Tag Archives: Virus

Alarmed as COVID patients’ blood thickened, New York doctors try new treatments

By Jonathan Allen

NEW YORK (Reuters) – As the novel coronavirus spread through New York City in late March, doctors at Mount Sinai Hospital noticed something strange happening to patients’ blood.

Signs of blood thickening and clotting were being detected in different organs by doctors from different specialties. This would turn out to be one of the alarming ways the virus ravages the body, as doctors there and elsewhere were starting to realize.

At Mount Sinai, nephrologists noticed kidney dialysis catheters getting plugged with clots. Pulmonologists monitoring COVID-19 patients on mechanical ventilators could see portions of lungs were oddly bloodless. Neurosurgeons confronted a surge in their usual caseload of strokes due to blood clots, the age of victims skewing younger, with at least half testing positive for the virus.

“It’s very striking how much this disease causes clots to form,” Dr. J Mocco, a Mount Sinai neurosurgeon, said in an interview, describing how some doctors think COVID-19, the illness caused by the coronavirus, is more than a lung disease. In some cases, Mocco said, a stroke was a young patient’s first symptom of COVID-19.

As colleagues from various specialties pooled their observations, they developed a new treatment protocol. Patients now receive high doses of a blood-thinning drug even before any evidence of clotting appears.

“Maybe, just maybe, if you prevent the clotting, you can make the disease less severe,” said Dr. David Reich, the hospital president. The new protocol will not be used on certain high-risk patients because blood thinners can lead to bleeding in the brain and other organs.

“FUNNY YOU MENTIONED THAT”

In the three weeks beginning mid-March, Mocco saw 32 stroke patients with large blood blockages in the brain, double the usual number for that period.

Five were unusually young, under age 49, with no obvious risk factors for strokes, “which is crazy,” he said. “Very, very atypical.” The youngest was only 31.

At least half of the 32 patients would test positive for COVID-19, Mocco said.

Meanwhile, Dr. Hooman Poor, a Mount Sinai lung specialist, found himself working a late shift with 14 patients on ventilators. The ventilator readings were not what he expected.

The lungs did not seem stiff, as is common in pneumonia. Instead, it seemed blood was not circulating freely through the lungs to be aerated with each breath.

Poor ran into a kidney doctor that night, who remarked that dialysis catheters were often getting blocked with clots.

“And I said, ‘It’s funny that you mentioned that because I feel like all these patients have blood clots in their lungs,'” Poor recalled.

Reich, the hospital president, told Poor about the surge in strokes seen by Mocco and said the two doctors should team up, setting off days of discussions and meetings with the hospital’s department heads.

At 2:46 a.m. on Easter Sunday, Poor sent Mocco his first draft of what would become the new treatment protocol.

DOCTORS SHARE FINDINGS

As their wards began to overflow with COVID-19 patients, the Mount Sinai doctors read papers describing similar findings from doctors in China’s Hubei province and other hard-hit areas, and discussed them with their peers in phone calls and webinars.

Mocco called neurosurgeons he knows elsewhere in the country. At Philadelphia’s Thomas Jefferson University Hospital, Dr. Pascal Jabbour had begun to see a similar surge in strokes among people with COVID-19. The way his patients’ blood congealed reminded him of congenital conditions such as lupus, or certain cancers.

“I’ve never seen any other viruses causing that,” Jabbour said.

In Boston, the Beth Israel Deaconess Medical Center began a clinical trial earlier this month to see if tPA, an anti-clotting drug, could help severely sick COVID-19 patients.

Clotting can develop in anyone who gets very sick and spends long periods of time immobile on a ventilator, but doctors say the problem seemed to show up sooner in COVID-19 patients as a more direct consequence of the virus.

At Mount Sinai, patients in intensive care often receive the blood-thinning agent heparin in weaker prophylactic doses. Under the new protocol, higher doses of heparin normally used to dissolve clots will be given to patients before any clots are detected.

The treatment joins a growing toolbox at the hospital, where some patients are receiving the antibody-rich plasma of recovered COVID-19 patients or experimental antiviral drugs.

The American Society of Hematology, which has also noted the clotting, says in its guidance to physicians that the benefits of the blood-thinning therapy for COVID-19 patients not already showing signs of clotting are “currently unknown.”

“I certainly wouldn’t expect harps to play and angels to sing and people to just rip out their intravenous lines and waltz out of the hospital,” said Reich. “It’s likely going to be something where it just moderates the extent of the disease.”

(Reporting by Jonathan Allen in New York; Editing by Nancy Lapid, Ross Colvin and Aurora Ellis)

‘We’re trying to keep our heads above water’: U.S. healthcare workers fight shortages – and fear

By Kristina Cooke, Gabriella Borter and Joseph Ax

LOS ANGELES/NEW YORK (Reuters) – U.S. nurses and doctors on the front lines of the battle against the new coronavirus that has infected tens of thousands of Americans and killed hundreds are shellshocked by the damage that the virus wreaks – on patients, their families and themselves.

Nurses and doctors describe their frustration at equipment shortages, fears of infecting their families, and their moments of tearful despair.

