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."
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