Coronaviruses: old and new

Dieter Stürchler

 

Conventional coronaviruses have circulated in humans since the mid-1960s. Infections range from inapparent to the common cold, flu-like illnesses and pneumonia. Worldwide, they may account for about 4% of all airway illness. Conventional coronaviruses must be differentiated from the new coronavirus COVID-19.

Coronavirus is a genus of enveloped RNA viruses (Nidovirales: Coronaviridae). Species in humans include 229E (1967), OC43 (1967), SARS (severe acute respiratory syndrome, 2002-03), NL63 (2004), HKU1 (2005), MERS (Middle East respiratory syndrome, 2012), and COVID (December 2019) [1–34].

Related species circulate in wildlife, livestock and pets. Coronaviruses fall into three groups: α infecting humans (229E, NL63), bats, camels and rats; β infecting humans (OC43, HKU1, SARS, MERS, COVID-19), bats, pigs, horses, cattle and dogs; and γ in birds and marine mammals.

Of conventional coronavirus infections (229E, OC43, NL63, HKU1), SARS or MERS, about 25−90% are inapparent. The main manifestations are the common cold (rhinitis, sore throat), acute upper (bronchitis) and lower (pneumonia) airway infections, and flu-like illnesses (fever, myalgia). Ongoing or past infection is detected from clinical materials (swabs, sputum, blood) by molecular methods (reverse transcription polymerase chain reaction [RT-PCR] sequencing) or serology (immunoglobulin [Ig] M and/or IgG). Tests need to differentiate conventional coronaviruses from COVID and other viruses such as human adenovirus, enterovirus-rhinovirus, influenzavirus, parainfluenza viruses and respiratory syncytial virus.

Here, I summarise the circulation of conventional coronaviruses in people and their significance in airway or febrile diseases. I searched the literature of the mid-1960s to early 2020s for coronavirus infections in people. Non-exhaustive crude prevalences in groups of ill or apparently healthy individuals were aggregated by continent.

Conventional coronaviruses were recorded in 69 countries on 5 continents (table 1).

 

Table 1: Conventional coronaviruses (229E, NL63, OC43, HKU1) in people, 1960s to early 2020s.

 

Parameter

Africa

America

Asia

Oceania

Europe

Countries, number (= n)

16 (of 56)

11 (of 45)

33 (of 48)

2 (of 23)

28 (of 41)

Prevalence: median (range), %

7 (0−22)

4 (0−48)

4 (0−67)

2 (0.3−3)

3 (0−58)

 

 

 

 

This compares with 62 countries for COVID (as of 1 March 2020), 27 countries for MERS (2012−19) and 27 for SARS (2002−03). Combining healthy and ill people and recent (viraemia, nucleic acid tests) and past (anti-coronavirus  IgG) infections gave median prevalences (and ranges) by continent of: 7% (0−22%) in Africa (15 studies), 4% (0−48%) in America (17 studies), 4% (0−67%) in Asia (48 studies), 2% (0.3−3%) in Oceania (3 studies) and 3% (0−58% in Europe (31 studies) (tables 2 to 6). The surprisingly homogenous medians gave an overall global prevalence of 4%, which compares with the above respiratory viruses in humans.

 

Table 2: Conventional coronaviruses (CoV) in people: prevalence (%, rounded) – Africa.

Country

%

n

Group, test, place, time, reference

Cameroon

5

561

Flu-like (0−75 y), NAT, 14 centres 2009 [35]

Côte d’Ivoire

11

470

Flu-like (0−5 y), NAT, 2009−10 [32]

Egypt

0

179

Abattoir work, anti-CoV 2013 [3]

Gabon

6.5

1041

Flu-like (0−82 y), NAT, 4 sites 2010−11 [36]

Kenya

0.2

1222

Livestock work, anti-CoV 2013–14 [3]

Kenya

0

760

Camel contact, anti-CoV 2012–13 [3]

