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2019–20 Wuhan coronavirus outbreak

MysteryN 2020. 2. 1. 06:16

2019–20 Wuhan coronavirus outbreak

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This article documents a current event. Information may change rapidly as the event progresses, and initial news reports may be unreliable. The latest updates to this article may not reflect the most current information. Please feel free to improve this article (but note that updates without valid and reliable references will be removed) or discuss changes on the talk page. (January 2020) (Learn how and when to remove this template message)

2019–20 Wuhan coronavirus outbreakDateLocationCasualties

Map of the 2019–20 Wuhan coronavirus outbreak as of 31 January 2020

  Region of origin (mainland China)

  Confirmed cases reported

  Suspected cases reported
1 December 2019–ongoing[1][2]
(1 month, 4 weeks and 2 days)
First identified in
Wuhan, Hubei, China

Confirmed cases: 9,948
Deaths: 213
Affected territories: 26

As of 31 January 2020

 

Animation showing the spread of confirmed 2019-nCoV cases since 25 January

A new coronavirus, designated 2019-nCoV,[3] was identified in late 2019 in Wuhan, the capital of China's Hubei province, after people developed pneumonia without a clear cause and for which existing vaccines or treatments were not effective.[4] The virus can spread between people, and its transmission rate (rate of infection)[5] appeared to increase in mid-January 2020.[6] Several countries across Europe, North America and the Asia-Pacific have reported cases.[7] The time from exposure to the development of symptoms is between two and 14 days and there is tentative evidence that it may be contagious before the onset of symptoms.[8][9][10] Symptoms include fever, coughing, and breathing difficulties, and death may result.[9]

As of 31 January 2020, approximately 9,948 cases have been confirmed, including in every province-level division of China.[11][12][13][14] The first confirmed death from the coronavirus infection occurred on 9 January and since then 213 deaths have been confirmed.[15][16][17][18] Studies estimate that a larger number of people may have been infected, but not detected.[19][20] Of the first 41 people confirmed to have been infected, two-thirds were found to have a link with the Huanan Seafood Wholesale Market, which also sold live animals.[21][22][23][24] The first local spread of the virus outside China occurred in Vietnam from a father to his son,[25] whereas the first local spread not involving family occurred in Germany, on 22 January when a German man contracted the disease from a Chinese business visitor at a meeting in the German state of Bavaria.[26]

In response, cities with a combined population over 57 million people including Wuhan and 15 cities in the surrounding Hubei province were placed on full or partial lockdown, involving the termination of all urban public transport and outward transport by train, air and long-distance buses.[27][28][29][30] Many New Year events and tourist attractions have been closed over fear of transmission, including the Forbidden City in Beijing, traditional temple fairs, and other celebratory gatherings.[31] Hong Kong also raised its infectious disease response level to the highest level and declared an emergency, closed its schools until mid-February and cancelled its New Year celebrations.[32][33]

A number of countries have issued warnings against travel to Wuhan and Hubei province.[34] Travellers who have visited Mainland China have been asked to monitor their health for at least two weeks and contact their healthcare provider to report any symptoms of the virus.[35] Anyone who suspects that they are carrying the virus is advised to wear a protective mask and seek medical advice by calling a doctor rather than directly visiting a clinic in person.[36] Some hotels have been providing refunds and no-fee cancellations for reservations in China or by people from China.[37] Airports and train stations have implemented temperature checks, health declarations and information signage in an attempt to identify carriers of the virus.[38]

Chinese scientists were able to rapidly isolate and determine the genetic sequence of the virus which they made available such that other could independently develop PCR tests to detect the disease.[39][40][41][42] 2019-nCoV's genome sequence has been reported to be 75- to 80-percent identical to SARS-CoV, and more than 85-percent similar to several bat coronaviruses.[43][44] Whether this virus is of the same lethality as SARS is unclear.[39][40][41][42]

On 30 January, the outbreak was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO), the sixth time that the measure has been invoked since the H1N1 pandemic in 2009.[45][46][47][48]

Contents

Background

Wuhan is the capital of Hubei province and is the seventh-largest city in China, with a population of more than 11 million people. It has been a major transportation hub of the country throughout the ages, long known as the "Nine Provinces' Thoroughfare" (九省通衢),[49] and the Wuhan Railway Hub is one of the four most important railway hubs in China. It is approximately 1,100 km (700 mi) south of Beijing,[50] 800 km (500 mi) west of Shanghai, and 970 km (600 mi) north of Hong Kong.[51] Direct flights from Wuhan also connect it to other major international cities in Europe and North America.[52]

In Wuhan, during December 2019, an inaugural cluster of cases displaying the symptoms of a "pneumonia of unknown cause" was linked to Huanan Seafood Wholesale Market, which had a thousand stalls selling fish, chickens, pheasants, bats, marmots, venomous snakes, spotted deer and the organs of rabbits and other wild animals (ye wei, bushmeat). The immediate hypothesis was that this was a novel coronavirus from an animal source (a zoonosis).[40][53][54][55]

Coronaviruses mainly circulate among animals but have been known to evolve and infect humans as in the cases of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) together with four further coronaviruses that cause mild respiratory symptoms similar to the common cold. All coronaviruses known to infect humans have been shown to spread from human to human.[56][57]

Epidemiology

According to Daniel R. Lucey at Georgetown University, the first human infections would have occurred in November 2019 and maybe earlier.[58] Following a publication in The Lancet on 24 January 2020, of the first 41 admissions with laboratory confirmed 2019-nCoV, where the earliest date for first symptoms was reported as 1 December 2019, in a person who did not have any exposure to the market or to the remaining affected 40 people, and as the number of secondary and tertiary cases have increased, the significance of the market lessened.[59][21] The first 59 suspected cases at the end of December 2019 and early January 2020 were admitted to Jinyintan Hospital, which was specially designated to isolate them. 41 of the 59 were confirmed with the 2019-nCoV infection. Of these 41 cases, there was one group of family members, 30 (73%) were men and the average age was 49 years. Almost a third (32%) had an underlying medical condition including eight with diabetes, six with high blood pressure and six with heart disease. Two-thirds had a history of exposure to the Huanan Seafood Wholesale Market. The most frequently reported symptoms were 40 (98%) with fever, 31 (76%) with cough, and 18 (44%) with muscle aches and tiredness. Less frequent symptoms included coughing sputum or blood, headache and diarrhoea. Around half of the cluster had shortness of breath and 13 were admitted to intensive care. CT scans of all 41 people revealed pneumonia. Complications included 12 with acute respiratory distress syndrome, five with acute cardiac injury and four with secondary infection.[21]

