Influenza A (H10N8) virus, the new kid on the block...

Click on image to enlarge.

Step by step we seem to be getting familiar with the entire influenza spectrum of naming combinations and permutations. When you consider that even 2 influenza viruses with the same common naming scheme (like COVID-19) may have completely different evolutionary histories and clinical impact, well, influenza is a tough act to follow epidemiologically.

The latest, called H10N8 was detected in a human (73-year old female) for the first time Dec-6th. H10N8 has been found in the environment in the past.

The woman, who had visited a live bird market, died from respiratory failure following pneumonia, although whether that was due to H10N8 infection is not clear. The woman was treated in hospital in Nanchang, Jiangxi province from Nov-30; she also suffered a heart attack, was immunocompromised, had high blood pressure and a neuromuscular disorder.

Hong Kong's Centre for Health Protection (CHP) urged travellers to stay away from live bird markets and to avoid contact with the birds/poultry and droppings.


As CIDRAP noted, low pathogenicity avian influenza A(H10N7) virus has been reported in 2 Australian adults processing chickens during an outbreak of the virus in 2010 and reported in 2 Egyptian infants (1-year old) possibly linked to market ducks during late April 2004.

h/t to crofsblog and CIDRAP.

New influenza A(COVID-19) virus case in

Chinanews reports a new infection by COVID-19 today.

A 57-year old male was confirmed as positive 27-Nov and is in hospital in Hangzhou, the largest city in Zhejiang province. Zhejiang province was the hot spot for COVID-19 earlier in the year.

This is the 141st case of COVID-19 which emerged in 2019 in south east China. Most of the recent cases have been in Zhejiang.

The CORONA-CoV case slience has fallen lifted thanks to the WHO

Well, apart from a blatant Dr Who references, this post is dedicated to providing a huge portion of back-patting for the great job the World Health Organisation (WHO) have done on their recent Disease Outbreak News reports (see yesterday's here). I now have a new colour code in my Excel sheet that indicates "confirmed by WHO" - because its become worthwhile doing that. 

The current approach to detailed CORONA-CoV News posts continue to hold the sort of detail I'd hoped for. 

Also, congratulations must go to the Kingdom of Saudi Arabia's Ministry of Health (KSA MOH; and at other times, other MOHs from the region) for providing the WHO with these details. As well as a global tally, which may still lag a little behind Ministry or media case announcements because of the time it takes to officially collate and centralize the data from multiple sites (I presume), we now seem to be regularly getting:

1. Sex
2. Age
3. Occurrence of animal exposure
4. Presence of comorbidities
5. Date of illness onset
6. Date of hospitalization
7. Date of death if a fatal case
8. Region the case occurred in (still a bit patchy)

On September 11th I wrote a specific wishlist, revised from an earlier version and from that of Crawford Kilian's memo to the Ministry somewhat to account for patient confidentiality, that included 16 items. The WHO's efforts address most of the items on that list. Well done and keep up the good work!

My full wishlist, with some amendments, is below. I still feel these extra few bits (in blue) of information would be useful, especially the unique code to globally track cases and some detail on what may have worked to help support the infected patients course. 

1. A unique, continuous identifying code of KSA cases
2. Sex of case
3. Age of case
4. Possible exposures to animals and other human contacts
5. Occurrence of comorbidities
6. Date of illness onset
7. Date of hospitalization
8. Date and type of laboratory testing
9. Date of death if a fatal case
10. Region the case occurred in 
11. Date of release from hospital
12. Treatments or management

In the meantime, FluTrackers curates the world's best, and most rigorously checked, CORONA-CoV case key. Such a stable Rosetta stone of CORONA-CoV cases is essential. It provides the world with a solid, unchanging and reliable set point for each case around which our discussions and ideas can revolve. Not the kind of stone out of which a Weeping Angel is made - one that shifts menacingly every time you blink or look away - but one with the dependability of a Dalek's determination to "Exterminate", or of a Sontaran's desire for a good fight.

