Media: France’s 1st MERS-CoV Patient Dies

Extracorporeal membrane oxygenation (ECMO) machine in a ICU patient in Santa Cruz Hospital, Lisbon, Portugalj - Wikipedia

 

 

# 7327

 

It’s being widely reported this morning that France’s first MERS-CoV case (see France: More Details On Imported nCoV Case) - the 65-year old man who returned form Dubai in Mid-April - has died after more than a month of hospitalization.

 

He, and another patient who shared a hospital room with him before he was diagnosed, were both reported to be in grave condition more than a week ago (see France: 2nd nCoV Patient Deteriorates, Placed On ECMO).

 

Although I’ve not found an official statement on the French Ministry of Health website, Reuters and AFP are both reporting the fatality.

 

French victim of coronavirus dies

Last updated: Tuesday, May 28, 2013 3:46 PM

Coronavirus sufferer dies in France - hospital source

Source: Reuters - Tue, 28 May 2013 12:50 PM

Chan: `My Greatest Concern Right Now Is The Novel Coronavirus’

D-G Margaret Chan – WHO

 

# 7325

 

 

If there were any doubts as to how seriously the World Health Organization views the threat posed by the MERS-CoV (novel coronavirus), they were dispelled yesterday by Director-General Margaret Chan during her closing remarks to the Sixty-sixth World Health Assembly in Geneva, Switzerland.

 

Dr. Chan devoted nearly a 1/3rd of her speech to her concerns over this emerging virus.  I’ve excerpted those portions below, but follow this link to read her speech in its entirety.

 

 

WHO Director-General praises the World Health Assembly for its work

Dr Margaret Chan
Director-General of the World Health Organization

Closing remarks at the Sixty-sixth World Health Assembly
Geneva, Switzerland
27 May 2013

(EXCERPT)

 

Ladies and gentlemen,

 

“Transparency” and “solidarity”. These are words I heard repeatedly during the session, and especially during discussion of the item on the International Health Regulations.

 

Looking at the overall world health situation, my greatest concern right now is the novel coronavirus.

 

We understand too little about this virus when viewed against the magnitude of its potential threat.

 

Any new disease that is emerging faster than our understanding is never under control.

 

We do not know where the virus hides in nature. We do not know how people are getting infected. Until we answer these question, we are empty-handed when it comes to prevention.

 

These are alarm bells. And we must respond.

 

The novel coronavirus is not a problem that any single affected country can keep to itself or manage all by itself. The novel coronavirus is a threat to the entire world. As the Chair of committee A succinctly stated: this virus is something that can kill us.

 

Through WHO and the International Health Regulations, we need to bring together the assets of the entire world in order to adequately address this threat. We need more information, and we need it quickly, urgently.

 

As I have announced, joint WHO missions with the Kingdom of Saudi Arabia and Tunisia will take place just as soon as possible. The purpose is to gather all the facts needed to conduct a proper risk assessment. I thank these countries for their cooperation and collaboration.

 

I thank Member States for supporting my views on the seriousness of this situation.

 

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Hong Kong CHP: Update On Novel Coronavirus

 

# 7281

 

Hong Kong’s CHP publishes an online "Communicable Diseases Watch" on a bi-weekly basis, that takes a close look at 2 or 3 infectious disease topics that are currently of concern.  

 

Today’s edition, in addition to carrying reports on listeriosis infection in Hong Kong and summary charts select notifiable diseases and outbreaks in Hong Kong, has a review of the novel coronavirus that has emerged on the Arabian peninsula.

 

Given their history with the SARS virus a decade ago (see SARS And Remembrance), outbreaks of a novel coronavirus anywhere in the world is understandably of of great interest to their public health community.

 

Follow the link to read:

 

Update on Severe Respiratory Disease Associated with Novel Coronavirus

Reported by Dr Henry Mou, Medical Officer, Respiratory Disease Office, Surveillance and EpidemiologyBranch, CHP.

Since September 23, 2012 (as of May 15, 2013), a total of 40 patients have been confirmed suffering from Severe Respiratory Disease associated with Novel Coronavirus (NCoV) worldwide, including 30 from the Kingdom of Saudi Arabia (KSA), three from the United Kingdom (UK), two from Qatar, two from Jordan, two from France and one from the United Arab Emirates (UAE). Most patients are male (79%; 30 of 38 cases with sex reported) and aged from 24 to 94 years (median 56 years).The first case had onset of illness in late March or early April 2012; whereas the most recent case reported had onset on May 8, 2013. Most patients presented with severe acute respiratory disease requiring hospitalisation and eventually required mechanical ventilation or other advanced respiratory support.To date, the case fatality rate is around 50%.
(Continue . . . )

 

While the H7N9 outbreak on the mainland may be closer to home, Hong Kong’s government website www.info.hk.gov carries almost daily updates on the novel coronavirus as well.

