China is stepping up efforts to contain
a new coronavirus outbreak but people
abroad have already been affected so are
these efforts enough or is the world
witnessing the start of a global
epidemic this is inside story
[Music]
hello and welcome to the program I'm
Mohammed Jim Jim
China's reporting people with
coronavirus outside the epicenter of the
outbreak have now died this as health
authorities fear around the world the
infection rate could increase during
what's usually China's busiest travel
period of the year hundreds of millions
of Chinese are preparing to celebrate
the Lunar New Year
although Beijing has canceled all public
celebrations and as the death toll rises
more countries are taking their own
precautions
Scott Heidler has more from Beijing
rushing to catch the last trains before
the Lunar New Year many of these
passengers of the Beijing west railway
station are thinking of the coronavirus
don't think this virus has been properly
controlled I just came back to China I
read a lot of news internet I'm not very
satisfied with how the government
prevented and controlled the disease I'm
very afraid of getting infected I am
really afraid of those people who lived
in left 400 but I do hope the situation
in Wuhan can be improved soon and those
inside the city of Wuhan are becoming
more frustrated because medical supplies
are running short and hospitals are
short-staffed many festivals for the
Lunar New Year holiday have been
cancelled across China and not just in
the central Hubei Province the epicenter
of the virus in the government has
closed the Forbidden City here in
Beijing over health concerns related to
the corona virus something they didn't
do some 17 years ago during the SARS
crisis the Chinese government was
criticized for the way it handled the
SARS virus back in 2003 mainly for its
lack of transparency the World Health
Organization has decided not to declare
the current outbreak a global health
emergency
but there's growing concern over the
coming week when the millions of people
who have travelled for the holiday
return again raising the risk the virus
may be spread further by people who are
contaminated but have yet to show
symptoms
Scott Heidler al-jazeera Beijing
in a moment we'll bring in our panel but
first let's speak to Tariq Azshara vich
from the World Health Organization in
Geneva
Tariq the w-h-o said it was too early to
consider this outbreak of public health
emergency of international concern why
well what are the reasons for that
decision and what would have to happen
for it to become a global health
emergency well as we have said yesterday
in a press conference following the
meeting there were different opinions
that have been expressed at the meeting
of the Emergency Committee and
director-general of the WTO I was very
clear when he said that this is clearly
an emergency in China and there is a
high risk of further spread he may
reconvene the meeting of the emergency
committee at a very short notice as as
the situation develops further China has
locked down numerous cities in their
response so far to this outbreak what is
the w-h-o stance on that and does the
w-h-o believe that that is an
appropriate or effective containment
measure well the role of w-h-o is to
provide science-based recommendations
and opinion to our countries every
country obviously has the right to
introduce measures that they think are
necessary on their territory we hope
that these measures will be will be
effective and that they will not last
very long it is really important to say
that that what is important when you
have an outbreak of a new virus you you
have to have containment measures and
mitigation measures meaning providing
help who those who fall sick and
containment basically are trying to
reduce the risk of a spread so different
measures can be introduced to do that to
try to at least slow down the disease
what is really important is that health
systems are on alert around the world as
China has already put in place
monitoring for sick people being able to
test them and diagnose them and being
able to treat them
and it's also important to provide right
information to the population so when it
comes to the measure measures it's it's
really difficult sometimes to strike the
balance between the benefits for the
population of some containment measures
and some social disruption so I think
each country based on their context will
decide what measures are needed since
you're speaking about measures the WHL
warned the public not to underestimate
the severity of this epidemic could you
speak to specific measures that people
can take to try to protect themselves
going forward exactly so I mentioned
what health systems should do what
health officials should do they should
be on alert they should raise a
preparedness levels in the health
facilities being equipped and and be
able to provide assistance to those who
Isaac now for the general public for the
time being there's still much of unknown
about the virus itself but we know it is
a corona virus so it is causing
respiratory illness so we recommend the
measures that are always recommended for
respiratory illnesses that is hand
hygiene that is basically a covering
mouth when when sneezing and coughing
avoiding contact with the person who is
sick with the flu like symptoms avoiding
contact with the live animals in the
market and really for people before they
travel if they are sick if they should
really first go and see their doctors so
they can be diagnosed so really everyone
should try really to help that the
health system because what may happen as
