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Acknowledges Milder Novel
"So that indicates to us that there is a milder form of the disease. It doesn't always involve multi-organ failure and so on," Mounts says.
"But how mild it could be is unknown. And you know, that's basically because where we look for this is in hospitals. And people have not yet started to test milder cases in the area."
The above comments from WHO acknowledge milder cases infected with the recent novel betacornavirus, which was described in more detail in the updated WHO surveillance protocol, which increases the number of confirmed cases to 7 and classifies the 8th case as probable. The newly confirmed case is the father (70M) of the 6th case, who was also fatally infected. Like the first two cases, these fatally infected cluster members also had renal failure, while the three other confirmed cases did not.
These differences in clinical presentation and outcomes were expected, as more cases were confirmed. However, when the first two cases were announced, WHO maintained that the renal failure in the first two cases distinguished these cases from 2003 SARS CoV cases. However, about 5% of the confirmed SARS CoV cases had renal failure and almost all died. Overall, almost 10% of confirmed SARS cases died, and most fatal cases were older (>40 years of age). Thus, the initial cases had infected with the novel betacornavirus were at the severe/fatal end of the clinical spectrum and they also fell into the older category.
Although WHO has not released the ages of the recent cases, media reports indicated the 7th confirmed cases was the father of the other fatal case in the cluster. The father was 70 years old, so his son was likely >40. The ages of the first to cases (60M and 49M) were also in the older category, suggesting many mild cases in younger victims have gone undetected.
The WHO update also noted that the more recent cases were from Riyadh, Saudi Arabia and Duha, Qatar, and the cases had not traveled supporting transmission from humans, not animals. Therefore, WHO has recommended expanded testing.
WHO has also not released disease onset dates, but media reports on the cluster indicated the fatally infect son was hospitalized after his father died, suggesting significant time gaps in disease onset dates for the cluster, further supporting human to human transmission.