Photo Credit NIAID
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ProMed Mail has recently published two emails from Ziad Memish, Deputy Minister for Public Health for the Kingdom of Saudi Arabia, that outline – in far greater detail – the first 7 coronavirus cases reported yesterday – and adds 3 more to the list.
You’ll find the details, including commentary by ProMed Editors, at NOVEL CORONAVIRUS - EASTERN MEDITERRANEAN (17): SAUDI ARABIA.
Subject: Urgent update on nCOV from KSA
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The following is the summary of the 7 reported cases confirmed microbiologically as of yesterday [2 May 2013]. Prior information was based on preliminary testing both to WHO and the press; we now confirm the following results.
- Case 1: 59 y.o. male with multiple comorbidities. Date of onset of symptoms [14 Apr 2013] and passed away [19 Apr 2013].
- Case2: 24 y.o. male with multiple comorbidities. Date of symptoms [17 Apr 2013] and still in ICU in critical but stable condition.
- Case 3: 87 y.o. male with multiple comorbidities. Date of symptoms [17 Apr 2013] and passed away [28 Apr 2013].
- Case 4: 58 y.o. male with multiple comorbidities. Date of symptoms [22 Apr 2013] still in ICU in stable but critical condition.
- Case 5: 94 y.o. male with multiple comorbidities. Date of symptoms [22 Apr 2013] and passed away [26 Apr 2013].
- Case 6: 56 y.o. male with multiple comorbidities. Date of Symptoms [22 Apr 2013] and passed away [30 Apr 2013].
- Case 7: 56 y.o. male with multiple comorbidities. Date of symptoms [22 Apr 2013] and passed away [29 Apr 2013].
As the NFP for KSA you should know that the investigations are ongoing and include both testing and epidemiology investigations of family members and healthcare workers. So far we have not found symptomatic infection in any healthcare workers linked to these cases. Family investigations for 3 families are to be completed tomorrow [4 May 2013]; the others will be done as we gain access. Sensitivities around grieving are of course an issue.
Subject: Urgent update nCOV cluster KSA
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This is a preliminary update on the status as of a few minutes ago. Three further cases have been discovered from the investigation which is still ongoing:
- Case 8: 53 y.o. female with comorbidities. Date of symptoms [27 Apr 2013] she is in stable but critical condition
- Case 9: 50 y.o. male with comorbidity. Date of symptoms [30 Apr 2013] with pneumonia and he is well on the inpatient ward.
- Case 10: 33 y.o. male with comorbidity. Family contact of a deceased patient. Date of symptoms [28 Apr 2013]. Inpatient in the medical ward and doing well.
As stated earlier our investigation of contacts and active screening of inpatients who fit case definition is ongoing.
Interestingly, 9 of the 10 cases here are male. The ages range from 24 to 94.
Follow this link to read ProMed’s commentary about onset dates and speculation that this virus – like Nipah in Bangladesh – may be jumping to humans from bats that feed on dates.
Saudi Arabia is the world’s second largest producer of dates (following Egypt), and the date tree yields not only fruit, but palm leaves which are used to make many common items (hats, screens, baskets, brooms), along with date juice or syrup.
Some types of bats, which are a suspected vector of the novel coronavirus (see EID Journal: EMC/2012–related Coronaviruses in Bats & mBio: New Coronavirus Linked To Bats) are known to roost in the tops of date palm trees in the Middle East.
Epidemiological investigations have fingered the consumption of raw (uncooked) date palm juice in Bangladesh as Nipah’s primary route into the human population.
The Nipah virus is carried by fruit bats of the Pteropodidae family, and their preference for roosting in the tops of trees rather than caves allows them to contaminate date juice collection jars with their virus laden urine and feces.
Date Palm Sap Collection – Credit FAO
Collection of date palm juice is a seasonal activity (December - May) in Bangladesh, and as you might expect, that time period also defines their Nipah season.
For more on the Nipah virus you may wish to revisit.
Bangladesh: Updating The Nipah Outbreak
Bangladesh: Nipah Update
Update: Hendra In Queensland, Nipah In Bangladesh
As far as the coronavirus goes - It is an interesting theory - but we’ll have to wait to see whether epidemiological investigations find any kind of solid connection.
