BEIJING: China on Thursday reported a sharp spike in deaths and infections from a new virus after the hardest-hit province of Hubei applied a new classification system that broadens the scope of diagnoses for the outbreak, which has spread to more than 20 countries.

Japan reported its first death, a woman in her 80s who had been hospitalised since early February. She is the third confirmed fatality outside of China, after deaths in the Philippines and Hong Kong.

The new diagnostic approach came on the same day that Hubei and its stricken capital, Wuhan, replaced their top officials in an apparent response to public criticism of how authorities have handled the epidemic.

The death toll in China reached 1,367, up 254 from the previous day. The number of confirmed cases jumped 15,152 to 59,804. The unusually large increases were due to the change in Hubei’s approach.

The total now includes more than 13,000 cases of clinical diagnosis in Hubei, which appears to include those based on a doctors’ analysis combined with lung imaging, as opposed to waiting for laboratory test results.

In breaking down the large number of new cases in China, National Health Commission spokesman Mi Feng said Hubei had adopted a revised diagnosis and treatment plan aimed at accelerating the identification and treatment of patients.

That adds a “clinical diagnosis case” classification to identify suspected cases who appear to have pneumonia so that patients can be accepted as soon as possible and treated as confirmed cases, Mi said, adding that should reduce severe illness and mortality.

One expert said the changed case definition in Hubei likely speaks to the crush of patients the health system is experiencing and the backlog of untested samples.

“Clearly in Wuhan, the health system is under extreme pressure and so the first priority has to be the patient,” said Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh.

He said it wasn’t unprecedented for case definitions to rely on doctors diagnoses rather than wait for laboratory confirmation, and that these kinds of changes usually happen when there are simply too many patients to process in a fast-moving outbreak.

“I’m not surprised that this has happened given the way the outbreak has been going in China, Woolhouse said. You have to be pragmatic and take the concerns of the patient first and treat them as if they already have the disease, even in the absence of lab confirmation.”

New officials

China also appointed new high-level officials in Hubei and Wuhan.

Former Shanghai mayor Ying Yong succeeded Jiang Chaoliang as the ruling Communist Party chief in the beleaguered province, the Xinhua state news agency reported, while Wang Zhonglin took over from Ma Guoqiang as the party secretary in Wuhan.

The appointments follow the sacking earlier this week of two leaders of the provincial health commission. State media also reported that a slew of others were expelled from the party for transgressions related to the epidemic.

The public has widely criticised local officials for failing to respond quickly and decisively to the new virus. Authorities initially assured people that there was little to no risk of human-to-human transmission, a statement that was later retracted. Wuhan residents said hospitals were overcrowded and lacked sufficient medical supplies. Doctors who tried to share information early on were reprimanded by police for spreading rumours.

Ship docks in Cambodia

Another cruise ship, the Westerdam, finally docked on Thursday in Cambodia after being turned away by several Asian and Pacific governments. No cases of the viral illness have been confirmed among its 1,455 passengers and 802 crew members, according to operator Holland America Line.

Thailand refused to allow the Westerdam to dock this week after it had already been turned away by the Philippines, Taiwan, Japan and Guam over virus concerns.

The Westerdam began its cruise in Singapore last month and its last stop before it was refused further landings was in Hong Kong, where 51 cases of the viral disease have been confirmed.

Published in Dawn, February 14th, 2020