These are some of their stories:

NEW YORK CONFIRMED CASES: 53,324. DEATHS: 773

Dr. Arabia Mollette, an emergency medicine physician, has started praying during the cab ride to work in the morning. She needs those few minutes of peace – and some lighthearted banter with the cafeteria staff at Brookdale University Hospital Medical Center in Brooklyn at 6:45 a.m. – to ground her before she enters what she describes as a “medical warzone.” At the end of her shift, which often runs much longer than the scheduled 12 hours, she sometimes cannot hold back tears.

“We’re trying to keep our heads above water without drowning. We are scared. We’re trying to fight for everyone else’s life, but we also fight for our lives as well,” Mollette said.

The hospitals where she works, Brookdale and St. Barnabas Hospital in the Bronx, are short of oxygen tanks, ventilators and physical space. Seeing the patients suffer and knowing she might not have the resources to help them feels personal for Mollette, who grew up in the South Bronx and has family there and in Brooklyn.

“Every patient that comes in, they remind me of my own family,” she said.

At least one emergency nurse at a Northwell Health hospital in the New York City area is wondering how much longer she can take the strain.

After days of seeing patients deteriorate and healthcare workers and family members sob, she and her husband, who have a young son, are discussing whether she should leave the job she has done for more than a decade.

The emergency room, always a hotbed of frenetic activity, is now dominated by coronavirus cases. There are beds all over the waiting room. The nurse, who spoke on condition of anonymity, said she sees family members dropping off sick relatives and saying goodbye.

“You can’t really tell them they might be saying goodbye for the last time,” she said.

On Thursday, some nurses and doctors were brought to tears after days of physical and emotional fatigue.

“People were just breaking down,” she said. “Everyone is pretty much terrified of being infected … I feel like a lot of staff are feeling defeated.”

At first, she was not too worried about her safety since the coronavirus appeared to be deadliest among the elderly and those with underlying health conditions.

That confidence dissolved after seeing more and more younger patients in serious condition.

“At the beginning, my mentality was, ‘Even if I catch it, I’ll get a cold or a fever for a couple of days,'” she said. “Now the possibility of dying or being intubated makes it harder to go to work.”

There is no official data on the number of healthcare workers who have contracted the virus, but one New York doctor told Reuters that he knew of at least 20.

WASHINGTON STATE CONFIRMED CASES: 4,310. DEATHS: 189

A Seattle nurse has started screening patients for coronavirus at the door of her hospital, a different job from her usual work on various specialty procedures.

She doesn’t talk about her new job at home, because she doesn’t want to worry her school-aged children, she said. Her husband does not understand her work and tells her to decline tasks that could put her at risk.

“I’m like, ‘Well it’s already unsafe in my opinion,'” she said.

But she is nervous about having to separate from her family if she contracts the virus.

“I’ll live in my car if I have to. I’m not getting my family sick,” she said.

The nurse spoke on condition of anonymity because she is not allowed to speak to the media.

During her last shift, she was told to give symptomatic patients napkins to cover their faces instead of masks – and not to wear a mask herself. She ignored that and wore a surgical mask, but she worries less experienced staff heeded the guidance.

“We get right in their faces to take their temperatures because we do not have six-feet-away infrared thermometers,” she said. “The recommendations seem to change based on how many masks we have.”

Her hospital has put a box outside for the community to donate masks because they are so short of supplies.

She blames the government for not doing more to prepare and coordinate: “People should not have to die because of poor planning.”

MICHIGAN CONFIRMED CASES: 4,650. DEATHS: 111

Nurse Angela, 49, says the emergency room at her hospital near Flint, Michigan, is eerily quiet. “We’ve all been saying this is the calm before storm,” said Angela, who asked that only her first name be used.

The patients who trickle in are “very sick” with the COVID-19 respiratory illness, she said, “and they just decline really quickly.”

As they go from room to room, the nurses discuss how many things they are contaminating due to their limited protective equipment.

“You’d have to walk around with someone with Clorox wipes all night walking behind you,” she said. “The contamination is just so scary for me.”

She accepts that she and most of her colleagues may be infected. But she is worried about her daughter and her sister, who are both nurses, and she worries about infecting her 58-year-old husband.

Angela’s daughter has sent her three children, including an 18-month-old who suffers from asthma, to stay with their father to avoid possibly infecting them.

“I normally see my grandchildren twice a week and I haven’t seen them. It’s hard. I just cannot fathom what my daughter’s going through,” Angela said.

Many of her co-workers have done the same, packing off children to live with relatives because they are terrified, not so much of contracting the disease, but of passing it on.

Some of them are talking about quitting because they feel unprotected.

Angela would not judge them, she said, but she told a friend recently, “You have to remember, what if your kid gets sick or your mom gets sick, who’s going to take care of them when you take them to the hospital if all of us just leave?”

(Reporting by Gabriella Borter, Kristina Cooke and Joey Ax; Editing by Ross Colvin and Daniel Wallis)

‘There are no funerals:’ Death in quarantine leaves nowhere to grieve

By Angelo Amante, Parisa Hafezi and Hayoung Choi

(Reuters) – Struck down by coronavirus at the age of 83, the long life of Alfredo Visioli ended with a short ceremony at a graveyard near Cremona, his hometown in northern Italy.

“They buried him like that, without a funeral, without his loved ones, with just a blessing from the priest,” said his granddaughter Marta Manfredi who couldn’t attend. Like most of the old man’s family – like most of Italy – she was confined to her home.

