niman

Discussion The 2019-nCoV has impacted multiple countries, caused severe illness, and sustained person-to-person transmission making it a concerning and serious public health threat. It is unclear how this virus will impact the U.S. over time. For the general population, who are unlikely to be exposed to this virus at the current time, the immediate health risk from 2019-nCoV is considered low. CDC, multiple other federal agencies, state and local health departments, and other partners are implementing aggressive measures to slow U.S. transmission of 2019-nCoV (4,5). These measures require the identification of cases and contacts in the United States and the effective management of the estimated 14,000 travelers arriving from mainland China to the United States each day (3). These measures are being implemented based on the assumption that there will be more U.S. 2019-nCoV cases occurring with potential chains of transmission, with the understanding that these measures might not prevent the eventual establishment of ongoing, widespread transmission of the virus in the United States. It is important for public health agencies, health care providers, and the public to be aware of this new 2019-nCoV so that coordinated, timely, and effective actions can help prevent additional cases or poor health outcomes. The critical role that the U.S. health care system plays in halting or significantly slowing U.S. transmission of 2019-nCoV is already evident: eight of the first 11 U.S. cases were detected by clinicians collaborating with public health to test persons at risk. The early recognition of cases in the United States reduces transmission risk and increases understanding of the virus, including its transmission and severity, to inform national and global response actions. 2019-nCoV symptoms are similar to those of influenza (e.g., fever, cough, or sore throat), and the outbreak is occurring during a time of year when respiratory illnesses from influenza, respiratory syncytial virus, and other respiratory viruses are highly prevalent. To prevent influenza, all persons aged ≥6 months should receive an annual influenza vaccine, and vaccination is still available and effective in helping to prevent influenza (10). Reducing the number of persons in the United States with seasonal influenza will reduce possible confusion with 2019-nCoV infection and possible additional risk to patients with seasonal influenza. Public health authorities are monitoring the situation closely. As more is learned about this novel virus and this outbreak, CDC will rapidly incorporate new knowledge into guidance for action. Top Acknowledgments Arizona Department of Health Services; Maricopa County Department of Public Health; California Department of Public Health; Los Angeles County Department of Public Health; Orange County Health Department; San Benito County Public Health Services Department; Santa Clara County Public Health Department; Illinois Department of Public Health; Chicago Department of Public Health; Cook County Department of Public Health; DuPage County Health Department; Massachusetts Department of Public Health; Washington State Department of Health; Snohomish Health District. 1Incident Manager, 2019-nCoV CDC Response, CDC. Top All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed. Top * Includes any of the following: dyspnea, respiratory rate >30 breaths per minute, hypoxemia, or chest x-ray with multilobar infiltrates or >50% progression of pulmonary infiltration within 24–48 hours per WHO. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200123-sitrep-3-2019-ncov.pdfpdf iconexternal icon. † https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)external icon. § https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspxexternal icon. ¶ Criteria to guide evaluation and testing of patients under investigation for 2019-nCoV include 1) fever or signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person, including a health care worker, who has had close contact with a patient with laboratory-confirmed 2019-nCoV infection within 14 days of symptom onset; 2) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person with a history of travel from Hubei Province, China, within 14 days of symptom onset; or 3) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) requiring hospitalization in any person with a history of travel from mainland China within 14 days of symptom onset. More information is available at https://emergency.cdc.gov/han/han00427.asp and https://emergency.cdc.gov/han/han00426.asp. ** https://wwwnc.cdc.gov/travel/notices/warning/novel-coronavirus-china. †† https://www.cdc.gov/media/releases/2020/p0117-coronavirus-screening.html. §§ CDC’s initial health screening includes a measurement of each traveler’s temperature with a handheld noncontact thermometer, observation of these travelers for visible signs of respiratory illness (e.g., cough or difficulty breathing), and review of symptoms through a self-administered questionnaire. ¶¶ The more comprehensive public health assessment determines, based on the traveler’s illness and exposure, whether the traveler should be taken to a hospital for further medical evaluation and care, which might include testing for 2019-nCoV. *** https://www.cdc.gov/coronavirus/2019-ncov/travelers/communication-resources.html. ††† https://emergency.cdc.gov/han/han00427.asp. §§§ https://emergency.cdc.gov/coca/calls/2020/callinfo_013120.asp. ¶¶¶ Close contact is defined as 1) being within approximately 6 ft (2 m) of a 2019-nCoV patient for a prolonged period while not wearing recommended personal protective equipment (PPE) (e.g., gowns, gloves, National Institute for Occupational Safety and Health–certified disposable N95 respirator, and eye protection); close contact can occur while caring for, living with, visiting, or sharing a health care waiting area or room with a 2019-nCoV patient; or 2) having direct contact with infectious secretions of a 2019-nCoV patient (e.g., being coughed on) while not wearing recommended PPE. **** https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html.

