On Dec 31, 2019, the WHO China Country Office was informed of cases of “pneumonia of unknown etiology” detected in Wuhan City, Hubei Province of China. This was reported in the first Novel Coronavirus (2019-nCOV) Situation Report on 21 Jan 2020.
It’s 128 days later as I write this. I’m listening to the WHO report now and they are discussing the origin day of the pandemic.
The photo is from January 21st, 2019, when I was traveling through Wuhan. I’ve been self-amusingly referring to my experience of the pandemic as being in a pandemic wormhole. It’s a mental construct I’m using in order to explain all of the changes I’ve seen since I began almost daily blogging 128 days ago.
On Dec 30, 2019, the AP reported: China investigates respiratory illness outbreak sickening 27, which was referring to the city’s health commission statement on China’s 31st (different time zone). The full text of the AP report:
BEIJING (AP) — Chinese experts are investigating an outbreak of respiratory illness in the central city of Wuhan that some have likened to the 2002-2003 SARS epidemic.
The city’s health commission said in a statement Tuesday that 27 people had fallen ill with a strain of viral pneumonia, seven of whom were in serious condition.
It said most had visited a seafood market in the sprawling city, apparently pointing to a common origin of the outbreak.
Unverified information online said the illnesses were caused by Severe Acute Respiratory Syndrome, which emerged from southern China and killed more than 700 people in several countries and regions. SARS was brought under control through quarantines and other extreme measures, but not before causing a virtual shutdown to travel in China and the region and taking a severe toll on the economy.
However, the health commission said the cause of the outbreak was still unclear and called on citizens not to panic.
It’s interesting to see that at this time, the respiratory illness was already linked to the SARS-1 epidemic and that a request was made for citizens “not to panic”, which many people read as “it’s time to panic, or at least prepare before everyone else panics”.
From a news scan of Dec 31, 2019 on CIDRAP, the following related notes:
Chinese officials probe unidentified pneumonia outbreak in Wuhan
Health officials in China are investigating the cause of a pneumonia outbreak in the city of Wuhan in Hubei province that has sickened 27 people and seems to be linked to a seafood market.
Government officials in Hong Kong and Taiwan detailed what’s known from mainland sources, and infectious disease news reporting sites such as FluTrackers, Avian Flu Diary, and ProMED Mail have been tracking official and media reports.
In a statement today, Hong Kong’s Centre for Health Protection (CHP), citing provincial health commission sources, said that, of 27 patients, 7 are in serious condition and the rest are stable. The main symptom is fever, but some patients have had shortness of breath.
Wuhan health officials said the pneumonia appears to be viral and that the patients are in isolation. No obvious human-to-human transmission has been observed, and no healthcare worker infections have been reported.
So far, the cause of the outbreak is still under investigation. News of the outbreak triggered rumors of possible severe acute respiratory syndrome (SARS). Virologist Leo Poon, DPhil, a SARS expert from Hong Kong University, told Radio Television Hong Kong (RTHK), a public broadcasting service in Hong Kong, that it’s too early to say the outbreak is a SARS event. He added that the emergence of atypical pneumonia cases requires identifying the responsible pathogen and ruling out SARS or other types of coronaviruses.
and in the same scan is coincidentally a report of a new fatal MERS (which should maybe be renamed SARS-1.5, or SARS-ME) case in Saudi Arabia:
The Ministry of Health (MOH) of Saudi Arabia reported a new MERS-CoV case from earlier this month.
The case-patient was a 70-year-old man from the city of Hafar Al Batin in the northeastern part of the country. The man died from complications of his Middle East respiratory syndrome coronavirus (MERS-CoV) infection. The MOH also said the man had camel contact, a common risk factor for MERS.
This is the fourth MERS case recorded in Saudi Arabia in December. In November the MOH noted 12 cases.
The WHO said in an update earlier this month that, since MERS-CoV was first detected in humans in 2012, it has received reports of 2,484 cases, at least 857 of them fatal. The vast majority were reported from Saudi Arabia.
The government of Hong Kong issues the following press release:
CHP closely monitors cluster of pneumonia cases on Mainland*************************************************
The Centre for Health Protection (CHP) of the Department of Health is today (December 31) closely monitoring a cluster of pneumonia cases in Wuhan, Hubei Province, and has contacted the National Health Commission for further information.