“When all this is over,” she vows, “we will give him a real funeral.”

Everywhere the coronavirus has struck, regardless of culture or religion, ancient rituals to honor the dead and comfort the bereaved have been cut short or abandoned for fear of spreading it further.

The virus, which has killed nearly 9,000 people worldwide, is reshaping many aspects of death, from the practicalities of handling infected bodies to meeting the spiritual and emotional needs of those left behind.

In Ireland, the health authority is advising mortuary workers to put face masks on dead bodies to reduce even the minor risk of infection. In Italy, a funeral company is using video links to allow quarantined families to watch a priest bless the deceased. And in South Korea, fear of the virus has caused such a drop in the number of mourners that funeral caterers are struggling for business.

There is little time for ceremony in hard-hit cities such as Bergamo, northeast of Milan, where the mortuaries are full and the crematorium is working around the clock, said Giacomo Angeloni, a local official in charge of cemeteries.

Bergamo, home to about 120,000 people, has been dealing with 5-6 times the number of dead it would in normal times, he said.

Italy has now reported nearly 3,000 deaths from COVID-19, the disease caused by the coronavirus – the highest outside China where the virus first emerged. The Italian army sent 50 troops and 15 trucks to Bergamo on Wednesday to take bodies to less overwhelmed provinces.

A ban on gatherings has shattered the vital rituals that help us grieve, said Andy Langford, the chief operating officer of Cruse Bereavement Care, a British charity providing free care and counseling to those in grief.

“Funerals allow a community to come together, express emotion, talk about that person and formally say goodbye,” he said.

“When you feel you have no control over how you can grieve, and over how you can experience those last moments with someone, that can complicate how you grieve and make you feel worse,” he said.

EXTRA STAFF

In Iran as in northern Italy, hospital and funeral workers are overwhelmed with bodies, as the virus has torn across the country, killing 1,284 people and infecting thousands, according to state TV.

The authorities have hired new people to dig graves, said a manager at Tehran’s Behesht-e Zahra cemetery. “We work day and night,” he said. “I have never seen such a sad situation. There are no funerals.”

Most corpses arrive by truck and are buried without the ritual washing that Islam dictates, he said.

Some Iranians suspect that the official haste to bury them has more to do with obscuring the spiraling death toll than halting the spread of the virus.

Deaths from COVID-19 have been recorded as heart attacks or lung infections, a hospital worker in Kashan, a city about a three-hour drive from Tehran, told Reuters.

“The officials are lying about the death toll,” the worker said. “I have seen dozens of corpses in the past few days, but they have told us not to talk about it.” Two nurses at Iranian hospitals also told Reuters they thought the death toll was higher than the official tally.

Iranian authorities have rejected allegations of a cover-up, and President Hassan Rouhani, in a televised speech on Mar. 18, said his government had been “honest and straightforward with the nation.”

INFECTION RISK

In several countries, clusters of infection have followed funerals. In South Korea, where more than 90 people have died, the government has urged the families of COVID-19 victims to cremate their loved ones first, and hold the funeral later.

Korean funerals usually take place in hospitals, and involve three days of prayers and feasting. Most of the country’s early cases were linked to a church in Daegu city and a hospital in a nearby county. In February, several members of the Shincheonji Church of Jesus attended a funeral at the hospital for the brother of the church’s founder.

Since the outbreak, the number of mourners at funerals has plunged by 90%, regardless of whether the deceased had the virus, said Choi Min-ho, secretary general of the Korea Funeral Association.

“The culture of funerals has changed significantly,” he said. “A handful of mourners quickly offer condolences and leave the place without dining together out of infection worries.”

Condolence money, traditionally handed over in cash, is now sent via bank transfer, he added.

Authorities in Wuhan, the epicenter of China’s outbreak and location of the majority of its deaths, quickly identified the funeral business as a potential source of transmission.

The local civil affairs bureau in late January ordered all funerals for confirmed COVID-19 victims to be handled at a single funeral home in the city’s Hankou district. Mourning ceremonies, usually boisterous social events in China, were curtailed along with all other public gatherings.

Those restrictions are still in place, even though the number of new cases has dwindled in recent weeks. Bereaved families are not even allowed to see the bodies of their loved ones, a worker at the funeral home told Reuters.

In China, the ashes of the deceased tend to be kept in funeral homes until they are taken to a family plot on public holidays such as the Tomb Sweeping Festival in April. That’s also canceled this year.

“DEATH MANAGEMENT”

In Spain, too, a large cluster of cases has been traced to a funeral in the northern town of Vitoria in late February. At least 60 people who attended tested positive after the event, said local media reports.

With over 600 deaths, Spain is the second-worst hit country in Europe after Italy, and most people are now confined to their homes. Referring to these restrictions, Prime Minister Pedro Sanchez has called coronavirus a “cruel” disease that paralyses the human need to socialize.

In Ireland, up to 100 guests are still allowed at all funerals – for now. But most families are opting for small private ceremonies and encouraging others to express their condolences online through websites such as RIP.ie, where death notices and funeral invitations are usually posted.

Open casket funerals are out for any victim of coronavirus, and “the family should be advised not to kiss the deceased,” according to new guidelines from Ireland’s Health and Safety Executive to its funeral directors.