Clinical and Infection Control Guidance Additional information about 2019-nCoV is needed to better understand transmission, disease severity, and risk to the general population. Although CDC and partners are actively learning about 2019-nCoV, initial CDC guidance is based on guidance for management and prevention of respiratory illnesses including influenza, MERS, and SARS. No vaccine or specific treatment for 2019-nCoV infection is currently available. At present, medical care for patients with 2019-nCoV is supportive. On January 31, CDC published its third Health Advisory with interim guidance for clinicians and public health practitioners.††† In addition, CDC issued a Clinical Action Alert through its Clinician Outreach and Communication Activity network on January 31.§§§ Interim guidance for health care professionals is available at https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html. Health care providers should identify patients who might have been exposed and who have signs or symptoms related to 2019-nCoV infection, isolate these patients, and inform public health departments. This includes obtaining a detailed travel history for patients being evaluated with fever and lower respiratory tract illness. Criteria to guide evaluation and testing of PUIs for 2019-nCoV include 1) fever or signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person, including health care workers, who has had close contact¶¶¶ with a patient with laboratory-confirmed 2019-nCoV infection within 14 days of symptom onset; 2) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person with a history of travel from Hubei Province, China, within 14 days of symptom onset; or 3) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) requiring hospitalization in any person with a history of travel from mainland China within 14 days of symptom onset. Additional nonhospitalized PUIs may be tested based on consultation with state and local public health officials. Clinicians should evaluate PUIs for other possible causes of illness (e.g., influenza and respiratory syncytial virus) as clinically indicated. CDC currently recommends a cautious approach to the examination of PUIs. These patients should be asked to wear a surgical mask as soon as they are identified, and directed to a separate area, if possible, separated by at least 6 ft (2 m) from other persons. Patients should be evaluated in a private room with the door closed, ideally an airborne infection isolation room, if available. Health care personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (e.g., goggles or a face shield). Clinicians should immediately notify the health care facility’s infection control personnel and local health department. The health department will determine whether the patient needs to be considered a PUI for 2019-nCoV and be tested for infection. If directed by the health department, to increase the likelihood of detecting 2019-nCoV infection, CDC recommends collecting and testing both upper and lower respiratory tract specimens.**** Additional specimen types (e.g., stool or urine) may be collected and stored. Specimens should be collected as soon as possible once a PUI is identified regardless of time since symptom onset. For persons who might have 2019-nCoV infection and their close contacts, information and guidance on how to reduce the risk for transmitting and acquiring infection is available at https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html. Close contacts should immediately call their health care providers if they develop symptoms. In addition, CDC is working closely with state and local health partners to develop and disseminate information to the public on general prevention of respiratory illness, including the 2019-nCoV. This includes everyday preventive actions such as washing your hands, covering your cough, and staying home when you are ill. Additional information and resources for this outbreak are available on the CDC website (https://www.cdc.gov/coronavirus/2019-ncov/index.html).

Laboratory and Diagnostic Support Chinese health officials posted the full 2019-nCoV genome sequence on January 10, 2020, to inform the development of specific diagnostic tests for this emergent coronavirus (1). Within a week, CDC developed a Clinical Laboratory Improvement Amendments–approved real-time RT-PCR test that can diagnose 2019-nCoV respiratory samples from clinical specimens. On January 24, CDC publicly posted the assay protocol for this test (https://www.cdc.gov/coronavirus/2019-nCoV/lab/index.html). On January 4, 2020, the Food and Drug Administration issued an Emergency Use Authorization to enable emergency use of CDC’s 2019-nCoV Real-Time RT-PCR Diagnostic Panel. To date, this test has been limited to use at CDC laboratories. This authorization allows the use of the test at any CDC-qualified lab across the country. CDC is working closely with FDA and public health partners, including the American Public Health Laboratories, to rapidly share these tests domestically and internationally through CDC’s International Reagent Resource (https://www.internationalreagentresource.org/external icon). In addition, CDC uploaded the genome of the virus from the first reported cases in the United States to GenBank, the National Institutes of Health genetic sequence database of publicly available DNA sequences (https://www.ncbi.nlm.nih.gov/genbank/external icon). CDC also is growing the virus in cell culture, which is necessary for further studies, including for additional genetic characterization. Once isolated, the virus will be made available through BEI Resources (https://www.beiresources.org/external icon) to assist research efforts.

Public Health Response CDC established a 2019-nCoV Incident Management Structure on January 7, 2020. On January 21, CDC activated its Emergency Operations Center to optimize coordination for domestic and international 2019-nCoV response efforts. To date, CDC has deployed teams to the U.S. jurisdictions with cases to assist with epidemiologic investigation and to work closely with state and local partners to identify and monitor close contacts and better understand the spectrum of illness, transmission, and virulence associated with this novel virus. Information learned from these investigations will help inform response actions. CDC has closely monitored the global impact of this virus with staff members positioned in CDC offices around the world, including mainland China, and in coordination with other countries and WHO. This coordination has included deploying CDC staff members to work with WHO and providing active support to CDC offices in affected countries. In addition, CDC in response to the escalating risks of travel from China has issued a series of Travelers’ Health Notices for both Wuhan and the rest of China regarding the 2019-nCoV outbreak. On January 27, CDC issued a Level 3 travel notice for travelers to avoid all nonessential travel to mainland China.** U.S. quarantine stations, located at 18 major U.S. ports of entry, are part of a comprehensive regulatory system authorized under section 361 of the Public Health Service Act (42 U.S. Code Section 264), that limits the introduction of infectious diseases into the United States to prevent their spread. On January 17, consistent with existing communicable disease response protocols, CDC Quarantine staff members instituted enhanced entry screening of travelers on direct and connecting flights from Wuhan, China, arriving at three major U.S. airports: Los Angeles (LAX), New York City (JFK), and San Francisco (SFO),†† which then expanded to include travelers arriving in Atlanta (ATL) and Chicago (ORD). These five airports together receive approximately 85% of all air travelers from Wuhan, China, to the United States. U.S. Customs and Border Protection officers identified travelers arriving from Wuhan and referred them to CDC for health screening.§§ Any traveler from Wuhan with signs or symptoms of illness (e.g., fever, cough, or difficulty breathing) received a more comprehensive public health assessment performed by CDC public health and medical officers.¶¶ All travelers from Wuhan were also provided CDC’s Travel Health Alert Notice (T-HAN)*** that advised them to monitor their health for 14 days and described recommended actions to take if relevant symptoms develop. As of February 1, 2020, a total of 3,099 persons on 437 flights were screened; five symptomatic travelers were referred by CDC to local health care providers for further medical evaluation, and one of these persons tested positive for 2019-nCoV. On January 24, 2020, travel bans began to be instituted by the Chinese government, resulting in restricted travel in and out of Hubei Province, including the city of Wuhan, and fewer travelers undergoing entry screening in the United States. In response to the escalating risks associated with travel from mainland China, on January 31, 2020, the Presidential Proclamation further refined the border health strategy to temporarily suspend entry, undergo additional screening, or possible quarantine for individuals that have visited China (excluding Hong Kong, Macau, and Taiwan) in the past 14 days. These enhanced entry screening efforts are taking place at 11 airports at which all air travelers from China are being directed.

