key: cord-0854163-xuiswu2l authors: Wang, Weier; Tang, Jianming; Wei, Fangqiang title: Updated understanding of the outbreak of 2019 novel coronavirus (2019‐nCoV) in Wuhan, China date: 2020-02-12 journal: J Med Virol DOI: 10.1002/jmv.25689 sha: 76fd94521258e6a5aaf47e2284456e4d85635b8f doc_id: 854163 cord_uid: xuiswu2l To help health workers and the public recognize and deal with the 2019 novel coronavirus (2019‐nCoV) quickly, effectively, and calmly with an updated understanding. A comprehensive search from Chinese and worldwide official websites and announcements was performed between 1 December 2019 and 9:30 am 26 January 2020 (Beijing time). A latest summary of 2019‐nCoV and the current outbreak was drawn. Up to 24 pm, 25 January 2020, a total of 1975 cases of 2019‐nCoV infection were confirmed in mainland China with a total of 56 deaths having occurred. The latest mortality was approximately 2.84% with a total of 2684 cases still suspected. The China National Health Commission reported the details of the first 17 deaths up to 24 pm, 22 January 2020. The deaths included 13 males and 4 females. The median age of the people who died was 75 (range 48‐89) years. Fever (64.7%) and cough (52.9%) were the most common first symptoms among those who died. The median number of days from the occurence of the first symptom to death was 14.0 (range 6‐41) days, and it tended to be shorter among people aged 70 years or more (11.5 [range 6‐19] days) than those aged less than 70 years (20 [range 10‐41] days; P = .033). The 2019‐nCoV infection is spreading and its incidence is increasing nationwide. The first deaths occurred mostly in elderly people, among whom the disease might progress faster. The public should still be cautious in dealing with the virus and pay more attention to protecting the elderly people from the virus. , Japan (2), South Korea (2), Vietnam (2), Nepal (1) The rest cases unlocated 442 | suggested bats 10 or snakes 11 to be the potential natural reservoir of 2019-nCoV. However, based on the latest statement by WHO on 23 January 2020, the source of 2019-nCoV is still unknown. 12 The 2019-nCoV appears to cause symptoms similar to SARS based on clinical data from the initial 41 cases 13 and seems to be capable of spreading from humans to humans and between cities, 14 according to two latest studies 13, 14 published in Lancet on 24 January 2020. Although WHO suggested that the current event did not constitute a Public Health Emergency of International Concern (PHEIC), they also indicated that the situation was urgent and needed further examination. 12 1 10 January 2020, 15 20 January 2020, 16 The distribution of 2019-nCov infection in China and worldwide is shown in Table 1 and Figure 1 . As listed in Table 1 (15), Yunnan (11), Tianjin (10), Shanxi (9), Heilongjiang (9), Hebei (8), Guizhou (5), Gansu(4), Jilin (4), Xinjiang (3), Ningxia (3), (2), Qinghai (1) Hong Kong (5), States (2), Japan (2), South Korea (2), Vietnam (2), Nepal (1), Australia (1) The rest cases unlocated Our study also showed that the first occurred deaths were mainly among elderly people. Although most of them had comorbidities or a history of surgery before admission, the potential association of underlying medical conditions and 2019-nCoV-associated death was not clear. By far, the median number of days of first symptom to death was 14, which was comparable to that of 14 days (median) of MERS. 28 For SARS, it was reported that the average duration of first symptoms to hospital admission was 3.8 days, and admission to death was 17.4 days for casualties. 29 Our study also found that people 70 years or older had shorter median days (11.5 days) from the first symptom to death than those with ages below 70 years (20 days), demonstrating that elderly people might have faster disease progression than younger people. Similar results were found in SARS in that the mean duration from admission to death was 5.7 days for people aged 80 to 93 years, 9.4 days for those aged 60 to 79 years, and above 12.0 days for those under 60 years of age. 29 It was also reported that older age (>60 years) was a risk factor that correlated with mortality in MERS. 28 In addition, the WHO also provided an interim guidance for infection prevention and control when a novel coronavirus was suspected 32 and further improved the guidance by indicating that patients with mild symptoms and without chronic conditions or symptomatic patients no longer requiring hospitalization might be cared for in home environment. 33 Another aspect worth noting is that health workers should minimize the possibility of exposure when collecting and transporting lab specimens of suspected infected patients. 32, 34 A goggle was necessary when health workers were questioning patients at fever clinics or performing operations for suspected patients since the virus might infect the eye conjunctiva through droplets. It would be interesting to test if robotics might be used in questioning or treating the infected or suspected patients, which will definitely decrease the possibility of exposure of health workers. Although the etiology is still unclear, some scholars suggest that 2019-nCoV and SARS/SARS-like coronaviruses may share a common ancestor resembling the bat coronavirus HKU9-1. 10 The 2019-nCoV may interact with human ACE2 molecules via its S-protein for human -to-human transmission. 10 However, future studies are warranted to uncover the source of the virus and potential mechanisms for humanto-human transmission. The 2019-nCoV infection is spreading fast with an increasing number of infected patients nationwide. The future development of the disease is not clear but the public should be cautious in dealing with the virus since it may be very contagious. The first occurred deaths were majorly elderly people who might have faster disease progression. 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Released on 20 Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan The authors declare that there are no conflict of interests. http://orcid.org/0000-0003-0871-2275