My last two posts looked at the problems that might be caused by hospital spread of the new coronavirus, based on what happened during the early days of SARS 10 years ago. Hospital spread of this new virus is a real concern; it was first identified, retrospectively, in an outbreak in a hospital in Jordan a year ago, and international concern really picked up after the acknowledgement of a current outbreak in the Al-Ahsa region of Saudi Arabia. Now it appears there is a third instance of hospital spread, in France. Several days ago the French Ministry of Health announced a single case, a Frenchman who had traveled to Dubai and may have been infected there. This morning, there is news of a second case, a person who shared a hospital room with the first patient. Here’s the announcement from the French Ministry and one from the World Health Organization. (And if you read French, I talk to the French newspaper Le Figaro about it here.) Simultaneously, the WHO has announced that two more patients have been recognized in that Saudi hospital cluster. That makes 15 patients (three of whom died) in that cluster, and 34 patients (18 deaths) worldwide.
There’s additional news today as well, which is both heartening and a little concerning too.
The WHO announced that its assistant director-general Dr. Keiji Fukuda held a press conference in Riyadh in Saudi Arabia about this emerging disease, and released the text of his statement there. This is good news because it is a sign that Saudi Arabia must be becoming more open to the involvement of international authorities (something which my contacts have told me they are worried about); in fact, toward the end of the statement, he makes a diplomatic point of praising the Kingdom’s public-health response to the outbreak.
At the same time, it is notable what the WHO and other health authorities, including the US Centers for Disease Control and Prevention, still do not know about this virus — which Fukuda makes a point of emphasizing as well.
Here is the full text of his statement. (The WHO sent it out by email; I’ll add a link to their site when I find it here it is on their site.)
WHO Press Statement Related to the Novel Coronavirus Situation
12 May 2013
The emergence of this new coronavirus is globally recognized as an important and major challenge for all of the countries which have been affected as well as the rest of the world. The Ministry of Health of the Kingdom of Saudi Arabia has recognized this and invited the World Health Organization (WHO) to help them assess the situation and to provide guidance and recommendations. WHO is pleased to be here to work together with the Kingdom of Saudi Arabia.
At this time there are some things about this new disease we understand. However I would like to remind everyone that this is a new infection and there are also many gaps in our knowledge that will inevitably take time to fill in.
We know that the disease is caused by a virus from a group called coronaviruses. One member of the coronavirus family is the SARs virus. This new virus is NOT the SARS virus. They are distinct from each other. However, the fact that they are related has added to the world’s concern. We know this virus has infected people since 2012, but we don’t know where this virus lives. We know that when people get infected, many of them develop severe pneumonia. What we don’t know is how often people might develop mild disease. We also know that most of the persons who have been infected so far have been older men, often with other medical conditions. We are not sure why we are seeing this pattern and if it will change over time.
There are many other things that we don’t understand. For example, how are people getting infected? Is it from animals? Is it from contaminated surfaces? Is it from other people? Finally, we don’t know how widespread is this virus, both in this region and in other countries.
The greatest global concern, however, is about the potential for this new virus to spread. This is partly because the virus has already caused severe disease in multiple countries, although in small numbers, and has persisted in the region since 2012. Of most concern, however, is the fact that the different clusters seen in multiple countries increasingly support the hypothesis that when there is close contact this novel coronavirus can transmit from person-to-person. This pattern of person-to- person transmission has remained limited to some small clusters and so far, there is no evidence that this virus has the capacity to sustain generalized transmission in communities.
At this point, several urgent actions are needed. The most important ones are the need for countries, both inside and outside of the region, to increase their levels of awareness among all people but especially among staff working in their health systems and to increase their levels of surveillance about this new infection. In Saudi Arabia, we have seen the importance of better surveillance. When new cases are found, as is likely, it is critical for countries to report these cases and related information urgently to WHO as required by the International Health Regulations because this is the basis for effective international alertness, preparedness and response. Countries also need to assess their level of preparedness and readiness if this virus should spread and to intensify strengthening the core capacities identified in the International Health Regulations if they are not adequate. WHO is ready to assist countries in this region and globaly in these tasks.
There are also some questions that urgently need to be answered including how are people are getting infected, and what are the main risk factors for either infection or development of severe disease. The answers to these questions hold the keys to preventing infection.
In closing, we want to note that the Government of Saudi Arabia has taken the novel coronavirus situation very seriously. The Ministry of Health has initiated crucial public health actions — including intensifying surveillance, initiating investigations and important research and putting control measures in place.
One of the reasons why more cases have been identified in KSA may be because they have gone ahead to strengthen their surveillance system and lab capacities and network.
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