RIYADH -- Saudi Arabia has confirmed four new cases of the SARS-like novel coronavirus in its Eastern Province, state media reported late on Monday, citing the health ministry. 

The health ministry said one of the four new cases had been treated and the patient had been released from hospital, the Saudi Press Agency reported. 

On Sunday, Saudi Arabia said it had had a total of 24 confirmed cases since the disease was identified last year, of whom 15 had died. In its latest outbreak in its Eastern Province, it said it had had 15 confirmed cases, of whom nine had died. 

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On the third day after his father's death from a respiratory infection, Hussein al-Sheikh began to feel feverish.

Shortly afterwards, says the 27-year-old Saudi, "I was almost dead".

Hussein, who had often visited his father's bedside in his last days, was admitted to intensive care in a hospital in Dhahran, in the Eastern Province oil heartland of Saudi Arabia.

Then his brother, Abdullah, and later his sister, Hanan, became ill. They got treatment in hospitals in the nearby oasis district of al-Ahsa.

Their father Mohammed, doctors now say, was probably a victim of what doctors believe was novel coronavirus, the new SARS-like infection that first emerged in the Gulf last year and has gone on to claim 18 lives, nine of them in the kingdom.

There is international concern, because it was a virus from the same family of pathogens that triggered the outbreak of Severe Acute Respiratory Syndrome (SARS) that swept the world after starting in Asia in 2003 and killed 775 people.

Some of the cases of the new virus were in Britain and France, among them people who had recently traveled from the Middle East. A total of 34 cases worldwide have been confirmed by blood tests so far.

"My temperature was really high, my blood oxygen levels were very low. I was so tired I couldn't walk for days and any kind of activity made me cough," said Hussein, a PhD student who studies in Canada. To avoid spreading infection, he wore a green face mask.

World Health Organization (WHO) experts this week visited Ahsa, a sleepy oasis of around a million people, to work with Saudi authorities in investigating the latest outbreak.

Much of the attention has focused on the private al-Moosa General Hospital in Hofuf, Ahsa's main town, where many of those infected, including Mohammed al-Sheikh, were treated in the intensive care unit.

A senior WHO official said on Sunday it appeared likely that the virus could be passed between people in close contact.

WHO Assistant Director-General Keiji Fukuda said, however, that there was no evidence so far that the virus was able to sustain "generalized transmission in communities", a scenario that would raise the specter of a pandemic.

A public health expert, who declined to beidentified,, said "close contact" in this context meant being in the same small, enclosed space with an infected person for a prolonged period of time.

Mohammed al-Sheikh, who suffered from diabetes and had been admitted to hospital with a high fever and low blood sugar never knew what had infected him. He lost consciousness two days before he died.

"The doctors said they didn't know what was wrong," said Hussein. "During his first two days in intensive care he could talk and eat by himself and go to the washroom. But then it got worse. He was on the highest level of oxygen and they had to drug him.” Then, al-Sheikh died.

“He left without saying goodbye," Hussein said.

Some families of people who were hospitalized said they had been asked by authorities not to speak to media.

Separated from the big cities of Riyadh and Dammam by large stretches of desert, Ahsa is a pretty area famous for its date farms. Drive through its dusty villages and goats appear grazing beneath the palm fronds. Between the trees jut pale rocky outcrops carved by the elements into outlandish shapes.

There was little sign in the al-Moosa General Hospital's reception area late on Saturday that it was at the center of a global health concern.

Visitors, doctors and nurses hurried down the corridors. Two women waited with their babies outside a door marked "vaccination room".

Hussein al-Sheikh said he believed his father contracted novel coronavirus in the hospital's intensive care unit and that he then caught it there himself during the hours he spent visiting his father in the days before he died on April 15.

But Malek al-Moosa, the hospital's general manager, denied this suggestion and said he believed the patients were in fact exposed to a common source of the virus outside Moosa General Hospital.

Fukuda of the WHO said it was not yet clear how the virus was transmitted.

Of the four members of the Sheikh family who got sick, only one, Abdullah al-Sheikh, 33, has so far been tested positive for the new coronavirus.

