COVID-19 Global Death Toll Surpasses 1,100 as Slower Pace of New Confirmed Cases in Outbreak’s Epicenter Offers Some Hope

The global death toll from the COVID-19 outbreak has surpassed 1,100 and the viral respiratory disease has infected more than 45,000 people worldwide. The WHO calls for “extreme caution” even as the number of newly confirmed cases in China appears to be declining with each day.

“The number of newly confirmed COVID-19 cases reported from China has declined steadily for the past week, but that must be interpreted with extreme caution. This outbreak could still go in any direction,” said WHO Director General Tedros Adhanom Ghebreyesus.

Tedros also highlighted how the number of countries reporting COVID-19 cases has remained the same since Feb. 4. At least 441 patients have tested positive for the illness across 24 countries, not including China, according to the WHO.

More than 100 patients died from coronavirus in a single day in Hubei, the Chinese province at the center of the outbreak, China’s national health commission reported Tuesday.

The number of new deaths in Hubei—which is home to Wuhan, where the coronavirus was initially tracked to a seafood market—hit 103 this week, and the number of worldwide deaths has now reached 1,117, according to Johns Hopkins University’s virus tracker. More than 45,200 cases of the coronavirus have been confirmed, with fewer than 600 outside mainland China.

However, one glimmer of hopeful news has emerged in the new data: Hubei saw the smallest daily increase in new cases Tuesday.

The U.S. confirmed its 13th case of coronavirus on Monday. The patient is an adult among the U.S. nationals who were evacuated from Wuhan last week and taken to a quarantine camp at the Marine Corps Air Station Miramar in San Diego, California.

On Wednesday, Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said on Wednesday that “At some point, we are likely to see community spread in the U.S. or in other countries … this will trigger a change in our response strategy.”

A San Diego hospital says an American citizen who was also evacuated from Wuhan was temporarily discharged after initial testing suggested they had not been infected with the virus. But further testing revealed that the patient had actually contracted the disease and they subsequently returned to the hospital. Health officials said on Tuesday that the error occurred because of a labeling error on samples.

A forum of more than 300 scientists and researchers hosted by the WHO this week has ended and experts have now identified priorities to focus on in responding to the outbreak. They include learning about the transmission, origin and diagnosis of the virus, as well as infection prevention and control and the development of potential therapeutics and vaccines.

Meanwhile, Chinese President Xi Jinping arrived in Beijing on Monday to inspect the response to the outbreak. Nearly 6,000 medical personnel from across China arrived in Wuhan on Sunday, according to Chinese state media.

The death toll from the coronavirus, which originated in the Chinese city of Wuhan has now surpassed the number of those killed during the 2002/2003 SARS epidemic. The SARS epidemic resulted in 774 deaths by the time the transmission chain ended in July 2003, according to the WHO.

The vast majority — 99% — of confirmed cases of the respiratory illness are in China, according to the WHO.

A 60-year-old U.S. citizen in China is the first American to die from the COVID-19 outbreak. A U.S. State Department spokesperson confirmed to TIME that the citizen died February 6 at Jinyintian Hospital in Wuhan, China — the epicenter of the outbreak. Japanese officials also reported the country’s first death from the respiratory illness — a Japanese citizen in his 60s who died in Wuhan, according to Japan Times.

The virus has also killed one person in the Philippines, and another in Hong Kong.

In Japan, 39 additional cases were found on a quarantined cruise ship on Wednesday, bringing the total number of cases onboard to 174. The Diamond Princess has been stuck in the Yokohama harbor since Feb. 3, after the cruise company learned a passenger from Hong Kong had tested positive for coronavirus after disembarking last month. The Health, Labor and Welfare Ministry said it was considering testing all of the roughly 3,600 passengers and crew, according to Japan Times.

