Why experts suspect more cases in China and why the US has more cases than it realizes

written by E Rosalie, originally published at https://www.nobelprose.com on January 20, 2020; edited to add US cases and for clarity

Prologue: The bodies often slumped to the side.

A bloody froth spilled from the nose and mouth, pooling on the floor, visible to onlookers awaiting the same fate. If the others did not die from the virus, they might still drown in their own blood— maybe pneumonia.

By the pandemic’s end in 1920, 50–100 million people had perished, and there was little doubt it would happen again. The pandemic the world has yet to forget; that’s what I thought of skimming the reports from Asia.

Still, we remain unprepared.

Closeup of pins on world map journey travel

They called it Pneumonia of Unknown Etiology, and the virus poised to descend on humanity like wildfire.

The close relative of SARS appeared out of thin air, but, just as abruptly, new cases in China disappeared — only the reports, not the sick people. The virus popped up in three, and now four, countries: Thailand, Japan, Korea, and the US.

China, believing animal markets to be the source, shut them down for cleaning on Jan 1, but multiple cases report not having visited animal markets.

How did they catch it if not at the market?

Potentially, human-to-human like SARS. SARS Coronavirus incubation took 4 to 6 days, with extremes of 2 to 14 days. That suggests community spread and the possibility of many more cases.

The virus’s reach likely extends beyond the recognized number.

Air droplets can suspend in the air for hours after an infected person has left. Finding everyone who trekked through airports seems unlikely.

Nothing indicates that mild infections cannot happen, meaning infected people may not know their status. This is most worrying given that a Wuhan doctor diagnosed the woman on Jan 18 with a cold.

The expected numbers are much higher than the numbers reported.


Depending on when this spilled over and how well it moves person-to-person, it could already be quietly spreading around the world.


Imperial College London released a report on Jan 17, echoing my concerns — only a student, I questioned my suspicion —estimating the number of infected parties:

The report estimated 1,723 cases, assuming Jan 12 as the latest onset date, and included assumptions on traffic through the airport based on averages.

Given the cases in Japan and Thailand from travelers to China and the incubation of SARS, one of three possibilities occurred:

1. China has cases it doesn’t know exist

2. China knows about cases and did not report after Jan 3

3. The virus defies mathematical models and has an uncommonly long incubation period

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  • Bogoch, Isaac I, Alexander Watts, Andrea Thomas-Bachli, Carmen Huber, Moritz U G Kraemer, and Kamran Khan. 2020. “Pneumonia of Unknown Etiology in Wuhan, China: Potential for International Spread Via Commercial Air Travel”. Toronto General Hospital.

  • Cauchemez, Simon, Christophe Fraser, Maria D. Van Kerkhove, Christl A. Donnelly, Steven Riley, Andrew Rambaut, Vincent Enouf, Sylvie van der Werf, and Neil M. Ferguson. 2014. “Middle East Respiratory Syndrome Coronavirus: Quantification of the Extent of the Epidemic, Surveillance Biases, and Transmissibility.” The Lancet Infectious Diseases 14 (1): 50–56. https://doi.org/10.1016/S1473-3099(13)70304-9.

  • DEPARTMENT OF COMMUNICABLE DISEASE SURVEILLANCE AND RESPONSE, SURVEILLANCE AND RESPONSE, DEPARTMENT OF COMMUNICABLE DISEASE. Consensus Document on the Epidemiology of Severe Acute Respiratory Syndrome (SARS). WHO/CDS/CSR/GAR; 2003. https://www.who.int/csr/sars/en/WHOconsensus.pdf. Accessed April 26, 2020.

  • Donnelly, Christl A., Azra C. Ghani, Gabriel M. Leung, Anthony J. Hedley, Christophe Fraser, Steven Riley, Laith J. Abu-Raddad, et al. 2003. “Epidemiological Determinants of Spread of Causal Agent of Severe Acute Respiratory Syndrome in Hong Kong.” Lancet 361 (9371): 1761–66. https://doi.org/10.1016/S0140-6736(03)13410-1.

  • Natsuko Imai, Ilaria Dorigatti, Anne Cori, Steven Riley, Neil M. Ferguson. Estimating the potential total number of novel Coronavirus cases in Wuhan City, China. Imperial College London (17–01–2020), doi: https://doi.org/10.25561/77149

  • Nickol, Michaela E., and Jason Kindrachuk. 2019. “A Year of Terror and a Century of Reflection: Perspectives on the Great Influenza Pandemic of 1918–1919.” BMC Infectious Diseases. https://doi.org/10.1186/s12879-019-3750-8.

  • World Health Organization. 2020. “WHO | Novel Coronavirus — Republic of Korea (Ex-China).”

  • World Health Organization. 2020. “WHO | Novel Coronavirus — China.” WHO. World Health Organization.

Originally published at https://www.nobelprose.com on January 20, 2020.



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