Where is the new coronavirus hiding? Where does it live? Most importantly, will it re-emerge to infect more people and start to spread?
No one has answers to those questions at present. But the World Health Organization is hoping to put together a more comprehensive picture of the mysterious and occasionally deadly virus next week.
The WHO is hosting a meeting on Monday and Tuesday in Cairo, pulling together researchers who work on coronaviruses, public health officials who have been involved in the outbreak and others who can help to flesh out what is known so far.
Among those attending will be people who led responses to other emerging disease outbreaks, such as the 2003 SARS crisis. Someone from Canada has been invited to attend to discuss the country's SARS experience, but the WHO won't reveal the list of the invitees.
In part, a WHO official admits, the aim is to encourage more sharing of information than has occurred up to date. Between 25 and 30 people have been invited, and the meeting will be held behind closed doors.
"Often what we find is that people who are involved in research are reluctant to share preliminary findings," said Dr. Anthony Mounts, the WHO's point person for the coronavirus investigation.
"(It's) partly because they want to publish but I think also because there's a reluctance to share stuff that they're not quite confident in yet, because it's still preliminary. But we find that when they come to meetings like this they're much more willing to share it openly."
Among those expected to attend is Dr. Ian Lipkin, director of the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health in New York. Lipkin is an expert on emerging infectious diseases; a brief biography on his centre's website says he has identified at least 400 previously unknown viruses in the past decade.
Lipkin travelled to Saudi Arabia last fall to try to find the source of the new coronavirus, and a comment he made to the journal Nature suggests he found something. But he hasn't shared that information in any depth and most observers believe a publication is probably pending. (Scientific journals typically won't publish findings that have already been reported elsewhere.)
The Nature article, published in early December, said Lipkin revealed he had discovered that partial genetic sequences of a virus from bats match the new coronavirus. "The finding gives insight into the original source of the virus," he told Nature.
To date there have been nine confirmed cases of infection with the new coronavirus, which is from the same family as the virus that caused SARS. Of the confirmed cases, all have been severely ill and five have died. Cases have occurred in Saudi Arabia, Qatar and Jordan.
As well, there are a number of probable cases, the status of which may become clearer once a test is developed that can detect antibodies to the virus in blood. Antibodies would be a sign of prior infection.
The WHO believes there may have been limited person-to-person spread of the virus on two separate occasions. Last fall four members of a large, extended family in Saudi Arabia became ill; three of the four tested positive for the coronavirus and the fourth is considered a probable case.
Last April, a group of at least 11 people in Jordan, including seven health-care workers, were sick with an undiagnosed form of pneumonia that was severe in most but not all cases. Stored sputum samples from two of those people — both of whom died — were tested for the virus months later and found to be positive.
So far the Jordanian cases are the first known to have occurred. But the first case which came to light was that of a Saudi man who died last June in Jeddah. When the hospital where he was cared for couldn't diagnose his illness, they sought help from Erasmus Medical Centre in Rotterdam, the Netherlands.
The Dutch scientists confirmed the presence of the new coronavirus, which they called hCoV-EMC, short for human coronavirus and the institute's initials.
News of the existence of the new virus was only shared publicly in September, via an Internet-based infectious diseases reporting system called ProMed. Two days later, Britain's Health Protection Agency reveals a London hospital was treating a gravely ill Qatari man infected with the virus. He had travelled by air ambulance to London for care.
In the weeks that followed seven more infections came to light.
But there haven't been any new cases reported since late November. And despite the fact that the WHO urged countries to test unexplained pneumonia cases for the virus, there hasn't been a deluge of samples sent for testing, Mounts said.
He is worried that people aren't taking the situation seriously enough. And so another goal of the meeting is to convey that the WHO feels there is more work to be done here.
"We don't want to be alarmist," Mounts said.
"But we do want to raise concerns a bit and ... create a bigger sense of urgency in the minds of the people involved, so that there is more collaboration, co-operation, data sharing and so on. And to get people to think realistically about what kinds of things we need to do next."
