H5N1

White House tells airlines it may suspend all China-US flights amid coronavirus outbreak

Thanks to @V2019N for alerting me to this CNBC report: White House tells airlines it may suspend all China-US flights amid coronavirus outbreak. Shades of West Africa 2014, when airlines serving Liberia, Guinea, and Sierra Leone just stopped flying there. It just made things harder for the countries' economies, not to mention the international Ebola response. 

The White House has told airline executives it’s considering suspending flights from China to the U.S. amid an escalating outbreak of a new coronavirus that has infected thousands of people across the world, people familiar with the matter said.  

The Trump administration is looking at a variety of measures to contain the fast-spreading virus that has infected roughly 4,700 people across the globe, U.S. health officials told reporters on a conference call Tuesday. White House officials called executives at major U.S. carriers on Tuesday, telling them that a temporary ban on China flights is on the table, according to people familiar with those conversations. 

United Airlines, which has the most service of the U.S. airlines to Hong Kong and mainland China with about a dozen daily flights, on Tuesday announced it would cancel dozens of flights next month to Hong Kong and mainland China as the outbreak worsens. The Chicago-based airline said it has experienced a “significant decline in demand for travel to China.” United and its rivals Delta and American are waiving cancellation and change fees for travelers booked to China. 

The restrictions could affect flights into and out of China, as well as airports across the United States, administration officials said. They declined to be named because no final decision has been made.  

A senior staff meeting was held at the White House on Monday during which the restrictions were discussed.

Canadian companies brace for further fallout from coronavirus

Via The Globe and Mail: Canadian companies brace for further fallout from coronavirus. Excerpt:

The Chinese city of Wuhan, the epicentre of the illness, is under lockdown with no public transportation permitted in or out as authorities try to contain the virus.  

Local officials have begun restricting movements in other regions, bringing travel and commerce to a standstill there. Global giants including Honda Motor Co. have begun evacuating workers. 

Concern is also growing that the virus has spread quickly, both inside and outside China. The government has extended the Lunar New Year holiday until Feb. 2 in an effort to slow postholiday travel, and quarantined for 14 days people who had been to Wuhan.  

Shares of Imax Corp., a Canadian film projection company listed on the New York Stock Exchange, fell further Monday after a drop last week. A big part of its business comes from China.  

The openings of five of its films scheduled for last weekend have been postponed, Imax spokesperson Mark Jafar said. The entire theatre system in China is shut down, he said.  

Shares in Canadian car parts maker Magna International Inc. also lost ground. The company employs some 18,750 people directly and through joint ventures in China, and is one of the most active Canadian companies in Wuhan’s Hubei province. 

“We are certainly keeping a close eye on the situation in China,” Magna spokesman Scott Worden said. “Our health and safety experts along with medical advisers are continuing to monitor it. As of today, we are not aware of any impact to our regional operations.” 

A federal laboratory has confirmed Canada’s first case of the new coronavirus and is investigating a second, both in Toronto, prompting Ontario to introduce new screening measures to protect paramedics responding to emergency calls. The province has an additional 19 patients with suspected cases of the new SARS-like coronavirus.

Awareness of the coronavirus and its potential impact is more acute in Canada than in many other nations. That’s likely because it has a similarity to severe acute respiratory syndrome (SARS), which killed 44 people in Canada in 2002 and 2003 – the most deaths outside Asia.  

Health authorities insist Canada is much better prepared to deal with a pandemic than it was 17 years ago. But the stakes for the Canadian economy from any disruption today are much higher because of China’s rise as a global power.  

China is so much bigger than it was, said National Bank of Canada chief economist Stéfane Marion, saying the country makes up 20 per cent to 25 per cent of the world’s manufacturing output while the number of Chinese people traveling by plane has gone from 73 million then to 611 million people a year now. 

“Is there a precedent for that on this scale? No. We’ve never seen it,” Mr. Marion said. “It’s the first time we’re dealing with the shock, the epicenter being in China, like SARS, but China being a much larger component of the global supply chain.”

Africa: Why the coronavirus should worry us all

Via allAfrica.com, an IPS article by Dr. Ifeanyi Nsofor: Africa: Why the Coronavirus Should Worry Us All.

