What is coronavirus and how worried should we be?

It appeared in a live animal market late last year in the sprawling Chinese city of Wuhan. Now a virus previously unknown to science has killed at least 2900 people, infected more than 85,000 and led to the lockdown of millions in central China in what experts warn looks increasingly like the world's next pandemic.

Cases have emerged in more than 50 countries since January, from England to Egypt, surpassing those officially diagnosed during the deadly SARS outbreak of 2003 and sparking extraordinary rescue efforts by foreign governments, including Australia, to free citizens trapped in the centre of the crisis. While the global race to develop a vaccine is picking up speed, new frontiers of the outbreak have erupted in Europe and the Middle East. The World Health Organisation (WHO) has already declared a global health emergency, though not a pandemic, and warns that the community spread of cases in countries beyond China could be the sparks that ignite "a bigger fire".

On February 11, the mystery illness was at last given a name, COVID-19. And it received another title from the WHO: "public enemy number one".

Australian has now banned foreign travellers from China and Iran and pulled the trigger on its own emergency pandemic response plan, a blueprint to release medical stockpiles, ramp up healthcare staff and set up isolated "fever clinics". So far there have only been 25 Australian cases. The first 15 patients, who were all linked to Wuhan, have already recovered but 9 more have been diagnosed in recent days as passengers from the cruise ship turned floating quarantine site, the Diamond Princess, arrive home. The latest person to test positive, a beautician in Queensland, had recently returned from Iran and saw about 30 to 40 clients before her condition was revealed but authorities say the risk of tranmission is "incredibly low".

So what is a coronavirus, how does it spread and is this really a pandemic?

China Eastern Airlines cabin crew at Brisbane International Airport.Credit:AAP

What is the coronavirus COVID-19?

Coronaviruses are a family of viruses causing respiratory illness that are mostly found in animals. Only six have previously been identified in humans including the common cold, and the more unusual SARS-CoV, which led to the SARS (Severe Acute Respiratory Syndrome) outbreak almost 20 years ago.

This illness, now known as COVID-19, brings that tally to seven. But so far it's considered milder than both SARS and the other dangerous coronavirus disease to emerge in recent years: Middle East Respiratory Syndrome (MERS). COVID-19 first appeared in December 2019 after workers starting fall ill at a live animal market in the capital of China's central Hubei province, Wuhan, which has since been quarantined by investigators.

People often catch coughs and colds from the four most common coronaviruses affecting humans. But when a new strain jumps into the population from animals, often through the handling and slaughter of wildlife, it can be dangerous as there is little natural immunity to fight it off.

What are the symptoms and how dangerous is COVID-19?

It appears to start with a fever, a cough or shortness of breath and can lead to pneumonia and more serious complications including organ failure. Experts say medical authorities have unlocked the genetic code of the virus – which is about 75 per cent similar to the SARS strain – in "record time". But a lot is still unknown. So far, the COVID-19 illness does not appear as deadly as SARS but it is already proving more contagious, capable of jumping person to person after close contact during its one-to-14-day incubation period, before symptoms appear.

WHO spokesman Tarik Jašarević says initial infection rates have now been upgraded as more information comes to hand, and it is believed each patient with COVID-19 will infect about four or more people. That makes it more infectious than the flu but much less infectious than measles, where one person is likely to infect up to 20 people.

The WHO estimates only about 20 per cent of the patients so far have suffered serious complications and the death rate is hovering at about 2 cent. Anyone can fall ill but, as with most respiratory illnesses, those most at risk of dying are the elderly and people with underlying conditions. Although young people have also died, very few children have so far been diagnosed or suffered serious cases – a phenomenon also observed during SARS.

Right now, without a vaccine, treatment involves getting oxygen into the lungs, monitoring vital organs and dealing with any resulting complications. Parallels in severity have been drawn with the common flu but emerging coronaviruses such as this strain and SARS can do more damage to the body. SARS punched “honeycomb-like” holes in patients' lungs and such lesions are appearing again in many COVID-19 cases. Antibiotics do not work on the virus as it is not caused by a bacteria.

Outside mainland China, the first major cluster of cases – more than 650 – emerged on a cruise ship floating off the coast of Japan, which saw thousands of people, including Australians, trapped on board under quarantine for most of February. That outbreak has since been surpassed by South Korea, where cases have exploded in recent days and now total close to 3000.

