Hello, and welcome to my chanel Medicine with Dr. Moran. Scientists from the well known lab
in Wuhan have just discovered a coronavirus called NeocoV. They claim could develop a 35% death toll.
There's been a lot of talk about NeocoV in the last few days and news media have sensationalized
a pre print by saying that this coronavirus is only one mutation away from a pandemic with a 35%
death rate. Now is this something to be extremely concerned about? NeocoV is a bat coronavirus that
is not known to infect humans. NeocoV has never been seen in humans, and at this time there's no
concerns in regard to NeocoV. There's many viruses in animals that have the potential to jump to
humans and we simply don't know about them at this point. This virus in fact would be one of those.
NeocoV is related to the Mers virus and likely is a variant of that. It was found in Vesper
bats in South Africa. I'ts very similar to Mers and felt to be a very close relative.
Now the Mers virus, as shown in this colorized electron-michroscopy image is the coronavirus
that causes Middle Eastern Respiratory Syndrome hense Mers M E R S. I talked about this virus in
detail in a previous video over a year ago on my channel. You can click the link in my description
below to find out more about it. MersCov was isolated in 2012 which was it's full name.
It's been found in the Arabian Peninsula particularly Saudi Arabia. The last signifivant
outbreak was in 2015 but cases are still getting reported globally. This is a map from 2017.
Cases have occurred worldwide of course. Why? Well because there's travel from the Arabian Peninsula.
It's believed that bats are the reservoir and that camels likely serve as the host.
Camel to human interaction can transmit the virus and it's also known that human to human
transmission can also occur. The incubation period which is the time from getting infected to the
time you first start getting some symptoms is 5 days with a range of 2 to 14 days. The symptoms
are fever, cough, shortness of breath, muscle aches, GI symptoms in 20% of people. Gi symptoms
are nausea, diarrhea, vomiting and abdominal discomfort. Acute Respiratory Risk Distress
Syndrome happens secondary to Pneumonia and PCR testing of lower respiratory track specimens as
opposed to upper respiratory track specimens from the throat and mouth is what is recommended here
for diagnosis. This is because the virus MERS tends to infect the lower respiratory track in
the lungs and much less in the upper track which would be the mouth throat and nose. Antibody tests
are available. There isn't a vaccine that's been approved for Mers and there isn't any specific
treatment for MERS other than supportive care. Now the presentation of MERS is very similar
to what we're seeing with the current pandemic in the beginning with the very first variants.
It's also essentially the same as the original SARS outbreak way back in 2,003.
How serious is Mers? In order to understand we have to understand the case fatality rate and the
infection fatality rate. We have statistics for case fatality rates only on this virus.
The case fatality rate means the number of deaths divided by the total number of cases.
Just remember that a case is somebody who actually comes to see a doctor like myself
and gets tested which is completely different from infection fatality rate that is the
number of deaths divided by the total number of infections. Many infectious people do not present
to doctors for testing or they may present but the doctor doesn't test for some reason.
Now we've seen this with the current pandemic where antibody tests suggest that the number of
infections suggest with the current coronavirus SARS Cov2 actually is 3 to 5 times the number
of cases. This number is currently likely to be higher because of limitations with testing.
Alot of people with Omicron are not being tested for Omicron. Now the overall case fatality rate
with MERS is 34% as of late September 2019 and that's based on a number of studies put together.
Remember that this case fatality rate is likely a significant overestimate
of the likelihood of dying if you do get the virus as there's no data on infection fatality rate.
There's never been any widespread testing in the Arabian Peninsula to know what the chances
of dying if you do get infected because we simply don't know how many people in this area have been
infected with the coronavirus and not even known it. Based on a single study of only 47 patients
case fatality rates rose with increasing age. Started at 39% for people under 50.
Up to 48% in people 50 - 60. 75% in people who were 60 or older. Small studies and the
lack of widespread antibody testing prevents us from knowing the true infection fatality rate.
Even the case fatality rate numbers I've just quoted obviously are based on small studies. Not
surprisingly as you might imagine comorbidities lead to a higher risk of lethal infection.
So again the data is quite limited and the numbers are likely a significant overestimate.
As I mentioned even those who come to the hospital may not have been diagnosed with MERS if testing
was not performed. So for example we're not going to test for MERS in North America unless perhaps
somebody's come from the Arabian Peninsula. In many cases pf pneumonias we don't come up
with a specific bacteria or virus that causes the pneumonia so a lot of these cases may get missed.
MERS does not use the human Ace-2 receptors to get into human cells.
Looking at the preprint here from Wuhan, and of course this is what's led to a lot of media
coverage. The preprint has not been peer reviewed and the study researchers wanted to study NeocoV
as well as a close relative, a coronavirus called PDF2180. They unexpectedy found that they used
some types of bat Ace2 receptors to get into cells but less favorably human Ace2 receptors for entry.
They looked further and they found molecular determinant close to the
viral binding interface that stops human Ace2 from supporting NeocoV infection.
They did find that NeocoV can efficiently infect human cells in the laboratory that express
Ace2 after a single mutation on the receptor binding motif. Now it's important to say that
this has not been studied directly in humans. It's simply in the laboratory.
Notably the infection itself cannot be neutralized by antibodies that target SARS-Cov2 or MERS.
So that means that if you have had previous SARS Cov2 Covid-19 or MERS your antibodies will not
neutralize NeocoV. The researchers stated that this is the first case of Ace2 usage in a MERS
related virus that could be, and I repeat could be a biosafety threat of the human emergence of
an Ace2 using new coronavirus potentially with significant transmission and potentially with
a significant fatality rate. Obviously knowing what the fatality rate is remains to be seen.
In general with MERS as well as SARS transmission was not as frequent then
our current coronavirus and that's due to the fact that both of those viruses infect the
lung and typically people were infectious when they started to develop symptoms, not before.
With the current coronavirus transmission occurs in the presymptomatic phase
meaning you can transmit Covid-19 to people before you're symptomatic. This I think is
the main reason why SARS in 2003 was able to be contained quite well. There was only about
8,000 cases worldwide, and why MERS has not spread rapidly either. So if you come across information
in the next few weeks on NeocoV that sensationally states that the virus is one mutation away from a
pandemic that could cause 35% death rate there's a lot more to the story. There's no question if
there were to be a change obviously in the virus for whatever reason and it did get transmitted
to humans it certainly would be a real concern so I don't mean to completely tale the concern away,
but I think it's important that people actually can put things in perspective and that's one of
the things that I try to do here on my channel. We want evidence based information. Thanks for
joining me today on Medicine with Dr. Moran. I'm Dr. Keith Moran. Get healthy and stay healthy.