The Centers for Disease Control and Prevention (CDC) confirmed a second U.S. case of the Wuhan coronavirus on Friday, pointing to a patient in Chicago while revealing that 63 other possible cases are being tracked across 22 states.
Though Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, stated that immediate risk remains low at this time, infections continue to mount globally. More than 800 cases of the novel coronavirus that was first detected in Wuhan City, China, in December 2019 have been confirmed worldwide. Dubbed 2019-nCoV by the World Health Organization (WHO), the virus has killed at least 25 people in China, which has resorted to lockdowns of several major cities even as thousands travel for the Lunar New Year. Thousands, likewise, remain under observation there.
Such quarantines have proven controversial, however, prompting critiques from health experts like Tom Inglesby, director of the Johns Hopkins Center for Health Security. “In past outbreaks, we haven’t seen evidence that large-scale quarantine diminishes spread of disease,” Inglesby said. “It runs the risk of people losing confidence in government.”
Observation of U.S. patients is ongoing, including close contacts of the Chicago woman who had traveled from Wuhan to Chicago this month. The CDC noted that she showed no symptoms while traveling and officials believe that the chance of spreading the virus prior to symptom onset seems low. However, little remains known of the virus, its origins or its capabilities. Aside from the United States and China, Japan, Singapore, South Korea, Thailand and Vietnam now host cases of the Wuhan coronavirus.
Plans to distribute a coronavirus diagnostic test throughout the United States are still underway.
The rapidly evolving situation briefly interrupted the ongoing impeachment trial in the U.S. Senate, with the Senate Health, Education, Labor and Pensions Committee and the Senate Foreign Relations Committee hosting a briefing on Friday morning for senators from senior government health officials regarding how the country is prepared to respond to the outbreak. Top health officials, including CDC Director Robert Redfield and Robert Kadlec, the Department of Health and Human Services assistant secretary for preparedness and response, provided the update.
“The novel coronavirus is an emerging public health threat,” Senate Health Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) said in a joint statement on Jan. 23.
Global Response
Amid a sharp increase in case numbers over the last week, two days of emergency meetings at the WHO were held. While noting suspected cases in other countries even beyond those already reported, WHO Director-General Dr. Tedros Adhanom Ghebreyesus said on Jan. 23 the Emergency Committee was divided over whether to declare the Wuhan coronavirus a Public Health Emergency of International Concern.
He did not downplay its threat, however.
“I am not declaring a public health emergency of international concern today,” Ghebreyesus said. “As it was yesterday, the Emergency Committee was divided over whether the outbreak of novel coronavirus represents a PHEIC or not. Make no mistake. This is an emergency in China, but it has not yet become a global health emergency. It may yet become one. WHO’s risk assessment is that the outbreak is a very high risk in China, and a high risk regionally and globally.”
The committee expects to reconvene to further examine the issue in 10 days.
In the meantime, the committee asked that China provide more information on cross-government risk management measures being undertaken there, along with moving to enhance its containment, mitigation, surveillance and case tracing going forward. Greater collaboration with WHO and its partners has been encouraged, to present a united effort at investigation of the Wuhan coronavirus’s nature.
For everyone else, WHO pressed for the continued sharing of information and urged that countries emphasize the reduction of human infection and prevention of secondary transmission. Greater research is necessary, and WHO said it expects more cases to crop up.
“It is expected that further international exportation of cases may appear in any country,” WHO said in a statement. “Thus, all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO.”
To date, WHO has not recommended any travel restrictions linked to the virus, but CDC recommends travelers avoid all nonessential travel to Wuhan.
In the shadow of SARS
In an article published on Jan. 23 in the Journal of the American Medical Association, officials from the National Institutes of Health discussed the connections that bind the larger coronavirus family. The Wuhan coronavirus shares a family with pathogens like the severe acute respiratory syndrome (SARS) that savaged Asia in the early 2000s, killing 774 in the process. Yet it is only in recent years that such coronaviruses have begun to evolve in such deadly ways; historically, when one thought of coronaviruses, they tended to think of the common cold.
The Wuhan coronavirus, according to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), and co-authors Dr. Hilary Marston, also of NIAID, and Dr. Catharine Paules of Penn State University College of Medicine, is now the third time in 20 years that a coronavirus has jumped from animals to humans, to deadly effect. Bats, camels and, according to some sources now, snakes, were respectively responsible.
Much of the focus with the Wuhan coronavirus, for example, has been on a Wuhan animal market which has remained closed since the early days of the outbreak.
Researchers have expressed hope in how quickly vaccine development has evolved since the SARS epidemic. Such vaccines can now be produced quicker than ever and, they note, a candidate vaccine for 2019-nCoV could be ready for human testing within three months, assuming more about the virus can be nailed down.
“The emergence of yet another outbreak of human disease caused by a pathogen from a viral family formerly thought to be relatively benign underscores the perpetual challenge of emerging infectious diseases and the importance of sustained preparedness,” the authors wrote.
At NIAID, though, researchers are already adapting approaches used with investigational SARS and Middle East Respiratory Syndrome (MERS) vaccines to boost developments to meet the latest threat.
Additionally, the Coalition for Epidemic Preparedness Innovations (CEPI) announced this week that it intends to develop three vaccines to address nCoV-2019. Its researchers will utilize existing rapid response platforms and coronavirus-focused partnerships with Inovio, the University of Queensland, Moderna, Inc. and NIAID to push toward clinical testing in as little as 16 weeks.
“Given the rapid global spread of the nCoV-2019 virus the world needs to act quickly and in unity to tackle this disease,” said Richard Hatchett, CEO of CEPI. “Our intention with this work is to leverage our work on the MERS coronavirus and rapid response platforms to speed up vaccine development. There are no guarantees of success, but we hope this work could provide a significant and important step forward in developing a vaccine for this disease.”