In South Korea, President Moon Jae-in has raised the health alert level to its maximum “Level 4,” after another day of triple digit growth of infections in that nation. This level empowers the military to forcibly quarantine areas, close businesses, and restrict travel within the nation. At a emergy meeting, President Moon declared this a “watershed” moment, saying that the “coming few days will be a critical time for us.”
In Italy, Prime Minister Giuseppe Conte has imposed “extraordinary measures” to contain an outbreak that is now in multiple regions, and which grew by another 55 cases on Saturday. For the moment, Conte has said he will not suspend the Shengen agreement—the agreement by which members of the European Union can move freely with neighboring states—but he is getting criticism for that move both inside and outside Italy. On Saturday, 12 towns in the northern regions of Veneto and Lombardy were placed on lockdown as testing continued.
And in Iran the cases and the deaths increased, but the news did not.
CDC has issued travel restrictions on nonessential travel to China, as well as warnings to use “enhanced precautions” on travel to South Korea and Japan. As of Saturday evening, no such travel warnings were in place for Italy. However, WHO officials declared that a “serious mistake was made [to not] quarantine people who arrived in Italy from China. They also declared that people in the region should avoid any crowded place — subways, trains, buses, schools, health cubs, dance halls … anywhere that people gather. It was not on WHO’s list, but considering that in both Singapore and South Korea a large number of infections traced back to church gatherings, they should also be shunned for the moment.
Italy appears to have taken that to heart. Schools, movie theaters, sporting events, concerts, and religious celebrations of all kinds have been canceled in Lombardy and Veneto. That includes cancelling the famous Carnival in Venice. So if this was the year you chose to go and see people wearing masks … surprise, they’re wearing a different kind of mask.
WHO announced that it would be clear if the world was facing a pandemic within the next two weeks. In the meantime, officials are rushing testing kits to African countries where no cases have been recorded at this point. WHO also announced that the window to avoid a global pandemic was “narrowing” as these new outbreaks expanded.
As has been the case for several days, reports out of China have placed recoveries ahead of new cases. That is driving down the total case load, even with the rapid growth of new cases outside of China. In the original epicenter near Wuhan, the number of cases reported on Saturday remained almost steady, at 630, but a steady increase in cases being released from medical facilities continues to drop the number of active cases.
Even though Taiwan has not seen a rapid increase in cases, I want to focus for a moment on a single case that was diagnosed there on Friday. The man in question was a traveler whose business ties took him frequently to Wuhan. On January 31, he developed a fever and other flu-like symptoms. After running a fever for four straight days, he visited a local clinic. This is on February 4, in Taiwan, at a point when there are already 20,000 cases in China and over a dozen cases in Taiwan. The man knew he had been to the epicenter of the outbreak at the height of it’s growth. He was not diagnosed and was sent home. Four days after that, with his fever even higher and other symptoms worsening, he went to an emergency room. This was February 8. There were 35,000 cases in China, over 20 in Taiwan. And again, the man knew he had been to Wuhan. He was diagnosed with pneumonia … and sent home. He returned to the hospital again on February 11. And was sent home. And he was back on February 18. And was sent home. Finally, on February 21, he was finally diagnosed and put in isolation.
The situation was almost identical to one in Italy in which a traveler coming back from China visited a local clinic three times — and was never diagnosed before 20 members of the that clinic themselves began to show symptoms. Both of these cases show that, outside of those areas where the epidemic is rampant, it is terrifyingly easy for healthcare workers to see the person in front of them as just another person with cold or flu. The average doctor, in the average clinic, almost anywhere in the world, is unlikely to look at the person in front of them and think “could this be a case of a new epidemic disease?” That exact attitude is directly connected to hundreds of cases in Italy. Hopefully there will be no similar outbreak in Taiwan.
But here’s what is happening around the world …
One new country was added with the first case being announced in Iraq—the third country to have a case that was probably acquired in Iran.
Iran itself continues to be mystery. Officials there reported 14 more cases and two more deaths overnight … but it’s absolutely obvious that the totals there are off by orders of magnitude.
One other number that changed today is worth noting: Even though most of the passengers have now been removed from the Diamond Princess, either being sent to their home countries or to quarantine on shore, fifty-seven new cases and one new death were announced on Saturday. Of those 57 cases, 55 were crew members who stayed on board and took care of the passengers during the ship’s long isolation. If there is such a thing as a Medal of Honor for cruise ship crew, please prepare to hold a big ceremony.
Some sources are now lumping all the remaining Diamond Princess cases in with Japan, as most of them are in quarantine off the ship. However, as long as the Japanese government continues to report these cases separably, and it makes some modicum of sense, I plan to keep the two apart. Japan itself had 14 new cases on Saturday — and continued the disturbing situation in which the connections between these cases and previous cases were hard to determine. Yokohoma continues to have the highest number of cases, but the cases are literally spread along the length of the islands.
As of Saturday, outcome mortality (deaths / deaths + recoveries) is down to 9.5% while case fatality (deaths / total cases) continues a slow rise at 3.13%. At this point, we have enough data to make a good estimate of final case fatality that can be compared with other diseases. On Monday, I’ll demonstrate how that number can be derived, and then take a second look at what it would mean to have an unconstrained outbreak of COVID-19 in the United States. You will not like it.
Finally, I’m going to return to what I said at the end of the very first article in this series: It is not time to panic. There remains a good chance that COVID-19 will not reach epidemic levels in the United States. There is certainly no sign of any such outbreak now. However, fear of infection and calls for restrictions can be expected to race ahead of actual infections. It is not a bad idea to use this time to look around and think about you might do to plan for a situation in which normal travel and services could be disrupted.