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    Coronavirus: Death toll rises

    January 30, 2020
     

    The death toll from the coronavirus outbreak has risen to 170, and a confirmed case in Tibet means it has reached every region in mainland China.Chinese health authorities said there were 7,711 confirmed cases in the country as of 29 January.Infections have also spread to at least 15 other countries.The World Health Organization (WHO) will meet on Thursday to again consider whether the virus constitutes a global health emergency."In the last few days the progress of the virus, especially in some countries, especially human-to-human transmission, worries us," WHO Director-General Tedros Adhanom Ghebreyesus said on Wednesday.He named Germany, Vietnam and Japan, where there have been cases of people catching the virus from others who have been to China.

    "Although the numbers outside China are still relatively small, they hold the potential for a much larger outbreak," the WHO chief said.More people have now been infected in China than during the Sars outbreak in the early 2000s, but the death toll remains far lower. Sars, also a coronavirus, caused acute respiratory illness.Researchers are racing to develop a vaccine to protect people from the virus. One lab in California has plans for a potential vaccine to enter human trials by June or July.

    What's the latest on evacuations?
    Voluntary evacuations of hundreds of foreign nationals from Wuhan are under way to help people who want to leave the closed-off city and return to their countries.

    The UK, Australia, South Korea, Singapore and New Zealand are expected to quarantine all evacuees for two weeks to monitor them for symptoms and avoid any contagion.

    British flight out of Wuhan 'unable to take off'
    Australia plans to quarantine its evacuees on Christmas Island, 2,000km (1,200 miles) from the mainland in a detention centre that has been used to house asylum seekers.

    Image copyrightREUTERS
    Image caption
    The Costa Smeralda cruise ship, carrying 6,000 people, is stuck at port near Rome
    Singapore is setting up a quarantine facility on Pulau Ubin, an island north-east of the city-state's mainland.

    In other developments:

    Six thousand passengers on board a cruise ship docked near Rome are being barred from disembarking after a woman from Macau was suspected of having coronavirus The 54 year old and her travelling companion are being held in isolation on the ship while tests are carried out
    Russia has closed its 4,300km (2,670-mile) far-eastern border with China
    Flights to take British and South Korean citizens out of Wuhan have both been delayed after relevant permissions from the Chinese authorities did not come through
    Two flights to Japan have already landed in Tokyo. Three passengers have so far tested positive for the virus, Japanese media report
    Around 200 US citizens have been flown out of Wuhan and are being isolated at a military base in California for at least 72 hours
    Two aircraft are due to fly EU citizens home with 250 French nationals leaving on the first flight
    India has confirmed its first case of the virus - a student in the southern state of Kerala who was studying in Wuhan
    Image copyrightAFP
    Image caption
    Japan's first flight with evacuees arrived on Wednesday
    How is China handling the outbreak?
    Although questions have been raised about transparency, the WHO has praised China's handling of the outbreak. President Xi Jinping has vowed to defeat what he called a "devil" virus.

    The central province of Hubei, where nearly all deaths have occurred, is in a state of lockdown. The province of 60 million people is home to Wuhan, the heart of the outbreak.

    The city has effectively been sealed off and China has put numerous transport restrictions in place to curb the spread of the virus.

    Image copyrightGETTY IMAGES
    Image caption
    The WHO warns the virus holds the potential for a much larger outbreak
    People who have been in Hubei are also being told by their employers to work from home until it is considered safe for them to return.

    The virus is affecting China's economy, the world's second-largest, with a growing number of countries advising their citizens to avoid all non-essential travel to the country.

    How are coronavirus patients treated?
    How worried should we be?
    Several international airlines have stopped or scaled back their routes to China and companies like Google, Ikea, Starbucks and Tesla have closed their shops or stopped operations.

    There have been reports of food shortages in some places. State media says authorities are "stepping up efforts to ensure continuous supply and stable prices".

    The Chinese Football Association has announced the postponement of all games in the 2020 season.

    Who has been affected?
    Although there have been nearly 8,000 infections, there has been little detailed information released on the profiles of patients and how the disease affects them.

    Most of the confirmed cases involve people either from Wuhan or who had close contact with someone who had been there.