 

Two additional overseas cases of Severe Respiratory Disease associated with Novel Coronavirus closely  Monitored by DH

The Department of Health (DH) is today (May 16) closely monitoring two additional cases of Severe Respiratory Disease associated with Novel Coronavirus reported to the World Health Organization (WHO) by the Kingdom of Saudi Arabia (KSA).

According to the WHO, the two patients are health-care workers who were exposed to patients confirmed with novel coronavirus. The first patient is a 45-year-old man who became ill on May 2 and is currently in critical condition while the second patient is a 43-year-old woman with underlying illness who became ill on May 8 and is now in stable condition.

To date, a total of 21 patients have been reported from the outbreak primarily linked to the same health-care facility in Eastern KSA since the beginning of May. Investigation by the KSA government is ongoing.

This brings the latest global number of confirmed cases of Severe Respiratory Disease associated with Novel Coronavirus to 40.

The WHO noted that this is the first time health-care workers have been diagnosed with Severe Respiratory Disease associated with Novel Coronavirus after exposure to patients. In view of recent clusters reported in health-care facilities, health-care workers and hospitals are reminded to maintain vigilance against novel coronavirus and adhere to strict infection control measures while handling suspected cases in order to reduce the risk of transmission to other patients and health-care workers.

"The Centre for Health Protection (CHP) of the DH will seek more information on the cases from the WHO and the relevant health authority. The CHP will stay vigilant and continue to work closely with the WHO and overseas health authorities to monitor the latest developments of this novel infectious disease," a DH spokesman said.

Locally, the CHP will continue its surveillance mechanism with public and private hospitals, practising doctors and the airport for any suspected case of severe respiratory disease associated with novel coronavirus.

(Continue. . . )

nCoV: PPE Adherence & Infection Control

 

 

# 7278

 

While we don’t know exactly how two healthcare workers (HCWs) in Saudi Arabia came to be infected with the novel coronavirus, the fact that it happened – not once . . but twice – should provide a clear signal on the the importance of maintaining proper infection control procedures in healthcare settings.

 

As we aren’t in possession of the facts, I don’t intend to speculate on what factors led to these two HCWs becoming infected.

 

Regardless of what happened, the best defense against this – or any other contagion – in a healthcare environment are solid infection control procedures and strict adherence to wearing the appropriate PPEs (Personal Protective Equipment).

 

Lest anyone think that lapses in taking protective measures  are in anyway unique to hospitals located in `other’ countries, a brief review of the literature shows a different story.

 

Whether due to inadequate infection control protocols, lack of education - or worse, supplies - or simple non-compliance on the part of the HCWs (PPEs can be hot, uncomfortable, and a considerable bother to put on and take off properly), lapses in infection control happen in hospitals around the world on a regular basis.

 

Exhibit A:

 

Infect Control Hosp Epidemiol.

2011 Mar;32(3):293-5. doi: 10.1086/658911.

Factors associated with unprotected exposure to 2009 H1N1 influenza A among healthcare workers during the first wave of the pandemic.

Banach DB, Bielang R, Calfee DP.

Abstract

Protecting healthcare workers (HCWs) from occupational exposure to 2009 H1N1 influenza was a challenge. During the first wave of the pandemic, many HCWs reported that they had been exposed to 2009 H1N1 when they were not using respiratory personal protective equipment. Unprotected exposures tended to be more frequent among HCWs caring for patients with atypical clinical presentations.

In a related article that appeared in Infection Control Today, the findings were discussed.  Excerpts below:

 

Lack of Adherence to Respiratory PPE Seen During First Wave of H1N1 Pandemic

March 8, 2011

(Excerpt)

The researchers note, "The identification of almost five unprotected healthcare exposures for each patient who presented with ILI was a more unexpected finding. Potential explanations include inconsistent use of the screening and isolation protocol, communication barriers, and suboptimal adherence to recommended PPE use. Each of these warrants further research. Previous studies have demonstrated that healthcare worker compliance with respiratory protection guidance, including that related to influenza, is generally poor. A recent study of healthcare workers’ opinions about respirator use identified the need for new equipment that better meets the needs of healthcare workers."

 

Banach, et al. add, "Since substantial numbers of unprotected exposures occurred during this period of heightened awareness of influenza and at a time when vaccination was not an option, it is likely that similar or perhaps even more exposures occur during typical influenza seasons. This highlights the importance of healthcare worker immunization, when available, and the need for a better understanding of barriers to effective implementation of screening protocols and adherence to recommended respiratory PPE use among healthcare workers."

 

Moving on to Exhibit B:

The use of personal protective equipment for control of influenza among critical care clinicians: A survey study.

Daugherty EL, Perl TM, Needham DM, Rubinson L, Bilderback A, Rand CS.

DESIGN, SETTING, AND PARTICIPANTS:

A survey of 292 internal medicine housestaff, pulmonary/critical care fellows and faculty, nurses, and respiratory care professionals working in four ICUs in two hospitals in Baltimore, MD.

