A month has passed, and it seems to have been a century. On January 22, China went to bed with the idea that Wuhan, the capital of Hubei, had a problem with a handful of cases of infection with the new coronavirus. On 23 he woke up with that city blocked by quarantine; would be added a fortnight more, with about 60 million inhabitants. Today, that outbreak is already an epidemic throughout the rule that limits the movements of hundreds of millions of people within China, presents numerous outbreaks in several countries and threatens to become a worldwide pandemic that doctors do not know if it will end up disappearing, as in the case of SARS, or it will become endemic among risk populations, such as AIDS. The cases have spread to two dozen other countries, three of which - South Korea, Iran and Italy - have experienced a sudden increase in contagion within their borders in the last three days.
The dispersion of the outbreaks of infection of the coronavirus draws a new scenario that is about to blow up, if it has not already done so, the pillar of the fight against the disease on which the World Health Organization has worked ( WHO) since the discovery of SARS-CoV-2: containment within the Chinese borders through draconian quarantines of the bulk of the epidemic in Hubei and the rapid identification and control of cases that were occurring in other countries.
South Korea, which has already been 433 infected, starred in the first major boom in internal infections. It was soon followed by Italy, which since Friday has registered two deaths and about seven dozen cases. And WHO and experts are especially concerned about Iran, a country that on Tuesday claimed not to have infected in its territory and on Saturday reported 28 infected and five deaths. The reason? Four people - two in the United Arab Emirates, one in Lebanon and one in Canada - have been diagnosed with the newly landed coronavirus from a flight from Iran. When a country begins to export cases, experts explain, it is that the virus has been circulating among its population for days, something that the Iranian authorities have not been able to detect in time or what they have not reported before.
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The strategy of China and WHO, which declared the international alert on January 30, to focus the fight on preventing the outbreak from settling in other countries has allowed time to gain, experts say. But in statements this Saturday, the director general of the WHO, Tedros Adhanom Ghebreyesus, has reiterated what he already said on Friday: "Time is running out to act" and control the disease before it becomes a global problem. And he has expressed concern about those cases in which the origin of the infection is unclear: those of people who have not traveled to China or have not maintained contact with another sick person. Singapore has at least seven of these cases, and Japan has a similar problem.
Throughout this month, the virus - whose incubation period was established in 14 days although some studies raise it to 24 - has proven to be very contagious. In addition to the aforementioned sources, in five Chinese prisons it has infected more than 500 people apparently in just one week. The Diamond Princess cruise ship , which the Japanese bureaucracy decided to quarantine in the port of Yokohama on February 3 with 3,700 people on board, has ended up generating more than 600 infections. And if South Korea already exceeds 400 cases, it is the result of a 61-year "supercontainer", linked to a Christian sect and which is related to half of the positive ones in that country. He also has another focus at a hospital in a nearby county, Cheongdo. In Italy, which already has two dead, new infections increase as the hours go by.
"What is not known is whether it is a virus that will become endemic and will attack at-risk populations around the world, or not," explains the professor of Epidemiology of Infectious Diseases at the London School of Hygiene and former Executive Director of the WHO Contagious Diseases group, David Heymann. For the expert, it is a "serious disease" because, given its novelty, the human being had never been exposed to it and, therefore, has no defenses.
WHO has corroborated the Chinese studies conducted among thousands of patients - almost 77,000 people have been infected in China, of which more than 2,400 have died - who find that 80% of infections are mild; 20% serious or very serious, and 2% end in death. The majority of fatalities are elderly people who suffered from another disease (diabetes, coronary ailments, respiratory problems), while the virus seems to attack children less.
According to Heymann, the most serious problem comes when the virus weakens the protective cells of the respiratory tract and other opportunistic bacterial infections occur. "It is a very serious disease in humans, but it is not more spectacular than other lung diseases. If there is an opportunity for another bacterial disease to occur, it is when people die," he says.
A WHO delegation that is in China this week and has already visited Beijing, Canton and the Sichuan province planned to arrive this Saturday in Wuhan, the city where the first cases originated and most of the almost 77,000 infections are concentrated in China. But although the latest data in this country seem to point to the beginning of a remission - this Saturday, its number of new infections did not reach 400, while the previous day was close to 900 -, WHO requests caution. "It is too early to make predictions about this outbreak," warned its CEO in his statements on Saturday, in a meeting with African officials.
"Our greatest concern remains the potential for Covid-19 to spread in countries with weaker health systems," said Tedros, who has specifically alluded to the countries of the African continent: "We are working hard to prepare these nations for the possible arrival of the virus. "
In total, outside of China, 1,200 cases have been detected in 26 countries, as indicated by the head of WHO. Of these, eight infections have resulted in death, including a case in Egypt, the first in the African continent. In the Middle East, the United Arab Emirates has also declared a contagion.
Second wave in China?
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In China, where the disease originated, hundreds of millions of people have been living in a semi-quarantine situation for weeks, with their restricted freedom of movement. In several cities in Hubei, including Wuhan, that restriction is extreme: after the central government has declared a "people's war" against the virus, no one can leave their residential complexes unless it is to see a doctor or cover services essential.
Economic activity is almost paralyzed, and many small and medium-sized companies fear for their survival. Bus, train and air routes have been suspended. Nearly 200 million people to whom the disease containment measures found outside the home have not been able to return.
One of the concerns of the Chinese authorities is precisely what may happen when those displaced return to their homes, if a second wave of contagion can occur after the last progressive declines. Heymann does not rule it out: "It is necessary to be prepared in case there is one," he says.