Can the coronavirus be contained? Unknowns complicate response

China has ordered an unprecedented quarantine of more than 50 million people. It has closed schools and shut down live animal markets. Airports across the globe are screening passengers coming from the world’s most populous country.

But three weeks after the new coronavirus emerged as a health crisis, experts can’t yet say whether these efforts will succeed at containing an infection that now threatens at least 15 countries.

Some early signs are discouraging: Six countries, including China, have confirmed human-to-human transmission of the infection. Those include four cases in Germany connected to a single person — a worrisome sign for containment of the disease. Cases in China continue to multiply, and five million residents of Wuhan, where the virus originated, have left the city, some of them surely carrying the disease.

But so far, the mortality rate is less than the rate of other severe respiratory coronaviruses. In China, where 5,974 people are infected, 132 have died through Tuesday. That is a high rate, but far less than the fatality rate of SARS and MERS. And countries like the United States that quickly began screening travelers, isolating sick people and tracing their contacts have just a handful of cases. There have been no fatalities outside China.

Public health officials said Tuesday that they are grappling with a long list of unknowns that will determine how successful they are in limiting the toll of the widening outbreak. Those questions include how lethal the virus may be, how contagious it is, whether it is transmitted by people who are infected but show no symptoms, and whether it can be largely contained in its country of origin.

“It is very striking how quickly the numbers are going up,” said Trish Perl, chief of infectious diseases and geographic medicine at UT Southwestern Medical Center, who has fought other respiratory virus outbreaks, including SARS and MERS.

“As the numbers are going up, do I think I’m concerned about the rapidity of it? Yes,” Perl said. “Do I think it may be difficult to control? Yes. But in the context of a lot of unknowns.”

Experts are not sure whether the rise in new cases means the virus is now widely circulating in China, or whether the Chinese are doing a better job of surveillance and testing, or both.

U.S. health officials held a news conference Tuesday to reassure a wary public that, for now, virtually no one here is in imminent danger.

“Americans should know that this is a potentially very serious public health threat, but, at this point, Americans should not worry for their own safety,” said Secretary of Health and Human Services Alex Azar.

The new virus is not nearly as infectious as the measles virus, which can live as long as two hours in the air after an infected person coughs or sneezes, and it is not comparable to the threat posed by the seasonal flu, which has killed at least 8,200 people in the United States so far this season.

But Azar also acknowledged, “We don’t yet know everything we need to know about this virus.”

China agreed Tuesday to allow a World Health Organization team of experts into the country to study the coronavirus, officials of the U.N. agency said after a meeting between the organization’s director general and Chinese leader Xi Jinping.

“The two sides agreed that WHO will send international experts to visit China as soon as possible to work with Chinese counterparts on increasing understanding of the outbreak to guide global response efforts,” the statement said.

It was unclear whether the team would include experts from the U.S. Centers for Disease Control and Prevention.

But several nations continued to pursue or consider evacuating their citizens from Wuhan, including France, South Korea, Morocco, Britain, Germany, Canada, the Netherlands and Russia.

In the Philippines, immigration authorities temporarily suspended the issuance of visas for Chinese nationals upon arrival. Immigration commissioner Jaime Morente said the move was designed “to slow down the influx of group tours” and prevent the spread of the virus.

Hong Kong Chief Executive Carrie Lam announced dramatic measures to stem the flow of mainland Chinese into the territory, including the closure of railways, ferries and cross-border tour buses. Flights to mainland China will be slashed by half, and the Hong Kong government will stop issuing individual travel visas to mainland Chinese, starting Thursday.

Yet for all the action taken, even the near future remains uncertain.

“There is a real possibility that this virus will not be able to be contained,” said former CDC director Tom Frieden, who oversaw the responses to the Ebola and Zika outbreaks.

Researchers are struggling to accurately model the outbreak and predict how it might unfold, in part because the data released by Chinese authorities is incomplete. China has shared information showing when cases were reported, but not when people became ill.

Researchers also want to know more about the incubation period, currently estimated at two to 14 days, and how severe most cases are.

