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    First death outside China reported in Philippines

    February 02, 2020

    The death was confirmed shortly after the Philippines halted the arrivals of foreign travellers from China
    A man has died of the coronavirus in the Philippines, the first confirmed fatality outside China.The patient was a 44-year-old Chinese man from Wuhan, in Hubei province, where the virus was first detected.He appeared to have been infected before arriving in the Philippines, the World Health Organization (WHO) said.More than 300 people have died in the outbreak so far, the vast majority from Hubei. More than 14,000 people have been infected.The US, Australia and an increasing number of other countries have barred the arrival of foreigners from China and are requiring their own citizens to be quarantined.The number of coronavirus cases worldwide has overtaken that of the similar Sars epidemic, which spread to more than two dozen countries in 2003. But the mortality rate of the new virus is much lower, suggesting it is not as deadly.
    The man travelled to the Philippines from Wuhan, via Hong Kong, with a 38-year-old Chinese woman who also tested positive last week, the Philippines Department of Health said.Officials said he was admitted to a hospital in the capital, Manila, where he developed severe pneumonia.The man is thought to have had other pre-existing health conditions.Rabindra Abeyasinghe, the WHO representative to the Philippines, urged people to remain calm: "This is the first reported death outside China. However, we need to take into mind that this is not a locally acquired case. This patient came from the epicentre of this outbreak."
    People in Manila rushed to buy face masks after the first case of coronavirus was confirmed in the Philippines last week
    According to local news outlet Rappler, Health Secretary Francisco Duque III said the patient was "stable and showed signs of improvement", but his condition deteriorated rapidly over 24 hours."We are currently working with the Chinese embassy to ensure the dignified management of the remains according to national and international standards to contain the disease," Mr Duque said, adding that the man would be cremated.The Department of Health was now trying to track down people who were on the same flight as the man so that they could be quarantined, he said, as well as any other people the man and woman may have come into contact with, such as hotel staff.The man's death was confirmed shortly after the Philippines announced it would immediately halt the arrivals of any foreign travellers from China.It had previously restricted only those from Hubei, which is at the epicentre of the outbreak.
    Authorities said 45 more deaths were recorded in Hubei province by the end of Saturday, bringing the death toll in the country to 304.Nationally, there were 2,590 new confirmed infections. The total number of infections in China is now 14,380, state TV quoted the National Health Commission as saying.
    Estimates by the University of Hong Kong suggest the total number of cases could be far higher than the official figures. More than 75,000 people may have been infected in the city of Wuhan, which is at the epicentre of the outbreak, experts say.The US and Australia have said they will deny entry to all foreign visitors who had recently been to China, where the 2019-nCov strain of the coronavirus first emerged in December.Other countries including New Zealand, Russia, Japan, Pakistan, Italy and Singapore have also announced travel restrictions.On Sunday, South Korea said it would bar entry to foreigners who had recently visited Hubei.In the US, citizens and residents returning from Hubei will be quarantined for 14 days. Those returning from other parts of China will be allowed to monitor their own condition for a similar period.The Pentagon said it would provide housing for 1,000 people who may need to be quarantined after arriving in the US from abroad. Four military bases in California, Colorado and Texas would provide up to 250 rooms each.
    Another confirmed case in the US on Saturday - in Massachusetts - brought the total number there to eight.Australia said any of its own citizens arriving from China would also be quarantined for two weeks.There have also been a number of evacuations from China as foreign governments work to bring their citizens back.
    Wuhan is in lockdown and other major cities across the country have suspended non-essential business.The mayor of Huanggang - a city of six million people to the east of Wuhan - has warned that the number of cases there is set to spike in the coming days, state media said. Up to 700,000 people had returned to the city from Wuhan before travel out of Wuhan was banned.Huanggang and the eastern city of Wenzhou have imposed draconian restrictions on residents, only allowing one designated person per family to leave home once every two days to buy food and other supplies, Chinese media reported.
    Wuhan: The London-sized city where the virus beganHubei officials have extended the Lunar New Year holiday to 13 February and said that marriage registrations would be suspended in an effort to discourage public gatherings.

    Meanwhile, hospital workers in Hong Kong have voted to go on strike from Monday unless the territory's border with mainland China is completely closed. The Hong Kong government has refused to do so, citing WHO recommendations to introduce screening measures at borders instead.

    Do the travel bans work?
    Global health officials have advised against the bans.

