Outbreak update –
The main source of infections is most likely people coughing and sneezing.
Experts at the World Health Organization have repeatedly said that even if asymptomatic spread is occurring, it is likely a minor source of infection ; coughing and sneezing people are simply much more likely to spread the virus.
Moreover, the corrected version of the NEJM article may highlight a more pressing threat to outbreak control — the fact that all five cases in the cluster were mild and unremarkable amid standard cold and flu season. Missed signs according to the new report in Science, the businesswoman’s -nCoV infection symptoms went unrecognized because they were mild, masked by over-the-counter medications, and — most notably — the authors of the NEJM article did not speak with her before the article was published.
Without direct communication with her prior to the publication, the NEJM article’s authors relied on the accounts of her four sickened colleagues in Germany , who said she didn’t seem sick during her visit. 
But government health officials in Germany were later able to reach the Shanghai woman by telephone. People privy to details of the call told Science that she said she felt tired, had muscle pains, and took a fever-reducer during her visit. Officials at the Robert Koch Institute (RKI). ), the German government public health agency, have sent a letter to NEJM informing them of the error in the article, according to an RKI spokesperson who spoke with Science.
One of the NEJM authors, Michael Hoelscher of the Ludwig-Maximilians University of Munich Medical Center, told Science that they should have been clearer about where they had gotten the information about the woman’s symptoms. “If I was writing this today, I would phrase that differently,” he said.
Another author on the article, virologist Christian Drosten of the Charité University Hospital in Berlin, said, “I feel bad about how this went, but I don’t think anybody is at fault here. Apparently, the woman could not be reached at first and people felt this had to be communicated quickly. ”
Drosten went on to say that — despite the correction — the five cases highlight a potentially dangerous feature of this outbreak — that is , that the infection may not be very dangerous. There is a greater the sense that patients may just experience mild cold symptoms, while already shedding the virus, ”he said. “Those are not symptoms that lead people to stay at home.” Circulating unknowns
Indeed, as the outbreak has continued to escalate, experts have noted that the virus appears more contagious than initially thought and that the early outbreak responses focused heavily on identifying the most severe cases, such as those involving pneumonia and respiratory distress. That focus may have potentially missed the spread of mild disease, which may be far more extensive than what is known even now.
the World Health Organization’s latest figures , approximately 20. 5 percent of cases are severe — though that estimate could change dramatically if many mild cases are missing, which is likely.
The US Centers for Disease Control and Prevention has confirmed 21 cases
in the country so far, including nine travel-related cases and two cases of person-to-person transmission within the US among close contacts. The first case identified in the US, a – year-old in Washington state, has been released from the hospital and is now in isolation at home. The second identified case, a Chicago woman in her s, has been described as doing “ quite well . ”and is primarily being hospitalized for isolation purposes. The look and feel of the exported. cases, I think, really support the argument that there’s a lot of mild disease that is not being detected in China at the moment for the very good reason that they just can’t do it, ” Dr. Allison McGeer told Stat News recently . McGeer is an infectious diseases researcher at Toronto’s Mount Sinai Hospital, who helped respond to other outbreaks of emerging coronaviruses, namely those behind SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).
Public health experts and media are now volleying predictions of how the outbreak will play out — whether it will be contained and fizzle out or become a pandemic (that is, with worldwide spread), and whether it could resurge sometimes or join its Four common coronavirus cousins in continually circulating among humans.
The answer is still unclear, of course, and, for now, the CDC still considers the risk to the general American public to be low.
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