The risk of catching coronavirus from a dead body is slim, public health officials say, but some countries are recommending extra measures.

Israel has reported no coronavirus deaths, but its health ministry says the deceased should be double-wrapped in impermeable plastic. Ritual washing and rites will be performed in full protective gear and the corpse re-wrapped in plastic for burial. Normally Israel’s Jewish dead are laid to rest in a cloth smock and shroud.

Ireland’s guidelines advise workers in funeral parlors to put face masks on dead bodies before moving them, in case they “expel a very small amount of air and viral droplets from the lungs” and infect the living.

In Britain, where the pandemic is still gathering pace, there is widespread anxiety about the likely death toll.

Britain has been slower in implementing the strict measures seen elsewhere in Europe, and expert estimates of how many will die from COVID-19 have ranged wildly from the tens to the hundreds of thousands.

An emergency bill to tackle the virus, which has killed 104 people in Britain, includes a number of measures the government says will “streamline the death management process.” The measures include allowing funeral directors to register a death on behalf of a self-isolating family.

Deborah Smith, a spokesperson for the National Association of Funeral Directors, said the bill will help the profession “preserve the dignity of those who die and care for their bereaved families with compassion – even if they are not able to have the kind of funeral they would have wanted.”

Smith would not be drawn on the expected numbers, but said “funeral directors are preparing for a variety of scenarios.”

“NOT ALONE”

One scenario is already playing out in Wuhan.

Last month, a worker at the funeral home in Hankou district, identifying himself only as Huang, wrote an essay that was circulated on social media. He said funeral workers were as overwhelmed as the city’s medics but had received less recognition.

He said staff had worked without a break since the start of the epidemic. “Some of our employees don’t even drink water because they need to go to the toilet and it’s difficult to take off the protective clothing,” he wrote.

Half a world away, in the virus-stricken Italian town of Bergamo, funeral workers wage a near-identical struggle.

“It’s like being in a war with an invisible enemy,” said Roberta Caprini, a partner in Centro Funerario Bergamasco, a funeral service in Bergamo. “We’ve been working without interruption for two weeks and sleeping 3-4 hours a night when we manage it. Everyone in our area, us included, has lost someone or have someone sick in their home.”

Bergamo’s Church of All Saints has become a makeshift mortuary, its pews pushed aside to accommodate the dead. Caprini said she had counted at least 60 coffins when she visited on Tuesday.

She spoke of the “real torture” felt by families who watched sick relatives taken away to hospital and never saw them again. Her company has arranged video links to burials, to allow families to watch the priest bless the deceased.

Sometimes, she said, they drive the hearses past the bereaved family’s home, so mourners “can at least come down at the moment and offer a quick prayer.”

(This story has been refiled to fix the bylines)

(Reporting by Elisa Anzolin and Emilio Parodi in Milan; Angelo Amante in Rome; Parisa Hafezi in Dubai; David Stanway in Shanghai; Joan Faus in Barcelona; Hayoung Choi in Seoul, Padraic Halpin in Dublin; Emma Farge in Zurich; Kate Kelland in London and Dan Williams in Jerusalem; Writing and additional reporting by Andrew RC Marshall; Edited by Sara Ledwith and Jason Szep)

Coronavirus spreading fast but stigma is more dangerous: WHO

By Stephanie Kelly and Se Young Lee

GENEVA/BEIJING (Reuters) – Coronavirus now appears to be spreading much more rapidly outside China than within but can still be contained, and stigma is more dangerous than the disease itself, the World Health Organization said on Monday.

WHO chief Tedros Adhanom Ghebreyesus said almost nine times as many cases had been reported outside China as inside in the previous 24 hours, adding that the risk of coronavirus spreading was now very high at a “global level”.

He said outbreaks in South Korea, Italy, Iran and Japan were the greatest concern, but that there was evidence that close surveillance was working in South Korea, the worst affected country outside China, and the epidemic could be contained there.

“Stigma, to be honest, is more dangerous than the virus itself. Let’s really underline that. Stigma is the most dangerous enemy,” he told a news briefing in Geneva.

He said the fight against the coronavirus should become a bridge for peace, commending the United States for supporting sending medical aid to Iran despite the tensions between them.

“I think we have a common enemy now,” he said.

The global death toll exceeded 3,000, with the number of dead in Italy jumping by 18 to 52 and Latvia, Saudi Arabia and Senegal reporting cases for the first time.

Yet equity markets surged after their worst plunge since the financial 2008 crisis last week, encouraged by the prospect of government action to stem the economic impact.

Finance ministers of the G7 group of leading industrialized democracies were expected to discuss measures in a conference call on Tuesday, sources told Reuters.

Oil prices jumped 4% amid hopes of a deeper output cut by the Organization of the Petroleum Exporting Countries.

( Graphic: Tracking the coronavirus https://graphics.reuters.com/CHINA-HEALTH-MAP/0100B59S39E/index.html )

MORE THAN PREDICTED

A senior U.S. official said he was concerned about a likely jump in the number of cases in the United States, which has had more than 90, with six deaths.

“When you have a number of cases that you’ve identified and they’ve been in the community for a while, you’re going to wind up seeing a lot more cases than you would have predicted,” Dr Anthony Fauci, head of the infectious diseases unit at the U.S. National Institutes of Health, told CNN.

