Wuhan markets sold mink, civets long before Covid-19 emerged, says study

https://www.straitstimes.com/asia/east-asia/wuhan-markets-sold-mink-civets-long-before-covid-19-emerged-says-study

A security guard stands outside the Huanan Seafood Wholesale Market in Wuhan, on Jan 24, 2020.
A security guard stands outside the Huanan Seafood Wholesale Market in Wuhan, on Jan 24, 2020.PHOTO: AFP
  • UPDATEDJUN 8, 2021, 4:11 PM

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WASHINGTON (BLOOMBERG, REUTERS) – Chinese markets linked to some of the earliest Covid-19 cases were illegally selling a range of wildlife from which the coronavirus may have spread, according to a study published less than two weeks after US President Joe Biden ordered a deeper probe into the pandemic’s genesis.

Mink, masked palm civets, raccoon dogs, Siberian weasels, hog badgers and Chinese bamboo rats were among 38 animal species sold live at markets in Wuhan from May 2017 to November 2019, researchers said on Monday (June 7) in a paper in the journal Scientific Reports originally submitted last October.

The hunt for Covid-19’s origins has become increasingly political amid criticism that the Chinese government has not been open and transparent with key information, including activities in a Wuhan lab studying coronaviruses.

The new findings support the conclusions of a World Health Organisation-led research mission in early 2021 that concluded that Sars-CoV-2 most likely spilled over to humans from animals – either directly from a bat or via another mammal, possibly one sold at the Huanan seafood and fresh produce market in central Wuhan.

“This report clearly places Sars-CoV-2 susceptible animals smack in the middle of Wuhan,” said microbiology and immunology expert Robert Garry from Tulane University in New Orleans, who was not involved in the research. It is a major revelation, he said in an e-mail.

Access to the detailed data in the study was serendipitous, the researchers said.

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The findings were based on routine monthly surveys of shops selling live wild animals as pets or for food across Wuhan in the years before Covid-19 emerged at the end of 2019, the authors said. That unrelated study was intended to identify the source of a tick-borne disease.

“While we caution against the mis-attribution of Covid-19’s origins, the wild animals on sale in Wuhan suffered poor welfare and hygiene conditions and we detail a range of other zoonotic infections they can potentially vector,” lead author Xiao Xiao, from the Lab Animal Research Centre at Hubei University of Chinese Medicine in Wuhan, and colleagues wrote.

Both wild-caught and farmed non-domesticated species were sold – alive, caged, stacked and in poor condition – by 17 vendors, the researchers said. None posted an origin certificate or quarantine certificate, “so all wildlife trade was fundamentally illegal”, they said.

The WHO-led research team reported that market authorities claimed all live and frozen animals sold in the Huanan market were acquired from farms officially licensed for breeding, and it found no verified reports of live mammals being sold around 2019. The market was shut down at 1am on Jan 1, 2020.https://fd67ec0c283365cde45cdab7fefd7669.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

“This paper is affirmative evidence that there was obfuscation regarding which animals were being sold at the wet markets in Wuhan,” Professor Garry said.

China temporarily banned all wildlife trade on Jan 26, 2020, and permanently banned eating and trading terrestrial wild animals for food a month later.

Before the ban, most stores offered butchering services, done on site, with considerable implications for food hygiene and animal welfare. Marmots – large ground squirrels – selling for more than US$25 (S$33) a kilogram, were the most expensive, while raccoon dogs and badgers were priced at about US$15-US$20 a kg, the researchers said.

“This group was able to learn a huge amount from vendors in these stalls, who were even willing to discuss openly that they were selling illegal wildlife,” said Dr Michael Worobey, head of ecology and evolutionary biology at the University of Arizona in Tucson, who was not involved in the study.

“It is hard to imagine them being so transparent with government authorities or even the WHO. This serves as a reminder that less ‘official’ investigations can play a huge role,” he said.

MORE ON THIS TOPIC

US agencies examine reports of early Covid-19 infections in Wuhan lab

WHO rechecks research on when coronavirus first surfaced in Italy

While the prevailing theory among virologists is that Covid-19 originated in bats and made its way into humans via an intermediary animal, efforts to pin down the details or identify any infected animals have been unsuccessful for the past year and a half. In part because of that futile attempt, combined with restrictions from China in the effort to gather information, some scientists have started calling for a more detailed investigation into the lab-leak theory.

President Biden directed his intelligence agencies to delve deeper into the issue last month, after he received a report on the origins earlier in May that detailed the scientific divide over whether Sars-CoV-2 arose naturally in animals or if it was leaked from the Wuhan Institute of Virology, one of the world’s foremost laboratories working on coronaviruses.

Mr Biden asked for another update in 90 days.

Any finding of a coronavirus closely related to Sars-CoV-2 circulating in wild animals would likely quell suspicions that the pandemic virus was created in a lab, said Associate Professor Joel Wertheim from the University of California, San Diego, who studies viral molecular epidemiology. Still, there is no guarantee that such a virus will ever be found.

“We don’t even know, if there’s an intermediate species, which one we’re looking for,” he said over Zoom. “And also, if it was in a market beforehand, it’s not any more.”

The Wuhan Institute of Virology. A report on the origins of Covid-19 by a US government national laboratory concluded that the hypothesis of a virus leak from a Chinese lab in Wuhan is plausible and deserves further investigation, the Wall Street Journal said. PHOTO: AFP

Meanwhile, a report on the origins of Covid-19 by a US government national laboratory concluded that the hypothesis of a virus leak from a Chinese lab in Wuhan is plausible and deserves further investigation, the Wall Street Journal (WSJ) said on Monday (June 7), citing people familiar with the classified document.

The study was prepared in May 2020 by the Lawrence Livermore National Laboratory in California and was referred to by the US State Department when it conducted an inquiry into the pandemic’s origins during the final months of the Trump administration, the WSJ report said.

Lawrence Livermore’s assessment drew on a genomic analysis of the Covid-19 virus, the Journal said. Lawrence Livermore declined to comment on the Wall Street Journal report.

Mr Biden said last month he had ordered aides to find answers to the origin of the virus.

US intelligence agencies are considering two likely scenarios – that the virus resulted from a laboratory accident or that it emerged from human contact with an infected animal – but they have not come to a conclusion, Mr Biden said.