    "Travel restrictions can cause more harm than good by hindering info-sharing, medical supply chains and harming economies," the head of the WHO said on Friday.


    Media captionInside the US laboratory developing a coronavirus vaccine
    The WHO recommends introducing screening at official border crossings. It has warned that closing borders could accelerate the spread of the virus, with travellers entering countries unofficially.

    China has criticised the wave of travel restrictions, accusing foreign governments of ignoring official advice.

    What other international action has been taken?
    India has evacuated 300 citizens from Wuhan. About 100 Germans have been flown home. Thailand and Russia are due to evacuate citizens from Wuhan and Hubei province in the coming days
    China asked the European Union to facilitate the sending of medical supplies from member countries
    Vietnam Airlines suspended all flights to China, Hong Kong and Taiwan. Other airlines, including Qantas, Air New Zealand, Air Canada and British Airways, cancelled or scaled back flights
    North Korean leader Kim Jong-un offered his condolences in a letter to China's president
    Hotel chains, including Hyatt, Radisson and Hilton, extended their cancellation policies for guests travelling to China
    Apple said it would temporarily close its stores in China
    The UK announced it would pull dozens of Foreign Office staff out of the mainland
    Russia said two Chinese citizens had been placed in isolation after they tested positive for the virus
    Germany, Italy, and Sweden confirmed further cases in Europe

    Can people recover? And other questions
    31 January 2020
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    Image copyrightBSIP
    There have now been almost 10,000 cases of coronavirus, which has been declared a global health emergency. The disease has spread to at least 17 countries, including two confirmed cases in the UK.

    The answers to a selection of readers' questions about the new virus are below.

    Why is the UK government organising the repatriation of citizens? - Jeff Otterside
    The Foreign Office (FCO) is providing repatriation to British citizens in Hubei Province, the source of the coronavirus, "due to increasing travel restrictions and difficulty accessing medical assistance".

    It is not repatriating the thousands of British citizens in other parts of China, but is advising against all but essential travel to the country.

    On Friday, 83 Britons and 27 foreign nationals were being flown back to the UK from Wuhan, the Hubei city at the centre of the outbreak. Other countries including Japan, the US and EU states are also repatriating their citizens.

    The FCO says its priority is to keep families together, but under Chinese law only British passport holders who do not hold Chinese nationality are allowed to leave through assisted departure.

    Image copyrightEPA/WU HONG
    Image caption
    Chinese people wear masks near the Tiananmen Gate Tower in Beijing, China
    What is the incubation period for the coronavirus? - Gillian Gibs
    The World Health Organization says the incubation period, which is the time before symptoms appear, ranges from two to 10 days.

    These estimates will be narrowed down as more data becomes available.

    Knowing and understanding the incubation period is very important. It allows doctors and health authorities to introduce more effective ways to control the spread of the virus.

    It means, for instance, that they can introduce more effective quarantine systems, isolating those suspected of carrying the virus from others.

    Do people who have contracted coronavirus return to full health? - Chris Stepney, Milton Keynes
    Yes. Many of those who contract coronavirus will experience only mild symptoms. These include fever, coughing and respiratory problems. Most people are expected to make a full recovery.

    But it can pose a particular risk for elderly people and those with pre-existing problems like diabetes or cancer, or weak immune systems.

    As of 31 January, Chinese health authorities said that 213 people had died from the virus. The number of confirmed cases stands at 9,962.

    An expert at China's National Health Commission has said that it can take a week to recovery from mild coronavirus symptoms.

    Why are we catching more diseases from animals?
    What does coronavirus do to the body
    How worried should we be?
    Wuhan: The London-sized city where the virus began
    Can the coronavirus be transferred through items bought from Wuhan and posted to UK? - Stefan
    There is no evidence this is a risk. Some diseases - including the coronavirus that causes Sars - can spread through surfaces contaminated by people coughing or sneezing on them.

    It has not been shown this new coronavirus can do that. Even if it could, there would still be questions about whether international shipping would be a major problem.

    Cold viruses tend to survive less than 24 hours outside the human body although norovirus (a severe stomach bug) can last months outside the body.

    The most reassuring fact so far is that cases seem to require close contact with another person - say, a family member or healthcare worker - in order to spread.

    Is there any reason such viruses are emerging more from China? - Gautam
    Yes - large populations of people living in close proximity to animals.

    This coronavirus almost certainly came from an animal source, with one suggestion being snakes. Sars, another coronavirus that originated in China, came from bats and the civet cat.

    The early cases of this new infection were traced to the South China Seafood Wholesale Market. Live wild animals were also sold including chickens, bats and snakes.


    Media captionThe BBC's online health editor talks us through what we know about the virus
    How did Sars spread? How did it originate? - Angelo Busato
    Sars, another form of coronavirus, started off in bats and then infected the civet cat, which in turn passed it on to humans.

    Some people were infected by direct contact with civet cats.

    But it was also able to spread from one person to another through coughs, sneezes and contaminated surfaces.

    Is it possible to vaccinate in order to prevent this respiratory illness? - Hans Friedrich
    At the moment, there is no vaccine that can protect people against this type of coronavirus, but researchers are looking to develop one.

    It is a new strain that hasn't been seen in humans before, which means doctors still have lots to learn about it.

    how quarantine has fought disease through the ages
    By Sophie Williams
    BBC News
    31 January 2020
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    Image copyrightGETTY IMAGES
    Image caption
    Women put dressings on plague victims' wounds, a painting by Jacopo Robusti, 1549
    In China's Hubei province, over a dozen cities are in lockdown in the hope of preventing further cases of the new Coronavirus. And Western countries are putting people returning from Wuhan, the city at the centre of the outbreak, into enforced isolation for up to two weeks.

    Quarantine has long been used to prevent the spread of diseases.

    The term itself comes from the first known example of the isolation method.

    As the Black Death raged through Europe in the 14th century, Venice enforced a rule where ships had to anchor for 40 days before crew and passengers were allowed to come ashore. The waiting period was named "quarantino", which derives from the Italian for 40.

    It's unclear where exactly the 40 days concept came from, said Mark Harrison, Professor of the History of Medicine at the University of Oxford. One possibility is that it was a biblical reference - the idea of spending 40 days and 40 nights in the wilderness as Jesus is said to have done.

    Over time, the duration of quarantine has been shortened, but it remains key to limiting disease outbreaks across the globe.

    In the UK, one of the most famous examples is the English village of Eyam's self-imposed quarantine during the bubonic plague. Between September and December 1665, 42 residents of the Derbyshire village died.

    In June 1666, the newly appointed rector Willliam Mompesson decided the village should be quarantined.

    Image caption
    A 1656 engraving of Dr Schnabel of Rome, wearing protective clothing typical of the city's plague doctors at the time
    He told his parishioners that the village must be enclosed with no-one allowed in, or out. He said the Earl of Devonshire had offered to send food and supplies if they agreed to be quarantined.

    The rector told villagers he would do everything in his power to alleviate their suffering and remain with them.

    That August, the village saw a peak of five or six deaths a day - but hardly anyone broke the cordon. Over time, the number of cases fell and by November the disease was gone. The lockdown had worked.

    Image copyrightGETTY IMAGES
    Image caption
    The village of Eyam, which enforced its own quarantine to protect other villages from the plague
    Nowadays, most quarantines are imposed by governments or health bodies.

    "When quarantine measures are introduced, they're not just based on medical calculations about whether or not they're going to be effective in stopping or slowing the advance of the infectious disease," said Mr Harrison.

    "You take measures such as quarantine in order to meet expectations of other governments, but also to reassure your own population."

    In San Francisco in 1900, Chinese immigrants were quarantined after a Chinese man was found dead in a hotel. It was later confirmed that he had died of the plague. Concerned, police officers strung rope and barbed wire around a section of Chinatown. Residents were not allowed to come in or out, and only police and health officials were allowed to cross the barrier.

    What does being in quarantine mean?
    Britons on Wuhan flights to be quarantined
    During World War One, about 30,000 sex workers were quarantined amid fears about the number of rising sexually transmitted diseases. They were allowed to leave once it was confirmed they no longer had STDs.

    Mr Harrison says the Sars epidemic of 2002-3 started a new era in infectious disease control.

    During the outbreak, people who had been exposed to the virus were quarantined. The Chinese government threatened to execute or jail anyone who was found to breach quarantine rules and spread the contagion.

    The disease reinforced lessons about the importance of working with other countries during a public health crisis.

    When the syndrome spread from China to the Canadian city of Toronto, 44 people were killed and several hundred more infected.

    About 7,000 people in Canada were placed in isolation to stop the spread of Sars.