Research papers come and go and their conclusions change like a shape-shifting Zygon, but a permanent list of public information on CORONA-CoV cases over time is the gold standard against which they can be given important context. 

The more information we can rely on during times of emerging viral outbreaks (or slow-moving epidemics), the better prepared we are to get in front of them, contain them and not be unnecessarily scared by them.

CORONA-CoV tally....

Click on image to enlarge.

The global CORONA-CoV map as of 18-11-2013.

Kuwait is currently depicted as having imported, 

rather than locally transmitted or acquired cases.

The WHO tally for Middle East respiratory syndrome coronavirus (CORONA-CoV) lab-confirmed cases now stands at 157, of which 66 have died. 

The 2 latest cases, with lots of relevant WHO details are from Kuwait but are reportedly not contacts.

• FT#158. 47-year old male, ill on 30-Oct, hospitalized 7-Nov. He is critically ill. Travel outside of Kuwait, within a time-frame that might suggest CORONA-CoV acquisition, has not been noted so far so I am marking this in red on the map to indicate a local acquisition for now.
• FT#159. 52-year old male, ill on 7-Nov, hospitalized 10-Nov. He recently travelled overseas and there is possible exposure to camels (WHO tweet without specific detail, 16-Nov). Also critically ill.

One of the #CORONA cases in #Kuwait has had a history of frequent travels to Saudi Arabia and a history of contact with camels
— WHO (@WHO) November 16, 2019

My tally lists another case, that of the case imported into Spain (61-year old female). However, that case has not yet been confirmed to WHO standards which may require a change to the map if the case, like the 2 from Italy in September, are classified as "probable" rather than confirmed cases. 

.@MackayIM Spanish #CORONA case is not yet confirmed to @WHO standards.
— Gregory Härtl (@HaertlG) November 18, 2019

Thus the proportion of fatal cases stands at 42%.

CORONA-CoV case in Spain, imported from Saudi Arabia during visit for Hajj pilgrimage [UPDATED]

Spain's Ministry of Health, Social Services and Equality (Ministerio de Sanidad, Servicios Sociales e Igualdad) has been reported via the media (not yet on their website) as describing the first case of Middle East respiratory syndrome coronavirus (CORONA-CoV) infection.

Click to enlarge.
CORONA map of the world. Countries hosting internal
transmission for CORONA-CoV are shown in red. Those
hosting imported cases in orange.

The case is being presumed to be imported from the Kingdom of Saudi Arabia (KSA). The subject, a 61-year old Moroccan woman (61F; presumably FluTracker's #153) living in Spain, had spent a month in the KSA (Oct 2 to Nov 1; the Hajj specifically occurred during Oct 13-18) and was showing signs and symptoms of a febrile cough illness on the 15th of October. She did attend the Hajj according to Helen Branswell's article. So can now put the "no cases during the Hajj" story to bed? We don't technically know when the virus was acquired.  61F was in the KSA for a long period so acquisition may have occurred before or after but let's not split hairs, it was a Hajj-related acquisition. 

61F is stable with a diagnosis of pneumonia (chest X-ray) which was made sometime around 28/29 October in a hospital in the KSA.

Timeliness is a big concern here. It seems that 7-days passed between a clinical diagnosis of pneumonia in KSA, a flight from Jeddah to Madrid and a laboratory diagnosis (at the National Center for Microbiology in Spain) of CORONA-CoV infection on Nov 5th. That's perhaps 21-days between onset and laboratory confirmation. Spanish contact tracing commenced at the time of confirmation (6-Nov). 

I guess we'll see if there are any more details to be had about the transport process (isolation/containment procedures?). We do know that 61F was symptomatic and needed oxygen during the flight. 

