Asia-Pacific
On Tuesday night, at least 144 people who have been trapped in Wuhan, the centre of the outbreak, are expected to arrive in Thailand on an evacuation flight. They will remain in isolation for 14 days, reportedly at a navy base in Chonburi province. The exact details of where they will be quarantined has not been made public in case there is opposition from local people, according to the broadcaster Thai PBS news.
The country is one of the most popular holiday destinations for Chinese people during the lunar new year break, and officials have warned that an outbreak is possible in its tourist areas. All arrivals from China are being screened at airports, while temperature scanners are being used in malls, and hand sanitiser given out in shops and on the transport system.
On Tuesday, it was announced that six more people in Thailand had been infected with the new coronavirus, bringing the total number of cases recorded so far to 25. The country confirmed its first case of human-to-human transmission of the virus last week, after a taxi driver was apparently infected by a traveller.
Hundreds more people have been undergoing investigation in hospitals, though most have been found to have seasonal influenza, according to the ministry of public health. Of the 25 cases recorded so far in Thailand, eight have since been discharged from hospital.
Not all countries in south-east Asia are offering to evacuate their citizens. Cambodia has refused to do so, prompting criticism that the country was prioritising economic interests and diplomatic relations over public health. Its leader, Hun Sen, said that an evacuation flight “would strain relations between the countries”. Cambodia has introduced screening at airports, though some reports have questioned how effectively this is being implemented.
What is the virus causing illness in Wuhan?
It is a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. Many of those initially infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city.
What other coronaviruses have there been?
New and troubling viruses usually originate in animal hosts. Ebola and flu are other examples – severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals.
What are the symptoms of the Wuhan coronavirus?
The virus causes pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. If people are admitted to hospital, they may get support for their lungs and other organs as well as fluids. Recovery will depend on the strength of their immune system. Many of those who have died were already in poor health.
Is the virus being transmitted from one person to another?
Human to human transmission has been confirmed by China’s national health commission, and there have been human-to-human transmissions in the US and in Germany. As of 7 February, the death toll stands at 636 inside China, one in Hong Kong and one in the Philippines. Infections inside China stand at 31,161 and global infections have passed 280 in 28 countries. The mortality rate is 2%.
Two members of one family have been confirmed to have the virus in the UK, and a third person was diagnosed with it in Brighton, after more than 400 were tested and found negative. The Foreign Office has urged UK citizens to leave China if they can.
The number of people to have contracted the virus could be far higher, as people with mild symptoms may not have been detected. Modelling by World Health Organization (WHO) experts at Imperial College London suggests there could be as many as 100,000 cases, with uncertainty putting the margins between 30,000 and 200,000.
Why is this worse than normal influenza, and how worried are the experts?
We don’t yet know how dangerous the new coronavirus is, and we won’t know until more data comes in. The mortality rate is around 2%. However, this is likely to be an overestimate since many more people are likely to have been infected by the virus but not suffered severe enough symptoms to attend hospital, and so have not been counted. For comparison, seasonal flu typically has a mortality rate below 1% and is thought to cause about 400,000 deaths each year globally. Sars had a death rate of more than 10%.
Should I go to the doctor if I have a cough?
Unless you have recently travelled to China or been in contact with someone infected with the virus, then you should treat any cough or cold symptoms as normal. The NHS advises that people should call 111 instead of visiting the GP’s surgery as there is a risk they may infect others.
Is this a pandemic and should we panic?
Health experts are starting to say it could become a pandemic, but right now it falls short of what the WHO would consider to be one. A pandemic, in WHO terms, is “the worldwide spread of a disease”. Coronavirus cases have been confirmed in about 25 countries outside China, but by no means in all 195 on the WHO’s list.
There is no need to panic. The spread of the virus outside China is worrying but not an unexpected development. The WHO has declared the outbreak to be a public health emergency of international concern, and says there is a “window of opportunity” to halt the spread of the disease. The key issues are how transmissible this new coronavirus is between people and what proportion become severely ill and end up in hospital. Often viruses that spread easily tend to have a milder impact.