According to an announcement from the Health Commission of Hubei Province, a number of pneumonia cases related to a local seafood market was recently reported in Wuhan. The Wuhan Municipal Health Commission has commenced investigation and so far identified 27 cases. Among them, seven cases were serious and the remaining were stable. Symptoms were mainly fever while a few had presented with shortness of breath. All patients are isolated and receiving treatment. Contact tracing of close contacts and medical surveillance are ongoing.
The Wuhan Municipal Health Commission announced that assessment by relevant experts revealed that the cases were compatible with viral pneumonia. For the time being, no obvious human-to-human transmission has been observed and no healthcare workers have been infected. The causative pathogen and cause of infection are still under investigation.
Locally, while surveillance, prevention and control measures are in place, the CHP will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments.
The CHP’s Port Health Division conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases with serious infectious diseases identified will be immediately referred to public hospitals for isolation, treatment and follow-up. The CHP has also informed the Hospital Authority about the cluster of pneumonia cases in Wuhan.
Travellers are reminded to wear surgical masks and seek medical attention if they present with respiratory symptoms, and reveal their travel history to doctors. The CHP will continue to closely monitor the latest situation of the cluster of pneumonia cases in Wuhan and update the surveillance criteria and testing strategies accordingly.
To prevent pneumonia and respiratory tract infection, members of the public should maintain good personal and environmental hygiene. They are advised to:
- Perform hand hygiene frequently, especially before touching the mouth, nose or eyes; after touching public installations such as handrails or door knobs; or when hands are contaminated by respiratory secretion after coughing or sneezing.
- Wash hands with liquid soap and water, and rub for at least 20 seconds. Then rinse with water and dry with a disposable paper towel or hand dryer. If hand washing facilities are not available, or when hands are not visibly soiled, hand hygiene with 70 to 80 per cent alcohol-based handrub is an effective alternative.
- Cover your mouth and nose with tissue paper when sneezing or coughing. Dispose of soiled tissues into a lidded rubbish bin, then wash hands thoroughly.
- When having respiratory symptoms, wear a surgical mask, refrain from work or attending class at school, avoid going to crowded places and seek medical advice promptly.
The public should take heed of the health advice below when travelling outside Hong Kong:
- Avoid touching poultry/birds or their droppings, and avoid visiting wet markets, live poultry markets or farms;
- Avoid making close contact with patients, especially those with symptoms of acute respiratory infections;
- Adhere to food safety and hygiene rules such as avoiding consuming raw or undercooked animal products, including milk, eggs and meat, or foods which may be contaminated by animal secretions, excretions (such as urine) or contaminated products, unless they have been properly cooked, washed or peeled.
- If feeling unwell when outside Hong Kong, especially if having a fever or cough, wear a surgical mask, inform the hotel staff or tour escort and seek medical advice at once.
- After returning to Hong Kong, consult a doctor promptly if having a fever or other symptoms, inform the doctor of recent travel history and wear a surgical mask to help prevent spread of the disease.
Ends/Tuesday, December 31, 2019
Issued at HKT 19:06
Notice the mention of the advise to wear a surgical mask if feeling unwell and to inform doctors of recent travel history outside of Hong Kong.
The Tiawan CDC reported in a 2019-12-31 press release that there would be border control for flights incoming from Wuhan:
In response to the outbreak of pneumonia in Wuhan, Mainland China, the CDC has continued to implement border quarantine and boarding quarantine for Wuhan inbound flights
Release Date: 2019-12-31
Regarding a number of cases of pneumonia reported in Wuhan, Mainland China, the CDC has confirmed the epidemic information to the Mainland China Centers for Disease Control and Prevention and the World Health Organization (WHO) IHR window today (31). In the evening, Lu Fang sent experts to Wuhan in response. Conducted pathogen detection and investigation of the cause of infection, and provided information released by the Wuhan Municipal Health and Health Committee on December 31, stating that 27 cases of pneumonia were recently discovered in the local area and 7 cases were critically ill. All of them have been treated in isolation and 2 cases have improved. The clinical manifestations are mainly fever, a few patients have difficulty breathing, and have bilateral lung infiltrative lesions. Most of the cases were operated by South China Seafood City, Jianghan District, Wuhan City. No obvious human-to-human transmission and medical staff infection have been found. Lu indicated that if there is further information, he will inform us in time.
