As a new kind of coronavirus grips China and makes its way to other parts of the world, scientists and the public alike are referring to it in different ways.
Naming a new infectious disease in humans can be tricky and contentious. Negative associations with a virus name can result in far-reaching implications on the social, cultural and economic fabric of a nation or community.
Currently, scientific groups, as well as the World Health Organization, are deliberating on the matter.
Around China, “Wuhan Pneumonia” or 武汉肺炎 has become a go-to shorthand. “Wu Flu” has also taken off on social media.
In the scientific community, "2019 novel coronavirus” — abbreviated as "2019-nCoV” — appears to be the dominant choice in name. That is how it was recently referenced in The Lancet and The New England Journal of Medicine.
Complicating matters, the full genome sequence of this new virus has been referred to as “Wuhan seafood market pneumonia virus,” and “Wuhan-Hu-1” in the open-access sequence database, GenBank.
Naming can get even more technical: Another database, GISAID, follows a convention that includes the location where a virus strain was found, its isolate designation (the unique genetic property of a particular virus) and the year it was identified.
So, what to formally call it?
"It’s really been interesting to me balancing all these things, how to get a name right so it’s accurate and it tells you how it’s related to other viruses, and [how to] make sure that it doesn’t put any negative connotations on people.”
“This kind of business is never totally trivial,” said Stanley Perlman, a professor of microbiology at the University of Iowa, and a member of a coronavirus study group. “It’s really been interesting to me balancing all these things, how to get a name right so it’s accurate and it tells you how it’s related to other viruses, and [how to] make sure that it doesn’t put any negative connotations on people.”
He and 10 others went back and forth all day last Thursday over what to recommend as the actual scientific name of this new virus. The study group is within the International Committee on Taxonomy of Viruses (ICTV), which often adopts a formal name after months — or more — of review.
The history of naming viruses
There is no official channel for naming diseases, but historically, it has been the scientists who discover a new pathogen who get first dibs on naming it, whether that be after a person or place.
The bacteria for plague, Yersinia pestis, was named in 1894 after its investigator, Alexandre Yierson.
Theodor Escherich gave the E. coli bacteria its name after himself in 1885 (E. stands for Escherichia).
“That was the big thing in the 19th century, to have things, diseases and so on, named after you. That was the sign of success in medicine."
“That was the big thing in the 19th century, to have things, diseases and so on, named after you. That was the sign of success in medicine,” said Howard Markel, a historian at the University of Michigan.
The Ebola virus was named after the Ebola River near the village in Democratic Republic of Congo, where it was first discovered in 1976. In many instances like this one, where it comes from, exactly, is still unknown.
“Heartland virus” is a tick-borne disease named by the doctor in Missouri who first found it in 2013.
But naming an infectious virus after a person or place has become poor practice. A rapid growth in global communication has upped the stakes, and fast forward to today, some now worry that widespread use of Wuhan could have a harmful effect.
“The people who live there are being unfairly associated with a virus,” Perlman said. “It’s not their fault.”
Wuhan refers to the name of the city in central China where the virus was first detected in humans, but when “Wuhan coronavirus” came up in the virus study group last week as a possible name, Perlman said, “it was thrown out immediately.”
That it’s still circulating so much on social media “needs to be addressed,” said Markel, acknowledging that it’s difficult to dictate what people tweet or say.
'First, do no harm'
The World Health Organization strongly discourages naming diseases after a specific person, place or thing, and the stance developed after observing the consequences of certain disease names in an era of increasingly fast communication.
“The use of names such as “swine influenza” and “Middle Eastern Respiratory Syndrome” (MERS) has had unintentional negative economic and social impacts by stigmatizing certain industries or communities,” wrote Keiji Fukada, Ren Wang and Bernard Vallet in a letter in 2015 titled, “Naming diseases: First do no harm,” in the journal Science.
That year, their respective organizations — the World Health Organization, the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health — issued guidelines for naming new human infectious diseases that have “a potential public health impact.”
The aim is 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.”
In 2009, the initial outbreak of H1N1 was called swine flu, but it “was a misnomer,” said Markel. “It really wasn't caused by pigs or anything like that. But everyone called it that.”
In turn, the pork industry took a hit, reporting a drop in sales.
MERS was identified in 2012 by scientists in the Netherlands and Saudi Arabia, where a lot of cases first emerged. Bart L. Haagmans, a virologist at Erasmus Medical Center in Rotterdam, recalled that initially there was an idea to include the initials S.A. in the name, for Saudi Arabia.
“But they don’t want this affiliation, that people think the virus is coming from that region, they don’t want this connection,” Haagmans said.