    Image copyrightGETTY IMAGES
    Image caption
    A man sits behind a glass wall at Hanoi airport after returning from China during the Sars epidemic
    "During the outbreak in 2003 when it started spreading to other countries, quarantine of various kinds was used extensively. The use of those measures of containment was credited with stopping the pandemic becoming worse than it could have been," said Mr Harrison.

    "One of the lessons that people drew was a victory for old-style public health methods."

    As China continues with the traditional method of quarantine to respond to the new coronavirus, the World Health Organisation (WHO) has praised the country for "taking extraordinary measures in the face of what is an extraordinary challenge".

    The lessons learned from the Sars outbreak
    By Kelly-Leigh Cooper
    BBC News
    24 January 2020
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    Image caption
    China was accused of covering-up the Sars epidemic
    In March 2003 it became clear a mysterious and previously unknown disease was starting to spread around the world.

    Severe Acute Respiratory Syndrome (Sars) went on to infect more than 8,000 people and kill almost 800. Many of those it infected, including doctors, went from having flu-like symptoms to severe pneumonia within days.

    The virus spread to 26 countries and China was criticised by the UN's global health body for concealing the scale of the outbreak.

    Now, 17 years later, the spread of a new deadly coronavirus is reviving memories of Sars and putting global scrutiny back on to the Chinese government.

    China has responded with tough measures, including effectively quarantining millions of residents in cities. But has its response gone far enough? And what lessons did it learn from the deadly Sars outbreak in 2003?

    Lesson one: Work with other countries
    Sars posed a huge challenge to China both as a public health crisis and a political one.

    The World Health Organization (WHO) was first alerted to reports of severe and unusual cases of pneumonia in the country's south in February 2003. Local officials said more than 300 people had become sick.

    Despite initial openness, other local government officials appeared to play down the risk or suggest the mystery threat was contained. Analysts who studied the Chinese response said the issue soon disappeared from the spotlight.

    Investigations later showed the first infections appeared in Guangdong Province in November 2002, but it took months for the scale of China's Sars crisis to be exposed. Physician Jiang Yanyong alerted the international media in April that the Chinese government was drastically understating the Sars threat.

    Image copyrightGETTY IMAGES
    Image caption
    Dozens died in the Toronto area - with Canada becoming one of the worst- hit nations
    Advice was circulated to hospitals and the director of the Chinese Centre for Disease Control and Prevention (CDC) even issued an unprecedented apology over the spread. "Our medical departments and mass media suffered from poor co-ordination," Li Liming told a news conference.

    Combating Sars was complicated because of uncertainties about how it was spreading. The WHO issued its first global alert on 12 March 2003 after a patient hospitalised in Hanoi, Vietnam led to handfuls of medical staff becoming sick. Hong Kong's Department of Health also confirmed outbreaks of respiratory illness among its hospital workers.

    "This was the first time a coronavirus had come to the attention as a pathogen that could spread around the world like this," Prof David Heymann, who led the WHO's infectious disease unit at the time of Sars, told the BBC. "So in the beginning it wasn't known what it was and nobody really looked for coronaviruses such as they are doing now."

    Prof Heymann told the BBC that Chinese authorities appeared to have been much more proactive with the new outbreak, including providing the WHO with information on a regular basis. This week, the WHO's director general praised China's response.

    Lesson two: Don't cover it up
    The lack of transparency over Sars hurt China's standing on the international stage and caused its economic growth to slow.

    Health experts, including Prof Heymann, stress transparency as a key factor in preventing the spread of viruses, especially unknown ones. Once proper control measures and infection prevention were implemented, Sars was contained within months.

    This was aided by public health information being shared by the WHO and local governments wherever Sars was a concern.

    Image copyrightGETTY IMAGES
    Image caption
    The spread of Sars was traced to an infected doctor at Hong Kong's Metropole Hotel
    Hong Kong was one of the major hotspots for the virus. People there began to change their routines, with surgical masks becoming the norm in public. Surfaces in public areas with high risks of transmission, like lift buttons, were cleaned hourly and every day the local news carried updated tolls of those infected killed by the virus.

    Helier Cheung, a BBC journalist who grew up in Hong Kong, remembers she and classmates having their temperatures taken daily. Classes were suspended for several days - right in the run-up to exams - and television adverts reminded the public to wash their hands and bleach surfaces.

    Her experience contrasts with that of another BBC employee who was working at a university in mainland China at the time of Sars. She remembers relying heavily on rumours and access to foreign news outlets when little official information was available. She also remembers misinformation spreading - with bowls of vinegar set on burners in classrooms in the mistaken belief they could disinfect the air.