Samples from Mohammed, Hussein and Hanan are still being tested but Moosa said it was likely that they also had the virus.

A poster-sized portrait of Mohammed al-Sheikh, a 56-year-old former employee of the national oil company Saudi Aramco, is displayed in the Sheikh family's reception room, where three of his 10 children sat to describe what they call the calamity that has hit their family.

"Our father's dream was that we should all live in one house with a big garden. He had started building it and finished almost 50 percent. This is just killing us," said Hussein.

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Centers for Disease Control and Prevention

A CDC scientist harvests H7N9 virus that has been grown for sharing with partner laboratories for research purposes.

More than 50 travelers just back in the United States from China who had flu-like symptoms have been tested for the H7N9 bird flu virus, federal health officials say. So far, none has tested positive.

But the fact that they’re being tested at all shows just how worried the U.S. government is about this new strain of bird flu, which threatens at the same time as a still-mysterious coronavirus from the Middle East. The test kits had to be specially made up and distributed under an emergency provision.

“While no cases of H7N9 have been detected at this time in the U.S., 54 people with flu-like symptoms after travel to China have been tested. All have 54 tested negative for H7N9; while six tested positive for seasonal influenza A, and three tested positive for seasonal influenza B,” the Centers for Disease Control and Prevention says in its latest update on the virus.

Emergency operations centers are running 24/7, keeping an eye on both situations. While it's not unusual for the centers to be operating around the clock, it is rare to have two pandemic threats at once to plan for, says Edward Gabriel, who heads preparedness and response issues at the health and Human Services Department. 

"We want the latest and best information that we can get," Gabriel told NBC News. "We also need to look and see where it is moving to. To try to isolate its motion is a pretty significant thing."

If either virus turns into a form that spreads easily from person to person, a pandemic could follow within weeks. Both seem especially deadly in their current form: H7N9 seems to have about a 20 percent fatality rate, while the new coronavirus appears to have killed more than half its victims.

“In the case of the two latest threats — the H7N9 influenza virus and the new coronavirus — the number of infected people is small, and the infections are occurring thousands of miles away from the United States. Yet we should be seriously concerned about both,” Mike Osterholm, an infectious disease expert at the University of Minnesota, wrote in the New York Times on Friday.

“Our public health tools to fight these viruses are limited. We have no vaccines or effective drugs readily available to stop or treat the new coronavirus in the Middle East,” Osterholm adds. 

CDC

Influenza A H7N9 as viewed through an electron microscope. Both filaments and spheres are observed in this photo.

The H7N9 flu can spread silently, as people transmit influenza before they’re sick themselves. If the flu did mutate into a pandemic form, it would probably take at least six months to make enough vaccines to protect large numbers of people.

“It may take longer than it takes the virus to spread,” says Dr. John Treanor, a flu vaccine expert at the University of Rochester Medical Center. “The technology that we have today is such that the bulk of the pandemic disease may have already taken place before a vaccine is in place and can be used,” he added.

“The virus can spread very, very quickly. You are in a race against time.”

That happened in 2009, when the new strain of H1N1 swine flu broke out to cause the first pandemic of a new flu in 40 years. Companies raced to make vaccine but it was months before it was ready.

There are drugs to fight flu – a pill called Tamiflu and an inhaled powder called Relenza. Neither is a cure, however, and both need to be given very quickly to do much good at all.

Right now, H7N9 seems mostly confined to China and the spread has slowed. The World Health Organization reports 32 people have died out of 131 lab-confirmed cases.

“The drop-off in newly reported H7N9 cases in China may be the result of containment measures reportedly taken by Chinese authorities, including closing live bird markets, a venue where the risk of exposure to bird flu viruses can be high," the CDC says. “However it may also be a result of changing seasons, or a combination of both.”

Researchers in Hong Kong did a computer analysis of the outbreak and estimate that at least 200-500 more people have likely been infected with H7N9. The virus seems to cause serious illness mostly in people over 65 – doctors are not sure why yet.

