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Calls for aggressive China-style containment amid sobering WHO warning

With coronavirus deaths now exceeding 1,100 and the World Health Organisation — not an organisation inclined to hyperbole — saying that it is a threat potentially worse than terrorism, there have been calls for other countries to adopt China-style containment measures, writes MedicalBrief.

China's top medical adviser, however, says that the mainland outbreak may be over by April. It's a view that's lent some credence by China now reporting the lowest number of infections since late January, according to media reports. (see live coronavirus statitical updates on the Johns Hopkins University site below)

The world must “wake up and consider this enemy virus as public enemy number one,” WHO chief Tedros Adhanom Ghebreyesus is quoted in the report as saying, adding the first vaccine was 18 months away.

China’s foremost medical adviser on the outbreak, Zhong Nanshan, said numbers of new cases were falling in some provinces and forecast the epidemic would peak this month.

But, a Reuters report says, the WHO’s Tedros was less sanguine about the virus, now officially named COVID-19 – CO for corona, VI for virus, D for disease and 19 for the year it emerged. World health organisations wanted a name that did not refer to a location or animal. “To be honest a virus is more powerful in creating political, social and economic upheaval than any terrorist attack,” Tedros said. “It’s the worst enemy you can imagine.”

A two-day WHO global research and innovation forum to mobilise international action in response to the novel coronavirus has kicked off in Geneva, Switzerland. According to a Polity report, the forum was expected to produce a global research agenda for the coronavirus, setting priorities and frameworks that could guide which projects were undertaken first.

"Publications, patents and profits are not what matters most now. What matters most is stopping the 2019nCoV outbreak, and saving lives. With your support, that is what we can do together," Tedros said. He said harnessing the power of science was critical for bringing the outbreak under control. "We hope that one of the outcomes of this meeting will be an agreed roadmap for research around which researchers and donors will align."

The report says the forum brought together key players including leading scientists as well as public health agencies, ministries of health and research funders pursuing 2019-nCoV critical animal health and public health research, and the development of vaccines, therapeutics and diagnostics, among other innovations. Participants were set to discuss several areas of research, including identifying the source of the virus as well as sharing of biological samples and genetic sequences.

The coronavirus epidemic could spread to about two-thirds of the world’s population if it cannot be controlled. The Guardian reports that this was according to Hong Kong’s leading public health epidemiologist Professor Gabriel Leung.

Speaking en route to the WHO meeting, the chair of public health medicine at Hong Kong University, said the overriding question was to figure out the size and shape of the iceberg. Most experts thought that each person infected would go on to transmit the virus to about 2.5 other people. That gave an “attack rate” of 60-80%.

An advance team of international experts led by the WHO has left for Beijing to help investigate China's coronavirus epidemic, reports Al Jazeera. The outbreak has caused huge disruptions in China with usually busy cities becoming virtual ghost towns over the past two weeks as Communist Party rulers ordered communities sealed off, cancelled flights, closed factories and shut schools.

The WHO director-general, who made a trip to Beijing for talks with President Xi Jinping and Chinese ministers in late January, returned with an agreement on sending an international mission. But, the report says, it has taken nearly two weeks to get the government's green light on its composition, which was not announced, other than to say that WHO veteran Dr Bruce Aylward, a Canadian epidemiologist and emergencies expert, was heading it.

The WHO declared the outbreak a global emergency on 30 January, days after the Chinese central government sealed off the province of Hubei and its capital Wuhan, the epicentre of a virus that emerged in December in a seafood market.

Dr Amesh Adalja, a senior scholar at Johns Hopkins Centre for Health Security, said the team would be able to investigate not only how the virus spreads, but also the severity of the outbreak. "There are a lot of unanswered questions and mysteries about how this outbreak is unfolding and the actions the Chinese government is taking," he is quoted in the report as saying. "(The team) will help us risk stratify this for the rest of the world."

More than 25,000 people across the globe have accessed real-time knowledge from WHO experts on how to detect, prevent, respond to and control the new coronavirus in the 10 days since the launch of an open online training, says the WHO. The learning team of the WHO Health Emergencies Programme worked with technical experts to quickly develop and publish the online course on 26 January – 4 days before the 2019-nCoV outbreak was declared a public health emergency of international concern.

