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      Genetic tracing of HCoV-19 for the re-emerging outbreak of COVID-19 in Beijing, China

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          Abstract

          The ongoing pandemic of coronavirus disease 2019 (COVID-19) caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also named as 2019-nCoV or HCoV-19) poses an unprecedented threat to public health (Zhu et al., 2020; Wang et al., 2020; Jiang et al., 2020). The novel HCoV-19 virus has rapidly spread into multiple countries across the world since it was first reported in December 2019. The World Health Organization (WHO) declared COVID-19 as a pandemic on 11th March 2020. As of 4th July, over 10 million confirmed COVID-19 cases have been reported in over 200 countries/regions with more than 0.5 million deaths, including 85,287 documented cases and 4,648 deaths in China (WHO, 2020a). Since the emergence of HCoV-19, Chinese government employed a series of rapid and effective non-pharmaceutical interventions, such as travel restriction, social distancing, extending holidays, and postponing large public events and mass gathering, to contain COVID-19 and prevent more infections (Lai et al., 2020). By the end of February 2020, the domestic spread of COVID-19 in China has been basically controlled but the epidemic situation outside China is still severe (WHO, 2020a). Since imported cases were sporadically reported, domestic resurgence caused by imported infections is likely in China (http://www.nhc.gov.cn/xcs/yqtb/list_gzbd.shtml; Li et al., 2020). Very recently, after no new case reported for 56 consecutive days, a confirmed COVID-19 case was identified in Beijing on 11th June, 2020 (http://www.nhc.gov.cn/xcs/yqtb/list_gzbd.shtml). Subsequently, a total of 334 COVID-19 cases were gradually confirmed by 4th, July 2020, and most of them have an exposure history in Xinfadi wholesale market, Beijing (WHO, 2020b). To reveal the potential genetic source and transmission paths of HCoV-19 causing this outbreak can help strengthen control measures to prevent such incidents in Beijing or other regions in the world. In this study, we collected clinical specimens from both patients and environments in Xinfadi wholesale market, and the specimens were individually processed and sequenced using nanopore and MiSeq system. 16 consensus sequences of HCoV-19 were generated for short sequencing reads mapped to a reference strain EPI_ISL_402119 from GISAID (https://www.gisaid.org/) in CLC Genomics Workbench 20.0.3.0 and later were submitted to China National Microbiology Data Center (NMDC; http://nmdc.cn/coronavirus; Accession id: NMDC60013485-NMDC60013500). All HCoV-19 sequences isolated from Xinfadi wholesale market were recognized as lineage B1.1 using PANGOLIN (https://github.com/hCoV-2019/pangolin). The lineage B1.1 was mostly circulating in Europe, and 8,822 sequences of lineage B1.1 were submitted to GISAID as of June 18, 2020, including sequences from England (6,924/78.49%), the United States of America (240/2.72%), Australia (200/2.27%), Belgium (147/1.67%), Netherlands (137/1.56%), and Iceland (128/1.45%) (https://github.com/cov-lineages/lineages). Few viruses of lineage B1.1 were isolated from mainland China and most of them were collected from imported cases before this outbreak. Further, HCoV-19 isolated in mainland China was genetically distant to these from Xinfadi wholesale market (Fig. 1A). The phylogenetic analyses and lineage assignment suggested that the virus isolated from Xinfadi wholesale market in the outbreak in Beijing may be imported from abroad. Figure 1 Phylogenetic and molecular characteristics of HCoV-19 viruses isolated from Beijing in June 2020, mainland China, and lineage B1.1. (A) Phylogeny of HCoV-19 among isolates from the re-outbreak of Beijing in June, mainland China (except the re-outbreak of Beijing in June), and representative viruses in different lineages. (B) The number of SNPs between isolates from Beijing and lineage B1.1, and between isolates from Beijing and other genomes from mainland China, respectively. (C) The proportion of GGG and AAC mutations at 28,881–28,883 sites of viruses isolated in Beijing, mainland China, and lineage B1.1 Furthermore, we counted the frequency of SNPs among HCoV-19 from Xinfadi wholesale market, mainland China (except isolates in this outbreak), and lineage B1.1 (Fig. 1B). More SNPs were found in virus genomes between Xinfadi wholesale market and mainland China, compared to those between Xinfadi wholesale market and lineage B1.1. Further, three consecutive base mutations (GGG mutated to AAC) at position 28,881–28,883 (according to coordinate of reference strain, MN908947.3) were detected in all HCoV-19 isolates from Xinfadi wholesale market (Fig. 1C). This mutation pattern was