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02/02/2020 2019–20 Wuhan coronavirus outbreak - Wikipedia

2019–20 Wuhan coronavirus outbreak


A new coronavirus, designated 2019-nCoV,[4] was
2019–20 Wuhan coronavirus
identified in late 2019 in Wuhan, the capital of China's
outbreak
Hubei province, after people developed pneumonia
without a clear cause and for which existing treatments
were not effective.[5] The virus has been shown to
spread between people, with the rate of spread
increasing as of mid-January 2020,[6][7] and several
countries across Europe, North America and the Asia-
Pacific reporting cases.[8] The time from exposure to
onset of symptoms is between 2 and 14 days.[9] There is
evidence that it may be contagious before the onset of Animated map of confirmed 2019-nCoV cases
symptoms[10] and possibly for several days after spreading from 12 January 2020.
recovery.[11] Symptoms include fever, coughing, and
Date 1 December 2019–ongoing[1][2]
breathing difficulties, and it can be fatal.[12]
(2 months and 1 day)
As of 2 February 2020, approximately 14,569 cases Location First identified in
have been confirmed,[3] including in every province- Wuhan, Hubei, China
level division of China.[3] The first confirmed death Casualties
occurred on 9 January and since then 305 deaths have
Confirmed cases: 14,569[3]
been confirmed.[3][13] A larger number of people may
Deaths: 305[3]
have been infected, but not detected (especially mild
Affected territories: 27
cases).[14][15] The first local transmission of the virus
outside China occurred in Vietnam from a father to his
son,[16] whereas the first local transmission not
involving family occurred in Germany, on 22 January,
when a German man contracted the disease from a
Chinese business visitor at a meeting near Munich.[17]
The first death outside China was reported in the
Philippines, when a 44-year old man confirmed to
have contracted the virus passed away on 1
February.[18][19]

In response, cities with a combined population over 57


million people including Wuhan and 15 others in the
surrounding Hubei province were placed on full or
partial lockdown, involving the stopping of all urban
Animation showing the spread of confirmed 2019-
public transport and outward travel by train, air and nCoV cases since 24 January (high resolution) (http
long-distance buses.[20][21][22][23] Many New Year s://upload.wikimedia.org/wikipedia/commons/b/b3/2
events and tourist attractions have been closed over 019-nCoV_Confirmed_Cases_Animated_Map.web
fear of spread, including the Forbidden City in Beijing m)
and traditional temple fairs. [24] Hong Kong also raised
its infectious disease response level to the highest
level and declared an emergency, closing its schools until mid-February and cancelling its New Year
celebrations.[25][26]

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A number of countries have issued warnings against travel to Wuhan and Hubei province.[27] Travellers who
have visited Mainland China have been asked to monitor their health for at least two weeks and contact their
healthcare provider to report any symptoms of the virus.[28] Anyone who suspects that they are carrying the
virus is advised to wear a protective mask and seek medical advice by calling a doctor rather than directly
visiting a clinic in person.[29] Some hotels have been providing refunds and no-fee cancellations for
reservations in China or by people from China.[30] Airports and train stations have implemented temperature
checks, health declarations and information signage in an attempt to identify carriers of the virus.[31]

On 30 January, the outbreak was declared a Public Health Emergency of International Concern (PHEIC) by
the World Health Organization (WHO), explaining that its decision was based on the possible effects that
the pathogen could have if it spreads to countries with weaker healthcare infrastructures. The declaration
makes it the sixth time that the measure has been invoked since the H1N1 pandemic in 2009.[32][33][34][35]

Contents
Background
Epidemiology
Areas affected
Estimates
Signs and symptoms
Cause
Spread
Virology
Diagnosis
Prevention
Quarantine measures
Evacuation of foreign citizens
Management
Domestic responses
International responses
Specialty hospitals
Reactions to prevention efforts
WHO response
International reactions
Criticism of local response
Treatment research
Impact
Mainland China
Hong Kong
Japan
Southeast Asia
South Asia
United States
See also
Notes
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References
Further reading
External links

Background
Wuhan is the capital of Hubei province and is the seventh-largest city in China, with a population of more
than 11 million people. It has been a major transportation hub of the country throughout the ages, long
known as the "Nine Provinces' Thoroughfare" ( 九 ),[36] and the Wuhan Railway Hub is one of the
four most important railway hubs in China. It is approximately 1,100  km (700  mi) south of Beijing,[37]
800  km (500  mi) west of Shanghai, and 970  km (600  mi) north of Hong Kong.[38] Direct flights from
Wuhan connect it to major international cities in Europe and North America.[39]

In Wuhan, during December 2019, a cluster of cases displaying the symptoms of a "pneumonia of unknown
cause" was linked to Huanan Seafood Wholesale Market, which had a thousand stalls selling fish, chickens,
pheasants, bats, marmots, venomous snakes, spotted deer, and other wild animals (ye wei, bushmeat). The
immediate hypothesis was that this was a novel coronavirus from an animal source (a
zoonosis).[40][41][42][43]

Coronaviruses mainly circulate among other animals but have been known to evolve and infect humans as in
the cases of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS)
together with four further coronaviruses that cause mild respiratory symptoms similar to the common cold.
All coronaviruses known to infect humans have been shown to spread between people.[44][45] Transmission
of coronaviruses is primarily thought to occur among close contacts via respiratory droplets generated by
sneezing and coughing.[46]

Epidemiology
Of the first 41 confirmed 2019-nCoV cases, the
Confirmed cases in Mainland China according to the
earliest reported symptoms occurred 1 National Health Commission daily reports[47] ()
December 2019, in a person who did not have
2020-01-16   45
any exposure to the market or to the remaining 2020-01-17   62
40 affected people.[48] As the number of cases 2020-01-18   121
have increased, the significance of the market 2020-01-19   198
lessened.[48][49] 2020-01-20   291
2020-01-21   440
Chinese scientists were able to quickly isolate a 2020-01-22   571
strain of the coronavirus and publish the 2020-01-23   830
2020-01-24   1,287
genetic sequence so that laboratories across the
2020-01-25   1,975
world could independently develop PCR tests 2020-01-26   2,744
to detect infection by the virus. The WHO had 2020-01-27   4,515
praised the Chinese for their swift 2020-01-28   5,974
efforts.[50][40][51][52][53] 2019-nCoV's genome 2020-01-29   7,711
sequence is 75- to 80-percent identical to 2020-01-30   9,692
2020-01-31   11,791
SARS-CoV, and more than 85-percent similar
2020-02-01   14,380
to several bat coronaviruses.[54][55] Of the first
41 confirmed cases, two-thirds were found to
have a link with the Huanan Seafood Wholesale Market, which also sold live animals.[49][56][57][58] Whether
this virus is of the same lethality as SARS is unclear.[50][40][51][52]

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On 17 January, an Imperial College group in the United Kingdom published a report that there had been
1,723 cases (95% confidence interval, 427–4,471) with onset of symptoms by 12 January. This was based on
the pattern of the initial spread to Thailand and Japan. They also concluded that "self-sustaining human-to-
human transmission should not be ruled out",[59][60] which has since been confirmed. As further cases came
to light, they later recalculated that "4,000 cases of 2019-nCoV in Wuhan City had onset of symptoms by 18
January 2020".[61][14] A Hong Kong University group has reached a similar conclusion as the earlier study,
with additional detail on transport within China.[15]

On 20 January, China reported a sharp rise in cases with nearly 140 new patients, including two people in
Beijing and one in Shenzhen.[62] On 25 January, the number of laboratory-confirmed cases stood at 2,062,
including 2,016 in Mainland China, seven in Thailand, six in Hong Kong, five in Macau, five in Australia,
four in Malaysia, four in Singapore, three in France, three in Japan, three in South Korea, three in Taiwan,
three in the United States, two in Vietnam, one in Nepal, and one in Sweden.[63][64][65]