South Korea has had 26 deaths and reported another 599 infections on Monday, taking its tally to 4,335.

Of the new cases in South Korea, 377 were from the city of Daegu, home to a branch of the Shincheonji Church of Jesus, to which most of South Korea’s cases have been traced after some members visited the Chinese city of Wuhan, where the disease emerged.

Vietnamese students of Hanoi National University of Education, wearing protective masks, attend the first day of classes after returning to the university, which was closed for over a month due to the novel coronavirus outbreak, Hanoi, Vietnam March 2, 2020. REUTERS/Kham

The Seoul government asked prosecutors to launch a murder investigation into leaders of the church. Seoul Mayor Park Won-soon said that if founder Lee Man-hee and other heads of the church had cooperated, fatalities could have been prevented.

Lee knelt and apologized to the country, saying that one church member had infected many others and calling the epidemic a “great calamity”. “We did our best but were not able to stop the spread of the virus,” Lee told reporters.

It was not immediately known how many of South Korea’s dead were members of the church.

‘OUTBREAKS ARE CURBED’

But Wuhan itself, at the center of the epidemic, shut the first of 16 specially built hospitals that were hurriedly put up to treat coronavirus cases, the Chinese state broadcaster CCTV said.

There was also a steep fall in new cases in Hubei, the province around Wuhan, but China remained on alert for people returning home with the virus from other countries.

The virus broke out in Wuhan late last year and has since infected more than 86,500 people, mostly in China.

Only eight cases were reported in China beyond Hubei on Sunday, the WHO said.

Outside China, meanwhile, more than 60 countries now have cases, with more than 8,700 infected and more than 100 deaths.

One of the worst-hit nations, Iran, reported infections rising to 1,501, with 66 deaths, including a senior official. With stocks of gloves and other medical supplies running low in pharmacies, authorities uncovered a hoard of supplies including millions of gloves.

In Britain, which has 40 confirmed cases, Prime Minister Boris Johnson urged people to be prepared for a further spread.

ECONOMIC DAMAGE

Factories worldwide took a beating in February from the outbreak, with activity in China shrinking at a record pace, surveys showed, raising the prospect of a coordinated policy response by central banks.

The epidemic has forced the postponement of festivals, exhibitions, trade fairs and sports events and damaged tourism, retail sales and global supply chains, especially in China, the world’s second-largest economy.

Middle East airlines have lost an estimated $100 million so far due to the outbreak.

An official of the International Air Transport Association (IATA) said airlines stood to lose $1.5 billion this year due to the virus and urged governments to help them.

The Organization for Economic Cooperation and Development warned that the outbreak was pitching the world economy into its worst downturn since the global financial crisis, urging governments and central banks to fight back.

(This story corrects to say almost nine times as many cases reported outside China as inside, not vice versa, in the second paragraph)

(Reporting by Stephanie Nebehay in Geneva, Hyonhee Shin and Jack Kim in Seoul, Ju-min Park in Gapyeong, Ryan Woo, David Stanway, Se Young Lee, Emily Chow and Andrew Galbraith in Beijing, Leigh Thomas in Paris, Michelle Price in Washington, Leika Kihara in Tokyo, Jonathan Cable in London, Donny Kwok and Twinnie Siu in Hong Kong and Grant McCool in Washington; writing by Nick Macfie and Philippa Fletcher; editing by Mark Heinrich and Kevin Liffey)

Six coronavirus cases discovered in north Italy, hundreds to be tested

By Elisa Anzolin and Angelo Amante

MILAN (Reuters) – Six people have tested positive in Italy for coronavirus, the northern Lombardy region said on Friday, in the first known cases of local transmission of the potentially deadly illness in the country.

Officials told residents from three small towns some 60 km (40 miles) southeast of Italy’s financial capital Milan, to stay at home as doctors tested hundreds of people who might have come into contact with the six coronavirus sufferers.

None of the six were believed to have visited China, which is the epicentre of the virus, but the first infected patient, a 38-year-old man now in intensive care, fell ill after meeting a friend who had recently been to China.

That man has since tested negative to the contagious disease, but doctors were investigating whether he carried the virus and subsequently recovered without showing any symptoms, said regional councillor Giulio Gallera.

The pregnant wife of the initial patient and one of his friends were also infected, along with three other people who were admitted to hospital overnight suffering from pneumonia-like symptoms.

“We have called on the residents of Codogno, Castiglione d’Adda and Casalpusterlengo to stay at home as a precaution,” Gallera told a news conference.

Prime Minister Giuseppe Conte said there was compulsory quarantine in place for all who have been in contact with the infected patients, as local authorities continued to track down everyone they had come into contact with.

“Most of the contacts of those who tested positive for coronavirus have been identified and subjected to the necessary tests and measures,” the region said in a statement.

Prior to Friday, just three people had been confirmed in Italy to have the virus which emerged in the Chinese city of Wuhan late last year.

Two Chinese tourists who came from Wuhan tested positive in Rome in late January, while an Italian who returned from the Chinese city with a special flight repatriating some 56 nationals was hospitalized a week later.

China has had more than 75,400 cases of the coronavirus and 2,236 people have died, most in Hubei province and its capital Wuhan.