Confirmed cases in Mainland China according to theNational Health Commission daily reports[60] (

)

2020-01-16

 

 45
2020-01-17

 

 62
2020-01-18

 

 121
2020-01-19

 

 198
2020-01-20

 

 291
2020-01-21

 

 440
2020-01-22

 

 571
2020-01-23

 

 830
2020-01-24

 

 1,287
2020-01-25

 

 1,975
2020-01-26

 

 2,744
2020-01-27

 

 4,515
2020-01-28

 

 5,974
2020-01-29

 

 7,711
2020-01-30

 

 9,692

On 17 January, an Imperial College group in the United Kingdom published a report that there had been 1,723 cases (95% confidence interval, 427–4,471) with onset of symptoms by 12 January. This was based on the pattern of the initial spread to Thailand and Japan. They also concluded that "self-sustaining human-to-human transmission should not be ruled out",[61][62] which has since been confirmed as happening. As further cases came to light, they later recalculated that "4,000 cases of 2019-nCoV in Wuhan City had onset of symptoms by 18 January 2020".[63][19] A Hong Kong University group has reached a similar conclusion as the earlier study, with additional detail on transport within China.[20]

On 20 January, China reported a sharp rise in cases with nearly 140 new patients, including two people in Beijing and one in Shenzhen.[64] On 25 January, the number of laboratory-confirmed cases stood at 2,062, including 2,016 in Mainland China, seven in Thailand, six in Hong Kong, five in Macau, five in Australia, four in Malaysia, four in Singapore, three in France, three in Japan, three in South Korea, three in Taiwan, three in the United States, two in Vietnam, one in Nepal, and one in Sweden.[65][66][67]

Super-spreaders were suspected multiple times by different experts and media. A widely believed super-spreader patient was reported to have infected 14 different members of medical staff. On 25 January, Gao Fu, the head of Chinese Center for Disease Control and Prevention denied such claims and "dismissed a media report" claiming this, according to an announcement made to the official Xinhua News Agency.[68] Earlier the same day, however, China Newsweek (operated by another official news agency, China News Service), citing an expert from Peking University, claimed that the aforementioned patient could be considered a super-spreader already, and criticised the hospitals involved for not having properly protected the staff who came in contact with the patient. China Newsweek also criticised the government's censorship, saying all doctors and nurses, except those in the fever clinic, have "basically nothing but a mask" to protect themselves.[69]

Areas affected

Main articles: Timeline of the 2019–20 Wuhan coronavirus outbreak and 2019–20 Wuhan coronavirus outbreak by country and territory

2019-nCoV Wuhan coronavirus outbreak data by territoryCountry/RegionConfirmedcasesDeathsReferences26 territories9,936213

 China (mainland) 9,781 213 [70][71][72][73][74]
 Thailand 19 0 [75][76]
 Japan 17[a] 0 [77][78][79]
 Singapore 16 0 [80][81][82]
 Hong Kong 13 0 [83][84]
 South Korea 11 0 [85][86][87]
 Taiwan 10 0 [88]
 Australia 9 0 [89][90]
 Malaysia 8 0 [91]
 Macau 7 0 [92][93]
 France 6 0 [94][95][96]
 Germany 7 0 [97][98][99]
 United States 6 0 [100][101]
 Vietnam 5 0 [102][103]
 Canada 4 0 [104][105][106][107]
 United Arab Emirates 4 0 [108][109]
 Italy 2 0 [110][111]
 Russia 2 0 [112][113]
 United Kingdom 2 0 [114]
 Cambodia 1 0 [115]
 Finland 1 0 [116][117]
 India 1 0 [118][119]
   Nepal 1 0 [120][121]
 Philippines 1 0 [122][123]
 Sri Lanka 1 0 [124]
 Sweden 1 0 [125][126]
As of 31 January 2020

The virus was first detected in Wuhan city, Central China, in December 2019. It is believed to have originated from wild animals, passing to humans due to the wildlife trade and wet markets. The virus spread to other Chinese provinces in early and mid-January 2020, helped by the Chinese new year migration. Cases started to be detected in other countries, carried by international travellers, typically to major trade partners: Thailand (13 January); Japan (15 January); South Korea (20 January); Taiwan and the United States (21 January); Hong Kong and Macau (22 January); Singapore (23 January); France, Nepal and Vietnam (24 January); Australia and Malaysia (25 January); Canada (26 January); Cambodia (27 January); Germany (28 January); Finland, Sri Lanka and the United Arab Emirates (29 January); India, Italy and Philippines (30 January); the United Kingdom, Russia and Sweden. (31 January).[127][65] As of 29 January, more than 9,800 cases have been formally detected worldwide, most in China proper.[127] 213 deaths have been attributed to the virus, all in China proper.[127] Estimative models suggest the real figure to be around 25,000~35,000 cases. Local human-to-human contamination has been confirmed in Vietnam, Japan, and Germany, but no active center of propagation have been confirmed outside China so far. Since around 23 January, an important effort, within China and abroad, is being led by the WHO and local governments to alert the population and set up measures preventing new propagation of the virus. On 30 January, citing 7,711 cases essentially in China and 83 hundred abroad across 18 countries on 29 January, the World Health Organization declares the novel coronavirus outbreak to be a Public Health Emergency of International Concern.[128]

 

  • Map of the 2019–20 Wuhan coronavirus outbreak as of 31 January 2020

      Region of origin (mainland China)

      Confirmed cases reported

      Suspected cases reported

Estimates

Based on cases reported and assuming a 10-day delay between infection and detection, researchers at Northeastern University and Imperial College London estimated that the number of actual infections may be 10 times higher than those confirmed at the time of reporting. Imperial College estimated 4,000 cases with 440 confirmed by 21 January 2020, Northeastern University estimated 21,300 infections by 26 January, increasing to 26,200 infections by 27 January (with a confidence of 95% within the interval 19,200-34,800).[129][130][131] On January 31, 2020 an article published in Lancet estimated that 75,815 individuals have been infected in Wuhan as of Jan 25, 2020. [132]