The virus’s fatality rate is just over two percent, if figures posted by the Chinese government are accurate. That is considerably lower than death rates from the respiratory coronaviruses that caused SARS, which killed nearly 10 percent of people infected, and MERS, which killed about 35 percent.

Some experts are encouraged that no case outside China seems to be severe. and that no fatalities have been recorded outside China so far.

Others cautioned that the current death rate may mean little because the most severe cases in an epidemic like this one often emerge early, when sick people present themselves to health care providers, then become fewer as public health measures are instituted and medical care is strengthened.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, noted in an interview that the virus may have been spreading unnoticed for weeks in Wuhan before it emerged into public view.

If many people had mild symptoms, it would have been easy to miss them, and that made it harder to put control measures in place, said Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security.

Experts also are unsure whether asymptomatic patients can transmit the virus. China’s health minister Ma Xiaowei alarmed officials around the world this weekend when he said his government had evidence that this type of spread was occurring.

But U.S. officials have challenged that conclusion, saying they have not seen data that prove it and want the Chinese to show them. And asymptomatic patients never drive more than a small percentage of infections in epidemics such as this one, Fauci said.

“Even if there some asymptomatic transmission, in all the history of respiratory-borne viruses of any type, asymptomatic transmission has never been the driver of outbreaks,” he said. “The driver of outbreaks is always a symptomatic person.”

Frieden and others emphasized that even if officials cannot stop transmission, they can still reduce the number of people who get infected, as well as those who get very sick and die. A critical measure, for example, is beefing up readiness by training health-care workers in hospitals to prevent the spread of illness.

At the moment, U.S. officials are isolating coronavirus patients in the hospital. But that may not be practical if there are many more cases. During SARS, highly infectious patients known as “super spreaders” were responsible for the virus’s rapid spread in health-care facilities.

It makes more sense to isolate someone with a mild coronavirus illness at home, said Nuzzo, the Hopkins expert. “If somebody only has a fever and runny nose, is there a need to freak out?” she said.

https://www.washingtonpost.com/health/coronavirus-spread-containment-strategy/2020/01/28/84c25030-4200-11ea-aa6a-083d01b3ed18_story.html

What are the obstacles to Bayer settling Roundup lawsuits?

Bayer AG is in mediation to potentially settle thousands of U.S. lawsuits claiming that the company’s Roundup weed killer causes cancer, but some legal experts said the cases raises novel questions that may prevent an easy settlement.

