A second coronavirus death has been confirmed outside mainland China.
A 39-year-old man has died in Hong Kong after travelling there from Wuhan.
The death toll in China stands at 425 people, and a single death was reported in the Philippines on Sunday bringing the global total to 427.
Hong Kong's Hospital Authority said the 39-year-old man developed muscle pain last week followed by fever and was being treated in an isolation ward. The authority said the man traveled to Wuhan by train on January 21 and returned to Hong Kong on January 23.
Worse than SARS
China suffered its worst day of the coronavirus outbreak, with 120 people dying in one day on Monday. It means the outbreak has exceeded SARS deaths, news.com.au reports.
The death toll from coronavirus in mainland China has now risen to 425 — exceeding the fatalities from Severe Acute Respiratory Syndrome (SARS). There has been one more death in the Philippines and one in Hong Kong taking the death toll globally to 427.
During the SARS outbreak of 2002-03 there were 349 deaths in mainland China and it eventually killed nearly 800 people globally.
Since the virus was detected late last year in the central city of Wuhan, it had spread to more than 20 countries, and several other nations have instituted tough travel rules with China.
The World Health Organisation has declared the crisis a global health emergency, and the first foreign death from the virus was confirmed in the Philippines on Sunday.
The Chinese government also said it "urgently" needed medical equipment and surgical masks, protective suits, and safety goggles as it battles to control the outbreak.
Authorities in provinces that are home to more than 300 million people — including Guangdong, the country's most populous — have ordered everyone to wear masks in public in an effort to contain the virus.
But factories capable of producing around 20 million masks a day are only operating at 60-70 per cent of capacity, industry department spokesman Tian Yulong said, adding that supply and demand remained in "tight equilibrium" as a result of the Lunar New Year break.
All but one of the new deaths reported Monday were in Wuhan and the rest of Hubei province, most of which has been under lockdown for almost two weeks.
The mortality rate for the new coronavirus is around 2.1 per cent, compared with 9.6 per cent for SARS.
Fears virus goes undetected
The official number of coronavirus cases in Wuhan might not reflect the true scale of the crisis as there may be many patients who are undiagnosed and not reported, medical experts said.
Wuhan – the city of 11 million people where the deadly virus outbreak began in December – has so far reported more than 5000 confirmed cases of the pneumonia-like illness, or about one-third of the total number across mainland China.
But some medical experts have expressed concern that the real number could be much higher because cases are only classified as confirmed once a patient has twice tested positive for the new strain of coronavirus, reports the South China Morning Post.
Given that there is also a shortage of coronavirus testing kits, the figure could be much higher than it actually is.
Professor David Hui Shu-cheong, a respiratory medicine expert from Chinese University of Hong Kong, said the official tally in Wuhan could be "just the tip of the iceberg" because it only reflected the acute cases where patients were admitted to hospital.
"There are many community cases that remain undiagnosed – unlike in Hong Kong, where cases are more carefully handled, including the mild ones. Of the 15 confirmed cases [in Hong Kong], 10 of [the patients] didn't even need to be put on oxygen," Hui said.
"So we're talking about different denominators here. For an actual picture, one usually has to wait until after the outbreak settles for a general population, zero-prevalence study to be carried out – where blood tests would reflect the number of positive cases containing the antibody without presenting the symptoms," Hui said.
In addition, Li Lanjuan, a member of the National Health Commission's expert panel on the coronavirus, told state broadcaster CCTV on Monday that since there were not enough testing kits in Wuhan, "not everyone can get tested".
"Early detection, early diagnosis, early isolation and early treatment cannot be done in Wuhan at the moment. I hope that the country can support Wuhan [more]," said Li, who was in the Hubei province city to help oversee the handling of the outbreak.
Frontline doctors in Wuhan confirmed that there was a limited number of testing kits available, and only a small number of "fortunate" patients who tested positive would be admitted to hospitals and receive treatment.
A doctor at the Union Hospital in Wuhan, who declined to be identified, said staff could only test about 100 patients a day, and they had to wait 48 hours for the results.
"When the National Health Commission announces the numbers, they're already two days old," the doctor said. "We also have to turn away patients with mild symptoms, knowing that many of them will return later [when their condition worsens]. But we don't have the space in the testing centre, or the hospital beds."
Dr Joseph Tsang Kay-yan, a Hong Kong-based infectious disease specialist, said the shortage of testing kits in Wuhan meant doctors were limited in their ability to determine the real number of cases.
"There have also been many patients who died of undifferentiated respiratory and undiagnosed pneumonia symptoms in Wuhan since December – before the virus testing kits were made available," Tsang said.
