Italy and South Korea virus outbreaks reveal disparity in deaths and tactics

Reuters
By Emilio Parodi, Stephen Jewkes, Sangmi Cha and Ju-min Park

MILAN/SEOUL (Reuters) – In Italy, millions are locked down and more than 800 people have died from the coronavirus. In South Korea, hit by the disease at about the same time, only a few thousand are quarantined and 67 people have died. As the virus courses through the world, the story of two outbreaks illustrates a coming problem for countries now grappling with an explosion in cases.

It’s impractical to test every potential patient, but unless the authorities can find a way to see how widespread infection is, their best answer is lockdown.

Italy started out testing widely, then narrowed the focus so that now, the authorities don’t have to process hundreds of thousands of tests. But there’s a trade-off: They can’t see what’s coming and are trying to curb the movements of the country’s entire population of 60 million people to contain the disease. Even Pope Francis, who has a cold and delivered his Sunday blessing over the internet from inside the Vatican, said he felt “caged in the library.”

Thousands of miles away in South Korea, authorities have a different response to a similar-sized outbreak. They are testing hundreds of thousands of people for infections and tracking potential carriers like detectives, using cell phone and satellite technology.

Both countries saw their first cases of the disease called COVID-19 in late January. South Korea has since reported 67 deaths out of nearly 8,000 confirmed cases, after testing more than 222,000 people. In contrast, Italy has had 827 deaths and identified more than 12,000 cases after carrying out more than 73,000 tests on an unspecified number of people.

Epidemiologists say it is not possible to compare the numbers directly. But some say the dramatically different outcomes point to an important insight: Aggressive and sustained testing is a powerful tool for fighting the virus.

Jeremy Konyndyk, a senior policy fellow at the Center for Global Development in Washington, said extensive testing can give countries a better picture of the extent of an outbreak. When testing in a country is limited, he said, the authorities have to take bolder actions to limit movement of people.

“I’m uncomfortable with enforced lockdown-type movement restrictions,” he said. “China did that, but China is able to do that. China has a population that will comply with that.”

The democracies of Italy and South Korea are useful case studies for countries such as America, which have had problems setting up testing systems and are weeks behind on the infection curve. So far, in Japan and the United States particularly, the full scale of the problem is not yet visible. Germany has not experienced significant testing constraints, but Chancellor Angela Merkel warned her people on Wednesday that since 60% to 70% of the populace is likely to be infected, the only option is containment.

South Korea, which has a slightly smaller population than Italy at about 50 million people, has around 29,000 people in self-quarantine. It has imposed lockdowns on some facilities and at least one apartment complex hit hardest by outbreaks. But so far no entire regions have been cut off.

Seoul says it is building on lessons learned from an outbreak of Middle East Respiratory Syndrome (MERS) in 2015 and working to make as much information available as possible to the public. It has embarked on a massive testing program, including people who have very mild illness, or perhaps don’t even have symptoms, but who may be able to infect others.

This includes enforcing a law that grants the government wide authority to access data: CCTV footage, GPS tracking data from phones and cars, credit card transactions, immigration entry information, and other personal details of people confirmed to have an infectious disease. The authorities can then make some of this public, so anyone who may have been exposed can get themselves – or their friends and family members – tested.

In addition to helping work out who to test, South Korea’s data-driven system helps hospitals manage their pipeline of cases. People found positive are placed in self-quarantine and monitored remotely through a smartphone app, or checked regularly in telephone calls, until a hospital bed becomes available. When a bed is available, an ambulance picks the person up and takes the patient to a hospital with air-sealed isolation rooms. All of this, including hospitalization, is free of charge.

South Korea’s response is not perfect. While more than 209,000 people have tested negative there, results are still pending on about 18,000 others – an information gap that means there are likely more cases in the pipeline. The rate of newly confirmed cases has dropped since a peak in mid-February, but the system’s greatest test may still be ahead as authorities try to track and contain new clusters. South Korea does not have enough protective masks – it has started rationing them – and it is trying to hire more trained staff to process tests and map cases.

And the approach comes at the cost of some privacy. South Korea’s system is an intrusive mandatory measure that depends on people surrendering what, for many in Europe and America, would be a fundamental right of privacy. Unlike China and the island-state of Singapore, which have used similar methods, South Korea is a large democracy with a population that is quick to protest policies it does not like.

“Disclosing information about patients always comes with privacy infringement issues,” said Choi Jaewook, a preventive medicine professor at Korea University and a senior official at the Korean Medical Association. Disclosures “should be strictly limited” to patients’ movements, and “it shouldn’t be about their age, their sex, or their employers.”

Traditional responses such as locking down affected areas and isolating patients can be only modestly effective, and may cause problems in open societies, says South Korea’s Deputy Minister for Health and Welfare Kim Gang-lip. In South Korea’s experience, he told reporters on Monday, lockdowns mean people participate less in tracing contacts they may have had. “Such an approach,” he said, “is close-minded, coercive, and inflexible.”

ITALY “AT THE LIMIT”

Italy and South Korea are more than 5,000 miles apart, but there are several similarities when it comes to coronavirus. Both countries’ main outbreaks were initially clustered in smaller cities or towns, rather than in a major metropolis – which meant the disease quickly threatened local health services. And both involved doctors who decided to ignore testing guidelines.

Italy’s epidemic kicked off last month. A local man with flu symptoms was diagnosed after he had told medical staff he had not been to China and discharged himself, said Massimo Lombardo, head of local hospital services in Lodi.

The diagnosis was only made after the 38-year-old, whose name has only been given as Mattia, returned to the hospital. Testing guidelines at the time said it was not necessary to test people who had no link to China or other affected areas. But an anaesthetist pushed the protocols and decided to go ahead and test for COVID-19 anyway, Lombardo said. Now, some experts in Italy believe Mattia may have been infected through Germany, rather than China.

Decisions about testing hinge partly on what can be done with people who test positive, at a time when the healthcare system is already under stress. In Italy at first, regional authorities tested widely and counted all positive results in the published total, even if people did not have symptoms.

