For more than a month, the Centers for Disease Control and Prevention has been offering to send a team of experts to China to observe its coronavirus outbreak and help if it can.
Normally, teams from the agency’s Epidemic Intelligence Service can be in the air within 24 hours.
But no invitation has come — and no one can publicly explain why.
The World Health Organization, which made a similar offer about two weeks ago, appears to be facing the same cold shoulder, though a spokeswoman said it is just “sorting out arrangements.”
Current and former public health officials and diplomats, speaking anonymously for fear of upsetting diplomatic relations, said they believe the reluctance comes from China’s top leaders, who do not want the world to think they need outside help.
In 2003, China was badly stung by criticism of its response to SARS, another coronavirus epidemic; it has also been embroiled in a trade war with the United States for more than a year.
Some experts also say that outsiders could discover aspects of the outbreak that are embarrassing to China: for example, the country has not revealed how many of its doctors and nurses have died fighting the disease.
But China does need help, experts argue.
In private phone calls and texts, some Chinese colleagues have indicated that they are overwhelmed and would welcome not just extra hands, but specialized expertise in a couple of fields.
Also, C.D.C. officials have said that they hope to learn more about the new coronavirus from their Chinese counterparts to improve the American response if the virus starts to spread widely here.
On Friday, Alex M. Azar II, secretary of health and human services, said at a news briefing that he had recently reiterated the offer of a team to his Chinese counterpart, Dr. Ma Xiaowei.
Asked what the holdup was, he answered: “It’s up to the Chinese. We continue to expect fully that President Xi will accept our offer. We're ready and willing and able to go.”
On Jan. 29, Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, returned from a brief trip to China full of praise for President Xi Jinping and the country’s extraordinarily aggressive response, which has nearly walled off Hubei Province from the rest of the country and the world.
China had “agreed to a mission of international experts” to better understand disease transmission and clinical severity, Dr. Michael Ryan, the W.H.O’s emergency response chief, said at the time.
Asked if that team would include American experts, Dr. Tedros replied that “best would be a bilateral arrangement.”
On Thursday, a W.H.O. spokeswoman said that there was no delay in the organization’s own mission to China.
“Our understanding is that the mission is on,” Marcia Poole, the spokeswoman, said. But she could not say when the team would leave or who would be on it.
“It’s a matter of sorting out the arrangements,” she added, noting that Dr. Ryan had said a team would “need representation from North and South, East and West, with relevant areas of expertise.”
The United States has offered Dr. Tedros 13 specialists who are ready to go, Mr. Azar said.
The two fields in which China appears to need outside help, experts said, are molecular virology and epidemiology.
The first involves sequencing the virus’s genome and manipulating it to refine diagnostic tests, treatments and vaccine candidates.
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Updated June 16, 2020
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I’ve heard about a treatment called dexamethasone. Does it work?
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
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What is pandemic paid leave?
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
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Does asymptomatic transmission of Covid-19 happen?
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
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What’s the risk of catching coronavirus from a surface?
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
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How does blood type influence coronavirus?
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
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How many people have lost their jobs due to coronavirus in the U.S.?
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
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Will protests set off a second viral wave of coronavirus?
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
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My state is reopening. Is it safe to go out?
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
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What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
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How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
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Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
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What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
The second involves figuring out basic questions like who gets infected and who does not, how long the incubation period is, why some victims die, how many other people each victim infects and how commonly hospital outbreaks are occurring.
“This isn’t rocket science, it’s basic stuff — but it’s been five weeks and we still don’t know the answers,” one expert said.
It would be very useful, for example, to have a blood test for antibodies. That would make it possible to see how many infected people had recovered, which would make it clearer as to how lethal the virus is — and how widespread.
A major epidemiological failure by China is that the Wuhan authorities appear to have closed and disinfected the seafood market that was the outbreak’s early focus without swabbing individual animals and their cages and without drawing blood from everyone working there. That would have provided a wealth of information about which animal might have been the source of the coronavirus and which people had become infected but survived.
Asked what had happened to the animals — whether they had been burned or buried, for instance, one expert said: “No one can tell me that. I don’t think they know.”
China has greatly improved its ability to fight disease since it was embarrassed by SARS, and its scientists now frequently publish in major medical journals.
Many of them trained at the American C.D.C. and have friends there.
“We have a decade-long relationship,” Mr. Azar said Friday. “It’s not an accident that it’s called the Chinese C.D.C.”
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Experts raised a related concern: China’s scientists are given large rewards for publishing in prestigious journals. That creates an incentive to hold back samples and data until publication. Although the American C.D.C. has in the past sometimes had fraught relations with other countries because it used their samples and published analyses of them without giving credit they felt was due, its first priority was still to issue epidemic warnings if they were needed and then to publish later.
“In an epidemic, you don’t want information held back,” one expert said. “You want transparency.”
