The Office of the CDO England shares a tripartite letter and a flowchart – read it here
Novel Coronavirus: Advice for the NHS in England
This letter updates the advice sent on 31st January 2020. Changes from the previous version are highlighted in blue font. The key changes are to the case definition. These include the expansion of geography for clinical case definition from mainland China to mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia and Macau; and the modification of the clinical case definition so that fever without any other symptoms is sufficient criteria for testing (if the patient has also travelled from or transited through the previously named countries in the previous 14 days). Alternative clinical diagnosis for fever in a returning traveller should be considered and tests performed at local NHS laboratories, according to published PHE guidance.
You will be aware of the evolving situation regarding the novel coronavirus (2019-nCoV). As of 7th February 2020 it has been reported that around 31,479 people worldwide have been identified with respiratory infections caused by 2019-nCoV. Most reported cases are at the mild end of the spectrum.
As of 9am on 7th February 2020, the UK had 628 confirmed test results. Of these, three cases tested positive. The first two cases were announced on 31st January. The third was announced on 6th February.
The severity of the infections ranges from mild symptoms of upper respiratory tract infection (with or without fever) to fulminant pneumonia requiring hospitalisation and advanced respiratory support, and the disease has sadly proved fatal in 636 cases in China.
Advice for NHS organisations is as follows:
• It is essential that an accurate travel history is obtained from all patients with acute respiratory infections to help identify potential cases.
• We are now recommending that all travellers who develop relevant symptoms, however mild, within 14 days of returning from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau should self-isolate at home immediately and call NHS 111. We are already recommending that travellers from Wuhan and Hubei Province should self-isolate for 14 days, even if they do not have symptoms, due to the increased risk from that area.
• Primary care practices are asked to identify possible cases, isolate them immediately, and ask the patient to call NHS111 from their mobile (or GP landline if a mobile is unavailable). Primary care settings are not
expected to undertake any clinical assessment or sampling. Guidance for primary care can be found here.
• All acute trusts are expected to assess possible cases of novel coronavirus using safe ways of working, including appropriate personal protective equipment. They should review the Public Health England (PHE) guidance and ensure that they have considered how to operationalise this in conjunction with regional NHS England teams. Clinical criteria for assessment have been updated today in the light of emerging evidence from China and the South-East Asian region.
• Acute trusts should be prepared to undertake sampling and transport samples to PHE for testing as well as making arrangements for such patients to be identified immediately and isolated according to the PHE guidance, or in home isolation with an appropriate risk assessment documented.
• If the novel coronavirus is detected, the patient will be transferred to an Airborne High Consequences Infectious Diseases centre. PHE will undertake contact tracing and advise on management as more is known about this infection. Guidance will be updated.
The attached pathway outlines the initial assessment questions to identify a patient who may require isolation and testing. All primary and secondary healthcare providers should make arrangements for such patients to be identified immediately and isolated according to the PHE guidance. The current patient pathway is for assessment using safe ways of working, agreed by the NHS, followed by testing and a period of isolation (at home or in hospital) whilst awaiting the results.
PHE in collaboration with the NHS has published guidance covering the following:
• Initial assessment and investigation of cases
• Infection prevention and control and guidance
• Guidance on diagnostics
• Guidance for primary care
The four key principles to bear in mind in community settings are to:
• Identify possible cases as soon as possible
• Isolate to prevent transmission to other patients and staff
• Avoid direct physical contact unless wearing appropriate personal protective equipment
• Get specialist advice from a local microbiologist, virologist or infectious disease physician at your local trust
For those working in primary care settings please follow the link: https://www.gov.uk/government/publications/wn-cov-guidance-for-primary-care/wn-cov-interim-guidance-for-primary-care
The main principles are:
- 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 2019-nCoV infection, and inform the local Health Protection Team (HPT)
Currently, if 2019-nCoV infection is seen in the UK, it is most likely to occur in travellers that have recently returned from mainland China (not including Hong Kong and Macao). Therefore, an accurate travel history is a key part of identifying potential risk. PHE guidance for advice on when investigations for 2019-nCoV are indicated.
Further Information re Coronavirus
Content is guidance from gov web page to continue reading to https://www.gov.uk/guidance/wuhan-novel-coronavirus-information-for-the-public#situation-in-the-uk
Situation in the UK
Two patients in England have tested positive for coronavirus. Chief Medical Officer for England, Professor Chris Whitty, has shared a statement. If more cases are confirmed in the UK, it will be announced as soon as possible by the Chief Medical Officer of the affected country.
Based on the World Health Organization’s declaration that this is a public health emergency of international concern, the UK Chief Medical Officers have raised the risk to the public from low to moderate. This permits the government to plan for all eventualities.
The risk to individuals in the UK has not changed at this stage. Our advice for travellers from Wuhan and Hubei Province remains unchanged from the below and we have added further advice for travellers from elsewhere in China.
As of 1 February, a total of 203 UK tests have concluded, of which 201 were confirmed negative and 2 positive.
1,466 passengers and 95 staff arrived in the UK on direct flights from Wuhan, China between 10 and 24 January.
- 162 of the passengers have already left the UK
- 53 of the crew have already left the UK
- 866 are now outside of the incubation period
Public Health England are working to contact the remaining passengers.
We have been working in close collaboration with international colleagues and the World Health Organisation to monitor the situation in China and around the world.