“Middle East” in the MERS name referred to a broader region, but still connected a contagious virus to a specific place.
Another cautionary example is the early days of AIDS and HIV. Early on it was called gay-related immune deficiency or GRID, or sometimes even “gay cancer.”
“Stigmatized group plus contagious disease equals bad stuff. ... People who are disenfranchised or are so-called undesirable groups — there's a long, long history of those people being blamed for the importation of that disease.”
“Stigmatized group plus contagious disease equals bad stuff,” Markel said. “People who are disenfranchised or are so-called undesirable groups — there's a long, long history of those people being blamed for the importation of that disease.”
Those who discovered Ebola chose not to name it after the actual Yambuku community in the northern DR Congo, where Ebola was discovered, over concerns that it would create a negative association with them.
Taking time to get the name right
When it comes to human diseases of “potential public health impact,” WHO may now take a more active role and issue an interim name for the disease if “an inappropriate name is released or used, or if a disease remains unnamed," according to WHO guidelines.
The agency has also outlined a list of the do's and don’ts when it comes to naming a disease and its acronym. It should be short and easy to pronounce, for example, malaria or polio. It’s also a good idea to include descriptive terms like “respiratory,” “neurologic,” “progressive” or “juvenile.” The specific cause of the disease, like a certain kind of virus or bacteria, should be part of the disease name, too. But that name should also include more specifics since viruses can cause more than one type of disease.
In an age of sophisticated technology, which includes faster and faster genome sequencing and more specific ways to detect and identify viruses, the art and science of naming diseases are changing, too.
H1N1 influenza stands for the type of hemagglutinin that is found in that virus, said Markel, though adding that “influenza” comes from the 15th-century reference when influenza epidemics were thought to be caused by otherworldly "influence.”
“It's an Italian word for the stars or the heavens or sometimes the devil,” he said.
Scientists also have a greater understanding of the properties of viruses nowadays and how they might be related to one another, all of which contribute to what they’re called.
“They don’t have names like John and Frank anymore,” Perlman said.
Scientists are referring to this new virus as a “coronavirus” because that is what it is in technical terms: a particular kind of virus that contains a single-stranded RNA genome and packages itself in a certain way to look like a crown.
“The reason it’s named coronavirus is because if you look at it under the microscope, particularly the electron microscope, you can see [the shape of] a corona that’s either the corona of the sun or the corona of a crown."
“The reason it’s named coronavirus is because if you look at it under the microscope, particularly the electron microscope, you can see [the shape of] a corona that’s either the corona of the sun or the corona of a crown,” Perlman said.
When it comes to “2019-nCoV,” 2019 refers to the year the virus was discovered, and the "n" refers to it being novel or new. Such a name follows WHO’s best practices for naming new human infectious diseases, according to a WHO spokesperson. But it’s not permanent. The virus may not always be a novel or new coronavirus as even more types are identified in the future.
A central point of this updated naming discussion, said Perlman, has been whether to support the inclusion of SARS in an updated name of this new coronavirus virus, such as “SARS-Coronavirus-2” or “SARS-like Coronavirus.”
That is because this coronavirus is also a close relative of the SARS coronavirus. SARS stands for “Severe Acute Respiratory Syndrome.” It first emerged in 2003 and quickly had an agreed-on name.
As Perlman points out, the name “immediately tells you the problem,” in terms of the actual characteristics of the illness. In the years since, several SARS-like coronaviruses have been identified, including the MERS-coronavirus in 2012.
But Perlman said that initially, he worried that including SARS might raise an undue public alarm.
“I’ve been talking to a lot of people, and the connotation of SARS is not positive, so I thought if we could keep SARS out of the title — out of the name right now — that might make it less of a scary virus,” he said.
SARS infected about 8,000 people and killed nearly 800 in 2003, but fast forward to today: it’s still not clear just how contagious or deadly this new virus is.
It can take time to get the name right, but that is also why in the end, a virus and a disease may actually have a couple of agreed-upon names: one that is more technical, that the scientific community uses, and one that is more common in public.
“The goal is to have something that’s probably in reality most useful for the scientific community, but then also can be referred to in a way that’s useful for the general public,” Perlman said. “So, influenza has these long names, but people call it the flu and we all understand that.”
Update as of Feb. 5, 2020: The World Health Organization has recommended an interim name for the novel coronavirus: "2019-nCoV acute respiratory disease." A final, official name will come later from the International Classification of Diseases. The WHO clarified that the name of this new virus is 2019-nCoV. The International Committee on Taxonomy of Viruses will make the final decision on a permanent name.