Amidst all the articles on H7N9 in China, the novel coronavirus (nCoV) is making headlines again. While the number of cases continues to trickle upward, there has been rapid progress in developing tools for monitoring, detecting and researching the virus, leaving the public health community feeling slightly more prepared for what this virus may bring.
The virus itself has raised concern because it is from the same family of viruses as SARS, a respiratory virus that caused global concern in 2003. SARS ultimately infected over 8,000 people and killed around 750. While the novel coronavirus is still under investigation, and cannot be classified as “SARS-like,” scientists warn that nCoV still has pandemic potential.
So far there have been 17 cases of nCoV, 11 of which have been fatal. The latest death was an Emerati man who died in a German hospital. He followed a trend: all of the cases have links to countries in the Middle East like Jordan and Saudi Arabia. Two cases had mild symptoms, appearing like a common cold. Since colds are usually mild and self-limited (i.e. go away without medical intervention), there are an unknown number of undiagnosed mild cases.
A number of reference laboratories have developed antibody tests (antibodies are proteins in the blood that look for and neutralize pathogens) for nCoV, giving clinicians the ability to determine who has been exposed to the virus. The presence of certain antibodies indicates that specific pathogens are or were present somewhere in the body.
The new serologic tests (tests looking for antibodies in bodily fluids) will help to identify more infected people, regardless of whether the symptoms are mild or severe. This will ultimately help clarify the ratio of severe to mild cases and give an indication of how efficiently the virus spreads. While human-to-human transmission has occurred, it seems as though this is not an efficient method of transmission for the virus as the latest patient who died in Germany passed away without infecting any of 60 potential contacts.
Much research remains to be done, however, as it is still unclear whether the detected cases represent the extent of the disease or if there are larger reservoirs of mild disease. Scientists in Germany have agreed to work with partners in the United Arab Emirates to extend capacity in laboratories there. A wider distribution of testing will help ensure the broadest surveillance network to determine the true extent and severity of this novel illness.
Most recently, scientists announced they have developed an animal model for the disease, using rhesus macaques, permitting more clinical studies and vaccine research. An animal model is useful because it allows scientists to study the disease without infecting humans. Unfortunately, rhesus macaques are some of the largest and most expensive animals for these studies, but after research testing ferrets or hamsters as potential models, the primates are the best alternative.
Overall, rapid progress is being made to facilitate detection, surveillance and research on nCoV. The new serologic tests will make it easier to detect cases of nCoV. Since the new tests require less expensive equipment, it will also make it easier for more laboratories to offer the test, expanding the surveillance network to detect cases that may appear beyond the Middle East. The development of an animal model for the disease will help us understand how the virus can cause such severe symptoms, and will enable researchers to start testing potential vaccine candidates.
While the threat of an epidemic is still present, these new advances will help public health officials be more prepared.