    A new study published by The Lancet medical journal gives a snapshot of 99 cases of the new coronavirus observed at Wuhan Jinyintan Hospital from 1-20 January. It reveals:

    Of the 99, 49 had been exposed to the seafood and animal market believed to be at the centre of the outbreak
    The average age was 55.5 years and most (67) were men
    Fever and a cough were the most common symptoms
    Seventeen patients developed acute respiratory distress syndrome and 11 of them died of multiple organ failure; 31 of the 99 had been released from hospital by 25 January
    The researchers said the infection appeared to be "more likely to affect older males" with additional medical conditions
    Of the 99, 51 suffered from a chronic condition (mostly cardiovascular or cerebrovascular)

    Living alone in a city gone quiet
    7 hours ago
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    Related TopicsCoronavirus outbreak
    Guo Jing lives in Wuhan, the Chinese city at the heart of the outbreak of a new virus which has got the world worried.

    Wuhan has been under lockdown since 23 January, to try to contain the infection. Transport is shut down, most shops and businesses closed, and people are being advised to stay at home.

    Jing is a 29-year-old social worker and rights activist who lives on her own. For the past week, she has kept a diary, which she shares here with the BBC.

    Thursday 23 January - the day of the lockdown
    I didn't know what to do when I woke up and learned about the lockdown. I don't know what it means, how long it will last and what kind of preparations I should make.

    There are a lot of infuriating comments [on social media]: that many patients cannot be hospitalised after diagnosis [because of a lack of places], that patients with fever are not properly treated.

    Many more people are wearing masks. Friends have told me to stock up on supplies. Rice and noodles have almost sold out.

     

    Media captionFears over coronavirus in China trigger face mask shortage
    A man was buying lots of salt, and someone asked him why he was buying so much. He replied: "What if the lockdown lasted for a whole year?"

    I went to a pharmacy and it was already limiting the number of shoppers. It had already sold out of masks and alcohol disinfectant.

    After stocking up on food, I am still in shock. Cars and pedestrians are dwindling, and the city has come to a stop all out of a sudden.

    When will the city live again?

    Friday 24 January - a silent New Year's Eve
    The world is quiet, and the silence is horrifying. I live alone, so I can only tell there are other human beings around from the occasional noises in the corridor.

    I have a lot of time to think about how to survive. I don't have any resources or connections.

    One of my goals is not to fall sick, so I have to make myself exercise. Food is crucial to survival too, so I have to know whether there is enough supply.

    The government hasn't said how long the lockdown will last, nor how we can carry on functioning. People are saying it might last until May.

    The pharmacy and the convenience store downstairs were closed today, but it was comforting to see that couriers are still out delivering food.

    Noodles are all sold out in the supermarkets, but there is some rice. I also went to the market today. I bought celery, garlic shoots and eggs.

    After going home, I washed all my clothes and took a shower. Personal hygiene is important - I think I am washing my hands 20 to 30 times a day.

    Wuhan: The London-sized city where the virus began
    People cry out 'stay strong' from Wuhan windows
    How do you quarantine a city - and does it work?
    Going out makes me feel that I am still connected to the world. It's very difficult to imagine how elderly citizens living alone and people with disabilities will get through this.

    I didn't want to cook less than usual, because it was the last night of the year of the pig - it was supposed to be a meal of celebration.

    Over dinner, I was on a video call with my friends. There was no escaping talk of the virus. Some people are in towns near Wuhan, some chose not to go home because of the disease, some still insist on gathering despite the outbreak.

    A friend coughed during the call. Someone jokingly told her to hang up!

    We chatted for three hours and I thought I could then fall asleep with happy thoughts. But when I closed my eyes, memories of the past few days came in flashbacks.

    Tears fell. I felt helpless, angry and sad. I thought about death, too.

    I don't have many regrets, because my job is meaningful. But I don't want my life to end.

    Saturday 25 January - Chinese New Year alone
    Today is Chinese New Year. I never have much interest in celebrating festivals, but now new year feels even more irrelevant.

    In the morning, I saw some blood after I sneezed, and I was scared. My brain was filled with worries about sickness. I was wondering if I should go out or not. But I had no fever and a good appetite, so I went out.

    I wore two masks even though people say it's pointless and unnecessary. I am worried about [poor quality] fakes, so a double mask makes me feel safer.

    It was still very quiet.

    Chinese wish is for new year health, not fortune
    Chinese diasporas stockpile surgical masks
    A flower shop was open, and the owner had placed some chrysanthemums [often used as funeral flowers] at the door. But I didn't know if that meant anything.

