<![CDATA[Asian health officials fear Wuhan coronavirus outbreak is larger than China's letting on]>

Health authorities across Asia are concerned the outbreak of the mysterious new coronavirus is larger than Chinese authorities have stated, amid a surge in the number of people infected in mainland China and as three other countries in the region confirm cases.

The number of people confirmed to have contracted the disease on the mainland jumped from 41 to more than 300 this week, with six deaths so far, while Thailand has reported two cases and Japan, Taiwan and South Korea have reported one case each of the virus " which is in the same family as the deadly severe acute respiratory syndrome (Sars) and Middle East respiratory syndrome (Mers) viruses.

"It is hard to believe [the official number of] cases, but there are all these cases popping up in so many neighbouring countries," said Piotr Chlebicki, an infectious disease expert at Mount Alvernia Hospital in Singapore who worked on the nation's Sars epidemic. "China has a track record of under-reporting cases, so the true picture may be completely different."

These procedures were put in place in response to the 2003 Sars outbreak, when China garnered international mistrust for initially covering up the full extent of the disease, which killed nearly 800 people and sickened more than 8,000 worldwide.

Asian countries are bracing for a daily influx of thousands of Chinese travellers during the Lunar New Year holiday, with markets in the region potentially in for a hit as consumers are seen as being more likely to stay home than spend during the scare.

President Xi Jinping on Monday urged officials to find the origin of the virus " three weeks after its first reported case " while Premier Li Keqiang said China would work with the World Health Organisation (WHO) to prevent its spread, according to state media.

Anant Bhan, professor of bioethics and global health at Yenepoya University in Mangalore, India, warned that all countries needed to be on "high alert". "Infectious diseases do not respect borders when spreading," he said.

Officials in Australia are monitoring a suspected case in Brisbane, while the Philippines on Tuesday confirmed a Chinese child in the country had tested positive for a coronavirus which was not Sars or Mers. The WHO said the case was not confirmed as the Wuhan coronavirus.

Philippine authorities also said three Chinese travellers were being tested for the virus in the central province of Aklan, which receives direct flights from mainland China. Singapore said people with pneumonia and those who had travelled to anywhere in China within a 14-day period before the onset of symptoms would be isolated in hospital.

Taiwan's Central Epidemic Outbreak Command Centre said a Taiwanese woman was hospitalised in isolation in Taipei after she had contracted the coronavirus while working in Wuhan, the capital of Hubei province, where it was first discovered.

A senior public health official in Korea told the South China Morning Post that while health authorities were in communication with their Chinese counterparts, "it is hard to say we are being provided with a sufficient amount of information".

Chinese health officials will attend a WHO meeting in Geneva on Wednesday, when a committee will decide whether to declare the outbreak an international public health emergency " a measure only taken in cases of serious pandemics like swine flu, Ebola and the Zika virus.

Travellers from Wuhan pass by body temperature scanners at Tokyo's Narita airport. Photo: Kyodo alt=Travellers from Wuhan pass by body temperature scanners at Tokyo's Narita airport. Photo: Kyodo

Just how contagious the virus is remains uncertain, though the WHO has confirmed it spreads between humans. One indicator is whether a virus is contracted by medical workers, and Chinese officials on Tuesday said 15 health care workers in Wuhan had fallen ill.

Leong Hoe Nam, infectious disease expert at Mount Elizabeth Novena Hospital in Singapore, said: "We were hoping all this crucial information [about the health care workers] could be released a lot earlier. The only way to beat the epidemic is to be more transparent and faster than the spread of the virus."

However, Leong and several other experts speaking to the Post said available information indicated the virus could be less deadly than Sars.

Experts suggest China's multilevel approval process is partly responsible for a delay in confirming cases. Provincial health officials have said they needed confirmation from the Chinese Centre for Disease Control and Prevention in Beijing before they could announce a case.

Making the molecular test for the virus available to all hospitals in China as well as to other countries would go a long way toward getting a handle on the true number of people infected, said Chlebicki from Mount Alvernia Hospital.

Officials in Singapore under the Home Team Science and Technology Agency are working to develop their own test for the virus.

Leong said health care workers should adopt a lower threshold for investigating any cases with respiratory symptoms, and that cases needed to be isolated earlier to reduce the risk of the virus adapting for easier transmission between humans.

Hong Kong experts on Tuesday estimated there could be as many as 1,700 cases in Wuhan, echoing earlier estimates by a specialist in Britain. The top international destinations for travellers from Wuhan are Bangkok, Hong Kong and Tokyo.

Tawee Chotpitayasunondh, senior medical consultant at Thailand's Ministry of Public Health, said officials were anticipating a 50 per cent increase in direct flights from Wuhan during the Lunar New Year holiday " as many as 1,500 passengers from the city a day.

Security guards stand in front of the closed Huanan wholesale seafood market in Wuhan, where health authorities say a man who died from the coronavirus had purchased goods. Photo: AFP alt=Security guards stand in front of the closed Huanan wholesale seafood market in Wuhan, where health authorities say a man who died from the coronavirus had purchased goods. Photo: AFP

International transit hubs around the region have ramped up detection methods, with Singapore now screening all travellers from China. South Korean authorities said body temperature scanners had been set up for all flights entering from Wuhan, while American officials last week began screening travellers on direct flights from the city at airports in Los Angeles, San Francisco and New York.

However, due to the nature of coronaviruses, airport temperature scans could be of limited effectiveness. Stanley Perlman, professor of microbiology at the University of Iowa's Carver College of Medicine, said patients might not be contagious until they felt ill " meaning infected patients could have crossed borders before they experienced symptoms.

Though it is monitoring its first suspected case of the disease, Australia's top health official earlier this week said the country would not be implementing widespread temperature screening at international airports. Officials there said they would target high-risk incoming flights from China with additional screenings.

In Hong Kong, health declaration forms are now being provided to travellers from Wuhan, and doctors are now required to report suspected cases among people who visited Hubei province in the past two weeks.

Chlebicki at Mount Alvernia Hospital said Hong Kong and Singapore were among the best-prepared places to handle the outbreak because of the protocols developed during the Sars, Mers and avian flu outbreaks.

"The spread of this virus will really come from poor containment in countries that are not as technologically well-prepared," he said. "The virus will spread faster in countries that have underfunded medical systems. Unfortunately, the biggest test to this will be the big movement of people during the Chinese New Year holiday."

Additional reporting by Park Chan-kyong, Vasudevan Sridharan and Jitsiree Thongnoi

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This article originally appeared on the South China Morning Post (SCMP).

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