated illnessPatients with uncomplicated upper respiratory tract viral infection, may havenon-specific symptoms such as fever, cough, sore throat, nasal congestion, malaise, headache, muscle pain or malaise. The elderly and immunosuppressed may present with atypical symptoms. These patients do not have any signs of dehydration, sepsis or shortness of breath. Mild pneumonia Patient with pneumonia and no signs of severe pneumonia.Child with non-severe pneumonia has cough or difficulty breathing + fast breathing: fast breathing(in breaths/min): <2 months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40and no signs of severe pneumonia. Severe pneumonia Adolescent or adult: fever or suspected respiratory infection, plus one of respiratory rate >30 breaths/min, severe respiratory distress, or SpO2<90% on room air(adapted from [1]). Child with cough or difficulty in breathing, plus at least one of the following:central cyanosis or SpO2<90%; severe respiratory distress (e.g. grunting, very severe chest indrawing); signs of pneumonia with a general danger sign: inability to breastfeed or drink,lethargy orunconsciousness, or convulsions.Other signs of pneumonia may be present: chest indrawing, fast breathing(in breaths/min):<2 months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40.2The diagnosis is clinical; chest imaging can exclude complications. Acute Respiratory Distress Syndrome7-9Onset: new or worsening respiratory symptoms within one week of known clinical insult.Chest imaging (radiograph, CT scan, or lung ultrasound):bilateral opacities, not fully explained by effusions, lobar or lung collapse,or nodules. Origin of oedema:respiratory failure not fully explained by cardiac failure or fluid overload. Need objective assessment (e.g. echocardiography) to exclude hydrostatic cause of oedema if no risk factor present.Oxygenation (adults):•Mild ARDS: 200 mmHg < PaO2/FiO2≤300 mmHg (with PEEP or CPAP≥5 cmH2O,7or non-ventilated8)•Moderate ARDS: 100 mmHg < PaO2/FiO2≤200 mmHg with PEEP ≥5 cmH2O,7or non-ventilated8)• Severe ARDS: PaO2/FiO2≤100 mmHg with PEEP ≥5 cmH2O,7or non-ventilated8)• When PaO2is not available, SpO2/FiO2≤315 suggests ARDS(including in non-ventilated patients)Oxygenation (children; note OI = Oxygenation Index and OSI = Oxygenation Index using SpO2):•Bilevel NIV or CPAP ≥5 cmH2Ovia full face mask: PaO2/FiO2≤300 mmHg or SpO2/FiO2≤264• Mild ARDS (invasively ventilated): 4≤OI<8or 5≤OSI<7. 5•Moderate ARDS (invasively ventilated): 8≤OI<16or 7.5≤OSI<12. 3•Severe ARDS (invasively ventilated): OI≥16or OSI≥12.3Sepsis10,11Adults: life-threatening organ dysfunction caused bya dysregulated host response to suspected or proven infection, with organ dysfunction*. Signs of organ dysfunction include: altered mental status, difficult or fast breathing, low oxygen saturation, reduced urine output, fast heart rate, weak pulse, cold extremities or low blood pressure, skin mottling, or laboratory evidence of coagulopathy, thrombocytopenia, acidosis,high lactate orhyperbilirubinemia. Children: suspected or proven infection and ≥2 SIRS criteria, of which one must be abnormal temperature or white blood cell count.Septic shock10,12Adults: persisting hypotension despite volume resuscitation, requiring vasopressors to maintain MAP ≥65mmHg and serum lactate level >2 mmol/L. Children (based on [12]): any hypotension (SBP <5thcentile or >2SD below normal for age) or 2-3 of the following: altered mental state; tachycardia or bradycardia (HR <90bpm or >160bpm in infants and HR <70 bpm or >150bpm in children); prolonged capillary refill (>2sec) or warm vasodilation with bounding pulses; tachypnea; mottled skin or petechial or purpuric rash; increased lactate; oliguria; hyperthermia or hypothermia. Abbreviations: ARI, acute respiratory infection; BP, blood pressure; bpm, beats/minute; CPAP, continuous positive airway pressure; FiO2, fraction of inspired oxygen; MAP, mean arterial pressure; NIV, noninvasiveventilation; OI, Oxygenation Index; OSI, Oxygenation Index using SpO2; PaO2, partial pressure of oxygen; PEEP, positive end-expiratory pressure; SBP, systolic blood pressure; SD, standard deviation;SIRS, systemic inflammatory response syndrome; SpO2, oxygen saturation. *If altitude is higher than 1000m, then correction factor should be calculated as follows: PaO2/FiO2 x Barometric pressure/760. *The SOFA score ranges from 0 to 24 and includes points related to 6 organ systems: respiratory (hypoxemia defined by low PaO2/FiO2), coagulation(low platelets), liver (high bilirubin), cardiovascular (hypotension), central nervous system (low level of consciousness defined by Glasgow Coma Scale), and renal (low urine output or high creatinine). Sepsis is defined by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score13of ≥2 points. Assume the baseline score is zero if data are not available
Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance42. Immediate implementation of appropriate IPC measuresIPC is a critical and integral part of clinical management of patientsand should be initiated at the point of entry of the patient to hospital (typically the Emergency Department). Standard precautions should always be routinely applied in all areas of health care facilities. Standard precautions include hand hygiene; use of PPE to avoid direct contact with patients’ blood, body fluids, secretions (including respiratory secretions) and non-intact skin. Standard precautions also include prevention of needle-stick or sharps injury; safe waste management; cleaning and disinfection of equipment; and cleaning of the environment.Table 2. How to implement infection prevention and control measuresfor patients with suspected or confirmed nCoV infection14,15At triageGive suspect patient a medical mask and direct patient to separate area, anisolation room if available. Keep at least 1meter distance between suspectedpatientsand other patients. Instruct all patients to cover nose and mouth during coughing or sneezing with tissue or flexed elbow for others. Perform hand hygiene after contact with respiratory secretions Apply droplet precautions Droplet precautions prevent large droplet transmission of respiratory viruses. Use a medical mask if working within 1-2metres of the patient. Place patients in single rooms,or group together those with the same etiological diagnosis. If an etiological diagnosis is notpossible, group patients with similar clinical diagnosis and based on epidemiological risk factors, with a spatial separation. When providing care in close contact with a patient with respiratory symptoms (e.g. coughing or sneezing), use eye protection (face-mask or goggles), because sprays of secretions may occur. Limit patient movement within the institution and ensure that patients wear medical masks when outside their rooms.Apply contact precautions Droplet and contact precautions prevent direct or indirect transmission from contact with contaminated surfaces or equipment (i.e. contact with contaminatedoxygen tubing/interfaces).Use PPE (medical mask, eye protection, gloves and gown) when entering room and remove PPEwhen leaving.If possible, use either disposableor dedicatedequipment(e.g.stethoscopes,blood pressure cuffsand thermometers). If equipment needs to be shared among patients, clean and disinfectbetween each patient use. Ensure that healthcare workers refrain from touching their eyes, nose,andmouth with potentially contaminated gloved or ungloved hands. Avoid contaminating environmental surfaces that are not directly related to patient care (e.g. door handlesandlight switches). Ensure adequate room ventilation. Avoid movement of patients or transport. Perform hand hygiene. Apply airborne precautions when performing an aerosol generating procedureEnsure that healthcare workers performing aerosol-generating procedures (i.e. open suctioning of respiratory tract, intubation, bronchoscopy, cardiopulmonary resuscitation)use PPE,including gloves, long-sleeved gowns, eye protection,and fit-tested particulaterespirators (N95 orequivalent,or higher level of protection). (The scheduled fit test should not be confused with user seal checkbefore each use.) Whenever possible, use adequately ventilated single rooms when performingaerosol-generating procedures, meaning negative pressure rooms with minimum of 12 air changes per hour or at least 160 litres/second/patient in facilities with natural ventilation. Avoid the presence of unnecessary individuals in the room. Care for the patient in the same type of room after mechanical ventilation commences.   Abbreviations: ARI, acute respiratory infection; PPE, personal protective equipment 3.Early supportive therapy and monitoring Give supplemental oxygen therapy immediatelyto patients with SARIand respiratory distress, hypoxaemia,or shock.Remarks: Initiate oxygen therapy at 5 L/min and titrateflow ratesto reach target SpO2≥90% in non-pregnant adults and SpO2≥92-95 % in pregnant patients.

