By Siouxsie Wiles 02/02/2020

Now officially a Public Health Emergency of International Concern here’s my second round-up of some of the week’s coronavirus-related news.

Gilead announces they are working with Chinese to test their antiviral drug remdesivir

On the 31st January, pharmaceutical company Gilead announced they are working with health authorities in China to establish a randomized, controlled trial to see if remdesivir can be used to treat people infected with the novel coronavirus.

Remdesivir is what’s known as a nucleotide analogue prodrug which was developed to stop the Ebola virus from replicating inside cells. It was one of four drugs tested last year in a clinical trial during the Ebola epidemic in the Democratic Republic of Congo (DRC). That trial was stopped early after two of the four drugs dramatically cut the number of deaths.

Remdesivir wasn’t one of the successful drugs, so Gilead have presumably been looking to see if it could be repurposed for other viral infections. Last year Timothy Sheahan and colleagues published a paper reporting that remdesivir (also known as GS-5734) was effective against the coronavirus responsible for MERS, both in cells and in infected mice. Gilead also announced they were expediting laboratory testing of remdesivir against this new coronavirus.

Are over 100,000 people in China infected with this virus?

This is a good question and the current answer is, possibly. Lots of researchers have been trying to estimate how many people in Wuhan are infected with the virus which is how this number has appeared. The first I heard about was a team at Imperial College London led by Professor Neil Ferguson. As of writing, they’ve published three reports, the first on the 17th January and the most recent on the 25th January.

They’ve been working back from the number of cases being seen outside of China and the probability a case would appear based on the number of people who were leaving from Wuhan International Airport. Given this is a new outbreak with a virus not ever seen before, they had to make some guestimates as to how infectious it is and the incubation period.

[Check Grant Jacobs’ explainer of how infectivity is measured, aka R0, and this fantastic graphic that has the R0’s of lots of different infectious microbes.]

Ferguson and colleagues’ estimates ranged from 190 – 5,341 cases by the 12th January in their first report, to between 1,000 – 9,700 by the 18th January in their second report.  Prof Ferguson was then quoted in the Guardian last week as saying his best guest was there were 100,000 people infected with the virus.

A few days ago a paper appeared in the Lancet that describes pretty much the same analysis. Professor Joseph Wu and colleagues estimate that between 37,304 and 130,330 people have been infected in Wuhan as of 25th January.

Why are these numbers so different from the official numbers?

As of writing this the number of confirmed cases in China is 14,412 according to the Hopkins outbreak-tracker. Which is a lot less than 100,000. So why are these numbers so different?

Lots of reasons! First of all, the estimates are based on best guesses of things like how infectious the virus is. Secondly, testing to confirm cases takes time and resources and it could be that the labs are working at capacity. What would be interesting is to see the number of tests that are pending, and how that number has been changing over time.

Another very plausible reason is that the Chinese are likely focusing their attention on the people who need medical attention. This means anyone with a mild form of the infection won’t be being tested. What wasn’t clear a week or so ago, was whether this new infection came as a spectrum ranging from mild to death, or whether everyone who got the virus would come down with a very serious infection. But some of the case reports being published are shedding some light on this.

The German cluster

Doctors in Germany just published a report in the New England Journal of Medicine (NEJM) of a cluster of cases. In it, they describe both human-to-human transmission of the virus from someone without any symptoms, as well as people experiencing a very mild infection.

On the 19th January, someone from Shanghai visited Germany for business meetings, held on the 20th and 21st. She was fine during her visit but became ill on her flight back to China. She tested positive for the virus on the 26th of January.

Update 06/02/2020: It’s now being reported that the authors of the NEJM report didn’t actually speak to the visitor from Shanghai and that she did have symptoms while in Germany. This means this wasn’t asymptomatic spread.

Meanwhile, a 33-year-old otherwise healthy German man who attended the meetings came down with a sore throat, chills, and muscle aches on the 24th January. The next day he had a fever and a cough but by soon started to feel better and went back to work on the 27th  of January.

That same day the company was told of the Chinese visitor’s infection and as part of the contact tracing, the German man was sent for assessment and swabbing. His two nose swabs and sputum sample tested positive for the virus. They were still positive a few days later.

On the 28th of January, another three people at the company tested positive for the virus. Only one of these had been to the same meetings as the visitor from China. The other two had only had contact with their German colleague. At the time of publishing their paper, none of them had shown any signs of severe disease.

Now it’s a case of waiting to see if they all stay relatively asymptomatic, or if they progress to more severe disease. It will also be interesting to see if the virus they are infected with has mutated slightly, or if it’s the same as the versions causing more severe symptoms.

Lastly, a quick note about the naming of the virus and disease…

There’s a good piece on STAT asking what we should be calling this new virus and disease. In the past, it’s generally the people who first identify the organism or disease that name it. Hence things can be named after people, places, symptoms, all sorts.

For the moment this new virus is being referred to as 2019-nCoV, for 2019 novel coronavirus, but as Helen Branswell points out that’s “a bit like calling a daughter “the girl born in 2019””.  What’s really important is that the virus and the disease do not get named after Wuhan or China.

Back in 2015, the WHO released a best practice guide for naming new human infectious diseases. Given the stigma that is attached to infectious diseases, the WHO want names that will in their words “minimize unnecessary negative impact… on trade, travel, tourism or animal welfare, and avoid causing offence to any cultural, social, national, regional, professional or ethnic groups.”

I’m already seeing reports of how Chinese people and anyone who looks vaguely Asian is already being treated appallingly as people worry they are a source of the virus – even in countries without the virus! Naming the disease after Wuhan or China will only perpetuate that stigma.