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Paradigm Shift Intervention Monitoring
Coronavirus Pandemic Concerns
The above comments are from the background section of the March 18 WHO update on nCoV surveillance. As seen above, the vast majority of the confirmed cases have been severe, and 9 of the 13 outcomes have been fatal (two of the confirmed cases remain hospitalized). As noted above, one of the confirmed cases was mild and did not require hospitalization or treatment, which is also true for one of the probable cases. However, it is the mild cases in the confirmed clusters that have raised concerns, and the failure to confirm nCoV in symptomatic contacts has force WHO to qualify their description of such cases as “seemingly sporadic”.
Clusters provide considerable insight into what is and isn’t been detected and the large number of symptomatic contacts which test negative in PCR tests raises concerns that the nCoV levels in upper respiratory samples in mild cases is undetectable.
The probable case cited above is from the Jordan cluster, where all confirmed cases and contacts were linked to an ICU in Zarqa in April, 2012. nCoV was retroactively confirmed in the two fatal cases (45F nurse and 25M intern), and it remains unclear if any of the 10 probable cases were tested after nCoV was identified in samples from Saudi Arabia and Qatar cases infected in the summer of 2012.
However, testing was extensive in the 2013 UK cluster and two contacts were nCoV confirmed, including the mild case cited above. Although these two contacts clearly demonstrated human to human (H2H) transmission since the index case developed symptoms while performing Umrah in Saudi Arabia, but neither confirmed contact had traveled outside of the UK in the weeks prior to the nCoV infection. However, there was no clear evidence indicating they were infected by the index case since they both were also co-infected with type 2 parainfluenza virus (HPIV-2), which was not detected in the index case. Moreover, there was no contact between the HPIV-2 cases and they developed symptoms a day apart, both were likely infected by another family member, suggesting that mild cases could also transmit nCoV.
Moreover, 2 contacts of the nCoV cases were also HPIV-2 confirmed, but nCoV was not detected increasing concerns that detection of nCoV in upper respiratory tract of mild cases. This concerns was increased further because nCoV in the mild case was only detected in the lower respiratory tract (sputum) sample.
Thus, the detection of HPIV-2 in four contacts, including twp nCoV positive contacts raises serious detection concerns and suggests that nCov, like SARS CoV is readily transmitted H2H.