Epidemiology of First U.S. Cases On January 21, 2020, the first person in the United States with diagnosed 2019-nCoV infection was reported. As of February 4, a total of 293 persons from 36 states, the District of Columbia, and the U.S. Virgin Islands were under investigation based on current patient under investigation (PUI) definitions,¶ and also included those being evaluated because they are close contacts. Of these PUIs, 11 patients have confirmed 2019-nCoV infection using a real-time reverse transcription–polymerase chain reaction (RT-PCR) assay developed by CDC. These 11 cases were diagnosed in the following states: Arizona (one), California (six), Illinois (two), Massachusetts (one), and Washington (one) (Table). Nine cases were in travelers from Wuhan. Eight of these nine cases were identified as a result of patients seeking clinical care for symptoms and clinicians connecting with the appropriate public health systems. Two cases (one each in California and Illinois) occurred in close contacts of two confirmed cases and were diagnosed as part of routine monitoring of case contacts. All patients are being monitored closely for progressing illness. No deaths have been reported in the United States.

On December 31, 2019, Chinese health officials reported a cluster of cases of acute respiratory illness in persons associated with the Hunan seafood and animal market in the city of Wuhan, Hubei Province, in central China. On January 7, 2020, Chinese health officials confirmed that a novel coronavirus (2019-nCoV) was associated with this initial cluster (1). As of February 4, 2020, a total of 20,471 confirmed cases, including 2,788 (13.6%) with severe illness,* and 425 deaths (2.1%) had been reported by the National Health Commission of China (2). Cases have also been reported in 26 locations outside of mainland China, including documentation of some person-to-person transmission and one death (2). As of February 4, 11 cases had been reported in the United States. On January 30, the World Health Organization (WHO) Director-General declared that the 2019-nCoV outbreak constitutes a Public Health Emergency of International Concern.† On January 31, the U.S. Department of Health and Human Services (HHS) Secretary declared a U.S. public health emergency to respond to 2019-nCoV.§ Also on January 31, the president of the United States signed a “Proclamation on Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirus,” which limits entry into the United States of persons who traveled to mainland China to U.S. citizens and lawful permanent residents and their families (3). CDC, multiple other federal agencies, state and local health departments, and other partners are implementing aggressive measures to slow transmission of 2019-nCoV in the United States (4,5). These measures require the identification of cases and their contacts in the United States and the appropriate assessment and care of travelers arriving from mainland China to the United States. These measures are being implemented in anticipation of additional 2019-nCoV cases in the United States. Although these measures might not prevent the eventual establishment of ongoing, widespread transmission of the virus in the United States, they are being implemented to 1) slow the spread of illness; 2) provide time to better prepare health care systems and the general public to be ready if widespread transmission with substantial associated illness occurs; and 3) better characterize 2019-nCoV infection to guide public health recommendations and the development of medical countermeasures including diagnostics, therapeutics, and vaccines. Public health authorities are monitoring the situation closely. As more is learned about this novel virus and this outbreak, CDC will rapidly incorporate new knowledge into guidance for action by CDC and state and local health departments. Some coronaviruses, such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), are the result of human-animal interactions. Preliminary investigation of 2019-nCoV also suggests a zoonotic origin (6), but the exact origin has not yet been determined. Person-to-person spread is evident (7); however, how easily the virus is transmitted between persons is currently unclear. 2019-nCoV is similar to coronaviruses that cause MERS and SARS, which are transmitted mainly by respiratory droplets. Signs and symptoms of patients with confirmed 2019-nCoV infection include fever, cough, and shortness of breath (8). Based on the incubation period of illness from MERS and SARS coronaviruses, CDC believes that symptoms of 2019-nCoV infection occur within 2 to 14 days following infection. Preliminary information suggests that older adults and persons with underlying health conditions or compromised immune systems might be at higher risk for severe illness from this virus (9); however, many characteristics of this novel coronavirus and how it might affect individual persons and potentially vulnerable population subgroups, such as the elderly or those with chronic health conditions, remain unclear.

Summary What is already known about this topic? In December 2019, an outbreak of acute respiratory illness caused by a novel coronavirus (2019-nCoV) was detected in mainland China. Cases have been reported in 26 additional locations, including the United States. What is added by this report? Nine of the first 11 U.S. 2019-nCoV patients were exposed in Wuhan, China. CDC expects more U.S. cases. What are the implications for public health practice? CDC, multiple other federal agencies, state and local health departments, and other partners are implementing aggressive measures to substantially slow U.S. transmission of 2019-nCoV, including identification of U.S. cases and contacts and managing travelers arriving from mainland China to the United States. Interim guidance is available at https://www.cdc.gov/coronavirus/index.html and will be updated as more information becomes available.

Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak — United States, December 31, 2019–February 4, 2020 Early Release / February 5, 2020 / 69 Anita Patel, PharmD1; Daniel B. Jernigan, MD1; 2019-nCoV CDC Response Team 2019-nCoV CDC Response Team Fatuma Abdirizak, National Center for Immunization and Respiratory Diseases, CDC; Glen Abedi, National Center for Immunization and Respiratory Diseases, CDC; Sharad Aggarwal, National Center for Immunization and Respiratory Diseases, CDC; Denise Albina, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Elizabeth Allen, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Lauren Andersen, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Jade Anderson, Center for Preparedness and Response, CDC; Megan Anderson, Center for Preparedness and Response, CDC; Tara Anderson, Center for State, Tribal, Local and Territorial Support, CDC; Kayla Anderson, National Center on Birth Defects and Developmental Disabilities, CDC; Ana Cecilia Bardossy, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Vaughn Barry, National Center for Injury Prevention and Control, CDC; Karlyn Beer, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Michael Bell, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Sherri Berger, Office of the Director, CDC; Joseph Bertulfo, Office of the Director, CDC; Holly Biggs, National Center for Immunization and Respiratory Diseases, CDC; Jennifer Bornemann, Office of the Director, CDC; Josh Bornstein, Office of the Director, CDC; Willie Bower, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Joseph Bresee, National Center for Immunization and Respiratory Diseases, CDC; Clive Brown, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Alicia Budd, National Center for Immunization and Respiratory Diseases, CDC; Jennifer Buigut, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Stephen Burke, National Center for Immunization and Respiratory Diseases, CDC; Rachel Burke, National Center for Immunization and Respiratory Diseases, CDC; Erin Burns, National Center for Immunization and Respiratory Diseases, CDC; Jay Butler, Office of the Deputy Director of Infectious Disease, CDC; Russell Cantrell, Center for State, Tribal, Local and Territorial Support, CDC; Cristina Cardemil, National Center for Immunization and Respiratory Diseases, CDC; Jordan Cates, National Center for Immunization and Respiratory Diseases, CDC; Marty Cetron, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Kevin Chatham-Stephens, National Center on Birth Defects and Developmental Disabilities, CDC; Kevin Chatham-Stevens, National Center on Birth Defects and Developmental Disabilities, CDC; Nora Chea, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Bryan Christensen, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Victoria Chu, National Center for Immunization and Respiratory Diseases, CDC; Kevin Clarke, Center for Global Health, CDC; Angela Cleveland, National Center for Immunization and Respiratory Diseases, CDC; Nicole Cohen, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Max Cohen, Center for State, Tribal, Local and Territorial Support, CDC; Amanda Cohn, National Center for Immunization and Respiratory Diseases, CDC; Jennifer Collins, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Erin Conners, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Aaron Curns, National Center for Immunization and Respiratory Diseases, CDC; Rebecca Dahl, National Center for Immunization and Respiratory Diseases, CDC; Walter Daley, Center for Preparedness and Response, CDC; Vishal Dasari, Center for State, Tribal, Local and Territorial Support, CDC; Elizabeth Davlantes, Center for State, Tribal, Local and Territorial Support, CDC; Patrick Dawson, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Lisa Delaney, National Institute for Occupational Safety and Health, CDC; Matthew Donahue, Center for State, Tribal, Local and Territorial Support, CDC; Chad Dowell, National Institute for Occupational Safety and Health, CDC; Jonathan Dyal, National Center for Immunization and Respiratory Diseases, CDC; William Edens, National Center for Immunization and Respiratory Diseases, CDC; Rachel Eidex, , National Center for Emerging and Zoonotic Infectious Diseases, CDC; Lauren Epstein, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Mary Evans, National Center for Injury Prevention and Control, CDC; Ryan Fagan, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Kevin Farris, National Center for Immunization and Respiratory Diseases, CDC; Leora Feldstein, National Center for Immunization and Respiratory Diseases, CDC; LeAnne Fox, National Center for Immunization and Respiratory Diseases, CDC; Mark Frank, Center for Preparedness and Response, CDC; Brandi Freeman, National Center for Immunization and Respiratory Diseases, CDC; Alicia Fry, National Center for Immunization and Respiratory Diseases, CDC; James Fuller, Center for Global Health, CDC; Romeo Galang, National Center for Chronic Disease Prevention and Promotion, CDC; Sue Gerber, National Center for Immunization and Respiratory Diseases, CDC; Runa Gokhale, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Sue Goldstein, National Center for Immunization and Respiratory Diseases, CDC; Sue Gorman, Center for Preparedness and Response, CDC; William Gregg, National Center for Immunization and Respiratory Diseases, CDC; William Greim, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Steven Grube, Office of the Director, CDC; Aron Hall, National Center for Immunization and Respiratory Diseases, CDC; Amber Haynes, National Center for Immunization and Respiratory Diseases, CDC; Sherrasa Hill, National Center for Immunization and Respiratory Diseases, CDC; Jennifer Hornsby-Myers, National Institute for Occupational Safety and Health, CDC; Jennifer Hunter, , National Center for Emerging and Zoonotic Infectious Diseases, CDC; Christopher Ionta, National Center for Immunization and Respiratory Diseases, CDC; Cheryl Isenhour, National Center for Immunization and Respiratory Diseases, CDC; Max Jacobs, Center for State, Tribal, Local and Territorial Support, CDC; Kara Jacobs Slifka, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Daniel Jernigan, National Center for Immunization and Respiratory Diseases, CDC; Michael Jhung, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Jamie Jones-Wormley, Center for Preparedness and Response, CDC; Anita Kambhampati, National Center for Immunization and Respiratory Diseases, CDC; Shifaq Kamili, National Center for Immunization and Respiratory Diseases, CDC; Pamela Kennedy, National Center for Immunization and Respiratory Diseases, CDC; Charlotte Kent, Center