Then, a few days after the patient known as Mattia was found to have COVID-19, Italy changed tack, only testing and announcing cases of people with symptoms. The authorities said this was the most effective use of resources: The risk of contagion seemed lower from patients with no symptoms, and limited tests help produce reliable results more quickly. The approach carried risks: People with no symptoms still can be infected and spread the virus.

On the other hand, the more you test the more you find, so testing in large numbers can put hospital systems under strain, said Massimo Antonelli, director of intensive care at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome. Testing involves elaborate medical processes and follow-up. “The problem is actively searching for cases,” he said. “It means simply the numbers are big.”

Italy has a generally efficient health system, according to international studies. Its universal healthcare receives funding below the European Union average but is comparable with South Korea’s, at 8.9% of GDP against 7.3% in South Korea, according to the World Health Organization.

Now, that system has been knocked off balance. Staff are being brought into accident and emergency departments, holidays have been canceled and doctors say they are delaying non-urgent operations to free up intensive care beds.

Pier Luigi Viale, head of the infectious disease unit at Sant’ Orsola-Malpighi hospital in Bologna, is working around the clock – in three jobs. His hospital is handling multiple coronavirus cases. His doctors are shuttling to other hospitals and clinics in the area to lend their expertise and help out with cases. In addition, his doctors also have to deal with patients with other contagious diseases who are struggling to survive.

“If it drags on for weeks or months we’ll need more reinforcements,” he told Reuters.

Last week, the mayor of Castiglione d’Adda, a town of about 5,000 people in Lombardy’s “red zone” which was the first to be locked down, made an urgent online appeal for help. He said his small town had to close its hospital and was left with one doctor to treat more than 100 coronavirus patients. Three of the town’s four doctors were sick or in self quarantine.

“Doctors and nurses are at the limit,” said a nurse from the hospital where Mattia was taken in. “If you have to manage people under artificial respiration you have to be watching them constantly, you can’t look after the new cases that come in.”

Studies so far suggest that every positive case of coronavirus can infect two other people, so local authorities in Lombardy have warned that the region’s hospitals face a serious crisis if the spread continues – not just for COVID-19 patients but also for others whose treatment has been delayed or disrupted. As the crisis spreads into Italy’s less prosperous south, the problems will be magnified.

Intensive care facilities face the most intense pressure. They require specialist staff and expensive equipment and are not set up for mass epidemics. In total, Italy has around 5,000 intensive care beds. In the winter months, some of these are already occupied by patients with respiratory problems. Lombardy and Veneto have just over 1,800 intensive care beds between public and private systems, only some of which can be set aside for COVID-19 patients.

The government has asked regional authorities to increase the number of intensive care places by 50% and to double the number of beds for respiratory and contagious diseases, while reorganizing staff rosters to ensure adequate staffing. Some 5,000 respirators have been acquired for intensive care stations, the first of which are due to arrive on Friday, deputy Economy Minister Laura Castelli said.

The region has already asked nursing institutes to allow students to bring forward their graduation to get more nurses into the system early. Pools of intensive care specialists and anaesthetists are to be set up, including staff from outside the worst affected regions.

To add to the burden, hospitals in Italy depend on medical personnel to try to trace the contacts that people who test positive have had with others. One doctor in Bologna, who asked not to be named, said he had spent a 12-hour day tracing people who had been in contact with just one positive patient, to ensure those who next need testing are found.

“You can do that if the number of cases remains two to three,” the doctor said. “But if they grow, something has to give. The system will implode if we continue to test everyone actively and then have to do all this.”

“MAXIMUM POWER”

In South Korea as in Italy, an early case of COVID-19 was identified when a medical officer followed their intuition, rather than the official guidelines, on testing.

The country’s first case was a 35-year-old Chinese woman who tested positive on Jan. 20. But the largest outbreak was detected after the 31st patient, a 61-year-old woman from South Korea’s southeastern city of Daegu, was diagnosed on Feb. 18.

Like the patient named Mattia in Italy, the woman had no known links to Wuhan, the Chinese province where the disease was first identified. And as in Italy, the doctors’ decision to recommend a test went against guidelines at the time to test people who had been to China or been in contact with a confirmed case, said Korea Medical Association’s Choi Jaewook.

“Patient 31,” as she became known, was a member of a secretive church which Deputy Minister for Health and Welfare Kim Gang-lip said has since linked to 61% of cases. Infections spread beyond the congregation after the funeral of a relative of the church’s founder was held at a nearby hospital, and there were several other smaller clusters around the country.

Once the church cluster was identified, South Korea opened around 50 drive-through testing facilities around the country.

In empty parking lots, medical staff in protective clothing lean into cars to check their passengers for fever or breathing difficulties, and if needed, collect samples. The process usually takes about 10 minutes, and people usually receive the results in a text reminding them to wash their hands regularly and wear face masks.

A total of 117 institutions in South Korea have equipment to conduct the tests, according to the Korea Centers for Disease Control and Prevention (KCDC). The numbers fluctuate daily, but an average of 12,000 is possible, and maximum capacity is 20,000 tests a day. The government pays for tests of people with symptoms, if referred by a doctor. Otherwise, people who want to be tested can pay up to 170,000 won ($140), said an official at a company called Seegene Inc, which supplies 80% of the country’s kits and says it can test 96 samples at once.

There are also 130 quarantine officers like Kim Jeong-hwan, who focus on minute details to track potential patients. The 28-year-old public health doctor spends his whole working days remotely checking up on people who have tested positive for COVID-19, the disease caused by the virus.

Kim, who is doing military service, is one of a small army of quarantine officers who track the movements of any potential carriers of the disease by phone, app or the signals sent by cell phones or the black boxes in automobiles. Their goal: To trace all the contacts people may have had, so they too can be tested.

“I haven’t seen anyone telling bad lies,” Kim said. “But lots of people generally don’t remember exactly what they did.”

Underlining their determination, quarantine officers told Reuters they located five cases after a worker in a small town caught the virus and went to work in a “coin karaoke,” a bar where a machine lets people sing a few songs for a dollar. At first, the woman, who was showing symptoms, did not tell the officers where she worked, local officials told Reuters. But they put the puzzle together after questioning her acquaintances and obtaining GPS locations on her mobile device.

“Now, quarantine officers have maximum power and authority,” said Kim Jun-geun, an official at Changnyeong County who collects information from quarantine officers.

