There’s lots of news to catch up with regarding the new coronavirus that emerged last summer in the Middle East and has been causing concern to international health authorities all autumn: additional cases, additional deaths, and new lab evidence that is more than a little concerning.
(This post has been updated; read to the end.)
Holidays. It never fails.
Today, while the United States has been largely off-line following our Thanksgiving holiday (and while Northern Europe was on its way to the pub for Friday evening revelry), the World Health Organization announced four new cases of the novel coronavirus that caused a great deal of worry immediately before the October hajj season. (Earlier posts here and here.)
In its bulletin, released by the WHO’s Global Alert and Response team (GOAR), the agency said:
- Four additional laboratory-confirmed cases have been identified; one of the four has died.
- One case is in Qatar, the location of one of the original two cases earlier this year.
- Three of the new cases, including the dead person, are in Saudi Arabia, site of the other original case (who also died).
- Two of the three Saudi cases, including the dead person, are members of the same family.
- In that family, two other people have also fallen ill, and one has died. The man who recovered showed no laboratory evidence of infection with the novel coronavirus. Analysis of the case of the person who died is continuing.
Have we dodged a bullet? Or is the other shoe yet to drop?
The uncertainty over the novel coronavirus that was recognized last month is captured in a research report and editorial just released this evening by the New England Journal of Medicine. (I believe these are the first peer-reviewed papers on the new organism, though it has several times been written up in the European CDC’s bulletin, EuroSurveillance.) The papers are a treatment report and analysis of the first known case, the 60-year-old Saudi man who died in June, and an examination of the larger issues raised by this case and the second known one, which occurred in Qatar and London in September.
Short summary of the situation from the second paper, co-authored by the former chief of the division of viral diseases at the US CDC:
Since there has been no evidence of human-to-human transmission or virus transmission to healthcare workers, [the novel virus] is not currently a public health risk. (NEJM Anderson 2012)
On Feb. 21, 2003, a 65-year-old physician who lived in the Chinese province that abuts Hong Kong crossed into the territory surrounding the city and checked into a hotel in Kowloon. He was given a room on the ninth floor. Sometime during his stay — no one has ever fully traced his path — he encountered roughly a dozen other people; most of them were hotel guests whose rooms were on the same floor, but some were staying on other floors, and some were visitors to events there. The physician had been sick for a week with symptoms that had started like the flu, but were turning into pneumonia, and the next day, he checked out of the hotel and went to a Hong Kong hospital. Before the end of the day, he died.
In the next few days, the people who had crossed paths with the physician left the hotel. Most of them were visitors to the special administrative region: Hong Kong is not only a port and transit hub, but a business and shopping destination for much of the Pacific Rim. They went to Vietnam, Singapore, Canada, and Ireland. As they traveled, some of them started to feel as though they had picked up the flu.
I was off-line for a week with family issues, and while I was gone, news broke out. (It senses your absence, news does. This is the real reason why coups and major foodborne outbreaks happen in August.)
So while I dive into the bigger stories that seem to be happening — and get some fun summer stuff lined up — here’s a quick recap of things worth noticing:
The World Health Organization has weighed in on the growing threat from antibiotic-resistant gonorrhea, saying in a statement this morning (emailed, and apparently not online):
Millions of people with gonorrhoea may be at risk of running out of treatment options unless urgent action is taken, according to the World Health Organization (WHO). Already several countries, including Australia, France, Japan, Norway, Sweden and the United Kingdom are reporting cases of resistance to cephalosporin antibiotics — the last treatment option against gonorrhoea. Every year an estimated 106 million people are infected.
The statement arrived as an adjunct to the launch of the WHO’s new global action plan for controlling the spread of resistant gonorrhea.
If you’ve been reading here for a while, the problem of resistant gonorrhea won’t be new to you. (Here are some past posts on data from the CDC and a call to action in the New England Journal of Medicine, along with a piece I wrote in Scientific American and a separate post by my SciAm editor Christine Gorman.) But in case you’ve just come in:
The data-dense graphic above may be too reduced to read (here’s the really big version), but its intricacy masks a simple and fairly dire message: The global trade in food has become so complex that we have almost lost the ability to trace the path of any food sold into the network. And, as a result, we are also about to lose the ability to track any contaminated food, or any product causing foodborne illness.
The graphic, and warning, come from a paper published last week in PLoS ONE by researchers from the United States, United Kingdom, Hungary and Romania. The group used United Nations food-trade data — along with some math that I do not pretend to understand — to describe an “international agro-food trade network” (IFTN) with seven countries at its center, but a dense web of connections with many others. Each of the seven countries, they find, trades with more than 77 percent of all the 207 countries on which the UN gathers information.
As a result, they say: “The IFTN has become a densely interwoven complex network, creating a perfect platform to spread potential contaminants with practically untraceable origins.”
So, these deadlines: They’ve been intense. (I know, I said last week I thought I was done. I was wrong. But now I think I’m done — though chairing a conference for the rest of the week, so still busy.) While I’ve been underwater, there has been literal tons of news on this blog’s core topics, all of which I need to get back to. But while I’m getting re-oriented, here’s an intriguing piece of news that I stashed last month for consideration. It’s worth thinking about, if you’re planning exotic travel.
TL;DR: If you’re going somewhere where you run the risk of being exposed to a disease that your doctors back home might not recognize, and you can take simple steps to prevent it, you should. Really. Wear your bug repellent, stay out of the stagnant water, keep your skin covered, take your pills. [Read more…]
On the heels of the news of totally drug-resistant (TDR) TB being identified in India — and disavowed, unfortunately, by the Indian government — the World Health Organization has released an update on the background situation of drug-resistant TB around the world.
The news is not good. Drug-resistant TB is at the highest rates ever recorded.
An independent monitoring board convened by the worldwide polio-eradication initiative has delivered a report on the global effort that is striking for its brutally frank and even frustrated tone.
Among its findings, just in its first few pages: “Case numbers are rising”; “unwelcome surprises continue”; “as many milestones are being missed as are being met”; and “the (eradication) Programme is not on track for its end-2012 goal, or for any time soon after unless fundamental problems are tackled.”
Possibly the biggest problem, the board concludes, is a get-it-done optimism so ingrained in the 23-year effort that it cannot acknowledge when things are not working:
We have observed that the Programme:
Is not wholly open to critical voices, perceiving them as too negative – despite the fact that they may be reporting important information from which the Programme could benefit.
Tends to believe that observed dysfunctions are confined to the particular geography in which they occur, rather than being indicative of broader systemic problems.
Displays nervousness in openly discussing difficult or negative items.
If some of this sounds familiar, that is because the board hit similar notes in its last report in July, in which it declared that the international effort “is not on track to interrupt polio transmission as it planned to do by the end of 2012.” I get the sense, reading the latest, that the board does not believe it was heard.