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Coronavirus live update: China changes diagnosis criteria, causing confusion

The new criteria resulted in a dramatic decrease in new infections calculated, excluding patients from Hubei province, the hardest-hit area of the outbreak

By The New York Times
Published: Feb 20, 2020

Coronavirus live update: China changes diagnosis criteria, causing confusionA quarantine station at Incheon International Airport near Seoul, South Korea, on Feb. 14, 2020. South Korea reported 15 more cases of the new coronavirus on Wednesday, Feb. 19, bringing the total number of patients infected with the disease to 46. Image: Lam Yik Fei/The New York Times

For the second time in a week, China on Thursday changed its criteria for confirming coronavirus cases, throwing into confusion the methodology that the country at the heart of the outbreak uses to track transmissions and resulting in a dramatic decrease in new infections.

The new criteria exclude patients from Hubei province, the hardest-hit area of the outbreak, who are diagnosed using clinical methods, including CT scans and an assessment of symptoms. Instead, patients there would be counted as having contracted the virus only when confirmed by a specialized nucleic acid test.

Using the new criteria, officials in the province Thursday recorded 349 new cases in the previous 24 hours, bringing the total national figures to 74,576. New deaths rose by 114 on Wednesday, bringing the death toll to 2,118.

In its sixth iteration of a diagnosis regime, the government said it would differentiate between “suspected” and “confirmed” cases from now on. Cases would only be considered confirmed after genetic testing.

Such tests are notoriously difficult to conduct, and the results are often wrong. It takes at least two days to process the results of the test.

The change has caused confusion among public health experts, who said it is now extra difficult to track the outbreak in China.

“For an epidemiologist, it’s really frustrating when case definitions keep on changing,” said Benjamin Cowling, a professor of epidemiology at the University of Hong Kong. “Why can’t they work out what’s a probable, suspected and confirmed case? It’s totally confusing.”

Last week, the government switched to counting cases based on diagnoses made in clinical settings, including scanning patients’ lungs, in an effort to more quickly isolate and treat patients.

As a result, however, the country may have overcounted cases because lung scans are an imperfect means to diagnose patients. Even patients with ordinary seasonal flu may develop pneumonia visible on a lung scan.

Japan Reports 2 Deaths Among Cruise Ship Passengers

Two passengers from the cruise ship quarantined in Japan have died after contracting the new coronavirus, the first deaths among the more than 600 people on board who have been infected, a Japanese health ministry official said Thursday.

The two people, both Japanese, were an 87-year-old man and an 84-year-old woman, the Japanese broadcaster NHK reported. They were taken to hospitals on Feb. 11 and 12, and both had underlying health issues, the broadcaster said. No other information about them was immediately available.

Hundreds of passengers have begun disembarking from the ship, the Diamond Princess, after Japan declared the two-week quarantine over, even as officials have continued to report dozens of new cases on the vessel.

The authorities have said they are releasing only people who have tested negative for the virus and are showing no symptoms. But experts on infectious diseases have pointed to deficiencies in the quarantine protocols on the ship and questioned the decision to let them go free.

All Americans evacuated from the Diamond Princess should be tested, the CDC said.

Americans who were passengers on a cruise ship quarantined in Japan should all be tested for the new coronavirus, the U.S. Centers for Disease Control and Prevention said, adding that it will begin to offer them tests on Thursday.

In light of the large outbreak aboard the ship, the Diamond Princess, the agency “has decided it is important to test all evacuees,” it said on Wednesday in a written notice distributed to Americans who were taken from the ship and are being held in quarantine at Travis Air Force Base in California.

“We strongly recommend that you undergo this testing,” it added.

Until now, passengers who were symptom-free and had not been in close quarters with infected people generally have not been tested, in part because the test often fails to detect the virus in the early stages of infection.

More than 600 people who were aboard the Diamond Princess have tested positive for the virus and have been hospitalized in Japan, and the number has risen sharply each day. After attempts to halt the spread by isolating people on the ship proved ineffective, Japan began to release most of them on Wednesday.

