Coronavirus May Be the "Disease X" Health Agency Warned About

[Ubiquitous]

The World Health Organization cautioned years ago that a mysterious “disease
X” could spark an international contagion. The new coronavirus, with its
ability to quickly morph from mild to deadly, is emerging as a contender.

From recent reports about the stealthy ways the so-called Covid-19 virus
spreads and maims, a picture is emerging of an enigmatic pathogen whose
effects are mainly mild, but which occasionally -- and unpredictably -- turns
deadly in the second week. In less than three months, it’s infected about
77,000 people, mostly in China, and killed more than 2,200.

“Whether it will be contained or not, this outbreak is rapidly becoming the
first true pandemic challenge that fits the disease X category,” Marion
Koopmans, head of viroscience at Erasmus University Medical Center in
Rotterdam, and a member of the WHO’s emergency committee, wrote Wednesday in
the journal Cell.

The disease has now spread to more than two dozen countries and territories.
Some of those infected caught the virus in their local community and have no
known link to China, the U.S. Centers for Disease Control and Prevention
said.

“We are not seeing community spread here in the United States yet, but it’s
very possible -- even likely -- that it may eventually happen,” Nancy
Messonnier, director of the CDC’s National Center for Immunization and
Respiratory Diseases, told reporters Friday.

Unlike SARS, its viral cousin, the Covid-19 virus replicates at high
concentrations in the nose and throat akin to the common cold, and appears
capable of spreading from those who show no, or mild, symptoms. That makes it
impossible to control using the fever-checking measures that helped stop SARS
17 years ago.

Spreading Surreptitiously
A cluster of cases within a family living in the Chinese city of Anyang is
presumed to have begun when a 20-year-old woman carried the virus from Wuhan,
the outbreak’s epicenter, on Jan. 10 and spread it while experiencing no
illness, researchers said Friday in the Journal of the American Medical
Association.

Five relatives subsequently developed fever and respiratory symptoms. Covid-
19 is less deadly than SARS, which had a case fatality rate of 9.5%, but
appears more contagious. Both viruses attack the respiratory and
gastrointestinal tracts, via which they can potentially spread.

While more than 80% of patients are reported to have a mild version of the
disease and will recover, about one in seven develops pneumonia, difficulty
breathing and other severe symptoms. About 5% of patients have critical
illness, including respiratory failure, septic shock and multi-organ failure.

“Unlike SARS, Covid-19 infection has a broader spectrum of severity ranging
from asymptomatic to mildly symptomatic to severe illness that requires
mechanical ventilation,” doctors in Singapore said in a paper in the same
medical journal Thursday. “Clinical progression of the illness appears
similar to SARS: patients developed pneumonia around the end of the first
week to the beginning of the second week of illness.”

Unpredictable Illness
Older adults, especially those with chronic conditions, such as hypertension
and diabetes, have been found to have a higher risk of severe illness. Still,
“the experience to date in Singapore is that patients without significant
co-morbid conditions can also develop severe illness,” they said.

Li Wenliang, the 34-year-old ophthalmologist who was one of the first to warn
about the coronavirus in Wuhan, died earlier this month after receiving
antibodies, antivirals, antibiotics, oxygen and having his blood pumped
through an artificial lung.

Update: Li Wenliang is currently in critical condition. His heart reportedly
stopped beating at around 21:30. He was then given treatment with ECMO
(extra-corporeal membrane oxygenation).

Global Times @globaltimesnewsWuhan Central Hospital said on Weibo
that Li Wenliang is still under emergency treatment. GT reporters
heard people weeping inside ICU. Li was one of the 8 whistleblowers
who tried to warn other medics of the #coronavirus outbreak in Dec
but were reprimanded by Wuhan police.
http://twitter.com/globaltimesnews/statuses/1225463450354110466

The doctor, who was in good health prior to his infection, appeared to have a
relatively mild case until his lungs became inflamed, leading to the man’s
death two days later, said Linfa Wang, who heads the emerging infectious
disease program at Duke-National University of Singapore Medical School.

A similar pattern of inflammation noted among Covid-19 patients was observed
in those who succumbed to the 1918 “Spanish flu” pandemic, said Gregory A.
Poland, the Mary Lowell Leary emeritus professor of medicine, infectious
diseases, and molecular pharmacology and experimental therapeutics at the
Mayo Clinic in Rochester, Minnesota.

“Whenever, you have an infection, you have a battle going on,” Poland said in
a phone interview Thursday. “And that battle is a battle between the damage
that the virus is doing, and the damage the body can do when it tries to
fight it off.”

Mild Symptoms
Doctors studying a 50-year-old man who died in China last month found Covid-
19 gave him mild chills and dry cough at the start, enabling him to continue
working. But on his ninth day of illness, he was hospitalized with fatigue
and shortness of breath, and treated with a barrage of germ-fighting and
immune system-modulating treatments.

He died five days later with lung damage reminiscent of SARS and MERS,
another coronavirus-related outbreak, doctors at the Fifth Medical Center of
PLA General Hospital in Beijing said in a Feb. 16 study in the Lancet medical
journal. Blood tests showed an over-activation of a type of infection-
fighting cell that accounted for part of the “severe immune injury” he
sustained, the authors said.

Controversially, he had been given 80 milligrams twice daily of
methylprednisolone, an immune-suppressing corticosteroid drug that’s in
common use in China for severe cases, though has been linked to “prolonged
viral shedding” in earlier studies of MERS, SARS and influenza, according to
the WHO.

The patient’s doctors recommended corticosteroids be considered alongside
ventilator support for severely ill patients to prevent a deadly complication
known as acute respiratory distress syndrome.

He was given at least double what would typically be recommended for patients
with the syndrome and other respiratory indications, said Reed Siemieniuk, a
general internist and a health research methodologist at McMaster University
in Hamilton, Ontario. Based on what was observed with MERS, the drug may
delay viral clearance in Covid-19 patients, he said.

“Corticosteroids could cause more harm than good because of that risk,”
Siemieniuk said in an interview. “I wouldn’t want to let a patient die
without trying steroids, but I would wait until patients were extremely ill.”

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