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Aussie expert on WHO team defends Covid-19 origin findings, amid speculation about ‘lab leak’ theory

Search for Covid-19 origin ‘poisoned by politics’, says WHO expert

A still-classified US intelligence report circulated during former president Donald Trump’s administration alleged that three researchers at China’s Wuhan Institute of Virology became so ill in November 2019 that they sought hospital care, US government sources have said.

US officials have accused China of not being transparent about the virus’ origins, a charge Beijing has denied.

Separately, Dr Mike Ryan, a top World Health Organisation official said on Monday the WHO cannot compel China to divulge more data on Covid-19’s origins, while adding that it will propose studies needed to take understanding of where the virus emerged to the next level.

Earlier this month, US infectious disease expert Anthony Fauci called on China to release the medical records of nine people whose ailments might provide vital clues into whether Covid-19 first emerged as the result of a lab leak.

MORE ON THIS TOPIC

Animal rights activists hold eerie demonstration in uptown Waterloo

WATERLOO — Wearing biohazard suits, activists gave an eerie performance at an animal-rights demonstration in Waterloo Town Square Sunday afternoon.

Silently, they held signs up over their heads naming various pandemics past, in order to bring attention to a connection between industrial animal farming practices and pandemic outbreaks.

Around them played the constant drone of air-raid sirens and a voice recording that repeatedly said: “This is not a drill. This is a warning. COVID-19 is a message.” played on repeat.

The protest organizers, K-W Animal Save, said the same scene was also played out at the same time in Toronto, Montreal and Ottawa.

A few passers-by stopped to take pictures. Patrons at nearby restaurant patio tables looked on.

The activists believe the current COVID-19 and many other global pandemics are caused by the industrial farming of animals.

Mo Markham, an organizer of the Waterloo protest, said this pandemic was predicted by global scientists and experts unless major changes were made.

She points the finger at wet markets where live animals are sold, and increasing amounts of industrial animal agriculture that encroaches on wild animal habitat and increases interaction between virus-carrying wild animals and livestock and humans.

Crew and cattle loss renew concern about livestock shipping

A Filipino crew member believed to be onboard Gulf Livestock 1 is rescued by a Japan Coast Guard boat. Picture: JAPAN COAST GUARD/HANDOUT VIA REUTERS

A Filipino crew member believed to be onboard Gulf Livestock 1 is rescued by a Japan Coast Guard boat. Picture: JAPAN COAST GUARD/HANDOUT VIA REUTERS

Sydney/Tokyo — A cargo ship with 43 crew and 5,800 cattle on board that overturned during stormy weather in the East China Sea has renewed concern about animal welfare issues in the live export trade in Australia and New Zealand.

The Gulf Livestock 1 capsized after engine trouble and as a powerful storm swept through the region, according to seafarer Sareno Edvardo, who was rescued on Wednesday. A second person pulled from the water on Friday was pronounced dead, according to the coast guard. The vessel was transporting cattle from New Zealand to China when it entered the path of Typhoon Maysak.

On Thursday, New Zealand suspended all live exports in the wake of the incident, local media reported. The government is already reviewing the industry and considering several options for new regulations including a potential total ban on specific types of exports. Any shipments of animals for slaughter already require the approval of the director-general of the Mmistry for primary industries.

“Our thoughts are with the families who are missing their loved ones, but we have to recognise the risk to animals that the live export trade brings,” she added in a separate statement.

Australasian Global Exports, the Melbourne-based trading company that chartered the Panamanian ship, said in a statement that its primary concern is for the safety and well-being of the ship’s crew. It declined to comment further.

Rigorous approvals processes are in place for all live exports, from both an animal welfare and maritime perspective, Australian Livestock Exporters’ Council CEO Mark Harvey-Sutton said by phone on Friday. However, “now is not the time” for a debate on animal welfare in the sector. “The families are our priority at the moment.”

New Zealand’s livestock exports, including cattle, deer, goats and sheep, were worth about NZ$54m ($36m) in the year to end-June 2019, according to a government report. It exported about 23,500 cattle during the year, the bulk of which were shipped to China.

Australia’s live export sector is far bigger and is worth about A$800m ($580m) a year, according to the government. It shipped and air freighted almost 2.3-million live animals in the 2018/2019 financial year, including about 1-million sheep and 960,000 cattle, to destinations throughout Asia and the Middle East.

“The incident underscores the risks sometimes involved in conducting our agricultural trade both domestically and internationally,” Australia’s minister for agriculture, David Littleproud, said in an e-mailed statement. “These risks extend far beyond the farm gate.”

I Was a Journalist Who Reported on Captive Animals — Then I Became One

After being damaged in a surgery, I understand their plight even more

Black-and-white photo of a giraffe in a cage, looking out a window.

Photo: Chan Mo via Unsplash

I had reported for years on animal cruelty, including stories on donkey abuse in Ethiopia; bear dancing in India; deadly swimming-with-dolphin programs in the Caribbean; and the mistreatment of horses in northern California.

Image for post

Photo: Jessy Hoffmann / Unsplash

At one zoo, supposedly one of the best in the country, I was led to a neon-lit basement where a stunning silverback gorilla had been living in isolation. For 10 years.

Black-and-white photograph closeup of an elephant’s face.

Photo: Karim MANJRA via Unsplash

The current fear, despair, mania, physical constraint, and existential heartache will most likely be temporary for those who have the fortune to survive this virus.

Live Animal Markets Should Be Improved ‘Not Outlawed'[?], Say WHO

WHO Scientist Discusses Role Wuhan Market Played in Coronavirus Outbreak Current Time 1:28 / Duration 3:22

By Associated Press
May 8, 2020 9:07 AM EDT

(LONDON) — The World Health Organization said Friday that although a market in the Chinese city of Wuhan selling live animals likely played a significant role in the emergence of the new coronavirus, it does not recommend that such markets be shut down globally.

In a press briefing, WHO food safety and animal diseases expert Peter Ben Embarek said live animal markets are critical to providing food and livelihoods for millions of people globally and that authorities should focus on improving them rather than outlawing them — even though they can sometimes spark epidemics in humans.

“Food safety in these environments is rather difficult and therefore it’s not surprising that sometimes we also have these events happening within markets,” Ben Embarek said.

He said reducing the risk of disease transmission from animals to humans in these often overcrowded markets could be addressed in many cases by improving hygiene and food safety standards, including separating live animals from humans. He added that it is still unclear whether the market in Wuhan linked to the first several dozens of coronavirus cases in China was the actual source of the virus or merely played a role in spreading the disease further.

