More U.S. Coronavirus Cases Emerge, as China’s Death Toll Rises – The New York Times

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The mayor of Wuhan, which is at the center of the viral outbreak, said on Sunday that there could be about 1,000 more confirmed cases of the mysterious illness in the city — a sign that China’s monumental efforts to halt the disease may only just be starting.

In a news conference, the mayor, Zhou Xianwang, said that the estimate was based on the assumption that around half of the city’s nearly 3,000 suspected cases of the coronavirus would eventually test positive for the disease. The youngest confirmed case involved a 9-month-old girl in Beijing, according to The People’s Daily, a state newspaper.

Mr. Zhou also said that five million people had left Wuhan before travel out of the city was restricted, leaving nine million people still living there.

As of Monday morning, the official count of confirmed cases across China stood at 2,744. The authorities in Hubei Province put the death toll at 76 there, bumping the overall deaths to at least 80.

On Sunday China announced 15 more deaths from the new coronavirus, including one in Shanghai, the first reported there. Thirteen deaths were announced in Hubei Province, where the outbreak began, and one in Henan Province. Across the country, 688 new cases were diagnosed on Saturday, the government said early Sunday.

Deaths from the coronavirus had previously been reported outside of Hubei. But the death in Shanghai, which is among China’s most populous cities and a major commercial hub, is likely to fuel anxieties about the disease’s spread.

Shanghai’s municipal health commission said on Sunday that the patient who died was an 88-year-old man.

Three more cases of the coronavirus were reported on Sunday in the United States, two in California and one in Arizona, bringing the country’s total to five, according to the C.D.C.

All three had recently been in Wuhan, health officials said. The three patients were all being kept in isolation.

A patient in Los Angeles County passed through Los Angeles International Airport from Wuhan on the way to a vacation elsewhere, Barbara Ferrer, the director of the county’s Department of Public Health, said at a news conference. The traveler returned to LAX on Jan. 22, wearing a mask, and approached airport staff about possibly having the virus.

The other California patient, in neighboring Orange County, was identified by the county health agency as a traveler from Wuhan.

The patient in Maricopa County in Arizona is an adult member of the Arizona State University community, health officials said.

Other cases have been found in Washington State and Chicago. The C.D.C. has sent teams to each of the states to help trace and follow up on contacts of the infected patients.

The C.D.C. said that just over 100 “patients under investigation” from 26 states were being monitored because they had traveled to Wuhan, or had contact with patients, and had symptoms like fever, cough or shortness of breath that could be caused by the virus.

So far, 25 of those under investigation have tested negative for the virus.

The risk to the general public is considered low, Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said Sunday at a news briefing. “But the threat is serious,” she said.

The C.D.C. is urging the public to get flu shots, to help reduce the number of people seeking treatment for symptoms that might be mistaken for the new coronavirus.

The agency is also preparing test kits to be sent to state health departments so that they can test for the virus instead of having to send samples to the C.D.C. for testing, but it will be a few more weeks before the kits are ready, Dr. Messonnier said.

The head of China’s National Health Commission, Ma Xiaowei, warned on Sunday that people who carried the disease but did not show flu symptoms could still infect others. That would be a major difference between the new virus and SARS, a coronavirus that spread in China and around the world nearly two decades ago, killing 800 people.

“The epidemic has entered a more serious and complex period,” said Dr. Ma, the director of China’s National Health Commission.

He also said on Sunday that the new coronavirus’s incubation period was about 10 to 14 days, and that the period is contagious.

“There have been mild cases where observation has shown that the patients were contagious during the incubation period. The incubation period is around 10 days,” he said. “The shortest time before the disease’s onset was one day. The longest was 14 days. This is very different from SARS.”

The rate of the current epidemic is accelerating, he added, and is “likely to continue for some time.”

A study by the medical journal The Lancet, published on Friday, had raised concerns that people infected with the coronavirus might be able to spread it even if they do not have flulike symptoms.

Health officials in the United States expressed some caution on Sunday.

“We at the Centers for Disease Control and Prevention don’t have any clear evidence of patients’ being infectious before symptom onset,” Dr. Messonnier of the National Center for Immunization and Respiratory Diseases said at a news briefing on Sunday. “We are actively investigating that possibility.”

