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Why Experts Suspect More Cases in China and Why the U.S. Has More Cases Than it Realizes

The close relative of SARS appeared out of thin air, poised to descend on humanity like wildfire. Then, just as abruptly as cases had appeared, they disappeared — the reports, not the sick people, it would seem.

January 20, 2020 Updated January 21

E. Rosalie Li, interdisciplinary public health Johns Hopkins Bloomberg School of Public Health

They called it Pneumonia of Unknown Etiology, but the mystery illness didn’t stay unknown for long.

The close relative of SARS appeared out of thin air, poised to descend on humanity like wildfire. Then, just as abruptly as cases had appeared, they disappeared — the reports, not the sick people, it would seem. A week later, cases arose in ThailandJapanKorea, and the U.S.

China, believing animal markets to be the source, shut them down for cleaning on Jan. 1, 2020, but multiple cases reported they had not visited the animal markets. The Wuhan Municipal Health Commission reported 59 cases of this pneumonia on Jan. 5, 2020. Vendors at local markets were among the sick, so follow-up with anyone who had contact may be impossible, and people may be reluctant to seek help or not realize what they have.

The WHO lists 63 reported cases in China, but it is unclear whether the country officially confirms it. Appearing as fever, chill, and muscle pain, the virus complicated breathing in the original outbreak victims. Doctors found fluid called “pulmonary infiltrates” in their lungs, a substance that is denser than air, often blood and pus.

China reports no cases after Jan. 3 in a Jan 11 statement, but Japan, Thailand, and now Korea all confirm cases of travelers to China (Wuhan Municipal Health Commission, 2020; WHO, 2020).

Accounts of the voyaging virus, now called 2019-nCoV, surfaced in Thailand on Jan. 14, 2020.

The woman flew from Wuhan City, China, to Thailand in a packed airplane on Jan. 8, 2020. Monitoring continues for at least 182 people who met the woman.

Japan also found the virus in a Japanese citizen who recently traveled to Wuhan City, China. DNA testing identified it as 2019-nCoV. Hirofumi Umeda from the Infectious Diseases Information Division in Japan confirmed the details of the cases on Jan. 15, 2020.

The Korean case today casts doubt on the Chinese report of no new infections. None report traveling to the animal markets, not the Korean woman or Japanese or Thai people.

The Korean case showed symptoms starting Jan 18 in Wuhan City, China, where a doctor diagnosed the woman with a cold before she traveled to Korea through Incheon International Airport. The Korea Centers for Disease Control found the virus through DNA testing (WHO, 2020).

These cases may constitute enough evidence to consider the possibility of human-to-human transmission, though it’s not a confirmation.

Most worrying, the Wuhan doctor diagnosed a Korean woman on Jan. 18 with a cold (WHO, 2020). How many more cases are there?

The estimated numbers exponentially outnumber China’s reported incidents, and SARS makes clear that we must be cautious about the reliability of reporting.

The dates of infection and travel should give pause.