Pneumonia in China: lack of information raises concerns among Hong Kong health workersBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m56 (Published 08 January 2020) Cite this as: BMJ 2020;368:m56
All rapid responses
The past few weeks have gradually spread fear due to the outbreak of a novel Coronavirus (nCoV). The outbreak presented as clusters of pneumonia of unknown etiology.  Epidemiological surveys have linked the outbreak to wholesale fish and live animal markets in the largest central city of China, Wuhan city  This suggests that the new strain is zoonotic in origin and belongs to the same family of the severe acute respiratory syndrome (SARS virus) and middle east respiratory syndrome (MERS virus). After their respective outbreaks, this rapid spread of novel coronavirus poses another major public health crisis for the region.
As of January 16th, 2020, relevant health authorities in Japan have reported their first diagnosed case of pneumonia due to the novel coronavirus.  This is now the second case reported outside China, while the first was reported in Thailand. Japan now becomes the third country to be affected by this latest outbreak. Cases in Wuhan presented with a history of exposure to live fish markets or live animals. However, the patient who surfaced in Japan had no history of visits to fish markets while in China. This could prove as evidence of transmission on direct contact with an unknown infected patient which priorly was lacking.
Reported symptoms in the original cluster of patients include fever, dyspnea, and bilateral lung infiltrates on chest x-ray. Keeping track of recent events, the CDC has issued a level 1 travel notice (practice usual precautions). Furthermore, the CDC has also recommended the following protocols for healthcare providers :
1. Providers should consider pneumonia due to novel coronavirus when severe respiratory distress symptoms occur in an individual who traveled to Wuhan since December 1, 2019. The onset of symptoms should be within two weeks of returning. Furthermore, the patient must not have other co-morbidities that would indicate their symptoms. If the criteria are met, the provider must contact the infection control staff and relevant state health authorities.
2. In suspected patients, collect multiple respiratory specimens such as nasopharyngeal, nasal and throat swabs. Patients with severe respiratory symptoms should further have lower respiratory specimens collected.
3. Identified patients should be placed in separate admission or examination rooms and must wear a surgical mask. Providers entering the room should wear an N95 disposable respirator. For patients admitted for inpatient care, relevant airborne isolation protocols must be followed.
1.HAN Archive - 00424 | Health Alert Network (HAN) [Internet]. Centers for disease control and prevention. 2020 [cited 16 January 2020]. Available from: https://emergency.cdc.gov/han/han00424.asp
2. Japan Confirms First Case of New Chinese Coronavirus [Internet]. The New York Times. 2020 [cited 16 January 2020]. Available from: https://www.nytimes.com/2020/01/15/world/asia/coronavirus-japan-china.html
3. Gan N. China's new SARS-like virus has spread to Japan, but we still know very little about it [Internet]. CNN. 2020 [cited 16 January 2020]. Available from: https://edition.cnn.com/2020/01/15/asia/wuhan-virus-questions-intl-hnk/i...
4. Novel Coronavirus in China - Watch - Level 1, Practice Usual Precautions - Travel Health Notices | Travelers' Health | CDC [Internet]. Centers for Disease Control and Prevention. 2020 [cited 16 January 2020]. Available from: https://wwwnc.cdc.gov/travel/notices/watch/novel-coronavirus-china
Competing interests: No competing interests
Chinese researchers are racing to uncover the cause of a mysterious respiratory illness that has infected almost 60 people in Wuhan City, with a population of 19 million, the capital city of Hubei Province of China, with a population of 58 million people . Chinese health authorities have ruled out influenza, bird flu, avian flu, adenovirus, and Middle East respiratory syndrome (MERS), as the source of the mystery Wuhan virus. Authorities have also ruled out the highly infectious severe acute respiratory syndrome (SARS), which killed 349 people in mainland China and 299 in Hong Kong in 2002 and 2003 . There was no vaccine and no effective treatment for SARS, aside from supportive steps such as mechanical breathing support and the administration of steroids to reduce lung inflammation.
Chinese authorities identified a new type of coronavirus (novel coronavirus, nCoV), which was isolated on 7 January 2020. The clinical manifestations of the cases were mainly fever, a few patients had difficulty breathing, and chest radiographs showed bilateral lung infiltrative lesions. Laboratory testing was conducted on all suspected cases identified through active case finding and retrospective review. According to information conveyed to the World Health Organization (WHO) by Chinese authorities on 11 and 12 January, 41 cases with novel coronavirus infection have been preliminarily diagnosed in Wuhan City . Of the 41 cases reported, seven are severely ill and one was dead. Six patients have been discharged from the hospital. No additional cases have been detected since 3 January 2020.
The first novel coronavirus infection has been detected outside of China, in a woman who traveled from Wuhan to Thailand, a development that the WHO said isn't surprising but has triggered discussions about convening an emergency committee .
According to the epidemiological survey, patients were operating dealers or vendors in the Wuhan seafood market, which has since been closed. Besides seafood, the market is known to also sell live animals, including birds and snakes, and the organs of rabbits and other wildlife . The infection is probably an emerging zoonotic virus — infections that spread from animals to humans, says Linfa Wang, a virologist at the Duke-National University of Singapore. Such infections often first appear in colder months when animal pathogens can survive and spread to people. At present, hygiene investigations and environmental sanitation disposals for the Wuhan seafood market are ongoing to prevent any possible spread of the infections. The quick response and public notification “is obviously progress for China” says Guan Yi of the University of Hong Kong, an expert in emerging viral diseases.
WHO is closely monitoring the situation and is in regular contact with national authorities in China to provide the support required. Technical guidance on novel coronavirus has been developed. WHO’s recommendations on public health measures and surveillance for novel coronaviruses apply. WHO does not recommend any specific health measures for travelers .
1. New virus identified as likely cause of mystery illness in China. (https://www.nature.com/articles/d41586-020-00020-9) (accessed January 14, 2020)
2. Chinese researchers reveal draft genome of virus implicated in Wuhan pneumonia outbreak (https://www.sciencemag.org/news/2020/01/chinese-researchers-reveal-draft...) (accessed January 14, 2020)
3. World Health Organization. Novel Coronavirus – China (https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/). (accessed January 14, 2020)
4. Thailand finds Wuhan novel coronavirus in traveler from China (http://www.cidrap.umn.edu/news-perspective/2020/01/thailand-finds-wuhan-...). (accessed January 14, 2020)
5. No answers yet in China's pneumonia outbreak (http://www.cidrap.umn.edu/news-perspective/2020/01/no-answers-yet-chinas...). (accessed January 14, 2020)
Competing interests: No competing interests