Spread of the virus by people with no symptoms would make the disease harder to control — if that really is occurring, said Dr. Thomas R. Frieden, a former C.D.C. director who is now president of Resolve to Save Lives, a public health organization. “We don’t know,” he said.

Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said he had seen no data to indicate that people with no symptoms were contagious.

“We surely haven’t seen that with any of the other coronaviruses, MERS or SARS,” Dr. Osterholm said. “When we could document transmission, patients were ill.”

He added, “Mother Nature is throwing us a curveball with this outbreak, but we shouldn’t accept every claim like this until we see the data.”

Dr. Julie Gerberding, another former C.D.C. director and now chief patient officer at Merck, said the spread by asymptomatic people was not impossible. Seemingly asymptomatic people could have the sniffles, she said, which might go unnoticed but spread the virus.

“The U.S. has faced multiple pandemics before,” Dr. Messonnier said. “We need to be preparing as if this is a pandemic, but I hope it’s not.”

If people with no signs or symptoms of illness can spread the infection, that “offers many more opportunities for spread, and increases the difficulty of curtailing the spread greatly, because you can’t just focus on sick individuals,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University.

“If an exposed person becomes contagious before they become sick, you can almost think of them as a secret spreader,” he said. “They’re healthy. Nobody suspects they’re sick. Nobody’s avoiding them, and they’re not staying home with their illness.”

He added: “SARS was largely transmitted from people who were already sick. Ebola was the same. If you were exposed, you were of no risk to anyone until you became sick, and even in the early day or two or three of illness you were not of risk to anyone.”

In Hong Kong — which was badly hit by the SARS coronavirus in 2003, with nearly 300 deaths — worries about the spread of infectious diseases run deep. On Sunday, the government said it would bar residents of Hubei Province, which includes Wuhan, and people who had been to the province in the past 14 days from entering Hong Kong until further notice.

The rule does not apply to Hong Kong residents, according to a government statement.

Six cases of the new coronavirus have been confirmed in the city, already hobbled by months of antigovernment protests.

Its efforts to contain the virus have been met with resistance. A plan to convert an unused public housing block into a quarantine site incited protests on Sunday, with demonstrators setting fires in the lobbies of two of the buildings.

The government condemned the fires set at the public housing complex, in Hong Kong’s New Territories. But it also backed away from its plan to use the buildings for quarantine, saying that it would use government-owned sites first.

The unrest came a day after Carrie Lam, the leader of the semiautonomous territory, declared a health emergency and said Hong Kong schools would be closed until February. She also said trains and flights between Wuhan and Hong Kong would be halted.

Calls had circulated in the past week for new arrivals from the mainland to be barred. Mrs. Lam initially said that would be “inappropriate and impractical” but on Sunday the government changed course on residents of Hubei Province.

The weeklong Lunar New Year holiday, which began on Saturday, is usually a peak travel period in China. CCTV, the Chinese state broadcaster, reported that the State Council would extend the holiday three days, until Feb. 2. That would keep people away from workplaces, schools and other public buildings for a longer period.

Fears about the virus are affecting tourism in the city, whose economy depends significantly on money spent by visitors at malls, hotels and restaurants, and which is now in a recession.

Two of Hong Kong’s biggest attractions, Disneyland and Ocean Park, said on Sunday that they were closing until further notice. A notice on Hong Kong Disneyland’s website called it a “precautionary measure.”

Shanghai’s Disneyland park had earlier been shut indefinitely. China said on Saturday that it would suspend all tour groups and the sale of flight and hotel packages for its citizens headed overseas starting on Monday.

China has banned the wildlife trade nationwide until the epidemic passes, three government departments said on Sunday.

The outbreak has drawn fresh attention to China’s animal markets, where the sale of exotic wildlife has been linked to epidemiological risks. The Wuhan virus is believed to have spread from one such market in the city. The SARS outbreak nearly two decades ago was also traced back to the wildlife trade.

