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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front.Virol.</journal-id>
<journal-title>Frontiers in Virology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front.Virol.</abbrev-journal-title>
<issn pub-type="epub">2673-818X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fviro.2022.875213</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Virology</subject>
<subj-group>
<subject>Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>SARS-CoV-2 and the Missing Link of Intermediate Hosts in Viral Emergence - What We Can Learn From Other Betacoronaviruses</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Schindell</surname>
<given-names>Brayden G.</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Allardice</surname>
<given-names>Meagan</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>McBride</surname>
<given-names>Jessica A.M.</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1677938"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dennehy</surname>
<given-names>Brendan</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Kindrachuk</surname>
<given-names>Jason</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/137706"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Laboratory for Emerging Viruses, Department of Medical Microbiology Infectious Diseases, University of Manitoba</institution>, <addr-line>Winnipeg, MB</addr-line>, <country>Canada</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Department of Biochemistry and Medical Genetics, University of Manitoba Winnipeg</institution>, <addr-line>MB</addr-line>, <country>Canada</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Martin H. Groschup, Friedrich-Loeffler-Institute, Germany</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Ivan Toplak, University of Ljubljana, Slovenia; Adam Cockrell, AavantiBio, Inc., United States</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Jason Kindrachuk, <email xlink:href="mailto:Jason.Kindrachuk@umanitoba.ca">Jason.Kindrachuk@umanitoba.ca</email>
</p>
</fn>
<fn fn-type="other" id="fn002">
<p>This article was submitted to Emerging and Reemerging Viruses, a section of the journal Frontiers in Virology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>07</day>
<month>07</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>2</volume>
<elocation-id>875213</elocation-id>
<history>
<date date-type="received">
<day>13</day>
<month>02</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>06</day>
<month>04</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2022 Schindell, Allardice, McBride, Dennehy and Kindrachuk</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Schindell, Allardice, McBride, Dennehy and Kindrachuk</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>The emergence of SARS-CoV-2 in 2019 has resulted in a global pandemic with devastating human health and economic consequences. The development of multiple vaccines, antivirals and supportive care modalities have aided in our efforts to gain control of the pandemic. However, the emergence of multiple variants of concern and spillover into numerous nonhuman animal species could protract the pandemic. Further, these events also increase the difficulty in simultaneously monitoring viral evolution across multiple species and predicting future spillback potential into the human population. Here, we provide historic context regarding the roles of reservoir and intermediate hosts in coronavirus circulation and discuss current knowledge of these for SARS-CoV-2. Increased understanding of SARS-CoV-2 zoonoses are fundamental for efforts to control the global health and economic impacts of COVID-19.</p>
</abstract>
<kwd-group>
<kwd>SARS-CoV-2</kwd>
<kwd>intermediate hosts</kwd>
<kwd>emergence</kwd>
<kwd>coronavirus</kwd>
<kwd>spillover</kwd>
<kwd>variants</kwd>
<kwd>zoonosis</kwd>
<kwd>reverse zoonosis</kwd>
</kwd-group>
<contract-sponsor id="cn001">Canada Research Chairs<named-content content-type="fundref-id">10.13039/501100001804</named-content>
</contract-sponsor>
<contract-sponsor id="cn002">Natural Sciences and Engineering Research Council of Canada<named-content content-type="fundref-id">10.13039/501100000038</named-content>
</contract-sponsor>
<contract-sponsor id="cn003">Canadian Institutes of Health Research<named-content content-type="fundref-id">10.13039/501100000024</named-content>
</contract-sponsor>
<contract-sponsor id="cn004">Mitacs<named-content content-type="fundref-id">10.13039/501100004489</named-content>
</contract-sponsor>
<counts>
<fig-count count="3"/>
<table-count count="1"/>
<equation-count count="0"/>
<ref-count count="261"/>
<page-count count="20"/>
<word-count count="11219"/>
</counts>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<title>Introduction</title>
<sec id="s1_1">
<title>History of <italic>Betacoronavirus</italic> Emergence</title>
<p>
<italic>Coronaviruses</italic> were first identified in 1937 with the identification of avian infectious bronchitis virus (<xref ref-type="bibr" rid="B1">1</xref>). The first human coronaviruses (HCoV) were discovered in 1967, and found to be predominantly associated with mild, self-limiting, cold-like illnesses: HCoV-OC43, a <italic>Betacoronavirus</italic> of subgenus <italic>embecovirus</italic> (also known as <italic>Betacoronavirus 1</italic>), and HCoV-229E, an <italic>Alphacoronavirus</italic> of subgenus <italic>Duvinacovirus</italic> (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B3">3</xref>). For more than three decades, HCoVs were not regarded as emerging global health threats (<xref ref-type="bibr" rid="B4">4</xref>). However, the emergence of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 rapidly changed this view; however, no cases have been identified since 2004 (<xref ref-type="bibr" rid="B5">5</xref>). In 2004, two additional HCoVs were identified - HCoV-NL63, an <italic>Alphacoronavirus</italic> of subgenus <italic>Setrecovirus</italic>, was identified and found to primarily infect children, the elderly and immunocompromised patients, followed by the identification of HCoV-HKU1, a <italic>Betacoronavirus</italic> of subgenus <italic>Embecovirus</italic>, in a patient admitted to hospital in early 2004 (<xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B7">7</xref>). Concerns regarding the global health threat of HCoVs were again fueled by the identification of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in humans in 2012; more than 2500 confirmed infections have subsequently been recorded with a case fatality rate of ~35% (<xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B9">9</xref>). At the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel <italic>Betacoronavirus</italic>, was identified from a cluster of patients in Wuhan, Hubei Province, China, and has subsequently resulted in a pandemic with devastating economic and public health impacts (<xref ref-type="bibr" rid="B10">10</xref>&#x2013;<xref ref-type="bibr" rid="B13">13</xref>). With three HCoVs that have had profound effects on global health having been identified in the last two decades, this demonstrates the pressing need to better understand the zoonotic origins and circulation patterns of these viruses (<xref ref-type="bibr" rid="B14">14</xref>).</p>
<p>The emergence of coronaviruses within the human population are believed to have occurred through spillover events from animal reservoirs, such as bats and rodents, to humans (<xref ref-type="bibr" rid="B15">15</xref>&#x2013;<xref ref-type="bibr" rid="B18">18</xref>). Reservoir hosts, wherein a pathogen can be maintained through persistent infection, may experience asymptomatic or mild infections while carrying the virus, the mechanism of which is still not well understood, but appears to be due to immune tolerance by the reservoir host (<xref ref-type="bibr" rid="B19">19</xref>).</p>
<p>4Transmission of viruses from a reservoir host to a susceptible host can occur directly or indirectly. Direct transmission occurs through direct contact with the reservoir host carrying the pathogen (<xref ref-type="bibr" rid="B20">20</xref>); this was observed during the SARS outbreak of 2003 when butchers at live animal markets in Guangdong province, China, had a higher infection rate than the general population (<xref ref-type="bibr" rid="B21">21</xref>). Indirect transmission occurs when the virus is shed by the reservoir host to the environment (e.g. airborne or vehicle) or to a vector (e.g. intermediate host) with the potential to be transmitted to humans (<xref ref-type="bibr" rid="B20">20</xref>). For example, during the first MERS outbreak in 2012, it is thought that bats infected with MERS-CoV shed the virus in their feces contaminating nearby water and food of domesticated camels (<xref ref-type="bibr" rid="B22">22</xref>). The camels are then thought to have transmitted MERS-CoV to the humans they came in contact with (<xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B23">23</xref>). The mechanisms by which these cross-species transmission events, or spillovers, occur varies depending on a number of factors such as intermediate host species, geographical locations, climate, and seasonal patterns (<xref ref-type="bibr" rid="B24">24</xref>). Many human activities, including urbanization, can increase contact between humans and reservoir/intermediary species and thus increase the likelihood of future spillover events (<xref ref-type="bibr" rid="B25">25</xref>). The coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 demonstrated the public health and economic tolls following the emergence of SARS-like-coronaviruses (SL-CoVs). In order to minimize the impact of future <italic>Betacoronavirus</italic> spillover events, we need to better understand the interactions between virus and reservoir, and subsequent interactions between animal reservoirs and humans (<xref ref-type="bibr" rid="B26">26</xref>). This review aims to compile and discuss available data on betacoronaviruses and their reservoir and intermediary hosts to highlight knowledge gaps and the importance of ongoing virus surveillance efforts.</p>
</sec>
<sec id="s1_2">
<title>SARS-CoV-2, COVID-19 and the Origins of Coronaviruses</title>
<p>In late December 2019, the first cluster of COVID-19 cases in Wuhan, China, was reported by the World Health Organization (WHO) (<xref ref-type="bibr" rid="B27">27</xref>&#x2013;<xref ref-type="bibr" rid="B29">29</xref>). While initially described as an atypical pneumonia and SARS-like illness, viral genome sequencing quickly identified the causative agent as a SARS-like coronavirus, initially termed nCoV-2019 but subsequently named SARS-CoV-2 (<xref ref-type="bibr" rid="B10">10</xref>, <xref ref-type="bibr" rid="B27">27</xref>, <xref ref-type="bibr" rid="B30">30</xref>). A unique feature that contributed to the rapid global spread of SARS-CoV-2 is the ability for the virus to spread prior to outward signs or symptoms of COVID-19 (<xref ref-type="bibr" rid="B31">31</xref>). Within four months of the initial outbreak, SARS-CoV-2 spread across the globe while governments rapidly instituted mitigation measures, including lockdowns and border closures, in an effort to reduce viral spread (<xref ref-type="bibr" rid="B32">32</xref>). Though the speed at which SARS-CoV-2 spread took the world by surprise, viral spillover events have been increasing in frequency in recent decades (<xref ref-type="bibr" rid="B33">33</xref>). Early analysis identified similarity of SARS-CoV-2 to bat coronaviruses, suggesting that SARS-CoV-2 may have originated as the result of a natural spillover event from bats to humans in late 2019 (<xref ref-type="bibr" rid="B34">34</xref>&#x2013;<xref ref-type="bibr" rid="B36">36</xref>). Genomic analyses were conducted on samples from nine patients exhibiting COVID-19 symptoms in Wuhan China (<xref ref-type="bibr" rid="B37">37</xref>). Eight of the nine tested patients had either visited or worked at a wet market in the region, which suggested that infections could have been acquired from contact with animals or food products sold at the market (<xref ref-type="bibr" rid="B38">38</xref>). There were two initial lineages of SARS-CoV-2 circulating in the early days of wet market circulation termed lineages A and B (<xref ref-type="bibr" rid="B29">29</xref>). Lineage B became the dominant lineage linked to early cases from the Hunan market, environmental samples at the time of identifying the outbreak and eventually spread globally (<xref ref-type="bibr" rid="B29">29</xref>). While lineage A was associated with cases at other markets in Hunan Province and other areas of China (<xref ref-type="bibr" rid="B29">29</xref> However, the identification of cases from early December not linked to the Huanan seafood market suggest that initial spillover occurred prior to subsequent cases that had contact with the market in mid-to-late December (<xref ref-type="bibr" rid="B29">29</xref>). The potential emergence of SARS-CoV-2 across multiple markets mirrors what occurred with the emergence of SARS-CoV with high levels of genetic diversity observed in both cities where SARS-CoV emerged (<xref ref-type="bibr" rid="B39">39</xref>&#x2013;<xref ref-type="bibr" rid="B41">41</xref>). This type of emergence pattern suggests SARS-CoV-2 emergence involved multiple contacts with infected animals/traders resulting in multiple spillover events (<xref ref-type="bibr" rid="B42">42</xref>). There is evidence to support this with potential infected or susceptible animals transported to/between Wuhan animal markets through supply chains (<xref ref-type="bibr" rid="B42">42</xref>). Based on recent models, the first SARS-CoV-2 case in Hubei Province likely occurred between mid-October to mid-November (<xref ref-type="bibr" rid="B43">43</xref>). Worobey and colleagues have recently provided supportive evidence that the Huanan market was the geographical epicentre for the pandemic based on both geospatial analysis of the earliest COVID-19 cases in humans as well as spatial analysis of SARS-CoV-2 positive environmental samples with vendors selling live animals (<xref ref-type="bibr" rid="B44">44</xref>). There are ongoing investigations into potential intermediate hosts of SARS-CoV-2 which will be discussed in detail in this review (<xref ref-type="bibr" rid="B36">36</xref>). The COVID-19 pandemic highlights the continual risks of cross-species transmission and spillover events that can rapidly lead to large-scale outbreaks due to the variability of host-pathogen dynamics and the unpredictability of emerging pathogens.</p>