Areas affected
The virus spread to other Chinese provinces in early and mid-January 2020, helped by the Chinese new year
migration. Cases started to be detected in other countries, carried by international travelers, typically to
major trade partners: Thailand (13 January); Japan (15 January); South Korea (20 January); Taiwan and the
United States (21 January); Hong Kong and Macau (22 January); Singapore (23 January); France, Nepal and
Vietnam (24 January); Australia and Malaysia (25 January); Canada (26 January); Cambodia (27 January);
Germany (28 January); Finland, Sri Lanka and the United Arab Emirates (29 January); India, Italy and
Philippines (30 January); the United Kingdom, Russia, Sweden and Spain (31 January).[77][63] As of 1
February, more than 12,000 cases have been confirmed worldwide, 98% in China proper.[77] 305 deaths
have been attributed to the virus, with the first death outside of China occurring in the Philippines on
February 1.[78][77] Estimative models suggest the real figure is several times higher than diagnosed and
communicated cases. Local human-to-human contamination has been confirmed in Vietnam, Japan,
Germany, and the United States (specifically Chicago),[79] but no active centers of propagation have been
confirmed outside China so far. Since around 23 January, an important effort, within China and abroad, is
being led by the WHO and local governments to alert the population and set up measures preventing
additional propagations of the virus. On 30 January, citing 7,711 cases essentially in China and 83 cases
abroad across 18 countries on 29 January, the World Health Organization declared the novel coronavirus
outbreak to be a Public Health Emergency of International Concern.[80]

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2019–20 Wuhan coronavirus outbreak by country and territory


Country or region Confirmed Deaths References
 China (mainland) 14,391 304 [66]

 Japan 20 0 [67]

 Thailand 19 0 [67]

 Singapore 18 0 [68]

 South Korea 15 0 [69]

 Hong Kong 14 0 [70]

 Australia 12 0 [67]

 Taiwan 10 0 [67][71]

 Germany 8 0 [67]

 Macau 8 0 [66][72]

 Malaysia 8 0 [67]

 United States 8 0 [67]

 Vietnam 7 0 [73]

 France 6 0 [67]

 United Arab Emirates 5 0 [74]

 Canada 4 0 [67]

 India 2 0 [67][75]

 Italy 2 0 [67]

 Philippines 2 1 [76]

 Russia 2 0 [67]

 United Kingdom 2 0 [67]

 Cambodia 1 0 [67]

 Finland 1 0 [72]

   Nepal 1 0 [67]

 Spain 1 0 [67]

 Sri Lanka 1 0 [67]

 Sweden 1 0 [67]

27 territories 14,569 305


As of 2 February 2020

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2019-nCoV cases in mainland Map of the 2019–20 Wuhan coronavirus outbreak as of 2


China, Hong Kong, Macau, and February 2020
Taiwan    Region of origin (mainland China)
   Confirmed 1–9
   Confirmed cases reported
   Confirmed 10–99
   Suspected cases reported
   Confirmed 100–999
   Confirmed ≥1000

Estimates
Based on cases reported and assuming a 10-day delay between infection and detection, researchers at
Northeastern University and Imperial College London estimated that the number of actual infections may be
10 times higher than those confirmed at the time of reporting. Imperial College estimated 4,000 cases with
440 confirmed by 21 January 2020, Northeastern University estimated 21,300 infections by 26 January,
increasing to 26,200 infections by 27 January (with a confidence of 95% within the interval 19,200–
34,800).[81][82][83] On 31 January 2020, an article published in the Lancet estimated that 75,815 individuals
have been infected in Wuhan as of 25 January 2020.[84]

There are concerns about whether adequate medical personnel and equipment are available in regions
affected by the outbreak for hospitals to correctly identify coronavirus cases instead of misdiagnosing
suspected cases as "severe pneumonia".[85][86][87] Many of those experiencing symptoms were told to self-
quarantine at home instead of going to a hospital to avoid close contact with other patients with different
levels of symptoms.[88] After 2 repatriation flights were conducted from Wuhan to Japan in late January, 5
out of approximately 400 persons repatriated were diagnosed with the virus, of whom 1 was symptomatic
and 4 were not.[89]

Signs and symptoms


Symptoms may include fever, cough, and shortness of breath,[12][91] and may vary from slight to very
severe.[12][91] Cases of severe infection can result in pneumonia, kidney failure, and death.[92][93] Upper
respiratory symptoms such as sneezing, a runny nose or sore throat are less frequent.[49][56]

The time from exposure to onset of symptoms is estimated at 2 to 10 days by the World Health
Organization[94] and 2 to 14 days by the US Centers for Disease Control and Prevention (CDC).[9]

Among the first 41 confirmed cases admitted to hospitals in Wuhan, 13 (32%) individuals had another
chronic condition, like diabetes or hypertension. Overall, 13 (32%) individuals required intensive care, and 6
(15%) individuals died.[49] Many of those who died had other conditions such as advanced age,
hypertension, diabetes, or cardiovascular disease that impaired their immune systems.[95]

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Cause

Spread
Coronaviruses are primarily spread through air
droplets expelled when an infected individual coughs
or sneezes within a range of about 3 feet (0.91 m) to 6
feet (1.8  m).[96][97][98]. There is also a possibility of
fecal-oral transmission. [99]

Of the initial 41 cases, two-thirds had a history of


exposure to the Huanan Seafood Wholesale
Market.[49]
Symptoms of 2019-nCoV (Wuhan coronavirus).
There are reports that it may spread even without
A super-spreader was reported to have infected 14
symptoms.[90]
different members of medical staff. On 25 January
2020, Gao Fu, the head of Chinese Center for Disease
Control and Prevention, in an announcement made to the Xinhua News Agency, denied that the said person
should be considered a "super spreader" simply because he was moved to multiple wards.[100] Earlier the
same day, however, China Newsweek (operated by another official news agency, China News Service),
citing an expert from Peking University, claimed that the aforementioned patient could be considered a
super-spreader already and criticised the hospitals involved for not having properly protected the staff who
came into contact. China Newsweek also criticised the government's censorship, saying healthcare providers,
except those in the fever clinic, have only a mask for protection.[101]

Basic reproduction number


The spread of the virus between people has been variable, with some
affected people not transmitting the virus to others while others have
been able to spread the infection to several people.[58] There have
been various estimates for the basic reproduction number, ranging
from 2.13[103] to 3.11.[104] The number describes how many people
a newly infected person is likely to pass the virus onto. The new
coronavirus has been reportedly able to transmit down a chain of up
to four people so far.[105] This is similar to severe acute respiratory
syndrome-related coronavirus (SARSCoV).[106]

Virology Semi-log plot of confirmed cases


The natural wildlife reservoir of the 2019‐nCoV and intermediate and deaths in China[102] (trend lines
host that transmitted the 2019-nCoV to humans has not been designate exponential growth)

confirmed.[107] However, it is likely that the primary reservoir for


the virus is bats.[55] Of 585 animal specimens taken from the
Genomic information
market, 33 showed evidence of 2019-nCoV.[108]

An updated preprint paper published 23 January 2020 on


bioRxiv from members of the Wuhan Institute of Virology,
Wuhan Jinyintan Hospital, University of Chinese Academy of
Sciences and the Hubei Provincial Center for Disease Control Genome organisation (click to enlarge)
and Prevention suggest that the 2019 novel coronavirus has NCBI MN908947 (https://www.nc
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possible bat origins, as their analysis shows that nCoV-2019 is genome ID bi.nlm.nih.gov/nucleotide/?t
96% identical at the whole genome level to a bat coronavirus erm=MN908947)
identified in 2013.[109] Genome 30473 bp
size
A report published one day earlier from Peking University,
Guangxi Traditional Chinese Medical University, Ningbo Year of 2020
University and Wuhan Biology Engineering College compares completion
the codon usage bias of 2019-nCoV with "humans, bats,
chickens, hedgehogs, pangolins, and two species of snakes",[110] and they concluded that "snake is the most
probable wildlife animal reservoir for the 2019‐nCoV" which then transmitted to humans.[110][111][112] This
claim has been widely disputed: some argued that the reservoir must be bats and the intermediate host, bird
or mammal, not snakes (as snakes, unlike humans, are poikilotherms),[113][113][114] while others used data
on recombination and SARS/MERS codon usage bias refute the reasoning. The recombination event
mentioned probably happened in bats instead.[115]

