January 24, 2020

expert reaction to first clinical data from initial cases of new coronavirus in China

Studies, published in The Lancet, report on the initial cases of the Wuhan coronavirus outbreak in china. 

Prof William Keevil, Professor of Environmental Healthcare, School of Biological Sciences, University of Southampton, said:

What does this paper tell us about the outbreak, what are we learning, what do we still need to learn?

“The latest published information indicated that middle aged healthy people are more susceptible, similar to SARS, especially men. One possibility for middle aged men being more susceptible might suggest regular smoking, similar to Legionnaires’ disease? The Wuhan coronavirus is 80% related to SARS and enters lung cells using the same receptor ACE2. It is even more related to other bat coronaviruses, pointing to bats as the original reservoirs of SARS and now Wuhan coronavirus; with the virus then jumping into other species such as civets in the case of SARS and camels in the case of MERS. Interestingly, the Wuhan market sold live mammals such as bats, rabbits and marmots (large ground squirrels).  So called “wet markets” selling live animals are common in Asia and this increases the risk of viruses being able to spread into humans.

What do these results suggest about what the future of the outbreak may look like?

“The problem is that we still do not have enough data to accurately specify the Ro (above 1 means more rapid and extensive spread). WHO said “may be sustained human to human” transmission which might suggest it could be widespread over a long time period unless containment and surveillance measures are maintained.

“Other research*, which has not yet been through peer review suggests that the Ro may be quite high, so if this is confirmed and the virus were to mutate in future to a more dangerous form, this would be concerning. Prevention is better than cure, so good containment and strict hygiene measures must be maintained.

Are more countries likely at risk?

“International jet travel means if passengers are not properly screened then the virus is capable of global spread. Various countries have reported cases but numbers are very low at the moment. Previous containment measures for outbreaks SARS, bird flu etc have proven effective, suggesting vigilance and intervention should be pursued for Wuhan coronavirus. Screening of passengers is helpful but if the incubation period takes a few days, or they are symptomatic carriers, then they may be missed. The virus is spreading to various Chinese cities so countries may be thinking to implement screening for passengers from more areas in China.

How dangerous is this new outbreak?

“The outbreak is still in its infancy but initial reports suggest a low mortality rate, albeit with a possible high Ro according to other non-peer reviewed research*. Good quarantine measures and traditional public health measures should be rigorously adhered to by everyone, such as washing hands frequently, using a tissue when coughing or sneezing and dispose of this safety (and immediately wash hands), WHO also recommend sneezing or coughing into the crook of your elbow if no tissue, try to avoid touching the face (eyes, nose and mouth), wash hands before preparing food, especially non-cooked fresh produce.  A worry would be infected patients with no symptoms if they are still capable of shedding the virus onto touch surfaces which can be touched by more vulnerable people e.g. public buildings, transportation systems.”

*https://www.medrxiv.org/content/10.1101/2020.01.23.20018549v1

Prof Trudie Lang, Director, The Global Health Network, Nuffield Department of Medicine, University of Oxford, said:

“The data published today from the Lancet and the findings of the COBRA, reported by the CMO all support that China is acting responsibly within a situation that needs vigilance. The Global Health community learnt much from the previous coronavirus outbreaks with MERS-CoV and SARS-CoV, as well as from experiences with Ebola and Zika. Much progress has been made in terms of how the world responds to these situations, manages the spread of infection and works together to answer the many unknowns that are the underlying and fundamentally important issues when these new diseases arise. We, as a research community, have got so much better at sharing our activities, plans, study designs and responses. This enables a coordinated, faster and better ability to gather the critical evidence that is needed in order to treat the patients, prevent further spread and develop drugs and vaccines. The WHO, research funders and governments are also better organised with plans and responses in place. There are strong international networks and committees constantly working on this question of how to be respond to new diseases such as this and what we have learnt from the previous examples are being put into place. Therefore, both in the UK, and globally there are systems, coordination and strong leadership from WHO in place and so if this outbreak does develop further I would say we have learnt much and are better placed and better prepared to respond quickly and effectively to this new and emerging situation with 2019-nCoV.”

Prof Paul Hunter, Professor in Medicine, Norwich Medical School, University of East Anglia, said:

“This is a useful and important initial summary of the clinical presentation of the early cases. What comes through strongly is that the clinical features and epidemiology of the recent outbreak is very similar to SARS with one big difference –  the relative lack of upper respiratory tract symptoms such as runny nose, sore throat and sneezing compared to what was seen in SARS.  This is very important as sneezes and runny noses are a prime way for people to spread infection.  It is possible that in the absence of such symptoms people early in the stages of the infection will be less infectious. If this is correct, providing people are referred to hospital and nursed using appropriate infection prevention protocols subsequent person to person spread can be reduced.”

Professor Tom Solomon, Director of the NIHR Health Protection Research Unit in Emerging Infections said:

“The early release of these preliminary data from 41 patients is very helpful. Specifically it gives us an indication of the symptoms that patients with the new coronavirus are likely to have. Fever, cough, fatigue and shortness of breath were common (occurring in at least half the patients who needed hospital admission). In contrast of upper respiratory tract symptoms, such as a runny nose and sore throat were not seen. Nor was diarrhoea which affected a quarter of the patients with SARS-Coronavirus. These data, which may help distinguish the new coronavirus from common coughs and colds, will help public health officials guide the public about when they should seek medical help.”

The paper ‘Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China’ by Chaolin Huang et al. was published in The Lancet on Friday 24 January.

DOI: 10.1016/S0140-6736(20)30183-5

Declared interests

Declarations were not asked for on this occasion