MEASUREMENTS AND MAIN RESULTS:

Of those surveyed, 88% (n = 256) completed the survey. Only 63% of respondents were able to correctly identify adequate influenza PPE, and 62% reported high adherence (>80%) with PPE use for prevention of nosocomial influenza. In multivariable modeling, odds of high adherence varied by clinician type. Respondents who believed adherence was inconvenient had lower odds of high adherence (odds ratio 0.42, 95% confidence interval 0.22-0.82), and those reporting likelihood of being reprimanded for nonadherence were more likely to adhere (odds ratio 2.40, 95% confidence interval 1.25-4.62).

CONCLUSIONS:

ICU HCWs report suboptimal levels of influenza PPE adherence. This finding in a high-risk setting is particularly concerning, given that it likely overestimates actual behavior.

 

Both suboptimal adherence levels and significant PPE knowledge gaps indicate that ICU HCWs may be at a substantial risk of developing and/or transmitting nosocomial respiratory viral infection. Improving respiratory virus infection control will likely require closing knowledge gaps and changing organizational factors that influence behavior.

 

I could provide more references (such as Addressing the Challenges of PPE Non-Compliance) but the point is, compliance wearing appropriate PPEs in healthcare facilities is far too often  – as they phrase it above - `suboptimal’.

 

Last week the World Health Organization released their Interim Infection Control Guidance On nCoV, and earlier this month PHAC released their Guidance On Handling H7N9 Cases.

 

Taking an even tougher stance, the CDC released their Interim H7N9 Infection Control Guidelines in the middle of April and are currently recommending their guidance for SARS when dealing with the novel coronavirus (see 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings).

 

These guidance documents will likely change and evolve as we learn more about this virus, but they provide a solid foundation for interim HCW protection.

 

Even though the novel coronavirus is not SARS, there are lessons we can learn from how that epidemic was eventually contained. Hospitals turned out to be an ideal breeding ground for the SARS virus, and it required bold, and difficult steps to stop its spread.

 

With no vaccine or antivirals available containment was accomplished primarily through the use of isolation, quarantine, and stringent infection control measures.

 

For more on how these measures have been successfully used in the past to contain epidemics, you may wish to revisit EID Journal: A Brief History Of Quarantine.

 

Today, in response to the news that two HCWs in Saudi Arabia have been infected, WHO issued a statement  offering the following advice:

 

Health care facilities that provide care for patients with suspected nCoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients and health care workers. Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC).

 

While the future of this virus is unknowable - if it plays out anything like SARS did in 2003 - the battle against this virus may very well end up being won or lost in the trenches of the health care environment.

 

The good news is - that with the proper precautions in place - that’s a battle that experience has shown we can win.

Branswell: Saudi Coronavirus Cluster Increases To 15

 

# 7254

 

Helen Branswell has the details on two more coronavirus cases in Saudi Arabia, retrospectively identified, that were both infected in April. The onset date for one of the cases goes back to April 6th, meaning that this virus began spreading in al Hofuf more than a month ago.

 

Follow the link to read:

 

Saudis find two more coronavirus cases; brings cluster to 15, 7 fatal

By Helen Branswell, The Canadian Press | Associated Press – 37 mins ago

Authorities in Saudi Arabia say they have found two more people who were infected with the new coronavirus in a large cluster of cases in the eastern portion of the country.

 

The two new cases bring the total to date of that cluster to 15 infections, seven of which were fatal.

 

One of the newly detected cases became ill on April 6, meaning the new virus has been spreading in al Hofuf for more than one month.

(Continue . . . )

 

 

 

The ProMed Mail update, referenced by Helen in the above article, can be viewed at this link.

CDC Updates On Novel Coronavirus

 

 

 

# 7253

 

Yesterday (May 8th) the CDC posted updates to their novel coronavirus webpage, including an updated Q&A overview, and a situation update which includes case definitions, links to a variety of guidance documents, and a brief discussion on what is known about this virus, including its potential for transmission.

 

Some excerpts below, but follow the links to read them in their entirety.

 

 

Novel Coronavirus

Updates-May 2013

In all, 31 people in Saudi Arabia, Qatar, Jordan, the United Kingdom, the United Arab Emirates, and France have been confirmed as having an infection caused by the novel coronavirus. Investigations are being done to figure out the source of the novel coronavirus and how it spreads.

 

So far, there are no reports of anyone in the U.S. getting infected and sick with the novel coronavirus.

• March 7, 2013 MMWR: Update: Severe Respiratory Illness Associated with a Novel Coronavirus - Worldwide, 2012-2013
• Update and revised case definition for healthcare professionals and state and local health departments
• Travel Notice: Novel (New) Coronavirus in the Arabian Peninsula and United Kingdom

 

 

 

Update, Case Definitions, and Guidance

Update

CDC continues to work closely with the World Health Organization (WHO) and other partners to better understand the public health risk presented by recently reported cases of infection with a novel coronavirus. As of May 8, 2013, 31 laboratory-confirmed cases have been reported to WHO - 22 from Saudi Arabia, two from Qatar, two from Jordan, three from the United Kingdom, one from the United Arab Emirates, and one from France. The onset of illness was between April 2012 and May 2013 (1). Among the 31 cases, 18 were fatal. Two of the 31 cases experienced a mild respiratory illness and fully recovered.

