Li Wenliang, a face to the frontline healthcare worker. The first doctor to notify the emergence of the SARS-CoV-2, (COVID-19), outbreak
Identifieur interne : 000A39 ( Pmc/Corpus ); précédent : 000A38; suivant : 000A40Li Wenliang, a face to the frontline healthcare worker. The first doctor to notify the emergence of the SARS-CoV-2, (COVID-19), outbreak
Auteurs : Eskild PetersenSource :
- International Journal of Infectious Diseases [ 1201-9712 ] ; 2020.
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DOI: 10.1016/j.ijid.2020.02.052
PubMed: 32142979
PubMed Central: 7129692
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Li Wenliang, a face to the frontline healthcare worker. The first doctor to notify the emergence of the SARS-CoV-2, (COVID-19), outbreak</title><author><name sortKey="Petersen, Eskild" sort="Petersen, Eskild" uniqKey="Petersen E" first="Eskild" last="Petersen">Eskild Petersen</name><affiliation><nlm:aff id="aff0005">Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman</nlm:aff></affiliation><affiliation><nlm:aff id="aff0010">European Sociaty for Clinical Microbiology and Infectious Diseases, Basel, Switzerland</nlm:aff></affiliation><affiliation><nlm:aff id="aff0015">Institute for Clinical Medicine, Faculty of Health Sciences, University of Aarhus, Denmark</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32142979</idno><idno type="pmc">7129692</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7129692</idno><idno type="RBID">PMC:7129692</idno><idno type="doi">10.1016/j.ijid.2020.02.052</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000A39</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000A39</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Li Wenliang, a face to the frontline healthcare worker. The first doctor to notify the emergence of the SARS-CoV-2, (COVID-19), outbreak</title><author><name sortKey="Petersen, Eskild" sort="Petersen, Eskild" uniqKey="Petersen E" first="Eskild" last="Petersen">Eskild Petersen</name><affiliation><nlm:aff id="aff0005">Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman</nlm:aff></affiliation><affiliation><nlm:aff id="aff0010">European Sociaty for Clinical Microbiology and Infectious Diseases, Basel, Switzerland</nlm:aff></affiliation><affiliation><nlm:aff id="aff0015">Institute for Clinical Medicine, Faculty of Health Sciences, University of Aarhus, Denmark</nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Infectious Diseases</title><idno type="ISSN">1201-9712</idno><idno type="eISSN">1878-3511</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Carrion, M" uniqKey="Carrion M">M. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Int. J. Infect. Dis</journal-id><journal-title-group><journal-title>International Journal of Infectious Diseases</journal-title></journal-title-group><issn pub-type="ppub">1201-9712</issn><issn pub-type="epub">1878-3511</issn><publisher><publisher-name>Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32142979</article-id><article-id pub-id-type="pmc">7129692</article-id><article-id pub-id-type="publisher-id">S1201-9712(20)30111-9</article-id><article-id pub-id-type="doi">10.1016/j.ijid.2020.02.052</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Li Wenliang, a face to the frontline healthcare worker. The first doctor to notify the emergence of the SARS-CoV-2, (COVID-19), outbreak</article-title></title-group><contrib-group><contrib contrib-type="author" id="aut0005"><name><surname>Petersen</surname><given-names>Eskild</given-names></name><email>eskild.petersen@gmail.com</email><xref rid="aff0005" ref-type="aff">a</xref><xref rid="aff0010" ref-type="aff">b</xref><xref rid="aff0015" ref-type="aff">c</xref><xref rid="cor0005" ref-type="corresp">⁎</xref></contrib></contrib-group><aff id="aff0005"><label>a</label>Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman</aff><aff id="aff0010"><label>b</label>European Sociaty for Clinical Microbiology and Infectious Diseases, Basel, Switzerland</aff><aff id="aff0015"><label>c</label>Institute for Clinical Medicine, Faculty of Health Sciences, University of Aarhus, Denmark</aff><contrib-group><contrib contrib-type="author" id="aut0010"><name><surname>Hui</surname><given-names>David</given-names></name></contrib></contrib-group><aff id="aff0020">Department of Medicine & Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China</aff><contrib-group><contrib contrib-type="author" id="aut0015"><name><surname>Hamer</surname><given-names>Davidson H.