Following recent reports of COVID-19 in Iran, British Columbia last night reported an infection in a traveler returning from Iran and Lebanon today reported an illness linked to an Iran traveler.
And amid rising suspicions of undetected transmission in Iran plus reports of surges in South Korea and Japan, as well as new local transmission in Italy, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, said the window of opportunity for containing the outbreak has narrowed.
In a related development, disease modeling experts from Imperial College London said today in a new report that two thirds of cases exported from China have probably gone undetected.
At a media briefing today, Tedros said the WHO-led international joint mission, which has been on the ground since last weekend, has visited Beijing, plus Sichuan and Guangdong provinces and will visit Wuhan tomorrow. He also announced six special WHO envoys who will provide advice to countries in different parts of the world.
He also said the WHO is aware of China's change in case reporting, which reverts to only including lab-positive cases among the confirmed cases. Tedros added that the change provides better clarity, since some of the clinically confirmed cases may not reflect COVID-19 infections. He said China's switch back to the original reporting system might be a sign of improved lab-testing capacity.
Canada, Lebanon note Iran-linked cases
Over the past few days, Iran reported five COVID-19 cases, two of them fatal, and last night health officials in British Columbia announced presumed positive test findings in a woman in her 30s who recently returned from Iran. Authorities from BC's Fraser health region are tracing the contacts of the woman, who is in isolation at her home. The illness brings Canada's total to 9, of which 6 are from BC.
In a similar development, Lebanon's health minister announced at a news conference today that the country had detected its first COVID-19 case, a 45-year-old woman who had arrived from Iran, Reuters reported. Authorities are following up on two other suspected cases.
At a WHO telebriefing today, Jaouad Mahjour, MD, MPH, said the illness was detected among symptomatic cases during airport surveillance. He added that the WHO stands ready to provide technical assistance.
Today, Iran's health ministry reported 13 more cases and 2 more deaths. Most are from Qom, where the country's first cases, both fatal, were detected. Officials said 7 are from Qom, 4 are from Tehran, and 2 are from Guilan. It said two of the newly reported patients died from the disease and that two more suspected cases are under investigation in Babylon, involving people who have a history of travel to Qom. Iran now has 18 cases, 4 of them fatal.
Elsewhere in the Middle East, the United Arab Emirates reported 2 new cases involving people who had close contact with an infected person from China, raising its total to 11, the ministry said on Twitter today.
South Korea, Japan reports more steep rises
South Korea today reported 100 more cases, raising its total to 204. Of the most recent cases, 85 are linked to the Shincheonji Church of Jesus cluster, according to Kyodo News, which cited the country's health ministry. It added that 400 of the sect's 3,500 members have shown symptoms of the disease.
Meanwhile, Japan has reported 21 more cases since yesterday, raising its total to 105. In a pair of health ministry summaries, one covering 9 cases and the other covering 12 cases, officials said the patients are from nine different locations: Hokkaido, Nagoya, Tokyo, Chiba, Fukuoka, Sagamihara, Isikawa, Saitama prefecture, and Okinawa.
In Singapore, the health ministry reported one more case today, a contact of an earlier confirmed case. The country now has 86 cases, and so far, all but 8 are linked to known cases.
Italy confirms first locally transmitted cases
In two separate reports today, Italy reported 16 cases, 14 in Lombardy region and 2 in neighboring Veneto region, Reuters reported. The ministry first reported 6 cases in Lombardy, which it said marked the first local transmission, then followed up with a report of 8 more.
A separate news agency report said two illnesses were reported, but it's not clear if they're linked to the cases in Lombardy. Italy now has 19 cases.
The WHO said in its latest situation report that over the past 24 hours it received reports of 127 new cases, raising the total outside of China to 1,200 , including 8 deaths, from 28 countries. Of those, 634 are related to Japan's Diamond Princess cruise ship cluster.
New estimates suggest multiple undetected transmission chains
Modeling experts from Imperial College London examined recent COVID-19 developments outside of China that suggest that two-thirds of cases exported from China's mainland have gone undetected, which could have triggered yet-undetected local spread of the virus.
For their analysis, they estimated the likely size of the epidemic in Wuhan based on air traffic volume and the number of cases outside of China. Then they examined country rates of confirmed cases related to flight volume to gauge the sensitivity of different surveillance systems.
Though travel restrictions from Wuhan and other parts of China may have reduced the number of travelers to and from China, their estimates still suggest that a significant number of exported cases (63% to 73%) have gone undetected.
They said that differences in illness severity make some cases tough to detect. "However, some countries have detected significantly fewer than would have been expected based on the volume of flight passengers arriving from Wuhan City, China," they wrote.
The report is Imperial College London's sixth to address issues related to the COVID-19 epidemic.
China reports prison clusters, another doctor death
China's National Health Commission today reported 889 more cases, raising the country's overall total to 75,465. It also reported 118 more deaths and 231 fewer serious cases, raising those respective totals to 2,236 and 11,633, respectively.
Shandong province, located on China's northeastern coast, has reported a spurt of 202 new cases over the past day, and at today's WHO media briefing, Tedros said health officials are seeking more information about the rise.
In other developments in China:
- Illness clusters have been reported at several prisons, three in Hubei province, one in Shandong province, and one in Zhejiang province, the South China Morning Post reported today. There were 200 confirmed cases at the Shandong province prison, but it's not clear if that total explains the province's recent spike in cases.
- Another death has been reported, in a doctor working at a Wuhan hospital, Xinhua, China's state news agency, reported today. Peng Yinhua, MD, age 29, a respiratory care specialist, was hospitalized on Jan 25 and died last night.
