Coronavirus could become the anticipated 'Disease X', expert warns
Is the killer coronavirus now disease X? World Health Organization expert warns the infection is ‘rapidly’ fitting category for the mysterious pathogen scientists fear will kill 80million
- Dr Marion Koopmans, from Erasmus University in the Netherlands, commented
- She said increased global travel made the outbreak particularly challenging
- Disease X is a name which refers to a future illness which spreads worldwide
- Coronavirus has infected around 80,000 people and killed more than 2,600
A virus expert from the World Health Organization said the coronavirus could be the ‘Disease X’ which experts have warned about.
The name is given to a future disease which could break out among humans and wreak havoc across the world.
The coronavirus, SARS-CoV-2, has infected around 80,000 people in the two months since it emerged at an animal market in Wuhan, China in December.
It has killed more than 2,600 and is capable of causing severe lung damage and triggering multiple organ failure, mainly among old or sickly patients.
Dr Marion Koopmans, a virologist for the WHO, said: ‘Whether it will be contained or not, this outbreak is rapidly becoming the first true pandemic challenge that fits the disease X category, listed to the WHO’s priority list of diseases for which we need to prepare in our current globalized society.’
Her comments come less than six months after a report led by a former WHO official which warned a flu-like illness could kill up to 80million people if it broke out.
Recent developments in the outbreak include the first cases being declared in Afghanistan, Bahrain and Kuwait today, and a fifth person dying in Italy.
Experts said the COVID-19 coronavirus (illustrated) could become the next serious global disease outbreak, which has been given the name Disease X until it emerges
Dr Marion Koopmans, a virologist for the World Health Organization, said the COVID-19 outbreak is ‘rapidly’ beginning to look like the Disease X outbreak for which the WHO said the world should prepare
‘Initial resemblances with the SARS outbreak in terms of its origin, the disease associated with infection, and the ability to spread are clear.
‘But since 2003, global air travel has increased more than 10-fold, and the efforts needed to try to contain the epidemic are daunting.’
Disease X is described by the WHO as this: ‘Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease’.
It is listed on the global organisation’s list of top priorities for research and development, despite not yet existing.
Authorities and scientists around the world should, the WHO says, be prepared to have to work together to stop this mysterious new illness when it appears.
SARS and MERS – both close cousins of the COVID-19 virus – both appear on the top priorities list.
Disease X is a term used by the World Health Organization (WHO) to refer to a disease which has not yet been discovered but is expected to have a global impact when it emerges.
On its website the WHO describes disease X like so:
‘Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease, and so the R&D [research & development] Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown “Disease X” as far as possible.
The name Disease X is essentially a placeholder for an illness which global experts are certain will appear at some point in the future but do not yet know what it is or where it will happen.
Simulations have predicted that a pandemic outbreak of a flu-like virus could kill tens of millions of people around the world and seriously injure the global economy.
Other illnesses which have a comparable level of concern include Ebola, Lassa fever, Zika and Congo haemorrhagic fever.
Source: World Health Organization
And others on the list include Crimean-Congo haemorrhagic fever (CCHF), Ebola, Lassa fever, the Nipah virus, Rift valley fever and Zika.
Dr Koopmans accused scientists and public health experts of ‘wasting precious time’ by not preparing for outbreaks of these diseases.
In her article she said: ‘In my birth town, we used to watch the rivers flood inevitably every winter, with some people losing their homes because ‘‘that is what happens.’’
‘Now, there are modern flood barriers built to channel the river, based on forward-looking investments in the past decades.
‘Our ways of dealing with outbreaks is a mixture of modern floodwalls in some parts of the world while relying on sandbags in others. Needless to say where the weakest links will be.
‘Time will tell whether the consolidated efforts of the Chinese authorities and the international public health and research community will succeed.’
A report last year said there was a ‘real threat’ of a flu-like pandemic spreading around the world and killing millions of people.
The Global Preparedness Monitoring Board (GPMB), a team of health experts led by a former chief of the World Health Organization, Dr Gro Harlem Brundtland, produced the report to try and spur world leaders into action.
‘The threat of a pandemic spreading around the globe is a real one,’ the group said.
‘A quick-moving pathogen has the potential to kill tens of millions of people, disrupt economies and destabilise national security.’
