Tag Archives: Outbreak

Mixed messages, test delays hamper U.S. coronavirus response

By Julie Steenhuysen, Andrew Hay and Brad Brooks

(Reuters) – Even as U.S. officials warn of an inevitable outbreak of coronavirus in the United States, and are alerting Americans to take precautions, some health agencies charged with protecting the public appear unprepared to deal with the threat.

Barely more than a handful of public health departments across the country are able to test for the novel virus, which began in China and has spread to at least 44 countries. The federal government has less than 10% of the protective masks required to protect healthcare workers and the public. And Washington still does not have adequate funding in place to support health departments’ efforts, though more money is on the way.

Conflicting messaging from the White House and top U.S. officials regarding the severity of the threat has only added to the uncertainty.

The U.S. Centers for Disease Control and Prevention (CDC) this week for the first time advised American businesses, schools, hospitals and families to prepare for domestic acceleration of the virus, which has infected more than 80,000 people worldwide and killed nearly 3,000.

President Donald Trump on Wednesday assured Americans that the risk of coronavirus transmission in the United States was “very low.” Despite an explosion of cases in China over the past two months, the Trump administration only this week put in a request for $2.5 billion to aid in the response, an amount both Republicans and Democrats have said is too small.

Critics of the federal response say the United States squandered precious weeks by focusing too narrowly on keeping the coronavirus from crossing U.S. borders rather than marshalling resources to prepare American communities for a widespread domestic outbreak that officials now say was inevitable.

“This has been a realistic risk for a month, and the signal to trigger that kind of preparedness has only been going out in the last few days in an explicit way,” said Jeremy Konyndyk, a senior policy fellow at the Center for Global Development in Washington. “That’s a huge problem.”

An employee carries cans of freeze dried food to put into boxes as part of personal protection and survival equipment kits ordered by customers preparing against novel coronavirus, at Nitro-Pak in Midway, Utah, U.S. February 27, 2020. REUTERS/George Frey

FEW BEING TESTED

There are 60 confirmed U.S. cases of the novel coronavirus, which causes the disease known as Covid-19, U.S. health officials said on Wednesday. But experts admit they have no way of knowing the true figure because access to testing at present is severely limited.

So far, the U.S. strategy has focused almost exclusively on testing infected travelers, using a test that looks for genetic material from the virus in saliva or mucus. As of February 23, fewer than 500 people from 43 states had been or are being tested for the virus.

Currently, just seven state and local health departments have the ability to screen for the virus, the Association of Public Health Laboratories (APHL) said on Wednesday. CDC-developed tests issued three weeks ago were producing inaccurate results in some labs, so new tests had to be made and cleared by the U.S. Food and Drug Administration (FDA), leaving many labs with no local testing capability, the group said.

The CDC and FDA have worked out a fix that will allow 40 more public health labs to do testing by the end of next week, the APHL’s Chief Executive Scott Becker told Reuters.

In the meantime, the burden has fallen largely on the CDC, which does testing for most of the country on its campus in Atlanta.

“Unfortunately, we are now in the bottom tier in countries capable of doing population-based testing,” said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

U.S. patients typically wait 24 to 48 hours to find out whether they have tested positive and need to be quarantined, health officials said, during which time those who are infected can spread the virus to others

The CDC’s test is restricted solely for use by public health labs, but if the virus begins spreading widely in the United States, hospitals will need to be able to do the tests themselves, public health experts say. Such testing is typically done using kits produced by commercial companies. Several privately developed tests are in the works, but none have yet won approval from the FDA.

Some health experts also fault the narrow testing criteria that the United States is using to screen for potential infections. Currently, individuals with flu-like symptoms are only tested for the coronavirus if they have traveled to a country where the virus is spreading. This has raised concerns that there are far more cases in the United States than are currently recorded.

“If the majority of testing is all around airports or travelers, we won’t know whether it’s circulating in communities,” said Dr. Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health.

Those worries were reinforced on Wednesday when the CDC confirmed the first U.S. case of coronavirus in a California patient with no apparent travel history. The University of California Davis said in a statement the patient was transferred to the hospital with severe pneumonia and the hospital requested testing. But since the patient didn’t fit the CDC’s criteria, those tests were delayed by several days.

On Thursday, CDC said it is broadening those criteria to allow testing when the virus is suspected.

MASKS IN SHORT SUPPLY

Around 15 state health departments contacted by Reuters raised concerns about challenges they would face in the event of community spread, including worries about not having enough personal protective gear to safeguard frontline medical workers.

The U.S. Department of Health and Human Services on Tuesday estimated that the United States would need 300 million face masks to protect healthcare workers and the public from people infected with the virus. The country has fewer than 20 million of the kind of masks needed to protect healthcare workers in the Strategic National Stockpile, a government repository of medical supplies needed to address public health emergencies.

“There is a real concern the availability of this equipment may be limited, in part because of the public buying it in a panic when they don’t need it,” said Matt Zavadsky, head of the National Association of Emergency Medical Technicians.