 

Clusters of cases in Saudi Arabia, Jordan and the United Kingdom are being investigated. The first cluster of two cases, both fatal, occurred near Amman, Jordan, in April 2012. Stored samples from these two cases tested positive retrospectively for the novel coronavirus. This cluster was temporally associated with cases of illness among workers in a hospital (2). A second cluster occurred in October 2012, in Saudi Arabia. Of the four individuals in the household, three were laboratory-confirmed cases, two of them died. In February 2013, a third cluster of three family members was identified in the United Kingdom. All three people tested positive for novel coronavirus. Among them, two died, and one recovered after experiencing a mild respiratory illness. This cluster provides evidence of person-to-person transmission of novel coronavirus. It also provides the first example of mild illness being associated with novel coronavirus infection. A fourth cluster among two family contacts occurred in Saudi Arabia in February 2013. One of the individuals died, and one recovered after experiencing a mild respiratory illness. In May 2013, a fifth cluster was reported in Saudi Arabia and is linked to one healthcare facility. A total of 13 cases have been reported in the cluster, of which seven have died. The Kingdom of Saudi Arabia Ministry of Health is investigating the situation.

 

There is clear evidence of limited, not sustained, human-to-human transmission, possibly involving different modes of transmission such as droplet and contact transmission. But further studies are required to better understand the risks. The efficiency of person-to-person transmission of novel coronavirus is not well characterized but appears to be low, given the small number of confirmed cases since the discovery of the virus.

 

The reservoir and route of transmission of the novel coronavirus are still being investigated. Genetic sequencing to date has determined the virus is most closely related to coronaviruses detected in bats. CDC is continuing to collaborate with WHO and affected countries to better characterize the epidemiology of novel coronavirus infection in humans.

(Continue . . . )

 

 

 

Overview of the Novel Coronavirus

Q: What is the new human coronavirus?

A: The new virus is a beta coronavirus. It is different from other coronaviruses that have been found in people before.

Q: Is this virus the same as the SARS virus?

A: No. The novel coronavirus is not the same virus that caused severe acute respiratory syndrome (SARS) in 2003. However, like the SARS virus, the novel coronavirus is most similar to those found in bats. CDC is still learning about this new virus.

Q: How many people have been infected?

A: From April 2012 to May 2013, a total of 31 people from Saudi Arabia, Qatar, Jordan, the United Kingdom, the United Arab Emirates, and France were confirmed to have an infection caused by the novel coronavirus.

Saudi Arabia: 22 people; 13 of them died

Qatar: 2 people; both survived

Jordan: 2 people; both died

UK: 3 people; 2 died, 1 recovered

UAE: 1 person; died

France: 1 person, receiving treatment

For more information, see the World Health Organization (WHO).

Q: What are the symptoms of novel coronavirus infection?

A: Most people who got infected with the novel coronavirus developed severe acute respiratory illness with symptoms of fever, cough, and shortness of breath. Only two people experienced a mild respiratory illness.

Q: Does the virus spread from person to person?

A: In the UK, one infected person likely spread the virus to two family members. This cluster of cases provides the first evidence of person-to-person transmission. The UK's Public Health England is continuing to investigate this.

(Continue . . .)

FluTrackers: Preliminary Analysis Of 27 Coronavirus Cases

Credit Laidback Al on FluTrackers

 

 

# 7228

 

 

Laidback Al is back at it on FluTrackers, making it easier for all of us to sort out and keep track of the now-year-long slow emergence of the novel coronavirus on the Arabian peninsula.

He provides maps, details, and commentary in his latest analysis, and it is well worth downloading and keeping as a reference.

 

Preliminary Overview of 27 NCoV Cases, May 3, 2013

Laidback Al, Senior Moderator, www.FluTrackers.com

A novel betacoronavirus (NCoV) infecting humans was first identified in late of 2012. Through April 15, 2013, a total of 17 cases have been reported from various countries. Incomplete case patient data on the first 17 NCoV cases can be found at this ECDC link.

 

In the past three days, another 10 cases have been reported, all from Saudi Arabia (FT Link). This discussion presents an over view of the first 27 cases of NCoV. The publicly available information on these cases is limited and sometimes official sources provide conflicting data. The data and discussions presented here are based on the information available as of May 3, 2013.

 

Quote:

 

Coronaviruses are a large, diverse group of viruses that affect many animal species. A few of these viruses cause a wide range of respiratory illness in humans, typically with "common cold" symptoms. Genetic sequence data indicate that this new virus is a beta-coronavirus similar to bat coronaviruses, but not similar to any other coronavirus previously described in humans, including the coronavirus that caused severe acute respiratory syndrome (SARS) . . . (link)

 

This coronavirus is referred to as betacoronavirus 2c EMC2012, but it is also cited in the research literature as HCoV-EMC/2012, NCoV, HCoV, and HCoV-EMC.