Kenya

7–7

96–759

Mild pneumonia (<12 y), NAT, coast 2007 [37]

Madagascar

10–10

60–80

Controls–pneumonia (≤5 y), NAT, 2010–14 [7]

Mali

9–9

93–118

Controls–pneumonia (≤5 y), NAT, 2011–12 [7]

Niger

13

160

Ill airway (<5 y), NAT, 5 regions 2010–12 [38]

Nigeria

0

261

Abattoir work (camels), anti-CoV (NT) 2016 [3]

RSA

4

627

Ill airway (<5 y), NAT, Pretoria 2006–07 [39]

Tanzania

14–8

166–207

Healthy–febrile (<5 y), NAT, Zanzibar 2011 [40]

Tunisia

22

372

Ill airway (0–5 y), NAT Sousse 2013–14 [41]

Zambia

0.5

199

Ill airway (≤5 y), NAT throat, 2011–12 [42]

MERS = Middle East respiratory syndrome; NAT = nucleic acid tests; y = year(s)

 

Table 3: Conventional coronaviruses (CoV) in people: prevalence (%, rounded) – Americas.

Country

%

n

Group, test, place, time, reference

Argentina

10.5

315

Ill (<6 y), NAT, Buenos Aires 2008–10 [40]

Bolivia

5

564

Flu-like (0–60+ y), NAT, 2010–12 [43]

Brazil

1

260

Ill (<3 y), NAT, Porto Alegre 2007 [44]

Canada

0.5(0.3–0.9)

4903

Ill airway, country 2014–19 (www.canada.ca/en/public-health.html)

Canada

4.5

177

Common cold, travel to MERS-areas 2012–14 [45]

Canada

1.8

3847

Child airway specimens, NAT, Montreal 2009–10 [44]

Chile

4.5

268

Pneumonia (>18 y), NAT 2005–07 [46]

Haiti

8–5

101–122

Pneumonia–controls (≤5 y), NAT, 2010–14 [7]

Mexico

7

1’051

Flu-like (0–96 y), 2010–11 [14]

Paraguay

8–7

99–100

Pneumonia–controls (≤5 y), NAT 2010–14 [7]

Trinidad

1–1

70–80

Children acute wheeze–stable, NAT 2004–05 [23]

USA

2

2259

Pneumonia (18–80+ y), NAT, IL/TN 2010–12 [10]

USA

6–4

440–425

Ill airway (<3 y), NAT 2005–07 [22]

USA

3

515

Ill (<1 y), NAT, 4 inner cities, 2005–08 [17]

USA

2.7–45

1990

Ill (<45 y), rise–CF ≥1:4, Michigan 1966–67 [29]

USA

0–7

222–317

Ill infant–adult, paired sera 229E, 1965–67 [30]

USA

2–48

222–317

Ill infant–adult, low titre to 229E, 1965–67 [30]

MERS = Middle East respiratory syndrome; NAT = nucleic acid tests; y = year(s)

 

Table 4: Conventional coronaviruses (CoV) in people: prevalence (%, rounded) – Asia.

Country

%

n

Group, test, place, time, reference

Cambodia

10

1904

Ill (≥5 y), NAT 2007–09 [47]

Cambodia

3–7

176–95

Pneumonia–controls (≤5 y), NAT 2010–14 [7]

China

0.9

3978

Fever (0–96 y), NAT, Beijing 2011–14 [48]

China

3

3181

Ill (≤16 y), NAT, Chongqing 2009–13 [12]

China

5–8

39–138

Pneumonia–controls (≤5 y), NAT 2010–14 [7]

China

5

279

Ill (0–12 y), NAT, Gansu Province 2011 [49]

China

3.7

4755

Ill (0–91 y), NAT, Guangzhou 2009–11 [16]

China

11

490

Flu-like, NAT, Nanjing 2010–11 [18]

Georgia

5

1624

Ill, NAT 2015–17 [50]