first detected in England on 15th February, 2020, and was a key molecular characteristic of lineage B1.1. The molecular characteristics of HCoV-19 further indicated that the virus causing Beijing’s outbreak might be introduced from abroad rather than from local. Five replicates of Bayesian phylodynamic inferences of HCoV-19 from Xinfadi wholesale market and lineage B1.1 (randomly selecting 10 sequences per week from lineage B1.1) were performed to infer the time of most recent common ancestor (TMRCA) of the genomes isolated in Beijing in June 2020 by BEAST 1.10.4 (Suchard et al., 2018). Our results are robust to different sampling datasets and indicated the virus causing the outbreak in Beijing may be firstly appeared on 6th May, 2020 (95% HPD: 2020-04-19, 2020-05-21). Currently, the spread routes of HCoV-19 associated with Xinfadi wholesale market imported into Beijing remain uncovered. In addition to HCoV-19 isolated in environmental samples (chopping board and floor drain) from Xinfadi wholesale market in our study, several surfaces in the market were also tested positive for HCoV-19, including a cutting board in a booth handling imported salmon (Normile, 2020). Further, HCoV-19 could be highly stable in low temperature (decreasing only about 0.7 log-unit of infectious titer after 14 days at 4 °C) (Chin et al., 2020). One hypothesis is proposed that the virus may be imported by contaminated fish from Europe and transported via cold chain transportation. Another possible transmission mode may be that international travelers with asymptomatic symptoms or false negative of nucleic acid test spread the virus into China, and the virus was transmitted to the market by infected humans. The humid and chilled air and suboptimal hygienic conditions in the market may provide an ideal environment for amplification of virus, and subsequently the virus was spread by people working and visiting in the markets, resulting in the re-emerging outbreak of COVID-19 in Beijing (Normile, 2020). In summary, strict strategies of monitor and quarantine for both international travelers and imported goods are essential to prevent the potential secondary extensive outbreak in China in the critical period of HCoV-19 still circulating worldwide. Implementing differentiated and location-specific prevention and control measures which tailored to local epidemic conditions could be an experience and lesson learned from China’s first phase of effective responses to COVID-19. Further, WHO played a crucial leading role to coordinate the global responses and build international expert networks to control and contain COVID-19 pandemic. International cooperation and collaboration to control the pandemic are needed to effectively fight and tackle the COVID-19 pandemic, with special attention to the vulnerable countries/regions by providing essential medicines, vaccines and medical equipment to combat COVID-19. Electronic supplementary material Below is the link to the electronic supplementary material. Supplementary material 1 (PDF 258 kb)

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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 novel coronavirus outbreak of global health concern

            In December, 2019, Wuhan, Hubei province, China, became the centre of an outbreak of pneumonia of unknown cause, which raised intense attention not only within China but internationally. Chinese health authorities did an immediate investigation to characterise and control the disease, including isolation of people suspected to have the disease, close monitoring of contacts, epidemiological and clinical data collection from patients, and development of diagnostic and treatment procedures. By Jan 7, 2020, Chinese scientists had isolated a novel coronavirus (CoV) from patients in Wuhan. The genetic sequence of the 2019 novel coronavirus (2019-nCoV) enabled the rapid development of point-of-care real-time RT-PCR diagnostic tests specific for 2019-nCoV (based on full genome sequence data on the Global Initiative on Sharing All Influenza Data [GISAID] platform). Cases of 2019-nCoV are no longer limited to Wuhan. Nine exported cases of 2019-nCoV infection have been reported in Thailand, Japan, Korea, the USA, Vietnam, and Singapore to date, and further dissemination through air travel is likely.1, 2, 3, 4, 5 As of Jan 23, 2020, confirmed cases were consecutively reported in 32 provinces, municipalities, and special administrative regions in China, including Hong Kong, Macau, and Taiwan. 3 These cases detected outside Wuhan, together with the detection of infection in at least one household cluster—reported by Jasper Fuk-Woo Chan and colleagues 6 in The Lancet—and the recently documented infections in health-care workers caring for patients with 2019-nCoV indicate human-to-human transmission and thus the risk of much wider spread of the disease. As of Jan 23, 2020, a total of 835 cases with laboratory-confirmed 2019-nCoV infection have been detected in China, of whom 25 have died and 93% remain in hospital (figure ). 