World's coronavirus death rate increases driven by China; Italy, Europe see more novel cases

Questions surround Tokyo Olympics 2020
SEOUL, South Korea -- Scientists raced to find a treatment, crews scrubbed everything from money to buses, and quarantines were enforced Wednesday from a beachfront resort in the Atlantic to an uninhabited island in the Pacific as the world fought the spread of a new virus.

Worries over the ever-expanding economic fallout of the COVID-19 crisis multiplied, with factories idled, trade routes frozen and tourism crippled, while a growing list of countries braced for the illness to claim new territory. Even five months away, wasn't far enough off to keep people from wondering if the Olympics would go on as planned.

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"We don't expect a miracle in the short term," said Kianoush Jahanpour of the health ministry in Iran, where an official tally of infections of 139 was doubted by some who thought the problem was far bigger.

About 81,000 people around the globe were sickened by the coronavirus that kept finding new targets.

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In Europe, where Germany, France and Spain were among the places with a growing caseload, an expanding cluster of more than 200 cases in northern Italy was eyed as a source for transmissions. In the Middle East, where cases increased in Bahrain, Kuwait and Iraq, blame was directed toward Iran. In Asia, where the crisis originated late last year in China, threats continued to emerge around the region, with South Korea battling a mass outbreak centered in the 2.5 million-person city of Daegu.

Though the virus pushed into countries both rich and poor, its arrival in places with little ability to detect, respond and contain it brought concern it could run rampant there and spread easily elsewhere.

"We're going to be trying to slow down the spread so that our hospitals are not overwhelmed in one big gulp, one big hit," said Ian Mackay, who studies viruses at the University of Queensland in Australia.

In South Korea, workers sanitized public buses, while in China, banks disinfected banknotes using ultraviolet rays. In Germany, authorities stressed "sneezing etiquette," while in the United States, doctors announced a clinical trial of a possible coronavirus treatment.

Around the world, as Christians marked the start of the holy season of Lent with Ash Wednesday, worshipers found churches closed and rituals changed by virus fears. Even in St. Peter's Square, many of those gathered for Pope Francis' weekly audience wore face masks and clergy appeared to refrain from embracing the pontiff or kissing his ring.

Services in Singapore were broadcast online to keep people from crowded sanctuaries where germs could spread, bishops in South Korea shuttered churches for what they said was the first time in the Catholic Church's 236-year history there, and in Malaysia and the Philippines, ashes were sprinkled on the heads of those marking the start of Lent instead of using a damp thumb to trace a cross of ashes.

"We would like to be cautious so that the coronavirus will not spread," said the Rev. Victorino Cueto, rector of the National Shrine of our Mother of Perpetual Help in Manila in the Philippines.

Major gatherings were eyed warily, with organizers scrambling to respond in the face of the epidemic. Looming largest of all are the Olympic games, whose opening ceremonies are scheduled for July 24 in Tokyo. A member of the International Olympic Committee, Richard Pound, sounded alarms a day earlier, saying the virus could force a cancellation of the games. The Japanese government, in turn, gave mixed signals, insisting they would go forward yet urging that sports events now be curtailed.

Prime Minister Shinzo Abe called for major sports and cultural events in the coming two weeks to be canceled or postponed to stem further infections. Meanwhile, the top government spokesman said Olympics preparations would proceed and the games would go on as planned.

Among the other crowded places that had officials worried: Military bases.

The South Korean military announced additional infections among its troops, with 20 cases on its bases and some 9,570 people in isolation. The U.S. military, which has 28,500 troops in South Korea, confirmed the first infection of an American soldier, a 23-year-old man based at Camp Carroll near Daegu, a day after Americans said a military spouse also had contracted the illness. Bowling alleys, movie theaters and a golf course on four American bases in the country were closed.

"This is a setback, it's true, there's no getting around that. But it's not the end of the war," Col. Edward Ballanco, commander of the U.S. Army Garrison Daegu told troops in a video message. "We are very well equipped to fight this thing off."

Italy recorded 52 new infections on Wednesday and Greece became the newest country to see a case of the virus. South Korea announced 284 new cases, largely in Daegu, bringing its total to 1,261. China, still the epicenter of the crisis even as new outposts caught the world's attention, reported 406 new cases and 52 more deaths. The country has a total of 78,604 cases of the virus and 2,715 fatalities.

China said Wednesday that those sickened by the virus included 555 prisoners who officials said likely became infected by guards using the same bus station as a nearby pulmonary hospital.