There are concerns on whether adequate medical personnel and equipment are available in regions affected by the outbreak for hospitals to correctly identify coronavirus cases instead of misdiagnosing suspected cases as "severe pneumonia".[133][134][135] Many of those experiencing symptoms was told to self-quarantine at home instead of going to a hospital to avoid to close with other patients with different levels of symptoms.[136] After 2 repatriation flights were conducted from Wuhan to Japan in late January 5 out of approx 400 persons repatriated were diagnosed with the virus of whom one was symptomatic and 4 were not. [137]

Signs and symptoms

 

Symptoms of 2019-nCoV (Wuhan coronavirus). There are reports that it may spread even without symptoms.[138]

Symptoms may include fever, fatigue, dry cough, and shortness of breath.[9][139][140] Cases of severe infection can result in pneumonia, kidney failure, and death.[9][141] Upper respiratory symptoms such as sneezing, a runny nose or sore throat are less frequent.[21][22] It has been described as "flu-like".[142]

Among the first 41 confirmed cases admitted to hospitals in Wuhan, 13 (32%) individuals had another chronic condition, like diabetes or hypertension. Overall, 13 (32%) individuals required intensive care, and 6 (15%) individuals died.[21] Many of those who died had other conditions such as hypertension, diabetes, or cardiovascular disease that impaired their immune systems.[143]

Cause

Main article: Novel coronavirus (2019-nCoV)

Spread

The virus is spread between people via droplets when breathing or coughing or via contacts.[144][145][146] Several aspects are unknown as of January 24th 2020, such as the proportion of asymptomatic carriers of the virus.[147] The detected cases with symptoms, pneumonia and deaths may simple be the visible part of a larger epidemic.[147]

Between humans

A public health official in the U.S. state of Washington noted that coronaviruses are primarily transmitted "through close contact with another individual, in particular through coughing and sneezing on somebody else who is within a range of about 3 feet (0.91 m) to 6 feet (1.8 m) from that person."[148] A study of the Wuhan (2019-nCoV) coronavirus published in a bioRxiv preprint on 23 January 2020, "found the basic reproduction number, R0, to be around 2.2 (90% high density interval 1.4–3.8), indicating the potential for sustained human-to-human transmission" and noted that transmission characteristics were "of a similar magnitude to severe acute respiratory syndrome-related coronavirus (SARSCoV)."[149]

Basic reproduction number

 

Semi-log plot of confirmed cases and deaths[150]

The transmissibility of the virus between human-to-human has been variable, with some affected people not transmitting the virus to others while others have been able to spread the infection to several people.[24] There have been various estimates for the basic reproduction number, ranging from 2.13[151] to 3.11.[152][153][154] The number describes how many people a newly infected person is likely to pass the virus to in the population. The new coronavirus has been reportedly able to transmit down a chain of up to four people so far.[155]

Virology

Genomic informationNCBI genome IDGenome sizeYear of completion

Genome organisation (click to enlarge)
MN908947
30473 bp
2020

The natural wildlife reservoir of the 2019‐nCoV and intermediate host that transmitted the 2019-nCoV to humans has not been confirmed.[156] However, it is likely that the primary reservoir for the virus is bats.[44] 33 out of 585 animal specimens taken from the market showed evidence of 2019-nCoV.[157]

An updated preprint paper published 23 January 2020 on bioRxiv from members of the Wuhan Institute of Virology, Wuhan Jinyintan Hospital, University of Chinese Academy of Sciences and the Hubei Provincial Center for Disease Control and Prevention suggest that the 2019 novel coronavirus has possible bat origins, as their analysis shows that nCoV-2019 is 96% identical at the whole genome level to a bat coronavirus identified in 2013.[158]

A report published one day earlier from Peking University, Guangxi Traditional Chinese Medical University, Ningbo University and Wuhan Biology Engineering College compares the codon usage bias of 2019-nCoV with "humans, bats, chickens, hedgehogs, pangolins, and two species of snakes",[159] and they concluded that "snake is the most probable wildlife animal reservoir for the 2019‐nCoV" which then transmitted to humans.[159][160][161] This claim has been widely disputed: some argued that the reservoir must be bats and the intermediate host, bird or mammal, not snakes (as snakes, unlike humans, are poikilotherms),[162][162][163] while others used data on recombination and SARS/MERS codon usage bias refute the reasoning. The recombination event mentioned probably happened in bats instead.[164]

Phylogenetic studies of 2019-nCoV examine the evolutionary history of the virus and its relationships with other organisms. The seventh member of the family of coronaviruses that can infect humans, 2019-nCoV has been reported to have a genome sequence 75% to 80% identical to the SARS-CoV and to have more similarities to several bat coronaviruses.[43][44] At least five genomes of the novel coronavirus have been isolated and reported.[165][166][167] These show that the virus is genetically distinct from other known coronaviruses such as Severe acute respiratory syndrome-related coronavirus (SARS-CoV) and Middle East respiratory syndrome-related coronavirus (MERS-CoV).[165] Like SARS-CoV, it is a member of Beta-CoV lineage B.[168]

A peer-reviewed paper by Domenico Benvenuto et al. describes a phylogenetic tree built from 15 available whole genome sequence of 2019-nCoV and 12 whole genome sequences of 2019-nCoV and 12 highly similar whole genome sequences available in gene bank. Genomic analysis shows that the Nucleocapsid and the Spike Glycoprotein have some sites under positive selective pressure. Homology modelling indicated certain molecular and structural differences among the viruses. The phylogenetic tree showed that 2019.nCoV significantly clustered with a Bat SARS-like Coronavirus sequence, whereas structural analysis revealed mutations in Spike Glycoprotein and nucleocapsid protein. The authors concluded 2019-nCoV is a coronavirus distinct from SARS virus that probably was transmitted from bats or another host that provided the ability to infect humans.[169]

Diagnosis

On 15 January 2020, the WHO published a protocol on diagnostic testing for 2019-nCoV, developed by a virology team from the Charité University of Medicine in Germany.[170] Since then, several other testing protocols have been proposed, and published by the WHO.[171]

Prevention

See also: Novel coronavirus (2019-nCoV) § Vaccine research

 

A doctor in a protective bunny suit sees a patient in a Wuhan hospital.