3 Figure Timeline of early stages of 2019-nCoV outbreak 2019-nCoV=2019 novel coronavirus. In The Lancet, Chaolin Huang and colleagues 7 report clinical features of the first 41 patients admitted to the designated hospital in Wuhan who were confirmed to be infected with 2019-nCoV by Jan 2, 2020. The study findings provide first-hand data about severity of the emerging 2019-nCoV infection. Symptoms resulting from 2019-nCoV infection at the prodromal phase, including fever, dry cough, and malaise, are non-specific. Unlike human coronavirus infections, upper respiratory symptoms are notably infrequent. Intestinal presentations observed with SARS also appear to be uncommon, although two of six cases reported by Chan and colleagues had diarrhoea. 6 Common laboratory findings on admission to hospital include lymphopenia and bilateral ground-glass opacity or consolidation in chest CT scans. These clinical presentations confounded early detection of infected cases, especially against a background of ongoing influenza and circulation of other respiratory viruses. Exposure history to the Huanan Seafood Wholesale market served as an important clue at the early stage, yet its value has decreased as more secondary and tertiary cases have appeared. Of the 41 patients in this cohort, 22 (55%) developed severe dyspnoea and 13 (32%) required admission to an intensive care unit, and six died. 7 Hence, the case-fatality proportion in this cohort is approximately 14·6%, and the overall case fatality proportion appears to be closer to 3% (table ). However, both of these estimates should be treated with great caution because not all patients have concluded their illness (ie, recovered or died) and the true number of infections and full disease spectrum are unknown. Importantly, in emerging viral infection outbreaks the case-fatality ratio is often overestimated in the early stages because case detection is highly biased towards the more severe cases. As further data on the spectrum of mild or asymptomatic infection becomes available, one case of which was documented by Chan and colleagues, 6 the case-fatality ratio is likely to decrease. Nevertheless, the 1918 influenza pandemic is estimated to have had a case-fatality ratio of less than 5% 13 but had an enormous impact due to widespread transmission, so there is no room for complacency. Table Characteristics of patients who have been infected with 2019-nCoV, MERS-CoV, and SARS-CoV7, 8, 10, 11, 12 2019-nCoV * MERS-CoV SARS-CoV Demographic Date December, 2019 June, 2012 November, 2002 Location of first detection Wuhan, China Jeddah, Saudi Arabia Guangdong, China Age, years (range) 49 (21–76) 56 (14–94) 39·9 (1–91) Male:female sex ratio 2·7:1 3·3:1 1:1·25 Confirmed cases 835† 2494 8096 Mortality 25† (2·9%) 858 (37%) 744 (10%) Health-care workers 16‡ 9·8% 23·1% Symptoms Fever 40 (98%) 98% 99–100% Dry cough 31 (76%) 47% 29–75% Dyspnoea 22 (55%) 72% 40–42% Diarrhoea 1 (3%) 26% 20–25% Sore throat 0 21% 13–25% Ventilatory support 9·8% 80% 14–20% Data are n, age (range), or n (%) unless otherwise stated. 2019-nCoV=2019 novel coronavirus. MERS-CoV=Middle East respiratory syndrome coronavirus. SARS-CoV=severe acute respiratory syndrome coronavirus. * Demographics and symptoms for 2019-nCoV infection are based on data from the first 41 patients reported by Chaolin Huang and colleagues (admitted before Jan 2, 2020). 8 Case numbers and mortalities are updated up to Jan 21, 2020) as disclosed by the Chinese Health Commission. † Data as of Jan 23, 2020. ‡ Data as of Jan 21, 2020. 9 As an RNA virus, 2019-nCoV still has the inherent feature of a high mutation rate, although like other coronaviruses the mutation rate might be somewhat lower than other RNA viruses because of its genome-encoded exonuclease. This aspect provides the possibility for this newly introduced zoonotic viral pathogen to adapt to become more efficiently transmitted from person to person and possibly become more virulent. Two previous coronavirus outbreaks had been reported in the 21st century. The clinical features of 2019-nCoV, in comparison with SARS-CoV and Middle East respiratory syndrome (MERS)-CoV, are summarised in the table. The ongoing 2019-nCoV outbreak has undoubtedly caused the memories of the SARS-CoV outbreak starting 17 years ago to resurface in many people. In November, 2002, clusters of pneumonia of unknown cause were reported in Guangdong province, China, now known as the SARS-CoV outbreak. The number of cases of SARS increased substantially in the next year in China and later spread globally, 14 infecting at least 8096 people and causing 774 deaths. 