COVID-19: The latest information on the new coronavirus
Lauren Vogel | CMAJ | February 14, 2020

Feb. 14: Cases among Chinese health workers declining

  • The World Health Organization reported that COVID-19 cases among health workers in China peaked in late January and have rapidly declined in the past two weeks. According to Chinese health officials, 1,700 health workers have been infected since the beginning of the outbreak, and six have died.

Feb. 14: Demand for masks remains high

  • Some Canadian pharmacies are having trouble keeping up with high demand for face masks, despite health officials advising that they won’t necessarily protect against COVID-19. According to the Canadian Pharmacist Association, some pharmacists are discouraging customers from purchasing the masks. At a recent briefing, Canada’s Chief Public Health Officer Dr. Theresa Tam said the masks are more useful for people who are “actually sick.” Meanwhile, the World Health Organization says that healthy people only need to wear a mask if they are caring for someone who is sick.

Feb. 14: Volunteers supporting people to self-quarantine

  • A group of 260 volunteers in Edmonton are helping travelers from China to self-quarantine. The volunteers pick up returning travelers from the airport, and deliver food and groceries. Some 50 people are currently under self-imposed quarantine in Edmonton.

Feb. 13: New coronavirus named

  • The International Committee on Taxonomy of Viruses named the new coronavirus “severe acute respiratory syndrome-related coronavirus 2,” or SARS-CoV-2, while the World Health Organization named the disease caused by the virus “coronavirus disease 2019,” or COVID-2019. The release of two names on the same day caused some confusion, and WHO clarified it will only use COVID-19 in communications to avoid the disease being mistaken for SARS.

Feb. 13: China reports largest one-day spike in cases

  • China reported 15,152 extra cases of COVID-19 and 254 additional deaths going back over an unknown number of days and weeks. WHO said the spike was due to a change in the way that Chinese authorities are counting cases; previously, they only counted lab-confirmed cases, but now they’re including clinical diagnoses based on lung imaging without requiring laboratory confirmation of coronavirus.

Feb. 13: Canadian hospitals unprepared for outbreak

  • Hospital overcrowding represents a potential critical weakness in Canada’s preparedness for an outbreak of the new coronavirus, warned a Perth, Ontario emergency physician. According to Dr. James Simpson, “There is no capacity in the system right now to manage a crisis. In fact, most hospitals currently have negative capacity as many are running with over 100% of their beds being filled.”

Feb. 13: Cruise passengers will finish quarantine on land

  • Twelve Canadians infected on board a quarantined cruise ship docked at Tokyo, Japan, have been moved to local health facilities, and three have been hospitalized. Japanese authorities will begin to allow passengers to leave the ship in phases and complete the quarantine on land.

Feb. 13: Faulty testing kits

  • Some of the testing kits sent by the Centers for Disease Control and Prevention to laboratories across the United States were faulty. The agency has stopped shipments of the tests to 30 other countries until their accuracy can be confirmed.

Feb. 12: Ontario reports resolved case

  • Ontario confirmed the province’s third case of COVID-19 is now resolved. The other two patients have recovered but continue to test positive for the virus and remain in isolation at home.

Feb. 11: Canada may expand self-quarantine advice

  • Canadian health officials are weighing whether to ask all travelers from China to self-quarantine for 14 days. Federal and provincial officials already recommend that travelers from Hubei province self-isolate to reduce the risk of spreading the virus. About 70 to 80 people from Hubei area are arriving in Canada each day, according to Chief Public Health Officer Dr. Theresa Tam.

Feb. 10: WHO warns cases outside China may accelerate 

  • Countries should prepare for the spread of the new coronavirus to accelerate outside of China, warned WHO Director-General Dr. Tedros Adhanom Ghebreyesus. The recent detection of cases with no link to China indicate “we may only be seeing the tip of the iceberg,” he said.
  • So far, 99% of confirmed coronavirus cases are contained within China, and of those 80% are in Hubei. Developing nations could be at particular risk if quarantine efforts fail in China. Cambodia, India, Malaysia, Vietnam, Sri Lanka, Nepal and the Philippines have recorded cases. As of Feb. 3, only two African nations, Senegal and South Africa, had capacity to diagnose coronavirus.

Feb. 10: Canadians infected on quarantined cruise ship

  • About 3,700 people are quarantined on a cruise ship docked at Tokyo, Japan, after a man who disembarked in Hong Kong was diagnosed with 2019-nCoV. According to the cruise operator, 135 people have been infected on board, including eight Canadians.