President Donald Trump’s administration is considering invoking special powers through a law called the Defense Production Act to quickly expand domestic manufacturing of protective masks and clothing to combat the coronavirus in the United States, two U.S. officials told Reuters.

With no Covid-19 vaccine or proven anti-viral medicine available, states are planning to isolate sick people in their homes, both to slow community spread and reduce pressure on hospitals, according to the CDC.

Their ability to track a rapidly expanding web of patients who test positive, and all the people with whom they have had contact, is of major concern, according to chief epidemiologists in several states.

Health departments in some states have purchased disease surveillance software to help them with that task. The state of Washington’s system, for instance, tracks patients and people they have had contact with, and asks them about their condition. If someone reports symptoms that merit hospitalization, the patient and doctors are informed of that.

The CDC said in a news conference on Tuesday that transmission of the virus could be slowed by the closure of schools and businesses and the cancellations of concerts and other mass gatherings.

But exactly who would make those decisions or how they would be enforced isn’t clear and could vary widely throughout the nation.

In Texas, for example, such decisions may be made by local officials, said Chris Van Deus, a spokesman with the Texas health department.

“Texas is a home rule state so the buck really stops with county judges and mayors,” Van Deus said.

Another concern is a flood of patients into health systems that are already overburdened in many parts of the country, particularly during winter flu season.

Washington state is considering temporary drive-through care facilities to stop potential coronavirus carriers entering healthcare facilities, mindful that hospitals can amplify outbreaks, as was the case with the viruses that cause MERS and SARS.

New Mexico is working with healthcare systems to turn outpatient facilities into care units if needed, said State Epidemiologist Michael Landen.

“The biggest challenge is getting a consistent message to the public with respect to their options with dealing with this virus,” Landen said.

(Reporting by Julie Steenhuysen in Chicago, Andrew Hay in Taos, New Mexico and Brad Brooks in Austin, Texas; Editing by Marla Dickerson)

Exclusive: U.S. mulls using sweeping powers to ramp up production of coronavirus protective gear

By Ted Hesson and Alexandra Alper

WASHINGTON (Reuters) – President Donald Trump’s administration is considering invoking special powers through a law called the Defense Production Act to rapidly expand domestic manufacturing of protective masks and clothing to combat the coronavirus in the United States, two U.S. officials told Reuters.

The use of the law, passed by Congress in 1950 at the outset of the Korean War, would mark an escalation of the administration’s response to the outbreak. The virus first surfaced in China and has since spread to other countries including the United States.

U.S. health officials have told Americans to begin preparing for the spread of the virus in the United States.

The law grants the president the power to expand industrial production of key materials or products for national security and other reasons. The biggest producers of face masks in the United States include 3M Corp and Honeywell International Inc.

Trump, a Republican seeking re-election on Nov. 3, has faced criticism from Democrats over his administration’s response to the outbreak.

Health and Human Services (HHS) Secretary Alex Azar told lawmakers this week that the United States needs a stockpile of about 300 million N95 face masks – respiratory protective devices – for medical workers to combat the spread of the virus. The United States currently has only a fraction of that number available for immediate use, Azar testified.

During an interagency call on Wednesday, officials from HHS and the Department of Homeland Security (DHS) discussed the possibility of invoking the Defense Production Act for the manufacture of “personal protective equipment” that can be worn to prevent infection, according to a DHS official.

Such equipment can include masks, gloves and body suits.

Azar said at a congressional hearing on Wednesday that China controls “a lot of the raw materials as well as the manufacturing capacity” related to face masks.

“Very little of this stuff is apparently made in the (United) States, so if we’re down to domestic capability to produce, it could get tough,” the DHS official told Reuters.

A White House official confirmed that the administration was exploring the use of the law to spur manufacturing of protective gear. Both the DHS official and the White House requested anonymity to discuss the issue.

“Let’s say ‘Company A’ makes a multitude of respiratory masks but they spend 80% of their assembly lines on masks that painters wear and only 20% on the N95,” the White House official said. “We will have the ability to tell corporations, ‘No, you change your production line so it is now 80% of the N95 masks and 20% of the other.'”

“It allows you to basically direct things happening that need to get done,” the official added.

HHS declined to comment. DHS did not immediately respond to a request for comment.

‘VERY LOW’

Trump said on Wednesday the coronavirus risk to the United States remained “very low,” but that federal health officials were prepared to take action and that Vice President Mike Pence would take control of the U.S. response.

Chuck Schumer, the top Senate Democrat, on Thursday accused Trump of “towering and dangerous incompetence” and said the president “must get his act together” on the coronavirus threat.

Invoking the Defense Production Act is one of a number of options under consideration by the administration to combat the virus, the officials said, and no final decision has been made. Trump invoked the law in 2017 to address technological shortfalls in a vaccine production capability and other items such as microelectronics.

The law grants the president broad authority to “expedite and expand the supply of resources from the U.S. industrial base to support military, energy, space, and homeland security programs,” according to a summary on the Federal Emergency Management Agency website.