12 The international spread of SARS-CoV in 2003 was attributed to its strong transmission ability under specific circumstances and the insufficient preparedness and implementation of infection control practices. Chinese public health and scientific capabilities have been greatly transformed since 2003. An efficient system is ready for monitoring and responding to infectious disease outbreaks and the 2019-nCoV pneumonia has been quickly added to the Notifiable Communicable Disease List and given the highest priority by Chinese health authorities. The increasing number of cases and widening geographical spread of the disease raise grave concerns about the future trajectory of the outbreak, especially with the Chinese Lunar New Year quickly approaching. Under normal circumstances, an estimated 3 billion trips would be made in the Spring Festival travel rush this year, with 15 million trips happening in Wuhan. The virus might further spread to other places during this festival period and cause epidemics, especially if it has acquired the ability to efficiently transmit from person to person. Consequently, the 2019-nCoV outbreak has led to implementation of extraordinary public health measures to reduce further spread of the virus within China and elsewhere. Although WHO has not recommended any international travelling restrictions so far, 15 the local government in Wuhan announced on Jan 23, 2020, the suspension of public transportation, with closure of airports, railway stations, and highways in the city, to prevent further disease transmission. 16 Further efforts in travel restriction might follow. Active surveillance for new cases and close monitoring of their contacts are being implemented. To improve detection efficiency, front-line clinics, apart from local centres for disease control and prevention, should be armed with validated point-of-care diagnostic kits. Rapid information disclosure is a top priority for disease control and prevention. A daily press release system has been established in China to ensure effective and efficient disclosure of epidemic information. Education campaigns should be launched to promote precautions for travellers, including frequent hand-washing, cough etiquette, and use of personal protection equipment (eg, masks) when visiting public places. Also, the general public should be motivated to report fever and other risk factors for coronavirus infection, including travel history to affected area and close contacts with confirmed or suspected cases. Considering that substantial numbers of patients with SARS and MERS were infected in health-care settings, precautions need to be taken to prevent nosocomial spread of the virus. Unfortunately, 16 health-care workers, some of whom were working in the same ward, have been confirmed to be infected with 2019-nCoV to date, although the routes of transmission and the possible role of so-called super-spreaders remain to be clarified. 9 Epidemiological studies need to be done to assess risk factors for infection in health-care personnel and quantify potential subclinical or asymptomatic infections. Notably, the transmission of SARS-CoV was eventually halted by public health measures including elimination of nosocomial infections. We need to be wary of the current outbreak turning into a sustained epidemic or even a pandemic. The availability of the virus' genetic sequence and initial data on the epidemiology and clinical consequences of the 2019-nCoV infections are only the first steps to understanding the threat posed by this pathogen. Many important questions remain unanswered, including its origin, extent, and duration of transmission in humans, ability to infect other animal hosts, and the spectrum and pathogenesis of human infections. Characterising viral isolates from successive generations of human infections will be key to updating diagnostics and assessing viral evolution. Beyond supportive care, 17 no specific coronavirus antivirals or vaccines of proven efficacy in humans exist, although clinical trials of both are ongoing for MERS-CoV and one controlled trial of ritonavir-boosted lopinavir monotherapy has been launched for 2019-nCoV (ChiCTR2000029308). Future animal model and clinical studies should focus on assessing the effectiveness and safety of promising antiviral drugs, monoclonal and polyclonal neutralising antibody products, and therapeutics directed against immunopathologic host responses. We have to be aware of the challenge and concerns brought by 2019-nCoV to our community. Every effort should be given to understand and control the disease, and the time to act is now. This online publication has been corrected. The corrected version first appeared at thelancet.com on January 29, 2020