And Indonesia said it evacuated 188 crew members from the World Dream cruise ship and planned to take them to remote Sebaru Island. The workers were released from quarantine in Hong Kong after finding no infections, but authorities mandated an additional observation period.

Italy seeks to calm coronavirus fears in Europe as cases, deaths rise



Italy sought international support for its virus containment efforts Wednesday even as its caseload reached 374, people linked to Italy got sick elsewhere in Europe and the world, and the U.N.'s health agency urged a scaled-up response.

Premier Giuseppe Conte's government appealed to European neighbors for cooperation, not isolation and discrimination. Italy has been struggling to contain the rapidly spreading outbreak that has given the country more coronavirus cases outside Asia than anywhere else.

"Viruses don't know borders and they don't stop at them," Italian Health Minister Roberto Speranza insisted at the start of a crisis meeting with World Health Organization and European Union representatives in Rome.

Twelve people infected with the virus have died in Italy since Friday, all of them elderly, having other health conditions or both, civil protection chief Angelo Borelli said.

The Italian government has been defending its handling of the crisis, even as it acknowledges alarm over its increasing cases and inability to locate the origin of the outbreak clustered in northern Italy.

Germany and France also reported two cases apiece in people with no known ties to Italy, travel to China or contact with an infected person, raising concern about additional clusters with no known origin possibly forming in Europe.

Latin America reported its first case, in a Brazilian man who recently visited Italy's Lombardy region, the epicenter of Italy's outbreak. Algeria reported Tuesday night that an Italian man who traveled to the north African country this month as its first case.

In Europe, Greece registered its first confirmed virus case in a woman who had recently traveled to Italy's afflicted north, after Austria, Croatia and Switzerland reported their first cases Tuesday from people who had also recently visited the region.

Spain has reported nine new cases since Monday, all with an Italy link and two of France's five new cases had ties to Italy. Local authorities in Austria took quarantine measures after two unconfirmed cases had an Italy link, only to remove them when tests came back negative.

Overnight, Italy registered 52 more cases, bringing its total to 374. Hard-hit Lombardy, where 10 towns are on army-manned lockdown, still had the most cases with 258 - four of them children. But Veneto saw a spike of 28 new cases overnight, bringing its total to 71.

In France, a 60-year-old Frenchman died in a Paris hospital, France's second virus-related death. His case worried French authorities, because he was one of two new patients who tested positive for the virus in France this week who had not traveled to a "risk zone," according authorities in his home region north of Paris.

A German man with the virus was in critical condition and his wife also tested positive, but German officials to date have not been able to trace the origin of their contagion. Officials expressed fear of infections spreading since the wife works in a kindergarten and the man had been to Carnival parties.

The man had come into contact with dozens of people, including doctors and nurses at a Cologne hospital where he had gone for an unrelated health checkup, German officials said. Schools and kindergartens in the area where he became ill remained shut.

The Italian national health system has been overwhelmed with distribution problems slowing the delivery of masks and protective gear for medical personnel in the hard-hit areas. In addition, officials are battling to contain panic among Italians who are stocking up on bottled water, long-life milk and other non-perishable food that have left some supermarket shelves empty.

Italy is in some ways a victim of its own scrupulousness, with virologists noting that it is registering so many cases because it's actively looking for them.

Borelli noted that Italy had tested 9,462 people already - more than 95% of whom have tested negative. Of those who are positive, two-thirds are being treated at home without requiring hospitalization.

WHO Europe chief Dr. Hans Kluge complimented Italy for its management of the emergency, but said it needed to "scale up" its response. He also noted shortcomings, particularly in outfitting medical personnel with necessary masks and protective gear.

Doctors and nurses are "the front-line heroes" of the response, Kluge said at a news conference with the Italian health minister at his side.

"We need to train them and provide them with the necessary protective equipment," he said.

He said it was important to avoid creating panic and keeping the measures proportional to the risk.

Borelli, the civil protection chief, acknowledged the mask supply problems Wednesday. He said the government had met with producers to centralize the distribution system to make sure the gear gets to the provinces where they were needed.

Rome authorities reported some good news on an otherwise bleak day: Both Chinese tourists from Wuhan who have been treated at the Spallanzani infectious disease hospital have now tested negative after more than two weeks of anti-viral treatment.

But alarm, caution and panic spread in Italy and beyond.