</sec>
<sec id="s1_3">
<title>Virology of Betacoronaviruses</title>
<sec id="s1_3_1">
<title>Phylogeny and Genome</title>
<p>
<italic>Coronaviruses</italic> possess the largest genomes of all RNA viruses at 26 &#x2013; 32 kilobases (kb) in length (<xref ref-type="bibr" rid="B45">45</xref>). These are enveloped, single-stranded, positive-sense RNA viruses whose genomes contain at least 6 open reading frames (ORFs) that encode 16 non-structural proteins (NSP), 4 structural proteins, a 5&#x2019; cap structure and a 3&#x2019; poly (A) tail (<xref ref-type="bibr" rid="B46">46</xref>, <xref ref-type="bibr" rid="B47">47</xref>). The family <italic>Coronaviridae</italic> belongs to the order <italic>Nidovirales</italic> (<xref ref-type="bibr" rid="B48">48</xref>). Within the family <italic>Coronaviridae</italic> is the subfamily <italic>Orthocoronavirinae</italic> which is subdivided into four genera, each containing a type species: <italic>Alphacoronavirus (alphacoronavirus I), Betacoronavirus (murine coronavirus), Gammacoronavirus (avian coronavirus)</italic>, and <italic>Deltacoronavirus (bulbul coronavirus HKU11) (</italic>
<xref ref-type="bibr" rid="B46">46</xref>
<italic>)</italic>. This review will be focused on the Betacoronavirus genera which is divided into five subgenera: <italic>Embecovirus, Sarbecovirus, Merbecovirus, Nobecovirus</italic> and <italic>Hibecoviru</italic>s with <italic>Embecovirus, Sarbecovirus</italic> and <italic>Merbecovirus</italic> relevant to humans, as seen in <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref> (<xref ref-type="bibr" rid="B10">10</xref>, <xref ref-type="bibr" rid="B26">26</xref>, <xref ref-type="bibr" rid="B49">49</xref>&#x2013;<xref ref-type="bibr" rid="B51">51</xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>SARS-CoV-2 genome organization. ORF 1a and 1b translated to pp1a and pp1ab are the two polypepdies which are processed into the 16 nonstructual proteins. The four structural proteins are S, spike; E, envelope; M, membrane; N, nucleocapsid. Created with BioRender.com.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fviro-02-875213-g001.tif"/>
</fig>
</sec>
<sec id="s1_3_2">
<title>Structure and Replication</title>
<p>Betacoronaviruses have a helical nucleocapsid contained within spherical envelopes which are coated with characteristic S glycoproteins protruding from the surface of the envelope (<xref ref-type="bibr" rid="B47">47</xref>). When observed <italic>via</italic> cryo-transmission electron microscopy, the S proteins of the virus have the appearance of a crown, which is where the name coronavirus originates (<xref ref-type="bibr" rid="B48">48</xref>). Each spike on the envelope of betacoronaviruses is a homotrimer of the glycosylated S protein. Each monomer S protein contains an S1 binding domain and an S2 fusion domain catalyzing anchoring to the membrane (<xref ref-type="bibr" rid="B52">52</xref>). The S protein, a class-1 fusion protein, is processed through the Golgi apparatus where it is heavily glycosylated <italic>via</italic> an encoded N-terminal signal tag. The M protein, the most abundant protein in the envelope, consists of three transmembrane domains, all of which give the virion its spherical form as well as binding to the nucleocapsid, serving as the scaffold for the virion (<xref ref-type="bibr" rid="B53">53</xref>). The E protein consists of 2 domains functioning to assist in the assembly and release of the viral particle from the host cell. Lastly, the N protein consists of two domains allowing binding to the genomic RNA and formation of the nucleocapsid (<xref ref-type="bibr" rid="B54">54</xref>). Both the N-terminal and C-terminal domains have RNA binding capacity, however the mechanism by which binding occurs varies. Due to large amounts of observed phosphorylation of the C-terminal domain of the N protein, it is hypothesized that phosphorylation catalyzes a conformational change, increasing the binding affinity between the N protein and viral RNA (<xref ref-type="bibr" rid="B55">55</xref>). Phosphorylation of the N protein also acts to tether the replicase-transcriptase complex (RTC) to the viral genome during virion assembly (<xref ref-type="bibr" rid="B48">48</xref>). The structural proteins play critical roles in virulence and establishment of infections within reservoirs and other hosts by facilitating viral attachment and entry into host cells.</p>
<p>
<italic>Betacoronavirus</italic> genomes are positive sense and therefore in the same orientation as host mRNA. This allows for direct translation by the host to produce the two viral polyproteins (<xref ref-type="bibr" rid="B48">48</xref>) (pp1a and pp1ab) which are then cleaved into the 16 NSPs (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2</bold>
</xref>). Some non-structural proteins exhibit host suppression, for example nsp3 and nsp16 seem to block the interferon-mediated immune response through inhibition of interferon (IFN) pathways (<xref ref-type="bibr" rid="B56">56</xref>). Through degradation of host mRNA and suppressing translation of host proteins, nsp1 contributes to the regulation of host cells and the immune response, while also promoting viral production (<xref ref-type="bibr" rid="B57">57</xref>). The use of 5&#x2019; caps on the viral genome is involved in immune evasion, by disguising as host mRNA which does not activate pattern recognition receptor pathways that would normally lead to the destruction of viral RNA (<xref ref-type="bibr" rid="B58">58</xref>, <xref ref-type="bibr" rid="B59">59</xref>). The S protein is critical in viral infection as this is the protein responsible for binding and gaining entry into host cells (<xref ref-type="bibr" rid="B60">60</xref>).</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>Phylogeneic tree of relevant Orthocoronaviruses. Phylogenetic tree with representative species CoVs. Virus names: HKU, coronavirus identified at Hong Kong University; HCoV, human coronavirus; MERS, Middle Eastern respiratory syndrome; MHV, murine hepatitis virus; SARS, severe acute respiratory syndrome; SL, SARS-like; TGEV, transmissible gastroenteritis virus. Created with BioRender.com.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fviro-02-875213-g002.tif"/>
</fig>
</sec>
<sec id="s1_3_3">
<title>
<italic>Betacoronavirus</italic> Host Range</title>
<p>The host specificity of betacoronaviruses is determined by their S protein, which binds host receptors that include aminopeptidase N, angiotensin converting enzyme 2 (ACE2) and dipeptidyl peptidase 4 (DPP4) in order to gain entry to host cells (<xref ref-type="bibr" rid="B61">61</xref>). Receptor-recognition of the S protein is facilitated by the S1 domain, which is composed of the N-terminal domain (NTD) and C-terminal domain (CTD) (<xref ref-type="bibr" rid="B62">62</xref>). The NTD is involved in receptor recognition whereas the CTD contains the receptor-binding domain (RBD) that binds the host cell receptor and determines specificity (<xref ref-type="bibr" rid="B63">63</xref>). In the case of SL-CoVs, there is a strong binding affinity between the viral S protein and the host cell receptor ACE2 (<xref ref-type="bibr" rid="B52">52</xref>), whereas MERS-like coronaviruses have a strong binding affinity to the DPP4 receptor in the host (<xref ref-type="bibr" rid="B64">64</xref>). Reservoir species, such as bats, have a protein homologous to the human ACE2 receptor which may enable transmission of SL-CoVs from bats to humans (<xref ref-type="bibr" rid="B65">65</xref>). As different SL-CoVs have varying binding affinity to ACE2 receptors, intermediate host infections can facilitate viral mutation of S protein allowing recognition and binding of ACE2 receptor in humans (<xref ref-type="bibr" rid="B66">66</xref>). Following binding of the S protein to its host cell receptor and endosomal uptake of the virus into the cell, the viral genome is subsequently released into the cytoplasm for transcription and replication (<xref ref-type="bibr" rid="B67">67</xref>).</p>
<p>ACE2 is the receptor used for cell entry by many <italic>Sarbecoviruses</italic>, including SARS-CoV and SARS-CoV-2 (<xref ref-type="bibr" rid="B65">65</xref>). ACE2 is a type-I transmembrane protein found in epithelial cells of the lung, vascular endothelial cells, and renal tubular epithelium (<xref ref-type="bibr" rid="B68">68</xref>, <xref ref-type="bibr" rid="B69">69</xref>). This receptor plays an important role in cardiac pathophysiology acting as a negative regulator of the Renin-angiotensin pathway in the lung, which regulates blood pressure and electrolyte levels (<xref ref-type="bibr" rid="B70">70</xref>). Numerous studies have been done to investigate the role of ACE2 in SARS-CoV infection. For example, viral loads in <italic>ACE2</italic> knockout mice were far lower than those in the wild-type control mice, suggesting the virus was unable to enter host cells without ACE2 (<xref ref-type="bibr" rid="B71">71</xref>). The ability of the S protein to bind ACE2 is largely dependent on the affinity of the viral RBD - which may vary due to mutations in this area of the genome (<xref ref-type="bibr" rid="B39">39</xref>, <xref ref-type="bibr" rid="B66">66</xref>, <xref ref-type="bibr" rid="B72">72</xref>). Researchers were able to show that minor variations within the S protein in the RBD of <italic>Sarbecoviruses</italic> can lead to binding of ACE2 receptors in other animals (intermediate hosts) and humans (<xref ref-type="bibr" rid="B73">73</xref>). Investigating the S protein variability within different <italic>Sarbecoviruses</italic> and SL-CoVs has allowed for greater understanding of how cross-species transmission occurs.</p>
</sec>
</sec>
</sec>
<sec id="s2">
<title>Mechanisms of <italic>Betacoronavirus</italic> Emergence</title>
<sec id="s2_1">
<title>
<italic>Betacoronavirus</italic> Spillover Events, Sylvatic Cycles and Synanthropy</title>
<p>There are many examples of coronavirus spillover from intermediate hosts from recent history (<xref ref-type="bibr" rid="B23">23</xref>, <xref ref-type="bibr" rid="B26">26</xref>, <xref ref-type="bibr" rid="B47">47</xref>, <xref ref-type="bibr" rid="B74">74</xref>). Many betacoronaviruses are known to originate from bats, including SARS-CoV, BtCoV-WIV1, MERS-CoV, BtCoV-HKU4, BtCoV-HKU5, and Ro-BtCoV-HKU9 (<xref ref-type="bibr" rid="B74">74</xref>&#x2013;<xref ref-type="bibr" rid="B77">77</xref>). Since &gt;70% of emerging infectious diseases are zoonotic in origin (<xref ref-type="bibr" rid="B78">78</xref>), human-animal interfaces, such as transitional zones bordering wild habitats, are an important factor that should be considered when analyzing viral emergence (<xref ref-type="bibr" rid="B79">79</xref>). Li and colleagues assessed bat coronavirus spillover potential in rural districts of Southern China and found serological evidence of SL-CoV antibodies despite the low probability of community exposure to SARS-CoV (<xref ref-type="bibr" rid="B79">79</xref>). It was determined that any antibodies detected were likely the result of SL-CoV exposure by cross-species transmission from bats, which are known hosts for these viruses (<xref ref-type="bibr" rid="B79">79</xref>). In this example, it had been reported that bats were living within the community which would increase the opportunity for spillover. This is one of many communities that are found within transitional zones, a number that is rapidly increasing due to the encroachment of humans on shrinking wild habitats.</p>