</given-names></name><xref rid="aff0025" ref-type="aff">a</xref><xref rid="aff0030" ref-type="aff">b</xref></contrib></contrib-group><aff id="aff0025"><label>a</label>Department of Global Health, Boston University School of Public Health, Boston, MA, USA</aff><aff id="aff0030"><label>b</label>Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, MA, USA</aff><contrib-group><contrib contrib-type="author" id="aut0020"><name><surname>Blumberg</surname><given-names>Lucille</given-names></name></contrib></contrib-group><aff id="aff0035">National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa</aff><contrib-group><contrib contrib-type="author" id="aut0025"><name><surname>Madoff</surname><given-names>Lawrence C.</given-names></name><xref rid="aff0040" ref-type="aff">a</xref><xref rid="aff0045" ref-type="aff">b</xref></contrib></contrib-group><aff id="aff0040"><label>a</label>International Society for Infectious Diseases, Boston, MA, USA</aff><aff id="aff0045"><label>b</label>University of Massachusetts, Division of Infectious Diseases, Worcester, MA, USA</aff><contrib-group><contrib contrib-type="author" id="aut0030"><name><surname>Pollack</surname><given-names>Marjorie</given-names></name></contrib></contrib-group><aff id="aff0050">International Society for Infectious Diseases, Boston, MA, USA</aff><contrib-group><contrib contrib-type="author" id="aut0035"><name><surname>Lee</surname><given-names>Shui Shan</given-names></name></contrib></contrib-group><aff id="aff0055">Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China</aff><contrib-group><contrib contrib-type="author" id="aut0040"><name><surname>McLellan</surname><given-names>Susan</given-names></name></contrib></contrib-group><aff id="aff0060">Biocontainment Treatment Unit, Biosafety for Research-Related Infectious Pathogens, University of Texas Medical Branch, Galveston, TX, USA</aff><contrib-group><contrib contrib-type="author" id="aut0045"><name><surname>Memish</surname><given-names>Ziad</given-names></name><xref rid="aff0065" ref-type="aff">a</xref><xref rid="aff0070" ref-type="aff">b</xref><xref rid="aff0075" ref-type="aff">c</xref></contrib></contrib-group><aff id="aff0065"><label>a</label>Research Centre, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia</aff><aff id="aff0070"><label>b</label>College of Medicine, Alfaisal University, Riyadh, Saudi Arabia</aff><aff id="aff0075"><label>c</label>Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA</aff><contrib-group><contrib contrib-type="author" id="aut0050"><name><surname>Praharaj</surname><given-names>Ira</given-names></name></contrib></contrib-group><aff id="aff0080">Indian Council of Medical Research, Department of Health Research, New Delhi, India</aff><contrib-group><contrib contrib-type="author" id="aut0055"><name><surname>Wasserman</surname><given-names>Sean</given-names></name><xref rid="aff0085" ref-type="aff">q</xref></contrib></contrib-group><aff id="aff0085"><label>q</label>Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa</aff><contrib-group><contrib contrib-type="author" id="aut0060"><name><surname>Ntoumi</surname><given-names>Francine</given-names></name></contrib></contrib-group><aff id="aff0090">Fondation Congolaise pour la Recherche Médicale/Université Marien Ngouabi, Republic of Congo and Institute for Tropical Medicine, University of Tübingen, Germany</aff><contrib-group><contrib contrib-type="author" id="aut0065"><name><surname>Azhar</surname><given-names>Esam Ibraheem</given-names></name></contrib></contrib-group><aff id="aff0095">King Fahd Medical Research Center (KFMRC), Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia</aff><contrib-group><contrib contrib-type="author" id="aut0070"><name><surname>Mchugh</surname><given-names>Timothy D.</given-names></name></contrib></contrib-group><aff id="aff0100">Center for Clinical Microbiology, Division of Infection and Immunity, University College London, United Kingdom</aff><contrib-group><contrib contrib-type="author" id="aut0075"><name><surname>Kock</surname><given-names>Richard</given-names></name></contrib></contrib-group><aff id="aff0105">The Royal Veterinary College, University of London, Hatfield, Hertfordshire, United Kingdom</aff><contrib-group><contrib contrib-type="author" id="aut0080"><name><surname>Ippolito</surname><given-names>Guiseppe</given-names></name></contrib></contrib-group><aff id="aff0110">National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy</aff><contrib-group><contrib contrib-type="author" id="aut0085"><name><surname>Zumla</surname><given-names>Ali</given-names></name></contrib></contrib-group><aff id="aff0115">Center for Clinical Microbiology, Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom</aff><contrib-group><contrib contrib-type="author" id="aut0090"><name><surname>Koopmans</surname><given-names>Marion</given-names></name></contrib></contrib-group><aff id="aff0120">Department of Viroscience, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands</aff><author-notes><corresp id="cor0005"><label>⁎</label>Corresponding author at: Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman. <email>eskild.petersen@gmail.com</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>4</day><month>3</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><month>4</month><year>2020</year></pub-date><pub-date pub-type="epub"><day>4</day><month>3</month><year>2020</year></pub-date><volume>93</volume><fpage>205</fpage><lpage>207</lpage><history><date date-type="received"><day>25</day><month>2</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder></copyright-holder><license><license-p>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.