In response to the epidemic of pneumonia in Wuhan, Mainland China, in order to prevent cases from moving abroad, China has initiated contingency measures for border quarantine in accordance with standard operating procedures, strengthened fever screening for inbound tourists, implemented travel history, occupation type, contact history of suspected cases, Inquiries about the gathering situation, health assessment and health education, the assessment of the epidemic can be effectively prevented from overseas, but for the sake of prudence, boarding and quarantine will be carried out for flights departing directly from Wuhan, Mainland China, except for proactive assessment of passenger health In addition to this situation, relevant preventive measures were also introduced to passengers on the flight.
The Department of Disease Control will continue to monitor the epidemic situation in Wuhan, Mainland China, and adjust the prevention and control according to the epidemic situation. As the local epidemic situation is not yet clear, the public is urged to receive information on unknown or unproven epidemic situations. Do not distribute or repost it at will. Article 63 of the Law on the Prevention and Control of Infectious Diseases stipulates that the spread of rumors or false information about the epidemic situation of infectious diseases, which is caused to the public or others in full, is subject to a fine of up to NT $ 3 million; and in accordance with the Law on the Maintenance of Social Order Article 63, paragraph 5, provides that those who spread rumors enough to affect public peace may be detained for less than three days or fined less than NT $ 30,000.
The Department of Disease Control stated that in addition to the flu epidemic season, winter is also a period of pneumonia. It reminds the public to take good personal hand hygiene and cough etiquette, and try to avoid crowded and airless public places. People in the Wuhan area of mainland China who have fever or acute respiratory symptoms within 10 days of returning to China should take the initiative to report the 1922 epidemic prevention line and wear a mask to seek medical treatment as soon as possible. When seeking medical treatment, please actively inform the history of tourism activities, timely diagnosis notification and obtain a complete Medical care.
ProMED International Society for Infectious Diseases posted Undiagnosed pneumonia – China (HU): RFI:
Published Date: 2019-12-30 23:59:00
Subject: PRO/AH/EDR> Undiagnosed pneumonia – China (HU): RFI
Archive Number: 20191230.6864153UNDIAGNOSED PNEUMONIA – CHINA (HUBEI): REQUEST FOR INFORMATION
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: 30 Dec 2019
Source: Finance Sina [machine translation]
Wuhan unexplained pneumonia has been isolated test results will be announced [as soon as available]
On the evening of [30 Dec 2019], an “urgent notice on the treatment of pneumonia of unknown cause” was issued, which was widely distributed on the Internet by the red-headed document of the Medical Administration and Medical Administration of Wuhan Municipal Health Committee.
On the morning of [31 Dec 2019], China Business News reporter called the official hotline of Wuhan Municipal Health and Health Committee 12320 and learned that the content of the document is true.
12320 hotline staff said that what type of pneumonia of unknown cause appeared in Wuhan this time remains to be determined.
According to the above documents, according to the urgent notice from the superior, some medical institutions in Wuhan have successively appeared patients with pneumonia of unknown cause. All medical institutions should strengthen the management of outpatient and emergency departments, strictly implement the first-in-patient responsibility system, and find that patients with unknown cause of pneumonia actively adjust the power to treat them on the spot, and there should be no refusal to be pushed or pushed.
The document emphasizes that medical institutions need to strengthen multidisciplinary professional forces such as respiratory, infectious diseases, and intensive medicine in a targeted manner, open green channels, make effective connections between outpatient and emergency departments, and improve emergency plans for medical treatment.
Another piece of emergency notification, entitled “City Health and Health Commission’s Report on Reporting the Treatment of Unknown Cause of Pneumonia” is also true. According to this document, according to the urgent notice from the superior, the South China Seafood Market in our city has seen patients with pneumonia of unknown cause one after another.
The so-called unexplained pneumonia cases refer to the following 4 cases of pneumonia that cannot be diagnosed at the same time: fever (greater than or equal to 38C); imaging characteristics of pneumonia or acute respiratory distress syndrome; reduced or normal white blood cells in the early stages of onset The number of lymphocytes was reduced. After treatment with antibiotics for 3 to 5 days, the condition did not improve significantly.
It is understood that the 1st patient with unexplained pneumonia that appeared in Wuhan this time came from Wuhan South China Seafood Market.
12320 hotline staff said that the Wuhan CDC went to the treatment hospital to collect patient samples as soon as possible, specifically what kind of virus is still waiting for the final test results. Patients with unexplained pneumonia have done a good job of isolation and treatment, which does not prevent other patients from going to the medical institution for medical treatment. Wuhan has the best virus research institution in the country, and the virus detection results will be released to the public as soon as they are found.
