Plagues of China

Scale of China’s Wuhan Shutdown Is Believed to Be Without Precedent
In sealing off a city of 11 million people, China is trying to halt a coronavirus outbreak using a tactic with a complicated history of ethical concerns.
By Michael Levenson

Hankou Railway Station in Wuhan, China, on Wednesday. The Chinese government said it would cancel planes and trains leaving Wuhan, and suspend buses, subways and ferries within it.

In closing off Wuhan, a city of more than 11 million people, China is deploying a centuries-old public health tactic to prevent the spread of infectious disease — this time, a mysterious respiratory infection caused by a coronavirus.
Experts said the stunning scale of the shutdown, isolating a major urban transit hub larger than New York City, was without precedent.
“It’s an unbelievable undertaking,” said Dr. Howard Markel, a professor of the history of medicine at the University of Michigan, adding that he had never heard of so many people being cordoned off as a disease-prevention measure.
Still, “people are going to get out,” he said. 

“It’s going to be leaky.”
By limiting the movements of millions of people in an attempt to protect public health, China is engaging in a balancing act with a long and complicated history fraught with social, political and ethical concerns.

James G. Hodge Jr., director of the Center for Public Health Law and Policy at Arizona State University, said the shutdown would almost certainly lead to human rights violations and would be patently unconstitutional in the United States.
“It could very easily backfire,” he said, adding that the restrictions could prevent healthy people from fleeing the city, perhaps exposing them to greater risk of infection. 

“In general, this is risky business.”
To combat the spread of the virus, which first appeared at the end of December and has killed at least 17 people and sickened more than 500, the Chinese government said it would cancel planes and trains leaving Wuhan beginning Thursday, and suspend buses, subways and ferries within it.

The practice of isolating people and goods to halt the spread of disease dates at least to the 14th century, when ships arriving in Venice during the plague epidemic were required to anchor off the coast for 40 days. 

The isolation period gave rise to the term quarantine, from the Italian quaranta giorni, meaning 40 days, according to the Centers for Disease Control and Prevention.

Professor Hodge said quarantines could be effective if they selectively isolate only those who have been infected or are suspected of infection. 

The response in Wuhan, with the establishment of a “cordon sanitaire”-type boundary, goes much further than that.
“Quarantine would be saying ‘You can’t leave your own home, can’t go to school, work or church,’” he said. 

But the Chinese authorities “have drawn a line around this city and said, ‘No one in and no one out.’ That type of thing is obviously an excessive response.”
In recent years, governments have imposed other large-scale measures to prevent the spread of infectious diseases.
Sierra Leone, a country of about seven million people, said “everybody” was expected to stay indoors for three days in September 2014, as 7,000 teams of health and community workers went door to door to find hidden Ebola patients.
Earlier that year, Liberian officials placed West Point, a sprawling slum in Monrovia where 60,000 to 120,000 people were crammed into shacks, under an Ebola quarantine. 

The order led to deadly clashes with soldiers and may have helped to spread the disease, experts said, forcing people to crowd together for basic humanitarian aid.
During the SARS outbreak of 2003, Canadian health officials asked anyone in Ontario who had even one symptom of the respiratory infection to stay home for a few days out of fear that the disease might spread during the Easter holiday weekend.
In Beijing, at least 4,000 residents who had been exposed to the virus were kept in isolation, and 300 college students who had had contact with infected people were sequestered in a military camp for two weeks.
Historians have noted that quarantines have often targeted marginalized populations.
During the plague epidemic of the 14th century, European city-states posted armed guards on roads and access points to keep out merchants, people with leprosy and minority groups such as Jews, according to Eugenia Tognotti, a researcher in Italy who has written on the history of quarantine.
And during a wave of cholera outbreaks in Europe in the 1830s, Naples restricted the movement of prostitutes and beggars, who were thought to be carriers of the contagion, she wrote.
Russian Jews brought typhus fever into the Lower East Side of Manhattan in 1892, Dr. Markel said. It was not only infected people who were rounded up and quarantined on an island off the Bronx, however, but also their neighbors and others whom they had simply greeted on the street.
“That’s the darker side of quarantine — its misuse as a social tool rather than its scientific use as a medical tool,” Dr. Markel said.

Plagues of China

Coronavirus Outbreak Forces Chinese to Rethink Travel Plans
The annual Spring Festival holiday travel rush would complicate efforts to contain the outbreak.
By Amy Qin and Vivian Wang

Spraying disinfectant on Wednesday at a train station in Wuhan, China, the center of the coronavirus outbreak.

BEIJING — The Lunar New Year holiday in China is the world’s largest annual migration of people, with hundreds of millions of travelers fanning out across the country and the world, and hundreds of billions of dollars spent on hotels, restaurants and shopping.
Now, with a mysterious new pneumonia-like coronavirus that spreads between people, it’s also an epidemiologist’s nightmare.
The authorities are scrambling to control a virus that has sickened more than 440 people, killed nine, and spread around the region and to the United States. 

Officials are imposing restrictions on travel out of Wuhan, the central Chinese city of more than 11 million at the epicenter of the outbreak, and stepping up screening at transportation hubs. 

The World Health Organization was expected to hold a meeting on Wednesday to discuss whether to declare the outbreak an international health emergency, which would escalate the global response.
Before the virus emerged, the government had estimated that Chinese travelers would make three billion trips over the holiday period, also known as the Spring Festival. 

But on Wednesday, a senior health official delivered a stark warning: the huge tide of travel during the holiday would make it more difficult to contain the outbreak. 

Li Bin, a deputy head of China’s health commission, also said that the virus could mutate and spread more easily.
Many Chinese have already canceled their travel plans, forgoing vacations and what for some is their only chance to return home for family reunions during the year. 

The Lunar New Year, a weeklong holiday, begins on Friday, when the country says farewell to the Year of the Pig and welcomes the Year of the Rat.
“After we heard how bad the situation was on Monday, we held a family meeting and decided that it just wasn’t worth the risk,” said Yan Chaowei, 32, a housewife in Shanghai who was planning on taking a seven-hour bullet train to her family home in southeastern Jiangxi Province.

“It just wouldn’t be a relaxing trip, especially with a small child,” she added. 

“When we finally made the decision to stay home, we sighed with relief.”

Where the Wuhan Coronavirus Has Spread? The virus has sickened more than 400 people in Asia and one person in the United States.

Even some working in the travel industry were nervous. 

Flight attendants at Cathay Pacific, Hong Kong’s leading airline, publicly lobbied the company to allow them to wear masks during all flights, a request that was granted on Wednesday.
“It will be too late and too painful for all of us and the Company to wait until one of our own is infected,” the airline’s union for flight attendants said in a statement. 

“The damage caused will be catastrophic.”
In Wuhan, a major transportation hub that is popular among tourists for its colonial architecture, spicy noodles and proximity to the Yangtze River, the authorities have urged residents to stay put and others to avoid visiting. 

They have stopped short of imposing a full lockdown, but issued a ban on large public gatherings and performances at hotels and sightseeing destinations.“We recommend that people not come to Wuhan if it isn’t necessary,” Zhou Xianwang, the mayor of Wuhan, said in an interview on Tuesday with the state broadcaster CCTV.
To encourage travelers to stay away from Wuhan, tour companies are promising penalty-free refunds for hotel bookings and air and train tickets to and from the city. 

Travel operators are suspending itineraries with stops there, raising concerns of a slump during what is usually one of the most lucrative weeks of the year.
For Chinese companies, the outbreak could deal yet another blow at a time of slowing economic growth.
According to official estimates, Chinese spent $74 billion on travel and $145 billion on shopping and food during the Spring Festival holiday last year. 

