New story in Health from Time: Wuhan Coronavirus Death Toll Rises to 106 in China as CDC Confirms 5 Cases in U.S.

The U.S. Centers for Disease Control and Prevention has confirmed five cases of a SARS-like form of coronavirus in the U.S. On Tuesday, Chinese officials announced 25 additional deaths from the infection, raising the death toll to 106. The disease, which is believed to have originated in a seafood market in the Chinese central city of Wuhan, has infected a few thousand people across China and has also spread to other countries.

Chinese officials have confirmed more than 4,400 cases of the novel coronavirus nationwide and more than 2,700 cases in Hubei, the province where Wuhan is located, according to a virus tracker maintained by researchers at Johns Hopkins University.

But experts are skeptical that official numbers capture the full extent of the outbreak. Researchers in Hong Kong have warned that the actual number of people infected in Wuhan could already be more than 30 times higher than the official tally.

Experts say many of those who died from the disease had underlying health conditions that involved weakened immune systems, like hypertension, diabetes or cardiovascular disease but note that there is still a lot to be learned about the virus’ origins, clinical features and severity.

Chinese President Xi Jinping has called the outbreak a “grave” situation and sent the country’s Premier, Li Keqiang to Wuhan to assess the response to the virus. Li, who is head of a new task force that’s coordinating efforts to contain the disease, said Monday that the government would send 2,500 more medical workers to Wuhan over the next two days.

Chinese officials have extended the Chinese New Year holiday in an effort to keep people at home.

Wuhan travel restricted

Gabriel Leung, the chair of public health medicine at the University of Hong Kong, said at a press conference Monday that the number of people infected is likely to be much higher than official figures — with as many as 44,000 people possibly infected in Wuhan alone, according to his team’s research models. Leung recommended that officials take “substantial draconian measures” to contain the virus, including cancelling large gatherings, closing schools and asking officer workers to work from home.

Chinese officials have shut down travel in and out of Wuhan — home to 11 million people — and enacted similar, strict transportation restrictions in a number of other cities. Immigration authorities say no passengers have left the Chinese mainland over the past four days through the Wuhan Tianhe International Airport or the Hankou Port. China’s Hubei Province has also suspended services to apply for passports and exit-entry permits.

Wuhan’s mayor has said that he is willing to resign if it would help contain the outbreak and acknowledged that information was not disclosed quickly enough when the virus first broke out.

Authorities have also banned all forms of wildlife trade and implemented strict regulations on activities related to wild animals. The virus was first detected as a form of viral pneumonia centered on a seafood market in Wuhan on Dec. 12. Many of the first reported cases were people who worked at the market, which also sold wild animal meat. Officials closed down the market.

So far, no deaths from the virus have been reported outside the Chinese mainland. The city of Beijing reported its first death on Monday and last week confirmed that a 9-month-old tested positive for the disease.

International cases

Patients have tested positive for the illness in at least 16 international locations. They include eight confirmed cases in Hong Kong and Thailand, six confirmed cases in Macau and five confirmed cases in Singapore, Australia and Taiwan. Governments and health officials in Nepal, Canada, Cambodia, Vietnam, France, South Korea, Malaysia, Sri Lanka and Japan have also reported patients testing positive for the virus. Mongolia’s official news agency has said the country closed border crossings with China on Monday, according to the Associated Press.

Multiple countries are also warning against travel to Hubei province and some are considering ways to evacuate citizens. Chinese authorities have said they will suspend tour groups and travel packages. Hong Kong has said it will ban anyone who has been to Hubei province from entering the city. The United Kingdom has advised against all non-essential travel to Hubei province. Canada has advised avoiding all travel to the province.

The U.S. State Department escalated a travel advisory warning for Hubei province to level four on Friday, advising visitors not to travel to the province because of the coronavirus. On Monday, a level three advisory to “reconsider travel” was issued for any travel to China in general.

On Sunday, the agency indicated plans to evacuate staff and some private citizens. The U.S. state department said that it is making arrangements to relocate personnel at the U.S. Consulate General in Wuhan to the United States and noted that there would be “limited capacity to transport private U.S. citizens on a reimbursable basis” on a flight leaving Wuhan’s international airport Tuesday and arriving in San Francisco.

The World Health Organization’s Director General Tedros Adhanom Ghebreyesus said on Twitter Sunday that he was “on (his) way” to Beijing to support the Chinese government and health officials respond to the outbreak. The WHO decided not to declare the outbreak a “public health emergency of international concern” after convening an emergency committee that met last week, saying that it was still “too early” to do so. They previously praised China’s swift response and encouraged them to remain transparent in sharing data regarding the outbreak.

The stock market has also taken a hit, as major US indexes fell more than 1% on Monday; the Dow Jones Industrial Average dropped as many as 500 points, the Associated Press reported.

CDC confirms 5 cases in U.S.

The CDC has confirmed five cases of the coronavirus infection in the U.S. — one in Arizona, two in California, one in Washington state and one in Illinois. The agency said all of these patients, the first of whom was diagnosed in Snohomish county, Wash., traveled from China. “It is likely there will be more cases reported in the U.S. in the coming days and weeks, likely including person-to-person spread,” the CDC said in a statement.

The agency said Monday that 110 individuals across 26 states were considered to be “persons under investigation.” “That is a cumulative number and will only increase,” said Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the CDC. Of these 110, five had tested positive, 32 tested negative and 73 determinations are still pending. The people being investigated could include those who have a fever and respiratory illness after traveling to Wuhan and individuals who have had contact with a patient who tested positive for the disease and have a fever and respiratory illness.

“At this time in the U.S., the virus is not spreading in the community. For that reason we continue to believe that the immediate health risk to the general American public is low at this time,” Messonnier said during a telebriefing on Monday.

The CDC’s travel precaution is currently at a level three, recommending that travelers avoid all nonessential travel to China because of the disease.

The CDC is continuing to screen passengers from Wuhan at five major airports in the U.S. and has screened about 2,400 people so far, Messonnier said, adding that the number of people coming from Wuhan is declining with the recent travel restrictions. (Since direct flights out of Wuhan have stopped, the agency said it is screening those with “broken itineraries” who may be transiting from Wuhan through another country back to the U.S.)

These screenings provide opportunities to detect and rapidly respond to the illness, as well as educate returning travelers on the signs and symptoms of the disease, she explained. The five airports where the CDC is conducting entry screenings of passengers on direct and connecting flights from Wuhan are New York City’s John F. Kennedy International Airport, Los Angeles International Airport, San Francisco International Airport, Chicago O’Hare International Airport and Hartsfield-Jackson Atlanta International Airport .

There is still more research and analysis needed before the CDC can be confident about how exactly the outbreak started but experts will likely look to MERS and SARS to guide them, Messonnier said.