Sarah Boseley Health editor and Hannah Devlin
In Indonesia, 238 nationals were sprayed with disinfectant by staff in protective suits as they disembarked from an evacuation flight on Sunday. After an examination, they were flown to Natuna island, where they have been placed in quarantine at Raden Sadjad airbase for two weeks. Indonesia has temporarily banned flights to and from mainland China, and said it won’t allow those who have been there in recent weeks to enter or transit. The country has also urged citizens to temporarily stop travelling there.
Malaysia evacuated 107 people from Hubei on Monday, with aircraft staff donating 500,000 pairs of rubber gloves as a gift to the Chinese government. Two people, who did not pass a health screening upon arrival, were sent to Kuala Lumpur hospital. Others were taken to a surveillance centre at an education academy, where they will remain for 14 days. The country has suspended all visas on arrival for travellers from Hubei, but not elsewhere.
Following growing public pressure, the Philippines president, Rodrigo Duterte, banned arrivals from across China, as well as Hong Kong and Macau. On Sunday, a 44-year-old Chinese man visiting the Philippines became the first person to die from the new coronavirus outside China. Authorities are now racing to trace those who had contact with the man, who had visited three provinces.
Vietnam has also halted all flights to and from China, as well as its autonomous regions, and stated that it will stop issuing visas for foreign visitors who have been in China in the past two weeks. As of Tuesday, Vietnam had recorded nine cases of the coronavirus.
In Myanmar, no cases have been recorded so far. However, the country lacks capacity to test for the virus, and results take about five days to arrive from Bangkok. Some 59 students who were evacuated in Wuhan remain under quarantine at Kandawnadi hospital, Mandalay, according to local media.
The 20 people confirmed to have contracted the coronavirus in Japan are being treated at several hospitals that are among 400 medical institutions designated by the government to treat the illness. Japan’s government drew criticism for allowing two men who were among the first group of evacuees from Wuhan to refuse to be tested last week – although they later agreed. Officials said Japanese law did not allow them to forcibly quarantine patients.
That policy changed at the weekend with the introduction of emergency measures allowing authorities to forcibly quarantine people who test positive, with penalties applying to those who refuse to be tested. Most of the evacuated people are staying in lodgings provided by the government, including a hotel and a training facility.
South Korea has recorded 16 cases, including two that appear to involve people who have not travelled to China: a 42-year-old woman who had recently returned to South Korea from Thailand, and a 48-year-old Chinese man who had been working as a tour guide in Japan.
About 700 South Koreans evacuated from Wuhan in recent days have been taken to two quarantine centres about 80km south of Seoul, where they will be kept in isolation for at least two weeks. Plans to quarantine evacuees at the centres, which are usually used to train civil servants, initially met with opposition from local residents who demanded that people returning from Wuhan be quarantined in more remote locations.
On Monday, South Korea said it would start testing everyone who develops even mild symptoms, such as a fever or cough, within 14 days of returning from any part of mainland China, Yonhap news agency said. In addition, those who have been in close or casual contact with a confirmed case will be made to self-quarantine for two weeks.
The first batch of an estimated 500 Taiwan residents stranded in Wuhan were allowed to return home late on Monday. The self-governing island has reported 10 cases of the virus and said it would deny entry to all foreign nationals who had been to China during the past 14 days. It has been in dispute with Beijing over coronavirus, saying it is excluded from the World Health Organization because of China’s objections and as such prevented from receiving timely information about the outbreak – a claim both China and the WHO have denied.
India has had three reported cases of coronavirus, all in Kerala, which has declared a “state calamity”. A total of 645 evacuees were flown to Delhi from Wuhan over Saturday and Sunday and are now in two mountain quarantine centres being managed by the army where they will be kept for two weeks.