Phylogenetic studies of 2019-nCoV examine the evolutionary history of the virus and its relationships with
other organisms. The seventh member of the family of coronaviruses that can infect humans, 2019-nCoV
has been reported to have a genome sequence 75% to 80% identical to the SARS-CoV and to have more
similarities to several bat coronaviruses.[54][55] At least five genomes of the novel coronavirus have been
isolated and reported.[116][117][118] These show that the virus is genetically distinct from other known
coronaviruses such as Severe acute respiratory syndrome-related coronavirus (SARS-CoV) and Middle East
respiratory syndrome-related coronavirus (MERS-CoV).[116] Like SARS-CoV, it is a member of Beta-CoV
lineage B.[119]

A peer-reviewed paper by Domenico Benvenuto et al. describes a phylogenetic tree built from 15 available
whole genome sequence of 2019-nCoV and 12 whole genome sequences of 2019-nCoV and 12 highly
similar whole genome sequences available in gene bank. Genomic analysis shows that the Nucleocapsid and
the Spike Glycoprotein have some sites under positive selective pressure. Homology modeling indicated
certain molecular and structural differences among the viruses. The phylogenetic tree showed that
2019.nCoV significantly clustered with a Bat SARS-like Coronavirus sequence, whereas structural analysis
revealed mutations in Spike Glycoprotein and nucleocapsid protein. The authors concluded 2019-nCoV is a
coronavirus distinct from SARS virus that probably was transmitted from bats or another host that provided
the ability to infect humans.[120]

Diagnosis
On 15 January 2020, the WHO published a protocol for testing for 2019-nCoV.[121] Since then, several other
testing protocols have been proposed, and published by the WHO.[122]

Testing uses real time reverse transcription-polymerase chain reaction (rRT-PCR).[123] The test can be done
on respiratory or blood samples.[124] Results are generally available within a few hours to days.[125][126]

Prevention
The protocols to prevent infection vary depending on the likelihood of the susceptible individuals making
effective contact and general differences in medical philosophy between culture. Official advice has
generally been limited to calls for good personal hygiene and regular hand washing. Those who suspect
themselves to be infected are asked to wear surgical masks and call a doctor for medical advice.[127][128] A
significant number of countries have issued advisories warning against travel to either Mainland China, the
province of Hubei, or just Wuhan.[27]

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The public has often taken precautions beyond of what is advised by


health authorities. There is widespread use of surgical masks by
healthy people in Hong Kong,[129] Japan,[130] Singapore[131][132]
and Malaysia.[133] Reports that people are panic-buying sanitary
products such as hand sanitizers and disinfectants relate to the public
preferring to keep their hands and laundry "clean' with antiseptic
products.[134][135] Additionally people have been avoiding contact
with Mainland Chinese people in places as far away as the United
States.[136] Japanese people have been reported to wear surgical
masks and spray themselves with air disinfectants in areas where
A doctor in a protective bunny suit foreigners are more likely to be found.[137]
sees a patient in a Wuhan hospital.
The Government of Hong Kong ask that people maintain good
personal hygiene and keep both hands clean. It furthermore warns
anyone travelling outside the city that they "do not touch animals; do not eat game meat; and avoid visiting
wet markets, live poultry markets or farms". Anyone who suspects themselves of infection are asked to wear
a surgical mask and ring a doctor.[127]

The Ministry of Health in Singapore asks that people practice a good standard of hygiene, such as washing
hands regularly.[138] Those who are unwell should wear a mask and see a doctor immediately.[128]

The WHO recommends "regular hand washing, covering mouth and nose when coughing and sneezing…
[and] avoid[ing] close contact with anyone showing symptoms of respiratory illness (such as coughing and
sneezing)."[116]

Quarantine measures
On 23 January 2020, a quarantine on travel in and out of Wuhan was imposed in an effort to stop the spread
of the virus out of Wuhan. Flights and trains in and out of Wuhan, public buses, the metro system and long-
distances coaches were suspended until further notice. Large-scale gatherings and group tours were also
suspended.[156] By 24 January 2020, a total of 15 cities in the Hubei province, including Wuhan, were
placed under similar quarantine measures.[23] Thus, the entire Hubei province came under quarantine, save
for Xiangyang and the Shennongjia Forestry District.

Due to quarantine measures, Wuhan residents rushed to stockpile essential goods, food, and fuel. The prices
of goods rose significantly.[157][158][159] Medical staff faced difficulties in commuting to their hospitals, as
they were now limited to walking and private cars.[160] Taxis and private-hire vehicles shunned them upon
learning of the destination.[160] 5,000,000 people left Wuhan, with 9,000,000 left in the city.[161]

Guan Yi, an epidemiologist and SARS virologist with teams consisting of medical specialists who just flew
back to Hong Kong after their one-day inspection in Wuhan told correspondents that "the Wuhan outbreak is
at least 10 times larger than that of SARS, calling people to stay away from Wuhan as soon as
possible."[162][163][164][165] Some posts on Weibo showed that as early as 12 January, hospitals in Wuhan
were already overwhelmed with patients suffering from fever, many of them having to sleep on the
floor.[166] Some were also highly critical of the reliability of the figures from the Chinese government as
well as the government response, with some calling for quarantine,[167] and post also showed sick people
and three dead bodies covered in white sheets on the floor of a hospital on 24 January, although many such
posts in Weibo about the epidemic have been deleted.[168][169]

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On 26 January, the city of Shantou in Hubei cities under transportation ban[23]


Guangdong declared a partial lockdown,[170] Date Estimated
though this was quickly reversed only two City Source
quarantined population
hours later.[171] This created chaos, as residents [139][140]
Wuhan 23 January 2020 11,081,000
rushed to supermarkets to stock food as soon as
Huanggang 23 January 2020 6,630,000 [139][141]
the lockdown was declared, and the surge of
stockpiling didn't come to an end until the Ezhou 23 January 2020 1,077,700 [139][142][143]

authorities reversed their decision. Caixin said, Chibi 24 January 2020 490,900 [144]
that the wording of Shantou's initial declaration
Jingzhou 24 January 2020 5,590,200 [145]
was "unprecedentedly strict" and will severely
affect residents' lives, if implemented as-is. Zhijiang 24 January 2020 497,600 [146]

Shantou's Department for Outbreak Control Yichang 24 January 2020 4,135,900 [147]
later clarified, that they will not restrict
Qianjiang 24 January 2020 966,000 [148]
travelling, and all they would do, is to sterilise
vehicles used for transportation.[172] Xiantao 24 January 2020 1,140,500 [149]

[150]
Local authorities of the capital Beijing and Xianning 24 January 2020 2,543,300

several other major cities, including Hangzhou, Huangshi 24 January 2020 2,470,700 [151]
Guangzhou, Shanghai and Shenzhen Dangyang 24 January 2020 469,600 [152]
announced on 26 January, that these cities will
777,000 [153]
not impose a lockdown similar to those in Enshi 24 January 2020

Hubei province. Rumours of these potential Xiaogan 24 January 2020 4,915,000 [154]
lockdowns had spread widely prior to the Jingmen 24 January 2020 2,896,500 [155]
official announcements.[173] A spokesperson of
Total 45,681,900
Beijing's Municipal Transportation
Commission claimed, that the expressways and
highways, as well as subways and buses are operating normally. To ease the residents' panic, the Hangzhou
city government stressed that the city will not be locked down from the outside world, and both cities said
that they will introduce precautions against potential risks.[174]

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People queueing outside a Wuhan


pharmacy to buy face masks and medical
supplies

Residents of Wuhan wearing masks rushed out to


nearby markets to buy vegetables and other food on
23 January during the outbreak

Residents of Wuhan waiting for the last train of the


city's metro on 10 A.M., 22 January

Evacuation of foreign citizens


Due to the effective lockdown of public transport in Wuhan and Hubei province, several countries have
planned to evacuate their citizens and/or diplomatic staff from the area, primarily through chartered flights
of the home nation that have been provided clearance by Chinese authorities. Japan, the United States,
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France, Australia, Sri Lanka, Germany and Thailand were among the first to plan the evacuation of their
citizens.[175][176][177][178][179][180]

As of 1 February, United States, Japan, South Korea, Jordan, Britain, Singapore and Germany evacuated
their citizens (including citizens from other EU countries).[181]