well that lots of people because of this
outbreak will rush to the hospitals even
though they they may not have symptoms
that are that are consistent with a
respiratory illness symptoms
toric do we know yet the actual extent
of human-to-human transmission rate but
we know that there is a human to human
transmission and this is consistent with
the corona viruses in general as we have
seen with SARS with MERS and with other
corona viruses
this means that there is a human to
human transmission among close contacts
so we have no really clear evidence of
sustained human to human transmission
although there are some indications that
that virus the virus has infected from
the infected person to another one so
second-generation but again so far we
see clusters but we really have to look
at it we have to look at the data we are
still at an early stage so we know about
Korean viruses in general but we have to
get into the data and try early to
understand to understand better and and
same goes really for the severity of the
virus
some people have mild symptoms some
people have severe symptoms we still
don't know if there are asymptomatic
cases we have noticed that majority of
people who get sick are older people and
those who eventually died most of them
had underlying health conditions but
again it's really too early to draw
conclusions because we need really to
look to look more we need to do more
testing and more studies to be able to
understand but as we do these studies to
understand the virus we need to be ready
to help those who will fall sick and
make sure that the old measures are
being put in place to reduce the risk
all right thank you so much for your
time Tarek we can now speak to our other
guests in Hong Kong we have Nicolas
Thomas he's an associate professor at
City University of Hong Kong
and specializes in Asian health security
and in London we have Nathalie McDermott
she is a clinical lecturer at King's
College London who researches disease
outbreak control Nicholas let me start
with you the Chinese government was
criticised for how it handled its
reaction to the SARS virus in 2003
especially for its lack of transparency
how is China dealing with this outbreak
and do you believe that they have
learned the lessons from the SARS
outbreak I think thank you I think that
that we need to sort of break this down
a little bit I think on the technical
side with the medical people this was a
very fast response we found out about
the market on the 31st of December in
line with the w-h-o Chinese authorities
shut down the market on the first on the
seventh the genome was sequenced on the
eighth
was confirmed as a coronavirus that's
fairly quickly however I think that when
we look at maybe at the local level
measures could have been implemented a
lot faster its but at the central level
at least has been significant concern
and pressure from the Chinese leadership
that the policies to address these
issues lessons that China has learned
sense ours be taken forward Natalie
right now in China there is an
unprecedented lockdown of cities going
on do you believe that this will
actually minimize the risk of the virus
spreading so I think that's a difficult
question because essentially we've never
locked down an entire city before to see
how well we can contain an outbreak it
depends on the population that you're
dealing with often because the the
primary understanding is that if you
lock down a city you prevent people
migration and so you prevent the disease
spreading further afield now we already
know that with this coronavirus outbreak
we have cases in what is 29 different
provinces in China already and we've had
cases go overseas so whether quarantine
in the entire city or several cities is
going to achieve much now I'm not sure
it also depends on how compliant the
population are willing to be with that
in this context we do seem to have a
population who are being very compliant
with what they've been asked to do but
in some circumstances if you quarantine
an entire city you introduce fear and
panic and sometimes you have people who
take things into their own hands and you
might end up creating a situation where
you have defiance and rioting and people
trying to escape the city and that
ultimately makes the situation worse so
it really depends on the population
you're addressing in that context
nicholas is the region capable of
handling this effectively well I think
I'd agree with Natalie I think China is
trying to deal with this as best it can
but to a certain extent it's winter in
China there are already different
viruses different flus in circulation
and so people's immune systems are
already going to be challenged now as
we're
Sene we are getting second and there are
reports from the w-h-o of third
generation transmission which means
we're no longer thinking just about the
people who are initially exposed to the
infected wildlife we're thinking about
the people that they're infected and
then the people the next tier the people
that they're infected as well this is
going to make the job of the authorities
to actually bring this to a halt that
much more difficult especially because
it is coming up to Chinese New Year as
well and we are looking at hundreds of
millions of people about to be going on
the move
so beyond Wuhan beyond the ten shut down
cities we are going to have a lot of
people who do carry the virus who are
moving to other parts of China and also
beyond China as well at the moment we're
talking about quarantine on flights out
of Wuhan in particular but we're already
finding cases in Shanghai for example or
