China nCoV Cases Top 40,000, with More Tied to French Cluster

Mike Ryan, MD, who directs the WHO’s health emergencies program, said the goals of the joint mission are to learn more about the nature of the 2019-nCoV threat from Chinese health officials and to exchange ideas. He added that many of the experts already know their colleagues in China, and that the joint mission offers a chance to reconnect. “We need to give them the space to interact, and step back and let the scientists do their work,” he said.

In other WHO developments, a 2-day international global research and innovation forum to lay out an international action plan to battle 2019-nCoV begins tomorrow in Geneva. It will bring together leading scientists, public health agencies, health ministries, and research funders. The end result is expected to be a research agenda, as well as a list of priorities to guide which projects groups tackle first, with an eye toward fast-tracking the development and testing of diagnostic tests, vaccines, and therapies.

U.K. Notes 4 New Cases—All Tied to French Ski Resort
The United Kingdom yesterday reported its fourth case yesterday, and then four more today, all linked to a British man who contracted the virus at a meeting in Singapore, then traveled to a ski resort in Les Contamines, France, where he passed it to five people, all member of a British family—four adults and a child.

Public Health England (PHE) said two of the UK’s four new cases involve healthcare workers, who have been asked to self-isolate, The Guardian reported Monday, citing Yvonne Doyle, MD, MPH, the PHE’s medical director. The BBC on Monday reported that the two are general physicians and that a GP practice in Brighton has been closed after a staff member tested positive.

In a related development, Spanish health officials said yesterday that a British man has tested positive for the virus in Mallorca, Reuters reported. He had contact with someone in France who was diagnosed as having the virus. The man’s three other family members who were with him, including his wife and two daughters, have tested negative. Spain has now recorded two cases.

At today’s media briefing, Tedros said the WHO is worried about instances of onward transmission, such as those occurring in France and the United Kingdom, which he called a small spark that becomes part of a bigger fire. “Right now it’s a spark, and the goal is containment,” he said.

Ryan said 12 cases outside of China have been linked to a business meeting at a hotel in Singapore, which he said isn’t classified as a super-spreading event.

Cruise Ship Total Grows to 135
Japan’s health ministry on Monday reported that 65 more passengers on the quarantined cruise ship have tested positive for 2019-nCoV, raising the total to 135, according to a health ministry statement.

The Diamond Princess has been in Yokohama port since 3 February.

The WHO said in its situation report Sunday that the main quarantine period will end on Feb 19, but quarantine will be extended beyond that for close contacts of the newly confirmed cases. Boat passengers are asked to stay in their cabins and wear a mask when they need to leave their cabins.

New CFR Estimate; More Cases Outside of China
In its fourth analysis on the outbreak today, which focuses on outbreak severity, the MRC Center for Global Infectious Disease Analysis at Imperial College of London on Monday estimated that the overall case fatality ratio (CFR) is 1%. For cases in travelers outside of mainland China, which involve a mix of severe and milder cases, they estimated the CFR to be 1 percent to 5 percent. And for cases in Hubei, which tilt toward severe cases, the group estimated the CFR to be 18 percent.

The group cautioned that the estimates don’t reflect underlying differences in disease severity among countries, and they added that CFRs in different countries will vary based on how sensitive surveillance systems are at picking up different severity levels and the type of clinical care that severely ill patients receive.

“All CFR estimates should be viewed cautiously at the current time, as the sensitivity of surveillance of both deaths and cases in mainland China is unclear,” they wrote, noting that data on time intervals from symptom onset to death or recovery influences CFR estimates.

Meanwhile:

·  Singapore on Monday reported two more cases, one of them locally acquired and one involving an evacuee from Wuhan, the health ministry said in an update. The country now has 45 cases, some of which involve three known clusters, including the private business meeting linked to a handful of exported cases.

·  The United Arab Emirates (UAE) today reported its eighth case, the WHO’s Eastern Mediterranean regional office said on Monday on Twitter. In another tweet, the UAE’s health ministry said the patient is an Indian national and that the earlier reported patients are in stable condition, except for one who is in the intensive care unit.

In its situation report today, the WHO said that over the last 24 hours it received reports of 12 more 2019-nCov cases detected outside of China, raising the total to 319, 1 of them fatal, from 24 countries.