<p>Human incursion into wild habitats is facilitated through activities such as farming, wild animal hunting and rapid transportation (<xref ref-type="bibr" rid="B80">80</xref>&#x2013;<xref ref-type="bibr" rid="B82">82</xref>). These activities have a direct effect on the circulation of zoonotic pathogens between their reservoir hosts, intermediate hosts and humans; this is referred to as the sylvatic cycle (<xref ref-type="bibr" rid="B83">83</xref>&#x2013;<xref ref-type="bibr" rid="B85">85</xref>). Sylvatic cycles are also affected by climate change as global warming can broaden habitat ranges, allowing species to migrate into geographical locations they previously did not inhabit (<xref ref-type="bibr" rid="B25">25</xref>). Broadening of these habitat ranges can lead to increased interactions with humans which increases the probability of a spillover event (<xref ref-type="bibr" rid="B86">86</xref>). Human-wildlife interactions will likely continue to increase and therefore the rate of zoonotic pathogen emergence will also increase if these factors are not controlled.</p>
</sec>
<sec id="s2_2">
<title>Asymptomatic Nature of Infections in Bats and Implications for Spillover Events</title>
<p>The evidence of bats harbouring and propagating virus while exhibiting little to no signs of disease when considered with the diversity of bat CoVs and close relationship to HCoVs make a case for bats to be considered the reservoir for CoVs (<xref ref-type="bibr" rid="B36">36</xref>, <xref ref-type="bibr" rid="B87">87</xref>, <xref ref-type="bibr" rid="B88">88</xref>). Horseshoe bats (<italic>Rhinolophus</italic>) are the most relevant natural CoV host demonstrated through the diversity of SL-CoVs discovered in several species in Africa, Asia and Europe (<xref ref-type="bibr" rid="B89">89</xref>&#x2013;<xref ref-type="bibr" rid="B91">91</xref>). It is not well understood how or why this occurs and therefore, the current research focuses on elucidating the underlying molecular mechanisms through the use of bat cells (<xref ref-type="bibr" rid="B15">15</xref>). The work so far suggests that there is early cellular recognition and response to viral replication coupled with moderate suppression of the immune system to tolerate low level infection by these viruses (<xref ref-type="bibr" rid="B92">92</xref>). Adaptation of immune system functioning, including variations in the expression levels of type I IFNs, has been demonstrated in different bat species. This may be due to co-evolution resulting from the long-term presence of these viruses among bat species (<xref ref-type="bibr" rid="B93">93</xref>). Major histocompatibility complex class one molecules (MHC I) have been found to differ among bat species in both the presentation and structure providing a partial explanation for the different levels of pathogenesis observed in bats (<xref ref-type="bibr" rid="B94">94</xref>). Among the differences observed, variations in the MHC I peptide binding groove that recognize distinct peptide epitopes are linked to alterations of bat immune responses (<xref ref-type="bibr" rid="B94">94</xref>). Immune suppression by the host in addition to viral evasion of the host&#x2019;s immune system allows for viral replication to continue uninterrupted, which in turn leads to increased viral shedding (<xref ref-type="bibr" rid="B95">95</xref>). These processes are integral to spillover events and thus understanding the complex relationship between the host and the virus is a key part of the transmission dynamic of which our understanding is severely lacking. Further research, specifically <italic>in vivo</italic> studies, are needed to further our understanding of the molecular mechanisms behind this suppression of symptomatic viral infections observed in numerous bat species.</p>
</sec>
</sec>
<sec id="s3">
<title>Evidence for Origins of Betacoronaviruses</title>
<sec id="s3_1">
<title>Embecoviruses</title>
<p>Human <italic>Embecoviruses</italic> (previously lineage A <italic>Betacoronaviruses</italic>) consist of HCoV-OC43 and HCoV-HKU1. Both HCoVs are globally endemic and most often present clinically as the common cold through upper respiratory tract infections (<xref ref-type="bibr" rid="B16">16</xref>). Rarely these viruses can cause more severe illnesses such as pneumonia, especially in immunocompromised individuals (<xref ref-type="bibr" rid="B96">96</xref>) and detection of HCoV-OC43 in patients with encephalitis hints that this virus has limited neuroinvasive capacity (<xref ref-type="bibr" rid="B97">97</xref>&#x2013;<xref ref-type="bibr" rid="B99">99</xref>). Studies suggest both HCoV-OC43 and HCoV-HKU1 originated from rodents (<xref ref-type="bibr" rid="B42">42</xref>). This notion has gained support through the discovery of <italic>Embecoviruses</italic> in rats from Norway and south western China (<xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B100">100</xref>&#x2013;<xref ref-type="bibr" rid="B102">102</xref>) in addition to the high degree of sequence homology of HCoV-HKU1 and mouse hepatitis virus (MHV) (<xref ref-type="bibr" rid="B16">16</xref>). Further evidence came with the identification of China Rattus CoV HKU24, an <italic>Embecovirus</italic> found in Norwegian rats in 2015 and it is believed to represent a lineage of CoVs that were present before HCoV-OC43 spilled over into humans in the late 1800s (<xref ref-type="bibr" rid="B100">100</xref>). This occupies an early branch of the <italic>Embecovirus</italic> subgenera and provides more support to suggest that rodents may be an important and understudied reservoir for <italic>Embecoviruses.</italic>
</p>
</sec>
<sec id="s3_2">
<title>Sarbecoviruses</title>
<sec id="s3_2_1">
<title>SARS-CoV</title>
<p>The <italic>Sarbecoviruses</italic> consist of SARS-CoV and SARS-CoV-2, two of the most pathogenic coronaviruses identified to date (<xref ref-type="bibr" rid="B103">103</xref>). SARS-CoV was originally believed to have emerged from <italic>Paguma larvata</italic> (masked palm civets) after a case of SARS transmission from masked palm civets to humans (<xref ref-type="bibr" rid="B83">83</xref>, <xref ref-type="bibr" rid="B104">104</xref>). However, this changed in 2005 when SL-CoVs were discovered in <italic>Chiroptera</italic> spp. bats, suggesting that bats may be the true reservoir for SARS-CoV (<xref ref-type="bibr" rid="B105">105</xref>) and that civets may instead be an intermediary host. This is not entirely a surprise as there are many coronaviruses which have been identified in various bat species, and SL-CoVs have been found in bat species such as <italic>Rhinolophus</italic> spp., <italic>Hipposideros</italic> spp. and <italic>Chaerophon</italic> spp. (<xref ref-type="bibr" rid="B5">5</xref>, <xref ref-type="bibr" rid="B89">89</xref>, <xref ref-type="bibr" rid="B104">104</xref>, <xref ref-type="bibr" rid="B106">106</xref>). More specifically, SL-CoVs that bind ACE2 to mediate cell entry have been found in <italic>Rhinolophus sinicus</italic> (Chinese horseshoe bats) (<xref ref-type="bibr" rid="B65">65</xref>, <xref ref-type="bibr" rid="B107">107</xref>). Further, in 2017 there were 11 new SL-CoVs identified in <italic>Rhinolophus sinicus</italic> bats from a cave in Yunnan province, China that shared 92-99% sequence homology to SARS-CoV (<xref ref-type="bibr" rid="B91">91</xref>). Today, <italic>Rhinolophus sinicus</italic> is considered the main reservoir of SL-CoVs and should likely be considered the origin point of SARS-CoV as well (<xref ref-type="bibr" rid="B108">108</xref>).</p>
</sec>
<sec id="s3_2_2">
<title>SARS-CoV-2</title>
<p>While SARS-CoV-2 has not been identified in bats to date bats are known to be an original source of alpha- and betacoronaviruses, with other Sarbecoviruses similar to SARS-CoV-2 known to be harboured in <italic>Rhinolophus</italic> spp. bats (<xref ref-type="bibr" rid="B109">109</xref>, <xref ref-type="bibr" rid="B110">110</xref>). However there remain only speculations about the origins of SARS-CoV-2 with no direct evidence for the original source, leaving room unfortunately for wild hypotheses around the origins of this virus. The existence of a major virology laboratory (Wuhan Institute of Virology) with a program studying coronaviruses in the city where SARS-CoV-2 was first identified proved to be too large a coincidence for some, subsequently birthing several lab origin hypotheses (<xref ref-type="bibr" rid="B14">14</xref>). The first claim is of the virus being of manmade origin involves the observation of human immunodeficiency virus (HIV) sequences in the SARS-CoV-2 genome in a now retracted article by Pradhan et&#xa0;al. and again in another article (<xref ref-type="bibr" rid="B111">111</xref>). These findings were quickly refuted through bioinformatic analyses demonstrating the four short sequences occurred at different times and independent of each other and are insufficient evidence for a common ancestor (<xref ref-type="bibr" rid="B112">112</xref>, <xref ref-type="bibr" rid="B113">113</xref>). Similarly there have been hypotheses around creation of a virus through gain of function experiments with both recombination and engineered mutations through serial passaging in animal models to obtain these changes to a SL-CoV suggested as possible routes of engineering this recombinant virus (<xref ref-type="bibr" rid="B114">114</xref>, <xref ref-type="bibr" rid="B115">115</xref>). However, many of these proposed mutations may be present in other coronaviruses such as the furin cleavage site observed in the RBD of SARS-CoV-2 or a N501Y mutation that would have occurred for efficient replication in animal models (which was not observed in the early stages of the pandemic) and there remains no evidence of engineering within the RBD with the only explanation for their presence being viral evolution (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B34">34</xref>, <xref ref-type="bibr" rid="B116">116</xref>&#x2013;<xref ref-type="bibr" rid="B121">121</xref>). There has been concern that the emergence of the virus into the human population may have resulted from a laboratory release. The two main hypotheses are, SARS-CoV-2 was created through gain of function experiments on related viruses <italic>via</italic> serial passaging though this has been refuted (<xref ref-type="bibr" rid="B34">34</xref>, <xref ref-type="bibr" rid="B122">122</xref>, <xref ref-type="bibr" rid="B123">123</xref>). The second hypothesis has posited that an accidental laboratory release of SARS-CoV-2 precipitated movement of the virus from the laboratory to the community though this has also been refuted (<xref ref-type="bibr" rid="B29">29</xref>, <xref ref-type="bibr" rid="B122">122</xref>). Recent investigation of SARS-CoV-2 genomic diversity by Pekar and colleagues has provided evidence to support the emergence of SARS-CoV-2 through multiple zoonotic events (<xref ref-type="bibr" rid="B124">124</xref>). The analysis supports that SARS-CoV-2 lineages A and B resulted from at least two separate spillover events into humans in late 2019.</p>
<p>However, despite these hypotheses there are historical patterns of zoonotic emergence and circulation for coronaviruses as well as the increasing identification of SARS-CoV-2 in numerous nonhuman animal species (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B125">125</xref>). This is supported by the similarity in the route to human exposure through animal markets as this follows previous coronavirus outbreaks (<xref ref-type="bibr" rid="B39">39</xref>). There remains much to be understood about SARS-CoV-2 spillover into humans, and much of our current understanding has relied on epidemiological modeling. Molecular clock modeling of the genome for SARS-CoV-2 and the subsequent mutations suggest a recent emergence, some suggest however, this may not be true due to the highly mutated state of the genome and the effect this may have had on the linearity of the analysis (<xref ref-type="bibr" rid="B126">126</xref>&#x2013;<xref ref-type="bibr" rid="B128">128</xref>). As a recent phylogenetic analysis suggests that the lineage of SL-CoVs that SARS-CoV-2 originates from diverged from ancestral bat CoVs sometime between 1948-1982 leaving the door open to the possibility of circulation under the radar (<xref ref-type="bibr" rid="B103">103</xref>). It is also unknown if a bat was the only animal involved in the evolution and emergence of SARS-CoV-2. Ongoing and future studies will continue to provide context and nuance for these questions.</p>
