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OUTBREAK OF 2019 NOVEL CORONAVIRUS (2019-nCoV) IN CHINA

  • World Health Organisation alerted to new cluster of pneumonia cases in Wuhan City, Hubei Province of China on 31st December 2019.

  • Outbreak linked to a wholesale fish and animal market in Wuhan.

  • Chinese authorities identified novel coronavirus (2019-nCoV) as the causative virus on 7 January.

  • 217 confirmed cases of 2019-nCoV and 4 deaths (20th January) with further reports of cases closer to 300 and 6 deaths in total (21st January).

  • Confirmed cases in ex-Wuhan region visitors in Thailand, Japan, South Korea and Taiwan.

  • Passenger screening in place for ex-Wuhan travellers to Australia, Japan, Hong Kong, Singapore, Thailand, South Korea, Italy and US.

  • Heavy population movements during upcoming Chinese New Year increases risk of transmission outside of Wuhan.

China coronavirus

Situation

The World Health Organisation was alerted to a new cluster of pneumonia cases in Wuhan City, China’s central Hubei Province, on the 31st December 2019. The outbreak is being linked to a wholesale fish and animal market in the city. Chinese authorities later identified a novel coronavirus (2019-nCoV) as the causative virus.

Most patients have been linked to the Wuhan South China Seafood City (also called the South China Seafood Wholesale Market and the Hua Nan Seafood Market). Chinese health officials closed the market for cleaning and disinfection on 01 January 2020.

There have been 217 confirmed cases of 2019-nCoV and 4 deaths (20th January) with further reports of cases closer to 300 and 6 deaths in total (21st January). In addition, there have been confirmed cases in neighbouring countries of infected individuals which had previously travelled from the Wuhan region; Thailand (8th January), Japan (10th January), South Korea (20th January) and Taiwan (21st January). There has also been an individual in Australia displaying symptoms, however they are yet to have a confirmed diagnosis. Of the six confirmed fatalities, three had serious pre-existing medical conditions which were exacerbated by the virus. Children, the elderly and those with a weakened immune system are most at risk.

Analysis

Coronaviruses, a large family of viruses, cause illnesses ranging in severity from the common cold to more severe disease such as Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

As a zoonotic disease, transmission is from animals to humans. However, there has been recent evidence that there is also person-to-person transmission; for example, the traveller arriving in Japan had not visited the market but did have close contact with unspecified pneumonia patients.

Typically, in other coronaviruses, the virus is found in respiratory secretions, therefore transmission occurs through sneezing and coughing. Consequently, basic hand and personal hygiene is of paramount importance to reduce the potential spread of the virus.

It is important to note, that at this stage there is no clear evidence to demonstrate whether the virus has the ability to easily transfer between people with more information needed to evaluate the full extent of this mode of transmission. However, according to China's National Health Commission human-to-human transmission is possible with reports of medical staff becoming infected after treating patients. The source of the infection is still unknown and could potentially still be active.

Clinical features and symptoms include fever, a dry cough and fatigue during the early infection and later respiratory difficulties include bilateral lung infiltrates on chest x-ray, a feature of other types of viral pneumonia. If symptoms develop within 14 days of travelling to Wuhan, seek medical advice/attention. Ring ahead before arrival and ensure they are aware of your recent travel history.

Implications

Australia, Japan, Hong Kong, Singapore, Thailand, South Korea, Italy and the US have already implemented passenger screening for those travelling from Wuhan. Other countries, such as the UK, are currently not screening passengers arriving from Wuhan although this is likely to change should the virus spread.

The upcoming Chinese New Year celebrations at the end of January will result in a significant increase in global travel volume to/from China and within China, hence increasing the likelihood of virus transmission. The period during the Lunar holidays is described as the largest annual human migration on Earth, with almost 7 million Chinese tourists travelling abroad during the 2019 Lunar New Year according to state media.

China's National Health Commission issued a statement on 19 January stating that the outbreak remains “preventable and controllable " at this time.

The World Health Organization, the US Centers for Disease Control and Prevention, The UK National Travel Health Network & Centre and the European Centre for Disease Prevention are not advising any travel or trade restrictions as a result of the outbreak at this time, although this could change at short notice. The outbreak remains an evolving, dynamic situation and is being continuously monitored.

The World Health Organization are due to hold a meeting on 22 January to determine the next course of action, and whether the outbreak constitutes an international public health emergency. If this is declared, travel restriction advisories will likely be implemented.