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Medical News & Perspectives
April 17, 2013

Lessons Learned From SARS Outbreak Prompt Rapid Response to New Coronavirus

JAMA. 2013;309(15):1576-1577. doi:10.1001/jama.2013.3251

The emergence of a novel and deadly coronavirus in Saudi Arabia last fall stirred up memories of the 2003 outbreak of severe acute respiratory syndrome (SARS), which emerged in Asia and quickly spread around the world. Ultimately, more than 8000 people became ill during the SARS epidemic, and about 10% of them died.

But this time around, public health authorities and researchers were primed to respond more rapidly to contain the potential threat. Public health authorities in the affected areas and international agencies have been sharing information about the outbreak with one another and the public, and researchers around the world have also been pulling together, sharing samples and other findings.

The identification of a novel coronavirus in humans in the Middle East and the United Kingdom has triggered concern.
(Photo credit: NIAID)

The identification of a novel coronavirus in humans in the Middle East and the United Kingdom has triggered concern.

Alarm bells go off

The similarities between the newly identified coronavirus and SARS, as well as the apparently high mortality rate associated with the new virus, triggered immediate concern from public health authorities, according to Miles W. Carroll, PhD, of the UK Health Protection Agency.

“Respiratory pathogens are much more concerning because of the route of transmission,” said Carroll.

At press time, there had been 14 laboratory-confirmed cases of the novel coronavirus and 8 deaths, according to the US Centers for Disease Control and Prevention (CDC). Most of the cases were identified on the Arabian Peninsula, but 3 of them were in the United Kingdom. Person-to-person transmission has been documented both in the United Kingdom and Jordan, according to Carroll. In the United Kingdom, the index patient was an individual who developed a severe respiratory illness before his return to the United Kingdom after a trip to Saudi Arabia and Pakistan. Subsequently, 2 contacts of this individual became ill, according to a report from the CDC (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm62e0307a1.htm?s_cid=mm62e0307a1_e). One developed a mild illness and recovered; the other had a preexisting medical condition and died after developing a severe respiratory infection.

Carroll noted that there is also evidence of human-to-human transmission leading to 2 deaths in a hospital in Jordan that occurred before the pathogen had been identified. He explained that samples from 2 deceased patients indicated possible spread within the hospital.

“We don't want to alarm people too much,” he said. He noted that the virus does not spread very easily from person to person but rather requires close contact as you would see between individuals living together. However, clinicians and public health authorities must be vigilant because the virus could mutate in a way that makes human-to-human spread easier.

The CDC has updated its recommendations for clinicians (http://emergency.cdc.gov/HAN/han00343.asp) emphasizing the need to consider the novel coronavirus when treating patients with a severe respiratory illness who have recently traveled to the Arabian Peninsula or who are close contacts of those who have traveled to this region. Suspect cases should be reported to state and local public health authorities, who should then pass the information along to the CDC, according to the recommendations.

Rapid response

In the meantime, virologists around the world are working together to identify the source of the virus and ways to prevent or treat related illness.

Vincent Munster, PhD, head of the Virus Ecology Unit at the National Institutes of Health Rocky Mountain Laboratories in Hamilton, Montana, and his colleagues have already begun studies of animals infected with the virus. He said there has been a great deal of cooperation, with researchers rapidly disseminating genetic information about the virus, tools for diagnosing the infection, and isolates of the virus to colleagues around the world. He attributed this openness to recognition that international collaboration is crucial in the aftermath of SARS. As a result of this openness, Munster and his colleagues were able to quickly acquire samples of the virus to begin studying it.

Munster explained that initial attempts by his group to use hamsters as a model failed, and the group has instead had to use nonhuman primates. So far, the infected animals have developed mild to moderate respiratory illness, and none has died. His team hopes to be able to test potential treatments and preventive measures, such as prophylaxis or vaccines. As a specialist in virus ecology, Munster is also interested in understanding the evolution of this virus and how it came to infect humans. Palm civets, a small Asian mammal, acted as a reservoir for the SARS virus. The animal reservoir for the newly identified coronavirus was unknown at press time; however, Munster noted that the virus is closely related to coronaviruses that infect bats.

Munster said it has been interesting to see how quickly the new virus spread from the Middle East to the United Kingdom.

“It's important that we keep a focus on what's going on in the world,” he said.

This article was corrected for errors on May 14, 2013.