Following the outbreak of the Wuhan novel coronavirus in China, Deborah Bellamy looks at what the virus is and what the current public health concerns are for the UK.

What is Wuhan novel coronavirus?

Wuhan novel coronavirus and avian flu is a new strain of coronavirus first classified in Wuhan City, China. The pneumonia outbreak was initially reported in Wuhan City, central China's Hubei Province, in December 2019 and experts have attributed the outbreak to a novel coronavirus that has since spread across China and abroad. The source of the outbreak has yet to be determined.

Public Health England (PHE) is currently using the name Wuhan novel coronavirus (WN-CoV), in the absence of internationally accepted names for the virus and the disease/syndrome it causes. Other sources may use alternative temporary names for the virus, such as 2019 novel coronavirus (2019-nCoV). PHE will keep the terms used under review until such time as an internationally accepted term has been adopted.

Middle East respiratory syndrome coronavirus was first identified back in the mid-1960’s and previously called novel coronavirus.

The UK Government is constantly monitoring the situation and collaborating closely with the World Health Organization (WHO) and the wider international community.

As this is an evolving situation, epidemiological information will be updated regularly on PHE and DH websites. The Department of Health and Social Care will be publishing updated data daily at 2pm until further notice.

Current position

As of 27 January 2020, more than 4000 cases and 106 fatalities have been reported in mainland China. This includes 16 health care workers who have been infected.

30 cities and provinces have launched Level I emergency response, while Hong Kong has declared its “highest” emergency response.

There are currently no confirmed cases in the UK or of UK citizens abroad, and therefore the risk to the public is deemed as low. As of 27 January 2020, a total of 73 UK tests have concluded, of which all 73 were confirmed negative and none were positive.

History of Wuhan novel coronavirus

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.

On 12 January 2020, it was announced that a novel coronavirus had been identified in samples obtained from these cases and that initial analysis of virus genetic sequences have suggested this to be the cause of the outbreak.

What is a coronavirus?

A coronavirus is a type of virus and as a group, common worldwide. Some typical symptoms of coronavirus include fever and a cough that may progress to a severe pneumonia culminating in severe shortness of breath and breathing difficulties.

Generally, coronavirus can cause more extreme symptoms in individuals with weakened immune systems, older people, and those with long-term conditions like diabetes, cancer and chronic lung disease, such as chronic obstructive pulmonary disease (COPD).

How is it spread?

As WN-CoV has only been recently identified, there is limited information about the precise routes of transmission.

Therefore, current PHE guidance is based on knowledge gained from previous experience in responding to coronaviruses with significant epidemic potential such as Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV).

It is known that both SARS-CoV and MERS-CoV can transmit person to person and while yet confirmed for WN-CoV, it is a fair assumption that human-to-human transmission is possible.

Other coronaviruses have been found to be transmitted by large respiratory droplets and direct or indirect contact with infected secretions, blood, faeces and urine. Under certain circumstances, airborne transmission of other coronaviruses is also understood to have occurred through unprotected exposure to aerosols of respiratory secretions and sometimes faecal material.

Outbreaks of novel virus infections are always of public health concern. Risk from such outbreaks is reliant on the characteristics of the virus and includes how rapidly it spreads between people, the severity of subsequent illness and treatment or other measures which are available to control the impact of the virus, ie vaccination or medical treatment/medication options.

Infection control

As there are currently no effective drugs or a vaccine, control of this disease relies on the rapid identification, risk assessment, isolation of potential and actual cases, effective management and the investigation and follow up of close contacts to minimise potential onward transmission.

Effective infection prevention and control measures, including transmission-based precautions (airborne, droplet and contact precautions) with the recommended personal protective equipment (PPE) essential to minimise these risks but cannot eliminate it.

PHE states that coronaviruses have what is known as a “lipid envelope” which means the outer envelope layer consisting of lipids, so a wide range of disinfectants are effective. Appropriate cleaning and decontamination of the environment is key in preventing the spread of this virus.

PHE has classified WN-CoV infection as an airborne high consequence infectious disease (HCID) in the UK.

British scientists believe around one million people worldwide are likely to become infected.

Symptoms of Wuhan novel coronavirus

Although most cases have been characterised by severe illness, there have been reports of a milder illness being detected.

Based on current evidence, WN-CoV presents with flu-like symptoms including a fever, cough, or difficulty breathing.

NHS UK states symptoms usually include:

  • feeling tired

  • difficulty breathing

  • a high temperature

  • a cough.

Those who have died in Wuhan appear to have had pre-existing health conditions.

