Debate goes on: Naming the 2019 Coronavirus

The arguments in academic-industrial sphere flew to and fro, and nothing seemed certain or obviously right. In real dilemma, layered on top of this, making informed and judicious choice is a catch-22 for each authoritative body.

In recent years, the world has seen the emergence of several new human infectious diseases. Given the rapid and global communication through social media and other electronic means, diseases are now often given common names by stakeholders outside as well as inside the scientific community. The use of names such as “swine influenza” and “Middle Eastern Respiratory Syndrome” has had unintentional negative economic and social impacts by stigmatizing certain industries or communities. Disease names, once given, are difficult to change later even if an inappropriate name is being used. Therefore, it is important that an appropriate name is assigned to a newly identified human disease by whoever first reports it.

In response to such concerns, the World Health Organization (WHO), in close collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO), and in consultation with the International Classification of Diseases (ICD), has developed a set of standard best practices for naming new human infectious diseases, with the aim of minimizing unnecessary negative effects on nations, economies, people, and animals. A full description of these best practices is available on the WHO Web site.

These best practices apply to new infections, syndromes, and diseases of humans that have never been recognized or reported before in humans, that have potential public health impact, and for which no disease name is yet established in common usage. They do not replace the existing ICD system, but rather provide an interim solution prior to the assignment of a final ICD disease name. As these best practices only apply to disease names for common usage, they also do not affect the work of existing international authoritative bodies responsible for scientific taxonomy and nomenclature of microorganisms.

WHO, OIE, and FAO strongly encourage all national, regional, and international stakeholders, including scientists, national authorities, and media, to follow these best practices in the event of the emergence of a new human disease, so that inappropriate disease names do not become established.

Debate goes on: Naming the 2019 Coronavirus

On the occasion of the Chinese New Year of 2020, a novel coronavirus outbreak was first emerged and contracted in Wuhan City of China, home to 11 million people. It is the seventh identified coronavirus that can cause diseases of the respiratory tract in humans.

• 2019-nCov

On 12 January 2020, the 2019 novel strain was temporarily named 2019-nCov by the World Health Organization.  The ‘2019-nCov’ disease outbreak has been declared a public health emergency of international concern.

An emergency ICD-10 code of U07.1 is assigned to the disease diagnosis of 2019-nCov acute respiratory disease by the International Classification of Diseases (ICD). In ICD-11 the code for the illness would be RA01.0.  The title of U07 will be changed back to ‘codes for emergency use’.ICD also announced that the name ‘2019-nCov’ is temporary and is likely to change (to be independent of date and virus family, and for consistency with international virus taxonomy).

• novel coronavirus (2019-nCoV)–infected pneumonia (NCIP)

On 29 January 2020, the 2019 novel strain was named as “novel coronavirus-infected pneumonia (NCIP)” by Chinese scientists in a article, entitled “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia” in the journal New England Journal of Medicine.

However, it will seem illogical if coronavirus is listed after NCIP, i.e., “novel coronavirus-infected pneumonia coronavirus (NCIP-CoV)”.

• WH-Human-1 coronavirus

On 3 February 2020, the novel coronavirus was designed as “WH-Human-1 coronavirus” in an online article, entitled “A new coronavirus associated with human respiratory disease in China” in the high-profile journal Nature.

Obviously, the “WH-Human-1 coronavirus” is against the related WHO principles of best practices for disease naming – “Names that should be avoided in disease names include geographic locations” and “Names should be short (minimum number of characters) and easy to pronounce”. It also unintended negative impacts by stigmatizing certain communities or economic sectors.

• PARS-CoV

On 5 February 2020,  Prof. Shibo Jiang published a article, entitled “A novel coronavirus (2019-nCoV) causing pneumonia-associated respiratory syndrome“, in Cellular & Molecular Immunology. In this article, Chinese researchers named the novel coronavirus as “Pneumonia Acute Respiratory Syndrome” or “PARS-CoV“.

• NCP

On 7 February 2020, China’s National Health Commission decided to temporarily call the disease “novel coronavirus pneumonia“, or “NCP“. The new name has received mix reception since it was published.

Chinese scientists are divided on the official scientific name of the novel coronavirus – “novel coronavirus pneumonia” or “NCP“, with supporters saying the name is descriptive and follows typical classification practices and others claiming it could easily be misunderstood and abused to cause unnecessary fears.

