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Monday, January 27, 2020

Confusion and lost time: how testing woes slowed China’s coronavirus response

Yang Zhongyi was still waiting on Monday for a coronavirus test in the Chinese city of Wuhan two weeks after she started to show signs of a fever, even though doctors privately told her family that she almost certainly has been infected, her son Zhang Changchun told Reuters.
Yang, 53, is just one of many Wuhan inhabitants finding it difficult to get tested or receive treatment for the new form of coronavirus, which authorities say has infected 2,800 people and killed at least 80 in China, a situation that may be contributing to the spread of the disease.
Yang has been unable to gain full-time admission to a hospital, her son said. She has been put on drips in unquarantined areas at four separate hospitals in the city to treat her deteriorating lungs, he said, while he is doing what he can to get her tested or admitted full-time.
“My brother and I have been queuing at the hospital every day. We go at 6 and 7 in the morning, and queue for the whole day, but we don’t get any new answers,” Zhang told Reuters. “Every time the responses are the same: ‘There’s no bed, wait for the government to give a notice, and follow the news to see what’s going on.’ The doctors are all very frustrated too.”
Officially known as 2019-nCoV, the new form of coronavirus was first identified as the cause of death of a 61-year-old man in Wuhan on Jan. 10, when China shared gene information on the virus with other countries. Some, such as Japan and Thailand, started testing travelers from China for the virus within three days.
However, testing kits for the disease were not distributed to some of Wuhan’s hospitals until about Jan. 20, an official at the Hubei Provincial Center for Disease Control and Prevention (Hubei CDC) told Reuters. Before then, samples had to be sent to a laboratory in Beijing for testing, a process that took three to five days to get results, according to Wuhan health authorities.
During that gap, hospitals in the city reduced the number of people under medical observation from 739 to just 82, according to data compiled by Reuters from Wuhan health authorities, and no new cases were reported inside China.
Despite the lack of reliable data and testing capacity in Wuhan, Chinese authorities assured citizens in the days after the virus had been identified that it was not widely transmissible. In previous weeks, it had censored negative online commentary about the situation, and arrested eight people it accused of being “rumor spreaders.”
“The doctor didn’t wear a mask, we didn’t know how to protect ourselves… no one told us anything,” a 45-year-old woman surnamed Chen told Reuters. Her aunt was confirmed to have the virus on Jan. 20, five days after she was hospitalized. “I posted my aunt’s photos on (Chinese social media site) Weibo and the police called the hospital authorities. They told me to take it down.”
National, regional and city health officials did not respond to requests for comment from Reuters on how the virus outbreak has been handled. National officials did say at a media briefing last week that there were some “loopholes” in initial treatment methods.
Wuhan’s mayor, Zhou Xianwang, told Chinese state television on Monday he recognized that “all parties were not satisfied with the disclosure of our information.” But he pointed to strictures placed upon him by provincial and national leaders.
“In local governance, after I receive information, I can only release it when I’m authorized,” he said. Zhou told a media briefing on Sunday that a further 1,000 people could be diagnosed with the virus in Wuhan, based on the number of patients yet to be tested.

DELAYED RESPONSE

China last week locked down the affected region in Hubei province in the biggest quarantine operation on record and is building two new hospitals to treat virus patients. President Xi Jinping has created a special committee to tackle the outbreak.
The country has been praised internationally for quickly sequencing the virus gene. However, its slow scale-up of testing has been questioned.
Once a virus has been identified, “You need to make sure you have all the reagent (a substance used in chemical analysis) samples and you’ve got it all pushed out to where you want to do testing,” said Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, who focuses on emerging infectious disease and pandemic preparedness.
Although information from the region is scarce, Adalja suggested China has had problems with this stage of tackling the outbreak. “We’re already hearing that there are shortages of medical professionals there, that there are shortages of test kits and medicines,” he said.
John Edmunds, a professor at the center for mathematical modeling of infectious diseases at the London School of Hygiene & Tropical Medicine, said China has not communicated enough detailed data after the initial outbreak.
“We have a very incomplete picture of what’s going on,” he told Reuters. “Whether it’s incompetence, secrecy, or deliberate, I don’t know, but it would be very useful if we could have some basic epidemiological data.”
The shortage of testing supplies and China’s initial reticence have drawn criticism that the country is still learning lessons from the outbreak of Severe Acute Respiratory Syndrome (SARS) in 2002 that killed almost 800 people.
“The improvements have been on the hard science side – figuring out the virus’s genome, building new hospitals at a moment’s notice – more than on the soft science side of managing information and dealing with people,” said Mary Gallagher, a political science professor who leads the University of Michigan’s Center for Chinese Studies.
City managers had little incentive to escalate problems to political superiors. The week in which no new virus cases were reported in Hubei coincided with preparations for the Lunar New Year and sessions of the province’s National People’s Congress and the Chinese People’s Political Consultative Conference.

