One of the biggest clinical surprises involving the coronavirus epidemic in recent days was the discovery that in addition to targeting ACE2 (angiotensin converting enzyme 2) receptors in the respiratory tract, resulting in an aggravated "cytokine storm" in the lungs and lethal pneumonia as the cause of death, the virus which increasingly appears as if it was developed in a the Wuhan Institute of Virology, also targets ACE2 receptors in other organs such as heart, kidney, liver, intestine, etc., which in turn explains why the first Hong Kong death from coronavirus was the result of heart failure and not pneumonia.
This discovery also hints at air passage as a likely form of viral transmission, which in addition to the discovery that the virus can survive as long as a week on any surface, has dramatically raised the odds of widespread distribution.
Concerns about the way the virus spreads are likely to surge following a report that nine members of the same Hong Kong family have been infected with the deadly new coronavirus after sharing a hotpot and barbecue meal. A hotpot - also known as a steamboat - is a bubbling cauldron of stock shared communally, to which diners add ingredients.
It wasn't immediately clear if the food was contaminated with the virus, or if one of those present for dinner was a carrier.
According to the SCMP, the nine made up almost all of the 10 positive cases reported in the city on Sunday after seven people – all members of the family – were confirmed late in the evening as having the infection. Earlier in the day, a 24-year-old male member of the family and his grandmother were confirmed to have the virus. The man’s mother and father, two aunts and three cousins were the others infected. Their ages range from 22 to 68.
Adding to the mystery of the viral spread, the other case confirmed earlier was a 70-year-old man who had not travelled out of Hong Kong since January 9, spending most of his time at home.
With the 10 new cases, the number of people infected in the city jumped by more than a third to 36, heightening fears of a community outbreak. The development came as health authorities warned of “major difficulties” in tracing possible virus carriers because some might only show mild flu-like symptoms at an early stage.
In response to the increasing number of cases, the Hospital Authority, which runs the city’s public health facilities, also said it would drastically adjust non-urgent services in the coming four weeks.
“We’re facing major difficulties in isolating the suspected cases and tracing those who had close contact with the confirmed patients,” Dr Chuang Shuk-kwan, head of the communicable disease branch of the Centre for Health Protection, said, adding that it was because some people would only show mild symptoms and thus it was hard to tell who might have the virus.
Nine of the new cases had been to a family gathering on January 19 at the Lento Party Room in Kwun Tong. Nineteen people had joined the dinner, including two relatives from mainland China who left the city at the end of last month.
“I suggest the public cuts down on these gatherings. If they are necessary, try to reduce the time spent together,” said Chuang, who also urged citizens not to share chopsticks with those they dine with.
Ironically, even as authorities warned that the virus may spread even as carriers show mild, or no symptoms, about 3,600 passengers and crew members on board the World Dream cruise ship quarantined in Hong Kong for four days finally left the vessel on Sunday after control measures were completed. According to the report, all of the 1,800 crew members, who possibly had contact with eight passengers infected with the new virus on a previous trip, tested negative for the disease.
Commenting on whether Hong Kong could stop the spread of the virus in the community, Chuang said it depended on how many virus carriers there were who showed little or no symptoms.
“If there are many people who have no symptoms or only mild symptoms, and they have infected many others, then there isn’t much we can do to stop the spread,” she said. “We will do all we can.”
Two medical sources, meanwhile, said a 69-year-old man with diabetes had also tested positive for the coronavirus, possibly raising the total tally further. He remained in critical condition on Sunday at Pamela Youde Nethersole Eastern Hospital’s intensive care unit. He travelled to the mainland more than a month ago, so well before China scrambled to quarantine hundreds of millions of people across more than 60 cities, a move that in retrospect now appears to have been moot.
Pursuing its own quarantine, the number of people entering Hong Kong dropped sharply as a 14-day mandatory quarantine scheme to tackle the coronavirus outbreak took effect on Saturday.
On that day, only 23,399 people entered the city through the airport, Hong Kong-Zhuhai-Macau Bridge and Shenzhen Bay Port, the three control points that remain open, down from 95,982 on Friday. Of these, only 1,430 came through land crossings on Saturday from Macau and the mainland.
From Saturday to 7pm on Sunday, 918 people were put under mandatory quarantine. They included 814 Hong Kong residents.