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Why Experts Suspect More Cases in China and Why the US Has More Cases Than it Realizes

The close relative of SARS appeared out of thin air, poised to descend on humanity like wildfire. Then, just as abruptly as cases had appeared, they disappeared — the reports, not the sick people it would seem.

Past is prologue.

The body often slumped to one side from a sitting position after someone died. A bloody froth would drain from the nose and mouth, pooling on the ground. People infected with the same virus watched as they sat lining the hospital hallways and awaited care that would never come.

By the pandemic’s end in 1920, 50–100 million people had perished, and there is little doubt it will happen again. The pandemic the world has yet to forget, that is what floods my mind as I skim reports of a novel virus in Asia.

We are not prepared.

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They called it Pneumonia of Unknown Etiology, but the mystery illness didn’t stay unknown for long.

The close relative of SARS appeared out of thin air, poised to descend on humanity like wildfire. Then, just as abruptly as cases had appeared, they disappeared — the reports, not the sick people it would seem. A week later cases turned up in Thailand, Japan, Korea, and now the US.

China, believing animal markets to be the source, shut them down for cleaning on Jan 1, 2020, but multiple cases reported not having visited the animal markets. The Wuhan Municipal Health Commission reported 59 cases of this pneumonia on Jan 5, 2020. Vendors at local markets were among the sick, so follow-up with anyone who had contact may be impossible, and people may be reluctant to seek help or not realize what they have.

The WHO lists 63 reported cases in China, but whether the country officially confirms it is unclear. Appearing as fever, chill, and muscle pain, the virus complicated breathing in the original outbreak victims. Doctors found fluid called “pulmonary infiltrates” in their lungs, a substance that is denser than air, often blood and pus.

China reports no cases after Jan 3 in a Jan 11 statement, but Japan, Thailand, and now Korea, all confirm cases of travelers to China (Wuhan Municipal Health Commission, 2020; WHO, 2020).

Accounts of the voyaging virus, now called 2019-nCoV, surfaced in Thailand on Jan 14, 2020.

The woman flew from Wuhan City, China, to Thailand in a packed airplane on Jan 8, 2020. Monitoring continues for at least 182 people who met the woman.

Japan also found the virus in a Japanese citizen who recently traveled to Wuhan City, China. DNA testing identified it as 2019-nCoV. Hirofumi Umeda from the Infectious Diseases Information Division in Japan confirmed details of the cases on Jan 15, 2020.

The Korean case comes today and casts doubt on the Chinese report of no new infections. None report traveling to the animal markets, not the Korean woman, nor the Japanese or Thai people.

The Korean case showed symptoms starting Jan 18 in Wuhan City, China where a doctor diagnosed the woman with a cold before she traveled to Korea through Incheon International Airport. The Korea Centers for Disease Control found the virus through DNA testing (WHO, 2020).

These cases may constitute enough evidence to consider the possibility of human-to-human transmission, though it’s not a confirmation.

Most worrying the Wuhan doctor diagnosed a Korean woman on Jan 18 with a cold (WHO, 2020). How many more cases are there?

The estimated numbers exponentially outnumber China’s reported incidents and SARS makes clear that we must be cautious about the reliability of reporting.

The dates of infection and travel give pause.

How Did nCoV Infect People Outside the Market?

Potentially, human-to-human like SARS. SARS Coronavirus incubation took 4 to 6 days, with extremes of 2 to 14 days. That suggests this virus has already spread into the community, meaning we must contemplate the possibility of many more cases in Asia — and in the US. Cases almost certainly extend beyond the recognized number.

Air droplets can suspend in the air for hours after an infected person has left. Finding everyone who trekked through airports seems unlikely. SARS had an infamous ability to capitalize on super-spreaders. An airplane with one case could become an airplane with tens of cases by the flight’s end.

Nothing indicates that mild infections cannot happen, meaning infected people may be totally unaware. This is most worrying given that a Wuhan doctor diagnosed the woman on Jan 18 with a cold. How could he have missed this? Who else has been missed?

The expected numbers are much higher than the numbers reported, which has potentially grim implications.

Depending on when this virus spilled over and how well it moves person-to-person, it may already be spreading quietly around the world.

Imperial College London, a leader in global epidemiology, published a report on Jan 17 that affirmed my fear — only a student I lack confidence in my conclusions:

The report estimated 1,723 cases, assuming Jan 12 as the latest onset date and included assumptions on traffic through the airport based on averages.

The cases in Korea, Japan, and Thailand among people who traveled to China and the incubation of SARS leaves one of three possibilities:

1. China has cases it doesn’t know exist.

2. China knows it has more cases but has not reported any since Jan 3.

3. The virus defies mathematical models and has an uncommonly long incubation period, which still means it’s spreading.

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Originally published at on January 20, 2020.

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Downloaded the original article and saved it in a Word document the following day. The title of the original article was “ Why the US Has More Cases than it Realizes: Wuhan Doctor Diagnoses Patient with a Cold.”
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Public health biologist studying at Johns Hopkins | Science writer & artist | Views reflect me alone | Subscribe @

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