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Health; The Chinese coronavirus fears

Health; The Chinese coronavirus may soon become a global health emergency

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The virus, which has infected more than 600 people and caused at least 18 deaths, arrived in Washington state this week.

A never-before-seen virus, detected in the Chinese city of Wuhan, has claimed at least 18 lives and infected hundreds of Chinese citizens with a pneumonia-like illness, according to China’s National Health Commission. The virus was first reported to the World Health Organization on Dec. 31 and has been under investigation since then. Chinese scientists have linked the disease to a family of viruses known as coronaviruses, the same family as the deadly SARS and MERS viruses.

Scientists have yet to fully understand how destructive the new virus, known as 2019-nCoV, might be. Researchers and investigators are just beginning to understand where it originated, how it’s transmitted and how far it has spread.

As of Thursday, case numbers had skyrocketed to more than 600 in China and abroad. Chinese authorities also confirmed that health workers have been infected with the virus, suggesting that it has achieved human-to-human transmission. As a result, authorities are taking steps to guard against its spread. On Thursday, the WHO reconvened an emergency committee to explore whether the virus constitutes a public health emergency. The body decided that it’s “still too early” to declare an emergency on a global level.

The Emergency Committee on the new #coronavirus (2019-nCoV) considered that it is still too early to declare a public health emergency of international concern given its restrictive and binary nature

— World Health Organization (WHO) (@WHO) January 23, 2020

The situation is rapidly evolving. We’ve collated everything we know about the mystery virus, what’s next for researchers and some of the steps you can take to reduce your risk.

What is a coronavirus?
Coronaviruses belong to a family of viruses known as Coronaviridae and look like spiked rings under an electron microscope. They are so named because of these spikes, which form a halo around their viral envelope.

Coronaviruses contain a strand of RNA within their envelope and cannot reproduce without getting inside living cells and hijacking the machinery found within. The spikes on their viral envelope help them bind to cells, which gives them a way in. It’s like blasting the door open with C4. Once inside they turn the cell into a virus factory, using its molecular conveyor belt to produce more viruses which are then shipped out. The virus progeny infect another cell and the cycle starts anew.

Typically, these types of viruses are found in animals ranging from livestock to household pets and wildlife such as bats. When they make the jump to humans, they can cause fever, respiratory illness and inflammation in the lungs. In immunocompromised individuals, such as the elderly or those with HIV-AIDS, such viruses can cause severe respiratory illness.

Extremely pathogenic coronaviruses were behind SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) and were easily transmitted from human to human. SARS, which showed up in the early 2000s, infected more than 8,000 people and resulted in nearly 800 deaths. MERS, which appeared in the early 2010s, infected almost 2,500 people and led to more than 850 deaths.Where did the virus come from?

The virus appears to have originated in the Huanan Seafood Wholesale Market in Wuhan, a Chinese city of over 11 million people about 650 miles south of Beijing. The market sells fish, as well as a panoply of other animal meats. However, it’s still unknown whether it emerged from an animal species like SARS and MERS did. The Wuhan market was shut down on Jan. 1.

Markets have been implicated in the origin and spread of viral diseases in past epidemics, and a large majority of the confirmed cases seen so far had been to the Huanan Seafood marketplace in recent weeks. The market seems like an integral piece of the puzzle, but researchers will need to conduct a range of experiments and tests to confirm the virus’ origin.

“Testing of animals in the Wuhan area, including sampling from the markets, will provide more information,” said Raina MacIntyre, a head of the biosecurity research program at the University of New South Wales’ Kirby Institute.

On Wednesday, a report in the Journal of Medical Virology by a team of Chinese researchers suggested snakes were the most probable wildlife animal reservoir for 2019-nCoV. The work examined the genetic code of the virus and compared it with two types of snakes, the many-banded krait and the Chinese cobra. The research demonstrated the snakes’ genetic shared the most similarity to the virus. Other animals known to be sold at the Huanan market (marmota, hedgehogs, bats and birds) were also analyzed — but did not show the same level of genetic likeness.

Another study refuted these claims suggesting 2019-nCoV was harbored by bats.

Here’s a study refuting the evidence for the snake as a #coronavirus reservoir. Suggests that the closest coronavirus relatives are found in bats (bats were also considered the reservoir for SARS in 2003)https://t.co/gRHWIdwMFX

— jackson ryan 🙏 (@dctrjack) January 23, 2020

“We haven’t seen evidence ample enough to suggest a snake reservoir for Wuhan coronavirus (2019-nCoV),” said Peter Daszak, president of non-profit EcoHealth Alliance, which researches the links between humans and animal health.

“This work is really interesting, but when we compare the genetic sequence of this new virus with all other known coronaviruses, all of its closest relatives have origins in mammals, specifically bats. Therefore, without further details on testing of animals in the markets, it looks like we are no closer to knowing this virus’ natural reservoir.”

How many confirmed cases have been reported?
Authorities have confirmed more than 600 cases as of Thursday. The bulk are in China, with a handful of cases confirmed in Thailand, Japan, South Korea and the US, where a man in his 30s in Washington state has been confirmed to have the disease. A suspected case in Australia was revealed not to be coronavirus.

National authorities in China continue to monitor over 1,300 residents who visited the Wuhan market or have had prolonged contact with those presenting symptoms of the novel disease.

