Wednesday, February 12, 2020

Wuhan Virus: Will Eventually Kill Millions?

Hundreds of bodies waiting to be cremated.
Funeral Home Workers in Wuhan Are Working 24/7 to Cremate Bodies: Workers at crematoriums in Wuhan City, the epicenter of the coronavirus outbreak, say their workload has increased dramatically in recent days, as they constantly transfer the bodies of victims from hospitals and private homes.

In an interview with The Epoch Times, a worker described long working hours to cope with the sudden increase in bodies to be cremated. Meanwhile, videos from workers dealing with the crisis have been circulating on social media, including one from a worker at a Wuhan funeral home who shared footage of more than 10 bodies lying on gurneys, lined up for cremation.

Some netizens also shared videos they shot within different hospitals in Wuhan, showing bodies waiting to be transferred from the hospitals to funeral homes. Since funeral home workers don’t know for sure whether the person died from the coronavirus, they wear protective suits and masks in order to defend themselves from potential infection.

Wuhan has three main funeral homes in the downtown area, which are equipped with crematoriums. While cremation is a common burial practice in China, in a notice issued on Feb. 1, China’s National Health Commission said that people who have died from the virus can’t be buried and their bodies should be cremated immediately.

Because of the coronavirus outbreak, Wuhan’s Civil Affairs Bureau designated the Hankou Funeral Home to deal with the bodies of those who were diagnosed and died of the virus, according to state-run media. In addition, the Wuchang Funeral Home and Qingshan Funeral Home were designated to attend to those who died from severe pneumonia, or who were suspected coronavirus cases and died.

A worker at a Wuhan crematorium said in a Feb. 4 interview that he and his colleagues have worked 24 hours, seven days a week since Jan. 28. He said they are exhausted, and are working without proper equipment such as body bags, protective suits, and face masks.

“Since Jan. 28, 90 percent of our employees are working 24/7 … we couldn’t go back home,” a man identified as Mr. Yun told the Chinese-language Epoch Times in a phone call. He works at the Caidian Funeral Home, one of four facilities in a suburban area of Wuhan. “We really need more manpower,” he said.

Meanwhile, more bodies continue to arrive every day. “We need to pick up bodies when they [hospitals, communities, or family members of the deceased] call us. Every day, we need at least 100 body bags,” he said.

His workplace is required to pick up bodies from the Wuhan Tongji Hospital, Wuhan No. 13 Hospital, the newly built Huoshenshan Hospital, and other small hospitals, as well as any residences that request its services.

Yun says he’s spoken with workers at other Wuhan funeral homes, who are also overwhelmed. “Almost all staff at each funeral home in Wuhan are fully equipped, and all Wuhan cremation chambers are working 24 hours,” he said.

The worker said staff can only sit on their chairs and nap whenever they get a chance. “We can’t stop because we can’t leave the bodies outside for a long time,” he said. The staff members also lack protective gear.

“For us who transfer the bodies, we don’t eat or drink for a long time in order to preserve the protective suit, because we need to take off the protective suit whenever we eat, drink, or go to the bathroom. The protective suit can’t be worn again after being used,” he said. Yun said other staff at the funeral home, such as the receptionists, don’t get to use protective suits. “They wear raincoats to protect themselves,” he said.

Yun says he’s heartbroken to see so many bodies and to know that many family members couldn’t see their loved ones in their final moment. “We pick up bodies from people’s houses. … Family members can’t see the body after we remove it,” he said.

According to new government regulations, funeral home staff pick up the bodies, then cremate them without notifying family members—so that the family can avoid contact with the body and potentially becoming infected with the virus. “When family members come here, they can pay the cremation costs and then pick up the ashes,” Yun said.

At hospitals, family members also are prohibited from seeing the bodies. Some of the deceased had hospital records, but many do not—because they could not receive prompt hospital treatment before their deaths or died waiting, he said. “Those are treated as unknown reason [for cause of death],” Yun said.

Guyu Lab, an independent online news outlet, interviewed a worker at the Wuchang funeral home who was asked to pick up bodies from hospitals and residences, beginning Jan. 26. “All male staff at our funeral home are picking up and moving bodies now, and female staff are answering the phones, disinfecting the funeral home, and so on,” Huang told the news outlet in a Feb. 3 report. “We work 24 hours. … We are very tired.”

Huang said his funeral home doesn’t have the equipment to properly disinfect the facility. Workers have to reuse disposable protective suits, as there are no new ones. They wear swim goggles because they don’t have protective goggles, and must wear two layers of disposable plastic gloves because they have no rubber gloves. “We are on the verge of collapsing. We really need help,” Huang said.