<p>In 2020, a group of researchers collected and sequenced samples from <italic>Rhinolophus</italic> spp. bats in Yunnan province, China, to better understand the zoonotic origins of SARS-CoV-2. Of interest, two bat CoVs had high nucleotide sequence homology to the full-length genome of SARS-CoV-2: RaTG13 (96.1%) and RmYN02 (93.3%) (<xref ref-type="bibr" rid="B129">129</xref>, <xref ref-type="bibr" rid="B130">130</xref>). These viruses were collected from <italic>Rhinolophus affinis</italic> and <italic>Rhinolophus malayanus</italic> bats, respectively. While RaTG13 maintained high nucleotide sequence homology to the S gene (92.9%) and the RBD (85.3%), RmYN02 showed far lower sequence homology for the S gene (71.9%) and RBD (61.3%). In contrast, they also compared Pangolin viruses GD/2019 and GX/P5L/2017 to SARS-CoV-2 and found lower levels of nucleotide homology for the whole genome (GX/P5L/2017 = 85.2%) but high levels of amino acid sequence homology in the S gene (GX/P5L/2017 = 92.4% and GD/2019 = 90.7%) and RBD (GD/2019 = 97.4% and GX/P5L/2017 = 86.8%) (<xref ref-type="bibr" rid="B130">130</xref>, <xref ref-type="bibr" rid="B131">131</xref>). It seems that while pangolins may have been involved in a recombination event affecting the RBD, the high level of homology between the genome sequences of SARS-CoV-2 and bat CoVs suggest that the virus originated from bats rather than pangolins (<xref ref-type="bibr" rid="B132">132</xref>, <xref ref-type="bibr" rid="B133">133</xref>).</p>
<p>To further investigate the bat origin hypothesis, investigations have assessed the selective pressures driving viral adaptation and evolution. MacLean and colleagues identified weak purifying selection among SARS-CoV-2 strains from the first 11 months of the pandemic (<xref ref-type="bibr" rid="B36">36</xref>). For the spike protein, diversifying selection occurred deeper in the phylogenetic branches of the <italic>Sarbecovirus</italic> clade, leading to a very generalist SARS-CoV-2 virus and is supported by the wide host range (<xref ref-type="bibr" rid="B36">36</xref>, <xref ref-type="bibr" rid="B134">134</xref>). Others have suggested that the closest ancestral divergence of this virus is likely to be approximately four or five decades ago, based on similarities to bat CoVs RmYN02 and RaTG13, respectively (<xref ref-type="bibr" rid="B135">135</xref>, <xref ref-type="bibr" rid="B136">136</xref>). Additionally, investigations have looked at the CG suppression within the viral genome (cytosine followed by a guanine in the 5&#x2019; to 3&#x2019; direction) due to their link to antiviral mechanisms in the host (<xref ref-type="bibr" rid="B137">137</xref>). Many vertebrate RNA viruses demonstrate similar patterns of 5&#x2019;-CG-3&#x2019; dinucleotide suppression, where there is a lower number of CG dinucleotides than expected, as found within vertebrate genomes (<xref ref-type="bibr" rid="B137">137</xref>). Further, Takata and colleagues suggested that this suppression may highlight an adaptation with RNA viruses to evade host immunity through reduced discrimination of self- and non-self RNA (<xref ref-type="bibr" rid="B137">137</xref>). Analysis of the <italic>Sarbecovirus</italic> clades identified a phylogenetic shift towards CG suppression followed by an elevated substitution rate (<xref ref-type="bibr" rid="B36">36</xref>). This suggests an increase in selective pressure in the surrounding environment at the time (<xref ref-type="bibr" rid="B138">138</xref>, <xref ref-type="bibr" rid="B139">139</xref>). These evolutionary factors taken together suggest that the virus evolved prior to the spillover event into humans, rather than through human-to-human infection during the pandemic (<xref ref-type="bibr" rid="B103">103</xref>). Thus, it is likely that SARS-CoV-2 was highly capable of infecting humans prior to the spillover event which led to the first COVID-19 case (<xref ref-type="bibr" rid="B140">140</xref>). Adding to this, the fact that SARS-CoV-2 can transmit readily to other animals (mink, cats, dogs, etc) - and in some cases transmit back to humans (mink) - supports the possibility of a generalist virus, where the virus already contained generalist ACE2 binding properties that could aid in efficient host switch across multiple intermediate animal species (<xref ref-type="bibr" rid="B139">139</xref>, <xref ref-type="bibr" rid="B141">141</xref>).</p>
</sec>
</sec>
<sec id="s3_3">
<title>Merbecoviruses</title>
<p>The <italic>Merbecoviruses</italic> (formerly lineage C betacoronaviruses) consist of MERS-CoV, the only known <italic>Merbecovirus</italic> to infect humans, as well as several bat CoVs including HKU4 and HKU5 (<xref ref-type="bibr" rid="B61">61</xref>). The Egyptian tomb bat, <italic>Taphozous perfortus</italic> is believed to be the reservoir species for MERS-CoV (<xref ref-type="bibr" rid="B142">142</xref>). Fecal samples collected from a trapped Egyptian tomb bat tested positive for MERS-CoV in the same region that the MERS-CoV index patient was found (<xref ref-type="bibr" rid="B143">143</xref>). These findings have been supported by studies demonstrating that the bat receptor dipeptidyl-peptidase 4 (DPP4) potentially co-evolved with MERS-CoV, supporting Egyptian tomb bats as an appropriate reservoir for MERS-CoV (<xref ref-type="bibr" rid="B102">102</xref>). HK4U and HK5U share over 65% amino acid sequence identity to MERS-CoV (<xref ref-type="bibr" rid="B61">61</xref>, <xref ref-type="bibr" rid="B144">144</xref>); HKU4 was first identified in lesser bamboo bats, while HKU5 has been found to circulate in Japanese pipistrelle bats (<xref ref-type="bibr" rid="B7">7</xref>). Using molecular clock analysis, studies have shown MERS-CoV, HKU4, and HKU5 have a common ancestor as recently as several centuries ago (<xref ref-type="bibr" rid="B100">100</xref>). Due to this phylogenetic ancestry, researchers believe the possibility of a species jump is high enough to warrant further surveillance (<xref ref-type="bibr" rid="B61">61</xref>, <xref ref-type="bibr" rid="B145">145</xref>).</p>
</sec>
</sec>
<sec id="s4">
<title>Intermediate Hosts of Betacoronaviruses and Their Role in Spillover Events</title>
<p>It is generally accepted that HCoV spillover to humans is often facilitated through an intermediate host (<xref ref-type="bibr" rid="B4">4</xref>, <xref ref-type="bibr" rid="B102">102</xref>). Intermediate hosts are animals that are biologically similar to the natural reservoir host and more frequently come in contact with humans; therefore, these hosts allow for opportunity to mutate to a form that is more easily transmissible to humans (<xref ref-type="bibr" rid="B146">146</xref>). There is some consensus on the intermediate hosts of three of the five human betacoronaviruses: SARS-CoV (masked palm civets), MERS-CoV (camelids) and HCoV-OC43 (bovine) (<xref ref-type="bibr" rid="B21">21</xref>, <xref ref-type="bibr" rid="B74">74</xref>, <xref ref-type="bibr" rid="B147">147</xref>). The same cannot be said for the remaining two HCoVs, HCoV-HKU1 and SARS-CoV-2, where intermediate hosts are the subject of continuing investigation. It is thought that each of these viruses have individually spilled over into intermediate hosts facilitating zoonotic transfer to humans (<xref ref-type="bibr" rid="B130">130</xref>, <xref ref-type="bibr" rid="B132">132</xref>). The known and proposed intermediate hosts of human betacoronaviruses are presented in the following sections. Nonhuman animal species that have been reported to be susceptible to <italic>Betacoronavirus</italic> infection are presented in <xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>.</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>Nonhuman animal species identified to be susceptible to <italic>Betacoronavirus</italic> infection. Source of evidence, confirmation of infection and suggested role in viral transmission are provided.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" align="left">Viral Genus</th>
<th valign="top" align="center">Viral species</th>
<th valign="top" align="center">Host Species</th>
<th valign="top" align="center">Latin name</th>
<th valign="top" align="center">Infection Evidence</th>
<th valign="top" align="center">Suggested Role</th>
<th valign="top" align="center">Evidence </th>
<th valign="top" align="center">References</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">
<italic>Embecovirus</italic>
</td>
<td valign="top" align="left">HCoV-OC43</td>
<td valign="top" align="left">Rodents</td>
<td valign="top" align="left">
<italic>Rodentia</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Reservoir host</td>
<td valign="top" align="left">Hypothesized</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B102">102</xref>, <xref ref-type="bibr" rid="B148">148</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HCoV-OC43</td>
<td valign="top" align="left">Cattle</td>
<td valign="top" align="left">
<italic>Bos taurus</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Hypothesized</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B102">102</xref>, <xref ref-type="bibr" rid="B148">148</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HCoV-OC43</td>
<td valign="top" align="left">Llama</td>
<td valign="top" align="left">
<italic>Llama glama</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B149">149</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HCoV-OC43</td>
<td valign="top" align="left">Alpacas</td>
<td valign="top" align="left">
<italic>Llama pacos</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B149">149</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HCoV-OC43</td>
<td valign="top" align="left">Guanaco</td>
<td valign="top" align="left">
<italic>Llama guanicoe</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B149">149</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HCoV-OC43</td>
<td valign="top" align="left">Bactrian camels</td>
<td valign="top" align="left">
<italic>Camelus bactrianus</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B149">149</xref>
</td>
</tr>
<tr>
<td valign="top" align="left">&#xa0;</td>
<td valign="top" align="left">HCoV-HKU1</td>
<td valign="top" align="left">Rodents</td>
<td valign="top" align="left">
<italic>Rodentia</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Reservoir host</td>
<td valign="top" align="left">Hypothesized</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B150">150</xref>
</td>
</tr>
<tr>
<td valign="top" align="left">
<italic>Sarbecovirus</italic>
</td>
<td valign="top" align="left">SARS-CoV</td>
<td valign="top" align="left">Horseshoe bats</td>
<td valign="top" align="left">
<italic>Rhinolophus</italic>
</td>
<td valign="top" align="left">Natural (hypothesized)</td>
<td valign="top" align="left">Reservoir host</td>
<td valign="top" align="left">Hypothesized</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B5">5</xref>, <xref ref-type="bibr" rid="B106">106</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV</td>
<td valign="top" align="left">Palm civets</td>
<td valign="top" align="left">
<italic>Paradoxurus hermaphroditus</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Isolates closely matched patients</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B21">21</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV</td>
<td valign="top" align="left">Racoon dogs</td>
<td valign="top" align="left">
<italic>Nyctereutes procyonoides</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Evidence for infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B151">151</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV</td>
<td valign="top" align="left">Ferrets</td>
<td valign="top" align="left">
<italic>Mustela furo</italic>
</td>
<td valign="top" align="left">Experimetal</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B152">152</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV</td>
<td valign="top" align="left">Chinese ferret badgers</td>
<td valign="top" align="left">
<italic>Melogale moschata</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B151">151</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV</td>
<td valign="top" align="left">Domestic cats</td>
<td valign="top" align="left">
<italic>Felis catus</italic>
</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Dead end host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B152">152</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Horseshoe bats</td>
<td valign="top" align="left">
<italic>Rhinolophus</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Reservoir host</td>
<td valign="top" align="left">Hypothesized</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B132">132</xref>, <xref ref-type="bibr" rid="B133">133</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Malayan pangolins</td>
<td valign="top" align="left">
<italic>Manis javanica</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Hypothesized</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B153">153</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">White tailed deer</td>
<td valign="top" align="left">
<italic>Odocoileus virginianus</italic>
</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Experimental infection/</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B154">154</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Domestic cats</td>
<td valign="top" align="left">
<italic>Felis catus</italic>
</td>
<td valign="top" align="left">Both</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B155">155</xref>; <xref ref-type="bibr" rid="B156">156</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Rabbits</td>
