For the third time in eight days — and the second time in 24 hours — Chinese public health officials made changes Friday to their criteria for counting coronavirus cases, once again sowing confusion over the widely fluctuating figures. In a further sign of potential inconsistencies, an official in China’s Hubei Health Commission suggested that agencies were not being transparent and accurate in their reported case numbers.

Another death amid a surge in coronavirus cases in South Korea — many traced to a church — also provoked fresh alarm Friday, after Chinese authorities reported hundreds of new infections at prisons, undercutting Beijing’s effort to show progress in containing the deadly epidemic.

The prison outbreaks underscored the high transmissibility of the virus, officially called SARS-CoV-2, in confined spaces. People on board the Diamond Princess cruise ship docked in Japan also have been hit hard by covid-19, the disease caused by the virus.

Meanwhile, Lebanon and Israel reported their first coronavirus cases, and infection numbers rose in Italy. By Friday night, Italy had reported its first death from the virus: a 78-year-old man. Authorities in Iran also reported two deaths among 13 new infections, raising the tally there to 18 cases.

Here are the latest developments:

●A second person died of covid-19 and cases in South Korea soared, with investigators focusing on a church and hospital as clusters of infection in the southern city of Daegu.

● Hundreds of passengers were disembarking from the Diamond Princess, but the massive case load left questions about the rigor of quarantine and testing procedures on board.

● Italy confirmed its first death from the virus Friday night. Earlier, Israel announced its first coronavirus case — a Diamond Princess passenger — while Lebanon reported its first infection — someone who had just traveled from Iran.

● Beijing braced for a potential explosion of infection numbers in the capital after two hospitals were put under quarantine.

● World Health Organization Director General Tedros Adhanom Ghebreyesus said that Friday’s “significant decrease in confirmed cases is partly due to another change in the way China reports numbers.”

China reports 2,350 total coronavirus deaths through Friday

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Chinese health officials on Saturday morning reported 109 new deaths and 397 new confirmed coronavirus cases on Friday, bringing the country’s total to 2,345 deaths and 76,288 confirmed cases.

Friday’s new cases were a dramatic drop from Thursday, when National Health Commission officials reported 889 new infections. The new tallies come as China has made even more changes to its criteria for counting coronavirus cases, causing confusion amid fluctuating numbers.

South Korea reports 142 new coronavirus cases, majority linked to existing clusters

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SEOUL — South Korea reported 142 additional cases of the coronavirus, Korea’s Centers for Disease Control and Prevention said on Saturday.

About two-thirds of the new cases have been traced to an existing cluster at a hospital in southern Cheongdo County, North Gyeongsang province. The majority of the remaining cases are linked to a church in nearby city of Daegu, according to the KCDC.

South Korean government has designated Daegu and North Gyeongsang as “special care zones” to which support will be concentrated.

The latest cases have brought up the national tally of the virus to 346, an 11-fold jump from the beginning of the week.

“Apart from the Diamond Princess cruise ship, [South] Korea now has the most cases outside China, and we’re working closely with the government to fully understand the transmission dynamics that led to this increase,” Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, told a briefing in Geneva on Friday.

Iran’s sudden spike in coronavirus cases spurs school closures aimed at cubring spread

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On Friday, Iran’s health ministry announced two new deaths and 13 coronavirus cases, raising the total tally to 18 infections, including four deaths, since the first case there was announced Wednesday.

The spike in coronavirus cases have spurred panicked school closures and border restrictions aimed at curbing Covid-19’s spread.

In response, the Tehran province ordered the closure of all schools on Saturday, which is a school day in Iran, state-run Fars News Agency reported.

In the holy city of Qom, the center of Iran’s outbreak about 100 miles south of Tehran, authorities called for the suspension of religious gatherings and schools and seminaries.

Iran is holding nationwide parliamentary elections Friday.

Iran’s neighbors and allies have also reacted with travel bans and movement restrictions. On Friday, Lebanon’s health ministry announced that the country’s first coronavirus case was a 45-year-old woman who had just traveled from Qom to Lebanon, prompting the ministry to request that any visitors from Iran self-quarantine for 14 days, the virus’ incubation period.

Turkey’s health minister on Friday announced tighter screening procedures of travelers from Iran and said the country would deny anyone showing symptoms of Covid-19. Turkey additionally said it would deny entry to Iranians who had traveled to Qom within the last 14 days.