Abuja — The coronavirus outbreak -- which began in Wuhan, China, and causes a pneumonia-like illness -- is raging across Asia, infecting close to 300 people and killing four. It was initially known to be transmitted from animals to human, and was just confirmed to be transmitted from human to human. 

The rapid nature of its origin and speed in transmission reminds us that national security is threatened when a pathogen can travel from a remote village to major cities on all continents in 36 hours. Therefore, global health security should be given the same priority as national security. 

The history of infectious disease outbreak is not new. In 1918, the Spanish flu pandemic infected about 500 million people globally (a third of world's population then) and caused the death of 20 million to 50 million victims. 

The 2014 -2015 Ebola outbreak in Liberia, Guinea and Sierra Leone infected 28,000 and killed over 11,000. By the end of the West Africa Ebola outbreak, the three nations lost a combined GDP of $2.8 billion. 

Infectious diseases continue to be a huge problem. Of recent, Ebola and measles outbreaks in DRC have killed 2236 and over 6,000 respectively.  

This Corona virus outbreak is happening during the Chinese Lunar New Year holiday as millions travel to visit with loved ones in country and travel abroad, making the current threat a global one. Most urgently, all countries must collaborate to contain this outbreak now 

The ease of travel in today's global community means the world must always be prepared for disease outbreaks. It is no longer whether an infectious disease outbreak would happen but when.  

Globally, 100,000 aircraft carry millions of passengers from one city to the other daily. A visit to flightradar24.com puts this in perspective and shows how interconnected countries are. 

 International borders really do not protect against infectious disease outbreaks. This is why governments, national public health institutes, communities, private sector and global health actors must act rapidly to contain this outbreak and others happening elsewhere.  

Also, processes must be put in place to prevent future outbreaks. These are four interventions to ensure response and prevention happen.  

First, increased screening at international borders using computerized thermal cameras should be intensified. No one should be exempt from this screening no matter how highly placed they are. 

In 2015, the global health community learnt the hard way the dangers of giving preference to diplomats in the way Patrick Sawyer moved freely from Monrovia to Lagos despite being already infected with Ebola. 

That oversight led to a short Ebola outbreak in Nigeria which could have gotten out of hand if not for quick response mounted by Nigerian authorities and other global health organisations. Beyond international air borders, most countries have very porous and poorly manned land borders. 

To overcome this challenge, communities along these borders must be properly informed about this current outbreak, its presenting symptoms and who to call when they suspect individual have symptoms. 

Second, prepare for the spread of fake news on infectious diseases and be proactive about pushing out the right information to counter it. Community education is very important, especially at this time when the infection is raging. People are scared and can easily fall prey to fake news.  

National public health institutes must take charge and disseminate the right information through different channels including TV, radio, Facebook, Twitter, Instagram, WhatsApp and community engagements. 

The experience with the spread of fake news during the Ebola outbreak in Nigeria in 2015 led to people bathing with salt water because they believed it would stop them from getting infected with Ebola. That fake news led to deaths of two victims.  

Third, governments in consultation with national public health institutes should designate specialized centers for handling suspected cases. At the same time, they should provide the necessary drugs for treatment too.  

These must be coordinated with staff at ports of entry. There should be no confusion about where to take a suspect case. If a suspected case presents at hospitals, there must be plans to immediately direct the individual to the right part of the hospital to prevent the spread of the infection. 

In 2015, while evaluating the African Union response to Ebola in West Africa, I heard firsthand the harmful effect of having hospital security workers who are not well informed. At Saint John of God Hospital in Port Loko District, Sierra Leone, the wrong handling of an Ebola case by a security officer led to deaths of 10 health workers.

Fourth, all governments must invest in epidemic preparedness. Although it is not cheap, it is cost effective. For instance, Nigeria Centre for Disease Control estimates that it would cost 40 cents per person for Nigeria to be prepared for epidemics.  

This amounts to $80 million for a population of 200 million. Not doing this and a pandemic occurs, Nigeria would lose $9.6 billion in GDP annually, according to the International Working Group on Financing Preparedness. 

