Novel coronavirus infection with overlapping symptoms as covid has not disappeared

Report by : Gan Yung Chyan

                  / KUCINTA SETIA

Image : The MERS virus and SARS-CoV-2 are novel coronaviruses. Courtesy of The Outbreak.

Just as the covid pandemic continues to surge in the world with no signs of dissipation, another novel coronavirus epidemic has not disappeared. This epidemic is the MERS epidemic. Since 2012, there have been reports of camel-to-human virus transmission, asymptomatic infections and human-to-human transmission of MERS virus in the Middle East. 

On 26 December 2019, the World Health Organization reports on a MERS case in Qatar with no contact with camels and no close contact with another MERS patient. The following is the complete report on the case from WHO web-site: 

"On 5 December 2019, the National IHR Focal Point for Qatar reported three laboratory-confirmed cases of Middle East respiratory syndrome (MERS-CoV) infection to WHO.

The first case-patient (case #1) is a 67-year-old female from Doha, Qatar. She developed fever, cough, shortness of breath and headache on 23 November 2019, and presented to a hospital on 25 November. On 27 November, she went to the same hospital for follow up. However, on 28 November, her condition worsened and she was admitted to the hospital. A nasopharyngeal swab was collected on 28 November and tested positive for MERS-CoV by reverse-transcriptase polymerase chain reaction (RT-PCR) on 29 November. The patient had underlying medical conditions, and passed away on 12 December 2019. The source of her infection is under investigation. The patient had neither a history of contact with dromedary camels nor recent travel. Follow up and screening of seven household contacts and 40 healthcare worker contacts is ongoing and two asymptomatic secondary cases have been identified so far.

The two contacts are a 50-year-old (case # 2) and a 32-year-old (case # 3), living in Doha. Both were identified through contact tracing and are asymptomatic. Case #2 is the son of case #1 and has an underlying medical condition . Case #3 was involved in direct contact with case #1 and has no underlying medical conditions. A nasopharyngeal swab was collected on 29 November for both case #2 and case #3 and tested positive for MERS-CoV by RT-PCR on 29 November. As of 23 December, both are in a stable condition in an isolation ward where protocols for infection prevention and control have been implemented."

There is no update on the cause of the infection in the Qatari patient that died on 12 December 2019. When she was alive, she did not come into contact with camels and had not travelled abroad. Her symptoms overlaps with covid symptoms, including fever, cough, shortness of breath and headache. 

CT scanning could have done on the Qatari patient to determine the exact kind of sudden onset of pneumonia before she passed away.

Qatar is facing both MERS and covid epidemics. With asymptomatic cases around, it is getting more difficult for the Middle East country to distinguish cases between the novel coronaviruses.

According to Qatar Ministry of Public Health on 9 June 2020, Qatar has a total of 71,879 confirmed covid cases, with 1721 new cases registered, and five deaths. A total of 47,569 patients have recovered from covid.

CDC states the following on clinical symptoms of MERS:

"A wide clinical spectrum of MERS-CoV infection has been reported ranging from asymptomatic infection to acute upper respiratory illness, and rapidly progressive pneumonitis, respiratory failure, septic shock and multi-organ failure resulting in death. Most MERS-CoV cases have been reported in adults (median age approximately 50 years, male predominance), although children and adults of all ages have been infected (range 0 to 109 years). Most hospitalized MERS-CoV patients have had chronic co-morbidities. Among confirmed MERS-CoV cases reported to date, the case fatality proportion is approximately 35%.

Limited clinical data for MERS-CoV patients are available; most published clinical information to date is from critically ill patients. At hospital admission, common signs and symptoms include fever, chills/rigors, headache, non-productive cough, dyspnea, and myalgia. Other symptoms can include sore throat, coryza, nausea and vomiting, dizziness, sputum production, diarrhea, and abdominal pain. Atypical presentations including mild respiratory illness without fever and diarrheal illness preceding development of pneumonia have been reported. Patients who progress to requiring admission to an intensive care unit (ICU) often have a history of a febrile upper respiratory tract illness with rapid progression to pneumonia within a week of illness onset."

Covid frontline workers have to be very cautious in determining the type of coronary disease in the patients and must not lie. Nucleic acid testing, saliva swab testing and identifying the symptoms of covid are insufficient. Patients need to undergo CT scanning to determine the exact type of pneumonia. 

In the initial stage of the Wuhan virus outbreak in Wuhan, patients undergo CT scanning to reconfirm if they have novel coronavirus pneumonia (covid). Unfortunately, to clear cases of covid, many hospitals in the People's Republic of China have diagnosed covid as "atypical pneumonia", "viral pneumonia" defying Li Keqiang's instruction to report cases of covid if there are any. Besides, there are shortages of kits, taking time to complete SARS-CoV-2 testing which may carry possibilities of false-negative results.

According to the study published at Genetic Engineering & Biotechnology News (GEN), entitled "Artificial intelligence–enabled rapid diagnosis of patients with COVID-19”, researchers at the Icahn School of Medicine on Mount Sinai, Israel, have sought an alternative method for rapid and accurate diagnosis of covid patients. They use artificial intelligence (AI) combined with imaging, and clinical data to analyze patients with SARS-CoV-2. In doing this, they have developed a method that can rapidly detect the coronavirus based on how lung disease looks in computed tomography (CT scans) of the chest, in combination with patient information including symptoms, age, bloodwork, and possible contact with someone infected with the virus.

The method could help hospitals across the world quickly detect SARS-CoV-2 correctly, isolate patients, and prevent it from spreading during this pandemic.

Refs:

Middle East respiratory syndrome coronavirus (MERS-CoV) - Qatar, Disease Outbreak News, WHO, https://www.who.int/csr/don/26-december-2019-mers-qatar/en/

MERS Clinical Features, CDC, https://www.cdc.gov/coronavirus/mers/clinical-features.html

COVID-19 Accurately Diagnosed by Al Model, Genetic Engineering & Biotechnology News (GEN), https://www.genengnews.com/news/covid-19-accurately-diagnosed-by-ai-model/?utm_medium=newsletter&utm_source=GEN%20Daily%20News%20Highlights&utm_content=01&utm_campaign=GEN%20Daily%20News%20Highlights_20200526&oly_enc_id=4892G0492578G8Y&fbclid=IwAR15v2g8Cb1q_lkoygXRkSEExhbPYYMgcUOFM7qdZCEJWVRlf0wMxXo8i_Q

COVID19 Home, Qatar Ministry of Public Health, https://covid19.moph.gov.qa/EN/Pages/default.aspx