“We estimated that risk of serious illness after infection is 5.1 times higher in persons 65 years and older versus younger ages,” Ben Cowling and colleagues at Hong Kong University wrote in the journal Eurosurveillance.

The evidence suggests that most of the patients got infected directly by birds, probably in poultry markets. So Cowling’s team took all the data and estimated how many younger people were likely to have been infected without knowing they had H7N9. "Our results suggest that many unidentified mild influenza A(H7N9) infections may have occurred, with a lower bound of 210–550 infections to date," they wrote. This would mean the virus isn’t that widespread, but which also confirms its high fatality rate. 

The coronavirus, which some are dubbing Middle East Respiratory Syndrome Coronavirus, or MERS, is a little different story. WHO says 33 infections have been reported, with 18 deaths. Experts are watching cases in France, where one patient who traveled from Dubai was confirmed to have the virus. 

A man who shared a hospital room with the 65-year-old man also has the virus, French officials said Sunday -- something that shows the virus and and does spread in hospitals. 

Officials were relieved that three health care workers who cared for the 65-year-old patient and who got sick have tested negative for the virus.

Also Sunday, WHO Assistant Director-General Keiji Fukuda could probably be passed between people in close contact, but there was no evidence of sustained "generalized transmission in communities."

Some reports suggest an outbreak in Saudi Arabia also affected people in the same hospital.

This worries Dr. Eric Toner of the Center for Health Security at the University of Pittsburgh Medical Center. SARS – severe acute respiratory syndrome – also spread mostly in hospitals. SARS spread to 29 countries in 2003, killing 775 people and making 8,000 sick before it was stopped.

“These cases, whether confirmed or not, should be a wake-up call,” Toner writes in his blog.

The good news is that SARS was stopped using good hospital hygiene. Face masks, gloves and careful disinfection prevented its spread. And SARS only spread once people were noticeably ill, unlike flu, which people can spread before they feel sick and after they feel better.

The bad news is that hospitals may have forgotten this lesson. “SARS was stopped by healthcare workers being aware of the disease, having a high index of suspicion of anyone with fever and respiratory symptoms who had recently been in an affected region, and quickly implementing infection control measures with any suspect case,” Toner says.

“Until now, all cases of MERS originated in the Middle East, but as the confirmed French case demonstrates, the virus is only a plane ride away from other parts of the world. In the 10 years since the SARS outbreak, many hospitals have become lax in their attention to respiratory precautions.”

Gabriel says he’s working to make sure this isn’t the case with U.S. hospitals. “Hygiene practices are now better than they ever have been,” Gabriel said. “We send out reminders daily.”

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This story was originally published on Sun May 12, 2013 9:33 AM EDT

World Health Organization (WHO) officials said on Sunday it seemed likely a new coronavirus that has killed at least 18 people in the Middle East and Europe could be passed between humans, but only after prolonged contact.

A virus from the same family triggered the outbreak of Severe Acute Respiratory Syndrome (SARS) that swept the world after emerging in Asia and killed 775 people in 2003.

On Sunday French authorities announced that a second man had been diagnosed with the disease after sharing a hospital room with France's only other sufferer.

WHO Assistant Director-General Keiji Fukuda told reporters in Saudi Arabia, the site of the largest cluster of infections, there was no evidence so far the virus was able to sustain "generalized transmission in communities" - a scenario that would raise the specter of a pandemic.

But he added: "Of most concern ... is the fact that the different clusters seen in multiple countries ... increasingly support the hypothesis that when there is close contact, this novel coronavirus can transmit from person to person.

"There is a need for countries to ... increase levels of awareness," he said.

A public health expert who declined to be identified, said "close contact" meant being in the same small, enclosed space with an infected person for a prolonged period.

The virus first emerged in the Gulf last year, but deaths have also been recorded in Britain and France of people who had recently been in the Middle East. A total of 34 cases worldwide have been confirmed by blood tests so far.

Saudi Deputy Health Minister for Public Health Ziad Memish told reporters that, of 15 confirmed cases in the most recent outbreak, in al-Ahsa district of Eastern Province, nine had died, two more than previously reported.