Earlier this week, the United States repatriated more than 300 passengers and quarantined them for two weeks. Fourteen of those people tested positive for the virus just before leaving Japan, and a few more have tested positive since reaching California.

“Those who are identified as positive for coronavirus will be transferred to a local hospital for observation and continued care,” the CDC notice said. “Those who test negative for coronavirus will remain on the base and continue to serve out their 14-day quarantine.”

The CDC said on Tuesday that it did not want the remaining American passengers — more than 100 of them, including people still on the ship and others who were hospitalized in Japan — to return for at least two weeks.

Iran reported two coronavirus cases, and then two deaths.

Two people have died of the coronavirus in Iran, a country that until Wednesday had reported no confirmed cases of the illness.

According to the state-run news agency IRNA, Alireza Vahabzadeh, an adviser to Iran’s health minister, confirmed the deaths, saying both were in the central city of Qom. The adviser described both of those who died as “old” and said one was a veteran of the Iran-Iraq war and a victim of Saddam Hussein’s chemical attacks.

The patients were the first confirmed cases of coronavirus in Iran, and raised the number of countries where it has now been detected to at least 27.

According to the semiofficial Iranian Students’ News Agency, the ministry said that it had isolated an unspecified number of people while they underwent testing for the virus, and that the results of those tests would be made public.

Schools, seminaries and universities in Qom will be closed on Thursday.

Fed reviewed coronavirus risks at January meeting, newly released minutes show. Officials at last month’s Federal Reserve Board meeting were concerned enough about how the global economy will fare under coronavirus that they reviewed the risks at the meeting.

Fed officials have signaled that they plan to leave policy unchanged as they wait to see how the economy shapes up in 2020, and the board announced after the Jan. 28 and 29 meeting that interest rates would not change.

But newly released minutes from the meeting show that officials called the virus “a new risk to the global growth outlook.”

The Fed is monitoring how the economic fallout in China will affect American growth and inflation.

“The question for us really is: What will be the effects on the U.S. economy? Will they be persistent, will they be material?” Jerome Powell, the Fed chair, told lawmakers while testifying last week. “We know that there will be some, very likely to be some effects on the United States. I think it’s just too early to say.”

Already, business in the United States and around the world have reported that coronavirus is upending their operations, disrupting virtually every major industry, from food, fashion and entertainment to automobiles and technology.

On Monday, Apple said that demand for its devices in China had been hurt by the outbreak; it closed all 42 of its stores in the mainland last month and most have yet to reopen.

Cambodia gave its cruise ship passengers 740 all-clears.

More than 700 passengers from another cruise ship, which was allowed to dock in Cambodia last week after being turned away by ports across Asia, have tested negative for the virus, Cambodian health officials said on Wednesday.

The 740 passengers have been in Cambodia since their ship, the Westerdam, was permitted to dock in the port city of Sihanoukville on Feb. 13. An additional 233 passengers, who had been forced to remain onboard, will be permitted to disembark on Wednesday.

Holland America Line, which operates the Westerdam, initially said none of the passengers or crew had been infected. Cambodia allowed more than 1,000 passengers to disembark after checking them for fever; only a few underwent laboratory testing for the virus.

But on Saturday, an American passenger was found to be infected after flying to Malaysia, raising concerns that others onboard the ship had also been exposed. She was one of hundreds from the Westerdam who had left Cambodia.

Cambodian officials said the 740 passengers checked since then had undergone laboratory tests for the virus. The results suggested — for now, at least — that a large-scale outbreak had not occurred. Before landing at Sihanoukville, the ship carried 1,455 passengers and 802 crew members.

“This completes the guests’ testing,” Holland America said in a statement. “These results provide the required clearance for remaining guests in Cambodia to begin their onward journey home.”

The cruise line said that those passengers who had already returned home “will be contacted by their local health department and provided further information,” but gave no details about how that would happen.

Passengers have flown home to countries on at least three continents, including the United States, the Netherlands and Australia.

A total of 747 crew members who remain aboard the Westerdam are being tested for the virus, the company said. It was unclear whether 55 crew members who previously left the ship had been tested or what countries they were in.

The ship will remain in Sihanoukville while the crew tests are conducted.

