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Coronavirus Infections Expanding at a Growing Rate As Coronavirus Fears Intensify, Effectiveness of Quarantines Is Questioned
(about 1 hour later)
SHANGHAI — A top Chinese health official warned on Sunday that the spread of the deadly new coronavirus, already extraordinarily rapid, could accelerate further, deepening global fears about an illness that has sickened more than 2,000 people worldwide and killed at least 80 people in China. WUHAN, China — A top Chinese health official warned on Sunday that the spread of the dangerous new coronavirus, already extraordinarily rapid, is accelerating further, deepening global fears about an illness that has sickened more than 2,700 people worldwide and killed at least 80 people in China.
Adding to the growing alarm, the official, Ma Xiaowei, the director of China’s National Health Commission, said that people carrying the virus but not showing symptoms could still infect others. The incubation period, he added, can vary from one to 14 days, with a typical duration of about 10 days. The grim diagnosis came amid concerns that China’s efforts to contain the spread of the disease, despite a lockdown of unprecedented scope affecting 56 million people, may not only have come too late but could even make the situation worse, including by exacerbating shortages of medical supplies.
Such asymptomatic transmission would represent a major difference between the new respiratory disease and SARS, which killed 800 people in China and around the world nearly two decades ago. Adding to the growing global alarm, people who are carrying the virus but not showing symptoms may still be able to infect others, according to the Chinese official, Ma Xiaowei, the director of China’s National Health Commission. Such asymptomatic transmissions would make the disease much more difficult to control, as seemingly healthy people travel and interact with others.
“The epidemic is now entering a more serious and complex period,” Mr. Ma said during a news conference in Beijing. “It looks like it will continue for some time, and the number of cases may increase.” “The epidemic is now entering a more serious and complex period,” Mr. Ma said during a Sunday news conference in Beijing. “It looks like it will continue for some time, and the number of cases may increase.”
In China, it was a weekend of grim new warnings about the little-understood virus and a rising tally of infections and deaths. The official number of confirmed infections across China jumped by half within a span of 24 hours, building to 1,975 on Sunday from around 1,300 on Saturday morning. China’s attempts to curb the disease’s spread — essentially cordoning off the major cities in the province of Hubei, including its capital, Wuhan, a city of 11 million people — are a “public health experiment, the scale of which has not been done before,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University. “Logistically, it’s stunning, and it was done so quickly.”
Among the most recent announced fatalities from the coronavirus was an 88-year-old man in Shanghai — the first death to be reported in the commercial hub, which is one of China’s most populated cities. One of the latest confirmed cases was that of a 9-month-old girl in Beijing. Whether the lockdowns will succeed in stemming the spread of the virus is a matter of debate by experts in public health and epidemiology. Some said the lockdowns would help, at least in theory.
New cases cropped up in Hong Kong, Taiwan and the United States, where the Centers for Disease Control and Prevention announced that California and Arizona both had patients, bringing the country’s total to five. The virus had already been found in Thailand, France, Japan, South Korea, Australia and beyond. “Anything that is done that increases social distancing can help decrease the spread of the virus, said Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention. “If you do it right, it’s not impossible it will have positive impact.”
In Wuhan, the Chinese city at the center of the outbreak, the mayor said on Sunday that health officials were likely to confirm an additional 1,000 cases of the illness in the city. But doing it right at this scale has never been tried before anywhere in the world.
The mayor, Zhou Xianwang, said that the estimate was based on the assumption that around half of the city’s nearly 3,000 suspected cases of the coronavirus would eventually test positive for the disease. “To put a ring around cities of this size and population is unprecedented,” said Dr. Howard Markel, a professor of the history of medicine at the University of Michigan and author of the book “Quarantine.”
Mr. Zhou also said that five million people had left Wuhan before travel out of the city was restricted, leaving nine million people still living there. That could imply that many more cases will be confirmed in other places in China over the next week or two. Maintaining the lockdown will pose tremendous challenges, starting with the provision of food, fuel and medical care to millions of people. “It’s enormously difficult to do effectively, and also difficult to assess the effectiveness,” said Dr. Schaffner.
China’s top leader, Xi Jinping, has promised drastic measures to contain the virus. The national government on Sunday banned the wildlife trade until the epidemic passes. The outbreak had drawn fresh attention to China’s animal markets, where the sale of exotic creatures has been linked to epidemiological risks. Other experts were skeptical that the travel restrictions would prove at all effective because they had probably come too late and the barriers would prove too permeable. Five million people had left Wuhan before travel out of the city was restricted, said the city’s mayor, Zhou Xianwang. It was a stunning disclosure that intensified questions about the government’s delayed response.
