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Recently a new killer Corona Virus has made its presence known. It has a high morbidity rate having killed 8 of the 14 people known to have been infected. The virus is related to the SARS corona virus and scientists are trying to determine whether it has the potential to lead to a pandemic. The critical question will be: How infectious is the new pathogen.
Most of the fourteen known cases have been in the middle east: Ten infections have been reported in Saudi-Arabia, Jordan, and Qatar with a further four in the UK (or the patients have been treated there).
At the recent annual conference of the Society for Virology at Kiel some of the characteristics of the new pathogen have been presented. It would appear that it is very easy for the virus to enter the cells of several types of mammals (reported by Christian Drosten of the University of Bonn). This is an unusual characteristic for Corona Viruses. Like SARS the new corona virus appears to have originally arisen in the bat population. If it is able to jump between different species of animals it is possible that the virus could reach the human population via multiple routes.
Working together with the Virologist Ron Fouchier, from the University of Rotterdam, Drosten’s research team has identified an important difference between the new corona virus and the SARS virus. The two pathogens enter the cells of their hosts through different mechanisms. The new Corona virus uses a cell receptor (the biological equivalent to a door handle used by a virus to get inside a cell) which is found mainly in cells in the lungs. These receptors are also found, but less frequently, in the cells of the upper respiratory tract (this is due to be reported in Nature this week).
The method by which a virus enters the host’s cells is an important factor when determining how infectious it will be. If the receptors (door handles) lie deep in the lungs it is only possible for the pathogen to be transmitted by very close contact between infected and un-infected host. This has been used as an explanation why the SARS virus 10 years ago did not lead to a much worse pandemic. The SARS corona virus used a different receptor to enter its hosts cells but this also only occurs deep in the lung tissue.
These results from the virologists’ laboratory work are reinforced by the latest information about the new corona virus coming out of the UK. One of the patients had been infected by his own father, demonstrating that the virus can be passed from person to person. However close physical contact was likely because of the father-son relationship between the two patients.
The scientists believe it is still too early to determine whether the new corona virus could develop into a full-blown pandemic. It is possible that the pathogen will adapt to its new hosts and further evolve in a way which could have either serious or weakening consequences. In case memories are fading let me take this opportunity to review what happened with SARS (I was managing a company and living in Asia at the time so the impact of SARS is somewhat indelibly engrained on my memory).
In the middle of November 2002, in the south Chinese province of Guangdong a patient was treated for fever and an unusual lung infection. We now think that the pathogen originated from animals kept in a local meat market: specifically investigations have pointed to the masked palm civet as the host which transmitted SARS to humans. These rather cute looking creatures which normally live in trees are considered to be a culinary delicacy by the Chinese. However it is believed that the normal host for the SARS virus is the bat and the masked palm civet was itself infected by a bat. The new Killer Corona virus may also have reached its first human host via another animal intermediary.
The 21st February 2003 was a key day for the SARS epidemic. A ‘super transmitter’ appeared in the form of a Chinese Doctor who had checked into a hotel in Hong Kong. Soon after arrival he felt ill and went to bed. The next day he checked into a hospital. Although he had hardly moved around in the hotel building he managed to infect at least a further 16 guests. These people, in addition to transmitting the pathogen through the densely populated Hong Kong community, managed to ensure it arrived within 12 hours in Vietnam, Singapore and Canada.
On 26th February officials in Vietnam reported the first cases of the ‘unknown’ respiratory infection to the World Health Organisation. By early March there were at least 195 patients in Vietnam and the WHO sent Dr Carlo Urbani to Hanoi to address the problem. He isolated the pathogen and introduced measures which quickly helped to bring the disease under control in Vietnam. Sadly he became a SARS victim and lost his life to the disease.
On 12th March 2003 the WHO issued a warning to the World about a Severe Acute Respiratory syndrome (SARS) which was described as an atypical lung infection of unknown origin. In many Asian countries fear started to break out. In my own Asian factory, which was part of a major industrial complex all of the many thousand employees had to wear face masks, have their temperatures measured upon entering and leaving the site and also had temperature measurements taken at several times during the day. Numerous additional hygiene measures were introduced, with alcohol-based gels distributed in all wash rooms and warning signs to encourage increased hygiene awareness. Antiviral agents became like gold dust and anyone travelling or meeting with someone suspected of having the infection was quarantined for three weeks. Within a short space of time many buildings had installed infrared sensors to monitor the temperature of people entering and leaving offices and hotels. The main places we all avoided, if at all possible, were the hospitals!
On 15th March Germany was also overcome by panic when a sick Asian doctor landed in Frankfurt on his way home to Singapore. SARS was identified and he was isolated and treated in intensive care. The man recovered.
US and German Scientists identified on 24/25th March 2003 the SARS agent: a new form of Corona Virus. This was a surprise as many had thought the epidemic was likely to be the result of a new strain of influenza. Until this time Corona viruses had been considered relatively harmless merely causing common-cold type illnesses. What was also surprising was the way the disease had arisen – until this time bats had not received much attention as hosts for diseases which could lead to serious human epidemics.
By 8th May 2003 7000 people had been infected with SARS worldwide and at that time a further 200 were being identified every day. Fear was spreading throughout the World.
In Summer 2003 the epidemic was starting to wane. Preventative measures like quarantine of all suspects and their contacts and strict controls at airports helped (I had to get a special ‘SARS free’ medical certificate to allow me to land in Thailand). It would appear that luck was on the side of humanity – the virus appeared to have become less virulent during its passage around the globe.
Finally more than 8000 people were infected with SARS in around 30 countries on six continents. Approximately every tenth infected person died of the disease. The World Bank has estimated the economic damage to have been 40-50 billion euros. Following the initial epidemic and until today the SARS virus has not been seen again in humans. However the new Corona Virus, arriving so soon after the SARS epidemic, is giving scientists and the medical authorities cause for concern.
Experts in epidemiology are certain that in the future there will be new pathogens which could lead to global diseases. On average in the last 30 years there were new pathogens discovered every year. Increasing globalisation is making the spread of new diseases easier and SARS demonstrated how quickly a new disease can spread across the globe.
If you are interested in other articles I have written on similar subjects please use the following links:
Pandemic Risk Management Article by Chris Duggleby (February 2012) (or ‘How to Prepare for the Consequences of Microbial Sex!’)
For German readers of ChrisDuggleby.com you can find much of the information presented here in German in the following articles in the Süddeutsche Zeitung: here and here. The scientific paper in the American Society of Microbiology involving Christian Drosten and Ron Fouchier refered to above can be found here.