 

“HCoV-EMC/2012 is the sixth coronavirus known to infect humans and the first human virus within betacoronavirus lineage C” (link). As noted by the CDC article this coronavirus shares similarities with bat coronavirus (link). Sequence analysis of fecal specimens of bats in Ghana and Europe led researchers to conclude that EMC/2012 originated from bats (link).

(Continue . . .)

 

Al, who provides an abundance of charts, graphs and maps on Flutrackers, frequently produces these in-depth overviews. 

 

Two recent ones well worth revisiting, include:

 

H7N9: A Demographic and Geographic Overview

H5N1 in 2012: The Year in Review

ProMed Mail: Details On 10 Coronavirus Cases In Saudi Arabia

 

Photo Credit NIAID

 

# 7225

 

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
----------------
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
-------------
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.

Saudi Arabia, The Novel Coronavirus, and Risk Communications

Coronavirus – Credit CDC PHIL

# 7224

 

It’s been just over 24 hours since Saudi Arabia first announced their discovery of a number of novel coronavirus (nCoV) cases (see hCoV-EMC: Saudi Arabia Reports 7 Cases, 5 Fatal). Disappointingly, their announcement contained pathetically little in the way of useful epidemiological information.

 

Since then journalists, public health experts, and bloggers have expressed deep concerns over what appears to be ongoing and  serious deficits in the Saudi government’s reporting of cases.

 

Maryn McKenna addressed these issues in New Diseases And National Transparency: Who Is Measuring Up?, yesterday Helen Branswell sought reaction from Dr. Keiji Fukuda in her article Saudi Arabia announces 7 new coronavirus cases, and I had a few choice words of my own in WHO: Novel Coronavirus Update – Saudi Arabia.

 

Today, we’ve got a `twofer’;  one of my favorite journalists, Jennifer Yang of the Toronto Star, interviewing one of my favorite experts, Dr. Jody Lanard (of The Peter M. Sandman Risk Communication Website) on the obvious lack of transparency being shown by the Saudi government in regards to these (and earlier) coronavirus cases.

 

Follow the link below to read the latest on the novel coronavirus, and extended remarks from Jody Lanard.

 

New SARS-related virus kills five more in Saudi Arabia

By: Jennifer Yang Global health reporter, Published on Thu May 02 2013

Saudi Arabia has revealed seven new cases of a novel coronavirus, including five deaths — a surprise announcement that is raising transparency concerns and seems to have caught even the World Health Organization off-guard.

 

<snip>

 

But to Dr. Jody Lanard, a Brooklyn-based risk communication expert who has consulted for the WHO in the past, it appears the Saudi government has been demonstrating a lack of transparency since the new coronavirus first came to public attention in September.

 

“Having analyzed communication as an expert in so many disease outbreaks, Saudi Arabia is showing all the signs of hiding information (and) delaying reports of information,” Lanard said. “We had the SARS outbreak in 2003 and we saw the repercussions of its widespread reach that partly resulted from delayed information — that’s a lesson that should already be learned.”

(Continue . . . )

Saudi Press Release On Novel Coronavirus (nCoV-EMC) Cases

Coronavirus – Credit CDC PHIL

 

# 7216

 

 

My thanks to Gregory Hartl, spokesperson for the World Health Organization, for the link to the Saudi Press release on the seven new novel coronavirus cases (see hCoV-EMC: Saudi Arabia Reports 7 Cases, 5 Fatal).

 

 

What follows is a machine translation from the original Arabic.

 

“Health" monitor seven cases of HIV Coruna five people have died

Riyadh 21 Jumada II 1434 H corresponding to May 1, 2013, SPA

Announced the Ministry of Health Monitoring (7) cases of infection Corona new during the past few days in the province of Al-Ahsa, died, including five people, two in intensive care.

 

The ministry said in a statement released by the evening that The Ministry of Health is doing all the precautionary measures for Mkhaltin for people by routers scientific local and global sampling of them to see if there are cases among them, indicating that it recorded so far 17 confirmed cases of the disease worldwide.

 

Showed that the virus Corona is one of the viruses that infect the respiratory tract, accounting for 15% of the viruses that cause influenza in humans, while the longer this pattern a new not yet exist at the level of the world accurate information about the source of this virus and its modes of transmission, as there is no vaccination and preventive or antibiotic treatment for the virus.

WHO:15th Confirmed NCoV Case

Coronavirus – Credit CDC PHIL

 

# 7001

 

A hat tip to @HelenBranswell for tweeting the latest update from the World Health Organization, announcing the 15th laboratory confirmed novel coronavirus (NCoV) case, that of a 39 year-old man from Saudi Arabia.

 

As I noted with last week’s report (see WHO: Saudi Arabia Reports Another NCoV Fatality), there’s not a great deal of epidemiological detail in this update – save the fact that this patient did not have contact with any previously identified NCoV cases.

