Wuhan pneumonia is similar to SARS but has a different mortality rate unknown

On January 24, The Lancet and The Lancet-Infectious Diseases published two new coronavirus case studies, the first to show the data of the first batch of people infected in Wuhan, as well as the transmission of the virus between people and cross-city between Wuhan and Shenzhen. In addition, several experts commented on the two studies, saying that it would be a top priority to mobilize the public to protect and control the spread of the virus. They also joined the Lancet in calling for open and transparent scientific information sharing and outbreak information sharing as key initiatives to help China and countries around the world weather the storm.

As of 9:30 a.m. on January 26, 2020, 1975 cases of 2019-nCoV infection had been confirmed nationwide, 2,684 suspected and 56 deaths. Most of the cases are linked to the South China Seafood Market in Wuhan, China, where freshly slaughtered wild animals are reported to be sold, but the initial source of the infection is still unknown.

2019-nCoV is likely to be closely related to coronaviruses carried by Chinese horseshoe bats. Currently, six coronaviruses (including seven in 2019-nCoV) are known to cause respiratory diseases in humans, but so far only infectious atypical pneumonia (SARS) and Middle East Respiratory Syndrome (MERS) have led to large-scale outbreaks and high mortality rates (10% and 37%, respectively). Currently, no specific anti-coronavirus drugs or vaccines have been shown to be effective in humans.

What can the first cases in Wuhan tell us?

In the first study, researchers analyzed the first 41 confirmed cases of infection with 2019-nCoV in Wuhan between December 16, 2019 and January 2, 2020.

Full paper:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736 (20) 30183-5/fulltext

The authors combined clinical characteristics, laboratory tests and imaging results with epidemiological data. The results showed that the proportion of patients aged 25-49 and 50-64 years old was 49%, 34%, the median age of patients was 49 years old, and most of them had been to the South China Seafood Market (66%, 27 cases), mainly male (73%, 30 cases).

As with SARS, the majority of infected people are healthy, with less than one-third of cases combined with chronic diseases such as diabetes (20%, 8), hypertension (15%, 6 cases) and cardiovascular disease (15%, 6 cases).

Similarly, patients with 2019-nCoV infection also showed more clinical symptoms. All patients admitted to the hospital had pneumonia, with most clinical lycing (98%, 40 cases), cough (76%, 31 cases) and fatigue (44%, 18 cases). More than half of patients also had breathing difficulties (55%, 22), but headaches (8%, 3 cases) and diarrhea (3%, 1 case) were rare.

The study’s authors, Professor Cao Bin of the China-Japan Friendship Hospital and Capital Medical University, explained: “Although some symptoms are similar to SARS (e.g. fever, dry cough, dyspnea), there are some important differences, such as the absence of upper respiratory symptoms in patients with 2019-nCoV infection (e.g. runny nose, sneezing, sore throat) and intestinal symptoms (e.g. diarrhea, seen in 20-25% SARS patients). [1]

About one-third of patients developed acute respiratory distress syndrome (29 percent, 12 cases) or were in intensive care (32 percent, 13 cases), of which 6 died. The researchers say cytokine storms can be seen in critically ill patients, but more research is needed to clarify how 2019-nCoV affects the human immune system.

“It is difficult to accurately understand the mortality rates associated with this new virus, as it is often easier to focus on critical cases in the initial stages of an epidemic and may overlook lighter or asymptomatic cases,” explains co-author Dr. Lili Ren, from the Institute of Pathogen Biology at the Chinese Academy of Medical Sciences. [1]

As of January 22, 2020, 28 (68%) of the 41 patients included in the study had been discharged from the hospital.

The researchers also point to some limitations of the study, including the difficulty of accurately assessing risk factors associated with disease severity and mortality due to the limited number of cases, and they call for larger studies in outpatient clinics and communities to confirm the complete disease spectrum of patients infected with 2019-nCoV infections.

Asymptomatic infections appear

The second paper is the first genetic analysis study, and the researchers looked at a family of seven who were treated for unexplained pneumonia. Of these, 2019-nCoV was found in five people who had recently visited Wuhan, and the same virus was found in another family member who was not travelling with him. Only one child was uninfected, and her mother said the child wore a surgical mask for most of her stay in Wuhan. Importantly, another child infected with 2019-nCoV did not show clinical symptoms, suggesting that the carrier may be spreading the disease within the community without knowing that he or she is infected.