It could well be that no further human cases are found, or that the occasional sporadic case pops up, but with no significant human-to-human spread.
But another possibility is that this virus is doing what the SARS virus may have done in 2002, before it hit the world's radar — occasionally jumping from its natural host to infect a human or two. If at some point the virus adapts to transmit effectively from person to person it could start to spread more widely.
Mounts said the WHO wants to be better prepared in case that last option is how things play out.
"We just want to be ready," he said. "We don't want to miss the opportunity. If this were to come back again, we want to make sure we have all the pieces in place."
ALSO: Old time diseases:
Yes, the black plague -- responsible for <a href="http://www.smithsonianmag.com/people-places/mall_aug99.html?c=y&page=2" target="_hplink">killing 56 million people in Europe the 14th century</a> -- is still around, but it isn't as deadly or prevalent as it was in Medieval times. Dr. Robert Gaynes, an infectious disease expert at Emory University and author of the book <a href="http://estore.asm.org/viewItemDetails.asp?ItemID=1036" target="_hplink">Germ Theory: Medical Pioneers in Infectious Diseases</a>, said that people contract the disease when they gain access to previously undistrubed ecosystems, thereby making "these types of diseases become evident as a result of animal contact." These days, the disease is most commonly spread by bites from fleas that are infected with Yersinia pestis. When the bacteria enters into a person's skin, it leads to headache, chills, and <a href="http://www.bt.cdc.gov/agent/plague/factsheet.asp" target="_hplink">swollen lymph glands</a>, according to the CDC. Early <a href="http://www.bt.cdc.gov/agent/plague/factsheet.asp" target="_hplink">treatment with antibiotics</a> is essential for survival, as the disease can cause respiratory failure and shock if left untreated. Every year, about 1,000 to 3,000 <a href="http://healthland.time.com/2011/05/10/first-case-of-bubonic-plague-in-2011-appears-in-new-mexico/" target="_hplink">bubonic plague cases</a> occur around the world, with 10 to 20 of those cases in the United States, <em>TIME</em> reported. The first 2011 case of bubonic plague was confirmed in May in a New Mexico man. The reason is murky for why black plague seems to be less deadly today than in the Medieval times, Weinberg said, but it probably has to do with more rats and unclean living conditions back then, as well as a lack of appropriate medicines. In addition, the bacteria back then may be different from the current form, he added.
<a href="http://www.medicinenet.com/scarlet_fever/article.htm#history" target="_hplink">Scarlet fever</a> was among the rash of diseases that commonly afflicted people in the 19th century (alongside yellow fever, rubella and measles), according to MedicineNet. Scarlet fever most often afflicts children, causing rash and fever. Fortunately, scarlet fever is a lot less common today than it was centuries ago, but it still can be deadly. Today, we now know that scarlet fever is just a form of group A streptococcus (strep), Weinberg said. But instead of just turning into a regular case of strep throat, scarlet fever manifests as a red skin rash. With antibiotics, the disease is easily treated, though complications can occur that <a href="http://www.medicinenet.com/scarlet_fever/article.htm#history" target="_hplink">can lead to sepsis</a> (bacteria in the blood, tissue or bone), according to MedicineNet. Just this summer, Reuters reported that a Hong Kong kindergarten was closed after tests revealed that a child there may have <a href="http://www.reuters.com/article/2011/06/21/us-scarletfever-china-idUSTRE75K14Q20110621" target="_hplink">died from scarlet fever</a>. Scarlet fever is relatively common in that part of the world, but this year a Hong Kong health department spokesman told Reuters that there seem to be more cases of it this year than in past years.