    In the supermarket, the vegetable shelves were empty and almost all dumplings and noodles were sold out. There were only a few people queuing.

    I keep having this urge to buy lots during each visit to the shop. I bought another 2.5 kg of rice, even though I have 7kg of rice at home. I also couldn't help buying some sweet potatoes, dumplings, sausages, red beans, green beans, millet and salted eggs.

    I don't even like salted eggs! I will give them to friends, after the lockdown is lifted.

    I have enough food for a month, and this compulsive buying seems crazy. But under such circumstances, how could I blame myself?

    I went for a walk by the river. Two snack shops were open and some people were out walking their dogs. I saw some others were taking a stroll as well - I guess they also didn't want to be trapped.

    I'd never walked along that road before. It felt like my world had expanded just a little bit.

    Sunday 26 January - making your voice heard
    It not just the city that's trapped. It's also the voices of the people.

    On the first day of the lockdown, I couldn't write [anything about it] on social media [because of censorship]. I couldn't even write on WeChat. Internet censorship has existed for a long time in China, but now it feels even more cruel.

    Can wearing masks stop the spread of viruses?
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    Has China learned lessons since deadly Sars epidemic‎?
    When your life is turned upside down, it's a challenge to build up your daily life again. I keep exercising in the mornings, using an app, but I can't focus because my brain is occupied.

     

    Media caption"Wuhan, add oil!": Watch residents shouting to boost morale in quarantined city
    I left home again today and tried to count how many people I met - I met eight during my walk to a noodle shop some 500m away from my home.

    I didn't want to go home. I wanted to explore more. It's only two months since I moved to Wuhan. I don't have many friends here, and I don't know the city very well.

    I guess I saw about 100 people today. I have to keep making myself heard and break the shackles. I hope everyone stays hopeful. Friends, I hope that we will meet and talk in the future.

    Around 8pm I heard the shouts of "Go, Wuhan!" from people's windows. The collective chanting is a form of self-empowerment.

    Tuesday 28 January - finally sunlight
    Panic has driven a wedge between people.

    In many cities, people are required to wear a face mask in public. On the face of it, the measure is to control the pneumonia outbreak. But actually it could lead to abuse of power.

    Some citizens without a mask have been thrown off public transport. We don't know why they didn't wear a mask. Perhaps they couldn't buy any, or they didn't know about the notice. No matter what, their rights to go out should not be taken away.

    In some videos circulating online, some people had sealed up the doors of people who'd self-quarantined themselves. People from Hubei province [where Wuhan is] were driven out of their homes and had nowhere to go.

    But at the same time, some people are offering accommodation to Hubei people.

    There are a lot of ways the government could encourage people to stay home. It has to ensure that every citizen has enough face masks, or even give cash rewards to citizens who stay home.

    Today, there's finally sunlight - just like my mood. I saw more people in my complex and there were a few community workers. They appeared to perform temperature checks on non-residents.

    It is not easy to build trust and bonds under a lockdown. The city is worn down by heaviness.

    In the midst of all this, I can't help but becoming more on-guard.

    My anxiety about survival has been slowly dissipating. Walking further in the city will be meaningless if I don't make any connections with people here.

    Social participation is an important need. Everyone has to find a role in society and makes one's life meaningful.

    In this lonely city, I have to find my role.

    Coronavirus: What it does to the body
    By James Gallagher
    Health and science correspondent
    29 minutes ago
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    Related TopicsCoronavirus outbreak
    Image copyrightGETTY IMAGES
    Fighting the new coronavirus has been a battle against the unknown for doctors.

    How does it attack the body? What are the full range of symptoms? Who is more likely to be seriously ill or die? How do you treat it?

    Now, an account by medics on the front line of this epidemic, at the Jinyintan Hospital, in Wuhan, is starting to provide answers.

    A detailed analysis of the first 99 patients treated there has been published in the Lancet medical journal.

    Lung assault
    All of the 99 patients taken to the hospital had pneumonia - their lungs were inflamed and the tiny sacs where oxygen moves from the air to the blood were filling with water.

    Other symptoms were:

    82 had fever
    81 had a cough
    31 had shortness of breath
    11 had muscle ache
    nine had confusion
    eight had a headache
    five had a sore throat
    First deaths
    The first two patients to die were seemingly healthy, although they were long-term smokers and that would have weakened their lungs.

