Coronavirus Live Updates: Clusters in Japan May Hint at How Virus Spreads

Public health officials are studying clusters of coronavirus cases that have emerged in Japan, searching for clues about how far the epidemic will expand beyond its center in China.

The issue has taken on greater urgency as hundreds of passengers disembark from the Diamond Princess, the cruise ship in Yokohama where 621 people have tested positive for the virus. Japan declared the ship’s two-week quarantine over, despite an uptick in cases among the passengers still onboard.

Alarmed officials are rushing to learn more about how the virus is transmitted, including how many of those infected experience mild symptoms or none at all, and to what extent it can be spread by people who experience no symptoms.

Virologists see two likely explanations for the spread of clusters. In one, a “superspreading event,” a person who has the propensity to spew more germs than others transmits the virus to a large group of people.

Alternatively, people can independently catch a virus from contaminated surfaces. It is unclear how long the new coronavirus can survive on surfaces, but studies of other such viruses have found they can stay active for a week or more.

On Thursday, a Japanese health ministry official said two infected passengers who were quarantined on the ship had died. The two, both Japanese, were an 87-year-old man and an 84-year-old woman, the Japanese broadcaster NHK reported. Both had underlying health issues, the broadcaster said.

The authorities have said they are releasing only people who have tested negative for the virus — though testing has been unreliable — and are showing no symptoms. But experts on infectious diseases have pointed to deficiencies in the quarantine protocols on the ship and questioned the decision to let them go free.

The coronavirus may be spreading fear and anxiety around the world, but adults middle-age and older, and particularly men, appear to be the most at risk.

This week, Chinese researchers published the largest analysis of coronavirus cases to date. They found that although men and women have been infected in roughly equal numbers, the death rate among men was 2.8 percent, compared with 1.7 percent among women.

A number of factors may be working against men, some biological and some rooted in lifestyle, researchers say.

When it comes to mounting an immune response against infections, men are the weaker sex.

“There’s something about the immune system in females that is more exuberant,” said Dr. Janine Clayton, director of the Office of Research on Women’s Health at the National Institutes of Health.

Health behaviors that differ by sex in some societies may also play a role in disparate responses to infections.

China has the largest population of smokers in the world, 316 million people. But just over 2 percent of Chinese women smoke, compared with more than half of all men.

Beyond that, some studies suggest that women may be more proactive about seeking health care. With the coronavirus, Chinese researchers have found, delayed treatment can have serious consequences.

With more than half of China’s population now under some form of lockdown, and its economy nearly at a standstill, business leaders and economists are increasingly arguing that Beijing’s efforts to fight the coronavirus are hurting people’s lives and livelihoods while doing little to the stop the virus’s spread.

If the country becomes poorer because of emergency health measures, they say, public health could deteriorate more than it would from the outbreak itself.

“Strike a balance that is conducive to protecting lives,” wrote James Liang, the executive chairman of Trip.com, China’s dominant online travel agency, in a widely circulated essay this week.

  • Updated Feb. 10, 2020

    • What is a Coronavirus?
      It is a novel virus named for the crown-like spikes that protrude from its surface. The coronavirus can infect both animals and people, and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS.
    • How contagious is the virus?
      According to preliminary research, it seems moderately infectious, similar to SARS, and is possibly transmitted through the air. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
    • How worried should I be?
      While the virus is a serious public health concern, the risk to most people outside China remains very low, and seasonal flu is a more immediate threat.
    • Who is working to contain the virus?
      World Health Organization officials have praised China’s aggressive response to the virus by closing transportation, schools and markets. This week, a team of experts from the W.H.O. arrived in Beijing to offer assistance.
    • What if I’m traveling?
      The United States and Australia are temporarily denying entry to noncitizens who recently traveled to China and several airlines have canceled flights.
    • How do I keep myself and others safe?
      Washing your hands frequently is the most important thing you can do, along with staying at home when you’re sick.

The debate — including questions about whether mandatory 14-day quarantines, roadblocks and checkpoints are really necessary in areas where there have been few cases — is unusual in a country where dissent is frequently censored.

Experts say there may be a middle ground between helping the economy and fighting the virus. A very strong emphasis on hand washing and on the immediate isolation of the sick may be more effective than mass quarantines, said Jennifer Huang Bouey, a Georgetown University epidemiologist.

On Thursday, officials in Beijing announced steps to help businesses struggling with the impact of the coronavirus.

Trials of two drug therapies against the coronavirus are beginning in China, World Health Organization officials said on Thursday. Early results may be available within three weeks.

One trial involves remdesivir, an experimental antiviral drug made by Gilead. It has not yet been licensed for use in any disease.

The drug was tested against the Ebola virus in Congo, where it was not very effective. But when it was given to the first American known to be infected with the coronavirus, an unidentified man in Washington State, he recovered.

The second treatment that is undergoing a trial is of a combination of two anti-H.I.V. drugs, ritonavir and lopinavir. That combination is sold as Kaletra in the United States and available in generic versions.

