This article was last updated on Feb. 21, 2020.
Jan. 24, 2020 -- News about the coronavirus outbreak that started in Wuhan, China, is changing rapidly. The respiratory infection, recently named COVID-19 by the World Health Organization (WHO), is closely related to SARS and MERS. While the vast majority of cases are in China, the disease has been diagnosed in more than two dozen other countries, including the United States. We’ll provide the latest updates on cases, deaths, travel restrictions, and more here.
What is the latest news?
Eighteen former U.S. passengers of the Diamond Princess cruise ship have tested positive for COVID-19, the CDC said Friday.
At least 10 more Americans returning the U.S. after quarantine on the Japanese cruise ship may have been infected with the new coronavirus before they left Japan. They traveled before anyone knew their status.
These 10 passengers were tested as they got off the ship. Their test results weren’t known until they arrived back in the U.S., meaning they rode home in the plane mixed in with the other passengers, according to the CDC.
The CDC says it was recently informed of the test results by public health authorities in Japan. The agency has not verified that they are infected, and the 10 passengers have not yet been included in the CDC’s official count.
The passengers were among 329 evaucated from the cruise ship, which had been under quarantine with more than 600 cases of COVID-19.
The Washington Post reported on Feb. 20 that 14 people who had tested positive for the virus rode on chartered flights with uninfected passenger. That happened even though the State Department had promised that no one with the infection would be allowed to board the planes.
Though the 14 people weren’t showing any symptoms, the Post reports that they flew home behind 10-foot-high plastic partitions that separated them from the other passengers.
The 10 new cases are in addition to those 14, according to the CDC.
“We do expect to see additional cases of COVID-19 among the passengers,” said Nancy Messonnier, MD, Director of the Center for the National Center for Immunization and Respiratory Diseases at the CDC.
“It is possible that some people were already incubating the disease when they left Japan,” she said. “More information will become available over the next couple of days as we evaluate these repatriated travelers and as we line up the lab results from Japan as well as testing in the United States.”
Eleven of the 14 passengers were later confirmed to be infected and are at the University of Nebraska Medical Center/Nebraska Medicine.
“Most of our guests aren’t showing symptoms of the disease, however several others are exhibiting minor symptoms,” the center said in an email.
Another five are getting care around Travis AFB in California, and two around Lackland AFB in Texas, the CDC said. The rest of the passengers will be kept in quarantine for 14 days, either at Travis AFB in California or Joint Base San Antonio.
Worldwide the number of cases has passed 76,000, the majority of them in China, and the number of deaths is now 2,247, according to the European Center for Disease Prevention and Control.
South Korea had a big jump in cases -- up to 156 -- and now has the largest number outside of China.
The CDC issued a Level 1 travel advisory for Japan and Hong Kong. Level 1 means to use precautions during travel. The U.S. State Department has advised against travel to China, issuing a Level 4 advisory. It's also asking people to reconsider travel on any cruises that go to or within Asia.
How many people have been diagnosed with the virus, and how many have died?
According to European CDC, the majority of the confirmed cases -- more than 76,000 – are in China. More than 1,100 are confirmed outside of China in more than two dozen countries. These include: Thailand, Japan, Singapore, Taiwan, Malaysia, South Korea, United Arab Emirates, Vietnam, Cambodia, Nepal, the Philippines, India, Sri Lanka, Germany, France, Italy, United Kingdom, Russia, Finland, Spain, Sweden, United States, Canada, Australia, Belgium, Macau, Iran and Egypt. South Korea, Japan and Singapore are the countries with the most cases outside of China.
Two passengers on the Diamond Princess from Japan have died of COVID-19, according to media reports. The husband and wife were from Japan and both were in their 80s. They had been in the hospital since early February.
On Tuesday, the director of one of Wuhan’s leading hospitals died from COVID-19, according to media reports. Liu Zhiming, 51, was the head of the Wuchang Hospital and is among nine medical personnel in China who have died so far during the outbreak.
More than 1,700 health care workers in China have been diagnosed with COVID-19, and six of them have died, according to media reports. Most of the cases were in Hubei, the province at the center of the outbreak.
Among those who died is a Chinese doctor, Li Wenliang, who was silenced by authorities when he was one of the first to sound the alarm about the coronavirus, The New York Times reported.
