Coronavirus: Signs the new Sars-like virus can spread between people

Dr Paul Cosford, HPA: "It appears very difficult to spread, and very difficult to catch"

Health officials in the UK believe they have the strongest evidence yet that a new respiratory illness similar to the deadly Sars virus can spread from person to person.

Cases of the infection may come from by contact with animals. However, if the virus can spread between people it poses a much more serious threat.

One man in the UK is thought to have caught the infection from his father.

However, officials say the threat to the whole population remains very low.

There have been 11 confirmed cases of the infection around the world. It causes pneumonia and sometimes kidney failure - five patients have died.

This is the third case identified in the UK. The first was a patient flown in from Qatar for treatment. The second was linked to travel to the Middle East and Pakistan.

The virus is then thought to have spread from the second patient to his son. There have been suggestions of person to person transmission in earlier cases in the Middle East, but this was not confirmed.

The third UK case is being treated in intensive care at the Queen Elizabeth Hospital in Birmingham.

The patient is known to have an underlying health condition which left them with a weakened immune system. This may have made them susceptible to the infection.

There have been no signs of the virus spreading to staff at the hospital.

Prof John Watson, head of the respiratory diseases department at the Health Protection Agency (HPA), said: "Confirmed novel coronavirus infection in a person without travel history to the Middle East suggests that person-to-person transmission has occurred, and that it occurred in the UK.

"Although this case provides strong evidence for person to person transmission, the risk of infection in most circumstances is still considered to be very low."

The exact source of the new virus and how it spreads is still unknown. The leading theory is that it comes from animals, the new Sars-like virus does appear to be closely related to a virus in bats.

However, if the infection needs to jump from an animal to a person with each infection the threat would be much lower.

The World Health Organization reported cases from within the same family in Saudi Arabia in November 2012.

It was impossible to tell whether each patient caught the infection separately - or if it had spread between them.

A WHO spokesperson said: "We know that in some of those cases there was close physical contact between family members caring for one another, so we can't rule out human-to-human transmission."

The two cases in the UK, with only one case linked to foreign travel, provide the strongest evidence that the infection can spread between people. The Health Protection Agency (HPA) said it was "overwhelmingly likely" human-to-human transmission had occurred.

However, if the virus could readily and easily spread between people then far more cases than the 11 detected so far would have been detected.

Continue reading the main story

Analysis Fergus Walsh Medical correspondent

The emergence of any new virus that poses a threat to human health is a cause for concern.

If the pathogen can spread from person to person, it becomes a significant issue. But the indications are the dangers to the general population are very low.

The very small number of cases strongly suggests if it does pass between people, it is not very contagious.

It appears infected animals - possibly bats - are the source of most of the cases so far.

Coronaviruses cannot survive outside the body for more than 24 hours and are killed by most detergents.

You will see it described as a "Sars-like virus" in headlines. But a key difference is that it does not pass easily from person to person.

Furthermore, it is also from the same family of viruses that produce the common cold.

• Read more from Fergus

Coronaviruses are a large family of viruses ranging from the common cold to the Sars (severe acute respiratory syndrome) virus, which spread through droplets of body fluids produced by sneezing and coughing.

It is thought these cases do not represent a "tip of the iceberg" with far more people being infected with mild or no symptoms, but the infection is still being analysed.

In 2003 an outbreak of Sars killed about 800 people after the virus spread to more than 30 countries around the world.

The new coronavirus was first identified in September 2012 in a patient in Saudi Arabia who has since died.

No travel restrictions are in place.

Prof John Oxford, a virology expert at Queen Mary, University of London, said: "This doesn't raise too many alarm bells.

"In a family things can spread far more easily than they would spread outside, people share towels and toothbrushes etc.

"If it was somebody who was not related or a nurse or a doctor - that would be a lot more serious."

Prof Ian Jones, from the University of Reading, said: "There is really close contact involved here, it is not 'true' human transmission in the general public.

"Although it is severe, it's not doing anything worse than some other respiratory infections, it's just a new one."

Prof Wendy Barclay, from Imperial College London, said it was wise to keep a close eye on the virus.

"We're an incremental step closer to worrying, but it isn't a worry where we need to say there is a pandemic coming," she said.

Health

Novel coronavirus infection - from SARS to SARI

Twelve cases, six deaths, no cure, a new deadly viral infection, fifty per cent mortality rate. It is lethal, it is unknown in humans, it can be transmitted from human to human, the mechanism is a mystery and it is spreading. On Sunday a patient admitted to hospital in the United Kingdom died of NCoV - Novel Coronavirus.

The scientific community is facing its worst nightmare: a pathogenic virus with the capacity to make a species jump and then become transmissible from human to human. It is called NCoV, or Novel coronavirus.

First appearing in 2012, Novel Coronavirus is a new strain of the Coronavirus which causes a number of infections to humans and animals, the most common of which is the common cold. It also causes more pathogenic diseases such as SARS (Severe Acute Respiratory Syndrome).

The World Health Organization states that there have been twelve reported cases of Novel Coronavirus infection, occasioning SARI (Severe Acute Respiratory Infection), kidney failure, pericarditis and disseminated intravascular coagulation, depending on the case. These cases were distributed as follows: 2 cases in Qatar, 5 in Saudi Arabia, 2 in Jordan, 3 in the UK. Six of these twelve patients have died.

Are there more cases?

How are these things documented? The WHO has claimed that there were two initial cases in Saudi Arabia, one of whom died, and they were unrelated since the victims came from different parts of the country. Then there was a cluster of three cases in the same family (2 died) but another family member living in the same house who developed similar symptoms does not count because he tested negative by Polymerase Chain reaction tests.

Both cases in Jordan died, the two from Qatar survived, one of the three in the UK has died (this was a cluster from the same family).

But what about, in the WHO's own report, "the number of health care workers with pneumonia associated with the cases...now considered probable case(s)"?

They don't count either. And those in Norway? Why have they "disappeared" from the media?

The WHO admits that the appearance of pneumonia among healthcare workers and family members "increases the suspicion that person-to-person transmission may have occurred". In the WHO's own reaction to the recent cases in the UK, this is more than confirmed: "The United Kingdom (UK) has informed WHO of another confirmed case of infection with the novel coronavirus (NCoV). This is the third case confirmed in the country this month and is in the same family cluster as the two recently confirmed cases.  The latest confirmed case does not have recent travel history outside the UK".

The Novel Coronavirus is sufficiently serious to have the WHO instructing the affected countries to test for new cases and have enhanced surveillance measures and communication with neighbouring countries. With significant numbers of people travelling to the area for different reasons, watch out for the next pandemic.

Sources: WHO

Department of Communicable Disease Surveillance and Response, Global Influenza Programme