</license-p></license></permissions></article-meta></front><body><p id="par0005">Dr Li Wenliang, who lost his life to the novel coronavirus, SARS-CoV-2, became the face of the threat of SARS-CoV-2 to frontline workers, the clinicians taking care of patients. Li, 34, was an ophthalmologist at Wuhan Central Hospital. On 30th December, 2019, when the Wuhan municipal health service sent out an alert, he reportedly warned a closed group of ex-medical school classmates on the WeChat social media site of “Seven cases of severe acute respiratory syndrome (SARS) like illness with links with the Huanan Seafood Wholesale Market” at his hospital. He was among eight people reprimanded by security officers for “spreading rumours”. In a tragic turn of events, he subsequently contracted SARS-CoV-2 and, after a period in intensive care, died on the morning of Friday 7th February, 2020 (<xref rid="bib0050" ref-type="bibr">South China Morning Post, 2020</xref>).</p><p id="par0010">This case is a stark reminder of the risks of emerging disease outbreaks for healthcare workers (HCWs). Dr Li Wenliang’s name is added to the long list of HCW that were at the forefront of outbreaks of SARS, Ebola, MERS and now SARS-CoV-2. It is important to recognise that it was the clinicians in Wuhan who sounded the alarm about the emergence of SARS-CoV-2 which was rapidly identified after these clinicians sent samples to a reference laboratory for next generation sequencing (NGS) (<xref rid="bib0095" ref-type="bibr">Zhou et al., 2020</xref>).</p><p id="par0015">Global public health security is of primary importance to prevent outbreaks of diseases with epidemic potential and every effort to detect, report, and institute infection prevention and control measures should be made. Astute clinicians, access to laboratories with state of the art tools, and openness, transparency and quick reporting are crucial components of this response (<xref rid="bib0025" ref-type="bibr">Kavanagh, 2020</xref>). This requires an open flow of information and collaboration between laboratory experts and clinicians on the frontline who may be the first to observe unusual clustering of cases or uncommon clinical presentations, both of which should be reported immediately.</p><p id="par0020">Healthcare workers are also one of the groups most at risk from outbreaks due to reemerging and novel pathogens. This has been seen in the current SARS-CoV-2 outbreak in China where as many as 1716 health workers have been reported to be infected by the virus with 6 deaths as on 14th February, 2020 (<xref rid="bib0070" ref-type="bibr">WHO, 2020a</xref>). In a single center case series of SARS-CoV-2 from Wuhan published recently, almost 29% of all patients were healthcare workers presumed to have been infected in the hospital (<xref rid="bib0060" ref-type="bibr">Wang et al., 2020b</xref>).</p><p id="par0025">The preliminary sequence data on the case cluster were obtained by NGS of specimens collected on 26th December 2019 through 7 January 2020 (<xref rid="bib0035" ref-type="bibr">Lu et al., 2020</xref>). The Chinese authorities ruled out SARS-CoV and MERS-CoV, and confirmed a novel coronavirus as the probable cause on 9th January, 2020 (<xref rid="bib0020" ref-type="bibr">Hui et al., 2020</xref>, <xref rid="bib0055" ref-type="bibr">Wang et al., 2020a</xref>). The first genome sequence was released on virological.org the 12th January 2020, seventeen days after obtaining the first specimen and several additional genomic sequences were then shared on GISAID (<xref rid="bib0065" ref-type="bibr">Wang et al., 2020c</xref>). This is an impressive rapid progression from initial outbreak notification to identification of a novel pathogen.</p><p id="par0030">The rapid identification of the SARS-CoV-2 virus by NGS illustrates the advances in molecular identification since the SARS-CoV (2003) and MERS-CoV (2012) outbreaks, where both viruses were initially identified by in vitro cell culture. Thus, clinician of the possibility of a new infectious disease coupled with NGS can serve to quickly identify novel pathogens and allow for the rapid initiation of control measures to reduce further spread and potentially prevent large-scale outbreaks.