1,2Children with emergency signs (obstructed or absent breathing, severe respiratory distress, central cyanosis, shock, coma or convulsions) should receive oxygen therapy during resuscitation to target SpO2≥94%; otherwise, the target SpO2is ≥90%.

4 All areas where patients with SARI are cared for should be equipped with pulse oximeters, functioning oxygen systems and disposable, single-use, oxygen-delivering interfaces(nasal cannula, simple face mask, and mask with reservoir bag). Use contact precautions when handling contaminated oxygen interfaces of patients with nCoV infection.Use conservative fluid management in patients with SARI when there is no evidence of shock.Remarks: Patients with SARI should be treated cautiously with intravenous fluids, because aggressive fluid resuscitation may worsen oxygenation, especially in settings where there is limited availability of mechanical ventilation.

16 Give empiric antimicrobials to treat all likely pathogens causing SARI. Give antimicrobials within one hour of initial patient assessmentfor patients with sepsis.   Remarks: Although the patient may be suspected to have nCoV, administer appropriate empiric antimicrobials within ONE hour of identification of sepsis.

17Empiric antibiotic treatment should be based on the clinical diagnosis(community-acquired pneumonia, health care-associated pneumonia [if infection wasacquired in healthcare setting], or sepsis), local epidemiologyand susceptibility data, and treatment guidelines. Empiric therapy includes a neuraminidase inhibitor for treatment of influenza when there is local circulation or other risk factors,including travel history or exposure to animal influenza viruses.18Empiric therapy should be de-escalatedon the basis of microbiology resultsand clinical judgment.Do not routinely give systemic corticosteroids for treatment of viral pneumoniaor ARDS outside ofclinical trialsunless they are indicated for another reason. Remarks: A systematic reviewofobservational studies ofcorticosteroidsadministered to patients with SARS reported no survival benefitand possible harms (avascular necrosis,psychosis, diabetes, and delayedviral clearance).19A systematic review of observational studies in influenza found a higher risk of mortality and secondary infections with corticosteroids; the evidence was judged as very low to low quality due to confounding by indication.

20A subsequent study that addressed this limitation by adjusting for time-varying confounders found no effect on mortality.

21Finally, a recent study of patients receiving corticosteroids for MERS used a similar statistical approach and found no effect of corticosteroids on mortality but delayed lower respiratory
Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance5tract (LRT)clearance of MERS-CoV.22Given lack of effectivenessand possible harm, routine corticosteroids should be avoided unless they are indicated for another reason. See section 6 for the use of corticosteroids in sepsis.Closely monitor patients with SARI for signs of clinical deterioration, such as rapidly progressive respiratory failureand sepsis, and apply supportive care interventions immediately. Remarks: Application of timely, effective,and safe supportive therapies is the cornerstone of therapy for patients that develop severe manifestations of nCoV. Understand the patient’s co-morbid condition(s) to tailor the management of critical illness and appreciate the prognosis. Communicate early with patient and family.Remarks: During intensive care management of SARI, determine which chronic therapies should be continued and which therapies should be stopped temporarily. Communicate proactively with patients and families and provide support and prognostic information. Understand the patient’s values and preferences regarding life-sustaining interventions.