<td valign="top" align="left">
<italic>Oryctolagus cuniculus</italic>
</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B157">157</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Bank voles</td>
<td valign="top" align="left">
<italic>Myodes glareolus</italic>
</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B158">158</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Syrian gold hamsters</td>
<td valign="top" align="left">
<italic>Mesocricetus auratus</italic>
</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B159">159</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Deer mice</td>
<td valign="top" align="left">
<italic>Peromyscus maniculatus</italic>&#xa0;</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B160">160</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Bushy tailed wood rats</td>
<td valign="top" align="left">
<italic>Neotoma cinerea</italic>
</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B160">160</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Skunks</td>
<td valign="top" align="left">
<italic>Mephitis</italic>
</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B160">160</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Mice</td>
<td valign="top" align="left">
<italic>Mus musculus</italic>
</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B161">161</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Racoon dogs</td>
<td valign="top" align="left">
<italic>Nyctereutes procyonoides</italic>
</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B162">162</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Rhesus macaque</td>
<td valign="top" align="left">
<italic>Macaca mulatta</italic>
</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Dead end host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B163">163</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Cattle</td>
<td valign="top" align="left">
<italic>Bos taurus</italic>
</td>
<td valign="top" align="left">Experimental</td>
<td valign="top" align="left">Dead end host</td>
<td valign="top" align="left">Experimental infection</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B164">164</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Tigers</td>
<td valign="top" align="left">
<italic>Panthera tigris</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Dead end host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B165">165</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Dogs</td>
<td valign="top" align="left">
<italic>Canis familiaris</italic>
</td>
<td valign="top" align="left">Both</td>
<td valign="top" align="left">Dead end host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B166">166</xref>; <xref ref-type="bibr" rid="B156">156</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Snow leopards</td>
<td valign="top" align="left">
<italic>Panthera uncia</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Dead end host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B165">165</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Gorillas</td>
<td valign="top" align="left">
<italic>Gorilla gorilla</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Dead end host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B165">165</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Lions</td>
<td valign="top" align="left">
<italic>Panthera leo</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Dead end host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B165">165</xref>
</td>
</tr>
<tr>
<td valign="top" align="left">&#xa0;</td>
<td valign="top" align="left">SARS-CoV-2</td>
<td valign="top" align="left">Cougar</td>
<td valign="top" align="left">
<italic>Puma concolor</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Dead end host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B165">165</xref>
</td>
</tr>
<tr>
<td valign="top" align="left">
<italic>Merbecovirus</italic>
</td>
<td valign="top" align="left">MERS-CoV</td>
<td valign="top" align="left">Egyptian tomb bat</td>
<td valign="top" align="left">
<italic>Taphozous perforatus</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Reservoir host</td>
<td valign="top" align="left">Isolates match index patient</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B142">142</xref>, <xref ref-type="bibr" rid="B143">143</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">MERS-CoV</td>
<td valign="top" align="left">Dromedary camels</td>
<td valign="top" align="left">
<italic>Camelus dromedarius</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Intermediate host</td>
<td valign="top" align="left">Hypothesized</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B4">4</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">MERS-CoV</td>
<td valign="top" align="left">Alpacas</td>
<td valign="top" align="left">
<italic>Llama pacos</italic>
</td>
<td valign="top" align="left">Both</td>
<td valign="top" align="left">Dead end host</td>
<td valign="top" align="left">Serology</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B167">167</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HKU4</td>
<td valign="top" align="left">Lesser bamboo bats</td>
<td valign="top" align="left">
<italic>Tylonycteris pachypus</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Reservoir host</td>
<td valign="top" align="left">First Identified</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B7">7</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HKU5</td>
<td valign="top" align="left">Japanese pipistrelle bats</td>
<td valign="top" align="left">
<italic>Pipistrellus abramus</italic>
</td>
<td valign="top" align="left">Natural</td>
<td valign="top" align="left">Reservoir host</td>
<td valign="top" align="left">Found to circulate</td>
<td valign="top" align="left">
<xref ref-type="bibr" rid="B7">7</xref>
</td>
</tr>
</tbody>
</table>
</table-wrap>
<sec id="s4_1">
<title>
<italic>Embecovirus</italic> Intermediate Hosts</title>
<p>Both known human embecoviruses (HCoV-OC43 and HCoV-HKU1) are suspected to use an intermediate host in their emergence. While it is generally accepted that HCoV-HKU1 likely originated from rodents as it is related to MHV (<xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B100">100</xref>, <xref ref-type="bibr" rid="B101">101</xref>), there is no evidence that points to an intermediate host for this virus. One hypothesis is that HKU1 was transmitted directly from rodents to humans, either through contact with rodent excrement, exposure to their blood or other biological products, or through consumption of rodents (<xref ref-type="bibr" rid="B150">150</xref>). HCoV-OC43 is also believed to have originated in rodents however, this virus has 96.6% sequence identity to Bovine Coronavirus (BCoV) (<xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B168">168</xref>) and is therefore thought to have used cattle as an intermediate host between rodents and humans (<xref ref-type="bibr" rid="B102">102</xref>, <xref ref-type="bibr" rid="B148">148</xref>). Estimations based on evolutionary rates of betacoronaviruses place HCoV-OC43 spillover from cattle into humans around 1890 (<xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B148">148</xref>, <xref ref-type="bibr" rid="B169">169</xref>). Serological studies have shown that HCoV-OC43 antibodies are also present in other animals including llamas, alpacas, guanaco, and Bactrian camels (<xref ref-type="bibr" rid="B149">149</xref>, <xref ref-type="bibr" rid="B170">170</xref>). These animals may have been exposed to HCoV-OC43 or BCoV if they had previous close contact with cattle, demonstrating the wide intermediary host range embecoviruses and other betacoronaviruses can have (<xref ref-type="bibr" rid="B171">171</xref>).</p>
</sec>
<sec id="s4_2">
<title>
<italic>Sarbecovirus</italic> Intermediate Hosts &#x2013; SARS-CoV</title>
<p>In 2002, the first recorded emergence of a <italic>Betacoronavirus</italic> that was highly pathogenic in humans occurred (<xref ref-type="bibr" rid="B80">80</xref>). The emergence of SARS-CoV and subsequent epidemic ignited interest in the origin of betacoronaviruses as prior to these, HCoVs were not considered global health threats (<xref ref-type="bibr" rid="B4">4</xref>). Zoonotic transmission of SARS-CoV was considered early on due to the fact that many of the early SARS cases appeared to have a common connection to an animal market in Shenzhen, China (<xref ref-type="bibr" rid="B80">80</xref>, <xref ref-type="bibr" rid="B102">102</xref>). An investigation into animals sold at the market identified both SARS-CoV and another SARS-related coronavirus in palm civets (<italic>Paguma larvata</italic>) and racoon dogs (<italic>Nyctereutes procynoides)</italic>, and SARS-CoV antibodies in Chinese ferret badgers (<italic>Melogale moschata</italic>) (<xref ref-type="bibr" rid="B80">80</xref>, <xref ref-type="bibr" rid="B151">151</xref>, <xref ref-type="bibr" rid="B172">172</xref>). Evidence of palm civet-to-human transmission arose during a small SARS outbreak in Guangdong Province in 2003-2004 where four individuals tested positive for SARS-CoV and three of these patients had either direct or indirect contact with masked palm civets (<xref ref-type="bibr" rid="B21">21</xref>). While this provided evidence that palm civets may have been a source for the 2003-2004 SARS outbreak, it does not indicate that civets were the original source for the jump of SARS-CoV to humans. It was found that SARS-CoV isolates from palm civets at the Shenzhen market had 99.6% sequence identity to SARS-CoV samples collected from infected patients (<xref ref-type="bibr" rid="B21">21</xref>); however, there was a 1000-fold difference in their affinity for the human ACE2 receptor (<xref ref-type="bibr" rid="B173">173</xref>, <xref ref-type="bibr" rid="B174">174</xref>). Additionally, while ~80% of the animals tested in Guangdong had SARS-CoV antibodies, infectious virus was not recovered from additional samples collected from wild and farmed palm civets (<xref ref-type="bibr" rid="B40">40</xref>). These data suggest that SARS-CoV does not naturally circulate in palm civet populations and it was likely introduced in the markets through storage of animals in close quarters (<xref ref-type="bibr" rid="B21">21</xref>, <xref ref-type="bibr" rid="B80">80</xref>, <xref ref-type="bibr" rid="B171">171</xref>). The high degree of sequence homology and lack of mutations suggests that SARS-CoV may have recently spilled over into masked palm civets not long before spillover to humans (<xref ref-type="bibr" rid="B175">175</xref>).</p>
<p>Additional animal species susceptible to SARS-CoV have been identified including house cats, ferrets, Chinese ferret badgers and racoon dogs; however, limited study has occurred in these species (<xref ref-type="bibr" rid="B152">152</xref>, <xref ref-type="bibr" rid="B171">171</xref>). The route and timing of SARS-CoV transmission to raccoon dogs in the Shenzhen market remains unknown (<xref ref-type="bibr" rid="B21">21</xref>). Investigation of raccoon dogs at a market in Guangzhou, China, did identify SARS-CoV antibodies (<xref ref-type="bibr" rid="B21">21</xref>). To date, available evidence supports the hypothesis that masked palm civets acted as an intermediate host for SARS-CoV.</p>
</sec>
<sec id="s4_3">
<title>
<italic>Sarbecovirus</italic> Intermediate Hosts &#x2013; SARS-CoV-2</title>
<p>Investigations on SARS-CoV-2 origins and potential intermediate hosts have focused on the linkages of patients to the Huanan market in Wuhan (<xref ref-type="bibr" rid="B176">176</xref>). Approximately two-thirds of patients from the initial cluster of COVID-19 cases in 2019 had visited this market prior to contracting the virus while others were in contact with people involved in live animal trade (<xref ref-type="bibr" rid="B133">133</xref>). There were also similarities to the emergence of SARS-CoV in Foshan and Guangzhou, Guangdong, China in 2002 (<xref ref-type="bibr" rid="B177">177</xref>). Yunnan province has been hypothesized as the originating region for SARS-CoV and SARS-CoV-2 since the discovery of animal traders with prevalence of SL-CoVs and high IgG levels there in 2003 (<xref ref-type="bibr" rid="B177">177</xref>). Sampling of various animals pointed to bats as one of the early candidates for zoonotic transmission due to the presence of SL-CoVs with high levels of homology to SARS-CoV-2 like viruses (RaTG13 and RmYN02) (<xref ref-type="bibr" rid="B178">178</xref>). In-depth phylogenetic analysis suggests that SARS-CoV-2 is a generalist virus which has been circulating in bats for some time, and that there was little mutation and adaptation required to be capable of infecting humans (<xref ref-type="bibr" rid="B36">36</xref>). This is highlighted by the fact that many animals can host productive SARS-CoV-2 infections and some animals, such as mink, are capable of transmitting the virus back to humans (<xref ref-type="bibr" rid="B141">141</xref>). In the following sections, we will examine the possible intermediate hosts of SARS-CoV-2 and what they may have contributed to the evolution of this virus.</p>