To prevent infection, the WHO recommends "regular hand washing, covering mouth and nose when coughing and sneezing… [and] avoid[ing] close contact with anyone showing symptoms of respiratory illness (such as coughing and sneezing)."[165]

Quarantine measures

Main article: 2020 Wuhan lockdown

Hubei cities under transportation ban[30]CityDatequarantinedEstimatedpopulationSourceTotal41,546,000

Wuhan 23 January 2020 11,081,000 [172][173]
Huanggang 23 January 2020 6,630,000 [172][174]
Ezhou 23 January 2020 1,077,700 [172][175][176]
Chibi 24 January 2020 490,900 [177]
Jingzhou 24 January 2020 5,590,200 [178]
Zhijiang 24 January 2020 497,600 [179]
Yichang 24 January 2020 4,135,900 [180]
Qianjiang 24 January 2020 966,000 [181]
Xiantao 24 January 2020 1,140,500 [182]
Xianning 24 January 2020 2,543,300 [183]
Huangshi 24 January 2020 2,470,700 [184]
Dangyang 24 January 2020 469,600 [185]
Enshi 24 January 2020 777,000 [186]
Xiaogan 24 January 2020 4,915,000 [187]
Jingmen 24 January 2020 2,896,500 [188]

On 23 January 2020, a quarantine on travel in and out of Wuhan was imposed in an effort to stop the spread of the virus out of Wuhan. Flights and trains in and out of Wuhan, public buses, the metro system and long-distances coaches were suspended until further notice. Large-scale gatherings and group tours were also suspended.[189] By 24 January 2020, a total of 15 cities in the Hubei province, including Wuhan, were placed under similar quarantine measures.[30] Thus, the entire Hubei province came under quarantine, save for Xiangyang and the Shennongjia Forestry District.

Due to quarantine measures, Wuhan residents rushed to stockpile on essential goods, food, and fuel. The prices of goods rose significantly.[190][191][192] Medical staff faced difficulties in commuting to their hospitals, as they were now limited to walking and private cars.[193] Taxis and private-hire vehicles shunned them upon learning of the destination.[193] 5,000,000 people left Wuhan, with 9,000,000 left in the city.[194]

Guan Yi, an epidemiologist and SARS virologist with teams consisting of medical specialists who just flew back to Hong Kong after their one-day inspection in Wuhan told correspondents that "the Wuhan outbreak is at least 10 times larger than that of SARS, calling people to stay away from Wuhan as soon as possible."[195][196][197][198] Some posts on Weibo showed that as early as 12 January, hospitals in Wuhan were already overwhelmed with patients suffering from fever, many of them having to sleep on the floor.[199] Some were also highly critical of the reliability of the figures from the Chinese government as well as the government response, with some calling for quarantine,[200] and post also showed sick people and three dead bodies covered in white sheets on the floor of a hospital on 24 January, although many such posts in Weibo about the epidemic have been deleted.[201][202]

On 26 January, the city of Shantou in Guangdong declared a partial lockdown,[203] though this was quickly reversed only two hours later.[204] This created chaos, as residents rushed to supermarkets to stock food as soon as the lockdown was declared, and the surge of stockpiling didn't come to an end until the authorities reversed their decision. Caixin said, that the wording of Shantou's initial declaration was "unprecedentedly strict" and will severely affect residents' lives, if implemented as-is. Shantou's Department for Outbreak Control later clarified, that they will not restrict travelling, and all they would do, is to sterilise vehicles used for transportation.[205]

Local authorities of the capital Beijing and several other major cities, including Hangzhou, Guangzhou, Shanghai and Shenzhen announced on 26 January, that these cities will not impose a lockdown similar to those in Hubei province. Rumours of these potential lockdowns had spread widely prior to the official announcements.[206] A spokesperson of Beijing's Municipal Transportation Commission claimed, that the expressways and highways, as well as subways and buses are operating normally. To ease the residents' panic, the Hangzhou city government stressed that the city will not be locked down from the outside world, and both cities said that they will introduce precautions against potential risks.[207]

    • People queueing outside a Wuhan pharmacy to buy face masks and medical supplies

 

    • Residents of Wuhan wearing masks rushed out to nearby markets to buy vegetables and other food on 23 January during the outbreak

 

  • Residents of Wuhan waiting for the last train of the city's metro on 10 A.M., 22 January

Evacuation of foreign citizens

Due to the effective lockdown of public transport in Wuhan and Hubei province, several countries have started to evacuate their citizens and/or diplomatic staff from the area, primarily through chartered flights of the home nation that have been provided clearance by Chinese authorities. Japan, the United States, France, Australia, Sri Lanka, Germany and Thailand were among the first to evacuate their citizens.[208][209][210][211][212][213]

Brazil, Czechia, India, Italy and Russia are considering similar measures.[214][215][216][217][218][219] Pakistan has said that it will not be evacuating any citizens from China.[220][221]

Panama and Sri Lanka began repatriation of their students in China.[222][223] Myanmar began repatriating 60 of their students from the vicinity of Wuhan.[224]

Vietnam permitted four exceptional flights to carry Wuhan passengers home in the period 24–27 January,[225] and organised a flight to evacuate citizens and diplomats.[226]

On 29 January, Australia and New Zealand announced that they would team up to evacuate their citizens from Wuhan. There are between 50-82 New Zealanders in Wuhan and 600 Australians in Hubei province including 140 Australian children in Wuhan.[227][228] The New Zealand Government has also chartered a Boeing 777-200ER aircraft from the national carrier Air New Zealand to assist in evacuation efforts, subject to approval from Chinese officials.[229][230][231] While priority will be given to New Zealand nationals, the plane will also be evacuating Australian and Pacific Island citizens.[232]

On 29 January, Australian Prime Minister Scott Morrison announced plans to quarantine Australian citizens evacuated from Wuhan, including children and the elderly, for a period of 14 days on Christmas Island. The decision to repatriate those citizens using controversial detention facilities formerly utilized to detain asylum seekers before they were shut down in 2018 has received criticism.[233] Controversially, the government plan also necessitates those evacuees to pay a fee of AU$1,000 and would drop them off in Perth after the quarantine period, where they would need to arrange their own transportation back to their home cities. The Australian Medical Association, in a statement on the same day, stated that the decision to hold Australian citizens in "a place where has been previously the focus of populations under enormous mental and physical trauma and anguish, is not a really appropriate solution."[234]

On 29 January, South Korea made last-minute preparations to airlift about 700 South Korean nationals out of Wuhan, including finalising logistical details with the Chinese Government. South Korea officials prepared two planes with two sets of medical teams comprising about 20 doctors, nurses, and foreign ministry and quarantine officials for each team.[235]

