[Updated 24 January, 2020]  Over 20 million people in three Chinese cities were under lockdown as of Friday morning, as authorities battled an outbreak of a novel coronavirus first discovered at the beginning of January in Wuhan, China, in the central province of Wuhei. The strong Chinese measures came after the World Health Organization decided not to declare the outbreak a “public health emergency of international concern”(PHEIC).

The cities of Ezhou and Huanggang, also in Hubei Province, followed Wuhan’s lead and temporarily suspended all public transportation, including rail and air transport in and out of the city. By Friday, the entire Hubei Province, along with several other major cities around China including Beijing, Tianjin, and Shanghai, had declared a Level I emergency – the highest level for a public health emergency. According to reports from state-owned news outlet CGTN, officials in Beijing, Shanghai and Hangzhou have shut down major tourist attractions for fear of the coronavirus spreading during the busy Lunar New Year – China’s biggest holiday season, which officially begins on Saturday.

The Chinese measures were taken just after the World Health Organization decided on Thursday not to declare the outbreak a PHEIC at this moment in time – after its Emergency Committee of expert advisors said the move would be premature.

“Now is not the time. It’s a bit too early,” said the chair of the WHO Emergency Committee, Didier Houssin, in a WHO press conference Thursday evening. The statement followed right after a second meeting of the expert committee in 24 hours. 

As the WHO committee debated, thousands became stranded in the city of Wuhan, home to 10 million people, while the city when on under virtual quarantine.  The tough official action came as the number of confirmed cases of the novel 2019-nCOV virus rose to 892 cases worldwide, including 25 deaths, according to the latest reports received by CGTN.

The Chinese Ministry of Finance “urgently” allocated 1 billion yuan (approximately US$ 144 million) to Hubei province – the hardest hit region – which appealed for donations of medical supplies and money. Construction on a specialized hospital for coronavirus patients began on Thursday in the epicenter of the outbreak, Wuhan, simulating Beijing’s actions during the 2002-2003 SARS outbreak.

Cases have also been exported abroad by travelers to Singapore, Japan, Thailand, South Korea, Taiwan, Viet Nam and the USA.

The decision on Thursday followed lengthy consultations by the Emergency Committee on Wednesday, where the experts split 50-50 in a vote to declare a PHEIC.

However, new information received on Thursday from China reassured the experts that the lockdown in Wuhan was not due to an unreported change in the pattern of infections, but rather a precautionary move to contain the spread of the virus.

So far, the disease also appears to be less fatal than the deadly SARS virus of the same family – which caused an outbreak in 2002-2003 that infected some 8098 people and killed 774, WHO officials said.

That, along with strong measures already taken by China itself in Wuhan, clearly raised concerns about the immediate justification for an emergency declaration, which would raise the state of alert but could also lead to further disruptions in international trade and travel.

WHO Director General Dr Tedros Adhanom Gheyebresus told reporters he would not hesitate to reconvene the committee “at a moment’s notice, at any time,” should the situation take a turn for the worse.

“I am not declaring a Public Health Emergency of International Concern,” said the WHO Director General. “Make no mistake.. this is an emergency in China, but it has not yet become a global health emergency.. It may become one.. The outbreak is very high risk in China and globally.”

Added Dr Tedros, “China has taken measures that it believes are appropriate to contain the virus in Wuhan and other cities. We hope they will be effective. For the moment WHO does not recommend any broader restrictions in travel and trade. We recommended screening at air ports, as part of a comprehensives set of [preventive] measures.”

WHO’s Mike Ryan, head of Emergencies, also warned that it was too early to draw firm conclusions about the outbreak’s real severity, saying, “At the beginning of an epidemic, we have to be very careful about making any statements about the severity of the epidemic.”

If more people with mild cases of the virus are identified, then the assessment of severity could decrease, he noted. On the other hand, “many people are seriously sick and in hospital and more may die, and this may increase the severity.  So we have to stick with the facts, and be careful about making any pronouncement’s regarding the true fatality rate, associated with this disease.”

In terms of infectious spread of the virus, human-to-human transmission between some family members, as well as to healthcare workers, has been confirmed. But so it appears that close, prolonged contact is still required to transmit the disease, the experts and WHO officials noted.  At the same time, however, the virus could mutate further to become more either deadly or infectious, it so far has appeared fairly stable, officials added.

Based on preliminary data, the WHO experts said that older people, and particularly men, seem to be at higher risk of serious disease and death. Approximately 72% of cases have occured in people over 40 and 64% of cases in males. Some 40% of these patients had underlying medical conditions such as diabetes and hypertension. Most of the deaths have been in people over the age of 60, according to press releases from the Wuhan City and Hubei Province authorities.

WHO experts are on the ground with Chinese authorities to gather more information about the developing situation, including the new city lockdowns.

Asked about the transport shutdown, Dr Tedros on Wednesday had commended city authorities’ “strong actions” in containing the outbreak, saying that they were not only “minimizing the chance of the outbreak “spreading further in their country” but also “out of the country.”  He further commended the Chinese authorities on Thursday for their “transparency” in sharing information about the virus.

Image Credits: Curt Carnemark / World Bank.