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As first Maryland patient is tested for new coronavirus, response will be based on past outbreaks

A Maryland resident is being tested for the new coronavirus that has sickened thousands and killed dozens in an outbreak that began in — and remains centered in — China, state health officials announced early Monday night.

It’s the third time in 18 years that a serious coronavirus outbreak has made its way to the United States, with the fifth confirmed case reported Sunday in Arizona.


The new coronavirus has sickened 2,886 so far, mostly in China, and killed 106. Maryland has no confirmed cases, but state health officials said that a resident, whose name and location were not identified, met the criteria for testing and is in good condition awaiting the results.

Public health officials and researchers, who never stopped preparing for the threat that a new form of the virus could emerge, are responding to this latest outbreak using the past as their guide.


“We predict these things can occur, though it’s always unexpected when they do,” said Matthew Frieman, a coronavirus researcher and associate professor of microbiology and immunology at the University of Maryland School of Medicine. “We hope that the knowledge base from studying SARS and MERS is helpful in studying and responding to this one.”

SARS, or severe acute respiratory syndrome, originated in Asia in 2003 and sickened 8,000 people and killed about 800. Middle East respiratory syndrome, or MERS, was first reported in Saudi Arabia in 2012. It sickened almost 2,500 and killed more than 850 and continues infecting people.

Officials from the U.S. Centers for Disease Control and Prevention say for now that the risk to Americans remains low from this coronavirus, which is part of a family of pathogens that also includes the common cold. But federal agencies have followed past protocols by opening an operations center, offering guidance to medical providers and screening people arriving from China at five U.S. airports.

“The emerging influenza viruses over the years and other emerging coronaviruses have given us a higher level of preparation that we can now leverage and test with this latest emerging virus."

—  Dr. Kathleen Neuzil, director of the University of Maryland School of Medicine’s Center for Vaccine Development

Samples from those suspected of being infected are sent to the U.S. Centers for Disease Control and Prevention for testing when the patient meets certain criteria, including showing respiratory symptoms and having traveled from China in the past two weeks. They also might qualify for testing if they have been in close contact with someone who has traveled and is sick.

“The Maryland Department of Health is closely monitoring the rapidly changing situation with 2019 N-CoV, both in the U.S. and in China,” said Fran Phillips, the state’s deputy secretary of public health, in a statement. “As we learn more, Marylanders are encouraged to practice everyday actions to promote good health and to protect yourself and your loved ones from respiratory viruses like the coronavirus — wash your hands thoroughly, cover your cough and avoid close contact with people who are sick. Stay home from work or school if you’re not feeling well.”

The five U.S. cases confirmed by the CDC are travelers from China to Arizona, California, Chicago and Seattle.

On Monday, the CDC said health officials were investigating more than 100 potential cases in 26 states, which did not include the potential Maryland case, reported early at night. Testing will show whether they are the new coronavirus or another infection.

Public health officials say there are less severe and far more common coronaviruses and influenza viruses now circulating and producing similar respiratory symptoms.


There are other precautions locally, including messages to students and faculty at the University of Maryland and Johns Hopkins University to call, not visit, a medical provider if they experienced flu-like symptoms after traveling to China. MedChi, the state association for doctors, is recommending medical providers screen anyone who has traveled to China and report suspected cases to local health departments.

At least one local Chinese New Year celebration in Howard County has been canceled as a precaution.

China has taken far stronger measures. Travel from the outbreak epicenter in Wuhan is restricted, Chinese New Year events have been canceled and officials are building a 1,000-person hospital to quarantine and treat those infected.

Maureen Regan, a spokeswoman for the Maryland Department of Health, said Friday that local health departments and medical providers began calling the state health officials last week for guidance on potential cases. At the time, none of those cases met the criteria for an infection, she said. That includes a passenger taken off a plane at BWI Thurgood Marshall Airport on Saturday.

Regan said the department is providing information and updates online. It’s also sent a letter to medical providers and local health departments and will rely on “a network of established communications and response protocols and resources” should there be a need in the state, she said.

There is still much that researchers don’t know about the new virus, Frieman said. Coronaviruses are carried by animals and passed for poorly understood reasons to humans. MERS was passed from camels, for example. Some viruses then transmit between humans, some more easily than others.


Frieman’s scientific work has aided in the development of treatments for both SARS and MERS. He’s now turned his attention to the new virus, which for now doesn’t appear to be as severe. Most people who have died so far have been elderly or suffering underlying health conditions.

Dr. Kathleen Neuzil, director of the University of Maryland School of Medicine’s Center for Vaccine Development, is already working directly on a vaccine for the new virus. She co-leads a consortium established by the National Institutes of Health at Emory University in Atlanta to quickly tackle new infectious diseases.

Neuzil said researchers will be prepared for an initial trial of a vaccine in the next three months, a timeline normally unheard of for any therapy. She said the vaccine will use an existing vaccine as a basis, or “platform,” for the new vaccine.

Neuzil wouldn’t say what that platform might be. But the Norway-based Coalition for Epidemic Preparedness Innovations, a public-private coalition founded in 2017 to fund and coordinate quick vaccine development, announced Thursday that the platform will be based on the MERS vaccine.

Specific researchers and manufacturers have been tapped for this rapid development and production, which is possible only because of research already done, Neuzil said.

“The emerging influenza viruses over the years and other emerging coronaviruses have given us a higher level of preparation that we can now leverage and test with this latest emerging virus,” she said.


In addition to development of therapies, others in Baltimore also continue contributing to global preparedness.

Lauren Gardner, a civil engineering professor at Johns Hopkins University, led a team that built a map based on information collected from various sources in China, the United States and elsewhere to track the spread of the virus. The map will help the public visualize where the virus is taking hold in real time, while the underlying data can be used by researchers.

Gardner, also co-director of Hopkins’ Center for Systems Science and Engineering, is now using the data to predict where there might be more cases and where public health officials should focus resources. The effort is similar to modeling she did last year that identified 25 countries most likely to experience a measles outbreak.

“This is not supposed to make people afraid or worried,” Gardner said. “We made the map for the public to understand something that is still largely unfolding on the other side of the world, to give them timely and reliable information.”

She said past outbreaks might be the reason that the data is so readily available. China has come under criticism initially for possibly withholding information about the number of people infected, but the nation’s health agencies shared data about the virus quickly, which led to timely gene sequencing of the virus. That information, in turn, is being shared by researchers and will be used to develop therapies, including the vaccine.

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The information also will help public health leaders respond. Already, different countries have come a long way in setting up systems to contain the threats and treat the infected, said Jennifer Nuzzo, an epidemiologist in Hopkins’ Center for Health Security.


She helped develop the Global Health Security Index, which ranks 195 countries’ preparedness and aims to spur leaders to fill gaps in their response systems.

Nuzzo got the idea for the index after seeing the quick response to another index that assesses nuclear materials security.

The health security index ranks such things as a country’s ability to detect a public health threat and respond. That includes having a lab able to test large numbers of patient samples in an emergency, for example. The index also looks at a country’s health systems readiness, ability to provide safe and secure care, and even the level of trust the public has in the government.

The United States generally ranks high in most categories, though below other countries for health care access, she said. A growing problem might be misinformation, such as that from vaccination critics spread easily through social media.

Nuzzo also said China does well in the index, though not as well as other wealthier countries because it’s not always been transparent.

“If we don’t know the state of preparedness, if people don’t even know who to call, it’s not a good state of preparedness," she said. “We’re living this now with China. The rest of the world is hinging on what China is sharing internationally. In this case, we have no reason to think they aren’t being transparent. There is worldwide attention on this."