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Information from: Dr. Cai Glushak, AXA Partners Chief Medical Officer and Dr. Alan Tan, AXA Partners Asia Region Medical Director

Situation

The World Health Organization (WHO) has declared Public Health Emergency of International Concern (PHEIC) now that the 2019 Coronavirus has spread to multiple countries.

A recent outbreak of severe respiratory infection that originated in Wuhan City in Hubei Province, China has now been traced to a newly identified virus, named 2019-nCoV. It is classified as a Coronavirus, which is in the same family of viruses that caused the SARS and Middle East Respiratory Syndrome in previous years, but it is not the same agent and has a different disease severity profile. It is also different from all influenza viruses, A, B and H1N1and other avian flu virus.

Source

The origin of the infection has been traced to a live animal and seafood market in Wuhan City. While originally most victims came from Wuhan City, within China secondary person-to-person transmission is now clearly established.

Spread

While person-to-person spread of the virus is clear, this has been very limited outside of China. Spread is primarily by respiratory droplet contamination, including through droplets from surface contact.

Hence hygiene precautions should focus on avoidance of contamination through coughing and sneezing as well as cleansing of surfaces and containment of contaminated clothing.

Clinical syndrome

Symptoms of the current illness are:

• Fever or sensation of fever

• Lower or upper acute respiratory symptoms including shortness of breath, cough and. Less commonly:

  • Runny nose
  • Sneezing
  • Diarrhea
  • In a smaller case percentage of cases:
    • Head congestion
    • vomiting

Since these are very non-specific symptoms, criteria for suspecting the syndrome also include recent presence in a high-risk area, primarily Wuhan City, or close contact with someone who has been in that location. Where secondary spread becomes prevalent, suspicion for Coronavirus infection will include those with no such history.

Complication and death

Most patients do not develop severe illness. A minority have severe respiratory illness requiring intensive treatment and a small percentage (about 2%) have died. It is as yet unknown how prevalent the infection may be in patients with mild illness who have not come to clinical attention.

Infectivity

The incubation period for the virus and duration the patient remains contagious after illness is unknown.

Based on prior Coronavirus outbreaks, health authorities advise it may take up to 14 days before an exposed person may develop symptoms. Until it is determined whether asymptomatic contaminated persons are contagious, health policy general requires that potentially exposed persons remain in isolation for 14 days. The duration of quarantine has not been determined for a patient who has recovered from symptoms.

Patients requiring hospital care will be placed in special hospitals or isolation units of medical facilities. Ill or exposed individuals who are not sick enough to require hospitalization will be subject to isolation and monitoring at home or in designated quarantine facilities.

Quarantine facilities are mainly used for returning travellers who may be contaminated. If contact with an infected individual is suspected, it is essential to report immediately to a health facility and strictly adhere to requirements for isolation from the public and other members of the household.

Testing & diagnosis

There is a rapid R-PCR test that can definitively confirm Coronavirus infection. The test is done by nasal swab and/or blood draw (or bronchial secretions in hospitalized patients). Testing is mainly done on patients with symptoms as a test on a patient who is in the incubation phase with no symptoms may yield a false negative result. At the moment many private facilities do not have the test.

Although distribution to local facilities is expected, it may only available at public facilities or public health laboratories. For this reason, it may take up to 48 hours to have results.

Treatment

There is currently no specific treatment for the illness. There is no preventive vaccine or medication that is effective.

Only supportive measure like supplemental oxygen, ventilators and general health measures are indicated until the infection abates.

Several investigation drugs are being trialed, but as yet, there is inadequate evidence they will be effective. Ostetalmivir (Tamiflu) is not effective for Coronavirus.

Preventive measures

• In addition to the quarantine on Wuhan and several cities of Hubei province, the CDC and most government authorities advise against all non-essential travel to mainland China. In China, authorities advise avoiding live markets and not to touch animals or eat game meat. Avoid visiting wet markets, live poultry markets or farms and ensure all animal products are well cooked.

• Patient with symptoms of cough, shortness of breath and/or fever, especially with a history of travel to China are advised to immediately seek medical attention. If arriving by air, you should report this to airport authorities immediately upon deplaning.

• Use stringent hygiene practices:

  • Wash hands regularly and liberally with soap and water and use alcohol based disinfectant lotions.

  • Clean surfaces regularly.

  • Avoid proximity to others who are coughing or have a fever.

  • If you have symptoms (coughing or sneezing), put on a surgical mask to avoid contaminating other people and stringently cover your face with tissue or a flexed arm when coughing.

  • Report any concerning symptoms to your manager at work before reporting for duty.

  • Consult your workplace manager regarding any additional measures advised by your employer.

  • If you suspect you have had contact with a person infected by Coronavirus, report immediately to a health facility and strictly follow local requirements for personal isolation to avoid infecting other individuals.

• Make sure to get your annual flu vaccine. This will not protect against2019-nCoV, but will reduce the likelihood of contacting standard flu, which may be indistinguishable at onset from the new outbreak and which may require isolation or detention until the cause is confirmed.

• Health care facilities are to take isolation precautions on any patients with the above symptoms and who have traveled from the source of the outbreak in China.

• Be prepared to be screened by remote temperature sensors and interviews in airports, especially where flights are arriving from China.