With the spread of coronavirus dominating the news agenda throughout the world this week, Dean of our College’s Faculty of Travel Medicine Jane Chiodini writes for our blog on the current situation, and what expert advice is available to healthcare professionals to help contain and treat the spread of this new virus.
On 31 December 2019, the World Health Organization (WHO) was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. A novel coronavirus was identified as the cause and was named Coronavirus (2019-nCoV).
Coronaviruses are a large family of viruses, some cause mild illness, such as the common cold but others can result in more severe disease such as Middle East respiratory syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Generally, coronavirus can cause more severe symptoms in people with weakened immune systems, older people, and those with long term conditions like diabetes, cancer and chronic lung disease
The main symptoms reported for Coronavirus (2019-nCoV) have been fever, cough or chest tightness, and dyspnoea. While most cases report a mild illness, severe cases are also being reported, some of whom require intensive care and some deaths have occurred.
World Health Organization updates
The WHO publish a daily situation report, at and on 30th January recommended that the interim name of the disease causing the current outbreak should be “2019-nCoV acute respiratory disease” (where ‘n’ is for novel and ‘CoV’ is for coronavirus). At that time there were 7818 cases confirmed globally of which 7736 were confirmed in China. Of these, 1370 were severe and 170 deaths had occurred. Outside of China there were 82 cases in 18 countries. The report provides a global map of the countries, territories or areas with reported confirmed cases of 2019-nCoV and a surveillance table of the numbers within each location.
However, this is a rapidly changing picture, and on 30th January the WHO convened the second International Health Regulations (IHR) Emergency Committee on novel coronavirus in China. The Committee stated they believed that ‘it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk. It is important to note that as the situation continues to evolve, so will the strategic goals and measures to prevent and reduce spread of the infection’. As a result, the Director-General declared that the outbreak of 2019-nCoV constitutes a Public Health Emergency of International Concern (PHEIC) and accepted the Committee’s advice and issued Temporary Recommendations under the IHR to the People’s Republic of China, to all countries and then to the global community – full details can be viewed on the WHO website.
In addition, the Committee emphasized that the declaration of a PHEIC should be seen in the spirit of support and appreciation for China, its people, and the actions China has taken on the frontlines of this outbreak, with transparency, and, it is to be hoped, with success. In line with the need for global solidarity, the Committee felt that a global coordinated effort is needed to enhance preparedness in other regions of the world that may need additional support for that.
The WHO also have a very helpful page of resources on the virus. This resource provides advice on protecting yourself, travel advice, myth-busters, situation reports and technical guidance. I would suggest that users visit it daily.
News from the United Kingdom
In the UK, our four Chief Medical Officers (CMOs) issued a press release on 30.01.20 explaining in light of the current situation they considered it prudent for their governments to escalate planning and preparation in case of a more widespread outbreak. For that reason, they advised an increase of the UK risk level from low to moderate, clarifying that this didn’t mean they thought the risk to individuals in the UK had changed at this stage, but that government should plan for all eventualities.
On the morning of 31st January, the Department of Health and Social Care (DHSC) announced two patients in England, who were members of the same family, had tested positive for novel coronavirus and were receiving specialist NHS care, using tried and tested infection control procedures to prevent further spread of the virus.
These are the first cases identified in the UK, but a very interesting blog prepared by Public Health England (PHE) explains the NHS is extremely well-prepared and used to managing infections. PHE is a world leader in developing techniques to aid the public health investigation of infectious disease and the UK is one of the countries outside China to have an assured testing capability for this disease. It is a complex test which can differentiate this type of coronavirus from other coronaviruses.
Health Protection Scotland (HPS) have also published their own resources including a comprehensive document on Wuhan novel coronavirus (WN-CoV) guidance for Primary Care: Management of patients presenting to primary care.
PHE have published a number of helpful resources, including guidance on aspects such as initial investigation of possible cases, self-isolation for patients undergoing testing, infection prevention and control, guidance for primary care. This page also contains links to news and announcements and all resources are reviewed and updated regularly. PHE data on Novel coronavirus (2019-nCoV): epidemiology, virology and clinical features is also available.
UK Travel advice – pre and post guidance
Regarding travel advice, the Foreign and Commonwealth Office (FCO) advise against all travel to Hubei Province due to the ongoing novel coronavirus outbreak and against all but essential travel to the rest of mainland China (not including Hong Kong and Macao). More details, including a downloadable map, can be found on travel advice here.
PHE were advising that anyone who has visited Wuhan in the last 14 days, should stay indoors and avoid contact with others where possible, and call NHS 111 informing them of their symptoms and recent travel to the city. Individuals in Northern Ireland, should call their GP. However in a CMO alert sent on 31st January 2020, (Alert Reference: CEM/CMO/2020/002) it was recommended that all travellers who develop relevant symptoms, however mild, within 14 days of returning from mainland China, should self-isolate at home immediately and call NHS 111. This document is essential information of all clinical staff encountering patients with respiratory infections arrived from overseas. This page also provides a flowchart for use in the Management of a suspected case of 2019-nCoV acute respiratory disease.
If an individual is planning travel abroad then excellent travel advice is available from Fit For Travel, a site for the general public produced by the International Health Team of Health Protection Scotland or Travax® which is designed for use exclusively by health care practitioners throughout the UK and Republic of Ireland when providing country specific advice for travellers, and has an additional level of detail. General health advice entitled Novel Coronavirus (Wuhan, China) Infection can also be found on the site.
TravelHealthPro is a site for the general pubic and health care practitioners alike, produced by the National Travel Health Network and Centre (NaTHNaC) a service commissioned by PHE. Their general advice for Coronavirus (2019-nCoV) can be found here. This current information for travellers advises the following:
To reduce the risk of coronavirus infection all travellers should:
- Maintain good hand and personal hygiene. Wash hands regularly with soap and water or a disinfectant before handling or consuming food.
- Avoid visiting live bird and animal markets, backyard or commercial poultry farms and do not touch wild or domestic birds (alive or dead).
- Avoid any contact with animals, birds or surfaces that may be contaminated with animal or bird droppings.
- Avoid eating or handling undercooked or raw meat including poultry, egg or duck dishes.
- Avoid close contact with anyone with cold or flu-like symptoms, or who appears unwell.
- Avoid sharing personal items
To reduce the risk of passing coronavirus to others, anyone with respiratory symptoms should:
- Cover their nose and mouth when coughing and sneezing with a tissue or flexed elbow
- Use paper tissues only once and dispose of them carefully
- Should a mask be worn, all the recommended precautions in order to minimise the risk of transmission should still be used
- There is currently no preventive vaccine or specific treatment for novel coronavirus (2019-nCoV)
Developments on 2019-nCoV acute respiratory disease is clearly an unfolding picture, but the speed with which the world seems to be responding so quickly is positive.
Our College is already in contact with the Chief Medical Officers in the UK about this issue, and our College President attended the first of a regularly planned teleconference on coronavirus earlier this week. We will continue to work with the Academy and others to ensure that we all continue to receive up to date information about the spread of the virus, and how we can work to best support our patients.