South Korea’s government also uses location data to customize mass messages sent to cellphones, notifying every resident when and where a nearby case is confirmed.

Lee Hee-young, a preventative medicine expert who is also running the coronavirus response team in South Korea’s Gyeonggi province, said South Korea has gone some of the way after MERS to increase its infrastructure to respond to infectious diseases. But she said only 30% of the changes the country needs have happened. For instance, she said, maintaining a trained workforce and up-to-date infrastructure at smaller hospitals isn’t easy.

“Until we fix this,” Lee said, “explosions like this can keep blowing up anywhere.”

(Reporting by Emilio Parodi, Stephen Jewkes, Angelo Amante, Sangmi Cha and Ju-min Park; Additional reporting by James Mackenzie in Milan and Josh Smith in Seoul, Julie Steenhuysen in New York; Edited by Sara Ledwith and Jason Szep)

North Korea fires three projectiles into sea; China urges dialogue

By Hyonhee Shin and Sangmi Cha

SEOUL (Reuters) – North Korea launched multiple short-range projectiles into the sea on Monday as part of firing drills, a week after it resumed missile tests following a three-month break, South Korea’s military said.

The projectiles, including from a multiple-launch rocket system (MLRS), flew up to 200 km (124 miles) and reached 50 km in altitude, South Korea’s Joint Chiefs of Staff (JCS) said.

They were launched from the eastern coastal town of Sondok, home to a military airfield where nuclear-armed North Korea fired missiles last year, the JCS said in a statement.

The JCS said the latest test appeared to be part of firing drills that have been under way since late last month and have been overseen by North Korean leader Kim Jong Un.

After a three-month halt in missile testing, North Korea tested an MLRS on March 2.

The JCS expressed “strong regret” over the launch and said it was watching for any more tests.

South Korea’s national security adviser, Chung Eui-yong, held a video conference with the defense minister and intelligence chief to analyze the North’s latest test and its intent, the presidential Blue House said.

“The ministers once again pointed out that the continued firing drills are unhelpful for efforts to build lasting peace on the Korean peninsula,” the Blue House said in a statement.

Japanese Defence Minister Taro Kono said the projectiles appeared to be ballistic missiles and did not fall into Japan’s exclusive economic zone, though the government was examining details about the launch.

A U.S. official, speaking on condition of anonymity due to the sensitivity of the matter, said North Korea had fired at least three projectiles towards the eastern sea and a detailed analysis was being conducted.

China’s foreign ministry called for all sides to use dialogue and show flexibility, saying the situation was “complex and sensitive”.

“We also urge parties to make positive efforts to calm the situation for talks to continue, and to realise the denuclearisation and lasting peace in this region and the peninsula,” spokesman Geng Shuang told a briefing.

Britain, Germany, France, Estonia and Belgium raised North Korea’s recent missile firings at the U.N. Security Council on Thursday, calling them provocative action that violated U.N. resolutions.

North Korea’s foreign ministry criticized the European stand as “U.S.-instigated reckless behaviour”. The sister of Kim Jong Un said the drills were not meant to threaten anyone.

Hopes were raised for dialogue with North Korea on its nuclear weapons and missiles when Kim met U.S. President Donald Trump for a historic summit in Singapore in June 2018.

But no significant progress has been made despite two more meetings between the leaders.

(Reporting by Sangmi Cha and Hyonhee Shin, additional reporting by Chris Gallagher in Tokyo, Idrees Ali in Washington and Yew Lun Tian in Beijing; Editing by Stephen Coates, Robert Birsel)

South Korea declares new ‘special care zone’ as coronavirus spreads

By Hyonhee Shin and Josh Smith

SEOUL (Reuters) – South Korea declared a “special care zone” on Thursday around a second city hit hard by the coronavirus and the U.S. military confirmed two new cases among relatives of its troops in the country, which is battling the biggest outbreak outside China.

Australia and Japan have joined the list of almost 100 nations now limiting arrivals of people from South Korea, which reported 760 coronavirus cases on Thursday for a total of 6,088.

Japanese Prime Minister Shinzo Abe said Japan will suspend existing visas for visitors from China and South Korea and quarantine them for two weeks in response to the widening outbreak of the flu-like virus.

The measures will go into effect on March 9.

Following the announcement, the South Korean Foreign Ministry summoned a Japanese diplomat to “hear Japan’s explanations regarding its announcement,” Yonhap news agency reported, citing a ministry official.

The South Korean government declared a “special care zone” around Gyeongsan, a city of about 275,000 people 250 km (150 miles) southeast of Seoul, promising extra resources such as face masks.

Gyeongsan has seen a spike in cases in recent days, many of them linked to a fringe Christian group at the center of South Korea’s outbreak. Similar zones have been declared around the neighboring city of Daegu and Cheongdo County.

About 75% of all cases in South Korea are in and around Daegu, its fourth-largest city, according to the Korea Centers for Disease Control and Prevention (KCDC).

“Every day is sad and tough like a war. But our Daegu citizens are showing surprise wisdom and courage,” Daegu Mayor Kwon Young-jin told reporters on Thursday.

About 2,120 patients were waiting for hospital beds in Daegu, city officials said. Dozens of newly commissioned military nurses were due to begin work in the city on Thursday, according to the health ministry.

The KCDC reported five more deaths from the virus, bringing the total to 37. The virus surfaced in China late last year and has infected more than 95,300 people and killed almost 3,300 worldwide, mostly in China, according to a Reuters tally.

South Korea also said it was banning the export of face masks, and would step up their production and ration them to limit individual purchases to two a week, in an attempt to ease shortages and curb hoarding.

People have flocked to supermarkets, pharmacies and online distributors to snap up masks and other supplies, with hundreds lining up at some stores every morning.

KCDC Deputy Director Kwon Jun-wook advised all South Koreans to stay home and avoid “any gatherings, especially those that take place in enclosed places with many people such as religious events”.

He also advised employers in Asia’s fourth-largest economy, highlighted by tech giants like Samsung Electronics Co Ltd, to allow staff to work from home.