On Thursday, Iraq, which neighbors Iran, suspended visas on arrival for Iranians. That same day Iraq and Kuwait, which is also along the Persian Gulf, both suspended direct flights to and from Iran.

Iraq, Turkey and Kuwait are all important business and trading partners with Iran, while Qom is a popular pilgrimage site among Shiite Muslims from all over.

Iranian authorities said that no one who tested positive with the disease had recently traveled to China. Minoo Mohraz, an Iranian health ministry official, told Iranian media that the virus “possibly came from Chinese workers who work in Qom and traveled to China,” the Associated Press reported. She provided no further evidence to back up the claim. A solar power plant in Qom is being built by a Chinese company.

Australia reports two more coronavirus cases from Diamond Princess passengers

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Two more passengers evacuated from the Diamond Princess cruise ship and repatriated to Australia have tested positive for coronavirus, bringing the number of confirmed cases to six, according to the Austrlian Broadcasting Corp.

The announcement comes after Australian health authorities on Friday announced four people from the Diamond Princess has contracted the virus.

“We will continue to screen every day and have that very precautionary approach to testing and ensuring that we are picking up early and isolating early anybody who is positive for COVID-19,” Austrailian medical officer Dianne Stephens told ABC.

What China’s efforts to contain the coronavirus look like from a satellite

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The satellite captured how concentrations of nitrogen dioxide, a pollutant released by burning fossil fuels, were down in China during this period – just when the government started to impose quarantines that dramatically cut the use of cars, flights, and freights that rely on coal and other fossil fuels.

Weather conditions and seasonal patterns can affect pollution, but Jessica Seddon, an air quality specialist at the Washington-based World Resources Institute, said that’s unlikely the case here given the stark contrast between the two images. Nitrogen dioxide is also quick to decompose, so it’s typically been emitted where the satellite catches it, she said.

Seddon said “it’s very plausible the coronavirus would affect” nitrogen dioxide emissions, given the sudden cut in everyday activities from factory production to transportation.

Coronavirus outbreak edges closer to pandemic

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In South Korea, coronavirus cases quadrupled over two days, as 144 members of a religious sect tested positive. In Singapore, clusters of infection have been traced to two churches, a hotel business meeting, a health products shop and a construction site. In Iran, an outbreak has seeded new cases in Lebanon and Canada — a worrisome sign that the disease could be spreading more widely than was realized.

There are outbreaks. There are epidemics. And there are pandemics, where epidemics become rampant in multiple countries and continents simultaneously. The novel coronavirus that causes the disease named covid-19 appears to be on the verge of that third, globe-shaking stage.

Amid an alarming surge in cases with no clear link to China, infectious disease experts think the flulike illness may soon be impossible to contain. The World Health Organization has not declared covid-19 a pandemic, and the most devastating effects, including more than 2,200 deaths, are still in China. But the language coming from the organization’s Geneva headquarters has turned more ominous in recent days as the challenge of containment grows more daunting.

“The window of opportunity is still there, but the window of opportunity is narrowing,” WHO Director General Tedros Adhanom Ghebreyesus said Friday. “We need to act quickly before it closes completely.”

If the coronavirus becomes a true pandemic, a large portion of the human population — a third, a half, two-thirds even — could become infected, although that doesn’t necessarily mean they will get sick. The word “pandemic” invokes fear, but it describes how widespread an outbreak may be, not its deadliness.

Read more here.

First coronavirus death reported in Italy

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A 78-year-old man who tested positive for coronavirus in Italy died late Friday, according to Corriere Della Sera, the country’s newspaper of record.

The death, which reportedly took place in the city of Padua, marks the first in Italy from the virus and comes as confirmed cases in the country continue to climb.

The newspaper, as well as the country’s ANSA news agency, reported 16 coronavirus cases in the country by Friday evening. Earlier in the day, ANSA confirmed the first cases of local transmission of coronavirus in Italy.

Officials say the first to locally contract the virus was a 38-year-old man in the northern region of Lombardy, who became sick after having dinner with a friend who recently returned from China. He then passed the virus on to his wife and another close friend, according to Reuters.

Australia confirms four coronavirus cases from Diamond Princess cruise ship passengers

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Australian health officials confirmed Friday that four people who had gotten off the Diamond Princess cruise ship have tested positive for coronavirus, the Australian Broadcasting Corp. reported.

Two Queensland women, ages 54 and 55, and a South Australian woman, 24, are among the four who tested positive for the virus, the news station reported.

