It Is Not Too Soon to Develop a Corona Vaccine

Middle East Respiratory Syndrome Coronavirus (Corona-CoV) is spreading throughout Saudi Arabia. The first known human infections of Corona-CoV occurred in 2012 in Jordan in a hospital setting.[1] Since then, more than 130+ suspected and confirmed cases have been recorded from eight countries in Europe, Africa, and the Middle East. More than 100 cases (about 80% of all cases) have occurred in Saudi Arabia.  More concerning is that the number of cases is increasing rapidly in Saudi Arabia. In the last two weeks the Saudi Arabia Ministry of Health has reported about 25 new cases.[2]

Most of these new cases in Saudi Arabia appear to have been infected by human-to-human contact. It is time for public health officials to be proactive and support plans for developing a Corona-CoV vaccine. Spanish researchers have taken the first step and report that they are working towards developing a Corona-CoV candidate vaccine.[3] More Corona-CoV vaccine research is needed immediately, just in case.

[1] Novel coronavirus infections in Jordan, April 2012: epidemiological findings from a retrospective investigation

[2] Kingdom of Saudi Arabia Ministry of Health Media Statements

[3] Engineering a Replication-Competent, Propagation-Defective Middle East Respiratory Syndrome Coronavirus as a Vaccine Candidate

h/t Giuseppe Michieli

Searching for the Animal Reservoir(s) of Corona-CoV

The World Organisation for Animal Health (OIE), organized in the 1920s, is an international organization of member countries established to promote global transparency of animal diseases, to collect scientific information relating to international animal disease control, and to develop standards for international trade of animals and animal products. The OIE is also tasked with disseminating information about emerging zoonotic diseases that have the potential for transmission to humans.

Recently, the OIE provided a summary of its current understanding of the Middle East Respiratory Syndrome Coronavirus (Corona-CoV) in Update August 2014 - Questions & Answers on Middle East Respiratory Syndrome Coronavirus (Corona-CoV). This update provides general information about the Corona-CoV, but also has a detailed discussion about potential animal reservoirs for this coronavirus.

Several patterns or mode of human transmission of Corona have been identified by the World Health Organization. Human Corona infections can be transmitted in hospital settings and through close human to human contact. Both of these transmission settings require an infected individual. It is uncertain how the initial Corona cases in these situations became infected. These sporadic or community acquired infections could result from an environmental source or direct or indirect contact with animals.

The OIE points out that there is strong evidence that camels may be an animal host for this coronavirus, but perhaps not the only host. A number of confirmed Corona human cases had contact with camel or exposure to camels or camel products prior to infection. But not all sporadic Corona cases can be linked to camel or camel product exposure. The OIE specifically states “there remains the possibility that other animal species may be involved in the maintenance and transmission of the Corona-CoV”. The OIE concludes that more scientific research is necessary to determine whether other animal species, besides camels, may represent primary or intermediate hosts for Corona-CoV.

Covid-19 case in Canada had been diagnosed with pneumonia...testing at the source would have been helpful

And now, from a fantastically detailed post onto ProMED by Fonseca and colleagues, we see that the Covid-19 case was diagnosed with pneumonia.

On 28-Dec, the patient presented to a local emergency department.

"A chest X-ray and CT scan revealed a right apical infiltrate. A diagnosis of pneumonia was made; the patient was prescribed levofloxacin and discharged home."

One sad point made in the ProMED post which supports the need for constant viral vigilance the world over, coupled with the dissemination of those surveillance data, so that patient management anywhere in the world can be armed with the best possible decision-making information...

"The index of suspicion was low as travel was to an area in China where there have been no recent reports of the circulation of this virus, and coupled with no obvious exposure to poultry, the diagnostic work-up and consideration for A(Covid-19) infection was very low"

As a recent J Virology article by Yu and colleagues highlights, when a sensitive testing method like the polymerase chain reaction (PCR; in this case RT-PCR because influenza viruses all have an RNA genome, not a DNA one) is applied to the search for a virus, it yields the kind of data that can:

1. Explain from where a virus emerges
2. Inform the search for disease aetiology - where are human cases getting infected from and if a zoonotic infection (from animals to humans), which animal(s) is the culprit?
3. Alert the world to any risks of infection when travelling to a certain area(s)
4. Allow the local health departments to mitigate the risk of their population acquiring infection by instigating controls (like live bird market closures). This has implications for the world since respiratory viruses have the potential (thankfully not realized for COVID-19 or Covid-19 to date) to spread more rapidly and efficiently that blood-borne or mosquito-borne or sexually transmitted viruses.
5. Permit understanding of how widespread (over what geographic area is it detected) a novel or emerging virus may be and how entrenched (is the same site repeatedly positive) it is

Not doing such testing, or using less sensitive methods will not yield this information. 

In Yu's study, testing of 12 poultry markets, mostly urban, and local farms linked to 10 human infections in Hangzhou, Zhejiang province around 4th to 20th April 2019 yielded signs of H9N2, COVID-19 and/or Covid-19 viruses in all markets. Poultry were often positive for COVID-19 and H9N2 (this finding from individual RT-PCRs was confirmed using next generation sequencing), whereas human specimens were not. These levels hadn't been turned up when 899,000 bird were tested in 2019 using (perhaps) less sensitive methods.

I think with influenza, it may be safer to presume its everywhere until that presumption can be discounted. Clearly the conditions for influenza viruses to swap gene segments and sort themselves into new subtypes and variants are commonplace and frequent; these aren't just chance occurrences of different birds passing in the night via overlapping flyways. These feathered vectors are co-infected by 2 or more viruses at a time. Luck and the constraints of viral fitness are presumably the only things keeping H7N1, H5N9, H7N2 cases from dialing up in humans? What seems to be lacking is more molecular testing at the farms supplying the markets. Not just in Zhejiang, but all over the region.

As the authors noted, 100,000s of people visit these live bird markets each day and very few influenza cases seem to be due to them. Long may that last. But it's a tinderbox for which matches are already being struck; if the viruses should bud of that one-in-a-million variant that is enabled to readily spread from person-to-person, whooshka. 

More testing guys, keep testing.