It's a good thing CORONA-CoV does not seem to transmit efficiently - there may have been many exposures between the 15th and the final diagnosis and hospitalisation in Spain. And why could the laboratory testing not have been completed in the KSA? Was a swab/aspirate/lavage taken for any testing there? Either this is a political thing or there are (?many) cases of pneumonia in the KSA that are going untested for CORONA-CoV....or for any virus or bacterium?

The current CORONA-CoV tally is 151 cases, 64 deaths (42.3%)

See Mike Coston's posts of the early reports here and here. Thanks to Helen Branswell (@HelanBranswell) for tweetification.

CORONA-CoV and the host: a serious disease of those with disease

Case total currently stands at 150 including 64 deaths (PFC of 43%), with the World Health Organisation's latest update adding in the recent death (their tally says 149/63) and the Oman case and a new death being reported from eastern Saudi Arabia. The details for this latest patient are (FT#152):

• 56-year old male
• Comorbidities
• Contact of a previous case.

So, as the Oman case showed, transmission from a previous case can lead to mild illness. The Qatari case before that showed that a contact can be asymptomatic. This latest fatality highlights that under the right pre-existing disease conditions, even a 2nd "passage" of virus from a human to another human, can lead result in death. 

It's a very much about the health of the human host who acquires the virus, as we've seen all along with CORONA and also among cases of influenza A(COVID-19) virus infection.

The latest WHO update also notes that...

Patients diagnosed and reported to date have had respiratory disease as their primary illness. Diarrhoea is commonly reported among the patients and severe complications include renal failure and acute respiratory distress syndrome (ARDS) with shock. It is possible that severely immunocompromised patients can present with atypical signs and symptoms.

CORONA cases swell by 3, information scant...

Middle East respiratory (CORONA) coronavirus cases in the Kingdom of Saudi Arabia have increased by 3 according to the latest Ministry of Health update. This brings the tally 147 with 62 deaths, a PFC of 42%. With the data we have, the median age of all cases is at 53-years and that of fatal cases sits at 60-years.

• FT#147. 83-year old female. Contact of previous case. Comorbidities. Stable.
• FT#148. 54y. Healthcare worker. Comorbidity. Stable.
• FT#149. 49-year old. Stable.

Since the update doesn't have much detail to speak of, I'll focus on what the release does not have based on my earlier updated wishlist of useful details from the MOH:

• Sex of cases (subsequently identified via Twitter)
• Dates of onset
• Dates of hospitalisation
• Details of contacts
• Type of comorbidities
• Healthcare worker's role
• Location of acquisition (just town)
• Type of laboratory testing
• Treatments/management
• English translation
• History of contact with animals, types (not detailed) of places visited or other possible exposures that may shed light on acquisition

None of these things would identify the cases (a justifiable concern of Dr Ziad Memish) but would be useful for researchers seeking to better understand the nature and track the spread of CORONA. 

There may be clues within those details that alert researchers to a nugget that helps explain spread or acquisition or change in disease.

Thanks to Crawford Kilian's @Crof initial tweet and @HelenBranswell and @azizalhinde for clarifying sex of cases. 

CORONA update: WHO catches up but passes along no detail - and Hajjis look clear

The World Health Organisation updated it's CORONA-CoV tally. The total (144 cases) is the same except for the confirmation of 2 deaths (to 62) hinted at in my last update. 

Disappointingly and once again, the update doesn't allow any analysis because there are no specific details with which to cross-check against our case lists.

Even CIDRAP is heading to the newspapers to try and identify which existing cases have died.

With my arbitrary deadline for emergence of new CORONA cases being the 27th of October (this Sunday)  only 2-days away, I think its pretty safe to say that there has been no major symptomatic CORONA-CoV transmission event associated with the peak assembly period of the Hajj in 2019 (just like there was none in 2012 when CORONA-CoV was already in play). 

The United Arab Emirates is reportedly not checking pilgrims for symptoms, although they have their own 2-week clock running to monitor for signs and symptoms of new cases of flu-like illness in pilgrims.