On 29 January, the Indonesian Air Force (TNI-AU) prepared three aircraft including two Boeing 737 and one C-130 Hercules, with a battalion of health experts to help evacuate Indonesian nationals and citizens from the city. As of 29 January, the TNI-AU was[needs update] waiting for instruction from the Indonesian Ministry of Foreign Affairs and on standby for 24 hours in case the order was given.[236][237]

On 30 January, 92 Singaporeans were evacuated from Wuhan via a special Scoot flight, crewed by volunteers from the airline after coordination between Singapore and Chinese authorities facilitated the flights. However, there are still some Singaporeans left behind as they display symptoms, and it made no sense to have them evacuated with the rest who may not be infected.[238]

On 31 January, a British plane carrying 110 EU nationals (83 Britons and 27 others, not including military medics from the UK on board) left Wuhan, arriving at RAF Brize Norton in England. The British passengers are quarantined at a segregated block of Arrowe Park Hospital on the Wirral; all passengers were tested before and during the flight, with none having the virus. The other EU nationals were flown on to Spain from Brize Norton. More Britons (up to 150) were supposed to be on the flight, which was planned to leave a day earlier; China initially declined permission, and then anyone who had a Chinese passport (including infants and a newborn to British parents) were told they could not leave. Shortly before the flight left, this decision was reversed, but too late for people to get to the airport even though the plane was also delayed for several hours. The British government plans to send another plane if necessary. On this day, the first cases of the virus were reported in the UK, but were unrelated.[239][240][241]

Management

See also: Novel coronavirus (2019-nCoV) § Treatment

 

Infrared cameras were installed in Wuhan railway station to check passengers' body temperature before they board the trains.

There is no specific medication or vaccine for 2019-nCoV, though development efforts are underway.[242][243]

The Centers for Disease Control and Prevention of the United States provides generic advice that an infected person can relieve their symptoms by taking regular flu medications, drinking fluids and resting.[244] Some countries require people to report flu-like symptoms to their doctor, especially if they have visited China.[245]

Domestic responses

 

'Aerial photography of roads after motor vehicles are banned in central urban areas of Wuhan: few vehicle traces' – Video news from China News Service

 

Passengers wearing masks going through an extra body temperature check as part of airport security. Captured on 26 January in NE China's Changchun Longjia Airport

 

Hong Kong residents queueing to refund their bullet train tickets to the mainland in West Kowloon railway station


On 25 January, Politburo of the Communist Party of China met to discuss novel coronavirus prevention and control. Chinese Communist Party general secretary Xi Jinping stated that the country is facing a "grave situation" as the number of infected people is accelerating.[246] In the evening, the authorities banned the use of private vehicles in Wuhan. Only vehicles that are transporting critical supplies or emergency response vehicles are allowed to move within the city.[247]

On 26 January, a leading group on the prevention and control of the novel coronavirus outbreak was established, led by Premier Li Keqiang.[248] The leading group has decided to extend Spring Festival holiday to contain coronavirus outbreak.

China Customs started to require all passengers entering and exiting China to fill out an extra health declaration form starting 26 January. The health declaration form was mentioned in China's Frontier Health and Quarantine Law, granting the customs rights to require it if needed. The customs said it will "restart this system" as it was not a requirement before.[249][250][251]

On 27 January, Premier Li Keqiang visited Wuhan to direct the epidemic prevention work.[252]

Authorities across China announced school closures and delayed the spring semester. All schools ranging from kindergartens to universities in the whole of Hubei province will have their winter break prolonged and the exact date of the new semester will be announced later, according to a statement made on 24 January.[253] China's Ministry of Education also asked all schools to halt public assemblies and delay major exams. Some universities with open campuses also banned the public from visiting.[254] The education department in Hunan province, which neighbours the centre of the outbreak Hubei province, stressed on the official newspaper Hunan Daily on 23 January, claiming it will strictly ban off-school tutors and restrict unapproved student gatherings, which are all common practices in China for students to get better grades.[255] Education departments in Shanghai and Shenzhen also imposed bans on off-school tutoring and ask schools to track and report students who have been to Wuhan or Hubei province during the winter break.[256][257] Several universities, including China's top-ranking Peking University and Tsinghua University announced the spring semesters will be delayed on 26 January.[258] The semi-autonomous regions Hong Kong and Macau also announced adjustments on schooling schedules. Hong Kong's Chief Executive Carrie Lam declared an emergency at a press conference on 25 January, saying the government will close primary and secondary schools for two more weeks on top of the previously scheduled Lunar New Year holiday, pushing the date for school reopening to 17 February.[259][260] Macau closed several museums and libraries, and prolonged the Lunar New Year holiday break to 11 February for higher education institutions and 10 February for others.[261] The University of Macau said they will track the physical conditions of students who have been to Wuhan during the Lunar New Year break.[262]

On 27 January, the General Office of the State Council of China, one of the top governing bodies of the People's Republic, officially declared a nation-wide extension on the Lunar New Year holiday and the postponement of the coming spring semester. The Office extended the previously scheduled public holiday from 30 January to 2 February, while it said school openings for the spring semester will be announced in the future.[263]

After the Chinese Lunar New Year on 25 January, there would be another peak of people travelling back from their hometowns to workplaces as a part of Chunyun. Several provinces and cities started to encourage people to stay in their hometowns and not travel back. Eastern China's Suzhou also encouraged remote working via the Internet and further prolonged the spring festival break.[264]

The Civil Aviation Administration of China and the China State Railway Group, which regulates China's civil aviation and operates rail services, announced on 24 January that passengers could have full refunds for their plane and train tickets without any additional surcharges, regardless of whether their flight or train will go through Wuhan or not. Some hotel chains and online travel agencies also allowed more flexibility in cancellations and changes.[265][266] China's Ministry of Culture and Tourism ordered travel agencies and online tourism firms to suspend package tours and stop offering "flight+hotel" bundles.[267][264]

More provinces and cities outside the most contaminated Hubei started to restrict travel. Beijing suspended all intercity bus coaches on 25 January,[268] with several others follow suit. Shanghai, Tianjin, Shandong, Xi'an, and Sanya all announced suspension of intercity or inter-province bus services on 26 January.[264]