Azar testified on Wednesday that the United States has a stockpile of around 12 million of the N95 masks that are in line with certifications from the U.S. National Institute for Occupational Safety and Health (NIOSH). HHS also has another 5 million N95 masks that are no longer NIOSH certified, Azar said, perhaps because they are past the expiration date.

In addition to those masks, the U.S. government has a stockpile of 30 million “gauze type” surgical masks, which the U.S. Centers for Disease Control and Prevention has said are less effective because they are loose-fitting.

Azar said the government needs a stockpile of approximately 300 million N95 masks.

U.S. Food and Drug Administration Commissioner Stephen Hahn said in a written statement on Thursday that the agency had heard reports of increased market demand for some types of protective medical gear and “supply challenges,” but was not aware of specific shortages.

CDC Director Robert Redfield testified at a House subcommittee on Thursday that he would ask ordinary Americans not to buy N95 masks at this time.

“There’s no role for these masks in the community,” he said. “These masks need to be prioritized for healthcare professionals.”

(Reporting by Ted Hesson and Alexandra Alper; Additional reporting by Michael Erman, Jeff Mason, Mike Stone and David Brunnstrom; Editing by Ross Colvin, Will Dunham and Daniel Wallis)

Explainer: Coronavirus reappears in discharged patients, raising questions in containment fight

By David Stanway and Kate Kelland

SHANGHAI/LONDON (Reuters) – A growing number of discharged coronavirus patients in China and elsewhere are testing positive after recovering, sometimes weeks after being allowed to leave the hospital, which could make the epidemic harder to eradicate.

On Wednesday, the Osaka prefectural government in Japan said a woman working as a tour-bus guide had tested positive for the coronavirus for a second time. This followed reports in China that discharged patients throughout the country were testing positive after their release from the hospital.

An official at China’s National Health Commission said on Friday that such patients have not been found to be infectious.

Experts say there are several ways discharged patients could fall ill with the virus again. Convalescing patients might not build up enough antibodies to develop immunity to SARS-CoV-2, and are being infected again. The virus also could be “biphasic”, meaning it lies dormant before creating new symptoms.

But some of the first cases of “reinfection” in China have been attributed to testing discrepancies.

On Feb. 21, a discharged patient in the southwestern Chinese city of Chengdu was readmitted 10 days after being discharged when a follow-up test came back positive.

Lei Xuezhong, the deputy director of the infectious diseases center at the West China Hospital, told People’s Daily that hospitals were testing nose and throat samples when deciding whether patients should be discharged, but new tests were finding the virus in the lower respiratory tract.

Paul Hunter, a professor of medicine at Britain’s University of East Anglia who has been closely following the outbreak, told Reuters that although the patient in Osaka could have relapsed, it is also possible that the virus was still being released into her system from the initial infection, and she wasn’t tested properly before she was discharged.

The woman first tested positive in late January and was discharged from the hospital on Feb. 1, leading some experts to speculate that it was biphasic, like anthrax.

A Journal of the American Medical Association study of four infected medical personnel treated in Wuhan, the epicenter of the epidemic, said it was likely that some recovered patients would remain carriers even after meeting discharge criteria.

In China, for instance, patients must test negative, show no symptoms and have no abnormalities on X-rays before they are discharged.

Allen Cheng, professor of infectious diseases epidemiology at Monash University in Melbourne, said it wasn’t clear whether the patients were re-infected or had remained “persistently positive” after their symptoms disappeared. But he said the details of the Japan case suggested the patient had been reinfected.

Song Tie, vice director of the local disease control center in southern China’s Guangdong province, told a media briefing on Wednesday that as many as 14% of discharged patients in the province have tested positive again and had returned to hospitals for observation.

He said one good sign is that none of those patients appear to have infected anyone else.

“From this understanding … after someone has been infected by this kind of virus, he will produce antibodies, and after these antibodies are produced, he won’t be contagious,” he said.

Normally, convalescing patients will develop specific antibodies that render them immune to the virus that infected them, but reinfection is not impossible, said Adam Kamradt-Scott, a specialist in infectious diseases at the University of Sydney.

“In most cases though, because their body has developed an immune response to the first infection, the second infection is usually less severe,” Kamradt-Scott said.

Other experts have also raised the possibility of “antibody-dependent enhancement”, which means exposure to viruses might make patients more at risk of further infections and worse symptoms.

China has so far discharged 36,117 patients, according to data from the National Health Commission released on Friday, which represents almost 46% of the total cases on the Chinese mainland. If the 14% rate of reinfection is accurate and remains consistent, it could pose a wider health risk.

“I would say that it is less about if it is possible that re-infection can occur than how often it occurs,” Cheng said.

(Reporting by David Stanway in Shanghai, Kate Kelland in London and Rocky Swift in Tokyo; Additional reporting by Gabriel Crossley in Beijing; Editing by Gerry Doyle)

Coronavirus outbreak ‘getting bigger’, WHO says

By Stephanie Nebehay and Ryan Woo

GENEVA/BEIJING (Reuters) – The rapid rise in coronavirus raised fears of a pandemic on Friday, with six countries reporting their first cases, the World Health Organization warning it could spread worldwide and Switzerland cancelling the giant Geneva car show.