Main principles

  • Identify potential cases as soon as possible.

  • Prevent potential transmission of infection to other patients and staff.

  • Avoid direct physical contact, including physical examination, and exposures to respiratory secretions.

  • Isolate the patient, obtain specialist advice and determine if the patient is at risk of WN-CoV infection, and inform the local Health Protection Team (HPT).

Actions to take at practice level

The Health Secretary has ordered a “belt and braces” approach under recent plans to control spread of the virus in the UK. All 1500 people who have returned from Wuhan since mid-January have been asked to remain in isolation for at least two weeks after their return. If unable to do this, facilities will be set up to ensure safe quarantine.

This is an added precaution as the WHO are unclear if the coronavirus is contagious during the incubation period.

If, despite this advice, an unwell patient presents at the surgery with a relevant travel history, this should be identified when they book in at reception and immediately placed in a room away from other patients and staff. The patient should remain in the room with the door closed and personal effects and any waste should also stay in the room. The patient should not be allowed to use communal toilet facilities.

Others should be advised not to enter the room and if a clinical history still needs to be obtained or completed, it is recommended this is undertaken by telephone.

Further specialist advice from a local microbiologist, virologist or infectious diseases physician should be urgently sought as to ongoing assessment and care. The DH and PHE websites should also be checked for further up-to-date advice which should be followed.

If it is determined that WN-CoV is possible, based on the current PHE criteria for a possible case, it is recommended that face-to-face assessment in primary care, including out-of-hours centres and GP hubs, is to be avoided.

The local secondary care infection specialist should be contacted as a matter of urgency to discuss safe assessment and management, which is likely to be a hospital with adequate facilities.

Practices should inform the local PHE Local Health Protection Team (HPT).

To find local HPTs on www.gov.uk/health-protection-team, practices can type in their postcode to access further local advice/support.

Further information, in other parts of the UK may be accessed from:

Diagnosis

The UK is now one of the first countries outside of China to have a prototype specific laboratory test for diagnosing this new disease.

If a clinician suspects Wuhan novel coronavirus, samples from the nose, throat and deeper respiratory samples will be taken and will need to be transported safely to PHE Colindale.

Transport of samples between laboratories should be in accordance with Category B transportation regulations. PHE follows the guidance on regulations for the transport of infectious substances 2019–2020 which should be referred to.

Specimens and request forms should be marked with a biohazard label. The specimen should be double bagged in the isolation room by a staff member wearing recommended PPE.

PHE can provide a laboratory result from this specific virus on the same working day to ensure speedy diagnosis.

A variety of abnormalities are also reported to be commonly seen on chest X-rays with bilateral lung infiltrates, similar to other types of viral pneumonia.

The WHO has issued interim guidance on the clinical management of suspected cases, which may be found at www.who.int.

Advice to travellers from Wuhan

For those who have visited Wuhan and subsequently developed a fever, difficulty breathing or a cough within the past 14 days, it is advised to seek medical attention.

Everyone has now been advised to stay isolated in their own homes, avoid contact with others where possible, and to contact their GP practice by phone or ring 111, informing them of symptoms and that they have recently travelled to the city.

For those in Northern Ireland, patients should be advised to contact their GP.

Summary of action to date

PHE have now introduced advanced monitoring at airports with direct flights from China. A team of public health experts has been established at Heathrow airport to support and screen anyone travelling back from China who feels unwell.

Such hubs will comprise of rotational teams of 7 clinicians, working in shifts. This will be in addition to medical staff who are permanently in place at all UK airports and the advice issued to all UK airports for people travelling to and from China.

The UK Government has issued clinical guidance for the detection and diagnosis of Wuhan novel coronavirus, and infection prevention and control.

An alert from the Chief Medical Officer, Medical Director at PHE and Medical Director at NHSE have issued advice through a Central Alerting System (CAS) to alert frontline staff and to increase awareness of the ongoing situation and any recommended actions.

Due to the incubation period, most individuals will develop symptoms after leaving the airport, therefore it is essential that UK residents and travellers are also kept abreast with the latest information to ensure they are aware of what to do if they experience symptoms.

NHS and PHE have established a plan of how to respond to someone who becomes unwell.

China has also introduced port-of-exit screening, so anyone found to be exhibiting symptoms will not be allowed to leave the country.

If and when a first case in the UK is confirmed, it will be announced as soon as possible by the Chief Medical Officer of the affected country. This will be followed by a statement by England’s Chief Medical Officer.

Last reviewed 29 January 2020