‘DEEPLY REGRETTABLE’

U.S. Forces Korea (USFK) reported two new cases, for a total of six among soldiers, employees or people related to the roughly 28,500 U.S. troops stationed in South Korea.

Despite the new cases, USFK had resumed sending troops to bases in Daegu and surrounding areas, according to the military newspaper Stars and Stripes.

It said commanders believed the bases were protected from the outside population, and troop rotations were needed to maintain readiness in the face of threats from nuclear-armed North Korea.

Australia’s ban on the arrival of foreigners from South Korea is a blow to Seoul’s efforts to prevent the United States from imposing such restrictions.

“It is a deeply regrettable step, and we will closely consult Australian authorities for a swift revocation of the measure and to minimize inconvenience for our citizens,” Foreign Ministry spokesman Kim In-chul told reporters.

South Korean officials met the U.S. ambassador in Seoul on Wednesday to urge the United States not to limit travel. Similar talks would be held on Friday with diplomats from other nations, the Foreign Ministry said.

According to the U.S. State Department, anyone with a fever of 100.4 Fahrenheit (38 Celsius) is already banned from boarding direct flights from South Korea to the United States.

Korean Air Lines said it would screen all departing passengers for high temperatures and reject those deemed a risk.

South Korea also sent three “rapid response” teams to Vietnam on Thursday to help more than 270 citizens quarantined there over coronavirus concerns, the Foreign Ministry said.

(Reporting by Josh Smith and Hyonhee Shin in Seoul; Additional reporting by Ju-min Park and Heekyong Yang; Editing by Stephen Coates and Mark Heinrich)

Thousands wait for hospital beds in South Korea as coronavirus cases surge

By Josh Smith and Sangmi Cha

SEOUL (Reuters) – South Korea reported hundreds of new coronavirus cases on Wednesday as many sick people waited for hospital beds in Daegu, the city at the center of the worst outbreak outside China.

The new cases bring South Korea’s total to 5,621, with at least 32 deaths, the Korea Centers for Disease Control and Prevention (KCDC) said.

Most cases were in and around Daegu, the country’s fourth-largest city, where the flu-like virus has spread rapidly through members of a fringe Christian group.

Health officials expect the number of new cases to be high for the near future as they complete the testing of more than 200,000 members of the sect, as well as thousands of other suspected cases from smaller clusters.

“We need special measures in times of emergency,” South Korean Prime Minister Chung Sye-kyun told a cabinet meeting, referring to extra medical resources for hotspots and economic measures including a $9.8 billion stimulus.

“In order to overcome COVID-19 as quickly as possible and minimize the impact on the economy, it is necessary to proactively inject all available resources.”

COVID-19 is the illness caused by the new coronavirus which emerged from China late last year to spread around the world.

Hospitals in South Korea’s hardest hit areas were scrambling to accommodate the surge in new patients.

In Daegu, 2,300 people were waiting to be admitted to hospitals and temporary medical facilities, Vice Health Minister Kim Gang-lip said. A 100-bed military hospital that had been handling many of the most serious cases was due to have 200 additional beds available by Thursday, he added.

South Korean President Moon Jae-in on Tuesday declared “war” on the virus, apologized for shortages of face masks and promised support for virus-hit small businesses in Asia’s fourth-biggest economy.

TRAVEL RESTRICTIONS

Moon’s office on Wednesday said he had canceled a planned trip to the United Arab Emirates, Egypt and Turkey in mid-March due to the crisis.

At least 92 countries have imposed some form of entry restrictions on arrivals from South Korea, according to a tally by Yonhap news agency.

Vice Foreign Minister Cho Sei-young met the U.S. ambassador on Wednesday as part of Seoul’s efforts to prevent the United States from imposing restrictions.

In the meeting, Cho outlined South Korea’s efforts to control the outbreak and urged the United States not to take steps that would affect exchanges between the two countries, the foreign ministry said.

U.S. President Donald Trump said this week his administration was watching Italy, South Korea and Japan – all with severe outbreaks – and would make a decision about travel restrictions “at the right time”.

“We remain confident in the South Korean government’s robust and comprehensive response efforts to limit the spread of the virus,” U.S. ambassador Harry Harris tweeted after meeting Cho.

Up to 10,000 people are being tested each day in South Korea, and daily totals have decreased slightly since a peak of 909 new cases on Saturday, the KCDC said.

Experts caution that the results of those tests could take some time to be processed, leading to future spikes in confirmed cases.

(Reporting by Josh Smith, Sangmi Cha, and Jack Kim; Writing by Josh Smith; Editing by Simon Cameron-Moore, Stephen Coates and Andrew Cawthorne)

South Korea seeks murder charges as coronavirus kills more than 3,000 worldwide

By Hyonhee Shin and Se Young Lee

SEOUL/BEIJING (Reuters) – South Korea sought murder charges against leaders of a secretive church at the center of a ballooning coronavirus outbreak in the country on Monday as the global death toll rose above 3,000.

World stock markets regained some calm as hopes for global interest rate cuts to soften the economic blow of the virus steadied nerves after last week’s worst plunge since the 2008 financial crisis.

South Korea reported 599 new coronavirus cases, taking its national tally to 4,335, following the country’s biggest daily jump on Saturday of 813 confirmed infections.

There were 586 more on Sunday, broadening the largest virus outbreak outside China. There have been 26 deaths in total.

Worldwide, the death toll has risen to 3,044, according to Reuters figures.

Of the new cases in South Korea, 377 were from the southeastern city of Daegu, home to a branch of the Shincheonji Church of Jesus, to which most of South Korea’s cases have been traced.

The agency said that in January some members of the church visited the central Chinese city of Wuhan, where the disease emerged late last year.

The Seoul government asked prosecutors to launch a murder investigation into leaders of the church, a movement that reveres founder Lee Man-hee.

Seoul Mayor Park Won-soon said that if Lee and other heads of the church had cooperated, preventive measures could have saved the people who died.

“The situation is this serious and urgent, but where are the leaders of the Shincheonji, including Lee Man-hee, the chief director of this crisis?” Park said in a post on his Facebook page late on Sunday.

Seoul’s city government said it had filed a criminal complaint with the Seoul Central District Prosecutors’ Office, asking for an investigation of Lee and 12 others on charges of murder and disease control act violations.