(Angelo Amante reported from Rome; Additional reporting by Francesco Guarascio in Brussels and Elvira Pollina in Milan; Editing by Crispian Balmer and Christina Fincher)

More coronavirus cases in Iran’s Qom; religious gatherings under threat

DUBAI (Reuters) – Iranian health officials urged all religious gatherings to be suspended in Qom, news agency ISNA said on Thursday, after two more people tested positive for the coronavirus in the holy city, where two died of it this week.

In all, three more people had tested positive for the virus, an Iranian health ministry spokesman said.

“Two people have tested positive for COVID-19 in Qom and one person in Arak, bringing the total of confirmed cases to five in Iran,” spokesman Kianush Jahanpur said in a tweet.

Jahanpur said all patients were Iranian and the person in the central city of Arak was a doctor from Qom, the semi-official news agency ISNA reported.

Jahanpur said health officials had called for the suspension of all religious gatherings in Qom, a Shi’ite Muslim holy city about 120 km (75 miles) south of the capital Tehran, according to ISNA.

Two Iranians died in hospital after testing positive in Qom, the head of the city’s University of Medical Sciences said on Wednesday.

(Reporting by Dubai Newsroom; editing by John Stonestreet)

Coronavirus cases on cruise ship marooned off Japan rise to 61

By Ju-min Park and Elaine Lies

TOKYO (Reuters) – Dozens more people onboard a cruise ship quarantined in the port of Yokohama, Japan, tested positive for the coronavirus on Friday and thousands of passengers remained confined to their cabins, only allowed on deck briefly for fresh air.

The Diamond Princess, owned by Miami-based Carnival Corp, was placed on a two-week quarantine on arriving at Yokohama on Monday after a man who disembarked in Hong Kong was diagnosed with the virus.

Japanese Health Minister Katsunobu Kato told a news conference that 41 people on the liner had tested positive for coronavirus on Friday, bringing the total of confirmed cases to 61. Twentyone of the new cases were Japanese.

Those infected were taken off the ship and moved to hospitals in Tokyo and neighbouring towns, the health ministry said. Blue and white tarpaulin sheets were hung up to screen them from the view of other passengers.

About 3,700 people are aboard the Diamond Princess, which usually has a crew of 1,100 and a passenger capacity of 2,670.

Operator Princess Cruises’ website describes the ship as “your home away from home” and it will remain so for most passengers at last until Feb. 19. The quarantine period could be extended if need be, a Japanese government official told a media briefing.

The 61 cases came from a sample of 273 people who had been tested because they had showed symptoms or been in close contact with those who did. More tests will be done if any more passengers developed symptoms, Kato said.

For the stranded passengers, who were promised “a treasure trove of exceptional delights” in the ship’s brochure, the new infections spelled only more gloom.

Staff distributed thermometers and passengers were told that mental health experts were available for telephone consultations around the clock.

“We have instructions to monitor our temperatures and report if we’re above 37.5,” one man, a 43-year-old Hong Kong resident on the ship with his family, told Reuters.

Normal human body temperature is generally accepted to be 37 Celsius (98.6 Fahrenheit).

Passengers were finding out about the new infections from the internet before they were announced on the ship, said the Hong Kong man, who declined to be identified.

Ashley Rhodes-Courter, an American whose parents are on the ship, said she hoped U.S. officials would be able to help her parents get off it.

“They are all breathing circulated contaminated air so they could be getting everyone infected,” Rhodes-Courter said.

Passengers wearing face masks are seen on the cruise ship Diamond Princess, where 10 more people were tested positive for coronavirus on Thursday, at Daikoku Pier Cruise Terminal in Yokohama, south of Tokyo, Japan February 7, 2020. REUTERS/Kim Kyung-Hoon

CRUISE SHIP CONCERN

The Japanese official said the government saw no risk of the virus being spread by the Diamond Princess’s ventilation system because transmission is not airborne. Rather it is spread by droplets from coughs or sneezes that can stick to surfaces and infect other people.

But Paul Hunter, an expert in infectious disease at Britain’s University of East Anglia, said the potential for cruise ships spreading the epidemic across the world was now becoming a serious concern.

“Cruise ships are environments where respiratory infections can spread very quickly,” he said.

They also carry the further risk of transmitting a viral infection to other countries as passengers embark and disembark.

“I would be surprised if we don’t see more problems with cruise ships in the coming weeks,” Hunter said.

Transport Minister Kazuyoshi Akaba told reporters Japan had asked another cruise ship, the Westerdam, not to make a port call in the country.

The governor of the U.S. island territory of Guam, in the Pacific Ocean, earlier on Friday rejected a U.S. State Department request to allow the Westerdam to dock there.

The new ship cases take the total number of coronavirus infections in Japan to more than 80, according to Reuters calculations. Health Minister Kato said Japan was not including those cases in its national count, which stands at 21.

The outbreak, which has killed almost 640 people in mainland China and two elsewhere, has also stoked concern about the Tokyo 2020 Olympics, which begin on July 24.

Games organisers have set up a task force to coordinate with health authorities on how to respond to the epidemic.