for Surveillance Epidemiology and Laboratory Services, CDC; Marie Killerby, National Center for Immunization and Respiratory Diseases, CDC; Lindsay Kim, National Center for Immunization and Respiratory Diseases, CDC; Hannah Kirking, National Center for Immunization and Respiratory Diseases, CDC; Lisa Koonin, National Center for Immunization and Respiratory Diseases, CDC; Ram Koppaka, National Center for Immunization and Respiratory Diseases, CDC; Christine Kosmos, Center for Preparedness and Response, CDC; David Kuhar, National Center for Emerging and Zoonotic Infectious Diseases CDC; Wendi Kuhnert-Tallman, Deputy Director for Infectious Diseases, CDC; Stephanie Kujawski, National Center for Immunization and Respiratory Diseases CDC; Archana Kumar, , National Center for Immunization and Respiratory Diseases, CDC; Alexander Landon, Office of the Director, CDC; Leslie Lee, National Center for Immunization and Respiratory Diseases, CDC; Jessica Leung, National Center for Immunization and Respiratory Diseases, CDC; Stephen Lindstrom, National Center for Immunization and Respiratory Diseases, CDC; Ruth Link-Gelles, National Center for Immunization and Respiratory Diseases, CDC; Joana Lively, National Center for Immunization and Respiratory Diseases, CDC; Xiaoyan Lu, National Center for Immunization and Respiratory Diseases, CDC; Brian Lynch, National Center for Immunization and Respiratory Diseases, CDC; Lakshmi Malapati, National Center for Immunization and Respiratory Diseases, CDC; Samantha Mandel, National Center for Immunization and Respiratory Diseases, CDC; Brian Manns, National Center for Immunization and Respiratory Diseases, CDC; Nina Marano, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Mariel Marlow, National Center for Immunization and Respiratory Diseases, CDC; Barbara Marston, Center for Global Health, CDC; Nancy McClung, National Center for Immunization and Respiratory Diseases, CDC; Liz McClure, Center for Global Health, CDC; Emily McDonald, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Oliva McGovern, National Center for Immunization and Respiratory Diseases, CDC; Nancy Messonnier, National Center for Immunization and Respiratory Diseases, CDC; Claire Midgley, National Center for Immunization and Respiratory Diseases, CDC; Danielle Moulia, National Center for Immunization and Respiratory Diseases, CDC; Janna Murray, National Center for Immunization and Respiratory Diseases, CDC; Kate Noelte, Center for Preparedness and Response, CDC; Michelle Noonan-Smith, Office of the Director, CDC; Kristen Nordlund, National Center for Immunization and Respiratory Diseases, CDC; Emily Norton, National Institute for Occupational Safety and Health, CDC; Sara Oliver, National Center for Immunization and Respiratory Diseases, CDC; Mark Pallansch, National Center for Immunization and Respiratory Diseases, CDC; Umesh Parashar, National Center for Immunization and Respiratory Diseases, CDC; Anita Patel, National Center for Immunization and Respiratory Diseases, CDC; Manisha Patel, National Center for Immunization and Respiratory Diseases, CDC; Kristen Pettrone, National Center for Health Statistics, CDC; Taran Pierce, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Harald Pietz, Center for Preparedness and Response, CDC; Satish Pillai, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Lewis Radonovich, National Institute for Occupational Safety and Health, CDC; Sarah Reagan-Steiner, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Amy Reel, National Center for Immunization and Respiratory Diseases, CDC; Heather Reese, National Center for Immunization and Respiratory Diseases, CDC; Brian Rha, National Center for Immunization and Respiratory Diseases, CDC; Philip Ricks, Center for Global Health, CDC; Melissa Rolfes, National Center for Immunization and Respiratory Diseases, CDC; Shahrokh Roohi, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Lauren Roper, National Center for Immunization and Respiratory Diseases, CDC; Lisa Rotz, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Janell Routh, National Center for Immunization and Respiratory Diseases, CDC; Senthil Kumar Sakthivel, National Center for Immunization and Respiratory Diseases, CDC; Luisa Sarmiento, National Institute for Occupational Safety and Health, CDC; Jessica Schindelar, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Eileen Schneider, National Center for Immunization and Respiratory Diseases, CDC; Anne Schuchat, Office of the Director, CDC; Sarah Scott, Center for State, Tribal, Local and Territorial Support, CDC; Varun Shetty, Center for State, Tribal, Local and Territorial Support, CDC; Caitlin Shockey, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Jill Shugart, National Institute for Occupational Safety and Health, CDC; Mark Stenger, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention CDC; Matthew Stuckey, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Brittany Sunshine, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Tamara Sykes, Office of the Director, CDC; Jonathan Trapp, Office of the Director, CDC; Timothy Uyeki, National Center for Immunization and Respiratory Diseases, CDC; Grace Vahey, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Amy Valderrama, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Julie Villanueva, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Tunicia Walker, Center for Preparedness and Response, CDC; Megan Wallace, National Center for Immunization and Respiratory Diseases, CDC; Lijuan Wang, National Center for Immunization and Respiratory Diseases, CDC; John Watson, National Center for Immunization and Respiratory Diseases, CDC; Angie Weber, National Institute for Occupational Safety and Health, CDC; Cindy Weinbaum, National Center for Immunization and Respiratory Diseases, CDC; William Weldon, National Center for Immunization and Respiratory Diseases, CDC; Caroline Westnedge, National Center for Immunization and Respiratory Diseases, CDC; Brett Whitaker, National Center for Immunization and Respiratory Diseases, CDC; Michael Whitaker, National Center for Immunization and Respiratory Diseases, CDC; Alcia Williams, Office of the Director, CDC; Holly Williams, Office of the Director, CDC; Ian Willams, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Karen Wong, Center for Surveillance, Epidemiology and Laboratory Services, CDC; Amy Xie, Center for State, Tribal, Local and Territorial Support, CDC; Anna Yousef, National Center for Immunization and Respiratory Diseases, CDC. Top Corresponding author: Anita Patel, [email protected], 770-488-7100. https://www.cdc.gov/mmwr/volumes/69/wr/mm6905e1.htm?s_cid=mm6905e1_w#