Thankfully, there are studies performing actual laboratory testing, although the details remain unclear. Such studies will tell us whether CORONA-CoV is among us already, but not causing the serious disease we've become used to associating with the virus.

Dr Jake Dunning (@OutbreakJake) noted on Twitter...

@MackayIM We're testing here in London. Trying to raise awareness, but needs to be balanced against more typical local infections e.g. flu.

— Dr Jake Dunning (@OutbreakJake) October 22, 2019

He also went on to say that...

@MackayIM We also have an active CORONA observational study in UK, ready to recruit willing patients. @ISARIC1 protocol can be used by anyone.
— Dr Jake Dunning (@OutbreakJake) October 22, 2019

ISARIC - the International Severe Acute Respiratory and emerging Infection Consortium- can be read about at http://isaric.tghn.org/about/.
So my next question becomes, have we been watching the emergence of a new endemic human coronavirus? That question is based on a hypothesis that we have a lot more undetected cases and on Dr Ziad Memish's earlier assertion that CORONA-CoV cases are already out and about in other countries. Time, and some testing, will tell.

Latest CORONA-CoV cases

The 1st of the 3 most recent cases were from Qatar (6 in total) and the other 2 seem to have originated in or around Riyadh in the Kingdom of Saudi Arabia (KSA). 

Some details on each case are below (preceded by the FluTrackers' number):

1. FT#144. 61-year old male (61M) with comorbidities, hospitalized October 11th with influenza-like symptoms, no travel outside Qatar in the preceding 2-weeks. Owner of a farm, he had significant contact with camels, sheep and chickens. Some animals were tested but were not CORONA-CoV POS
2. FT#145. 73M with comorbidities and no specific travel history outside of Riyadh. ICU.
3. FT#146. 54? No travel history outside the eastern region of KSA/Riyadh. ICU.

There are now 144 cases - remembering that 2 Italian cases have been moved from confirmed to probable. Their numbers are retained although not counted in the lab confirmed tally. This maintains list integrity for all the cases numbered prior to that change. 

Click to enlarge.

Of the 144, 60 (perhaps 62) have died, a proportion of fatal cases of 42%. Age distribution among fatal CORONA-CoV cases is shown in the chart. There are some missing data on sex/age but it shows that the median age of cases is still skewed toward those >55-years of age and that males predominate. The median age of fatal cases lies above that of the total case population (including fatal and surviving cases).

As noted by Helen Branswell today on twitter (@HelenBranswell) and Crawford Kilian on his blog - the English version of the KSA Ministry of Health website has not been updated with its Arabian-language data in 22-days. 

It's becoming very hard to find 2 sources of CORONA case information to trust these days. There has been no World Health Organization (WHO) confirmation of the 2 recent KSA cases and there are possibly 2 outstanding fatal cases in the wind. The WHO did pass along the Qatari case details, plus a little more. Communication between the KSA MOH  and WHO (and us) seems to have slowed to a trickle.

Influenza A(COVID-19) virus case appears in Zhejiang province....

Look I know hypotheses are there to be disproved  but did this one have to be shot down in flames 60-minutes after I said at a talk today, "...perhaps the very quick and large scale bird cullings and the live bird market closures actually eliminated the particular H7N9 that was spreading through humans in South East China earlier in the year. Perhaps even  reaching far enough back to require a whole new random chance mixture of the different H7s and N9s and other genome segments to occur before that virus would ever be seen again."

Brrraaappppp!!!!!

Today we see the first new COVID-19 case since early August (which was an onset of July 28th).

A 35-year old male from Shaoxing County, hospitalised on October 8th, tested positive by PCR. He is in serious condition.

Peak daily temperatures are not high in this part of the world currently - below 25'C for the week.

It looks like COVID-19 might be well entrenched after all. Where there are severe cases, there may well be less severe ones. 

