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.
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.
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.”
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.
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.”
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.”
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.”
Japan confirms third case of new coronavirus – The Japan Times
The health ministry said Saturday it has confirmed a third case of a new deadly virus that has been rapidly spreading in China and beyond.
The patient is a woman from the central Chinese city of Wuhan, where the outbreak of the mysterious coronavirus began, the ministry said, adding she arrived in Japan on Jan. 18.
The ministry has not disclosed her nationality and from where she entered Japan.
The woman in her 30s, who is in stable condition, is said to have had no symptoms at the time of arrival but developed a fever and started coughing on Tuesday night, according to the ministry.
She visited a Tokyo hospital on Thursday and later tested positive for the virus, which has killed at least 41 people in China.
The number of people with pneumonia caused by the virus topped 1,300 worldwide on Saturday, just as hundreds of millions of Chinese citizens set out on domestic and overseas trips at the start of the Lunar New Year holiday.
China coronavirus Death toll rises
Health officials in China say a coronavirus has killed 15 more people in the province of Hubei, where the outbreak first started.
There are currently 1,287 confirmed cases in China, 41 of whom have died.
It comes as China is begins celebrations of the Lunar New Year, one of the most important dates in its calendar.
Many events have been cancelled and a new hospital is being built in the city of Wuhan.
The virus has now spread to Europe, with three cases confirmed in France.
The first case was in Bordeaux, while the other two were in the Paris area, the French health minister said on Friday night.
And one case has been confirmed in Australia.
Chinese media outlets said the new 1,000-bed hospital could be ready within six days. A total of 35 diggers and 10 bulldozers are currently working on the site.
The project will “solve the shortage of existing medical resources” and would be “built fast [and] not cost much… because it will be prefabricated buildings”, the Changjiang Daily said.
Pharmacies in Wuhan have begun to run out of supplies and hospitals have been filled with nervous members of the public.
Symptoms seem to start with a fever, followed by a dry cough and then, after a week, leads to shortness of breath and some patients needing hospital treatment.
Around one-in-four cases are thought to be severe.
What restrictions are in place in Hubei?
Travel restrictions vary from city to city.
Wuhan is effectively on lockdown: all bus, metro and ferry services have been suspended, and all outbound planes and trains cancelled.
Residents have been advised not to leave, and roadblocks have been reported.
Ezhou, a smaller city in Hubei, shut its railway station. The city of Enshi has suspended all bus services.
And the rest of China?
City officials in the capital, Beijing, and Shanghai have asked residents who return from affected areas to stay at home for 14 days to prevent the spread of the virus, local media report.
- Have you been affected? Get in touch: firstname.lastname@example.org
Authorities have also shut major tourist sites including the Forbidden City in Beijing and a section of the Great Wall, and cancelled major public events in other parts of the country, including:
- Traditional temple fairs in Beijing
- An international carnival in Hong Kong
- Hong Kong’s annual football tournament
- All public Lunar New Year celebrations in Macau
Shanghai’s Disney Resort is temporarily closing, as are McDonald’s restaurants in five cities.
On Thursday, a coronavirus patient died in northern Hebei province – making it the first death outside Hubei.
Another death was later confirmed in north-east Heilongjiang province, more than 2,000km (1,200 miles) from Wuhan.
Earlier, when the death toll was 17, information from China’s National Health Commission said the youngest person who died from the virus was 48 and the oldest was 89.
But 15 of the 17 were over 60, and more than half suffered from other chronic diseases including Parkinson’s and diabetes. Just four were women.
What’s the global situation?
French Health Minister Agnès Buzyn said one of the French cases, a 48-year-old man of Chinese origin who had been visiting Wuhan, had been hospitalised in Bordeaux. Little was known about the second case, in hospital in Paris, except that the patient had been travelling in China.
It was likely other cases would occur in Europe, Ms Buzyn added.
She confirmed a third case, in Paris, later on Friday evening.
On Saturday, Australia reported its first case, a patient who is in hospital in Melbourne, after arriving from China last weekend.
Earlier on Friday a case was confirmed in Chicago, the second in the US.
Singapore confirmed its third case, known to be the son of another patient, also on Friday. Nepal recorded its first case on the same day.
Thailand has five cases confirmed; Japan, Vietnam and South Korea two each; and one in Taiwan.
The World Health Organization has not classed the virus as an “international emergency”, partly because of the low number of overseas cases.
“It may yet become one,” said the WHO’s director-general, Dr Tedros Adhanom Ghebreyesus.
Learn more about the new virus
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Federal Government Increasing Measures to Monitor Wuhan Novel Coronavirus Risks at Canadian Airports, Including Pearson – Government of Ontario News
TORONTO — Today, Christine Elliott, Deputy Premier and Minister of Health, and co-chair of the federal-provincial-territorial health table, released the following statement on Ontario’s preparedness for the Wuhan novel coronavirus following a joint call with her federal and provincial counterparts:
“While there remain no confirmed cases of the virus in Canada, the federal government is putting in place enhanced screening and detection measures at Toronto Pearson International Airport to further protect the health of the public from the Wuhan novel coronavirus.
Today, I joined Patty Hajdu, Minister of Health for Canada, and my ministerial colleagues from each of the provinces and territories to share important information and further coordinate our joint efforts to protect the health and well being of all Canadians, including Ontarians, from the emerging issues of the Wuhan novel coronavirus. The federal government outlined their enhanced measures, which now include:
- Screening questions at border kiosks will now include questions about previous travel to Wuhan, China in the past 14 days. A positive response would trigger an enhanced screening process, including sending the traveller to a Canadian border agent for further questioning about their health status. The border agent will determine whether the traveller needs to seek immediate medical assessment and treatment and, if so, EMS will transport the traveller from the airport directly to hospital. This screening will be done in Vancouver and Montreal as well.
- Fact sheets are also being developed in English, French and Chinese for people who have travelled to China and are not currently exhibiting signs of illness. These fact sheets will outline the symptoms that individuals should watch for and any next steps should they experience symptoms, including seeking an immediate medical assessment.
The federal government’s enhanced screening measures build on Ontario’s robust and comprehensive protocols in place to actively monitor for, detect and contain any suspected cases of Wuhan novel coronavirus. The federal government’s measures will further support my ministry, in collaboration with Public Health Ontario, local health units, hospitals and health care providers, to monitor the Wuhan novel coronavirus and contain any cases, should one present in Ontario.
While the risk to Ontarians remains low, we will continue to be in close contact with the Public Health Agency of Canada and other jurisdictions to monitor this developing situation and safeguard the health of all Ontarians.
I’d like to thank all our partners for their on-going efforts in responding to this emerging situation. I want to reiterate our top priority will always remain safeguarding the health of the public, patients and care providers.”
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