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Wuhan Novel Coronavirus (2019-nCoV)

What is it?

Coronaviruses are a large family of viruses with some causing less-severe disease, such as the common cold, and others causing more severe disease such as Middle East respiratory syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) coronaviruses.

Preliminary investigations identified environmental samples positive for 2019-nCoV in Huanan Seafood Wholesale Market in Wuhan City, however some laboratory-confirmed patients did not report visiting this market. The animal source of the outbreak has not been identified yet, but investigations are ongoing.

Transmission

Human-to-human transmission is occurring. Hence, precautions to prevent human-to-human transmission are appropriate for both suspected and confirmed cases (see infection control). 2019-nCoV infections have been reported in health care workers in China.

2019-nCoV is extremely contagious, and so far (5-Feb-2020), 282,813 people have been identified as having had close contact with infected patients. 186,354 are now under medical observation. As of 5-Feb-2020 the Chinese National Health Commission had received 28,018 reports of confirmed cases and 563 deaths.

We do not know the routes of transmission of 2019-nCoV; however, other coronaviruses are mainly transmitted by large respiratory droplets and direct or indirect contact with infected secretions. In addition to respiratory secretions, other coronaviruses have been detected in blood, faeces and urine.

Under certain circumstances, airborne transmission of other coronaviruses is thought to have occurred via unprotected exposure to aerosols of respiratory secretions and sometimes faecal material.

SYMPTOMS

Initial clinical findings from patients to date have been shared by China and WHO. Fever, cough or chest tightness, and dyspnoea are the main symptoms reported. While most cases report a mild illness, severe are also being reported, some of whom require intensive care. A small number of fatalities have been reported.

A variety of abnormalities may be expected on chest radiographs, but bilateral lung infiltrates appear to be common (similar to what is seen with other types of viral pneumonia).

Treatment

No specific treatment for 2019-nCoV infection is currently available. Clinical management includes prompt implementation of recommended infection prevention and control measures and supportive management of complications, including advanced organ support if indicated. Corticosteroids should be avoided unless indicated for other reasons (for example, chronic obstructive pulmonary disease exacerbation or septic shock per Surviving Sepsis guidelines), because of the potential for prolonging viral replication as observed in MERS-CoV patients. For more information, see: WHO interim guidance on clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected and Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America.

Healthcare personnel should care for patients in an Airborne Infection Isolation Room (AIIM). Standard Precautions, Contact Precautions, and Airborne Precautions and eye protection should be used when caring for the patient. See Interim Health Care Infection Prevention and Control Recommendations for Patients Under Investigation for 2019 Novel Coronavirus.

Patients with a mild clinical presentation may not initially require hospitalization. However, clinical signs and symptoms may worsen with progression to lower respiratory tract disease in the second week of illness; all patients should be monitored closely. Possible risk factors for progressing to severe illness may include, but are not limited to, older age, and underlying chronic medical conditions such as lung disease, cancer, heart failure, cerebrovascular disease, renal disease, liver disease, diabetes, immunocompromising conditions, and pregnancy.

The decision to monitor a patient in the inpatient or outpatient setting should be made on a case-by-case basis. This decision will depend not only on the clinical presentation, but also on the patient’s ability to engage in monitoring and the risk of transmission in the patient’s home environment.

Prognosis

This is still being determined. The Wuhan Novel Coronavirus is a killer, but until we have more reliable statistics we won’t publish a mortality rate.

Infection Control

When in an environment where there is a risk of close proximity to an infected individual you should wear the following PPE as a minimum standard. For the donning and removal process follow the process on our How to Wear Infection Control PPE for Airborne HCIDs.

Gloves

Perform hand hygiene, then put on clean, non-sterile gloves before leaving your safe area. Change gloves if they become torn or heavily contaminated. So, carry some spare gloves and a portable alcohol-based hand sanitiser with you.

Respiratory Protection

Use respiratory protection (i.e., a respirator) that is at least as protective as a fit-tested NIOSH-certified disposable N95 or EN149:2001 FFP2 filtering facepiece respirator before leaving your safe area.

Disposable respirators should be removed and discarded after re-entering your safe area. Perform hand hygiene after discarding the respirator.
If reusable respirators (e.g. reusable half-mask, powered air purifying respirator/PAPR) are used, they must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use. Usually that will involve removing and discarding the filters and then washing the re-usable components with a chlorine-based, or alcohol-based disinfectant solution.

Eye Protection

Put on eye protection (e.g., goggles, a disposable face shield that covers the front and sides of the face) before leaving your safe area.

Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use. Usually that will involve washing them with a chlorine-based, or alcohol-based disinfectant solution. Disposable eye protection should be discarded after use.