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Novel Beta Coronavirus HCW Clusters Raise Concerns
Recombinomics Commentary 19:00
December 3, 2012

Contact Flow Chart

Figure 2. Outcome of close contact follow-up ten days or more since last exposure to index case with a novel coronavirus infection, London, September 2012 (n=64)

The above figure is from the Eurosurveillance report entitled “The United Kingdom public health response to an imported laboratory confirmed case of a novel coronavirus in September 2012” which included testing of contacts of the first confirmed novel betacornavirus case (49M) from Qatar.  As seen in the flow chart, there were 13 health care worker (HCW) contacts who were symptomatic.  Ten were tested by PCR, but as noted above, samples were collected from cases who were exposed 10 or more days prior to collection.  These HCWs were not hospitalized (they self quarantined at home) and viral RNA levels would likely be low.  Thus, collection times would have to be optimal for detection, so a failure to detect the novel betacornavirus was not unexpected.  Moreover, a fatal case (from Saudi Arabia), who died at the beginning of September, was not tested.

The large frequency of contacts with symptoms (13/56 = 23%) was similar to frequencies seen in the SARS CoV outbreak in 2003, raising concerns that the negative data for the HCWs reported above was false.

The cluster in Jordan was more serious.  The cases were linked directly or indirectly to the ICU in Zarpa.  Local media reports noted that the presentation was similar to SARS and the symptomatic cases were hospitalized.  Although many of the 12 cases were only hospitalized briefly, two of the cases died, one with renal complications and the other with cardiac problems (which were in addition to respiratory problems).  Samples were sent to labs in France and Egypt.  The ECDC report noted that the US CDC and WHO were aware of the outbreak.  Initial testing in April was negative for respiratory virus including a panel of known coronaviruses, including SARS.  However re-testing use a PCR test using the sequence from the initial isolate, EMC/12, identified the virus in the two fatal cases.

The positive results were reported by WHO, but the report had no detail (age, gender, or key dates of disease onset, hospitalization, death or discharge).  However, media reports on the press conference by the Jordan MoH indicated the first fatality (40F nurse) died on April 19, while the second fatality (25M intern) died on April 26.   The one week gap in date of death suggests that disease onset dates had gaps supporting human to human (H2H) transmission, as did symptoms in the son of the first fatal case.

The confirmation of the novel coronavirus in two members of the cluster, as well as symptoms in at least one family member and the 1 week gap in the date of death for the two fatal cases, raises strong concerns that the other members of the cluster were also infected, but tested negative due to collection and/or sensitivity issues.

The transmission within the group is also supported by the Riyadh family cluster, which tested positive for three of the four symptomatic family members, including the two fatal cases whose date of death were at least 4 days apart.

Although WHO undoubtedly has the age, gender, and key dates for each of the confirmed / probable / suspect cases in these clusters, the data has been withheld as WHO continues to cite possible common sources for the clusters, which have no scientific support, but are cited, in part, because the data that contradicts this possibility is withheld.

WHO should release the withheld data, which will strongly support sustained human transmission over a seven month period.  Sequences should also be released, which will also clearly support the emergence of a human contagion.

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