Germany, Saudi Arabia report new novel coronavirus cases

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Mar 25, 2013 (CIDRAP News) – The German media and Saudi Arabia's health ministry have reported two new novel coronavirus (NCoV) cases, one in a patient hospitalized in Munich and the other a mild illness in a Saudi Arabian resident.

According to an early report today in German from Abendzeitung, a news source based in Munich, the German patient arrived in Germany from the Middle East by medical transport. It says the patient is in isolation in the intensive care unit (ICU) at Munich Municipal Hospital.

The patient is a 73-year-old man from the United Arab Emirates who was first treated in an Abu Dhabi hospital on Mar 19, another German news source, TZ Online, reported today. It said medical authorities are monitoring about 50 people who had contact with the patient.

The case appears to be Germany's second NCoV case. In October a Qatari man was hospitalized and treated in Germany but has since recovered. The man's NCoV infection wasn't detected until almost a month after he was hospitalized, and so far no evidence of infection has been found in any of that case-patient's German contacts.

Saudi Arabia's health ministry said its new case is a contact of a 39-year-old man who died in early March from the disease in that country, according to a Mar 23 World Health Organization (WHO) statement. The patient had a mild illness, recovered, and has been discharged from the hospital. It said there isn't enough information to allow a conclusive assessment of the mode and source of transmission.

The WHO provided no other details about the patient's NCoV infection. However, Ziad Al-Memish, undersecretary with the health ministry, said the patient is from Riyadh, Arab News, an English-language newspaper based in Jeddah, reported yesterday. He added that the ministry has taken prevention measures and is monitoring the disease.

The latest infection in Saudi Arabia  appears to represent yet another instance of a mild illness in a person who had contact with another infected patient. Though the disease has been fatal for many patients infected with NCoV, the emergence of mild cases has raised questions about surveillance for the disease and whether people with asymptomatic or mild disease could be playing a role in the spread of the virus.

In a related development, the index patient in a recent three-case British family cluster has died, according to a Mar 23 Birmingham Mail report. The man died at Wythenshawe Hospital in Manchester on Mar 19, and his body has been taken to Pakistan for burial. The 60-year-old man got sick at the end of January after traveling to Pakistan and Saudi Arabia and has remained hospitalized.

The Saudi Arabian case pushes the number of WHO-confirmed NCoV cases to 16, and the UK death raises the fatality count to 10. That count does not include Germany's new case.

The second patient sickened in the UK family cluster was a 38-year-old male household contact who died on Feb 17. The Birmingham Mail report said he was the older man's son. The third patient is a 30-year-old woman from a different household who got sick with a mild NCoV infection after visiting the older man three times in the hospital.

Two other clusters have been reported among the NCoV cases, but few details are known. One involved three members of one Saudi family and the other included two Jordanian deaths that were part of a cluster linked to a hospital ICU.

In other coronavirus developments, though NCoV doesn't appear to spread easily from person-to-person so far, some infectious disease experts aren't ruling out the possibility that "superspreaders" could contract the virus and contribute to a more global outbreak, much the way SARS (severe acute respiratory syndrome) spread 10 years ago, the Canadian Press (CP) reported today.

Ron Fouchier, PhD, told the CP that the current transmission pattern could change quickly if an NCoV superspreader were hospitalized in a facility that didn't recognize the disease and take precautions. The CP story noted that during the SARS epidemic only a few people infected a fair number more, which uncovered the disease and sparked global panic.

Donald Low, MD, a microbiologist from Toronto who played a key role in Canada's response to SARS, told the CP that it's impossible to predict the spread of NCoV, because coronaviruses are RNA viruses, which are known for mutating rapidly.

See also:

Mar 25 Abendzeitung Google translation

Mar 25 TZ Online Google translation

Mar 23 WHO statement

Mar 23 Birmingham Mail story

Mar 25 CP story

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