A statement issued by China’s markets regulator, agriculture ministry and forestry bureau said that all transactions of wildlife would be forbidden immediately in wholesale markets, supermarkets, restaurants and e-commerce platforms. It also encouraged consumers to understand the health risks of eating wild animals.

The consumption of exotic creatures has been driven partly by beliefs about their supposed health benefits, although such ideas are starting to lose their grip, particularly on younger people.

A popular travel blogger, Wang Mengyun, apologized recently for eating bat soup in a video from a few years ago. Ms. Wang, who has more than two million followers on the social platform Weibo, said that she had been unaware of the health risks of eating bats when she made the video in the Pacific island nation of Palau. She said she had been trying to highlight the local cuisine.

In her post, Ms. Wang emphasized that the bat had been locally raised and was not wild. “Many countries around the world eat these,” she wrote.

Her post has since been deleted.

The United States government offered details on a plan to evacuate American diplomats and other citizens from Wuhan, saying on Sunday that it was arranging a flight to leave Tuesday bound for San Francisco.

The State Department has ordered all American employees at the United States Consulate in Wuhan to leave the city. In an email sent on Sunday to Americans living in China, the department asked all other citizens who wanted a spot on the plane to contact the embassy. Capacity will be “extremely limited,” the message said, and priority will be given to people at greater risk from the virus.

It is unclear who will fall into that category.

Jonny Dangerfield, 30, an American who went to Wuhan to celebrate the Lunar New Year with his wife and children, said he hoped his family might be given priority because his three children are all under 5.

“If it weren’t for them, we maybe would not have much worry at all,” Mr. Dangerfield, who works in finance in Phoenix and whose in-laws live in Wuhan, said in a telephone interview.

“Just to keep ourselves sane,” he said, “we have low expectations about getting on that plane.”

Around the world, health officials worked to minimize the risks for their citizens. France’s health minister, Agnes Buzyn, said Sunday that several hundred natives of France in the Wuhan area would be flown home in the middle of the week but would have to undergo 14 days in quarantine.

The Russian Embassy was also working with the Chinese authorities to evacuate Russian citizens from the area, and Prime Minister Shinzo Abe of Japan told reporters on Sunday that his government would help repatriate all citizens wishing to leave Wuhan, “by charter planes and all other means.”

Public health officials in Toronto on Saturday night announced test results showing that Canada had its first “presumptive” case of the coronavirus.

Dr. Barbara Yaffe, Ontario’s associate chief medical officer of health, said the patient was a man in his 50s who returned to Toronto on Jan. 22 after visiting Wuhan. The next day, he was admitted to a hospital with a respiratory infection.

Dr. David Williams, Ontario’s chief medical officer of health, said that additional tests were expected to confirm that the man, who was in stable condition, had been infected with the virus.

Taiwan, which on Sunday confirmed its fourth case, said it would bar all visitors from Hubei Province. Taiwan’s government also said it would suspend applications from Chinese citizens for travel permits except in special cases, such as disease control or humanitarian medical assistance.

Macau announced that starting from Monday, it would restrict travelers from Wuhan.

Despite the rising number of coronavirus cases and the dozens of deaths, public health experts say there is no cause for panic. The common flu kills roughly 35,000 people a year and hospitalizes about 200,000 in the United States alone.

Yet the unknowns around the current outbreak are causing widespread worry. And there are signs that this outbreak could be more serious than the common flu. Other coronaviruses have far higher mortality rates than the flu, and have led to global outbreaks.

In addition, conclusive evidence about how this outbreak started is lacking. Although officials in Wuhan first traced it to a seafood market, some who have fallen ill never visited it. Researchers have also offered disparate explanations about which animals may have transmitted the virus to humans.

China’s record doesn’t help. During the SARS epidemic in 2002 and 2003, officials covered up the extent of the crisis, delaying the response. The Chinese government has promised far more transparency this time, and the World Health Organization has praised its cooperation with scientists.

But mistrust of the local and national authorities, compounded by missteps and mistakes in handling the illness, runs deep. Though China’s initial delay in reporting cases of the new virus may suggest a cover-up, experts see something more worrying: weaknesses at the heart of the Chinese political system.

In a sign that the central government is bolstering its effort to contain the outbreak, China’s National Health Commission said it would send 1,230 medical experts to Wuhan to assist in treatment.