4.Collection of specimens for laboratory diagnosis WHO guidance on specimen collection, processing, and laboratory testing, including related biosafety procedures,is available.23Collect blood cultures for bacteria that cause pneumonia and sepsis, ideally before antimicrobial therapy. DO NOT delay antimicrobial therapy to collect blood cultures.Collect specimens from BOTH the upper respiratory tract (URT; nasopharyngeal and oropharyngeal) ANDlower respiratory tract (LRT; expectorated sputum, endotracheal aspirate,or bronchoalveolar lavage)for nCoV testing by RT-PCR. Clinicians may elect to collect only LRT samples when these are readily available (for example, in mechanically ventilated patients). Serology for diagnostic purposes isrecommended only when RT-PCR is not available.23Remarks: Use appropriate PPE for specimen collection (droplet and contact precautions for URT specimens; airborne precautions for LRT specimens). When collecting URTsamples,use viral swabs (sterile Dacron or rayon, not cotton) and viral transport media. Do not sample the nostrils or tonsils. In a patient with suspected novel coronavirus, especially with pneumonia or severe illness, a single URT sample does not exclude the diagnosis, and additional URT and LRT samples are recommended.

23LRT (vs. URT) samplesare more likely to be positive and for a longer period.23Clinicians may elect to collect only LRT samples when these are readily available (for example, in mechanically ventilated patients). Sputum inductionshould be avoided due to increased risk of increasing aerosol transmission.Remarks: Dual infections with other respiratory viral infectionshave been found in SARS and MERS cases. At this stage we need detailed microbiologic studies in all suspected cases. Both URT and LRT specimens can tested for other respiratory viruses, such as influenza A and B(including zoonotic influenza A), respiratory syncytialvirus, parainfluenza viruses, rhinoviruses, adenoviruses, enteroviruses(e.g. EVD68), human metapneumovirus, and endemic human coronaviruses (i.e.HKU1, OC43, NL63, and 229E). LRT specimens can also be tested for bacterial pathogens, including Legionella pneumophila. In hospitalized patients with confirmed nCoV infection,repeat URT and LRT samples should be collected to demonstrate viral clearance.

Thefrequencyof specimencollectionwill dependonlocalcircumstances but should be atleastevery 2to4 days until there are two consecutive negative results (both URT and LRTsamples if both are collected) in a clinically recovered patientat least 24 hours apart.If local infection control practice requires two negative results before removal of droplet precautions, specimens may be collected as often as daily. 5.Management of hypoxemic respiratory failure and ARDSRecognize severe hypoxemic respiratory failure when a patient with respiratory distress is failing standard oxygen therapy.Remarks: Patients may continue to have increased work of breathing or hypoxemia even when oxygen is delivered via a face mask with reservoir bag (flow rates of 10-15 L/min, which is typically theminimumflow required to maintain bag inflation; FiO20.60-0.95).Hypoxemic respiratory failure in ARDS commonly results from intrapulmonary ventilation-perfusion mismatch or shunt andusually requires mechanical ventilation.High-flow nasal oxygen (HFNO)or non-invasive ventilation (NIV) should onlybe usedin selectedpatients with hypoxemic respiratory failure. The risk of treatment failure is high in patients with MERS treated with NIV, and patients treated with either HFNO or NIV should be closely monitored for clinical deterioration.Remark1: HFNOsystems can deliver 60 L/min of gas flowand FiO2up to 1.0; paediatric circuits generally only handle up to 15 L/min, and many children will require an adult circuit to deliver adequate flow.Compared to standard oxygen therapy, HFNO reduces the need for intubation.24Patients withhypercapnia(exacerbation of obstructive lung disease, cardiogenic pulmonary oedema), hemodynamic instability,multi-organ failure, or abnormal mental statusshould generally not receive HFNO, although emerging data suggest that HFNO may be safe in patients with mild-moderate and non-worsening hypercapnia.25Patients receiving HFNO should be in a monitored setting and cared for by experienced personnelcapable of endotracheal intubationin case the patient acutely deteriorates or does not improveafter a short trial (about 1 hr). Evidence-based guidelines on HFNO do not exist, and reports on HFNOin MERS patients are limited.26


Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance7only be offered in expert centres with a sufficient case volume to maintain expertiseand that can apply the IPC measures required for nCoV patients.48Avoid disconnecting the patient from the ventilator, which results in loss of PEEP and atelectasis. Use in-line catheters for airway suctioningand clamp endotracheal tube when disconnection isrequired (for example, transfer to a transport ventilator). 6.Management of septic shock Recognize septic shock in adults when infection is suspected or confirmed ANDvasopressors are needed to maintain mean arterial pressure (MAP)≥65 mmHg AND lactate is≥2 mmol/L, in absence of hypovolemia. Recognize septic shock in children with any hypotension (systolic blood pressure [SBP]<5thcentile or >2 SD below normal for age) or 2-3 of the following: altered mental state; tachycardia or bradycardia (HR <90 bpm or >160 bpm in infants and HR <70 bpm or >150 bpm in children); prolonged capillary refill (>2sec) or warm vasodilation with bounding pulses; tachypnea; mottled skin or petechial or purpuric rash; increased lactate; oliguria; hyperthermia or hypothermia.Remarks: In the absence of a lactate measurement, use MAP and clinical signs of perfusion to define shock. Standard care includes early recognitionand the following treatments within 1 hourof recognition:antimicrobial therapyand fluid loadingand vasopressors for hypotension.49Theuse of central venous and arterial catheters should be based on resource availability and individual patient needs.Detailed guidelines are available for the management of septic shock in adults17and children.2,3,12In resuscitation from septic shockin adults, give at least 30 ml/kg of isotonic crystalloid in adults in the first 3 hours. In resuscitation from septic shock in childrenin well-resourced settings, give 20 ml/kg as a rapid bolus and up to 40-60 ml/kg in the first 1 hr.Do not usehypotonic crystalloids,starches,or gelatins for resuscitation.Fluid resuscitation may lead to volume overload, including respiratory failure. If there is no response to fluid loading and signs of volume overload appear (for example,jugular venous distension, crackles on lung auscultation, pulmonary oedemaon imaging,or hepatomegaly in children),then reduce or discontinue fluid administration. This step is particularly important where mechanical ventilation is not available. Alternate fluid regimens are suggested when caring for children in resource-limited settings50Remarks: Crystalloids include normal saline and Ringer’s lactate. Determine need for additionalfluid boluses (250-1000 ml in adults or 10-20 ml/kg in children) based on clinical responseand improvement of perfusion targets. Perfusion targets include MAP (>65 mmHg or age-appropriate targets in children), urine output (>0.5 ml/kg/hr in adults, 1 ml/kg/hr in children), and improvement of skin mottling, capillary refill, level of consciousness, and lactate.Consider dynamic indices of volume responsiveness to guide volume administration beyond initial resuscitationbased on local resources and experience.17These indices include passive leg raises, fluid challengeswithserial stroke volume measurements, or variations in systolicpressure, pulse pressure, inferior vena cava size, or stroke volume in response tochanges inintrathoracic pressure duringmechanical ventilation.Starches are associated with an increased risk of death and acute kidney injury vs. crystalloids. The effects of gelatins are less clear, but they are more expensive than cyrstalloids. 51,52Hypotonic (vs. isotonic) solutions are less effective at increasing intravascular volume. Surviving Sepsis also suggestsalbumin forresuscitation when patients require substantial amounts of crystalloids, but this conditional recommendation is based on low-quality evidence.17Administer vasopressors when shock persists during or after fluid resuscitation. The initial blood pressure target is MAP ≥65 mmHg in adults and age-appropriate targets in children.If central venous catheters are not available, vasopressors can be given through a peripheral IV, butuse a large vein andclosely monitor for signs of extravasation and local tissue necrosis. If extravasation occurs, stop infusion.Vasopressors can also be administered through intraosseous needles.If signs of poor perfusion and cardiac dysfunction persist despite achieving MAP target with fluids and vasopressors, consider an inotropesuch as dobutamine.Remarks: Vasopressors (i.e. norepinephrine, epinephrine, vasopressin,and dopamine) are most safely given through a central venous catheter at a strictly controlled rate, but it is also possible to safely administer them via peripheral vein53and intraosseous needle. Monitor blood pressure frequentlyand titrate the vasopressor to the minimum dose necessary to maintain perfusionand prevent side effects. Norepinephrine is considered first-linein adult patients; epinephrine or vasopressin can be added to achieve the MAP target. Because of the risk of tachyarrhythmia, reservedopamine forselected patients with low risk of tachyarrhythmia or those with bradycardia. In children with cold shock (more common), epinephrine is considered first-line,while norepinephrine is used in patients with warm shock (less common).No RCTshave compared dobutamine to placebo for clinical outcomes.17

Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance87. Prevention of complicationsImplement the following interventions(Table3)to prevent complications associated with critical illness.These interventions are based on Surviving Sepsis17or other guidelines,54-57and are generally limited to feasible recommendations based on high quality evidence.Table

3. Prevention of complicationsAnticipated OutcomeInterventionsReduce days of invasivemechanical ventilation•Use weaning protocols that include daily assessment for readiness to breathe spontaneously. Minimize continuous or intermittent sedation, targeting specific titration endpoints(light sedation unless contraindicated) or with daily interruption of continuous sedative infusionsReduce incidence of ventilator-associated pneumonia• Oral intubation is preferable to nasal intubationin adolescents and adults•Keep patient in semi-recumbent position(head of bed elevation 30-45º)• Use a closedsuctioning system; periodically drain and discard condensate in tubing•Use a new ventilator circuit for each patient; once patient is ventilated, change circuit if it is soiled or damaged but not routinely• Change heat moisture exchanger when it malfunctions, when soiled,or every 5–7 daysReduce incidence of venous thromboembolism•Use pharmacological prophylaxis (low molecular-weight heparin[preferred if available]or heparin 5000 units subcutaneously twice daily) in adolescents and adults without contraindications. For those with contraindications, use mechanical prophylaxis (intermittent pneumatic compression devices).Reduce incidence of catheter-related bloodstream infection•Use a checklist with completion verified by a real-time observer as reminder of each step needed for sterile insertion and as a daily reminder to remove catheter if no longer neededReduce incidence of pressure ulcers•Turn patient every two hoursReduce incidence of stress ulcers and gastrointestinal bleeding• Give early enteral nutrition (within 24–48 hours ofadmission)• Administer histamine-2 receptor blockers or proton-pump inhibitorsin patients with risk factors for GI bleeding. Risk factors for gastrointestinal bleeding include mechanical ventilation for ≥48 hours,coagulopathy, renal replacement therapy, liver disease, multiple comorbidities,and higher organ failure score Reduce incidence of ICU-related weakness• Actively mobilize the patient early in the course of illness when safe to do so8.Specific anti-Novel-CoV treatmentsand clinical researchThere is no current evidence from RCTsto recommend any specific anti-nCoV treatmentfor patients with suspected or confirmed nCoV.Unlicensedtreatmentsshould be administeredonly in the context of ethically-approved clinical trials or the Monitored Emergency Use of Unregistered Interventions Framework (MEURI), withstrict monitoring. https://www.who.int/ethics/publications/infectious-disease-outbreaks/en/Clinical characterization protocols are available, including the SPRINT-SARI https://isaric.tghn.org/sprint-sari/and WHO-ISARIC forms available at https://isaric.tghn.org/protocols/severe-acute-respiratory-infection-data-tools/. Contact oubreak@who.intfor additional questions.9.Special considerations for pregnant patientsPregnant women with suspected or confirmed nCoVshould be treated with supportive therapies as described above,taking into account thephysiologic adaptations ofpregnancy. The use of investigational therapeutic agents outside of a research study should be guided by individual risk-benefit analysis based on potential benefit for mother and safety to fetus, with consultation from anobstetric specialist and ethics committee. Emergency delivery and pregnancy termination decisions are challenging and based on many factors: gestational age, maternal condition, and fetal stability. Consultations with obstetric, neonatal,and intensive care specialists(depending on the condition of the mother) are essential