Full paper:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736 (20) 30154-9/fulltext

Wuhan pneumonia is similar to SARS but has a different mortality rate unknown

“Previously, this new coronavirus has been transmitted from person to person in hospital and home environments, and cases of infected travelers have been reported in other countries, and the findings of our study are consistent with these.” “Because of the potential for asymptomatic infections, controlling the prevalence of new coronaviruses also relies on isolating patients, tracking and isolating contacts as early as possible, educating the public about food and hygiene, and ensuring that health care workers comply with infection control measures,” said Professor Yuan Guoyong of the University of Hong Kong’s Shenzhen Hospital, the study’s lead author. “[1]

The researchers also studied the family’s epidemiological, clinical, laboratory and microbiological findings.

The first patient, aged 65, female, developed symptoms five days after visiting a 1-year-old relative of hyperthermal pneumonia at a hospital in Wuhan on December 29, 2019. Upon her return, she was admitted to the Shenzhen Hospital of the University of Hong Kong (HKU-SZH) on 10 January 2020, and her husband, aged 66, was also admitted to the hospital at the same time (above).

On January 11, the University of Hong Kong’s Shenzhen Hospital tested four other family members – their daughters (37) and son-in-law (36) – who first appeared symptoms on January 1-2, which lasted 9-10 days. Their two children have no symptoms. A seventh family member, a 63-year-old mother-in-law, had not been to Wuhan, but several family members stayed with her on her return and she then felt unwell and was admitted to hospital on 15 January 2020 due to persistent symptoms.

Wuhan pneumonia is similar to SARS but has a different mortality rate unknown

Genetic tests found that five patients with a new coronavirus into the cell with a protoprotein positive. Of these, the complete 2019-nCoV genome was identified from clinical samples from two patients.

During their stay in Wuhan, the family did not go to the food market or come into contact with animals. The author believes that the most likely cause of the family infection was that the 65-year-old woman contracted 2019-nCoV while visiting a 1-year-old relative at a hospital in Wuhan, then spread it to four other family members during the seven-day trip and to another family member after flying back to Shenzhen. However, the local health department is still conducting further contact tracking of the family.

Currently, all six patients are hospitalized and are in stable condition as of January 20, 2020.

“Strict prevention and control measures are needed at an early stage of the outbreak,” the authors stress. It is worth noting, however, that the study simply reflects a family cluster, and the ability of the virus to spread remains unknown.

The paper’s co-author, Dr. From the University of Hong Kong. “With improved surveillance networks and laboratory testing capabilities in the wake of the SARS pandemic, China has the ability to identify this new outbreak within weeks and disclose the virus genome to help control its spread,” said Rosana Wing-Shan Poon. The outbreak of SARS began with ‘animal-to-human’ transmission, from which lessons were learned, and all wildlife meat trades should be better regulated to end this potential route of transmission. Further research is needed to clarify the potential threat posed by this new type of virus and asymptomatic cases. “[1]

Strict prevention and control is the most important

Wuhan pneumonia is similar to SARS but has a different mortality rate unknown

In a related comment published online, Professor Wang Chen, Director of the Beijing Concord School of Medicine of the Chinese Academy of Medical Sciences, Gao Fu, Director of the Centers for Disease Control and Prevention (CDC), Professor Peter Horby of the Center for Tropical Medicine and Global Health at the University of Oxford, UK, and Frederick Frederick, School of Medicine, University of Virginia, USA G. Professor Hayden wrote: “To improve testing efficiency, front-line clinics should be equipped with effective clinical diagnostic kits in addition to the local Centers for Disease Control and Prevention… Awareness-raising campaigns should be carried out to urge visitors to take preventive measures, including frequent hand washing, cough etiquette and the use of personal protective clothing (e.g. masks) in public places. In addition, people should be encouraged to proactively report risk factors for fever and other coronavirus infection, including travel history of affected areas and close contact with confirmed or suspected cases. Considering that a large number of SARS and MERS patients are infected in a medical facility, precautions need to be taken to prevent the virus from spreading in hospitals. “

Wuhan pneumonia is similar to SARS but has a different mortality rate unknown

In a second review, David Heymann, a professor at the London School of Hygiene and Tropical Medicine (not involved in the study), wrote: “This rapid sharing of (and open source) scientific information can provide epidemiologists with real-time guidance to control outbreaks and help clinicians manage patients. And help modelers understand the potential future direction sands and the possible effects of various interventions. “

The Lancet editorial, published at the same time, also states: “It is vital that open and shared data … There is a great need for rapid access to information about the new virus, information on affected patients and communities, and on appropriate measures taken. But it is equally important to ensure the reliability and effectiveness of these data and to conduct independent reviews. For current and future health emergencies, all relevant Research content of The Lancet will be completely free of charge. “