Amid claims the coronavirus has been circulating for months, experts are hunting for an elusive ‘Patient Zero’ who holds the answers. As the Coronavirus epidemic spreads haunting imagery has emerged at the virus epicentre in Wuhan, China.

The deadly coronavirus sweeping the globe did not begin in a Chinese fish market. Instead, researchers warn it was spreading through Wuhan for up to a month before being detected. Known as 2019-nCoV, the virus belongs to the same family as SARS and, more recently, MERS. About 10 per cent of those infected with SARS died. The mortality rate for MERS is about 35 per cent.

How deadly 2019-nCoV? That’s yet to be determined. And that’s why finding a ‘Patient Zero’ is so important. The Huanan Seafood Wholesale Market had been the primary suspect for where the new virus made its jump from the wild into humans.

But new research has found the virus must have already been in the human population. Instead, the wild trade facility served as a “super spreader” – a concentrated hive of activity where the virus rapidly jumped to new hosts.

The Chinese government has so far remained silent about these doubts. But researchers the world over are pressing for more significant efforts to identify the earliest possible known sources of the infection.

Medical science journal The Lancet at the weekend published an update into the first known clinical reports of the virus. Chinese researchers tracked reports to 41 original cases. The earliest infections pose a serious mystery. “No epidemiological link was found between the first patient and later cases,” they state. In fact, 13 of the first 41 had no link to the market whatsoever.

So vital questions remain: Where did the virus come from? How did it get into the Huanan Seafood Wholesale Market? “Now it seems clear that the seafood market is not the only origin of the virus,” study co-author Bin Cao told the American Association for the Advancement of Science (AAAS). “But to be honest, we still do not know where the virus came from now.”

“China must have realised the epidemic did not originate in that Wuhan Huanan seafood market,” says infectious disease specialist at Georgetown University Dr Daniel Lucey. “The presumed rapid spread of the virus apparently for the first time from the Huanan seafood market in December did not occur,” Dr Lucy says.

“Instead the virus was already silently spreading in Wuhan, hidden amid many other patients with pneumonia at this time of year. “The virus came into that marketplace before it came out of that marketplace”.

Initial reports identified the first patient as one diagnosed on December 8. They also said “most” cases had an epicentre of the seafood market, and that the virus did not transmit between humans. The majority also came from one specific area of the market – that selling captured wild animals, like snakes, civet cats, beavers – and bats.

“The results suggest that the novel coronavirus outbreak is highly relevant to the trading of wild animals,” state-controlled media agency Xinhua reported. Huanan market was closed on January 1 in a bid to slow the rate of infection. That move now appears inadequate.

The Wuhan Municipal Health Commission had the case histories of 41 patients by January 11. The lack of contact with the market by 13 patients should have sounded alarms. There were no further official updates for the next seven days.

The mayor of Wuhan and the Communist Party secretary responsible for the city of 11 million has since offered to resign. But only after insisting they had been unable to raise a timely warning due to strict laws about not going public until the Central Committee in Beijing agreed.

With the first diagnosis now known to have been on December 1, the virus must have been on the move in November. Its spread went unnoticed because of its apparently infectious incubation period. But Dr Lucey says China’s new testing regimen has helped undo the damage: “Having, and rapidly deploying, the new rapid diagnostic test was a brilliant action to fight this epidemic”.

The quest for a Patient Zero is an almost impossible one. But the closer researchers get, the greater the chance they have of understanding the disease. It’s not like in the movies, where their blood provides a near-magical serum to cure the contagion. But it does act as a baseline from which to measure its behaviour, characteristics and mutations. And that’s vital in assessing exactly how dangerous the virus is.

China’s health minister Ma Xiaowei has warned it already seems to be mutating, jumping from human to human much quicker than at first.  He said his country, which has taken draconian steps to control its spread, was entering a “crucial stage.”

Which brings us back to Patient Zero. The best candidate we have so far is the person admitted to a Wuhan hospital on December 1. “Whether this patient was infected from an animal or another person in November, directly or by fomites, his infection occurred at a location other than the Huanan seafood market,” Dr Lucey told the Science Speaks blog.

Implications are the virus had begun its march through Wuhan’s population much earlier than its appearance in the seafood market. “Initial and potentially repeated animal-person transmission, followed by subsequent person-to-person transmission, could have begun in October-November or earlier in 2019,” Lucey says.

“Patients with pneumonia due to infection with the novel coronavirus could have started to spread across Wuhan, and (through) infected travellers leaving Wuhan to other locations.” This, along with an apparent 14-day incubation period, and an ability to infect others while a host is not displaying symptoms indicates it may have spread much further than believed.

