Three more Asian countries confirmed coronavirus infections on Tuesday among citizens who had not travelled to China, as Hong Kong reported its first death from the disease and millions more people in Chinese cities were ordered to stay indoors.
The toll in mainland China soared to 425 after 64 more people died, the biggest single day tally since the first fatalities emerged last month.
More than 20 countries have confirmed cases of the virus, prompting the World Health Organization (WHO) to declare a global health emergency, several governments to institute travel restrictions, and airlines to suspend flights to and from China.
But it has continued to spread with Singapore, Malaysia, and Thailand on Tuesday reporting new infections that were not imported from China.
In a sign of growing concern about a spread to other densely-populated Chinese metropolitan areas, authorities in three cities in eastern Zhejiang province — including one near Shanghai — limited the number of people allowed to leave their homes.
Three districts in Hangzhou — including the area where the main office of Chinese tech giant Alibaba is based — now allow only one person per household to go outside every two days to buy necessities, affecting some three million people.
The city is only 175 kilometres (110 miles) southwest of the financial hub of Shanghai, which has reported more than 200 cases, including one death, so far.
Similar measures were imposed in Taizhou and three districts in Ningbo, covering a total population of nine million people.
Days before, similar restrictions were placed on Wenzhou, home to another nine million.
Zhejiang has confirmed 829 cases — the highest number outside the central province of Hubei, whose capital, Wuhan, is the epicentre of the outbreak.
The disease is believed to have emerged in December in a Wuhan market that sold wild animals, and spread rapidly as people travelled for the Lunar New Year holiday in late January.
China has struggled to contain the virus despite enacting unprecedented measures, including virtually locking down more than 50 million people in Hubei.
On Sunday the Philippines reported the first death abroad: a Chinese man who had come from Wuhan.
However, the WHO said Tuesday that the outbreak does not yet constitute a “pandemic”.
The death of the 39-year-old man in Hong Kong came as the semi-autonomous city closed all but two land crossings with the Chinese mainland.
Hong Kong media said the man had underlying health issues that complicated his treatment. He had visited Wuhan last month and his 72-year-old mother was also infected.
The financial hub has been particularly on edge over the virus as it has revived memories of the Severe Acute Respiratory Syndrome (Sars) outbreak of 2002-03, which killed nearly 300 people in the city and 349 people in the mainland.
“We can’t rule out the possibility that there will be massive transmission in the near future,” said Chuang Shuk Kwan, an official from Hong Kong’s Centre for Health Protection.
With more than 20,400 confirmed infections in China, health officials noted on Tuesday that the mortality rate for the new coronavirus stood at 2.1 percent, with most victims either old or with underlying health problems. SARS killed nearly 10 percent of patients.
Singapore announced on Tuesday its first four cases of people being infected locally, taking the total number of infections in the city-state to 24.
“There is as yet no evidence of widespread sustained community transmission in Singapore,” the health ministry said in a statement.
In another example of growing global anxiety, Japan has quarantined a cruise ship carrying 3,711 people and was testing those on board for the virus after a former passenger was diagnosed with the illness in Hong Kong.
Macau, China’s semi-autonomous gambling hub that is popular with mainland Chinese visitors, decided to temporarily close all of its casinos for at least two weeks.
And the UK’s Foreign Secretary Dominic Raab on Tuesday advised Britons to leave China, “if they can” to minimise their risk of exposure to the virus.
China’s Communist leadership made a rare admission of fallibility on Monday, acknowledging “shortcomings and difficulties exposed in the response to the epidemic”.
The elite Politburo Standing Committee called for improvements to the “national emergency management system” at the meeting, according to the official Xinhua news agency.
The government also said it “urgently” needed medical equipment such as surgical masks, protective suits, and safety goggles as it battles to control the outbreak.
Most of the deaths have been in Wuhan and the rest of surrounding Hubei province, which has largely been under lockdown for almost two weeks.
A 1,000-bed field hospital in Wuhan built from scratch within two weeks to relieve overburdened medical facilities started receiving patients on Tuesday, with a second makeshift hospital due to open later this week.
A cultural building, an exhibition centre and a gymnasium have also been converted into improvised clinics with 3,400 beds.