A novel coronavirus infection has been confirmed in a UK patient who had recently returned from Pakistan and the Middle East, the UK Health Protection Agency announced. Coronaviruses are causes of severe respiratory infections, such as SARS (Severe Acute Respiratory Syndrome) as well as the common cold.

The HPA (Health Protection Agency) says the patient is in a Manchester hospital receiving intensive care treatment. This case brings the total number of cases confirmed worldwide to 10 (two of them diagnosed in the United Kingdom).

Below is a list of where the ten confirmed laboratory cases of SARS occurred:

  • 5 – Saudi Arabia, of whom three died.
  • 2 – Jordan. Both of them died.
  • 2 – UK. One a Qatari, the other one a British citizen. They are both currently receiving treatment.
  • 1 – Germany. Made a full recovery and was discharged from hospital. The patient was from Qatar.

Update (February 13th) – on Wednesday, February 13th, the Health Protection Agency confirmed another case of novel coronavirus infection in the UK. This time the patient, a British citizen, had no recent history of travel and no history of travel to the Middle East at all. This latest case points to a human-to-human transmission of the novel coronavirus.

Head of respiratory disease at the HPA, Professor John Watson, said:

“The HPA is providing advice to healthcare workers to ensure the patient under investigation is being treated appropriately and that healthcare staff who are looking after the patient are protected. Contacts of the case are also being followed up to check on their health.

Our assessment is that the risk associated with novel coronavirus to the general UK population remains extremely low and the risk to travellers to the Arabian Peninsula and surrounding countries remains very low. No travel restrictions are in place but people who develop severe respiratory symptoms, such as shortness of breath, within ten days of returning from these countries should seek medical advice and mention which countries they have visited.

Since the first case of novel coronavirus was diagnosed in the UK in September 2012, the HPA has maintained increased vigilance for illness caused by this virus, working closely with national and international authorities including the WHO and the European Centre for Disease Prevention and Control (ECDC). We have also produced updated guidance for health professionals in the UK on the investigation and management of possible cases.”

The HPA now has a range of lab tests which it developed to test for coronavirus infection when patients with severe respiratory infection have an unexplainable cause. Professor Maria Zambon, director of reference microbiology services at the HPA, said that the tests are available for use at some frontline HPA labs.

In November 2012, the HPA published the full genome sequence of a coronavirus from the first UK patients, allowing researchers globally to more deeply understand the diversity of this virus. Having access to its full genome will help the scientific community determine the virus’ origin, as well as develop strategies for prevention and treatment, Professor Zambon explained.

SARS, which stands for Severe Acute Respiratory Syndrome, is a highly contagious and potentially fatal form of lung infection (pneumonia), according to the National Health Service (NHS), UK. However, in September 2012, the WHO (World Health Organization) said the novel coronavirus cannot spread easily from human-to-human. SARS is caused by the SARS Coronavirus (SARS CoV). Several coronaviruses are associated with infections in animals and humans.

Scientists and doctors know about two human coronaviruses that caused mild respiratory infections, including the common cold. This kind of virus also includes strains that can cause SARS.

The first case of SARS was recorded in 2002 in the Guangdong province of southern China. The infection rapidly became a pandemic and led to over 8,000 cases and 774 deaths before it was eventually brought under control.

The signs and symptoms of SARS include:

  • Flu-like symptoms which start within two to ten days after infection
  • Muscle pain
  • Loss of appetite
  • High fever
  • Headaches
  • Extreme tiredness
  • Diarrhea
  • Chills
  • Three to seven days after these signs and symptoms start, the infection spreads to the lungs and airways, and the patient experiences a dry cough, breathing difficulties and a progressive drop in blood-oxygen levels – in very severe cases this can become life-threatening.

Experts believe a coronavirus strain which only infected small mammals mutated and became transmissible to humans. The SARS infection spread rapidly among humans in China, and then to other Asian countries. Other countries also reported confirmed cases of SARS, including many in Toronto, Canada and four in the UK.

Sars Cases and Deaths
Areas around the world that were affected by SARS in 2002-2003

In July 2003, the SARS pandemic was finally brought under control. WHO (World Health Organization) says this was thanks to a policy of isolating suspected infected people, and screening all airplane passengers travelling from affected countries.

The 2002/2003 SARS pandemic killed approximately 10% of infected people, and 1 in every 2 infected patients over 65 years of age.

A small laboratory in China was involved in another small SARS outbreak in 2004. WHO said this was caused by somebody coming into direct contact with a virus sample, rather than human-to-human or animal-to-human transmission.

How does SARS spread?

Like the common cold or influenza (flu), SARS is an airborne virus that spreads in small droplets of water that people cough or sneeze into the air. People can become infected by inhaling the droplets.

SARS can also spread by touching surfaces that an infected person had previously touched, such as door handles. Infected people who do not wash their hands after going to the toilet (passing stools) can also spread the infection by touch. That is why good hand hygiene is so important in stemming the spread of infection.

Those caring for or living with somebody infected with SARS are most at risk of developing the infection, according to studies carried out during the 2002/2003 pandemic.

What are the treatment options for SARS?

According to the National Health Service (NHS, UK) and the HPA, there is no cure for SARS. However, scientists are currently researching on a vaccine.

Current treatment focuses on supporting the patient with:

  • Steroids to reduce inflammation in the lungs
  • Breathing assistance, for example using a ventilator to deliver oxygen
  • Antiviral drugs
  • Antibiotics for treating pneumonia

Zoonotic virus, related to SARS, could repeatedly pass from animals to humans. A new type of coronavirus that is starting to worry public health authorities can infect cells from bats and humans alike, a fact that could make it easily animal-to-human transmissible (zoonotic), researchers from the University of Bonn Medical Centre, Germany, reported in the journal mBio.

Known as hCoV-EMC, the new coronavirus is believed to be the cause of five human deaths and many other cases of disease that originated in the Middle East. Laboratory tests show that hCov-EMC uses a different receptor in the human body than the SARS virus and can infect cells in a wide range of pigs and bat species. This means that there is not much we can do to stop the virus from jumping from animals to humans repeatedly.

Written by Christian Nordqvist