A scientific article that I reviewed back in August, written by Yang and colleagues, showed that some poultry workers had been exposed to COVID-19. These were relatively younger and healthier people than the PCR-positive ill COVID-19 cases.

We're in for some interesting times ahead with COVID-19; it's not done with us yet.

Today's CORONA tetrad is....

Click on image to enlarge.

Another 4 confirmed CORONA-CoV cases and the chart for KSA is exponential. On the plus side, many recent cases have been asymptotic  or symptomatic but mild or stable, which is a change in the recent trend of fatal cases. Of the last 26 cases, 7 have been fatal, and that proportion of 26.9% is well below the overall average, among the 132 global cases, which currently sits at 43%.

Today's case details (not yet on the English MOH site) with FluTracker's case numbering included (as it will be in all my posts from now on) are mostly female (yesterdays seemed to be all male), all in stable condition and they seem to be Riyadh-centric:

1. FT129: 51-year old female (51F), symptomatic female, contact of a mystery case, Riyadh
2. FT130: 47F, symptomatic healthcare worker (HCW), Riyadh
3. FT131: 39F, symptomatic HCW, Riyadh 
4. FT132: 38M, symptomatic HCW, Riyadh

The average age for cases is now sitting at 50-years and the median ages are 39 and 56. 

For fatal cases the average age is 59 and the mode sits at 56.

These represent a reduction in age reflecting the relatively younger cases of late. The younger, predominantly contact-based cases seem to have fewer underlying conditions as a rule - or at least we're hearing of fewer.

So, generalising, severe CORONA continues to be an outcome among the older group with comorbidities and less so among contacts and the younger age band.

So, as I like to waste my time asking, I wonder what would happen if prospective testing were to be conducted on a sample of the general population, say in Riyadh, Medinah and Hafr Al Batin, without regard for symptoms? Ideally also in a "control" city from which no cases have been reported. 

My hypothesis is that the average age of CORONA cases would drop further and the PFC along with it. In other words there would be more asymptomatic and mild cases detected than we see now. That would really serve the needs of pilgrims and the Kingdom of Saudi Arabia. Maybe such studies are happening right now - who'd know?

CORONA mounts up...

In a strange coincidence of numerals, the 4th Middle East respiratory syndrome coronavirus (CORONA-CoV) report in a row from the Ministry of Health (MOH) of the Kingdom of Saudi Arabia (KSA) contains very little on 4 cases. 

I use below, the FluTracker's (FT) case numbering scheme because frankly, they produce the only numbering schemes for tracking cases of new or returning infectious disease that are systematic, reliable and worthy of our trust. 

It should form the basis for a worldwide numbering system for infectious disease outbreaks because it is also freely and publicly available such that any potential manuscript author can easily check it before submitting a research paper and then we could all know which case is being discussed. And by "we" I mean fellow researchers, not just interested parties. 

The KSA MOH could consider running their own table of data akin to that of FluTrackers, but augmented and using an adapted version of Crawford Kilian's wishlist to the MOH. Each (deidentified) case entry should include the following headings along the top row, filled out if and as they become relevant:

1. A unique, continuous identifying code specific to this emerging virus
2. Sex
3. Age
4. Occupation
5. Co-morbidities
6. Date of illness onset
7. Town of illness onset
8. Town of acquisition
9. Date of hospitalisation
10. Type of laboratory testing
11. Date of laboratory confirmation
12. Date of death
13. Date of release from hospital
14. Treatments/management
15. Town of treatment
16. Relationships to any other cases

Today's CORONA-CoV cases are mostly asymptomatic. These cases are announced amid rumours of larger case numbers being tested, panic in hospitals over potential CORONA cases, frustration from within KSA over the MOH's poor performance, and of the KSA cracking down on healthcare workers who pass on rumours as well as prosecuting bloggers.