(Reporting by Ju-min Park, Elaine Lies, Rocky Swift, Kiyoshi Takenaka, David Dolan, Tim Kelly and Aaron Sheldrick in Tokyo and Kate Kelland in London; Editing by Angus MacSwan)

Pilots, flight attendants demand flights to China stop as virus fear mounts worldwide

By Tracy Rucinski and Laurence Frost

CHICAGO/PARIS (Reuters) – Pilots and flight attendants are demanding airlines stop flights to China as health officials declare a global emergency over the rapidly spreading coronavirus, with American Airlines’ pilots filing a lawsuit seeking an immediate halt.

China has reported nearly 10,000 cases and 213 deaths, but the virus has spread to 18 countries, mostly, presumably, by airline passengers.

The United States has advised its citizens not to travel to China, raising its warning to the same level as those for Iraq and Afghanistan.

U.S. airlines, which have been reducing flights to China this week, were reassessing flying plans as a result, according to people familiar with the matter.

It is possible the White House could opt to take further action to bar flights to China in coming days, but officials stressed that no decision has been made.

The Allied Pilots Association (APA), which represents American Airlines pilots, cited “serious, and in many ways still unknown, health threats posed by the coronavirus” in a lawsuit filed in Texas, where the airline is based.

American said it was taking precautions against the virus but had no immediate comment on the lawsuit. On Wednesday, it announced flight cancellations from Los Angeles to Beijing and Shanghai, but is continuing flights from Dallas.

APA President Eric Ferguson urged pilots assigned to U.S.-China flights to decline the assignment. In a statement, the American Airlines’ flight attendants union said they supported the pilots’ lawsuit and called on the company and the U.S. government to “err on the side of caution and halt all flights to and from China.”

Pilots at United Airlines, the largest U.S. airline to China, concerned for their safety will be allowed to drop their trip without pay, according to a Wednesday memo from their union to members.

United announced on Thursday another 332 U.S.-China flight cancellations between February and March 28, though it will continue operating round trip flights from San Francisco to Beijing, Shanghai and Hong Kong.

The American Airlines pilot lawsuit came as an increasing number of airlines stopped their flights to mainland China, including Air France KLM SA, British Airways, Germany’s Lufthansa and Virgin Atlantic.

Other major carriers have kept flying to China, but protective masks and shorter layovers designed to reduce exposure have done little to reassure crews.

‘COUNTDOWN’

A U.S. flight attendant who recently landed from one major Chinese city said a big concern is catching the virus and spreading it to families, or getting quarantined while on a layover.”I didn’t understand the gravity of the situation until I went there,” she said on condition of anonymity, describing general paranoia on the return flight, with every passenger wearing a mask.

“Now I feel like I’m on a 14-day countdown.”

Thai Airways is hosing its cabins with disinfectant spray between China flights and allowing crew to wear masks and gloves.

Delta Air Lines is operating fewer flights and offering food deliveries so crew can stay in their hotels. The carrier is also allowing pilots to drop China trips without pay, a memo from its union to members said.

Korean Air Lines Co Ltd and Singapore Airlines are sending additional crew to fly each plane straight back, avoiding overnight stays.

The South Korean carrier also said it was loading protective suits for flight attendants who might need to take care of suspected coronavirus cases in the air.

Airlines in Asia are seeing a big drop in bookings along with forced cancellations because of the coronavirus outbreak, the head of aircraft lessor Avolon Holdings Ltd said, adding the impact could last for some months.

The outbreak poses the biggest epidemic threat to the airline industry since the 2003 SARS crisis, which led to a 45% plunge in passenger demand in Asia at its peak in April of that year, analysts said.

Fitch Ratings said airlines with more moderate exposure to China and the Asia-Pacific region were likely to be able to re-deploy capacity to alternative routes to mitigate the effect on traffic, but that could increase competition on those routes and reduce airfares.

Air France, which maintained China flights throughout the SARS epidemic, suspended its Beijing and Shanghai flights on Thursday after cabin crews demanded an immediate halt.

“When the staff see that other airlines have stopped flying there, their reaction is ‘Why are we still going?’,” said Flore Arrighi, president of UNAC, one of the airline’s four main flight attendants’ unions.

(Reporting by Tracy Rucinski, Laurence Frost and David Shepardson; Additional reporting by Allison Lampert in Montreal, Aradhana Aravindan, John Geddie and Anshuman Daga in Singapore, Chayut Setboonsarng and Panu Wongcha-um in Bangkok, Caroline Pailliez in Paris, Josephine Mason in London, Jamie Freed in Sydney and Joyce Lee in Seoul; Writing by Jamie Freed and Tracy Rucinski; Editing by Marguerita Choy and Lisa Shumaker)

CDC confirms second U.S. case of Wuhan coronavirus

(Reuters) – The Centers for Disease Control and Prevention on Friday confirmed that a second case of Wuhan coronavirus in the United States had been detected in Chicago, and said as many as 63 people were being monitored as the virus spreads around the globe.

The infected person had traveled to Wuhan, China recently. The woman, 60, had not taken public transportation and was not ill when she traveled, Chicago health authorities said on a conference call.

Of the 63 people under investigation from 22 states, 11 tested negative, CDC said in a conference call with reporters.

The newly discovered virus has killed 26 people and infected more than 800, but most of the cases and all of the deaths so far have been in China, where officials have imposed restrictions on travel and public gatherings.

The CDC said it believes the immediate threat to U.S. residents remains low.

