Robert Roos 
News Editor
News Editor
May 6, 2013 (CIDRAP News) – Three new cases yesterday, with two
deaths, increased a cluster of novel coronavirus (nCoV) cases in eastern
Saudi Arabia to 13, and authorities confirmed that the illnesses are
associated with a healthcare facility.
The new cases added to concern about possible person-to-person
transmission of the novel virus. Human transmission has been clearly
demonstrated only once before, in a family cluster of three cases in the
United Kingdom in February.
Seven of the 13 patients in the current Saudi cluster have died.
With the three new cases, the global count of confirmed nCoV cases has
reached 30, including 18 deaths.
The three cases were reported yesterday by Ziad A. Memish, MD,
Saudi Arabia's deputy ministry for public health, via ProMED-mail, the
online reporting service of the International Society for Infectious
Diseases. The World Health Organization (WHO) issued a short statement
about the cases today.
"So far there is no apparent community transmission and
transmission seem[s] linked to one HCF [health care facility]," Memish
wrote. All the cases have been in Alhasa (also written as Al-Ahsa) in
the country's Eastern Province.
The WHO statement said, "The government is conducting ongoing
investigation into this outbreak which is linked to one health care
facility."
Memish said the cases involve:
- A 62-year-old woman with multiple comorbidities who fell ill on Apr 19 and died May 3
- A 71-year-old man with multiple comorbidities who got sick Apr 15 and died May 3
- A 58-year-old woman with comorbidities who became ill May 1, is on a ventilator, and is in critical but stable condition
He gave no details about their preexisting conditions and did not
identify the hospital involved. Nor did he mention any connections
between the cases, though two earlier patients in the cluster were said
to be related.
The WHO reported the first seven cases in the region on May 2, and
Memish cited three more on May 3. All 13 patients have been reported to
have one or more comorbidities, and 11 of the patients are over age 50.
The underlying illnesses and the localization of the cases prompted
earlier speculation that they were all in one healthcare facility.
Illness-onset dates in the cluster have ranged from Apr 14 to May
1, a long enough period to suggest to some that the virus has spread
from person to person in the facility, rather than that all the patients
caught it from a common nonhuman source.
The virus's incubation period has not been clearly established,
but researchers who analyzed the UK family cluster estimated that the
period ranges from 1 to 9 days, according to a Mar 14 report in Eurosurveillance.
Michael T. Osterholm, PhD, MPH, said the information about the
cluster suggests person-to-person transmission, possibly with more than
one generation of cases, according to a Canadian Press story published
yesterday. He is director of the University of Minnesota's Center for
Infectious Disease Research and Policy, publisher of CIDRAP News.
"With no evidence of an animal reservoir in the hospital, the only
conclusion that can be drawn is that this is person-to-person," he
said. Concerning the range of illness-onset dates, he added, "This is
far too wide to be an incubation period. This [event] is much more
complicated than that."
Osterholm told CIDRAP News that the cluster could involve one
person who passed the virus to others over a period of several weeks or
"multiple person-to-person transmission episodes from different
sources," with the latter scenario more likely.
The novel virus is related to coronaviruses found in bats, but
experts have not succeeded in uncovering its animal source or the route
it follows to get into humans.
One previous hospital cluster of nCoV cases has been reported. The
illnesses occurred in a hospital in Jordan in April 2012, but they were
not identified as nCoV until later in the year, after the virus was
first identified in a Saudi Arabian man. The Jordan cluster included two
confirmed cases and 11 probable ones, and 10 of the 13 people involved
were healthcare workers, according to the WHO.
The new virus is in the same family as the SARS (severe acute
respiratory syndrome) virus, which spread to about 30 countries and
killed around 900 people in 2003. Experts have been alert for hospital
outbreaks of nCoV, because such outbreaks played a major role in the
rapid spread of SARS.
In other developments, a group of scientists and public health
officials plans to recommend a new name for nCoV, according to a ScienceInsider report today. The proposed name is Middle East respiratory syndrome coronavirus (MERS-CoV).
The name is being suggested by the Coronavirus Study Group of the
International Committee on Taxonomy of Viruses (ICTV), which took the
initiative to find a new, widely accepted name, according to the story.
Raoul de Groot, a veterinary virologist at Utrecht University in
the Netherlands, chair of the study group, said it plans to publish a
paper recommending the new name. It will be up to researchers to decide
whether to use it or not, since the study group has no power to require
its use.
So far the virus has gone by a few different names. As noted in
the story, the virus was first isolated in Saudi Arabia but was first
characterized by a group at Erasmus Medical Center in the Netherlands,
who picked the name "human coronavirus-Erasmus MC," or HCoV-EMC. That
irritated some Saudi officials. Some researchers have dropped the "EMC"
and just use HCoV (human coronavirus), while the WHO has used nCoV.
De Groot commented that the name his group chose refers to a large region and avoids singling out any country.
The countries involved in the nCoV outbreak and their numbers of
cases and deaths, as tallied by ProMED, are: Saudia Arabia, 22 cases and
13 deaths; Jordan, 2 and 2; the United Kingdom, 3 and 2; Qatar, 2 and
1; United Arab Emirates, 1 and 1. (One Qatari patient is still being
treated in the UK, and one Qatari and the UAE patient were treated in
Germany.)
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