Every country must have a financed plan and ensure that their national public health institute gets the required funds to lead prevention, detection and response to infectious diseases. Infectious diseases spare no one. 

As the World Economic Forum holds in Davos, Switzerland, business leaders must discuss ways of supporting governments to fund epidemic preparedness. It makes business sense and will protect their investments.

China coronavirus death toll climbs to 106 as confirmed cases near 4,500

We're a bit confused about the precise number of cases at the moment, but it does seem to have risen very sharply. Until I get better numbers, here's the South China Morning Post's tally: China coronavirus death toll climbs to 106 as confirmed cases near 4,500. That is, 4,494 in China, 4,559 worldwide.

The death toll from a coronavirus outbreak in China has soared to 106, Chinese authorities confirmed on Tuesday morning. 

In addition to air transmission, the coronavirus can be spread through physical contact, China’s National Health Commission (NHC) said on Tuesday. 

The incubation period of the new virus is on average 3-7 days, with the longest being no more than 14 days, the NHC stated, adding that the coronavirus strain is 85 per cent similar to severe acute respiratory syndrome (Sars). 

It also said the virus can infect children and infants, but their symptoms have been relatively mild. 

The total number of confirmed cases has climbed to almost 4,500 in China alone. Most of those who have died are from Hubei province, which is at the epicentre of the outbreak. Hubei health authorities said on Monday that 24 more people had died from the virus and 1,291 more people were infected in the province.  

In Shanghai, a newly developed broad-spectrum antiviral spray has been used in the emergency ward of the Shanghai Public Health Clinical Center to protect medical staff, according to news website Thepaper.cn. 

But the spray cannot be used for patient treatment as it has not obtained necessary approval, said Xu Jianqing, director of the health centre’s Institute of Infectious Diseases in an interview with Thepaper.cn.

While US officials from the Centres for Disease Control and Prevention (CDC) said the immediate health risk of the pneumonia-like illness – known as 2019-nCoV – to the American public remained low, the nation’s companies are starting to restrict their employees’ travel to China.

Facebook has started restricting employee travel, according to Bloomberg. The limits, which went into effect on Monday, halt non-essential travel to China by all Facebook employees. If workers have to visit the country, they need specific approval. 

Facebook staff based in China, and those who recently returned from trips to the country, are being told to work from home, Bloomberg reported.  

Some US banks and financial firms, including Citigroup, have told staff in Hong Kong to stay home for two weeks and monitor their health if they have travelled to Wuhan or surrounding areas. 

Banks in mainland China have extended the Lunar New Year break for staff until February 3 after the State Council, the nation’s cabinet, extended the public holiday to help stem the spread of the outbreak. 

The Shanghai stock market announced late Monday that it would resume trading on February 3 after being shut since January 23. The smaller Shenzhen exchange in southern China is expected to observe a similar suspension, according to a person familiar with the matter.

Global stocks fall as dangerous coronavirus spreads

Via The New York Times: Global Stocks Fall as Dangerous Coronavirus Spreads.

Stocks tumbled on Monday and oil prices fell, as the spread of a dangerous virus in China raised investor worries about the global economy. 

The sudden appearance of the coronavirus, which has now killed at least 80 people in China and infected others in Europe and the United States, among other countries, has pierced a calm that had settled over financial markets in recent months. Monday’s decline in the S&P 500 followed a similar drop on Friday. 

Nearly 3,000 people, mostly in China, have now contracted the disease. China extended the Lunar New Year holiday by three days until Feb. 2 in an effort to limit travel and contain the outbreak that started in the city of Wuhan. On Sunday, a fifth case of the disease was confirmed in the United States. 

The S&P 500 fell more than 1.5 percent on Monday, with shares of airlines and companies dependent on tourism from China particularly hard hit. American Airlines dropped more than 4 percent in early trading, and Wynn Resorts, which operates casinos in Macau, a special administrative region of China and a gambling haven for Chinese high rollers, dropped more than 7 percent. 

Major stock benchmarks in Europe were down more than 2 percent. While many markets in Asia were closed for Lunar New Year, Tokyo’s benchmark Nikkei 225 index also sank 2 percent.  