 

First the @WHO twitter announcements, followed by the Global Alert & Response (GAR) update.

 

 

Novel coronavirus infection - update

12 March 2013 - The Ministry of Health in Saudi Arabia has informed WHO of a new confirmed case of infection with the novel coronavirus (nCoV).

The patient, a 39-year-old male, developed symptoms on 24 February 2013. He was hospitalized on 28 February 2013 and died on 2 March 2013. Preliminary investigation indicated that the patient had no contact with previously reported cases of nCoV infection. Other potential exposures are under investigation.

To date, WHO has been informed of a global total of 15 confirmed cases of human infection with nCoV, including nine deaths.

Based on the current situation and available information, WHO encourages all Member States (MS) to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. WHO is currently working with international experts and countries where cases have been reported to assess the situation and review recommendations for surveillance and monitoring.

All MS are reminded to promptly assess and notify WHO of any new case of infection with nCoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course.

WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.

WHO continues to closely monitor the situation.

Hong Kong: SFH On Novel Coronavirus Surveillance

 

Coronavirus – Credit CDC PHIL

 

# 6996

 

Hong Kong’s Secretary for Food and Health (SFH), Dr Ko Wing-man, responded to a reporter’s question on the novel coronavirus (NCoV) while attending a public function Sunday morning.

 

This exchange occurred before test results (which were negative) on the recent traveler from KSA (and his spouse) were released, and focused on ongoing surveillance efforts.

 

It’s fair to say that no city experienced a greater impact from the SARS epidemic a decade ago than did Hong Kong. Between March 11th and June 6th, 2003, a total of 1750 cases were identified, and of those, 286 died (see SARS And Remembrance).

 

While this novel coronavirus is not SARS, it is a related coronavirus, and so concerns over its spread are understandably heightened in Hong Kong.

 

 

SFH on suspected case of Severe Respiratory Disease associated with Novel Coronavirus

Following is the transcript of remarks (English portion) made by the Secretary for Food and Health, Dr Ko Wing-man, after attending a public function this morning (March 10):

Reporter: (On a report received by the Centre for Health Protection from Queen Elizabeth Hospital last night about a suspected case of Severe Respiratory Disease associated with Novel Coronavirus), how would the Government step up the surveillance measures especially regarding airline companies?

Secretary for Food and Health: A few days ago, the World Health Organization notified the 14th confirmed case of infection with new Novel Coronavirus causing severe respiratory disease. There has been a total of 14 cases since the discovery of the disease last year.

 

There are also evidences of human to human transmission in the most recent cluster of cases in the United Kingdom.

 

There is currently a patient in the Queen Elizabeth Hospital with a history of travel to the middle-east and with relevant upper respiratory tract symptoms and fever. The specimens of the patient have been sent to the Public Health Laboratory and we could have the result of the rapid test at noon today, the earliest.

 

I would like to take this opportunity to appeal to the public to adopt tightened public and personal hygiene measures. Whenever you are travelling outside Hong Kong, do not get into contact with wild animals, wild birds and poultry.

 

If you got upper respiratory tract symptoms and fever within certain days after you returned to Hong Kong, please take personal protection measures and see a doctor.

 

In particular, do not take wild animals or wild birds as a cuisine.

 

Regarding the airlines, we are considering stepping up preventive measures including incorporating a warning, in particular for inbound air flights especially from the affected areas, to alert the air crew as well as the passengers that if they have fever or upper respiratory tract symptoms, they should report their situation to the crew members and our port health staff.        

Reporter: Is there higher risk right now in terms of the season?

Secretary for Food and Health: At this period of time, when we are in the transition from winter to spring, it is also the peak of the seasonal flu as well as other upper respiratory tract illnesses. I think the whole community at this particular time should tighten the awareness and preparedness.     

Ends/Sunday, March 10, 2013
Issued at HKT 14:18

 

With the reservoir of this novel coronavirus still unknown, the admonition to avoid contact with (or consumption of) wild birds or animals when abroad is an understandable precaution.

 

The SARS epidemic of 10 years ago was linked to the consumption of `wild flavor’ cuisine in Southern China, where exotic animals were butchered and prepared to order. 

 

One popular menu item – palm civits – were later found to carry the virus (see A Civets Lesson). Additional studies suggested that bats may have passed the virus down to civits. 

 

So far, NCoV is only showing up sporadically, and all 14 confirmed cases have had epidemiological ties to the Arabian peninsula.   

 

It remains to be seen just how much of a public health threat this virus actually poses. 

 

Until we understand it better, it is prudent policy to treat this virus with respect. So we can expect to see aggressive measures taken in Hong Kong – and around the world – whenever a suspect case is identified.

Hopefully, as we’ve seen overnight in Hong Kong, most of these cases will turn out negative.

Hong Kong Investigating Fever Case With Travel To Saudi Arabia

 

Credit WHO Coronavirus webpage

 

UPDATE 3/10/12: Test results have now come back negative for the novel coronavirus (NCoV) on this traveler, and his wife. The latest CHP press release indicates he has tested positive for H3 influenza (see Case of fever with travel history to KSA tested negative for novel coronavirus).