The virus has also gained a foothold in Iran: least 34 people have died and even the vice president has been infected. Italy, meanwhile, has cut short its famous Carnival festival in Venice as whole towns in the north come under quarantine lockdown. The first cases to emerge in Norway, Austria, Croatia and Switzerland have been reportedly linked to that Italian outbreak but the country's government has defended containment efforts even as people slip through roadblocks and checkpoints. So far European leaders are resisting calls to close borders but French president 

The total number of new cases reported outside of China have now begun to surpass the number counted within the country for the first time – including the first case of community spread (without links to China) in the US. This has heath authorities, including the WHO, increasingly worried the virus is evolving into a pandemic – and could even threaten the summer Olympic Games scheduled for July in Tokyo. On another measure, some experts say the apparent slowdown in China is a sign the communist government's unprecedented containment measures – from forced quarantines of the suspected infected to city and transport lockdowns – are working.

So is COVID-19 a pandemic?

While the WHO has already declared COVID-19 a global health emergency, whether or not to use the “P" word is another matter. According to the WHO, a pandemic, colloquially, refers to "a new pathogen that spreads easily from person to person across the globe”. But its own assessment takes into account severity (i.e death tolls) as well as just reach.

And since the world’s last pandemic – swine flu in 2009 – the organisation has moved to a different “phasing system” to measure such outbreaks, meaning pandemic is no longer a designation triggering a formal response. The WHO may use the word, spokesman Tarik Jašarević says, but it has already sounded its top alert in declaring an emergency last month (which called on nations to step up their resources). Still the WHO's language will influence countries now contemplating rolling out their own pandemic response plans – as Australia has already done.

So far, WHO director-general Tedros Adhanom Ghebreyesus has maintained COVID-19 is not a pandemic as the window to contain it has not yet closed – though in recent days the authority has upgraded its global risk from "high to very high". Dr Ghebreyesus says further investment and “aggressive” measures are now needed in countries across the world to stop it in its tracks, and warns prematurely declaring a pandemic could “paralyse” those efforts.

"For the moment, we are not witnessing the uncontained global spread of this virus [or] large-scale severe disease or death" that would warrant the term, he said. "This is not influenza, [it] can be contained…Some media and politicians [are] pushing for a pandemic to be declared…Using the word pandemic carelessly has no tangible benefit. But it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralysing systems."

How do you catch the coronavirus?

Infectious disease specialist Sanjaya Senanayake says he expects the virus will travel in a similar fashion to SARS – people will catch it in the way they catch a cold, from close contact with infected people, animals or contaminated surfaces. Health authorities say the virus can jump within at least 15 minutes of face-to-face conversation, or at least two hours in an enclosed space with an infected person.

It's passed through bodily fluids, mostly airborne droplets from the nose and mouth expelled during coughing. The virus does not appear to be airborne but it is thought to survive outside the body on surfaces longer than initial estimates – the WHO now says “for a few hours or up to several days”. The good news is it can be killed with even simple disinfectant, though companies like airlines are not leaving anything to chance, turning to some of the world’s hardest-hitting cleaners known to take down everything from herpes to the MRSA superbug.

It is still highly unlikely you could catch COVID-19 from passing someone on the street, eating Chinese food, patting an animal or receiving a package from an infected area like China. If you are travelling near a confirmed patient on a plane, either in the same row or up to two in front or behind, health authorities say this is considered close contact and you should get advice and self-isolate.

Those with symptoms should also stay clear of others, seek medical treatment and wear face masks to stop the spread of the virus. Everyone is urged to wash their hands regularly and observe good "cough etiquette", by covering the mouth, but face masks are not recommended unless you are sick or working with infected people.

In the depths of China's winter (and flu season), more people have likely been infected than official counts, though many people with suspect symptoms may have a more common coronavirus.

Is COVID-19 as serious as the flu or SARS?

It took the new coronavirus 48 days to infect the first thousand people. By contrast, SARS took 130 days and the less infectious MERS more than two years to infect a thousand people after it emerged in 2012.

When SARS finished its spread after nine months in 2003, only 8098 cases had been confirmed but close to 10 per cent of those were fatal. MERS has been circulating for eight years and kills about a third of those who fall ill – out of about 2500 confirmed cases so far.

The infamous 1918 "Spanish flu" killed about 2.5 per cent of its victims over two years – but because it infected so many (close to 27% of the world's population), about 50 million died.