World share markets crashed again, winding up their worst week since the 2008 global financial crisis and bringing the global wipeout to $6 trillion.

Hopes that the epidemic that started in China late last year would be over in months, and that economic activity would quickly return to normal, have been shattered as the number of international cases has spiralled.

“The outbreak is getting bigger,” WHO spokesman Christian Lindmeier told reporters in Geneva.

“The scenario of the coronavirus reaching multiple countries, if not all countries around the world, is something we have been looking at and warning against since quite a while.”

Switzerland joined countries banning big events to try to curb the epidemic, forcing cancellation of next week’s Geneva international car show, one of the industry’s most important gatherings.

Mainland China reported 327 new cases, the lowest since Jan. 23, taking its tally to more than 78,800 cases with almost 2,800 deaths.

China’s three biggest airlines restored some international flights and the Shanghai fashion show, initially postponed, went ahead online.

TROOPS DEPLOYED

But as the outbreak eases in China, it is surging elsewhere.

Five more countries have reported their first case, all with travel history connected to Italy. They were Nigeria, Estonia, Denmark, Netherlands and Lithuania, Lindmeier said.

Mexico also detected its first cases of infection in two men who had travelled to Italy, making the country the second in Latin America to register the virus after Brazil.

Countries other than China now account for about three-quarters of new infections.

Bulgaria said it was ready to deploy up to 1,000 troops and military equipment to the border with Turkey to prevent illegal migrant inflows as steps up measures against the coronavirus. It has not reported any cases.

Mongolia, which has yet to confirm a case, placed its president, Battulga Khaltmaa, in quarantine as a precaution after he returned from a trip to China, state media reported.

A Chinese official called the epidemic the most difficult health crisis in the country’s modern history. Another said some recovered patients had been found to be infectious, suggesting the epidemic may be even harder to eradicate than previously thought.

Lindmeier said the WHO was looking very carefully into reports of some people getting re-infected.

In addition to stockpiling medical supplies, governments ordered schools shut and cancelled big gatherings to try to halt the flu-like disease.

U.S. President Donald Trump’s administration was considering invoking special powers to expand production of protective gear.

In Europe, France’s reported cases doubled, Germany warned of an impending epidemic and Greece, a gateway for refugees from the Middle East, announced tighter border controls.

The death toll in Italy, Europe’s worst-hit country, rose to 17 and those testing positive increased by more than 200 to 655.

Germany has nearly 60 cases, France about 38 and Spain 23, according to a Reuters count.

OLYMPIC DOUBTS

South Korea has the most cases outside China. It reported 571 new infections on Friday, bringing the total to 2,337 with 13 people killed.

The head of the WHO’s emergency programme, Dr Mike Ryan, said Iran’s outbreak may be worse than realised. It has the most deaths outside China – 34 from 388 reported cases.

U.S. intelligence agencies are monitoring the spread of coronavirus in Iran and India, where only a handful of cases have been reported, sources said.

U.S. Secretary of State Mike Pompeo said the United States had offered to help Iran, raising doubts about its willingness to share information.

Japan is scheduled to host the 2020 Olympics in July but Ryan said discussions were being held about whether to go ahead.

Organisers will decide next week on the ceremonial torch relay, due to arrive on March 20 for a 121-day journey past landmarks including Mount Fuji and Hiroshima’s Peace Memorial Park.

A woman wearing a face mask collects food purchased through group orders at the entrance of a residential compound in Wuhan, the epicentre of the novel coronavirus outbreak, Hubei province, China February 28, 2020. REUTERS/Stringer CHINA OUT.

As of Friday, confirmed cases in Japan had risen above 200, with four deaths, excluding more than 700 cases on a quarantined cruise liner, Diamond Princess.

A British man infected on the ship had died, bringing the death toll among passenger to six, Kyodo newswire reported.

Prime Minister Shinzo Abe had called for schools to close and vowed to prevent a severe blow to an economy already teetering on the brink of recession.

In Moscow, authorities were deporting 88 foreigners who violated quarantine measures imposed on them as a precaution, the RIA news agency cited Moscow’s deputy mayor as saying.

Chinese-ruled Hong Kong, where the coronavirus has killed two and infected more than 90, quarantined a pet dog of a coronavirus patient after it tested “weak positive”, though authorities had no evidence the virus can be transmitted to pets.

 Follow this link for Interactive graphic tracking global spread of coronavirus.

