Robert Roos 
News Editor
News Editor
Nov 26, 2012 (CIDRAP News) – The reporting of four more novel coronavirus infections in recent weeks, raising the total to six, has prompted the World Health Organization (WHO) to suggest that governments consider a major escalation of testing for the virus, a potentially burdensome undertaking.
In a Nov 23 statement, the WHO reported three new cases, with one death, in Saudi Arabia and one new case in Qatar. The latest Saudi Arabian cases included two in the same household, but it was not known if person-to-person transmission was involved.
The global case count since the virus emerged in June has reached six, of which two were fatal. The latest cases noted by the WHO apparently include two that were reported earlier by Saudi health officials and the news media.
Until more is known, the WHO statement said, "It is prudent to consider that the virus is likely more widely distributed than just the two countries which have identified cases. Member States should consider testing of patients with unexplained pneumonias for the new coronavirus even in the absence of travel or other associations with the two affected countries."
The European Centre for Disease Prevention and Control (ECDC), in a risk assessment released today, said it was considering the implications of the WHO recommendation and commented that increasing testing to that extent would probably be burdensome for European countries.
The novel coronavirus, a relative of the SARS (severe acute respiratory syndrome) virus, emerged in June, but it was not publicly announced until late September.
The first case was in a 60-year-old Saudi Arabian man who died in a Jeddah hospital Jun 24. The second case struck a Qatari man who fell ill in early September and was flown to London, where he apparently remains hospitalized. Both patients had pneumonia and acute renal failure.
A Saudi health official reported the third case on Nov 4, in a Saudi man in Riyadh who had been critically ill but was recovering. The fourth case, as reported Nov 21 by a Saudi newspaper quoting government sources, involved another Saudi man who was hospitalized in Riyadh and was said to be improving.
The Nov 23 WHO statement gave few details on the latest four cases, but it said two of the patients came from the same family and household and had similar symptoms. One of the patients died and the other recovered, the agency said.
Further, two more members of the same family were sick with similar symptoms, and one of them died, the WHO said. Test results for the deceased family member are pending, and the other patient, who is recovering, tested negative.
Investigations concerning the source of infection, the route of exposure, and the possibility of human-to-human transmission are ongoing, the WHO said.
The latest Qatari patient got sick in October and was flown to Germany, where he was hospitalized and received intensive care but eventually recovered and was discharged this week, according to Germany's Robert Koch Institute.
In a Nov 23 statement, the institute said the patient was treated for 4 weeks at a hospital in North Rhine–Westfalia. No illnesses have been reported among hospital personnel, though an investigation of the patient's contacts is ongoing.
The institute said samples taken while the patient was still in Qatar were tested in the United Kingdom and found to be positive.
The WHO in its statement did not list specific reasons for its suggestion that the novel virus may exist in countries other than just Saudi Arabia and neighboring Qatar.
In response to a query on the topic today, WHO spokesman Glenn Thomas told CIDRAP News via e-mail, "This is based on the fact that the cases confirmed to date are geographically far apart, and that investigations are still ongoing into the characteristics of this novel coronavirus."
The ECDC, in its statement today, noted that the possibility of person-to-person transmission in the Saudi Arabian family case cluster has not been excluded. It added, "There is indication that some cases had a history of visits to farms prior to illness, but no details are available concerning the kind of farms or related animal contact."
The agency said healthcare workers who treat people from the Middle East who have severe respiratory infections may be at risk for infection with the novel virus. It's possible, though, that the infections are more widespread, as suggested by the WHO, and seroepidemiologic studies are needed to investigate the possibility of mild and asymptomatic cases, the EU agency said.
"The fact that there have not been any expanding clusters of cases indicates that currently the risk for EU citizens to acquire these infections has not increased and remains very low, based on the current information," the ECDC said.
The ECDC statement evidenced some wariness about the WHO suggestion to consider testing patients with unexplained pneumonia even if they have no ties to Saudi Arabia or Qatar. The ECDC said it is considering the recommendation in relation to the potential burden of testing and the possibility of false-positive results.
For European countries, following the WHO testing suggestion probably would mean a "high" burden, the ECDC said. It estimated that EU countries have roughly 750,000 cases of community-acquired pneumonia of unknown cause each year. http://www.cidrap.umn.edu/cidrap/content/other/sars/news/nov2612corona.html
