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

E. Rosalie | January 20, 2020
Edited to reflect US cases Jan 21 and for clarity
Disclaimer: The views expressed reflect only me and do not represent any other persons or institutions.

A bloody froth spilled from the nose and mouth, pooling on the floor, visible to onlookers awaiting the same fate. If the others did not die from the virus, they might still drown in their own blood—maybe pneumonia.

By the pandemic’s end in 1920, 50–100 million people had perished, and there was little doubt it would happen again. The pandemic the world has yet to forget; that’s what I thought of skimming the reports from Asia.

Still, we remain unprepared.

The close relative of SARS appeared out of thin air, but, just as abruptly, new cases in China disappeared — only the reports, not the sick people. The virus popped up in three, and now four, countries: Thailand, Japan, Korea, and the US.

China, believing animal markets to be the source, shut them down for cleaning on Jan 1, but multiple cases report not having visited animal markets.

Potentially, human-to-human like SARS. SARS Coronavirus incubation took 4 to 6 days, with extremes of 2 to 14 days. That suggests community spread and the possibility of many more cases.

Air droplets can suspend in the air for hours after an infected person has left. Finding everyone who trekked through airports seems unlikely.

Nothing indicates that mild infections cannot happen, meaning infected people may not know their status. This is most worrying given that a Wuhan doctor diagnosed the woman on Jan 18 with a cold.

The expected numbers are much higher than the numbers reported.

Imperial College London released a report on Jan 17, echoing my concerns — only a student, I questioned my suspicion—estimating the number of infected parties:

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.

Given the cases in Japan and Thailand from travelers to China and the incubation of SARS, one of three possibilities occurred:

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

2. China knows about cases and did not report after Jan 3.

3. The virus defies mathematical models and has an uncommonly long incubation period.

Originally published at on January 20, 2020.

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  • Bogoch, Isaac I, Alexander Watts, Andrea Thomas-Bachli, Carmen Huber, Moritz U G Kraemer, and Kamran Khan. 2020. “Pneumonia of Unknown Etiology in Wuhan, China: Potential for International Spread Via Commercial Air Travel”. Toronto General Hospital.
  • Cauchemez, Simon, Christophe Fraser, Maria D. Van Kerkhove, Christl A. Donnelly, Steven Riley, Andrew Rambaut, Vincent Enouf, Sylvie van der Werf, and Neil M. Ferguson. 2014. “Middle East Respiratory Syndrome Coronavirus: Quantification of the Extent of the Epidemic, Surveillance Biases, and Transmissibility.” The Lancet Infectious Diseases 14 (1): 50–56.
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  • World Health Organization. 2020. “WHO | Novel Coronavirus — Republic of Korea (Ex-China).”
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Originally published at on January 20, 2020.

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Public health biologist studying at Johns Hopkins | Science writer & artist | Views reflect me alone | Subscribe @

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