It’s two crisis-hit ships, but one cruise giant.

Both of the cruise ships caught up in the coronavirus outbreak belong to parts of the same company: Carnival Corp., which finds itself facing an international crisis and financial pain.

Carnival runs Holland America Line, whose fleet includes the Westerdam cruise ship that docked in Cambodia. Another Carnival ship, the Diamond Princess, has been moored outside the Japanese city of Yokohama with hundreds of coronavirus cases reported onboard.

Carnival serves nearly 11.5 million travelers a year, roughly half the global cruise market. In the coming months, industry analysts say, the coronavirus crisis could take a financial toll on the company, which has been looking to make inroads into the fast-growing Chinese market.

China revoked three Wall Street Journal reporters’ credentials over an opinion headline. China on Wednesday said it would revoke the credentials of three Wall Street Journal reporters working in mainland China, in a significant escalation of Beijing’s pressure on foreign news organizations.

A spokesman for China’s Ministry of Foreign Affairs said the move was in retaliation for a headline on a Feb. 3 opinion piece about the economic impact of the coronavirus, “China Is the Real Sick Man of Asia.”

“Sick man of Asia” was a derogatory characterization of China’s weaknesses in the late 1800s and early 1900s, when it suffered internal divisions and was exploited by foreign powers.

Chinese officials have “demanded that The Wall Street Journal recognize the seriousness of the error, openly and formally apologize, and investigate and punish those responsible,” Geng Shuang, the ministry spokesman, said in a transcript provided by the Chinese government.

The revocations come less than a day after American officials said they would treat representatives of five government-controlled Chinese news organizations — Xinhua, CGTN, China Radio, China Daily and People’s Daily — as foreign government functionaries, subject to rules similar to those applied to diplomats.

New cases in China appear to be slowing.

On Wednesday, the number of confirmed new cases in mainland China appeared again to be slowing, was 1,749, the health ministry said. That brought the country’s total number of reported infections to 74,185. The ministry reported 136 deaths in the previous 24 hours, bringing the total in the mainland to 2,004.

Hong Kong reported a second death from the virus.

Hong Kong reported its second death from the coronavirus on Wednesday, bringing the number of deaths from the virus outside of mainland China to six.

The victim, 70, had underlying health conditions and had traveled to the mainland for a day in late January, according to the Hong Kong Department of Health.

He was taken to Queen Mary Hospital on Feb. 12 after a fall at home, the department said. The hospital said in a statement that he died Wednesday morning.

Hong Kong has had 63 confirmed cases of coronavirus and has isolated more than 100 other patients as they await test results. The semiautonomous Chinese city has restricted entry from the mainland, and has so far avoided a large-scale outbreak.

But several confirmed patients had no recent travel history outside Hong Kong, and some transmissions may have occurred between colleagues, neighbors and friends who had shared meals, officials have said.

Trump says Xi is doing ‘a very good job.’

President Donald Trump doubled down on his support of the Chinese leader Xi Jinping’s handling of the coronavirus outbreak on Tuesday, calling his counterpart’s efforts “a very good job.”

“I think President Xi is working very hard,” Trump told reporters. “President Xi loves the people of China, he loves his country and he’s doing a very good job with a very, very difficult situation.”

He added that the United States was “working with him and helping him as of the last few days.”

The president’s praise for the Chinese Communist Party’s handling of an outbreak that has killed more than 2,000 people in China contrasts with comments made by members of his administration.

Larry Kudlow, the director of the National Economic Council, last week said the White House was “disappointed in the lack of transparency coming from the Chinese” and said China had turned down American offers of help.

The outbreak raises the pressure on the wildlife trade.

Among some conservationists and scientists, the spread of the new coronavirus has prompted a renewed focus on the dangers of the global trade in wildlife.

The SARS epidemic, caused by a different coronavirus, began in China with the consumption of a catlike animal called the palm civet. The MERS epidemic began with a coronavirus transmitted to humans from camels in the Middle East.

Experts still do not know which species transmitted the new coronavirus to people. But pangolins, also known as scaly anteaters, are now the leading suspects.

