The first person known to have been infected by the Wuhan coronavirus had never visited the city's seafood market - regarded as the epicentre of the outbreak - according to Chinese researchers, who also called for extra precautions against airborne transmission of the disease between humans.
The researchers, seven of whom work at Wuhan's Jinyintan hospital, designated for patients with the illness, revealed on Friday in The Lancet medical journal that symptoms of the new disease were first reported on December 1 - much earlier than the Wuhan government's initial announcement on December 31 of 27 cases of the pneumonia-like infection.
According to the report, the first patient had no exposure to the Huanan seafood market which was shut down on January 1 over fears - later confirmed - that the new virus was linked to its trade in wild animals. The researchers added that none of the patient's family had developed fever or any respiratory symptoms. There was also no epidemiological link between the first patient and the later cases, they found.
The researchers analysed data from 41 patients with confirmed infections who had showed an onset of symptoms up to January 2. Six of those patients died, putting the fatality rate of the group at 15 per cent. The researchers noted that clinical presentations of the patients greatly resembled severe acute respiratory syndrome.
The first patient to die from the new coronavirus had continuous exposure to the market before he was admitted to hospital with a seven-day history of fever, cough and breathing difficulties, according to their report.
Five days after the onset of symptoms, his wife, a 53-year-old woman with no known history of exposure to the market, also presented with pneumonia and was hospitalised in the isolation ward, they said.
The absence of a link to the seafood market is one of the indicators for human-to-human transmission of the virus and the researchers identified another 13 patients who also had no direct exposure to the market.
"Taken together, evidence so far indicates human transmission for 2019-nCoV, the report said. "We are concerned that 2019-nCoV could have acquired the ability for efficient human transmission," the researchers added, along with a strong recommendation for precautions such as fit-tested N95 respirators and other personal protective equipment.
Most of the infected patients in the study were men, and fewer than half had underlying diseases, including diabetes, hypertension and cardiovascular disease.
According to the researchers, all but one of the patients had fever. The most common other symptoms included cough, muscle pain and fatigue. Some cases also involved sputum production, coughing up blood, headache and diarrhoea. More than half of the patients had dyspnoea (breathing difficulties), and the median time between illness onset and dyspnoea was eight days.
In a separate study, also published in The Lancet on Friday, a team of doctors including top Hong Kong infectious disease expert Yuen Kwok-yung reported that the coronavirus may be present in patients with no obvious symptoms.
Their conclusion was based on a family of seven admitted to the University of Hong Kong-Shenzhen Hospital from January 10 to 15. Six members of the family were later diagnosed with the coronavirus but the seventh, a 10-year-old boy, showed no outward symptoms. A CAT scan of the boy's lungs revealed irregularities which suggested he had been infected.
The number of confirmed cases on the mainland rose to 1,287 as of Friday evening, according to the National Health Commission, which also put the death toll from the disease at 41 people, 39 from Hubei province, which includes Wuhan, one in the northern province of Hebei and another in Heilongjiang province, northeast China.
On Saturday, a 62-year-old doctor suspected of having the coronavirus died. Liang Wudong, a surgeon at Xinhua Hospital in Wuhan, was believed to have been infected last week, before he was transferred for treatment to Wuhan's Jinyintan Hospital, according to Shanghai-based news portal Thepaper.cn.
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