</p><p id="par0035">The SARS-CoV outbreak originating from China in 2003 was first reported to the global health community by ProMED (<xref rid="bib0040" ref-type="bibr">ProMED, 2003</xref>, <xref rid="bib0005" ref-type="bibr">Carrion and Madoff, 2017</xref>, <xref rid="bib0015" ref-type="bibr">Hamer et al., 2017</xref>). It took six weeks for the authorities to acknowledge the outbreak had spread significantly from Guangdong throughout China after cases were reported from Hong Kong, Hanoi, Singapore, and Toronto.</p><p id="par0040">In reporting the existence of a new respiratory disease to the WHO on December 31 st, the Chinese authorities formally acknowledged the outbreak much sooner this time, perhaps in part because of the ongoing spread of information on informal social media networks. ProMED posted the initial report of the unknown pneumonia outbreak in Wuhan on 30 December 2019 (<xref rid="bib0045" ref-type="bibr">ProMED, 2019</xref>). Since then, transmission of information has been relatively transparent, with the prompt sharing of the sequence of the virus and actual numbers of cases reported on a daily basis. The case figures have demonstrated the upward trajectory of the rapid spread of SARS-CoV-2 from Wuhan and Hubei Province to all of China.</p><p id="par0045">On 13th February 2020 the Chinese authorities changed the case definition and the number of newly reported cases over the prior 24 h jumped to 14,886 from a previous high of 4370 on 6th February 2020. This was not a real increase, but reflected the addition of the cumulative number of clinically diagnosed cases (without laboratory confirmation) to the reported number of laboratory confirmed cases and demonstrates how easily a case definition can influence numbers. On 19 February 2020, the Chinese authorities changed the case definition to include laboratory confirmed cases only and designating clinically diagnosed cases as suspected cases. This resulted in a rapid drop of daily newly confirmed cases, again demonstrating the impact of case definition on reported case numbers. As of 23 February 2020, WHO has reported a total of 78,007 cases with 2,462 deaths globally with reports of cases from 29 countries (<xref rid="bib0070" ref-type="bibr">WHO, 2020a</xref>, <xref rid="bib0075" ref-type="bibr">WHO, 2020b</xref>).</p><p id="par0050">A key question remains “what is the real number of people infected since many cases may be mild or asymptomatic?” A recent modelling estimated the population attack rate to be between 0.75 per 100,000 to 15.8 per 100,000 analysing rates down to prefecture level in China (<xref rid="bib0090" ref-type="bibr">Yang et al., 2020</xref>). Any determination of incidence will likely be an underestimate since it will not include mild and asymptomatic cases. Accuracy of such estimates will depend on the development of sensitive and specific serologic tests.</p><p id="par0055">Recognizing disease in travelers is a particularly important aspect of surveillance for the importation of emerging infections. Multi-site collaborations such as the GeoSentinel Surveillance Network (<xref rid="bib0080" ref-type="bibr">Wilder-Smith and Boggild, 2018</xref>) can act as sentinel systems to recognize new patterns of disease in travelers from specific areas. Previous GeoSentinel data showed that despite receiving care at specialized post-travel medicine sites, up to 40% of returning ill travellers with febrile illness do not have a confirmed etiology; frequently no specific diagnostic testing is available to identify a cause (<xref rid="bib0010" ref-type="bibr">Freedman et al., 2006</xref>, <xref rid="bib0085" ref-type="bibr">Wilson et al., 2007</xref>, <xref rid="bib0030" ref-type="bibr">Leder et al., 2013</xref>). The current large-scale outbreak of a novel pathogen, SARS-CoV-2, highlights the critical importance of prioritizing the identification of disease etiology through clinician awareness and modern laboratory techniques such as NGS.</p><p id="par0060">There has been widespread mourning of the sad demise of Dr Li from COVID-2019. Dr Li Wenliang’s example as an astute clinician should inspire all of us to be vigilant, bold and courageous in reporting unusual clinical presentations. The SARS-CoV-2 outbreak underscores the responsibilities and the vulnerabilities of frontline health care workers in tackling novel and highly transmissible pathogens. We must use our knowledge and skills, with the backup of laboratory support, to rapidly detect and report any suspicion of emerging infections. Rapid, transparent communication is paramount when infectious diseases emerge. 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