Monday 8 April 2013

SCIENCEINSIDER: 11 cases of Coronavirues since Sep.2012-Camel-Humen-Zoonosis

مرض الكرونا موجود في الابل وحيوانات اخر
وهي من الامراض التي ستنتشر في شرق للابيض المتوسط

German Researchers to Probe Camel Link to New Coronavirus

Martin Enserink on 4 April 2013,
On 26 March, a 73-year-old man from Abu Dhabi, the capital of the United Arab Emirates, died at the Klinikum Schwabing, a hospital in Munich. He was the 11th known fatality related to infection with the novel coronavirus (nCoV), a pathogen that was first reported in September 2012 and is attracting substantial interest from researchers. Overall, officials have reported 17 cases of nCoV infection.
Clemens Wendtner, a professor of medicine and assistant medical director at the University of Cologne, is a physician at the Munich hospital. ScienceInsider asked Wendtner how the case was handled and why he thinks the patient may have been infected by one of his racing camels. Questions and answers have been edited for brevity and clarity.

Q: Why did the patient seek treatment in Germany and why did he come to the Klinikum Schwabing?

C.W.: We are one of seven reference centers for infectious diseases in Germany; the Klinikum Schwabing has a unit for highly contagious patients, and one of the first SARS patients was treated here in 2003. This particular patient was treated in Munich for multiple myeloma, which had been diagnosed in 2009. He flew into Germany on a frequent basis to get chemotherapy and even stem cell transplantation at a private center.

While in Abu Dhabi, his condition deteriorated, and his treating hematologist here in Munich asked to fly him in to get a closer look; the family also wanted him to be transferred. At this point we only knew he had some pulmonary problems, but we were not aware of any coronavirus testing; this was not done in the United Arab Emirates.

Q: When did you suspect he might have the virus?

C.W.: When we examined his condition and saw his medication list; he had even started on [the influenza drug] Tamiflu, but his condition didn't improve. So we said: "Maybe it's a good idea to check for the coronavirus." So we did a bronchoalveolar lavage, [a procedure to sample fluid from the lungs,] and sent the material to Christian Drosten's lab at the University of Bonn; this is the German reference lab for the new coronavirus. The results came back on 23 March. At this point, the patient's medical condition was quite bad.

Q: Did you take special precautions once you knew he was infected to prevent further infections?

C.W.: That was done from the beginning. We are trained with difficult infectious disease situations, so this is what we do when we don't know what is going on. He was in an intensive care unit and put in special isolation; the staff used special precaution measures, such as 3M masks. We also tested staff for the virus, but nobody was positive.

Q: How many people did you test?

C.W.: We had a group of roughly 60 people, and not only staff members. … The patient flew in on a private jet, and we screened the crew members, as well as four relatives who had come with him. But we did PCR testing only for people who had symptoms, such as coughing and flulike symptoms. There were fewer than 10 of those, and all were negative. The others were put on surveillance screening, but if they didn't develop symptoms, they weren't tested.

Q: Have these precautions ended now?

C.W.: Yes.

Q: Is it worrying that quite a few patients with the new coronavirus have sought medical attention in Germany and the United Kingdom? With SARS, you saw people infecting others on planes or seeding new outbreaks in the countries where they arrived.

C.W.: This virus is not in the same category as SARS in terms of the risk of spread. But one point is very valid: The screening tests, especially in the [Arabian Peninsula], are underdeveloped. So there may be a higher number of undetected cases. I was approached by officials from the U.A.E.; they were worried about this first case, because most other cases have been in Saudi Arabia, and they are quite interested in getting testing set up in their country. We will help them, together with professor Drosten in Bonn.

Q: The German tabloid Bild has said the patient was a "sheik" from a "ruling family."

C.W.: Well, at Bild, the truth is not their greatest concern. … He is a wealthy man from Abu Dhabi, for sure. He has the money to rent a Learjet and to get treatment in Germany. But he's not a member of the royal family.

Q: You have said in interviews that he may have become infected through contact with a camel. What is the evidence for that?

C.W.: So far, it's only circumstantial evidence. The patient owned racing camels. One of them got ill and was very weak; the patient was in close contact with that camel, and on the evening the camel got very sick, the patient developed flulike symptoms. Three days later, he was in a medical unit in Abu Dhabi. There is another family member who also had close contact with the camel, he also got ill, but we could not follow up with that gentleman.

We are really interested to find the missing link, to maybe get some material—some blood, some stool—out of this camel. Professor Drosten may send one of his scientific colleagues to Abu Dhabi. We will also get some help from the U.A.E. consulate in Munich.

Q: So the United Arab Emirates is willing to collaborate on this?

C.W.: Yes, they have understood that it's in their best interest to get a better understanding of how the disease might spread from animals to humans.

Q: Is the camel still alive?

C.W.: Yes—at least it was alive a couple of days ago.

Q: When will this investigation start?

C.W.: As you can imagine we are very interested to solve this issue, so this would probably have to happen in the next couple of days.

Q: Have you heard about other camels in Abu Dhabi or the United Arab Emirates getting sick?

C.W.: No, I don't have any information on this. Even the consulate could not tell me. But maybe they didn't pay attention before. This just popped up as a problem, so they may have a closer look at this in the future.

Q: Have you done an autopsy of the patient?

C.W.: We would have wished to get some material, but as you can imagine, it's very difficult in [the patient's] culture to get any kind of autopsy. So the family refused and we did not insist
[Of interest in the above report/interview is the history of contact
with an ill animal prior to onset of illness. In earlier reports of
cases in the Eastern Mediterranean region, there had been reports of
contact with farm animals; in one case, there was report of contact
with a sick animal prior to onset of illness as well.

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