In Kerala, 2,239 people are under observation and 84 have been admitted to various hospitals – the vast majority of the 2,815 people are presently under community surveillance across India’s 29 states.
The Indian government has revised the travel advisory asking the public to refrain from travelling to China and ordered that anyone who has travelled to China since 15 January 2020 should report themselves and be put in quarantine. The government has also temporarily suspended the e-Visa facility for Chinese passport holders and e-Visas already issued to Chinese nationals are also not valid temporarily.
Foreigners who have flown from or transited through China are barred from New Zealand for two weeks beginning Monday, and the government has raised its warning level for the country to “do not travel”. The national carrier, Air New Zealand, has suspended its Auckland-Shanghai route until late March.
Citizens, permanent residents and their families returning to New Zealand from China are subject to additional checks by nurses at the border, and required to isolate themselves for 14 days upon returning.
Those who wanted to leave Wuhan province have faced a longer wait and an impending quarantine period: a plane carrying about 250 people – New Zealanders, Australians, and people from the Pacific Islands – is due to land in Auckland on Wednesday.
Those onboard will be quarantined at a military base on New Zealand’s North Island for two weeks, where officials said they would have access to remote working, education, and recreation facilities.
Australia has separately evacuated 243 people, including 89 children, who were in Wuhan to an immigration detention centre on remote Christmas Island, where they will be quarantined for 14 days.
There have been no recorded cases of the virus in North Korea, but the country has taken measures to guard against the disease amid warnings that an epidemic could put an intolerable strain on its poor healthcare infrastructure.
North Korea has suspended flights from China and Russia and closed train routes across its borders with those two countries. It has also imposed a ban on foreign tourism and suspended operations at a liaison office it runs with South Korea just north of the demilitarised zone, the heavily armed border separating North and South Korea.
The country’s authorities have stepped up border inspections and health screenings of North Koreans returning from overseas business trips, according to the Rodong Sinmun, the newspaper of the ruling Workers’ party.
The newspaper said 30,000 health workers had been mobilised to monitor residents and distribute advice on how to avoid becoming infected.
Europe
Italy has evacuated 56 people from Wuhan and is quarantining them for two weeks at a military facility near Rome. A passenger who was expected to be on the flight remained in Wuhan after coming down with a fever. The condition of a Chinese couple being treated for coronavirus at Rome’s Lazzaro Spallanzani institute for infectious diseases health has worsened, the hospital has said.
Italy has a state of emergency in place for the next six months, allowing authorities to unlock investment to try and prevent the spread of the virus. Flights between Italy and China have also been suspended. Panic over the virus continues in Italy, with general practitioners and hospital emergency units overwhelmed with people suffering flu symptoms or simply seeking information from professionals. Codacons, the consumers’ group, has called for group tours at popular sites including the Colosseum to be banned.
Two flights bringing repatriated citizens from China have arrived in France. The first flight brought back 180 French citizens from the Wuhan region. A second flight brought back 250 passengers, mostly EU citizens, including 65 French nationals. The repatriated French people are being held in quarantine for two weeks either at a specially prepared centre in a firefighters’ training school at Aix-en-Provence, or a holiday centre at Carry-le-Rouet, in the Bouches-du-Rhone.
France has six reported cases of coronavirus. Two patients, a man of 31 and a woman of 31, are in a Paris hospital in a serious but not life-threatening condition. A 48-year-old man of “Chinese origin” is in hospital in Bordeaux in a stable condition, a Chinese tourist aged 80 is in intensive care in a Paris hospital, and his daughter, who tested positive for the virus, is also in hospital. The first reported case of human-to-human transmission in France is a GP said to have contracted the virus after examining one of the above in Paris.
A total of 12 people have tested positive with the virus in Germany so far. Eight of them are employees of car part supplier Webasto, headquartered in Stockdorf, Bavaria; two are the children of one of the employees. Four of the infected Webasto employees had taken part in a training workshop that was run by a Chinese employee who had only started to feel ill on her return flight to China, where she was subsequently tested positive for the 2019-nCov virus.