Feb. 10: Conflicting reports on aerosol transmission

  • A Shanghai official reported that the virus can be spread through direct transmission, contact transmission and aerosol transmission, and as such, could linger in the air for long periods. However, other Chinese officials later told reporters there is no evidence that the virus can form aerosols and the most likely route of transmission appears to be via droplets coughed or sneezed by infected people.

Feb. 9: New spike in infections

  • China reported 3,062 new infections on Feb. 9, up 15% from Saturday, breaking a string of daily declines that some had hoped indicated the success of containment measures. The death toll in China also rose by 97 to 908 over the same 24-hour period.

Feb. 9: Canadian leading WHO investigation

  • Canadian epidemiologist Dr. Bruce Aylward is leading a team of international experts to investigate China’s outbreak for the WHO. It took nearly two weeks for the agency to receive permission for the mission from the Chinese government.

Feb. 9: Possible fecal transmission 

  • A study published in JAMA found that nearly half of the first 138 patients diagnosed at one hospital Wuhan were infected at the hospital. Data in the study indicate rapid person-to-person transmission, with each patient spreading the infection to 2.2 others, on average.
  • The study also raised questions about the potential for fecal transmission of the virus. About 10% of patients initially presented with diarrhea and nausea before developing fever and difficulty breathing, and 2019-nCoV has been found in the feces of patients with abdominal symptoms.

Feb. 6: Doctor who issued early warnings dies

  • A Chinese doctor who issued early warnings about the coronavirus outbreak in Wuhan died after becoming infected with the virus. Li Wenliang faced government censure for warning fellow doctors to wear protective clothing after noticing cases that he thought looked like SARS. Local authorities later apologized, and the news of his death triggered an outpouring of grief in China.

Feb. 6: Mass quarantines in Wuhan

  • The Chinese government has ordered authorities in Wuhan to round up all infected residents and place them in isolation, quarantine or designated hospitals. The order includes sending city investigators to the homes of infected patients to check the temperatures of all residents and interview close contacts. However, there is growing concern about the basic conditions in the makeshift mass quarantine shelters, with reports of power failures and shortages of medical staff and supplies.

Feb. 4: Rising tensions over travel

  • Thousands of medical workers in Hong Kong went on strike to compel the government to shut its borders with mainland China to prevent the spread of 2019-nCoV.
  • The WHO reaffirmed that there is no need to impose restrictions that “unnecessarily” interfere with travel and trade
  • China’s foreign ministry criticized the United States and other countries for overreacting to the outbreak. The US was the first to impose a travel ban on foreign nationals who have travelled in China within the past two weeks.

Feb. 4: Canadians with coronavirus won’t be evacuated

  • The federal government has a plane ready to evacuate Canadians from Hubei province in China, where the novel coronavirus is thought to have originated. Some 325 people have requested evacuation but those with respiratory symptoms will not be allowed to board the flight. On return to Canada, evacuees will be kept under observation for two weeks at a military base in Trenton, Ont.

Feb. 3: Human trials of potential treatments

  • Doctors in China are testing the efficacy of the antiviral drug Remdesivir as a potential treatment for 2019-nCoV in some 270 patients in Wuhan with mild and moderate pneumonia caused by the virus. The HIV medicine Kaletra is also set to undergo human trials.
  • Thailand’s health ministry reported dramatic improvements in a patient with coronavirus treated with a combination of the anti-viral drug oseltamivir and the HIV treatments lopinavir and ritonavir. The ministry is awaiting further research into the case.

Feb. 3: China builds hospital in 10 days

  • China’s government built a 1,000-bed hospital in Wuhan in 10 days to increase capacity to respond to the outbreak in the city. The country deployed 1,400 doctors, nurses and other personnel from the military to staff the new hospital. A second 1,500-bed facility is due to open this week.

Feb 3: Could coronavirus be spread via imported goods?

  • According to the CDC, there is currently no evidence of transmission of 2019-nCoV associated with imported goods. In general, because of the poor survivability of coronaviruses on surfaces, there is likely very low risk of spread from products or packaging that are shipped over a period of days or weeks at ambient temperatures.

Feb. 2: Death toll exceeds that of SARS outbreak

  • According to Chinese health officials, there were 361 deaths from 2019-nCoV in mainland China in the past month, exceeding the 346 deaths from SARS between 2002 and 2003.
  • Health officials in the Philippines reported the first death from 2019-nCoV outside of China, although the deceased, a 44-year-old man from Wuhan, harbored a mix of pathogens.

Jan. 31: How serious is the outbreak?

