Novel Coronavirus: What’s in a name?

Have you ever wondered how pandemics get their names? Is it a catch-phrase coined by copy writers inside a media board room or enthusiastic bloggers propagating a name for popular global events through social media hashtags as in case of ‘Arab Spring’ and ‘Yellow Vests’? How did 2019 nCOV get its name?

When a new human disease comes to notice and not all aspects of the disease are known to the public health authorities, a comprehensive nomenclature system like the International Classification of Disease (ICD) cannot be applied. A working nomenclature for diseases needs to be developed. This is where all intended or unintended mischief occurs.

Before the advent of binomial nomenclature for species and International Union of Pure and Applied Chemistry nomenclature for organic compounds, haphazard names were used, leading to widespread confusion.

A similar problem was encountered while naming a new disease. Haphazard and irresponsibly named epidemics often led to building up of stereotypes, caused offense and at times, contributed to mass hysteria. At times, names were not adequately informative about the new disease.

The recent attempt to name the nCov2019 outbreak as the ‘Wu Flu’ by some parties because of its association with Wuhan city in China can be quoted as an example of what damage a name can make. The epidemic may be brought under control but the cultural, social and economic damage due to a wrong name might last well beyond the epidemiological cycle.

It is all in the rules

So, the World Health Organization (WHO), in consultation and collaboration with the World Organisation for Animal Health and the Food and Agriculture Organization of the United Nations, has identified best practices for the naming of new human diseases.

This is done with the aim of minimising 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.

It says that generic descriptive terms can be used in any name. For instance, respiratory disease, hepatitis, neurologic syndrome, watery diarrhoea, enteritis. Specific descriptive terms should be used whenever the available information is considered sufficiently robust that the vast changes to the epidemiology or clinical picture are unlikely to occur. Plain terms are preferred to highly technical terms like progressive, juvenile, severe, winter.

If the causative pathogen is known, it should be used as part of the disease name with additional descriptors. The pathogen should not be directly equated with the disease as a pathogen may cause more than one disease like novel coronavirus respiratory syndrome for instance.

Names should be short (minimum number of characters) and easy to pronounce. For instance, H7N9, rabies, malaria, polio

Geographic locations like cities, countries, regions, continents — For instance Middle East Respiratory Syndrome, Spanish Flu, Rift Valley fever, Lyme disease, Crimean Congo haemorrhagic fever, Japanese encephalitis — should be avoided.

People’s names like Creutzfeldt-Jakob disease, Chagas disease and species or class of animal or food like swine flu, bird flu, monkey pox, equine encephalitis, paralytic shellfish poisoning should also be avoided.

Cultural, population, industry or occupational references like occupational, legionnaires, miners, butchers, cooks, nurses are also not desirable terms. Terms that incite undue fear unknown, death, fatal, epidemic should also be avoided.

‘Severe’ is appropriate to use for diseases with a very high initial case fatality rate (CFR), recognising that the CFR may decrease as an event progresses. For instance, SARS.

‘Novel’ can be used to indicate a new pathogen of a previously known type, recognising that this term will become obsolete if other new pathogens of that type are identified. For instance, nCOV.

A date (year, or month and year) may be used when it is necessary to differentiate between similar events that happened in different years.

The name assigned to a new human disease by WHO or other parties following the present best practices may or may not be confirmed by the International Classification of Diseases (ICD) at a later stage. The ICD, managed by WHO and endorsed by its member states, provides a final standard name for each human disease.

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