The army has sent 450 other people from three military medical universities, according to a state media article that the health commission shared on its website. And the air force sent military transport aircraft to the cities of Shanghai, Xi’an and Chongqing to pick up emergency airlifts of medical teams and supplies for Wuhan.

In Wuhan, health officials said that they would assign 24 hospitals to treat potential coronavirus patients only, according to People’s Daily, the Communist Party’s main newspaper. National officials had called for patients to be concentrated in specialized hospitals, and new hospitals were being built specifically to treat patients.

A top Chinese official warned on Sunday that the nation needs many more masks and protective suits than it can currently produce.

His remarks, in a news conference, came as more local governments around the country mandated that citizens wear masks in public as the coronavirus outbreak grows. On Sunday, the government in Guangdong, China’s most populous province, became the latest to require people to wear masks in public.

Wang Jiangping, China’s vice minister of industry and information technology, said that Hubei Province alone needed 100,000 protective suits a day to fight the illness, but that Chinese manufacturers could supply only 30,000 suits each day.

The Lunar New Year holiday is also making it hard for factories to produce at full capacity, Mr. Wang said.

Roads were quiet. Where cars, trucks and motorbikes once roared and honked, there was the sound of birds tweeting and dogs barking. Shoppers mostly hauled their baskets home by foot or on bicycle.

Wuhan, the city at the center of China’s viral outbreak, has been subdued since the government put it under a smothering net of travel restrictions on Thursday. It was even quieter on Sunday, after the city announced heavy restrictions on the use of cars, even within the urban limits.

But along with general silence, there was confusion.

The announcements about which vehicles were allowed on the roads were murky, leaving even police officers befuddled.

First, the Wuhan authorities said that most cars should stay off the roads and that a fleet of 6,000 taxis would be on call to transport people in need and deliver food and medicine. Then, the authorities said drivers would be notified by text message if they had to stay off the roads. Nobody seemed to receive text messages on Sunday.

“My understanding,” a police officer said, “is that you can drive in your district if you don’t get a text message telling you that you can’t. But you should check that with the transport authorities.”

In the end, most drivers stayed off the streets. But as the day went on, more ventured out, and the police did not seem to do much about it.

For some residents, it was another exasperating fumble by Wuhan officials who many believe have mishandled the epidemic. But most seemed to accept the restrictions with the same stoicism that many have shown since the city imposed bans on leaving for all but a select few.

On Sunday morning, many groceries in Wuhan were crowded with residents stocking up, especially on fresh vegetables, fruit and meat, in case even tighter rules might be announced that impeded food supplies or that deterred them from leaving home.

“Because it’s the New Year, a lot of stores close anyway, and now we have the disease and now this,” said Ai Wenjun, who had lined up to pay for a basket of turnips, cabbage and beans. “Each extra thing makes me worry more.”

So far, shops still have supplies, though some residents said prices had risen despite government warnings to keep them steady.

“If we can’t bring in produce, it will become more expensive, or we might even have to close up,” said Zuo Qichao, who was selling piles of cucumbers, turnips and tomatoes. As he spoke, a woman accused him of unfairly raising the turnips’ price.

“Every county, every village around here is now putting up barriers, worried about that disease,” Mr. Zuo said. “Even if the government says it wants food guaranteed, it won’t be easy — all those road checks.”

For now, the Wuhan city authorities have the benefit of a population willing to endure restrictions to slow the epidemic. But that mood could shift if the measures hamper food supplies and worsen medical shortages.

“Now is not the time for recriminations,” said Li Xiandu, a retired business manager. “The local government wasn’t forthcoming with information and didn’t take vigorous enough measures. But we need to get through this first, and then we can assign blame.”

Reporting was contributed by Raymond Zhong, Chris Buckley, Motoko Rich, Austin Ramzy, Denise Grady, Roni Rabin, Ezra Cheung, Max Fisher, Vivian Wang, Ian Austen, Josh Keller, Yonette Joseph, Nicholas Bogel-Burroughs and Aurelien Breeden. Claire Fu and Wang Yiwei contributed research.