#14,641
Now that a novel coronavirus has been linked to the outbreak of pneumonia in Wuhan, China (see WHO (WPRO) Statement On Cluster Of Pneumonia Cases In Wuhan, China) - public health authorities around the world are racing to set up protocols to deal with its possible spread.
While detailed information on this particular novel coronavirus is still making its way out of China, we do have two other novel coronavirus outbreaks (SARS in 2003 and MERS 2012-present) from which to form some preliminary guidance.Despite both being coronaviruses - likely of bat origin - MERS and SARS have played out quite differently. SARS come out of the gate far more aggressively among humans than MERS, spreading out of China and infecting thousands of people around the world in a matter of months (see SARS And Remembrance).
SARS produced a roughly 10% mortality rate, and was eventually contained and eradicated due to the use of aggressive surveillance and quarantining of exposed individuals, along with having a fortuitous lack of a widespread non-human intermediary host.
MERS-CoV on the other hand, emerged in humans long after it had quietly become endemic in dromedary camels (see Epi.& Inf.: Global Status Of MERS-CoV In Camels - A Systemic Review). While it has a much higher mortality rate (35%) - it is (thus far) less easily transmitted between people than SARS.
Unfortunately, infected camels continue to reintroduce the virus back into the human population. And so, unlike SARS - which was eradicated in a matter of months - MERS continues to spillover and spread in the Middle East.The ecology of this new novel coronavirus is still unknown. It likely emerged from bats, since surveillance studies have identified a number of novel coronaviruses among chiropteran species in China (see PNAS: SARS-like WIV1-CoV Poised For Human Emergence), but to what intermediate species has yet to be determined.
If it has jumped to something ubiquitous, like pigs, and is spreading widely, then we could have a sizable problem. If it is being carried by something with less direct human contact, then containment should be easier.While we'll get answers to many of these questions in the days and weeks ahead, for now public health entities need to enact procedures and protocols to deal with its potential arrival. To that end, on Wednesday of this week, the CDC issued a HAN Advisory: Pneumonia of Unknown Etiology (PUE) in Wuhan, China.
Over the past 72 hours a coronavirus origin has been established, and so yesterday the UK's PHE (Public Health England) issued a pair of detailed initial guidance documents - along with travel advice - based largely on past experiences with SARS and MERS-CoV.
For the past two weeks we've been dealing with a number of awkward descriptive terms for this outbreak - ranging from the cautious ` Pneumonia of Unknown Etiology (PUE) ' coined by the CDC to the equally vague (and overused) `novel coronavirus'.The UK's PHE has apparently adopted WN-CoV (Wuhan Novel Coronavirus), although it will probably take months before an officially sanctioned name is decided upon. At this point, anything that differentiates it from SARS seems an improvement.
First, a synopsis and links to the new (lengthy and detailed) guidance from the UK's PHE, then I'll return with a postscript.
Wuhan novel coronavirus
Information on Wuhan novel coronavirus, including assessment and management of suspected UK cases.
Published 10 January 2020
From:Public Health England
This page contains information and advice on Wuhan novel coronavirus (WN-CoV).
On 31 December 2019, WHO was informed by the People’s Republic of China of cases of pneumonia of unknown microbial aetiology associated with Wuhan City, Hubei Province, central China.
In the report to WHO on 3 January 2020, there were 44 cases of WN-CoV, which 11 were reported as severely ill.
Some but not all cases were associated with Wuhan South China Seafood City market, which sells meat, live animals and seafood.
A Wuhan Municipal Health Commission update (in Chinese) on 5 January reported 59 cases, including 7 critically ill patients, with no deaths. The first case became unwell on 12 December 2019 and the onset date of the last case was 29 December 2019.
On 9 January 2020, WHO announced that a novel coronavirus had been detected in patient samples in Wuhan.
Reports as of January 2020 describe no evidence of significant human to human transmission, including no infections of healthcare workers.
Cases of pneumonia possibly linked to Wuhan City have been assessed in Hong Kong and other neighbouring countries.
Documents
Wuhan novel coronavirus: initial investigation of possible cases10 January 2020
Guidance
Wuhan novel coronavirus: infection prevention and control10 January 2020
Guidance
Just as the case counts have changed over the past 24 hours (down to 41 confirmed), and we've learned more about this virus's similarity to other coronaviruses, all of this preliminary guidance is subject to revision and change.
It is far too soon to even guess whether this `WN-CoV' virus will follow a MERS-like, or a SARS-like trajectory, or perhaps even more likely, carve out a unique path of its own.What we can say, using nautical terms, is that this outbreak is Nature's most recent shot across our collective bow, and whether this escalates or not, we can expect more to come in the months and years ahead.
We live in an age of emerging and re-emerging infectious diseases (see The Third Epidemiological Transition (Revisited)) - and while most of these threats will be limited in scope or can be contained - another devastating pandemic is probably inevitable (see WHO/World Bank GPMB Pandemic Report : `A World At Risk').
We go forward unprepared for that eventuality at our own peril.