The 50 million people of Hubei Province, where Wuhan is the capital, found themselves in a virtual lockdown on Sunday. Chinese officials were considering extending the Lunar New Year holiday, which would delay the reopening of schools and offices and encourage more people to stay home. They are also limiting intercity bus travel and have ordered Chinese tour groups to cease operations starting Monday. “You can’t board up a germ. A novel infection will spread,” said Lawrence O. Gostin, a law professor at Georgetown University and director of the World Health Organization Collaborating Center on National and Global Health Law. “It will get out; it always does.”
But worries remained about whether the government could contain the spread of the virus. Epidemiologists at Imperial College London estimated that each case infected an average of 2.6 other people in the early stages of the crisis. In China, it was a weekend of grim new warnings about the little-understood virus and a rising tally of infections and deaths. The official number of confirmed infections across China jumped significantly within a span of 24 hours, building to 2,744 by Monday from around 1,975 the day before.
That number could drop as the authorities take more stringent measures to halt the spread. But if it holds up, the number of infected could rise sharply. Among the most recent announced fatalities from the coronavirus was an 88-year-old man in Shanghai — the first death to be reported in the commercial hub, and one likely to fuel anxieties about the disease’s spread.
New cases cropped up in Hong Kong, Taiwan and Orange County, Calif., bringing to five the number of confirmed cases in the United States. The virus had already been found in Thailand, France, Japan, South Korea, Australia and beyond.
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In Wuhan, the city at the center of the outbreak, the streets were eerily quiet as the authorities had ordered people not to drive, forcing some to walk to hospitals. Mr. Zhou, the mayor, said that health officials were likely to confirm an additional 1,000 cases of the illness in the city. He said that the estimate was based on the assumption that around half of the city’s nearly 3,000 suspected cases of the coronavirus would eventually test positive.
China’s top leader, Xi Jinping, has promised drastic measures to contain the virus.
In a signal of the gravity of the crisis, and its likely disruption to China’s short-term growth, the government announced on Monday that the annual weeklong Lunar New Year Holiday would be extended. For now, at least, many workers will get another three days off, and go back to work on Feb. 3.
Even before that notice, Suzhou, a big manufacturing hub in eastern China, declared that factories there should not start back at work any earlier than Feb. 8.
The national government on Sunday also banned the wildlife trade until the epidemic passes. The outbreak had drawn fresh attention to China’s animal markets, where the sale of exotic creatures has been linked to epidemiological risks.
In Hong Kong — which was badly hit by the SARS coronavirus in 2003, with nearly 300 deaths, more than any city in the world — worries about the spread of infectious diseases run deep. On Sunday, the government said it would bar residents of Hubei Province, which includes Wuhan, and people who had been to the province in the past 14 days from entering Hong Kong until further notice.
Six cases of the new coronavirus have been confirmed in the city, already hobbled by months of antigovernment protests.
Health officials in the United States, in what could turn out to be a positive development in stemming the disease, said there was no “clear evidence” that asymptomatic transmissions of the disease were happening.
“We at the Centers for Disease Control and Prevention don’t have any clear evidence of patients’ being infectious before symptom onset,” Dr. Nancy Messonnier of the National Center for Immunization and Respiratory Diseases said at a news briefing on Sunday. “We are actively investigating that possibility.”
Some global health experts said China’s focus, and resources, going forward should not be devoted to closing off cities.
Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, thought China’s approach to the crisis could easily “backfire,” comparing it to the so-called cordons sanitaires that were imposed to seal off swaths of West Africa during the 2014-2016 Ebola epidemic that left people starving and spurred violent uprisings. Others routinely found ways to sneak around or through the boundaries.
“It was a disaster,” Dr. Osterholm said.
Dr. Tom Inglesby, an infectious diseases specialist and director of the Johns Hopkins Center for Health Security, also expressed concern.
“If you continue to quarantine more and more places in China, you’re going to start to really break normal societal interaction, normal movement of goods and people and medical supplies and food and medicine,” Dr. Inglesby said. “At a macro level, it seems to me that it’s more likely to be harmful than helpful in controlling the epidemic.”
Instead, Drs. Inglesby, Osterholm and other health experts suggested China should concentrate on traditional public health measures that have stopped other outbreaks, like identifying and monitoring contacts and making sure medical care is available to everyone.
Even as the highest echelons of China’s government mobilize to fight the illness, much of the task of preventing contagion still falls on local officials, who can be unsure of how to respond to crises and uneven about following through on policies.Even as the highest echelons of China’s government mobilize to fight the illness, much of the task of preventing contagion still falls on local officials, who can be unsure of how to respond to crises and uneven about following through on policies.
