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What to Expect with the Plague | TIME ONLINE

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Anyone who has recently been to China and now has a strong cough and fever should not take the subway to the doctor. And call the practice beforehand instead of just sitting in the waiting room. So far this is due to the disease the new corona virus known:

What is this new plague?

It is a lung disease that first appeared around Christmas China has broken out. It is triggered by a virus from the corona virus family (see box). The 2019-nCoV pathogen is related to those of the dangerous Sars and Mers infections. The new disease, which does not yet have its own name, is less likely to be fatal than the severe acute respiratory syndrome, Sars for short, or Mers, its abbreviation for Middle East Respiratory Syndrome it was said at the beginning. But in the meantime, researchers are no longer quite sure.

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What are the symptoms?

The disease begins with shortness of breath, pain in the lungs, cough and high fever. If doctors push the patient into a computer tomograph, the picture on the lungs is similar to that of Sars. But it looks different from conventional pneumonia – regardless of whether it is caused by viruses or bacteria. coronaviruses as such you have known for a long time. Most people get a cold at most. But this time a variant of the pathogen that is dormant in the animal kingdom seems to have been skipped over to humans, which is different. And it is spreading rapidly – across national borders.

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How dangerous is the virus?

According to previous knowledge
the virus less contagious than the Sars pathogen. To date, there is only reliable information on the first deaths reported from China. Accordingly, it was primarily older people with some serious previous illnesses who died as a result of infection with the 2019-nCoV pathogen. The first officially registered dead person had a tumor in the abdomen and was chronically liver-sick.
 The two patients, whose death was confirmed on January 21, were one
 66-year-old man with chronic lung disease and high blood pressure
as well as a 48-year-old woman with diabetes and a stroke in her
Medical history. The new virus variant seems particularly older and
being able to become dangerous to sick people. Know this pattern
Doctors also of flu viruses.

The new corona virus is harmless
by no means, at the same time, scientists are always calling for prudence. About a quarter of all cases lag behind
Current level of knowledge is very difficult, according to the World Health Organization (WHO). Of
 41 patients from a hospital in Wuhan, who are described in a scientific article, died six, or about 15 percent
 (The Lancet: Huang et al., 2020). In one of the study
attached comment, however, doctors point out that
many infected people have few or no symptoms. Therefore be more
assume that approximately three percent of those infected die (The Lancet: Wang et al., 2020).
 But this number, too, the authors write, should be used with caution
enjoy, because "not all patients have their illness behind
relaxed (that is, died or recovered) and the
the true number of sufferers is unknown ".

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How many people are infected

After the number of reported cases stagnated in the first half of January, it has been increasing continuously since mid-January. On January 28, more than 4,000 cases of infection were confirmed, and at least 100 people died from pneumonia caused by the virus.

The majority of infections affect China. According to Chinese information, around 6,000 are confirmed cases
Suspected cases (as of January 26). The World Health Organization WHO also publishes new outbreak figures on its website every day.

Meanwhile, more and more other countries are reporting individual infections, such as Japan, South Korea, Thailand, Australia and the USA. On January 24, France became the first European country to announce three infections with the novel corona virus. One of the sick women is said to have traveled to Lyon from Wuhan, where the outbreak had started. According to the Minister of Health there, the two other infected people in France had previously been to China. There is a first confirmed case in Germany. A man from Bavaria is said to have contracted a Chinese woman who was a guest in Germany for further training.

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What is the number of unreported cases?

It is certain that there are a large number of people who have become infected but do not know anything about it. So they do not appear in the official figures. The number of unreported cases depends on various factors: How good is the surveillance system in China? How well is it possible to find contact persons for infected people? How many easy courses of the disease are there that those affected only consider to be a simple cold and therefore never go to the doctor? Neil Ferguson, a professor of healthcare at Imperial College, London, said that Guardian As of January 26, he estimated that around 100,000 people worldwide could already be infected with the virus. He and his team used model calculations to determine the possible number of infected people.

Most cases outside of China appear to be fairly mild cases of the lung disease. Ferguson says this could mean that they spread more easily than serious infections. But that would also mean that many people do not even notice that they are infected. Then they could infect other people unnoticed – even those who then become more seriously ill, for example because of an already poor state of health.