Oil prices dropped, reflecting concern that travel shutdowns and other reactions to the virus could slow the global economy, and shares of major oil companies also declined. Brent crude, the international benchmark, slipped below $60 a barrel, its lowest since October.  

China’s leaders are under pressure as the epidemic spreads at an accelerating rate. Concerns have been raised that the government’s response to the outbreak, which includes a lockdown of cities that affects 56 million people, is too late and could even make the situation worse.

The country’s economy, trying to shrug off its worst slowdown in nearly three decades, is already hurting from the impact on travel and tourism. There are fears the virus will dampen further the consumer spending that fuels the economy as more residents stay home over the Lunar New Year.

World braces for economic impact of Wuhan coronavirus outbreak

Via Nikkei Asian Review: World braces for economic impact of Wuhan coronavirus outbreak. Excerpt:

Although there are no readily available estimates yet on the economic impact of the latest coronavirus, China's economic rise since 2002 to become the world's second-biggest economy, with its industry deeply entwined in global supply chains, means it is unlikely to be negligible.  

So far, the most visible impact of the virus has been on tourism-related business -- not least in Japan, where Chinese visitors accounted for about 30% of the country's 32 million visitors last year, spending roughly 1.77 trillion yen ($16 billion). 

A hotel in Toyako, Hokkaido, said almost all of its 200 or so rooms were booked for the Lunar New Year holiday, which started this past weekend. But it has been hit by a flurry of cancellations by Chinese guests over the past few days, and now has as many as 50 vacant rooms on some days. A hotel representative said that with Beijing banning group tours, cancellations are likely to grow.  

A hotel near Mount Fuji in Yamanashi Prefecture, said that almost 100 would-be guests will not be arriving because five group tours from China have been called off.  

A Tokyo-based tour bus operator said that most tours for Chinese visitors to Tokyo Disney Resort and Mount Fuji have been canceled. ANA Holdings unit All Nippon Airways is suspending all flights between Wuhan and Narita Airport near Tokyo until Saturday.  

A Chinese economic slowdown would hurt the earnings of Japanese companies, and concern among investors would result in downward pressure on stock prices. 

"Risks will grow for such stocks as retailers that have been propped up by inbound tourism demand," said Yoshinori Shigemi at JPMorgan Asset Management.

Health officials expect more coronavirus cases, but say risk of outbreak in Canada remains low

Via CBC News: Health officials expect more coronavirus cases, but say risk of outbreak in Canada remains low. Excerpt and then a comment:

Federal health officials expect more cases of the coronavirus, but say the risk of an outbreak in Canada remains low.  

Health Minister Patty Hajdu said officials at all levels of government are working with hospitals and international partners to prevent and respond to potential infections.   

"We're working actively to limit the spread of the virus," Hajdu said at a news conference in Ottawa Sunday morning after the first "presumptive" case of coronavirus was reported in Toronto. 

Hospitals have an "incredibly strong" system to prevent and control infections, she said.

Hajdu said much has been learned from the SARS virus in 2003. Since the first cases of this novel coronavirus were reported in China in December, the federal government has been in close contact with the provincial health authorities and international players to share information in a "collaborative, responsive" approach.

Hajdu said there is considerable misinformation being spread about the virus which "belies the reality" that the risk to Canadians remains extremely low. C

BC News has reported that misinformation and unverified claims about the virus have been circulating on social media.  

While the government does not expect a chartered plane is necessary to evacuate Canadians from the Wuhan region where the outbreak began, Hajdu said Global Affairs Canada stands ready to provide support services for any Canadian trying to leave China. 

CBC News has learned that one Canadian will be on board a flight chartered by Washington to fly diplomats and Americans out of Wuhan. A government official said 67 Canadians are registered as being in the affected region, but because registration is voluntary, the figure does not give a complete picture of Canadians in Hubei or in China. 

Canada's Chief Public Health Officer Theresa Tam said despite the fact the number of cases in China is increasing, the export to other countries remains low and the risk remains low in Canada.  

Tam said the reported case Saturday was "not unexpected."

I completely agree that Canadian hospitals and the healthcare system in general will handle this well. SARS sandbagged us in 2003 because the Chinese had been too secretive about it; this time we've had a month to prepare a system already primed for such an event.