in Guangdong where there are major
international transit hubs and that's
going to further challenge not just the
Chinese authorities to contain it but
also the regional and international
ports as well to deal with this Nataly
how much does the concern grow if the
virus spreads to a poorer country let's
take Myanmar as an example a country
whose health sector is not as developed
may not be able to respond as quickly
yes so I think that that's probably
where the major concerns are because
we're aware that countries that have a
very developed and robust health
infrastructure are probably able to
contain any cases that arrive in their
country and identify them very quickly
and trace any contacts and so the
likelihood of a disease spreading in a
country like that is much more limited
but if you take a country that perhaps
doesn't have ready access to testing
facilities that perhaps doesn't have the
personnel or the infrastructure to
implement any kind of screening or
monitoring of people who've arrived in
the country and also that may have a
health infrastructure that's quite
limited with a limited number of health
professionals perhaps not even
appropriate isolation facilities or
equipment things start to become much
more complicated and it's likely that in
that situation while this virus may
cause a disease and may
cause problems and spread in a country
like that it's likely actually that it's
the overwhelming of the health
infrastructure in that country that's
going to cause secondary effects such as
people who have other diseases or other
illnesses not being able to access
treatment because the facilities are
overwhelmed by trying to deal with an a
viral disease outbreak Nicholas
hospitals and medical workers in Wuhan
are making urgent appeals for supplies
the central government has acknowledged
the severe strain on resources but just
how bad is the situation right now we're
seeing videos being uploaded through
various Chinese social media sites
showing very crowded hospitals where
people are going along to them still
wearing face masks of course but going
along complaining of high fevers and
other flu-like symptoms now in some
cases on the social media sites
these have been corridors that have been
jam-packed with people and simply not
enough healthcare frontline health care
as around doctors and nurses now the
danger with this of course is that most
of those people will not actually have
the corona virus they may have the flu
which makes them more susceptible but
then in being in tight confined spaces
with someone who would have the corona
virus there's a much greater risk of it
spreading into the general population
and as you said at the same time the
hospitals in Wuhan in their quarantined
cities simply don't have the resources
to deal with this massive influx and so
here's another question for China how do
they get this all the equipment they
need from the rest of the country and
indeed from overseas into these affected
cities this is very much a supply and
logistics question which I think the
learning curve on this is very steep and
I think what we're seeing here is China
really trying to sort of play catch-up
to all the technical infrastructure type
issues such as gowns masks and so on
that the people coming into the
hospitals need Natalie I just want to
take a step back for a moment for our
viewers so we can help them better
understand this topic could you tell us
more about coronaviruses how rare is it
that they transmitted from animals to
humans how rare is it they transmit from
human
human so we know now that there's about
seven coronaviruses that cause disease
in humans this most recent one from
Wuhan is the seventh so we've known that
there are corona viruses for quite a
long time that can infect humans and the
vast majority of them cause some form of
respiratory illness so we've known also
that they can usually spread from human
to human by droplet infection so when
people sneeze and cough and if they're
infected and somebody is nearby they
might become infected
now that really varies though depending
on the virus you're talking about so we
know that SARS was which was also a
corona virus was quite infectious so if
people sneezed and coughed other people
became infected as well whereas we don't
see that as much with the MERS virus
which is a corona virus that we see
circulating in the Middle East for the
most part and while that sometimes can
spread to humans particularly in
hospital settings we don't see it so
much in immediate family members
although it has been reported that that
can occur so they these corona viruses
can vary and how infectious they are and
they can vary a little bit in the type
of disease that they cause as well how
often a virus essentially does a species
hops so from a an animal host into a
human is is a good question we know that
there's a number of corona viruses as
well that infect animals that don't at
the moment infect humans over the last
couple of decades we've seen three
corona viruses essentially do a species
hops so SARS in 2002 2003 that was found
in bats but originally did the species
hop from a civet animal into humans and
then with MERS that was around 2012 so
that again was found in bats but it
infected camels and and then did the
species hop from camels into humans and
obviously in this current outbreak we're
still waiting to identify what the
animal reservoir is in the past two
decades several fast spreading diseases
have caused global alarm between 2002
and 2003 the highly contagious severe
acute respiratory syndrome or SAR
outbreak in China led to nearly 800