The 24-year-old woman initially tested negative for coronavirus in Yokohama, Japan, but started experiencing mild flulike symptoms when she arrived in Darwin, the capital city of Australia’s Northern Territory, the outlet reported.

She will be flown to Royal Adelaide Hospital, where she’ll be treated in an isolated unit. The other two women will receive medical attention in Brisbane, according to the Australian Broadcasting Corp.

No details about the fourth patient were reported.

Brendan Murphy, Australia’s chief medical officer, told the outlet that the new diagnoses aren’t abnormal.

“Given there was continued evidence of spread of infection on board the Diamond Princess in recent days, the development of some positive cases after return to Australia is not unexpected, despite all of the health screening before departure,” he said.

Australian passengers aboard the cruise ship arrived Thursday in Darwin, where many of the evacuees are being quarantined at an unused workers’ camp. They joined 266 other Australians who were moved out of Wuhan, the Australian Broadcasting Corp. reported.

At least 46 Australians aboard the cruise ship were infected with the coronavirus, the outlet reported.

In China, discharged coronavirus patient is rehospitalized

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A coronavirus patient in China who was discharged after recovering from the illness has been readmitted because of another positive test result for the virus, Reuters reported.

The patient recuperated in Chengdu, the capital of Sichuan province, and entered a recommended quarantine period at home, according to Reuters.

The city’s public health clinical center told the news organizations that similar cases have been reported in other regions of the country.

Patients who recover from coronavirus are advised to monitor their health for two weeks, wear face masks and limit their time outside to avoid contracting diseases, according to China’s National Health Commission.

In similar coronaviruses, 14 days is the longest incubation period that has been observed.

The fraught history of the term ‘pandemic’

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At a daily media briefing Friday, WHO officials were asked repeatedly whether the coronavirus outbreak was likely to become a pandemic.

In their responses, they seemed to take pains to avoid the p-word as much as possible.

The WHO officially defines a pandemic as “the worldwide spread of a new disease.” Many experts use the word to describe the stage of an outbreak when a virus is transmitting in a self-sustaining way across multiple countries and regions.

For now, most new coronavirus cases are still tied to China.

But Sylvie Briand, director of the WHO’s infectious hazard management department, said health investigators are concerned about the new cases spreading in Italy, Iran and elsewhere, with no clear link to China or contact with previously confirmed cases.

“I think one of the things people misunderstand when it comes to pandemics is it’s not about how severe it is or how many cases there are or even how worried we need to be,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “It’s about literal geography.”

The pandemic designation is not one that WHO officials will make lightly. That’s because it comes with massive political and economic consequences.

The last time WHO declared a pandemic — during the H1N1 outbreak in 2009 — the decision later came under harsh criticism from some countries, which thought that it spread fear and led to unnecessarily aggressive responses.

H1N1, also known as swine flu, turned out not to cause the massive deaths and chaos some initially feared. But the pandemic declaration triggered requirements, for example, for some governments to buy vaccines — which a number of governments came to feel was a waste of money.

There was even a mini-scandal when the WHO revised the definition it had published online during the 2009 outbreak, deleting a reference — after a reporter asked about it — to pandemics causing “enormous numbers of deaths and illness.”

The Council of Europe accused the WHO afterward of changing the definition to make it easier to declare a pandemic. The WHO said the website was outdated and that it had not changed its definition.

In China’s ‘war’ on coronavirus, hospitals turn away other patients — with dire results

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BEIJING — Nie Mingtao arrived at Wuhan Union Hospital’s tumor center on Feb. 9, hoping to continue with chemotherapy treatment for the late-stage lung cancer that left him unable to eat or sleep.

When Nie showed up, paperwork in order, a doctor apologized and turned him away: The hospital was emptying its cancer ward to make room for patients suffering from the coronavirus that was ravaging Hubei province, said his son, Nie Wenjie.

A month into its battle to contain the outbreak, China is overseeing an unprecedented triage on a national level by scaling back or suspending public health services for patients with ailments unrelated to the epidemic.

Within Hubei province at the outbreak’s epicenter, hospitals are so overwhelmed by the disease that they lack manpower or beds to treat nearly anything else. Beyond Hubei, hospitals from Chongqing in the southwest to Beijing in the north are choosing to shutter departments and reject patients seeking surgeries, kidney dialysis, diabetes medication and help for a variety of other conditions in an all-out effort to minimize the chance of virus transmission.

A United Nations program said this week that one-third of Chinese living with HIV say they are at risk of running out of antiretroviral medication and that many don’t know how they can get their next refill.