The World Health Organization on Thursday declared the virus an “emergency in China”, but stopped short of declaring it a global health emergency.

(Reporting by Saumya Sibi Joseph in Bengaluru and Julie Steenhuysen in Chicago; Editing by Shinjini Ganguli)

China heads into Lunar New Year on shutdown as virus toll hits 26

By Judy Hua and Cate Cadell

BEIJING, China (Reuters) – China shut part of the Great Wall and suspended public transport in 10 cities, stranding millions of people at the start of the Lunar New Year holiday on Friday as authorities rush to contain a virus that has killed 26 people and infected more than 800.

The World Health Organization (WHO) has declared the new coronavirus an “emergency in China” but stopped short of declaring it of international concern.

People line up outside a drugstore to buy masks in Shanghai, China January 24, 2020. REUTERS/Aly Song

While restrictions on travel and gatherings have already been imposed to curb the outbreak, China will take stricter and more targeted measures, state television reported citing a State Council meeting on Friday, but gave no further details.

“The spread of the virus has not been cut off … Local authorities should take more responsibility and have a stronger sense of urgency,” state broadcaster CCTV said.

The Defence Ministry said it is organizing military medical experts to take part in the fight against the virus, without giving details.

Most of the cases and all of the deaths have been in China, but the virus has also been detected in Thailand, Vietnam, Singapore, Japan, South Korea, Taiwan, Nepal and the United States.

Britain convened an emergency response meeting on Friday.

While health officials have been at pains to say it is too soon to evaluate the severity of the outbreak, the newly identified coronavirus has triggered alarm because it is too early to know how dangerous it is and how easily it spreads.

Symptoms include fever, difficulty breathing and coughing. Most of the fatalities have been elderly, many with pre-existing conditions, the WHO said.

As of Thursday, there were 830 confirmed cases and 26 people had died there, China’s National Health Commission said.

WUHAN ISOLATED

Most cases have been in Wuhan, where the virus is believed to have originated in a market that traded illegally in wildlife. Preliminary research suggested it crossed to humans from snakes.

China has advised people to avoid crowds and 10 cities in the central province of Hubei, where Wuhan is located, have suspended some transport, the Hubei Daily reported.

The week-long celebrations to welcome the Year of the Rat began on Friday, raising fears the infection rate could accelerate as hundreds of millions of people have already traveled to see family at home and abroad.

The city of 11 million people, and neighboring Huanggang, a city of 7 million, were in virtual lockdown. Nearly all flights at Wuhan’s airport had been canceled. Airports worldwide have stepped up the screening of passengers from China.

Checkpoints blocked the main roads leading out of town, and police checked incoming vehicles for wild animals.

About 10 people got off a high-speed train that pulled into Wuhan on Friday afternoon but nobody got on before it resumed its journey. Although it stopped there, Wuhan had been removed from the train’s schedule.

“What choice do I have? It’s Chinese New Year. We have to see our family,” said a man getting off the train who gave his family name Hu.

Some sections of the Great Wall near Beijing will be closed from Saturday, state media said.

Some temples have also closed, including Beijing’s Lama Temple where people make offerings for the new year, have also been closed as has the Forbidden City, the capital’s most famous tourist attraction.

Shanghai Disneyland will close from Saturday. The theme park has a 100,000 daily capacity and sold out during last year’s new year holiday. Film premieres have also been postponed and McDonald’s suspended business in five cities in Hubei province.

In Wuhan, where the outbreak began last month, pharmacies were running out of supplies and hospitals were flooded with nervous resident seeking medical checks.

The city was rushing to build a 1,000-bed hospital for the infected by Monday, the official Changjiang Daily reported.

“There’s so much news, so much data, every 10 minutes there’s an update, it’s frightening, especially for people like us in a severely hit area,” Lily Jin, 30, a resident of the city, told Reuters by phone.

VACCINE QUEST

The WHO said on Thursday it was a “bit too early” to designate the outbreak a public health emergency of international concern, which would require countries to step up their response.

Some experts believe the virus is not as dangerous as the one that caused the 2002-03 outbreak of Severe Acute Respiratory Syndrome, which also began in China and killed nearly 800 people, or the one that caused Middle East Respiratory Syndrome (MERS), which has killed more than 700 people since 2012.

There is no known vaccine or particular treatment yet.

“There is some work being done and there are some trials now for MERS (vaccines). And we may look at some point whether those treatments and vaccines would have some effect on this novel coronavirus,” WHO spokesman Tarik Jasarevic said on Friday.

Gilead Sciences Inc said it was assessing whether its experimental Ebola treatment could be used. Meanwhile, three research teams were starting work on vaccines, the Coalition for Epidemic Preparedness Innovations said.

The virus is expected to dent China’s growth after months of economic worries over trade tensions with the United States, unnerving foreign companies doing business there.

Shares in luxury goods firms have suffered from the anticipated drop in demand from China, and on Friday French spirits group Remy Cointreau said it was “clearly concerned” about the potential impact.

(Reporting by Roxanne Liu, David Stanway, Martin Pollard, Tony Munroe, Muyu Xu, Engen Tham, Cate Cadell, Judy Hua and Ben Blanchard; Writing by Michael Perry, Robert Birsel; Editing by Simon Cameron-Moore and Alison Williams)