Lee apologized on Monday that one of its members had infected many others, calling the epidemic a “great calamity”.

“We did our best but was not able to stop the spread of the virus,” Lee told reporters.

It was not immediately known how many of South Korea’s dead were directly connected to the church.

Wuhan, the Chinese city at the center of the epidemic, closed the first of 16 specially built hospitals, hurriedly put up to treat people with the virus, after it discharged its last recovered patients, state broadcaster CCTV said on Monday.

Graphic: Tracking the novel coronavirus.

‘OUTBREAKS ARE CURBED’

News of the closure coincided with a steep fall in new cases in Hubei province, but China remained on alert for people returning home with the virus from other countries.

“The rapid rising trend of virus cases in Wuhan has been controlled,” Mi Feng, a spokesman for China’s National Health Commission, told a briefing.

“Outbreaks in Hubei outside of Wuhan are curbed and provinces outside of Hubei are showing a positive trend.”

The virus broke out in Wuhan late last year and has since infected more than 86,500 people, the majority in China, with most in Hubei.

Outside China, it has in recent days spread rapidly, now to 53 countries, with more than 6,500 cases and more than 100 deaths. Italy has 1,694 cases, the vast majority in the wealthy northern regions of Lombardy, Veneto and Emilia Romagna.

Iran’s number of reported cases rose to 1,501 on Monday, with 66 deaths.

Global factories took a beating in February from the outbreak, with activity in China shrinking at a record pace, surveys showed on Monday, raising the prospect of a coordinated policy response by central banks to prevent a global recession.

The global spread has forced the postponement of festivals, exhibitions, trade fairs and sports events, crippled tourism, retail sales and global supply chains, especially in China, the world’s second-largest economy.

Retail sales in Chinese-ruled Hong Kong, already rocked by months of often violent anti-government unrest, fell 21.4% in January from a year earlier.

Middle East airlines have lost an estimated $100 million so far due to the outbreak and governments should help the carriers through this “difficult period”, an official of the International Air Transport Association (IATA) said.

Global airlines stand to lose $1.5 billion this year due to the virus, he said.

The Organization for Economic Cooperation and Development warned that the outbreak was pitching the world economy into its worst downturn since the global financial crisis, urging governments and central banks to fight back.

Officials in U.S. President Donald Trump’s administration on Sunday tried to calm market panic that the coronavirus could cause a global recession, saying the U.S. public had over-reacted and that stocks would rebound due to the American economy’s underlying strength.

The S&P 500 index tumbled 11.5% last week. Roughly $4 trillion has been wiped off the value of U.S. stocks.

Speaking to NBC’s “Meet the Press” on Sunday, Vice President Mike Pence, who is leading the administration’s response to the virus, said the market “will come back”.

“The fundamentals of this economy are strong. We just saw some new numbers come out in housing and consumer confidence and business optimism. Unemployment is at a 50-year low. More Americans are working than ever before,” Pence said.

(Graphic: Reuters graphics on the new coronavirus ,

(Reporting by Hyonhee Shin and Jack Kim in Seoul, Ju-min Park in Gapyeong, Ryan Woo, David Stanway, Se Young Lee, Emily Chow and Andrew Galbraith in Beijing, Leigh Thomas in Paris, Michelle Price in Washington, Leika Kihara in Tokyo, Jonathan Cable in London, Donny Kwok and Twinnie Siu in Hong Kong Writing by Nick Macfie; Editing by Mark Heinrich)

South Korea says flight attendant infected with virus worked Los Angeles route

By Joyce Lee and Hyunjoo Jin

SEOUL (Reuters) – A Korean Air flight attendant who worked on flights between Seoul and Los Angeles subsequently tested positive for the coronavirus, South Korea’s disease control agency and sources said on Thursday.

South Korea reported 334 additional cases of the new coronavirus on Thursday, the largest daily increase yet, as the U.S. State Department issued a new travel warning for South Korea and a joint military drill was postponed.

The new cases bring the total tally to 1,595, giving South Korea the biggest number of infected people outside China.

The flight attendant worked on Korean Air’s flight KE017 from Seoul’s Incheon airport to Los Angeles on Feb. 19, and on the return flight KE012 on Feb. 20, Yonhap news agency and other media reported. A South Korean official familiar with the case verified those flight details, adding that between flights the woman had stayed in Los Angeles overnight.

“She took a flight after showing symptoms, and we are investigating people who had contact with the employee on the flight,” the Korea Centers for Disease Control and Prevention (KCDC) said in a statement on Thursday.

The flight attendant, described as being in her 20s, later tested positive for the virus, and she is currently in hospital.

The crewmember had been on a Korean Air KE958 flight from Israel to Incheon on Feb. 15-16, the KCDC said. The passengers on that flight included a South Korean religious group that 31 coronavirus cases have been traced to.

“An investigation is under way about the places the patient visited and the people she had contact with,” the KCDC said.

Korean Air said crewmembers who were on the same flights with her have self-quarantined for 14 days, but referred other inquires to KCDC, as the authority in charge.

“We will continue to work closely with the relevant authorities to ensure the safety of our passengers and employees,” the airline said.

U.S. President Donald Trump assured Americans on Wednesday the risk from coronavirus remained “very low” and was not immediately considering travel restrictions to and from countries such as South Korea and Italy that are dealing with outbreaks.

(Reporting by Joyce Lee and Hyunjoo Jin; Editing by Kim Coghill, Michael Perry & Simon Cameron-Moore)

Secretive church at center of South Korea’s explosive coronavirus outbreak

By Hyonhee Shin and Hyun Young Yi

DAEGU/SEOUL, South Korea (Reuters) – An So-young had a gut feeling that the 31st person in South Korea to test positive for the coronavirus might be a member of the controversial religious sect she quit four years ago.

The person, dubbed “Patient 31,” was the first of an explosive wave of cases that made South Korea’s outbreak the largest outside of China. What caught An’s attention was how health authorities were struggling to track the woman’s movements before she was tested.

“That’s their culture, they have to hide their movements, and that’s why I guessed she was with Shincheonji,” An, 27, said in an interview, referring to the Shincheonji Church of Jesus.