Date: 31 Dec 2019
Source: Sina Finance Mobile
Patients with unknown cause of pneumonia in Wuhan have been isolated from multiple hospitals
Whether or not it is SARS has not yet been clarified, and citizens need not panic.
On [31 Dec 2019], various hospitals in Wuhan held an emergency symposium on the topic of the treatment of patients with pneumonia of unknown cause in some medical institutions. The 21st Century Business Herald reporter learned from multiple cross-examinations that these patients have gradually appeared in the South China Seafood Market in Wuhan. At present, the patients have been isolated at the hospital where they saw them. At the scene of the South China Seafood Market, the scene has been isolated and medical staff have confirmed Preventive treatment on site. However, several hospital sources said that at present, the etiology of these patients is not clear, and it cannot be concluded that it is the SARS virus [presently] rumored online. Even if the SARS virus is eventually diagnosed, there is a mature prevention and treatment system in place, and citizens need not panic.
On [31 Dec 2019], an official report from Hubei Province said: “Following the report of the Provincial Health and Health Commission, since December , Wuhan has continued to monitor influenza and related diseases, and 27 cases of viral pneumonia have been found, all of which were diagnosed with viral pneumonia / pulmonary infection. Of the 27 cases, 7 were critically ill, and the remaining cases were controllable. Two of them improved and were expected to be discharged soon. The investigation found that most of the cases were operated by South China Seafood City in Jianghan District, Wuhan. The National Health and Health Commission has decided to send an expert group to our province to guide the epidemic disposal on the morning of [31 Dec 2019]. At present, related virus typing, isolation treatment, public opinion control, and terminal disinfection are underway.
On the evening of [30 Dec 2019], an “Urgent Notice on Doing a Good Job in the Treatment of Unknown Cause of Pneumonia” issued by the Wuhan Municipal Health Commission circulated. The document was verified by cross-examination. “We are holding a special meeting on this,” said a medical worker at a famous 3rd-level hospital in Wuhan on the morning of [31 Dec 2019], but it was clear that the cause of the patient was not clear. For more detailed information, it is temporarily inconvenient to disclose. At present, Wuhan Health and Health Commission official phone 12320 and official website are busy and unable to log in respectively.
Baidu encyclopedia information shows that human diseases caused by SARS virus are mainly respiratory infections (including severe acute respiratory syndrome). The virus is sensitive to temperature and grows well at 33 C, but it is suppressed at 35 C. Because of this characteristic, winter and early spring are the epidemic seasons of the virus disease. SARS virus is one of the main pathogens of the common cold in adults. The infection rate in children is high, mainly upper respiratory tract infection, and it rarely spreads to the lower respiratory tract. In addition, it can cause acute gastroenteritis in infants and newborns. The main symptoms are watery stools, fever, and vomiting. It can be pulled more than 10 times a day. In severe cases, bloody stools can occur. In rare cases, it also causes nervous system syndrome. .
The serotype and antigenic variability of SARS virus is unknown. SARS virus can be repeatedly infected, indicating that it has multiple serotypes (at least 4 are known) and antigenic variations, and its immunity is difficult.
The SARS virus is mainly excreted through respiratory secretions, transmitted through oral fluids, sneezing, and contact, and transmitted through air droplets. The peak of infection occurs in autumn, winter, and early spring. Sensitive to heat, UV, Lysol water, 0.1% peroxyacetic acid, and 1% keliaolin [?] can kill the virus in a short time. [studies on removal of the SARS-CoV from surfaces demonstrated that the virus was rapidly killed by bleach, ethanol, acetone, and formaldehyde. http://www.cidrap.umn.edu/news-perspective/2003/05/sars-virus-can-last-2-days-surfaces-and-feces. – Mod.MPP]
There is specific prevention for SARS virus prevention, that is, targeted preventive measures, that is, prevention through vaccines, but there is no preventive vaccine against SARS. In addition, non-specific preventive measures can be taken, that is, measures to prevent respiratory infections in the spring, such as keeping warm, washing hands, ventilating, avoiding excessive fatigue and contacting patients, and going to less public places.
[Having been involved in moderating the SARS-CoV (Severe acute respiratory syndrome – coronavirus) and the MERS-CoV (Middle Eastern Respiratory Syndrome – coronavirus), the type of social media activity that is now surrounding this event, is very reminiscent of the original “rumors” that accompanied the SARS-CoV outbreak. The exception is the transparency of the local government in responding to this currently undiagnosed outbreak. While this report does not contain the tweets, there have been numerous tweets about this as yet undiagnosed outbreak.