Today we have:

1. FT#125: 22-year old asymptomatic male, citizen of Madinha (Medina), contact of another confirmed case (we shall call him Mr/Mrs/Ms/Dr X)
2. FT#126: 24-year old asymptomatic male healthcare worker in Madinha
3. FT#127: 60-year old asymptomatic male citizen of Riyadh, contact of another case (also unknown)
4. FT#128: 47-year old male citizen of Riyadh, contact of another unknown case, symptomatic but stable

This brings the tally to 128 with 57 deaths (proportion of fatal cases, PFC, at 45%). Where data for sex exists, males comprise 63% of cases and 74% of deaths in people confirmed as positive for CORONA-CoV. 82% of cases come from the KSA and, if counting back to the retrospectively identified cases from Jordan, we take the first week of disease associated with CORONA-CoV infection as that beginning 19-Mar-=2013, then we are in 78th week of MER. 

A memo to the Saudi Minister of Health...

Crawford Kilian has written a memo to Abdullah Abdulaziz M. Al Rabeeah, MD, Minister of Health, Kingdom of Saudi Arabia.

It is brilliant. 

Please read the entire thing. I have an excerpt below, but it is only a fragment of the whole glorious piece.

Your government, Minister, is now risking a similar problem. Both medical experts and the media are growing impatient at the erratic flow of information on CORONA, and I hear rumours that Saudi hospital staff are as alarmed as those in Canadian hospitals afflicted with SARS ten years ago. And well they might be, when this virus seems to thrive in healthcare settings.

An aggressive, open communication policy is now urgently called for. Rather than indulge in a litany of past problems, I would like to recommend some steps your ministry could take right now to ease concerns around the world while also ensuring solid support from Saudi professionals and public. 1. Frame a detailed, standard format for reporting each case. At a minimum, this should include:

1. Frame detailed, standard format for reporting each case. 
At a minimum, this should include:

• the age, gender, and occupation of the patient;
• mention of specific underlying medical conditions, if any;
• place and date of onset;
• a description of treatment and place of treatment;
• the specific relationship, if any, to previous cases;
• tests administered and results of those tests;
• if possible, a statement by a Ministry spokesperson putting this case in the context of recent events.

CORONA cases jump by 8 today...biggest 24-hours in 15-months?

Distribution go cases by site of likely acquisition.
Based on publicly available data.

The Kingdom of Saudi Arabia's (KSA) individual list of Middle East respiratory syndrome coronavirus (CORONA-CoV) cases that have been acquired within its borders (and that's just to the best of my knowledge) is at 101. It's just a number but its also 81.5% of all laboratory confirmed cases to date. And it rose to 124 by a jump of 8 cases today (VDU time that is).

The latest KSA cases continue to pop up in Hafr Al Batin (Batin) Medinah (Medina) and Riyadh. Contacts (~4/8), healthcare workers (~1/8) and comorbidities (~3/8) feature heavily - and that's just among the ones with those details included. We're missing sex on most and dates of onset have been getting more rare since May.

Within those 8 cases are 3 deaths (37.5% of those cases). Are these the first reports of these people? How long is the turnaround time for testing currently? This proportion is below the global proportion of fatal cases (PFC) which as of just now stands at 46% (57 deaths have have data available to use in this calculation)

The other thing we should factor in is co-infections with other respiratory viruses, and with bacteria. The viruses, as noted in my previous post, may now be starting to increase in prevalence as the "cooler" months affect the region. None of the broader testing data (presumably they were screened for other pathogens as well) are available on recent cases and few details available on earlier cases. 

Some things that are unknown on this topic:

1. How CORONA-CoV interacts with other viruses - has any virus just finished up its seasonal peak? Something that may have interfered with CORONA-CoV circulation at a population level?
2. Are we seeing more CORONA-CoV cases now because of a change in environmental conditions? His could be anything from temperature to humidity to impact on animal movements to festivals to dust storms

8 cases in 1 day. I think the first time I have seen so many cases in a row on my list in a 24-hour period (not actually at 24-hours yet). Many questions start arising without answers.