At a high school in Vienna, students were kept inside to be tested for the virus after a teacher who recently returned from a trip to Italy started showing symptoms of the virus, Austrian media reported. But the test came back negative.

Elsewhere, authorities in Austria placed an apartment complex in the southern town of Bad Kleinkirchheim under quarantine after a 56-year-old woman from Italy died overnight. That test, too, came back negative and the quarantine was lifted.

In Croatia, where a second case was confirmed in the twin brother of a young man who contracted the virus in Milan, Prime Minister Andrej Plenkovic warned against panic shopping.

"Panic should stop," Plenkovic said. "Don't go shopping in such a way that others cannot buy groceries."

Syracuse University was sending home 342 students on its study abroad program in Florence, and Ireland's Six Nations rugby match against Italy in Dublin on March 7 was postponed.

German government spokesman Steffen Seibert said the country is preparing for the possibility of an increase in cases.

"The appearance of the coronavirus in Italy has certainly created a new situation in Europe, the virus has come a lot closer," Seibert told reporters. "This means a new challenge for all states in Europe, including for Germany."

How deadly is new coronavirus? It's still too early to tell



Scientists can't tell yet how deadly the new virus that's spreading around the globe really is - and deepening the mystery, the fatality rate differs even within China.

As infections of the virus that causes COVID-19 surge in other countries, even a low fatality rate can add up to lots of victims, and understanding why one place fares better than another becomes critical to unravel.

"You could have bad outcomes with this initially until you really get the hang of how to manage" it, Dr. Bruce Aylward, the World Health Organization envoy who led a team of scientists just back from China, warned Tuesday.

WHAT DO WE KNOW ABOUT THE DEATH RATE?

In the central China city of Wuhan, where the new coronavirus first exploded, 2% to 4% of patients have died, according to WHO. But in the rest of hard-hit China, the death rate was strikingly lower, 0.7%.

There's nothing different about the virus from one place to another. Instead, the never-before-seen strain of coronavirus struck Wuhan fast - before anyone knew what the illness was - and overwhelmed health facilities. As is usual at the beginning of an outbreak, the first patients were severely ill before they sought care, Aylward said.

By the time people were getting sick in other parts of China, authorities were better able to spot milder cases - meaning there were more known infections for each death counted.

And while there are no specific treatments for COVID-19, earlier supportive care may help, too. China went from about 15 days between onset of symptoms and hospitalization early in the outbreak, to about three days more recently.

Still, Aylward expressed frustration at people saying: "'Oh, the mortality rate's not so bad because there's way more mild cases.' Sorry, the same number of people that were dying, still die."

WHAT ABOUT DEATHS OUTSIDE OF CHINA?

Until the past week, most people diagnosed outside of China had become infected while traveling there.

People who travel generally are healthier and thus may be better able to recover, noted Johns Hopkins University outbreak specialist Lauren Sauer. And countries began screening returning travelers, spotting infections far earlier in places where the medical system wasn't already strained.

That's now changing, with clusters of cases in Japan, Italy and Iran, and the death toll outside of China growing.

Aylward cautioned that authorities should be careful of "artificially high" death rates early on: Some of those countries likely are seeing the sickest patients at first and missing milder cases, just like Wuhan did.

HOW DOES COVID-19 COMPARE TO OTHER DISEASES?

A cousin of this new virus caused the far deadlier severe acute respiratory syndrome outbreak in 2003, and about 10% of SARS patients died.

Flu is a different virus family, and some strains are deadlier than others. On average, the death rate from seasonal flu is about 0.1%, said Dr. Anthony Fauci of the U.S. National Institutes of Health.

That's far lower than what has been calculated so far for COVID-19. But millions of people get the flu every year around the world, leading to an annual death toll in the hundreds of thousands.

WHO'S MOST AT RISK FROM COVID-19?

Older people, especially those with chronic illnesses such as heart or lung diseases, are more at risk.

Among younger people, deaths are rarer, Aylward said. But some young deaths have made headlines, such as the 34-year-old doctor in China who was reprimanded by communist authorities for sounding an early alarm about the virus only to later succumb to it.

In China, 80% of patients are mildly ill when the virus is detected, compared with 13% who already are severely ill. While the sickest to start with are at highest risk of death, Aylward said, a fraction of the mildly ill do go on to die - for unknown reasons.

On average, however, WHO says people with mild cases recover in about two weeks, while those who are sicker can take anywhere from three to six weeks.
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