“Despite the enormous and admirable efforts in China and around the world, we need to plan for the possibility containment of this epidemic isn’t possible,” Imperial College London infectious diseases expert Neil Ferguson told The Guardian after modelling the known characteristics of this outbreak.

Evolutionary biologist Kristian Andersen of the US-based Scripps Research Institute has analysed segments of 2019-nCoV DNA to pin down its origin. He told the AAAS that the condition of the virus suggests a single common source from as early as October 1. This means its introduction to the market by a human source was entirely consistent with the evidence.

Bats remain the number one suspect. They have a unique immune system which enables them to tolerate viruses. Combined with their ability to fly, this makes bats particularly effective at spreading disease. Which is why it is no surprise that the 2019-nCoV has a 96 per cent similarity to a wild bat coronavirus.

“There’s an ever-increasing diversity of animal coronavirus species, especially in bats. So the likelihood of viral genetic recombination leading to future outbreaks is high,” writes virology investigator Professor Burtram Fielding. “The threat of future pandemics is real as highly pathogenic coronaviruses continue to spill over from animal sources into the human population.”

Dr Lucey says he believes the original transmission of 2019-nCoV occurred elsewhere in the food supply chain. “Potentially at one or multiple places in the supply chain of the infected animals, for example in one or more multiple markets, or restaurants, or farms, or with wild animals, legal or illegal trade.”

He argues human and animal specimens collected during 2018 and 2019 must be tested for the virus or its antibodies. And all other animal markets must be put under observation to prevent retransmission from the wild. “There might be a clear signal among the noise,” he says.

The deadly animal-borne coronavirus spreading globally may have originated in a laboratory in the city of Wuhan linked to China’s covert biological weapons program, said an Israeli biological warfare analyst.

Radio Free Asia last week rebroadcast a Wuhan television report from 2015 showing China’s most advanced virus research laboratory, known the Wuhan Institute of Virology. The laboratory is the only declared site in China capable of working with deadly viruses. Dany Shoham, a former Israeli military intelligence officer who has studied Chinese biological warfare, said the institute is linked to Beijing’s covert bio-weapons program.

“Certain laboratories in the institute have probably been engaged, in terms of research and development, in Chinese [biological weapons], at least collaterally, yet not as a principal facility of the Chinese BW alignment,” Mr. Shoham told The Washington Times. Work on biological weapons is conducted as part of dual civilian-military research and is “definitely covert,” he said in an email.

Mr. Shoham holds a doctorate in medical microbiology. From 1970 to 1991, he was a senior analyst with Israeli military intelligence for biological and chemical warfare in the Middle East and worldwide. He held the rank of lieutenant colonel. China has denied having any offensive biological weapons, but a State Department report last year revealed suspicions of covert biological warfare work.

A novel coronavirus outbreak (From The Lancet)

In The Lancet, Chaolin Huang and colleagues report clinical features of the first 41 patients admitted to the designated hospital in Wuhan who were confirmed to be infected with 2019-nCoV by Jan 2, 2020. The study findings provide first-hand data about severity of the emerging 2019-nCoV infection.

Symptoms resulting from 2019-nCoV infection at the prodromal phase, including fever, dry cough, and malaise, are non-specific. Unlike human coronavirus infections, upper respiratory symptoms are notably infrequent. Intestinal presentations observed with SARS also appear to be uncommon, although two of six cases reported by Chan and colleagues had diarrhoea.

Common laboratory findings on admission to hospital include lymphopenia and bilateral ground-glass opacity or consolidation in chest CT scans. These clinical presentations confounded early detection of infected cases, especially against a background of ongoing influenza and circulation of other respiratory viruses.

Exposure history to the Huanan Seafood Wholesale market served as an important clue at the early stage, yet its value has decreased as more secondary and tertiary cases have appeared.

Of the 41 patients in this cohort, 22 (55%) developed severe dyspnoea and 13 (32%) required admission to an intensive care unit, and six died. Hence, the case-fatality proportion in this cohort is approximately 14·6%, and the overall case fatality proportion appears to be closer to 3%. However, both of these estimates should be treated with great caution because not all patients have concluded their illness (ie, recovered or died) and the true number of infections and full disease spectrum are unknown.

Importantly, in emerging viral infection outbreaks the case-fatality ratio is often overestimated in the early stages because case detection is highly biased towards the more severe cases. As further data on the spectrum of mild or asymptomatic infection becomes available, one case of which was documented by Chan and colleagues, the case-fatality ratio is likely to decrease.

Nevertheless, the 1918 influenza pandemic is estimated to have had a case-fatality ratio of less than 5% but had an enormous impact due to widespread transmission, so there is no room for complacency.