A 73-year-old man from the United Arab Emirates who had been transferred to Germany by air ambulance for treatment for novel coronavirus (NCoV) infection died on March 26th.

The patient had been treated in intensive care at The Robert Koch Institute, Munich, Germany. German health authorities say this is the second case of novel coronavirus infection that was imported to Germany. The first patient was transferred to a German hospital on October 24th, 2012 and made a full recovery.

United Kingdom – a patient from a family cluster of humans infected with the novel coronavirus who was reported on February 11th, 2013, has died. He had recently travelled to Pakistan and Saudi Arabia. Last month, another family member with no history of recent travel also became ill and died – confirming suspicions that NCoV is human-to-human transmissible. The HPA (Health Protection Agency), UK, emphasized that NCoV is only mildly human transmissible.

So far, the World Health Organization (WHO) reports that it knows of 17 confirmed cases of human infection with nCoV, of whom 11 have died.

Update June 8th, 2013 – the World Health Organization announced that there are 51 cases of MERS-CoV infection so far, and 31 deaths. MERS-CoV (the new name for the virus) stands for Middle East Respiratory Syndrome Coronavirus. Scientists at the CDC are expressing frustration at the delays in getting samples of MERS-CoV. Experts say very little is known about this virus – nobody knows where it lives and how people contract it.

According to the European Centre for Disease Prevention and Control (ECDC), since reporting started – there have been six diagnosed and confirmed cases of human nCoV infection in Europe. In three cases – 1 in the UK and 2 in Germany – they came to Europe as part of transfer for care from the Arabian Peninsula where they became infected.

The ECDC informs that a fourth case became ill while in the Arabian Peninsula, but his infection may have occurred there or in Pakistan, before travelling to the UK. English and German health authorities have undertaken extensive contact tracing. So far, the investigations have revealed two cases of human-to-human transmission in the UK. Testing of other people, a measure recommended by WHO and ECDC has not revealed any further cases.

WHO and ECDC explained that although the number of novel coronavirus infections rose last month, the majority of cases continue to be associated with the Middle East, specifically the Arabian Peninsula. Public Health Authorities in Saudi Arabia, Jordan, Qatar and the United Arab Emirates are conducting tracing and epidemiological investigations in order to determine the possible source of infection.

Below are data on 14 of the 17 cases of nCoV, published by ECDC.

Confirmed cases of infection with the Novel Coronavirus (nCoV), 03/28/2013.

  • April 2012. Age 45. Female. Data submitted November 30th, 2012. Part of a hospital cluster. Outcome – patient died.
    Probable place of infection – Jordan.
  • April 2012. Age 25. Male. Data submitted November 30th, 2012. Part of a hospital cluster. Outcome – patient died.
    Probable place of infection – Jordan
  • June 13, 2012. Age 60. Male. Data submitted 20 Sept 23, 2012. Not part of a hospital cluster. Outcome – patient died.
    Probable place of infection – Saudi Arabia
  • Sept 3, 2012. Age 49. Male. Data submitted Sept 23, 2012. Not part of a hospital cluster. Outcome – patient alive, in hospital.
    Probable place of infection – Qatar or Saudi Arabia. The patient was transferred to the United Kingdom.
  • Oct 10, 2012. Age 45. Male. Data submitted Nov 11, 2012. Not part of a hospital cluster. Outcome – patient alive.
    Probable place of infection – Saudi Arabia
  • Oct 12, 2012. Age 45. Male. Data submitted Nov 23, 2012. Not part of a hospital cluster. Outcome – patient alive.
    Probable place of infection – Qatar. The patient was transferred to Germany.
  • Nov 3-5, 2012. Age 31. Male. Data submitted Nov 20, 2012. Part of a family cluster. Outcome – patient alive.
    Probable place of infection – Saudi Arabia
  • Oct 28, 2012. Age 39. Male. Data submitted Nov 23, 2012. Part of a family cluster. Outcome – patient died.
    Probable place of infection – Saudi Arabia
  • Oct, 2012. Age unknown. Male. Data submitted Nov 28, 2012. Part of a family cluster. Outcome – patient died.
    Probable place of infection – Pakistan or Saudi Arabia. The patient became ill in the United Kingdom
  • Jan 6, 2013. Age adult. Male. Data submitted Jan 12, 2013. Part of a family cluster. Outcome – patient died.
    Probable place of infection – United Kingdom. First case of somebody becoming infected outside the Middle East or Pakistan
  • March 6, 2013. Age 69. Male. He had no recent history of travel or contact with a confirmed case, hospitalized on February 10, 2013 and died on February 19.
    Probable place of infection – Saudi Arabia
  • March 12, 2013. Age 39. Male. Potential exposures are under investigation, developed symptoms 24 February, 2013 and died on March 2 while in hospital.
    Probable place of infection – Saudi Arabia
  • March 23, 2013. Patient with mild symptoms who was hospitalized and has since recovered. Source and mode of transmission not identified, but the person is known to be a contact from the case above.
    Probable place of infection – Saudi Arabia
  • March 25, 2013. 73-year-old male from the United Arab Emirates who was transferred to Germany. Despite intensive care in Germany, where nCoV infection was confirmed, the patient died on March 26, 2013. German public health authorities are performing contact tracing and other investigations.

