Mapped: The rapid spread of the new coronavirus in China and beyond

Tracking the global response to the coronavirus outbreak.

Coronavirus cases have been reported in more than two dozen countries.
Coronavirus cases have been reported in more than two dozen countries. (TNH)

The number of new coronavirus cases continues to climb, as countries and health authorities rush to contain its spread.

A sudden rise in cases in hotspots outside China is fuelling fears that the outbreak is gaining a global foothold.

In Iran, there's growing concern that its outbreak will threaten Middle East countries with poor health systems. Cases in Iraq, Afghanistan, Kuwait, Bahrain, Lebanon, the United Arab Emirates, and Canada have been linked to travellers from Iran. Many of Iran's neighbours have announced border closures, though unregulated land crossings are common.

Infections in South Korea have risen dramatically, driven by an outbreak among church members in the city of Daegu. In Italy, several areas were on lockdown as health authorities contended with more than 300 cases. Several European countries – and Algeria – this week announced cases linked to Italy's outbreak.

Global confirmed cases of the coronavirus exceeded 80,000 by 26 February, including at least 2,700 deaths. The vast majority of the cases and deaths are in mainland China. More than 30 other countries have reported infections. 

The World Health Organisation says the spread appears to be slowing within China's borders, but the rise in cases elsewhere is "deeply concerning".

The illness caused by the virus is officially known as Covid-19, short for "coronavirus disease 2019".

More than three quarters of China’s cases are found in Wuhan, the capital of Hubei province and the outbreak's epicentre. Chinese authorities first publicly reported the emergence of a new respiratory illness with pneumonia-like symptoms in Wuhan on 31 December.

Chinese authorities have twiced changed the way they classify confirmed cases in recent weeks, complicating efforts to track how the outbreak is evolving. Infection numbers skyrocketed by nearly 15,000 on 13 February as health authorities in Hubei began including clinical diagnoses in addition to lab-confirmed cases. It shifted its system again a week later.

Beyond Asia, confirmed cases have been reported in Australia, Europe, North America, the Middle East, and North Africa. Russia has reported two cases, including one in the Transbaikal region, which shares a border with China.

Egypt and Algeria have recorded confirmed cases – the first two on the African continent. Testing is underway in other countries. One of Spain’s cases was found in the Canary Islands, off Morocco’s western coast.

The WHO has launched a $675 million response plan aimed at helping countries with weaker health systems get ready. It has declared the virus outbreak a global health emergency – known as a public health emergency of international concern, or PHEIC.

“All countries are at risk and need to prepare,” the response plan warns.

Why is there disagreement about global containment efforts?

There are unanswered questions about the virus itself, how it spreads, and how to contain it – not just in terms of the mass quarantines within China but also with regard to the mounting border restrictions and screenings internationally.

The WHO says at least 72 countries have erected some form of travel restrictions. Many jurisdictions have stepped up health screenings at major airports.

But there’s disagreement among public health professionals about whether border shutdowns and screenings are effective – or even counterproductive.

The WHO has been cautious about border restrictions and even screenings when taking the rare step of declaring global health emergencies.

The European Centre for Disease Prevention and Control says the effectiveness of coronavirus entry screening is “low” – its models estimated that three quarters of cases would go undetected.

Separate estimates by the London School of Hygiene and Tropical Medicine found thermal scanning might only flag one in every five arriving passengers infected with the virus.

Just as important are public education and robust medical follow-up procedures to ensure people who do develop symptoms know to seek out healthcare – and that healthcare staff know the signs and what to do. The Lancet medical journal has urged that frontline clinics – not just higher-level disease-control centres – are “armed” with diagnostic kits.

The WHO has been cautious about border restrictions and even screenings when taking the rare step of declaring global health emergencies.

When the WHO declared a PHEIC for the ongoing Ebola outbreak in the Democratic Republic of Congo last year, it warned against shutting borders or imposing travel restrictions.

“Such measures are usually implemented out of fear and have no basis in science,” the WHO said at the time. “They push the movement of people and goods to informal border crossings that are not monitored, thus increasing the chances of the spread of disease.”

Under international health regulations, countries are obligated to justify their emergency border restrictions with the WHO. At least 23 have done so, but it’s unclear what, if any, actions the agency will take.

Are there undetected cases?

The outbreak’s rapid evolution means that researchers are rushing to study the virus in real time – and revising early estimates that become obsolete by the day as confirmed cases rise.

A 31 January study published in The Lancet warned that “2019-nCoV could be about to become a global epidemic in the absence of mitigation”.

The study estimated there were likely 75,815 infections in Wuhan alone on 25 January. At the time, China’s health commission had announced only 1,975 total cases nationwide, along with 2,684 suspected cases.

Previous research by Gabriel Leung, the chair of public health medicine at the University of Hong Kong and co-author of the Lancet study, estimated about 43,000 in Wuhan (and only 1,300 cases a week before that).

“Substantial, draconian measures limiting population mobility should be taken immediately,” Leung said at the time. He suggested school closures, working from home, and cancelling large gatherings.

Separate studies led by a team including researchers from Northeastern University in the US and Italy’s Institute for Scientific Interchange have also estimated ever-growing numbers of detected and undetected cases.

The latest version published on 29 January estimated there could be about 46,400 total cases in Wuhan. An earlier version just three days earlier put the figure at about 31,000, and yet another version five days earlier at about 6,000.

Health experts warn that all such studies are based on models that rely on incomplete data and assumptions – useful for estimating risk or potential spread, but far from definitive.

The researchers have also projected where the new coronavirus is likely to spread internationally, based on calculations including airline passenger data. There have now been reported cases in most of the countries the researchers identified.

Also at risk, but not yet reporting cases, is Indonesia’s prime tourist hotspot, Bali.

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