deaths in 17 countries according to the
w-h-o that's almost 10 percent of those
who became infected it's thought to have
spread from the civet cat to humans
swine flu also known as h1n1 quickly
spread around the world in 2009
categorized as a pandemic it's estimated
to have killed between 100,000 and half
a million people the Middle East
respiratory syndrome irse was identified
in Saudi Arabia in 2012 it killed more
than 850 people and it's thought to have
come from a camel nicholas let me ask
you are the chinese authorities do
providing enough information about how
this disease is spreading i think what
we've seen in the past two weeks in
particular the chinese cdc has been very
proactive in releasing patient data as
fast as they can on a daily basis the
question though is to what extent the
frontline doctors actually have the
diagnostic testing facilities to
correctly identify people who are
suffering from the new novel coronavirus
this is an issue that goes along with
many more masks and more gowns needing
more diagnostic facilities and also more
technicians who can run the tests we're
seeing very quickly the local
infrastructure in Wuhan although it has
some very good hospitals being
overwhelmed with the demand being placed
on them and the amount of tests that
they're actually there then subsequently
having to do so I think on the one hand
there is a clear line of reporting
coming out the Chinese CDC but the
information coming into that at the
grassroots root level is very much still
being what it is being overwhelmed and
there needs to be more streamlining of
the procedures but then this we're
dealing with populations we've never
dealt with before into quarantine
situations and so I think this is very
much a case of learning as best as you
can as you go Nataly China's government
cabinet has now been appointed control
over this crisis how significant is that
what message does that send to the
international community as far as how
China is dealing with this versus how
they dealt with with other outbreaks in
the past
yes I think it sends the message that
they're taking it very seriously I think
all of their actions so far have
demonstrated how seriously they're
taking this and as Nicolas said we have
seen them act far more promptly this
time than with the SARS outbreak in 2002
and 2003 such that we actually had the
sequence of this virus very promptly and
that sequence was released to healthcare
professionals and researchers around the
world very promptly so that they could
start developing diagnostic tests in
their own countries and they could start
looking at the nature of the virus and
how it might behave so this has been
very prompt I think that the nature of
quarantine in communities and cities
well that's that's something that hasn't
really been done before and I think as
Nicolas said time will tell as to how
effective that is in in this context but
I don't think that even if it is
effective in this context I don't think
we can necessarily extrapolate that to
other cultures and other countries
necessarily I think each country needs
to make their own decisions about how
best to address that understanding their
population and ensuring that they have
circulated appropriate disease messaging
as well Nicholas I saw you nodding along
toward Natalie was saying did you want
to jump in no I just think that we are
very much in a new situation I think
everyone looks at SARS as the touchstone
it's a corona virus it emerged from
China but I think when you look at for
example the h7n9 outbreak which took
place roughly eight years ago seven
years ago in China there you have an
example of when the Chinese authorities
were very proactive and engaging and
engaging the international community and
I think that lesson is perhaps more
relevant to what we're seeing today
without external experts come in the
central level government and the CDC
have been quite proactive in sharing the
scientific information I think the
question is very much now getting local
authorities at the municipal at the
provincial level and perhaps even lower
down at County levels within China to be
more responsive to whenever a novel
threat is identified - immediately
putting in place measures - can
as well as get information out to the
local population at the same time I
think that also implies that local
populations themselves are in a bit of a
learning curve as to how to deal with
these issues because undoubtedly they're
going to rehearse in in China for the
last two decades certainly here in Hong
Kong
I mean I was here in 2003 when SARS
broke out there was considerable fear we
had streets being very empty now today
what we're seeing are people taking
those lessons forward and saying right
there's an outbreak we need to wear
masks we need to observe better personal
hygiene and even if they're not sick
themselves they're already wearing masks
as a preventative measure and so I think
at a social level you can see how here
in Hong Kong people have actually taken
those lessons on board and are applying
them in a way which helps to limit the
possible transmission of the disease
alright we've run out of time so we're
going to have to leave it there thanks
so much to our guests Nicholas Thomas
and Natalie McDermott and thank you too
for watching you can see the program
again any time by visiting our website
aljazeera.com and for further discussion
go to our Facebook page
that's facebook.com /aj Inside Story you
can also join the conversation on
twitter our handle is at aj inside story
from me Muhammad Tim Jewell and the
whole team here bye for now
[Music]