Saudi Arabia's Health Ministry said in a statement the country had had 24 confirmed cases since last summer, of whom 15 had died. Fukuda said he was not sure if the two newly reported Saudi deaths were included in the numbers confirmed by the WHO.

Memish added that three suspected cases in Saudi Arabia were still under investigation, including previous negative results that were being re-examined.

The first French patient was confirmed as suffering from the disease on Wednesday after travelling in the Gulf. The second patient was transferred to intensive care on Sunday after the two men shared a room in a hospital in Lille.

Professor Benoit Guery, head of the Lille hospital's infectious diseases unit, said the first patient had not been immediately isolated because he presented "quite atypical" symptoms.

He added in comments broadcast by BFMTV channel the case suggested that airborne transmission of the virus was possible, though still unusual, and that the public "should not be concerned" as there had been only 34 cases globally in a year.

Fukuda, part of a WHO team visiting Saudi Arabia to investigate the spread of the disease, said although no specific vaccine or medication was yet available for novel coronavirus, patients were responding to treatment.

"The care that is taken in the hospitals, in terms of using respirators well, in terms of treating pneumonia, in terms of treating complications, in terms of providing support, these steps can get patients through this very severe illness," he said.

Fukuda said that as far as he knew all cases in the latest outbreak in al-Ahsa district were directly or indirectly linked to one hospital.

He added that Saudi Arabian authorities had taken novel coronavirus very seriously and had initiated necessary health measures such as increased surveillance systems.

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This story was originally published on Sun May 12, 2013 9:13 AM EDT

LILLE, France -- Two people who had contact with a Frenchman who is seriously ill with the new SARS-like coronavirus have fallen sick and been admitted to hospital, health officials in northern France said on Thursday. 

One is a patient who shared a ward with the 65-year-old man infected with the virus when he was in a hospital in the town of Valenciennes, northern France, at the end of April, and the other is a doctor who treated him there.

The 65-year-old man, who became ill on his return from a trip to Dubai, has since been transferred to an isolated intensive care wing in a hospital in Douai, near the northern city of Lille, where he is in a critical condition.

The ARS local health authority said the two other men were in individual rooms in separate hospitals, one in Lille and the other in the nearby town of Tourcoing, and that tests had been carried out on both of them.

"They show symptoms which require a special infectious diseases consultation," the ARS said in a statement. "The results of the tests carried out on these two people will be known soon and will be made public."

As France reported the 65-year-old as its first case of the coronoavirus on Wednesday, the World Health Organization said it would send experts to visit a Saudi hospital from which the virus has spread, killing seven people so far.

The French case brought the total number of known infections worldwide to 31, of which 18 resulted in death.

Coronavirus is from the same viral family that triggered the outbreak of Severe Acute Respiratory Syndrome (SARS) that swept the world from Asia in late 2003, killing 775 people.

Despite there being no evidence so far of sustained human-to-human transmission, health experts' concerns are growing over clusters of new cases. 

Saudi Arabia says five more people have died of a deadly new virus from the same family as SARS, and two other people were in intensive care.

The seven cases were discovered in al-Ahsa governorate in the Eastern Province, the Saudi news agency SPA quoted the Saudi Health Ministry as saying in a statement late on Wednesday.

A Saudi man died in March from the virus.

The novel coronavirus is from the same family of viruses as a type that also causes common colds and the one that caused the deadly outbreak of Severe Acute Respiratory Syndrome (SARS) that first emerged in Asia in 2003. It infected around 8,000 people and killed 800 before it was stopped.

The new virus is similar to SARS and to other coronaviruses found in bats. It was unknown in humans until it emerged in the Middle East last year. There have been confirmed cases in Saudi Arabia, Jordan and Britain.

In a March 26 update on its website the World Health Organization said it had been informed of a global total of 17 confirmed cases of human infection with the new virus, including 11 deaths.

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British officials say a mysterious virus related to SARS may have spread between humans, as they confirmed the 11th case worldwide of the new coronavirus in a patient who they say probably caught it from a family member.