The holiday is also one of the most profitable periods for the Chinese box office, but there are concerns that potential moviegoers might stay home to avoid sitting in enclosed spaces with strangers.
Many also take advantage of the weeklong holiday to travel abroad, particularly in the region, but may be forced to change their plans this year.
Tsai Ing-wen, Taiwan’s president, said on Wednesday that all travel by tour groups between Wuhan and Taiwan would be suspended, a day after her government confirmed the island’s first case of the new coronavirus.
In Hong Kong, one of the biggest travel agencies said it was cutting all tour groups to, or passing through, Wuhan until the end of March, according to news reports.
Airports around the world have stepped up screening measures for travelers arriving from Wuhan. The health authorities in Hong Kong are also requiring airlines to distribute health declaration forms and to make face masks and antiseptic wipes available at boarding gates for passengers arriving from Wuhan.
Experts have warned that with the travel rush already underway this week, the virus’s continued spread may be inevitable.
Zhong Nanshan, a prominent scientist who is leading a government-appointed panel of experts working to control the outbreak, singled out the cramped train rides that many Chinese have to endure during the holiday as potential hotbeds of transmission.
Buying masks at a pharmacy in Wuhan on Wednesday.

The government, particularly in Wuhan, has drawn public criticism at home for a delay in the reporting of cases that evoked the memory of a 2002-2003 outbreak of SARS in which the Chinese government withheld critical information. 

A top committee of the ruling Communist Party warned officials on Tuesday in a social media post that anyone who sought to hide infections would be “forever nailed to history’s pillar of shame.”
Outside of China, countries including the United States and Australia have stepped up screenings and security measures at airports for travelers coming from China. 

Experts say there is still a risk that the symptoms of the virus don’t become apparent until after the sick have crossed the border, as was the case in the United States, where the first confirmed case was a resident of Snohomish County, Wash., who had recently traveled around Wuhan.
But some experts are urging the public to remain calm.
“This is a SARS-like event but not as severe as SARS,” said Wang Linfa, director of the emerging infectious disease program at Duke-NUS Medical School in Singapore. 

“During an outbreak like this from an unknown pathogen, overreacting might be better than underreacting, but we still have to be realistic.”

Taiwan confirms case of killer Chinese coronavirus as six patients have now died from SARS-like infection in China as more than 300 patients across Asia have now caught the deadly illness

• Chinese officials yesterday confirmed the virus has spread between humans
• Fifteen healthcare workers have caught the respiratory virus, figures show
• A total of 304 people in Asia have now tested positive for the unnamed virus
• Three other countries have reported cases -- Thailand, Japan and South Korea
• Three more deaths have been announced today, taking the death toll to six.

By STEPHEN MATTHEWS

A total of 304 people are confirmed to have caught the illness, with another 54 cases suspected and more than 900 people under observation (Pictured: The most recently available breakdown of where cases have been diagnosed).

Taiwan has confirmed its first case of the lethal Chinese coronavirus, which has killed six and sickened more than 300 people.
Health officials in the Asian territory announced a woman, thought to be around 50 years old, had caught the never-seen-before virus.

She is currently in hospital receiving treatment, according to local media.
It comes after the mayor of Wuhan – at the centre of the outbreak – announced two more victims of the lethal SARS-like infection this morning.
A total of 304 people are confirmed to have caught the virus, with another 54 cases suspected and more than 900 people under observation.Australia and the Philippines have also reported suspected cases of the coronavirus, which China yesterday admitted has spread between humans.
The World Health Organization will hold an emergency meeting later in the week to discuss the outbreak, which has already spread to Thailand, South Korea, Japan and now Taiwan.
Fifteen healthcare workers have caught the respiratory virus while treating patients. 

Cases have soared six-fold in the space of a few days.
Public health officials in the UK have issued advice to the NHS on how to deal with potential cases – but renowned virologists say the outbreak is 'unlikely to go global'.
Stock markets in China and Hong Kong dipped today amid fears tourists will refrain from travelling, despite people being urged not to panic. 

But shares in firms which make surgical face masks have surged as investors expect sales to rise as people seek to protect themselves.

Workers at Almaty International Airport in Kazakhstan are using thermal scanners to detect travellers from China who may have symptoms of the coronavirus sweeping Asia
Malaysian officials use thermal imaging scanners and cameras to check passengers for fevers upon their arrival at the Kuala Lumpur International Airport
Malaysia is one of many countries that have stepped up their passenger screening, with airport workers screening travellers for symptoms of the virus
Pictured: A close-up of travellers on the thermal imaging camera at Kuala Lumpur International Airport
South Korean cleaners prepare to disinfect the facilities at the customs, immigration and quarantine area at Incheon International Airport
Officials at Taiwan's Center for Disease Control use thermal scanners to screen passengers arriving on a flight from China's Wuhan province
A child wears a facemask at Daxing international airport in Beijing as he heads home for the Lunar New Year
The outbreak is believed to have started late last month among people connected to a seafood market in Wuhan, where all six fatalities have happened
An official uses an infrared thermometer on a traveler at a health screening checkpoint at Wuhan Tianhe International Airport. Wuhan is at the centre of the outbreak
Staff in biohazard suits hold a metal stretcher by the in-patient department of Wuhan Medical Treatment Centre, where patients are being treated for the new coronavirus
Quarantine workers spray disinfect at Incheon International Airport in South Korea. South Korea confirmed its first case on January 20 after a 35-year-old woman arriving at Seoul’s Incheon airport tested positive for the virus.

WHAT DO WE KNOW ABOUT THIS OUTBREAK SO FAR? 
A total of 304 people are confirmed to have caught the unnamed coronavirus, which has never been seen before. 

Six patients have died.
Most of the cases have occurred in Wuhan, a city in Hubei province home to 11 million people. 

But patients have been diagnosed across China, including in Beijing and Shanghai.
The coronavirus, which is from the same family as SARS, has also spread to South Korea, Thailand, Japan and Taiwan.
Chinese officials yesterday confirmed the virus has spread between humans, suggesting it can be passed through coughs and sneezes.
The outbreak is believed to have started late last month among people connected to a seafood market in Wuhan, which has since been shut.
China is entering its busiest travel period due to the Lunar New Year, which sees many people travelling back to their home town or village.
Virologists fear the increased travel that will happen over the holidays will cause a surge in cases.
So where have cases been recorded?
IN CHINA
Hubei province, 270 cases, 6 deaths
Guangdong province, 14 cases
Zhejiang province, 1 case
Shanghai, 6 cases
Beijing, 5 cases
Tianjin, 2 cases
Zhengzhou, 1 case

ABROAD
Thailand, 2 cases
South Korea, 1 case
Japan, 1 case
Taiwan, 1 case

The outbreak is believed to have started late last month among people connected to a seafood market in Wuhan, where all six fatalities have happened.
State media reported on a fourth victim this morning – an 89-year-old is home to 11 million people, later revealed there had been two more deaths – a 66-year-old man, known only as Li, and a 48-year-old woman, known only as Yin. 

Both died from multiple organ failure. Zhou Xianwang said there has been a total of 258 cases in Wuhan. 

Twelve cases have been recorded elsewhere in Hubei province, where Wuhan is the capital.
Other cases have been confirmed today in Tianjin – a port city just outside of Beijing, as well as one in Zhejiang province, one in Zhengzhou and four more in Shanghai.
Wuhan officials have today said they will pay for all medical costs for patients infected with the virus.
Professor John Oxford, a virologist at Queen Mary College, admitted he was 'quaking in my shoes' over the potential spread of the virus that could happen over the Chinese New Year.
He told LBC: 'None of us have faced a new virus faced with so many people in a community travelling around. That's what's going to happen in China at the end of the week. Once they are close together in taxis or small rooms, then there may be a problem.'

And Professor Oxford added: 'The only way to stop it is physical cleaning and social distance --keeping away from people.'
Locals have made more than four million trips by train, road and air since January 10 in the annual travel rush for the most important holiday in the country.
The transport peak season will last until February 18 and see three billion trips made within China, according to official statistics.
Australian officials today announced a traveller had been placed in quarantine with symptoms of the virus after returning home from a trip to China.

Two patients in southern China have caught the virus from infected family members, according to local media. Pictured, Chinese residents wear masks in Wuhan.