  • The World Health Organization (WHO) declared an international public health emergency following a second emergency meeting about the 2019-nCoV outbreak. In a statement, WHO said it is still possible to interrupt the spread of the virus, so long as countries put in place strong measures to detect, isolate and treat cases, trace contacts and promote social distancing measures.
  • Federal Health Minister Patty Hajdu said the risk to Canadians remains low and Canada’s response is fully in line with WHO recommendations.
  • The number of cases in China exceeds the number of worldwide SARS cases (8,098) during the 2003 outbreak.

Jan. 31: How does the virus spread?

  • According to the United States Centres for Disease Control and Prevention (CDC), this coronavirus strain is linked to a large seafood and animal market in Wuhan, China, which suggests that it was first spread from animal to person. However, there have since been cases of people who didn’t have contact with any animal markets, indicating that the virus is able to travel from person to person.
  • Symptoms appear within 2 to 14 days and people without symptoms may be infectious during that period, according to Chinese health officials.

Jan. 31: What are the symptoms?

  • According to Health Canada, typical coronavirus symptoms include headaches, coughing, a sore throat and fever. Milder cases may be indistinguishable from a cold or flu. More serious cases can lead to pneumonia, organ failure and death.
  • A Lancet study of 99 confirmed cases in Wuhan found that 83% had fevers, 81% experienced fits of coughing, and 31% experienced shortness of breath. Three-quarters showed signs of bilateral pneumonia. Eleven patients, most of whom had other underlying conditions, later died of multiple organ failure.

Jan. 31: How can people protect themselves?

  • The WHO recommends the following standard hand and respiratory hygiene and safe food practices:
      • Frequently clean hands using soap and water or alcohol-based hand rub, and avoid touching your eyes, nose or mouth
      • Avoid close contact with anyone who has fever and cough
      • Cover your mouth and nose when coughing and sneezing with an elbow or a tissue, and immediately throw used tissues away and wash your hands
      • Avoid consuming raw or under-cooked animal products, and avoid contact with live animals in affected areas
      • If you have fever, cough and difficulty breathing, seek medical care early and share travel history with your care provider
  • A diagnostic test is available to detect infection, but there is no vaccine yet.

Jan. 30: Evacuations, quarantine and travel advisories

  • Canada has warned citizens to avoid all non-essential travel to China, and avoid all travel to Hubei province, where the outbreak originated.
  • Many countries are evacuating citizens from China, including the United States, South Korea, Japan, Australia, New Zealand, India, and countries in the European Union. Canada’s Foreign Affairs Minister Francois-Philippe Champagne said the government is working out the logistics of evacuating Canadians and has a plane lined up to do so.
  • Italy is stopping air traffic with China, Russia is closing its far-east border, and numerous airlines including Air Canada are suspending flights to and from mainland China.
  • Some 60 million people in the city of Wuhan and across Hubei province are on some level of lockdown and travelers from the region have been ordered to self-quarantine.

Jan. 30: Misinformation and anti-Chinese racism on the rise

  • Canada’s Chief Public Health Officer Theresa Tam urged a stop to racist acts and stigmatizing comments on social media against people of Chinese and Asian descent. Memes have spread on the internet blaming the outbreak on Chinese eating habits and hygiene. Chinese businesses in Canada also reported declines in customers.
  • Misinformation has spread online including false claims of tens of thousands of deaths and unsubstantiated conspiracy theories linking the outbreak to espionage and biological warfare. Three Canadian post-secondary schools have issued warnings about false information circulating on campuses.

Jan. 29: Global run on face masks  

  • A global run on surgical masks saw Amazon and Alibaba run out of stock. There were also reports of masks selling out at retailers in major cities in the United States and Canada, including Toronto and Montreal. But health professionals caution that masks are unlikely to protect people from the virus.

Jan. 28: When will the virus peak?

  • Speaking to Chinese state media on Jan. 28, respiratory expert Zhong Nanshan said he expected the number of cases to peak within 10 days. Researchers at Imperial College London estimated there may be anywhere between 20,000 and 100,000 cases in China, including those already confirmed.

Jan. 28: Real-time map shows spread of virus

  • Researchers at the Johns Hopkins Whiting School of Engineering have developed an online dashboard showing the daily status of coronavirus infections worldwide. The dashboard culls data from major health organizations such as the WHO, CDC, China CDC, ECDC and others.

Jan. 28: Work on vaccine underway

  • The Coalition for Epidemic Preparedness Innovations announced that it will give three companies a total of $12.5 million to develop 2019-CoV vaccines. Work started within hours after Chinese researchers posted a sequence of the virus in a public database, and two of the companies say they could have enough vaccine produced in one month to begin animal testing.
  • Canada’s chief public health officer says it will likely take at least a year before a vaccine is developed to protect people. In the meantime, people infected with the virus will be treated with supportive care.

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