How many cases of COVID-19 are in the United States?
There are a total of 34 cases in the U.S. of COVID-19, including the 18 evacuated cruise ship passengers. Those passengers are receiving medical care at the University of Nebraska Medical Center/Nebraska Medicine. Only a few are showing symptoms, officials said.
Here's where the U.S. cases are:
- Nebraska: 11 (evacuated cruise ship passengers)
- California: 14 (includes 5 evacuated passengers)
- Illinois: 2
- Arizona: 1
- Massachusetts: 1
- Texas: 3 (includes 2 evacuated passengers)
- Wisconsin: 1
- Washington: 1
The CDC has tested 413 people for the virus. The latest case not related to the cruise ship is in Humboldt County in northern California.
Other recent cases include:
- Three people under a quarantine who recently returned to the country from China on State Department-chartered flights. One is housed in Texas at JBSA-Lackland. The patient is in isolation at a nearby hospital. Two are at a base in California. The CDC says there’s no connection between the two in California as they came on different planes and were staying in separate facilities.
- A man in Wisconsin. Health officials there say the man has a history of travel to Beijing and was recently exposed to other known coronavirus patients while in China. The patient is isolated at home, and is doing well, Wisconsin officials say.
- A husband and wife diagnosed in San Benito County, California. The husband had recently traveled from Wuhan, China, although the wife did not. She caught the virus from him, county officials said. They are both 57 and in the hospital.
- A person who had recently traveled to Wuhan and then to Santa Clara County. The person is in isolation.
- A man in his 20s from Boston who had just returned from Wuhan, according to the Massachusetts Department of Public Health. He will remain in isolation until cleared by health officials.
- A man from Santa Clara County who recently returned from Wuhan and was never sick enough to need hospitalization, health officials said. He was “self-isolating” at home but has since been released from isolation. His case is not related to the other one in Santa Clara County.
- A husband and wife in their 60s from Chicago. The man in Illinois became the first case of person-to-person transmission of the virus in the U.S, the CDC said. He is the husband of a Chicago woman diagnosed with the virus after returning from Wuhan. Both were hospitalized but have since been released, according to the Chicago Department of Public Health.
- California has three others: one in Los Angeles County, one in Orange County and the most recent case in San Diego. The patient from Orange County is a man in his 50s. He is in a local hospital in isolation and is in good condition, according to the Orange County Health Care Agency. Los Angeles County officials did not provide additional details about the patient there.
- Arizona's Department of Health Services said its patient is a Maricopa County resident and member of the Arizona State University community who did not live in student housing. The patient is not severely ill and is being kept in isolation.
- The first man diagnosed with coronavirus in the U.S. has been released from the hospital, according to news reports. The Washington state resident, who had recently traveled to Wuhan, said he was continuing to recover at home. He was released from Providence Regional Medical Center in Everett.
The CDC is prioritizing the testing based on a person’s risk.
What are public officials doing to contain the virus?
The WHO declared on Jan. 30 that the 2019-nCoV outbreak is a Public Health Emergency of International Concern, or PHEIC.
WHO Director General Tedros Adhanom Ghebreysus said the agency had already released $9 million in reserve funding to help poorer countries prepare for a pandemic. The agency is also sending hundreds of thousands of masks, gloves and respirators to areas in need.
"We are only as strong as the weakest link,” Tedros said.
He also stressed, though, that much more money would be needed to fund a global response — an estimated $675 million for just the next 3 months.
“It’s a lot of money, but it’s much less than the bill we will face if we don’t invest in preparedness now,” he said.
The Bill and Melinda Gates Foundation has already donated $100 million to the effort.
The U.S. has also declared the crisis a public health emergency.
The U.S. is banning any foreign visitors who have come from China from entering the country. All U.S. citizens who have visited China’s Hubei province in the past 14 days will face mandatory quarantine for 14 days. Other visitors returning from China will be screened and asked to self-quarantine for 14 days. Their movements will be monitored.
Planes carrying Americans out of China have landed at one of three Air Force bases: Travis Air Force Base in Fairfield, CA, southwest of Sacramento, Marine Corps Air Station Miramar in San Diego, Lackland Air Force Base in San Antonio, TX, and Eppley Airfield in Omaha, NE. The CDC is coordinating the quarantines.