“Unfortunately, the Diamond Princess is one of three cruise ships that have experienced delayed port clearance or have been denied entry to ports, often without an evidence-based risk assessment,” Tedros said. He added that the WHO will be working with countries to ensure the rights of travelers are respected and has already published guidance on how to handle public health events like this on ships.

On Sunday, the WHO stated that the quarantine period would end on Feb. 19, following concerns that the 14-day quarantine period kept resetting each time a new person on the ship tested positive for the virus.

Now, when a new case is found on the ship, only close contacts of the person are considered for additional quarantine, said Sylvie Briand, WHO’s Director of Global Infectious Hazard Preparedness, at a press conference on Monday. (Those close contacts may then be under quarantine for longer than Feb. 19.) All passengers and crew who tested positive for the illness are being hospitalized and should no longer be present on the ship, Briand said.

Last Friday morning, 27 passengers aboard a Royal Caribbean cruise ship were screened for possible coronavirus sickness when the ship was docked in Bayonne, N.J.. No cases were confirmed from the screening.

Another U.S. cruise ship with about 2,000 passengers and crew aboard is stranded on the open seas after four different nations and the U.S. territory of Guam denied it entry, even though no one on board had been diagnosed with the illness. The Holland America Line Westerdam has now said that Cambodia will allow the ship to dock in the country on Feb. 13.

As of Feb. 7, 72 countries are implementing “travel restrictions through official reports, official statements and the media,” according to the WHO.

On Wednesday, organizers of the world’s biggest mobile technology fair—the annual Mobile World Congress—say the event has been canceled because of “global concern regarding the coronavirus,” according to the Associated Press. Dozens of tech companies and wireless carriers, including Nokia, Vodafone, Amazon, Intel and LG, had already dropped out before the announcement.

Last week, Li Wenliang, a Chinese doctor who tried to warn others about the coronavirus outbreak, died of the virus in Wuhan. Li had been punished by police for “making untrue comments” and “severely disturbing social order.”

The Wuhan Central Hospital reported Dr. Li’s death on social media, saying that he was “unfortunately infected during the fight against the pneumonia epidemic of the new coronavirus infection,” the Associated Press reported.

World Health Organization coordinates global response

The World Health Organization (WHO) officially named the new coronavirus disease COVID-19 on Tuesday and hosted a meeting of more than 400 scientists from around the world this week to look at urgent questions that need answering on the outbreak.

The WHO said the new name was decided following guidelines that ensure the name does not refer to a geographical location, an animal, an individual or group of people, while still being pronounceable and related to the disease.

“Having a name matters to prevent the use of other names that can be inaccurate or stigmatizing,” said Director-General of the WHO, Tedros Adhanom Ghebreyesus. “It also gives us a standard format to use for any future coronavirus outbreaks.”

The WHO said Monday that it has sent an initial team of experts to China to lay the groundwork for a larger international team as part of efforts to stop the coronavirus outbreak.

The WHO has identified 168 laboratories around the world with the right technology to diagnose the disease and has sent diagnostic kits to several countries, including Cote D’ivoire, Kenya, Morocco, Zambia, Tunisia, Ethiopia and Egypt. “Without vital diagnostic capacity, countries are in the dark as to how far and wide the virus has spread,” Tedros said.

The WHO also activated a UN crisis management team on Tuesday to allow the agency to focus on a health response to the COVID outbreak, while other UN agencies dealt with wider social, economic and developmental aspects of the outbreak.

The WHO said in an earlier press conference on Saturday that it is stepping up efforts to battle misinformation by coordinating with search and social companies such as Facebook, Google and Twitter to filter out false information and promote accurate information from the WHO, CDC and others.

The agency has also announced plans to raise at least $675 million for a strategic plan to respond to the outbreak and a forum to convene global researchers to fast-track solutions. Part of that money — $60 million — is to fund WHO’s operations, while the remainder is for “countries that are especially at risk,” said Tedros last week.

Meanwhile, the WHO has warned that the world is facing “severe disruption” in the market for personal protective equipment due to the coronavirus outbreak.