(Reporting by Stephanie Nebehay in Geneva, Ryan Woo, Yingzhi Yang in Beijing, Lisa Lambert and Mark Hosenball in Washington, Sangmi Chai in Seoul, Leika Kihara in Tokyo, Kate Kelland in London, Tsvetelia Tsolova in Sofia, Michael Shields and Brenna Hughes Neghaiwi in Zurich, Daina Beth Solomon in Mexico City; Writing by Robert Birsel, Giles Elgood and Nick Macfie; Editing by Simon Cameron-Moore, Jon Boyle and Timothy Heritage)

Secretive church at center of South Korea’s explosive coronavirus outbreak

By Hyonhee Shin and Hyun Young Yi

DAEGU/SEOUL, South Korea (Reuters) – An So-young had a gut feeling that the 31st person in South Korea to test positive for the coronavirus might be a member of the controversial religious sect she quit four years ago.

The person, dubbed “Patient 31,” was the first of an explosive wave of cases that made South Korea’s outbreak the largest outside of China. What caught An’s attention was how health authorities were struggling to track the woman’s movements before she was tested.

“That’s their culture, they have to hide their movements, and that’s why I guessed she was with Shincheonji,” An, 27, said in an interview, referring to the Shincheonji Church of Jesus.

Patient 31 attended services at the church’s branch in the southeastern city of Daegu this month, staying for two hours each time, before testing positive on Feb. 18.

The South Korean disease control chief Jeong Eun-kyeong said the church’s services, where thousands of people sit on the floor, shoulder-to-shoulder, for hours, could have contributed to the surges.

“You would be 5 centimeters away from the person who sits next to you, and have to say ‘Amen’ after every sentence the pastor speaks – it’s the best environment for the virus to spread,” said An, who is now a theology student.

In a media interview, Patient 31 said she did not refuse to be tested. But health authorities said she sought care at a traditional medicine hospital in Daegu after a minor car accident, where a medical worker who treated her later tested positive for the virus. While running a fever, she went to a buffet at a hotel and the church services.

Shincheonji is in the biggest crisis in its 36-year history, as hundreds of members have tested positive for the virus, SARS-CoV-2. All of its 210,000 known followers are being tested amid unprecedented scrutiny from authorities and the public.

After initial resistance, the church released the addresses of 1,100 facilities around the country – 82 churches and 1,018 “affiliates,” – and asked the public to avoid making “groundless criticism.” It was the “biggest victim of the virus,” it said.

Calls by Reuters to the church’s headquarters seeking comment went unanswered.

During a visit to the Daegu branch on Friday, a man who identified himself as a member said he was the only one there and told Reuters that “all of our 9,000 members are taking self-quarantine measures in compliance with the government instruction.” He said the building was disinfected twice last week.

 

‘THE DEVIL’S DEED’

South Korea reported 334 new cases of the coronavirus on Thursday, bringing the national tally to 1,595. More than 1,000 are from Daegu, according to the Korea Centres for Disease Control and Prevention (KCDC), and nearly 600 are directly linked to Shincheonji’s branch there.

KCDC said that it is still investigating the exact origin of the outbreak, but that five or six other members of the church were infected together with Patient 31.

The church had a presence in Wuhan, the center of the virus in China, according to the KCDC, though it is unclear whether that played a role.

Also known as the Temple of the Tabernacle of the Testimony, the church was founded and is headed by self-proclaimed messiah Lee Man-hee.

“This disease case is the devil’s deed to stop the rapid growth of Shincheonji,” Lee said in a message on Friday on an internal app used by members.

But its secretive practices and often-aggressive recruitment tactics have made the church a controversial presence in South Korea’s religious community.

New members are forced to leave home and live in dormitories as part of initiation. Many break ties with their family and begin aggressively recruiting new members, An said.

According to its website, followers must undergo six months of classes and complete a demanding written exam before “graduating” and joining the church.

The church has denied previous reports by Christian news organizations describing it as a “brainwashing cult”, calling those accusations “blatant lies” and a plot to rein in its expansion.

‘SECRET HARVESTERS’

All members work as “harvesters” tasked with courting new followers from other churches, dubbed “harvest fields”, former members said.

“It may appear Christian, but is actually completely different. They revere founder Lee Man-hee as a saviour, like Jesus,” said Lee Duck-sure, a Christian pastor who runs a counseling center in Seoul for former members of Shincheonji.

South Koreans vented anger after an official at a Daegu public health center that carries out virus tests continued to work even after he was told to get tested. He revealed he was a member of the Daegu Shincheonji church only after the test showed he was infected, Daegu officials said.

But health officials and experts cautioned the blame should not be focused on the church and its believers, saying they were also victims.

KCDC is also looking into links between the church and a hospital in nearby Cheongdo County, which reported the second-highest number of patients in the country with more than 110.

The county is a holy site for Shincheonji believers as the birthplace of Lee, and recently a funeral for his older brother was held at that hospital.

On a recent visit, the Daegu church was shuttered and silent, surrounded by empty streets and closed stores. Someone had thrown eggs at the front gate of the building.

Son, who did not want to give her full name and lives in the neighborhood, said many believers, especially young women, have moved to live near the church, and several restaurants are run by members.

Doo Song-Ja, 64, said she had not heard from her daughter since 2015, when she joined the church.