Brazil, Czechia, India, Italy and Russia are considering similar measures.[182][183][184][185][186][187] Pakistan
has said that it will not be evacuating any citizens from China.[188][189]

Panama and Sri Lanka began repatriation of their students in China.[190][191] Myanmar began repatriating 60
of their students from the vicinity of Wuhan.[192]

Vietnam permitted four exceptional flights to carry Wuhan passengers home in the period 24–27
January,[193] and organised a flight to evacuate citizens and diplomats.[194]

On 29 January, Australia and New Zealand announced that they would team up to evacuate their citizens
from Wuhan. There are between 50-82 New Zealanders in Wuhan and 600 Australians in Hubei province
including 140 Australian children in Wuhan.[195][196] The New Zealand Government has also chartered a
Boeing 777-200ER aircraft from the national carrier Air New Zealand to assist in evacuation efforts, subject
to approval from Chinese officials.[197][198][199] While priority will be given to New Zealand nationals, the
plane will also be evacuating Australian and Pacific Island citizens.[200]

On 29 January, Australian Prime Minister Scott Morrison announced plans to quarantine Australian citizens
evacuated from Wuhan, including children and the elderly, for a period of 14 days on Christmas Island. The
decision to repatriate those citizens using controversial detention facilities formerly utilized to detain asylum
seekers before they were shut down in 2018 has received criticism.[201] Controversially, the government
plan also necessitates those evacuees to pay a fee of AU$1,000 and would drop them off in Perth after the
quarantine period, where they would need to arrange their own transportation back to their home cities. The
Australian Medical Association, in a statement on the same day, stated that the decision to hold Australian
citizens in "a place where has been previously the focus of populations under enormous mental and physical
trauma and anguish, is not a really appropriate solution."[202]

On 29 January, South Korea made last-minute preparations to airlift about 700 South Korean nationals out
of Wuhan, including finalising logistical details with the Chinese Government. South Korea officials
prepared two planes with two sets of medical teams comprising about 20 doctors, nurses, and foreign
ministry and quarantine officials for each team.[203]

On 29 January, the Indonesian Air Force (TNI-AU) prepared three aircraft including two Boeing 737 and
one C-130 Hercules stationed in Halim Perdanakusuma Air Force Base, with a battalion of health experts to
help evacuate Indonesian nationals and citizens from the city. As of 29 January, the TNI-AU was waiting for
instruction from the Indonesian Ministry of Foreign Affairs and on standby for 24 hours in case the order
was given.[204][205] On 1 February the evacuation for as many as 243 Indonesians will commence, and they
will be quarantined in Natuna Regency for 14 days, the evacuation process is planned to take around 9
hours, the 42 man team will evacuate about 245 Indonesians. They will depart at Soekarno Hatta
International Airport, on Saturday (1/2/2020) at 13:00 WIB.[206] The Indonesian government chartered Lion
Air Group's Batik Air aircraft to evacuate around 200 Indonesian citizens from Hubei province, China,
including Wuhan City.[207]

On 30 January 92 Singaporeans were evacuated from Wuhan via a special Scoot flight, crewed by
volunteers from the airline after coordination between Singapore and Chinese authorities facilitated the
flights. However, there are still some Singaporeans left behind as they display symptoms, and it made no

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sense to have them evacuated with the rest who may not be infected. Two of the evacuees were later
confirmed as the first Singaporeans to have the virus. Both were asymptomatic during the flight but were
found to have a fever upon arrival.[208]

On 31 January, a British plane carrying 110 EU nationals (83 Britons and 27 others, not including military
medics from the UK on board) left Wuhan, arriving at RAF Brize Norton in England. The British passengers
are quarantined at a segregated block of Arrowe Park Hospital on the Wirral; all passengers were tested
before and during the flight, with none having the virus. The other EU nationals were flown on to Spain
from Brize Norton. More Britons (up to 150) were supposed to be on the flight, which was planned to leave
a day earlier; China initially declined permission, and then anyone who had a Chinese passport (including
infants and a newborn to British parents) were told they could not leave. Shortly before the flight left, this
decision was reversed, but too late for people to get to the airport even though the plane was also delayed for
several hours. The British government plans to send another plane if necessary. On this day, the first cases of
the virus were reported in the UK, but were unrelated.[209][210][211]

On 1 February morning, a chartered airplane departed from Thailand to Wuhan to evacuate 64 Thai
nationals from the city led by Public Health Minister Anutin Charnvirakul. The airplane includes a team of
medical team specialized in respiratory tract infection and emergency medicine.[212]

On 1 February 2020, a German Air Force plane was denied a stopover in Moscow after its starting point in
Wuhan, according to the German Minister of Defense. Originally, the plane got an approval for a layover in
Moscow. The plane needed a stop for refueling and a change of crew personnel. The aircraft evacuated 102
German and 26 non-German citizens. The plane made a stopover in Helsinki on its way to Frankfurt
Airport. The German Minister of Health stated that all passengers show no symptoms of the
coronavirus.[213] On its way to Wuhan the airplane carried 10,000 suits of protective equipment as requested
by the Chinese government.[214]

On 1 February 2020, an advanved team of officers from the Malaysian Embassy in Beijing headed to Wuhan
by road to rescue and evacuate their 120 citizens from the city and the surrounding areas. The evacuation
order was carried out after the decision of the Cabinet on 29 January 2020.[215]

Management
2019-nCoV does not have any effective medications or vaccines,
though development efforts are underway.[216][217] It is however
possible to attempt to relieve the symptoms of the coronavirus,
which include taking regular (over-the-counter) flu
medications, [218][219] drinking fluids and resting. [220] Oxygen
therapy, intravenous fluids, and breathing support may be
required.[221] Some countries require people to report flu-like
Infrared cameras were installed in
symptoms to their doctor, especially if they have visited Mainland Wuhan railway station to check
China.[222] passengers' body temperature
before they board the trains.

Domestic responses
On 25 January, Politburo of the Communist Party of China met to discuss novel coronavirus prevention and
control. Chinese Communist Party general secretary Xi Jinping stated that the country is facing a "grave
situation" as the number of infected people is accelerating.[223] In the evening, the authorities banned the use
of private vehicles in Wuhan. Only vehicles that are transporting critical supplies or emergency response
vehicles are allowed to move within the city.[224]

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On 26 January, a leading group on the prevention and control of the


novel coronavirus outbreak was established, led by Premier Li
Keqiang.[225] The leading group has decided to extend Spring
Festival holiday to contain coronavirus outbreak.

China Customs started to require all passengers entering and exiting


China to fill out an extra health declaration form starting 26 January.
The health declaration form was mentioned in China's Frontier 'Aerial photography of roads after
motor vehicles are banned in central
Health and Quarantine Law, granting the customs rights to require it
urban areas of Wuhan: few vehicle
if needed. The customs said it will "restart this system" as it was not traces' – Video news from China
a requirement before.[226][227][228] News Service

On 27 January, Premier Li Keqiang visited Wuhan to direct the


epidemic prevention work.[229]

Authorities across China announced school closures and delayed the


spring semester. All schools ranging from kindergartens to
universities in the whole of Hubei province will have their winter
break prolonged and the exact date of the new semester will be
announced later, according to a statement made on 24 January.[230]
China's Ministry of Education also asked all schools to halt public Passengers wearing masks going
assemblies and delay major exams. Some universities with open through an extra body temperature
[231] check as part of airport security.
campuses also banned the public from visiting. The education
Captured on 26 January in NE
department in Hunan province, which neighbours the centre of the China's Changchun Longjia Airport
outbreak Hubei province, stressed on the official newspaper Hunan
Daily on 23 January, claiming it will strictly ban off-school tutors
and restrict unapproved student gatherings, which are all common
practices in China for students to get better grades.[232] Education
departments in Shanghai and Shenzhen also imposed bans on off-
school tutoring and ask schools to track and report students who
have been to Wuhan or Hubei province during the winter
break.[233][234] Several universities, including China's top-ranking
Peking University and Tsinghua University announced the spring Hong Kong residents queueing to
semesters will be delayed on 26 January.[235] The semi-autonomous refund their bullet train tickets to the
regions Hong Kong and Macau also announced adjustments on mainland in West Kowloon railway
schooling schedules. Hong Kong's Chief Executive Carrie Lam station
declared an emergency at a press conference on 25 January, saying
the government will close primary and secondary schools for two
more weeks on top of the previously scheduled Lunar New Year holiday, pushing the date for school
reopening to 17 February.[236][237] Macau closed several museums and libraries, and prolonged the Lunar
New Year holiday break to 11 February for higher education institutions and 10 February for others.[238] The
University of Macau said they will track the physical conditions of students who have been to Wuhan during
the Lunar New Year break.[239]

