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The start of 2020 has seen the emergence of a new disease - the Wuhan novel coronavirus. Everywhere in the news at the moment, but how worried should we be and what do we need to know in general practice?
What is it?
Coronavirus itself is actually a large group of viruses, ranging from the human coronavirus, one of many viruses which cause the common cold, to more serious infections such as SARS and MERS. This outbreak is specifically the Wuhan novel coronavirus (WN-CoV).
It’s not yet clear how this developed – many viruses mutate from animal-based versions (SARS is a close relative and came from bats) and it was thought the WN-CoV may have originated from seafood linked to a local Wuhan fish market.
How is it spread?
Still to be fully confirmed, but there seems little doubt that transmission is now human-to-human. The mode has not been clarified, but it's likely respiratory droplet spread and direct contact. The virus has been isolated from basically every orifice so wash those hands and flush with the lid down… It has also been demonstrated that, just like with many infections, it is transmissible prior to symptoms developing.
Any figures in the blog will be out of date by the time you read it, but currently the virus has been isolated in almost 8 thousand people throughout China, is linked to >200 deaths and now present in 15 countries, but not yet the UK. The death rate is relatively high although bear in mind the lab-confirmed numbers are likely to grossly under-represent the actual level of disease burden in China, so may not be as bad as it appears.
What are the clinical features?
Most people have mild illness and simple URTI symptoms of fever, cough, chest tightness and/or dyspnoea. We need to be vigilante for symptoms suggesting more severe disease as clearly some patients will be very unwell.
How should we manage suspected cases?
Don’t let them in the practice! No really, that’s the recommendation from public health.
Hopefully patients will already be aware of their personal risk and they will contact by phone. If they have symptoms of acute respiratory illness and have lived in or travelled to Wuhan in the past 14 days, or had contact with a person with confirmed WH-CoA then advise them to stay at home, seek specialist advice from the local infectious diseases team and notify your local Health Protection Team.
Hopefully patients will simply call 111 for advice – there is a national system in place to manage patients recently returned from Wuhan.
If during the course of a face to face consultation it becomes apparent that the patient may have WN-CoV the advice is: “withdraw from the room, close the door and wash your hands thoroughly with soap and water… the patient should remain in the room with the door closed … seek further specialist advice from a local microbiologist, virologist or infectious diseases physician.”
Seriously ill patients may need ambulance transfer in which case we should ensure they are aware of the potential for WN-CoA. If transfer is not urgent, we should call the hospital and discuss with them first. Don’t ask them to take a bus or taxi… After the patient has gone the advice is to close the room and await advice from the local HPT. My friends in public health have been waiting for years to get the flame throwers out…
There is a very clear algorithm from PHE on management of suspected cases – click here. It also encourages us to keep an open mind. It could be Avian flu instead…
Clearly, the authorities are taking it VERY seriously until we know more about the nature of the infection and we need to as well.
These have developed rapidly and may change, but right now:
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