The World Health Organization would like more and quicker information about new coronavirus cases, the organization’s head of infectious diseases said Thursday after Saudi Arabia revealed it had found seven additional infections.
The Saudi ministry of health informed the WHO late Wednesday that it had diagnosed the new cases. In the same communication, the Saudis alerted the WHO that five of the infected people were already dead. The remaining two are in critical condition.
Dr. Keiji Fukuda, the WHO’s assistant director general for health security and the environment, said the WHO has been given little information about the new cases, which bring the total number of known infections to 24. It has asked for more detail, Fukuda said in an interview with The Canadian Press.
“As a matter of course we would prefer to hear and know about things as early as possible. The whole aim of detecting (diseases) is really to try to move and protect as quickly as possible,” Fukuda said from Geneva.
“I won’t speak for the government of Saudi Arabia, but I can speak for WHO in saying that it’s a point that we have made and it’s a position that we hold very clearly with everybody.”
Canada’s deputy chief public health officer said this country too would like to see more information, noting that the Public Health Agency of Canada has been watching the outbreak closely since the new virus’s existence was first announced last fall.
“Obviously we have lots of questions,” Dr. Gregory Taylor said in an interview.
“So of these new seven cases, when did they become ill? Have they been ill for a while? Is it a sudden onset? What are their ages? What are their exposures? All that information we’re quite interested in and the WHO is obviously interested in that, so we’re going to heighten our awareness on this one.
“We have no mechanism to force any jurisdiction to release the information. (But) … it’s in everybody’s global best interest, given these things can transmit so quickly, to share the information.”
The new coronavirus is a member of the same family as the pathogen that caused the 2003 SARS outbreak, and triggers a lung disease that is at least as vicious as SARS was. To date, 16 of the infected people have died. A few have recovered and left hospital, and a few more remain in hospitals on breathing machines months after they were infected.
Though the existence of the new virus first hit global radar screens last September, it appears no progress has been made in finding where the virus lives in nature and how people contract it. Teams of infectious diseases specialists from the United States and the United Kingdom went to several affected Middle Eastern countries last fall to try to help find the source, but no results have been revealed and no journal articles have been published as a result of those missions.
The lack of progress on this front worries experts like Dr. Donald Low, the infectious diseases specialist who was a leader in Toronto’s response to the SARS outbreak.
“What continues to concern me is the lack of information regarding its reservoir and the high mortality rate,” Low, chief of microbiology at Toronto’s Mount Sinai Hospital, said via email. “Obviously transmission is continuing to occur from some reservoir and one time it may be with a more adapted strain for humans.”
Comparison of the virus’s genetic code suggests it is most closely related to a bat coronavirus. And as a number of other bat coronaviruses have been found, it is thought this new virus probably originated in some species of the winged mammals. But at this point it is unclear how a bat virus is infecting people.
Experts suspect another animal or animals may be playing a role in spreading the virus, which the WHO calls nCoV for short. A couple of cases had contact with goats and camels before becoming sick, but others reportedly had no exposure to animals.
A WHO statement on the cases said preliminary investigations suggest none of the seven had recently travelled outside the country and none was known to have had animal contact before falling ill.
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The WHO statement also said the agency had been informed that none of the cases were from the same family. That’s important as infections within a family or household might suggest that the virus had spread from one sick individual to others.
Disease experts have been anxiously watching this new coronavirus to see if it will acquire the ability to spread from person to person, as the SARS virus did. So far there has been one confirmed and a couple of suspected cases of limited person-to-person spread, but no evidence of ongoing transmission among humans.
Still, the fact that these cases are not members of the same family doesn’t eliminate the risk that the virus might have spread among them. If they were employees from a single work site, health-care workers who tended a sick case or people who lived near one another in an apartment building, suspicions of human-to-human spread would arise.
Fukuda said the WHO doesn’t know if the cases were linked. “Actually we don’t have much epidemiological information or supporting information about these cases right now. This is again some of the things that we would very much like to know.”
Comments from the Saudi deputy minister of health do not put to rest concerns on this score. Dr. Ziad Memish told a Saudi newspaper, The National, that the cases all occurred at or were being treated in the same hospital, in the eastern part of the country.
“All the cases that have been reported were in the same hospital in Alhasaa. We have not found any cases anywhere else in the eastern region,” Memish told the paper. Memish did not respond to an emailed request for an interview.
In addition to Saudi Arabia, infections have popped up in Qatar, Jordan, the United Arab Emirates and in Britain. Britain, in fact, reported the confirmed case of person-to-person spread, in a cluster of three members of an extended family. But the original infection in that cluster was a man who was ill on his return to Britain from a trip to Pakistan and Saudi Arabia, and the timing of his illness suggests he probably contracted the virus in the latter country.
Though Saudi Arabia has seen the majority of the total cases – 16 infections, 11 of them fatal – the Kingdom’s government has been very close-mouthed about the outbreak. It has released sparse information about cases, and has on other occasions only reported cases publicly when the patient had recovered and left hospital, or had died.
The first known cases of the new infection occurred in April 2012, in a cluster of 11 illnesses in a hospital in Jordan. At the time, a reason for the outbreak wasn’t found. But months later stored samples from two of those cases were tested and found to be positive for the new virus.
The coronavirus was first spotted when a Saudi man died of a mysterious and severe pneumonia last June. When the cause of his illness could not be detected, an infectious diseases specialist sent a sample to Erasmus Medical Centre in Rotterdam, the Netherlands, where virologists determined a new coronavirus was behind the infection.
Since then 21 additional cases have been discovered, but the world appears to be no closer to knowing what the source of the virus is or how it is jumping to people. Said Fukuda: “We need to understand how people are getting infected by this virus and how it’s getting around. And it’s still not clear.”
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