Officials in Hubei province, where Wuhan is located, said Wednesday that the virus is responsible for 18 deaths. The first death was a 61-year-old man who had frequented the Wuhan market and had chronic liver disease and abdominal tumors. The second was a 69-year-old man who went to a hospital with severe damage to multiple organs.

A study, published by the Imperial College London on Jan. 17, estimates the total number of 2019-nCoV cases could be much higher than reported, reaching over 1,700 cases. The work, led by Neil Ferguson, calculated how far the virus is likely to spread based on its incubation period and the amount of travel in and out of Wuhan since it was first detected.

How do we know it’s a new coronavirus?
In short, genes.

Chinese scientists were able to isolate and unravel the genetic code of the virus from patients, ruling out other potential causes such as influenza, and confirm it is completely new. However, the genetic code shows this virus has around 70% similarity to the SARS coronavirus.

Understanding the genetic code also helps researchers in two ways: It allows them to create tests that can identify the virus from patient samples and gives them potential insight into creating treatments or vaccines.

How does the coronavirus spread?
This is one of the major questions researchers are working feverishly to answer. Although the first infections were potentially animal-to-human transmission, it’s likely that human-to-human transmission has followed.

On Monday, the University of Minnesota’s Center for Infectious Disease Research and Policy reported that health workers in China had been infected with the virus. This was a notable turning point in the previous SARS epidemic, as health workers moving between countries spread the disease.

Chinese authorities have since confirmed that health workers have been infected with the virus, suggesting human-to-human transmission.

“The major concern is hospital outbreaks, which were seen with SARS and MERS coronaviruses,” MacIntyre said. “Meticulous triage and infection control is needed to prevent these outbreaks and protect health workers.”

China has shut down Wuhan, canceling transportation leaving the city starting at 10 a.m. Thursday to reduce the spread of the virus. The travel restrictions, which are being extended to four other cities (Huanggang, Ezhou, Chibi and Zhijiang), will be in effect until an as-yet unspecified date. The restrictions come during a busy travel period for China, when citizens typically travel for the Lunar New Year.

WHO convenes emergency committee
Tedros Adhanom Ghebreyesus, the director-general of the WHO, convened an emergency committee on Wednesday to ascertain whether this new virus constitutes a public health emergency.

“There was an excellent discussion during the committee today, but it was also clear that to proceed, we need more information,” Ghebreyesus said during a press conference on Wednesday. A full replay of the press conference is below.

LIVE: Press conference on the Emergency Committee meeting on new #coronavirus (2019-nCoV) https://t.co/8WOYQk9Scf

— World Health Organization (WHO) (@WHO) January 22, 2020

The emergency committee reconvened Thursday to continue to discuss the outbreak. On Thursday, the committee decided that it was “still too early” to declare a public health emergency.

“If WHO declares a public health emergency of international concern, it enables WHO greater powers for disease control using the International Health Regulations,” MacIntyre said.

In the fall, an emergency committee met regarding the ebola virus epidemic in the Democratic Republic of the Congo. The meeting outlined key strategies and commitments to strengthen and protect against the spread of the disease.

What are the symptoms?
The new coronavirus causes symptoms similar to those of previously identified disease-causing coronaviruses. In currently identified patients, there seems to be a spectrum of illness: A large number experience mild pneumonia-like symptoms, while others have a much more severe response.

Patients present with:

Elevated body temperature
Dry cough
Shortness of breath or breathing difficulties.
As the disease progresses, patients may also present with pneumonia, which inflames the lungs and causes them to fill with fluid which can be detected via X-ray, according to the WHO.

Is there a treatment for coronavirus?
Coronaviruses are notoriously hardy organisms. They’re effective at hiding from the human immune system, and we haven’t developed any reliable treatments or vaccines that can eradicate them. In most cases, health officials attempt to deal with the symptoms.

“There is no recognized therapeutic against coronaviruses,” said Mike Ryan, executive director of WHO Health Emergencies Programme during the Emergency Committee press conference on Wednesday. “The primary objective in an outbreak related to a coronavirus is to give adequate support of care to patients, particularly in terms of respiratory support and multi-organ support.”

That doesn’t mean vaccines are an impossibility, however. Chinese scientists were able to sequence the virus’ genetic code incredibly quickly, giving scientists a chance to study it and look for ways to combat the novel disease. According to CNN, researchers at the National Institute of Health are already working on a vaccine — though note it could be a year or more away from release.

Notably, SARS, which infected around 8,000 people and killed around 800, seemed to run its course and then mostly disappear. It wasn’t a vaccine that turned the tide on the disease but rather effective communication between nations and a range of tools that helped track the disease and its spread.

“We learnt that epidemics can be controlled without drugs or vaccines, using enhanced surveillance, case isolation, contact tracking, PPE and infection control measures,” MacIntyre said.

How to reduce your risk of coronavirus
With confirmed cases now seen in the US, Thailand, Japan, South Korea and potentially Australia, it’s possible that 2019-nCoV could be spreading much further afield. The WHO recommends a range of measures to protect yourself from contracting the disease based on good hand hygiene and good respiratory hygiene, in much the same way you would reduce the risk of contracting the flu.

Meanwhile, the US State Department has issued a travel advisory, urging people to “exercise increased caution in China,” and a warning from the Centers for Disease Control and Prevention advises people to “avoid nonessential travel.”

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