Patient 31 attended services at the church’s branch in the southeastern city of Daegu this month, staying for two hours each time, before testing positive on Feb. 18.

The South Korean disease control chief Jeong Eun-kyeong said the church’s services, where thousands of people sit on the floor, shoulder-to-shoulder, for hours, could have contributed to the surges.

“You would be 5 centimeters away from the person who sits next to you, and have to say ‘Amen’ after every sentence the pastor speaks – it’s the best environment for the virus to spread,” said An, who is now a theology student.

In a media interview, Patient 31 said she did not refuse to be tested. But health authorities said she sought care at a traditional medicine hospital in Daegu after a minor car accident, where a medical worker who treated her later tested positive for the virus. While running a fever, she went to a buffet at a hotel and the church services.

Shincheonji is in the biggest crisis in its 36-year history, as hundreds of members have tested positive for the virus, SARS-CoV-2. All of its 210,000 known followers are being tested amid unprecedented scrutiny from authorities and the public.

After initial resistance, the church released the addresses of 1,100 facilities around the country – 82 churches and 1,018 “affiliates,” – and asked the public to avoid making “groundless criticism.” It was the “biggest victim of the virus,” it said.

Calls by Reuters to the church’s headquarters seeking comment went unanswered.

During a visit to the Daegu branch on Friday, a man who identified himself as a member said he was the only one there and told Reuters that “all of our 9,000 members are taking self-quarantine measures in compliance with the government instruction.” He said the building was disinfected twice last week.

 

‘THE DEVIL’S DEED’

South Korea reported 334 new cases of the coronavirus on Thursday, bringing the national tally to 1,595. More than 1,000 are from Daegu, according to the Korea Centres for Disease Control and Prevention (KCDC), and nearly 600 are directly linked to Shincheonji’s branch there.

KCDC said that it is still investigating the exact origin of the outbreak, but that five or six other members of the church were infected together with Patient 31.

The church had a presence in Wuhan, the center of the virus in China, according to the KCDC, though it is unclear whether that played a role.

Also known as the Temple of the Tabernacle of the Testimony, the church was founded and is headed by self-proclaimed messiah Lee Man-hee.

“This disease case is the devil’s deed to stop the rapid growth of Shincheonji,” Lee said in a message on Friday on an internal app used by members.

But its secretive practices and often-aggressive recruitment tactics have made the church a controversial presence in South Korea’s religious community.

New members are forced to leave home and live in dormitories as part of initiation. Many break ties with their family and begin aggressively recruiting new members, An said.

According to its website, followers must undergo six months of classes and complete a demanding written exam before “graduating” and joining the church.

The church has denied previous reports by Christian news organizations describing it as a “brainwashing cult”, calling those accusations “blatant lies” and a plot to rein in its expansion.

‘SECRET HARVESTERS’

All members work as “harvesters” tasked with courting new followers from other churches, dubbed “harvest fields”, former members said.

“It may appear Christian, but is actually completely different. They revere founder Lee Man-hee as a saviour, like Jesus,” said Lee Duck-sure, a Christian pastor who runs a counseling center in Seoul for former members of Shincheonji.

South Koreans vented anger after an official at a Daegu public health center that carries out virus tests continued to work even after he was told to get tested. He revealed he was a member of the Daegu Shincheonji church only after the test showed he was infected, Daegu officials said.

But health officials and experts cautioned the blame should not be focused on the church and its believers, saying they were also victims.

KCDC is also looking into links between the church and a hospital in nearby Cheongdo County, which reported the second-highest number of patients in the country with more than 110.

The county is a holy site for Shincheonji believers as the birthplace of Lee, and recently a funeral for his older brother was held at that hospital.

On a recent visit, the Daegu church was shuttered and silent, surrounded by empty streets and closed stores. Someone had thrown eggs at the front gate of the building.

Son, who did not want to give her full name and lives in the neighborhood, said many believers, especially young women, have moved to live near the church, and several restaurants are run by members.

Doo Song-Ja, 64, said she had not heard from her daughter since 2015, when she joined the church.

“I’m so worried because so many Shincheonji followers are testing positive but I don’t know where she is,” said Doo, who said her 33-year-old daughter had sued her for “forcible confinement” for trying to keep her home. “I just hope she is OK.”

(Reporting by Hyonhee Shin and Hyun Young Yi; Additional reporting by Chaeyoun Won and Soohyun Mah; Editing by Josh Smith, Jack Kim and Gerry Doyle)

World scrambles to curb fast-spreading coronavirus

By Colin Packham and Parisa Hafezi

SYDNEY/DUBAI (Reuters) – The coronavirus’ rapid spread in Iran, Italy, South Korea and elsewhere left alarmed governments and people across the globe rushing on Thursday to implement emergency measures.

For the first time, new infections around the world in the past 24 hours surpassed those in mainland China, where the flu-like disease emerged two months ago but is on the decline after an aggressive containment campaign.

In Japan, where cases rose to 200, there was particular concern after a female tour bus guide tested positive for a second time – one of very few worldwide to do so.

Tokyo has halted big gatherings and sports events for two weeks, and is closing schools early for the spring break. But it still plans to go ahead with the 2020 Olympics, whose cancellation or relocation would be a massive blow for Japan.

The coronavirus has mainly battered China, causing 78,596 cases and 2,746 deaths. But it has spread to another 44 countries with 3,246 cases and 51 deaths reported.

Though meeting the dictionary definition of a pandemic – widespread contagion across a large region – the World Health Organization (WHO) has so far held back from using that term.

“There is every indication that the world will soon enter a pandemic phase of the coronavirus,” Australian Prime Minister Scott Morrison said as he ordered hospitals to ensure sufficient medical supplies, protective gear and staff.

U.S. President Donald Trump put his vice president, Mike Pence, in charge of America’s response, while France’s President Emmanuel Macron rallied the nation.

“We have a crisis before us. An epidemic is on its way,” Macron said at a Paris hospital where a 60-year-old Frenchman this week became the second person to die from the coronavirus in France.

