The World Health Organization has stepped back from declaring the growing viral pneumonia outbreak in China to be a public health emergency of international concern, saying its expert committee would meet again on Thursday to discuss more evidence from its teams on the ground.
“This is an evolving and complex situation,” said Dr Tedros Adhanom Ghebreyesus, the director-general of the WHO. “Today there was an excellent discussion but it was also clear that to proceed we need more information.”
More than 540 people have been taken to hospital with breathing difficulties and 17 have died, all in Hubei province, the Chinese authorities said on Wednesday. Many more are thought to have developed a milder form of the illness. UK infectious disease experts have doubled their estimate of the likely number of cases to 4,000.
The WHO’s emergency committee met as the international spread of the virus became clear, following the diagnosis of cases in people who have travelled not only to other regions of China but also abroad. There have been cases in Thailand, Japan, South Korea and most recently, the United States.
The coronavirus is from the same family that caused 800 deaths globally from Sars (severe acute respiratory syndrome) in 2002-03 and Mers (Middle East respiratory virus), identified in 2012.
The UK government has warned against all but essential travel to Wuhan, the centre of the epidemic, and announced checks on travellers arriving from the city. Chinese state media announced on Wednesday night that Wuhan is shutting down outbound flights and trains.
The official Xinhua News Agency said the city also asked people not to leave Wuhan without specific reasons. The People’s Daily newspaper tweeted that no one would be allowed to leave the city from 10am on Thursday and that train stations, the airport, city buses, subways, ferries and long-distance shuttle buses would be temporarily closed.
The novel coronavirus has been linked to a market selling seafood and live animals in Wuhan, which has now been closed. The type of coronavirus has never been identified before and it has been confirmed that human-to-human transmission is taking place.
Experts believe it is quite possible the disease, which causes coughing, fever and breathing problems, will arrive in the UK. It can take at least five days for symptoms to show. The airport checks may not pick it up, but will serve to alert people to the need to get medical attention if they fall sick.
Prof Neil Ferguson’s team at Imperial College London, who carry out disease modelling for the WHO, said they had increased their estimate from 1,700 cases at the end of last week to 4,000. However, they say there is considerable uncertainty and the true number could be between 1,000 and 9,700.
“You should not interpret that as the epidemic doubling in size in five days,” Ferguson said. The increase was due to more information coming out of China, where doctors were struggling to deal with a rapidly evolving situation. “All the reports I have read from within China [suggest] that hospitals are now overwhelmed with suspect cases.”
The confirmed cases tend to be the more severe ones, in people who end up in hospital. It is possible there are many more mild cases, which do not get reported but maybe more easily transmitted from one person to another. “It is vital we understand the rate of human-to-human transmission,” he said. “That will determine the feasibility of control and what measures will need to be taken.”
Peter Horby, a professor of emerging infectious diseases and global health at the University of Oxford, said there was “quite a long latency” after infection before serious symptoms show, starting with a mild fever and a dry cough. “After about a week or so, they develop shortness of breath and then severe respiratory distress. About 15 to 20% of hospitalised cases are severe, requiring oxygen or ventilation.”
Experts say the spread of the coronavirus fulfils the criteria for the WHO to declare it of international concern. “Personally, I think this is a big event,” said Horby. “Is it extraordinary? Yes, it pretty much is. We haven’t seen this large-scale spread since Sars.”
The death rate at the moment appears to be about 2%, which is far lower than in Mers (Middle East respiratory syndrome) which kills about a third, or Sars, which had a death rate above 10%. Both are also coronaviruses. The big Sars outbreak began in China in 2002 but spread globally. The Chinese authorities were criticised for failing to share information about the epidemic. There have been around 2,500 cases of Mers, which is far less transmissible, mostly in Saudi Arabia.
Heathrow has put health screening in place before, notably during the huge west Africa Ebola outbreak. In that case, all arrivals from the three affected countries – Sierra Leone, Liberia and Guinea – had their temperatures checked and filled out questionnaires about any possible exposure to the virus.
There will be warning messages during the direct flights from Wuhan, in Hubei province, said the Department of Health and Social Care, and captains will be required to report on any passenger feeling unwell before takeoff.
“This is a new and rapidly evolving situation where information on cases and the virus is being gathered and assessed daily. Based on the available evidence, the current risk to the UK is considered low. We are working with the WHO and other international partners, have issued advice to the NHS and are keeping the situation under constant review,” said Dr Nick Phin, the deputy director of the National Infection Service at Public Health England.
“If you are traveling to Wuhan, you should maintain good hand, respiratory and personal hygiene and should avoid visiting animal and bird markets or people who are ill with respiratory symptoms. Individuals should seek medical attention if they develop respiratory symptoms within 14 days of visiting Wuhan, either in China or on their return to the UK. They should phone ahead before attending any health services and mention their recent travel to the city.”
Public Health England has shifted its risk assessment slightly from “very low” to “low”, but, said the transport secretary, Grant Shapps, “obviously we want to stay ahead of the issue so we are keeping a very close eye on it”.
Most cases diagnosed have been in Wuhan but the virus has also spread to other Chinese cities, as well as the handful of overseas cases.
Ahead of the lunar new year on Saturday 25 January, Chinese authorities have advised against travel into and out of Wuhan, adding that the country was at the “most critical stage” of prevention and control.
The UK Foreign Office has updated its advice for Britons travelling to China, warning the virus had spread to other areas outside Hubei province.
