Euro Clinical Microbiology 2020 Reflections on Wuhan Viral Pneumonia (2019-nCov)

Reza Nassiri

Abstract

The new decade started with a devastating outbreak of Wuhan viral pneumonia which is currently known is 2019-nCoV and questions about this new coro-navirus remain. On December 31, 2019, a mystery cluster of pneumonia-like symptoms were reported in late 2019 from Wuhan Province in China. As the alarming confirmed cases as well as fatalities in China continues to rise, the global health community may face a pandemic potential of 2019-CoV. Although the epidemic is not declining as of February 2020, some insights can be reflected. The source of Wuhan viral pneumonia as reported by the Chinese health authorities, was presumably related to the Hunan Seafood Market in the city of Wuhan. Most recent-ly, researchers at South China Agricultural University who tested more than 1000 samples from wild an-imals, reported a 99% match between the genome sequences of a virus found in pangolins and those in 2019-nCoV infected patients - such observation must be further validated. The Chinese scientists posted the full genome of the 2019-nCoV in GenBank. The genome sequences obtained from the nine infect-ed patients (a cohort of 10 patients) were markedly similar and exhibited about 99% sequence homolo-gy within the patient cohort and was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses. Analysis of the clinical specimens also showed the virus belongs to a subfamily of betacoronavirus. Fur-ther investigation revealed 2019-nCoV share same receptor with SARS-CoV, Angiotensin-converting en-zyme-II. The virus appears to be more virulent in el-derly and those with comorbid conditions. Although asymptomatic transmission has been reported in Germany, much questions remain about the biol-ogy of asymptomatic carriers since our current un-derstanding of the mode(s) of transmission this this novel virus is limited. It is now evident 2019-nCoV is the third epidemic of the coronavirus family in the past decades which has crossed species infecting vul-nerable and at-risk individuals. Much of the investi-gational work has been attributed to the infected pa-tients, and to date, there are no published papers on human handlers of the animals serving as the source of the virus. What has been documented so far is like outbreaks caused by SARS-CoV and MERS-Cov, this novel outbreak causes severe respiratory syndrome indicating a virulent capacity of the virus causing vi-ral pneumonia especially in elderly and those with comorbid conditions with an average fatality rate of almost 3% in Hubei province. Understanding the vir-ulent factor in an error-prone RNA-dependent RNA polymerase virus such as 2019-nCoV is highly import-ant in order to access the efficacy viral transmission as mutations and recombination of viral polymerase frequently occurs. It has been reported in critically ill patients who present with acute respiratory distress syndrome, there is reduction in peripheral blood lymphocytes. This finding in the context of adaptive immune response should be fully investigated since lymphocytes appear to be responsible in immuno-pathogenic events for Wuhan viral pneumonia. Par-ticularly, the evidence of viral presence in peripheral lymph organ may provide insight for further under-standing of immunopathogenesis of 2019-nCoV, let alone it provides better understanding of the patho-genic process in lung microenvironment. To effectively unlock the ambiguous mode of trans-mission (so far animal-human, person-to-person, Euro Clinical Microbiology 2020 Reflections on Wuhan Viral Pneumonia (2019-nCov)Reza NassiriDepartments of Pharmacology and Toxicology, and, Family and Community Medicine, Michigan State Uni-versity, East Lansing, Michigan, USA. Plant Biotechnology and Microbiology Short Communication2020Vol. 3, Iss. 2 Plant Biotechnology and Microbiology Short Communication2020Vol. 3, Iss. 2symptomatic carriers, and super spreaders have been reported) international research exchanges are urgently needed to coherently address so many questions about the biological, immunological and pathological characteristics of this novel virus. It appears the transmission of 2019-nCoV occurs fast by the means of miniscule contact droplets or pos-sibly via airborne transmission. Measures to pre-vent or reduce transmission should be implement-ed in populations at risk applying the principles of public health prevention and control with emphasis on contact tracing and surveillance issues. In addi-tion, deeper investigation of the specific immune response to acute infection will shed more lights on pulmonary and systemic inflammatory responses as-sociated with 2019-nCoV. The immune response to coronaviruses in general is presumed to be triggered by the innate immune system when it recognizes the corona family viruses. Regarding the presumptive si-lent carriers of the virus in the endemic regions who present non-respiratory symptoms such as diarrhea, nausea and vomiting, should be promptly evaluated for possible coronavirus infection. Because of sever-al uncertainties of 2019-nCov, the full scientific ev-idenced-based investigations necessitate stakehold-ers of various agencies collaborate and communicate efficiently through transparency, openness, and most importantly, unbiased data sharing – One Health concept. One Health integrates collaboration and communication of a broad range of biological, micro-biological, biomedical and other related disciplines to focus on 2019-nCoV parameters such as animal reservoir(s), transmission route(s), epidemic curve, viral kinetics in the host system, clinical microbiolog-ical findings, unusual symptoms presentation in few clusters, and most importantly, autopsy findings that will help to foster more effective care and preventive strategies. Dr. Nassiri is hematologist with a fellowship training in biochemical pharmacology. He is currently Profes-sor of Pharmacology and Toxicology, and, Family and Community Medicine, lecturer in Global Health, In-fectious Diseases and Tropical Medicine at Michigan State University in East Lansing, Michigan, USA. He has served as director of the MSU Institute of Inter-national Health and as a former Associate Dean of Global Health. He currently works on global health issues particularly antibiotic resistance and viruses without borders. He has made significant contribu-tions in various fields of medical sciences including clinical investigation, health education, and academic medicine. Based on his extensive experience and ex-pertise in chronic infectious diseases including HIV/AIDS and diseases of the tropics, he had previously developed clinical research programs in Brazil, South Africa, Haiti, Dominican Republic and Mexico. He had served as editorial board member for the journal of HIV and AIDS Review. He is currently on editorial board member for AIDS Patient Care and STDs. Prof. Nassiri has delivered seminar presentations on Tropi-cal Medicine, HIV/AIDS, Antibiotic Resistance, deadly viral epidemics and Global Health, in numerous na-tional and international conferences and workshops. He is internationally recognized for his work in the areas of building effective international partnerships particularly in global health, community health, clin-ical care capacity building, and technical assistance mechanisms. He is the founder of Michigan State University Osteopathic and Primary Health Clinic in Merida, Yucatan, Mexico. He has developed academ-ic and research partnership programs with Federal University of Para Institute of Tropical Medicine in Belem, Brazil. His research interests are clinical phar-macology of anti-infective agents, deadly viral epi-demics, antibiotic resistance, prevention and control of infectious diseases, tropical diseases, community health, global health, and community-based public health interventions. In collaboration with his Bra-zilian colleagues, he conducts research in the eastern Brazilian Amazon population on incidence and prev-alence of HIV, TB, Hepatitis C, HPV, and antimicrobial resistance