STILL WAITING

Seven of the largest hospitals in Wuhan are now equipped with testing kits for the virus, which in theory deliver results within a day, the Hubei CDC official said.
But four people told Reuters they were refused tests because the process involved a complex reporting system including hospital, district and city health authorities and disease control officials.
To qualify for the test, patients need to meet certain criteria, such as having symptoms of fever and pneumonia, and a surge in patients means it is “impossible to conduct the test right away,” an official at the Wuhan Center for Disease Control and Prevention told Reuters.
Three hospital and local government workers, who have been briefed on how doctors are handling tests and confirming cases, told Reuters that official numbers of infections and deaths do not reflect the actual toll.
Wuhan health authorities have a limit on tests, chiefly because of the shortage of testing kits, and are screening lists of patients before deciding who gets a test, which takes several hours, one hospital worker told Reuters.
“Some severely ill patients were left out from the final list for testing because they know they wouldn’t be able to be treated,” the worker told Reuters. “The actual deaths were higher.”
Reuters could not independently confirm the hospital worker’s account. Hubei and Wuhan health authorities did not respond to Reuters requests for comment.
Zhang, whose mother is still waiting for a test, said doctors at three Wuhan hospitals told her family privately that they are almost certain she has contracted the coronavirus.
However, he said two of those hospitals told him they are not equipped with testing kits, and the other told him it has no available bed to accommodate his mother for the test.
None of those hospitals replied to Reuters requests for comment.
Sixty-nine year-old Xu Enen, who has had fever and a lung infection since Jan. 8, was rejected by six hospitals in Wuhan for testing as they said they had ran out of beds, his daughter told Reuters. Xu’s symptoms have worsened lately, and he is starting to have breathing difficulties.
He was finally admitted on Jan. 22 to queue for the test at Hankou hospital in Wuhan after his daughter publicized his case on Weibo.
Researchers at Lancaster University estimate that only 5.1% of infections in Wuhan have been identified. By Jan. 21, they estimated a total of 11,341 people had been infected in Wuhan since the start of the year. More than 30,000 people in Wuhan are under observation, according to the city’s health authorities.
“All we want is to confirm the case is the virus or not,” said a 33-year-old Wuhan woman surnamed Liu, whose father has been on a respirator in hospital since Jan. 14 and was still untested on Monday. “At least if it’s confirmed we have a direction. If there’s no direction, there’s no hope.”
https://www.reuters.com/article/us-china-health-testing-insight/confusion-and-lost-time-how-testing-woes-slowed-chinas-coronavirus-response-idUSKBN1ZQ21K

WHO corrects China virus global risk level to ‘high’

The World Health Organization on Monday admitted an error in its assessment of the global risk of a deadly virus in China, saying it was “high” and not “moderate”.
The Geneva-based UN health agency said in a situation report published late Sunday that the risk was “very high in China, high at the regional level and high at the global level.”
In a footnote, the WHO explained that it had stated “incorrectly” in its previous reports on Thursday, Friday and Saturday that the global risk was “moderate”.
The correction of the global risk assessment does not mean that an international health emergency has been declared.
WHO spokeswoman Fadela Chaib said only that there had been “an error in the wording”.
Asked what the risk categorisation meant, the WHO said it was “a global evaluation of risk, covering severity, spread and capacity to cope”.
The WHO on Thursday had stopped short of declaring the novel coronavirus a public health emergency of international concern—a rare designation used only for the most severe outbreaks that could trigger more concerted global action.
WHO chief Tedros Adhanom Ghebreyesus, who is visiting China this week to discuss how to contain the outbreak, on Thursday said: “This is an emergency in China, but it has not yet become a global health emergency”.
WHO’s cautious approach can be seen in the context of past criticism over its slow or too hasty use of the term, first used for the deadly 2009 H1N1 swine flu pandemic.
During that outbreak, the UN agency was criticised for sparking panic-buying of vaccines with its announcement that year that the had reached pandemic proportions, and then anger when it turned out the virus was not nearly as dangerous as first thought.
But in 2014, the WHO met harsh criticism for dragging its feet and downplaying the severity of the Ebola epidemic that ravaged three West Africa countries, claiming more than 11,300 lives by the time it ended in 2016.

