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J Med Virol. 2020;92:401–402. wileyonlinelibrary.com/journal/jmv © 2020 Wiley Periodicals, Inc.
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401
DOI: 10.1002/jmv.25678
COMMENTARY
Outbreak of pneumonia of unknown etiology in Wuhan,
China: The mystery and the miracle
Hongzhou Lu
1
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Charles W. Stratton
2
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Yi‐Wei Tang
3
1
Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
2
Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
3
Cepheid, Danaher Diagnostic Platform, Shanghai, China
Correspondence
Hongzhou Lu, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.
Email: luhongzhou@fudan.edu.cn (HL)
Yi‐Wei Tang, Cepheid, Danaher Diagnostic Platform, Shanghai, China.
Email: yi-wei.tang@cepheid.com (Y‐WT)
Since December 2019, a total of 41 cases of pneumonia of unknown
etiology have been confirmed in Wuhan city, Hubei Province, China.
Wuhan city is a major transportation hub with a population of more than
11 million people. Most of the patients visited a local fish and wild animal
market last month. At a national press conference held today, Dr Jianguo
Xu, an academician of the Chinese Academy of Engineering, who led a
scientific team announced that a new‐type coronavirus, tentatively
named by World Health Organization as the 2019‐new coronavirus
(2019‐nCoV), had caused this outbreak.
1
The 2019‐nCoV has a different coronavirus‐specific nucleic acid
sequence from known human coronavirus species, which are similar to
some of the beta coronaviruses identified in bats.
2,3
The virus‐specific
nucleic acid sequences were detected in lung fluid, blood and throat swab
samples in 15 patients and the virus that was isolated showed a typical
coronavirus appearance under electron microscopy. Further research will
be conducted to better understand the new coronavirus to develop
antiviral agents and vaccines.
4
We applauded the excellent job that has been done so far. The
infection was first described in December. Within 9 days, a special
team consisted of physicians, scientists and epidemiologists who
ruled out several extremely contagious pathogens including SARS,
which killed hundreds of people more than a decade ago, and MERS.
This has surely alleviated environmental concerns as Hong Kong
authorities had quickly stepped up the disinfection of trains and
airplanes and checks of passengers due to this outbreak.
Most of the patients visited the fish and wild animal market last
month in Wuhan. This fish and wild animal market also sold live animals
such as poultry, bats, marmots, and snakes. All patients received prompt
supportive treatment in quarantine. Among them, seven patients were in
serious condition and one patient died. All of the 42 patients so far
confirmed were from China except one Thailand patient who was a
traveler from Wuhan. Eight patients have been cured of the disease and
were discharged from the hospital last week. The 2019‐nCoV now have
been isolated from multiple patients and appears to be the culprit.
But the mystery has not been completely solved yet. Until there
is a formal published scientific manuscript, the facts can be argued,
particularly regarding causality despite these facts having been
officially announced. The data collected so far is not enough to
confirm the causal relationship between the new‐type coronavirus
and the respiratory disease based on classical Koch's postulates or
modified ones as suggested by Fredricks and Relman.
5
The viral‐
specific nucleic acids were only discovered in 15 patients, and
successful virus culture was extremely limited to only a few patients.
There remains considerable work to be done to differentiate
between colonization, shedding, and infection. Additional strains of
the 2019‐nCoV need to be isolated to study their homologies. It is
expected that antigens and monoclonal antibodies will be developed
so serology can be used to confirm previous and acute infection
status.
The episode demonstrates further the need for rapid and
accurate detection and identification methods that can be used in
the local hospitals and clinics bearing the burden of identifying and
treating patients. Recently, the Clinical Laboratory Improvement
Amendments (CLIA) of 1988 has waived highly sensitive and specific
molecular devices known as CLIA‐waived devices so that these
devices are gradually becoming available for point of care testing.
Finally, the epidemiological similarity between this outbreak and that
of SARS in 2002‐2003
6
is striking. SARS was then traced to animal
markets
7
and eventually to palm civets.
8
Later bats were identified as
animal reservoirs.
9
Could this novel coronavirus be originated from wild animals? The
family Coronaviridae includes two subfamilies.
10
One, the subfamily
Coronavirinae, contains a substantial number of pathogens of mammals
that individually cause a remarkable variety of diseases, including
pneumonia. In humans, coronaviruses are among the spectrum of viruses
that cause the common cold as well as more severe respiratory disease—
specifically SARS and MERS, which are both zoonoses. The second
subfamily, Torovirinae, contains pathogens of both terrestrial and aquatic
animals. The genus Torovirus includesthetypespecies,equinetorovirus
(Berne virus), which was first isolated from a horse with diarrhea, and the
Breda virus, which was first isolated from neonatal calves with diarrhea.
White bream virus from fish is the type species of the genus Bafinivirus.
However, there is no evidence so far that the seafood from the fish and
animal market caused 2019‐nCoV‐associated pneumonia.
This epidemiologic similarity clearly provides a starting point for
the further investigation of this outbreak. In the meantime, this fish
and animal market has been closed until the epidemiological work
determines the animal host of this novel coronavirus. Only then will
the miracle be complete.
ORCID
Yi‐Wei Tang http://orcid.org/0000-0003-4888-6771
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How to cite this article: Lu H, Stratton CW, Tang Y‐W.
Outbreak of pneumonia of unknown etiology in Wuhan,
China: The mystery and the miracle. J Med Virol. 2020;92:
401–402. https://doi.org/10.1002/jmv.25678
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LU ET AL.