New coronavirus infection confirmed on a cruise ship calling at Yokohama Port 　The cruise ship “Diamond Princess” arriving at Yokohama Port on February 3 is undergoing quarantine at sea, but 10 out of 31 people have been tested for the new coronavirus so far. Was transported to a medical institution in Kanagawa Prefecture because a positive new coronavirus test was confirmed. Quarantine of the cruise ship continues to be implemented. Currently, a new type of coronavirus test is being conducted, mainly for the affected, and the results will be announced later. https://www.mhlw.go.jp/stf/newpage_09276.html

Four plane loads of Americans arriving (as described in press release) Some nCoV positives expected Influenza Pandemic preparation applies to nCoV 800 working at CDC alone on Pandemic response Looking at supply chains for PPEs

11 confirmed positive cases (no new positives) testing pending on 76 PUI diagnostics shipping to 100 labs enhanced capacity by next week

The company confirmed to CNBC that one of the passengers who tested positive for the coronavirus is from the United States. The others are two passengers from Australia, three from Japan and three from Hong Kong and one Filipino crew member. https://www.cnbc.com/2020/02/04/princess-cruises-quarantines-3700-after-10-passengers-test-positive-for-virus.html

Media Statement For Immediate Release Wednesday, February 5, 2020 Contact: CDC Media Relations (404) 639-3286 HHS and CDC Receive Additional Flights Carrying Passengers from China This week, several planes carrying passengers from Wuhan China will arrive in three states. These locations are Travis Air Force Base in Sacramento, CA, Marine Corps Air Station Miramar in San Diego, CA, Lackland Air Force Base in San Antonio, TX, and Eppley Airfield in Omaha, NE. These planes will be met by a team of CDC personnel deployed there to assess the health of the passengers. The passengers have been screened, monitored and evaluated by medical and public health personnel every step of the way, including before takeoff and during the flight. CDC staff will conduct risk assessments to ensure the health of each traveler, including temperature checks and observing for respiratory symptoms. These passengers will be issued quarantine orders upon arrival at their designated quarantine location. This legal order is intended to protect the travelers, their families, and the community. This quarantine order will begin on the day the flight left Wuhan and will continue for up to 14 days. Medical care will be readily available at the first onset of symptoms, if needed. CDC will work with the state and local public health departments to transport any passenger exhibiting symptoms to a hospital for further evaluation. CDC is committed to protecting the health and safety of Americans. We continue to believe the immediate risk of coronavirus exposure to the general public is low, however, CDC is undertaking these measures to help keep that risk low. CDC is taking these measures to fully assess and care for these passengers to protect them, their loved ones, and their communities.

This week, several planes carrying passengers from Wuhan China will arrive in three states. These locations are Travis Air Force Base in Sacramento, CA, Marine Corps Air Station Miramar in San Diego, CA, Lackland Air Force Base in San Antonio, TX, and Eppley Airfield in Omaha, NE.

Media Advisory For Immediate Release Wednesday, February 5, 2020 Contact: CDC Media Relations (404) 639-3286 CDC Media Telebriefing: Update on 2019 Novel Coronavirus (2019-nCoV) What The Centers for Disease Control and Prevention (CDC) will provide an update to media on the 2019 Novel Coronavirus response. Who Nancy Messonnier, M.D., Director, National Center for Immunization and Respiratory Diseases RADM Denise Hinton, Chief Scientist Food and Drug Administration When 12:15 p.m. ET Wednesday, February 5, 2020 Dial-In Media: 800-857-9756 International: 1-212-287-1647 PASSCODE: CDC MEDIA Non-Media: 888-795-0855 International: 1-630-395-0498 PASSCODE: 2684824 Important Instructions Due to anticipated high volume, please plan to dial in to the telebriefing 15 minutes before the start time. Media: If you would like to ask a question during the call, press *1 on your touchtone phone. Press *2 to withdraw your question. You may queue up at any time. You will hear a tone to indicate your question is pending. TRANSCRIPT A transcript will be available following the briefing at CDC’s web site: www.cdc.gov/media.

The Centers for Disease Control and Prevention (CDC) will provide an update to media on the 2019 Novel Coronavirus response.

DETAILED discussion of this ship in last night's interview http://mediaarchives.gsradio.net/rense/special/rense_020420_hr3.mp3

Last night's interview discussed this ship IN DETAIL http://mediaarchives.gsradio.net/rense/special/rense_020420_hr3.mp3

Quarantined: 4 Utahns trapped on cruise ship after passengers infected with coronavirus by Alyssa Roberts and Heidi Hatch Wednesday, February 5th 2020 SALT LAKE CITY (KUTV) — At least four Utahns are stuck on board a cruise ship near Tokyo, Japan that is now quarantined due to an outbreak of coronavirus on board. Jerri Larson Jorgensen and her husband have been touring southeast Asia for several weeks. They visited Hong Kong, China, Japan, and Vietnam so far, she said. Another woman, Karey Maniscalco, sent a Facebook message to 2News saying she and her husband were also on board the quarantined ship. Jorgensen said they were eating dinner when someone came over the ship's intercom and announced that a fellow passenger from Hong Kong was showing symptoms of coronavirus. Ship passengers were informed Tuesday morning that at least 10 people on board were infected with the virus, Jorgensen told 2News. The 10 who tested positive were taken to hospitals, the Associated Press reports. Japanese authorities came to their cabins and checked them for signs or symptoms of the virus. Jorgensen said. Japanese authorities told the Associated Press there were at least 3,700 passengers on board Jorgensen's ship. Jorgensen told 2News she thought there were between 100 and 200 Americans on board, along with "many more Australians," and Asian citizens from several countries. "When we got into Japan, they were not letting us off the ship," she said. https://kutv.com/news/local/quarantined-utah-woman-trapped-on-cruise-ship-with-coronavirus-infected-passengers .