    The first, a 61-year-old man, had severe pneumonia when he arrived at hospital.

    He was in acute respiratory distress, meaning his lungs were unable to provide enough oxygen to his organs to keep his body alive.

    Despite being put on a ventilator, his lungs failed and his heart stopped beating.

    He died 11 days after he was admitted.

    The second patient, a 69-year-old man, also had acute respiratory distress syndrome.

    He was attached to an artificial lung or ECMO (extra-corporeal membrane oxygenation) machine but this wasn't enough.

    He died of severe pneumonia and septic shock when his blood pressure collapsed.

    At least 10% die
    As of 25 January, of the 99 patients:

    57 were still in hospital
    31 had been discharged
    11 had died
    This does not mean the death rate of the disease is 11%, though, as some of those still in hospital may yet die and many others have such mild symptoms they do not end up in hospital.

    Market workers
    Live animals sold at the Huanan seafood market are thought to be the source of the infection, called 2019-nCoV.

    And 49 out of the 99 patients had a direct connection to the market:

    47 worked there, either as managers or manning the stalls
    two were shoppers who had only popped in
    Middle-aged men worst affected
    Most of the 99 patients were middle-aged, with an average age of 56 - and 67 of them were men.

    However, more recent figures suggest a more even gender split. The China Centers for Disease Control and Prevention said 1.2 men were infected for every 1.0 women.

    There are two possible explanations for the difference:

    Men could be more likely to become severely ill and need hospital treatment
    Men, for social or cultural reasons, may have been more likely to be exposed to the virus at the beginning of the outbreak
    Dr Li Zhang, at the hospital, says: "The reduced susceptibility of females to viral infections could be attributed to the protection from X chromosome and sex hormones, which play an important role in immunity."

    And those who were already sick
    Most of the 99 had other diseases that may have made them more vulnerable to the virus as a "result of the weaker immune functions of these patients":

    40 had a weak heart or damaged blood vessels due to conditions including heart disease, heart failure and stroke
    A further 12 patients had diabetes

    A visual guide to the outbreak
    By The Visual and Data Journalism Team
    BBC News
    2 hours ago
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    Related TopicsCoronavirus outbreak
    Image copyrightGETTY IMAGES
    A respiratory virus first detected in the Chinese city of Wuhan has now infected thousands of Chinese citizens and spread to a number of other countries.

    The fast-moving infection, which causes pneumonia-like symptoms, has claimed almost 200 lives and prompted Chinese authorities to quarantine several major cities.

    Here are six maps and graphics that will help you understand what is going on.

    1. Cases have been mainly in China
    Thousands of confirmed cases have been recorded across China, with central Hubei province the worst-affected.

    The World Health Organisation (WHO) is warning the number of cases is likely to rise further, and Chinese authorities have introduced a number of measures to try to halt the virus's spread.

    Travel restrictions have been imposed on a number of cities in Hubei province and people have been asked to wear face masks in public places.

    The Chinese government has also closed a number of temples, the Forbidden City and part of the Great Wall.

    The growing list of restrictions came at the beginning of a week-long holiday celebrating Lunar New Year - one of the most important dates in the Chinese calendar - when millions of people travel home. The national new year holiday was extended by three days to 2 February, in an attempt to contain the spread.

    The WHO has not yet classed the virus as an "international emergency", partly because of the low number of overseas cases, but has said it "may yet become one".

    WHO Girector-General Tedros Adhanom Ghebreyesus said a meeting of the organisation's emergency committee would be held later on Thursday to discuss the status of the outbreak.

    "In the last few days the progress of the virus, especially in some countries, especially human-to-human transmission, worries us," he said on Wednesday..

    'The silence is horrifying': A diary of life under lockdown
    How worried should we be?
    Can wearing masks stop the spread of viruses?
    Image copyrightGETTY IMAGES
    2. Hubei province has been particularly badly affected
    More than 4,500 cases have been recorded in Hubei province - the centre of the outbreak - which has also seen almost all of the deaths as a result of the virus.

    Restrictions on travel are affecting at least 20 million people across 10 cities - including the capital Wuhan, where the virus emerged.