China reported on January 20 the mysterious virus had spread across the country from Wuhan. Pictured, medical staff at Jinyintan hospital, Wuhan.

CHINESE TOUR FIRMS OFFER FREE CANCELLATIONS ON TRAVEL BOOKINGS 
Chinese travel booking platforms are offering free cancellations on bookings made for Wuhan amid mounting fears over the coronavirus outbreak.
The firms offering customers the cancellations include Trip.com, Alibaba Group's Fliggy, Meituan Dianping and Qunar.com.
The travel booking platforms said that Chinese civil aviation and railway authorities had still to set a special cancellation policy.
But the firms added that they would try to meet the needs of customers wanting to cancel their trips.
China is entering its busiest travel period due to the Lunar New Year, which sees many people travelling back to their home town or village
The holiday is a high season for tourism and retail industries in China and overseas, but fears of the outbreak may mean many opt to stay home.

The man is being kept at his home in Brisbane as he awaits test results for the virus.

Earlier tests were inconclusive, Queensland health chiefs said.
The suspected case prompted Prime Minister Scott Morrison to warn Australians travelling to China to 'exercise a high degree of caution' in China’s Wuhan area.
The authorities in Wuhan are taking their own precautions and are using infrared thermometers to scan people from a distance to try and pick out possible cases.
Scanners have been put in place at airports, railway stations and coach stops around the city, which is home to some 11million people.
Medics have also been filmed reportedly scanning people's heads to take their temperatures on-board a flight leaving Wuhan on Monday.
The Philippines also announced today that it was investigating its first potential case of the coronavirus.
A five-year-old child arrived in the country on January 12 from Wuhan and has since been hospitalised with flu symptoms.
While the child tested positive for a virus, authorities in Manila said they were not sure if it was the same one that has killed four people in China.
Over the weekend, 136 fresh infections were reported in Wuhan, bringing the total number of cases China has confirmed to more than 200
The majority of patients have been traced to the Huanan Wholesale Seafood Market (pictured)
Ash Shorley, 32, is fighting for his life in Thailand and is feared to be the first Western victim of the coronavirus sweeping across China
Mr Shorley is in critical condition in a hospital in Phuket after being struck down with the pneumonia-like lung infection while visiting Koh Phi Phi island.

WHAT DO WE KNOW ABOUT THE NEW CHINESE VIRUS? What is this virus?The virus has been identified as a new type of coronavirus.
Coronaviruses are a large family of pathogens, most of which cause mild respiratory infections such as the common cold.
But coronaviruses can also be deadly. 

SARS, or severe acute respiratory syndrome, is caused by a coronavirus and killed hundreds of people in China and Hong Kong in the early 2000s.

Why hasn’t it been named yet?
The virus has not been named, although commonly goes by ‘nCoV2019’, which stands for novel (new) coronavirus 2019.
When a virus emerges slowly, as this one has, scientists have to work quickly to understand its severity, how it is spread and how deadly it is.
Jeremy Farrar, a specialist in infectious disease epidemics and director of the Wellcome Trust global health charity, said he thinks the virus will be named over the coming weeks and months because it is the ‘least important decision at the moment’.

What symptoms does it cause?
Its symptoms are typically a fever, cough and trouble breathing, but some patients have developed pneumonia, a potentially life-threatening infection that causes inflammation of the small air sacs in the lungs.
People carrying the novel coronavirus may only have mild symptoms, such as a sore throat. 

They may assume they have a common cold and not seek medical attention, experts fear.

How is it detected?
When the outbreak started in December 2019, the Wuhan Municipal Health Commission said hospitals across the city had treated a 'successive series of patients with unexplained pneumonia'.
After investigations, a never-before-seen strain of coronavirus was identified and reported on January 9.
The virus's genetic sequencing was released by scientists in China to the rest of the world to enable other countries to quickly diagnose potential new cases. 

This helps other countries respond quickly to disease outbreaks.
To contain the virus, airports are detecting infected people with temperature checks. 

But as with every virus, it has an incubation period, meaning detection is not always possible because symptoms have not appeared yet.
The incubation period of nCov2019 is not known. 

Research by Imperial College London suggested there is a 10-day window between someone being infected and detected, based on the evidence so far.

Can it kill?
Three people have so far died after testing positive for the virus. 

The first two patients who died suffered other health problems, so it is possible the virus is more lethal in vulnerable people.
The first patient, a 61-year-old-man, had abdominal tumours and chronic liver disease. 

The second, who was 69, had severe cardiomyopathy – a heart condition, abnormal kidney function, and seriously damaged organs.
Details about the third death have not been revealed.

How is it spread?
Investigations have focused on animals as the source because the majority of the first infected patients in Wuhan were traced to the Huanan Wholesale Seafood Market, which has been shut down since January 1.
On January 14, the World Health Organization said there is some 'limited' human-to-human transmission of the virus.
Professor Zhong Nanshan, a scientist at China’s National Health Commission, said human-to-human transmission is 'affirmative', in a press conference on January 20.
Two patients in southern China caught the virus from infected family members, according to local media. 

They had not visited Wuhan.

'The child is considered a person under investigation,' Philippine health secretary Francisco Duque told a press briefing in Manila.
Samples from the child were sent to a laboratory in Australia for further testing and authorities are awaiting the results.
The child had a fever, throat irritation and a cough before arriving in the central city of Cebu with a parent, the health department said.
Three other travellers from China were checked by authorities at another airport, but they did not show symptoms that corresponded with the coronavirus.
Increased control measures have been enforced at many places, with scientists still uncertain of the outbreak’s nature and mode of transmission.
But Professor Zhong Nanshan, of China's National Health Commission, said human-to-human transmission was 'affirmative' in a press conference yesterday.
'Currently, it can be said it is affirmative that there is the phenomenon of human-to-human transmission,' he said, according to state broadcaster CCTV.
Two patients in southern China caught the virus from infected family members, and had not visited a seafood market thought to be at the centre of the outbreak.
Huanan Wholesale Seafood Market has been closed and under investigation since January 1 as scientists scramble to determine where the virus has come from.
In the same interview with CCTV, Professor Nanshan said 14 medical workers had been infected after treating a patient with the coronavirus.
Details about the healthcare workers have not yet come to light and only been discussed by Professor Nanshan.
A total of 222 people in Asia have now tested positive for the virus, which marks a sharp increase from the 48 on January 17. 
The outbreak has spread within China, with cases recorded in Guangdong province, as well as Beijing and Shanghai.
People in China have been urged not to panic and to try and enjoy the festive season.
A piece in Chinese newspaper the Global Times said on Sunday: 'The entire Chinese society should be vigilant but should not be in panic. We should make the upcoming Spring Festival happy and peaceful, and also pay close attention to every link where the pneumonia may increase transmission.'
Three other countries have also reported cases of the virus -- Thailand, Japan and South Korea.
The World Health Organization (WHO) said earlier an animal source seemed to be 'the most likely primary source' of the virus.
Jeremy Farrar, a specialist in infectious disease epidemics and director of the Wellcome Trust global health charity, raised concerns about the number of people travelling through Wuhan.
He said: 'Wuhan is a major hub and with travel being a huge part of the fast approaching Chinese New Year, the concern level must remain high.
'There is more to come from this outbreak.'
He added that coughing is the 'quickest way to spread an infection around the world'. 'Whenever you get something new happening in humans, especially when it is spread by coughing, it is always a worry. It could get worse, it could get better – but you have to plan for it getting worse,' Mr Farrar told MailOnline.
China is entering its busiest travel period due to the Lunar New Year, which sees many people travelling back to their home town or village.
Countries including Japan, Australia and the US have adopted screening measures for those arriving from China due to concerns about a global outbreak like that caused by severe acute respiratory syndrome (SARS), which spread from China to more than a dozen countries in 2002 and 2003 and killed nearly 800 people.
An analysis from Imperial College London last week estimated the number of cases in Wuhan was probably around 1,700 – but could even be as high as 4,500.
The team did not look at how the virus may be transmitted, but said 'past experience with SARS and MERS-CoV outbreaks of similar scale suggests currently self-sustaining human-to-human transmission should not be ruled out.'
South Korea confirmed its first case on January 20 after a 35-year-old woman arriving at Seoul’s Incheon airport tested positive for the virus. She had been in Wuhan last week.