Source (PDF):   https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf?sfvrsn=bc7da517_2&download=true

https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-(2019-ncov)-in-suspected-human-cases

First cousin! Alike in so many ways!

Other things to consider if the estimates are accurate with this nCoV, and it does in fact spread globally:

Coinfections are common with coronaviruses and the flu. What happens during flu season and coinfections with this one?

Is it here to stay forever like other coronaviruses?

Are animals also going to be transmitting it, and which ones? pets?


Would like to take China's word for it that they can contain it and the situation in controllable, but I guess we will know that in the coming days.   

At the moment, 1700 are estimated to have it and 2 have died. That is not a high fatality rate; 2/1700 is just over 0.1% (0.1176470588235294%).

Of course, more may die yet. We do not know the R0, method of transmission, incubation period - OR EVEN THE FULL SET OF SYMPTOMS. We don't know even if it exhibits H2H transmission, let alone how long it remains contagious for - assuming H2H.

So, ignore my figures, only God knows - and he/she is as silent as the Chinese!

[In my opinion, this is just more proof (As if we needed it!) that China intends to whitewash everything.]


World News

January 19, 2020 / 12:07 PM / Updated 2 hours ago

China's national health commission says viral outbreak is 'controllable'

1 Min Read

BEIJING (Reuters) - China’s National Health Commission on Sunday said the outbreak of a new strain of coronavirus is controllable, in the first statement from the body since the outbreak was reported in late December.

The transmission path of the new virus hasn’t been mapped completely and the source of the virus is unknown, it said, adding that it will step up monitoring during Lunar new year, when much of China’s population will travel to celebrate the holiday next week.


Source:   https://www.reuters.com/article/us-china-health-pneumonia-commission/chinas-national-health-commission-says-viral-outbreak-is-controllable-idUSKBN1ZI0E8

SCREENINGS

UK - None yet https://www.theguardian.com/world/2020/jan/18/no-airport-screening-for-new-sars-like-virus-yet-china

Canada - Three airports https://www.thestar.com/news/canada/2020/01/17/three-canadian-airports-to-screen-air-travellers-from-central-china-amid-outbreak.html

TESTS

18 January 2020 Last Updated at 3:06 pm | Source: IANS
Researchers develop 1st diagnostic test for new Chinese virus

London, Jan 18 (IANS) Researchers have developed the first diagnostic test to detect the novel Chinese coronavirus, which is likely to spread globally.

The assay protocol has now been published by the World Health Organisation (WHO) as a guideline for diagnostic detection. The new method also enables suspected cases to be tested quickly.

The virus, which first emerged in Wuhan, China, and can cause severe pneumonia, can now be detected in the laboratory.

"Now that this diagnostic test is widely available, I expect that it won''t be long before we are able to reliably diagnose suspected cases," said study researcher Christian Drosten, Director of the Institute of Virology on Campus Charité Mitte in Germany.

"This will also help scientists understand whether the virus is capable of spreading from human to human, this is an important step in our fight against this new virus," Drosten added.

Developed by a researchers from German Centre for Infection Research, the world''s first diagnostic test for the coronavirus has now been made publicly available.

Following its online publication by the WHO, the test protocol will now serve as a guideline for laboratories. An international consortium is currently conducting a joint evaluation study.

The Union Ministry of Health and Family Welfare on Friday issued an advisory for travellers visiting China in the wake of the Novel Coronavirus outbreak in the neighbouring country.

As on January 11, 41 novel coronavirus confirmed infection case have been reported from China, of which one has died. One travel related case each has been reported in Thailand and Japan.

The clinical signs and symptoms are mainly fever with a few patients having difficulty in breathing. The mode of transmission is unclear as of now. However, so far there is little evidence of significant human-to-human transmission.

--IANS

Source:   https://www.outlookindia.com/newsscroll/irregularities-in-bsf-recruitment-exam-cbi-carries-out-searches-in-delhincr/1711592?scroll

China reports 17 new cases of mystery virus in Wuhan


Of the 17 new cases in the central city of Wuhan - believed to be the epicentre of the outbreak - three were described as "severe" with two of those patients too critical to be moved, authorities said.


https://www.aljazeera.com/news/2020/01/china-reports-17-cases-mystery-virus-wuhan-200119040403271.html

Anyone any ideas how long incubation time ?

How long after infection are you contagious?

How long before you start to show symptoms ?

Surely they know the answers ?

Based on the original pandemic model and original definition, we're at defcon 3.

That is only the top of the bell-curve of prediction. 6σ in mathematical modeling (or the very much less likely option - but still just possible - in normal speak) could be far higher.

There is a glimmer of good news: so far only very ill people (sick before infection) have died, so this could be less serious than a dose of the flu. It will be a while before the whole picture emerges* however, so we will have to just wait and see.

It's too early to panic, but a close watch is recommended




*A bloody long time if China has its way.

