WHO Worries Over Virus Clusters        02/22 09:58

   (AP) -- In South Korea, Singapore and Iran, clusters of infections are 
leading to a jump in cases of the new viral illness outside China. But it's not 
the numbers that are worrying experts: It's that increasingly they can't trace 
where the clusters started.

   World Health Organization officials said China's crackdown on parts of the 
country bought time for the rest of the world to prepare for the new virus. But 
as hot spots emerge around the globe, trouble finding each source --- the first 
patient who sparks every new cluster --- might signal the disease has begun 
spreading too widely for tried-and-true public health steps to stamp it out.

   "A number of spot fires, occurring around the world is a sign that things 
are ticking along, and what we are going to have here is probably a pandemic," 
said Ian Mackay, who studies viruses at Australia's University of Queensland. 

   That worst-case isn't here yet, the WHO insists. It isn't convinced that 
countries outside China need more draconian measures, but it pointed to spikes 
in cases in Iran and South Korea to warn that time may be running out to 
contain the virus.

   "What we see is a very different phase of this outbreak depending where you 
look," said WHO's Dr. Sylvie Briand. "We see different patterns of transmission 
in different places."

   The World Health Organization defines a "global pandemic" as a disease 
spreading on two continents, though some public health experts would call an 
outbreak a pandemic if the spread is over a wide area or across many 
international borders. 

   The newest red flag: Iran has reported 28 cases, including five deaths, in 
just days. The cluster began in the city of Qom, a popular religious 
destination, but it's not clear how. Worse, infected travelers from Iran 
already have been discovered in Lebanon and Canada.

   In South Korea, most of the hundreds of new cases detected since Wednesday 
are linked to a church in the city of Daegu and a nearby hospital. But health 
authorities have not yet found the "index case," the person among the church's 
9,000 followers who set off the chain of infections.

   There also have been several cases in the capital, Seoul, where the 
infection routes have not yet been traced. In Europe, Italy saw cases of the 
new virus more than quadruple in a day as it grapples with infections in a 
northern region that apparently have spread through a hospital and a cafe.

   A cluster of cases isn't inherently worrying --- in fact, it's expected as 
an infection that's easy to spread is carried around the world by travelers. 
The first line of defense: Isolate the sick to treat them and prevent further 
spread, and quarantine people who came in contact with them until the 
incubation period is over.

   But as the virus becomes more widespread, trying to trace every contact 
would be futile, Singapore's Prime Minister Lee Hsien Loong acknowledged 
earlier this month. 

   "If we still hospitalize and isolate every suspect case, our hospitals will 
be overwhelmed," he said. So far, the city-state has identified five clusters 
of transmission, including two churches. But there remain eight locally 
transmitted cases with no links to earlier cases, or to China. 

   Viruses vary in how they infect. The new coronavirus --- unlike its cousins 
SARS, or severe acute respiratory syndrome, and MERS, or Middle East 
respiratory syndrome --- spreads as easily as a common cold. 

   And it's almost certainly being spread by people who show such mild symptoms 
that no one can tell, said Dr. Amesh Adalja of the Johns Hopkins Center for 
Health Security.

   "If that's the case, all of these containment methods are not going to 
work," Adalja said. "It's likely mixed in the cold and flu season all over the 
place, in multiple countries" and gone unnoticed until someone gets severely 
ill.

   These milder symptoms are good news "in terms of not as many people dying," 
said Mackay, of Australia. "But it's really bad news if you are trying to stop 
a pandemic," he added.

   When Hong Kong reported it first death from the virus earlier this month, it 
also confirmed three locally transmitted cases with no known link to any 
previous cases or any travel history to China. Chuang Shuk-kwan of the Center 
for Health Protection warned then that "there could be invisible chains of 
infection happening within communities." 

   Officials in both South Korea and Japan have signaled in the past week that 
the spread is entering a new phase in their countries. 

   On Friday, South Korean Prime Minister Chung Se-kyun said the government 
would have to shift its focus from quarantine and border control to slowing the 
spread of the virus. Schools and churches were closed and some mass gatherings 
banned. 

   Takaji Wakita, head of Japan's National Institute of Infectious Diseases, 
earlier urged people to work at home or in shifts to avoid being in a crowd, 
and refrain from holding non-essential and non-urgent meetings.

   But Adalja cautioned that far-reaching measures like China instituted in the 
outbreak's epicenter of Wuhan --- where citizens have been ordered to stay in 
their homes for weeks --- can backfire. While it remains to be seen if the new 
virus is waning, that kind of lockdown makes it hard for people to get other 
critically important care, like fast treatment for a heart attack.

   There's no way to predict if the recent clusters will burn out or trigger 
widespread transmission. 

   For now, health officials should try and contain the infection for as long 
as possible while preparing for a change in strategy by preparing hospitals, 
readying protective equipment and bolstering laboratory capacity, said 
Gagandeep Kang, a microbiologist who leads India's Translational Health Science 
and Technology Institute.

   "Although the window of opportunity is narrowing to contain the outbreak, we 
still have a chance to contain it," said WHO Director-General Tedros Adhanom 
Ghebreyesus. "But while doing that, we have to prepare at the same time for any 
eventualities, because this outbreak could go any direction -- it could even be 
messy."


(KR)