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How well do China and the world react?

All the experts with whom ZEIT ONLINE spoke have confirmed that China has responded quickly and in a coordinated manner. The government in Beijing very quickly made important data public, in particular the number of suspected cases and the gene sequence of the pathogen. The neighboring countries also reacted in an exemplary manner, said Jonas Schmidt-Chanasit from the Bernhard Nocht Institute for Tropical Medicine in Hamburg. He is one of the leading German virologists. With the Sars epidemic, in the course of which around 800 people died in the early 1990s, the situation was very different. At that time, "the dramatic situation was mainly caused by the late reaction," said Schmidt-Chanasit.

So far, the World Health Organization has decided against declaring the outbreak of the coronavirus an "emergency of health of international importance". The crisis meeting held at the end of January alone made it clear that the WHO classified the outbreak as an event of global importance. In addition, this international epidemic advisory body reserved the right to change its mind at any time and still declare an emergency. January 26th WHO Director General Tedros Ghebreyesus traveled to Chinato discuss how to proceed with the government.

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What measures have been taken?

In Wuhan, where the first cases of illness had occurred, two hospitals are said to join in within days
a total of 2,300 beds will be built. In several provinces, people have to wear face masks. To prevent the virus from spreading further, train stations, airports, local transport and motorways in the affected region are blocked. There are at least 56 million Chinese in 22 cities
affected.

There is criticism of the latest measures: Lawrence Gostin, for example, Professor of Global Affairs
Health at Georgetown University said German science
Media Center (SMC): "A cordon off of Wuhan will result in the epidemic
Driving underground and triggering fear and panic. "During such an outbreak, one has to do exactly the opposite, namely the" trust of the
Gaining Community ". Only in this way would people work on what it does
Enable authorities to track infection chains seamlessly,
Identify contact persons of infected and quarantine
and ultimately curb the epidemic, said Gostin.

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Can the outbreak be contained?

Some experts warn that the virus can no longer be controlled. If it didn't stop in China, it could spread worldwide permanently. In the worst case, it would have to be added to the list of viruses that regularly infect people, such as the flu virus. "The more we learn about the virus, the more likely it is that public health measures will not control the transmission," said University of Toronto infectious disease specialist Allison McGeer of the US news portal Stat, How dangerous such a global distribution would be is difficult to assess at the moment. One thing is certain: The virus has long since reached other countries and continents, including Europe.

Experts believe that in addition to the confirmed cases in France and Germany, there will be further infections in Europe. So far, all European sufferers have been infected in China, but, according to what is known to date, it is only a matter of time before human-to-human transmissions will also take place in Europe. The European Infection Protection Agency (ECDC) said: "European countries have the capacity to prevent and control an outbreak as soon as cases are discovered."

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Where did the virus come from?

The novel corona virus was probably originally transmitted from an animal to humans. There are now growing indications that a market in Wuhan, which was thought to be the source of the virus and on which all kinds of animals such as snakes, foxes and seafood were offered, may not have been the only source of the virus. According to a study by Chinese scientists, a patient who fell ill on December 1, 2019 had no contact with the market (The Lancet, Huang et al. 2020). Of the 41 patients who were initially treated in a Wuhan hospital, 13 were probably not on the market. It is therefore possible that a person became infected as early as November of last year and only introduced the virus into the market in the first place, where other people could have become infected.

The gene sequence of the previous samples suggests that the virus was originally caused by a bat (Biorxiv: Benvenuto et al., 2020). From there it could have been transferred to another animal that could have infected a human. This chain of infection is also not unlikely because it is similar to that of the Sars virus, which is closely related to the new corona virus. The general rule for viruses is that they sleep in different variants in animals and can also be contagious across species boundaries. When a new disease passes from animal to human in this way, scientists speak of zoonoses.

However, it is now clear that the causative agent of the new lung disease is also jumping from person to person. Chinese authorities have confirmed such a transfer. The WHO reported an infection chain with four links,
 that means: a person has been infected by the animal source,
then infected a second person who infected a third party,
 who passed the virus on to a fourth.