Mebratu A. Bitew, a biology PhD candidate at the University of Melbourne, said on his Twitter account that he favored the new name over the previous 2019-nCoV title, which implies a novel coronavirus discovered in 2019. He said the word “novel” was a “confusing jargon” because neither the disease nor the host range can be used to reliably determine a virus’s novelty, since a few mutations can turn a virus deadly or switch to another host. On the other hand, viruses continue to spread from animals to people, this coronavirus won’t be novel for long.

• COVID-19

On 11 February 2020, the World Health Organization renamed the coronavirus involved in the recent outbreak with the hope of minimizing stigma. The World Health Organization has officially named the disease caused by the coronavirus “COVID-19″. The term “COVID-19” means ‘coronavirus disease’, with ‘CO’ meaning ‘corona’, ‘VI’ for ‘virus’, ‘D’ for ‘disease’, and ’19’ pertaining to the year it emerged, being 2019. This will replace various monikers and hashtags given to the emerging illness over the past few weeks.

COVID-19, as the virus will now be known, was decided on by the WHO, with the organization giving a number of reasons as to why it was chosen. “Under agreed guidelines between WHO, we had to find a name that did not refer to a geographical location, an animal, an individual or group of people, and which is also pronounceable and related to the disease,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO. “COVID-19 stands for coronavirus disease in 2019,” said Soumya Swaminathan, chief scientist at the World Health Organization in Geneva, Switzerland, at a press briefing. She explained that there are many coronaviruses, and this style of naming will provide a format for referring to new coronavirus diseases in future years. “The virus itself is named by international group of virologists who will look into the taxonomy,” she said. “But it is important to have a name for this disease that everybody uses.”

• SARS-CoV-2

Most recently, on 11 February 2020, shortly after the WHO announced the disease’s official name, the virus causing it was named “SARS-CoV-2″ (“Severe Acute Respiratory Syndrome coronavirus 2”) by the International Committee on Taxonomy of Viruses (ICTV), the global authority on the designation and naming of viruses. In a paper (“Severe acute respiratory syndrome-related coronavirus: The species and its viruses – a statement of the Coronavirus Study Group“) posted to the bioRxiv preprint server, the committee’s study group on coronaviruses explains that this term highlights the new virus’ similarity to the SARS virus identified in 2003.

However, to the untrained eye, simply adding a ‘2‘ behind the SARS-CoV virus may lead the public to perceive the new virus as a direct descendant, rather than a close relative, to the pathogen that caused China’s first major viral outbreak in the 21st century, according to The Intellectual, a public WeChat account founded by renowned scientists including neuroscientist Rao Yi.

SARS’s visible symptoms are also more serious, and it has a higher death rate, around 9.6 percent, than the novel coronavirus, which is estimated to be around 2 to 4 percent, according to the Chinese Center for Disease Control and Prevention. Therefore, the SARS virus still strikes a sensitive nerve in the Chinese public, and scientists have been very careful when comparing the two coronaviruses.

On 9 February 2020, virologist Chen Huanchun made a public apology for mistakenly saying the novel coronavirus is a type of SARS-CoV virus, which caused panic on Chinese social media as the public thought that the novel virus and the SARS-CoV virus were the same. It led to prominent scientists scrambling to debunk the claim.

Scientists divided on official scientific names for novel coronavirus

The name for the virus is called Severe Acute Respiratory Syndrome Coronavirus 2, or SARS-CoV-2. On 11 February 2020, It was released in the nonpeer reviewed journal database BioRxiv by the Coronavirus Study Group of the International Committee on Taxonomy of Virus (TCTV). The ICTV group said the new pathogen is a sister strain parallel to the SARS virus from 2003, and both viruses fall under the species of SARS-related coronavirus.

The rationale behind the classification is to “highlight the need to study the entire virus species to complement research focused on individual pathogenic viruses of immediate significance“. The present outbreak is the third spillover in two decades of an animal coronavirus to humans resulting in a major epidemic. Therefore, “the research will improve our understanding of virus-host interactions in an ever-changing environment and enhance our preparedness for future outbreaks,” it said.

The new title has also followed traditional naming conventions, such as those used in naming Dengue fever. According to the ICTV, the mosquito-borne tropical virus has four serotypes with similar hosts, symptoms and transmission methods, and thus its variants are named DENV-1, DENV-2, DENV-3 and DENV-4.

The virus for the SARS epidemic in 2003 was named SARS-CoV. Since the latest coronavirus also originates from bats, uses the same receptor to infect cells and shares nearly 80 percent of its genetic material with the SARS virus, it is natural for scientists to add a numeral behind it to signify their relation.