The company’s headquarters in Stockdorf have been disinfected by experts over the weekend and are to remain closed until 11 February. A further 140 employees were tested for the virus, and 80 of them have been ordered to stay indoors and avoid human contact even though their test results had returned negative.
People arriving in Germany from Wuhan are being assessed at Frankfurt airport’s medical assessment centre, and then brought to German army barracks in Germersheim, near Heidelberg, where they are put into quarantine for 14 days from arrival or outbreak of the virus. Two German citizens were tested positive after being flown from Wuhan to Frankfurt on a chartered Luftwaffe flight.
The United Kingdom flew back 83 people from Wuhan on Friday with 11 arriving via France on Sunday. All are being quarantined at Arrowe Park hospital in Wirral, where they will stay in staff accommodation and be monitored around the clock for 14 days.
Ireland has no confirmed case of coronavirus and is not quarantining people but officials in hazmat suits escorted a passenger from an airplane as a precaution.
The man, believed to be from China, was transferred to an ambulance on Saturday after arriving in Dublin on an Aeroflot flight from Russia. He had flu-like symptoms but a test revealed he did not have coronavirus. Last week test results had to be sent to the UK but Ireland’s National Virus Reference Laboratory now has kits, speeding up tests.
A military cargo plane from Turkey on Saturday airlifted 34 Turkish citizens, seven Azerbaijanis, seven Georgians, and one Albanian from Wuhan after medical checks confirmed they were not infected. They are all under a 14-day quarantine at a hospital in Ankara. A Chinese citizen suspected of infection was held in quarantine on arrival in Istanbul for 36 hours then voluntarily returned home after that.
Seven people evacuated from Wuhan arrived in Hungary on Sunday and will be quarantined for two weeks.
Russia has sent planes to China as it begins its evacuation from Wuhan and Hubei province. More than 700 Russians are said to be living in the region, of whom 132 had expressed a desire to return to Russia, the country’s embassy in Beijing has reported. They will be subject to a two-week quarantine period at a sanatorium in Tyumen region with a guarded perimeter.
In the past few days, Russia has quickly stepped up travel restrictions to and from China. Late Monday night, the government announced a temporary ban on direct travel for foreigners from China to Russia, except via Moscow’s Sheremetyevo airport.
Two cases of infection have been reported in Russia, one in Siberia and the other in Russia’s far east. Both of the victims are Chinese citizens. One of the men, Yan Wunbin, wrote in a letter to the Chita.ru website that he was never given his test results and only learned that he had been diagnosed with the coronavirus from media reports. He complained about conditions at the hospital in Russia’s Zabaykalsky Krai region about 240 miles from the Chinese border. There were not enough doctors on call and he was worried for the health of his two-year-old daughter, who was ill and in quarantine with him.
Middle East
The United Arab Emirates has recorded five cases of coronavirus, four of whom are Chinese tourists from the same family. Emirates officials say the family, along with a fifth patient, have been quarantined in local hospitals in rooms that have lower air pressure than normal. Air can flow into these rooms, but not out, minimising the risk of the virus spreading.
As one of the world’s most important transit hubs, with major airports in Dubai and Abu Dhabi, an outbreak of the virus there would be of particular concern. Authorities say they are confident in their ability to contain its spread, and on Tuesday took further measures to do so – banning most flights to and from mainland China and introducing strict protocols, involving up to eight hours of vetting and health checks for anyone wanting to travel from Beijing, which remains the only route still flown, and only by Emirates Airlines.
Officials in the UAE say the threat from Middle East respiratory syndrome six years ago sparked a comprehensive response this time round. Mers was an even more potent form of coronavirus, killing up to 17% of those who contracted it. By contrast the current virus has a death rate of closer to 3%. The five patients in the UAE will be quarantined for 14 days in government-run hospitals.
