This blog looks at information available about the recent outbreak of a new air-borne respiratory infection in China.
The UK Department of Health hasn’t been slow in providing information and guidance on this infection, which has been in the news over the past few days. There are links on the UK Gov website for diagnostics labs, GPs and clinicians, as well as for the public.
The first alerts were buried in the noise of new year, but 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. Hence the infection being labelled ‘Wuhan novel coronavirus’.
Some reporting has suggested that China has tried to underplay the extent of the spread. But the BBC reports that junior officials in China have been warned not to attempt any concealment. The WHO stated on 9 January that:
Chinese investigators conducted gene sequencing of the virus, using an isolate from one positive patient sample. Preliminary identification of a novel virus in a short period of time is a notable achievement and demonstrates China’s increased capacity to manage new outbreaks.
They also make comment in the same report on the efficiency and rigour of the Chinese public health and early warning systems.
What is a coronavirus? (CoV)
Coronaviruses are a large family of viruses that affect humans and animals. In humans they cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.
Coronaviruses can be transmitted between animals and people. SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans, and tend to present a higher risk than human coronaviruses. The SARS outbreak of 2002/3 was of concern for several months before it was contained, and killed 770 people out of around 8000 known to be infected worldwide. No cases have been reported since 2004.
Symptoms can be that of an ordinary cold – raised temperature, sore throat, coughs and sniffles, as well as shortness of breath. However, they can develop into something more serious, like pneumonia. One of the issues with this coronavirus is that it can take some days for the infection to worsen into something that clearly isn’t a cold, and, as has been seen, to death.
What should we do to prevent the virus spreading?
WHO reminds us that advice for normal hygiene around respiratory infection spread is the most relevant in this case:
- “Avoiding close contact with people suffering from acute respiratory infections;
- Frequent hand-washing, especially after direct contact with ill people or their environment;
- Avoiding unprotected contact with farm or wild animals;
- People with symptoms of acute respiratory infection should practice cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands);
- Within healthcare facilities, enhance standard infection prevention and control practices in hospitals, especially in emergency departments.” (see below for advice from Health Protection Scotland)
How well is the virus, and those infected, being tracked?
The WHO are issuing information on a daily basis, including this first Situation Report and a range of Technical documents, summarising all that is known so far and information for managing the spread. The effectiveness of the tracing and tracking systems can be seen in this case of a Korean woman, reported by WHO on 21 January, and summarised here:
On 20 January 2020, the Republic of Korea reported the first case of novel coronavirus in the Republic. The case is a 35-year-old female, Chinese national, residing in Wuhan in China.
She had developed fever, chill, and muscle pain on 18 January while in Wuhan. She visited a local hospital in Wuhan and was initially diagnosed with a cold. On 19 January, she was detected with fever upon arrival at the Incheon International Airport, South Korea. She was transferred to an isolation hospital for testing and treatment and tested positive for novel coronavirus on 20 January at the Korea Centers for Disease Control and Prevention (KCDC). Upon detection, the patient had chills, runny nose, and muscle pain.
In the same report, WHO said that this woman is the fourth case of the infection found in travellers from Wuhan City, China.
Since the initial report of cases on 31 December 2019, and as of 20 January 2020, 278 laboratory-confirmed cases of 2019-nCoV infection including six deaths were reported to WHO from China. 51 are severe cases, and 12 cases are critically ill and are in isolation. Most are being treated in Wuhan, although some of the cases were reported from other areas of China
In addition, there are:
- two cases originally from Thailand,
- one case from Japan, and
- one case from the Republic of Korea.
It is not yet clear how many cases are due to human to human transmission and how many from animal to human.
More recent press reports now puts the deaths at seventeen, with around 450 confirmed cases.
This is a fast-changing situation. But sixteen years on from the SARS outbreak, it seems that the identification and isolation of the virus, the tracing and monitoring systems globally and the treatment of cases is working effectively so far
There has been reporting in US media about a man returning from Wuhan area to the US who has been confirmed as suffering from the virus . He was well when he travelled but sought health advice when he started to develop symptoms. Fellow passengers on his flight are being monitored. He has mild pneumonia.
Most airports have set up screening for passengers where flights are coming in from Wuhan, including Heathrow.
WHO publishes general resources about the management and features of epidemics, including outbreaks of SARS and MERS – other coronaviruses.
The response in Scotland
Health Protection Scotland has information on the current outbreak. It has also issued specific detailed guidance on how to manage and isolate any suspected cases that arise in Scotland.
There is a written ‘Memorandum of Understanding’ between the Scottish Government, Health Protection Scotland (HPS) and Public Health England (PHE) about co-operation on outbreaks such as these.
There are a number of UK-wide groups, involving Public Health England and the devolved nations to co-ordinate a consistent response to so-called High Consequence Infectious Diseases (HCIDs). Wuhan novel coronavirus has been added to the list of these HCIDs.
One of these groups is Nervtag, the ‘New and Emerging Respiratory Virus Threats Advisory Group’. Daily phone calls are also being held between the four UK nations.
The situation is fast-moving, but so far, the global response appears to be efficient, comprehensive and collaborative.
Anne Jepson, Senior Researcher, Health and Social Care