On Sunday in Wuhan, for example, police officers were flummoxed by new restrictions on driving within the city limits.On Sunday in Wuhan, for example, police officers were flummoxed by new restrictions on driving within the city limits.
First, the city authorities said that most cars should stay off the roads, and that a fleet of 6,000 taxis would be on call to deliver food and medicine. Then, the authorities said drivers would be notified by text message if they had to stay off the roads. Nobody seemed to receive the text messages on Sunday.First, the city authorities said that most cars should stay off the roads, and that a fleet of 6,000 taxis would be on call to deliver food and medicine. Then, the authorities said drivers would be notified by text message if they had to stay off the roads. Nobody seemed to receive the text messages on Sunday.
“My understanding,” one police officer said, “is that you can drive in your district if you don’t get a text message telling you that you can’t. But you should check that with the transport authorities.”“My understanding,” one police officer said, “is that you can drive in your district if you don’t get a text message telling you that you can’t. But you should check that with the transport authorities.”
In the end, most drivers stayed off the streets. But as the day went on, more ventured out, and the police did not seem to do much about it.In the end, most drivers stayed off the streets. But as the day went on, more ventured out, and the police did not seem to do much about it.
For some residents, it was another exasperating fumble by Wuhan officials, who many believe have mishandled the epidemic. But the restrictions seemed to be mostly accepted with the same stoic fortitude that many showed over the past several days as the city imposed bans on travel out of Wuhan for all but a select few. For some residents, it was another exasperating fumble by Wuhan officials, who many believe have mishandled the epidemic.
That mood could shift, however, if the measures hamper food supplies and worsen medical shortages. Health experts said the government’s ability to keep the trust of the public was a key element in any successful quarantine, and never easy to do.
“Taking away people’s freedom to move around just antagonizes them and provokes distrust and resentment of the government,” said Mr. Gostin, the Georgetown law professor.
Dr. Inglesby said that previous, much smaller scale lockdown efforts — including closing off the Amoy Gardens housing complex in Hong Kong during the SARS outbreak 17 years ago — show that residents may become fearful and lose confidence in the government.
“You need people to willingly present themselves for diagnosis,” he said. “If they don’t understand what the government’s doing or they feel in some way their bond with the government has been broken, that’s another key process that’s being interrupted by the quarantine.”
For now, in Wuhan, the restrictions seem to be mostly accepted with the same stoic fortitude that many residents showed over the past several days as the city imposed bans on outbound travel for all but a select few.
That mood could shift, however, if, for example, food prices rise.
“Now is not the time for recriminations,” said Li Xiandu, a retired business manager. “The local government wasn’t forthcoming with information and didn’t take vigorous enough measures. But we need to get through this first, and then we can assign blame.”“Now is not the time for recriminations,” said Li Xiandu, a retired business manager. “The local government wasn’t forthcoming with information and didn’t take vigorous enough measures. But we need to get through this first, and then we can assign blame.”
The sense of confusion and uncertainty has even extended to the United States government’s effort to evacuate American diplomats and citizens from China. While the government has pledged to build at least two new hospitals with thousands of beds in Wuhan — and to do so in just a few days — the city’s existing hospitals remain intensely crowded, a condition that does not bode well for stopping the disease.
The State Department said on Sunday that it was arranging a flight that would leave Wuhan on Tuesday and travel to San Francisco. Apart from diplomatic personnel, the plane was also to carry a limited number of private citizens, the State Department said. “If you wanted to create the perfect mixing vessel for a coronavirus,” Dr. Osterholm said, “you’d create the emergency rooms in Wuhan right now.”
But the department did not say who would be given priority on the flight if there are not enough seats for everyone who wants to leave. Chris Buckley reported from Wuhan, China, Raymond Zhong from Shanghai, and Denise Grady and Roni Caryn Rabin from New York. Sheri Fink contributed reporting from New York, and Claire Fu and Wang Yiwei contributed research.
That was not much help for people like Jonny Dangerfield, 30, an American who went to Wuhan to celebrate the Lunar New Year with his wife and children.
Mr. Dangerfield, who works in finance in Phoenix, said he hoped that his family might be considered to be at greater risk from the virus because his three children are all under 5. But for now, he simply does not know.
“Just to keep ourselves sane, I guess, we have low expectations about getting on that plane,” Mr. Dangerfield said in a telephone interview.
Raymond Zhong reported from Shanghai, and Chris Buckley from Wuhan, China. Claire Fu and Wang Yiwei contributed research.