New England Journal of Medicine Documents Human-to-Human Infection by China Virus

New England Journal of Medicine Documents Human-to-Human Infection by China Virus
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TO THE EDITOR:

The novel coronavirus (2019-nCoV) from Wuhan is currently causing concern in the medical community as the virus is spreading around the world.1 Since its identification in late December 2019, the number of cases from China that have been imported into other countries is on the rise, and the epidemiologic picture is changing on a daily basis. We are reporting a case of 2019-nCoV infection acquired outside of Asia in which transmission appears to have occurred during the incubation period in the index patient.

A 33-year-old otherwise healthy German businessman (Patient 1) became ill with a sore throat, chills, and myalgias on January 24, 2020. The following day, a fever of 39.1°C (102.4°F) developed, along with a productive cough. By the evening of the next day, he started feeling better and went back to work on January 27.

Figure 1.

Timeline of Exposure to Index Patient with Asymptomatic 2019-CoV Infection in Germany.

Before the onset of symptoms, he had attended meetings with a Chinese business partner at his company near Munich on January 20 and 21. The business partner, a Shanghai resident, had visited Germany between Jan. 19 and 22. During her stay, she had been well with no signs or symptoms of infection but had become ill on her flight back to China, where she tested positive for 2019-nCoV on January 26 (index patient in Figure 1).

On January 27, she informed the company about her illness. Contact tracing was started, and the above-mentioned colleague was sent to the Division of Infectious Diseases and Tropical Medicine in Munich for further assessment. At presentation, he was afebrile and well. He reported no previous or chronic illnesses and had no history of foreign travel within 14 days before the onset of symptoms. Two nasopharyngeal swabs and one sputum sample were obtained and were found to be positive for 2019-nCoV on quantitative reverse-transcriptase–polymerase-chain-reaction (qRT-PCR) assay.2 Follow-up qRT-PCR assay revealed a high viral load of 108 copies per milliliter in his sputum during the following days, with the last available result on January 29.

On January 28, three additional employees at the company tested positive for 2019-nCoV (Patients 2 through 4 in Figure 1). Of these patients, only Patient 2 had contact with the index patient; the other two patients had contact only with Patient 1. In accordance with the health authorities, all the patients with confirmed 2019-nCoV infection were admitted to a Munich infectious diseases unit for clinical monitoring and isolation. So far, none of the four confirmed patients show signs of severe clinical illness.

This case of 2019-nCoV infection was diagnosed in Germany and transmitted outside of Asia. However, it is notable that the infection appears to have been transmitted during the incubation period of the index patient, in whom the illness was brief and nonspecific.3

The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak. In this context, the detection of 2019-nCoV and a high sputum viral load in a convalescent patient (Patient 1) arouse concern about prolonged shedding of 2019-nCoV after recovery. Yet, the viability of 2019-nCoV detected on qRT-PCR in this patient remains to be proved by means of viral culture.

Despite these concerns, all four patients who were seen in Munich have had mild cases and were hospitalized primarily for public health purposes. Since hospital capacities are limited — in particular, given the concurrent peak of the influenza season in the northern hemisphere — research is needed to determine whether such patients can be treated with appropriate guidance and oversight outside the hospital.

Camilla Rothe, M.D.
Mirjam Schunk, M.D.
Peter Sothmann, M.D.
Gisela Bretzel, M.D.
Guenter Froeschl, M.D.
Claudia Wallrauch, M.D.
Thorbjörn Zimmer, M.D.
Verena Thiel, M.D.
Christian Janke, M.D.
University Hospital LMU Munich, Munich, Germany
This email address is being protected from spambots. You need JavaScript enabled to view it.

Wolfgang Guggemos, M.D.
Michael Seilmaier, M.D.
Klinikum München-Schwabing, Munich, Germany

Christian Drosten, M.D.
Charité Universitätsmedizin Berlin, Berlin, Germany

Patrick Vollmar, M.D.
Katrin Zwirglmaier, Ph.D.
Sabine Zange, M.D.
Roman Wölfel, M.D.
Bundeswehr Institute of Microbiology, Munich, Germany

Michael Hoelscher, M.D., Ph.D.
University Hospital LMU Munich, Munich, Germany

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

This letter was published on January 30, 2020, at NEJM.org.