Meanwhile, I'm increasingly anxious about the political and economic consequences of the outbreak, which the world's media have so far ignored.

 

Quite about from the collateral damage to routine healthcare in China, which will likely cause more illness and death than coronavirus itself, I worry about a Chinese economy that's hemorrhaging money due to lost production, shuttered tourism, and a crippled transportation system.

 

I also worry about the political and social unrest that is already simmering below the surface: distrust of the healthcare system leading to resentment of a repressive government and all its other institutions. President Xi Jinping has already sent his own Beijing people to Wuhan to run the response, which shows how seriously he's taking the outbreak.

 

I tried to outline these concerns in a recent Tyee article, and the last two days have only worsened my anxiety. If China staggers, the whole world will shudder.

Wuhan leaders blamed for spread of China coronavirus as hospitals beg for supplies, death toll rises

Via the South China Morning Post: Wuhan leaders blamed for spread of China coronavirus as hospitals beg for supplies, death toll rises. Excerpt and then a comment:

Pressure is mounting for local leaders to be held accountable for their response to the Wuhan coronavirus outbreak, in the central Chinese province of Hubei, which has so far killed 56 and infected more than 1,900 people in the country. 

Doctors in Wuhan have been among those calling for health officials to be held to account and, in an unusually blunt statement on social media platform Weibo, a senior reporter from the province’s official Communist Party newspaper Hubei Daily said the city’s leaders should be removed “immediately”. 

“Like many people, I used to believe that a temporary decision to replace leaders with those less familiar with the situation would not be good for pushing through the [antivirus] work, but based on the worsening situation that is getting increasingly severe, those currently in the role have no capability of leadership,” reporter Zhang Ouya wrote on Friday. 

“For Wuhan, please change the leadership immediately,” he added. The post was later removed. It is particularly rare in China – where any criticism or scepticism is closely controlled under the country’s strict media censorship policy – for a journalist with a state-owned media outlet to make such a call publicly. 

Hours after the post was published, Hubei Daily released a statement, apologising to the city government and leaders for “making negative publicity” and confirming it had ordered Zhang to remove the post. 

The statement, which was widely circulated online, urged local reporters to “spread positive spirit” and said Zhang’s comments did not represent the newspaper “but still made a negative impact”. Neither the newspaper nor Zhang responded immediately to inquiries from the South China Morning Post. 

In a public letter to China’s top health authority, the National Health Commission, a doctor who claimed to be from a top hospital in Wuhan laid the blame for the serious nature of the coronavirus outbreak on the slow response by local health officials. 

The doctor, who did not give his real name, said the numbers of patients infected with the disease had been growing since January 12 but the local health authority had failed to report new cases.

“These patients were not given proper quarantine nor medical treatment and they could travel in every corner of the city,” the doctor wrote. “Later, when we warned patients and the public to wear masks and avoid crowded areas, they didn’t take it seriously and thought we were exaggerating, and even some medical staff, including surgeons didn’t believe it and were not willing to take basic precautions.”

This is precisely the kind of challenge to legitimacy that an outbreak poses—especially to a powerful authoritarian government. That's why, as I tried to explain in my recent article in The Tyee, an outbreak like this is a serious threat to the status quo, far beyond the mere number of people who fall ill and die. From any government's point of view, the case count is irrelevant; the economic and political consequences are what matter.

A novel coronavirus emerging in China: Key questions for impact assessment

Via NEJM: A Novel Coronavirus Emerging in China — Key Questions for Impact Assessment. The concluding paragraphs:

The substantial involvement of nosocomial transmission in both SARS-CoV and MERS-CoV outbreaks suggests that such transmission is a serious risk with other newly emerging respiratory coronaviruses. In addition to the vulnerability of health care settings to outbreaks of emerging coronaviruses, hospital populations are at significantly increased risk for complications from infection. Age and coexisting conditions (such as diabetes or heart disease) are independent predictors of adverse outcome in SARS-CoV and MERS-CoV. Thus, emerging viruses that may go undetected because of a lack of severe disease in healthy people can pose significant risk to vulnerable populations with underlying medical conditions.  