On Tuesday afternoon Mr Morrison urged Australians to 'exercise a high degree of caution'

Footage on social media purports to show medics in hazardous material suits checking Chinese passengers one by one with thermometers. The clip is reported to be filmed on an Air China flight from Wuhan to Macau on January 12 after the plane arrived at the airport in Macau.

Last week, one case was confirmed in Japan and two in Thailand, meaning the total number of confirmed cases outside of China now sits at four.
A British tourist fighting for his life in Thailand is feared to be the first Western victim, but this has not been confirmed.
Ash Shorley, 32, is in critical condition in a hospital in Phuket after being struck down with a lung infection while visiting Koh Phi Phi island.
Mr Shorley had to be transported to hospital by a specialised seaplane because his lung had collapsed and he could not cope with high altitude travel.
Doctors revealed his symptoms were consistent with the Chinese coronavirus. 

He has been in hospital for nearly a month.Public Health England maintains that the risk of travellers becoming infected is 'very low', and 'low' for those travelling specifically to Wuhan.
Dr Nick Phin, a deputy director at PHE, said: 'We have issued advice to the NHS and are keeping the situation under constant review.
'People travelling to Wuhan should maintain good hand, respiratory and personal hygiene and should avoid visiting animal and bird markets or people who are ill with respiratory symptoms.
'Individuals should seek medical attention if they develop respiratory symptoms within 14 days of visiting Wuhan, either in China or on their return to the UK, informing their health service prior to their attendance about their recent travel to the city.'

A plague to make panic go viral: 
As the Chinese coronavirus claims more victims, top historian PETER FRANKOPAN examines the lesson from the past that has a chilling resonance today
The nightmare is all too real. 

A man arrives at a health centre, complaining of a sore throat, fever and headache. 

Another person arrives soon after; then another. 

By lunchtime, there are dozens; within a week, hundreds.
The winter months usually see an onset of influenza. 

But this time far more people than normal are infected.
That is not the only strange thing. 

Usually, the flu virus flourishes among the young and the old, with less robust immune systems. 

But those turning up to see the doctor are primarily in the prime of life, aged 20 to 40, who usually have no problem seeing off what is usually a seasonal bug.

FACT BOX TITLE
December 31 2019: The WHO China Country Office was informed of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province of China. 

Around 44 suspected cases were reported in the month of December.
January 1 2020: A seafood market was closed for environmental sanitation and disinfection after being closely linked with the patients.
January 5 2020: Doctors ruled out severe acute respiratory syndrome (SARS) as being the cause of the virus, as well as bird flu, Middle East respiratory syndrome and adenovirus. 

Meanwhile, Hong Kong reported
January 9 2020: A preliminary investigation identified the respiratory disease as a new type of coronavirus, Chinese state media reported.
Officials at Wuhan Municipal Health Commission reported the outbreak's first death on January 9, a 61-year-old man.
January 13 2020: A Chinese woman in Thailand was the first confirmed case of the mystery virus outside of China. 

The 61-year-old was quarantined on January 8, but has since returned home in a stable condition after having treatment, the Thai Health Ministry said.
January 14 2020: The WHO told hospitals around the globe to prepare, in the 'possible' event of the infection spreading.
It said there is some 'limited' human-to-human transmission of the virus. 

Two days previously, the UN agency said there was 'no clear evidence of human to human transmission'.
January 16 2020: A man in Tokyo is confirmed to have tested positive for the disease after travelling to the Chinese city of Wuhan.
A second death, a 69-year-old man, was reported by officials at Wuhan Municipal Health Commission. 

He died in the early hours of January 15 at Jinyintan Hospital in Wuhan city having first been admitted to hospital on December 31.
January 17 2020: Thailand announces it has detected a second case. 

The 74-year-old woman had been quarantined since her arrival on Monday. 

She lived in Wuhan.
Scientists at Imperial College London fear up to 4,500 patients in Wuhan may have caught the virus. A report said if cases are this high, substantial human to human transmission can't be ruled out.
John F Kennedy International Airport (JFK), San Francisco International Airport and Los Angles International Airport (LAX) will start screening passengers arriving from Wuhan, US officials said.
January 20 2020: China reported a sharp rise in the number of people infected with a new coronavirus over the weekend, including 136 more cases in Wuhan city.
The outbreak spread across China, as authorities in Shenzhen in southern China reported one case, and Chinese state media said Beijing had reported two cases.
South Korea confirmed its first case -- a 35-year-old woman arriving at Seoul’s Incheon airport tested positive for the virus. 

She had been in Wuhan the week prior.
The total number of confirmed cases reached 205, including three deaths and four confirmed cases outside China.
Details were not revealed about the third death.

Soon it becomes clear that something is very wrong. 

It turns out that those who are sick are not coming just to one hospital in a single town; they are turning up everywhere. 

Literally everywhere. All over the world. 

A quarter of the world’s population report symptoms. 

And then people start dying. In large numbers.
The scale is frightening. 

In the U.S., where a third of the population are infected, hundreds of thousands die. India pays a terrible price as 18 million succumb.
This is no Hollywood blockbuster, hoping to scare its way to box office success. This is what happened 100 years ago as the Spanish flu took hold.
Between January 1918 and the end of the following year, 500 million people had become infected. By the end of the outbreak, perhaps as many as five per cent of all the men, women and children on the planet lay dead.
Only a century on, no wonder health officials have been so concerned about the emergence of ‘2019-CoV’, a new strain of coronavirus that emerged recently in the city of Wuhan in China and which has infected more than 200 people, killing at least three.
The true figure of the dead and infected may well be higher: the Chinese authorities have been accused of covering up the scale of the outbreak, while scientists at Imperial College London have suggested that ‘substantially more cases’ have taken hold.
The new coronavirus strain has been found in neighbouring Japan, Thailand and South Korea, and has infected at least one Briton, backpacker Ashley Shorley, 32, who fell ill while travelling in Thailand and was airlifted to hospital.
It does not even matter where an outbreak of an infectious disease originates. 

In our interconnected world, a disease can potentially infect billions in weeks or less.
Airlines carry infected people from one side of the planet to another, faster than at any time in history.
London is connected to Wuhan by three direct flights per week. 

Almost every other city on Earth is a maximum of 18 hours away.
So although the death toll from the new strain of coronavirus has, mercifully, so far remained low, the lesson of history is that global pandemics have struck many times, playing a key role in shaping — and ending — civilisations.
One will strike again: the only question is when. 

The World Health Organisation has been warning of these dangers for some time, reminding us that global pandemics represent a major threat to human existence.
Perhaps the most famous case was the Black Death that swept through Asia into the Middle East, Europe and Africa in the middle of the 14th century. 

Those infected with the yersinia pestis bacterium suffered terribly as their organs were attacked in turn, with bags of pus and blood pooling at the lymph nodes in the armpit or groin, then multiplying to cause swellings that could grow as large as an apple.
The haemorrhaging of poisoned blood that turned black gave the outbreak of plague its name.
Large-scale outbreaks of plague have been closely connected to climate change, meaning that the disease moves beyond its local habitat and spreads rapidly.
This is what happened in the AD540s, when the ‘Justinianic plague’ (named after the Byzantine Emperor Justinian) was so devastating that there were said to be not enough people to bury the dead in Constantinople (now Istanbul). 

Bodies were dumped in empty towers and left to rot, producing a foul smell across the city.
Plague kills quickly: when there is no one left, it dies out, which in turn means that quarantine is a useful strategy against it.