The second coming of a H1N1 influenza pandemic, dubbed "swine flu", in early 2009 also spread far – infecting between 11 and 21 per cent of the world's population. The WHO declared the outbreak a pandemic and governments mounted costly responses until it was deemed to have ended in October 2010. But the virus killed about 285,000 (fewer than seasonal flu normally does) with a relatively low fatality rate of .02 per cent, and the WHO copped criticism for labelling it a pandemic at all.

Each year, regular seasonal flu kills between 291,000 and 646,000 people worldwide, the US Centers for Disease and Prevention calculates. In the US, influenza has already killed 10,000 people this season and in Australia, government figures for the last season ending October 2019 show 812 people died out of 298,120 reported cases – a fatality rate of about 0.27%.

While new vaccines for influenza are developed each season, there is no inoculation against COVID-19 so far. But under an extraordinary push worldwide, led in part by Australia, clinical trials for the first vaccines could just be months away, though a ready to roll out vaccine will take about a year.

So far the WHO says the virus's mutation remains stable, with no significant change to its DNA since it emerged, amid concern a novel coronavirus could shift its behaviour or severity as it develops. But it hit at "the worst possible time" for China as hundreds of millions travelled for Lunar New Year.

Where did COVID-19 come from?

Coronaviruses are commonly carried by animals such as bats and rodents and then passed on to humans through contact with blood, faeces and other bodily fluids. Wild animals packed together and then butchered in live markets throughout Asia can be incubators for viruses to evolve and jump species barriers – SARS was traced back to a colony of bats but was believed to have passed into humans via the Himalayan palm civet, an ancient species of mammal eaten as a delicacy in China.

Early work suggests COVID-19 is 96 per cent similar to a SARS-like virus discovered in bats in 2017 and a study by Chinese scientists which is yet to be released for further scrutiny claims to have found an even closer match – 99 per cent – to a strain found in the endangered pangolin, the most illegally trafficked animal in the world.

Hanging over the crisis is the shadow of SARS – which also spread from a live animal market in China and saw the authoritarian government accused of a cover-up as it hid patients from international view. While China has been praised by the WHO for its response this time around (including the release of the virus's genome to the world science community), doctors within Wuhan who raised the alarm were threatened by police and reports people under quarantine are now being mistreated keep piling up, fuelling another wave of suspicion.

China has also temporarily banned its wildlife trade. But, under pressure from citizens, conservation groups and experts who say the country has not learnt the lesson of SARS, this time Chinese President Xi Jinping is moving to permanently outlaw selling wild animals for food and to further restrict their trade for medicine, scientific research and as pets.

How big is the risk to Australia?

Due to the "escalating threat of the virus", Australia has beefed up its border measures and banned travellers from China and now Iran, although citizens, permanent residents and their dependents or spouses will be accepted in and urged to self-isolate. (Countries including the US, Italy, New Zealand and South Korea have introduced similar bans but the measures have been slammed as "truly mean" by China.)

Australia’s Chief Medical Officer, Professor Brendan Murphy says the virus is not circulating in the Australian community, as is now being observed in countries like Italy and South Korea, but expects it will soon become a pandemic. Those diagnosed in Australia so far have contracted the virus overseas. But health officials are calling for people to come forward who might have visited the beauty salon at the Australia Fair Shopping Centre on the Gold Coast, where the latest patient briefly worked on February 27.

Prime Minister Scott Morrison acknowledged on Thursday that Australia was leaping ahead of the WHO in calling the virus a pandemic but stressed the risk is "well upon us". "We're effectively operating now on the basis that there is a pandemic," he said, as Australia pressed go on its emergency plan.

Under worse case scenarios, the plan will guide things like aged care home lockdowns, school closures and public event cancellations but it was being rolled out early due to an "abundance of caution", Mr Morrison said and Australians could still go about their daily lives as usual- whether to sports games, concerts or restaurants. "We've got ahead, we intend to stay ahead," he said. At this stage, the government has also advised against stockpiling goods.

Health Minister Greg Hunt said that while Australia was still in the containment stage, it was preparing "for a much more significant event". "One of the things we're most focused on is to make sure we have the personnel capacity if there is a surge within our hospitals and medical system in the event of a pandemic,” he said.

A 2019 report into the world's preparedness for a such a health crisis found Australia ranked highly (fourth behind the US, the UK and the Netherlands), even as researchers warned no country was fully prepared and most had dangerously weak measures in place.

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