Returning to the rumor mill, the discussion of this outbreak (a cluster of 4 or 7 cases) involves an “atypical pneumonia”. and now additional information of apparently 27 cases, with 7 severe cases. We do not know if influenza tests were performed, or if tests for the SARS-CoV are underway (but presumably are according to section  media report) in addition to other known (or unknown) respiratory viruses. As one of the tweets mentioned, another unusual pneumonia could be associated with infection with the bacteria _Yersinia pestis_ (plague) which has been diagnosed in Inner Mongolia in November 2019, but presumably has already been ruled out. The most recent report refers to the outbreak as a “viral pneumonia”, suggesting bacterial agents have been ruled out. But has legionellosis been ruled out? or have viral panels been performed?
More information on this outbreak including demographics of cases, possible known common contacts, and a clinical description of the illness would be greatly appreciated. And if results of testing are released.
According to Wikipedia, Wuhan city is the capital city of Hubei province. It has an estimated population over 11 million inhabitants and is the largest city in central China, and the 7th largest city in all of China. Geographically it is located in the eastern Jianghan Plain, on the Yangtze river’s intersection with the Han river.
A map of China showing locations of major cities in China can be found at https://www.chinadiscovery.com/china-maps/city-maps.html.
The HealthMap/ProMED map of China: http://healthmap.org/promed/p/155.
In flutrackers.com, there is this alert by “alert”, a Senior Moderator with 8747 posts who joined Apr 2009. Notice the “seems incredibly unlikely, unless a laboratory accident has occurred.”
SARS (or a related animal coronavirus) seems incredibly unlikely, unless a laboratory accident has occurred. Nevertheless:Some mainland media have also quoted sources from Shanghai’s Tongji University as saying the new cases of pneumonia and the Sars virus appear to be very similar, with both belonging to the coronavirus category.
(It should take very little time, perhaps less than 24 hours, to confirm or rule out SARS and influenza A. – alert)
The original Wuhan city health briefing on 31 Dec 2019 is no longer available at the originally posted link. Here is an English translation:
Wuhan Municipal Health and Health Commission’s briefing on the current pneumonia epidemic situation in our city
Issuing authority: Wuhan City health committee | Published: 2019-12-31 13:38:05 | Hits: 48254 |
Recently, some medical institutions found that many of the pneumonia cases received were related to South China Seafood City. After receiving the report, the Municipal Health and Health Commission immediately launched a case search and retrospective investigation related to South China Seafood City in the city’s medical and health institutions. Twenty-seven cases have been found , of which 7 are in serious condition, and the remaining cases are stable and controllable. Two patients are expected to be discharged in the near future. The clinical manifestations of the cases were mainly fever, a few patients had difficulty breathing, and chest radiographs showed bilateral lung infiltrative lesions. At present, all cases have been isolated for treatment, follow-up investigations and medical observations of close contacts are ongoing, and hygiene investigations and environmental sanitation disposals for South China Seafood City are ongoing.
Wuhan organized consultations with clinical medical, epidemiological, and virological experts from Tongji Hospital, Provincial CDC, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan Infectious Diseases Hospital, and Wuhan CDC. According to the analysis of epidemiological investigations and preliminary laboratory tests, the above cases are considered to be viral pneumonia. Investigations so far have not revealed any apparent human-to-human transmission or infection by medical staff. Detection of the pathogen and investigation of the cause of the infection are ongoing.
Viral pneumonia is more common in winter and spring, and can be spread or outbreak. The clinical manifestations are fever, soreness, dyspnea in a small part, and lung infiltration. Viral pneumonia is related to the virulence of the virus, the route of infection, and the age and immune status of the host. Viruses that cause viral pneumonia are common with influenza viruses, others are parainfluenza virus, cytomegalovirus, adenovirus, rhinovirus, and coronavirus. Confirmation depends on pathogenic tests, including virus isolation, serological tests, and viral antigen and nucleic acid tests. The disease can be prevented and controlled, and indoor air circulation can be prevented to prevent the public places and crowded places where there is no air circulation. People can wear masks when going out. Symptomatic treatment is the main clinical practice, and bed rest is required. If you have the above symptoms, especially the persistent fever, you should go to the medical institution in time.
December 31, 2019