More than 42,700 plaintiffs claim Roundup causes a type of cancer called non-Hodgkin’s lymphoma.
Bayer to date has lost three U.S. jury trials in the Roundup litigation. The company is appealing or has vowed to appeal the decisions, saying Roundup and its active ingredient glyphosate are not carcinogenic and safe for human use.
Legal experts outlined several obstacles the parties may face on the path towards settlement.
WHY IS THE ROUNDUP LITIGATION DIFFERENT FROM OTHER PRODUCT CASES?
Settlements involving drugs, medical devices or consumer goods often result in the addition of a warning label, a recall or the outright discontinuance of a product. Those steps generally close the door to future lawsuits, making settlement costs and risks predictable.
Bayer has never publicly considered pulling Roundup off the market. The company in June announced a $5.6 billion investment to research and develop a glyphosate alternative.
Bayer unit Monsanto began selling Roundup in 1974 and while the formulation is no longer patent-protected, Roundup remains widely available today. Bayer has repeatedly said Roundup is safe and important to farmers who use the herbicide in combination with the company’s genetically modified seeds
Non-Hodgkin’s lymphoma on average can take up to 10 years to emerge, increasing the likelihood of claims being filed after the litigation has settled. Product liability settlements generally include a cut-off date for future claimants and need to be properly funded for a court to approve the agreement.
As long as the product continues to be sold without changes to the label, plaintiffs may continue to file lawsuits, said Elizabeth Burch, a law professor at the University of Georgia.
COULD BAYER ADD A CANCER WARNING?
Plaintiffs lawyers, who claim the company manipulated the science, told Reuters they would insist on a cancer warning label as part of any Roundup settlement.
Such a warning has been rejected by the U.S. Environmental Protection Agency, which regulates pesticides and repeatedly has found glyphosate to be safe.
The agency said it has finished a regulatory review that found glyphosate is not a carcinogen.
In a filing to a federal appeals court, which hears one of the appeals to a jury verdict, the EPA and the U.S. Justice Department backed Bayer and said it was unlawful for manufacturers to make label claims that differ from EPA approval.
David Noll, a professor at Rutgers Law School, said adding a cancer warning over a regulator’s explicit opposition presented unchartered legal territory.
HOW COULD BAYER SETTLE THE ROUNDUP LITIGATION?
To settle product liability litigation, companies generally set up a fund and the parties define criteria that current and future claimants must fulfill to receive compensation.
In the Roundup litigation, claimants could be divided into different groups depending on the frequency of their Roundup use and disease severity and length.
But Adam Zimmerman, a law professor at Loyola Law School, said defining those groups is complicated by the lack of a signature disease associated with Roundup, making it difficult to predict Bayer’s liability.
For example, in asbestos litigation, mesothelioma, a rare tissue cancer, was recognized as a signature disease caused by exposure to asbestos fibers.
Doctors recognize several risk factors leading to non-Hodgkin’s lymphoma, but the disease is largely considered to have no known cause. Around 74,000 people in the United States are expected to be diagnosed with the disease in 2019, according to the American Cancer Society.
Settling claims might not preclude future lawsuits if the fund runs out of money. In the Agent Orange litigation, Vietnam War veterans were allowed to sue chemical companies decades after a settlement was reached because the compensation fund was depleted by the time they developed their diseases.

https://www.marketscreener.com/BAYER-AG-436063/news/Bayer-What-are-the-obstacles-to-Bayer-settling-Roundup-lawsuits-29921670/

China to exempt taxes for imports of products related to virus control

China will implement tax exemptions for imports of products related to curbing the coronavirus outbreak, the finance ministry said on Saturday.

Materials directly used for epidemic control will be exempt from import tariffs from Jan. 1 to March 31, the ministry said in a statement on its website.
Imports of donations including ambulances and disinfectant products will also be exempt from tariffs, value-added tax and consumption tax, it said.

https://www.marketscreener.com/news/China-to-exempt-taxes-for-imports-of-products-related-to-virus-control–29928618/

As coronavirus misinformation spreads on social media, Facebook removes posts

Facebook Inc said it will take down misinformation about China’s fast-spreading coronavirus, in a rare departure from its usual approach to dubious health content that is presenting a fresh challenge for social media companies.