More than 5,300 people are being quarantined on two cruise ships off Hong Kong and Japan amid concerns passengers and crew were inadvertently exposed to the Wuhan coronavirus by infected passengers. People aboard both ships are being given health screenings, and those with suspicious symptoms are being tested for the virus that has quickly spread throughout mainland China and beyond. The Diamond Princess is anchored off the coast of Yokohama, near Tokyo, with 1,045 crew and 2,666 passengers -- including 428 Americans -- on board. The second ship, the World Dream, is docked at Hong Kong's Kai Tak Cruise Terminal with 1,800 people on board, the city's Department of Health said Wednesday.

CNN is reporting that 428 Americans are among the 3700 quarantined off the coast of Japan after 11 passengers and crew nCoV confirmed in first 31 test. 120 symptomatic travelers with 153 contacts have been tested. 10 positive in first 31 test results. https://www.cnn.com/2020/02/05/asia/coronavirus-cruise-quarantines-intl-hnk/index.html

More than 5,300 people are being quarantined on two cruise ships off Hong Kong and Japan amid concerns passengers and crew were inadvertently exposed to the Wuhan coronavirus by infected passengers. People aboard both ships are being given health screenings, and those with suspicious symptoms are being tested for the virus that has quickly spread throughout mainland China and beyond. The Diamond Princess is anchored off the coast of Yokohama, near Tokyo, with 1,045 crew and 2,666 passengers -- including 428 Americans -- on board. The second ship, the World Dream, is docked at Hong Kong's Kai Tak Cruise Terminal with 1,800 people on board, the city's Department of Health said Wednesday. https://www.cnn.com/2020/02/05/asia/coronavirus-cruise-quarantines-intl-hnk/index.html

Feb 4 PCR confirmed cases increase to 47,584 National lab confirmations increase - Suspect cases (23,260) below Confirmed (24,324) Discharged cases (892) doubles deaths (490) Confirmations on quarantined cruise ship off coast of Japan ex-Hong Kong Ship has 3711 people with 120 symptomatic and 153 contacts (11 nCov confirmed in first 31 tests) First sequence from South Korea has orf8 mutation orf8 mutations in nCoV and SARS CDC sequences two isolates from first nCoV case in United States orf8 mutation is US sequences from 4 of first 5 cases (WA IL CA AZ) San Benito cluster cases worsen - transferred to UCSF Sudden death videos from China including security guard Striking similarities with 1918 pandemic http://mediaarchives.gsradio.net/rense/special/rense_020420_hr3.mp3