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CDC is monitoring 110 possible coronavirus cases in 26 US states

  • U.S. health officials are currently monitoring 110 people across 26 states for the coronavirus, including the five patients who contracted the deadly infection in China and brought it back to America.
  • The disease isn’t spreading within the community in the U.S. and the risk to the public right now is still considered low, the CDC says.
U.S. health officials are currently monitoring 110 people across 26 states for the coronavirus, including the five patients who contracted the deadly infection in China and brought it back to America.
The disease, which has killed at least 81 people in China and sickened more than 2,800 worldwide, isn’t spreading within the community in the U.S. and the risk to the public right now is still considered low, Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, told reporters on a conference call Monday.
“We understand that many people in the United States are worried about this virus and how it will affect Americans,” Messonnier said. “Every day we learn more, every day we assess to see if our guidance or our response can be improved.”
The number of “patients under investigation” in the U.S. has almost doubled from the 63 the Centers for Disease Control and Prevention said were under surveillance on Thursday. The CDC says 32 people have tested negative for the virus.
“While that number is 110, we are certainly prioritizing based on [patients under investigation] that might be at higher risk,” Messonnier said.
The CDC confirmed Sunday a fifth U.S. case of the virus — a patient in Maricopa County, Arizona, who recently traveled to Wuhan, China, the epicenter of the disease’s outbreak and where the majority of cases have been reported.
Messonnier said the CDC has screened roughly 2,400 people flying from Wuhan to five major U.S. airports and is considering expanding its screening. The agency increased its travel warning for all of China, asking people traveling to practice “enhanced precautions.”
“This outbreak is unfolding rapidly and we are rapidly looking at how that impacts our posture at the border. We’re certainly considering broadening of that screening,” she said.
Coronaviruses are a large family of viruses that usually infect animals but can sometimes evolve and spread to humans. Symptoms in humans include fever, coughing and shortness of breath, which can progress to pneumonia. Physicians have compared it to the 2003 outbreak of SARS, which had a short incubation period of two to seven days.
China’s National Health Commission minister, Ma Xiaowei, said on Sunday that the incubation period could range from one to 14 days, and the virus was infectious during incubation, unlike the outbreak of severe acute respiratory syndrome, Reuters reported.
On Monday, the CDC said it hasn’t seen “any evidence of patients being” infected “before onset.”
Messonnier said the incubation period for the new virus is somewhere between two and 14 days. There’s been some debate over how contagious the disease is and she said it may not be known for a while.
“This outbreak is really unrolling in front of our eyes,” she said.
The so-called R naught, a mathematical equation that shows how many people will get an illness from each infected person, is somewhere around 1.5 to 3, she said. Measles, which is one of the most contagious infections in the world, has an R naught of around 12 to 18, by comparison, she said.
The CDC is trying to speed up testing and to get the tests in the hands of state health officials. It currently takes the CDC about four to six hours to make a diagnosis once a sample makes it to its lab.
U.S. health officials have warned that the flu or other respiratory illnesses could complicate identifying more cases. They recommend that people call a health-care provider before seeking treatment so the appropriate measures can be put in place.
In China, some 50 million people are now under travel restrictions. Shanghai Disney is closing until further notice at a time when the theme park would normally be packed with tourists during the Lunar New Year holiday. Starbucks and McDonald’s also closed stores in Hubei province where Wuhan is located.
The WHO’s director-general, Dr. Tedros Adhanom Ghebreyesus, is traveling to Beijing to meet with government and health officials. According to the organization, more data needs to be collected before the virus, which can spread through human-to-human contact, is declared a global health emergency. The WHO declined at two emergency meetings last week to say it was a worldwide emergency.
https://www.cnbc.com/2020/01/27/cdc-is-monitoring-110-possible-coronavirus-cases-across-26-states-in-us.html?recirc=taboolainternal

Biogen’s Alzheimer’s Drug Has ‘Decent Shot’ At FDA Approval, Analyst Says

Despite the controversy surrounding Biogen Inc’s BIIB 0.81% Alzheimer’s drug trial results and skepticism concerning its approvability, an analyst at Canaccord Genuity sounds upbeat.