Censorship and police responses

On 20 January, Chinese Communist Party general secretary Xi Jinping made his first public remark on the outbreak and "spoke of the need for the timely release of information," according to state-run News Agency.[269][270] Chinese premier Li Keqiang also urged efforts to prevent and control the epidemic.[271] One day later, the Central Political and Legal Affairs Commission of the Chinese Communist Party, the most powerful political organ in China overseeing legal enforcement and the police, wrote "self-deception will only make the epidemic worse and turn a natural disaster that was controllable into a man-made disaster at great cost," and "only openness can minimise panic to the greatest extent." The commission then added, "anyone who deliberately delays and hides the reporting of cases out of self-interest will be nailed on a pillar of shame for eternity."[272][273]

However, also on the same day, Xi Jinping reportedly instructed authorities "to strengthen the guidance of public opinions", language which some view as a call for censorship after commentators on social media became increasingly pointedly critical and angry at the government due to the epidemic. Notably, many Chinese citizens have reportedly used innovative methods to avoid censorship and express anger about how government officials have handled the outbreak, such as using the word 'Trump' to refer to Xi Jinping, or 'Chernobyl' to refer to the outbreak as a whole.[274] Some view this as contradictory to the calls for "openness" that the central government had already declared.[275] Since then, incidents have been noted where police have detained people for supposedly such online posts, with an case on 25 January in Tianjin where a man was detained for 10 days for “maliciously publishing aggressive, insulting speech against medical personnel.”[276]

The Human Rights Watch, an international advocacy group, states that "there is considerable misinformation on Chinese social media and authorities have legitimate reasons to counter false information that can cause public panic," but has also noted incidents where censorship by the authorities has included social media posted by families of infected people who were potentially seeking help as well as by people living in cordoned cities allegedly only documenting their daily lives amidst the lockdown.[277]

International responses

See also: Timeline of the 2019–20 Wuhan coronavirus outbreak § Reactions and measures outside Mainland China

Since 31 December 2019, some regions and countries near China tightened their screening of selected travellers.[42] The Centers for Disease Control and Prevention (CDC) of the United States later issued a Level 1 travel watch.[53][278] Guidances and risk assessments were shortly posted by others including the European Centre for Disease Prevention and Control and Public Health England.[279] In China, airports, railway stations and coach stations installed infrared thermometers. People with fevers are subsequently taken to medical institutions after being registered and given masks.[280] Real time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test was used to confirm new cases of coronavirus infection.[281]

An analysis of air travel patterns was used to map out and predict patterns of spread and was published in the Journal of Travel Medicine in mid-January 2020. Based on information from the International Air Transport Association (2018), Bangkok, Hong Kong, Tokyo, and Taipei had the largest volume of travellers from Wuhan. Dubai, Sydney and Melbourne were also reported as popular destinations for people travelling from Wuhan. Using the validated tool, the Infectious Disease Vulnerability Index (IDVI), to assess the ability to manage a disease threat, Bali was reported as least able in preparedness, while cities in Australia were considered most able.[282][283]

On 22 January 2020, North Korea closed its borders to international tourists to prevent the spread of the virus into the country. Chinese visitors make up the bulk of foreign tourists to North Korea.[284]

Also on 22 January, the Asian Football Confederation (AFC) announced that it would be moving the matches in the third round of the 2020 AFC Women's Olympic Qualifying Tournament from Wuhan to Nanjing, affecting the women's national team squads from Australia, China PR, Chinese Taipei and Thailand.[285] A few days later, the AFC announced that together with Football Federation Australia they would be moving the matches to Sydney.[286] The Asia-Pacific Olympic boxing qualifiers, which were originally set to be held in Wuhan from 3–14 February, were also cancelled and moved to Amman, Jordan to be held between 3–11 March.[287][288]

On 27 January 2020, the United States CDC issued updated travel guidance for China, recommending that travellers avoid all nonessential travel to all of the country. The CDC has directed U.S. Customs and Border Protection to check individuals for symptoms of the coronavirus.[289]

On 29 January 2020, British Airways cancelled all their flights to mainland China as a reaction to the spread of the virus.[290] Lufthansa followed hours later by also suspending all their flights.[291] Lion Air and Air Seoul also suspended all their flights.[292]

On 30 January 2020, Egyptair announced suspension of flights between Egypt and Hangzhou starting 1 February 2020 while those to Beijing and Guangzhou will be suspended starting 4 February 2020 until further notice.[293]

Though some of the airlines cancelled flights to Hong Kong as well, British Airways, Finnair and Lufthansa have not, and American Airlines continues operating a limited service to the area. Hong Kong's four airlines halved the flights to mainland China.[294] The following airlines have so far reduced or cancelled flights to and from China:[295][296]

International aid

The United States city of Pittsburgh has announced plans to promptly send aid to Wuhan, with its mayor Bill Peduto stating that "Our office has reached out to the mayor of Wuhan, which is our sister city" and promising that "over the next two days we should be able to have a care package that has been put together."[citation needed] He speculated that the contents of such a package will be coordinated with the consultation of medical experts, but that it will consist of "likely face masks, rubber gloves and other material that could be hard to find in the future.[citation needed] Additionally, the University of Pittsburgh Medical Center (UPMC) has declared plans to provide help, with UPMC spokesman Paul Wood stating that "UPMC has a significant presence in China and has been in contact with our partners there”, also declaring that “we stand ready to assist them and others in China with their unmet humanitarian needs.”[297]

The humanitarian aid organisation Direct Relief, in coordination with FedEx transportation and logistics support, sent 200,000 face masks along with other personal protective equipment, including gloves and gowns, by emergency airlift to arrive in Wuhan Union Hospital, who requested the supplies by 30 January.[298] The Gates Foundation has stated on 26 January that it will donate US$5 million in aid to support the response in China that will aimed at assisting "emergency funds and corresponding technical support to help front-line responders."[299]

Japan, in the process of coordinating a plane flight to Wuhan to pick up Japanese nationals in the city, has promised that the plane will first carry into Wuhan aid supplies that Japanese foreign minister Toshimitsu Motegi stated will consist of "masks and protective suits for Chinese people as well as for Japanese nationals".[300] On 26 January, the plane arrived in Wuhan, donating its supply of one million face masks to the city.[301] Also among the aid supplies were 20,000 protective suits for medical staff across Hubei donated by the Tokyo Metropolitan Government.[302]

Support efforts have sprung across Japan to help aid residents in Wuhan. On 27 January, the city of Oita, a sister city to Wuhan for 40 years, sent 30,000 masks from its own disaster relief stockpile to its sister city through the Red Cross network with boxes labelled "Wuhan Jiayou!," meaning "Hang in there, Wuhan!" in Chinese. Its International Affairs Office division head, Soichiro Hayashi, said that “The people of Wuhan are like family” and expressed hopes that "people can return to their ordinary lives as quickly as possible.” Peace Winds Japan has declared it will send a staff member to China to help distribute the face masks and other goods that the NGO will send to the country.[302]

On 31 January 2020, Malaysia said it would donate 18 million medical gloves to China as announced by the Minister of Primary Industries Teresa Kok.[303]

Specialty hospitals

 

Jinyintan Hospital had initially been tasked with treating those with the coronavirus.