On 27 January, the General Office of the State Council of China, one of the top governing bodies of the
People's Republic, officially declared a nation-wide extension on the Lunar New Year holiday and the
postponement of the coming spring semester. The Office extended the previously scheduled public holiday
from 30 January to 2 February, while it said school openings for the spring semester will be announced in
the future.[240]

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After the Chinese Lunar New Year on 25 January, there would be another peak of people travelling back
from their hometowns to workplaces as a part of Chunyun. Several provinces and cities started to encourage
people to stay in their hometowns and not travel back. Eastern China's Suzhou also encouraged remote
working via the Internet and further prolonged the spring festival break.[241]

The Civil Aviation Administration of China and the China State Railway Group, which regulates China's
civil aviation and operates rail services, announced on 24 January that passengers could have full refunds for
their plane and train tickets without any additional surcharges, regardless of whether their flight or train will
go through Wuhan or not. Some hotel chains and online travel agencies also allowed more flexibility in
cancellations and changes.[242][243] China's Ministry of Culture and Tourism ordered travel agencies and
online tourism firms to suspend package tours and stop offering "flight+hotel" bundles.[244][241]

More provinces and cities outside the most contaminated Hubei started to restrict travel. Beijing suspended
all intercity bus coaches on 25 January,[245] with several others follow suit. Shanghai, Tianjin, Shandong,
Xi'an, and Sanya all announced suspension of intercity or inter-province bus services on 26 January.[241]

On 1 February 2020, Xinhua News reported that China's Supreme People's Procuratorate (SPP) has "asked
procuratorates nationwide to fully play their role to create a favourable judicial environment in the fight
against the novel coronavirus outbreak." This includes severe punishments for those found guilty of
dereliction of duty and the withholding of information for officials. Intensified charges were proscribed for
commercial criminal activities such as "the pushing up prices, profiteering and severely disturbing market
order" along with the "production and sale of fake and shoddy protective equipment and medicines."
Prosecuting actions against patients who deliberately spread the infection or refuse examination or
compulsory isolation along with threats of violence against medical personnel were also urged. The
statement also included urging to prosecute those found "fabricating coronavirus-related information that
may lead to panic among the public, making up and spreading rumors about the virus, sabotaging the
implementation of the law and endangering public security" and also stressed harsh punishment for the
lilegal hunting of wildlife under state protection, as well as improving inspection and quarantine measures
for fresh food and meat products."[246]

Censorship and police responses


On 20 January, Chinese Communist Party general secretary Xi Jinping made his first public remark on the
outbreak and "spoke of the need for the timely release of information," according to state-run News
Agency.[223][247] Chinese premier Li Keqiang also urged efforts to prevent and control the epidemic.[248]
One day later, the Central Political and Legal Affairs Commission of the Chinese Communist Party, the
most powerful political organ in China overseeing legal enforcement and the police, wrote "self-deception
will only make the epidemic worse and turn a natural disaster that was controllable into a man-made disaster
at great cost," and "only openness can minimise panic to the greatest extent." The commission then added,
"anyone who deliberately delays and hides the reporting of cases out of self-interest will be nailed on a pillar
of shame for eternity."[249][250]

Also on the same day, Xi Jinping instructed authorities "to strengthen the guidance of public opinions",
language which some view as a call for censorship after commentators on social media became increasingly
pointedly critical and angry at the government due to the epidemic. Some view this as contradictory to the
calls for "openness" that the central government had already declared.[251] Notably, Chinese citizens have
reportedly used innovative methods to avoid censorship and express anger about how government officials
have handled the outbreak, such as using the word 'Trump' to refer to Xi Jinping, or 'Chernobyl' to refer to
the outbreak as a whole.[252] The Human Rights Watch, an international advocacy group, states that "there is
considerable misinformation on Chinese social media and authorities have legitimate reasons to counter
false information that can cause public panic," but has also noted incidents where censorship by the
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authorities has included social media posted by families of infected people who were potentially seeking
help as well as by people living in cordoned cities allegedly only documenting their daily lives amidst the
lockdown.[253]

Along with accusations of having censored news articles and social media posts deemed to hold negative
tones about the coronavirus and the governmental response,[254] police have detained people for online posts
critical of authorities' response to the epidemic, with an case on 25 January in Tianjin where a man was
detained for 10 days for "maliciously publishing aggressive, insulting speech against medical
personnel."[255]

On 30 January, China's Supreme Court delivered a rare rebuke against the country's police forces, calling the
"unreasonably harsh crackdown on online rumours" as undermining public trust. In what has been called a
"highly unusual criticism" by observers, supreme court judge Tang Xinghua said that if police had been
lenient against rumours and allowed the public to have taken heed of them, an earlier adoption of "measures
like wearing masks, strictly disinfecting and avoiding wildlife markets" may might have been beneficial
against the epidemic.[256]

International responses

Countries/regions that have imposed travel restrictions in response to the Wuhan coronavirus
outbreak as of 2 February 2020. These include entry bans on Chinese citizens or recent visitors to
China, halted issuing of visas to Chinese citizens or reimposed visa requirements on Chinese
citizens and also countries that have responded with border closures with China.

Since 31 December 2019, some regions and countries near China tightened their screening of selected
travellers.[52] The Centers for Disease Control and Prevention (CDC) of the United States later issued a
Level 1 travel watch.[41][257] Guidances and risk assessments were shortly posted by others including the
European Centre for Disease Prevention and Control and Public Health England.[258] In China, airports,
railway stations and coach stations installed infrared thermometers. People with fevers are subsequently
taken to medical institutions after being registered and given masks.[259] Real time Reverse Transcription-
Polymerase Chain Reaction (rRT-PCR) test was used to confirm new cases of coronavirus infection.[260]

An analysis of air travel patterns was used to map out and predict patterns of spread and was published in
the Journal of Travel Medicine in mid-January 2020. Based on information from the International Air
Transport Association (2018), Bangkok, Hong Kong, Tokyo, and Taipei had the largest volume of travellers
from Wuhan. Dubai, Sydney and Melbourne were also reported as popular destinations for people travelling

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from Wuhan. Using the validated tool, the Infectious Disease Vulnerability Index (IDVI), to assess the
ability to manage a disease threat, Bali was reported as least able in preparedness, while cities in Australia
were considered most able.[261][262]

As a result of the outbreak many countries including Schengen Area, Armenia, Australia, Iraq, Kazakhstan,
Kuwait, Malaysia, Philippines, Singapore, Sri Lanka, Vietnam and the United States have imposed
temporary entry bans on Chinese citizens or recent visitors to China, or have ceased issuing visas and
reimposed visa requirements on Chinese citizens.[263][264][265][266][267][268][269][270][271][272][273] Several
neighbouring countries including Mongolia, Nepal, North Korea and Russia have also responded with
border closures with China.[274]

On 22 January 2020, North Korea closed its borders to international tourists to prevent the spread of the
virus into the country. Chinese visitors make up the bulk of foreign tourists to North Korea.[275]

Also on 22 January, the Asian Football Confederation (AFC) announced that it would be moving the
matches in the third round of the 2020 AFC Women's Olympic Qualifying Tournament from Wuhan to
Nanjing, affecting the women's national team squads from Australia, China PR, Chinese Taipei and
Thailand.[276] A few days later, the AFC announced that together with Football Federation Australia they
would be moving the matches to Sydney.[277] The Asia-Pacific Olympic boxing qualifiers, which were
originally set to be held in Wuhan from 3–14 February, were also cancelled and moved to Amman, Jordan to
be held between 3–11 March.[278][279]