The WHO is also working with local authorities in Singapore to look into an outbreak at a hotel. At least three Asian businessmen who attended a meeting of more than 100 people at The Grand Hyatt Singapore hotel last month were infected with the virus, according to Reuters. Of the 109 participants, 94 were from abroad, Reuters reported.

Tedros also downplayed criticism from John Mackenzie, a member of WHO’s coronavirus emergency committee, who said that China’s initial response to the outbreak was “reprehensible” and that they did not report cases quickly enough. Tedros said he would expect more cases to spread from China to the rest of the world if China was hiding cases, but noted that the WHO would still have a retrospective review in the future.

American response

The State Department announced on Friday that they are sending medical supplies, including masks, gowns and respirators to China to assist with the virus.

The United States is also prepared to spend up to $100 million in funds to help China and other countries impacted by the spread.

A second wave of American evacuations from Wuhan took place last week as a plane with 178 passengers landed at Travis Air Force Base in California, the U.S. Centers for Disease Prevention and Control confirmed. Those on board are now subject to a 14-day federal quarantine and will stay at the air force base temporarily.

Those entering the U.S. within 12 days of having been in Hubei or the rest of mainland China will be directed to one of 11 U.S. airports for an additional health assessment, according to the CDC. They include Los Angeles International Airport, San Francisco International Airport, John F. Kennedy International Airport, Hartsfield-Jackson Atlanta International Airport, Honolulu International Airport, Chicago’s O’Hare International Airport, Seattle-Tacoma International Airport, Washington Dulles International Airport, Newark Liberty International Airport, Dallas/Fort Worth International Airport and Detroit Metropolitan Airport.

Americans traveling back to the U.S. from Hubei province 14 days before returning to the country will be subject to up to 14 days of a mandatory quarantine, Secretary of Health and Human Services Alex Azar told reporters at a White House press briefing. Any American citizens who were in mainland China 14 days before returning to the U.S. will have to undergo a “self-imposed” quarantine for 14 days.

International cases and response

At least 441 patients have tested positive for the illness across 24 countries, not including China, according to the WHO.

A 44-year-old man died in the Philippines earlier this month, the country’s Department of Health confirmed, marking the first person to succumb to the virus outside of China. The man, a resident of Wuhan, China, had arrived in the Philippines on Jan. 21 with a 38-year-old woman, who was also infected.

A 39-year-old man in Hong Kong died last week, making him the second death outside of mainland China. The patient reportedly had an underlying illness.

There are 50 confirmed cases of the coronavirus in Hong Kong, which was hard-hit by the 2002-2003 outbreak of severe acute respiratory syndrome (SARS). More than one-third of the nearly 800 deaths from SARS worldwide were in Hong Kong, and the semi-autonomous Chinese territory had more than 1,700 of the 8,000 confirmed cases of the virus.

Hong Kong’s neighbor, the gambling hub of Macau, confirmed its 10th case of the virus last Tuesday. Macau announced the same day that it would be shutting its casinos for two weeks. (The city’s casinos are overwhelmingly reliant on mainland Chinese tourists.)

There are also at least 47 cases in Singapore and 33 in Thailand, according to Johns Hopkins University’s virus tracker. Outside of China, the largest cluster of cases is on the Diamond Princess cruise that is docked in Yokohama, Japan, with 174 confirmed cases.

Governments and health officials in Nepal, Canada,Cambodia, Vietnam, Malaysia, Sri Lanka, UAE, France, the U.K., Italy, Russia, Sweden, Spain and Germany have also reported patients testing positive for the virus.

Several countries have tightened their borders to restrict the flow of mainland Chinese visitors. Seventy-two countries are implementing “travel restrictions through official reports, official statements and the media,” according to the WHO.

