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January 23, 2020

#2019-nCoV: Novel Coronavirus Revives Fears Of SARS-CoV And MERS-CoV

#2019-nCoV: Novel Coronavirus Revives Fears Of SARS-CoV And MERS-CoV Commuters wearing facemasks walk at the Hankou railway station in Wuhan, capital of China’s Hubei province, as cases of the novel coronavirus or 2019-nCoV are reported in the city. Photo by AFP

When news broke last December about 44 people in Wuhan City in China’s Hubei province contracting a new coronavirus strain, everyone was reminded of a deadly and highly transmissible disease that gripped the world almost 17 years ago – the severe acute respiratory syndrome-coronavirus (SARS-CoV).

Fears of a revival of SARS-CoV are not unfounded. A viral respiratory illness, SARS-CoV infected a total of 8,098 people in 26 countries from 2002 to 2003, according to the World Health Organization (WHO). Of these, 774 died.

What added to the worries at the time was that SARS-CoV could not be immediately identified, and no treatment was readily available. According to the WHO, SARS-CoV was first reported in the southern Chinese province of Guangdong in November 2002, and it was identified only in February 2003.  It was “thought to be an animal virus from an as-yet uncertain animal reservoir, perhaps bats that spread to other animals (civet cats),” the WHO reported.

The virus spread to Hong Kong through an infected traveler, who transmitted it to 15 other guests in a hotel where he had checked in. These guests, in turn, proceeded to different countries, initiating outbreaks in Vietnam, Singapore and Canada. 

There was no stopping SARS-CoV after this as it could be easily transmitted from one person to another, especially during the second week of illness.  Most of the cases occurred within the health care systems due to the lack of adequate infection control to protect medical workers. 

The WHO said the implementation of “appropriate infection control action practices brought the global outbreaks to an end” – but not before it had declared a global pandemic of SARS-CoV. The WHO declared that the SARS-CoV outbreak was contained on May 14, 2004.

In 2012, however, another type of coronavirus emerged in Saudi Arabia, which spread to 27 other countries.  It was called the Middle East respiratory syndrome-coronavirus (MERS-CoV) and it was believed to have originated from camels.

Based on WHO data, 2,494 people got infected with MERS-CoV and 858 of them died.  The largest outbreak was reported in South Korea, which started with a 68-year-old man who returned from the Arabian Peninsula.

2019 novel coronavirus or 2019-nCoV

The novel coronavirus detected in Wuhan City has been named 2019-nCoV.  It is believed to be less deadly and least transmissible compared with SARS-CoV and MERS-CoV.

Last Monday, Chinese authorities confirmed human-to-human transmission of the novel coronavirus. The United States also announced its first case of 2019-nCoV, joining other countries in ramping up measures to block its spread. The man, a US resident in his 30s who lives near Seattle, is in good condition, according to federal and state officials, and had approached authorities himself after reading about the SARS-like virus in news reports.

The South China Morning Post (SCMP) reported that there were 481 cases of 2019-nCoV and nine deaths as of last night. As of this morning, the SCMP said there are already 552 cases, 541 of which are in mainland China, including 17 deaths. Two of the confirmed cases were in Hongkong, the SCMP said in its report and that the four family members of the first one traveled to Manila via Cebu Pacific flight 5J111 yesterday morning.  

According to the SCMP, the first case involved a Chinese man who boarded high-speed trains from Wuhan to West Kowloon, Hongkong and was intercepted by port health officials because he was showing signs of a fever. His family members, who showed no symptoms, were allowed through.

The family members then stayed at the Empire Hotel Kowloon in Tsim Sha Tsui before taking the flight to Manila.  The Cebu Pacific flight arrived at the NAIA Terminal 3 at 1:20PM on Wednesday, based on FlightStats.com.

Hongkong health authorities have set up a hotline to trace the passengers who were on the same trains as the patient and same flight as his family members, the report added

Based on the same SCMP report, there are confirmed 2019-nCoV cases in Macau (1), Taiwan (1), Vietnam (1), Japan (1), South Korea (1) and Thailand (4). Australia and the Philippines are monitoring possible infections.

Reuters reported that the WHO was set to convene an emergency committee of experts yesterday to assess whether the coronavirus outbreak in China constitutes an international emergency.

Human-to-human transmission

 In a press conference at the Department of Health (DOH) on Tuesday, WHO representative in the Philippines Dr. Rabindra Abeyasinghe said the person-to-person transmission is “demonstrated by the fact” that among the more than 200 confirmed 2019-nCoV cases in China, there are 14 hospital employees who got infected after caring for sick patients.

But Abeyasinghe noted that while this “points to possible human to human transmission,” the theory may not yet be sustained.

“It’s still premature,” he said. “At this point, there is still a lot of unknown issues concerning this novel virus. We are not sure about the source – if they came from animals or meat or another source.  We still need to understand better the mode of transmission.”

Interim guidelines

Since 2019-nCoV is new, there are still no guidelines developed on how it can be prevented and managed.

Because of this, Abeyasinghe said the WHO is recommending the use of the “tried and tested guidelines that we have used for prevention and control of infection during previous coronavirus infections” – referring to MERS-CoV and SARS-CoV.

“We are advocating following those same precautions and management guidelines until we have clearer information that will help us to give more specific guidelines (for 2019-nCoV),” Abeyasinghe said.

