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Mild UK Beta Coronavirus Case Concerns
Recombinomics Commentary 22:30
February 19, 2013

On 5 February, an adult member of the same extended family of the two confirmed cases – who had not travelled abroad – developed an influenza-like illness. The illness remained mild, not requiring hospital admission, and there has been a full recovery. A sputum sample from this case was later confirmed to contain novel coronavirus. This case had limited exposure to the index case on three occasions while the latter was in hospital, and had no contact with the second case.

The limited contact that one of the cases had with the index case, however, leaves open the possibility of an intermediary case within the extended family.

The above comments are from a detailed description by the HPA of the four cases who were novel betacornavirus confirmed in the UK.  The other three cases had severe disease and were placed on life support (ECMO machines).  The first case (49M) developed symptoms while performing Umrah in Saudi Arabia in August.  Symptoms resolved after he returned to Qatar, but reappeared 2 weeks later and his condition deteriorate prior to transport to the UK by air ambulance.  He was placed on an ECMO machine and has been hospitalized for five months.  Contact health care workers developed mild symptoms and tested negative for the virus.

The second case (60M) also developed symptoms while performing Umrah in Saudi Arabia.  He returned to the UK via commercial airline and his condition deteriorated.  He was confirmed to be co-infected with the novel coronavirus as well as pandemic H1N1 (H1N1pdm09). He was also placed on an ECMO machine and remains hospitalized in critical condition.

The third case (38M) was the son of the index case and had contact at home and in the hospital.  He had no recent travel outside of the UK and developed symptoms.   He tested positive for the novel coronavirus, supporting import into the UK via his father's arrival via commercial airline, representing the first confirmed case due to import of the novel coronavirus.  He was also placed on life support (EMCO machine), but subsequently died.

The third family member (30F), described above, had limited contact with the index case and no contact with his son.  She also had no recent travel outside of the UK and represents the second example of a confirmed case infected by an imported virus.

She developed a mild case and was confirmed via testing of a sputum sample.  The testing of a sputum sample may explain why she is the first confirmed mild case.  The limited testing of mild cases has targeted nasal samples, which may have an undetectable level of viral RNA, leading to false negatives.

There have now been 12 confirmed cases.  Two were linked to symptomatic health care workers who tested negative.  However, eight of the remaining ten confirmed cases were linked to clusters with at least one additional confirmed case, raising concerns that the novel coronavirus is readily transmitted human to human, but confirmation remains depressed due to technical issues linked to lab confirmation.

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