 

 

# 6994

 

Public health officials around the world are on the lookout for unusual cases of fever or pneumonia with ties to the Middle East as part of a global NCoV (novel coronavirus) surveillance effort. 

 

The World Health Organization has urged such vigilance, and just yesterday we saw an updated CDC HAN Health Advisory On NCoV issued, as well.

 

When casting a relatively broad surveillance net such as this one, it is realistic to expect that a good many non-NCoV cases will be flagged and tested during the process.

 

Hong Kong’s CHP has tested a small number of suspect cases since last September, and so far, all of them have proved negative for the novel coronavirus. 

 

Today, we have a press release from Hong Kong indicating they have flagged another patient, recently returned from KSA (Kingdom of Saudi Arabia) – and his spouse - for testing.

 

This is the sort of story we are probably going to have to get used to seeing as surveillance efforts regarding this novel virus ramp up.

 

As we’ve seen with other emerging diseases (including H5N1), testing is often done out of an abundance of caution, and results often come back negative.

 

 

Case of fever with travel history to KSA under investigation

The Centre for Health Protection (CHP) of the Department of Health (DH) received a report from Queen Elizabeth Hospital (QEH) tonight (March 9) of a suspected case of Severe Respiratory Disease associated with Novel Coronavirus.

 

The 31-year-old man, with good past health, presented with cough on March 3 and fever and headache since March 9. He was admitted to QEH for isolation and treatment tonight. His current condition is stable.

 

Investigations by the CHP revealed that the patient travelled to the Kingdom of Saudi Arabia (KSA) from March 4 to 7. His wife with no recent travel history has cough and sore throat since March 8. She is also being isolated in QEH as a precautionary measure.

 

Their chest X-ray were clear. Laboratory test results are expected to be available tomorrow.

 

"The CHP will continue its surveillance mechanism with public and private hospitals, practising doctors and the airport for any suspected cases of Severe Respiratory Disease associated with Novel Coronavirus," a DH spokesman remarked.

 

"No human infection with this virus has been identified so far in Hong Kong," the spokesman stressed.

 

The spokesman advised travellers returning from novel coronavirus-affected countries with respiratory symptoms to wear face masks, seek medical attention and reveal their travel history to doctors.

 

The spokesman reminded members of the public to pay attention to personal hygiene, especially wash hands:

 
* Before touching the eyes, nose and mouth;
* Before eating or handling food;
* After using the toilets; and
* After sneezing or coughing and cleaning the nose.

For more information on personal hygiene, members of the public may visit the CHP's website:
www.chp.gov.hk/en/content/9/460/19899.html .

Ends/Saturday, March 9, 2013
Issued at HKT 23:20
NNNN

Hong Kong is particularly proactive in keeping the public informed of public health issues, and so I fully expect we’ll get an update in the next 24 to 48 hours.

The CDC On The Novel Coronavirus (NCoV)

 

Photo Credit NIAID

# 6989

 

This afternoon the CDC has released a series of NCoV updates, including a new MMWR report, an updated Q&A, along with low level travel notice on their Travelers Health website.  

 

Our first stop is the CDC’s NOVEL CORONAVIRUS webpage, where you can find general information about coronaviruses and the following update.

 

Updates-March 2013

In all, 14 people in Saudi Arabia, Qatar, Jordan, and the United Kingdom have been confirmed as having an infection caused by the novel coronavirus. Investigations are being done to figure out the source of the novel coronavirus and how it spreads.

 

So far, there are no reports of anyone in U.S. getting infected and sick with the novel coronavirus.

• March 7, 2013 MMWR: Update: Severe Respiratory Illness Associated with a Novel Coronavirus – Worldwide, 2012-2013
• Update and revised case definition for healthcare professionals and state and local health departments
• Travel Notice: Novel (New) Coronavirus in the Arabian Peninsula and United Kingdom

 

Today’s MMWR update adds to previous reports, such as this one from last October (see CDC. Severe respiratory illness associated with a novel coronavirus—Saudi Arabia and Qatar, 2012. MMWR 2012;61:820).

 

Update: Severe Respiratory Illness Associated with a Novel Coronavirus — Worldwide, 2012–2013

Early Release

March 7, 2013 / 62(Early Release);1-2

CDC continues to work closely with the World Health Organization (WHO) and other partners to better understand the public health risk posed by a novel coronavirus that was first reported to cause human infection in September 2012 (1–3). Genetic sequence analyses have shown that this new virus is different from any other known human coronaviruses, including the one that caused severe acute respiratory syndrome (SARS) (2). As of March 7, 2013, a total of 14 confirmed cases of novel coronavirus infection have been reported to WHO, with eight deaths (4). Illness onsets have occurred from April 2012 through February 2013 (4,5). To date, no cases have been reported in the United States.