Scientists describe live meat markets like the one in Wuhan, China, where the coronavirus appears to have originated, as unintended laboratories for creating new viruses.

“You have a bird pooping on a turtle that poops on a civet,” said Christian Walzer, executive director of health at the Wildlife Conservation Society. “For getting new viruses to emerge, you couldn’t do it much better even if you tried.”

Last month, as the coronavirus spread, the central government in Beijing issued a nationwide but temporary ban on all trade in wild animals, including their transport and sale in markets, restaurants and via online platforms.

Officials in Beijing have now drafted legislation to end “the pernicious habit of eating wildlife,” according to a statement released on Monday by the standing committee of the National People’s Congress.

15 more South Koreans, including 10 members of the same church, have been infected. South Korea reported 15 more cases of the new coronavirus on Wednesday, bringing the total number of patients infected with the disease to 46.

Of the 15 new patients, 13 were residents of Daegu, 186 miles southeast of Seoul, said the Korea Centers for Disease Control and Prevention in a daily news briefing.

Ten of those infected were members of the same church, it said.

Of the new patients, 11 were believed to have contracted the disease through contact with a 61-year-old woman in Daegu who had earlier been diagnosed with the virus.

Officials said they had shut down or quarantined hospital emergency rooms in Daegu where the patients passed through.

South Korea has tested more than 10,000 people for the virus. Of the 46 who have tested positive, 12 have recovered and been discharged from quarantine, officials said.

Russia is barring most visitors from China.

Russia has barred entry to most Chinese citizens, a significant escalation of the country’s scramble to stop the spread of the coronavirus from its neighbor to the southeast.

The entry of many Chinese citizens, including residents of the semiautonomous regions of Hong Kong and Macao, onto Russian territory will be halted indefinitely as of Thursday, according to an order issued on Tuesday by Prime Minister Mikhail Mishustin.

In a separate statement on Wednesday, the country’s Foreign Ministry clarified that the move would be temporary and that it applied only to visitors with tourist, private, student and work visas. Russia will continue to issue official, business, humanitarian and transit visas, and allow entry to their holders.

Russia, which has so far reported only two confirmed cases of the coronavirus, closed its 2,600-mile land border with China last month and limited travel between the two countries. But it allowed some flights from China into Moscow to proceed.

The new move carries significant economic and geopolitical implications: China is by far Russia’s biggest trading partner, with more than $100 billion in imports and exports in 2018. The Kremlin has looked to cement tighter strategic ties with Beijing amid both countries’ confrontations with the West.

More than 1.5 million Chinese tourists visited Russia last year, helping to prop up regional economies across the country. Russia’s Association of Tourism Operators said on Tuesday that if the ban continues into the high summer season, the industry will lose more than $500 million.

WHO says China’s harsh tactics worked.

The restrictive measures adopted by China delayed the spread of the virus to other countries by two to three weeks, World Health Organization officials said on Tuesday.

Harsh internal measures — like canceling train, bus and airline travel; closing schools and factories; and pressuring citizens to stay home — slowed the virus’s spread from Wuhan to the rest of China by two to three days, they added.

“Right now, the strategic and tactical approach in China is the correct one,” said Dr. Michael Ryan, the agency’s chief of emergency response.

“You can argue whether in this case they are excessive or restrictive on people, but there is an awful lot at stake here in terms of public health — and not only public health within China.”

Some health experts have condemned China’s restrictions, saying they could lead to panic, economic hardship, stigmatization of Chinese people, difficulty moving supplies to affected areas and possibly a recession. On Jan. 30, as it declared China’s outbreak a public health emergency, the World Health Organization advised against restricting travel or trade.

In the past, agency officials — including the director general, Tedros Adhanom Ghebreyesus — lavishly praised China’s sacrifices and leadership but declined to comment on its use of harsh measures. At the same time, agency officials reiterated that they opposed travel restrictions by other countries.

On Wednesday, a global ministerial summit on patient safety planned in Switzerland this month, was postponed. The Swiss authorities said in a statement that “numerous participants” had to remain in their own countries to deal with the coronavirus outbreak.

©2019 New York Times News Service