Review of Related Literature: Novel Coronavirus

2019 Novel Coronavirus (2019-nCoV) is a virus (more specifically,

a coronavirus) identified as the cause of an outbreak of respiratory
illness first detected in Wuhan, China. Early on, many of the patients
in the outbreak in Wuhan, China reportedly had some link to a large
seafood and animal market, suggesting animal-to-person spread.However,
a growing number of patients reportedly have not had exposure to
animal markets, indicating person-to-person spread is occurring. At
this time, it’s unclear how easily or sustainably this virus is
spreading between people.

1. What is the source of 2019 NCov?

Chinese health authorities were the first to post the full genome of
the 2019-nCoV in GenBankexternal icon, the NIH genetic sequence
database, and in the Global Initiative on Sharing All Influenza Data
(GISAIDexternal icon) portal, an action which has facilitated
detection of this virus. CDC is posting the full genome of the 2019-
nCoV viruses detected in U.S. patients to GenBank as sequencing is
completed.

2019-nCoV is a betacoronavirus, like MERS and SARs, all of which have

their origins in bats. The sequences from U.S. patients are similar to
the one that China initially posted, suggesting a likely single,
recent emergence of this virus from an animal reservoir.

Early on, many of the patients in the outbreak of respiratory illness

caused by 2019-nCov in Wuhan, China had some link to a large seafood
and live animal market, suggesting animal-to-person spread. Later, a
growing number of patients reportedly did not have exposure to animal
markets, indicating person-to-person spread. Chinese officials report
that sustained person-to-person spread in the community is occurring
in China. Person-to-person spread has been reported outside China,
including in the United States and other countries. In addition, cases
asymptomatic spread of the virus have been reported.

https://www.cdc.gov/coronavirus/2019-nCoV/summary.html#anchor_1580079137454

2. How does 2019 NCov spreads?

Current knowledge is largely based on what is known about similar

coronaviruses. Coronaviruses are a large family of viruses that are
common in many different species of animals, including camels, cattle,
cats, and bats. Rarely, animal coronaviruses can infect people and
then spread between people such as with MERS, SARS, and now with 2019-
nCoV.

Most often, spread from person-to-person happens among close contacts

(about 6 feet). Person-to-person spread is thought to occur mainly via
respiratory droplets produced when an infected person coughs or
sneezes, similar to how influenza and other respiratory pathogens
spread. These droplets can land in the mouths or noses of people who
are nearby or possibly be inhaled into the lungs. It’s currently
unclear if a person can get 2019-nCoV by touching a surface or object
that has the virus on it and then touching their own mouth, nose, or
possibly their eyes.

Typically, with most respiratory viruses, people are thought to be

most contagious when they are most symptomatic (the sickest). With
2019-nCoV, however, there have been reportsexternal icon of spread
from an infected patient with no symptoms to a close contact.

It’s important to note that how easily a virus spreads person-to-

person can vary. Some viruses are highly contagious (like measles),
while other viruses are less so. There is much more to learn about the
transmissibility, severity, and other features associated with 2019-
nCoV and investigations are ongoing. 

https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html

3. Is 2019-nCoV the same as the MERS-CoV or SARS virus

 No. Coronaviruses are a large family of viruses, some causing illness

in people and others that circulate among animals, including camels,
cats and bats. The recently emerged 2019-nCoV is not the same as the
coronavirus that causes Middle East Respiratory Syndrome (MERS) or the
coronavirus that causes Severe Acute Respiratory Syndrome (SARS).
However, genetic analyses suggest this virus emerged from a virus
related to SARS. There are ongoing investigations to learn more. This
is a rapidly evolving situation and information will be updated as it
becomes available.
For confirmed 2019-nCoV infections, reported illnesses have ranged
from people with little to no symptoms to people being severely ill
and dying. Symptoms can include:

 Fever
 Cough
 Shortness of breath
 Runny nose
 Sore throat
  In most cases, you won't know whether you have a coronavirus
or a different cold-causing virus, such as rhinovirus.