Wuhan residents have made made more than four million trips by train, road and air since January 10 during the annual Lunar New Year travel rush. Above, a screen grab from CCTV's news programme shows flocks of passengers leaving Wuhan Train Station on Monday
Experts from the country's National Health Commission have urged Wuhan's 11 million residents not to leave the city after finding 'affirmative' evidence that the fatal virus could spread between humans. The life-threatening virus has killed six people in the Chinese city
World Health Organization officials called an emergency meeting o Monday to discuss whether the coronavirus outbreak stemming from China comprises a global emergency (file).

Isolating the infected has been used regularly in Africa in recent decades to contain another devastating disease.
First identified in 1976, ebola virus causes bleeding, vomiting and diarrhoea, weakening the liver and kidneys and often killing its host in a matter of days.
It is highly infectious, being passed through fluid exchange during sex, kissing, from sweat, breastmilk or exposure to an open wound via mucous membranes in the eyes, mouth and nose. Clothing contaminated with body fluids from someone infected can also spread the virus.

TOURISM STOCKS HIT BY VIRUS FEARS BUT FACE MASK MAKERS SURGE
Stock markets in China and Hong Kong saw share prices dip in tourism and retail sectors today over fears the outbreak will scare off tourists, the Financial Times reported.
Hong Kong's main index, the Hang Seng, fell by 2.8 per cent today, January 21, while the Shanghai Composite Index in China dropped by 1.7 per cent.
Analysts say the drop followed the Chinese health commission's announcement that the coronavirus outbreak was spreading between people, not just from animals. 

This raises the prospect of the outbreak becoming much more severe and fast-spreading.
The Chinese New Year will be celebrated this weekend and millions of people in East Asia are expected to travel during the festivities.
But tourism and shopping companies may see their profits take a hit if people change their plans for fear of the deadly virus spreading.
Major Chinese airlines saw their share values drop – Air China fell by 3.2 per cent and China Eastern by 3 per cent – and a company called Wharf Real Estate Investment, which runs shopping malls in Hong Kong, dropped by more than four per cent.
Economists told the FT the growing number of viral infections was 'extremely concerning' for businesses in China's big cities and Hong Kong.
While tourism firms saw their prospects hit, companies producing pharmaceuticals and those which make surgical face masks saw the opposite effect, surging over the weekend, according to CNBC.
The companies Jiangsu Sihuan Bioengineering, Shandong Lukang Pharmaceutical and Shenzhen Neptunus Bioengineering all saw stock values rise by about 10 per cent on Monday.
And shares in companies making face masks – notably Tianjin Teda and Shanghai Dragon – also jumped by between 9.8 and 10 per cent.
This happened after authorities revealed that the disease was able to spread between people, raising the risk of it developing into a serious outbreak.

There have been outbreaks in Africa — the most recent of which began in August 2018. In the past 18 months, at least 1,700 have died, with the situation becoming so worrying that last summer the World Health Organisation (WHO) issued a global health emergency.
Mercifully, preventive measures seem to have stalled ebola’s progress — at least for now.
Few experts have any illusions, though, of how close we have sailed to the wind — or how poorly prepared we are to face a pandemic.
A study produced by Johns Hopkins University in the U.S. last year warned that there are ‘severe weaknesses in countries’ abilities to prevent, detect and respond to significant disease outbreaks’. Most countries have almost no systems or agreements in place on how to co-operate in the event of a serious pandemic.
So concerned is the WHO that it has identified diseases that demand special attention.
These include the zika virus, which sprang to public attention in 2015 after an outbreak led doctors to urge women thinking of becoming pregnant to wait, so great were the threats of neurological problems and birth defects to unborn children from the mosquito-borne disease.
Most chilling, however, is that alongside well-known illnesses, such as severe acute respiratory syndrome (Sars, of which family the coronavirus is part), the WHO also includes another potential killer.
This is named simply Disease X: ‘a serious international epidemic’ that could be ‘caused by a pathogen currently unknown to cause human disease’.
Like something out of a dystopian film, this could come from a virus that has jumped the species barrier from animals and mutated to infect humans, killing us in huge numbers.
We live in a world where it is cheaper and easier to create and engineer new pathogens in laboratories, by mistake or on purpose. These can, of course, be released intentionally to cause harm — perhaps by a state seeking revenge for international humiliation or by a non-state perpetrator as an act of terrorism. 

Diseases can also escape by mistake or spill out of control. Any such scenario brings unknown, but potentially devastating, consequences.
The good news is that a century on from the Spanish flu, research capabilities, including the development of antibiotics, as well as improved sanitation, hygiene and medical care, mean we do have some weapons to wield against a major disease outbreak.
The internet and other modern channels for spreading information rapidly and widely would also prove important — but it is likely that, in the event of a new global pandemic, the authorities would have to spend a lot of time countering misinformation online.
In the event of Disease X emerging as a 21st-century plague, it is not inconceivable that airports and perhaps even cities would be shut down and quarantined — and not impossible that those within the quarantine zone would pay a terrible, deadly price.
The Wuhan outbreak may be just another tremor. 

But few should have any doubts. 

The problem about nightmares is that they are reflections of realities. As the past shows, sometimes they have come true.

Chinese Peril

CHINESE CORONAVIRUS CONTINUES TO SPREAD AHEAD OF LUNAR NEW YEAR, THE WORLD'S BIGGEST HUMAN MIGRATION
BY KASHMIRA GANDER

Health officials in China have increased monitoring efforts for a mysterious form of pneumonia which has affected over 100 people, as the country gears up for the Lunar New Year—the world's biggest human migration.
China has reported 139 new cases of the illness caused by a new coronavirus, the World Health Organisation said Sunday. 

The WHO said the reports were "the result of increased searching and testing" for the virus among people sick with respiratory illnesses.
According to Reuters, China's National Health Commission said over the weekend that the bug appeared to be "controllable". 

The organization will step up its efforts to track the infection as new year celebrations are due to start on January 24, with what is known as the Chunyun travel period set to last 40 days. 

According to Bloomberg, Chinese citizens will make up to three billion trips in what is the largest human migration on the planet. 

A spike in railway travel of 8 percent on last year is forecast.
Dr Suwannachai Wattanayingcharoenchai, head of Thailand's Department of Disease Control, said according to the Bangkok Post: "We are now on full alert to prevent a disease outbreak, especially during the coming Chinese New Year."
The WHO has not recommended any specific health measures for travelers. 

Individuals who have symptoms of a respiratory illness either during or after travel "are encouraged to seek medical attention and share their travel history with their health care provider," it said. 

The body advised travelers to keep up standard hygiene procedures to prevent the spread of a range of illnesses, including by washing hands and avoiding close contact with others, particularly "anyone showing symptoms of respiratory illness such as coughing and sneezing."
Coronavirus is the term used to describe a large family of viruses encompassing common colds as well as more serious illnesses such as Severe Acute Respiratory Syndrome (SARS). 

The virus has killed two people since it was first identified late last year in the city of Wuhan, about 700 miles south of Beijing with a population of more than 11 million people. 

One victim had serious underlying medical conditions, according to the U.S. Centers for Disease Control and Prevention (CDC).
On Sunday, the WHO said new cases had been detected outside the city within China for the first time "over the past two days," in the capital Beijing and Shenzhen. 

This comes after it was confirmed in travelers from Wuhan in Thailand as well as Japan according to the CDC. 

The Yonhap news agency reported on Monday, citing the Korea Centers for Disease Control, that a Chinese woman who had traveled to Wuhan last week had fallen ill at South Korea's Incheon International Airport.
Last week, the CDC announced travelers entering the U.S. from Wuhan would be screened for symptoms of the condition. 

This is planned for the airports which receive the most travelers from Wuhan: San Francisco (SFO), New York (JFK), and Los Angeles (LAX).


San Francisco International Airport (SFO)
✔@flySFO
In response to an outbreak in China caused by a novel (new) #coronavirus, @CDCgov will begin health screenings of travelers arriving from #Wuhan, China at SFO. https://bit.ly/2v13H1J #novelcoronavirus #2019nCoV https://twitter.com/CDCgov/status/1218252302647287808 …
CDC
✔@CDCgov
Replying to @CDCgov
Health screenings of travelers arriving from #Wuhan, China is part of a layered approach used with other public health measures already in place to slow and reduce possible spread of #2019nCOV into the United States. https://bit.ly/2v13H1J .