“I’m so worried because so many Shincheonji followers are testing positive but I don’t know where she is,” said Doo, who said her 33-year-old daughter had sued her for “forcible confinement” for trying to keep her home. “I just hope she is OK.”

(Reporting by Hyonhee Shin and Hyun Young Yi; Additional reporting by Chaeyoun Won and Soohyun Mah; Editing by Josh Smith, Jack Kim and Gerry Doyle)

Trump says coronavirus risk in U.S. is low; CDC confirms first case of unknown origin

By Jeff Mason and Jonathan Allen

WASHINGTON/NEW YORK (Reuters) – President Donald Trump told Americans on Wednesday that the risk from coronavirus remained “very low,” and placed Vice President Mike Pence in charge of the U.S. response to the looming global health crisis.

At a White House briefing, Trump defended his administration’s handling of the crisis and said health experts were “ready, willing and able” to move quickly if the virus spreads.

Trump made his comments as public health officials warned Americans to prepare for more coronavirus cases. The Centers for Disease Control and Prevention confirmed an infection of the new coronavirus in California in someone who had not traveled outside the United States or been exposed to a person known to have the virus, a first for the country.

How the person was infected was not known. It brought the total number of cases in the United States to 15, according to the CDC.

New York Mayor Bill de Blasio called on the government to help the city obtain 300,000 extra protective masks. There were no confirmed cases in the city but de Blasio announced plans to provide up to 1,200 hospital beds if needed.

U.S. stock markets fell for the fifth consecutive day on investors’ alarm about the respiratory disease spreading.

At the White House, Trump said he was not ready to institute new travel restrictions for countries such as South Korea and Italy that are dealing with outbreaks – although he could not rule it out. The State Department raised its travel alert level for South Korea and urged Americans to reconsider going there.

The CDC has advised Americans to not visit China and South Korea, and on Wednesday stepped up travel warnings for Iran, Italy and Mongolia.

“The risk to the American people remains very low,” Trump said, flanked by Pence and public health officials.

He said the spread of the virus in the United States was not “inevitable” and then went on to say: “It probably will, it possibly will. It could be at a very small level, or it could be at a larger level. Whatever happens we’re totally prepared.”

Dr. Anthony Fauci, the head of the National Institute of Allergy and Infections Diseases, said that while the virus was contained in the United States, Americans must prepare for a potential outbreak as transmissions spread outside of China.

U.S. Health and Human Services Secretary Alex Azar said the United States has 59 coronavirus cases, including 42 American passengers repatriated from the Diamond Princess cruise ship docked in Japan.

‘POSSIBILITY OF PANDEMIC’

“We have to be alert to the possibility of a pandemic,” Peter Marks, director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, said in an interview.

House of Representatives Speaker Nancy Pelosi, a Democrat, said in a statement that the Trump administration “has mounted an opaque and chaotic response to this outbreak.”

She said the House would put forward a “funding package with transparency and accountability that fully addresses the scale and seriousness of this public health crisis.”

Trump is seeking $2.5 billion from Congress to boost the government’s virus response, an amount Democrats said falls far short of what is needed. Senate Democratic Leader Chuck Schumer called for $8.5 billion to prepare.

Global stock markets have slumped in recent days due to worries over a prolonged disruption to supply chains and economies from the virus, which has infected about 80,000 people and killed nearly 3,000, mostly in China.

U.S. stocks turned lower in afternoon trading – the S&P 500 index fell for a fifth straight day and the Dow Jones Industrial Average <.DJI> ended down 123.77 points, or 0.46%. [.N]

Trump, who is running for a second term in the November election, has been increasingly alarmed by the drop in U.S. stock markets, which he considers a barometer of the health of the American economy and sees as important to his re-election.

He told reporters at the White House that fears of the coronavirus had hurt the stock markets. But he also blamed the Democratic presidential candidates for spooking investors.

“I think the financial markets are very upset when they look at the Democrat candidates standing on that stage making fools out of themselves,” Trump said in reference to debates among the Democratic contenders vying for the right to challenge him.

Earlier in the day, Trump accused two cable TV news channels, CNN and MSNBC, of presenting the danger from the virus in as bad a light as possible and upsetting financial markets.

(Reporting by Jeff Mason and Jonathan Allen; additional reporting by Steve Holland, Makini Brice, Susan Heavey and Michael Erman; Writing by John Whitesides and Alistair Bell; Editing by Jonathan Oatis, Bill Berkrot and Grant McCool)

UK conducts random coronavirus testing as part of early warning plan

LONDON (Reuters) – Britain has started random tests for coronavirus on flu patients to have an early warning system in place in case the outbreak becomes more widespread, a senior health official said.

Britain has so far had 13 cases of coronavirus. An outbreak in northern Italy worsened on Wednesday, and the illness has spread to Spain, Austria, Switzerland, Croatia and France via visitors who were recently in northern Italy.

“We’re heightening our vigilance because of the apparent spread of the virus in countries outside mainland China,” Public Health England’s medical director, Paul Cosford, told BBC radio on Wednesday.

