Hong Kong (CNN)The number of deaths from the Wuhan coronavirus has spiked again in China, as confirmed cases topped 24,500 worldwide and there were worrying signs of new outbreak clusters in Hong Kong and Japan.

As of Wednesday morning, the number of deaths from the virus stood at 492, an increase of 67 from the previous day, including a second death outside of mainland China.

The number of confirmed cases grew to 24,536 worldwide, an increase of almost 4,000, or around 20%. The majority of cases are still centralized in Hubei, the Chinese province of which Wuhan is the capital, where more than 12,600 people remain in hospital.

China’s National Health Commission said Tuesday that the death rate from the virus stands at 2.1% nationwide. The figure is higher for Hubei, at 3.1%. A spokeswoman for the commission said 80% of victims were over the age of 60 and 75% had some form of underlying condition.

Outside mainland China, concern is growing in Hong Kong, which has sealed off most of its border crossings. The semi-autonomous Chinese city reported its first death from the virus on Tuesday, as authorities also confirmed three “local infection cases,” who had not recently returned from China.

Authorities said an ongoing strike by healthcare workers has had a “serious impact on services.” Unions have demanded that the border be fully closed and extra support provided for frontline staff before they will end their walkout action — though most doctors and nurses continue to work.

Anyone who had close contact with the new cases has been placed under quarantine, Hong Kong health authorities said.

Chuang Shuk-kwan, head of the Hong Kong health authority’s communicable disease branch, told reporters Tuesday the new cases showed “there could be invisible chains of infection happening within communities.”

“We are not ruling out a large spread (of the virus) in the future,” she said.

Cruise ship quarantined

Also under quarantine are the passengers of the Diamond Princess cruise ship, currently sitting in Yokohama Bay, south of Tokyo. Ten people on board have been confirmed to have the virus, and were being taken to the hospital, as authorities waited for test results of other passengers.

There are 2,666 guests and 1,045 crew members on board the ship, owner Princess Cruises said in a statement.

The ship has been held at the Japanese harbor since early Tuesday, after the virus was detected in a Hong Kong man who had previously disembarked from the cruise.

Cruise ships can become hotbeds for viral infections, typically norovirus and other gastrointestinal bugs — this time last year, a cruise in the Caribbean had to return to port early after more than 400 passengers got sick.

“Commercial maritime travel is characterized by the movement of large numbers of people in closed and semi-closed settings,” according to the US Centers for Disease Control (CDC). “Like other close-contact environments, these settings can facilitate the transmission of influenza viruses and other respiratory viruses from person to person through droplet spread or potentially through contact with contaminated surfaces.”

As the Yokohama ship remains under quarantine and testing, attention will turn to other vessels in the region. Hong Kong is a major cruise ship terminal, with routes to much of southeast Asia, Taiwan and Japan.

Where is Xi?

With at least three cities in China reporting more than a thousand cases, there are signs that the stringent controls put in place to try and contain the virus may not be working.

In a front page editorial Tuesday, the People’s Daily — the official mouthpiece of the Communist Party — called for a “people’s war” against the virus, adding that people should “more closely rally around the CCP with comrade Xi Jinping as the core.”

Xi himself, however, has been missing in recent days, not appearing on front pages or in the nightly newscast on state broadcaster CCTV. This is extremely unusual for the Chinese leader, who typically dominates media coverage even when his activities are relatively routine.

His disappearance has led to a great deal of speculation in China and abroad. However, due to the opaque nature of the Communist Party’s internal politics, it is difficult to do much more than speculate as the likely reason. Even though he has not been appearing, Xi’s name continues to feature in state media coverage, which has emphasized his role in chairing meetings related to the virus and overseeing relief and containment methods.

Treatment methods

With fear of the virus — and reported cases — growing worldwide, the World Health Organization (WHO) on Tuesday urged governments not to impose travel and trade restrictions, though many already have.

“We reiterate our call to all countries not to impose restrictions that unnecessarily interfere with international travel and trade. Such restrictions can have the effect of increasing fear and stigma, with little public health benefit,” Tedros Adhanom Ghebreyesus said Tuesday during a briefing to the UN’s executive board in Geneva.

“Where such measures have been implemented, we urge that they are short in duration, proportionate to the public health risks, and are reconsidered regularly as the situation evolves,” he added.

He also called on member states to “facilitate rapid collaboration between the public and private sectors to develop the diagnostics, medicines and vaccines,” in order to bring the outbreak under control.

Those efforts are under way globally, with slow progress being made both on treatment methods and vaccines. The lack of both throughout this outbreak is one factor which makes it far scarier than seasonal influenza and similar bugs — while the flu kills more people annually, there is a vaccine and hospitals are well acquainted with treating and containing it.

Officials in Thailand said Monday that a second patient has been treated with a new combination of HIV and flu drugs, after doctors said the cocktail had been successful in treating a 71-year-old woman from China with the virus. Officials have yet to provide an update on the success of the treatment for the second patient.

A purpose-built hospital dedicated to treating the virus also opened in Wuhan Monday. The institution was constructed in under a week, and a second is due to open Thursday. Both will only handle coronavirus patients, helping to take the pressure off the severely stretched Wuhan healthcare system.

Chinese health officials said that the average time needed for a patient to recover is nine days. However, in Hubei province, the average recovery time is currently at 20 days because there are more severe cases.

The death rate has also been higher in Hubei because of a lack of hospital beds and large number of cases creating delays in treatment.

CNN’s Steven Jiang in Beijing; Kocha Alorn in Bangkok; Junko Ogura in Tokyo; and Carly Walsh, Laura He and Nectar Gan in Hong Kong; and Lindsay Isaac, Zahid Mahmood and Meera Senthilingam in London contributed reporting.

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