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Novel Beta Coronavirus Mecca Linkage Raises Concerns
Recombinomics Commentary 20:00
November 28, 2012

He was a previously well 49 year-old man who developed a mild undiagnosed respiratory illness while visiting Saudi Arabia during August 2012, which fully resolved. He subsequently presented to a physician in Qatar on 3 September, with cough, myalgia and arthralgia, and was prescribed oral antibiotics. Five days later, he was admitted to a Qatari hospital with fever (38.4 °C) and hypoxia, with oxygen saturation of 91% on room air. A chest X-ray showed bilateral lower zone consolidation. He was treated with ceftriaxone, azithromycin and oseltamivir. After 48 hours, he required intubation and ventilation and was transferred by air ambulance to London. During transfer, he was clinically unstable, requiring manual ventilation.

Mounts says when the first two infections with this virus were spotted, in June and then September, both men had been in Mecca, Saudia Arabia, before they got sick. As such the chance existed that the source of infection — which is currently unknown — was only found there.

But the newest infections show that isn't possible. Some of the Saudi cases had not been to Mecca before they got sick. They live in and fell ill in Riyadh, the capital. And the most recent case from Qatar lives in Doha and had not recently travelled outside the country.

The above comments raise questions about a Mecca source for the novel betacornavirus reported in the past few months.  The first set of comments (in red) is from a Eurosuveillance report on the first confirmed case (49M) from Qatar.  Although the patient developed a severe illness more than 10 days after returning from a visit to Saudi Arabia, a mild respiratory illness developed while in Saudi Arabia, raising concerns that the coronavirus isolated after transfer to London caused the mild disease in Saudi Arabia and then caused the more severe symptoms when the patient relapsed.

The second set of comments (in blue) cite a WHO technical representative, who notes that both of the initial confirmed cases had traveled to Mecca prior to symptoms, raising concerns that these initial cases were linked to infections in Mecca that were linked to preparations for the Hajj which includes visits to Mecca and Medina by pilgrims who journey to Saudi Arabia from many countries outside of the Middle East including Indonesia, Pakistan, and India.  The brother of the surviving case 49F indicated his brother went to Mecca for Umrah week.

This linkage of the Qatar case to the Hajj may have precipitated the curious comments in an October 22 ProMed report by Dr Ziad Memish who is the Deputy Minister of Public Health for the Kingdom of Saudi Arabia (KSA) as well as Director for WHO Collaborating Center for Mass Gatherings.  Memish was concerned that ProMED was reporting notifiable diseases outside of normal channels and noted that there was more of a story to tell.  Although KSA reported the two cases above, the reports on subsequent cases lacked detail.  The third case was hospitalized in Riyadh and was recovering, but no age, gender, or dates were released.  The same was true for the fourth case, which was also in Riyadh and media reports indicated the KSA MoH noted the cases had no serious consequences, yet two relatives of the fourth case had died after renal failure.  Renal failure was also reported for the first two confirmed cases as well as about 5% of SARS cases in 2003.  Most of the SARS CoV cases with renal failure died.

Similarly, WHO described the recent cases from Saudi Arabia as well as the second case from Qatar, while withholding age, gender, and dates.  The WHO report did indicate that two of the confirmed cases were epidemiologically linked to each other as well as two additional symptomatic family members.  The untested family member (70M) died after developing renal failure as did his son, who tested positive for the novel betacornavirus.  The fourth family member was symptomatic, but tested negative.  Some media reports suggest he may be retested.  Media reports also indicted the son was hospitalized after his father died, suggest a gap in disease onset dates signaling human to human transmission.  Media reports also indicate the cluster was in October, but not reported until November 23.  The height of Hajj activities were in October, which is also when the second Qatar case was infected, although he did not travel outside of Doha prior to his illness.

Media reports indicated all six confirmed cases and the two probable cases were male, which may have affected testing or may have been related to religious ceremonies which limit interactions between genders.  The linkage of the first two confirmed cases to Mecca raises concerns that the novel coronavirus may have spread among Hajj attendees, who subsequently spread the virus to other locations, including Riyadh and Doha.

More information on the Riyadh cluster, include ages and disease onset dates as well as sequences from the associated coronavirus, would be useful.

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