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Beta2c Coronavirus Import To KSA From Egypt?
Recombinomics Commentary 23:45
March 27, 2013

#  Date of onset  Age Sex  Probable place of infection  Date reported    

13  24-25/01/2013  61  F  Egypt/KSA    20/02/2013   
Undersecretary to the Ministry of Health for Public Health, Dr. Ziad Al-Memish, told Arab News yesterday that the victim was a 61-year-old Saudi woman. The cause of death was confirmed by a laboratory test.
It is the third such fatality in the Kingdom and the constitutes the 13th confirmed case of a coronavirus infection. It is the seventh death blamed on the virus worldwide.

The Saudi patient was hospitalized on Jan. 29 in a hospital in Riyadh and died there on Feb. 10.

The woman had recently returned from abroad with symptoms of severe acute respiratory syndrome (SARS), the official said.

The above comments (in red) are from the updated ECDC table on the 17 confirmed nCoV cases, which notes that case #13 (61F) had been in Egypt prior to her return to Saudi Arabia (KSA).  The comments in blue are from a media report which cites a disease onset while abroad, suggesting the case was infected in Egypt.  This would be the first confirmed case from Egypt and represent the first example of the import of nCoV into KSA.  This origin would increase the number of countries surrounding KSA with confirmed nCoV infections to four. 

However, KSA maintains that the concentration of confirmed cases in KSA is due to a lack of testing in neighboring countries, and none of these four countries has locally confirmed an nCoV case.  The two confirmed cases in Jordan were confirmed in Egypt.  The two confirmed cases in Qatar were confirmed in the UK and Germany.  The confirmed UAE case was confirmed in Germany, and as noted above, the symptomatic case who returned from Egypt was confirmed in KSA.

Of greater concern are the mild cases in KSA which have not been reported by WHO.  Reports on the most recent confirmed case from KSA was mild, but was a contact of a fatal case (39M) from Riyadh.  Media reports on that cluster cited mild cases in KSA, including a concentration in Jeddah.  However, the only confirmed case from Jeddah is the first KSA case (60M), who lived in Bisha but was treated and died in Jeddah. 

The recently released sequence of one of the fatal cases in the SARS-like health care worker cluster in Jordan was closely related to the fatal Jeddah case, raising concerns that this sub-clade has been circulating in western KSA since the spring of 2012.  Those two sequences are easily distinguished from the two cases who developed symptoms while performing Umrah in the summer of 2012 or the winter of 2013 in Mecca.

Although these two sets of sequences are easily distinguished from each other, all are distantly related to European bat sequences which are the most closely related animal nCoV sequences.

The close sequence identity in the human nCoV sequences, as well as the concentration of confirmed and probable cases in clusters, indicate nCoV is transmitting in the Arabian Peninsula in a sustained manner, WHO denials notwithstanding.

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