Cases have been declared all over the world – Afghanistan, Bahrain and Kuwait were today the most recent countries to confirm infections
Coronavirus infections have surged in Italy over the weekend to more than 200 confirmed cases and five deaths (Pictured: An ambulance to the south-east of Milan today)
South Korea has also recorded a fast rise in infections and now has more than 800 cases despite the toll only being around 30 a week ago (Pictured: Workers spray disinfectant at the national assembly in Seoul)
The group estimated that a pandemic could kill between 50 and 80million people and wipe out five per cent of the global economy.
It said national health systems, particularly those in poor countries, would collapse under the strain of a disease spreading widely and quickly.
And the report said that recommendations and warnings it made in an earlier report have been largely ignored by world leaders.
‘Many of the recommendations reviewed were poorly implemented, or not implemented at all, and serious gaps persist,’ the GPMB wrote.
‘For too long, we have allowed a cycle of panic and neglect when it comes to pandemics: we ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides. It is well past time to act.’
Dr Koopmans made the comments in an article in the scientific journal Cell.
WHAT DO WE KNOW ABOUT THE DEADLY CORONAVIRUS IN CHINA?
Someone who is infected with the coronavirus can spread it with just a simple cough or a sneeze, scientists say.
Over 2,600 people with the virus are now confirmed to have died and more than 79,000 have been infected. But experts predict the true number of people with the disease could be as high as 350,000 in Wuhan alone. Here’s what we know so far:
What is the coronavirus?
A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.
The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.
Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.
The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.
Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals.
‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses).
‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’
The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.
By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.
The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000.
Just a week after that, there had been more than 800 confirmed cases and those same scientists estimated that some 4,000 – possibly 9,700 – were infected in Wuhan alone. By that point, 26 people had died.
By January 27, more than 2,800 people were confirmed to have been infected, 81 had died, and estimates of the total number of cases ranged from 100,000 to 350,000 in Wuhan alone.
By January 29, the number of deaths had risen to 132 and cases were in excess of 6,000.
By February 5, there were more than 24,000 cases and 492 deaths.
By February 11, this had risen to more than 43,000 cases and 1,000 deaths.
A change in the way cases are confirmed on February 13 – doctors decided to start using lung scans as a formal diagnosis, as well as laboratory tests – caused a spike in the number of cases, to more than 60,000 and to 1,369 deaths.
By February 24, around 80,000 people had been infected and some 2,600 had died.
Where does the virus come from?
According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.
The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.
Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat.
A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.
However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.
Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.
‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’
So far the fatalities are quite low. Why are health experts so worried about it?
Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.
It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however.
Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.
Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.
‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’
If the death rate is truly two per cent, that means two out of every 100 patients who get it will die.
‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.
‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’
How does the virus spread?
The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.
It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky.
Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person.
There is now evidence that it can spread third hand – to someone from a person who caught it from another person.
What does the virus do to you? What are the symptoms?
Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.
If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients – at least 97 per cent, based on available data – will recover from these without any issues or medical help.
In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.
What have genetic tests revealed about the virus?
Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world.
This allows others to study them, develop tests and potentially look into treating the illness they cause.
Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.
However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.
This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.
More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.
How dangerous is the virus?
The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.
However, experts say the true number of patients is likely considerably higher and therefore the death rate considerably lower. Imperial College London researchers estimate that there were 4,000 (up to 9,700) cases in Wuhan city alone up to January 18 – officially there were only 444 there to that date. If cases are in fact 100 times more common than the official figures, the virus may be far less dangerous than currently believed, but also far more widespread.
Experts say it is likely only the most seriously ill patients who are seeking help and are therefore recorded – the vast majority will have only mild, cold-like symptoms. For those whose conditions do become more severe, there is a risk of developing pneumonia which can destroy the lungs and kill them.
Can the virus be cured?
The COVID-19 virus cannot be cured and it is proving difficult to contain.
Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.
No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.
The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.
Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.
People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.
And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).
However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.
Is this outbreak an epidemic or a pandemic?
The outbreak is an epidemic, which is when a disease takes hold of one community such as a country or region.
Although it has spread to dozens of countries, the outbreak is not yet classed as a pandemic, which is defined by the World Health Organization as the ‘worldwide spread of a new disease’.
The head of WHO’s global infectious hazard preparedness, Dr Sylvie Briand, said: ‘Currently we are not in a pandemic. We are at the phase where it is an epidemic with multiple foci, and we try to extinguish the transmission in each of these foci,’ the Guardian reported.
She said that most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.
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