DOH Secretary Francisco Duque III said the interim guidelines pertain to the “case definition” of 2019-nCoV to ensure that those infected are immediately identified and given proper treatment management.

“Let me just underscore that there are still many blind spots with regard to the novel coronavirus and the information stream continues,” Duque said at the Kapihan sa Manila Bay forum yesterday. “The interim guidelines of novel coronavirus is aligned with the guidelines as adopted for MERS-CoV. It’s no longer SARS because the latest is MERS-CoV.”

First in the list, Duque explained, is the “case definition,” wherein frontline workers will have to watch out for a person with “acute respiratory illness with a history of cough and colds, requiring hospital admission with no known etiology that is causing the clinical manifestation” in a person.

“In short, you don’t know the cause... And any of the following, any history of travel or any person who lived in Wuhan City and a person who might have interacted with a health care worker (in a facility) where care for acute severe respiratory illness was given, regardless of history of travel and residence (are suspected cases),” Duque said.

Persons manifesting symptoms shall also be investigated if they had direct physical contact with a confirmed case of 2019-nCoV and if they got exposed to health facilities that had reported a case, the health chief added.

 What is coronavirus?

The WHO defines coronavirus as a “large family of viruses that cause illnesses ranging from the common cold to more severe diseases” such as MERS-CoV and SARS-CoV.

“Coronaviruses are zoonotic, meaning they are transmitted between animals and people.  Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans,” the WHO said.

The viruses got the name because they look like a halo or corona – Spanish for crown – when viewed under an electron microscope.

CoV is associated with high fever, headache, body aches and cough. Most patients develop pneumonia.  It is spread by close person-to-person contact through respiratory droplets that are produced when one is sneezing or coughing.

“Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to three feet) through the air and deposited on the mucous membranes of the mouth, nose, or eyes of persons who are nearby,” the WHO said.

The virus can also spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose or eyes.

First 2019-nCoV in the Philippines?

Currently, the DOH is investigating the case of a five-year-old Chinese boy in Cebu City who was found positive for coronavirus.

The boy came from Wuhan and arrived in Cebu City with his mother on Jan. 12 to learn English.  His mother did not manifest any symptoms of coronavirus.

Duque said the case was immediately reported to the Regional Epidemiology and Surveillance Unit of the DOH regional office for Central Visayas and the child was endorsed for admission.

As of Monday, the patient was still “experiencing cough but was currently stable and afebrile,” he said.

Throat swabs from the boy were tested at the Research Institute for Tropical Medicine (RITM) and yielded negative results for SARS-CoV and MERS-CoV.

However, the samples tested positive for the “non-specific pancoronavirus assay,” so the specimen was sent to the Victorian Infectious Disease Reference laboratory in Melbourne, Australia to identify the coronavirus strain that infected the boy.

Duque stressed that while the boy is infected with a coronavirus, it is “not necessarily” the 2019-nCoV. He pointed out that the boy tested negative for six types of coronaviruses, including SARS-CoV and MERS-CoV.

RITM director Celia Carlos explained that the “non-specific pancoronavirus assay” is a screening test for coronaviruses.

She said that if a “specific sequence in the assay detects a coronavirus type,” the results would turn positive for such type. 

“But since we have a new or a novel coronavirus now, there is probably a need for more specific tests to identify the specific strain,” Carlos stressed.

 Contact tracing

As a precautionary measure, Dr. Ferdinand Salcedo, head of the DOH’s Bureau of Quarantine, assured the public that the agency has conducted “contact tracing” of the people who came in contact with the boy, especially those on his flight to the Philippines.

The boy arrived in Cebu at 3 p.m. and was rushed to a hospital at 6 p.m.  He was already manifesting fever, throat irritation and cough prior to entering the country.

Salcedo said they were able to track down the boy’s fellow passengers who sat far from him on the flight, and they were not showing any symptoms.

To keep 2019-nCoV at bay, Salcedo said they would be meeting with airlines and airport authorities to “strengthen border surveillance.” The Epidemiology Bureau, for its part, is heightening its community surveillance of possible cases.

Salcedo said the DOH also wants to make sure that the surveillance protocols for travelers arriving from abroad, especially from countries where 2019-nCoV cases have been reported, are strictly observed by airlines and airport personnel. 

These protocols include the health cards that passengers are required to fill out upon arrival in the Philippines. 

Through these health cards, the DOH can trace the fellow passengers of a traveler who tests positive for an infectious illness.

Salcedo said airline authorities must also report if they have passengers who are feeling sick or manifesting symptoms.

The quarantine bureau has been subjecting incoming travelers to a thermal body scan at the airports to detect fever. 

Those who are found to be febrile are placed under quarantine for assessment by medical personnel.  If required, they will be brought to hospitals that have isolation facilities.

Duque said the DOH is closely monitoring individuals who manifest signs of respiratory infection and have a history of travel to China. The DOH is also coordinating with the WHO and China Center for Disease Control for updates.

He assured the public that systems have been in place and functional in various hospitals nationwide since the SARS-CoV outbreak.

With the expected increase in travel between China and the Philippines because of the upcoming Chinese New Year, Duque urged those going to China to avoid visiting Wuhan City.

He also asked health workers to “be vigilant and take extra precautionary measures when in contact with patients with acute respiratory infection, especially those with travel history to China.”  – With AFP

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