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WHO Cites More Detail On Jordan Beta Coronavirus Cases
Recombinomics Commentary 01:45
December 23, 2012

The mission included hospital site visits, interviews with patients, relatives and caregivers, and review of case files. In addition to the two previously confirmed cases, a number of health care workers with pneumonia associated with the cases were also included in the review and are now considered probable case(sic).

Disease was generally milder in the unconfirmed probable cases. One patient who is a probable case had symptoms that were mild enough to be managed at home and was not admitted to hospital.

No patient in this cluster had renal failure.

One patient presented with pneumonia and was discovered to also have pericarditis. This patient had laboratory confirmation of infection and has died.

A second patient developed disseminated intravascular coagulation as a complication of severe respiratory disease. This patient also had laboratory confirmation of infection and has died.

The above comments are from the December 21 WHO update on betacoronavirus infections.  The data are consistent with contemporary media reports from April with regard to the severity of disease in the milder cases, as well as complications in the two confirmed cases.  However, the pericarditis in the second fatal case (25M) was used to deny that that fatal case was related to the above cluster, in spite of being a health care worker in contact with the other cases.  This case died a week after the first fatal case, signaling human to human transmission.

Although the WHO has acknowledged reviewing the case files from these patients, it has yet to even cite the number of probable cases in Jordan.  WHO updates on reportable diseases usually include the age, gender, disease onset and hospitalization dates, as well as date of death.  All of the above has been withheld from this cluster, as well as the cluster in Saudi Arabia

These data would undoubtedly provide compelling evidence for human to human transmission.  This transmission is supported by the size of the cluster as well as the range of clinical presentations.  As noted above, several probable cases were contacts of the health care workers, and was probable case was not hospitalized.  Contemporary media reports also indicated several case were only briefly hospitalized.  Thus, the cliniacl presentations range frm mild to sever/fatal, but lab confirmation has been limited to the severe/fatal cases.

In addition to withholding the relevant ages and dates for these cases, the WHO has also withheld detail on the testing of the cases.  In April, Jordan sent clinical samples from these cases to France and Egypt (NAMRU-3).  In April the novel coronavirus (group 2c) had not been identified in humans and only a pancornavirus test was available.

A PCR test using primers developed from the sequence of the first confirmed case was used to confirm the presence of the virus in the two fatal cases.  However, this test failed to detect the virus in the probable cases in Jordan, as well as the 4th family member in the Riyadh cluster in Saudi Arabia, raising serious questions about the ability of the test to detect the virus from samples collected from the upper respiratory tract.

As noted in the newly released December 21 testing procedures, the viral load has been higher in samples from the lower respiratory tract and collection of such samples is more common in the severe and fatal cases.

Thus, the WHO has failed to demonstrate an ability to detect the novel coronavirus in such samples, and claims of no sustained or widespread transmission have little credibility.  The lack of credibility in the WHO statements on transmission is further damaged by the withholding of the key clinical information on the confirmed and probable cases.

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