The coronavirus outbreak has stoked a wave of anti-China sentiment around the globe. Hoaxes have spread widely online, promoted by conspiracy theorists and exacerbated by a dearth of information from the cordoned-off zone around China’s central city of Wuhan, where the outbreak began.
Nearly 12,000 people have been infected in China, according to local health authorities, and more than 130 cases reported in at least 25 other countries and regions.
Facebook said in a blog post that it would remove content about the virus “with false claims or conspiracy theories that have been flagged by leading global health organizations and local health authorities,” saying such content would violate its ban on misinformation leading to “physical harm.”
The move is unusually aggressive for the world’s biggest social network, which generally limits the distribution of content containing health misinformation to its 2.9 billion monthly users through restrictions on search results and advertising, but allows the original posts to stay up.
It also puts it at odds with other major U.S.-based social networks. Alphabet Inc YouTube, which has 2 billion monthly users and Twitter and Reddit, which have hundreds of millions of users, confirmed they do not consider inaccurate information about health to be a violation of their policies.
Those companies, like Facebook in other cases, rely on techniques such as elevating medical information from authoritative public health sources and warning users about content that has been debunked.
TikTok, owned by China’s Bytedance, and Pinterest Inc do ban health misinformation and are actively removing false coronavirus content, they told Reuters.
FAKE NEWS, PHYSICAL HARM
Fact-checking initiative PolitiFact said misinformation about the virus online included hoaxes about its source, its spread, and how to treat it, as well as false conspiracies about its connection to biological warfare and the Chinese government.
Rumors about the coronavirus have also spread widely on Chinese social networks, which are usually quick to remove sensitive content but have in recent days allowed an unusual level of public criticism over the government’s handling of the crisis.
Information in China is tightly controlled, and Chinese laws dictate that rumor-mongers can face years in prison. In the early days of the outbreak, Chinese state media reported that police in Wuhan had detained eight people for spreading rumors about a “local outbreak of unidentifiable pneumonia.”
Suspicion also lingers over accusations that Beijing initially covered up the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak.
A spokeswoman for Tencent Holdings Inc’s Chinese messaging app WeChat, which has 1.15 billion monthly users, told Reuters the company was removing posts containing coronavirus-related misinformation.
The U.S. tech industry’s mostly hands-off approach has angered critics who say social media companies have failed to curb the spread of medical inaccuracies that pose major global health threats.
In particular, misinformation about vaccination has proliferated on social media in many countries in recent years, including during major vaccination campaigns to prevent polio in Pakistan and to immunize against yellow fever in South America.
Facebook, under fierce scrutiny worldwide in recent years over its privacy and content practices, has previously removed vaccine misinformation in Samoa, where a measles outbreak killed dozens late last year.
The spread of illness there was so severe that the company classified anti-vaccination content a risk of physical harm, a spokeswoman told Reuters, calling the move an “extreme action.”
The coronavirus and Samoa decisions indicate Facebook is expanding its definition of “physical harm” to include misinformation contributing to the rapid spread of illness.
The company did not say whether it had acted in a similar way in other cases.
It removed misinformation about polio vaccines in Pakistan, but the imminent harm in that case involved risks of violence against the health workers carrying out the immunization campaigns, the spokeswoman said.

https://www.marketscreener.com/TENCENT-HOLDINGS-LIMITED-3045861/news/As-coronavirus-misinformation-spreads-on-social-media-Facebook-removes-posts-29923909/?countview=0

Health experts warn China travel ban will hinder coronavirus response

The Trump administration’s decision to ban most foreign nationals who had been to China in the last two weeks from traveling to the United States amid an accelerating outbreak of a novel coronavirus there was preceded by calls for similar policies from conservative lawmakers and far-right supporters of the president. Public health experts, however, warn that the move could do more harm than good.
The administration’s public health emergency declaration also requires U.S. citizens returning from China to undergo some level of quarantine, depending on where they had been in China.
Before the announcement Friday, Sen. Tom Cotton (R-Ark.) had called for a ban on all commercial flights from China, and Rep. Paul Gosar (R-Ariz.) said the government should consider “implementing a temporary travel ban on travelers from China until the threat is resolved.”

Beyond Capitol Hill, Mike Cernovich, a prominent conspiracy theorist and early Trump supporter, had agitated on Twitter for a Chinese travel ban, as has Michael Savage, another conspiracy theorist and a radio host with white nationalist beliefs. “QUARANTINE! STOP TRAVELERS FROM CHINA NOW!” he said on Twitter last week.
The ban comes on top of moves by major U.S. airlines halting flights to and from mainland China.
The outbreak has sickened nearly 10,000 people, mostly in China, and killed more than 200. A few countries have responded by imposing full or limited travel bans. The Philippines, for instance, has banned travel from the city of Wuhan, the epicenter of the outbreak. Countries including the Bahamas, Mongolia, and Singapore have banned all travel from China.
Public health experts have warned that travel bans are not effective at stemming the spread of a virus and can make responding to an outbreak more challenging.
“From a public health perspective, there is limited effectiveness. And then there are a host of other reasons why they can actually be counterproductive,” said Catherine Worsnop, who studies international cooperation during global health emergencies at the University of Maryland.
The World Health Organization, which declared the outbreak a global health emergency this week, has recommended against any travel or trade restrictions in response to the outbreak. Member countries, however, do not have to comply with that guidance.
“Although travel restrictions may intuitively seem like the right thing to do, this is not something that WHO usually recommends,” said Tarik Jašarević, a WHO spokesperson. “This is because of the social disruption they cause and the intensive use of resources required,” he added.
Experts said travel bans could lead to a slew of downstream effects and risk complicating the public health response.
“There’s not only the financial toll on a country that is dealing with this outbreak, but this can discourage transparency, both in this outbreak and in the future,” Worsnop said.
Travel and trade restrictions can lead to dire economic consequences for countries involved, creating a disincentive for them to quickly disclose potential outbreaks to the WHO or other nations. They can hinder the sharing of information, make it harder to track cases and their contacts, and disrupt the medical supply chain, potentially fueling shortages of drugs and medical supplies in the areas hit hardest by the outbreak. They also send a punitive message, which could contribute to discrimination and stigmatization against Chinese nationals, experts warned.
Any effort and money spent crafting and enforcing travel and trade restrictions also take away already-stretched resources from public health measures that have been proven to be far more effective, experts said. Those measures include providing assistance to countries with weaker health systems, accelerating the development of a vaccine or rapid diagnostic test, and clearly communicating with the public about when and how to seek care.

