May 8, 2013 (CIDRAP News) – France reported its first case of novel coronavirus (nCoV) illness today, while the World Health Organization (WHO) voiced concern over the cluster of 13 recent cases in Saudi Arabia, saying answers to the virus's many mysteries are urgently needed.
French authorities confirmed the virus yesterday in a patient who has a preexisting medical condition, including immunocompromise, and recently traveled to Dubai, United Arab Emirates (UAE), the WHO announced. The Associated Press (AP) described the patient as a 65-year-old man who is hospitalized in the northern French city of Douai.
The patient became ill Apr 23 but did not have respiratory symptoms until later, the WHO said. A nasopharyngeal sample from the patient was negative for the virus, but fluid from the lungs (a bronchoalveolar lavage sample) tested positive.
The AP story said the man had vacationed in Dubai for 9 days on a package tour and returned home Apr 17. A French health official said he was in "worrying condition" and receiving breathing assistance and blood transfusions.
The French health ministry said the man's family members have tested negative for the virus, and other known contacts are being tested, the AP reported. The story said a national hotline has been established in an effort to find other contacts.
The French case raises the global nCoV count to 31 cases, with 18 deaths. France becomes the sixth country affected, joining Saudi Arabia, Jordan, Qatar, the United Kingdom, and the UAE.
In a separate "summary and literature update" on nCoV, the WHO indicated that 2 of the 13 cases in the current Saudi cluster are non-hospitalized family members of hospitalized patients, which "raises concern about potential broader transmission in the community."
Earlier reports had said the cases—which include seven deaths—were all linked to one healthcare facility, though at least one news report quoted sources saying more than one hospital was involved.
Today's WHO report says, "Most of the cases were patients at a single health care facility. Two were family members of two patients from the facility; no health care workers have been affected."
It adds that the hospital setting suggests nosocomial transmission and that the patients might have been more susceptible to infection or severe disease because they all had underlying conditions.
"However, the presence of infection in two family members not associated with the facility itself raises a concern about potential broader transmission in the community," the statement says.
In other observations, the WHO said, "The reappearance of this virus and the pattern of transmission currently being observed in Saudi Arabia increase the level of concern regarding this novel pathogen. The questions of the exposures that result in human infection, the mode of transmission, the source of the virus, and the extent of infection in the community urgently need to be answered and are being actively pursued by the Ministry of Health of Saudi Arabia."
Meanwhile, a Canadian Press story today said at least some of the nCoV case-patients were being treated in a dialysis clinic at Al-Moosa Hospital in Hofuf in the country's Eastern province. Kidney failure was reported as a complication in some of the earlier nCoV cases, but it has not been specifically mentioned in connection with the Saudi case cluster.
On the question of what originally sparked the cluster, the WHO statement said, "Early information indicated that only a small minority of these cases had contact with animals in the time leading up to their illnesses."
Though the virus is assumed to have jumped to humans from some animal, no animal source has yet been identified. The pathogen is related to coronaviruses found in bats. Some of the case-patients had visited farms before they got sick.
Several of the 31 cases recorded to date have been in clusters, as noted by the WHO in today's update. A three-case family cluster in the United Kingdom in February, which started with a man who got sick after visiting Saudi Arabia, proved that the virus can spread among people in close contact. But no ongoing spread in communities has been detected.
The WHO report also revealed that clinical experts think the most promising treatment for nCoV patients at this point is blood plasma from recovering patients, which would contain antibodies to the virus.
An international network of clinical experts that was set up to discuss therapeutic options "concluded that in the absence of clinical evidence for disease-specific interventions, convalescent plasma is the most promising therapy," the WHO said. The agency has sent advice for setting up international or regional serum centers, to obtain and share convalescent plasma, to health ministries in affected countries.
The WHO also set out a sizable list of ongoing topics of nCoV research, including further development of serologic tests and diagnostic tests, testing of antivirals and vaccines in animals, further study of genetic sequences to understand the virus's evolution, testing of persons exposed to case-patients, and field research to identify the animal reservoir of the virus.
No serologic testing for nCoV has yet been done in Saudi Arabia or elsewhere, WHO spokesman Gregory Hartl told CIDRAP News today. Such testing can detect antibodies signaling past infection with the virus and help determine if there have been mild or asymptomatic cases that have gone undetected.
The US Centers for Disease Control and Prevention (CDC) is involved in several lines of nCoV research. The agency is developing an assay to detect antibodies to nCoV, working on diagnostic tools, and evaluating genetic sequences as they become available, CDC spokeswoman Jeanette St. Pierre told CIDRAP News.
An international team of experts is due to go to Saudi Arabia this week to help investigate the nCoV cases. Today's Canadian Press story said the team will include two WHO officials and Allison McGeer, MD, a Toronto-based expert on SARS (severe acute respiratory syndrome, caused by another coronavirus).
The team does not include anyone from the CDC, according to St. Pierre.