(Live blog: Online site for coronavirus news – https://www.reuters.com/live-events/coronavirus-6-id2921484)

MARKETS DOWN FOR SIXTH DAY

Spooked by the impact on China, the world’s second-biggest economy and the heart of corporate supply chains, and the increasing effect on other countries, stock markets sank deeper into the red and oil prices fell

Global markets have dropped for six straight days, wiping out more than $3.6 trillion in value.

A rash of countries have had their first cases in recent days, the latest being Denmark with a man back from a ski holiday in Italy, and Estonia with someone returning from Iran.

There is no cure for the virus that can lead to pneumonia, and a vaccine may take up to 18 months to develop.

New cases in South Korea took its total to 1,261 with 12 deaths, while Europe’s hotspot Italy had 453 infections and 12 deaths, and Iran reported 245 cases and 26 fatalities.

Urging people to avoid unnecessary travel, Tehran extended its closure of cinemas, cultural events and conferences for another week. Iran’s outbreak has added to the isolation of a nation already under U.S. sanctions.

The coronavirus has played havoc with global aviation and tourism as airlines cancel flights, countries ban visitors from hot spots and nervous passengers put off travel.

News that a Korean Air flight attendant who worked on flights between Seoul and Los Angeles later tested positive was likely to unnerve passengers further.

The United States is managing 59 cases – most of them Americans repatriated from a cruise ship quarantined in Japan where almost 700 cases developed. But Trump said the risk was “very low” in the United States which was “very, very ready”.

Chinese authorities said the number of new deaths stood at 29 on Thursday, its lowest daily tally since Jan. 28. There were just 433 new cases in mainland China in the last 24 hours, compared to 586 in nations and territories elsewhere.

Interactive graphic tracking global spread of coronavirus: open https://graphics.reuters.com/CHINA-HEALTH-MAP/0100B59S39E/index.html in an external browser)

(Reporting by Ryan Woo, Yilei Sun and Lusha Zhang in Beijing, Daniel Leussink in Tokyo, Parisa Hafez in Dubai, Stephanie Nebehay in Geneva, Sudip Kar-Gupta and Michel Rose in Paris; Writing by Robert Birsel and Andrew Cawthorne; Editing by Nick Macfie)

Germany ‘heading for epidemic’ as virus spreads faster outside China

By David Stanway and Josh Smith

SHANGHAI/SEOUL (Reuters) – Germany said on Wednesday that it was heading for a coronavirus epidemic and could no longer trace all cases, as the number of new infections inside China – the source of the outbreak – was for the first time overtaken by those elsewhere.

Asia reported hundreds of new cases, Brazil confirmed Latin America’s first infection and the new disease – COVID-19 – also hit Pakistan, Greece and Algeria. Global food conglomerate Nestle suspended all business travel until March 15.

Stock markets across the world lost $3.3 trillion of value in four days of trading, as measured by the MSCI all-country index, but on Wednesday Wall Street led something of a rebound.

U.S. health authorities, managing 59 cases so far, have said a global pandemic is likely, but President Donald Trump accused two cable TV channels that frequently criticise him of “doing everything possible to make (the coronavirus) look as bad as possible, including panicking markets”.

The disease is believed to have originated in a market selling wildlife in the central Chinese city of Wuhan late last year and has infected about 80,000 people and killed more than 2,700, the vast majority in China.

While radical quarantining measures have helped to slow the rate of transmission in China, elsewhere it is accelerating.

Germany, which has around 20 cases, said it was already impossible to trace all chains of infection, and Health Minister Jens Spahn urged regional authorities, hospitals and employers to review their pandemic planning.

“Large numbers of people have had contact with the patients, and that is a big change to the 16 patients we had until now where the chain could be traced back to the origin in China,” he said.

The U.S. Centers for Disease Control and Prevention had also spoken on Tuesday of a nascent pandemic. “It’s not a question of ‘if’. It’s a question of ‘when’ and how many people will be infected,” said its principal deputy director, Anne Schuchat.

‘PANDEMIC’ – OR NOT?

The World Health Organization (WHO) said China had reported 411 new cases on Tuesday – against the 427 logged in 37 other countries.

However, WHO chief Tedros Adhanom Ghebreyesus advised diplomats in Geneva on Wednesday against speaking of a pandemic.

“Using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralysing systems,” he said.

“It may also signal that we can no longer contain the virus, which is not true.”

Dr Bruce Aylward, head of a joint WHO-Chinese mission on the outbreak, told reporters on his return to Geneva:

“Think the virus is going to show up tomorrow. If you don’t think that way, you’re not going to be ready … This a rapidly escalating epidemic in different places that we have got to tackle super-fast to prevent a pandemic.”

Trump tweeted that he would attend a briefing on Wednesday. But the White House denied a report by the Politico outlet that it was considering appointing a “coronavirus czar”.

The WHO says the outbreak peaked in China around Feb. 2, after measures that included isolating Hubei province.

China’s National Health Commission reported 406 new infections on Wednesday, down from 508 a day earlier and bringing the total confirmed cases in mainland China to 78,064. Its death toll rose by 52 to 2,715.

The WHO said only 10 new cases were reported in China on Tuesday outside Hubei.

FEARS FOR OLYMPICS

South Korea, which with 1,261 cases has the most outside China, reported 284 new ones including a U.S. soldier, as authorities prepared to test more than 200,000 members of a Christian church at the centre of the outbreak.

Brazil reported the first case in Latin America, a source said on Wednesday – a 61-year-old who had visited Italy.

In Japan, Prime Minister Shinzo Abe called for sports and cultural events to be scrapped or curtailed for two weeks to stem the virus as concern mounted for the 2020 Tokyo Olympics.

Japan has nearly 170 cases, besides the 691 linked to a cruise ship that was quarantined off its coast this month. Six people have died there, including four from the ship.

There have been nearly 50 deaths outside China, including 12 in Italy and 19 in Iran, according to a Reuters tally.

While Iran has reported only 139 cases, epidemiologists say the death rate of around 2% seen elsewhere suggest that the true number of cases in Iran must be many times higher, and cases linked to Iran have been reported across the Middle East.

In Europe, Italy has become a front line in the global outbreak with 322 cases. Italians or people who had recently visited Italy have tested positive in Algeria, Austria, Croatia, Romania, Spain and Switzerland.

