Coronavirus May Be Spreading Undetected in Indonesia, Experts Warn

The good news is that the reported number of coronavirus (2019-nCoV)) cases in Indonesia and Thailand is low. The bad news is that people with undetected infections may be unknowingly spreading the virus that now has killed more than 600 and sickened over 31,000.

The co-author of a new study, epidemiologist Marc Lipsitch at the Harvard T.H. Chan School of Public Health, has posted the work on medRxiv, an online medical site that focuses on preliminary reports of works that have not been peer-reviewed.

Lipsitch’s research is based on estimates of the number of passengers flying from Wuhan, China, where the coronavirus originated, to other global cities. If a certain number of cases are detected in the other cities, the expectation is that a similar or greater number of cases would occur in cities located closer to Wuhan.

“Indonesia,” Lipsitch said, "has reported zero cases, and you would expect to have seen several already.” He commented on Thailand’s 25 reported cases, saying, "but you would expect more.” As to Cambodia which has reported one case, Lipsitch said, "is not very likely," but "not completely beyond what you would expect."

The fear is that health systems in countries with close ties to China and Wuhan are not catching cases as people enter. The problem is exaggerated as the virus is very contagious during its incubation period, estimated at about 10 days. Therefore, people who are thought to have the coronavirus are quarantined for 14 days as on a cruise boat docked in Japan or military bases in California.

Lipsitch added, "Undetected cases in any country will potentially seed epidemics in those countries.” And just like China being unable to contain the virus, neither will Indonesia and Thailand be able to keep it from spreading beyond their borders.

Any study that has not gone through the normal scientific process of review by outside experts will be viewed with some skepticism, but researchers contacted by Voice of America (VOA) find the results of Lipsitch’s study as plausible. The enigma that the experts face is: Why does the outbreak seem stalled outside China while inside the Communist superpower, the numbers of deaths and infections are climbing every day?

Christopher Mores, a virologist at George Washington University’s Milken Institute School of Public Health, had these comments, "This [the study] does get at, I think, a significant question that a number of us have, which is: Where are these cases?"

Mores offered two possible answers to his own question, "It's either that transmission is demonstrably different outside of the main outbreak zone for some reason that has not yet been described. Or, we're just not capturing it and counting it, and there's a failure to detect.”

It is doubtful that the new coronavirus strain has developed the ability to infect people of a specific origin or ethnicity, so the second option offered by Mores seems the likely answer.

Another answer may be that the significantly warmer February temperatures of Thailand and Indonesia compared to Wuhan could make them less susceptible to the viral infection. This was the case with SARS in 2003 and the Spanish Flu in 1918 where warmer temperatures slowed the virus. We will know one way or the other in about 10 to 14 days.