Evidence for close-contact spread of coronavirus grows

May 13, 2013 (CIDRAP News) – The World Health Organization (WHO) said the growing number of clusters of novel coronavirus (nCoV) cases offers increasing evidence that the virus can spread between people in close contact, as France confirmed the infection in a patient who shared a hospital room with the country's first case-patient.

In addition, two more patients in a hospital-centered cluster of 15 nCoV cases in Saudi Arabia have died, bringing the toll in that cluster to nine, a Saudi official revealed yesterday.

The latest developments raise the global count of nCoV cases to 34, with 20 deaths, for a case-fatality rate of 59%.

Keiji Fukuda, MD, the WHO's assistant director-general of health security and environment, talked about the evidence for close-contact transmission of nCoV in a statement he released yesterday during a visit to Saudi Arabia.

"Of most concern . . . is the fact that the different clusters seen in multiple countries increasingly support the hypothesis that when there is close contact this novel coronavirus can transmit from person-to-person," he said. "This pattern of person-to- person transmission has remained limited to some small clusters and so far, there is no evidence that this virus has the capacity to sustain generalized transmission in communities."

France's second case
The new case in France—the country's second—was also announced by the WHO yesterday. The second patient shared a hospital room in Valenciennes with the first case-patient from Apr 27 to 29, the agency said. It gave no other information about the second patient except to say that he or she was hospitalized and isolated in an infectious disease hospital.

France's first patient is a 65-year-old man who had vacationed in the United Arab Emirates in mid April and got sick after returning home; he tested positive on May 7. French authorities identified 120 contacts of his and tested five of them for the virus. All but the man who had shared a hospital room with the patient tested negative, the WHO said.

Earlier reports said others suspected of being infected included a doctor who treated the first patient at the Valenciennes hospital and a nurse who worked at another hospital where the patient was treated later.

The WHO urged healthcare providers to watch for people who suffer a severe respiratory infection after traveling in areas affected by the novel virus.

Three healthcare-related nCoV clusters have now been reported: one in Jordan in April 2012, which was identified as nCoV retrospectively; the recent cluster in Saudi Arabia, and the one in France.

In addition, as noted in a statement today from the Hong Kong Centre for Health Protection (CHP), three small family case clusters have been reported: one in Saudi Arabia in October 2012, another in the same country in February 2013, and one in the United Kingdom, also in February.

"These outbreaks illustrated the potential for NCoV to spread through health care facilities and close contacts," the CHP said.

More deaths in Saudi Arabia
The two additional deaths in Saudi Arabia were reported by Ziad Memish, MD, the country's deputy minister for public health, according to a Reuters story yesterday. He said 9 of 15 patients in the cluster had died, two more than reported previously. The story gave no identifying information about the victims.

The cluster involves a hospital in Hofuf in the country's Eastern province.

Memish said three suspected cases in Saudi Arabia were still being investigated, including illnesses in patients who previously tested negative.

A separate Reuters story yesterday reported on a Saudi family in which four members were sick with suspected nCoV infection, but only one had tested positive. The father in the family, Mohammed al-Sheikh, died of probable nCoV infection but tested negative, the story said. He was treated at al-Moosa General Hospital in Hofuf.

Two of Mohammed's sons and one daughter also fell ill, but only 33-year-old Abdullah al-Sheikh tested positive, according to Reuters. The story said samples from Mohammed and the other two children were still being tested, but Malek al-Moosa, the hospital's general manager, said it was likely that they had the virus.

Hussein al-Sheikh, 27, told Reuters he got sick on the third day after the death of his father, whom he had often visited in the hospital. The younger man said the infection left him so tired that he couldn't walk for days, and any kind of activity made him cough. He was treated in the intensive care unit of a hospital in Dhahran, also in Eastern province.

The WHO's Fukuda, in his statement, praised Saudi Arabia's response to the outbreak. He said the Saudi government "has taken the novel coronavirus situation very seriously," with actions including increasing surveillance, investigating cases, and implementing control measures. Some public health experts have complained that the Saudis have been slow and stingy with information about nCoV cases.

In other comments, Fukuda cited several of the key unanswered questions about nCoV.

"We don't know where this virus lives," he said. "We know that when people get infected, many of them develop severe pneumonia. What we don't know is how often people might develop mild disease. We also know that most of the persons who have been infected so far have been older men, often with other medical conditions. We are not sure why we are seeing this pattern and if it will change over time."

Fukuda also noted that it's still unclear how people are getting infected and what the risk factors are for either infection or development of severe disease.

He called on all countries to increase awareness of the nCoV threat and on healthcare providers to increase surveillance for the virus.

Although there is no specific treatment for nCoV illness so far, Fukuda said proper supportive treatment can help patients survive it, according to Reuters.

Besides Fukuda, the team of experts that visited Saudi Arabia to help assess the nCoV situation included one other WHO official and four other experts, including two from the United States, one from Singapore, and one from Canada, according to an Arab News story today.

See also:

May 12 statement by Fukuda

May 12 WHO statement on new case in France

May 13 CHP statement

May 12 Reuters story covering new deaths

May 12 Reuters story about suspected cases in Saudi family

May 13 Arab News story

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