According to the CDC, over 60,000 people fly from Wuhan to the U.S. each year, with around 10 percent of the total annual travel between the China and the U.S. happening in January due to the Lunar New Year.
The health body stressed the available evidence suggests the virus poses a "low" risk to the American public, but said "nevertheless, CDC is taking proactive preparedness precautions."
Animals seem to be the most likely primary source of the coronavirus outbreak, the WHO said, but there is "some limited human-to-human transmission occurring between close contacts." 

Most infected patients were exposed to a market where live animals are kept in Wuhan, the CDC said citing Chinese health officials. 

This suggests "this is a novel virus that has jumped the species barrier to infect people," the CDC said.As more cases are identified and analyzed, the WHO said it hopes to "get a clearer picture of disease severity and transmission patterns.
"We will update and expand our guidance as we learn more," the body added.
A passenger walks past a notice for passengers from Wuhan, China displayed near a quarantine station at Narita airport on January 17, 2020 in Narita, Japan. Japan's Ministry of Health, Labour and Welfare has confirmed its first case of pneumonia infected with a new coronavirus from Wuhan City, China.

Plagues of China

Japan Confirms First Case of New Chinese Coronavirus

The detection of the virus in Japan adds to fears that it will spread outside China’s borders after a case was also reported in Thailand this week.
By Sui-Lee Wee

A seafood wholesale market in Wuhan, China, now shut down, where some people appear to have contracted the new coronavirus.

BEIJING — Japan on Thursday reported its first case of a new coronavirus that has sickened at least 41 people in China, adding to concerns about the spread of the virus beyond China’s borders ahead of a major holiday.
Japan’s Health Ministry said that a Chinese man in his 30s tested positive for the mysterious pneumonia-like coronavirus.
The man, a resident of Kanagawa Prefecture, just south of Tokyo, returned to Japan on Jan. 6 after traveling to the central Chinese city of Wuhan, the epicenter of the outbreak.
The man, who came down with a fever on Jan. 3, was hospitalized on Friday but was discharged five days later because he had recovered, according to the Health Ministry.
The World Health Organization said it was highly likely that the virus had spread from a seafood market in Wuhan that also sells live birds and other animals.
But Japan’s Health Ministry said the patient had not visited any seafood markets in China, adding that “it is possible that the patient had close contact with an unknown patient with lung inflammation while in China.”
Malik Peiris, a public health virologist at the University of Hong Kong, said, “If that was the case, that there had been no direct exposure to animals, then that is very concerning, for sure.”
It was the second confirmed case of the new coronavirus reported outside of China in the last week. In Thailand on Monday, the authorities detected the virus in a 61-year-old Chinese woman who was visiting from Wuhan, the capital of the central Chinese province of Hubei.
Dr. Sopon Iamsirithaworn, director of the communicable diseases division at Thailand’s Ministry of Public Health, said the woman had not visited the Wuhan seafood market, and had come down with a fever on Jan. 5.
However, the doctor said, the woman visited a different smaller market in Wuhan, in which live and freshly slaughtered animals were also sold.
The woman is in good health now, according to Dr. Suthat Chottanapund, a senior official in the disease control department of Thailand’s Public Health Ministry.
But, he said, the health authorities were waiting for laboratory results to confirm that the woman is free of the coronavirus before discharging her.
She said that she wanted to do some sightseeing after she leaves the hospital, he said.
The revelation that neither the patient in Japan nor Thailand had visited the Huanan Seafood Market, to which most of the cases have been linked, is a troubling sign that the outbreak could be spreading in Wuhan.
The market was shut down and disinfected on Jan. 1, but new cases have appeared since, suggesting the virus has not been eradicated.
Concerns have grown across the region since the Chinese health authorities announced the discovery of the new mysterious virus that has caused dozens of people in Wuhan to fall ill with a pneumonia-like illness.
The city’s health commission said on Wednesday that the risk of human-to-human transmission is low but possible.
Officials also said they detected the first cluster of the virus involving members of a single family.
The new virus has stirred memories in China of the 2003 outbreak of severe acute respiratory syndrome, or SARS.
That virus, which is believed to have jumped to humans from animals at markets, originated in China and killed more than 800 people worldwide in 2002 and 2003.
At the time, the Chinese government tried to cover up the problem, resulting in a backlash among its people.
While flu experts have said the Chinese government is trying to be more transparent now, many in China are skeptical.
The local authorities in Wuhan and the W.H.O. have reiterated for weeks that no cases of human-to-human transmission have been confirmed.
Last week, researchers in China said they had “initially identified” a new coronavirus as the pathogen behind the mysterious new respiratory illness.
Of the 41 cases diagnosed in Wuhan, the majority of patients were middle-age and older men, the city’s health commission said on Wednesday.
Last weekend, the local authorities said one 61-year-old man died after contracting the virus.
The most recent case in China was detected on Jan. 3.
The minimum incubation period for some viral infections is 15 days, suggesting that it could be a few more days before the authorities are able to determine the full extent of the outbreak.
That timeline has fueled concerns among governments across the region, especially ahead of the Lunar New Year holiday, which begins next week.
Hundreds of millions of people in China are expected to travel during the holiday.
Thailand expects more than 300,000 Chinese visitors during the holiday, according to local tourism officials.
Hong Kong, Singapore, Thailand and South Korea have taken precautionary measures, quarantining patients with flu-like symptoms and increasing temperature screenings at their airports.
Japan said it was investigating who the patient there had been in contact with since he returned from China and has asked people who experience symptoms to report them.
While the new coronavirus appears to be less virulent and deadly than SARS, many questions remain, including the source of the virus and its transmission route.
Infectious disease experts say the source is very likely to be a mammal because coronaviruses spread easily from mammals to humans.
Coronaviruses are a large family of viruses that infect animals and people.
Symptoms of different coronaviruses can include those that resemble the common cold, influenza or pneumonia.
“There’s no need to panic but I think there needs to be an urgency to address these questions,” said Dr. Peiris of the University of Hong Kong.
“The problem is that most of these animals are illegally sold, so that might not be so easy to do.”
Dr. Peiris said he was encouraged that there were no cases of hospital workers falling ill, reducing the likelihood of a widespread outbreak within the community, as there had been with SARS.
Guan Yi, a professor of infectious diseases at the University of Hong Kong, said he was also reassured that the Wuhan government had not reported any new cases in recent days.
“If there are no new cases in the next few days, the outbreak is over,” said Dr. Guan, who was part of a team that successfully identified the coronavirus that caused SARS.

Plagues of China

China Responds Slowly, and a Pig Disease Becomes a Lethal Epidemic

The bungled effort to contain Chinese swine fever could result in higher food costs for years and shows the limits of Beijing’s top-down approach to problems.
By Keith Bradsher and Ailin Tang

Buyers and sellers at a pork wholesale market in Beijing.

WULONGQIAO, China — A devastating disease spreading from China has wiped out roughly one-quarter of the world’s pigs, reshaping farming and hitting the diets and pocketbooks of consumers around the globe.
China’s unsuccessful efforts to stop the disease may have hastened the spread — creating problems that could bedevil Beijing and global agriculture for years to come.
To halt Chinese swine fever, the authorities must persuade farmers to kill infected pigs and dispose of them properly. 

But in China, officials have been frugal to the point of stingy, requiring farmers to jump through hoops to seek compensation from often cash-poor local governments.As a result, Chinese officials are not reaching farmers like Peng Weita. 

When one of his pigs suddenly died three months ago from swine fever, he said, he quickly slaughtered his other four dozen before they could fall sick as well. 

But he buried them and took a big loss rather than reporting the deaths to the government for compensation.
“Three years of costs were all for nothing,” Mr. Peng said.
His loss was the government’s as well. 

Because he did not report the episode, local officials could not make sure he followed all the steps necessary to halt the spread, like burying carcasses a considerable distance from the farm. 

