The World Health Organization (WHO) says its recent investigation of illnesses associated with two confirmed novel coronavirus (CoV) infections in Jordan suggests that some cases can be relatively mild and that investigators are now more suspicious that the cluster involved person-to-person transmission.
On Nov 30 the WHO announced that the novel virus had been confirmed retrospectively in two fatal illnesses that were part of a hospital cluster of respiratory infections in Jordan in April. That report increased the number of confirmed novel CoV cases to nine, including five deaths. Besides the Jordanian cases, Saudi Arabia has had five cases and Qatar has had two. All the patients were severely ill.
WHO experts went to Jordan at the government's invitation in November to investigate the hospital cluster, the agency said in a statement today. The team visited the hospital; interviewed patients, relatives, and caregivers; and reviewed case files.
In particular, the investigators looked at a number of healthcare workers who had had pneumonia associated with the confirmed novel CoV cases. Their illnesses are now considered probable cases, the WHO said.
"All patients had significant respiratory disease presenting as pneumonia," the agency said. "Disease was generally milder in the unconfirmed probable cases. One patient who is a probable case had symptoms that were mild enough to be managed at home and was not admitted to hospital."
Although all the confirmed novel CoV cases have been severe, the WHO said, "The additional unconfirmed probable cases in Jordan indicate that milder presentations may also be a part of the clinical appearance associated with infection."
The WHO didn't say exactly how many illnesses were in the Jordan cluster. Back in May, months before the novel CoV was discovered, a report from the European Centre for Disease Prevention and Control said the cluster involved 11 people, including eight healthcare workers, in a hospital intensive care unit.
Investigators couldn't identify either the index case or the route of exposure in the Jordan cluster, today's WHO statement said. Most family members and healthcare workers who had close contact with the confirmed and probable case-patients didn't experience any respiratory illness.
"However, the appearance of pneumonia in some who provided care in at least two family members with direct personal contact increases the suspicion that person-to-person transmission may have occurred," the WHO said.