An estimated 1700 infected? Well if that were true, then the next pandemic has most likely begun.   China is the master of cover-ups. And they are not making the WHO look good in all of this.    

JFK airport is also now screening passengers. hmmmm

Carbon - multi organ failure can also result from sepsis following an infection like pneumonia.

Jac here.

Lung condition worse, coughing and not able to speak at all.

Talking to 15 people on wechat who also have it. Friends not from chan like this. 50 seems still low.

The organ damage is scary.

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China
Coronavirus: more cases and second death reported in China
Experts fear numbers affected may be higher than first thought as US begins screening passengers arriving from Wuhan

Kate Hodal , Sarah Boseley, Calla Wahlquist and agencies
@katehodal
Fri 17 Jan 2020 21.58 EST
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More cases of coronavirus have been confirmed in the Chinese city of Wuhan and a second person has died, according to local authorities. It comes as disease-modelling experts warned that far more people may have been affected by the previously unknown virus than thought.

The Wuhan municipal health commission said in a statement that four patients diagnosed with pneumonia on Thursday were in a stable condition, taking the total number of cases to nearly 50. The statement released in the early hours on Saturday is the first confirmation of new cases by the commission in nearly a week.

On Friday, the commission announced the second death from the virus. A 69-year-old man was admitted to hospital with abnormal renal function and severe damage to multiple organs, and died on 15 January, the commission said.

Preliminary lab tests cited by state media showed the pathogen could be from a new type of coronavirus, a large family of viruses that can cause infections ranging from the common cold to deadly severe acute respiratory syndrome (Sars).

Case of mystery Sars-like illness found outside China for first time
World Health Organization disease-modelling experts based at Imperial College, London, said that far more people may have been infected and they warned human-to-human transmission could not be ruled out.

Prof Neil Ferguson and colleagues, from the MRC Centre for Global Infectious Disease Analysis at Imperial, calculated that the number of cases in Wuhan may be more than 1,700. “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,” they said in a report.

The report said all hospitalised cases of pneumonia or severe respiratory disease in the Wuhan area and other well-connected Chinese cities should be investigated.

Japan confirms first case of new China coronavirus strain
They cautioned that because of the unknown factors in their estimates, the case numbers could be anywhere from 190 to over 4,000. But in a tweet, they said that “the magnitude of these numbers suggests that substantial human-to-human transmission cannot be ruled out. Heightened surveillance, prompt information sharing and enhanced preparedness are recommended.”

Their calculation is based on the two people in Thailand and one in Japan who were diagnosed with the virus. Based on flight and population data, said Ferguson, “there is only a 1 in 574 chance that a person infected in Wuhan would travel overseas before they sought medical care. This implies there might have been over 1,700 (3 x 574) cases in Wuhan so far.”

US authorities announced they would begin screening passengers arriving from Wuhan on direct or connecting flights at three airports: San Francisco, New York’s JFK and Los Angeles. Authorities in Hong Kong, Thailand, Malaysia, Singapore and South Korea, Indonesia and the Philippines have all stepped up screening.

In Australia, the New South Wales and Victorian governments both issued alerts to health professionals about the virus, but there was no specific screening for the virus or change to travel advice.

Japan and Thailand both reported new cases of the mystery strain of coronavirus virus this week and experts say it might spread further as a result of the Chinese lunar new year holiday starting next week, which sees millions of people travel across the country.

On Thursday Japan confirmed a man in his 30s had been infected with the virus, and a Chinese woman was quarantined in Thailand. The World Health Organization (WHO) has warned a wider outbreak is possible.

On Friday, Thailand confirmed a second case. A 74-year-old Chinese woman from Wuhan had been quarantined since her arrival on Monday and was found to be infected with the newly identified coronavirus, said Sukhum Karnchanapimai, permanent secretary of the Public Health Ministry.

Sukhum also urged Thais to remain calm, saying that there was no outbreak in the country.

The Wuhan health commission said late on Thursday that 12 people had recovered and been discharged from hospital but five others were in serious condition. It also said no human-to-human transmission had been confirmed but the possibility “cannot be excluded”.

China pneumonia outbreak may be caused by Sars-type virus: WHO
Another WHO doctor said it would not be surprising if there was “some limited human-to-human transmission, especially among families who have close contact with one another”.

“It is not surprising that we are starting to hear of more cases in other countries and a range of severity from asymptomatic, to mild and severe illness,” said infectious disease expert and director of Wellcome Dr Jeremy Farrar.

“It is possible that the often mild symptoms from this coronavirus may be masking the true numbers of people who have been infected, or the extent of person-to-person transmission. It is probable that we are looking at patients being affected over a number of days from multiple animal sources and with some degree of human-to-human transmission.”

The first confirmed fatality from the virus was a 61-year-old man in Wuhan who died of pneumonia after testing positive.

Memories remain fresh in Asia of a 2002-03 outbreak of Sars, which emerged in China and killed nearly 800 people around the world.

With Reuters and Agence France-Press
© 2020 Guardian News & Media Limited or its affiliated companies. All rights reserved.

From the link Carbon posted.

BBC wrote: While the outbreak is centred on Wuhan, there have been two cases in Thailand and one in Japan. "That caused me to worry," said Prof Ferguson. He added: "For Wuhan to have exported three cases to other countries would imply there would have to be many more cases than have been reported." It is impossible to get the precise number, but outbreak modelling, which is based on the virus, the local population and flight data, can give an idea. Wuhan International Airport serves a population of 19 million people, but only 3,400 a day travel internationally. The detailed calculations, which have been posted online ahead of publication in a scientific journal, came up with a figure of 1,700 cases.

The estimate of 1 700 cases is less than a previous reported estimate of over 4 000 cases, but in anyways both are vastly more than being reported.

Oh, Yeah....

