Coronavirus (2019-nCoV) epidemic, an emergency in progress.... and a short article here trying to follow the progress and knowledge on potential global effect, diagnostic testing, and what appears to be early intervention strategies on the part of globally
Mailman School of Public Health, Columbia University, NY, NY, USA
Received 28 January 2020
Coronavirus – Early Responses
Twenty-nine (29) days ago, the Ministry of Health (MOH) of the People’s Republic of China reported cases of pneumonia, of unknown etiology (unknown cause) detected in Wuhan City, Hubei Province to the World Health Organization (WHO) WHO China Country Office (31December 2019) (1). By January 3 2020, a total of 44 case-patients with pneumonia of unknown etiology were reported to WHO. During this reporting period, the causal agent was not identified (2).
Reports of this pneumonia of unknown cause, now classified as novel coronavirus outbreak, in Wuhan, indicated that early cases emanated from an open market selling live poultry, seafood and wild animals. Health authorities in China announced a temporary ban on the trade of wild animals, in response to demands from group of prominent researchers from the Chinese Academy of Sciences, the Wuhan Institute of Virology and the nation’s top universities calling for the government in China to crack down on wildlife markets such as the one at the center of the Wuhan outbreak (3).
By Jan 2, 2020, 41 were admitted to hospital were identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (73%); with 32% having underlying diseases that included diabetes, hypertension, and cardiovascular disease. Twenty-seven (27) of 41 patients had been exposed to human seafood market. And, by 7 January 2020, Chinese scientists had isolated a novel coronavirus (CoV) from patients in Wuhan (3).
While Novel Coronavirus (2019-nCoV) has likely spread from animal to person, Chinese officials report that the spread of disease is predominantly in person-to-person. Since the cause was unknown at the onset of these emerging infections, the diagnosis of pneumonia of unknown cause in Wuhan was based on clinical characteristics, chest imaging, and the ruling out of common bacterial and viral pathogens that cause pneumonia. Suspected patients were isolated using airborne precautions in the designated hospital, Jin Yin-tan Hospital (Wuhan, China), and fit-tested N95 masks and airborne precautions for aerosol-generating procedures were taken. This study was approved by the National Health Commission of China and Ethics Commission of Jin Yin-tan Hospital (KY-2020-01.01). Written informed consent was waived by the Ethics Commission of the designated hospital for emerging infectious diseases (4).
By 20 January, the Chinese Ministry of Health had reported 258 cases in Wuhan, 14 in Guangdong Province, 5 in Beijing Municipality and 1 in Shanghai Municipality. Thus far, 37 cases have been identified in 11 other countries, including Japan, Republic of Korea, Viet Nam, Singapore, Australia, Malaysia, Thailand, Nepal, United States of America, Canada, and France. In other countries, possible cases are under evaluation (5).
WHO issued interim guidance for laboratory diagnosis, clinical management, infection prevention and control in health care settings, home care for mild patients, risk communication and community engagement; provided recommendations to reduce risk of transmission from animals to humans; updated the travel advice for international travel in health in relation to the outbreak of pneumonia caused by a new coronavirus in China; and is working with global expert networks and partners for laboratory, infection prevention and control, clinical management and mathematical modelling (6).
On 23 January 2020, the People’s Daily, China tweeted that “No people in #Wuhan, C China’s Hubei will be allowed to leave the city starting 10 a.m. of Jan. 23. Train stations and airport will shut down; the city bus, subway, ferry and long-distance shuttle bus will also be temporarily closed: local authority (7).”
The WHO Emergency Committee was convened by the WHO Director-General on 23 January 2020 under the International Health Regulations (IHR) (2005) regarding the outbreak of novel coronavirus 2019 in China. After deliberation with the Emergency Committee, WHO declined to classify the outbreak as a global health emergency. WHO plans to reassess that question in ten days, if not sooner (8).
The virus requires close contact to spread between humans and that the majority of those who have perished from the illness suffered from other immune-system deficiencies. As of Sunday, 26 January 2020, the coronavirus was responsible for 80 deaths in China, up from 56 the day before, and more than 2,761 infections, with 5794 suspected cases, according to WHO. All indications are that the number of cases will increase substantially (9).
