What spurt in China's cases suggests about coronavirus
SINGAPORE (Reuters) - A new diagnostic method has led the Chinese province at the epicenter of a coronavirus outbreak to report a record rise in deaths and thousands more cases on Thursday.
The central province of Hubei had previously only allowed infections to be confirmed by RNA tests, which can take days to process. RNA, or ribonucleic acid, carries genetic information that enables identification of organisms such as viruses.
But it has begun using quicker computerized tomography (CT) scans, which reveal lung infections, to confirm virus cases, health officials said.
Here are the comments of some experts on the significance of the jump in numbers.
DR. EYAL LESHEM, CLINICAL ASSOCIATE PROFESSOR, TEL AVIV UNIVERSITY SCHOOL OF MEDICINE, ISRAEL:
“I think the other very new issue that’s going to be very hot is that China is changing case definition.
“The Chinese added the suspected cases to the count and I believe the data on disease severity may be impacted, because what we’re seeing is that as the denominator grows substantially and the number of deaths does not grow, then possibly we may find out this disease is less lethal than we have initially thought.”
ON WORLD HEALTH ORGANIZATION (WHO) DATA ON DEATHS BY PROVINCE:
“Hubei province, the epicenter of the disease, reported over 1,000 deaths out of 33,000 cases. However, all the other provinces have reported less than 10 deaths and several hundreds of cases.”
“So it seems like the mortality rate in Hubei is much higher than other provinces.
“And one way to look at these data is that in Hubei, the medical system was overwhelmed with cases and was only able to test severe hospitalized patients.
“And ... other provinces tested milder cases. And the real mortality of rate of disease may be lower than the 2% we’re seeing in the reports.”
QI XIAOLONG, PROFESSOR OF MEDICINE, FIRST HOSPITAL OF LANZHOU UNIVERSITY, GANSU, CHINA:
The change in the way cases are counted reflects a local policy in Hubei to promote early detection and early isolation, he said, adding:
“The case data would not be timely if Hubei uses nucleic acid testing only to confirm cases, because patients there, without enough test-kits and testing staff, need to wait for days to get out a result.
“Meanwhile, the quality of kit and sampling error will lead to a probability of false negative. The false negative person might be the mobile source of infection in the community.”
Outside Hubei, Qi said there was no urgent need to change the methodology, as the number of patients was fewer, and nucleic acid testing could still reflect the accurate situation in a timely fashion.
Qi added that he did not think the number of newly confirmed cases would show any spike in the near future, and predicted the combined number of confirmed cases and clinical diagnostic cases would stay stable, or even decline.
PROFESSOR CHOI JAE-WOOK, CHAIRMAN, SCIENTIFIC REVIEW COMMITTEE, KOREA MEDICAL ASSOCIATION (KMA):
“The reason the Chinese health authorities decided to change the diagnostic procedure by including the clinical diagnosis, I assume, is because they lack diagnostic kits, delaying treatment of those with symptoms.
“And since only a few companies are making these testing kits in such a short period of time, the authorities cannot rely on their quality.
“I don’t think the move was long overdue. We are still in the early stage of the epidemic.
“South Korean health authorities also discussed about adopting clinical diagnosis last week. If they do, there will be a lot more suspected cases of the virus patients.”
LEE SEOK-WON, SOUTH KOREA’S CENTERS FOR DISEASE CONTROL AND PREVENTION (KCDC):
“CT scans can be faster in producing results than our current RT-PCR method using RNA amplification techniques, but it can only determine whether it was pneumonia, not whether it is the new coronavirus.
“China seems to have decided to use CT scans to more quickly sort out pneumonia cases, given the rapid spread of the virus and high likelihood that they contracted the virus.”
DR. ANOOP KUMAR A.S., CHIEF, CRITICAL CARE MEDICINE, BABY MEMORIAL HOSPITAL, INDIA:
“Even though Hubei is saying they can process up to 6,000 samples per day, the sample size may be in excess.
“The problem is there are many other viral pneumonias with almost similar features in China, so you cannot say with 100% accuracy that the cases identified in this manner are the coronavirus itself.
“In that case, we may be overestimating the number of cases and underestimating the number of deaths.
“Another thing is that whether you make the diagnosis or not, basically you are getting symptomatic treatment, there is no specific anti-viral at all.
“So it is only for surveillance purposes that your diagnosis will make a difference.
“As for the jump in cases, it is difficult to comment, since we don’t have data as to how many labs confirmed or those (that were) confirmed via radiology.
“This methodology may be used in places where they have a huge number of cases which cannot be processed using other methods.
“What the world has to think about is, we will have to get more ‘point of care’ machines, allowing for rapid processing of samples, the WHO or international agencies will have to think about mobilizing that.”
Reporting by Cheng Leng in Beijing; Rocky Swift in Tokyo; Sangmi Cha and Hyonhee Shin in Seoul and Arpan Daniel Varghese in Bangalore; Writing by Clarence Fernandez; Editing by Andrew Cawthorne