Two hotels, one in Austria and one on Tenerife in Spain’s Canary Islands, were locked down over cases linked to Italy.

Authorities said the more than 700 guests at Tenerife’s four-star Costa Adeje Palace could leave their rooms after a day of confinement but would have to stay in the hotel for 14 days.

“It’s very scary because everyone is out, in the pool, spreading the virus,” said 45-year-old Briton Lara Pennington, fearing for her two young sons and her elderly in-laws.

(Interactive graphic tracking global spread of coronavirus https://graphics.reuters.com/CHINA-HEALTH-MAP/0100B59S39E/index.html)

(Reporting by Julie Steenhuysen and Susan Heavey in Washington, Diane Bartz in Chicago, Gavin Jones, Francesca Piscioneri and Crispian Balmer in Rome, Ryan Woo, Yilei Sun and Lusha Zhang in Beijing, Kate Kelland in London, Hyonhee Shin and Josh Smith in Seoul, Geert De Clercq in Paris, Paresi Hafezi and Alexander Cornwell in Dubai and Stephanie Nebehay and Michael Shields in Geneva; Writing by Michael Perry, Nick Macfie and Kevin Liffey; Editing by Pravin Char and John Stonestreet)

Coronavirus pandemic a question of ‘when’ not ‘if’, warns U.S.

By David Stanway and Josh Smith

SHANGHAI/SEOUL (Reuters) – Asia reported hundreds of new coronavirus cases on Wednesday, including a U.S. soldier stationed in South Korea, as the United States warned of an inevitable pandemic and outbreaks in Italy and Iran spread to other countries.

World stocks tumbled for the fifth day on fears of prolonged disruption to global supply chains, while safe-haven gold rose back toward seven-year highs and U.S. bond yields held near record lows.

Stock markets globally have wiped out $3.3 trillion of value in the past four trading sessions, as measured by the MSCI all-country index.

The disease is believed to have originated in a market selling wildlife in the central Chinese city of Wuhan late last year and has infected about 80,000 people and killed more than 2,700, the vast majority in China.

The U.S. Centers for Disease Control and Prevention urged Americans to prepare, saying that while the immediate risk there was low the global situation suggested a pandemic was likely.

“It’s not a question of if. It’s a question of when and how many people will be infected,” the CDC’s principal deputy director, Anne Schuchat, said on Tuesday.

World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus, however, advised against referring to a pandemic.

“We should not be too eager to declare a pandemic without a careful and clear-minded analysis of the facts,” Tedros said in remarks to Geneva-based diplomats.

“Using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralyzing systems. It may also signal that we can no longer contain the virus, which is not true.”

 

‘DON’T WAIT’

The United States has reported 57 cases of the virus. U.S. President Donald Trump, back in Washington after a visit to India, said on Twitter that he would meet U.S. officials for a briefing on the coronavirus on Wednesday.

Dr Bruce Aylward, head of a joint WHO-Chinese mission on the outbreak, told reporters on his return to Geneva that countries’ preparations should not wait.

“Think the virus is going to show up tomorrow. If you don’t think that way, you’re not going to be ready,” he said. “This a rapidly escalating epidemic in different places that we have got to tackle super-fast to prevent a pandemic.”

Aylward said China’s “extraordinary mobilization” showed how an aggressive public health policy could curb its spread.

The WHO says the outbreak peaked in China around Feb. 2, after authorities isolated Hubei province and imposed other containment measures.

China’s National Health Commission reported another 406 new infections on Wednesday, down from 508 a day earlier and bringing the total number of confirmed cases in mainland China to 78,064. Its death toll rose by 52 to 2,715.

The WHO said only 10 new cases were reported in China on Tuesday outside Hubei.

South Korea, which with 1,261 cases has the most outside China, reported 284 new ones including a U.S. soldier, as authorities readied an ambitious plan to test more than 200,000 members of a church at the center of the outbreak.

Of the new cases, 134 were from Daegu city, where the virus is believed to have been passed among members of the Shincheonji Church of Jesus, the Korea Centers for Disease Control and Prevention said.

The U.S. military said a 23-year-old soldier based in Camp Carroll, about 20 km (12 miles) from Daegu, had been infected and was in self-quarantine at home.

OLYMPIC WORRIES

 

In Japan, Prime Minister Shinzo Abe called for sports and cultural events to be scrapped or curtailed for two weeks to stem the virus as concern mounted for the 2020 Tokyo Olympics.

Japan’s professional baseball teams would play matches without spectators until March 15 due to virus concerns, Kyodo news agency reported.

Japan has nearly 170 virus cases, besides the 691 linked to a cruise ship that was quarantined of its coast this month. Six people have died in Japan, including four from the ship.

There have been nearly 50 deaths outside China, including 11 in Italy and 19 in Iran, the most outside China, according to a Reuters tally.

Iran’s deputy health minister – seen mopping his brow at a televised news conference – was among its 139 coronavirus infections. Cases linked to Iran have been reported across the fregion.

Kuwait said six new coronavirus cases, all linked to travel to Iran, took its tally to 18, while Bahrain said its infections had risen to 26 after three new ones on a flight from Iran.

The United Arab Emirates, which has reported 13 coronavirus cases, is prepared for “worst case scenarios” as it spreads in the Middle East, a government official said.

In Europe, Italy has become a front line in the global outbreak with 322 cases. Italians or people who had recently visited the country, have tested positive in Algeria, Austria, Croatia, Romania, Spain and Switzerland.

Two hotels, one in Austria and one in Spain’s Canary Islands, were also locked down after cases emerged linked to Italy. Spain also reported its first three cases on the mainland.

France, with 17 cases, reported its second death.

 

(Reporting by Julie Steenhuysen and Susan Heavy in Washington, Diane Bartz in Chicago, Gavin Jones, Francesca Piscioneri and Crispian Balmer in Rome, Ryan Woo, Yilei Sun and Lusha Zhang in Beijing; Hyonhee Shin and Josh Smith in Seoul; Paresi Hafezi and Alexander Cornwell in Dubai; Stephanie Nebehay and Michael Shields in Geneva; Writing by Michael Perry and Nick Macfie; Editing by Stephen Coates, Simon Cameron-Moore and Alex Richardson)