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Chinese pneumonia outbreak highlights potential for global pathogen spread

Seventeen years after the Severe Acute Respiratory Syndrome (SARS) global epidemic, its shadow lingers in an ongoing outbreak of mysterious pneumonia cases in China, which an international group of researchers says showcase the potential for pathogens to appear suddenly and wreak deadly global consequences.

This outbreak is linked to what is known as a coronavirus, a large family of viruses responsible for infections, including SARS and the common cold.

In a new report, researchers note that although it remains unclear whether human-to-human contact factors into this latest virus’s spread — in a recent tweet, the World Health Organization (WHO) noted “no clear evidence of human-to-human transmission” — major Asian hubs have become probable sites of exportation, should the epidemic continue its advance. The report was prepared by members of the University of Toronto Department of Medicine, Divisions of General Internal Medicine and Infectious Diseases at Toronto’s University Health Network, the Li Ka Shing Knowledge Institute at Toronto’s St. Michael’s Hospital, BlueDot, the University of Oxford’s Department of Zoology and the Centre for the Mathematical Modelling of Infectious Diseases at the London School of Hygiene & Tropical Medicine.

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For their report, these researchers evaluated 2018 travel data generated by the International Air Transport Association, specifically in regards to the passenger volumes flowing from the international airport in Wuhan, China. Wuhan is where this outbreak is believed to have begun, following reports of a cluster of pneumonia cases there on Dec. 30, 2019. At the time, these cases’ causes remained unknown — and they still are.

“Public health agencies around the world are reminding frontline healthcare providers to be vigilant for potential imported cases, however, this may be complicated in the northern hemisphere by high levels of influenza-like illnesses at this time of year,” the authors wrote. “To our knowledge, no advisories against travel to Wuhan have been issued.”

The new report tracked trips originating in Wuhan, as well as indirect trips that originated in Wuhan but connected flights before their final destinations. It also factored in for countries that receive significant numbers of travelers from Wuhan, reporting Infectious Disease Vulnerability Index (IDVI) scores that showcase countries’ capacity to respond to outbreaks. Most countries that receive the largest volumes of Wuhan passengers, however, had fairly high scores on that index — meaning the illness is cropping up in countries with relatively strong public health and healthcare capacity.

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Bangkok, Hong Kong, Tokyo, and Taipei, Taiwan, received the largest volumes of passengers from Wuhan between January and March. Cities in Thailand, South Korea, Singapore, Malaysia, Macao, Indonesia, Australia, and the United Arab Emirates were also on the list. Bali, Indonesia, is the most at risk.

Urgency was added to the situation with news that officials in Thailand confirmed the hospitalization of a traveler with the same virus, from Wuhan. WHO said that it is now working with officials in Thailand and China to address the novel coronavirus — meaning a strain that has not previously been identified in humans. It has also issued interim lab testing guidance for anyone testing patients potentially associated with the new virus.

“The possibility of cases being identified in other countries was not unexpected and reinforces why WHO calls for on-going active monitoring and preparedness in other countries,” WHO wrote in a Jan. 13 statement. “WHO has issued guidance on how to detect and treat persons ill with the new virus. The genetic sequencing shared by China enables more countries to rapidly diagnose patients. WHO reiterates that it is essential that investigations continue in China to identify the source of this outbreak and any animal reservoirs or intermediate hosts.”

WHO added that a meeting of the Emergency Committee could be called.

According to WHO, Chinese public health officials are still tracing contacts, conducting environmental assessments at a seafood market potentially central to the case and investigating the pathogen behind it all. To date, 41 cases of pneumonia have cropped up in Wuhan, with a single death linked to the outbreak and 121 close contacts placed under observation. Wuhan city has a population of 19 million.

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