ROME–The sharp jump in the number of coronavirus cases outside China has caused panic attacks around the world. The Dow plummeted nearly 1,000 points on Monday, countries are slamming borders shut and quarantining people based on racial profiling, and hand sanitizer and face masks are impossible to find.
But authorities have something far more worrying on their minds. They are increasingly focused on clusters of coronavirus with untraceable, or at least so far untraced, beginnings.
That’s the case in Italy, where infections shot from four on Friday to 230 and climbing fast on Monday, including at least six fatalities. In the north of the country, where all of the current cases are concentrated at the moment, authorities still have not identified “patient zero,” the first carrier of the virus who sparked the outbreak.
That is also the case in South Korea, where infections rocketed past the 800 mark on Monday with seven confirmed deaths, and where the outbreak is closely tied to members of the Shincheonji religious sect in the city of Daegu. There, too, officials have not identified what they are calling the “index case,” or the first church member to introduce the virus to the rest of the flock.
What makes these clusters so worrisome is that without identifying the primary source who set off the contagion in a cluster, authorities say they cannot effectively predict the trajectory of the spread or, more importantly, stop it. If they don’t know where it started, they don’t know how it got there, and theoretically at least the carrier could still be spreading the disease and could even set off another cluster.
In Italy, two major clusters are miles apart, and health officials have no idea if they are related. “We don't have primary contagion,” Luca Zaia, head of the Veneto region, site of the smaller of two major clusters. Veneto also is home to Venice, which has just canceled Carnival celebrations set for Tuesday night.
“We are faced with secondary infections in people who have not had relationships with citizens from infected areas or who have been to infected areas,” said Zaia.
But there is an upside to the cluster outbreaks, too. In Italy, the civil protection authorities have locked down the infected areas entirely as armed guards try to contain the outbreak.
Anyone defying the order to stay indoors until every single person in the area is tested risks jail time and fines. The same is true in South Korea, where containment has meant infected people are prohibited from leaving large metropolitan areas and carrying the virus farther afield.
Attempts to control the outbreak nodes within countries dealing with the crisis have done little to calm nerves.
Austrian authorities stopped a train leaving Italy through the Brenner pass Sunday while they tested a passenger with a fever. Italians on an Alitalia flight to Mauritius were also turned back to Rome on Monday after being told those from Milan onboard would face quarantine.
The French Health Ministry also added Italy’s Lombardy and Veneto regions to the list of high-risk coronavirus areas, now requiring all people who visit there to stay quarantined at home for at least two weeks upon entering France, according to a spokesperson for the General Health Directorate.
Israel has acted similarly, refusing admittance to 180 non-Israeli passengers on a Korean Air flight to Tel Aviv. Jordan, Democratic Republic of Congo, Bahrain, and Samoa soon followed suit, banning all air traffic from Korea.
There is also a growing concern that some countries are underreporting, or not even testing for the virus at all. Iran has reported 61 cases and 12 deaths, a much higher percentage of death to infection than seen elsewhere, meaning infections are not being recorded. And there is speculation that the true death toll could be much closer to 50. The outbreak started in the city of Qom, the most important religious center in the country, filled with students and pilgrims. There, too, authorities have not identified who introduced it.
The World Health Organization has warned that as these clusters emerge, they will soon force it to declare a “global pandemic,” defined as a disease spreading on two continents. “What we see is a very different phase of this outbreak depending where you look,” Dr. Sylvie Briand of WHO said at a press conference Monday. “We see different patterns of transmission in different places.”
But what is most troubling of all is the situation—or curious lack thereof—in Africa, where just one case has been confirmed in Egypt, and in North Korea, where no cases have been announced.
China has a robust relationship with several African nations, which makes the lack of cases very hard to understand.
Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, said Saturday that in other places “the number of cases with no clear epidemiological link, such as travel history to China or contact with a confirmed case,” is worrying.
But the opposite is even more so, and the prevailing theory about Africa is that a lack of medical facilities and testing capacity may mean the virus is spreading silently. The WHO has been working to get testing kits and other preparedness measures in place in Africa for when, not if, the virus takes hold.
“Our biggest concern continues to be the potential for COVID-19 to spread in countries with weak health systems,” said Tedros. “We know a little bit more about this virus and the disease it causes. We know that more than 80 percent of patients have mild disease and will recover, but the other 20 percent of patients have severe or critical disease, ranging from shortness of breath to septic shock and multi-organ failure. These patients require intensive care, using equipment such as respiratory support machines that are, as you know, in short supply in many African countries.”
With additional reporting from Donald Kirk in Seoul.