The Intellectual reported that many Chinese scientists are dissatisfied with the formal name for the virus, including Shi Zhengli, the virologist who discovered the new virus’s bat origin. She said they are giving suggestions to the study group to possibly amend the name.

Other names for the virus have been discussed recently in the Chinese scientific community, including TARS-CoV, HARS-CoV, CARSCoV and PARS-CoV. The “ARS “represent acute respiratory syndrome, with T standing for transmissible, H for human, C for contagious and P for pneumonia.

On 11 February 2020, the WHO named the disease caused by the virus COVID-19, meaning coronavirus disease discovered in 2019. WHO Director-General Tedros Adhanom Ghebreyesus said the name is neutral, pronounceable and related to the disease. “Having a name matters to prevent the use of other names that can be inaccurate or stigmatizing,” he said. “It also gives us a standard format to use for any future coronavirus outbreaks.”

However, it is unclear whether the ICTV will take these suggestions into consideration. The name Middle East Respiratory Syndrome coronavirus, or MERS-CoV, has persisted and been widely used since it was discovered in Saudi Arabia in 2012, despite experts and the WHO criticizing the name for stigmatizing Middle Eastern people.

Does a virus’ name really matter?

Previous evidence would seem to suggest yes. “Swine flu,” which was actually a flu strain thought to originate in pigs, resulted in consumers shunning pork and causing great financial damage to U.S. pork farmers, despite there being no evidence that the disease could be spread via consuming pork.

MERS (Middle East Respiratory Syndrome), was first reported in Saudi Arabia in 2012 and is a particularly deadly coronavirus with around a third of people contracting it dying from the disease. However, the disease has so far been found in 27 different countries, including South Korea which reported a serious hit to its tourism industry when it reported cases in 2015. Two other diseases caused by coronaviruses were given names describing the clinical manifestations: SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Shortly after the WHO announced the disease’s official name, the virus causing it was named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. In a paper posted to the bioRxiv preprint server, the Committee’s study group on coronaviruses explains that this term highlights the new virus’ similarity to the SARS virus identified in 2003.

Since these incidents, the WHO has decided on names which are more generic and not related to people, places or specific animals. “Having a name matters to prevent the use of other names that can be inaccurate or stigmatizing. It also gives us a standard format to use for any future coronavirus outbreaks,” said Ghebreyesus. It may be too late, but by renaming the current virus to COVID-19, the WHO likely hopes to de-stigmatize its association with the city of Wuhan and the people who live there.

The virus is thought to have originated in the city of Wuhan in China, which led to it being frequently named the “Wuhan coronavirus,” or “Chinese coronavirus,” but neither of these were official names and some believe they may have contributed to discrimination against Chinese people. Chinese communities from around the world have been reporting racist incidents and dramatic impacts on their business including Chinese restaurants all over the world.

What’s best practices for naming new human infectious diseases?

WHO, in consultation and collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO), has identified best practices for the naming of new human diseases, with the aim to minimize unnecessary negative impact of disease names on trade, travel, tourism or animal welfare, and avoid causing offence to any cultural, social, national, regional, professional or ethnic groups.

On 8 May 2015, WHO called on scientists, national authorities and the media to follow best practices in naming new human infectious diseases to minimize unnecessary negative effects on nations, economies and people.

“In recent years, several new human infectious diseases have emerged. The use of names such as ‘swine flu’ and ‘Middle East Respiratory Syndrome’ has had unintended negative impacts by stigmatizing certain communities or economic sectors,” says Dr Keiji Fukuda, Assistant Director-General for Health Security, WHO. “This may seem like a trivial issue to some, but disease names really do matter to the people who are directly affected. We’ve seen certain disease names provoke a backlash against members of particular religious or ethnic communities, create unjustified barriers to travel, commerce and trade, and trigger needless slaughtering of food animals. This can have serious consequences for peoples’ lives and livelihoods.”

Diseases are often given common names by people outside of the scientific community. Once disease names are established in common usage through the Internet and social media, they are difficult to change, even if an inappropriate name is being used. Therefore, it is important that whoever first reports on a newly identified human disease uses an appropriate name that is scientifically sound and socially acceptable.

The best practices apply to new infections, syndromes, and diseases that have never been recognized or reported before in humans, that have potential public health impact, and for which there is no disease name in common usage. They do not apply to disease names that are already established.

The best practices state that a disease name should consist of generic descriptive terms, based on the symptoms that the disease causes (e.g. respiratory disease, neurologic syndrome, watery diarrhoea) and more specific descriptive terms when robust information is available on how the disease manifests, who it affects, its severity or seasonality (e.g. progressive, juvenile, severe, winter). If the pathogen that causes the disease is known, it should be part of the disease name (e.g. coronavirus, influenza virus, salmonella).