"These cases should have been investigated and counted [in the tally] if confirmed. These are factors pointing to inaccurate reporting of the official figures," he said.
The Chinese government said on Monday that production of the testing kits had been disrupted by the Lunar New Year holiday break and that there should be more available soon.
"By February 1, our daily output was 773,000 [testing kit] units – equivalent to 40 times the number of suspected patients at the moment," said Tian Yulong, chief engineer with the Ministry of Industry and Information Technology.
"We have only reached 60 to 70 per cent of our production capacity, and our work in the next stage is mainly about [fully] restoring production capacity," he said.
But a doctor at the Tongji Hospital in Wuhan, speaking on condition of anonymity, said the kits were still in short supply.
"I don't know what's gone wrong – we only have a very limited number of testing kits every day, there's been no increase yet," the doctor said.
A global problem as infections top 20,000
China said today the number of infections from a new virus surpassed 20,000 as medical workers and patients arrived at a new hospital and President Xi Jinping said "we have launched a people's war of prevention of the epidemic."
Xi presided over a special meeting of the top Communist Party body for the second time since the crisis started, telling the Politburo standing committee on Monday the country must race against time to curb the spread of the virus. He also said those who neglect their duties will be punished, state broadcaster CCTV reported.
Hong Kong shut almost all of its land and sea border crossings with the mainland at midnight after medical workers began a strike demanding the border be closed completely.
More than 2000 hospital workers went on strike Monday, and their union has threatened a bigger walkout today.
Hong Kong was hit hard by SARS, or severe acute respiratory syndrome, in 2002-03, an illness from the same family of viruses as the current outbreak and which many believe was intensified by official Chinese secrecy and obfuscation.
The mainland's latest figures of 425 deaths and 20,438 confirmed infections with the new coronavirus were up from 361 deaths and 17,205 cases the previous day.
Outside mainland China, at least 180 cases have been confirmed, including one fatality, in the Philippines.
Other countries are continuing evacuations and restricting the entry of Chinese or people who have recently traveled in the country.
A plane carrying Malaysians from Wuhan, the capital of Hubei province where the illness has been concentrated, arrived in Kuala Lumpur this morning, and the 133 people on board were to be screened and quarantined for 14 days, the maximum incubation period for the virus.
Medical teams from the People's Liberation Army were arriving in Wuhan to relieve overwhelmed health workers and to staff the new 1000-bed hospital.
It was built in just 10 days, its prefabricated wards equipped with state-of-the-art medical equipment and ventilation systems.
A 1500-bed hospital also specially built for patients infected with the new virus is due to open within days.
With no end to the outbreak in sight, authorities in Hubei and elsewhere extended the Lunar New Year holiday break, due to end this week, well into February to try to keep people at home and reduce the spread of the virus.
All Hubei schools are postponing the start of the new semester until further notice.
Chinese scientists said they have more evidence the virus, which was first detected in Wuhan in December, likely originated in bats.
In a study published in the journal Nature, Shi Zhen-Li and colleagues at the Wuhan Institute of Virology reported that genome sequences from seven patients were 96 per cent identical to a bat coronavirus.
SARS is also believed to have originated in bats, although it jumped to civet cats before infecting people.
Scientists suspect the latest outbreak began at a seafood market in Wuhan where wild animals were on sale and in contact with people.
The World Health Organisation last week declared the virus a global health emergency and expressed concern about how it was spreading in other countries, beyond those who were Chinese or who had travelled in Hubei recently.
On Tuesday, the Korea Centers for Disease Control and Prevention said a 42-year-old South Korean woman tested positive for the virus, days after she returned from a trip to Thailand with chills and other symptoms.
It is South Korea's 16th case.
Thailand has confirmed 19 cases, mostly Chinese tourists but also in a Thai taxi driver.
A passenger on a Japanese-operated cruise ship tested positive after leaving the vessel while it was in Hong Kong, and Japanese officials were considering a quarantine of the more than 3000 people on board.
The Diamond Princess returned to Yokohama after making port calls in Vietnam, Taiwan and Okinawa.
A team of quarantine officials and medical staff boarded the ship Monday and began medical checks of everyone on board, a health ministry official said, speaking on condition of anonymity in keeping with department rules.
The ship's captain said Hong Kong's health authorities notified the ship about the passenger's infection on Saturday, according to a recording of the announcement tweeted by a passenger.
The patient is recovering, and his travelling companions so far have not been infected, the captain's announcement said.
"I wish we were informed as soon as they found out, then I could have worn a mask or washed hands more carefully," the passenger said. "I was in Hong Kong nine days ago and it seems to be too late now."
-South China Morning Post, news.com.au, AP