For a few hours on Thursday it appeared the new coronavirus (2019-nCoV) had spread to Saudi Arabia with reports that a nurse in Asir was infected.
But it was a case of mistaken virus identification, quickly corrected.
The unfortunate nurse was actually infected with a different but equally frightening coronavirus — MERS (Middle Eastern respiratory syndrome MERS-CoV) which made the leap from animals to humans in 2012, creating a brand new human disease.
It was a vivid reminder that for almost a decade there has been a threat from another highly pathogenic never-before-seen virus. MERS was only the second coronavirus ever known to leap from animals to humans and cause a deadly illness.
The first of these notorious bugs was SARS, (severe acute respiratory syndrome SARS-CoV) which swept the world in the spring of 2003 killing more than 800 people, including 44 Canadians.
2019-nCoV makes 3
With scant information about the novel virus that has just emerged in China, experts are reviewing the experience of SARS and MERS for important clues about what to expect.
“The interesting thing about this is that we’re really not sure which way it’s going,” said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases. “We first thought, well, there really wasn’t much transmission from human to human.”
Now that it’s clear the virus can spread between people, Fauci said the next question is how easily it will spread.
“The real question right now is will it get better at going in what we call ‘sustained transmission’ from human to human. Because if it doesn’t then we have a very good chance of pretty quickly getting our arms around it and, by public health measures, essentially stopping it.”
Michael Osterholm, an infectious disease specialist at the University of Minnesota, is a veteran of the SARS and MERS outbreaks, and he’s blunt about the current situation.
“This is a bad disease. It makes people very sick and it can kill you. And so I think that is an important combination. But the ultimate case fatality rate is still yet to be determined.”
In other words, experts still don’t know how dangerous the new virus is or how it compares to SARS — with a case fatality rate around 10 per cent — or MERS with an estimated fatality rate as high as 30 per cent.
“I know how this picture is starting but I don’t know how it ends. And so I think that’s the question we’re all asking,” said Osterholm.
Part of the genetic sequence of the new coronavirus 2019-nCoV. (GenBank by Shanghai Public Health Clinical Center & School of Public Health, Fudan University)
The SARS and MERS viruses followed different paths.
SARS began in China in the fall of 2002 and spread around the world quickly. By spring of 2003 it had travelled to 37 countries including Canada, sickening more than 8,000 people.
Still, SARS lacked the ability to spread easily between humans.
“It never really developed the capability of having sustained vigorous transmission from person to person,” said Fauci. “There was clearly person-to-person transmission but it wasn’t like influenza. You had thousands of cases but not millions of cases.”
And after nine frightening months, SARS was extinguished, apparently forever.
“SARS was actually a huge public health success in that we were able to control contain and eliminate that virus,” said Dr. Catharine Paules, who co-authored a new paper with Fauci about coronavirus infections published this week in JAMA.
“But then in 2012 we had the emergence of a second animal coronavirus in the human population.”
Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota, is a veteran of the SARS and the MERS outbreaks. (University of Minnesota)
MERS first appeared in Jordan in 2012 with cases showing up in 27 countries over eight years. The U.S. Centres for Disease Control states that all of the MERS cases are linked to travel or residence in countries around the Arabian Peninsula. There was a major outbreak of MERS in a South Korean hospital in 2015 where 186 people were infected and 36 died.
Sneezing camels
So far, public health agencies have been able to limit the human-to-human spread of MERS but they have not been able to eradicate the virus. That’s because MERS has become the camel version of the common cold.
“The camels will be sneezing or coughing and they sort of sneeze or cough this virus onto people; that’s how we think it’s transmitted,” said Paules.
In the case of SARS, animal-to-human transmission was eliminated when live-animal markets stopped selling small mammals including palm civets, which were found to be carrying the SARS virus.
“Once we realize that palm civets were the primary animal species transmitting is to humans, and the markets were eliminated, we literally shut off the faucet of new infections coming into humans,” said Osterholm.
So far the animal reservoir for the new virus is a mystery. Experts are extremely skeptical about early reports of an association with snakes.
