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Coronavirus: How worried should we be? Coronavirus: How worried should we be?
(about 5 hours later)
A virus - previously unknown to science - is causing severe lung disease in China and has also been detected in other countries.A virus - previously unknown to science - is causing severe lung disease in China and has also been detected in other countries.
People are known to have died from the virus, which appeared in the city of Wuhan in December. People are known to have died and the outbreak shows no sign of stopping soon.
The disease has been spreading and experts expect the number of people infected will keep rising.
A new virus arriving on the scene, leaving patients with pneumonia, is always a worry and health officials around the World Health Organization has declared a global emergency.A new virus arriving on the scene, leaving patients with pneumonia, is always a worry and health officials around the World Health Organization has declared a global emergency.
Can this outbreak be contained or is this something far more dangerous?Can this outbreak be contained or is this something far more dangerous?
What is this virus?What is this virus?
Officials in China have confirmed the cases are caused by a coronavirus.Officials in China have confirmed the cases are caused by a coronavirus.
These are a broad family of viruses, but only six (the new one would make it seven) are known to infect people.These are a broad family of viruses, but only six (the new one would make it seven) are known to infect people.
Severe acute respiratory syndrome (Sars), which is caused by a coronavirus, killed 774 of the 8,098 people infected in an outbreak that started in China in 2002.Severe acute respiratory syndrome (Sars), which is caused by a coronavirus, killed 774 of the 8,098 people infected in an outbreak that started in China in 2002.
"There is a strong memory of Sars, that's where a lot of fear comes from, but we're a lot more prepared to deal with those types of diseases," says Dr Josie Golding, from the Wellcome Trust."There is a strong memory of Sars, that's where a lot of fear comes from, but we're a lot more prepared to deal with those types of diseases," says Dr Josie Golding, from the Wellcome Trust.
How severe are the symptoms?How severe are the symptoms?
It seems to start with a fever, followed by a dry cough and then, after a week, leads to shortness of breath and some patients needing hospital treatment.It seems to start with a fever, followed by a dry cough and then, after a week, leads to shortness of breath and some patients needing hospital treatment.
Around one-in-five cases are thought to be severe.Around one-in-five cases are thought to be severe.
Notably, the infection rarely seems to cause a runny nose or sneezing.Notably, the infection rarely seems to cause a runny nose or sneezing.
The coronavirus family itself can cause symptoms ranging from a mild cold all the way through to death. The coronavirus family itself can cause symptoms ranging from a mild cold all the way through to severe lung problems, which can kill.
"When we see a new coronavirus, we want to know how severe are the symptoms. This is more than cold-like symptoms and that is a concern but it is not as severe as Sars," says Prof Mark Woolhouse, from the University of Edinburgh.
How deadly is it?How deadly is it?
While the ratio of deaths to known cases appears low, the figures are unreliable.While the ratio of deaths to known cases appears low, the figures are unreliable.
It is far too simplistic to divide the number of deaths by the number of cases to calculate the death rate to get a figure of around 2% at this stage of the outbreak.It is far too simplistic to divide the number of deaths by the number of cases to calculate the death rate to get a figure of around 2% at this stage of the outbreak.
Thousands of patients are still being treated and we do not know if any of those cases will die - so the death rate could be higher.Thousands of patients are still being treated and we do not know if any of those cases will die - so the death rate could be higher.
And it is unclear how many unreported cases there are - so the death rate could also be lower. And it is unclear how many unreported mild cases are out there - so the death rate could also be lower.
Where has it come from?Where has it come from?
New viruses are detected all the time. This virus is not really "new" - it is just new to humans, having jumped from one species to another.
They jump from one species, where they went unnoticed, into humans.
"If we think about outbreaks in the past, if it is a new coronavirus, it will have come from an animal reservoir," says Prof Jonathan Ball, a virologist at the University of Nottingham."If we think about outbreaks in the past, if it is a new coronavirus, it will have come from an animal reservoir," says Prof Jonathan Ball, a virologist at the University of Nottingham.
Many of the early coronavirus cases were linked to the South China Seafood Wholesale Market, in Wuhan.Many of the early coronavirus cases were linked to the South China Seafood Wholesale Market, in Wuhan.
But the earliest documented case, which has been traced back to 1 December, had no connection to the market.
Sars started off in bats and then infected the civet cat, which in turn passed it on to humans.Sars started off in bats and then infected the civet cat, which in turn passed it on to humans.
And Middle East respiratory syndrome (Mers), which has killed 858 out of the 2,494 recorded cases since it emerged in 2012, regularly makes the jump from the dromedary camel.And Middle East respiratory syndrome (Mers), which has killed 858 out of the 2,494 recorded cases since it emerged in 2012, regularly makes the jump from the dromedary camel.
