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Pneumonia in China: lack of information raises concerns among Hong Kong health workers

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m56 (Published 08 January 2020) Cite this as: BMJ 2020;368:m56

Linked Editorial

Containing pneumonic plague

Rapid Response:

Mysterious virus making China nervous

Dear Editor,

Chinese researchers are racing to uncover the cause of a mysterious respiratory illness that has infected almost 60 people in Wuhan City, with a population of 19 million, the capital city of Hubei Province of China, with a population of 58 million people [1]. Chinese health authorities have ruled out influenza, bird flu, avian flu, adenovirus, and Middle East respiratory syndrome (MERS), as the source of the mystery Wuhan virus. Authorities have also ruled out the highly infectious severe acute respiratory syndrome (SARS), which killed 349 people in mainland China and 299 in Hong Kong in 2002 and 2003 [2]. There was no vaccine and no effective treatment for SARS, aside from supportive steps such as mechanical breathing support and the administration of steroids to reduce lung inflammation.

Chinese authorities identified a new type of coronavirus (novel coronavirus, nCoV), which was isolated on 7 January 2020. The clinical manifestations of the cases were mainly fever, a few patients had difficulty breathing, and chest radiographs showed bilateral lung infiltrative lesions. Laboratory testing was conducted on all suspected cases identified through active case finding and retrospective review. According to information conveyed to the World Health Organization (WHO) by Chinese authorities on 11 and 12 January, 41 cases with novel coronavirus infection have been preliminarily diagnosed in Wuhan City [3]. Of the 41 cases reported, seven are severely ill and one was dead. Six patients have been discharged from the hospital. No additional cases have been detected since 3 January 2020.

The first novel coronavirus infection has been detected outside of China, in a woman who traveled from Wuhan to Thailand, a development that the WHO said isn't surprising but has triggered discussions about convening an emergency committee [4].

According to the epidemiological survey, patients were operating dealers or vendors in the Wuhan seafood market, which has since been closed. Besides seafood, the market is known to also sell live animals, including birds and snakes, and the organs of rabbits and other wildlife [5]. The infection is probably an emerging zoonotic virus — infections that spread from animals to humans, says Linfa Wang, a virologist at the Duke-National University of Singapore. Such infections often first appear in colder months when animal pathogens can survive and spread to people. At present, hygiene investigations and environmental sanitation disposals for the Wuhan seafood market are ongoing to prevent any possible spread of the infections. The quick response and public notification “is obviously progress for China” says Guan Yi of the University of Hong Kong, an expert in emerging viral diseases.

WHO is closely monitoring the situation and is in regular contact with national authorities in China to provide the support required. Technical guidance on novel coronavirus has been developed. WHO’s recommendations on public health measures and surveillance for novel coronaviruses apply. WHO does not recommend any specific health measures for travelers [3].

References:
1. New virus identified as likely cause of mystery illness in China. (https://www.nature.com/articles/d41586-020-00020-9) (accessed January 14, 2020)
2. Chinese researchers reveal draft genome of virus implicated in Wuhan pneumonia outbreak (https://www.sciencemag.org/news/2020/01/chinese-researchers-reveal-draft...) (accessed January 14, 2020)
3. World Health Organization. Novel Coronavirus – China (https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/). (accessed January 14, 2020)
4. Thailand finds Wuhan novel coronavirus in traveler from China (http://www.cidrap.umn.edu/news-perspective/2020/01/thailand-finds-wuhan-...). (accessed January 14, 2020)
5. No answers yet in China's pneumonia outbreak (http://www.cidrap.umn.edu/news-perspective/2020/01/no-answers-yet-chinas...). (accessed January 14, 2020)

Competing interests: No competing interests

14 January 2020
Musaddique Hussain 1,2,3
Pharmacist (Doctor)
Musaddique Hussain1,2,3†, Abdul Majeed1,4, Naveed Akhtar2, Ikhlaq Hussain5, Hu Hu3, Ximei Wu3
1 School of Pharmacy, The University of Faisalabad, Faisalabad, 38,000, Pakistan; 2 Faculty of Pharmacy, The Islamia University of Bahawalpur, 63100, Pakistan; 3 Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou City, 310058, China; 4 Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60000, Pakistan; 5 Department of Urology, Nishtar Medical University, Multan, 60000, Pakistan
1 School of Pharmacy, The University of Faisalabad, Faisalabad, 38,000, Pakistan; 2 Faculty of Pharmacy, The Islamia University of Bahawalpur, 63100, Pakistan;