India

8–14

96–96

Pneumonia–controls (≤5 y), NAT, 2010–14 [7]

India

1–3

71–70

Pneumonia–controls (≤5 y), NAT, 2010–14 [7]

Indonesia

5

148

Pneumonia (>13 y), NAT Semarang 2007–09 [51]

Iran

2.5

455

Ill (0–80 y), NAT, Isfahan 2009–10 [51]

Israel

10

1910

Flu-like, NAT, 2015–16 [4]

Japan

5

1380

Ill (0–15+ y), NAT, 2014–16 [6]

Jordan

7

124

MERS contacts, anti-CoV, 2012–13 [3]

Korea, South

4

36,915

Ill (<1–65+ y), NAT, country 2013–15 [5]

Korea, South

8

207

Ill soldiers, NAT, 2011–12 [13]

Korea, South

5

675

MERS contacts, NAT 2015 [3]

Korea, South

1

1169

Health care work, anti-MERS-CoV, 2015 [3]

Kuwait

0

1014

Ill (0–76 y), NAT <2010 [52]

Laos

2

292

Admitted ill airway (0–86 y), NAT 2009–10 [53]

Malaysia

3

2060

Ill adults, NAT, 2012–13 [8]

Mongolia

8–4

108–93

Pneumonia–controls (≤5 y), NAT 2010–14 [7]

Nepal

0.8

3693

Flu-like, pregnant, NAT, 2011–14 [53]

Oman

0.4

259

Ill (<5 y), NAT, 2007–08 [54]

Pakistan

13

91

Near camels (8–76 y), anti-MERS-CoV, 2017–18 [55]

Pakistan

0

840

Camel herders, anti-CoV, 2016 [3]

Qatar

3

294

Work (camels), anti-CoV 2013–14 [3]

Saudi Arabia

67

30

Work (camels), anti-CoV/T cell response 2018 [3]

Saudi Arabia

2–8

879–107

Health care work, NAT, 2 studies 2017 [3]

Saudi Arabia

1

57,363

MERS suspects, NAT, 2015–16 [3]

Saudi Arabia

2-20

1206–1162

Pilgrims (18–88 y) arrive–depart, NAT, 2013 [56]

Saudi Arabia

0–0

191–226

Abattoir work, anti-CoV, 2013/4–2012 [3]

Saudi Arabia

1

1695

Health care work, NAT, 2012–13 [3]

Saudi Arabia

14–10

79

MERS contacts, NAT–anti-CoV 2014 [3]

Saudi Arabia

4

280

MERS contacts, anti-CoV, 2013 [3]

Saudi Arabia

0.1

10,009

Residents, anti-CoV, 13 provinces 2012–13 [3]

Saudi Arabia

0.2–1

519–2699

Pilgrims, arrive-depart, NAT, 2009 [57]

Singapore

0.6

500

Ill (0–12 y), NAT, 2005–07 [58]

Sri Lanka

1.5

571

Flu-like (1–75 y), NAT 2013–15 [59]

Taiwan

5

113

Bronchiolitis (<2 y), 2009–11 [60]

Thailand

0

48

MERS contacts, NAT, 2015 [3]

Thailand

0.8

5833

Flu-like, NAT, 2012–13 [61]

Turkey

6

624

Sore throat (3–85 y), NAT, Kayseri 2013 [62]

UAE

54–0

124

Patients–contacts, anti-CoV, 2013–18 [3]

UAE

4

1586

MERS suspects, NAT, 2013–14 [3]

Vietnam

8

309

Ill (<15 y), NAT, Ho Chi Minh City 2004–08 [63]

MERS = Middle East respiratory syndrome; NAT = nucleic acid tests; y = year(s)

 

Table 5: Conventional coronaviruses (CoV) in people: prevalence (%, rounded) – Oceania

Country

%

n

Group, test, place, time, reference

Australia

3

543

Ill (<5 y), NAT, Melbourne 2003–04 [64]

Australia

0.3

23,177

Submitted stools, any test, 1991–2000 [65]

New Zealand

2

304

Pneumonia (>18 y), NAT, 1999–2000 [26]

MERS = Middle East respiratory syndrome; NAT = nucleic acid tests; y = year(s)

 

Table 6: Conventional coronaviruses (CoV) in people: prevalence (%, rounded) – Europe.