<sec id="s4_3_1">
<title>Potential Intermediate Hosts and Animals With Role in Viral Dissemination</title>
<p>We summarize the growing evidence of SARS-CoV-2 circulation and transmission patterns across various animal species in <xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3</bold>
</xref>. Ferrets (<italic>Mustela putorius furo</italic>) are instrumental models for studying respiratory pathogenicity and transmission of viruses (<xref ref-type="bibr" rid="B181">181</xref>). Experimental studies show that ferrets are susceptible to SARS-CoV-2 infection of the upper respiratory tract early in the disease course (<xref ref-type="bibr" rid="B166">166</xref>). However, clinical signs of illness appear to be uncommon with transient fever, and mild respiratory symptoms reported (<xref ref-type="bibr" rid="B166">166</xref>, <xref ref-type="bibr" rid="B182">182</xref>&#x2013;<xref ref-type="bibr" rid="B185">185</xref>). There is still substantial viral shedding observed in the respiratory tract during infection making ferrets a useful model for studying transmission. During infection ferrets have been shown to infect healthy ferrets in close contact through the high degree of viral shedding in their feces, nasal secretions, urine and saliva (<xref ref-type="bibr" rid="B12">12</xref>). Direct and indirect transmission of SARS-CoV-2 has been demonstrated in ferrets and healthy ferrets become symptomatic following direct contact with infected ferrets, though separation of the animals with maintenance of shared airspace did result in some viral positivity in the absence of symptoms (<xref ref-type="bibr" rid="B139">139</xref>). The lack of clinical signs of illness in conjunction with the high amount of viral shedding suggest mostly asymptomatic infection and evidence that mustelids such as ferrets may have played a role as an intermediate host in SARS-CoV-2 emergence. While infection of ferret badgers has not been documented, they have a high degree of similarity to other animals which are permissive to SARS-CoV-2 infection and therefore are still an animal of interest.</p>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>Zoonotic circulation of SARS-CoV and SARS-CoV-2. Suspected and confirmed zoonotic circulation of both SARS-CoV and SARS-CoV-2 are presented. Suspected routes of transmission are presented by dashed arrows. Question marks designate routes that have yet to be demonstrated by direct or indirect methods (though are theorized or probable). Note that there is epidemiological and genetic evidence for some human-to-captive animal transmission events (<xref ref-type="bibr" rid="B179">179</xref>, <xref ref-type="bibr" rid="B180">180</xref>) while others are suspected/probable. Solid lines represent confirmed transmission events. Created with BioRender.com.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fviro-02-875213-g003.tif"/>
</fig>
<p>Mink (<italic>Neovison vison</italic>) are also a potential SARS-CoV-2 intermediate host given the SARS-CoV-2 detection and onward transmission in mink from two farms in the Netherlands (<xref ref-type="bibr" rid="B186">186</xref>). The animals showed respiratory and gastrointestinal symptoms (<xref ref-type="bibr" rid="B187">187</xref>), and approximately 1.2-2.4% of animals succumbed to infection, the majority of which were pregnant females (<xref ref-type="bibr" rid="B188">188</xref>). Necropsies found signs of interstitial pneumonia and lung lesions (<xref ref-type="bibr" rid="B186">186</xref>). There is supportive evidence that SARS-CoV-2 was introduced to mink by farm workers with subsequent transmission between the animals (<xref ref-type="bibr" rid="B186">186</xref>). This was supported by sequencing of viral samples from both mink and humans which revealed significant homology between the viruses present in each sample (<xref ref-type="bibr" rid="B187">187</xref>). This became a cause for concern as it was also observed that variants of the virus had been transmitted from mink to humans (<xref ref-type="bibr" rid="B189">189</xref>), suggesting an intermediate host which could support viral recombination and rapid transmission (<xref ref-type="bibr" rid="B190">190</xref>). Transmission between humans and mink was observed in ten countries: Canada, Denmark, France, Greece, Italy, Lithuania, the Netherlands, Spain, Sweden and the USA (<xref ref-type="bibr" rid="B190">190</xref>, <xref ref-type="bibr" rid="B191">191</xref>). It was determined early on that the mode of transmission was not direct as mink are housed separately. Viral RNA was also detected in early collection of inhalable dust samples indicating a potential route of exposure (<xref ref-type="bibr" rid="B186">186</xref>).</p>
<p>Raccoon dogs (<italic>Nyctereutes procyonoides)</italic> initially gained attention as possible intermediate hosts of SARS-CoV (<xref ref-type="bibr" rid="B21">21</xref>, <xref ref-type="bibr" rid="B80">80</xref>, <xref ref-type="bibr" rid="B151">151</xref>) for two main reasons: i) susceptibility to SARS-CoV infection (<xref ref-type="bibr" rid="B192">192</xref>); and ii) high ACE2 sequence similarity between raccoon dogs and humans (<xref ref-type="bibr" rid="B193">193</xref>, <xref ref-type="bibr" rid="B194">194</xref>). Raccoon dogs can be productively infected with SARS-CoV-2 through experimental inoculation and transmit the virus to other healthy animals (<xref ref-type="bibr" rid="B162">162</xref>). However, clinical signs of illness such as increased body temperature or weight loss were not observed and virus isolated from infected animals had 100% sequence homology to the viral inoculum.</p>
<p>The susceptibility of white tailed deer (<italic>Odocoileus virginianus</italic>) to experimental infection was assessed in early 2021 (<xref ref-type="bibr" rid="B154">154</xref>). Intranasal inoculation of deer resulted in virus shedding through nasal secretions and transmission to na&#xef;ve deer who later seroconverted. Indirect transmission was also observed as virus was identified in nasal swabs and transiently in fecal samples from na&#xef;ve fawns housed in separate pens from infected animals, and which included plexiglass barriers (<xref ref-type="bibr" rid="B154">154</xref>). Additionally, RNA was detectable in infected animal tissues for up to 21 days post-infection. Other woodland animals such as bushy-tailed wood rats and skunks are capable of shedding virus in respiratory secretions (<xref ref-type="bibr" rid="B160">160</xref>). As these animals are shedding the virus and, in some cases, appear capable of transmitting to their surrounding environments, their role as intermediate hosts and potential future sources of spillback of novel SARS-CoV-2 variants to humans needs to be investigated.</p>
<p>Rodents are believed to have played a significant role in the emergence of human <italic>Embecoviruses</italic> (HCoVs OC43 and HKU1) and have therefore been hypothesized as potential intermediate hosts of SARS-CoV-2. Early studies suggested that mice were unlikely to be an intermediate host candidate for SARS-CoV-2 (<xref ref-type="bibr" rid="B130">130</xref>, <xref ref-type="bibr" rid="B195">195</xref>, <xref ref-type="bibr" rid="B196">196</xref>). However, subsequent work by Griffin and colleagues has demonstrated that deer mice are susceptible to infection resulting in asymptomatic or mild disease (<xref ref-type="bibr" rid="B197">197</xref>). Infected deer mice could also transmit virus to co-housed na&#xef;ve mice. More recently, Stone and colleagues demonstrated that the SARS-CoV-2 Alpha and Beta variants could result in productive infection of wild-type C57BL/6 mice <italic>via</italic> intranasal inoculation (<xref ref-type="bibr" rid="B198">198</xref>). Alternatively, Syrian hamsters are susceptible to infection with SARS-CoV-2 presenting with clinical disease that resembles respiratory infection in humans as well as weight loss (<xref ref-type="bibr" rid="B159">159</xref>, <xref ref-type="bibr" rid="B199">199</xref>&#x2013;<xref ref-type="bibr" rid="B201">201</xref>). One study demonstrated that Syrian hamsters that had previous infection to SARS-CoV-2 had protection from re-infection with reduced replication in the upper respiratory tract and no observed transmission to na&#xef;ve contact animals (<xref ref-type="bibr" rid="B202">202</xref>). Thus, hamsters have become widely used for investigations of SARS-CoV-2 infection (<xref ref-type="bibr" rid="B7">7</xref>, <xref ref-type="bibr" rid="B161">161</xref>, <xref ref-type="bibr" rid="B200">200</xref>). A recent preprint provides evidence for transmission of SARS-CoV-2 to humans from naturally infected hamsters, though the implications of this on the initiation of new human-to-human transmission chains remains to be determined (<xref ref-type="bibr" rid="B203">203</xref>).</p>
</sec>
<sec id="s4_3_2">
<title>Susceptibility of Additional Species to SARS-CoV-2</title>
<p>ACE2&#x2019;s ubiquitous presence within the animal kingdom and its high degree of similarity amongst mammalian species is a major contributor to the spread of betacoronaviruses around the world, most recently with SARS-CoV-2 (<xref ref-type="bibr" rid="B204">204</xref>). <italic>In silico</italic> modelling predicted the following species may exhibit binding affinity for the SARS-CoV-2 S protein: cats, cattle, monkeys, dogs, pigs, horses, sheep, and rabbits (in decreasing order) (<xref ref-type="bibr" rid="B205">205</xref>). Many other animals have been infected with SARS-CoV-2 experimentally or in nature and are able to host a productive infection. These cases will be discussed in the following paragraphs.</p>
<p>Initial attention was given to domestic animals such as dogs and cats as they would be high risk to transmit to humans if they could host a productive infection. Reports showed domestic cats had tested positive for SARS-CoV-2 in Europe, Asia, and North America (<xref ref-type="bibr" rid="B163">163</xref>, <xref ref-type="bibr" rid="B205">205</xref>). Cats have also been shown to spread SARS-CoV-2 <italic>via</italic> respiratory droplets (<xref ref-type="bibr" rid="B166">166</xref>) though viral RNA has also been detected in nasal, oropharyngeal and rectal swabs (<xref ref-type="bibr" rid="B155">155</xref>, <xref ref-type="bibr" rid="B206">206</xref>). This was concerning due to the proximity of cats to humans however, one study showed that cats exposed to the virus did not exhibit any symptoms (<xref ref-type="bibr" rid="B88">88</xref>, <xref ref-type="bibr" rid="B207">207</xref>). There is conflicting data as to whether or not cats are asymptomatic throughout the infection (<xref ref-type="bibr" rid="B208">208</xref>), but if cats are in fact asymptomatic they may not be effective intermediate hosts. As for dogs, studies show that SARS-CoV-2 replicates poorly in these animals and that healthy dogs who come into contact with SARS-CoV-2-positive dogs remain seronegative (<xref ref-type="bibr" rid="B166">166</xref>). Overall, infected dogs showed no obvious signs of infection and most often did not have detectable levels of RNA present in biological samples (<xref ref-type="bibr" rid="B88">88</xref>, <xref ref-type="bibr" rid="B166">166</xref>, <xref ref-type="bibr" rid="B206">206</xref>). In an attempt to determine why this occurs, scientists analyzed the ACE2 receptor in dogs and found 5 amino acid substitutions but none within the RBD; therefore, this is believed to have minimal impact on binding of the S protein (<xref ref-type="bibr" rid="B196">196</xref>, <xref ref-type="bibr" rid="B209">209</xref>). Based on the studies conducted so far it is unlikely cats or dogs played a role in the emergence of SARS-CoV-2.</p>
<p>Investigations into agriculturally significant animals such as cattle were an important consideration as there are previous bovine links to coronaviruses in addition to an identified bovine coronavirus (<xref ref-type="bibr" rid="B210">210</xref>). For the most part, cattle did not seem to be able to host a productive SARS-CoV-2 infection with little to no viral replication or immune response detected in these animals. They also did not exhibit clinical signs of infection or transmit to nearby animals (<xref ref-type="bibr" rid="B164">164</xref>). Cattle and other farm animals are important to consider as they are commonly in contact with humans. One study in particular looked at susceptibility to SARS-CoV-2 in poultry and determined that chickens along with turkeys, geese, quail and ducks are not susceptible to infection (<xref ref-type="bibr" rid="B166">166</xref>, <xref ref-type="bibr" rid="B211">211</xref>). Similarly, many studies have investigated SARS-CoV-2 infection in pigs, and it seems that they are resistant to infection as there are no signs of infection, no pathology and no viral RNA detected (<xref ref-type="bibr" rid="B212">212</xref>&#x2013;<xref ref-type="bibr" rid="B214">214</xref>).</p>