But for politicians, those responses might not feel as tangible an action as enacting a travel ban. During the 2013-2014 Ebola outbreak, there was a flurry of calls for a U.S. ban on travel from the affected countries, including from Donald Trump, then a private citizen.
“People want their government to do something when these outbreaks are happening, and adopting a border restriction is a visible policy that people think works,” Worsnop said.
Enacting such a ban would go directly against the recommendation of the WHO, which has said countries must inform the organization of any travel restrictions they put in place.
“Adopting these restrictions undermines the cooperative approach we need to respond to this kind of outbreak, specifically by undermining the authority of the WHO, which has recommended against these restrictions,” Worsnop said.
Worsnop said she is hopeful that the WHO will be able to hold countries accountable for disregarding its guidance, including pressing countries for scientific justification for their travel policies and calling out governments that have gone against its recommendations.
“Unfortunately, [governments] face domestic and international pressures, and have faced few costs in the past for not following WHO recommendations,” she said.

Health experts warn China travel ban will hinder coronavirus response

Gilead Offers Experimental Drug for Coronavirus Treatments, Testing

Gilead Sciences Inc. said on Friday that it had provided doses of an experimental antiviral drug to doctors for the emergency treatment of a small number of patients infected by the new coronavirus.
Gilead, based in Foster City, Calif., also said it has formalized an agreement with Chinese authorities to conduct a clinical trial of the drug remdesivir in patients infected with the coronavirus.
Health authorities have been searching for a treatment for China coronavirus infections, which lack an approved drug or vaccine. Several drugmakers have said they are trying to develop a vaccine, which could prevent but not treat infections.
Researchers had been hoping to study whether Gilead’s remdesivir and other antivirals could work as treatments.
Unlike some of the other antivirals being examined, Gilead’s drug isn’t approved for use in humans by regulators in the U.S. or internationally.
Separately, the drug was administered to an infected patient in Washington state, researchers reported in the New England Journal of Medicine on Friday. The man, 35 years old, had traveled to Wuhan, the Chinese city where the outbreak started, and after returning to the U.S. was the first person in the country to test positive for the China coronavirus.
The patient was given remdesivir on the seventh day of his hospitalization, Jan. 26, and the following day the patient’s clinical condition improved. As of Jan. 30, the patient remains hospitalized, but “all symptoms have resolved with the exception of his cough, which is decreasing in severity,” the researchers wrote.
On the day he was treated with the Gilead drug, the patient’s fever reached 39.4 degrees Celsius (102.9 degrees Fahrenheit). The following day it dropped to 37.3 degrees Celsius (99.1 degrees Fahrenheit) and declined into the normal range over subsequent days, the paper said.
“Before treatment he had high fevers and was getting sicker,” George Diaz, the patient’s attending physician at Providence Regional Medical Center Everett, said in an interview on Friday. “After treatment, he had reduced fevers and no longer required oxygen; his lungs cleared up, and he generally felt better.”
Dr. Diaz cautioned, however, that the drug has to be studied in large clinical trials to determine whether it is an effective treatment for the coronavirus.
A Gilead spokeswoman declined to say how many patients are receiving the drug or where they are based. In clinical trials of Ebola patients, the drug was less effective than rival treatments. In animal studies, the drug helped lessen lung disease in mice infected with Middle East respiratory syndrome, a coronavirus known as MERS.
https://www.marketscreener.com/GILEAD-SCIENCES-4876/news/Gilead-Sciences-Offers-Experimental-Drug-for-Coronavirus-Treatments-Testing-29923511/

