The recent coronavirus (2019-nCoV) outbreak that originated in the city of Wuhan, China has received vast media attention due to its rapid transmission and the number of associated deaths, particularly in China. This blog aims to provide an overview on what is currently known about the virus, the state of affairs globally and the measures in place for Northern Ireland and the rest of the UK.
Because this is an ongoing and evolving situation, there are still many unknowns and new figures and details are emerging daily.
What is a coronavirus?
According to the World Health Organization (WHO), coronaviruses (CoV) constitute a family of viruses, of which seven (including 2019-nCoV) are known to infect humans. These viruses range from the common cold, to the ones that caused the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 and the Middle East Respiratory Syndrome (MERS) outbreak in 2014. Many coronaviruses are zoonotic, meaning they can be transmitted from animal hosts to humans, potentially leading to development of novel diseases. For example, civet cats and dromedary camels were identified as the sources of SARS and MERS respectively.
Coronavirus infections typically cause respiratory symptoms, which can range in severity from coughs, shortness of breath or breathing difficulties to pneumonia or severe acute respiratory distress. These symptoms can also be accompanied by fever, headache, a runny nose or sore throat.
The Centre for Disease Control and Prevention (CDC) states that the most common routes of transmission for coronaviruses are:
- The air, via coughing and sneezing.
- Touching of contaminated surfaces.
- Close contact with an infected individual.
The new coronavirus – 2019-nCoV
The coronavirus outbreak began in the city of Wuhan, in the Hubei province of China. Initial reports to the WHO identified 44 cases between 31st December 2019 and 3rd January 2020 for ‘pneumonia of unknown etiology’. Several days later 2019-nCoV was isolated and identified as the causative agent, with authorities in China then sharing the genetic sequence.
The origin of infection for 2019-nCoV is believed to be from the Huanan seafood and live animal market, with subsequent transmission occurring through person-to-person contact. Symptoms can range from mild to severely ill and are similar to those seen for other coronaviruses (e.g. fever, cough and shortness of breath).
The period of incubation for the virus has been estimated at between 2-10 days, with a standard quarantine period of 14 days being used for individuals with suspected infections.
There has been some evidence that individuals with 2019-nCoV who have yet to present symptoms may be infectious. Although other viruses, such as influenza, are known to be transmissible prior to presentation of symptoms, this was not believed to be the case with SARS or MERS.
On 11th February 2020, the WHO announced that COVID-19 would become the official name for the disease caused by the new coronavirus.
Prevention and treatment
The WHO has published advice to the public on basic protection measures for 2019-nCoV. They have also released a Myth Busters section, with a series of graphics to combat some of the myths surrounding the outbreak.
As yet, there is no specific antiviral treatment for 2019-nCoV, with care instead focussing on the relief of symptoms. Most mild cases are unlikely to require hospitalisation, but patients are advised to self-isolate to prevent passing on the virus to others. For more severe cases, the WHO has advised a range of treatments, depending on the disease presentation.
A global initiative has been set up to develop a vaccine, with the UK Government donating £20 million to the Coalition for Epidemic Preparedness Innovations (CEPI), a partnership with several pharmaceutical companies and academic institutes. CEPI is currently implementing plans to fast-track development of a vaccine within the next 6–8 months.
Current known epidemiology
As of 12th February 2020, over 99% of the confirmed 2019-nCoV cases have arisen in China, and this includes all but one of the attributed deaths (which occurred in the Philippines). An additional 24 countries have reported incidences of the coronavirus, including eight cases in the UK. Daily updates from the WHO can be found here.
This graphic illustrates the global spread of the virus from 20th January – 11th February 2020:
Data source: WHO; Numbers for Japan include those diagnosed on a cruise ship in Japanese territorial waters.
According to China’s National Health Commission roughly 80% of the deaths that have occurred due to the coronavirus have been in people aged over 60, and 75% had underlying medical conditions, such as diabetes or heart disease.
The current estimated mortality rate for 2019-nCoV is around 2%, which is lower than those seen for the SARS or MERs outbreaks, which were approximately 10% and 34% respectively. Although less deadly, 2019-nCoV appears to be more contagious, with more reported cases than both SARS (8,098 cases with 774 deaths) and MERS (2,494 cases and 858 deaths) put together.
How has the world reacted to the outbreak?
On 23rd January 2020 China declared a lockdown of Wuhan, the city where the outbreak originated. Public transport was suspended, many businesses closed and people were advised to stay indoors. Additional cities in the Hubei province also initiated similar quarantines in the following week. With 50-60 million people now estimated to be living under these conditions, no end date has yet been declared. China has also introduced port-of-exit screenings, to prevent individuals who present with symptoms from leaving the country.
On 11th February 2020, the BBC reported that several Hubei senior officials have been removed from office by the Chinese government, after being accused of mishandling the outbreak. China has also developed a close contact detector app, which will inform users if they have been in close proximity with someone who has, or is suspected of having, the coronavirus.