    "I do remember being worried, but very poorly informed," she said. Information and clarity were sparse even when students were quarantined and her campus later locked down.

    Image copyrightGETTY IMAGES
    Image caption
    Hong Kong's Amoy Gardens became notorious when hundreds of residents became sick
    In recent days, Chinese officials have tried to show they are being much more open this time. President Xi Jinping described combating the virus as "extremely critical" and there have been public warnings against any attempts at cover-ups.

    "Anyone who puts the face of politicians before the interests of the people will be the sinner of a millennium to the party and the people," a commentary on a Central Political and Legal Affairs Commission account said on Tuesday. "Anyone who deliberately delays and hides the reporting of [virus] cases out of his or her own self-interest will be nailed on the pillar of shame for eternity."

    However, the Chinese government has strengthened its control over the flow of information since the time of Sars. Some international scientists have estimated the true number of people impacted by the new coronavirus is far higher than has been publicly confirmed.


    Media captionThe BBC's online health editor talks us through what we know about the virus
    Steve Tsang, director of the Soas China Institute in London, told the BBC he became aware of rumours circulating about a new virus in Wuhan several weeks ago - well before the first cases were confirmed on 31 December. Local officials may have been very nervous to be the ones to raise the alarm, he said.

    "President Xi Jinping pays a lot more attention to the international image of China than his predecessors, and he has concentrated much more power than his predecessors," Mr Tsang said.

    "Therefore anything that could potentially have a negative impact on the international image of China becomes sensitive."

    Learn more about the new virus
    Image copyrightGETTY
    Your questions: You asked, we answered
    The story explained: How worried should we be?
    Wuhan profiled: The city now in lockdown
    In detail: Follow all our coverage here
    Chinese social media is also highly regulated and the New York Times reported that the hashtag #WuhanSARS was blocked locally. Police even questioned eight people about spreading "rumours" of the virus online, according to reports.

    Lesson three: Improve medical response
    The Sars outbreak was a catalyst for change in China's medical system, with health spending rising afterwards.

    Health officials used to report infectious diseases by filling in cards by hand and then posting or faxing them to a central office. After Sars, the government created a centralised online system that links up clinics and hospitals across the country and lets them report cases in real time.

    Image copyrightGETTY IMAGES
    Image caption
    The global epidemic was eventually contained within months
    "China... has developed excellent disease surveillance systems since Sars, including real-time emergency department surveillance for severe acute respiratory infections, so this will help with rapid identification of new cases," Raina MacIntyre, head of the biosecurity research programme at Sydney's Kirby Institute, told Reuters.

    'Increased likelihood' of new virus reaching UK
    "Spreading at alarming rate" - one doctor in Wuhan speaks
    Gabriel Leung, chair of public health at Hong Kong University, said the timescale of "recognising, characterising, releasing and reporting information" had been vastly improved from the time of the Sars outbreak. "What did take months during the time of Sars is now compressed into a matter of weeks or days," he told a news conference earlier this week.

    But not all of the public health reforms suggested after Sars have been implemented.


    Media captionFears over new coronavirus in China trigger face mask shortgae
    In 2006, Zhong Nanshan, the doctor who identified Sars and who is leading the Chinese government's efforts in Wuhan, said it was crucial to clean up China's wildlife markets, which were "poorly managed and insanitary" and "a dangerous source of possible new infections".

    But reports from Wuhan suggest inter-species transmission is also at the centre of the new outbreak. A market in Wuhan, which was shuttered the day after the first cases were confirmed, is thought to have sold animals including rats, live wolf pups and civets, the last of which have been linked with previous pandemics in the past.

    Typically, traditional use in local delicacies or medicines has hindered efforts to clean-up the animal trade. But with a market again identified as a source of an outbreak, even official media are mobilising appeals against the wildlife trade in response. Propaganda posts telling people #SupportBanningWildAnimalMarkets have been widely shared on Chinese social media.

    Whether the radical measures implemented by China, going beyond even WHO recommendations, are enough to avoid a repeat of Sars remains to be seen.

    Dr W Ian Lipkin, a US-based epidemiologist who worked on Sars, is among the experts who have cast doubt on whether the travel restrictions from cities, including Wuhan, will be enough to stop the global spread.
    "The horse is already out of the barn," he was quoted by the New York Times as saying.


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