Welcome aboard jac_wong ! VERY, VERY PLEASED TO HAVE YOU!

[This is Carbon's article - minus the attendant pictures and graphics (Sorry but I can't upload them. If you want them follow Carbon's link.). As you can tell from all the yellow, it contains a wealth of new information (THANK YOU, THANK YOU, CARBON!). The only bit that is not news is that the information from China is patchy at best; which should have been expected on China's past behaviour.]

Scientists fear up to 4,500 Chinese patients may have caught the new coronavirus as health chiefs in Wuhan confirm four more cases

    Health officials confirmed four new cases today, taking the total to 48
    Imperial College London researchers say the true toll is likely to be much higher
    They estimated there have been 1,700 cases of the coronavirus, and up to 4,000
This was based on the fact three cases have been recorded outside of China

By Vanessa Chalmers Health Reporter For Mailonline

Published: 17:11, 17 January 2020 | Updated: 18:49, 17 January 2020

Up to 4,500 patients in China may have caught the same strain of coronavirus that has killed two people, scientists fear.

Health officials in Wuhan – the city at the heart of the outbreak which started in December – confirmed four new cases today, taking the total to 48.

But Imperial College London researchers say this may be the 'tip of the iceberg' after analysing flights out of the city.

Experts say the fact three Chinese tourists have tested positive for the virus outside Wuhan indicates the disease toll may be higher than reported.

They estimated there has been 1,700 cases of the coronavirus – which has never before seen in humans. But they added it could have passed 4,000.

Thailand today announced a second confirmed case of the coronavirus in a woman who had travelled from Wuhan. Japan reported its first case on Thursday.

Two men in their sixties in Wuhan have already died in the outbreak, which has left health chiefs scrambling to contain the virus amid fears it will spread.

Up to 4,500 patients in China may have caught the same strain of coronavirus that has killed two people, scientists fear. Health officials in Wuhan – the city at the heart of the outbreak – confirmed four new cases today, taking the total to 48

People carrying the novel coronavirus may only have mild symptoms and assume they have a common cold, British scientists warned.

Some 1.4billion Chinese citizens will be travelling abroad during Lunar New Year.

Professor Neil Ferguson, who led the research, told MailOnline: 'Our main estimate is 1,700, but the range means we are 95 per cent sure the real number relies within 190 and over 4,000.

'I became more concerned when cases were detected in places other than China. Generally when we see cases overseas it implies there are more cases.

'There have been three cases detected overseas. There is about one in 600 chance each case would happen to be getting on a plane and going somewhere.

'If that’s the case, it would imply there is 1,700 cases in Wuhan itself. Which is a lot more that has been so far confirmed. There have to be a lot more cases.'

A total of 48 people who have pneumonia-like symptoms have now tested positive for the coronavirus, Wuhan Municipal Health Commission has said.

Four new cases were revealed today, all of whom were male and fell ill between January 5 and 8, and hospitalised between January 8 and 13. They are now in a stable condition at Jinyintan Hospital.

'We don’t know if this is the tip of the iceberg. We need more information, we only have scant details,' Professor Ferguson said.

He investigated the spate of cases in Wuhan city with colleagues at MRC Centre for Global Infectious Disease Analysis and Modelling, a branch of Imperial College London which provides advice for new diseases.

Using flight data, they reported that 3,300 people in Wuhan fly internationally per day, and Wuhan International Airport has a catchment population of 19million individuals.

Based on these figures, and the time it takes for symptoms to onset, they calculated that there is only a one in 574 chance that a person infected in Wuhan would travel overseas before they sought medical care in their holiday destination.

Using the number of cases detected outside China, researchers estimated how many people within Wuhan city may carry the virus.

Three travellers from Wuhan have tested positive for the coronavirus outside China, which implies there might have been over 1,700 cases in Wuhan so far.

But researchers add the estimated figure could be anywhere from 190 cases to 4,471 based on different scenarios.

The report concludes: '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.'

The new coronavirus, which is yet to be named, causes cold-like symptoms including a runny nose, headache, cough, sore throat and a fever.

Professor Ferguson said: 'It's winter, it’s an enormous city with lots of people with cold and flu. People would realise they were feeling ill, but not that they have the coronavirus.

'We want to start recommendation from this that surveillance needs to be enhanced across the city, looking for people that are reporting even flu-like symptoms.

'They need to start looking generally in hospitals for people with respiratory symptoms – that might be happening already but we don’t know.'

Forty-five cases have been contained in the Chinese city of Wuhan since December. The majority of patients have been traced to the Huanan Wholesale Seafood Market

Some 1.4billion Chinese citizens will be travelling abroad during Lunar New Year. Airports have stepped up surveillance, including in Japan

The second case in Thailand was reported on January 17. A 74-year-old tourist was intercepted at Thailand's biggest airport Suvarnabhumi. Pictured, Bangkok airport staff performing thermal scans on a traveller

GERMAN RESEARCHERS DEVELOP FIRST TEST FOR NEW VIRUS IN CHINA

Scientists scrambling to contain the outbreak of the mystery virus have developed the first diagnostic test for doctors.

Virologists in Germany claim the test will allow laboratories to diagnose the 'novel' coronavirus in a 'very short period of time'.

World Health Organization chiefs will share details of the test with countries around the world, amid fears cases may crop up in other nations.

Laboratories can order a molecule from the team AT Berlin's Charite hospital to compare patient samples with that of an infected adult.

Following its online publication by the WHO, the test protocol will now serve as a guideline for laboratories.

Dr Christian Drosten, a virologist at the institute, said: 'We have just started receiving orders and are now starting to post the molecule.'

So far, doctors have only been able to perform a general virus test and then had to sequence and interpret the genome, which takes time.

The report added that if cases are this high, substantial human to human transmission can't be ruled out.