Ben Embarek said investigations are continuing in China to pinpoint the animal source from which COVID-19 jumped into humans but that studies have since found other species are susceptible to the disease, including cats, tigers, ferrets and dogs. Identifying other vulnerable species will allow certain interventions to be put in place to prevent future outbreaks. “We don’t want to create a new reservoir in animals that could continue to create infections in humans,” he said.

Ben Embarek said it might take considerable time to identify the original animal source for the new coronavirus, explaining that extensive studies need to occur first, involving health officials carefully interviewing many of those infected in the early stages of the outbreak, to narrow down what their interactions with animals were before they fell sick. Scientists would then need to take samples from animals to find a close match to the coronavirus circulating in humans.

To date, China has not invited WHO or other external experts to be part of that investigation. Ben Embarek said China likely has the necessary expertise to conduct such studies and WHO has not noted any problems in China’s willingness to collaborate with others.

https://time.com/5834143/live-animal-markets-not-shut-who-coronavirus/

Coronavirus Outbreak Likely Began With Bats, an Omen for Next Epidemic

Scientists say future pandemics are inevitable as cities and villages encroach on wild habitats

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Somewhere in China, perhaps in the southern Yunnan province, there’s a cave that may hold the mysterious origins of the deadly coronavirus that’s infected thousands, cut off millions of Chinese from their jobs and families and wreaked havoc in global financial markets.

Peter Daszak, a disease ecologist at nonprofit EcoHealth Alliance, would know. He and his team have suited up and ventured into caves all over China and the rest of world in search of bats and the pathogens they carry. “We go into caves,” said Daszak. “We don’t just walk in. We wear a full-body suit: breathing masks, gloves and all the correct equipment.” What he and other scientists around the globe are concluding is that the rapid spread of human settlements in once-remote regions have put people in ever-closer proximity to virus-carrying animals.

More people, meeting more animals, carrying more diseases—a perfect viral melting pot.

As the human population rises, “the number of those spillover events is rising exponentially. It is a direct product of human activity,” Daszak said. And it’s “a simple mathematical certainty” that there will be more outbreaks like the new coronavirus in the future, he said. Total confirmed cases have exploded in recent days to almost 17,400 Monday, with more than 360 deaths. Some disease modelling experts project there are likely 75,000 or more actual cases, as accurate counts from overwhelmed parts of China are impossible to come by.

The U.S. Centers for Disease Control and Prevention estimates that three out of every four emerging infectious diseases in humans first come from animals. Bats contain the highest proportion of mammalian viruses that are likely to infect people in so-called zoonotic infections, according to research published in 2017 by Daszak in the scientific journal Nature.

“I have 90% confidence it is a bat-borne virus,” says Linfa Wang, who heads the emerging infectious disease program at Duke-National University of Singapore Medical School. He has been studying bat origins of human viruses for decades and works with a group of researchers sometimes dubbed “the bat pack.”

The CDC has said it’s preparing for the disease to spread more widely in the U.S. and doesn’t expect to stop all cases at the border.

virus bat cave china handouts
Researchers handle a bat captured in the Guangdong province of China, left, and search for virus-laden bats in a cave in the Yunnan province of China, right.
Source: EcoHealth Alliance

One of his colleagues at the Wuhan Institute of Virology found that the new coronavirus is more than 96% genetically identical to a bat virus from the Yunnan province in the southern China, according to results published in the journal Nature on Monday. Zheng-Li Shi, a top coronavirus expert at the Wuhan Institute of Virology, has been studying the bat viruses with Wang and Daszak for more than a decade. She’s leading an emergency science team to respond to the outbreak in Wuhan, according to a Chinese media report.

The Nature study found that the new coronavirus is a distant cousin of SARS, sharing almost 80% of its genetic sequence. SARS, or Severe Acute Respiratory Syndrome, is another coronavirus that swept through China and other countries in 2002 and 2003, eventually killing more than 800 people around the globe. It also hijacks the same receptor on lung cells that SARS uses to penetrate cells deep inside the lungs, providing a clue to how it spreads. That receptor is also in the gut, explaining how it may pass through diarrhea as well.

Shi didn’t respond to Bloomberg News inquiries sent via email.

Exactly how the deadly new coronavirus sweeping through China made the leap from animal to human remains a mystery, but scientists say it’s closely linked to urban sprawl and the chaotic and loosely regulated free-for-all of China’s open-air markets. The so-called wet markets, also present in Vietnam, Indonesia and elsewhere around Southeast Asia, feature wild and domesticated animals. They make a perfect mixing ground for viruses.

China Virus GETTY Sub
Emergency response team workers conduct searches at the closed seafood wholesale market in Wuhan on Jan. 11.
Photographer: Noel Celis/AFP via Getty Images

“These animals are live,” says Christian Walzer, executive director for health at the Wildlife Conservation Society, a New York-based conservation group that also runs zoo and field programs. “You will see a bird on top of a domestic pig, and you might have snake and bats, all stacked together” in wire-mesh cages. Virus-laden fluids and secretions can mix, helping create new viruses, especially when the animals are slaughtered right in front of customers.

“If you planned it and thought, ‘I am going to make new viruses,’” says Walzer, “that is exactly how you would do it.”

The markets may have produced outbreaks in the past that burned out locally. Now, with exploding populations and access to cheap airlines and fast trains, bat viruses from the depths of a jungle can spread to every corner of the globe within days.

In the new coronavirus outbreak, more than 49 of 99 early patients were linked to a market in Wuhan, which also sold wild animals. It now has been closed. The Wildlife Conservation Society is calling for a ban on the markets across Asia. If they aren’t closed, deadly new viruses will emerge every few years, Walzer says.

For years, coronavirus research was considered a backwater. The viruses, named for the crown-like spike on their surface, were known mostly for causing the common cold. The SARS outbreak almost two decades ago abruptly changed things, and helped jump-start a worldwide search for other viruses that could spill into humans after contact with animal excrement, saliva or mucus. The research has often led back to infected bats as the source.

