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There are worrying signs the coronavirus outbreak is entering a new phase, with spread outside of China — until recently at low levels — beginning to rapidly pick up steam.

Experts point to the sharp rise of the number of cases in South Korea, which went from 30 on Monday to 204 by Friday, and in Italy, which had no cases at the start of Friday and 16 at the end of it. Five of the infected people in Italy are health workers.


Iran — which began the week with no confirmed cases and ended it with 18, four of whom have already died — is a particular source of concern, having exported two cases within 36 hours of announcing it had found two patients infected with the virus. A traveler from Canada and another from Lebanon tested positive for the virus after returning home from Iran.

The fact that Iran is already exporting cases suggests transmission there is far more widespread than the official numbers would indicate, said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy.

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“I think people are missing the importance of a case like the Canadian traveler to Iran,” he said, referring to a case reported by health officials in British Columbia on Thursday. “This tells us that there has to be a much larger number of people infected in Iran and we’re literally just detecting the tip of the iceberg.”


Even Iranian health officials acknowledged that likelihood. “It’s possible that it exists in all cities in Iran,” health ministry official Minou Mohrez said, according to the official IRNA news agency.

Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, resisted the notion Friday that the outbreak was at a tipping point. But he did tell reporters that the “window of opportunity” to stop spread of the virus is shrinking.

“Our window of opportunity is narrowing,” said Tedros, as he is known. “We need to act quickly before it closes completely.”

The WHO has been seeking funding to help developing countries prepare to cope with the outbreak and has been urging countries to prepare their health systems to respond, if efforts to stop spread of the virus fail.

“This outbreak could go in any direction. It could even be messy,” he warned. “What I’m saying is: It’s in our hands now. If we do well within the narrowing window of opportunity, we can avert any serious crisis. If we squander the opportunity, then there will be a serious problem on our hands.”

As of Friday there were nearly 77,000 cases reported globally, with all but 1,200 reported by China. There were also roughly 2,350 deaths.

The growth in the daily case count in China has been tamped down of late by the country’s extraordinary quarantine effort. Cities that are home to tens of millions of people have been on virtual lockdown for several weeks. While the apparent impact of those measures has instilled hope in some that there is still time to stop circulation of the virus, skeptics warn that disease levels in China could rebound when the country eases its movement restrictions and allows people to return to their jobs.

Most of China’s cases have occurred in Hubei province, where the outbreak appears to have begun in the city of Wuhan. But Tedros noted that there has been a worrying uptick in cases in Shandong province; he said the WHO is asking China for more information about that situation.

Gary Kobinger, director of the Infectious Disease Research Center at Laval University in Quebec, also said Friday he believes stopping the virus is still a possibility. Kobinger is on an expert committee that advises the WHO’s Health Emergencies Program; the group wrote a recent letter to the journal The Lancet urging the world to continue to try to stop spread and eliminate the virus, as was done with the virus responsible for the 2002-2003 SARS outbreak.

“We’re not at the tipping point to say ‘OK, this is now unstoppable.’ I don’t think we are there yet, personally,” Kobinger told STAT. “We’re definitely in a grey zone where you could argue both ways and be wrong or right both ways.”

Osterholm and others suggested overly narrow testing protocols are obscuring the world’s ability to see how far the virus has spread. In the United States, for instance, the Centers for Disease Control only recommends testing people who have symptoms and have been to China or who have symptoms and have been in contact with a suspected or confirmed case.

“Basically if you get tested and you’re found and you’re positive, then we know. But how many people right now are not being tested who are just like this case in Canada?” he asked.

If the Canadian doctor who caught the country’s most recent case had been following that type of protocol, the woman who returned from Iran would not have been tested for Covid-19, the disease the new virus causes.

Bonnie Henry, British Columbia’s provincial health officer, said an astute emergency department doctor ordered the test because of the woman’s recent international travel. It turned out to be a good call.

“It is not something we are recommending … but we have had a low threshold for testing and the lab will test if there is a request from an emergency room with compatible symptoms,” Henry said.

Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said Friday that the agency may broaden its recommendations for who should be tested if spread in countries outside of China continues to grow.

With the rapid upswing in cases in multiple countries, a number of experts are warning the world needs to plan for wider global spread of this virus.

“We need to start with assumption that we will be facing a pandemic,” said Caitlin Rivers, an assistant professor of epidemiology at the Johns Hopkins Center for Health Security. “If that doesn’t come to pass, then great. But I think we have an opportunity to learn from the lessons that we’re observing in Hubei province. And it’s in our best interest to lean in on that.”

Andrew Joseph contributed reporting.

  • The USA are seriously dropping the ball. They need to test anyone entering this country. The Chinese Gov’t has quarantined the entire city of Wuhan. They are not aloud to drive cars and the streets are barracaded so they can contain further spread. This is crazy. The USA needs to step up to the plate before we have problems that are uncontrolled.

  • I just can’t believe the Australian Government announced on the tv news that next week it will allow year 11 & 12 Highschool students from China to come back into Australia and then the following week it will allow University Chinese students..basically it means 100,000 Chinese students in a matter of weeks.
    Has our Government lost its damn mind!. What about allowing all those thousands of Chinese tourists in during the Chinese New Year and Australia Day celebrations over the weekend??. No surprise China Town in Sydney is a ghost town and the Chinese restaurants are all empty.
    But as for the EXPOSURE towards our citizens during New Years Eve, Australia Day and the Chinese New Year, the Australian Government could care less!. It chose MONEY over the SAFETY & WELL BEING of its own citizens.


