The total number of active COVID-19 cases around the world has dropped by over 6,000 cases in the last week. That’s unabashedly good news. Unfortunately, that reflects nothing except that health officials in China’s Hubei province have wrangled the epicenter of the outbreak to the extent that the number of recoveries is now handly outpacing the number of new cases. If that news was happening in a vacuum, it might be time to relax a bit and look toward a point, not so many months in the future, when this epidemic was genuinely under control.
But what’s happening in China is no longer the single point of concern about 2019-novel coronavirus. Until just a few days ago, it was possible to look at cases outside China and see them as a handful of cases, most of them returning travelers who had been infected in China. It was also easy to believe that health services around the world were on top of these cases. That is no longer true. With a continued explosion of cases in South Korea, an outbreak in Italy, and an unknown reservoir of disease lurking in Iran, the CDC is now warning that COVID-19 represents "a tremendous public health threat” that could become pandemic.
The sharp warning comes from a briefing provided on Friday by Director for the National Center for Immunization and Respiratory Diseases Nancy Messonnier. Her announcement was also not exactly cheery when discussing the condition of Americans who had been infected so far.
“There are several Americans with COVID-19 who are hospitalized in japan and who are seriously ill. Sadly, we may see poor outcomes in others, not just people who were on board the Diamond Princess, but among others who become sick with this virus.”
Messonnier did say that she believed that the “aggressive travel precautions” were working to contain the spread of COVID-19 in the United States, and the fact that the number of cases actually diagnosed in the U.S. has been so low, despite the amount of worldwide travel into America, was good news. But the hammer was still about to drop.
”We never expected we’d catch every traveler with novel coronavirus from China. It would be impossible. We’re not seeing spread here in the United States yet, but it is possible, even likely, that it may eventually happen. Our goal continues to be slowing the introduction of the virus into the U.S. This buys us more time to prepare our communities for more cases and possibly sustained spread. This new virus represents a tremendous public health threat.”
Much of the announcement might be regarded as “bracing for impact,” as Messonnier restated that there was no vaccine, that the CDC was working closely to prepare local and state health departments, and warned that the CDC may need to take “more aggressive action” to slow the spread.
What’s powering these concerns is no longer just what’s happening in China, but the secondary, tertiary and unknown generations of infections that are now affecting nations around the world. While some of those who surfaced a handful of cases in the early days have managed to contain or even clear the books of any COVID-19 inside their borders, others have not.
The numbers out of China continue to trend well, and the strained health care system in Hubei is getting some relief—though reports continue to come out about large numbers of infected doctors and nurses. The growth of the disease has also been arrested in many other provinces. The strict quarantine that China has imposed in many areas, and the long period of both mandatory and voluntary isolation appears to have been effective in giving the system there the relief it needed to bring the outbreak somewhat under control. However, with tens of thousands of active cases, the possibility of the outbreak re-igniting in China requires nothing more than lax action by local officials almost anywhere in the nation.
Looking around the world, some nations are seeing increases as passengers from the Diamond Princess are repatriated. At this point the ship has been essentially emptied. Statistics from the Princess have been fixed for the last two days, and this is the last day it will remain on the chart of active cases outside China, as those cases are now more properly reported in the nations where they are being treated. Nations like the United States and Australia have seen increased counts in the last few days almost entirely because of returning passengers from the ill-fated ship, though there was one new case in the U.S. reported on Friday — a traveler who had visited China early in February was diagnosed in Sacramento County, California.
But the big areas of concern remain the same as on Friday: South Korea, Italy, and Iran.
As it has for five days running, the number of cases in South Korea doubled again. While many of these cases were connected to the church and hospital near Daegu which were the original hot spots for infection in South Korea, the number also includes dozens of cases whose relationship to earlier cases is unknown.
The first case of COVID-19 was reported in South Korea on January 20. That number of cases increased slowly and by the end of the month the count stood at 6. While the number appeared to double in the first two days of February, these cases were actually South Koreans airlifted out of Wuhan—similar to the flights conducted by the U.S. State Department—and the returnees went straight into quarantine. So no real source of concern. But on February 5, a slow trickle of cases began to emerge, especially around Daegu. By February 18, the total number of the cases in the country was up to 31, but cases were still coming in small numbers … then this happened. On Feburary 19, the case count was 58. The next day, 111. By Thursday, it had cleared 200. And then 433 on Friday. Those cases come from 17 different communities in all parts of South Korea. Looking back to early January figures, this rate of growth is actually considerably faster than that around the original outbreak in Wuhan. Public health officials in South Korea have declared that the outbreak remains “manageable” … but the numbers are certainly daunting.
The next big area of concern is Italy. The cases in Italy came seemingly out of nowhere, bursting from just two cases to 55 in two days. The original vector appears to be a man who returned from China and hosted a large dinner party. Then an infected person visited a local hospital and went undiagnosed for several days, during which period the hospital itself became a source of new infections. Most of the cases are in the Lombardy region, but there have also been cases as far away as Rome and Venice. The outbreak has led to a closing of schools, businesses, and government offices across large parts of the country as officials rush to track down connections and test thousands of individuals across ten different communities. This is already the largest outbreak outside of Asia. Especially concerning is that many of the cases in Italy are reported as serious or critical, which suggests that they may have been active for several days before being diagnosed.
Then there’s Iran. With only 10 new cases reported overnight, Iran’s total case count of 28 still looks rather puny — but with a death count now up to 9 and at least two other countries tracing cases to travelers who visited Iran, there appears to be large, diagnosed reservoir of disease.
Cases from outside China are now coming in quickly enough that these numbers and charts are guaranteed to be out of date before I can publish them. Please refer to the sources below for more updated values.
World Health Organization 2019 Coronavirus information site.
World Health Organization 2019 Coronavirus Dashboard.
2019-nCoV Global Cases from Johns Hopkins.
BNO News 2019 Novel Coronavirus tracking site.
Worldometer / Wuhan Coronavirus Outbreak.
CDC Coronavirus-2019 (COVID-19) information site.