The new virus was first identified last year in the Middle East and the 10 people who have previously been infected had all traveled to Qatar, Saudi Arabia, Jordan or Pakistan.

According to Britain's Health Protection Agency, the latest patient is a U.K. resident with no recent travel to any of those countries but who had close personal contact with an earlier case. The patient may also have been at greater risk of infection due to an underlying medical condition and is currently in intensive care at a Birmingham hospital.

"Although this case provides strong evidence for person to person transmission, the risk of infection in most circumstances is still considered to be very low," John Watson, head of the respiratory diseases department at the Health Protection Agency, said in a statement. "If (the) novel coronavirus were more infectious, we would have expected to have seen a larger number of cases."

Six hospital staffers where the patient is being treated are being monitored for infection but none has so far showed any symptoms of the illness. The patient did not come into contact with any other hospital patients and is currently being kept in isolation.

The new coronavirus is part of a family of viruses that cause ailments including the common cold and severe acute respiratory syndrome or SARS. In 2003, a global outbreak of SARS killed about 800 people.

Officials at the World Health Organization said the new virus has probably already spread between humans in some instances. In Saudi Arabia last year, four members of the same family became ill and two died. And in a cluster of about a dozen people in Jordan, the virus may have spread at a hospital's intensive care unit.

"We know that in some of those cases there was close physical contact between family members caring for one another, so we can't rule out human-to-human transmission," said Gregory Hartl, a WHO spokesman.

He said there were still big gaps in the understanding of the novel coronavirus, which can cause acute pneumonia and kidney failure. Of the 11 cases to date, five people have died.

Health experts still aren't sure how humans are being infected. The new coronavirus is most closely related to a bat virus and scientists are considering whether bats or other animals like goats or camels are a possible source of infection.

Michael Osterholm, an infectious diseases expert at the University of Minnesota, warned the virus could be adapting into a more transmissible form. "At any moment the fire hydrant of human-to-human transmission cases could open," he said. "This is definitely a 'stay tuned' moment." He said before SARS spread worldwide, there were a handful of human-to-human cases. Something such as a virus mutation may have triggered the explosion of cases.

WHO says the virus is probably more widespread than the Middle East and has advised countries to test any people with unexplained pneumonia.

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LONDON -- A new virus from the same family as SARS that sparked a global alert in September has now killed two people in Saudi Arabia, and total cases there and in Qatar have reached six, the World Health Organization said Friday.

The U.N. health agency issued an international alert in late September saying a virus previously unknown in humans had infected a Qatari man who had recently been in Saudi Arabia, where another man with the same virus had died.

On Friday it said in an outbreak update that it had registered four more cases and one of the new patients had died.

"The additional cases have been identified as part of the enhanced surveillance in Saudi Arabia (3 cases, including 1 death) and Qatar (1 case)," the WHO said.

The new virus is known as a coronavirus and shares some of the symptoms of SARS, or Severe Acute Respiratory Syndrome, which emerged in China in 2002 and infected about 8,000 people, killing nearly 800.

Among the symptoms in the confirmed cases are fever, coughing and breathing difficulties.

Of the six laboratory-confirmed cases reported to WHO, four cases, including the two deaths, are from Saudi Arabia and two cases are from Qatar.

Britain's Health Protection Agency, which helped to identify the new virus in September, said the newly reported case from Qatar was initially treated in October in Qatar but then transferred to Germany, and has now been discharged.

Coronaviruses are typically spread like other respiratory infections, such as flu, travelling in airborne droplets when an infected person coughs or sneezes.

The WHO said investigations were being conducted into the likely source of the infection, the method of exposure, and the possibility of human-to-human transmission of the virus.

"Close contacts of the recently confirmed cases are being identified and followed-up," it said.

It added that so far, only the two most recently confirmed cases in Saudi Arabia were epidemiologically linked - they were from the same family, living in the same household.

"Preliminary investigations indicate that these two cases presented with similar symptoms of illness. One died and the other recovered," the WHO's statement said.

