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Novel Coronavirus H1N1pdm09 Dual Infection Detection
Recombinomics Commentary 18:30
February 11, 2013

The man, who is critically ill with breathing problems, has been isolated in a Manchester hospital while he receives treatment for "novel coronavirus".
The man is being treated in the intensive care unit at Wythenshawe Hospital.

One man was flown to London from Qatar last year for specialist treatment. Sky News understands he is still severely ill.

The above comments describe the current novel coronavirus case in England, who had traveled to the Middle East and Pakistan, as well as the earlier case from Qatar who was infected in September but remains hospitalized.  In addition to the above two cases, there have been eight additional confirmed cases with outcomes.  Five of the eight have died, while there other three were hospitalized for several weeks and required mechanical ventilation.

Thus, all 10 confirmed cases have been severe, raising concerns that the current protocols have a limited abilty to detect milder cases.  The two fatal cases from Jordan were part of a larger cluster.  The size of the cluster and clinical presentations similar to SARS-CoV cases from 2002 raised considerable concerns.  Samples were sent to France and Egypt (NARU-3) for analysis, and initial testing for SARS was negative.  However, new PCR probes based on the sequence from the novel betecornavirus from the above Qatar case as well as an earlier case from Saudi Arabia allowed for detection of the virus in the two fatal cases from Jordan.

However, the symptomatic contacts of the two fatal cases were not confirmed, raising serious sensitivity issues with the testing.  Similarly, symptomatic contacts of the Qatar case also tested negative.

Most of the confirmed cases developed renal failure as did the more severe SARS-CoV cases (about 5% and most with renal failure died), suggesting that there are many more milder betacoronavirus cases than the 10 confirmed severe cases.

The discovery of H1N1pdm09 as a co-infection of the most recent case raises serious concerns that such co-infections would be diagnosed as H1N1pdm09 cases, especially in the Middle East and eastern Europe, where H1N1pdm09 is dominant.  Co-infection with H1N1pdm09 would allow for easier transmission and harder detection, raising concerns that the novel betacornavirus is widespread, but undetected in milder cases, which are not tested for betacornavirus, or more severe cases because H1N1pdm09 is detected and these cases are therefore not tested for betacornavirus because they are influenza A positive.

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