Africa
There have been no verified infections in Africa to date, but several countries, including Ethiopia, Kenya, Angola, Botswana and Ivory Coast, have signalled possible infections. Confirming or ruling out coronavirus in the continent can take time, as health authorities lacking expertise have to send samples to labs in countries such as South Africa.
The WHO has identified 13 top priority countries on the continent, including much of eastern, central and southern Africa, which either have direct links or a high volume of travel to China. All the concerned states have put in place controls at airports, using thermal cameras to detect potentially infected passengers, and have readied isolation units. At the weekend, Air Tanzania joined five other African airlines in suspending or restricting flights to China, though Ethiopia’s national flag carrier, which carries almost half of all passengers, has maintained flights.
Nigeria has urged any person arriving from China to “self-isolate” for at least two weeks, even if they are not ill, and in Mozambique, the government has suspended visas for Chinese citizens and forbidden its citizens from travelling there. Authorities in South Africa said they had set up an emergency operations centre and were monitoring passengers at 36 entry points.
The one confirmed case of an African with coronavirus is a 21-year-old student from Cameroon living in Jingzhou city, one of more than 80,000 students from the continent in Africa. At least 4,000 of that number are believed to be in Wuhan.
Americas
The Trump administration declared the coronavirus a public health emergency and has severely limited who can enter the United States based on their travels to China. People who recently travelled to mainland China and are neither permanent residents nor immediate relatives of permanent residents will not be allowed to enter the country. It is the most severe travel restriction since a smallpox outbreak prompted mandatory quarantines five decades ago.
Citizens and permanent residents returning from Hubei, the province including Wuhan, will be quarantined on military bases for two weeks. Americans returning from other parts of mainland China will be subject to a two-week at-home quarantine.
All three major US airlines have cancelled services to China and US officials are “funnelling” all travellers from China to just seven airports in New York, Los Angeles, Chicago, Honolulu, Seattle and Atlanta.
To date, 11 people in the US have been diagnosed with the coronavirus, two of whom live outside Chicago.
Canada has chartered an aircraft to evacuate 304 citizens from Wuhan. Upon arrival in Canada, all passengers on the flight will be quarantined for two weeks at CFB Trenton, a military base in Ontario.
Instead of barring travellers from China, Canada has instead requested that they self-report any symptoms related to the coronavirus, resisting calls for broader screening measures. Of the four confirmed cases in Canada – all of which were self-reported – one patient has been discharged from hospital following a successful recovery.
So far no cases of coronavirus have been confirmed in Latin America, but there are particular fears over how Venezuela’s collapsed health service might cope with any outbreak. But regional governments have begun taking steps to identify any possible cases and evacuate citizens from Wuhan.
Private companies are also acting. Uber this week said it had suspended the accounts of two drivers and 240 users in Mexico after discovering that a Chinese man who was later diagnosed with coronavirus in the United States had used the ride-hailing service while visiting the capital.
In the northern city of Ciudad Juárez the Taiwanese tech giant Foxconn reportedly placed 45 Chinese business people in informal quarantine at one of its factories as a precautionary measure since many employees had visited Wuhan.
But Mexican newspapers have raised concerns that citizens returning from China are not being screened on arrival. Mexico’s health ministry says only those arriving from Hubei province are being examined.
Brazil said on Sunday that it would evacuate its citizens from Wuhan by plane after facing criticism for its slow response. Once back in Brazil, those evacuated are expected to be placed in quarantine on a military base.
Reporting team: Rebecca Ratcliffe, Justin McCurry, Hannah Ellis-Petersen, Charlotte Graham-McLay, Angela Giuffrida, Kim Willsher, Philip Oltermann, Rory Carroll, Shaun Walker, Bethan McKernan, Martin Chulov, Jason Burke, Jessica Glenza, Leyland Cecco and Tom Phillips
