By: Stephen Morgan | Executive Director of Nottingham China Health Institute, Nottingham University Business School (China), University of Nottingham Ningbo China, Professor of Chinese Economic History, University of Nottingham.

Reported confirmed cases of Wuhan virus have increased nearly 1,500 overnight to 5,997 and another 26 deaths to 132 deaths in China, including Hong Kong, Macau and Taiwan (the PRC treats Taiwan as part of China), as per Wednesday, January 29. There are now 64 cases outside of China. Suspected cases are now about 9,000. More than 50,000 were under observation.

The rate of reported confirmed cases has risen steeply over the past week. The epidemic has a long way to go. Public health specialists predict reported cases and deaths will continue to rise for another 10 days or more. But there is much uncertainty still around the genetic characteristics of the virus, its origin, incubation, transmissibility, and lethality.

A Harvard University School of Public Health epidemiologist on Twitter (@DrEricDing) yesterday summarised the most recent scientific modeling. The transmissibility factor R0 is anywhere between 2.0 and 4.0, which makes it more infectious than SARS or common influenza. This suggests quarantine and restrictions on the movement of people will only become more severe. But the modeling of the Wuhan virus epidemic is still in its early days. China’s tight control over information – especially in the early period of the virus, which was in December, but not publicized – gets in the way of good science and good policy.

(On the need for open science and collaboration, see my comments in the Times Higher Education reported here yesterday)

The early studies including those of China’s Centre for Disease Control report an incubation period on average of 10 days, but the period can range from 1-14 days. Unlike SARS or influenza, the Wuhan virus can be transmitted during the incubation phase without the infected person showing any sign of illness at all. This makes it more difficult to control. The use of temperature scanners to check for fever is of limited use in identifying any infected person before they display symptoms. But not everyone infected presents with a fever – some have had diarrhea but no fever.

Although the virus looks as if it might be more difficult to contain than SARS because of the variable incubation periods and contagion occurring without the infected person showing symptoms, the estimated death rate from infection is about one-quarter to one-third that of SARS. Most people who have died from the virus were elderly and underlying health issues, such as diabetes, hypertension, coronary heart disease, and respiratory system diseases.

Everywhere people are wearing masks, but these are of little use outside of crowded areas where there might be potentially infected persons. On the cold and often near-deserted streets of China’s cities masks are unnecessary – the cold and fresh air will protect. More important is wearing gloves, not touching one’s face, and regularly washing your hands and cleaning surfaces that you come into contact with. Check the foreign policy here.

Many provinces have suspended long-distance bus transport. Trains that originate or terminate in Wuhan/Hubei have all been suspended. Those that are running carry very few passengers. Hong Kong has suspended rail transport between China and the territory and Cathay will halve flights between Hong Kong and China destinations.

A major issue is a potential for law and order breakdown that have often accompanied pandemics during human history. This can be fuelled by the lack of information and rumors. Local communities around the country are setting up roadblocks, disrupting transport and resisting instructions to keep highways open.

Non-local visitors are driven away by ad hoc local security in rural and suburban areas. Around China housing estates, hotels, shopping centers, restaurants, and other opened venues check temperatures of people coming in. But many public venues are closed on the instruction of the government.

McDonald’s have closed their restaurants in Wuhan and Starbucks have closed about half of their more than 4000 venues. Universities and schools have postponed for up to two weeks re-opening after the Chinese New Year. This might be extended if the virus is not brought under control.

Data by province or territories:

• Hubei 3554 cases, 125 deaths
• Zhejiang 296 cases
• Guangdong 241
• Hunan 241
• Henan 206 cases, 2 deaths
• Anhui 152 cases
• Chongqing 147
• Shandong 121
• Jiangxi 109
• Sichuan 108
• Jiangsu 99
• Beijing 91 cases, 1 death
• Shanghai 80 cases, 1 death
• Fujian 80 cases
• Guangxi 58
• Hebei 48 cases, 1 death
• Shaanxi 46 cases
• Yunnan 44
• Hainan 43 cases, 1 death
• Heilongjiang 37 cases, 1 death
• Liaoning 36 cases
• Shanxi 27
• Tianjin 24
• Gansu 24
• Inner Mongolia 15
• Xinjiang 13
• Ningxia 11
• Jilin 9
• Guizhou 9
• Taiwan 8
• Hong Kong 8
• Macau 7
• Qinghai 6
• Tibet, 1 suspected case

Overseas reported confirmed cases:

• Thailand 14
• Singapore 7
• Japan 7
• Malaysia 7
• Australia 5
• USA 5
• South Korea 4
• France 4
• Germany 4
• Canada 2
• Nepal 1
• Sri Lanka 1
• Cambodia 1
• Finland had a case but this is no longer counted.

Most of the overseas cases are people who come from Wuhan City, Hubei Province, or have visited the area. This is the case with Malaysia where all are Chinese nationals.

Two especially worrying developments are reports from Japan and Germany. The most recent Japanese infected had not been to China and was reported to be a bus driver who had driven a Chinese tourist group. The first case in Germany was also a person who had not been to China and the three subsequent infections were all close contacts.

The source of the infection is believed to be a Chinese woman who had visited the first infected workplace a week ago.

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