On 3rd February 2020, Hong Kong announced it would close 10 of the 13 crossings from mainland China, after already closing cross-border ferries and high-speed rail services five days earlier.
Although counter to WHO recommendations, various travel bans have been put in place across the globe. The US, Australia and Singapore are currently denying entry to all foreign nationals who have visited China within the previous 14 days. New Zealand, Israel and Russia are denying entry to foreigners who have travelled directly from mainland China, whereas for Japan and South Korea the ban only applies to foreigners who have travelled from the Hubei province. In the UK, several airlines have suspended flights to and from mainland China.
Several countries, including the UK, have evacuated their own nationals from the city of Wuhan, with a subsequent two week mandatory quarantine.
Is the new coronavirus in the UK?
So far there have been eight confirmed cases of 2019-nCoV in England. The initial two cases were identified in the city of York, with the individuals both being Chinese nationals and members of the same family. They were taken to a specialist unit at Newcastle Royal Victoria Infirmary. One of the cases was imported from China, with subsequent transmission to the other family member in the UK.
The third case, a businessman, was diagnosed in Brighton and is believed to have contracted the virus in Singapore, whilst at a conference. He is currently being treated in St. Thomas’s Hospital in central London. This patient has also been linked to five cases in France, and one in Majorca, after staying in a French ski resort, along with the additional five UK cases. In connection with this, a GP practice has been temporarily closed in Brighton as a precaution.
What’s the advice for the UK?
Following on from the WHO declaration of the 2019-nCoV outbreak as a PHEIC, the UK Chief Medical Officers increased the risk to the public from low to moderate.
The most up-to-date information and guidance for the UK public can be found here.
Currently the Foreign and Commonwealth Office advise against all travel to the Hubei region and to avoid all other non-essential travel to the rest of mainland China. On 4th February 2020, the Foreign Secretary, Dominic Raab, stated that:
…we now advise British nationals in China to leave the country if they can, to minimise their risk of exposure to the virus.
Hospitals have been ordered to set up priority assessment pods by 7th February 2020, for suspected coronavirus infections.
A Government campaign was launched in early February 2020, providing information on 2019-nCoV to the UK public.
On 10th February 2020, the UK Health Secretary, Matt Hancock, announced that the Health Protection (Coronavirus) Regulations 2020 had been put in place with ‘immediate effect’, allowing greater powers to police to enforce quarantine for those at risk of the new coronavirus.
Northern Ireland and the Republic of Ireland
As of 12th February 2020, there has been no reported cases of 2019-nCoV on the island of Ireland.
The Northern Ireland Department of Health has stated that they are following the situation and liaising with partners across the rest of the UK and the Republic of Ireland (RoI).
The NI Chief Medical Officer, Dr Michael McBride, has issued advice to health care workers on what to do in the event of a suspected coronavirus infection and has assured that measures are in place to isolate and treat any such cases.
The Health Minister, Robin Swann, has stated that:
The PHA and HSCB has also activated its Emergency Operations Centre and continues to closely monitor the situation and risk in Northern Ireland.
Up-to-date information on the 2019-nCoV for Northern Ireland can be found here.
Advice for RoI is largely similar to that for the UK, with all non-essential travel to China discouraged. As RoI does not have any direct flights from China, entry screening measures have not yet been recommended and the risk to the public is considered low.
The media coverage and response to 2019-nCoV is understandable. However, it is important to put this outbreak into perspective. Seasonal flu, for instance, has a lower mortality rate (well below 1%) but has a major global healthcare burden due to the millions of people who catch it yearly and the hundreds of thousands of associated deaths. One study estimated that between 1999 and 2010, in the UK alone, 7,000 to 25,000 people died each season from influenza.
The key concern with 2019-nCov is that it is a newly emerged virus, and it is unclear how the situation will unfold. A group from the London School of Hygiene and Tropical Medicine has released preliminary data projecting that the outbreak may peak in mid-late February, with the potential for at least 500,000 infections in Wuhan alone. Another model, from the Dalla Lana School of Public Health, University of Toronto, predicts up to 300,000 cases by 24th February 2020 if rates of transmission occur at the top end of WHO estimates.
According to a news article from the Business Insider, experts have suggested three possible outcomes of the 2019-nCoV outbreak:
- The virus remains in circulation, but becomes more seasonal (like flu) or presents as a milder infection;
- Public health interventions eventually lead to a containment of the outbreak (similar to SARS);
- Development of a vaccine.
However, it is important to stress that much is still not yet known about 2019-nCoV, and that these estimates and outcomes may change as more information comes to light.
Currently, risk to individuals in the UK remains low and the best approach is to follow the advice to undertake good hygiene practices and to self-isolate and inform the relevant health professionals if exhibiting symptoms.