Novel Coronavirus Health Advice – updated March 13th (17:00)
- Public Health England (PHE) have advised that anyone with a new continuous cough or a high temperature (over 37.8 degrees centigrade) should self-isolate.
- Reliable sources indicate c.60% of the population may become infected – the figure is clearly stated as the very worst case scenario.
- Mitigation efforts such as those deployed in China and starting in Italy greatly reduce transmission.
- Moving into the warmer Summer season may have a modest impact on transmission rates and may not be enough to stop the virus spreading.
- The virus does mutate in vivo following infection, which may affect onward transmission, virulence and infectivity in the future.
- There appear to be two strains of COVID-19 circulating (S-Cov and L-Cov) which may explain isolated and unconfirmed reports of people becoming re-infected after recovering from the virus.
- Hydroxychloroquine, a common anti-malarial drug which is also used to treat arthritis and is therefore commonly available has been shown to be three times more potent than chloroquine (which has been used extensively in China) at treating the virus.
- Despite frequent references in the media, some experts consider a vaccine will take at least a year to become available, because of notable difficulties in conducting Phase 3 trials and scaling up production enough to meet demand.
- A study has suggested transmission could occur one or two days before symptoms present, although there were only 17 participants.
- Additional reliable sources indicate that people can transmit the virus without having any symptoms and that symptoms-based screening (which is commonly being used at airports) may be ineffective at controlling the spread of the virus.
- A study in America showed that transmission occurred between a patient returning from China and her husband following prolonged, unprotected exposure, but 347 contacts who were traced (including 43 who were regularly tested) all gave negative results.
- Targeted social distancing for those in at risk groups (mature with pre-existing health conditions) is likely to be warranted and effective.
- Mass fever screening at public buildings, offices, hotels and places of worship appear to be helping to contain the outbreak in Singapore, without major social disruption.
- Experts suggest that school closures are unlikely to be effective given the low rate of infection amongst children, although much uncertainty surrounds children and transmission rates.
- A retrospective study of hospital admissions in Wuhan shows COVID-19 occurred in children at the start of the epidemic and caused moderate-to-severe respiratory illness.
- A case presenting rate which doubles every 4-7 days, as we are currently experiencing, suggests the epidemic may continue for four to five months (see below).
- Although the mortality rate has been around 2-3%, it is substantially lower where hospitals and medical teams are well prepared – around 0.4%.
- The World Health Organisation has released updated guidance for employers with clear and pragmatic advice about the steps businesses need to take.
- Private testing for potential COVID-19 cases is not currently possible and all potential cases should self-isolate at home.
- Other than quarantine, regular hand washing with an alcohol based sanitising cleanser is the single most effective way of slowing the spread of transmission.
- Remdesivir, a broad spectrum anti-viral drug, also shows promise in curbing the virus and further trials are underway.
The 2019-novel coronavirus (COVID-19) will continue to attract high levels of attention in the media for many weeks. Some of the media reporting continues to be alarmist in nature, however, validated sources of information continue to build a better picture of the clinical situation and are enabling better advice to be formulated.
The World Health Organisation (WHO) and Public Health England (PHE) continue to be our main reference sources.
Cases in the UK
As of 09:00 on March 13th, PHE had tested 32,771 individuals in the UK with 798 positive results. Although confirmed cases continue to be found, PHE is very well prepared and robust protection measures are in place. Some contact tracing is underway to mitigate the risk of further transmission in the UK, however, these steps will become more limited as case numbers continue to rise.
Currently (as of March 12th) there are 125,048 confirmed cases with 4,613 deaths reported, which continues to suggests a ~3% mortality rate. The evidence is that most cases appear to be mild.
Self-sustaining human-to-human transmission is occurring (amongst some individuals who may not display obvious symptoms) and the currently predicted rate of onward infection from each confirmed case is ~2.6 people. This in turn implies that control measures (travel restrictions, increased hygiene, face masks etc) need to block over 60% of transmissions to be effective in controlling the outbreak, which appears to be successful in China.
The steps taken to prevent the spread of the virus are mostly being seen amongst medical professionals as robust, however, the situation remains fluid and may change in the coming days. Although there is cause for concern, there is still no cause for alarm.
Advice for employers
The outbreak can no longer be contained in the UK, and it is still likely to be some weeks before the full profile of risks and the likely progression of the disease is clear.
Although there is a continuing risk, PHE are very well prepared and it is still unlikely that UK businesses will need to take any enforced measures at this stage, other than sensible risk planning steps.
It is definitely worth preparing for mitigating steps, such as providing alcohol-based gel cleansers for staff and facilitating preparations for home working if necessary.
Mass fever screening at the entrance to office buildings may help delay transmission.
Symptoms of Novel Coronavirus
Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. A sore throat is no longer associated as a symptom of the disease.
It remains prudent to always:
- Maintain good hand and personal hygiene, using alcohol-based hand sanitisers frequently
- As the virus appears to be spreading via respiratory tracts, high quality face masks are likely to be an effective control method for those who may be working or travelling in the affected areas (however, the efficacy is reduced for those who have beards)
- Avoid animals (alive or dead), animal markets and products that come from animals (such as uncooked meat and eggs)
- Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing
- Seek medical attention if any respiratory symptoms develop within 14 days of visiting the areas and inform your health service prior to attendance about your recent travel
- People with symptoms of acute respiratory infection should practice cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands)
Please feel free to contact our health team of doctors at any time via our support team if there is any information, assistance or support we can provide at any time.
This article is based on currently available reports and reference sources: