Had the nightmare returned? That’s the question many were asking in the first 10 days of this year, after a new form of pneumonia emerged in Wuhan, a megacity in central China. The outbreak revived memories of severe acute respiratory syndrome (SARS), the disease that emerged in China in 2002 and sickened 8098 people in 37 countries before it was quashed in the summer of 2003. Like SARS, the Wuhan pneumonia cases were linked to a market selling myriad species of live animals, and they appear to be caused by a new member of the coronavirus family closely related to the SARS virus. And once again, China appeared to be less than forthcoming with information.
Today, global health experts are breathing a little easier. As Science went to press, only one of 42 people known to be infected had died: a 61-year-old man already suffering from abdominal tumors and chronic liver disease. (SARS had a 9.6% mortality rate.) No evidence suggests the virus easily passes between humans, which can turn a local problem into a global crisis. And Chinese researchers have now shared the sequence of six genomes of the as-yet-unnamed virus with the world.
Scientists in other countries have used the data. The World Health Organization (WHO) plans to soon publish a diagnostic test for the new virus that was developed by Christian Drosten, a virologist at Charité University Hospital in Berlin, and other researchers based on the sequences released by China. It detects fragments from three different genes in the novel coronavirus that are also present in the SARS virus. “We wanted to use SARS as a basis because every public health laboratory has SARS RNA as a positive control so they can get started immediately,” says Drosten, noting that SARS itself has not been detected in humans in 15 years. Ralph Baric, a coronavirus researcher at the University of North Carolina, Chapel Hill, is already trying to synthesize live virus from the data so that he can study it in animals and help develop a simple-to-use antibody test.
Still, many questions remain. Researchers have not identified the animal species at the marketplace that harbored the virus. When it emerged and the true number of people infected remain a mystery. Meanwhile, a case in Thailand, reported on 13 January—in a tourist who flew from Wuhan to Bangkok—led WHO Director-General Tedros Adhanom Ghebreyesus to consult experts on outbreak responses. The patient had not visited the Wuhan market at the center of the outbreak but had been to other animal markets, WHO reported on 14 January.
The first known patient developed symptoms—which can include difficulty breathing and fever—on 8 December 2019. Officials closed the seafood market on New Year’s Day, and no new patients have been identified in Wuhan since 3 January. The virus was not found in 763 close contacts of those infected, or in health care workers, who often fall ill during outbreaks of viruses that can transmit between humans. “It is a limited outbreak,” says Xu Jianguo, who runs an infectious disease laboratory at the Chinese Center for Disease Control and Prevention and heads an evaluation committee that’s advising the Chinese government. “If no new patients appear in the next week, it might be over.”
WHO said in a 12 January statement that it was “reassured of the quality of the ongoing investigations and the response measures implemented in Wuhan, and the commitment to share information regularly.”
But others criticized the way early information came out. News that researchers had discovered a novel coronavirus came in an 8 January story in The Wall Street Journal; Xu confirmed the finding on a state-run TV station several hours later. “It’s not a good situation when The Wall Street Journal [reports] a SARS-like coronavirus before the Chinese government announces it,” Baric says. On 10 January, Jeremy Farrar, an infectious disease specialist who heads the London-based Wellcome Trust, tweeted his worry about rumors that the Chinese government did not share “critical public health information” because Chinese researchers wanted to ensure publication of their findings in high-profile journals first.
Less than 12 hours later, however, evolutionary biologist Edward Holmes of the University of Sydney published an “initial” sequence of the new coronavirus on virological.org, on behalf of a consortium led by Zhang Yong-Zhen of Fudan University in Shanghai. The next day, three groups working under China’s National Health Commission posted another five sequences of the virus, gathered from different patients, on GISAID, a database primarily used for sharing data on influenza viruses.
The six sequences differ little from each other, which evolutionary biologist Andrew Rambaut of the University of Edinburgh says is “consistent with a point source”—meaning they likely came from the same batch of infected animals at the Huanan Seafood Wholesale Market, which also sells birds, snakes, and rabbit meat. (No coronaviruses have ever been found in fish.) But the fact that cases surfaced over the course of 1 month suggests the source was more than one group of animals at one location, Farrar says: “It makes me worry that whatever the exposure was to, it went on for quite a long time.” Virologist Guan Yi of Hong Kong University agrees that the Wuhan outbreak was caused by multiple jumps from animal to human hosts “separately and independently.”
Whatever species spread the virus at the market may have picked it up from some natural reservoir. Many coronaviruses occur naturally in bats, and the new virus is closest to four bat viruses that have surface proteins capable of infecting human cells. Still, Rambaut cautions there may well be another natural host. “It’s quite similar to a bat virus in parts of its genome, but not so much in other parts,” he says.
Farrar notes that most confirmed cases to date were mild, which means that even before health officials recognized the outbreak, the virus may have infected many other people who never sought medical care. That makes it premature to conclude the pathogen doesn’t spread from human to human, he says. Nurses and doctors, too, may have been infected without anyone noticing, he adds: “With a coronavirus, I’d be very surprised if there wasn’t some limited human-to-human transmission.” So far, cases have been confirmed by detecting nucleic acid from the virus, which disappears after patients recover. Now that the virus has been isolated, researchers can also develop antibody tests that pick up signs of past infection.
Limited as the outbreak appears to date, Farrar and others still worry that travel of hundreds of millions of people for the Lunar New Year celebration on 25 January could spread the virus from Wuhan, a major transportation hub, to other cities. “With people, food and animals move,” says Farrar, who suspects that this outbreak “is not going away anytime soon.”
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.
