Shots - Health Blog
4:27 pm
Fri October 5, 2012

Arabian Coronavirus: Plot Thickens But Virus Lies Low

It now appears that the new coronavirus found on the Arabian Peninsula is more widespread than initially thought, even though only two people are known to have gotten sick from it.

At first it seemed likely that the two known cases of illness from the new cousin-of-SARS virus may have been exposed in or near the Saudi Arabian city of Jeddah on the Red Sea coast.

But now it's pretty certain that a 49-year-old Qatari man who had traveled to Jeddah last month didn't pick up the virus there. Investigators say he probably got infected after he returned home to Qatar, a tiny Persian Gulf kingdom 825 miles to the east.

A report in the journal Eurosurveillance traces the man's movements, which hadn't been publicly known before.

"It is likely that the patient's infection was acquired in Qatar, as he was in Qatar for the 16 days prior to the onset of his most recent respiratory illness in September," write researchers from the U.K.'s Health Protection Agency and co-workers.

The man remains on life support in a London hospital after he got infected last month by the previously unknown coronavirus. He can't breathe on his own, so requires treatment called extracorporeal membrane oxygenation, or ECMO, basically an artificial lung. He has also suffered kidney failure.

The other known victim of the coronavirus was a 60-year-old Saudi man who died back in June.

The Qatari man, whose identity hasn't been disclosed, suffered a respiratory illness while he was traveling in Saudi Arabia. But, investigators learned, he recovered from that cold 16 days before he fell ill again, that time from the new coronavirus.

In the meantime, he spent time on a farm in Qatar, where he keeps camels and sheep, but reportedly had no direct contact with the animals. Genomic studies of the new virus suggest it is most closely related to a coronavirus that infects bats.

His symptoms were mild at first. But within six days he went to the hospital with pneumonia in both lungs and went steadily downhill. On September 12 his family hired an air ambulance to evacuate him to London. By that time he was in renal failure.

By this week, investigators had traced 64 people who had close contact with the Qatari man – health care workers in Qatar and London and those on the air ambulance, family members and friends. None suffered serious respiratory illness, and 13 of the health care workers had mild respiratory symptoms within 10 days of exposure all recovered.

None of the 10 symptomatic health care workers tested for the virus came up positive. That allowed the World Health Organization to conclude that the new virus is not easily transmitted from person to person. But the source of infection is still unknown.

The Qatari man might have remained just another case of undiagnosed respiratory illness but for the fact that one of his caregivers noticed a Sept. 20 post on an infectious disease network called ProMED Mail. It described the first case of a novel coronavirus — the 60-year-old Saudi man who had died three months earlier.

That caused the London doctors to run a general test for coronaviruses, something they hadn't suspected before. When that turned up positive, they quickly did genetic sequencing on a piece of the Qatari man's virus. Lo and behold, it was for all practical purposes identical to the one from the Saudi man.

At that point, alarm bells rang. As they are supposed to under new international health regulations, the U.K. physicians notified the World Health Organization of a second case of a novel infectious agent. And the investigation was on to see what sort of threat it represents.

That's still unclear. But more is known about it than perhaps ever before in such an early stage of a new microbe's emergence.

It wouldn't have happened without the ProMed posting, which shows the importance of fast communications in responding to potential public health emergencies. "It's really the major reason for ProMED's existence," its founder, Dr. Larry Madoff, told Shots with a hint of pride.

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