One early clue of bats’ role came from a 1998 outbreak of brain-infecting Nipah virus in Malaysia that killed more than 100 people. It turned out that fruit bats with the virus were feeding on mango trees overhanging a pig enclosure, according to the EcoHealth Alliance. The bats dropped fruit into the pens and infected the pigs; the pigs then passed the pathogen onto people.

wet market
A wet market in Vietnam.
Source: Wildlife Conservation Society

To date, researchers have identified at least 200 coronaviruses in bats around the world, according to a recent review in the journal Viruses. In another study, researchers from Columbia University and elsewhere found 12 new coronaviruses in 606 bat samples in Mexico. Due to quirks in their immune system, bats don’t get sick from the myriad viruses they harbor.

Daszak and his colleagues have teams in 10 countries that conduct roughly 50 bat-virus-hunting expeditions a year. In China, trained bat-hunters go into caves to capture the animals, collect oral and genital swabs, as well as urine, feces and blood. The samples are then shipped directly in cold storage to a high-tech lab for testing, Daszak said.

In one crowded bat cave in Yunnan province, Shi and her colleagues from the Wuhan Institute of Virology found coronaviruses containing “all of the building blocks” of SARS. The conditions in the cave were ripe for the viruses to keep mixing, creating the potential for a dangerous new pathogen, they wrote in a 2017 analysis in the scientific journal Plos Pathogens.

“The risk of spillover into people and emergence of a disease similar to SARS is possible,” they said. Several years later, their dire prediction appears to have come true.

Want more of Bloomberg’s health-care reporting delivered to you? Click here to get Prognosis, our weekly newsletter, delivered your inbox every Thursday afternoon.

(Adds CDC remark in the seventh paragraph. An earlier version of this story corrected the full name of the Centers for Disease Control and Prevention.)

Indonesia, time to ban wildlife markets: Activists’ take on Wuhan coronavirus

News Desk

The Jakarta Post

Jakarta / Thu, January 30, 2020 / 11:34 am Sellers display animals for sale on a sidewalk of Jl. Matraman Raya in Jatinegara, East Jakarta, on June 20, 2019. (Kompas.com/Ardito Ramadhan)
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Responding to the outbreak of the novel coronavirus, animal rights organizations have called on the Indonesian government to close all markets that slaughter or sell illegal wildlife. The virus, 2019-nCoV, is believed to have first emerged among wild animals in a market in the Chinese city of Wuhan.

Read also: Monitor wildlife trade as certain animals ‘have potential’ as coronavirus carriers, warns LIPI

In an open letter sent to President Joko “Jokowi” Widodo, Dog Meat Free Indonesia, a coalition of several animal rights organizations in the country, says that zoonotic coronaviruses can originate from wild animal markets.

“We urge the Indonesian government to take strong and immediate action to mitigate the risk posed by Indonesia’s animal markets,” the coalition states in the letter, which was made available to The Jakarta Post on Wednesday.

It further says: “We have visited a good number of animal markets in Indonesia, where the conditions are the same as those being described by scientists as the perfect breeding grounds for new and deadly zoonotic viruses, such as coronaviruses.”

The coalition argues that wild animals, many of which are protected, are sold and slaughtered in public and unsanitary conditions alongside domestic animal species, including dogs and cats, potentially exposing thousands of people every day to a variety of zoonotic diseases throughout Indonesia.

The organization points out that dog and cat meat markets in Indonesia can be a hotbed for disease transmission, especially rabies. Dog and cat meat are sold for consumption in some Indonesian markets alongside snakes, bats and rats.

“[…] given the current state of emergency in China, we urge you to please take preventative and proactive measures to make sure Indonesia is not the next point of origin of a deadly virus.

“We urge you to prioritize the health and well-being of the overwhelming majority of the Indonesian population, rather than the preferences and profitability of a few at the expense of national and global interests,”
the letter states.

Read also: Indonesia well prepared to handle coronavirus outbreak: WHO

The 2019 novel coronavirus (2019-nCoV), also known as the Wuhan coronavirus, is a contagious virus that causes respiratory infection. It can be transmitted from human to human.

The virus was first identified by authorities in Wuhan, Hubei, China, as the cause of the ongoing outbreak. It has spread to Thailand, Vietnam, Singapore, Malaysia, Japan, South Korea, Hong Kong, Macau, Taiwan, the United Arab Emirates, Australia, the United States, Canada, France and Germany, among other countries.

The World Health Organization, which initially downplayed the severity of a disease that has now killed 170 nationwide, warned all governments to be “on alert” as it weighed whether to declare a global health emergency, AFP reported

Chinese health authorities said there were 7,711 confirmed cases of infection as of the end of Wednesday, mostly in Hubei province where the death toll rose by 37 to 162.

https://www.thejakartapost.com/news/2020/01/30/indonesia-time-to-ban-wildlife-markets-activists-take-on-wuhan-coronavirus.html

Virus Sparks Soul-Searching Over China’s Wild Animal Trade

Beijing faces uncomfortable questions over its failure to clean up wildlife trade and public calls for a permanent ban on wild meat

Police on Jan. 9 examined items seized from a store suspected of trafficking wildlife in Guangde in central China’s Anhui province.
PHOTO: ASSOCIATED PRESS
By Jeremy Page
Updated Jan. 26, 2020 7:52 pm ET

BEIJING—It didn’t take long to identify the suspected source of a deadly coronavirus outbreak in the Chinese city of Wuhan: a cluster of vendors in a downtown market offering carcasses and live specimens of dozens of wild animals—from bamboo rats to ostriches, baby crocodiles and hedgehogs.

The Huanan food market, a scruffy complex of 1,000 stalls spread over an area the size of nine football fields, is the largest of its kind in central China, mostly supplying seafood to Wuhan’s residents and restaurants. It is typical of the wet markets where most people in this country buy their food.

Like many such markets, it also sold wild animals enjoyed as culinary delicacies or used as traditional medicine—an ancient trade Beijing has continued to allow despite warnings that it caused a deadly coronavirus outbreak almost two decades ago and could trigger another global epidemic.

On Sunday, authorities imposed a temporary nationwide ban on the trade of wild animals and quarantined all wildlife breeding centers.

The central government also said it is taking over the effort to stem the outbreak from officials in Hubei province, of which Wuhan is the capital, after those officials’ sluggish reaction drew criticism. State media reported that Premier Li Keqiang has been put in charge of the Communist Party’s new “leading small group” of senior officials that is directing response to the virus nationwide.

Chinese public-health officials warned on Sunday that the virus is growing more contagious.