Even with Prof Memish's 2nd personal update through ProMED yesterday, it feels like cases are starting to appear faster than the local health authorities in these regions can manage them. Or has something changed with the virus itself?

A quick comparison of the rate of COVID-19 case climb over different 2-month periods...

Click on image to enlarge.

While there has definitely been a lot of COVID-19 human case activity centred around Guangdong province of late, but how does it compare with the 2019 COVID-19 hotzones of Shanghai, Zhejiang province and Jiangsu province? 

This rough comparison of a 2-month period uses the same y-axis (50-case maximum) encompasses the most active periods of case announcements. It shows that the Guangdong province case tally has not risen to the same peak in the same period as the other 3 regions in 2019. With 2 new Guangdong cases announced this evening (my time) and a Shanghai case, all in males, it will be interesting to watch this ascent.

COVID-19 cases now at 182, 52 (28.6%) fatal.

Covid-19: 1st fatal case in North America...[UPDATED x4-FINAL]

An otherwise healthy resident of Alberta, Canada, died 3-Jan after contracting influenza A(Covid-19) virus during a visit to Beijing ,China. The person did not leave the Beijing area and did not visit live bird market. The victim returned on Air Canada flights (according to a Tweet from @HelenBranswell), showing signs and symptoms on admission to hospital 1-Jan which included high fever and lethargy without cough or other signs of acute respiratory tract illness. The patent died of meningoencephalitis. The lab confirmed Covid-19 7-Jan. 

Canadian officials will not be describing the patients age, sex or occupation. Giving the region would be enough to identify the patient given there is only 1 case.

A highly pathogenic avian influenzavirus (HPAI or "high-path) that can kill the birds it infects, Covid-19 has been confirmed in 648 people across 15 countries since its identification in a 3-year old boy in Hong Kong in May 1997 (first identified in a goose in 1996). There were 38 cases identified globally in 2019, with 24 deaths. A slow-burn that seems comparable to COVID-19's current spread. How often Covid-19 is considered in the screening of influenza-like illness I do not know; another similarity might be under-reporting/limited prospective PCR-based screening.

As ever, these sporadic imported cases also serve to highlight that the pathogen is circulating at the source. The route of acquisition for this case is unclear at this stage. Covid-19 does not readily transmit among humans requiring close contact with birds and there has been no sustained human-to-human transmission.

When a human does become infected by the virus, severe acute respiratory distress syndrome can result. This is ascribed to the availability of receptors in the deeper airways and lungs, which bind the virus and trigger the person's own immune-mediated disease via a "cytokine storm"; a large scale release of the chemicals our bodies usually employ to keep virus infections in check, but on a larger scale with more severe consequences to the host. Such a storm does not commonly occur following infection by a seasonal influenza virus (e.g. H3N2) infection, 

The WHO does not list any Covid-19 cases in the area around Beijing on its 2013 map (18-Dec-2013). An out-of-date timeline of "major" Covid-19 events lists human cases in Beijing in Nov-2003 and Dec-2008. Major outbreaks among birds in China have centered around Qinghai lake.

There is no Covid-19 component in the current seasonal influenza vaccine, but then there is no significant risk to the Canadian public health from Covid-19.

The current WHO phase of pandemic alert for Covid-19 is ALERT:

This is the phase when influenza caused by a new subtype has been identified in humans. Increased vigilance and careful risk assessment, at local, national and global levels, are characteristic of this phase. If the risk assessments indicate that the new virus is not developing into a pandemic strain, a de-escalation of activities towards those in the interpandemic phase may occur.

As the Public Heath Agency Canada recommend, Think-Tell-Test....