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How do you get infected?

"Most likely by airborne droplet infection," said Peter Hotez, a tropical doctor at Baylor College of Medicine, Houston. Compared to ZEIT ONLINE, Hotez relies on experiences with Sars and Mers. A mixture between droplet and smear infection is also plausible, said virologist Christian Drosten of the Berlin Charité in the tagesthemen, In order to know exactly how and above all how easily the virus is transmitted, however, detailed epidemiological studies are necessary, said the tropical doctor Schmidt-Chanasit from the Bernhard Nocht Institute. Chinese researchers have just carried out these studies. First results are expected in the coming days and weeks.

There are various estimates of how many people are infected by an infected person on average. On January 23, the WHO estimated that the number was between 1.4 and 2.5. A previously unexamined scientific work, however, came to 3.8 (Medrxiv: Read et al., 2020). For comparison: an average person with measles is twelve
to 18 people, a person who has the influenza virus flu, two to
three. All these numbers, said the virologist
 Schmidt-Chanasit on January 25th, are currently more of a guide
assess how the epidemic could develop and which
Take action now.

Little is known about the incubation period – the time between infection and the appearance of the first signs of the disease. With Sars, the average is five days, it can be two, but also ten. Both Schmidt-Chanasit and Hotez suspect that the new corona virus is similar. But that should also show further investigations.

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Can the virus continue to mutate?

It's even safe. All viruses – not just corona viruses – change their genome as they multiply. This can make pathogens more contagious or more dangerous. China's deputy health minister had recently expressed this concern. Jonas Schmidt-Chanasit believes that both of these things happen at the same time: "In order for viruses to become more dangerous, they have to increase their transferability and at the same time remain as pathogenic as before." The related Mers virus, he added, has not been seen in recent years.

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Does fever measurement at airports make sense?

Infected people are actively searched at many train stations in China and at airports around the world. The virologist Schmidt-Chanasit does not consider these temperature controls to be really useful when entering the country. He said ZEIT ONLINE on January 22nd: "You may be able to identify some sufferers, but overall there is no evidence that such measures improve the situation." One of the reasons is that people who already carry the virus but do not yet have any symptoms simply cannot be found. Such controls are primarily symbolic in nature.

China – First corona death in Beijing
The coronavirus continues to spread in China. Now, for the first time, a person has died in Beijing. However, the risk remains low for Germany.
© Photo: Pu Xiaoxu / XinHua / dpa

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What happens next?

China is currently trying to contain the outbreak. In parallel, the first clinical studies for therapy begin. For this, the doctors use antiviral drugs that have shown a certain effectiveness against the related Mers and Sars viruses, especially ritonavir, lopinavir and remdesivir (The Lancet: Huang et al., 2020).

Vaccination against the pathogen is also underway. Peter Hotez wrote ZEIT ONLINE that cooperation partners such as Fudan University in Shanghai are now examining whether the vaccine candidates already developed for Sars and Mers are also effective against 2019-nCov. Because these viruses are very similar, this is quite possible. "We'll know if that's the case in the coming weeks," said Hotez. Then the safety tests and clinical studies will be carried out. However, all of this is "unfortunately not a quick process".

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Is the plague more dangerous than the flu?

At the moment, the growing number of infected people sounds particularly threatening – especially if you assume that up to a quarter of the infected will die. However, the information on mortality from the lung disease will probably be put into perspective. "It was expected that the numbers would increase rapidly after a test for the virus is available," said virologist Schmidt-Chanasit in an interview with ZEIT ONLINE. Because this is now widely used in China, more cases would be documented. Among them are many in which the disease takes only a slight course. This also puts the number of deaths into perspective. One is then pretty quickly in an area that is comparable to the seasonal influenza influenza. He doesn't think that is worrying. In Germany alone, up to 20,000 people can die from influenza during a severe flu season, according to the Robert Koch Institute. Between five and 20 percent of the population are infected with the flu virus each season. Nevertheless, there is no need to panic with the new corona virus, says Schmidt-Chanasit: "Everyone is vigilant and very well prepared. It really doesn't get any better than this."

Read everything about the current outbreak of the new corona virus here.

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