Hong Kong’s government, meanwhile, said it would deny entry to people who have visited Hubei during the past two weeks in an effort to restrict the spread of the virus. The city has confirmed six cases of the virus in Hong Kong, all from patients who either lived in or recently visited Wuhan.

After giving Huanan market an all-clear during inspections late last year, city officials have now closed it. When Wall Street Journal reporters visited this past week, it was cordoned off by police tape and stall holders were lining up in the rain to receive compensation and Lunar New Year handouts.

A police officer stands guard outside the now-shuttered Huanan Seafood Wholesale market in Wuhan where the coronavirus was detected. PHOTO:
HECTOR RETAMAL/AGENCE FRANCE-PRESSE/GETTY IMAGES Racing to contain the outbreak, which has infected more than 2,700 people and killed at least 80, China’s national authorities have locked down Wuhan and several other cities in Hubei.

Beijing now faces uncomfortable questions over its failure to clean up the wildlife trade in recent years. It is also confronting unusual public calls in China for a permanent ban on wild meat, something it has been reluctant to impose for fear of angering its relatively wealthy aficionados.

President Xi Jinping of China has spoken about the country’s ability to show leadership on global issues, such as public health. His response to the current crisis is likely to be seen as an important test, health experts and political analysts said.

“This incident should be used as an opportunity to rectify the chaos” in China’s wildlife trade, said a petition published on Thursday by 19 prominent Chinese scientists, including a former head of Peking University.

A meat stall in Beijing’s Shengfu Xiaoguan market on Friday. PHOTO:
GIULIA MARCHI FOR THE WALL STREET JOURNAL Medical researchers have determined that the outbreak of severe acute respiratory syndrome, or SARS, that started in 2002 originated in bats and spread to humans via palm civets—cat-sized mammals that look a bit like weasels—sold in Chinese food markets.

Studies have shown that SARS-type coronaviruses reside naturally in bats but can easily jump to other hosts, mutating along the way, especially in markets where species, including humans, mingle.

Although Chinese authorities have yet to identify the precise origin of the current outbreak, a study released on Thursday by the Wuhan Institute of Virology, based on patient samples, found a 96% genetic match with a bat coronavirus.

Another Chinese study suggested snakes sold in the market were the source, although other scientists think it less likely the virus jumped between reptiles and mammals.

“Why do I eat it? It is delicious.” —Terry Gao, who usually eats wild meat and loves civet “This is a wildlife-origin virus—it’s pretty clear,” said Peter Daszak, president of EcoHealth Alliance, a U.S.-based nonprofit organization that has been studying the origins of SARS and related viruses in China for 15 years.

“Probably bats are the origin from looking at the virus itself, and it got from bats into people in the wildlife market,” he said. “This is absolutely déjà vu all over again from SARS.”

China is a hot spot for such outbreaks because it combines large bat populations with densely populated rural areas and a long tradition of eating wildlife, especially in the southern provinces of Guangdong and Guangxi.

“Why do I eat it? It is delicious,” said Terry Gao, a 30-year-old businessman from Guangxi, where he usually eats wild meat. He said he had a particular taste for civets.

“It is really hard to describe. Like how lamb has that special taste, civets are the same. Just the flavor of the meat itself. You don’t need to cook it in any special way: Once you taste it, you’ll know it’s civet.”

Emergency health workers conducted searches on Wuhan’s closed Huanan market on Jan. 11. PHOTO: NOEL CELIS/AGENCE FRANCE-PRESSE/GETTY IMAGES He said he had long known of the health risks and would avoid eating wild meat during the current outbreak, but attributed the problem to poor regulation rather than consumer demand.

Since SARS, China has vastly improved its capacity to respond to disease outbreaks, health experts said. It has also improved hygiene at wet markets, and sought to encourage licensed trade in wild animals bred on farms where they must undergo sanitary checks.

And yet regulation of wildlife farms and markets has been lax. As a result, an underground trade has thrived, with restaurants often commissioning wild meat—including endangered species—from hunters via middlemen, researchers and wildlife activists said.

Online trading has also made it easier to source and distribute wild meat across China and to import creatures such as pangolins from other countries, exacerbating the risk of infections spreading over longer distances.

Two men from the eastern province of Jiangxi, known as the Huanong Brothers, have even become video-streaming stars in China by posting clips from the farm where they breed bamboo rats for their meat, as well as from their regular trips to hunt for wild animals.

Customers line up outside a store suspected by activists of selling trafficked wildlife in Anji in eastern China’s Zhejiang province. PHOTO:
ASSOCIATED PRESS
“If China doesn’t take action on this now, I fear this is just going to happen again,” said Zhou Jinfeng, head of the nongovernmental China Biodiversity Conservation and Green Development Foundation.

Mr. Zhou, who has filed official complaints about wildlife markets all around China, estimated that there were hundreds in the country, with at least one in every major city like Wuhan, and more still online.

“The authorities just don’t take any notice,” he said. “They think it’s good for the local economy.”

China banned all wildlife trade in 2003, when Hong Kong researchers first identified civets as a potential source of SARS, but it lifted the ban later that year on 54 species—including civets—that it said could be bred in licensed farms, subject to sanitation checks.

Guangdong province banned the breeding and sale of civets in 2004, but they continued to be traded there and in other provinces. On Thursday, Guangdong imposed a total ban on wild-animal trading.

The central government, however, was slower to respond. First the agriculture ministry ordered a halt on Friday to the trade only of wild animals that can carry the coronavirus, which it said included badgers and bamboo rats. Two days later, the State Administration of Market Regulation declared a ban on all wildlife trade but said it would end once the outbreak was over.

A seller at another Wuhan market wore a face mask to help prevent the spread of the deadly coronavirus on Friday. PHOTO: HECTOR RETAMAL/AGENCE FRANCE-PRESSE/GETTY IMAGES The Communist Party’s Central Commission for Discipline Inspection, usually focused on fighting corruption, also made an unusual appeal for people to stop eating wild meat in a posting on its website in recent days. “We must respect the laws of nature and promote scientific and healthy eating habits,” it said.

The market at the epicenter of the current outbreak, officially known as the Wuhan Huanan Seafood Wholesale market, was home to vendors selling a range of wild meat.

One of them, called Dazhong Livestock and Game, boasted that it could provide more than 100 wild animals, freshly slaughtered or flash frozen, on site or via home delivery, according to a price list published online. Among the most expensive items were a live ostrich for 4,000 yuan (about $580) and a small live deer for 6,000 yuan. The list also included baby crocodiles, wolves and hedgehogs. The owner couldn’t be reached for comment.