Mr. Peng said he probably buried them too close to his farm but declined to discuss details of the disposal.
The epidemic shows the limits of China’s emphasis on government-driven, top-down solutions to major problems, sometimes at the expense of the practical. 

It has also laid bare the struggle of a country of 1.4 billion people to feed itself.
China has long viewed food security as tantamount to national security. 

It had become essentially self-reliant in pork as well as in rice and wheat thanks to subsidies and aggressive farmland management. 

The swine fever epidemic will test that commitment to its increasingly affluent people, who more often expect meat at the dinner table.
The pig disease — which is not fatal to humans but can be spread by us — has now extended swiftly out of China. 

It has moved across nine other Asian countries, particularly Vietnam, which is the world’s fifth-largest pork producer and has lost much of its herd this autumn. 

Before reaching China, the disease had been slowly infecting occasional farms in Russia and elsewhere in Eastern Europe.
Powered by pork, China’s overall food prices last month were one-fifth higher than they were a year ago, after seven years of little change. 

Large purchases of pork by China are driving up live hog prices in the United States, Europe and around the globe, pushing up costs for everything from German sausages to Vietnamese pork meatballs.
Beef and lamb prices have risen as families worldwide seek alternatives, so much so that overall meat prices in international commodity markets have increased nearly 20 percent in the past year. 

Brazil is now ramping up beef and chicken production to meet demand, partly by burning forests in the Amazon to clear land for agriculture.
Workers unloading pork carcasses from trucks at a warehouse that is part of a network of China’s national pork reserve, in the outskirts of Beijing.

“The epidemic could have broad and deep economic impacts at the global level,” said Boubaker Ben Belhassen, the director of trade and markets at the United Nations’ Food and Agriculture Organization in Rome. 

“There’s enough pork in the world to offset China’s shortfall.”

China used to have 440 million pigs — almost half the world’s population — but its herd has shrunk by half or more, according to Rabobank, a Dutch bank with a heavy agricultural focus. 

Pork prices in China have more than doubled.
The problem has become so pressing that Beijing accepted a partial trade deal with the United States last month, in part to resume imports of American food. 

Pig prices have climbed so high that one livestock company, Guangxi Yangxiang, printed red banners to recruit potential farmers that read, “Raise 10 sows and drive a BMW next year.”
Stopping the epidemic was always going to be tough. 

Small farms, often packed together in crowded agricultural areas, produce nearly half of China’s pigs. To stop diseases from spreading, Chinese officials have to reach millions of traditional small farmers.
China’s leadership has focused on remaking farming to stop the spread. 

With generous subsidies, Beijing has ordered governments and businesses to build industrial-scale farms with safeguards like quarantine areas for new arrivals and incinerators for diseased pigs.
That solution could help long-term, but China’s immediate response has made the spread worse.
When the swine fever began to spread 16 months ago, the Ministry of Agriculture told the country’s local governments to cull all pigs in herds if there was even one sick animal, and to compensate the farmers. 

The ministry authorized local governments to pay up to $115 for the largest pigs, a cap later raised to $170. 

Before the epidemic, however, many pigs sold for $250 or more apiece, particularly breeding sows, according to government data. 

With the epidemic, the price has soared to $600 or more.
To get that partial reimbursement, many farmers had to deal with tightfisted local officials. 

The ministry said it would reimburse local governments only for between 40 percent and 80 percent of their costs. 

Local governments also had to provide proof, often including laboratory tests, that pigs died of Chinese swine fever and not some other ailment.

Su Dezhi, a 34-year-old butcher in Guo Village, said that he had gone from selling two pigs a day worth of pork to half a pig.

As a result, culling has been slow. 

Official data show only 1.2 million pigs, or less than 0.3 percent of the country’s herds, have been culled. 

It is not clear where the rest of the country’s vanished herds went, but food experts say many were likely butchered and turned into food. 

That would worsen the spread, because the disease can lurk in meat for months.
Australia has found that almost half of the sausages and other pork products carried by recently arriving Chinese passengers or the mail were contaminated, said Mark Schipp, the president of the 182-nation World Organization for Animal Health in Paris and Australia’s chief veterinarian.
In Wulongqiao, a quiet village in the low, pine-studded hills of northern Hunan Province, a number of farmers said they did not bother with seeking compensation, citing the low payout.
Where many pigs went is a mystery. 

Mr. Peng, the farmer, said that when he slaughtered his pigs, he had panicked and buried them in secrecy, and so had no record of what became of them. 

He filed for the loss under his commercial insurance, which covered only a tenth of the value of the pigs, he said.
Chinese officials have tried to be reassuring. 

In April, July and October, officials said they had brought the disease under control, only to see signs of further spread. 

Each new statement was provided by a less senior official than the one before. 

Most recently, the agriculture ministry said that it only hoped production at the end of next year would be four-fifths of normal levels — still a shortfall equal to the entire pork production of the United States, the world’s second-largest pork-producing nation.
For now, dying pigs and rising pork prices are changing diets and cooking practices across China.
Su Dezhi, a pork butcher at an open-air market about 20 miles from Mr. Chen’s farm, said that he used to buy and carve up two pigs a day for sale. 

Now he can only sell half a pig a day. 

The wholesale price per pound for him to buy pigs has more than tripled.
“I can barely cover my costs,” he said, a large cleaver in his hand as he stood behind a table with only a few bloody slabs of pork.

Chen Zhixiang, 36, is among the very few pig farmers in Wulongqiao who have not lost any pigs.

Yet many in China seem reluctant to eat anything else. 

Across an aisle from Mr. Su stood several large cages full of chickens and ducks. 

But the poultry vendor, She Xinbao, said that his sales had only increased from about 30 birds a day to 33 or 34, partly because poultry prices have also risen.
Those who have pigs have enjoyed the surging prices. 

Chen Zhixiang, a 36-year-old pig farmer with a black dragon tattoo on his right forearm, is among the very few pig farmers in Wulongqiao who have not lost any pigs. 

He said he had cooked meals for his pigs from raw corn this year rather than buy feed that might be contaminated.
Pigs have become so rare in his part of Hunan Province that when he drives to a village these days to sell an animal or two, he draws a crowd.
“People gathered around the truck to stare at them,” he said. 

“It’s like they were seeing a panda.”

Plagues of China

China has the world's biggest hepatitis C problem, says WHO
By Julie Zaugg and Yong Xiong

In this picture taken on November 28, 2011, a Chinese parent shows a test result slip confirming his child has hepatitis C, at a hospital in Hefei, east China's Anhui province.

China is facing a hepatitis C epidemic. 

The infectious disease, which can lead to cirrhosis, liver cancer and early death if left untreated, has hit rural areas particularly hard.
In June, China recorded 21,419 new cases of hepatitis C and 14 deaths related to the disease, according to new figures released by China's Center for Disease Control and Prevention. 

For the whole of 2018, the country had 219,375 new cases -- 43% more than in 2010.
China now has the world's largest burden of hepatitis C -- an estimated 8.9 million people, or 0.6% of the overall population -- according to a WHO study released in March. 

Many of them will die from it: China accounts for more then half of the world's annual liver cancer fatalities caused by hepatitis C, according to the study.
The disease is commonly spread by shared needles. 

Consumption of crystal methamphetamine, which has snowballed in recent years in China according to the United Nations Office on Drugs and Crime and can be taken by injection or inhalation, has contributed to the growing number of new infections, according to the WHO.
In Yi Prefecture, a mountainous region in Sichuan province along a major trafficking route with a high proportion of drug users, nearly five times the national average -- 2.8% of the population -- have hepatitis C, according to a study published in 2017 in the British Medical Journal.
Another contributor to China's epidemic is "unsterile medical injections which are often administered for unnecessary reasons," say the WHO report's authors. 

In May this year, 69 dialysis patients were infected in eastern China's Jiangsu province, primarily by unclean equipment and hospital workers' hands, China Central Television reported in May.
To exacerbate the problem, hepatitis C patients in China are not getting the care they need. 