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  • This commment is unpublished.
    HJ Richards · 2 months ago
    CDC SAYS REPATRIATED AMERICANS ARE UNDER FEDERAL QUARANTINE
    QUARANTINE ORDER IS THE FIRST IN THE U.S. IN 50 YEARS
    CDC OFFICIAL: VIRUS CONTINUES TO SPREAD RAPIDLY IN CHINA
  • This commment is unpublished.
    Copperhead · 2 months ago
    Now in 28 countries and counting -

    Australia, Canada, Vietnam, Germany, Cambodia, Malaysia, Nepal, South Korea, Singapore, United States, Thailand, France, Japan, Sri-Lanka, Russia, Taiwan, China, Finland, UAE, Tibet, Zambia, Philippines, India, United Kingdom, Italy, Turkey, Sweden, Brazil
  • This commment is unpublished.
    Joe Williams · 2 months ago
    As i was in my morning routine. I was thinking about Hals broadcast on the origin of this bio virus. China purposely went to hard research to find rare ingredients in BATS that would mix with other things to create a COVERT bio weapon to purposely destroy America down the road. The U.S. needs to realize this and PERMANENTLY stop ALL trade with China. We dont what covert and invisible trojans is being sent over here in containers. Yes, most everything is made in China. Can the U.S economically handle that move. I don't know. But LIVES BEFORE MONEY is more important.
    • This commment is unpublished.
      K · 2 months ago
      Here's the problem...U.S. corn and soybean farmers have depended on the Chinese market for so long that many of them are very upset about the tariff wars. Additionally, ever since oil went low, for various reasons, their corn-for-ethanol market has dried up too.

      You really have to find a new market for their corn and soy or you have to convince them to stop growing so much of it because, coming on the heels of the idiotic "meat is bad, milk is bad" global-warming idiots, losing the Chinese market will create a flood of US farming bankruptcies.
    • This commment is unpublished.
      Copperhead · 2 months ago
      I'm very surprised that no one (at least that I've seen) has floated the possibility that this virus was released by a rogue nation and not an accidental release by China.
  • This commment is unpublished.
    QRM · 2 months ago
    Good article. People need to copy it directly from nejm.org while they still can. Before it is retracted.
  • This commment is unpublished.
    Joe Williams · 2 months ago
    I just read on the back of a can of lysol spray that it kills human coronavirus.
    Since this is "a novel(new) coronavirus" im curious if it will work..
  • This commment is unpublished.
    Joe Williams · 2 months ago
    #1. Is this the post Hal said he was working last night on his show.

    #2. For those of us, that are unfortunately not scientific savvy, what does this post mean. Break it down.
    • This commment is unpublished.
      Copperhead · 2 months ago
      #2 - basically it is contagious and can be spread by asymptomatic or pre-symptomatic infected patients, and that 'recovered' patients can still be shedding the virus.
      • This commment is unpublished.
        Joe Williams · 2 months ago
        Thank you for explaining this
  • This commment is unpublished.
    SIG NEWS UK · 2 months ago
    SIG NEWS™ UK 31st Jan 2020

    Once again the news in the UK is being severely managed and restricted despite the numerous indicators and external academic and impirical reports already emerging about the potential of this Global Pandemic and Virus.

    Already reports like the one provided here by 'Hal' from the New England Journal of Medicine, or the infection model from Bianci Research, reports in 'The Lancet' and even Bill Gates research and models conducted at the Pirbright Institute. All of these are being ignored and are invisible from UK MainStreem Media Reports.

    There are two 'virologists who are repeatedly appearing on 'Sky News' in the UK saying how much we shouldn't be worried about this virus and that it doesn't even have a mortality rate of 2% when 'The Lancet'has clearly reported 15%. How they can report what they are reporting with any certainty at this stage is astounding and extremely misleading.

    Nobody knows what the secondary or subsequent infection rates are yet or how it is mutating as it IS indeed mutating. Some experts are saying that the initial transmission rate is 3.8 and could be possibly more in the secondary and subsequent stages, even beyound 6 or 7. Do the Mainstream Media and UK Authorities really think that we are ALL ASLEEP?

    Now that the first two UK 'OFFICIALLY' recognised patients (from Newcastle UK) are admitted as being infected in the UK, no one now seems to be reporting that this virus may have come out of the Chinese BioWeapons Lab in Wuhan or whether it is just 'novel CoronaVirus or is indeed a Hybrid of Corona Virus and other vectors such as Pneumonic Plague and Ebola.

    At the very least, as those allegations are in the public domain, then the authorities in the UK must move to confirm or discount these reports and explain why Chinese Citizens were filmed dying in the streets of Wuhan over 7 days ago (UK Daily Star images). Why would this be happening if the kill rate is less than 2%?, why would over 60million people be quaranteened in Hubei and why is the whole of China starting to self-quaranteen?

    DavidT@SIG NEWS™ UK

    Please continue to support Hal Turner Radio Show subscribe or donate right now so that 'freedom' news sites like this can remain active and independent.
  • This commment is unpublished.
    James Huff · 2 months ago
    Dear God, if as they say, "In this context, the detection of 2019-nCoV and a high sputum viral load in a convalescent patient (Patient 1) arouse concern about prolonged shedding of 2019-nCoV after recovery." if proven to be true through future cultures, then eventually, every person on the planet will become exposed to this strain. As the recovered infected people will still be carriers.
  • This commment is unpublished.
    Gifford Rodine · 2 months ago
    The most valuable news on this disease outbreak to date. Many thanks Hal, we will send a little extra. Most have known very valuable people in their lives. You are an outstanding example.

    Where are our government employees, bureaucrats and elected, in providing this information, "continuation of government," screw'um.