Novel Coronavirus outbreak: update and information for healthcare professionals

What is the novel coronavirus?

Coronaviruses are a large family of viruses that can cause illness ranging from the common cold to more severe diseases like Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The 2019 novel coronavirus, called 'SARS-CoV-2' (previously referred to as 2019-nCoV), is a new strain that has not been identified in humans before.

On 11 February 2020, WHO formally named the disease caused by the 2019 novel coronavirus as 'COVID-19'. The acronym stands for coronavirus disease 2019, as the illness was first detected toward the end of last year.

Do you have questions about the 2019 novel coronavirus? Send them to education@ersnet.org and topic experts will address them in the ERS / PREPARE Europe webinars focusing on COVID-19.

Outbreak summary: where, when and possible source

On 31 December 2019, the World Health Organization (WHO) was informed of several cases of viral pneumonia of unknown cause detected in Wuhan City, China. COVID-19 patients exhibited respiratory symptoms such as fever, cough, shortness of breath and breathing difficulties. On 30 January 2020, WHO declared the SARS-CoV-2 outbreak to be a Public Health Emergency of International Concern (PHEIC).

Cases of COVID-19 have been reported elsewhere in China and in 33 other countries worldwide, including in the regions of Asia, Europe, North America, UAE and Australia. ERS recommends consulting the WHO's situation reports for the latest figures on confirmed cases and the geographic spread of SARS-CoV-2.

From 17 February 2020 WHO began reporting all confirmed COVID-2019 cases, including both laboratory-confirmed cases and cases that have been clinically diagnosed. Clinical diagnoses of COVID-2019 were not previously included in the WHO’s situation reports, which accounts for the large increase in case numbers compared with previous WHO reports.

How is the virus transmitted?

The WHO reports that human-to-human transmission is occurring with a preliminary R0 estimate of 1.4-2.5.

Current estimates of the incubation period of the virus range from 2–10 days, but more information about the mode of transmission is needed to confirm this. Experts are also still unclear whether transmission can occur from asymptomatic individuals or during the incubation period.

To prevent the spread of the novel coronavirus, the public should follow standard infection prevention recommendations including regular hand washing, covering the mouth and nose when coughing and sneezing, and thoroughly cooking meat and eggs. Where possible, people should avoid close contact with persons showing symptoms of respiratory illness, including coughing and sneezing.

What is the risk of cases in the European region?

So far there have been 276 cases and 3 deaths due to COVID-19 reported in the EU/EEA and the UK, including 226 locally-acquired cases in Italy, 14 in Germany, 7 in France and 1 in the UK.

The European Centre for Disease Prevention and Control (ECDC) say that due to the extensive movement of people and the fact that the virus is transmitted from one person to another, it is expected that further cases will be reported in the EU. In its latest risk report, ECDC states that:

  • the probability of further transmission in the EU/EEA and the UK is considered to be low, but cannot be excluded;
  • the possibility of new introductions from other countries outside China in the EU/EEA appears to be increasing as the number of non EU/EEA countries reporting cases keeps going up;
  • the impact of sustained transmission in the EEA/UK would be high among elderly populations with comorbidities;
  • however, the risk associated with COVID-19 infection for people from the EU/EEA and UK is currently considered to be low to moderate;
  • and widespread SARS-CoV-2 infection remains low during the 2019–2020 influenza season.

Regarding the cluster of cases in northern Italy, the ECDC also say:

  • transmission appears to not be first generation transmission from people travelling or returning from an affected area, but seems to have occurred locally;
  • the risk of the occurrence of similar clusters, similar to the ones in Italy, associated with COVID-19 in other countries in the EU/EEA and the UK is currently considered to be moderate to high;
  • but extraordinary public health measures have been implemented in northern Italy to identify, isolate and test contacts in order to contain the outbreak.

Read the ECDC latest risk assessment for full details

Advice for healthcare professionals

As with SARS and MERS, when dealing with suspected COVID-19 cases, health professionals should follow CDC airborne precautions and wear respiratory masks (N95 or higher) during intubation and when entering a negative pressure room.

The WHO has prepared clinical guidance for the management of suspected COVID-19 cases and technical guidance on laboratory testing for the novel coronavirus in humans:

WHO COVID-19 patient management guidance WHO technical guidance on laboratory testing for COVID-19 in humans
Covering:
• Early recognition of patients with SARS-CoV-2 associated with COVID-19
• Immediate implementation of appropriate IPC measures
• Early supportive therapy and monitoring
• Collection of specimens for laboratory diagnosis
• Management of hypoxemic respiratory failure and ARDS
• Specific anti-Novel-CoV treatments and clinical research
Covering:
• Suspected case definition
• Specimen collection and shipment
• Effective usage of Global Laboratory Networking
• Testing of novel coronavirus in reference laboratories
• Diagnostic knowledge gaps

The ECDC advise that infection with the novel coronavirus should be immediately reported to the Early Warning and Response System (EWRS) in accordance with Decision No 1082/2013 on serious cross-border threats to health and to the IHR system in accordance with the International Health Regulations 2005 (IHR).

The EU's PREPARE network has now mobilised to mode 2 response activity, representing an important next level of preparedness for the actual conduct of clinical research in the event of further SARS-CoV-2 spread in Europe. At present, 366 hospitals and 73 paediatric sites from PREPARE partner networks, COMBACTE and Penta, were mobilised to contribute to the important collective global efforts in standardising the information gathered from affected patients. Read the latest PREPARE report for more information on its outbreak response.

Further information:


Last checked: 25 February, 2020