    Its origins have been linked to illegally traded wildlife at the city's seafood market, which sells live animals including bats, rabbits and marmots. However, the exact source of the outbreak has not been identified.

    Wuhan - which has a population of 11 million people - has gone into lockdown, with authorities suspending flights and train services in and out of the city. Local officials said no-one from the city had left Wuhan in four days.

    "My university is checking every student's body temperature every day and are offering free masks. It also has its own hospital and ambulance," Chongthan Pepe Bifhowjit, an Indian student at the Wuhan University of Technology, told the BBC.

    In a bid to tackle the increased demand for medical services in the city, authorities are building two makeshift hospitals, one with 1,000 beds and another with a capacity of 1,500 beds.

    State-owned news outlet China Global Television Network said the first could be ready by 3 February and the second by 5 February. More than 3,500 workers are involved in their construction.

    Image copyrightGETTY IMAGES
    Image caption
    Diggers in Wuhan at the site for new field hospital
    Voluntary evacuations of hundreds of foreign nationals from Wuhan are under way to help people who want to return to their countries.

    The UK, Australia, South Korea, Singapore and New Zealand are expected to quarantine all evacuees for two weeks to monitor them for symptoms and avoid any contagion.

    How do you quarantine a city?
    How can China build a hospital so quickly?
    3. A number of other countries have seen cases
    Outside China, infections have spread to at least 15 other countries, including the the US, Canada, France and Germany, but no deaths have yet been reported.

    Other nations are investigating suspected cases.

    A growing number of countries have advised their citizens to avoid all non-essential travel to China and many have announced screening measures for passengers from China, including the major airport hubs of Dubai and Abu Dhabi.

    4. The symptoms are respiratory
    Coronaviruses are common, and typically cause mild respiratory conditions, such as a cough or runny nose.

    But some are more serious - such as the deadly Sars (Severe Acute Respiratory Syndrome) and Middle East Respiratory Syndrome (Mers).

    This outbreak - known as novel coronavirus (nCoV) - is a new strain that has not been previously identified in humans.

    It seems to start with a fever, followed by a dry cough and then, after a week, leads to shortness of breath.

    But in more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.

    Most victims have been elderly people, suffering from other chronic diseases including Parkinson's and diabetes.

    An expert from the Chinese National Health Commission (NHC) has said it could take 10 more days for the outbreak to peak.

    Image copyrightGETTY IMAGES
    Peter Piot, professor of global health and director of the London School of Hygiene & Tropical Medicine, said the "good news" was that data suggested the virus may have a lower mortality than Sars.

    There was also a diagnostic test and greater global sharing of information than previously, he said.

    "And that is essential because you cannot deal with a potential pandemic in one country alone."

    There is not yet a specific anti-viral treatment for the infection, so people with the virus are currently being treated for their symptoms.

    Researchers are racing to develop a vaccine, though, with one lab in California planning for a potential vaccine to enter human trials by June or July.

    5. You can do things to reduce your chances of catching it
    The WHO is advising people in affected areas to follow standard procedures to reduce the chance of catching the virus.

    They include hand and respiratory hygiene as well as safe food practices.

    People are advised to avoid close contact with people suffering from acute respiratory infections; wash hands regularly, especially after direct contact with ill people or their environment; and avoid unprotected contact with farm or wild animals.

    Avoiding eating raw or undercooked animal products is also advised.

    Those with symptoms of coronavirus should practise "cough etiquette", including maintaining distance, covering coughs and sneezes with disposable tissues or the inside of an elbow, and washing hands.

    Image copyrightGETTY IMAGES
    6. If a case is suspected, there are processes to follow
    The Chinese government has classified the outbreak in the same category as the Sars epidemic.

    This means people diagnosed with the virus in the country must be isolated and can be placed in quarantine.

    Within healthcare facilities, the WHO advises staff to implement enhanced standard infection prevention and control practices, especially in emergency departments.

    The WHO advises that patients should be assessed quickly and treated for the level of severity of the disease they have - mild, moderate, or severe.

    It also recommends immediately implementing infection prevention measures. These include staff wearing protective clothing and limiting patient movement around the hospital.

    In the UK, family doctors - GPs - are being advised to place patients suspected of having coronavirus in isolation and avoid physical examinations.

    Official guidance from Public Health England (PHE) says patients should remain in a room away from other patients and staff and be prevented from using communal toilets.

     

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