If either therapy helps prevent severe pneumonia, sepsis or organ failure in coronavirus patients, death rates may fall. Right now, almost 5 percent become critically ill and 2.3 percent die, according to the Chinese Center for Disease Control and Prevention.

Those figures rates are based on an initial study of almost 45,000 patients released by the China C.D.C. on Monday.

Two other drugs, favipiravir and chloroquine, have been discussed as possible coronavirus treatments because they have shown some effectiveness in laboratory tests.

With the epidemic darkening the mood across China, the Communist Youth League apparently thought the nation’s youth would appreciate some new, patriotic cartoon mascots. It was wrong.

The Communist Party’s youth wing unveiled, then quickly canned, two new animated spokesmen this week, after receiving a torrent of online mockery and criticism.

The derisive response suggested that China’s social media generation may be tiring of the party’s efforts to make propaganda fun and relatable, especially at this moment of fear and frustration with government officials.

The league’s new digital avatars were styled like anime characters and were called Hong Qi Man and Jiang Shan Jiao, names derived from Chairman Mao’s poetry. They were supposed to function like the nationalistic rap songs, viral videos and other projects by the Communist Party meant to win over younger audiences.

Instead, they sparked a backlash, as internet users expressed disbelief that the government would roll out such a campaign during a national crisis.

Some social media users also pummeled the female character, Jiang Shan Jiao, with questions about the challenges that women face in China.

“Jiang Shan Jiao, when a teacher sexually harasses you, are you forced to drop out of school?” asks a person in a video on the social platform WeChat. Another asks, “Jiang Shan Jiao, when your husband hits you, do the police respond?” Still another asked: “Jiang Shan Jiao, do you shave your hair for your country?”

The question referred to a recent video, circulated by state-run news media, featuring female medical workers having their heads shaved before marching off to Wuhan, the center of the epidemic. The video was panned on Chinese social media as exploitative.

A group of Russian Cossacks is sending patrols into a Chinatown in the Ural Mountains in search of people who they fear may be spreading the coronavirus, Russian news outlets reported on Thursday.

The patrols have raised the prospect of vigilante violence targeting Chinese people as fears over the virus grow, but the patrol organizers insist that is not happening.

The three-man patrols approach people who sneeze or cough and recommend that they visit a hospital, Znak.com reported, citing the group’s leader, Gennady Kovalyov. They also hand out face masks in the Chinese neighborhood.

“This is our little help for society,” Mr. Kovalyov said. “There are no statistics on the success of our action, but thanks to the masks at least somebody won’t be infected.”

Such groups have previously coordinated with the Russian police for crowd control but are not part of the government.

In neighboring Ukraine, residents of a village tried to block a road leading to a rural clinic where Ukrainians evacuated from the Chinese province of Hubei will be quarantined for two weeks.

President Volodymyr Zelensky responded by assuring Ukrainians that the evacuees had showed no signs of illness when they left China and that precautions were being taken to prevent the virus from spreading in Ukraine.

“But there is another danger I would like to mention,” he said in a statement. “The danger of forgetting that we are all human and we are all Ukrainian.”

Chinese health authorities announced on Thursday that they were using new criteria to count cases of the coronavirus, appearing to undo a change they had announced just a week ago.

That earlier change allowed health officials in Hubei Province — the hardest-hit area of the outbreak — to count cases diagnosed in clinical settings, including with the use of CT scans showing lung infections, not just those confirmed using specialized kits to test for the virus.

The government in Hubei has been confronted with a severe shortage of testing kits and hospital beds, and officials described the use of CT scans and clinical symptoms as a way to help identify more patients and get them into needed care.

But the government said Hubei would now resume using the same criteria as the rest of the country. Cases will be considered confirmed only if the virus is found.

The change has caused confusion among public health experts, who say it is now even more difficult to track the outbreak.

“For an epidemiologist, it’s really frustrating when case definitions keep on changing,” said Benjamin Cowling, a professor of epidemiology at the University of Hong Kong. “Why can’t they work out what’s a probable, suspected and confirmed case? It’s totally confusing.”

Health officials have run into problems with the viral tests, which can be difficult to conduct and often turn up false negatives. It also takes at least two days to process the results.

But lung scans are also an imperfect means to diagnose patients, leading to the possibility of an overcount. Even patients with ordinary seasonal flu may develop pneumonia visible on a lung scan.

On Thursday, the number of new cases in the previous 24 hours fell sharply across the country, to 394, from 1,749 the day before, according to data from Chinese health officials. It was not immediately clear whether the decline was a result of changes in how the Chinese government defines cases.

The total number of infections in the country reached 74,576 on Thursday. There were 114 more deaths in the country on Wednesday, bringing the toll to 2,118.

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Amazon, which typically stocks more than 100 million items and relies heavily on Chinese manufacturing, is becoming a case study in how a giant retailer grapples with the fallout from the coronavirus.