 

Construction site of Huoshenshan Hospital as it appeared on 24 January.

A specialty hospital named Huoshenshan Hospital has been under construction as a countermeasure against the outbreak and to better quarantine the patients. Wuhan City government had demanded that a state-owned enterprise construct such a hospital "at the fastest speed" comparable to that of the SARS outbreak in 2003.[304] On 24 January, Wuhan authorities specified its planning, saying they planned to have Huoshenshan Hospital built within six days of the announcement and it will be ready to use on 3 February. The specialty hospital will have 813 beds[305] and it will take up 25,000 square metres. The hospital is modelled after the Xiaotangshan Hospital [zh], which was fabricated for the SARS outbreak of 2003, itself built in only seven days.[306][307] State media reported that there were 1,500 workers and nearly 300 units of construction machinery on the site at peak, and another backup team of 2,000 workers had already gathered.[308]

Authorities announced plans for a second specialty hospital on 25 January which will be named Leishenshan Hospital, with a capacity of 1,600 beds[309]; operations are scheduled to start by 5 February.[310][311] Some people voiced their concerns through social media services, saying the authorities' decision to build yet another hospital in such little time showed the severity of the outbreak could be a lot worse than expected.[312]

On 24 January 2020, the authority announced that they would convert an empty building in Huangzhou District, Huanggang to a 1,000-bed hospital named Dabie Mountain Regional Medical Centre. Works began the next day by 500 personnel and the building began accepting patients on 28 January 2020 at 10:30 p.m.[313]

The British Government and National Health Service have set up a Coronavirus isolation facility at Arrowe Park Hospital in The Wirral for British People coming back on a special flight from Wuhan.

Reactions to prevention efforts

WHO response

The World Health Organization (WHO) has commended the efforts of Chinese authorities in managing and containing the epidemic with its Director-General Tedros Adhanom Ghebreyesus expressing "confidence in China’s approach to controlling the epidemic" and calling for the public to "remain calm".[314]

The WHO noted the contrast between the 2003 epidemic, where Chinese authorities were accused of secrecy that impeded prevention and containment efforts, and the current crisis where the central government "has provided regular updates to avoid panic ahead of Lunar New Year holidays."[315] In reaction to the central authorities' decision to implement a transportation ban in Wuhan, WHO representative Gauden Galea remarked that while it was "certainly not a recommendation the WHO has made", it was also "a very important indication of the commitment to contain the epidemic in the place where it is most concentrated" and called it "unprecedented in public health history".[315] Tedros states that "there is no reason for measures that unnecessarily interfere with international travel and trade" and that "WHO doesn’t recommend limiting trade and movement".[316]

On 30 January 2020, following confirmation of human-to-human transmission outside of China and the increase in number of cases in other countries, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC), the sixth PHEIC since the measure was first invoked during the 2009 Swine flu pandemic. Tedros clarified that the PHEIC in this case was "not a vote of no confidence in China", but because of the risk of global spread, especially to low- and middle-income countries without robust health systems capable.[45][317]

International reactions

China's response to the virus, in comparison to the 2003 SARS outbreak, has been praised by some foreign leaders.[318] US President Donald Trump thanked Chinese President Xi Jinping "on behalf of the American People" on 24 January 2020 on Twitter, stating that "China has been working very hard to contain the Coronavirus. The United States greatly appreciates their efforts and transparency" and declaring that "It will all work out well."[319] Germany's health minister Jens Spahn, in an interview on Bloomberg TV, said with comparison to the Chinese response to SARS in 2003: "There's a big difference to SARS. We have a much more transparent China. The action of China is much more effective in the first days already." He also praised the international cooperation and communication in dealing with the virus.[320][321]

At a Sunday mass at St. Peter's Square in Vatican City on 26 January 2020, Pope Francis praised "the great commitment by the Chinese community that has already been put in place to combat the epidemic" and commenced a closing prayer for "the people who are sick because of the virus that has spread through China".[322]

Criticism of local response

Local officials in Wuhan and the province of Hubei have faced wide criticism, both domestically and internationally, for mishandling the initial outbreak.[323] Allegations included insufficient medical supplies, lack of transparency to the press and censorship of social media during the initial weeks of the outbreak.[324][325] On 1 January 2020, the Wuhan police interviewed eight residents for spreading false information (referring to the new infection as a reappearance of SARS).[326][327] The Wuhan police later stated through a post on its official Weibo account that "all of them been dealt with according to the law."[328][329] Criticism was directed at Hubei Governor Wang Xiaodong after he repeatedly misstated the production of face masks in a press conference.[330]

Several Hong Kong media correspondents were detained by police for over an hour when they were conducting interviews at Wuhan's Jinyintan Hospital on 14 January. Reports said the police brought the correspondents to a police station, where the police checked their travel documents and belongings, then asked them to delete video footage taken in the hospital before releasing them.[331][332]

Authorities in Wuhan and Hubei provinces have been criticised for downplaying the severity of the outbreak and responding slower than they could have. The Beijing-based media journal, Caixin noted that Hubei did not roll out the first level of "public health emergency response mechanism" until 24 January, while several other provinces and cities outside of the centre of the outbreak have already done so the day before.[333]