4. MERS, SARS and other coronaviruses as causes of pneumonia

Since Dec 8, 2019, several cases of pneumonia of unknown aetiology

have been reported in Wuhan, Hubei province, China
 Most patients worked at or lived around the local Huanan seafood
wholesale market, where live animals were also on sale. In the early
stages of this pneumonia, severe acute respiratory infection symptoms
occurred, with some patients rapidly developing acute respiratory
distress syndrome (ARDS), acute respiratory failure, and other serious
complications. On Jan 7, a novel coronavirus was identified by the
Chinese Center for Disease Control and Prevention (CDC) from the
throat swab sample of a patient, and was subsequently named 2019-nCoV
by WHO.
Coronaviruses can cause multiple system infections in various animals
and mainly respiratory tract infections in humans, such as severe
acute respiratory syndrome (SARS) and Middle East respiratory syndrome
(MERS).
 Most patients have mild symptoms and good prognosis. So far, a few
patients with 2019-nCoV have developed severe pneumonia, pulmonary
oedema, ARDS, or multiple organ failure and have died. All costs of
2019-nCoV treatment are covered by medical insurance in China.
At present, information regarding the epidemiology and clinical
features of pneumonia caused by 2019-nCoV is scarce.

 In this study, we did a comprehensive exploration of the epidemiology

and clinical features of 99 patients with confirmed 2019-nCoV
pneumonia admitted to Jinyintan Hospital, Wuhan, which admitted the
first patients with 2019-nCoV to be reported on

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30211-7/fulltext#back-bib5

5. Respiratory infection caused by NCov

Illnesses associated with the new coronavirus, named 2019-nCOV, are

similar to several respiratory illnesses and include fever, dry cough,
sore throat and headache. Most cases are considered mild to moderate
with a subset experiencing more severe illness with shortness of
breath and difficulty breathing. Deaths have been reported among about
two to four per cent of detected cases in China although it is likely
that the actual risk of such severe outcomes is lower given milder
cases are less likely to be detected.
Cases were initially linked to exposure to live animals at a seafood
market in Wuhan City but the substantial increase in cases thereafter
is due to human-to-human transmission of the virus. Other respiratory
viruses can be spread from a cough or sneeze or from touching
something an infected person has touched and then touching your eyes,
mouth or nose. The main ways and efficiency of 2019-nCoV spread still
require better understanding.

Health authorities in China have taken prevention and control measures

to prevent the spread of infection and are continuing to investigate
the source of 2019-nCOV.

http://www.bccdc.ca/about/news-stories/stories/2020/information-on-novel-coronavirus

6. Is this virus comparable to SARS or to the seasonal flu

(influenza)?

This novel coronavirus detected in China is genetically closely

related to the 2003 SARS virus and appears to have similar
characteristics, although there is still limited data available on
this virus.
SARS emerged at the end of 2002 in China and more than 8 000 SARS-
cases were reported by 33 countries over a period of eight months. At
the time, one in ten people who contracted SARS died.
The current 2019-nCoV outbreak has caused around 10 000 reported cases
in China since the end of December 2019 (as of end of January 2020.)
Other countries have also reported cases of 2019-nCoV, including some
in the EU/EEA. At this point, there is too little data available to
say for sure how deadly 2019-nCoV is but preliminary findings indicate
that it is less fatal than SARS-CoV.
While both 2019-nCoV and influenza viruses are transmitted from
person-to-person and may cause similar symptoms, the two viruses are
very different and consequently behave differently. It is still very
early to draw conclusions on how 2019-nCoV spreads, but preliminary
information indicates that 2019-nCoV is as transmissible as SARS and
some other pandemic influenza strains have been. ECDC estimates that
each year, up to 40 000 people in the EU/EEA die prematurely due to
causes associated with influenza.