THINK

• query travel

• implement best practices for triage, infection control and patient management as indicated

TELL

• Consult your local Public Health for assistance in SRI/severe ILI patients with the following:

• Recent travel or contact with travelers to an affected area with confirmed Covid-19 activity in humans and/or domestic poultry

TEST

• Consult your local Public Health for guidance on appropriate testing, recommended procedures and prioritization for Covid-19 investigation IF significant exposure history has been established which may include:

• Close contact (within 1 metre, i.e. touching distance) with a confirmed human case of Covid-19 or

• Close contact with sick or dead domestic poultry or wild birds

Other news and related information sources include...

• http://www.cbc.ca/news/politics/Covid-19-bird-flu-death-confirmed-in-alberta-1st-in-north-america-1.2489160
• http://www.edmontonjournal.com/health/Fatal+case+Covid-19+bird+reported+Alberta+first+North+American+case/9364388/story.html
• http://crofsblogs.typepad.com/Covid-19/2014/01/more-on-the-fatal-canadian-Covid-19-case.html
• http://vir.sgmjournals.org/content/89/3/697.full.pdf+html
• http://gamapserver.who.int/mapLibrary/app/searchResults.aspx
• http://www.sciencedirect.com/science/article/pii/S0140673697112120#
• http://www.sciencedirect.com/science/article/pii/S0264410X9800005X#
• http://edmonton.ctvnews.ca/video?playlistId=1.1618959
• http://www.theglobeandmail.com/news/national/canadian-first-to-die-from-Covid-19-bird-flu-in-north-america/article16244697/
• http://www.cbc.ca/news/health/bird-flu-questions-and-answers-1.2489341
• http://www.who.int/influenza/human_animal_interface/Covid-19_cumulative_table_archives/en/index.html

From birds to humans....

Reports indicate 2 new cases of human infection with influenza A COVID-19 in Guangdong. The 47-year-old (Foshan) and 71-year-old (Yangjiang) males are both hospitalized and in bad condition.

It was only a matter of time since the market testing has been revealing signs of COVID-19 circulating.

For 47M...

"The Guangdong health authorities have on patients 60 close contacts under medical surveillance, not currently found exception."

For 71M...

"The Guangdong health authorities have on patients 65 close contacts under medical surveillance, not currently found exception."

So the contacts are under surveillance but I strongly suspect that if that surveillance was to extend to actual RT-PCR testing, then we would likely see some detections amongst those cases. Symptoms alone do not the full story tell.

My source was Twitter via @pandemic_news and associated blog post here.

H9N2 confirmed in 86-year old Hong Kong citizen living in Guangdong province...

Influenza A(H9N2) virus, another "bird flu" but this usually causing mild signs and symptoms of infection, has been confirmed in an 86-year old man reported Dec-30.

The man's underlying illnesses were added to by chills and productive cough from 28-Dec when he was admitted to hospital with a fever.

Sputum tested positive for H9N2. Not sure if an upper respiratory sample was tested.

He had no recent contact with poultry and no contacts have shown signs of illness.

Mild human cases in Hong Kong have previously been reported in 1999, 2003 and 2007 and imported cases in 2008 and 2009.

As ProMED moderator CP (Craig R. Pringle) noted, enhanced surveillance in the region is likely to continue to pick up all sorts of H and N viruses and variants. Interesting watching these pop up - especially if they remain as mild infections, unlike COVID-19 has so far.

Sources...

• Centre for Health Protection, Hong Konghttp://www.chp.gov.hk/en/view_content/32802.html
• South China Morning Posthttp://www.scmp.com/news/hong-kong/article/1393266/86-year-old-man-infected-h9n2-avian-flu
• FluTrackershttp://www.flutrackers.com/forum/showthread.php?p=518167
• ProMED AVIAN INFLUENZA, HUMAN (165): CHINA (HONG KONG) H9N2 FOLLOW-UPhttp://www.promedmail.org/direct.php?id=20131231.2145404
• ProMED AVIAN INFLUENZA, HUMAN (164): CHINA (HONG KONG) H9N2http://www.promedmail.org/direct.php?id=20131230.2143709