Cruise ship virus infection confirmed 10 people transported to medical institutions in Kanagawa Prefecture February 5, 2020 11:45New type pneumonia A Hong Kong man infected with the new coronavirus is on board and a cruise ship anchored off the port of Yokohama has been tested for viruses such as those with fever symptoms, and so far 31 results have been found It was confirmed that 10 of them were infected with the virus. According to the Ministry of Health, Labor and Welfare, the policy is to have passengers and crew members left on board ships wait in their cabin for 14 days in principle. According to the Ministry of Health, Labor and Welfare, the cruise ship Diamond Princess has been berthed off the coast of Daikoku Wharf in Yokohama Port from the night of March 3, and quarantine of about 3,700 passengers and all crew members has been carried on board. Then, 120 people who had symptoms such as fever and cough, and 153 people who were in close contact with those who had symptoms were collected from 273 people, and virus tests were conducted sequentially. So far, results for 31 people have been identified, and 10 of them have been confirmed to have been infected with the virus. A marine cruise ship was dispatched to the cruise ship, and from around 7:30 am, 10 men and women with confirmed infections were transported to multiple medical institutions in Kanagawa Prefecture. Ten people were four in their fifties and sixties, and one in their seventies and eighties, and none of them had severe symptoms. Of these, three people in their fifties and two in their sixties were Japanese That is. One of the confirmed cases spent half a day on an optional bus tour with a virus-infected 80s man from Hong Kong in Kagoshima, Japan, where a cruise ship stopped last month. about it. 33 people were infected in Japan. The policy is that approximately 3,700 passengers and crew members who remain on board will stay on board for 14 days in principle, and have them wait in the cabin. The cruise ship departed Yokohama last month and visited Hong Kong around Kagoshima, and it was confirmed that an 80-year-old passenger man living in Hong Kong who got off the ship was infected with the new coronavirus. Was. The Ministry of Health, Labor and Welfare is calling for efforts to combat infectious diseases such as hand-washing and cough etiquette, as well as measures against colds and influenza, as the situation is not currently recognized in Japan. Cruise ship 16-day itinerary around Hong Kong and Taiwan The cruise ship Diamond Princess is a large passenger ship operated by a US cruise company. He left Yokohama on the 20th of last month and traveled to Kagoshima, Hong Kong, Vietnam, Taiwan and Naha in 16 days, and arrived at Yokohama Port on June 4 at 6.30am. According to Hong Kong officials, an 80-year-old man living in Hong Kong on this cruise ship was infected with the new coronavirus after leaving the ship in Hong Kong last month. The man has had a cough since the 19th, before boarding, boarding a cruise ship from Yokohama Port on the 20th, leaving Kagoshima on the 22nd and getting off in Hong Kong on the 25th. In Kagoshima, he got off the ship and participated in a bus tour for passengers on the ship. After the infection of the male was confirmed, the cruise ship was moored off the coast of Yokohama Port on March 3 and all passengers and crew members were quarantined. going. According to the Ministry of Health, Labor and Welfare, the ship initially had a total of 3711 passengers, with 2666 passengers and 1045 crew. At 9:00 am on the 5th, 3,699 people, including those who were confirmed to have been infected with the virus and were transported to the hospital, remain on board. Approximately half of the passengers, 1281 were Japanese, and there were people from 56 countries and regions including Hong Kong and Taiwan. According to the operator, another cruise originally scheduled to leave Yokohama Port on the 4th evening on the same boat was canceled. Sample collection from 273 passengers and crew According to the Ministry of Health, Labor and Welfare, the cruise ship Diamond Princess had 2,666 passengers and 1,045 crew members when it arrived off the coast of Yokohama Port, bringing a total of 3711 people on board. There are a total of 56 passengers from 56 countries and regions, of which 1281 are Japanese passengers, nearly half. Of the passengers and occupants, 120 people with symptoms such as fever and cough, and 153 people who have close contact with symptoms or Hong Kong men, collect samples from 273 people and conduct virus tests . Of these, 36 had a close contact with a man from Hong Kong on an optional bus tour in Kagoshima last month. Operating company "at least 14 days anchored" The operator of the cruise ship commented on the website and said, "The ship will continue to be quarantined and will remain at Yokohama Port. The quarantine period will be a minimum of 14 days as determined by the Ministry of Health, Labor and Welfare." "We will make every effort to ensure that all passengers are comfortable." He also suggests that he may leave the berthed area before conducting loading and other operations at Yokohama Port before conducting operations such as purifying fresh water. Ambulance arrives at Yokohama Hospital Two ambulances arrived at "Yokohama Municipal Citizen Hospital" in Hodogaya-ku, Yokohama at around 10:30 a.m., apparently carrying a patient infected with the virus on a cruise ship. Although we could not see the patient, we could see rescue workers wearing goggles and masks in white protective clothing on the driver's and passenger seats. On board According to the cruise ship's passengers, an announcement was made at around 8:10 a.m. on the 5th in the morning. According to the inspection, it was explained that 10 of the passengers and crew had shown a positive reaction. Was instructed to wait at. In addition, passengers and occupants were not allowed to disembark for 14 days in principle, and it was stated that meals would be distributed to all guest rooms through room service. The man said, "There is a possibility that we will not be able to disembark for the foreseeable future. We will also check the luggage packed in the trunk to secure the medicine." According to a woman who is on board with her mother in her 80s, "I can't get off, so I'm having trouble getting my mother's high blood pressure medicine out of the way. What will happen in the future? " Passengers in their 70s "Respond as soon as possible" A 70-year-old man on the cruise ship Diamond Princess told NHK on the morning of the morning that he would like to take immediate action as his wife's medicine is running out soon. According to the men, just after 8:00 am on the 5th, it was confirmed that 10 people had been infected on board the ship, and that they were all instructed to stay in their rooms for 14 days in principle. The man said, "Until yesterday I was able to spend table tennis etc. in the common space, but I could not get out of the room from Kesa.I went to the restaurant to eat breakfast, but I said, Please wait for room service, but it has not arrived yet. There is no signs of being confused on board, but I have no choice but to stay in the room. " Then, "I'm worried that my wife's herbal medicine to improve blood circulation will run out in a few days. I think that there are many elderly people on the ship, and there are people who use high blood pressure drugs, so we will respond as soon as possible. I want you to do that. " PM: "Remaining passengers and crew members stay on board" In this connection, Prime Minister Abe stated at the House of Representatives Budget Committee that he would make every possible effort to prevent the spread of infection, such as by leaving remaining passengers and crew members on board for a certain period of time. Among them, Prime Minister Abe conducted a test for a new type of coronavirus on a cruise ship anchored off the port of Yokohama on people with fever symptoms and found that 10 people had been infected so far. Was explained. He further stated, "These patients will be disembarked and will be hospitalized as a patient under the Infectious Diseases Control Law." "When judging the presence or absence of the new coronavirus only by epidemiological conditions, we will take measures that assume a maximum incubation period of 14 days. Based on this, we will not allow the remaining occupants and passengers to land for the time being And stay on board for as long as necessary ", and continued to make every effort to prevent the spread of infection. https://www3.nhk.or.jp/news/html/20200205/k10012273171000.html?utm_int=detail_contents_news-related_001

Virus infection of 10 cruise ships confirmed by Atsushi Kato February 5, 2020 8:55New type pneumonia Minister of Health, Labor and Welfare Kato held a press conference and conducted a test of the new coronavirus on people with fever symptoms on a cruise ship anchored off the port of Yokohama from March 3 Revealed that the infection was confirmed. Minister of Health, Labor and Welfare Kato said on Monday that a Hong Kong man who had been infected with the new coronavirus was on board and responded to passengers and crew members of the Diamond Princess, a cruise ship anchored off the coast of Yokohama Port from March 3. In the morning, we had a press conference. Minister Kato collected samples from 273 people, including those who had symptoms such as fever and those who had close contact with those who had symptoms, and conducted virus tests, and confirmed that 10 people have been infected so far. It was clarified that they were transported to a medical institution in Kanagawa Prefecture and hospitalized. In addition to the Japanese, there are people from 56 countries and regions, including Hong Kong and Taiwan, indicating that three out of 10 people who have been infected are Japanese nationals. Minister Kato also explained that other passengers and crew would be kept on board for 14 days in principle, taking into account the incubation period of the virus. He further stated that the elderly and people with pre-existing illness are more likely to become more severe when infected, and that they will conduct additional virus tests. Minister Kato stated, "We will give due consideration to the health of occupants and passengers and make every effort to prevent the spread of infection while prioritizing it." https://www3.nhk.or.jp/news/html/20200205/k10012273181000.html?utm_int=detail_contents_news-related_002