“The actions we have taken and continue to take compliment the work of China and the World Health Organization to contain the outbreak within China," Health and Human Services Secretary Alex Azar said.
“This is a significant global situation, but I want to emphasize at this time that the risk to the American public is low,” said CDC Director Robert Redfield, MD.
These are the first federal quarantine orders issued in 50 years, the last coming in the 1960s for smallpox evaluations, CDC officials said.
Last week, the first group of Americans who had been quarantined were released.
Public health officials kept the 195 evacuees at March Air Reserve Base for 14 days to monitor them for symptoms of the coronarvirus. None of them tested positive for the virus in that time, officials said, and they pose no health risk to the public.
The State Department has issued a level 4 travel advisory telling people not to travel to China because of the outbreak.
Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said the strict precautions are warranted because of “the issue now with this is that there are a lot of unknowns.”
He pointed out that the number of cases “has steeply inclined each and every day.”
We now know for certain that a person without symptoms can transmit the disease, Fauci said.
Health officials also clarified the distinctions between isolation and quarantine. Isolation is used to keep a person who’s already sick from infecting others. Quarantines restrict the movement of someone who is exposed, but not yet sick.
In the U.S., the number of airports that will screen passengers from China for symptoms has expanded to 20.
When did the outbreak start?
China first reported the outbreak in Wuhan on Dec. 30, 2019.
Is the virus seasonal, like the flu?
Will the coronavirus die out once warmer weather hits? It’s possible, but we don’t know enough about the virus yet to know for sure, said Messonnier.
Messonnier urged caution with that hypothesis during a CDC press briefing Wednesday. Most respiratory viruses, like flu, are seasonal. Coronavirus may behave like flu and we’ll see cases go down in spring and summer, she said. “But it’s premature to assume that,” Messonnier said. The agency continues to take aggressive action because it can’t count on that.
What are the symptoms, and how is the virus diagnosed?
China created a test for the virus and shared that information with other countries. The CDC has developed its own test.
Symptoms include a fever, coughing, and shortness of breath. They may appear 2 to 14 days after you’re exposed to the virus.
What is the source of the virus, and how is it spread?
Health officials are not sure of the source of the virus yet or how easily it can spread.
The virus can spread from person to person. A new case report published in the New England Journal of Medicine, describes how a woman from China infected 4 co-workers at a German company before she showed any symptoms of the disease herself.
The CDC believes that severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), two other types of coronavirus, are spread through droplets when someone coughs or sneezes.
Coronaviruses are found in many different animals, including camels, cattle, cats, and bats. One research paper also suggested snakes as a possible source. The new virus may be linked to a seafood and live animal market in Wuhan that has since been closed.
Is there a vaccine?
There is no vaccine, but the National Institutes of Health is working on one and hopes to begin testing in several months. That testing would be for safety. If it’s safe, there would be testing to see how well it works.
How is it treated?
There is no specific treatment for the virus. Patients are generally given supportive care for their symptoms, such a fluids and pain relievers. Hospitalized patients may need support with breathing.
Is travel to China safe?
The U.S. State Department issued a level 4 travel advisory telling people not to travel to China because of the outbreak. Some cities in China, such as Wuhan, are closed to travelers.
Several airlines, including Delta, United and American, have announced they are ending service to China until the outbreak wanes.
But, commercial flights continue to come and go between the U.S. and China, and the CDC said it was currently evaluating whether or not to restrict the movement of passengers coming in on those flights.
“At this point we’re evaluating the appropriate strategy in light of the new information. There’s really nothing new to share at this point,” said Martin Cetron, MD, Director for the Division of Global Migration and Quarantine at CDC.
Travelers who do go should:
- Avoid contact with sick people.
- Avoid animals, animal markets, and products that come from animals.
- Wash their hands often with soap and water, or use an alcohol-based sanitizer if that’s not available.
- Seek medical care right away for a fever, cough, or difficulty breathing. Tell a health care professional about any travel.
Correction: An earlier version of this story included the wrong location for Travis Air Force Base. It is in Fairfield, CA., not Sacremento.