May 14, 2013 (CIDRAP News) – Two healthcare workers are among six new novel coronavirus (nCoV) cases reported in Saudi Arabia since late yesterday, suggesting that the virus might have spread from infected patients to hospital staff members.
The World Health Organization (WHO) today reported four new cases and indicated that they were part of a hospital-centered cluster in the country's Eastern province. One of the four patients died, two were in critical condition, and one has recovered, the agency said. It said the new cases increased the hospital cluster to 19.
On the heels of the WHO statement came a brief statement from the Saudi Ministry of Health (MOH), saying, "MOH would like to point out that two new confirmed cases of Coronavirus have been detected among health practitioners in the Eastern Region, and they are currently still under the medical observation receiving the proper treatment."
The MOH gave no information about where the patients were working or whether they are now considered part of the hospital cluster, which reports have linked to Al-Moosa General Hospital in Hofuf, Eastern province. Nor did the statement give any other details about the health workers or their condition.
An Agence France-Presse (AFP) story today said the Saudi MOH identified the two sick healthcare workers as nurses.
With the six latest cases, the global count of nCoV cases increases to 40, including 20 deaths. Saudi Arabia's case count appears to have reached 30, with at least 15 deaths.
Of the four new Saudi cases reported by the WHO (and previously by the news media), all the patients have or had multiple preexisting conditions, and two of the three surviving patients are in critical condition, the WHO said. The other patient recovered and has been discharged from a hospital.
The WHO described the patients as:
- A 69-year-old woman who became ill on Apr 25 and has died
- A 48-year-old man who got sick on Apr 24 and is in critical condition
- An 81-year-old man who got sick on Apr 26 and is in critical condition
- A 56-year-old man who fell ill on May 7 and has recovered
The WHO did not say where the patients have been treated, whether any of them are related, or how they might have been exposed to the virus, other than to say that the hospital-centered cluster increased to 19 patients. (The cluster was previously said to include 15 cases.) Nor did the WHO give any information on the patients' preexisting medical problems.
Yesterday a Saudi health official said the number of deaths in the hospital cluster had increased by two, for a total of nine. Today's WHO statement likewise listed the number of deaths in the cluster as nine. It wasn't immediately clear why the 69-year-old woman's death didn't increase the death toll in the cluster to 10.
The hospital cluster has added to the evidence that the novel virus can spread among people who are in close contact. Another hospital cluster has been identified in the past week in France, where a hospital roommate of the country's first nCoV case-patient was reported to have the virus 2 days ago.
The hospital cases also have recalled the SARS epidemic of 2003, which involved another species of coronavirus. Hospital outbreaks played a pivotal role in spreading the virus to 30 countries, ultimately killing about 800 people.
In related developments, a leading German virologist expressed concern that Saudi Arabia has not been sharing nCoV samples with European laboratories so they can study it, according to a report today from the German news broadcaster Deutsche Welle. The story quoted Christian Drosten, MD, director of the Institute of Virology at the University of Bonn Medical Center.
"We are all really trying to collaborate and provide materials, diagnostic tests and also assistance," Drosten said. "But what we don't really see is feedback in terms of samples for investigation. Because it's what we really need to do. We need to look at the virus—especially if we are concerned that the virus could evolve. The virus could change and optimize itself and spread more efficiently."
Drosten said it was unclear whether the lack of sample sharing is due to political factors or other reasons. "The solution to the whole thing is of course to establish lab capacity there, in the country, but this is a process," he commented.
Also today, experts told ABC News that vaccines are unlikely to play a role in controlling nCoV, mainly because it's hard to develop vaccines for coronaviruses. Instead, infection control is likely to be the key weapon, as it was in stopping the SARS epidemic, the experts said.
"There was no vaccine for SARS," Robert Atmar, MD, a professor in the departments of medicine and molecular virology and biology at Baylor College of Medicine in Houston, told ABC. "But the public health system was able to control the infection and basically eradicate it. That might also work for this new coronavirus."
Atmar said it's very difficult to devise vaccines for coronaviruses. Some candidate SARS vaccines caused lung damage in mice that were exposed to the virus, and there was concern that the same thing could happen in humans, he explained.
May 14 Saudi MOH statement
Drosten comments reported May 14 by Deutsche Welle