“I know there was a recent publication that came out about snakes but that’s hotly being debated right now as we aren’t even sure that reptiles can get infected with coronaviruses,” said Paules.
“I think many of us thought that that was in error and not likely to be the source,” said Osterholm. “But at this point we have no data otherwise from the Chinese to know what might have been the animal reservoir.”
“If you want to put some money on it you’d get a bat involved,” said Fauci. “SARS went from the bat to the palm civet cat to the human and MERS went from the bat to the camel to human. I don’t have any idea what the animal is for this one but I would not be surprised if a bat was involved somewhere.”
Dr. Catharine Paules, an infectious disease specialist at Penn State University in Hershey, Pa., co-authored a new paper about coronaviruses. (Penn State Health Hershey)
There are also major questions about the transmissibility of the new virus. Scientists still don’t know how the virus spreads, although Fauci said environmental tests revealed traces of the virus at the market in Wuhan, China.
“They did environmental samples and it was able to be seen on some of these inanimate objects in the fish market,” he said. “Though no one has yet done the definitive experiment of seeing whether it stays alive on a doorknob or not, I wouldn’t be surprised if it did last for a limited period of time on inanimate objects.”
Fauci said it appears to take about six days for someone who has been infected to show symptoms, but it’s not clear whether the virus can be spread by someone who does not appear to be sick.
“But there are anecdotes, for example the individual from Seattle who got infected does not remember coming into contact with anyone that was sick nor does he remember coming into contact with any animals nor did he feel that he had any exposures, yet he got infected.”
‘Super-spreaders’
A grim aspect of all three diseases is the phenomenon of the super-spreader — a person who, for some reason that’s still not well understood, is able to infect a large number of people.
“That’s one of the big mysteries,” said Osterholm. “Super-spreaders have been individuals who have been severely ill and even people who’ve been moderately ill. Why they’re putting out so much virus is just not clear.”
In the case of MERS, Osterholm said one person in a South Korean emergency room was able to infect 82 people in 2015.
In the case of SARS, one super-spreader in Beijing was responsible for a chain of infections in 76 people.
It’s been reported that one man in Wuhan infected 14 hospital workers, which could be the first evidence of a super-spreader in this outbreak. But because it happened during surgery, the infection could be related to the surgical procedures.
“I think we have to still be a little bit careful, because this individual actually had had surgery and anytime you intubate somebody you know you may very well have induced a higher rate of spreading the virus,” said Osterholm.
Lessons from SARS and MERS
One of the encouraging aspects of the SARS story is that the virus was contained, said Osterholm, pointing to Canada, where most of the more than 400 infections and 44 deaths happened in and around Toronto.
“While Canada suffered miserably because of what was going on in Toronto, there weren’t even any cases in Calgary, and Winnipeg,” he said.
“So what we need to get people to understand is that we can’t say this isn’t going to come to every country in the world. It’s unlikely, but it could. But when it does, it’s going to likely be largely an institution-based outbreak like a hospital.”
“So that just helps give people a sense that we’re not all going to die from this,” he said.
Training to respond to a viral threat
At her hospital in Hershey, Pa., Paules is part of a team that trains regularly to respond to an emerging viral threat.
She said some of the strategies developed during the SARS and MERS outbreaks are already bein used, including the closing of animal markets and airport screening.
“Some of those things have been able to get up and running very quickly, probably because of the lessons learned from SARS,” said Paules.
China was able to sequence the new virus and get that critical genetic code to the world quickly. Diagnostic tests have been developed, which means cases can be identified and isolated to contain the spread.
“I think some of the things from SARS and MERS that have really helped us here is how quickly the Chinese authorities were able to globally circulate the sequence of this virus,” said Paules, who echoes Osterholm’s point that most people don’t have to worry about this virus.
“I would be concerned if I was in some of these areas in China. I would not myself probably decide to travel to any of those areas right now. But here sitting in my office in Hershey, Pennsylvania I have a low concern that this virus is going to impact me personally, although I’m concerned for the global community.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