Which animal?Which animal?
Once the animal reservoir (where the virus normally camps out) is detected, then the problem may become easier to deal with. While some sea-going mammals can carry coronaviruses (such as the Beluga whale), the South China Seafood Wholesale Market also had live wild animals, including chickens, rabbits, snakes, which are more likely to be the source.
While some sea-going mammals can carry coronaviruses (such as the Beluga whale), the South China Seafood Wholesale Market also has live wild animals, including chickens, bats, rabbits, snakes, which are more likely to be the source.
The new virus is closely related to one found in Chinese horseshoe bats.The new virus is closely related to one found in Chinese horseshoe bats.
However, this does not mean wild bats are the source of the outbreak - they could have passed the virus onto another species sold at the market. However, South China Agriculture University has suggested the virus could have moved from bats to pangolins and finally to humans.
Why China?Why China?
Prof Woolhouse says it is because of the size and density of the population and close contact with animals harbouring viruses. Two reasons - people coming into close contact with animals harbouring viruses and dense urban populations that allow it to spread.
"No-one is surprised the next outbreak is in China or that part of the world," he says. "No-one is surprised the next outbreak is in China or that part of the world," says Prof Mark Woolhouse, from the University of Edinburgh.
How easily does it spread between people?How easily does it spread between people?
At the beginning of the outbreak, the Chinese authorities said the virus was not spreading between people - but now, such cases have been identified. It largely spreads when infected people cough droplets containing the virus into the air that infect those nearby.
Scientists say each infected person is passing the virus on to between two and three people. Initially, the Chinese authorities said the virus was not spreading between people.
This figure is called the virus' basic reproduction number - anything higher than 1 means it's self-sustaining. But now we know each infected person is passing the virus on to between two and three other people.
This is not a virus that will burn out on its own and disappear. This figure is the basic reproduction number of the virus - anything higher than one means the virus is self-sustaining.
Only the decisions being made in China - including shutting down cities - can stop it spreading. In other words, this is not an outbreak that will burn out on its own and disappear.
Those figures are constantly being revised, but put the novel coronavirus in roughly the same league as Sars.
When are people infectious?When are people infectious?
Chinese scientists say people are infectious even before their symptoms appear. Mostly when people are coughing, however, Chinese scientists have suggested some people may be infectious even before their symptoms appear.
The time between infection and symptoms - known as the incubation period - lasts up to 14 days.The time between infection and symptoms - known as the incubation period - lasts up to 14 days.
Sars and Ebola are contagious only when symptoms appear. Such outbreaks are relatively easy to stop: identify and isolate people who are sick and monitor anyone they came into contact with.Sars and Ebola are contagious only when symptoms appear. Such outbreaks are relatively easy to stop: identify and isolate people who are sick and monitor anyone they came into contact with.
Flu, however, is the most famous example of a virus that you spread before you even know you're ill. But "symptomless spreaders" are much harder to stop.
Prof Wendy Barclay from the department of infectious disease at Imperial College London said it was common for lung infections to spread without symptoms.
The virus is "carried into the air during normal breathing and talking by the infected person," she explained.
"It would not be too surprising if the new coronavirus also does this."
We are not at the stage where people are saying this could be a global pandemic like swine flu.
But the problems of stopping such "symptomless spreaders" will make the job of the Chinese authorities much harder.
What is not known is how infectious people are during the incubation period.
How fast is it spreading?How fast is it spreading?
It might appear as though cases have soared. But this is somewhat misleading. There are thousands of new cases being reported each day.
Many of these seeming new cases will have come to light as a result of China improving its ability to find infected people. However, outbreak analysts believe these are only the tip of the iceberg.
Estimates by the University of Hong Kong suggest the true total number of cases could be far higher than official figures suggest. Their mathematical models suggest the true scale of the outbreak could be 10 times larger than the official figures.
Their mathematical models of the outbreak suggest more than 75,000 people may have been infected in the Chinese city of Wuhan alone. Multiple groups have estimated the number of cases is doubling every five to seven days.
Multiple groups have estimated the number of cases is doubling every week.
Why a global emergency?Why a global emergency?
The World Health Organization (WHO) says the virus is a public health emergency of international concern - as it did with swine flu and Ebola.The World Health Organization (WHO) says the virus is a public health emergency of international concern - as it did with swine flu and Ebola.