 

Three of the confirmed cases of novel coronavirus infection were identified in the United Kingdom (UK) as part of a cluster within one family (6). The index patient in the cluster, a man aged 60 years with a history of recent travel to Pakistan and Saudi Arabia, developed respiratory illness on January 24, 2013, before returning to the UK on January 28 (5,7,8). He was hospitalized on January 31 with severe lower respiratory tract disease and has been receiving intensive care (5,7,8). Respiratory specimens from this patient taken on February 1 tested positive for influenza A (H1N1) virus and for novel coronavirus infection (8). The second patient was an adult male household member with an underlying medical condition who became ill on February 6, after contact with the index patient, and received intensive treatment but died with severe respiratory disease (5,9). This patient's underlying illness might have made him more susceptible to severe respiratory infection. The third patient is an adult female who developed a respiratory illness on February 5, following contact with the index patient after he was hospitalized (5,10). She did not require hospitalization and had recovered by February 19 (5,6). Only the index patient had traveled recently outside the UK. Based on their ongoing investigation of this cluster of illnesses, the UK Health Protection Agency has concluded that person-to-person transmission likely occurred in the UK within this family (6).

 

This recent cluster provides the first clear evidence of human-to-human transmission of this novel coronavirus, coinfection of this novel coronavirus with another pathogen (influenza A), and a case of mild illness associated with this novel coronavirus infection. In light of these developments, updated guidance has been posted on the CDC coronavirus website (http://www.cdc.gov/coronavirus/ncv). Persons who develop severe acute lower respiratory illness within 10 days after traveling from the Arabian Peninsula or neighboring countries* should continue to be evaluated according to current guidelines. Persons whose respiratory illness remains unexplained and who meet criteria for "patient under investigation" should be reported immediately to CDC through state and local health departments. Persons who develop severe acute lower respiratory illness of known etiology within 10 days after traveling from the Arabian Peninsula or neighboring countries but who do not respond to appropriate therapy may be considered for evaluation for novel coronavirus infection. In addition, persons who develop severe acute lower respiratory illness who are close contacts† of a symptomatic traveler who developed fever and acute respiratory illness within 10 days of traveling from the Arabian Peninsula or neighboring countries may be considered for evaluation for novel coronavirus infection. Testing of specimens for the novel coronavirus will be conducted at CDC.

 

Recommendations and guidance on case definitions, infection control (including use of personal protective equipment), case investigation, and specimen collection and shipment for testing, are available at the CDC coronavirus website. Additional information and potentially frequent updates will be posted on the CDC coronavirus website. State and local health departments with questions should contact the CDC Emergency Operations Center (770-488-7100).

 

And finally, the CDC’s Travel Health division has posted an `In the News’ level Travel Notice – the lowest of four stages of  notices they issue (the others in order of increasing importance are Outbreak Notice, Travel Health Precaution, and Travel Health Warning), on the novel coronavirus linked to the Middle East.

 

In the News
Novel (New) Coronavirus in the Arabian Peninsula

This information is current as of today, March 07, 2013 at 00:29 EST

Updated: December 20, 2012

What Is the Current Situation?

In recent months, a new (or novel) coronavirus has been identified in Saudi Arabia, Qatar, and Jordan. Public health authorities around the world are increasing monitoring of respiratory illnesses and collaborating to learn more about the new coronavirus and the disease in humans.

The risk of the new coronavirus for travelers is thought to be low. CDC recommends that travelers to countries on the Arabian Peninsula or neighboring countries monitor their health and see a doctor right away if symptoms such as cough, breathing difficulties, and fever develop. Countries on and near the Arabian Peninsula are Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.

What Is a Coronavirus?

Coronaviruses are a cause of the common cold. A coronavirus also was the cause of the severe respiratory illness called SARS (severe acute respiratory syndrome). SARS caused a global epidemic in 2003, but there has not been any known case of SARS since 2004. This new coronavirus is not similar to the coronavirus that caused SARS.

What Is Known About This New Coronavirus?

Little is known about this new coronavirus. For example, it is not yet known how this virus is spread. What is known is that this virus is different from any other that has been previously found in humans. Symptoms of this new virus appear to be fever, cough, and breathing difficulties.

How Can Travelers Protect Themselves?

Although little is known at this time about how this virus is spread, taking these everyday actions can help prevent the spread of germs and protect against colds, flu, and other illness:

• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Avoid close contact with sick people.
• There is no vaccine for this new coronavirus, but there are shots available to protect you from other illnesses. Be sure you are up to date with all of your shots, and see your healthcare provider at least 4 to 6 weeks if possible before travel to get any additional shots. Visit CDC’s Coronavirus website for more information about this situation and Travelers' Health website for more information on healthy travel.
• This new coronavirus causes a respiratory infection that may be confused with influenza. It is therefore especially important to get a flu vaccine as this will help your doctor look for other causes for your illness should you develop any flu-like symptoms.
• If you are sick
  • Cover your mouth with a tissue when you cough or sneeze, and throw the tissue in the trash.
  • Avoid contact with other people to keep from infecting them.