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28 Feb 2020

Background

  • COVID-19 novel coronavirus is a new strain of coronavirus affecting humans.
  • Disease severity ranges from an illness akin to the common cold through to more severe illness similar to that seen with Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MARS).
  • Knowledge of illness phenotypes, transmission and treatment are still evolving.
  • People of all ages can be affected.
  • Elderly people and those with prior illness (e.g. asthma, diabetes, heart disease, etc) are more vulnerable to becoming severely ill.
  • Australian Governments monitoring situation carefully and coordinating planning and resource allocation to manage greater infection rates if they occur in Australia.
  • The Commonwealth Government activated the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) on 27 February 2020.

General population protection measures

  • Cleaning hands with soap or alcohol-based hand rubs.
  • Covering nose/mouth with flexed elbow or tissue when coughing/sneezing.
  • Avoid contact (especially close contact such as touching) with anyone who has fever, cough, sore throat, fatigue, dyspnoea.
  • Stay home if unwell.

Epidemiology

  • Currently over 81,000 cases worldwide (39 countries).
  • As of 27 February: China 78 191 confirmed cases, 2718 deaths; outside of China 2918 confirmed cases in 37 countries; 43 deaths.
  • 23 confirmed cases in Australia, all of these people have now returned to their home states for medical treatment.
  • 94% of deaths have occurred in people >50 years old. All had a severe, significant illness prior to death.
  • Infection doubling rate is 6-8 days, equating to approximately 10 weeks from point of undetected infection to exponential growth.
  • Mortality rate 2-3%

Transmission

  • Transmission is from person to person via droplet, mucous membranes, faecal-oral and via fomites (doorknobs, tables, cutlery etc).
  • Virus sheds in asymptomatic people (but no confirmation of transmission from asymptomatic patients in Australia, perhaps one case in North America).
  • One infected person is estimated to potentially infect 2-4 other people.
  • Incubation period 5-14 days (possibly longer).
  • Illness peaks day 9-13 (with hospitalisation requirement evident by day 5).
  • Virus survives for 48 hours on surfaces at room temperature.
  • Healthcare staff caring for affected, isolated patients and those performing procedures on suspected/infected patients e.g. intubation or swab collection, should wear appropriate personal protection equipment. Local hospitals will have information on correct procedures for their use.

Diagnosis

  • Nasopharyngeal swab for PCR testing – very sensitive test now widely available. Serological blood specimens also being routinely collected for later use.

Treatment

  • There is no treatment for COVID-19.
  • Vaccine development underway (including at University of Queensland) but timeframe likely 12-18 months.

Suggested action by Australian doctors

  • Remain informed.
  • Vigilance for potential cases i.e. patients with typical respiratory symptoms who in the last 2 weeks have been in China, Thailand, Singapore, Hong Kong, Indonesia and Japan (and other areas with sustained person to person transmission has occurred) or have known contact with someone who has travelled to these areas.
  • Upon presentation, to a health care setting of a person who is under quarantine or investigation or is a suspect case:
    • Immediately give the patient a surgical mask and ensure they put it on correctly.
    • Direct them to a single room, whether or not respiratory symptoms are present.
    • If this is the first contact with a health care provider, contact the local public health unit or state/territory communicable disease branch for advice if you are uncertain about the need for testing.
  • Promote flu vaccination in all eligible patients this year to reduce combined infections.
  • PCR testing available at no cost to patient, in an array of public and private pathology laboratories across the country.
  • MBS funded general practitioner consultation for clearance to work, if required (not mandatory after appropriate isolation and recovery).

Further information

 

Related document (Public): 

Published: 28 Feb 2020