China Deserves Some Credit for Its Handling of the Wuhan Pneumonia
The country’s response to this outbreak has been far better than to SARS, although even more information-sharing is important.
In contrast to China’s early efforts to cover up the SARS epidemic that first struck southern China in 2002 and eventually spread worldwide, China has handled the outbreak of a new mystery pneumonia very differently. Within weeks of detection of the initial outbreak in December in Wuhan, China has already identified the novel coronavirus (“nCoV”) that is the likely cause of infection in 41 patients and shared the genetic sequence of that virus with the world to allow for specific laboratory testing.
China’s rapid recognition of this outbreak is particularly remarkable given that it is winter, when influenza and other infections cause many respiratory illnesses that make it difficult to tell whether any particular case of illness is the responsibility of a new respiratory disease. The major clue to this outbreak was that the initial patients had all had recent exposure to a single seafood and live animal market in Wuhan. So far, all of them experienced the onset of illness between Dec. 8 and Jan. 2. The incubation period—the time between exposure to the virus and the onset of fever, cough, or trouble breathing—is still unknown.
As of Jan. 12, one patient has died, seven remain in critical condition, and six have been able to leave the hospital. Unlike with the SARS coronavirus that infected well over 1,000 health care workers worldwide (and which also originated in a market in China), none of the 419 health care workers possibly exposed to this new virus have so far become ill, according to the latest official update from the Wuhan Municipal Health Commission.
Since Jan. 1, when the Wuhan market’s link to the outbreak became clear, that particular market has been shut down. The number of new reported cases since then has slowed. If, as some reports say, the virus is not easily spread from person to person, major communitywide outbreaks in Wuhan are unexpected, as is a major pandemic spread by travelers. Given that several hundred million people will travel across China before and after the Lunar New Year on Jan. 25, this month will provide a crucial stress test of this hypothesis.
Now the race is on to identify the one or more animal species that are the source of the new virus. A diagnostic laboratory test for the virus’s nucleic acid, developed by Chinese researchers after isolating the nCoV on Jan. 7, will be used to test animals. If an animal source of the virus is found, then the same species will be tested in other markets in Wuhan and elsewhere inside and outside China.
Beyond the credit Beijing should rightly take for acting relatively swiftly on this disease, the World Health Organization (WHO) has also played a key supporting role. The organization posted official updates on its website on Jan. 5, 9, 10, 11, and 12. WHO has also provided detailed guidance on whom to evaluate for infection, on laboratory testing, on infection prevention and control, and on travel.
Hong Kong, likewise, has offered an exemplary model for how to respond to the outbreak—and others that are sure to come. Immediately after publicly recognizing the Wuhan outbreak on Dec. 31, the Hong Kong Department of Health and its Centre for Health Protection took a series of precautionary steps. Those started with public guidance for health workers, schools, and extended-care facilities. Authorities also spoke with the media about the disease and created a dedicated webpage for information on the outbreak in Wuhan, which they updated daily. On Jan. 4, Hong Kong also posted a detailed “Preparedness and Response Plan for Novel Infectious Disease of Public Health Significance (2020)” on this site. The document is perhaps the first such comprehensive plan for a novel infectious disease that has been publicly released anywhere in the world.
Notably, Hong Kong immediately began evaluating and testing travelers coming from Wuhan with respiratory illness. Between Dec. 31 and midday on Jan. 12, they had tested 67 such patients and posted daily updates of the results on a government website. None had reported links to the Wuhan market before its closing on Jan. 1. Most had laboratory evidence for common winter viral infections such as seasonal human influenza, parainfluenza, adenovirus, rhinovirus, and respiratory syncytial virus. None tested positive for either the SARS or MERS coronavirus or for any other coronavirus. The pan-coronavirus test Hong Kong authorities used would have likely indicated whether the novel coronavirus linked to the Wuhan market was present; however, the new laboratory test specific for this novel virus would still be needed for precise identification. The 16 patients in the reported cases mentioned in a Jan. 8 Foreign Policy article have all since be discharged from the hospital and discounted as potential Wuhan pnuemonia cases.
Meanwhile, one Chinese tourist from Wuhan who was hospitalized in Thailand earlier this month has been confirmed to be infected with the new coronavirus. No links to the Wuhan market at the epicenter of the outbreak have been reported. The source of her infection—from another market or person-to-person spread—is not known. As a result of this development, WHO Director-General Tedros Adhanom Ghebreyesus has announced that he “will consult with the Emergency Committee members and could call for a meeting of the committee on short notice.”
This is the third pneumonia outbreak caused by coronavirus, The trajectory to date makes it unlikely that this particular outbreak will become as bad as the SARS or MERS coronavirus pneumonia epidemics. The caveat is that projections are difficult at the beginning of any epidemic.
However it plays out, the Wuhan pneumonia is unlikely to be the last such outbreak. While China and Hong Kong seem to have pulled off a scientific success story and an impressive level of national preparedness, control at a global level requires timely and complete information-sharing—or, even better, a universal coronavirus vaccine that could end this kind of epidemic for good.
Daniel Lucey is an M.D. at Georgetown University Medical Center in Washington, D.C.