A lack of severe disease manifestations affects our ability to contain the spread of the virus. Identification of chains of transmission and subsequent contact tracing are much more complicated if many infected people remain asymptomatic or mildly symptomatic (assuming that these people are able to transmit the virus). More pathogenic viruses that transmit well between humans can generally be contained effectively through syndromic (fever) surveillance and contact tracing, as exemplified by SARS-CoV and, more recently, Ebola virus. Although containment of the ongoing Ebola virus outbreak in the Democratic Republic of Congo is complicated by violent conflict, all previous outbreaks were contained through identification of cases and tracing of contacts, despite the virus’s efficient person-to-person transmission.  

We currently do not know where 2019-nCoV falls on the scale of human-to-human transmissibility. But it is safe to assume that if this virus transmits efficiently, its seemingly lower pathogenicity as compared with SARS, possibly combined with super-spreader events in specific cases, could allow large-scale spread. 

In this manner, a virus that poses a low health threat on the individual level can pose a high risk on the population level, with the potential to cause disruptions of global public health systems and economic losses. 

This possibility warrants the current aggressive response aimed at tracing and diagnosing every infected patient and thereby breaking the transmission chain of 2019-nCoV. 

Epidemiologic information on the pathogenicity and transmissibility of this virus obtained by means of molecular detection and serosurveillance is needed to fill in the details in the surveillance pyramid and guide the response to this outbreak. Moreover, the propensity of novel coronaviruses to spread in health care centers indicates a need for peripheral health care facilities to be on standby to identify potential cases as well. In addition, increased preparedness is needed at animal markets and other animal facilities, while the possible source of this emerging virus is being investigated. 

If we are proactive in these ways, perhaps we will never have to discover the true epidemic or pandemic potential of 2019-nCoV.

Supplies of N95 mask running low in Hong Kong as Wuhan virus scare sparks panic buying and marked-up prices

Via the South China Morning Post: Supplies of N95 mask running low in Hong Kong as Wuhan virus scare sparks panic buying and marked-up prices. Excerpt:

Supplies of a mask widely used during the 2003 Sars outbreak in Hong Kong are running low amid the mystery pneumonia scare in the city, with some retailers doubling prices of limited stocks. 

At least three online platforms and 15 of the 21 pharmacies contacted by the Post said they had no more N95 respirators, but a doctor assured the public there was no need for panic buying as there was no sign yet of the disease spreading from the mainland Chinese city of Wuhan.

As of Monday, 59 cases were reported in Wuhan, with 21 suspected infections in Hong Kong. Some of the local cases have been found to involve known viruses or the flu, with others still pending test results. 

There has been no confirmed case outside the mainland city or evidence to suggest human-to-human transmission, according to health authorities there.

A check by the Post on Monday on three local online platforms selling N95 respirators and recommended by manufacturer 3M showed they were out of stock. 

“Due to the huge number of mask orders, the delivery time will be a bit delayed,” mall.builderhood.com, a website selling hardware materials, stated on its page.

Checks on other online retailers such as HKTVmall and Henry Chemical also showed that the respirators, with prices ranging from HK$8 to HK$12 each, were unavailable. 

A salesperson from Henry Chemical said they had been receiving a lot of orders from medical institutions since last week. “The masks should arrive at the end of this week. You can get them next week at the soonest.” 

Disposable surgical masks on the three sites were also out of stock. 

On Monday afternoon, the Post also conducted phone inquiries with 21 drug stores citywide on stocks for N95 respirators. Fifteen said they had no more supply, with four of the remaining six stores doubling prices to more than HK$24 [US$3] a piece. 

Some retailers told the Post they marked up prices because suppliers had raised costs as customers rushed to hoard the item. 

The N95 is a disposable mask that can guard against hazardous substances, and was widely used during the severe acute respiratory syndrome outbreak in 2003 which killed 299 people in the city. 

One staff member at a pharmacy in Sheung Shui told the Post that a new product batch would arrive on Monday afternoon, but he complained that the supplier had raised the wholesale cost. 

“The supplier’s price is crazy. It’s HK$480 [US$61.76] for a box, which means HK$24 per pack. I used to sell these at HK$10 to HK$14 each,” he said on the phone.