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Paradigm Shift Intervention Monitoring
Coronavirus Cases In Clusters
The patient is a contact of the previous case reported in the Disease Outbreak News on 12 March 2013. This person suffered a mild illness, and has recovered and been discharged from hospital.
The above comments from the WHO March 23 coronavirus update define the second confirmed nCoV cluster in Riyadh. As was seen in the first cluster, the index case died, and a contact was confirmed with a mild infection involving hospitalization not involving the ICU.
Similar results were seen in the UK cluster, except the mild case was not hospitalized and did not require treatment, which was also seen in the ICU cluster in Jordan. The non-fatal cases were classified as probable and at least one did not require hospitalization. WHO also noted that many of the probable cases had a milder course and local media indicated several were only hospitalized for 1 or 2 days, suggesting they were also not admitted to the ICU and had a mild course.
However, there have been no reports of confirmed mild cases that were not linked to a confirmed cluster, raising concerns that the vast majority of nCoV infections are either not tested, produce a false negative, or are not reported.
WHO is targeting more severe cases, so most mild cases will not be tested. WHO has also recommended sampling from the lower respiratory tract, and the only confirmed cases who was not hospitalized was identified with a sputum test (targeting the low respiratory tract). The same case tested negative for nCoV when a nose and throat swab was tested.
Concern regarding the testing / reporting of mild cases was increased significantly by recent local media reports offering assurances by noting that mild nCoV cases in Saudi Arabia are recovering without treatment, and most such cases are in Jeddah. However, the only confirmed case from Jeddah is the first confirmed cases, which was fatal in July. Two additional cases developed symptoms after a pilgrimage to Mecca, which is adjacent to Jeddah, but both confirmed case were severe (one has been hospitalized for 6 months, while the other was fatal). The second UK traveler to Mecca (daughter of index case), tested negative, but may have been the source of the nCoV infections in the UK, since both were co-infected with HPIV-2, which was not reported in the index case (who was co-infected with H1N1pdm09).
WHO has not commented on these reported mild cases in Jeddah or other location in KSA or adjacent countries, although WHO has launched a twitter campaign to call the nCoV a cold virus, suggesting they are well aware of the mild cases.
The WHO silence on these cases continues to be hazardous to the world’s health, as the similarities between nCov in 2013 and SARS-CoV in 2003 continue to increase.