Approximately 3,000 new users have registered for the training every day since its launch, demonstrating the high level of interest in the virus among health professionals and the general public. In addition, more than 200 000 people have viewed the introductory video to the course on YouTube.

The high engagement levels emerged as the international community launched a $675m preparedness and response plan to fight further spread of the new coronavirus and protect states with weaker health systems.

The free learning resource is available to anyone interested in novel coronavirus on WHO’s open learning platform for emergencies, OpenWHO.org. The platform was established 3 years ago with emergencies such as nCoV in mind, in which WHO would need to reach millions of people across the globe with real-time, accessible learning materials.

The online training is currently being produced in all official UN languages and Portuguese.

Health officials in Africa are still bracing themselves for the worst, says a Fin24 report. Two-way travel between Africa and China, the epicentre of the respiratory illness that's infected more than 34 000 people since late December, has surged over recent years as they forged closer financial and political ties, raising the region's risk of exposure.

About 20 African nations have already issued alerts of possible cases, and the WHO has expressed concern that a widespread outbreak would overwhelm their fragile health systems. "We are not waiting for an outbreak," said Amadou Sall, a director at Institut Pasteur de Dakar, a bio-medical research centre in Senegal. "We're anticipating it."

A lot of progress has been made in dealing with highly pathogenic viruses since the Ebola outbreak, with many Africans having been trained to deal with them, according to Sall. Laboratories and research centres have also been built, while new surveillance methods have been introduced, he is quoted in the report as saying. South Africa and Senegal have been conducting tests for the coronavirus for other countries in their respective regions. Ghana, Madagascar, Sierra Leone and Nigeria also have the capacity to do sampling, and another 24 countries are set to join their ranks.

The report says the Africa Centres for Disease Control and Prevention (Africa CDC), which helps nations on the continent tackle and prevent infectious diseases, has also voiced concern about their capacity to cope with a wide-scale epidemic. High population growth and unplanned urbanisation have increased the risk of an outbreak starting and spreading, and governments have limited resource to respond, it said.

"The real point of entry of a virus to a country is very often in a poorly equipped emergency room, in a doctor's clinic where there's no awareness of the disease," said Mike Ryan, head of the WHO's Health Emergencies Programme. "What we absolutely have to avoid is the disease arriving in an unprotected health facility with untrained, unaware workers."

South Africa's National Institute for Communicable Diseases (NICD) says it has tested 61 people for the coronavirus and all have come back negative, reports News24. According to Professor Cheryl Cohen of the NICD, although there were possibilities the disease could be detected, the country was, however, prepared to fight it.

She said there were possibilities because South Africa remained a destination of choice for many travellers, with a lot of traffic coming from Cape Town and OR Tambo international airports. Cohen added all entry ports were on high alert for any possible cases.

"We can confirm that as of 11 February, 2020, 61 individuals have been tested for the virus and all tests have come back negative, therefore there is no confirmed case of the 2019-nCoV in South Africa. The NICD, working with the national Department of Health, continues to enhance systems to rapidly identify and detect any imported cases that may reach our borders," Cohen is quoted in the report as saying.

The report says 130 health professionals – including medical doctors, environmental health practitioners, emergency personnel, nurses and others – were trained at Tshepong Hospital in North West to build capacity to respond to the virus.

Cohen, from the Centre for Respiratory Diseases and Meningitis at the NICD, said since the virus was declared a global emergency the institute has worked closely with all relevant stakeholders, private and public health institutions and the Health Department to make sure a comprehensive plan is in place to take action against the deadly virus.

However, she is quoted in a Polity report as saying that the institute was aware that some people could enter the country via illegal ports of entry. “We are also reaching out to the public by using questionnaires and making sure that everyone is aware of the virus and also making sure that doctors and nurses know the signs and symptoms to worry about and the kinds of travel history there is to worry about, and should there be a specific case they will know what to do in terms of managing the case, as well as isolating the case to prevent the spread, and also submitting samples to our laboratories where we can make the diagnosis,” she said.