<a href="http://articles.sfgate.com/2011-09-20/bay-area/30178479_1_whooping-cough-booster-shots-childhood-vaccine" target="_hplink">Whooping cough</a>, caused by the Bordetella pertussis bacteria, was a common illness among children in the early 1900s, according to HealthCentral. However, when the vaccine for whooping cough was introduced in the 1940s, cases dropped. But while whooping cough cases are still dramatically lower than 50 years ago, there are still cases that persist today possibly because the vaccine against the disease doesn't provide lasting protection later in life, Weinberg said. Another reason is that older people seem to be able to carry whooping cough in their throats without actually getting sick (due to being vaccinated at a younger age), but that whooping cough is then passed on to infants who haven't yet been vaccinated against the disease, Gaynes said. "This problem has led to a recent recommendation by [the] CDC to have adults get TDAP once as adults (it contains pertussis in the vaccine) and not just a tetanus booster, which is needed every ten years," Gaynes told HuffPost. Recent research presented just last month shows that the <a href="http://articles.sfgate.com/2011-09-20/bay-area/30178479_1_whooping-cough-booster-shots-childhood-vaccine" target="_hplink">protection from the whooping cough vaccine</a> is decreased dramatically once a child reaches age 8 or 9, the <em>San Francisco Chronicle</em> reported. <a href="http://www.cdc.gov/features/pertussis/" target="_hplink">Whooping cough is very contagious</a> -- spread by cough and sneezing -- and is so named because of the sound people who have it make when they cough. Last year, 27,550 people had whooping cough in the United States, according to the CDC. The disease is the deadliest for babies, as it can lead to pneumonia, convulsions and even death.
Polio, the paralysis-causing disease that afflicted former president Franklin D. Roosevelt, isn't completely gone from the world today. However, it has been eliminated from the western world, Weinberg said. The Mayo Clinic reports that the last known <a href="http://www.mayoclinic.com/health/polio/DS00572" target="_hplink">case of polio in the U.S.</a> was in 1979. Polio is still present in <a href="http://www.who.int/mediacentre/factsheets/fs114/en/" target="_hplink">Afghanistan, Pakistan, India and Nigeria</a>, where unrest and dangerous conditions can make it more difficult to get everyone vaccinated against the disease, according to the World Health Organization. Recently, the WHO reported that a dangerous strain of polio -- called wild poliovirus type 1 -- had <a href="http://www.huffingtonpost.com/2011/09/20/polio-china-pakistan_n_971787.html" target="_hplink">made its way from Pakistan to China</a>. Polio<a href="http://www.mayoclinic.com/health/polio/DS00572" target="_hplink"> causes paralysis</a> and can make it hard to breathe, the Mayo Clinic reported. It can even lead to death.
Gout has been known throughout history as the "<a href="http://www.bl.uk/learning/langlit/booksforcooks/1700s/1700sfood.html" target="_hplink">disease of kings</a>" and the "rich man's disease," as it was most commonly seem among the gluttonous rich in the 1700 and 1800s, according to the British Library. Gout is considered an ancient form of <a href="http://www.cdc.gov/arthritis/basics/gout.htm" target="_hplink">inflammatory arthritis</a>, and is caused by metabolic disorder that has not been properly controlled. It occurs when uric acid crystals build up in tissues and fluids, thereby leading to a red, swollen joint that is very painful, according to the Centers for Disease Control and Prevention. The condition is most common in overweight men and women who have gone through menopause. Gout rates have <a href="http://arthritis.webmd.com/news/20101110/gout-cases-on-the-rise-in-u-s" target="_hplink">been on the rise</a> since the 1960s, with cases doubling between 1960 and 1990 and then continuing to rise through 2008, according to WebMD. More than 8 million Americans currently have gout. WebMD reported that the <a href="http://arthritis.webmd.com/news/20101110/gout-cases-on-the-rise-in-u-s" target="_hplink">rise in gout cases</a> may be due to people living longer, as the condition is seen in women only after they have passed menopause. In addition, "you can go years with hyperuricemia and no symptoms. But at some point, enough uric acid accumulates to have a flare-up of gout, so if you're living longer you are more likely to reach that threshold," gout expert Dr. John S. Sundy told WebMD. In addition, Gaynes speculated that it may not even be that gout rates are actually rising -- rather, detection and diagnosis may have improved throughout the years.