Terms that should be avoided in disease names include geographic locations (e.g. Middle East Respiratory Syndrome, Spanish Flu, Rift Valley fever), people’s names (e.g. Creutzfeldt-Jakob disease, Chagas disease), species of animal or food (e.g. swine flu, bird flu, monkey pox), cultural, population, industry or occupational references (e.g. legionnaires), and terms that incite undue fear (e.g. unknown, fatal, epidemic).

WHO developed the best practices for naming new human infectious diseases in close collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO), and in consultation with experts leading the International Classification of Diseases (ICD).

The new best practices do not replace the existing ICD system, but rather provide an interim solution prior to the assignment of a final ICD disease name. As these best practices only apply to disease names for common usage, they also do not affect the work of existing international authoritative bodies responsible for scientific taxonomy and nomenclature of microorganisms.

The final name of any new human disease is assigned by the International Classification of Diseases (ICD), which is managed by WHO. ICD is used by doctors, nurses, researchers, health information managers and coders, policymakers, insurers and patient organizations around the world to classify diseases and other health problems and record them in a standardized way on health records and death certificates. This enables the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes. These records are also used by WHO Member States to compile national mortality and morbidity statistics. Finally, ICD is used for reimbursement and resource allocation decision-making by countries.

What’s the Next?

The arguments in academic-industrial shpere flew to and fro and nothing seemed certain or obviously right. In real dilemma, layered on top of this, making informed and judicious choice is a catch-22 for each authoritative body. We now see collaborative efforts as a potential way to help strengthen and standardize ongoing international initiatives of WHO and ICTV:

• Having individuals who are well versed in naming conventions for new viruses and pathogenic diseases and collaborate directly with researchers on a regular basis is critical.
• The army of authoritative organizations should work togther with each other and cultivate a well-trained cadre of professionals to mediate infodemic risks in a dynamic nomenclature landscape.
• Policy-makers should learn from best practice in the reduction of deliberate infodemic risks, with the pull of go-to resources for knowledge and expertise into academic sphere.

References

• Zhiwen Hu, Zhongliang Yang, Qi Li, An Zhang, Yongfeng Huang. Infodemiological study on COVID-19 epidemic and COVID-19 infodemic. DOI:10.20944/preprints202002.0380.v3
• World Health Organization, International Classification of Diseases (www.who.int/classifications/icd/en).
• WHO issues best practices for naming new human infectious diseases. 8 May 2015, https://www.who.int/mediacentre/news/notes/2015/naming-new-diseases/en/
• World Health Organization, World Health Organization Best Practices for the Naming of New Human Infectious Diseases. May 2015, https://apps.who.int/iris/bitstream/handle/10665/163636/WHO_HSE_FOS_15.1_eng.pdf (WHO_HSE_FOS_15.1)
• WHO best practices for naming of new human infectious diseases. www.who.int/topics/infectious_diseases/naming-new-diseases/en.
• Fukuda K, Wang R and Vallat B (2015) Naming diseases: First do no harm. Science 348(6235): 643–643. DOI: 10.1126/science.348.6235.643.
• Emergency use ICD codes for ‘2019-nCoV’ disease outbreak. https://www.who.int/classifications/icd/covid19/en/
• Wu F, Zhao S, Yu B, et al. (2020) A new coronavirus associated with human respiratory disease in China. Nature. DOI: 10.1038/s41586-020-2008-3.
• Alexander E. Gorbalenya, Susan C. Baker, Ralph S. Baric, Raoul J. de Groot, Christian Drosten, Anastasia A. Gulyaeva, Bart L. Haagmans, Chris Lauber, Andrey M Leontovich, Benjamin W. Neuman, Dmitry Penzar, Stanley Perlman, Leo L.M. Poon, Dmitry Samborskiy, Igor A. Sidorov, Isabel Sola, John Ziebuhr. Severe acute respiratory syndrome-related coronavirus: The species and its viruses – a statement of the Coronavirus Study Group. bioRxiv, doi: 10.1101/2020.02.07.937862.
• Zhang Zhihao.  13 February  2020. Naming of virus receives mixed review from scientists. China Daily. https://www.chinadailyhk.com/article/121010
• Li Q, Guan X, Wu P, et al. (2020) Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. New England Journal of Medicine. DOI: 10.1056/NEJMoa2001316.
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