On 27 January 2020, the United States CDC issued updated travel guidance for China, recommending that
travellers avoid all nonessential travel to all of the country. The CDC has directed U.S. Customs and Border
Protection to check individuals for symptoms of the coronavirus.[280]

On 29 January 2020, British Airways cancelled all their flights to mainland China as a reaction to the spread
of the virus.[281] Lufthansa followed hours later by also suspending all their flights.[282] Lion Air and Air
Seoul also suspended all their flights.[283]

On 30 January 2020, Egyptair announced suspension of flights between Egypt and Hangzhou starting 1
February 2020 while those to Beijing and Guangzhou will be suspended starting 4 February 2020 until
further notice.[284]

On 1 February 2020, Qatar Airways took the decision to suspend flights to mainland China from 3 February
until further notice, due to significant operational challenges caused by entry restrictions imposed by several
countries.[285] Qatar Airways is the first carrier in the Middle East to do so, and an ongoing review of
operations will be conducted weekly with the intention to reinstate the flights as soon as the restrictions are
lifted.[285]

Though some of the airlines cancelled flights to Hong Kong as well, British Airways, Finnair and Lufthansa
have not, and American Airlines continues operating a limited service to the area. Hong Kong's four airlines
halved the flights to mainland China.[286] The following airlines have so far reduced or cancelled flights to
and from China:[287][288][289]

Air Astana Air Seoul


Air Canada Air Tanzania
Air France American Airlines
Air India Asiana Airlines
Air KBZ Austrian Airlines
Air New Zealand British Airways

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Cathay Pacific Myanmar National Airlines


China Airlines Qantas
Delta Air Lines Qatar Airways
El Al Royal Brunei Airlines
EVA Air RwandAir
Fiji Airways Scandinavian Airlines
Finnair SCAT Airlines
Hong Kong Airlines Scoot
Iberia Singapore Airlines
IndiGo SkyUp
Jetstar Asia Swiss International Air Lines
KLM Turkish Airlines
Kenya Airways Turkmenistan Airlines
Lion Air Ukraine International Airlines
LOT Polish Airlines United Airlines
Lufthansa Ural Airlines
MIAT Mongolian Airlines Virgin Atlantic
Myanmar Airways International
On 31 January 2020 the United States declared the virus a public health emergency. Starting 2 February, all
inbound passengers who have been to Hubei Province in the previous 14 days will be put under quarantine
for up to 14 days. Any U.S. Citizen who has traveled to the rest of mainland China will be allowed to
continue their travel home if they are asymptomatic, but will be monitored by local health departments.[290]

On 1 February 2020 Vietnam suspended all flights to and from China.[291]

International aid
The United States city of Pittsburgh has announced plans to promptly send aid to Wuhan, with its mayor Bill
Peduto stating that "Our office has reached out to the mayor of Wuhan, which is our sister city" and
promising that "over the next two days we should be able to have a care package that has been put together."
He speculated that the contents of such a package will be coordinated with the consultation of medical
experts, but that it will likely consist of "face masks, rubber gloves and other material that could be hard to
find in the future."[292] Additionally, the University of Pittsburgh Medical Center (UPMC) has declared
plans to provide help, with UPMC spokesman Paul Wood stating that "UPMC has a significant presence in
China and has been in contact with our partners there”, also declaring that “we stand ready to assist them
and others in China with their unmet humanitarian needs.”[293]

The humanitarian aid organisation Direct Relief, in coordination with FedEx transportation and logistics
support, sent 200,000 face masks along with other personal protective equipment, including gloves and
gowns, by emergency airlift to arrive in Wuhan Union Hospital, who requested the supplies by 30
January.[294] The Gates Foundation has stated on 26 January that it will donate US$5 million in aid to
support the response in China that will be aimed at assisting "emergency funds and corresponding technical
support to help front-line responders."[295]

Japan, in the process of coordinating a plane flight to Wuhan to pick up Japanese nationals in the city, has
promised that the plane will first carry into Wuhan aid supplies that Japanese foreign minister Toshimitsu
Motegi stated will consist of "masks and protective suits for Chinese people as well as for Japanese

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nationals".[296] On 26 January, the plane arrived in Wuhan, donating its supply of one million face masks to
the city.[297] Also among the aid supplies were 20,000 protective suits for medical staff across Hubei
donated by the Tokyo Metropolitan Government.[298]

Support efforts have sprung across Japan to help aid residents in Wuhan. On 27 January, the city of Oita, a
sister city to Wuhan for 40 years, sent 30,000 masks from its own disaster relief stockpile to its sister city
through the Red Cross network with boxes labelled "Wuhan Jiayou!," meaning "Hang in there, Wuhan!" in
Chinese. Its International Affairs Office division head, Soichiro Hayashi, said that “The people of Wuhan
are like family” and expressed hopes that "people can return to their ordinary lives as quickly as possible.”
Peace Winds Japan has declared it will send a staff member to China to help distribute the face masks and
other goods that the NGO will send to the country.[298]

On 31 January 2020, Malaysia said it would donate 18 million medical gloves to China as announced by the
Minister of Primary Industries Teresa Kok.[299]

On 1 February 2020, Germany delivered various aids for China to fight the virus, including 10,000
protective suits.[300]

Specialty hospitals
A specialty hospital named Huoshenshan Hospital has been under
construction as a countermeasure against the outbreak and to better
quarantine the patients. Wuhan City government had demanded that
a state-owned enterprise construct such a hospital "at the fastest
speed" comparable to that of the SARS outbreak in 2003.[301] On 24
January, Wuhan authorities specified its planning, saying they
planned to have Huoshenshan Hospital built within six days of the
announcement and it will be ready to use on 3 February. The
specialty hospital will have 813 beds[302] and it will take up 25,000 Jinyintan Hospital had initially been
square metres. The hospital is modelled after the Xiaotangshan tasked with treating those with the
coronavirus.
Hospital, which was fabricated for the SARS outbreak of 2003, itself
built in only seven days.[303][304] State media reported that there
were 1,500 workers and nearly 300 units of construction machinery
on the site at peak, and another backup team of 2,000 workers had
already gathered.[305]

Authorities announced plans for a second specialty hospital on 25


January which will be named Leishenshan Hospital, with a capacity Construction site of Huoshenshan
of 1,600 beds;[306] operations are scheduled to start by 6 Hospital as it appeared on 24
February.[307][308] Some people voiced their concerns through social January.
media services, saying the authorities' decision to build yet another
hospital in such little time showed the severity of the outbreak could
be a lot worse than expected.[309]

On 24 January 2020, the authority announced that they would convert an empty building in Huangzhou
District, Huanggang to a 1,000-bed hospital named Dabie Mountain Regional Medical Centre. Works began
the next day by 500 personnel and the building began accepting patients on 28 January 2020 at
10:30 p.m.[310]

The British Government and National Health Service have set up a Coronavirus isolation facility at Arrowe
Park Hospital in The Wirral for British people coming back on a special flight from Wuhan.
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Reactions to prevention efforts

WHO response
The World Health Organization (WHO) has commended the efforts of Chinese authorities in managing and
containing the epidemic with its Director-General Tedros Adhanom Ghebreyesus expressing "confidence in
China's approach to controlling the epidemic" and calling for the public to "remain calm".[311]

The WHO noted the contrast between the 2003 epidemic, where Chinese authorities were accused of
secrecy that impeded prevention and containment efforts, and the current crisis where the central
government "has provided regular updates to avoid panic ahead of Lunar New Year holidays."[312] In
reaction to the central authorities' decision to implement a transportation ban in Wuhan, WHO representative
Gauden Galea remarked that while it was "certainly not a recommendation the WHO has made", it was also
"a very important indication of the commitment to contain the epidemic in the place where it is most
concentrated" and called it "unprecedented in public health history".[312] Tedros states that "there is no
reason for measures that unnecessarily interfere with international travel and trade" and that "WHO doesn't
recommend limiting trade and movement".[313]

On 30 January 2020, following confirmation of human-to-human transmission outside of China and the
increase in number of cases in other countries, the WHO declared the outbreak a Public Health Emergency
of International Concern (PHEIC), the sixth PHEIC since the measure was first invoked during the 2009
Swine flu pandemic. Tedros clarified that the PHEIC in this case was "not a vote of no confidence in China",
but because of the risk of global spread, especially to low- and middle-income countries without robust
health systems capable.[32][314]

