Covid-19: As State Department recommends travelers "reconsider" Asia cruise ship travel, CDC separate case count of "repatriated"

Moves come as WHO DG Tedros warns amid sluggish international funding response that "the window of opportunity" to control coronavirus spread is "narrowing"

Reflecting rising concerns of community spread in countries outside of China, and a more than doubling of U.S. cases with the return of Americans from the Diamond Princess cruise ship that was held off the coast of Japan, the United States Department of State and the U.S. Centers for Disease Control and Prevention have posted recommendations that travelers "reconsider" boarding cruise ships bound for and within Asia.

The move comes as the case count of Americans who had been quarantined aboard the cruise ship and boarded a State Department sponsored flight home, rose sharply, with the confirmation of virus among arriving passengers who had not been diagnosed before boarding the plane. They join those who had been diagnosed -- after leaving the ship, but before boarding the flight to the U.S. -- to make a total of 18 American passengers from the self-proclaimed "luxury destination in itself" now in this country who have been diagnosed with the virus. Noting that many of the returning passengers are older than 60 years of age -- a marker for increased risks of severe illness from the virus -- Dr. Nancy Messonnier of the CDC said that some patients from the ship may require higher levels of care. While more diagnoses of returned passengers are expected, according to Dr. Messonnier, WHO has noted repeatedly that the vast majority of the more than 2,500 passengers, including 329 aboard the ship, however, have not been diagnosed with Covid-19.

To reflect an accurate picture of coronavirus risks in the U.S. the CDC will now separate its case counts of those confirmed with Covid-19 into two categories: Those whose illnesses were identified through public health departments, either among individual recently returned travelers to mainland China, and those whose illnesses were identified in screenings and during quarantined of large-scale "repatriations" of Americans either living and working in Hubei Province -- the China epidemic's epicenter -- or from the Diamond Princess cruise ship, which during its quarantine became home to the largest number of people infected with the virus outside of China. With those case categories, Dr. Messonnier said, 13 Americans have now been confirmed to have Covid-19 by public health departments, 21 among screened and quarantined passengers aboard State Department flights  -- three from Wuhan, and 18, so far, from the Diamond Princess.

The move comes as China officials also revised its case count categories, after briefly combining counts of lab-confirmed cases -- people who had been confirmed to have the the virus through laboratory testing of samples, and "clinically confirmed" cases, those who, in the absence of laboratory results, showed signs of the virus in scans. China is now reporting cases that have not been confirmed by laboratory testing as "suspected," a category that has been used during outbreaks of Ebola and other viruses. This change brought the number of new daily cases sharply down, as some who had been included in the second category were found through laboratory testing not to have the virus. At the same time, WHO Director-General Tedros Adhanom Ghebreyesus said, the decreased new case count also likely reflects decreased incidence, as well as regained capacities in overwhelmed China health settings to test for the virus.

This potentially positive sign, however, is offset by chains of transmission not evidently originating among China travelers, including sharp rises in South Korea and in both cases and deaths in Iran where four people with the virus have died, as well as the discovery of the virus in at least 200 people incarcerated in China prisons. In addition, while preparations to diagnose, treat, and contain the virus in  countries with limited health infrastructures, including across Africa, continue, WHO officials could not say how hospitals in those settings will manage large influxes of patients needing respiratory and organ support for severe cases of the virus.

For these reasons, Dr. Tedros said today, the "window of opportunity" to control the spread of the new coronavirus, that he has said for weeks "remains open" now appears to be "narrowing," amid an apathetic international response to calls for the $675 million that WHO officials say will be needed immediately to contain the spread of Covid-19.