In 2018, just 3.5% of infected people in the country were treated, according to the Polaris Observatory, a non-profit US initiative.
And while the most advanced antiviral treatments for the disease can cure 90% of cases, many patients simply can't afford medication, especially in rural areas. 

Three new hepatitis C drugs were approved by China's Food and Drug Administration in 2017, but they are not covered by China's basic medical insurance, which means patients have to pay for them out of pocket, according the Beijing medicine purchasing database, a government list of medicine purchased by state hospitals.
A 12-week course of Sofosbuvir, one of the treatments not covered by basic insurance, costs 69,600 yuan ($9700 USD).

Plagues of China

China's pig virus threatens its $128 billion pork industry

By Brett Molina

Scientists and officials in China are trying to isolate a deadly pig virus threatening the nation's pork industry.
According to Reuters, an outbreak of Chinese swine fever was discovered on a farm in inner Mongolia. 

Eight pigs died and 14 more were infected.
Since August 1, the virus has spread to seven provinces in China, reports Bloomberg. 

About 40,000 pigs have died, disrupting a pork industry valued at $128 billion.
China has introduced several new rules to attempt to curb the spread of the virus. 

Reuters reports Chinese officials have banned transporting live hogs or pig products from areas bordering a province with an outbreak.
China also introduced bans on feeding kitchen waste or using feed from pig blood, reports Reuters.
Chinese swine fever is a virus affecting pigs. 

There is currently no vaccine to combat the disease, reports Bloomberg. 

Last month, the U.N.'s Food and Agriculture Association warned the outbreak could move to neighboring countries in Asia, reports The Associated Press.

Plagues of China

Dust storm chokes Beijing and northern China
BBC News

Beijing's skyline could barely be made out amid the dust on Thursday morning

A dust storm is choking a large swathe of northern China including the capital, Beijing, in yet another air quality crisis to affect the country.
Official air quality readings have soared well above the recommended World Health Organization (WHO) limit.
Authorities are advising residents to avoid outdoor activity and for children and elderly people to remain indoors.
The dust is blowing in from neighbouring Mongolia and China's Inner Mongolia Autonomous Region.

Officials have advised that children and the elderly stay indoors

Beijing's environmental agency said that as of 11:00 local time (03:00 GMT), the PM2.5 reading -- which measures pollution in the form of small breathable particles -- was 500 micrograms per cubic metre.
The WHO says the maximum safe level should be 25 micrograms per cubic metre.
Authorities said Beijing would be affected until Thursday evening and visibility would be noticeably low throughout the day. 

Dozens of flights have been delayed or cancelled.

Officials say visibility in Beijing will drop noticeably on Thursday

State media quoted city officials as saying that the dust storm began moving towards Beijing in the late afternoon on Wednesday, and enveloped the city overnight.
The dust storm has also affected, to varying degrees, a vast swathe of northern China stretching from the far west province of Xinjiang to eastern Heilongjiang, with Inner Mongolia experiencing particularly bad conditions.

Beijing environmental authorities issued an advisory saying residents should avoid outdoor activity

Chinese people have, as usual, not hesitated to take to social media to vent their frustration.
"Sandstorm is hitting Beijing. I feel closer to lung cancer," said one commenter on microblogging network Sina Weibo.
Others made comparisons to the capital's infamous smog problem.
"I've got used to smog, time to try something new. If I have to choose one to live in, between sandstorm and smog, I prefer the former," said another Weibo commenter.
China has seen particularly intense air pollution in recent years, especially in winter as many of its northern cities still largely rely on burning coal for heating.
But it is also increasingly affected by dust storms, as its cities expand towards nearby deserts which in turn have been spreading due to climate change.

There were some tour groups at Tiananmen Square in Beijing on Thursday despite the bad air quality

Authorities have been attempting to halt this progress by planting more trees, besides other measures to cut pollution such as reforming the coal industry and shutting factories.
Beijing issued its first red alert, the highest level in air pollution alerts, in 2015, and has done so a few more times since.

Plagues of China

Hard to detect, China bird flu virus may be more widespread
Reuters

A quarantine researcher checks on a chicken at a poultry farm in Xiangyang, Hubei province, China, February 3, 2017.

BEIJING – Bird flu infection rates on Chinese poultry farms may be far higher than previously thought, because the strain of the deadly virus that has killed more than 100 people this winter is hard to detect in chickens and geese, animal health experts say.
Poultry that have contracted the H7N9 strain of the avian flu virus show little or no sign of symptoms. 

That means any infection is only likely to be detected if farmers or health authorities carry out random tests on a flock, the experts said.
But in humans, it can be deadly.
That’s different to other strains, such as the highly pathogenic H5N6 that struck South Korean farms in December, prompting the government to call in the army to help cull some 26 million birds.
But that strain didn’t kill any people.
There have been multiple outbreaks of bird flu around the world in recent months, with at least half a dozen different strains circulating. 

The scale of the outbreaks and range of viral strains increases the chances of viruses mixing and mutating, with new versions that can spread more easily between people, experts say.
For now, H7N9 is thought to be relatively difficult to spread between people. 

China’s Center for Disease Control and Prevention has said the vast majority of people infected by H7N9 reported exposure to poultry, especially at live markets.
“There are very few, if any, clinical signs when this (H7N9) virus infects birds, and that’s the main reason we’re not seeing reporting coming from poultry farms in China,” said Matthew Stone, deputy director general for International Standards and Science at the World Organisation for Animal Health (OIE).

INTENSIVE OUTBREAK
As many as 79 people died from H7N9 bird flu in China in January alone, up to four times higher than the same month in past years.
While spikes in contamination rates are normal in January – the main influenza season – the high level of human infections has prompted fears the spread of the virus among people could be the highest on record – especially as the number of bird flu cases reported by farmers has been conspicuously low.
The high number of human infections points to a significant outbreak in the poultry population that is not being detected, says Guan Yi, director of the State Key Laboratory of Emerging Infectious Diseases and the Center of Influenza Research at the University of Hong Kong.
“If we have so many human infections, naturally it reflects activity, an intensive outbreak in chickens. They are highly associated,” he said.
China has the world’s largest flock of chickens, ducks and geese, and slaughtered more than 11 billion birds for meat in 2014, according to the United Nations’ Food and Agriculture Organisation (FAO).
The last major bird flu outbreak in China, in 2013, killed 36 people and cost the farming industry around $6.5 billion.

CONTROL CHALLENGE
The experts’ assessment underscores the challenge for China’s government and health ministry in monitoring and controlling the H7N9 outbreak in both people and poultry.
While, with few visible signs of infection in birds, it’s easier for farmers to flout the reporting rules and continue selling poultry at market, Stone at the OIE said China has a “very significant” surveillance programme at live markets.
The government promised on Thursday to tighten controls on markets and poultry transport to help battle the virus.
The agriculture ministry last month collected more than 102,000 serum samples and 55,000 virological samples from birds in 26 provinces. 

Of the latter samples, only 26 tested positive for the virus, according to data on the ministry’s website.
But the rapid rise in human infections and spread to a wider geographic area is likely to increase pressure on Beijing to do more poultry testing at markets and on farms.
The ministry did not respond to faxed questions on its surveillance efforts.
The National Health and Family Planning Commission said on Thursday the spread of H7N9 among people was slowing.
Some Chinese netizens have called for more timely reports on infections, and experts said China has been slow to respond to the human outbreak. 

The authorities have warned the public to stay alert for the virus, cautioning against panic.
Others played down the threat to humans, as long as they stay away from live markets.
“As scientists, we should be watching this outbreak and the effectiveness of any control measures,” said Ian Mackay, a virologist and associate professor at the University of Queensland in Australia. “We don’t have a vaccine available for H7N9 in humans, but we do have effective antivirals.”
“So far, the virus does not spread well between humans,” he added. 

“As members of the public, who do not seek out live poultry from markets in China, we have almost nothing to worry about from H7N9 right now.”