“It is important for South Africans to know that the coronavirus is not circulating and the only people who should worry are people who have travelled to China. If someone has been in China in the last fourteen days, they should worry if they have the signs and symptoms,” she stressed.

State hospitals in South Africa are readying themselves and Addington Hospital is said to be better prepared with an isolation ward that meets the required standards compared to that of the provincially designated Grey’s Hospital, says a Sunday Tribune report. The national Health Department appointed Grey’s in Pietermaritzburg to manage all suspected coronavirus cases in Kwazulu-Natal. However, Nomakiki Majola, a member of the provincial legislature and chair of the health portfolio committee, said that Addington had better facilities, although upgrades were needed.

According to the report Majola met the heads of different units at Addington to discuss the coronavirus master plan and to assess the hospital’s state of readiness. “The ward is a work in progress, but it needs a deadline because we can have a case any time,” said Majola.

The report says Majola would also visit Grey’s, Empangeni’s Ngwelezane and far northern Zululand’s Manguzi hospitals in the next few days.

The Africa CDC says it has received reports that some African countries are refusing entry to their own citizens returning from China in the wake of the coronavirus outbreak. Polity quotes the organisation's director Dr John Nkengasong as saying that this went against the instructions of the WHO that there should be no restrictions of movement, goods and air travel. Nkengasong refused to name the countries in question, saying that the media should not create fear.

Africa CDC has been funded with $5m by the Bill and Melinda Gates Foundation to respond to the outbreak. And AU commissioner for social affairs Amira Elfadil added that 15 countries had already received training on diagnostics. The 15 countries which received priority are those with direct flights to China.

"Africa has had suspected cases, but no confirmed cases. We are working on prevention methods, working with the government of China which is supporting CDC. We are doing our maximum best to protect the continent from the coronavirus."

The report says until recently, South Africa, Cameroon, Ghana and Nigeria were the only countries equipped with the ability to run accurate testing. To mitigate this, Africa CDC is planning to do another round of training for 20 additional countries and will supply them with test kits.

[link url="https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6"]Johns Hopkins University – live coronavirus statistical updates[/link]

[link url="https://uk.reuters.com/article/us-china-health/expert-sees-coronavirus-over-by-april-in-china-who-still-alarmed-idUKKBN20504Y"]Full Reuters report[/link]

[link url="https://www.polity.org.za/article/who-convenes-global-forum-on-coronavirus-2020-02-11"]Full Polity report[/link]

[link url="https://www.theguardian.com/world/2020/feb/11/coronavirus-expert-warns-infection-could-reach-60-of-worlds-population?CMP=Share_iOSApp_Other"]Full report in The Guardian[/link]

[link url="https://www.aljazeera.com/news/2020/02/health-agency-china-mainland-deaths-rise-900-200210013811845.html"]Full Al Jazeera report[/link]

[link url="https://www.who.int/news-room/detail/07-02-2020-online-training-as-a-weapon-to-fight-the-new-coronavirus"]WHO material[/link]

[link url="https://www.who.int/emergencies/diseases/novel-coronavirus-2019"]WHO coronavirus information[/link]

[link url="https://www.fin24.com/Economy/coronavirus-threat-looms-over-fragile-african-health-systems-20200208"]Full Fin24 report[/link]

[link url="https://www.news24.com/SouthAfrica/News/update-sa-still-coronavirus-free-as-61-people-test-negative-for-the-virus-20200211"]Full News24 report[/link]

[link url="https://www.polity.org.za/article/ports-of-entry-beefed-up-to-detect-coronavirus-nicd-2020-02-11"]Full Polity report[/link]

[link url="https://www.pressreader.com/south-africa/sunday-tribune-south-africa/20200209/281586652595694"]Full Sunday Tribune report (subscription needed)[/link]

[link url="https://www.polity.org.za/article/some-african-countries-refuse-entry-to-own-citizens-coming-from-china-amid-coronavirus-fears-africa-cdc-2020-02-10"]Full Polity report[/link]

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