U.S. Declares Public Health Emergency for Coronavirus

Citing the U.S. cases of novel coronavirus, including one case of human-to-human transmission and several unknown factors, the U.S. Department of Health and Human Services declared a public health emergency in the U.S. on Friday.
Beginning on February 2, 2020 at 5 p.m. Eastern time, the U.S. government will be enacting several temporary measures involving U.S. citizens returning from China back to this country, HHS Secretary Alex Azar announced at a press conference of President Trump’s Novel Coronavirus Task Force:

• U.S. citizens returning from Hubei province within 14 days, the epicenter of the outbreak in China, will be medically quarantined for up to 14 days
• All U.S. citizens returning from China within 14 days, once medically cleared in airport screening, will be asked undergo mandatory self-isolation for up to 14 days once medically cleared
• Foreign nationals considered to pose a risk of transmitting novel coronavirus will be denied entry to the country

These actions were described by officials as “prudent, targeted and temporary,” and mainly designed to reduce the burden of screening on public health officials screening for novel coronavirus.
Azar reiterated the government’s position that risks to the U.S. from the coronavirus remain low. “Our job is to keep it that way,” he added.
“Safety of the American people” was repeated over and over during the briefing, but Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, cited the “unknown aspects of this particular outbreak” as the chief reasons why this was necessary from a medical standpoint.
While the novel coronavirus has killed far fewer people than seasonal flu, the difference, Fauci said, was “unknown” versus “certainty.” Whereas with novel coronavirus, he cited asymptomatic transmission, and the inability to detect the illness when patients are asymptomatic, as a major factor.
“One of the problems is when a virus is transmitted in an asymptomatic way, it puts a terrible burden on the screening process,” Fauci said. “We still have a low risk to the American public, but we want to keep it at a low risk … because there are so many unknowns here.”

CDC Director Robert Redfield, MD, also emphasized the limitations of current novel coronavirus testing, adding that of the six cases we have seen in the U.S., a number were asymptomatic, but only one was picked up by airport screening, while the rest were “picked up by astute doctors.”
Fauci also cited the “unknown accuracy” of current diagnostic testing.
“If we absolutely had an accurate test that was very sensitive and very specific, we could test people and we’re good to go,” he said, adding “it’s not a test that’s absolute,” unlike, for example, an HIV test — which can determine with 100% accuracy if a person has HIV in their blood.
Fauci gave another example: “Ebola doesn’t get actively transmitted unless you’re very ill,” he said.
Redfield added that the self-isolation for U.S. citizens returning from China was the standard for the 2014 Ebola outbreak in West Africa, and “98% of the American public voluntarily accepted the importance of this.”

Officials stressed that this is not a “travel ban,” as all U.S. carriers to China have been taking down passenger flights, such that it has been a “market response by airlines and voluntary decisions taken by travelers.”
So far, there are 12 cases of human-to-human transmission outside China, and Redfield said they are most concerned with “expansion of sustained community human-to-human transmission,” such as the type occurring inside China.
“This is a precautionary message and action put out today,” he said, adding that it is “intended to keep this virus from causing significant consequences to the American public.”
A seventh U.S. case of novel coronavirus was confirmed by the CDC late Friday in Santa Clara County, California. This was a travel-associated case, with the man reporting travel history to Wuhan, according to NBC Bay Area. He is currently “self-isolated,” never having become sick enough to be hospitalized, the report said.
https://www.medpagetoday.com/infectiousdisease/publichealth/84662