China's novel coronavirus (2019-nCoV) outbreak topped 20,000 cases with the country's latest report of 3,235 new cases, as more countries outside of China reported additional local cases as well as imported cases coming from other nations in the region.

In other developments, an error in a recent medical journal case report involving German patients casts doubt on claims of asymptomatic spread, while another German research team found hints that patients with mild cold symptoms may be able to transmit the virus.

Hubei province still main China worry

Early this morning, China's National Health Commission (NHC) said the new cases put the country's overall total at 20,438 cases. Officials reported 64 more deaths, all in Hubei province, lifting the fatality count to 425.

The country recorded 492 more severe cases, raising that number to 2,788.

At a technical briefing today during the World Health Organization (WHO) executive board meeting, Director-General Tedros Adhanom Ghebreyesus, PhD, said, "It's important to underline that 99% of the cases are in China, and 97% of deaths are in Hubei province. This is still first and foremost an emergency for China."

He added that working closely with China to support its efforts is still the best chance of averting a global crisis. Tedros said China's response measures at the outbreak epicenter have created a window of opportunity for the world to act. He noted that 23 countries have imposed travel restrictions, counter to recommendations made in the WHO's emergency declaration. He said he hopes the restrictions are short, proportional to the risk, and reviewed regularly.

Tedros also strongly urged countries to share more data on their imported and other cases, pointing out that, of the 176 notifications the WHO has received, it has full data for only 38%.

Imported cases from outside of China

A handful of countries today reported more local spread and cases with connections to countries in the region outside of China.

At the WHO's technical briefing today, Oliver Morgan, who directs the WHO's health emergency information and risk assessment department, said that so far, nine countries have reported 27 cases of human-to-human spread. And he said investigations are under way into how a number of people outside of China contracted their infections.

South Korea today reported an illness in a man who got sick after he came back to Korea on Jan 19 after visiting Thailand, the country's Centers for Disease Control and Prevention (KCDC) said in a statement today, adding that officials are investigating further.

Malaysia's health ministry said a man who got sick after traveling to Singapore to attend a meeting—also attended by people from China—tested positive for 2019-nCoV; the country also reported another imported case involving a Chinese traveler, raising the country's total to 10, according to a report from The Star, an English language newspaper based in Malaysia.

Thailand's health ministry in its report on six new cases said two involve a husband and wife who returned from Japan recently, but it's not clear where they contracted the virus, according to a statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog.

Two of the cases are in taxi drivers and two in tourists from China. Officials added that they are aware of the report from Japan, and for now, it's now clear how the Japanese pair were infected, given that both countries have reported local 2019-nCoV transmission.

Other countries reporting more cases include:

Australia today reported its 13th case, involving an 8-year-old child who is part of a Wuhan tour group linked to travel-related cases in Queensland state, the Brisbane-based Courier Mail reported today.

Belgium today reported its first case, which involves one of nine people recently evacuated from Wuhan, Reuters reported, citing the country's health ministry.

Singapore's health ministry today reported 6 more cases, 4 of which involve local transmission, raising the country's total to 18. Of the local transmission case-patients, three had contact with travelers from mainland China and the fourth is a close contact of an earlier local transmission case. Two new cases were detected in people evacuated from Wuhan on Jan 30.

Vietnam has two new patienets, one of whom is a close contact of an earlier patient, presumably marking another instance of local spread, according to a health ministry update.

Hong Kong reports death

Hong Kong's 2019-nCoV situation has escalated, and today it reported its first death, in a 39-year-old man who was identified as the 13th case, the government said in a statement. It said it's not clear if underlying disease contributed to his death.

In another development, Hong Kong's Centre for Health Protection (CHP) reported three new cases, all of them locally acquired. One patient is a 64-year-old woman who had no history of international travel but only commuted between her home and her shop. The woman is in critical condition, and her family contacts are asymptomatic and have been placed in quarantine.

The second is a 60-year-old man with no travel history during his incubation period who mainly stayed home. He is in stable condition, and his contacts have symptoms and are being treated. The third patient is a 30-year-old man with no recent travel history. He is in stable condition and his wife has no symptoms and was placed in quarantine.

Hong Kong has now recorded 18 2019-nCoV cases.

High-profile 'asymptomatic' patient actually had symptoms

In research developments, Science reported yesterday that a recent case report on possible asymptomatic transmission in a German cluster—widely used to support evidence of the pattern—was wrong in its description of the index patient's lack of symptoms.

The Chinese woman who passed the virus to her German coworkers, triggering a 10-person cluster, reportedly didn't have any symptoms when she flew back to China, according to the New England Journal of Medicine (NEJM) report published on Jan 28.

The authors of the original NEJM report, however, had not talked to the Chinese woman, according to Science. Citing sources familiar with the case, Science said Robert Koch Institute (RKI) scientists did talk to the woman, who said she actually did have symptoms in Germany, which included fatigue and muscle pain, for which she took fever medication.

RKI researchers told Science that it has sent a letter to NEJM editors informing them of the error in the original report.

In a separate development, the reporter who wrote the Science article said today that two German labs are testing virus shedding in patients from the German cluster who are being treated in Munich. He added that the labs have isolated the virus in pharyngeal swabs of several patients.

Citing a statement from the researchers, journalist Kai Kupferschmidt said on Twitter that the patients have mild infections, and taken together, the findings hint that people with mild or early cold-type symptoms may be able to transmit the virus to others.

See also:

Feb 4 China NHC report

Feb 4 KCDC statement

Feb 4 Star story

Feb 4 AFD post

Feb 4 Courier Mail story

Feb 4 Reuters story

Feb 4 Singapore health ministry statement

Feb 4 Vietnam health ministry update

Feb 4 Hong Kong government statement

Feb 3 Science report

Feb 4 Kai Kupferschmidt Tweet thread