<p>SARS-CoV-2 infections in a variety of zoo animals have been widely reported, including tigers, snow leopards, lions, gorillas and pumas. Animal testing followed signs of respiratory symptoms of disease and while transmission between animals in the same enclosures was reported, widespread transmission was observed in any of these cases (<xref ref-type="bibr" rid="B215">215</xref>). It is thought that the animals contracted the virus from asymptomatic workers.</p>
<p>Aside from these examples of natural infection, much of what we know of SARS-CoV-2 infection in animals has come from experimental infections. This has led to the discovery that rhesus monkeys can be experimentally infected (<xref ref-type="bibr" rid="B163">163</xref>). Two Rhesus macaque species (<italic>M. fascularis and M. mallata</italic>) and one common marmoset species (<italic>C. jacchus</italic>) were able to be infected with SARS-CoV-2 <italic>via</italic> the intratracheal and intranasal routes and demonstrated clinical signs of infection (<xref ref-type="bibr" rid="B216">216</xref>, <xref ref-type="bibr" rid="B217">217</xref>). It has been reported old world monkeys are susceptible to infection and new world monkeys have much lower susceptibility when compared to human ACE2 there are 4 amino acid differences (<xref ref-type="bibr" rid="B218">218</xref>). Nonhuman primates have similar clinical presentation of COVID-19 to humans including viral replication in the upper and lower respiratory tracts, inflammation and focal edema among other less frequent signs and symptoms (<xref ref-type="bibr" rid="B13">13</xref>). Due to these clinical presentations, the phylogenetic relatedness of nonhuman primates to humans, and previous reports of HCoV-OC43 infections in nonhuman primates, concerns have been raised regarding the potential impacts of SARS-CoV-2 on endangered species, including great apes (<xref ref-type="bibr" rid="B88">88</xref>, <xref ref-type="bibr" rid="B219">219</xref>).</p>
<p>Bank voles have been experimentally infected and had viral RNA present in nasal tissue for up to 21 days post infection, though no transmission to animals in direct contact was observed (<xref ref-type="bibr" rid="B220">220</xref>). Rabbits have been reported to be susceptible to infection with SARS-CoV-2 (<xref ref-type="bibr" rid="B164">164</xref>) however, there is conflicting data stating that in fact white cotton tail rabbits are resistant to infection (<xref ref-type="bibr" rid="B160">160</xref>). Additional studies have determined that squirrels (<xref ref-type="bibr" rid="B211">211</xref>), raccoons and black-tailed prairie dogs (<xref ref-type="bibr" rid="B160">160</xref>) are resistant to SARS-CoV-2 infection [Recommended further readings on the topic of experimental and natural infections of animals. (<xref ref-type="bibr" rid="B221">221</xref>&#x2013;<xref ref-type="bibr" rid="B223">223</xref>)].</p>
</sec>
<sec id="s4_3_3">
<title>Evidence Regarding the Role of Pangolins</title>
<p>Malayan pangolins (<italic>Manis Javanica</italic>) and Chinese pangolins (<italic>Manis pentadactyla</italic>) are considered vulnerable or critically endangered as they are the most trafficked mammals in the world (<xref ref-type="bibr" rid="B224">224</xref>) due to the use of their meat and scales in traditional African and Chinese medicine (<xref ref-type="bibr" rid="B225">225</xref>). Pangolins are solitary, nocturnal mammals that dwell in remote sandy forests (<xref ref-type="bibr" rid="B226">226</xref>) away from humans (<xref ref-type="bibr" rid="B227">227</xref>), and thus, poaching provides the only real opportunity for human contact with wild populations (<xref ref-type="bibr" rid="B37">37</xref>). Pangolins were proposed as an intermediate host in the emergence of SARS-CoV-2 in the early days of the pandemic due to a high degree of sequence identity to pangolin-CoVs, their interaction with bat populations and their presence at the Hunan wet market during the time when the first documented cases of SARS-CoV-2 were identified (<xref ref-type="bibr" rid="B153">153</xref>).</p>
<p>Sequence similarity was identified by two independent studies that identified SL-CoV in Malayan pangolins confiscated from illegal wildlife traders (<xref ref-type="bibr" rid="B77">77</xref>, <xref ref-type="bibr" rid="B228">228</xref>). The identified SL-CoVs had 85.5-92.4% sequence identity to SARS-CoV-2; however, these pangolin-CoVs had 97.4% sequence identity to the RBD of the SARS-CoV-2 S protein (specifically pangolin CoVs GD/P1L and GD/P2S) (<xref ref-type="bibr" rid="B77">77</xref>, <xref ref-type="bibr" rid="B131">131</xref>, <xref ref-type="bibr" rid="B132">132</xref>, <xref ref-type="bibr" rid="B228">228</xref>). Specifically, the six amino acid residues in the RBD of the S1 protein identified as critical for binding the host ACE2 receptor are conserved between pangolin-CoVs and SARS-CoV-2 (<xref ref-type="bibr" rid="B34">34</xref>, <xref ref-type="bibr" rid="B131">131</xref>, <xref ref-type="bibr" rid="B229">229</xref>). This high degree of sequence identity in the RBDs of SARS-CoV-2 and pangolin-CoVs suggests either a recombination event occurred or these viruses have highly similar RBDs due to convergent evolution (<xref ref-type="bibr" rid="B77">77</xref>, <xref ref-type="bibr" rid="B228">228</xref>). For the recombination hypothesis it was posited to have occurred between pangolin-CoVs from Malayan pangolins and RaTG13 from <italic>R. affinis</italic> bats due to the high degree of similarity in the RBD of pangolin-CoVs to SARS-CoV-2, while SL-CoV RaTG13 is the closest relative to SARS-CoV-2 albeit with a distinct RBD site of the S protein (<xref ref-type="bibr" rid="B77">77</xref>, <xref ref-type="bibr" rid="B131">131</xref>, <xref ref-type="bibr" rid="B132">132</xref>, <xref ref-type="bibr" rid="B228">228</xref>). However, when analyzed through alignment there is low nucleotide similarity compared to the high amino acid similarity and many misalignments within the sequence, suggesting recombination is unlikely and merely convergently evolved features of these distinct SARS-CoV-2 and pangolin CoV viruses (<xref ref-type="bibr" rid="B77">77</xref>, <xref ref-type="bibr" rid="B103">103</xref>, <xref ref-type="bibr" rid="B172">172</xref>, <xref ref-type="bibr" rid="B229">229</xref>, <xref ref-type="bibr" rid="B230">230</xref>). Although recombination has been observed in CoVs there is no evidence in the S protein of the SARS-CoV-2 lineage and instead appears to be an artifact of the metagenomic analysis that detected recombination initially (<xref ref-type="bibr" rid="B103">103</xref>, <xref ref-type="bibr" rid="B123">123</xref>). Supporting the idea of convergent evolution, a recent analysis of SL-CoV RaTG13, pangolin-CoVs and SARS-CoV-2 finding that pangolin-CoVs diverged from the SL-CoVs approximately 150-180 years ago (<xref ref-type="bibr" rid="B103">103</xref>). If recombination occurred it would be expected for these viruses to have a higher degree of similarity in specific regions, which has not been observed (<xref ref-type="bibr" rid="B29">29</xref>, <xref ref-type="bibr" rid="B132">132</xref>, <xref ref-type="bibr" rid="B174">174</xref>). For recombination to occur it also implies the viruses, in this case SL-CoV RaTG13 and pangolin-CoV GD/P1L or GD/P2S, would co-infect the same cell; however, <italic>R. affinis</italic> bats (Species SL-CoV RaTG13 was found in) do occupy the same natural range as <italic>M. javanica</italic> pangolins (<xref ref-type="bibr" rid="B122">122</xref>, <xref ref-type="bibr" rid="B231">231</xref>, <xref ref-type="bibr" rid="B232">232</xref>).</p>
<p>To date, pangolin-CoVs have not been found in Chinese pangolins, which share the same habitat range as <italic>R. affinis</italic> bats (<xref ref-type="bibr" rid="B228">228</xref>). There is limited evidence for cohabitation of bats with pangolins of any species and does not appear very common, with one study finding bats and pangolins in Gabon within the same burrows (<xref ref-type="bibr" rid="B233">233</xref>). Follow up studies to detect pangolin-CoVs in Malayan pangolins have been unsuccessful with a study of 334 confiscated pangolins finding no sarbecoviruses raising doubts around the role of pangolins in the emergence of SARS-CoV-2 (<xref ref-type="bibr" rid="B123">123</xref>, <xref ref-type="bibr" rid="B228">228</xref>, <xref ref-type="bibr" rid="B234">234</xref>). Further to this point, a study of wild Malayan pangolins in Malaysia determined that there is no observed circulation for betacoronaviruses, filoviruses and flaviviruses, suggesting that any detected sarbecoviruses are most likely acquired through contact within the smuggling trade of these animals (<xref ref-type="bibr" rid="B234">234</xref>). The animals that pangolin-CoVs have been isolated were found to be either severely ill or already dead (<xref ref-type="bibr" rid="B82">82</xref>, <xref ref-type="bibr" rid="B228">228</xref>). Animals becoming severely ill is not what is expected for intermediate hosts as this would greatly limit viral amplification through host immune response and ultimately death, as well as interactions with other species limiting ability to spread the virus to other species (<xref ref-type="bibr" rid="B110">110</xref>). Some have presented the possibility for contributing factors to the severe illness and death of the tested animals, including due to the stressful environment they find themselves in in close contact with other animals and humans as well as other viruses that are commonly found in pangolins including Sendai virus (<xref ref-type="bibr" rid="B235">235</xref>, <xref ref-type="bibr" rid="B236">236</xref>). While some studies have shown the presence of coronaviruses in captivity (<xref ref-type="bibr" rid="B82">82</xref>), there remains no evidence of SARS-CoV-2 or SL-CoVs in wild pangolins. More to that point, Yuan <italic>et al.</italic> claim that pangolins were not present at the Huanan Wildlife Market during the initial identification of SARS-CoV-2 in 2019 (<xref ref-type="bibr" rid="B237">237</xref>). In addition to the lack of circulating coronaviruses, the solitary lifestyle of pangolins makes it difficult for pangolin populations to amplify pangolin-CoVs, which suggests they would be a poor intermediate or reservoir host candidate from an epidemiological standpoint (<xref ref-type="bibr" rid="B103">103</xref>). Considering the studies conducted to date on the role of Malayan pangolins in the emergence of SARS-CoV-2 as an intermediate host does not line up with the hypothesis and the initial phylogenetic reports have been refuted.</p>
</sec>
<sec id="s4_3_4">
<title>No Intermediate Host</title>
<p>There is continuing evaluation of the susceptibility and onward transmission potential of various animal species to SARS-CoV-2. However, it has also been hypothesized that SARS-CoV-2 emergence may have occurred in the absence of an intermediate host (<xref ref-type="bibr" rid="B36">36</xref>). Here, the authors suggest that diversifying positive selection was limited to the early phase of the pandemic and that SARS-CoV-2 has much weaker purifying selection as compared to related sarbecoviruses. The authors further suggest that the transmission of SARS-CoV-2 to additional nonhuman animal species supports the generation of a generalist virus in a bat reservoir.</p>
<p>Ongoing research continues to actively investigate the hypotheses for the emergence and transmission of SARS-CoV-2 demonstrating the collective effort of the scientific community to determine the origins of this pandemic, there is still much to be known and continued collaboration will be essential.</p>
</sec>
</sec>
<sec id="s4_4">
<title>
<italic>Merbecoviruses</italic> Intermediate Hosts</title>
<p>Dromedary camels were identified as the intermediate host of MERS-CoV after camels tested positive for virus with 100% sequence identity to viral isolates from humans that were infected through close contact with the animals (<xref ref-type="bibr" rid="B238">238</xref>). MERS-CoV can be transmitted from dromedary camels to humans <italic>via</italic> respiratory droplets as well as the fecal/oral route (<xref ref-type="bibr" rid="B4">4</xref>). It is postulated that MERS-CoV can spread between camelids when kept in close contact (<xref ref-type="bibr" rid="B167">167</xref>) but more studies are needed to confirm this (<xref ref-type="bibr" rid="B239">239</xref>). MERS-CoV outbreaks usually occur when an infected camel transmits to a human, who can then transmit to their close contacts (<xref ref-type="bibr" rid="B240">240</xref>). During the 2012 outbreak there were multiple lineages of MERS-CoV circulating, indicating that multiple zoonotic transmission events may have contributed to this outbreak (<xref ref-type="bibr" rid="B241">241</xref>). Dudas et&#xa0;al. estimate that hundreds of spillover events between camels and humans have resulted in the cases of MERS that we know of today (<xref ref-type="bibr" rid="B242">242</xref>). This is supported by the fact that neutralizing MERS-CoV antibodies have been found in dromedary camels in Africa, Asia and the Middle East (<xref ref-type="bibr" rid="B102">102</xref>, <xref ref-type="bibr" rid="B243">243</xref>, <xref ref-type="bibr" rid="B244">244</xref>). Experimental and serological studies have also shown that alpacas can be infected with MERS-CoV and may potentially serve as intermediary hosts however, this appears to be restricted to regions where MERS-CoV is endemic in dromedary camels (<xref ref-type="bibr" rid="B149">149</xref>, <xref ref-type="bibr" rid="B167">167</xref>, <xref ref-type="bibr" rid="B239">239</xref>, <xref ref-type="bibr" rid="B245">245</xref>). Since MERS-CoV is believed to have spilled over into dromedary camels from bats more than 20 years ago (<xref ref-type="bibr" rid="B106">106</xref>, <xref ref-type="bibr" rid="B244">244</xref>), it is thought that the camel coronavirus adapted to the dromedary camel hosts and therefore caused minimal health effects (<xref ref-type="bibr" rid="B242">242</xref>, <xref ref-type="bibr" rid="B245">245</xref>, <xref ref-type="bibr" rid="B246">246</xref>). For this reason, dromedary camels have been reclassified as the reservoir hosts of MERS-CoV (<xref ref-type="bibr" rid="B242">242</xref>, <xref ref-type="bibr" rid="B245">245</xref>, <xref ref-type="bibr" rid="B246">246</xref>).</p>
