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Incident Brief Incident Brief China – Coronavirus Outbreak Location Multiple Locations Date February 4, 2020 Issued by On Call International Global Security & Medical Teams SUMMARY: The On Call Security & Medical Teams are continuing to monitor the outbreak of coronavirus coined ‘Novel Coronavirus’ which originated in Wuhan, China and has since been reported in several other locations globally. As of the issuance of this report on Tuesday 4 February, there are 20,704 confirmed cases of coronavirus globally with an estimated 212 cases outside of mainland China. 426 deaths have been reported in China and 1 death has been reported in the Philippines; bringing the global death count to 427. The U.S. Department of State (DOS) maintains its travel advisory for mainland China as Level 4: Do Not Travel. The DOS, however, still ranks travel to both Hong Kong and Macau as Level 2: Exercise Increased Caution. The Centers for Disease Control (CDC) maintains its advisory for China as Warning-Level 3: Avoid Nonessential Travel, their highest level. Additionally, the World Health Organization (WHO) has announced that the coronavirus outbreak is a Global Health Emergency of International Concern; however, they have not gone so far yet as to declare the outbreak a pandemic. The Chinese government has established new quarantine zones in Zhejiang Province, the Chinese province that has seen the second highest rate of virus infection. New quarantine zones in Zhejiang include the cities of Wenzhou, Taizhou, and parts of Hangzhou. These new quarantines are in addition to the previously established quarantine in Hubei Province. Modes of transportation such as flights, trains, buses, ferries, and private automobiles are banned to varying degrees within quarantine zones. Residents of quarantine zones are solely permitted to leave their accommodations once every two days to purchase necessities or if seeking medical attention. Those present in a Chinese quarantine zone are also subject to random ID checks and virus screening while in public locations. While various foreign governments are currently or have already conducted evacuations of their respective citizens from Hubei, there have been no reports of foreign governments conducting evacuations from Zhejiang as of the issuance of this report. Macao has ordered the closure of all its casinos and the cessation of all public transportation. Additionally, all residents of Macao have been ordered to remain in their accommodations. Hong Kong has closed ten of thirteen border crossings and suspended a majority of its flights to the mainland; however, this has done v 02.04.2020 On Call International 11 Manor Parkway Salem, NH 03079, USA A member of the Tokio Marine HCC group of companies little to assuage the fears of Hong Kong’s residents. Hospital employees in Hong Kong recently staged a strike for the purpose of convincing the government to close all border crossing with the mainland. There is no indication that the Hong Kong government intends to take this step. To date, there are 10 confirmed cases of coronavirus in Macao and 17 in Hong Kong. 1 death due to the virus has also been reported in Hong Kong. Approximately 75 airlines have either partially or fully suspended flights to China. These airlines include Delta Airlines, American Airlines, United Airlines, Vietnam Airways, Qantas Airways, Air New Zealand, Qatar Airways, Oman Airlines, Saudi Airlines, Uzbekistan Airways, Lufthansa, British Airways, Air Canada, Korean Air, Air India, Finnair, Lion Air, Air Asia, Cathay Pacific, Scandinavian Airlines, and EgyptAir. After previously ceasing all flights to China, Pakistan has announced it will allow its aircraft to resume flying to China; albeit, with increased screening being conducted on all passengers arriving from China. In the coming days, more airlines are likely to suspend their operations in China. Thus, it is likely to become increasingly difficult to depart China via commercial flights. Travelers are advised to expect further cancellations to be issued with little to no forward notice. Upon arrival in their home countries, evacuees and regular returning travelers can expect to be screened for infection and may be placed in quarantine for varying lengths of time. The following countries have placed varying immigration and travel restrictions on Chinese nationals or those who have recently traveled to China: Australia, India, Malaysia, Maldives, the United Kingdom, Germany, the United Arab Emirates, Taiwan, Thailand, Indonesia, Iraq, Israel, New Zealand, Pakistan, South Korea, Vietnam, the United States, Mongolia, Russia, Singapore, the Philippines, Japan, Kazakhstan, Czech Republic, and Bangladesh. This list is not exhaustive and many other countries are likely to implement additional restrictions on travelers from China as the situation evolves. NOVEL CORONAVIRUS SPECIFICS: Novel corona (2019-nCoV) virus belongs to a large family of coronaviruses that are common in many different animal species including camel, cows, cats, and bats. Sometimes the virus can transmit to humans in close contact. Prior examples include MERS and SARS, both of which also belong to the coronavirus family. All three of these viruses have been traced back to originating in bats. 2019-nCoV first manifested as a respiratory illness in Wuhan, China in those who attended a large seafood and live animal market suggesting an animal to human spread in December 2019. Subsequently, multiple cases were confirmed in people who had no such contact. Sustained spread from person-to-person has led to a growing epidemic in China with spread to numerous other countries. The virus spreads from person-to person occurs between close contacts due to airborne respiratory droplets expelled from an infected person’s sneeze or cough. Close contact is considered within 6 feet. These droplets can contact the mouth, nose, or eyes, and be inhaled into the lungs. Touching a surface contaminated with the virus and subsequently touching the eyes, nose, or mouth is another potential exposure route. 2 On Call International 11 Manor Parkway Salem, NH 03079, USA A member of the Tokio Marine HCC group of companies Symptoms of 2019-nCoV infection include fever, cough, and shortness of breath. The severity of symptoms can range from slight to no symptoms to people with pneumonia, severe respiratory distress, organ failure, and death. The elderly and those with significant pre-existing medical problems are most at risk for severe manifestations and worse outcomes. Treatment is symptomatic as there is no specific antiviral medication for 2019-nCoV. For severe cases, antiviral agents designed for other viruses have been utilized on an investigational basis. Clinical trials will be conducted to develop specific treatments. Vaccine development is in the works but will not be available for many months. UNITED STATES QUARANTINE REQUIREMENTS: The U.S. Department of Health and Human Services (HHS) declared the Coronavirus a public health emergency and announced that specific measures would be implemented to ensure the containment of the virus. HHS Secretary Alex Azar stated in a White House briefing that these measures would include: Any foreign national who has traveled to mainland China in the past 14 days with the exceptions of immediate family members of American citizens and permanent residents will be banned from entering the United States. American citizens returning to the United States, who travelled to Hubei Province within the past 14 days, will face 14 days of mandatory quarantine. American citizens returning to the United States, who visited mainland China within the past 14 days will be screened at a port of entry and are encouraged to self-quarantine and monitor their health. Travelers coming from mainland China will have to enter the United States through a few selected airports as the government will divert all flights to these specific ports of entry. At the moment seven airports have been listed John F. Kennedy International Airport, Chicago’s O’Hare, Los Angeles International Airport, San Francisco International Airport, Hartsfield-Jackson Atlanta International Airport, Seattle-Tacoma International Airport, and Honolulu’s Daniel K. Inouye International Airport. The U.S. may implement additional measures as the situation dictates in the coming days. If symptoms develop for an individual who has self-quarantines, they are advised to contact their medical care provider before arrival at the health care facility so that precautions can be implemented beforehand. STANDING ADVICE FOR TRAVELERS: Exposure avoidance is the best way to prevent infection. As such, the CDC has released the following preventative recommendations for 2019-nCoV and other respiratory viruses: Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty. 3 On Call International 11 Manor Parkway Salem, NH 03079, USA A member of the Tokio Marine HCC group of companies Avoid touching your eyes, nose, and mouth with unwashed hands. Avoid close contact with people who are sick. Stay home when you are sick. Cover your cough or sneeze with a tissue, then throw the tissue in the trash. Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe. Please
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