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Update on novel coronavirus
With over 37000 confirmed cases and 811 dead in China (as stated by Chinese Ambassador Liu Xiaoming to BBC’s Andrew Mars, Feb 9*) - and growing - with cruise ships and returning travellers in quarantine, and the WHO declaring that US$675 million is needed for new coronavirus preparedness and response global plan to cover the next 3 months, how did we get here (to this situation) again? What do we know about this “new” coronavirus - Covid-19 - formerly 2019-nCoV?
Man’s actions encourage the emergence of zoonotic diseases
17 years ago, SARS, another coronavirus, sounded a wakeup call…it lasted 8 months from 2002-2003, infected 8100, killed 774, in 37 countries. Subsequent research established that the virus reached humans via civets sold in a “wet” market in mainland China. A wet market is where wildlife is sold and butchered on the spot for meat and traditional medicine.
Such markets haven’t ceased activities. It was only a matter of time before a wet market was implicated again. This time it happened in Wuhan, Hubei province, and Politico reports that Chinese researchers suspect the animal intermediate is the pangolin. However this is pre-publication data from the South China Agricultural University** and is based on genome comparisons: more evidence is needed to convince other scientists, according to Reuters.
Pangolins (scaly anteaters) are endangered, illegal to trade in, but imported for their scales (traditional medicine) and as “exotic meats” to wet markets and were present in the particular market in Wuhan blamed for the outbreak. An estimated 6 out of 10 infectious diseases are zoonotic and spread between animals and humans, say the CDC.
Furthermore, It is believed that the major reservoir for species-leaping coronaviruses are bats (Anthony, S.J. et al, Virus Evolution 2017). According to a recent Telegraph article, one research team led by Dr. Peter Daszak has, since the SARS epidemic, spent their time in bat caves in 10 countries looking for coronaviruses and others linked to human disease, their contribution to planetary preparedness. Over 500 coronaviruses in China were apparently from bats.
You can understand therefore why there is a call to ban the trade in wildlife: to save endangered species and to limit the chances of such novel diseases arising.
We have to face the fact that its man’s actions that bring about the juxtaposition of humans, wildlife markets, poor food safety/slaughter practices and the encouragement of “bushmeat” consumption.
Bushmeat in Africa was linked to the West African Ebola outbreak (Ordaz-Németh, I. et al. PLOS 2017). Luckily, the new coronavirus seems to have a 2% death rate, not the 50% averaged for Ebola.
Prevent, detect and respond
WE are in a much better position to prevent the spread of and control this new virus, as evidenced by the handful of cases imported into 25 countries. Dealing with SARS, MERS and H1N1 has produced established protocols which the WHO and national public health agencies know work. The work of the Global Health Security Agenda (GHSA) has helped build country capacity to “detect, prevent and respond to infectious diseases”, and so reduce them crossing borders. The issue now is do we have a treatment that can be rolled out at scale and how can we stop the disease reaching less well-prepared countries, those with weaker health systems?
DR Tedros Ghebreyesus, WHO Director-General, said in reference to the call for $650 million (5 Feb 2020):
“My biggest worry is that there are countries today who do not have the systems in place to detect people who have contracted with the virus, even if it were to emerge"
These comments are supported by the 2019 Global health security index, which finds that 131 of 195 countries “lack foundational health systems capacities vital for epidemic and pandemic response”, and only 5% of countries allocate national funding to fill preparedness gaps.
Africa is particularly vulnerable, explains the Africa Center for Strategic Studies, having built up extensive financial and trade ties with China in recent years. An example of how vulnerable was reported by The New Humanitarian. A student returning from Wuhan arrived with suspicious symptoms at the airport in Nairobi, was quarantined, but it took 3 days to get the all-clear simply because, as it was a novel disease, the authorities did not yet have diagnostic kit. Not very reassuring for the Kenyan public.
Weaker health systems are also found in countries recovering from conflict (Syria), experiencing economic crisis (Venezuela) and disasters (Bahamas). Such countries do not have the resources to provide the right level of support to patients nor do they have control of porous borders
What else do we know?
Chinese researchers have sequenced the virus from patients in Wuhan, the epicentre, and established that the new coronavirus is more closely related to SARS than to MERS. The infection rate, according to the WHO declaration of a global emergency (January 23) was around the same as SARS (roughly 1 person can infect up to 2.5 people), but it may actually be higher now. The death rate is less than SARS (2% rather than 10%). Unlike SARS, where you were only infectious whilst you had symptoms, there are reports that this virus may be transmitted whilst you are asymptomatic.
*WHO data February 10 2020: more than 40,500 confirmed cases and over 900 deaths.
**South China Agricultural University: Global Health's fulltext repository includes the Journal of South China Agricultural University
What have we learnt from the past and can bring to the future to stop this happening again?
Sharing data, expertise and collaborating across the world is key.
1. major publications and organizations have committed to the open sharing of all data related to the coronavirus
2. Coronavirus 2019-nCoV Global Cases by Johns Hopkins CSSE
A map showing total confirmed cases, total deaths and total recovered. Read news article 2019-nCoV: real-time disease outbreak map to learn more
3. Coronavirus Outbreak Knowledge Hub
Created by the Global Health Network, a community of practice. A pop-up knowledge-sharing space to generate evidence, collect standardised quality data and give access to guidance on the Coronavirus 2019-nCoV.
4. Researchers in Germany developed the 1st rapid diagnostic test and shared it with WHO.
In summary: we are where we should not be. Mistakes have been made locally. Cultural practices and travel have played a role in spreading the virus. The results are unnecessary death and disruption. Déjà vu. Fortunately, we are all in a much better position to take action and minimise the impact long-term than we were previously. It’s in all our interests that WHO should receive the funds it needs to support countries with weaker health systems.
CABI shares information
As much research information as possible needs to be shared to bring the emergency under control, and to this end CABI is making all its coronavirus information freely available for the next 3 months. This includes coronaviruses in animals other than man, drawn from our CAB Abstracts database.
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