The disease is believed to have originated in a market selling wildlife in the Chinese city of Wuhan late last year and has infected about 80,000 people and killed more than 2,700, the vast majority in China.

British health minister Matt Hancock said the government had plans in place in case the virus becomes a pandemic.

In Britain, random tests for the virus will be carried out at 11 hospitals and 100 general medical offices on people who have flu symptoms including a cough, plus shortness of breath and a fever.

“This testing will tell us whether there’s evidence of infection more widespread than we think there is. We don’t think there is at the moment,” PHE’s Cosford said.

“The other thing it will do is, if we do get to the position of more widespread infection across the country, then it will give us early warning that that’s happening,” he added.

Hancock told parliament the government expected more cases in Britain and was planning to introduce home testing.

“We are taking all necessary measures to minimise the risk to the public,” he said. “The public can be assured that we have a clear plan to contain, delay, research and mitigate this virus.”

Media have reported several schools have closed or sent pupils home after returning from trips to northern Italy during last week’s school holiday. Hancock said there was no need for schools to close or other students or staff to be sent home.

(Reporting by Sarah Young and Kylie MacLellan; Editing by William Schomberg and Stephen Addison)

Coronavirus travel: national advice not all of a piece

LONDON (Reuters) – Should travelers avoid parts of the world near coronavirus hotspots? Or go – but then tread carefully? The official advice they receive may depend on whether they live in Amsterdam, Helsinki, Madrid or Lagos.

As the new coronavirus spreads from China, travel guidelines being issued by governments across the world all express notes of growing caution. But they contain subtle differences on where to avoid, how to behave and what to do after a trip.

With few exceptions, the prevailing advice of national authorities is to avoid Hubei province – epicenter of an outbreak that has now infected 80,000 people worldwide – and to reduce Chinese travel to the bare minimum.

Once inside China, Swiss travelers for example are urged by their government to avoid large gatherings and “cough or sneeze into a tissue, or use the crook of your arm”. France tells its nationals not to eat raw meat or visit animal markets.

The Spanish Foreign Ministry also urges against contact with animals in China and suggests making sure that you stay at least one meter away from the next person.

For travelers to Italy – the country most badly hit by the virus in Europe – the Dutch government recommends that its citizens avoid areas already locked down by local authorities and only travel to parts of the wider Lombardy region around the closed-off towns if necessary. The Finnish Foreign Ministry advice on Italy is simply to “take special care”.

Differences also emerge in the advice to travelers on their return from an affected area.

Germany’s main authority for infectious diseases tells those returning with symptoms from outbreak regions in Italy to see a doctor and call prior to their visit. But France asks such people not to visit the doctor but to call emergency services.

Britain urges its nationals to “self-isolate” at home if they have been to the areas quarantined by Italy whether or not they have symptoms. The Danish Health Authority currently stipulates no routine quarantine or isolation of people who have traveled to China or other places hit by the outbreak.

Countries outside Europe take different stances. Turkey advises against all but essential travel to China but has not yet issued travel advice on Italy.

Nigeria has a voluntary two-week self-quarantine in place for all passengers arriving from China or any country with “a major outbreak”. Guidance for returning air passengers says “try to avoid” going out but wear a mask if you do.

(Reporting by Reuters bureaus; compiled by Mark John; Editing by Gareth Jones)

U.S. says Iran may have suppressed ‘vital details’ on coronavirus outbreak

WASHINGTON (Reuters) – U.S. Secretary of State Mike Pompeo on Tuesday said the United States was “deeply concerned” Iran may have covered up details about the spread of coronavirus, and he called on all nations to “tell the truth” about the epidemic.

“The United States is deeply concerned by information indicating the Iranian regime may have suppressed vital details about the outbreak in that country,” Pompeo told reporters, as he also criticized Beijing for what he characterized as the censorship of media and medical professionals.

“All nations, including Iran, should tell the truth about the coronavirus and cooperate with international aid organizations,” he said.

Iran’s coronavirus death toll rose to 16 on Tuesday, the highest outside China, increasing its international isolation as nations from South Korea to Italy accelerated emergency measures to curb the epidemic’s global spread.

Believed to come from wildlife in Wuhan city late last year, the flu-like disease has infected 80,000 people and killed 2,663 in China. But the World Health Organization (WHO) says the epidemic there has peaked and has been declining since Feb. 2.

Beijing last week revoked the credentials of three Wall Street Journal correspondents over a column China said was racist, and the United States has said it was considering a range of responses to their expulsion.

Pressed on what steps the Trump administration might take, Pompeo declined to provide any details beyond saying a broad range of options were on the table.

“Expelling our journalists exposes once again the government’s issue that led to SARS and now the coronavirus – namely censorship. It can have deadly consequences,” Pompeo said, referring to the 2002-2003 outbreak of severe acute respiratory syndrome.

“If China permitted its own and foreign journalists and medical personnel to speak and investigate freely, Chinese officials and other nations would have been far better prepared to address the challenge” of coronavirus, he added.

