Coronavirus Case Confirmed in Washington State

The deadly and dangerous coronavirus has touched ground in the United States. The US Centers for Disease Control and Prevention (CDC) has officially confirmed the first case of novel coronavirus (2019-nCoV) or Wuhan coronavirus in the United States.

CDC and Washington state officials said in a telebriefing that the patient is a male US resident who arrived at Seattle-Tacoma airport on January 15, 2020. The patient did not have a fever at the time of arrival, and the flight was not a direct flight from Wuhan.

Additionally, the patient did not go to implicated animal markets in Wuhan, nor did he report close contact with an ill individual.

The patient had apparently researched the virus online, and upon developing symptoms reached out to his health care provider on January 19th. 2019-nCoV was confirmed on the 20th using samples shipped overnight. Public health officials from Washington indicated that the patient was hospitalized out of precaution but in overall good condition. 

A CDC team has been deployed to Washington for investigation, including contact tracing.

New cases of the 2019-nCoV outbreak have also been confirmed globally, including outside of the city of Wuhan, according to Chinese state media outlet Xinhua News Agency.

As of January 20, World Health Organization (WHO) officials have confirmed at least 278 cases of 2019-nCoV infection. So far, 6 people have died. Cases have now been reported outside Wuhan, including in the capital city of Beijing.

Reporting by WHO also mentioned confirmed cases in Japan, Thailand, and South Korea.

The outbreak was originally tied to a seafood market in Wuhan.

On January 19, WHO wrote on Twitter that an animal source was likely the primary source of 2019-CoV. The tweet also indicated that human transmission is occurring in this outbreak, which has since been validated by official Chinese sources.

“It has been confirmed that 2 people in Guangdong province were infected through human-to-human transmission," said Zhong Nanshan, MD, in a CCTV news conference reported on by China Daily. Zhong was the pulmonologist who discovered severe acute respiratory syndrome (SARS) in 2003.

Daniel Lucey, MD, MPH, adjunct professor of infectious diseases at Georgetown University Medical Center, explained that this confirmation was not surprising.

“Obviously, now there's been a lot of patients in the past 3 days reported from Wuhan…you [also] have patients elsewhere, in Shanghai and Beijing, in Guangdong Province. And a lot of [patients] came from Wuhan, but not from that market, it’s been closed since January 1st.”

Earlier public statements were cautious about the possibility of human transmission, despite the likelihood it would become an issue.

“There were some statements from China saying, ‘we've got things under control. There's no evidence of significant person-to-person spread,’ but that made me a little bit nervous. What does that mean, ‘significant person-to-person spread?’ And that it’s only in Wuhan. But all that changed, of course, over the weekend,” Lucey, a spokesperson for the Infectious Diseases Society of America said.

Overall, however, China appears to be taking a different approach from the early days of the SARS response. The Chinese government has modernized its public health infrastructure and participated in international epidemic responses to train health care workers.

“China has worked a lot over the last 17 years, for not just the next SARS-like coronavirus, but for any kind of disease, like pandemic flu in 2009. They sent people to West Africa, Sierra Leone and Liberia-where I worked with patients with Ebola in 2014-to work with patients and at the same time to gain experience,” Lucey explained.

“So, just like the United States really started doing more and better things after the anthrax attacks in 2001, I think China started doing more to fight off infectious diseases starting in 2003.”

Several countries in the region are relaying details about cases exported from China. On January 17, WHO summarized information from the Japanese Ministry of Health, Labor, and Welfare concerning a male patient between the age of 30-39 years, living in Japan.

According to the WHO statement, the case-patient in Japan had traveled to Wuhan in late December and developed a fever on January 3rd. He did not visit the Huanan Seafood Wholesale Market or any animal markets in Wuhan, and instead indicated close contact with a person who had pneumonia. On January 15th, testing identified a small amount of 2019-nCoV RNA.

WHO also reported case details from the Thai Ministry of Public Health. A 61-year-old Chinese woman with a fever, who had been living in Wuhan, traveled to Thailand on January 8. The illness was detected by surveillance activities at the airport of arrival and the patient was hospitalized the same day. The patient reported visiting a local fresh market on a regular basis, but had not visited the market associated with most cases. Genetic samples tested positive for coronaviruses on January 12th.

On January 17th, the US Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security’s Customs and Border Protection announced health screenings for travelers from Wuhan at 3 US airports.

“We fully anticipate that there'll be at least 1 person with this new virus that arrives in the United States. I think it's good to be as informed and aware as possible...I know that the CDC has daily conferences sharing information with the WHO. So that's a very important and positive thing,” Lucey said on January 20th in an interview with Contagion®.
WHO Reaction

The WHO also announced on January 20th that WHO Director-General Tedros Adhanom Ghebreyesus, PhD, would convene an emergency committee on January 22nd to ascertain whether 2019-nCoV constitutes a public health emergency of international concern.

The declaration of a public health emergency of international concern would lead to WHO making advisory statements on travel and outbreak response. The last time China faced a highly publicized outbreak, the mechanism for declaring a public health emergency of international concern did not yet exist.

“That was really catalyzed by the SARS epidemic, people said we need to have a more formalized system to declare whether an epidemic is really a global public health concern. And then, what are the rules for the temporary recommendations…so it's a really big, major significant event that's going to occur this Wednesday,” Lucey commented.

In pointing to the memory of SARS, however, Lucey noted that the United States saw only 28 cases of probable SARS in 2003, without any deaths.

This article originally appeared on ContagionLive.com.