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      Game consumption and the 2019 novel coronavirus

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          Abstract

          In December, 2019, the 2019 novel coronavirus (2019-nCoV) infecting humans was first identified in Wuhan, China.1, 2, 3 As of Feb 3, 2020, the National Health Commission of China had reported 20 471 confirmed cases of 2019-nCoV infection in 34 provinces (autonomous regions, municipalities, and special administrative regions). 4 Cases have also been confirmed globally. Coronaviruses are RNA viruses that are phenotypically and genotypically diverse. As well as in humans, coronaviruses are widespread in other species worldwide, including birds, rabbits, reptiles, cats, dogs, pigs, monkeys, and bats. They can cause respiratory, enteric, hepatic, and neurological diseases of variable severity, and are sometimes fatal in humans.5, 6 Two of the previously identified strains of coronaviruses—severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)—have caused widespread epidemics and are zoonotic in origin.7, 8 2019-nCoV is also likely to have a zoonotic origin. Early confirmed cases of the new coronavirus in Wuhan were closely linked to the Huanan seafood market (a wet market),1, 9, 10 where a large variety of vertebrate and invertebrate animals, wild caught and farm raised, are sold. Right after the official confirmation of the close linkage between severe pneumonia and the game animals in the market, it was closed on Jan 1, 2020. The practice of consuming meat and products of wild animals in China dates back to prehistoric times. In modern times, although game is not needed for food, the tradition of eating it persists. In China, especially in the southeastern part where Guangdong and Wuhan are located, game is a favourable delicacy on everyday menus. The obsession with meat and products from wild animals may originate from the philosophy of medicine food homology. Huang Di Nei Jing Su Wen (The Yellow Emperor's Internal Classics) from the Hang dynasty (206 BC–220 AD) states “[of things] eaten when hungry is food, eaten when ill is medicine” and is considered an early reflection of the homology. However, through not being able to fully comprehend the essence of the philosophy, many Chinese people mistakenly extend the scope of the homology and simply think that one is made of the supplements they eat. For instance, kidney and penis of deer or tiger are believed to have aphrodisiac effect, and brain of fish or monkey are supposed to make people brighter. Another false belief often held is that meat and products from wild animals have certain therapeutic effects. For example, Chinese pangolin meat is believed to help relieve rheumatism, its blood is believed to promote blood circulation and remove meridian obstruction (a concept in traditional Chinese medicine), and its bile is believed to eliminate so-called liver fire (irascibility) and improve eyesight. Behaviours seen on the internet may have also encouraged the spread of the 2019-nCoV. On popular livestream platforms such as Kuaishou and Douyin, hosts engage in so-called mukbangs, which involve hosts eating food in front of their audience. Sometimes the food they eat is strange or dangerous. In 2016, a host was broadcast live eating soup made from bats. Eating of other wild animals, such as African snail, frog, bamboo rat, or octopus, has also been broadcasted. Sometimes the animals are eaten raw or even alive, especially octopuses, despite the possibility that these are infected with various viruses. Instead of attempting to control outbreaks of zoonotic viral diseases such as SARS, MERS, Ebola, and 2019-nCoV after the fact, the key is to interrupt their emergence by refraining from game, with legislation being only part of the solution. The ultimate solution lies in changing people's minds about what is delicious, trendy, prestigious, or healthy to eat. In response to the outbreak of 2019-nCoV, the Chinese Government has banned all forms of wild animal transaction, and there are already spontaneous efforts on the internet to explain the risks involved in consuming game, together with pleas to withhold from buying, selling, or consuming wild animals. We believe that through a change in the outdated and inappropriate tradition of consuming wild animals and their products, we can conserve the natural habitat of wild animals, and humans and other living creatures can coexist in harmony. This online publication has been corrected. The corrected version first appeared at thelancet. com/infection on February 26, 2020

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            A Novel Coronavirus from Patients with Pneumonia in China, 2019

            Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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              A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster

              Summary Background An ongoing outbreak of pneumonia associated with a novel coronavirus was reported in Wuhan city, Hubei province, China. Affected patients were geographically linked with a local wet market as a potential source. No data on person-to-person or nosocomial transmission have been published to date. Methods In this study, we report the epidemiological, clinical, laboratory, radiological, and microbiological findings of five patients in a family cluster who presented with unexplained pneumonia after returning to Shenzhen, Guangdong province, China, after a visit to Wuhan, and an additional family member who did not travel to Wuhan. Phylogenetic analysis of genetic sequences from these patients were done. Findings From Jan 10, 2020, we enrolled a family of six patients who travelled to Wuhan from Shenzhen between Dec 29, 2019 and Jan 4, 2020. Of six family members who travelled to Wuhan, five were identified as infected with the novel coronavirus. Additionally, one family member, who did not travel to Wuhan, became infected with the virus after several days of contact with four of the family members. None of the family members had contacts with Wuhan markets or animals, although two had visited a Wuhan hospital. Five family members (aged 36–66 years) presented with fever, upper or lower respiratory tract symptoms, or diarrhoea, or a combination of these 3–6 days after exposure. They presented to our hospital (The University of Hong Kong-Shenzhen Hospital, Shenzhen) 6–10 days after symptom onset. They and one asymptomatic child (aged 10 years) had radiological ground-glass lung opacities. Older patients (aged >60 years) had more systemic symptoms, extensive radiological ground-glass lung changes, lymphopenia, thrombocytopenia, and increased C-reactive protein and lactate dehydrogenase levels. The nasopharyngeal or throat swabs of these six patients were negative for known respiratory microbes by point-of-care multiplex RT-PCR, but five patients (four adults and the child) were RT-PCR positive for genes encoding the internal RNA-dependent RNA polymerase and surface Spike protein of this novel coronavirus, which were confirmed by Sanger sequencing. Phylogenetic analysis of these five patients' RT-PCR amplicons and two full genomes by next-generation sequencing showed that this is a novel coronavirus, which is closest to the bat severe acute respiatory syndrome (SARS)-related coronaviruses found in Chinese horseshoe bats. Interpretation Our findings are consistent with person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected travellers in other geographical regions. Funding The Shaw Foundation Hong Kong, Michael Seak-Kan Tong, Respiratory Viral Research Foundation Limited, Hui Ming, Hui Hoy and Chow Sin Lan Charity Fund Limited, Marina Man-Wai Lee, the Hong Kong Hainan Commercial Association South China Microbiology Research Fund, Sanming Project of Medicine (Shenzhen), and High Level-Hospital Program (Guangdong Health Commission).
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                Author and article information

                Contributors
                Journal
                Lancet Infect Dis
                Lancet Infect Dis
                The Lancet. Infectious Diseases
                Elsevier Ltd.
                1473-3099
                1474-4457
                7 February 2020
                March 2020
                7 February 2020
                : 20
                : 3
                : 275-276
                Affiliations
                [a ]School of Geographical Sciences, Guangzhou University, Guangzhou 510006, Guangdong, China
                [b ]College of Resources and Environmental Science, Ningxia University, Yinchuan, Ningxia, China
                [c ]School of Tourism Management, South China Normal University, Guangzhou, Guangdong, China
                [d ]School of Life Science, South China Normal University, Guangzhou, Guangdong, China
                [e ]Division of Geography and Tourism, Department of Earth and Environmental Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
                Article
                S1473-3099(20)30063-3
                10.1016/S1473-3099(20)30063-3
                7128108
                32043979
                20a66447-3504-48a8-a978-fb4d76adfacd
                © 2020 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Infectious disease & Microbiology

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