Researchers from the German Center for Infection Research (DZIF) at Charité – Universitätsmedizin Berlin have developed a new laboratory assay to detect the novel Chinese coronavirus. The work is based on the establishment and validation of a diagnostic workflow for 2019-nCoV screening and specific confirmation, designed in the absence of available virus isolates or original patient specimens. The design relies on close genetic relatedness of 2019-nCoV with the SARS coronavirus making use of synthetic nucleic acid technology. The assay protocol was published by WHO as a guideline for diagnosis detection. The new assay enables suspected cases to be tested quickly (10).
Chinese scientists were able to quickly identify the genetic sequence of the new coronavirus and officials posted it publicly within a few days, allowing scientific research teams to get to work right away. With the genetic code in hand, scientists can start vaccine development work without needing a sample of the virus. According to a JAMA Viewpoint article posted online on 23 January 2020, biomedical researchers are initiating ‘countermeasure development for 2019-nCoV using SARS-CoV and MERS-CoV as prototypes.’ For 2019-nCoV, they hope to proceed more rapidly, using messenger RNA (mRNA) vaccine technology. With these prototypes, it is likely that other researchers will be able to ‘construct viral vectors and subunit vaccines.’ (11)
The European Union issued a request to Member States to share travel advice and report on measures or plans regarding entry screening, or other measures at entry points to inform in writing on clinical management capacities available (stocks of antivirals, shortages), and dedicated hospitals (isolation facilities, respiratory treatment, PPE). The Directorate-General for Health and Food Safety (DG SANTE) is working with European Union Aviation Safety Agency (EASA) on information exchange related to air traffic/contact tracing as well as with air flight operators to share incoming airlines passenger data timely, provide guidelines for entry screening, mapping laboratory and other capacities since 23 January; and circulate a survey on preparedness on capacities, including capacities to manage novel coronavirus, based on survey developed by the European Centre for Disease Prevention and Control (ECDC) (12)
US Centers for Disease Control issued guidance for public health entry professionals, in particular those where known cases have entered the country (San Francisco, New York, Los Angeles, Atlanta and Chicago. An alert was issued to clinicians for careful review of patients with respiratory symptoms, especially for those who had traveled to Wuhan, and guidance for testing and management of home care patients with 2019-nCoV. CDC also reports that it is developing a diagnostic test to detect this virus in clinical specimens, accelerating the time it takes to detect infection, and activated its Emergency Operations Center to better provide ongoing support to the response (13)
- World Health Organization (WHO). Coronavirus. Geneva: WHO; 2020 Available from: https://www.who.int/health-topics/coronavirus
- Pneumonia of unknown cause-China, Disease outbreak news, Geneva: WHO; Available from: https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/
- Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. 2020; (published online Jan 24) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext
- Hornby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet.2020; (published online Jan 24). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30185-9/fulltext
- World Health Organization. (WHO). Novel Coronavirus (2019-nCoV). Situation report – 1. Geneva: WHO; 21 Jan 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf
- Coronavirus: China bars 11m residents from leaving city at center of outbreak, The Guardian. 22 January 2020. https://www.theguardian.com/world/2020/jan/22/coronavirus-china-measures-rein-spread-mutate-disease-death-toll
- Novel coronavirus (2019-nCoV) situation report – 2 (22 January 2020). Geneva: World Health Organization. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200122-sitrep-2-2019-ncov.pdf
- Statement on the meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV), 23 January 2020, Statement, Geneva, Switzerland. Available from: https://www.who.int/news-room/detail/23-01-2020-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)
- World Health Organization. (WHO). Novel Coronavirus (2019-nCoV) SITUATION REPORT – 6 26 JANUARY 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200126-sitrep-6-2019–ncov.pdf?sfvrsn=beaeee0c_4
- CormanVM, OlfertL, KaiserM, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill.2020;25(3): pii=2000045. https://doi.org/10.2807/1560-7917.ES.2020.25.3.2000045Received: 21 Jan 2020; Accepted: 22 Jan 2020
- Paules CI, Marston HD, Fauci AS. Coronavirus Infections—More Than Just the Common Cold. Published online January 23, 2020. https://jamanetwork.com/journals/jama/fullarticle/2759815
- Novel coronavirus 2019-nCoV. https://ec.europa.eu/health/coronavirus_en
- First travel-related case of 2019 novel coronavirus detected in United States. Atlanta, GA: US Centers for Disease Control and Prevention. https://www.cdc.gov/media/releases/2020/p0121-novel-coronavirus-travel-case.html