The Analyst

Sumant Kulkarni upgraded Biogen from Hold to Buy and increased the price target from $305 to $360.

The Thesis

Even the aducanumab skeptics agree for a variety of reasons it has a decent shot at FDA approval, and this likelihood is not reflected in shares at current levels, Kulkarni said in a note. The analyst likes the opportunity Biogen presents heading into the regulatory saga on aducanumab.
Kulkarni clarified that the update isn’t based on the merits or lack of thereof of the data or the longer-term implications of the eventual regulatory outcome on aducanumab.
“We cannot, however, underestimate investors’ fear of missing out on the potential to get ahead of what might be an approval for the first ever disease-altering therapy for Alzheimer’s, which simultaneously presents high unmet need and a large addressable market,” the analyst wrote in the note.
Kulkarni believes investors don’t appreciate Biogen’s excluding-aducanumab pipeline much. The firm pointed out that there are several readouts coming through 2021.
The firm also said it likes the growth Biogen’s biosimilars can drive over the longer term.
Kulkarni expects a fairly decent quarter when Biogen reports results on Thursday. Apart from the risk posed by aducanumab, the analyst sees other risks such as a ruling on Mylan NV’s MYL 2.49% inter partes review on the Tecfidera patent in early February and competitive pressure for spinal muscular dystrophy drug Spinraza.
https://www.benzinga.com/analyst-ratings/analyst-color/20/01/15189591/biogens-alzheimers-drug-has-decent-shot-at-fda-approval-analyst-says

Coronavirus fears wipe billions from European stocks

Potential damage to business from China’s fast-spreading coronavirus knocked more than 2% off European stocks on Monday, after the world’s second biggest economy ramped up travel bans and extended the Lunar New Year holidays.

More than 97% of stocks in the STOXX 600 were trading in the red with many toppling from record highs, wiping out around 180 billion euros of market capitalisation from the European share index.
The biggest jolt was felt by luxury, airlines and hotel issues, which see big demand from Chinese consumers. Europe’s major luxury players have lost more than $50 billion in market value since the outbreak last week.
Most major country indices in Europe fell more than 2%, while regional sectors lost at least 1% each.
Germany’s DAX slumped almost 3%, while France’s CAC posted its worst day in almost four months as LVMH, Christian Dior, Hermes and Gucci owner Kering fell more than 3.6%.
Other companies in the luxury space such as Burberry Group Plc, Moncler SpA, Swiss watchmakers Swatch and Richemont declined between 2.5% and 4.8%.
Comparing the new coronavirus with the SARS outbreak in 2002-03, Bernstein analysts highlighted that Chinese nationals accounted for just 2% of the global luxury goods market in 2003 versus a whopping 35% in 2019.
“Equities are finally beginning to contemplate the possibility that the virus 2019-nCoV (coronavirus) in China will have significant economic impact as the lockdown is now affecting 56 million people,” said Peter Garnry, head of equity strategy at Saxo Bank.
Meanwhile, safe-haven investment options such as gold and government bonds rose as the death toll from the outbreak in China increased to 81 and the number of cases of infection jumped by about 30% in a day.
The Euro Stoxx 50 volatility index <.V2TX>, European investors’ “fear gauge”, has jumped to its highest level since Dec. 3.
“With a market looking to take some profit, what you’ll probably see until everything clears is a move from risk-on type of holdings to more value-focused holdings and going back to companies that pay decent dividends and are more domestically focused,” said Stephan Lueck, senior vice president, European equity sales at Auerbach Grayson.
“For the short-term, we should have a clearer picture in a week to two weeks. So give the market a few weeks to sell-off and if there aren’t too many deaths we should see some stability within a month and some normalcy going forward.”
With rising travel curbs, flight operators Air France, Lufthansa, cruise line operator Carnival Corp, hotel group Accor and IHG took a hit, with IHG clocking its worst day in more than three years. Europe’s travel & leisure index ended at its lowest in to nearly seven weeks.
The basic resources index eyed its worst day in nearly six months hit by growth fears in China, the world’s top metals consumer.

https://www.marketscreener.com/news/Coronavirus-fears-wipe-billions-from-European-stocks–29894481/?countview=0