It flies in the face of statements from the World Health Organization (WHO), which state there is 'limited' to zero evidence that humans can spread the virus.

Investigations have focused on animals as the source because the majority of the infected patients in Wuhan have been traced to the Huanan Wholesale Seafood Market, which has been shut down since January 1.

The WHO has said 'much remains to be understood' about the coronavirus, which has been described as 'novel'.   

Although the genetic sequence of the strain has now been released, scientists are still questioning how deadly it is, and whether it can be spread between humans.

Professor Ferguson said information like this tends to come to light around one month after the outbreak begins, but relies heavily on co-operation from China.

He said: 'We need more systemic data from China. Their only really two weeks from discovering this and I suspect they are focusing on collecting data.

'We really don’t know the spectrum for the disease severity is.'

Fears of global spread have increased after Thailand announced it has detected a second case of the virus in a 74-year-old woman.
Local authorities have confirmed that a second person in Wuhan has died of a pneumonia-like virus since the outbreak started in December.

Authorities said she had been quarantined since her arrival at Thailand's biggest airport Suvarnabhumi on January 13. She lived in Wuhan.

She is being treated in the same hospital, east of Bangkok, as a Chinese woman who was diagnosed with the virus after entering the country last week.

The 61-year-old, also from Wuhan, was the first case of the coronavirus to be detected outside of China on January 8.

Yesterday, Japan's health ministry announced its first case, a man who had been hospitalised with pneumonia symptoms after travelling to Wuhan earlier this month.

Though the known cases of the pneumonia outbreak so far involve only individuals who have travelled to or live in Wuhan, the WHO has warned that a wider outbreak is possible.

It comes just days before Lunar New Year holidays next week, when nearly a million Chinese visitors are expected to arrive in Thailand.

Some 1.4billion Chinese citizens will be travelling abroad, leaving airports scrambling to implement surveillance in Singapore, Hong Kong, Indonesia, Thailand and Japan.

The first patient diagnosed with the novel strain, a 61-year-old man, died on January 9. The second death, a man known only as Xiong, died on January 15.

Both suffered other health problems, the former from abdominal tumours and chronic liver disease and the latter of severe cardiomyopathy – a heart condition, abnormal kidney function, and seriously damaged organs.

But it is not clear if these were complications of the virus or underlying conditions.


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

THE NEW CORONAVIRUS IN CHINA TIMELINE

December 31 2019: The WHO China Country Office was informed of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province of China. Around 44 suspected cases were reported in the month of December.

January 1 2020: A seafood market was closed for environmental sanitation and disinfection after being closely linked with the patients.

January 5 2020: Doctors ruled out severe acute respiratory syndrome (SARS) as being the cause of the virus, as well as bird flu, Middle East respiratory syndrome and adenovirus. Meanwhile, Hong Kong reported

January 9 2020: A preliminary investigation identified the respiratory disease as a new type of coronavirus, Chinese state media reported.

Officials at Wuhan Municipal Health Commission reported the outbreak's first death on January 9, a 61-year-old man.

January 13 2020: A Chinese woman in Thailand was the first confirmed case of the mystery virus outside of China. The 61-year-old was quarantined on January 8, but has since returned home in a stable condition after having treatment, the Thai Health Ministry said.

January 14 2020: The WHO told hospitals around the globe to prepare, in the 'possible' event of the infection spreading.

It said there is some 'limited' human-to-human transmission of the virus. Two days previously, the UN agency said there was 'no clear evidence of human to human transmission'.

January 16 2020: A man in Tokyo is confirmed to have tested positive for the disease after travelling to the Chinese city of Wuhan.

A second death, a 69-year-old man, was reported by officials at Wuhan Municipal Health Commission. He died in the early hours of January 15 at Jinyintan Hospital in Wuhan city having first been admitted to hospital on December 31.

January 17 2020: Thailand announces it has detected a second case. The 74-year-old woman had been quarantined since her arrival on Monday. She lived in Wuhan.

https://www.dailymail.co.uk/health/article-7900047/Scientists-fear-4-500-Chinese-patients-caught-coronavirus.html

Bear in mind that news is from the daily mail?

The numbers might be out, DM is not the best newspaper,

Hi Jac_Wong,

your English is good reminds me of a Russia who is immune....

Technophobe wrote: Hong Kong authorities on Tuesday said several dozen people had been hospitalised with fever or respiratory symptoms after travelling to Wuhan, but no cases of the new virus have so far been confirmed.

Well that doesn't sound good.

'Sars-family' virus claims second victim in China

4 hours ago

A second person has died in China from a new, pneumonia-like virus, local officials have announced.

They say the death was recorded in the eastern city of Wuhan, where the outbreak began in December.

Meanwhile, Japan confirmed its first case of the virus - the second country outside China after Thailand to do so.

The disease has been identified as a coronavirus, which can cause illnesses ranging from common colds to the potentially deadly Sars.

The new virus has infected dozens of people, and many cases have been linked to a fish market in Wuhan. The market was closed on 1 January.

Sars - severe acute respiratory syndrome - killed more than 700 people around the world during an outbreak in 2002-03, after originating in China.

In total, it infected more than 8,000 people in 26 countries. China has been free of Sars since May 2004.

Unconfirmed reports on social media say the latest victim was 69 years old.

What about the Japanese case?

The Japanese authorities say the man in his 30s recently travelled to Wuhan.

They say he lives near Tokyo, without identifying him. Local media say he is a Chinese national.

It is not yet clear whether the virus can be transmitted between humans.

Earlier this week, a woman in Thailand became the first person outside China diagnosed with the virus.

The woman - who has not been named - was quarantined after landing in Bangkok from Wuhan.


Source:   https://www.bbc.co.uk/news/world-asia-china-51141007