Country

%

n

Group, test, place, time, reference

Multicenter

0–2.5

2 501

Healthy, routine test–NAT, 51 studies 1965–2007 [66]

Croatia

2

182

Ill (>18 y), NAT, 2016–18 [67]

Cyprus

5

424

Ill (0–12 y), NAT, Nicosia 2010–13 [9]

Finland

3

194

Cold (<5 y), Turku (60°N) 1996–98 [24]

France

1

162

MERS contacts, NAT 2013 [3]

France

1

85

Pneumonia (<17 y), NAT St-Etienne 2012–13 [68]

France

9

1021

Children (<2 y), NAT, Caen 2009–10 [69]

GBR

0–6

59–33

Health care work, NAT, 2 studies 2013 [3]

GBR

0

4821

Submitted samples, NAT, 2009–10 [70]

GBR

1.6

12,830

Submitted samples, NAT, Edinburgh 2006–09 [19]

Germany

9

75

Colds, adults, NAT self/staff sampling, 2011 [71]

Germany

3

18,999

Ill (0–16 y), NAT 1996–2006 (CoV >2003) [69]

Germany

58–7

3016–331

Healthy, anti-CoV, past–new 1974–76 [70]

Greece

4

1272

Flu-like (0–18 y), NAT, Athens 2005–08 [21]

Italy

2

237

Ill children NAT, Siena 2006–07 [72]

Italy

9

322

Ill (<2 y), NAT, Milan 2004–06 [25]

Netherlands

2

339

Ill (≥18 y), NAT 2007–10 [73]

Netherlands

6

107

Ill adults, NAT, Utrecht 2002–04 [74]

Netherlands

2

1172

Ill, NAT, 1997–99 [75]

Norway

15

452

Ill (0–16 y), NAT, Trondheim 2006–07 [20]

Poland

15

399

Flu-like, military/families, NAT 2011–12 [76]

Portugal

0

249

Bronchiolitis (0–2 y), NAT, 2007–08 [73]

Romania

0.4

241

Ill (0–8 y), NAT, 2010–11 [77]

Russia

0.8

1560

Ill (0–15 y), NAT, Siberia 2013–17 [78]

Slovenia

5

278

Ill (<5 y), NAT, 2012–13 [79]

Spain

1.3

884

Pneumonia (<14 y), NAT, Madrid 2004–10 [80],

Sweden

16–5.5

1843–403

Adults (25–63 y), NAT self-clinical, 2011–12 [11]

Sweden

3

502

Flu-like (0–17 y), NAT, Stockholm 2009 [81]

Sweden

10

79

Flu-like, travel to MEX/USA, NAT, Gotaland 2009 [82]

Sweden

1

232

Healthy (10–15 y), NAT Malmö (56°N) 2005 [83]

Switzerland

3

117

Ill (1–83 y), Geneva 2001–02 [27]

MERS = Middle East respiratory syndrome; NAT =nucleic acid tests; y =year(s)

In conclusion, as SARS (eliminated by a concerted global effort by 2003) and MERS (virtually not sustained by human-to-human spread) have demonstrated, coronaviruses can be contained or even eliminated. However, information about conventional coronaviruses suggests that COVID could become part of the airway illnesses that, according to host, season and infective dose, may range from inapparent to mild, severe or critical illness. In this latter scenario, COVID must be distinguished from conventional coronaviruses and other respiratory viruses, preferentially by multiple genomic assays.

 

Dieter Stürchler, Emeritus professor of Basel University, Switzerland

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