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              Stability of SARS-CoV-2 in different environmental conditions

              We previously reported the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in different clinical samples. 1 This virus can be detected on different surfaces in a contaminated site. 2 Here, we report the stability of SARS-CoV-2 in different environmental conditions. We first measured the stability of SARS-CoV-2 at different temperatures. SARS-CoV-2 in virus transport medium (final concentration ∼6·8 log unit of 50% tissue culture infectious dose [TCID50] per mL) was incubated for up to 14 days and then tested for its infectivity (appendix p 1). The virus is highly stable at 4°C, but sensitive to heat. At 4°C, there was only around a 0·7 log-unit reduction of infectious titre on day 14. With the incubation temperature increased to 70°C, the time for virus inactivation was reduced to 5 mins. We further investigated the stability of this virus on different surfaces. Briefly, a 5 μL droplet of virus culture (∼7·8 log unit of TCID50 per mL) was pipetted on a surface (appendix p 1; ∼cm2 per piece) and left at room temperature (22°C) with a relative humidity of around 65%. The inoculated objects retrieved at desired time-points were immediately soaked with 200 μL of virus transport medium for 30 mins to elute the virus. Therefore, this recovery of virus does not necessarily reflect the potential to pick up the virus from casual contact. No infectious virus could be recovered from printing and tissue papers after a 3-hour incubation, whereas no infectious virus could be detected from treated wood and cloth on day 2. By contrast, SARS-CoV-2 was more stable on smooth surfaces. No infectious virus could be detected from treated smooth surfaces on day 4 (glass and banknote) or day 7 (stainless steel and plastic). Strikingly, a detectable level of infectious virus could still be present on the outer layer of a surgical mask on day 7 (∼0·1% of the original inoculum). Interestingly, a biphasic decay of infectious SARS-CoV-2 could be found in samples recovered from these smooth surfaces (appendix pp 2–7). 39 representative non-infectious samples tested positive by RT-PCR 3 (data not shown), showing that non-infectious viruses could still be recovered by the eluents. We also tested the virucidal effects of disinfectants by adding 15 μL of SARS-CoV-2 culture (∼7·8 log unit of TCID50 per mL) to 135 μL of various disinfectants at working concentration (appendix p 1). With the exception of a 5-min incubation with hand soap, no infectious virus could be detected after a 5-min incubation at room temperature (22°C). Additionally, we also found that SARS-CoV-2 is extremely stable in a wide range of pH values at room temperature (pH 3–10; appendix p 1). Overall, SARS-CoV-2 can be highly stable in a favourable environment, 4 but it is also susceptible to standard disinfection methods.
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                Author and article information

                Contributors
                huangch@bjcdc.org
                beeyh@im.ac.cn
                tanwj@ivdc.chinacdc.cn
                Journal
                Protein Cell
                Protein Cell
                Protein & Cell
                Higher Education Press (Beijing )
                1674-800X
                1674-8018
                17 August 2020
                17 August 2020
                : 1-3
                Affiliations
                [1 ]GRID grid.9227.e, ISNI 0000000119573309, CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Center for Influenza Research and Early-warning (CASCIRE), CAS-TWAS Center of Excellence for Emerging Infectious Diseases (CEEID), , Chinese Academy of Sciences, ; Beijing, 100101 China
                [2 ]GRID grid.198530.6, ISNI 0000 0000 8803 2373, National Institute for Viral Disease Control and Prevention, , Chinese Center for Disease Control and Prevention (China CDC), ; Beijing, 102206 China
                [3 ]Beijing Center for Diseases Prevention and Control, Beijing, 100013 China
                [4 ]GRID grid.9227.e, ISNI 0000000119573309, Center for Biosafety Mega-Science, , Chinese Academy of Sciences, ; Wuhan, 430071 China
                [5 ]GRID grid.410726.6, ISNI 0000 0004 1797 8419, University of Chinese Academy of Sciences, ; Beijing, 101408 China
                Author information
                http://orcid.org/0000-0003-4183-8873
                http://orcid.org/0000-0002-5595-363X
                http://orcid.org/0000-0002-5963-1136
                Article
                772
                10.1007/s13238-020-00772-0
                7430935
                32808156
                268fddb6-39f1-49ab-9595-4e1b8c25ca38
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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