Been doing my best to avoid twittering over the break, but a rumored return of #SARS in 2020 caused me to dive into twitter and google translate for more information. Here are some random facts, thoughts, and speculation on what may or may not be happening with in Wuhan.
First, #SARS does not necessarily mean SARS-CoV, the virus that caused the 2002-03 worldwide outbreak. Instead, it could refer to many illnesses like bird flu bacterial pneumonias as in the past before id. However, the description of atypical viral pneumonia echoes of SARS-CoV.
In reading google translate, a seafood market in Wuhan has been associated with all cases. The good news is that no healthcare workers seem to have been infected. This was a major factor in the spread of SARS and MERS CoV spread.
In reading background info, the seafood market does have live animals similar to the markets that carried SARS-CoV in the Guangdong province of China. This market is currently undergoing sterilization based on the pictures posted online.
Interesting to me (based on speculation) is the 1st case has been linked to a fruit merchant. While SARS-CoV was not associated with fruit, bat populations have been known to inoculate fruit with viruses (Nipah among the most well known.) A link to bats may be very important.
Work done at the Wuhan Institute of Virology (more on this location) identified clusters of SARS-like viruses in horseshoe bats. These viruses are similar to the epidemic strain of SARS-CoV. Since then, more SARS-like viruses have been found. ncbi.nlm.nih.gov/pubmed/24172901
Work I did as a post-doc found some of these bat SARS-like CoVs could infect human cells. However, they were not equivalent to the epidemic SARS-CoV in pathogenesis. We predicted more adaptation would be required for their emergence in humans. ncbi.nlm.nih.gov/pubmed/26552008
Rumors are that it is and is not a CoV. For MERS and SARS-CoV, testing is difficult based on the deep lung location. Upper airway samples often test negative & lower airway samples are more accurate. However, these samples are more difficult to acquire and risk transmission.
A number of PCR and sequencing approaches can/will be used to determine if virus in the CoV family. These can target the CoV RDRP or specific CoV targets (envelope/nucleocapsid). The results are dependent on sample quality, but if a CoV, we should be hearing confirmation soon.
Other causes that look like SARS include influenza with high temperature being a primary symptom. Because of the season and the # of flu cases already, I expect flu was ruled out early. However, I am not sure if the standard flu assay covers the more exotic bird flu viruses.
In the SARS outbreak, strict quarantine procedures and the culling of live markets were key in ending the outbreak. Airplane travel was associated with the spread of the SARS-CoV around the world. As such, it appears authorities have begun surveillance on travel from Wuhan.
They likely are screening for passengers with high temperatures and respiratory symptoms for further questioning. That being said, if I was on this plane, this would not be comforting.
As I described earlier, many of the SARS like viruses discoveries were found by a group at the Wuhan Institute of Virology, located in the same area as this market. I find it unlikely that this is a lab associated infection, but the location makes it a curious coincidence.
Much of the work in this outbreak, CoV or not, will center on finding the source. Animals in the market will be tested and zoonotic surveys done in the areas these animals are sourced. Civet cats were found to harbor SARS-CoV in live markets and served a potential reservoir.
Bats progenitors viruses were subsequently linked to SARS-CoV, and in my opinion, are the original reservoir. If this infection turn out to be a CoV, my bet is the long and winding road will lead back to bats.
Finally, please excuse any oversights and errors in this thread. I'm doing it mostly off of my vacation addled memory. Lots of good people to follow on the story including @ProMED_mail @Crof @PeterDaszak @ironorehopper and even more.