WHO is urging member states to continue their surveillance for SARI (severe acute respiratory infection) and to carefully follow up any unusual patterns. WHO says it is liaising with international experts and nations where cases have been reported.

WHO, the ECDC, the CDC (Centers for Disease Control and Prevention, USA), the HPA (Health Protection Agency, UK) and German health authorities do not advise special screening at points of entry or any travel or trade restriction.

Coronaviruses belong to the subfamily Coronavirinae in the family Coronaviridae. They usually infect the respiratory tract of humans and other mammals, and are associated with pneumonia, SARS (severe acute respiratory syndrome) and the common cold. In some cases the gut may also be affected.

An avian infection bronchitis virus, which can seriously affect poultry stocks, was isolated in 1937 and is thought to be the first time scientists ever isolated a coronavirus.

Over the last seven decades, scientists have discovered that coronaviruses can infect cattle, pigs, horses, turkeys, mice, rats, dogs and cats.

Human coronaviruses, also referred to as HCoV, are coronaviruses that infect humans. They are responsible for about one third of all common colds.

They are called coronaviruses because they have a crown or halo around them when seen under an electron microscope. “Corona” is Latin for “crown” or “halo”.

Coronaviruses 004 lores
See the coronaviruses’ halo, or crown-like (corona) appearance viewed under an electron microscope

The Novel Coronavirus, also known as nCoV is a new coronavirus strain that started appearing in the Middle East last year. It was first discovered near the beginning of 2012 when a man in Saudi Arabia became sick with symptoms that appeared to be very similar to SARS – he died in June 2012. Three months later, a patient from Qatar became ill in his own country, he had recently travelled to Saudi Arabia. He was transported to the UK for further treatment.

Laboratory tests showed that both the Saudi and Qatari patients had been infected with the same virus – nCoV.

Some media channels refer to nCoV as the “Saudi SARS”. The World Health Organization has asked newspapers, TV and radio not to do this because it can lead to confusion and ambiguity.

So far, nCoV has killed over half of all infected humans – this is much higher than the 9.6% death rate during the SARS pandemic in 2002/2004.

Health authorities and scientists say that nCoV’s main transmission is most likely from animal-to-human (zoonic).

However, there is evidence that it is also mildly human-transmissible. A man in the UK became infected with nCoV and died – he had never been to the Middle East and had not been abroad recently. Other members of his family had become infected after traveling to the Arabian Peninsula. The man must have caught the infection from an infected family member.

The Health Protection Agency, UK, says that nCoV is much less human transmissible than SARS was.

With only 17 cases to go by, WHO says that it is not yet possible to be sure about the signs, symptoms and other aspects of the disease. From data gathered so far, the signs and symptoms include:

  • Acute serious respiratory illness
  • Fever
  • Shortness of breath
  • Breathing problems

In the majority of cases, the infection progresses to pneumonia. In some infected patients there may be kidney failure.

Earlier this month, the Centers for Disease Control and Prevention (CDC), USA, warned state and health officials about “a deadly new coronavirus which so far has killed 8 of 14 infected people in the Middle East and the UK” (numbers since then have risen).

The CDC added that this extremely virulent coronavirus comes from the same virus family as SARS and the common cold.

Although no infections have been reported in the USA so far, health care professionals and administrators need to be watchful for any patients who have travelled to the Middle East during the previous ten days with unexplained respiratory infections. A CDC Coronavirus Website has been set up with latest updates.

Written by Christian Nordqvist