https://www.ecdc.europa.eu/en/novel-coronavirus-china/questions-answers

7. What is the mode of transmission? How easily does it spread?

While animals are the source of the virus, this virus is now
spreading from one person to another (human-to-human transmission).
There is currently not enough epidemiological information to
determine how easily and sustainably this virus is spreading between
people. The virus seems to be transmitted mainly via respiratory
droplets that people sneeze, cough, or exhale.
 The incubation period for 2019-nCov (i.e. the time between exposure
to the virus and onset of symptoms) is currently estimated at
between two and 12 days. While people are mostly infectious when
they present (flu-like) symptoms, there are indications that some
people maybe be able to transmit the virus without presenting any
symptoms or before the symptoms appear. If this is confirmed, it
would make early detection of 2019-nCoV infections more difficult.
However, it is not unusual for viral infections of this type, as is
also seen with measles, for example.
If people with 2019-nCoV are tested and diagnosed in a timely manner
and rigorous infection control measures are applied, the likelihood
of sustained human-to-human transmission in community settings in
the EU/EEA is low. Systematic implementation of infection prevention
and control measures were effective in controlling SARS-CoV and
MERS-CoV.

https://www.ecdc.europa.eu/en/novel-coronavirus-china/questions-answers

8. What about animals or animal products imported from China

Due to the animal health situation in China, notably the presence

of contagious animal diseases, only a few live animals and
unprocessed animal products from China are authorized for import
into the European Union. There is no evidence that any of the
animals or animal products authorized for entry into the European
Union pose a risk to the health of EU citizens as a result of the
presence of 2019-nCoV in China.

https://www.ecdc.europa.eu/en/novel-coronavirus-china/questions-answers

9. What about food products imported from China?

As with the imports of animals and animal products, due to the animal
health situation in China, only a few products of animal origin are
authorized for import into the EU from China, on the condition that
they meet strict health requirements and have been subjected to
controls. For the same reasons, travelers entering the EU customs
territory are not allowed to carry any meat, meat products, milk or
dairy products in their luggage.
There has been no report of transmission of the 2019-nCoV via food and
therefore there is no evidence that food items imported into the
European Union in accordance with the applicable animal and public
health regulations governing imports from China pose a risk for the
health of EU citizens in relation to 2019-nCoV. The main mode of
transmission is from one person to another.

https://www.ecdc.europa.eu/en/novel-coronavirus-china/questions-answers
10. Zoonotic transmission

By August 2014, the evidence is accumulating that the dromedary

camel is a host species for MERS-CoV and that camels play an
important role in the transmission to humans. Serological studies
in dromedary camels in Jordan, Oman, Qatar, Saudi Arabia and the
United Arab Emirates have shown high rates of antibodies against
MERS-CoV, indicating widespread circulation of the virus in the
Arabian Peninsula, even before the evidence of human infection.
Antibodies against MERS-CoV have been detected also in dromedary
camels in Egypt, Ethiopia, Kenya, Nigeria, Tunisia, and the
Canary Islands (Spain; some originating from Morocco) suggesting
that the virus could also be geographically widespread in these
animals on the African continent
 
The hypothesis that dromedary camels are hosts of MERS CoV has
been proven by the viral RNA detection in different specimens
collected from these animals in Qatar, Saudi Arabia, Oman and
Egypt and the isolation of the virus from nasal and faecal
samples. MERS-CoV RNA has also been detected in the milk of
camels actively shedding the virus. Whether infected camels
excrete MERS-CoV directly into the milk or the milk is cross-
contaminated during milking is unclear [38]. Infection in
dromedary camels has been reported to be either asymptomatic or
associated with only mild respiratory signs with nasal discharge.
A prospective study of two camel herds in Saudi Arabia from
November 2013 to February 2014 showed that acute MERS-CoV
infections resulted in increased anti-MERS-CoV titres, that very
young animals ( less than one month old) were also infected and
that reinfection of animals also appeared to occur, indicating
that neither maternal antibodies nor pre-existing antibodies are
fully protective. There was no evidence of prolonged virus
shedding or viraemia among the tested animals. Two
investigations, one in Qatar and one in Saudi Arabia, reported
evidence for the direct cross-species transmission of MERS-CoV
from infected camels to their owner. Also, preliminary results
from recent studies in Qatar indicate that people handling or
working with camels are at increased risk of infection with MERS-
CoV compared with people who do not have contact with camels.

https://www.ecdc.europa.eu/en/facts-0