As the outbreak shuts or slows factories in China, Amazon has responded by making larger and more frequent orders of Chinese-made products that had already been shipped to the United States, trying to keep up its inventory. Some sellers have also reduced their advertising and promotions on the site so they don’t run out of products.

The company — which is likely to feel potential shortages of goods earlier than its peers because it usually keeps fewer items on hand — also sent an urgent email to brands about Prime Day, its large midsummer sale, indicating that it has begun worrying about inventory for the event.

Some of the potential supply problem may be hidden, since even products made in America can rely on Chinese suppliers.

Procter & Gamble, the consumer products giant, said in a federal filing on Thursday that disruptions to supply and demand caused by the coronavirus outbreak would “materially” affect the company’s quarterly results.

The company relies on 387 suppliers in China, each facing difficulties in resuming operations, Jon R. Moeller, the chief operating officer and chief financial officer, said at a conference in New York, according to the filing. He said the virus was also reducing department store traffic in many major Asian metropolitan areas, “with many stores closed or operating with reduced hours.”

“China is our second largest market — sales and profit,” he said. “Some of the demand has shifted online but supply of delivery operators and labor is limited.”

“The operating challenges change with the hour, and of course the path of the virus is unknown, making it very difficult to provide precise estimates of impact,” he added.

Despite the expected drag in the current quarter, the company still stood by its guidance for the fiscal year ending June 30, according to the statement. It said last month that it expected annual sales growth of 4 to 5 percent.

Procter & Gamble on Thursday also confirmed that all eight of its manufacturing plants and six out of eight distribution centers in China have restarted operations, as first reported by the Cincinnati Business Courier.

When Apple told shareholders this week that it would take a financial hit because of the epidemic, it was the kind of warning that might have inspired a sharp sell-off on Wall Street.

But the stock market has barely reacted, despite the idling of countless factories and fears that the virus could spread more widely. The S&P 500 index is up 5.6 percent from its levels at the end of January, when the World Health Organization declared the outbreak a global health emergency.

Even the Dow Jones travel and tourism index, which includes airlines and hotel chains that would suffer from a drop in Asian tourism, is down just 1.2 percent since mid-January, when fears started becoming widespread.

U.S. stock investors seem to be betting that the Fed will bail them out of any damage to corporate profits and the world economy. But this means they are also betting that the Fed’s diminished capacity to deal with future shocks won’t be a problem.

South Korea reported what officials said could be its first death from the coronavirus on Thursday, as the number of people infected in the country more than doubled.

A 63-year-old patient with symptoms of pneumonia died on Wednesday at the Daenam Hospital in Cheongdo, a town in the southeast of South Korea, according to the Korea Centers for Disease Control and Prevention. On Thursday, officials learned that the patient had been infected with the virus.

South Korea reported 53 additional cases of the coronavirus on Thursday, bringing the total to 104.

All but two of the 53 new patients were residents of Daegu, a city 80 miles southeast of Seoul, or residents of the surrounding province of North Gyeongsang. Twenty-eight of the new patients were members of a church in Daegu where 43 members were confirmed to have been infected.

All 747 crew members remaining aboard the cruise ship Westerdam in Sihanoukville, Cambodia, have been tested for the coronavirus, and none of them were found to be infected, the cruise company, Holland America Line, announced Thursday.

With these tests results, all 1,528 passengers and crew members who remained in Cambodia have tested negative for the virus and are cleared to leave the country, the cruise company said.

The ship, which left Hong Kong on Feb. 1 with more than 2,200 people aboard, was turned away by ports in five countries before Cambodia agreed to let it dock a week ago.

The company said there was never any sign of coronavirus aboard the ship, but one passenger, an 83-year-old American woman, was found to have the virus after she departed and was stopped by airport health inspectors in Malaysia.

Holland America said Wednesday that all 781 passengers who remained in Cambodia had tested negative for the disease and were free to leave the country.

Earlier this week, a comedian from Oregon who had performed on the Westerdam posted a video on YouTube boasting that he slipped out of his hotel and headed to the airport before his test results had come back.

The man, Frank King, said in the video that he had eluded hotel security. KOMO-TV in Seattle reported that he arrived home on Monday. He said that he had been “cleared by the C.D.C.” and did not have any symptoms, but regretted his decision because of a backlash on social media.

In an email to The Times on Thursday, he said that in hindsight, he would have chosen to stay “simply to avoid recrimination.”

Reporting and research were contributed by Sui-Lee Wee, Keith Bradsher, Choe Sang-Hun, Alexandra Stevenson, Andrew Kramer, Richard C. Paddock, Steven Lee Myers, Elaine Yu, Amie Tsang, Neil Irwin, Karen Weise, Michael Corkery, Tess Felder, Karen Zraick, Russell Goldman, Tiffany May, Edward Wong, Makiko Inoue, Eimi Yamamitsu, Claire Fu, Niraj Chokshi and Wang Yiwei.