The Wuhan Market Regulation Administration inspected the market in November and December but found nothing wrong, according to documents published on its website. It didn’t respond to a request for comment.

In September, local officials also inspected some eight stalls selling wild animals and checked their business licenses but found nothing illegal, according to the website of a newspaper run by Wuhan’s Communist Party committee.

In a rare admission for a senior Chinese official, Wuhan Mayor Zhou Xianwang told the official Xinhua News Agency that local authorities had failed to properly regulate the market—one of 400 in the city.

Civet cats caged in China in 2004 after the SARS outbreak. PHOTO:
ANTONIO PISACRETA/ROPI/ZUMA PRESS
The first signs of the outbreak came on Dec. 29, when four workers at the market were admitted to a Wuhan hospital with pneumonia.

The hospital alerted the local center for disease control, and Wuhan authorities closed the market on Jan. 1. Health officials took specimens from the site and found evidence of the virus in 33 out of 585 samples, according to the Chinese Center for Disease Control and Prevention, or CCDC.

The virus had been found not just in people’s bodies, but on wild-meat stalls, Gao Fu, the CCDC director told Chinese state television on Thursday. “We must thus call on everyone not to eat wild animals,” he said. “It is only a matter of time to find out which is the specific animal.”

—James T. Areddy and Shan Li in Wuhan, Qianwei Zhang and Xiao Xiao in Beijing, and Yifan Wang in Singapore contributed to this article.

https://www.wsj.com/articles/virus-sparks-soul-searching-over-chinas-wild-animal-trade-11580055290?mod=e2tw

Wuhan virus outbreak exposes perils of exotic wildlife trade

ASEAN+

Thursday, 23 Jan 2020
4:40 PM MYT

SHANGHAI/BEIJING (Xinhua): A new coronavirus spreading from the city of Wuhan has put a spotlight on China’s poorly regulated wild animal trade
– driven by relentless demand for exotic delicacies and ingredients for traditional medicine.

China’s markets, where wild and often poached animals are packed together, have been described as a breeding ground for disease and an incubator for a multitude of viruses to evolve and jump the species barrier to humans.

More than 500 people have been infected by the new flu-like virus that authorities say emerged from illegally traded wildlife in a seafood market in the central Chinese city, with the death toll at 17 and expected to rise.

“The origin of the new coronavirus is the wildlife sold illegally in a Wuhan seafood market,” Gao Fu, director of China Center for Disease Control and Prevention, told a briefing.

Preliminary research suggested that in the most recent stage of its evolution, the Wuhan virus was passed on to humans from snakes. But Chinese government medical adviser Zhong Nanshan has also identified badgers and rats as possible sources.

Conservationists and health experts have long denounced the trade in wildlife for its impact on biodiversity and the potential for spreading disease in markets.

“The animal welfare part of this is obvious, but much more hidden is this stashing and mixing of all these species together in a very small area, with secretions and urine mixed up together,” said Christian Walzer, executive director of the New York-based Wildlife Conservation Society.

China’s wet markets have already been blamed for outbreaks of other infectious diseases in China and southeast Asia, including the virus responsible for Severe Acute Respiratory Syndrome (SARS), which killed nearly 800 people worldwide in 2003.

“The other thing you have to consider is that these animals are massively stressed in these cages so their immune systems fail very quickly,” said Walzer.

“It is a perfect system. You couldn’t do it any better if you tried,”
Walzer said of the markets’ propensity to generate viruses.

Photographs taken at the Wuhan market before it was closed at the end of last year show cages packed with snakes, porcupines and foxes. Media said about 50 types of wild animal were on sale at the market, including endangered pangolins.

According to a report by the China Business Journal, a state-owned paper that interviewed the sister of a vendor infected by the virus, snakes, ducks and wild rabbits were popular at the market.

Since the outbreak began, authorities in Wuhan and elsewhere have shut down markets, zoos and forest parks, suspended trade in live poultry and the trade and transport of wild animals, though residents in some areas said the measures appeared to be largely symbolic.

The southeastern province of Guangdong, where a wide variety of animals are sold, has long been regarded as a prime source of new diseases.

Scientists believe Sars was caused by cross-species transmission in the province – with the blame initially falling on masked palm civets, which are considered a delicacy.

Authorities slaughtered thousands of the animals although bats were later believed to have been the source of Sars.

After Sars, China tried to improve the way the animal trade is regulated. At the same time, authorities have tried to curb the poaching of exotic species and has a long list of officially protected wildlife.

But efforts to protect animals often lose out to generations of tradition.

Environmentalists have long campaigned for new laws to restrict the use of wild animals in Chinese medicine and to develop synthetic alternatives.

But many animal products are still easily available.

Snakes, peacocks and even crocodiles are on sale via Taobao, a Chinese e-commerce website run by Alibaba.

Reuters contacted an Inner Mongolia resident named Gong Jian who sells snake, camel, crocodile and deer meat via WeChat.

Given booming business, he said he was aiming to expand his online marketing.

“Customers really like the crocodile – they stew it,” he said. – Xinhua

https://www.thestar.com.my/news/regional/2020/01/23/wuhan-virus-outbreak-exposes-perils-of-exotic-wildlife-trade

A SARS-like virus is spreading quickly. Here’s what you need to know.

Hundreds of people have been sickened by a new coronavirus in at least eight countries, including the US.

A Chinese girl wears a protective mask as she is held by a relative in Beijing, China on January 21, 2020.
 Kevin Frayer/Getty Images

Only three and a half weeks ago, China announced the outbreak of a mysterious new coronavirus in the city of Wuhan involving a group of people who’d been exposed to animals at a local food market.

Flash-forward to Friday: The number of cases of 2019-nCoV, as the virus is known, has leaped to more than 800, and there are sick people in at least seven other countries.

That includes two cases in the United States.

A man in his 30s in Washington state tested positive for 2019-nCoV after being hospitalized with pneumonia last week, according to a Centers for Disease Control and Prevention (CDC) briefing Tuesday. A second case, reported by CDC on January 24, involves a woman in her 60s who lives in Chicago. She returned from Wuhan on January 13, and didn’t have any symptoms while traveling.

Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said Friday that although the outbreak is a “very serious public health threat, the immediate risk to the US public is low at this time.”