It said it has done so in order to provide extra support to lower and middle-income countries with weaker health systems that might not be able to spot or isolate cases of coronavirus.It said it has done so in order to provide extra support to lower and middle-income countries with weaker health systems that might not be able to spot or isolate cases of coronavirus.
Could the virus mutate? Is the virus mutating?
Yes, you would expect viruses to mutate and evolve all the time. But what this means is harder to tell. The virus seems to be quite stable, so far.
China's National Health Commission has warned the coronavirus's transmission ability is getting stronger, but they were unclear on the risks posed by mutations of the virus. However, it is possible for viruses to mutate and that is something scientists will be watching closely.
This is something scientists will be watching closely. Can the outbreak be stopped?
How can the outbreak be stopped? The World Health Organization say the outbreak can be contained, but this is not a universally shared view.
We now know the virus will not stop on its own; only the actions of the Chinese authorities can bring this epidemic to an end. Experts, including the former head of the US Centers for Disease Control, argue the virus could become a pandemic - a global epidemic.
The only option is to prevent people who have become infected from spreading the virus to others. The only way it can be stopped is to prevent people who have become infected from spreading the virus to others.
That means:That means:
A massive feat of detective work will also be needed to identify people whom patients have come into contact with to see if they have the virus. A massive feat of detective work will also be needed to identify people who have been in close contact with patients to see if they have the virus.
Are there any vaccines or treatments?Are there any vaccines or treatments?
No.No.
However, the work to develop them is already under way. It is hoped that research into developing a vaccine for Mers, which is also a coronavirus, will make this an easier job. However, the work to develop them is already under way and it is hoped there will be human trials before the end of the year.
And hospitals are testing anti-viral drugs to see if they have an impact.And hospitals are testing anti-viral drugs to see if they have an impact.
A combination of two drugs - lopinavir and ritonavir - was successful in the Sars epidemic and is being tested in China during this outbreak.A combination of two drugs - lopinavir and ritonavir - was successful in the Sars epidemic and is being tested in China during this outbreak.
Treatment at the moment relies on the basics. But at the moment, treatment relies on the basics - keeping the patient's body going, including breathing support, until their immune system can fight the virus off.
Patients are kept in isolation so they do not spread the virus; breathing support is given to people with the worst lung disease; and doctors manage the other conditions the patients have. Can summer save us?
Colds and flu tend to do their main business in the winter months, so there is hope that the turning of the seasons may help stem the outbreak.
"Schools are closed for a long time in the summer and that helps limit the spread of many of these respiratory infections," said Prof John Edmunds from the London School of Hygiene and Tropical Medicine.
However, Mers-coronavirus emerged in the summer in Saudi Arabia.
"These viruses can certainly spread during the high temperature seasons, but the extent of the spread is what's important," said Prof David Heymann.
How have Chinese authorities responded so far?How have Chinese authorities responded so far?
China has done something unprecedented anywhere in the world - by effectively putting entire cities into quarantine. China has done something unprecedented anywhere in the world - effectively putting entire cities into quarantine.
The central province of Hubei, where nearly all deaths have occurred, is in a state of lockdown. The central province of Hubei, which includes Wuhan, is in lockdown with around 60 million people affected.
The province of 60 million people is home to Wuhan, the heart of the outbreak. Beijing has banned group dining for events such as birthdays and weddings while cities such as Hangzhou and Nanchang are limiting how many family members can leave home each day.
The city has effectively been sealed off and China has put numerous transport restrictions in place to curb the spread of the virus. Hubei province has even switched off lifts in high-rise buildings to discourage residents from going outside.
Some mass gatherings have been banned and tourists sites, including part of the Great Wall, have been closed.
And a ban on the sale of wildlife, a possible source of the infection, has been imposed.
In Wuhan - the centre of the outbreak - two new hospitals have been built with beds for a total of 2,300 people.
How worried are the experts?How worried are the experts?
Dr Golding says: "At the moment, until we have more information, it's really hard to know how worried we should be.Dr Golding says: "At the moment, until we have more information, it's really hard to know how worried we should be.
"Until we have confirmation of the source, that's always going to make us uneasy.""Until we have confirmation of the source, that's always going to make us uneasy."
Prof Ball says: "We should be worried about any virus that explores humans for the first time, because it's overcome the first major barrier.Prof Ball says: "We should be worried about any virus that explores humans for the first time, because it's overcome the first major barrier.
"Once inside a [human] cell and replicating, it can start to generate mutations that could allow it to spread more efficiently and become more dangerous."Once inside a [human] cell and replicating, it can start to generate mutations that could allow it to spread more efficiently and become more dangerous.
"You don't want to give the virus the opportunity.""You don't want to give the virus the opportunity."
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