International reactions
China's response to the virus, in
comparison to the 2003 SARS
outbreak, has been praised by
some foreign leaders.[316] US
President Donald Trump thanked
Chinese leader Xi Jinping "on
behalf of the American People" on
24 January 2020 on Twitter, On 29 January, Russian President On 30 January, US President
stating that "China has been Vladimir Putin held a meeting on Donald Trump received a briefing
working very hard to contain the measures to counter the spread of on the Coronavirus in China.
coronavirus in Russia.[315]
Coronavirus. The United States
greatly appreciates their efforts
and transparency" and declaring
that "It will all work out well."[317] Germany's health minister Jens Spahn, in an interview on Bloomberg
TV, said with comparison to the Chinese response to SARS in 2003: "There's a big difference to SARS. We
have a much more transparent China. The action of China is much more effective in the first days already."
He also praised the international cooperation and communication in dealing with the virus.[318][319]

At a Sunday mass at St. Peter's Square in Vatican City on 26 January 2020, Pope Francis praised "the great
commitment by the Chinese community that has already been put in place to combat the epidemic" and
commenced a closing prayer for "the people who are sick because of the virus that has spread through
China".[320]

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Criticism of local response


Local officials in Wuhan and the province of Hubei have faced wide criticism, both domestically and
internationally, for mishandling the initial outbreak.[321] Allegations included insufficient medical supplies,
lack of transparency to the press and censorship of social media during the initial weeks of the
outbreak.[322][323] On 1 January 2020, the Wuhan police interviewed eight residents for spreading false
information (referring to the new infection as a reappearance of SARS).[324][325] The Wuhan police later
stated through a post on its official Weibo account that "eight people had been dealt with according to the
law."[326][327] The police latter clarified through Weibo that they had only given out "education and
criticism" and refrained from harsher punishments such as "warnings, fines, or detention."[328]

Criticism was directed at Hubei Governor Wang Xiaodong after he repeatedly misstated the production of
face masks in a press conference.[329]

Several Hong Kong media correspondents were detained by police for over an hour when they were
conducting interviews at Wuhan's Jinyintan Hospital on 14 January. Reports said the police brought the
correspondents to a police station, where the police checked their travel documents and belongings, then
asked them to delete video footage taken in the hospital before releasing them.[330][331]

Authorities in Wuhan and Hubei provinces have been criticised for downplaying the severity of the outbreak
and responding slower than they could have. The Beijing-based media journal, Caixin noted that Hubei did
not roll out the first level of "public health emergency response mechanism" until 24 January, while several
other provinces and cities outside of the centre of the outbreak have already done so the day before.[332]

On 19 January, four days before the city's lockdown, a "Wan jia yan" (Chinese: 万
; literally: 'ten-
thousand family banquet') was held in Wuhan, with over 40,000 families turning out at the banquet tables
which attracted retrospective criticism. The domestic The Beijing News argued that the local authorities
should not have held such a public assembly while attempting to control the outbreak. The paper also argued
that the time when their journalists visited the Huanan Seafood Wholesale Market where the coronavirus
likely originated, most residents and merchants there weren't even donning face masks.[333] Zhou
Xianwang, the Mayor of Wuhan, later spoke to China Central Television defending that this banquet was
held annually, and it is a "sample of the people's self-autonomy." He asserted that the decision of allowing
such a banquet was made based on the fact that the scientists used to falsely believe that the ability of the
virus to spread human-to-human was limited.[334][335] Meanwhile, on 20 January, Wuhan's municipal
department for culture and tourism was giving out 200,000 tickets good for visiting all tourist attractions in
Wuhan to its citizens for free, which was then criticised for disregarding the outbreak.[333]

Notable in relation to the widespread criticism of the local response, the central government's response has
been contrasted with praise for their reporting of the crisis by international experts,[336] but also especially
by state media.[337] This has led to suggestions that the tendency of provincial governments to minimize
reporting local incidents have been because of the central governments directing the large proportion of the
blame onto them.[338] Critics, such as Steve Tsang, director of the China Institute at the University of
London, have further argued this was also exacerbated through local officials being "apprehensive about
taking sensible preventive measures without knowing what Xi and other top leaders wanted as they feared
that any missteps would have serious political consequences."[339] The mayor of Wuhan, in particular, as
response to those criticisms defended himself, referring to those suggestions by blaming regulatory
requirements where local governments must first seek Beijing's approval which delayed disclosure of the
epidemic.[340]

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Tang Zhihong, the chief of the health department in Huanggang, the city with the second most cases in
Hubei after Wuhan, was fired hours after she was unable to answer questions on how many people in her
city were being treated. During an interview on state television, she responded to a central government
inspection team who queried how many sick people may be in the city's care: "I don't know, I'm unclear, I
only know how many beds there are. Don't ask me how many people are being treated."[341]

Treatment research
Several organisations around the world are developing vaccines or testing antiviral medicine. In China, the
Chinese Center for Disease Control and Prevention (CCDC) has started developing vaccines against the
novel coronavirus and is testing existing drug effectiveness for pneumonia.[342][343] Also, Hong Kong
researcher Yuen Kwok-yung and his team in the University of Hong Kong announced that a new vaccine is
developed, but needs to be tested on animals before conducting clinical tests on humans.[344] The Russian
consumer health watchdog Rospotrebnadzor started the development of a vaccine, relying on the WHO's
recommendations.[345]

In Western countries, The United States' National Institutes of Health (NIH) is hoping for human trials of a
vaccine by April 2020,[346][347] and the Cambridge, Massachusetts–based Moderna is developing a mRNA
vaccine with funding from CEPI.[348][349] Inovio Pharmaceuticals received a grant from CEPI and designed
a vaccine in two hours after receiving the gene sequence.[350] The vaccine is being manufactured so that it
can be first tested on animals.[350] The Norwegian Coalition for Epidemic Preparedness Innovations (CEPI)
is funding three vaccine projects[351] and hopes to have a vaccine in trials by June 2020 and approved and
ready in a year. The University of Queensland in Australia has received AU$10.6 million in funding from
CEPI to develop a "molecular clamp"[352] vaccine platform.[353][354]

Remdesivir was used on the first US patient after he progressed to pneumonia.[355]

Impact
The epidemic coincided with the New Year, which marks a major festival season for the region and the
busiest travel period in China. A number of events involving large crowds were cancelled by national and
regional governments, including the annual New Year festival in Hong Kong, with private companies also
independently closing their shops and tourist attractions such as IKEA and Hong Kong Disneyland.[356]

As Mainland China is a major economy and a manufacturing hub, the viral outbreak has been seen to pose a
major destabilizing threat to the global economy. Agathe Demarais of the Economist Intelligence Unit has
forecast that markets will remain volatile until a clearer image emerges on potential outcomes. Some
analysts have estimated that the economic fallout of the epidemic on global growth could surpass that of the
SARS outbreak.[357]

Mainland China
The travel sector has been hit hard by travel restrictions and fears of contagion, including a ban on both
domestic and international tour groups.[358] Many airlines have either cancelled or greatly reduced flights to
China and several travel advisories now warn against travel to China. Foreigners have been evacuated from
Wuhan and Hubei province by many countries, including the United States and Japan.[359]

The majority of schools and universities have extended their annual holidays to mid-February.[360] Overseas
students enrolled at Chinese universities have been returning home over fears of being infected—the first
cases to be reported by Nepal and Kerala, a southern state of India, were both of students who had returned
home.[361][361][362]
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Hong Kong
Hong Kong has been recovering from high-profile protests that saw tourist arrivals from Mainland China
plummet over an eight-month period. The viral epidemic has however placed doubt on the ability of the
travel sector to withstand a prolonged period of downturn. A drop in arrivals from third countries more
resilient during the previous months has also been cited as a concern.[359] The city is already in
recession[363] and Moody has lowered the city's credit rating, also stating that the government had failed to
respond to "to the concerns that have contributed to the continuing protests" and that decreasing autonomy
of its economic and political system from Mainland China was undermining its credentials.[364][365] The
worst economic effects from the outbreak are expected for Australia, Hong Kong and China.[366]