Yet Tom Frieden, the former director of the CDC, told Vox he’s concerned by how infectious the virus is. “If the sustained human transmission and a high rate of severe illness are confirmed, then it clearly is an event of international concern.”

With information about 2019-nCoV — and its risk of spreading — evolving by the hour, we’ve answered basic questions about the outbreak here. We’ll be updating this story as more information becomes available.

1) Where did this coronavirus outbreak come from?

The outbreak was first reported to the World Health Organization by Chinese officials on December 31 in Wuhan, a city of 11 million in Hubei province. At that time, cases centered around Wuhan’s Huanan South China Seafood Market. Local health officials reported then that patients with the virus were “mainly business staff and purchasers” at the market, where vendors peddle seafood as well as animals such as birds and rabbits.

Scientists in China quickly ruled out known pathogens as the likely cause. The leading hypothesis then was that a yet-to-be-identified novel virus had spread to humans from one of the animals in the market.

A staff member screens arriving passengers with thermal scanners at Hankou railway station in Wuhan on January 21, 2020.
 AFP via Getty Images

By January 9, the state broadcaster, China Central Television, reported a major discovery: a new virus, known as 2019-nCoV. Many of the people who had become ill tested positive for 2019-nCoV. Two days later, Chinese scientists shared the genetic sequence of the new virus, and the WHO applauded China’s efforts for sharing information readily. (This transparency was a contrast to the SARS outbreak of 2003, when China was heavily criticized for withholding information about the outbreak for too long. The virus eventually killed 774 people and infected more than 8,000.)

While Chinese authorities still believe the 2019-nCoV outbreak may have started at the market — with animals spreading the virus directly to humans — on January 20, they confirmed that human-to-human transmission is also occurring. On January 21, the WHO’s Western Pacific Regional Office said on Twitter that the spread may involve “sustained” human-to-human transmission, meaning the virus can transmit easily from one person to the next and then onward to others. Knowing that, “the scope of this outbreak expands massively,” Peter Daszak, the president of EcoHealth Alliance, a US global health research organization working in China, told Vox.

2) How many people are sick? How many have died?

As of January 24, at least 881 people have fallen ill. The vast majority of these patients (868) are in mainland China, where most (549) are concentrated in Hubei province, home to Wuhan. The remaining cases are spread across more than 20 Chinese provinces and cities — including Shanghai, Guangdong, Hong Kong, and Beijing. To get the latest numbers, check out this website from researchers at Johns Hopkins; it collects data from various sources: the WHO, the CDC, the National Health Commission of the People’s Republic of China (NHC), and two other sites. (The map is embedded below.)

Source: Johns Hopkins University Center for Systems Science and Engineering

Additional cases have turned up in travelers to the US, Thailand, Japan, Taiwan, Macau, Singapore, Vietnam, and South Korea. A total of 26 people have died.

But the real toll may be much higher.

Hong Kong– and London-based researchers who have modeled the outbreak’s potential suggest there are likely many more undetected cases — from 1,300 to more than 4,000. That’s in Wuhan alone. And the risk of rapid spread is heightened, as hundreds of millions start to travel this week for China’s Lunar New Year on January 25.

3) How is the world responding?

Chinese authorities first warned people to stop traveling in and out of Wuhan, and then said they would put the city under quarantine beginning January 23, suspending public transport within Wuhan, and canceling flights and trains leaving the city. It was an extraordinary move given that Wuhan has a population of 11 million, more people than New York City. By the evening of January 24, quarantine measures had expanded to 12 cities near Wuhan, effectively stifling the movement of 35 million people.

According to the New York Times, the government said the quarantine was needed to “effectively cut off the transmission of the virus, resolutely curb the spread of the epidemic, and ensure the safety and health of the people.” But the evidence for travel restrictions during outbreaks shows, counterintuitively, that they don’t actually do much to stop the spread of disease.

Health officials in China and the region are now scrambling to find cases through screening at transportation hubs and follow-up with the contacts of those infected with the virus — an effort that’s supported by the WHO.

Other countries at risk of imported cases have also implemented screening measures. In the US, the CDC — along with the Homeland Security Department’s Customs and Border Protection — began screening travelers from Wuhan for the virus at US airports on January 17, and all travelers from the city will be funneled through airports that are looking out for cases.

4) What do we know about the US cases?

The second case, reported on January 24, involves a woman in her 60s who lives in Chicago. She returned from Wuhan on January 13, and didn’t have any symptoms while traveling. A few days after returning, when she started to feel ill, she called healthcare providers to report her symptoms and was admitted to hospital and placed in isolation. Right now, she’s in stable condition.

The CDC would not say which hospital she’s in at this time, but they did say she’s had “limited movement” outside of her house since coming home from China.

The first patient’s name also hasn’t been released, but we know he’s a resident of Snohomish County in Washington state. We also know he recently traveled to Wuhan, returning to Seattle on January 15, two days before airport screening started (though the man didn’t have symptoms yet). By January 19, he reached out to health care providers to report his symptoms and travel history. They suspected 2019-nCoV.

The man is currently being treated for mild pneumonia at Providence Regional Medical Center in Everett, Washington. He told officials he didn’t visit markets in Wuhan, or have any contact with sick people. The CDC and health officials in Washington are starting to do contact tracing to suss out if the man transmitted the virus to anyone else in the US. So far, no one he had contact with has fallen ill.

As of January 24, CDC officials said they’ve screened over 2,000 people coming into the US for the disease on 200 flights, and found zero cases. The agency also said it’s investigating 63 possible cases of coronavirus in 22 states. So far, two have been confirmed positive and 11 negative.

5) How does the new coronavirus spread?

We don’t yet know the exact way the virus is spreading, but we do know it’s part of a large family of viruses called coronaviruses, which mostly infect mammals, including bats. Coronaviruses attack the respiratory system, sometimes targeting the cells deep within the lungs. Only seven, including 2019-nCoV, SARS, and MERS, have evolved to infect humans.

According to the CDC, human coronaviruses are most commonly passed via:

  • Through coughing and sneezing
  • Close personal contact, including touching and shaking hands
  • Touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands
  • And rarely, through fecal contamination

As for how easily the new coronavirus spreads, that’s also unclear. According to a preliminary estimate from WHO, at the moment, each individual has transmitted the virus to an average of 1.4 to 2.5 others. That makes 2019-nCoV, based on what we know now, less contagious than SARS.