On 19 January, four days before the city's lockdown, a "Wan jia yan" (Chinese: 万家宴; literally: 'ten-thousand family banquet') was held in Wuhan, with over 40,000 families turning out at the banquet tables which attracted retrospective criticism. The domestic The Beijing News argued that the local authorities should not have held such a public assembly while attempting to control the outbreak. The paper also argued that the time when their journalists visited the Huanan Seafood Wholesale Market where the coronavirus likely originated, most residents and merchants there weren't even donning face masks.[334] Zhou Xianwang, the Mayor of Wuhan, later spoke to China Central Television defending that this banquet was held annually, and it is a "sample of the people's self-autonomy." He asserted that the decision of allowing such a banquet was made based on the fact that the scientists used to falsely believe that the ability of the virus to spread human-to-human was limited.[335][336] Meanwhile on 20 January, Wuhan's municipal department for culture and tourism was giving out 200,000 tickets good for visiting all tourist attractions in Wuhan to its citizens for free, which was then criticised for disregarding the outbreak.[334]

Tang Zhihong, the chief of the health department in Huanggang, the second worst affected city in Hubei after Wuhan, was fired hours after she was unable to answer questions on how many people in her city were being treated. During an interview on state television, she responded to a central government inspection team who queried how many sick people may be in the city's care: "I don’t know, I’m unclear, I only know how many beds there are. Don’t ask me how many people are being treated."[337]

Treatment research

 

This section is in list format, but may read better as prose. You can help by converting this section, if appropriate. Editing help is available. (January 2020)

Main articles: Novel coronavirus (2019-nCoV) § Vaccine research, and Novel coronavirus (2019-nCoV) § Treatment

Several organisations around the world are developing vaccines or testing antiviral medicine. Efforts include:

Impact

The epidemic coincided with the New Year, which marks a major festival season for the region and the busiest travel period in China. A number of events involving large crowds were cancelled by national and regional governments, including the annual New Year festival in Hong Kong, with private companies also independently closing their shops and tourist attractions such as Ikea and Disneyland Hong Kong.[351]

As Mainland China is a major economy and a manufacturing hub, the viral outbreak has been seen to pose a major destabilizing threat to the global economy. Agathe Demarais of the Economist Intelligence Unit has forecasted that markets will remain volatile until a clearer image emerges on potential outcomes. Some analysts have estimated that the economic fallout of the epidemic on global growth could surpass that of the SARS outbreak.[352]

Mainland China

The travel sector has been hit hard by travel restrictions and fears of contagion, including a ban on both domestic and international tour groups.[353] Many airlines have either canceled or greatly reduced flights to China and several travel advisories now warn against travel to China. Foreigners have been evacuated from Wuhan and Hubei province by many countries, including the United States and Japan.[354]

The majority of schools and universities have extended their annual holidays to mid-February.[355] Overseas students enrolled at Chinese universities have been returning home over fears of being infected -- the first cases to be reported by Nepal and Kerala, a southern state of India, were both of students who had returned home.[356][356][357]

Hong Kong

Hong Kong has been recovering from high profile protests that saw tourist arrivals from Mainland China plummet over an eight month period. The viral epidemic has however placed doubt on the ability of the travel sector to withstand a prolonged period of downturn. A drop in arrivals from third countries more resilient during the previous months has also been cited as a concern.[358] The city is already in recession[359] and Moody has lowered the city's credit rating, also stating that the government had failed to respond to "to the concerns that have contributed to the continuing protests" and that decreasing autonomy of its economic and political system from Mainland China was undermining its credentials.[360][361] The worst economic effects from the outbreak are expected for Australia, Hong Kong and China.[362]

There has also been a renewed increase in protest activity as hostile sentiment against Mainland Chinese strengthens over fears of viral transmission from Mainland China, with many calling for the border ports to be closed and for all Mainland Chinese travellers to be refused entry. Incidents have included a number of petrol bombs being thrown at police stations,[363] homemade bombs exploding in toilets,[364] and foreign objects being thrown onto transit rail tracks between Hong Kong and the Mainland Chinese border.[365] Political issues raised have included concerns that Mainland Chinese may prefer to travel to Hong Kong to seek free medical help (which has since been addressed by the Hong Kong government).[366][367]

Since the outbreak of the virus, a significant number of products have been sold out across the city, including face masks and disinfectant products (such as alcohol and bleach).[368] An ongoing period of panic buying has also caused many stores to be cleared of non-medical products such as bottled water, vegetables and rice.[369] The Government of Hong Kong had its imports of face masks canceled as global face masks stockpiles decline.[370]

Japan

Japan has been evacuating its citizens from Hubei province, three of whom were confirmed to be infected with the Wuhan virus and twelve of whom have been hospitaized.[371] The first domestic local transmission of the virus was confirmed on January 28 when a tourist bus driver in Nara Prefecture became infected despite having never been to China.[372]

Economic politician Yasutoshi Nishimura warned that the viral epidemic could have a strong impact on the Japanese economy due to disruption of logistics and factory operations.[373] Japanese airlines have started suspending flights to Mainland China[374], whereas manufacturers, including Toyota, have halted all their production lines in Mainland China.[375] Prime Minister Abe has considered using emergency funds to mitigate the outbreak's impact on tourism, of which Chinese nationals account for 40%.[376]

Chinese, or people assumed to be Chinese, have reported discrimination in Japan as Japanese people fear possible viral contagion.[377]

Southeast Asia

Economists have advised that the viral outbreak would have an impact on the economy of Singapore, but that it was too soon to provide a certain answer. The tourism sector was considered to be an "immediate concern" along with the effects on production lines due to disruption to factories and logistics in Mainland China.[378] In Thailand, the threat of the viral outbreak's impact on tourism has caused the Baht to fall to a seven month low.[379]

South Asia

India is highly dependent on trade across the Himalayas and the disruption in Mainland China could adversely impact the economy of India, especially the electronics and pharmaceutical industries, with the closure of Chinese ports having a knock-on effect on Indian logistic operations as well.[380][381] Sri Lanka has warned of a short term impact on the tourism sector.[382]

United States

In a tweet on 27 January, President Trump offered China "any help that is necessary," writing that American experts were "extraordinary".[383] The viral outbreak was cited by many companies in their briefings to shareholders, but several maintained confidence that they would not be too adversely affected by short-term disruption due to "limited" exposure to the Chinese consumer market, however those with manufacturing lines in Mainland China are warning about possible exposure to supply shortages.[384]

See also

Notes

  1. ^ Total confirmed infected people. Japan's Ministry of Health, Labour and Welfare is reporting separate totals for a) confirmed infected people who have symptoms; b) confirmed infected people who are not yet showing symptoms (asymptomatic).

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