ALERT: Coronavirus Pandemic Event Now A Serious Risk

Via Peak Prosperity

The details are still sketchy, but this is a careful summary of what’s known from the Imperial College of London’s disease specialists.

Importantly, the period between infection and detection is thought to be 5-6 days.  Another 4-5 days between symptoms and detection.

They note that the initial report/alert to the WHO was Dec 31st 2019.  Wuhan airport was closed down yesterday, 1/22/20.

They also noted that “Total volume of international travel from Wuhan over the last two months has been 3,301 passengers per day”  So … 3,301 x 22 days = in excess of 72,000 possibly infected carriers that went who knows where.

Source – https://www.cdc.gov/coronavirus/2019-ncov/summary.html

Background
On the 31^st December 2019, the World Health Organization (WHO) China Country Office was informed of cases of pneumonia of unknown aetiology in Wuhan City, Hubei Province, China [1]. A novel Coronavirus (2019-nCoV) related to the Middle Eastern Respiratory Syndrome virus (MERS-CoV) and the Severe Acute Respiratory Syndrome virus (SARS-CoV) has since been implicated [2].

As of 4 a.m. 21^st January (Beijing Time) 2020, 440 cases (including nine deaths) have been confirmed across 13 provinces in China, plus suspected cases in multiple other provinces [3]. As of 9:00 GMT 22^nd January 7 confirmed cases in travellers from Wuhan with symptom onset on or before the 18^th January were detected outside mainland China in Thailand (3 cases), Japan (1 case), South Korea (1 case), Taiwan (1 case) and the United States (1 case) [4–10]. Chinese authorities have also confirmed evidence of human-to-human transmission, as well as 15 cases in healthcare workers [11,12]. Of these cases, four travelled before exit screening in Wuhan International Airport was introduced on 15^th January [13], three (South Korea, Taiwan, USA) on or after.

Using the number of cases detected outside mainland China with who had disease onset by 18^th January, it is possible (see Report 1 [14]) to infer the number of clinically comparable cases within Wuhan City that may have occurred thus far. Here we update our estimates to account for the additional international exported cases (7 cases).

Summary
We estimate that a total of 4,000 cases of 2019-nCoV in Wuhan City (uncertainty range: 1,000 – 9,700) had onset of symptoms by 18^th January 2020 (the last reported onset date of any case) [15].

Our estimates should not be interpreted as implying the outbreak has doubled in size in the period 12^th January to 18^th January – delays in confirming and reporting exported cases and incomplete information about dates of symptom onset together with the still very small numbers of exported cases mean we are unable to estimate the epidemic growth rate at the current time.

This estimate is based on the following assumptions:

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• Wuhan International Airport has a catchment population of 19 million individuals [1].
• There is a mean 10-day delay between infection and detection, comprising a 5-6 day incubation period [16,17]  and a 4-5 day delay from symptom onset to detection/hospitalisation of a case (the cases detected in Thailand and Japan were hospitalised 3 and 7 days after onset, respectively) [4,18].
• Total volume of international travel from Wuhan over the last two months has been 3,301 passengers per day. This estimate is derived from the 3,418 foreign passengers per day in the top 20 country destinations based on 2018 IATA data [19], and uses 2016 IATA data held by Imperial College London to correct for the travel surge at Chinese New Year present in the latter data (which has not happened yet this year) and for travel to countries outside the top 20 destination list.
• Exit screening (which reportedly came into force on the 15^th January [13]) had no impact on exported cases reported up to 16^th January. Exit screening may have reduced exports in recent days, in which case our baseline prediction may be an underestimate of the true number of cases in Wuhan.
• We assume all cases in travellers flying to destinations outside mainland China are being detected at those destinations. This may well not be the case. If cases are being missed in other countries, our baseline prediction will underestimate the true number of cases in Wuhan.
• We now report uncertainty as the range spanned by the 95% confidence intervals of the first three scenarios in Table 1. Thus, our uncertainty range represents uncertainty in key assumptions as well as statistical assumptions.

Additional caveats

1. We assume that outbound trip durations are long enough that an infected Wuhan resident travelling internationally will develop symptoms and be detected overseas, rather than being detected after returning to Wuhan. We also do not account for the fact that international visitors to Wuhan (such as the case who was detected in Japan) might be expected to have a shorter duration of exposure and thus a lower infection risk than residents. Accounting for either factor correctly requires additional data but would increase our estimate of the total number of cases.

2. We estimate the potential number of symptomatic cases with disease severity of a level requiring hospitalisation (both the cases detected in Thailand and Japan were moderately severe). Our estimates do not include cases with mild or no symptoms.

3. The incubation period of 2019-nCov is not known and has been approximated with the estimates obtained for MERS-CoV and SARS [16,17].

4. We assume that international travel is independent of the risk of exposure to 2019n-CoV and of infection status. If zoonotic exposure were biased towards wealthier people, travel frequency may be correlated with exposure. Also, some travel might be causally linked to infection status (to seek healthcare overseas) or the infection status of contacts in Wuhan (this may apply to the case detected in Japan) [18]. Accounting for either association would increase the probability of a case travelling and therefore reduce our estimates of the total number of cases.

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