    • Right you are, Debbie. Any government allowing such hordes of Chinese into their country at this time is certifiably nuts. For sure if it does so without testing them all in temporary quarantine. You and other smart Australians ought to whip up action to stop this quite possibly infected influx. As the US is also lax about travel, both contintents stand to get hit on large scale. As will also be the case in Europe, if not all countries stop (train)travel like Austria now does to prevent spread from northern Italy. The whole globe needs to curb travel – NOW – because there is no cure / treatment / vaccine.

  • Keeping an eye on Hawaii. Lots of Asian travelers. A limited number of hospitals, so a cluster of atypical pneumonia would be very obvious, very quickly. This is a real test of the “warm climate hypotheses,” align with other tropical locales. Haven’t heard a thing from the Philippines.

  • Based on my observations, the four most important tenets of public health are:

    1) Let know-nothing bureaucrats make all the key decisions.

    2) Never tell the public anything.

    3) Don’t take any action which might damage commerce

    And, most importantly:

    4) For god’s sake, make sure the planes keep flying!

  • The Italian minister of Health said yesterday that the economy and foreign relationships come after the health of our citizens.

    The truth is that Italy’s stock market is not major, it seems to me that countries that their economies have nothing to loose from being honest are reporting infections.

    In US, how do we know that people dying from flu and not coronavirus if they are not tested for coronavirus? The victims of flu this season have increased, are we sure that people dying from flu?

    Yesterday, a graduate student in NY died before 911 answered his call and the news reported this case as dying from the flu, how did they know? He had just died. Did they test him for coronavirus?

    Who is tested for coronavirus afterall in US? Because in Italy after they start testing everyone with flu symptoms for coronavirus, the infections went from 3 to 79 in three days. And this in an area that is 3 hours away from countries that haven’t reported any case yet. It is hard to believe that this is true anymore.

    We are now 29 days after the first person was identified with the coronavirus in US and we have only 35 cases. I do not see how, unless if the virus is not contracted in the ways announced.

    Given that any infected person infects 2-3 persons around him, I would expect to have infections in Illinois for example where the husband was found to have the virus was free of quarantine for 10 days ( unless this was not the case)
    Is the 2-3 infections per person true only for the epicenters? Shouldn’t we be seen more infections in more populated areas? Why Wuhan’s virus infected heavily the cities southern than Wuhan and not east of it? The cities east of Wuhan are much more populated than the Southern China.

    The winds at Wuhan go mainly north to south during the months of August to February. Is it possible that this virus is transported by the “wind” mainly? It sounds absurd to me to even suggest it, but this is what my model shows. I have no knowledge about this or if it is possible, can someone please help, is it even a possibility? But it seems that the outbreaks in China and surrounding countries develop from north to south.

    If it is true that North Korea is infected too, then eastern China province, North Korea and NOW South Korea, also verify such a pattern.

    Otherwise, the infections increasing in countries such as Iran and not Iraq, or Italy and not Switzerland( at Italy’s border) where there are no chains of patients found follow no other apparent pattern.

    Nevertheless, I assume we will all find out after the markets absorb the issue ( or crush) but maybe by then will be too late for containment.

    • Increased testing very obviously increases Covid-19 positive result numbers, and this is falsely interpreted as “explosive growth”. Expect more “active pockets” labelling – when tests will be performed in other countries, specially on the African continent ….. The concept of “wind-driven” spread is interesting, as is the notion that this virus seeks to thrive in warmer zones.

    • Everything you need to know was written a month ago by Gabriel Leung et al:

      China read it, but ROW not so much. The job of public health is to cut height if peak by reducing R0, transmissibility. Thus has to be done early. Public hygiene education, no large gatherings, work and school from home. Also, have to use testing to create line lists, so public health authorities can take action before it’s too late.

      I’d argue that the US is doing, essentially, nothing. The CDC has no test to offer the states, and the FDA will never approve a test under EUA without a multi-month process. That’s just how they roll.

      We’re essentially gambling that warm weather will save us.

  • The notion of Covid-19 being man-made as a bio-weapon is hilarious Angst, needs psychiatric care. But there is solid reason to fear pandemic spread – as it has spread to South Korea, and clearly has run rampant for a while already in chaotic countries like Iran. Africa is likley already infected but simply not yet diagnosed as it lacks the means. The WHO with its wishy washy corrupt economics / political bias has utterly failed, and deserves full “credit” for what will kill so many. It is of utmost importance the race for cure, treatment and vaccine MUST be stepped up – globally. And for the lack of solid global intervention: individuals need to chose to avoid travel and large gatherings, and to avoid contact with those who have traveled or have attended events. This is a challenge of Darwinian proportions: survival of the fittest, smartest.

  • “This outbreak could go in any direction. It could even be messy,” he warned. “What I’m saying is: It’s in our hands now. If we do well within the narrowing window of opportunity, we can avert any serious crisis. If we squander the opportunity, then there will be a serious problem on our hands.”

    The window probably slammed shut a week ago, and I think it is safe to say we are far beyond “serious problem”. Assumptions such as two week quarantines are adequate and no asymptomatic spread were totally wrong. Look at Northern Italy’s sudden explosive cluster if you have any doubts.

    The FDA needs to look at current case histories of patients treated with Remdesivir, and if safe and effective, approve the drug NOW on an emergency basis. We don’t have time for GILD’s China trial to get fully enrolled. There will be thousands of deaths between now and April. China has the capacity to ramp production and a desperate world will need the drug ASAP.

    Somewhat off topic, if you look at the SARS literature there are several journal articles that indicate Zinc Lozenges may have an inhibitory effect on Coronavirus replication. This may be clinically as effective as garlic (not at all), but at least there is legitimate science to back it. Hopefully someone far more knowledgable than me is at least looking at this.

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