“There is an emergency in China, but it
has not yet become a global health emergency…WHO is following this
outbreak every minute of every day”, said Dr Tedros Ghebreyesus,
Director-General of WHO, on Jan 23. A novel coronavirus (2019-nCoV)
outbreak is emerging, but it is not yet a Public Health Emergency of
International Concern (PHEIC). As we went to press, more than 500 cases
have been confirmed in China, as well as in Japan, South Korea,
Thailand, and the US. The virus can cause a severe respiratory illness,
like SARS and MERS, and human-to-human transmission has been confirmed.
These characteristics are driving China’s urgent public health actions,
as well as international concern. But much remains unknown. The pieces
of the puzzle that is 2019-nCoV are only now beginning to come together.
Today, we publish the first clinical data
from individuals confirmed to be infected with 2019-nCoV from Wuhan,
China. Chaolin Huang and colleagues provide comprehensive findings for
the first 41 laboratory-confirmed cases. 27 of these 41 cases had direct
exposure to the Wuhan seafood market that is thought to be the initial
site of infection from an animal source. All had viral pneumonia. The
severity of illness is concerning: almost a third of patients developed
acute respiratory distress syndrome requiring intensive care; six
patients died; five had acute cardiac injury; and four required
ventilation.
Separately, Jasper Fuk-Woo Chan and
colleagues report clinical and microbiological data from a family of six
people who had travelled to Wuhan and later presented with pneumonia to
Shenzhen Hospital in Guangdong province. Five were identified as
infected with 2019-nCoV. Notably, none had been to the Wuhan market, but
two had visited a Wuhan hospital. The authors suggest these findings
confirm human-to-human transmission. Together, these Articles provide an
important initial picture of the clinical spectrum and transmission of
this new disease.
In an accompanying Comment, Chen Wang,
George Gao, and colleagues describe the early sharing of clinical data
from the outbreak and emphasise the urgent need for more information
about pathogenesis and viral transmission, as well as the pressing need
to develop best supportive care and a vaccine. They also caution against
overstating the mortality risk, as early reported case-fatality rates
may be high due to bias towards detecting severe cases. As David Heymann
reflects in another accompanying Comment, publication of these Articles
provides peer-reviewed information urgently needed to refine the risk
assessment and response, which are happening in real time.
China has quickly isolated and sequenced
the virus and shared these data internationally. The lessons from the
SARS epidemic—where China was insufficiently prepared to implement
infection control practices—have been successfully learned. By most
accounts, Chinese authorities are meeting international standards and
isolating suspected cases and contacts, developing diagnostic and
treatment procedures, and implementing public education campaigns. Dr
Tedros has praised China for its transparency, data sharing, and quick
response. Likewise, WHO has reacted fast and diligently. Despite massive
attention and conjecture about the level of threat posed by 2019-nCoV,
and whether WHO should declare a PHEIC, the agency’s emergency committee
has not bowed to pressure to take such a decision until necessary. We
commend WHO for its resilience.
There are still many gaps in our
understanding. The early experiences of these patients and the response
to their symptoms before cases were reported remain undocumented. The
exposure and possible infection of health workers remain extremely
worrying. We will not know for some time the consequences of the
quarantine imposed in Wuhan on Jan 23, 2020. Chinese public health
authorities are under enormous pressure to make difficult decisions with
an incomplete, and rapidly changing, understanding of the epidemic. The
shutdowns may seem a drastic step—whether they represent an effective
control measure deserves careful investigation and much will likely
depend on maintaining trust between authorities and the local
population. News media that worsen fears by reporting a “killer virus“
only harm efforts to implement a succesful and safe infection control
strategy.
Openness and sharing of data are
paramount. There are enormous demands for rapid access to information
about this new virus, the patients and communities affected, and the
response. But equally crucial is the need to ensure that those data are
reliable, accurate, and independently scrutinised. As for all public
health emergencies, we will be making all related Lancet content fully and freely available.
Article Info
Publication History
Published: January 24, 2020
Identification
DOI: https://doi.org/10.1016/S0140-6736(20)30186-0Copyright
© 2020 Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Articles
- A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster
- Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
- Data sharing and outbreaks: best practice exemplified
- A novel coronavirus outbreak of global health concern
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