</sec>
</sec>
<sec id="s5" sec-type="discussion">
<title>Discussion</title>
<sec id="s5_1">
<title>Human Interactions With Zoonotic Coronavirus Hosts</title>
<p>Understanding how viruses emerge and the role that humans play in these emergence events are of central importance to early detection and prevention of large-scale outbreaks (<xref ref-type="bibr" rid="B204">204</xref>). As the human population grows, a greater area of land is being converted into farmland and housing to meet the demand. This naturally means that humans, and the domesticated animals that accompany them, will be overlapping more with wild animals like bats (<xref ref-type="bibr" rid="B15">15</xref>). Sharing habitats like this facilitates cross-species transmission of viruses and emergence of infectious diseases (<xref ref-type="bibr" rid="B4">4</xref>). However, eliminating all human contact with possible <italic>Betacoronavirus</italic> hosts is not feasible due to urbanization and in many cases the cultural and economic importance of these animals (<xref ref-type="bibr" rid="B247">247</xref>). A recent example of this is the role of dromedary camels in MERS-CoV circulation and spillover. Camels are a central part of the livelihoods of many families, providing a source of transportation, food, and commodity trade (<xref ref-type="bibr" rid="B248">248</xref>). Culling dromedary camels to prevent the spread of MERS-CoV would negatively impact the well-being of the people in these communities and the local economy (<xref ref-type="bibr" rid="B248">248</xref>). Preventative strategies for MERS instead relies on recognizing illness in camels, rapid testing, national surveillance, international communication, and the development of vaccines for dromedary camels to decrease MERS-CoV transmission to humans (<xref ref-type="bibr" rid="B249">249</xref>).</p>
</sec>
<sec id="s5_2">
<title>Surveillance and Monitoring for Future Zoonotic Outbreaks</title>
<p>The increase in globalization and urbanization over the last half-century have led to a dramatic change in both the mode and the frequency in which humans and animals come in contact. As we continue to piece together the roles of intermediate hosts in zoonoses, including for SARS-CoV-2, we must continue to examine the magnitude of their role in viral emergence and subsequent public health emergencies. Public health responses to outbreaks have primarily been reactionary in nature (i.e. quarantines, travel restrictions, vaccine and therapeutic development) as opposed to preventative including global surveillance, pandemic prediction, early warnings and control (<xref ref-type="bibr" rid="B250">250</xref>, <xref ref-type="bibr" rid="B251">251</xref>). Precautionary rather than reactive responses would seem far more logical given the global health and economic toll of the COVID-19 pandemic. One Health approaches to emerging virus surveillance and preparedness are critical in this regard given that ~ 60% of emerging infectious disease outbreaks are of zoonotic origin (domestic or wildlife), with almost 75% of zoonotic emergence events originating with wildlife (<xref ref-type="bibr" rid="B78">78</xref>). However, it is imperative to consider the potential for bidirectional transmission between humans and animals for emerging viruses, such as has been identified for SARS-CoV-2, when considering outbreak response and containment plans (<xref ref-type="bibr" rid="B252">252</xref>). Indeed, observations from mink and white-tailed deer during the COVID-19 pandemic highlight the importance of consideration for the complexities of routes of transmission and reservoir-host interactions (<xref ref-type="bibr" rid="B141">141</xref>, <xref ref-type="bibr" rid="B253">253</xref>). However, there is ongoing development of emerging infectious disease surveillance systems which utilize wildlife screening techniques to sample and test for various pathogens in healthy animals, and monitor morbidity and mortality rates of regional animal species (<xref ref-type="bibr" rid="B254">254</xref>). This information can then be collated and relayed to additional research groups conducting similar surveillance programs across the globe (<xref ref-type="bibr" rid="B255">255</xref>). Understanding that the most effective way to combat future outbreaks is with a preventative/precautionary approach as opposed to a responsive/reactive approach, researchers continue to lobby for more holistic approaches to monitor animal-human interfaces (<xref ref-type="bibr" rid="B256">256</xref>). There are independently-funded holistic programs such as the One Health Project which takes into consideration environmental, animal, and human factors to understand and monitor disease spread from animals-to-humans as well as from human-to-animal (<xref ref-type="bibr" rid="B256">256</xref>). Surveillance work is currently focused on regions that have high potential for inter-species viral transmission. Some of these environmental factors include regions experiencing extreme effects of climate change, or regions with tropical rainforests, high population density, and high numbers of mammalian species (<xref ref-type="bibr" rid="B251">251</xref>). Based on these criteria, Sub-Saharan Africa, Southeast-Asia, and Latin America are the focus of current research into surveillance and are considered high risk regions for emerging infectious disease (EID) events to occur (<xref ref-type="bibr" rid="B257">257</xref>, <xref ref-type="bibr" rid="B258">258</xref>). It will be of paramount importance to invest into monitoring and surveillance of animals in these regions, ensuring that any future outbreaks are detected early and minimized.</p>
<p>A One Health approach to limiting the exposure and spread of emerging disease is a better model for outbreak/pandemic response because despite the availability of vaccines for SARS-CoV-2 these alone are not enough with the likelihood of endemicity due to demonstrated instances of zooanthroponosis (<xref ref-type="bibr" rid="B259">259</xref>). As new variants of SARS-CoV-2 continue to emerge the protective coverage that vaccines have provided will continue to wane with diverging spike proteins and have demonstrated a comprehensive One Health approach is needed to bring the current and future pandemics under control (<xref ref-type="bibr" rid="B260">260</xref>). An approach of this kind would encompass public health and human vaccination campaigns already being implemented globally as well as animal vaccination campaigns and wildlife surveillance (<xref ref-type="bibr" rid="B259">259</xref>). The development and integration of animal vaccines for zoonotic viruses could have great impacts on zoonoses and zooanthroponoses as well as impacting reservoir establishments. Animal vaccination against SARS-CoV-2 have already been approved and demonstrated to be safe and effective with administration of the Zoetis vaccine being utilized at zoos, on mink farms as well as domestically (<xref ref-type="bibr" rid="B261">261</xref>). Early detection and prevention measures should be implemented within a One Health model beyond humans alone as humans are only a part of the story of outbreaks and pandemics (<xref ref-type="bibr" rid="B223">223</xref>, <xref ref-type="bibr" rid="B260">260</xref>). Global collaboration and cooperation are necessary in tracing the source and will be necessary for mitigation of outbreaks and pandemics in the future (<xref ref-type="bibr" rid="B125">125</xref>).</p>
</sec>
<sec id="s5_3">
<title>Conclusions</title>
<p>Many facets of coronaviruses are yet to be uncovered. Here we provide a collection of evidence for the complexities of coronavirus transmission patterns across species. There are some important clarifications that have been identified for sarbecoviruses. For example, embecoviruses likely emerged from rodents with cattle acting as an intermediate host in HCoV-OC43 whereas HCoV-HKU1 is suspected to have used an intermediate host that has yet to be identified. The transmission of SARS-CoV to humans utilized an intermediate host believed to be palm civets or raccoon dogs and MERS-CoV utilizes dromedary camels as a reservoir and intermediate host following an original spillover event from bats to camels. Other human coronaviruses pose a greater challenge. While there is evidence that SARS-CoV-2 originated from bats, and there was likely the involvement of an intermediate host, the specific details of these events have yet to be conclusively determined.</p>
<p>It is critical to appreciate that while spillover events of viruses that rapidly become public health threats occur unpredictably, this should not preclude global investments in robust surveillance and prediction systems, in particular within regions that are &#x2018;hot spots&#x2019; for emergence events. For decades infectious disease experts have studied how increased contact with wild animals &#x2013; whether it be through deforestation, climate change, or other factors &#x2013; leads to new diseases spilling over to humans. In our fast-growing world, expansion is not slowing (<xref ref-type="bibr" rid="B80">80</xref>&#x2013;<xref ref-type="bibr" rid="B82">82</xref>). We should not expect the spillover rate of infectious diseases to humans to slow either. Thus, several strategies need to be utilized to limit the economic, health and social impacts of these events.</p>
<list list-type="bullet">
<list-item>
<p>Reduction of transmission risk through preventative hygiene measures and public health education campaigns in place early on following identification of a spillover of a new virus.</p>
</list-item>
<list-item>
<p>Have a framework in place, infrastructure and trade agreements in place to allow for accelerated development and deployment of therapeutics and vaccines to all countries to shorten the duration of a pandemic through reduced risk of variants.</p>
</list-item>
<list-item>
<p>Global education campaigns for risks of contact with certain wild and domestic hunted/farmed species as well as the sale and consumption of species. In addition to the appropriate aid work to find safe sustainable alternatives for impacted communities</p>
</list-item>
<list-item>
<p>The identification of reservoir and intermediate hosts of known infectious diseases is important for the prevention of future viral outbreaks/pandemics through understanding the viral ecology of animal populations and the circulating pathogens within these animal communities.</p>
</list-item>
<list-item>
<p>Proactively reduce the risk of spillover events through implementing ecosystem stewardship measures in conjunction with prioritizing climate change reduction measures and biodiversity conservation measures. While also ensuring access to proper sanitation, safe and sustainable food sources and clean water sources.</p>
</list-item>
</list>
</sec>
</sec>
<sec id="s6" sec-type="author-contributions">
<title>Author Contributions</title>
<p>All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.</p>
</sec>
<sec id="s7" sec-type="funding-information">
<title>Funding</title>
<p>JK is funded by a Tier 2 Canada Research Chair in the Molecular Pathogenesis of Emerging and Re-Emerging Viruses provided by the Canadian Institutes of Health Research (Grant no. 950-231498), by the Natural Sciences and Engineering Research Council Discovery Grant (RGPIN-2018-06036) and from the Coronavirus Variants Rapid Response Network (FRN# 175622). MA was funded by an internship through the MITACS Accelerate program (FR53425).</p>
</sec>
<sec id="s8" sec-type="COI-statement">
<title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s9" sec-type="disclaimer">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
</body>
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