“This is not right,” said Nie Wenjie, 28, this week from his rural village in northern Hubei as he watched his father heave and moan, his condition worsening. “All the lives not touched by the coronavirus — are those lives not worth saving?”

28 U.S. residents infected with coronavirus from cruise ship

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Twenty-eight U.S. residents brought home from the Diamond Princess cruise ship Monday are infected with the coronavirus, and health officials expect to see more infections among that group in coming days, the Centers for Disease Control and Prevention announced Friday.

Eighteen of the Americans who were passengers on the cruise ship in Yokohama harbor had positive results in CDC tests, Messonnier said. Ten others showed positive results in tests conducted by the Japanese, but those results have not yet been confirmed by the CDC through additional testing. The CDC is not yet including them in their official count.

The 28 cruise ship passengers, along with three infected people previously returned from Wuhan, China, brings the total number of repatriated patients with the covid-19 infection to 31.

That is more than double the 13 U.S. patients who so far have either picked up the infection by traveling to China or from close contact with a family member.

The cruise ship passengers are “considered at high risk of infection and we do expect to see additional cases,” Nancy Messonnier, director of the agency’s National Center for Immunization and Respiratory Diseases, said in a media briefing.

The Japanese government quarantined nearly 3,700 passengers and crew aboard the ship for nearly two weeks, a policy that resulted in widespread transmission of the virus. More than 600 people from the Diamond Princess have tested positive — the second-largest number of any place outside China.

On Monday, the State Department flew 329 U.S. residents home from the ship on two separate aircraft. The Washington Post reported that the evacuation was delayed by a last-minute disagreement between government officials when 14 infections were found as the passengers arrived at the airport in buses. CDC officials did not want to put infected people on the plane with uninfected passengers, but were overruled by the State Department and another top government health official.

At Friday’s briefing, the State Department said the tests for those 14 people were conducted 48 to 72 hours before they boarded the buses.

Canadian passengers repatriated from virus-stricken cruise liner

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TORONTO — A plane carrying 129 Canadians and accompanying family members from the coronavirus-stricken Diamond Princess cruise ship in Japan has arrived in Canada, government officials said Friday.

The government-chartered flight landed at a Canadian air force base in Trenton, Ontario. The evacuees, who had already been quarantined aboard the cruise liner, must complete another 14 days of quarantine at a facility in Cornwall, Ontario, some 270 miles east of Toronto.

Global Affairs Canada, the country’s foreign ministry, said that none of the passengers had symptoms of the coronavirus upon arrival. Anyone exhibiting symptoms was not allowed to board the plane in Tokyo. It is unclear whether anyone was turned away.

Of the 256 Canadians aboard the Diamond Princess, 47 tested positive for the virus and are being treated in hospitals in Japan.

Lolita Wiesner, a passenger who was repatriated, said in a Facebook post that “riotous applause” broke out when the plane landed in Trenton and that she is “glad to be on Canadian soil.”

“Everyone we have seen since we landed has welcomed us home,” she wrote. “It made my eyes all weepy.”

What WHO officials are most worried about right now

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World Health Organization officials said Friday they were particularly concerned with the appearance of coronavirus cases in several countries, in which it is unclear how the patients were infected.

“Although the total number of cases outside Flag of China remains relatively small, we are concerned about the number of cases with no clear epidemiological link, such as travel history to Flag of China or contact with a confirmed case,” said WHO Director General Tedros Adhanom Ghebreyesus.

Health officials are focused on determining whether instances of local transmission have occurred and where — because that would indicate containment is not working and that the outbreak is instead spreading geographically.

Apart from the Diamond Princess cruise ship where local transmissions occured, South Korea now has the most cases outside China, and WHO officials said they’re working with the Korean government to understand the exact transmission dynamics that caused that increase.

Iran is another hotspot WHO officials said they are focused on. In three days, Iran has gone from zero cases to 18 cases and four deaths. The WHO has supplied testing kits and said it plans to provide further support to Iran in coming days.

But the biggest concern, WHO officials said, continues to be the possible spread of the coronavirus to developing countries with weaker health systems that are ill-equipped to handle such an epidemic.

Because of that, Tedros said he would be meeting with African health ministers on Saturday to talk about their preparation efforts.

Within China, Tedros said that although the number of cases in the epicenter Hubei province continues declining, “we are concerned about an increase in the number of cases in Shandong province, and we are seeking more information about that.”