There has also been a renewed increase in protest activity as hostile sentiment against Mainland Chinese
strengthens over fears of viral transmission from Mainland China, with many calling for the border ports to
be closed and for all Mainland Chinese travellers to be refused entry. Incidents have included a number of
petrol bombs being thrown at police stations,[367] homemade bombs exploding in toilets,[368] and foreign
objects being thrown onto transit rail tracks between Hong Kong and the Mainland Chinese border.[369]
Political issues raised have included concerns that Mainland Chinese may prefer to travel to Hong Kong to
seek free medical help (which has since been addressed by the Hong Kong government).[370][371]

Since the outbreak of the virus, a significant number of products have been sold out across the city,
including face masks and disinfectant products (such as alcohol and bleach).[372] An ongoing period of
panic buying has also caused many stores to be cleared of non-medical products such as bottled water,
vegetables and rice.[373] The Government of Hong Kong had its imports of face masks cancelled as global
face masks stockpiles decline.[374]

Japan
Prime Minister Abe has sad that “the new coronavirus is having a major impact on tourism, the economy
and our society as a whole”.[375] Japan has been evacuating its citizens from Hubei province in China, three
of whom were confirmed to be infected with the Wuhan virus and twelve of whom have been
hospitalized.[376] The first domestic local transmission of the virus was confirmed on 28 January when a
tourist bus driver in Nara Prefecture became infected despite having never been to China[377] – a day later,
the tour guide on the same tourist bus was also confirmed to be infected.[378] Another tour guide who was
identified whilst in South Korea as being infected, unrelated to the previous tour guide reported as infected
in Nara, is suspected to have contracted the virus whilst in Japan from another person who has also been
confirmed infected.[379] The health minister has said that the situation has not reached a point where mass
gathering must be called off.[380]

The epidemic is expected to have a negative impact on the economy of Japan. Mitsubishi UFJ Morgan
Stanley predicts that the economic fallout of the epidemic would be worse than that of SARS since tourism
plays a larger part in the current Japanese economy.[381] Economic politician Yasutoshi Nishimura also
warned that the viral epidemic could have a strong impact on the Japanese economy due to disruption of
logistics and factory operations.[382] Japanese airlines have started suspending flights to China[383] and JTB,
the country's largest travel agency, has cancelled all tours to China.[384] Manufacturers, including Toyota,
have halted all their production lines in Mainland China[385] and Honda has evacuated all its staff from
Wuhan.[386] Prime Minister Abe has considered using emergency funds to mitigate the outbreak's impact on
tourism, of which Chinese nationals account for 40%.[387] S&P Global noted that the worst hit shares were
from companies spanning travel, cosmetics and retail sectors which are most exposed to Chinese
tourism.[388] It is noted that increased sales of face masks and protective gear are unlikely to compensate for
the economic downturn.[389]

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Chinese, or people assumed to be Chinese, have reported discrimination in Japan as Japanese people fear
possible viral contagion.[390] There have been reports that face masks have been selling out across the nation
and that there has been pressure placed on the healthcare system as demands for medical checkups
increase.[391] Shops have said that their stocks are depleted within a day of new arrivals.[392]

Southeast Asia
Among ASEAN countries, the city-state of Singapore was forecast to be one of the worst hit countries by
Maybank.[393] Economists have advised that the viral outbreak would have an impact on the economy of
Singapore, but that it was too soon to provide a certain answer. The tourism sector was considered to be an
"immediate concern" along with the effects on production lines due to disruption to factories and logistics in
Mainland China.[394] Singaporeans have been stocking up on face masks, themometers and sanitation
products despite being advised against so by the Singaporean government.[395][396]

Maybank economists had also rated Thailand as being most at risk, with the threat of the viral outbreak's
impact on tourism has causing the Baht to fall to a seven-month low.[397]

In Malaysia, economists predict the outbreak will affect the country's GDP, trade and investment flows,
commodity prices and tourist arrivals with varying degrees.[398]

South Asia
India is highly dependent on trade across the Himalayas and the disruption in Mainland China could
adversely impact the economy of India, especially the electronics and pharmaceutical industries, with the
closure of Chinese ports having a knock-on effect on Indian logistic operations as well.[399][400] Sri Lanka
has warned of a short term impact on the tourism sector.[401]

United States
The viral outbreak was cited by many companies in their briefings to shareholders, but several maintained
confidence that they would not be too adversely affected by short-term disruption due to "limited" exposure
to the Chinese consumer market, however those with manufacturing lines in Mainland China are warning
about possible exposure to supply shortages.[402]

Silicon Valley has been fearing serious disruption to its production lines as much of the technology sector
relies on factories in Mainland China. Since there had been a scheduled holiday over Lunar New Year, the
full effects of the outbreak on the tech sector aren't yet known for sure."[403]

See also
2009 flu pandemic
Emerging infectious disease
Rousettus bat coronavirus HKU9

Notes

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Further reading
Mainland China and Hong Kong

Statutory Reporting of Severe Respiratory Disease associated with a Novel Infectious Agent (h
ttps://www.chp.gov.hk/files/pdf/letters_to_private_hospitals_20200107.pdf). CHP, Hong Kong,
(7 January 2020)
WHO

World Health Organization (2020). Surveillance case definitions for human infection with novel
coronavirus (nCoV): interim guidance v1, January 2020 (Report). World Health Organization.
hdl:10665/330376 (https://hdl.handle.net/10665%2F330376). WHO/2019-
nCoV/Surveillance/v2020.1.
World Health Organization (2020). Laboratory testing of human suspected cases of novel
coronavirus (nCoV) infection: interim guidance, 10 January 2020 (Report). World Health
Organization. hdl:10665/330374 (https://hdl.handle.net/10665%2F330374). WHO/2019-
nCoV/laboratory/2020.1.
Europe

"Cluster of pneumonia cases caused by a novel coronavirus, Wuhan, China" (https://www.ecd


c.europa.eu/sites/default/files/documents/Risk%20assessment%20-%20pneumonia%20Wuha
n%20China%2017%20Jan%202020.pdf). ECDP (17 January 2020)
Threat level remains LOW but authorities raise alertness to symptoms (http://www.msn.com/en
-gb/news/newslondon/coronavirus-new-precautions-to-be-put-in-place-for-travellers-arriving-in-
uk-from-china-grant-shapps-confirms/ar-BBZcQVS) MSN (22 January 2020)

External links
Novel Coronavirus (2019-nCoV) situation reports (https://www.who.int/emergencies/diseases/n
ovel-coronavirus-2019/situation-reports/) at WHO website, include official numbers of
confirmed cases in countries of the world
Live global map of Wuhan novel coronavirus (2019-nCoV) spread using official Chinese
sources (https://medgic.co/virus) by Medgic (https://medgic.co), updated daily

https://en.wikipedia.org/wiki/2019–20_Wuhan_coronavirus_outbreak 55/56
02/02/2020 2019–20 Wuhan coronavirus outbreak - Wikipedia

Interactive global map of Wuhan novel coronavirus (2019-nCoV) spread (https://gisanddata.ma


ps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6) and
spreadsheet (https://docs.google.com/spreadsheets/d/1yZv9w9zRKwrGTaR-YzmAqMefw4wMl
aXocejdxZaTs6w) by Johns Hopkins University, updated daily
CORONATRACKER (https://www.coronatracker.com) – a community-based project by data
scientists, medical professionals and web developers to keep track of and collect data about
latest developments about 2019-nCoV
"Coronavirus" (https://www.cdc.gov/coronavirus/index.html). Centers for Disease Control and
Prevention (CDC).
Geographical distribution of 2019-nCov cases (https://www.ecdc.europa.eu/en/geographical-di
stribution-2019-ncov-cases) by European Centre for Disease Prevention and Control
"Statement on the meeting of the International Health Regulations (2005) Emergency
Committee regarding the outbreak of novel coronavirus 2019 (n-CoV) on 23 January 2020" (htt
ps://www.who.int/news-room/detail/23-01-2020-statement-on-the-meeting-of-the-international-
health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-
(2019-ncov)). World Health Organization (WHO).

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