Pompeo said that despite the coronavirus epidemic, the United States planned to move forward and host a special meeting with the 10-member Association of Southeast Asian Nations (ASEAN) in Las Vegas in March.

(Reporting by Humeyra Pamuk; Writing by Tim Ahmann; Editing by Chizu Nomiyama and Paul Simao)

Coronavirus increases Iran’s isolation, strains South Korea and Italy

By Parisa Hafezi and Ryan Woo

DUBAI/BEIJING (Reuters) – Iran’s coronavirus death toll rose to 16 on Tuesday, the highest outside China, increasing its international isolation as dozens of countries from South Korea to Italy accelerated emergency measures to curb the epidemic’s global spread.

Believed to come from wildlife in Wuhan city late last year, the flu-like disease has infected 80,000 people and killed 2,663 in China. But the World Health Organization (WHO) says the epidemic there has peaked and has been declining since Feb. 2.

Beyond mainland China, however, it has jumped to about 29 countries and territories, with some three dozen deaths, according to a Reuters tally. Growing outbreaks in Iran, Italy and South Korea are of particular concern.

“We are close to a pandemic but there is still hope,” said Raina MacIntyre, head of a biosecurity program at the University of New South Wales, using the term for a widespread global epidemic.

Global stocks sank to their lowest levels in over two months on Tuesday in anxiety over the coronavirus’ spread and its damage to the world economy.

Iran’s outbreak, amid mounting U.S. sanctions pressure, threatens to leave it further cut off. Several countries suspended flights due to cases in travelers from Iran to Canada, Lebanon, the United Arab Emirates and Iraq.

Some neighbors also closed borders, while Oman’s Khasab port halted imports and exports with Iran.

“It is an uninvited and inauspicious visitor. God willing we will get through … this virus,” Iranian President Hassan Rouhani said in a televised speech.

The deputy health minister was among those infected.

Iran canceled concerts and soccer matches nationwide, and schools and universities closed in many provinces. Many Iranians took to social media to accuse authorities of concealing facts.

Popular anger has been high over the handling of a Ukrainian passenger plane crash in January, which the military took three days to acknowledge was caused by an Iranian missile fired in error.

Authorities say U.S. sanctions are hampering its response to the coronavirus by preventing imports of masks and medicines.

CHURCH UNDER SCRUTINY

South Korea has the most virus cases outside China, with 977 infections and 10 deaths, the majority linked to the Shincheonji Church of Jesus in the city of Daegu, where the outbreak is believed to have begun with a 61-year-old woman.

Authorities were to test all members of the church, estimated by media at about 215,000 people. President Moon Jae-in acknowledged the situation was “very grave”.

In Europe, Italy is the front line, with more than 280 cases and seven deaths, most in the northern Lombardy and Veneto regions but one case emerging in Sicily, the first in the country south of Rome.

Italy’s tourist industry, which accounts for about 13% of the economy, fears a plunge amid restrictions on public events affecting soccer matches, cinemas and theaters.

A planned three-week shoot in Italy for Tom Cruise’s seventh outing in the “Mission: Impossible” series was also postponed, while Milan cathedral was closed and Venice carnival canceled.

Airlines began restricting flights to Italy, while prices for masks and gels skyrocketed.

Eurasia consultancy’s Scott Rosenstein said the bad news from Iran, South Korea and Italy had undercut confidence sustained human-to-human transmission can be limited to China.

“This worsening narrative around disease containment has overshadowed the cautious optimism narrative coming out of China,” he said. “Markets have responded accordingly.”

“DON’T HANG ABOUT”

Afghanistan, Bahrain, Iraq, Kuwait and Oman reported their first new coronavirus cases, all in people who had been to Iran.

With dozens of sporting events already hit, Japan, which has had four deaths and 850 cases, said it was premature to talk about cancelling the Tokyo Olympics due to start on July 24.

The United States pledged $2.5 billion to fight the disease, with more than $1 billion going towards developing a vaccine.

China reported a rise in new cases in Hubei province, the epicenter of the outbreak. But excluding those, it had just nine new infections on Monday, its fewest since Jan. 20.

With the pace of new infections slowing, Beijing said restrictions on travel and movement that have paralyzed activity in the world’s second-largest economy should begin to be lifted.

An official with the Beijing Center for Disease Prevention and Control noted that supermarkets were becoming busier – but offered some pointers for shoppers.

“Choose a supermarket with relatively low foot traffic and good ventilation, and prepare a shopping list before actually going to shop,” Liu Xiaofeng told reporters.

“Don’t hang about. Don’t chit-chat.”

(Interactive graphic tracking global spread of coronavirus https://graphics.reuters.com/CHINA-HEALTH-MAP/0100B59S39E/index.html)

(Reporting by Ryan Woo, Yilei Sun and Lusha Zhang in Beijing; Hyonhee Shin and Josh Smith in Seoul; Jeff Mason and Phil Stewart in Washington; Ritvik Carvalho in London; Writing by Andrew Cawthorne; Editing by Nick Macfie and Timothy Heritage)