Two other members of the same family also suffered similar symptoms of illness, and one died and the other is recovering. But the WHO said laboratory test results on the fatality were still pending, and the person who is recovering had tested negative for the new coronavirus.

The virus has no formal name, but scientists at the British and Dutch laboratories where it was identified refer to it as "London1_novel CoV 2012".

The WHO urged all its member states to continue surveillance for severe acute respiratory infections.

"Until more information is available, it is prudent to consider that the virus is likely more widely distributed than just the two countries which have identified cases," it said.

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Global health officials are closely monitoring a new respiratory virus related to SARS that is believed to have killed at least one person in Saudi Arabia and left a Qatari citizen in critical condition in London.

The germ is a coronavirus, from a family of viruses that cause the common cold as well as SARS, the severe acute respiratory syndrome that killed about 800 people, mostly in Asia, in a 2003 epidemic.

In the latest case, British officials alerted the World Health Organization on Saturday of the new virus in a man who transferred from Qatar for treatment in London. He had recently traveled to Saudi Arabia and is now being treated in an intensive care unit after suffering kidney failure.

WHO said virus samples from the patient are almost identical to those from a 60-year-old Saudi national who died earlier this year. The agency isn't currently recommending travel restrictions and said the source of infection remains unknown. Still, the situation has raised concerns ahead of next month's annual Hajj pilgrimage, which brings millions of people to Saudi Arabia from around the world.

Health officials don't know yet whether the virus could spread as rapidly as SARS did or if it might kill as many people. SARS, which first jumped to humans from civet cats in China, hit more than 30 countries worldwide after spreading from Hong Kong.

"It's still (in the) very early days," said Gregory Hartl, a WHO spokesman. "At the moment, we have two sporadic cases and there are still a lot of holes to be filled in."

He added it was unclear how the virus spreads. Coronaviruses are typically spread in the air but Hartl said scientists were considering the possibility that the patients were infected directly by animals. He said there was no evidence yet of any human-to-human transmission.

"All possible avenues of infection are being explored right now," he said.

No other countries have so far reported any similar cases to WHO, he said, and so far there is no connection between the cases except for a history of travel in Saudi Arabia.

Hartl said the first patient may have had an underlying condition but it probably didn't make him more susceptible to catching the virus.

Other experts said it was unclear how dangerous the virus is.

"We don't know if this is going to turn into another SARS or if it will disappear into nothing," said Michael Osterholm, a flu expert at the University of Minnesota. He said it was crucial to determine the ratio of severe to mild cases.

Osterholm said it was worrying that at least one person with the disease had died. "You don't die from the common cold," he said. "This gives us reason to think it might be more like SARS." SARS killed about 10 percent of the people it infected.

Britain's Health Protection Agency and WHO said in statements that the 49-year-old Qatari became ill on Sept. 3, having previously traveled to Saudi Arabia. He was transferred from Qatar to Britain on Sept. 11 and is being treated in an intensive care unit at a London hospital for problems including kidney failure. Respiratory viruses aren't usually known to cause serious kidney problems.

In Qatar, Mohammed bin Hamid Al Thani of the Public Health Department said the patient was in Saudi Arabia for Ramadan during the summer and became ill after returning to Qatar. Doctors could not immediately identify the virus and decided he should be treated in London.

A public health official, Abdullakef al-Khal, said there is no indication that the patient's family or others were infected.

"There is no special alert for now," he said. "We are being vigilant."

David Heymann, chairman of the Health Protection Agency, said the new virus didn't appear that similar to SARS.

"It isn't as lethal as SARS and we don't know too much about its transmissibility yet," he said. "If people are getting infected, they aren't getting serious disease."

Heymann said none of the health workers involved in treating the Qatari patient had become ill.

Saudi officials said they were concerned that the upcoming Hajj pilgrimage next month could provide more opportunities for the virus to spread. They advised pilgrims to keep their hands clean and wear masks in crowded places.

Several disease outbreaks have occurred during The Hajj including the flu, meningitis and polio.

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