In Hong Kong, the government has closed all but two entry points, leaving a cross-border bridge and a port in a northwestern part of the territory open. (Visitors can still fly to Hong Kong, though flights between mainland China and Hong Kong have been cut by half.)

Last week, authorities in Hong Kong announced that all arrivals from mainland China would be quarantined for 14 days starting Saturday, acknowledging that there is risk of an outbreak in the city. However, Chief Executive Carrie Lam once again stopped short of closing the border, despite demands from many Hong Kong residents, including thousands of medical workers who went on strike in an attempt to force the action.

Singapore has said it is banning visitors with recent travel history to mainland China and has also banned the entry and transfer of travelers holding passports issued by China’s Hubei Province.

Russian Prime Minister Mikhail Mishustin said last Thursday that Russia would be closing its land border with China from Friday at least until March 1, the Associated Press reported.

Multiple countries are also warning against unnecessary travel to China, and many have already started evacuating their citizens from Wuhan.

China travel restricted

Chinese officials have shut down travel in and out of Wuhan — home to 11 million people — and enacted similar, strict transportation restrictions in a number of other cities. Wuhan has suspended immigration administration services, local authorities said Monday, according to Chinese state media.

China’s Hubei Province has also suspended services to apply for passports and exit-entry permits.

Royal Caribbean also announced restrictions, including the cancellation of eight cruises out of China due to the outbreak, according to the AP. The cruise line announced last week that it would also prohibit any guest or crew member, regardless of nationality, to board a ship if they traveled through mainland China or Hong Kong less than 15 days prior.

Japanese officials said they would ban foreign nationals who have been to Hubei province within two weeks before their arrival. Those carrying Chinese passports issued in Hubei are also banned from entering the country, although special exceptions may be made, government officials said, according to Japan Times.

Australia said on Feb. 1 that it would ban travelers who have visited or transited through mainland China for the next two weeks. The restrictions will not apply to Australian citizens, permanent residents and members of their immediate family, although these groups will be asked to isolate themselves for two weeks from when they departed China, Australian Prime Minister Scott Morrison said last week, according to the Sydney Morning Herald.

Additionally, Singapore has banned all travelers arriving from mainland China who had been there in the past 14 days from entry and transit from Feb. 1. The U.S. Federal Aviation Administration says that Vietnam has suspended almost all flights from and to mainland China, Hong Kong and Macau until May 1, according to the New York Times.

As the deadly virus spreads, a growing number of airlines, including British Airways, Air France, Delta and Lufthansa, are suspending all flights to China. Many have cut down the number of flights, and some have stopped flying to major cities.

CDC confirms second human-to-human transmission in the U.S.

Last week, the U.S. Centers for Disease Control and Prevention confirmed the second case of the disease transmitting from person-to-person within the U.S. The first American patient diagnosed with the new coronavirus was also discharged from hospital.

A patient in California, who had not recently traveled to China, tested positive for the virus. The patient is married to a person who had previously traveled to China and tested positive for the respiratory illness, according to the California Department of Public Health.

Last week, hospital officials at the Providence Regional Medical Center in Everett, Washington, said the 35-year-old man who was the first to test positive for the new coronavirus in the U.S. has left the facility, the Associated Press reported. The unidentified man is recovering and looking forward to life returning to normal, he told the AP.

The CDC has now confirmed at least 13 cases of the coronavirus infection in the U.S. across Wisconsin, Arizona, Massachusetts, California, Washington state and Illinois.

Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, maintained that the risk to the American public continued to be low, but that the CDC expects to find additional cases in the U.S.

The U.S. Food and Drug Administration issued an emergency use authorization for the first 2019 new coronavirus diagnostic last week, before which the test had been limited to being used at CDC’s laboratories. The authorization now allows the test to be used at any CDC-qualified lab in the U.S.

The CDC said as of Monday that 398 individuals across 37 states were considered to be “persons under investigation.” Of those, 318 had so far tested negative for the disease. The status of another 68 cases is currently pending.