The most recent WHO report of severe respiratory illness in a 60 year old British national warrants comment about limitations of the current novel coronavirus case definition [e.g., see ProMED post: Novel coronavirus - Eastern Med. (02): UK ex Saudi Arabia, Pakistan 20130212.1539086. - Mod.CP]
Press releases following the UK Health Protection Agency's announcement again emphasize the fact that this individual has had contact with the Middle East though the incubation period and appearance of symptoms are ambiguous enough that a more cautious statement is needed, that is, that it remains unknown where and when this patient became infected.
As well, a finding of dual novel coronavirus and 2009 H1N1 [influenza A(H1N1)pdm09] influenza genes by molecular test methods should be interpreted with caution until confirmation is available from an independent source.
We have made a thorough search for dual infections (both viral and bacterial) on our SARI [severe acute respiratory infection] cases, and have yet to find any. Meanwhile the incidence and severity of influenza infections have made headlines this winter [e.g., see the ProMED post: Influenza (17): Czech Republic, severity 20130208.1535245, - Mod.CP] Alerts for severe 2009 H1N1 infections are prominent on south Asian websites following reports of flu deaths in India last week [e.g., see ProMED-mail post Influenza (15): India (RJ) mortality 20130204.1528727. - Mod.CP]
To put the matter in context, morbidity and mortality from influenza this winter will dwarf the 9 [now 10] cases of novel coronavirus infections reported so far. Saudi Arabia continues to conduct surveillance for novel coronavirus in patients who meet the current SARI definition. It is one of several agents being investigated at our laboratories and by our colleagues at outside referral labs.
During the last Hajj season , we were able to test more than 300 sick pilgrims and found no evidence of novel coronavirus infection. Neither was this virus detected by our French (1) and Egyptian colleagues (personal communication) who reported surveillance findings on returned pilgrims.
Our efforts to identify cases are ongoing, but now that validated detection tests are commercially available (2), we recommend that an expanded search for this virus is undertaken. Thus far it is less associated with focused or even regional outbreaks than it is with sporadic disease in widely separated locales.
Unless and until SARI investigations are expanded, our understanding of its epidemiology and disease spectrum will remain limited. An urgent discussion of the current case definition is needed.