Dr. Melvin Sanicas@Vaccinologist

Preliminary R0 (number showing how contagious / transmissible a pathogen is) for novel : 1.4 – 2.5. Here are the figures for other diseases & their case-fatality rates to put things in perspective

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WHO also confirmed that there is “fourth-generation” spread of the virus in Wuhan, meaning there are cases where an individual has spread it to a second person, that second person to a third, and the third to a fourth. Outside of Wuhan, they also have evidence of second-generation cases.

We also know at least 15 health care workers have been infected. “It’s unusual to get health care worker infections in outbreaks,” explained Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health. “It’s always a sign of alarm when that happens,” he added, because it means the virus may be easily transmitted, even in settings where people are taking precautions.

6) What are the symptoms of the new coronavirus?

Two of the seven coronaviruses that infect humans, SARS and MERS, can cause severe pneumonia and even death. The rest lead to milder symptoms, like a common cold. Right now, it’s not clear where 2019-nCoV falls on that spectrum.

According to the CDC, it takes about two weeks on average for symptoms to start appearing.

An early report, published in the Lancet, had a good overview of symptoms — albeit, in a subset of the first 41 patients with confirmed 2019-nCoV in Wuhan. In this group, the most common symptoms were fever, cough, muscle pain, and fatigue; less common were headache, diarrhea, and coughing up mucus or blood. A little more than half of the 41 patients had difficulty breathing, and 63 percent had low levels of white blood cells. As for the disease severity: 13 patients were admitted to an ICU and six died. By January 22, 68 percent of the patients had been discharged from hospital.

All patients had pneumonia and lung abnormalities on CT scans. (A quick refresher: Pneumonia is an infection in the lungs that can be caused by a variety of organisms — bacteria, fungi, viruses, even parasites. In this case, 2019-nCoV is causing the infection and leading the lungs’ air sacs to become inflamed and fill up with fluid or pus instead of air.)

A passenger walks past a notice about the coronavirus from Wuhan at Narita airport in Narita, Japan, on January 17, 2020.
 Tomohiro Ohsumi/Getty Images

In the Lancet group, most patients were men and most didn’t have underlying diseases. The median age was 49.

So far, Chinese health officials have said the deaths are occurring in mostly older people with existing health conditions.

It’s possible there are many more people with the virus who have very mild symptoms or who are asymptomatic, said Dr. Jeremy Farrar, director of the Wellcome Trust, a research charity focused on global health. If that’s the case, and there are thousands carrying 2019-nCoV while only a few people have died, this outbreak will look milder.

It’s also possible this virus winds up behaving like SARS, said Inglesby, which kills about one in 10 patients infected. With SARS, “We saw substantial spread in health care settings where health care workers became ill during care for patients,” for example. “This is a very serious outbreak with the potential for widespread transmission.”

7) What’s the likelihood this becomes a global public health emergency?

The potential for this virus to spread further is so great that the WHO gathered an expert committee on Wednesday and Thursday to decide whether the emergence of 2019-nCoV constitutes a global public health emergency, a rare designation the agency gives outbreaks that pose an international threat.

By the end of Thursday, WHO’s Director-General, Tedros Adhanom Ghebreyesus, announced the committee’s decision that the outbreak doesn’t yet constitute one, mainly because of the limited number of cases outside of China, and China’s efforts to control the spread of the disease.

“Make no mistake, this is an emergency in China. But it has not yet become a global health emergency,” Tedros explained. He also vowed to reconvene the emergency committee in the coming days to review new data. “At this time, there is no evidence of human-to-human transmission outside China, but that doesn’t mean it won’t happen,” Tedros added.

Formally, a public health emergency of international concern, or PHEIC — pronounced “fake” — is defined as “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response.” In reality, it’s a political tool the WHO uses to sound the alarm about a serious disease that has caught the world off guard and put people’s health in danger. It’s meant to draw countries’ immediate attention, to galvanize resources, and stop the disease from spreading further across borders.

World Health Organization Director General Tedros Adhanom Ghebreyesus at the WHO headquarters in Geneva on October 18, 2019. 
Fabrice Coffrini/AFP via Getty Images

A key consideration in declaring a PHEIC is whether the disease threat is dire enough to risk countries enacting travel and trade restrictions. Declarations can be devastating to local economies and are often associated with economic losses. So they’re not taken lightly. In fact, the WHO has only declared a public health emergency five times since the International Health Regulations, which govern global health emergency responses, were enacted in 2007.

The first time was in 2009, with the outbreak of the H1N1 swine flu pandemic. The second time was in May 2014, when polio seemed to surge again, threatening the eradication effort. The third time, in August 2014, came as the Ebola outbreak in West Africa was growing out of control. The fourth was related to Zika in 2016. And the fifth, in 2019, was another outbreak of Ebola that’s ongoing in the Democratic Republic of the Congo.

8) How worried should I be about a pandemic?

There are too many unknowns to say. We don’t know which animal carries this virus. We don’t know how exactly it spreads. We don’t know how easily it spreads among people, or how deadly and severe the virus is.

To put the cases and deaths so far into perspective, remember that seasonal flu kills between 250,000 and 650,000 people each year. “Right now, you’re probably more likely to be catching flu than you are to be getting coronavirus,” said Devi Sridhar, chair in global public health at the University of Edinburgh.

Even so, the fact that cases are already turning up in so many countries — mere weeks after this outbreak was first declared — suggests we should brace ourselves for an escalation. The WHO stopped short of recommending any travel or trade restrictions at this time, instead suggesting people take precautions — like making sure their hands are clean and that they don’t cough on others if they’re sick.

Messonnier of CDC said there are likely to be several more cases — in the US and beyond. Her agency is advising Americans to avoid non-essential travel to Wuhan. As for those traveling to other parts of China, officials suggest avoiding contact with sick people, and practicing good hand hygiene.

“This is a rapidly changing situation — abroad and domestically — and we’re still learning,” Messonnier said.

That doesn’t, however, mean American officials expect the US to be inundated with dozens of patients or that the virus will spread broadly within the country. It’s the major cities in and around China that are most at risk, according to a paper posted on January 14 in the Journal of Travel Medicine. The top travel destinations out of Wuhan — and most at risk of spread of the infection — include Bangkok, Hong Kong, Tokyo, and Taipei.