Coronavirus criteria expand again

Matt Woodley

17/02/2020 3:49:03 PM

UPDATED: GPs should now consider testing symptomatic patients who have a recent travel history in a number of different countries.

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Patients with symptoms who have recently travelled to Hong Kong, Indonesia, Japan, Singapore, Thailand, Iran, South Korea, Italy or Cambodia are considered to be ‘person under investigation’.

The latest advice, published in updated interim guidelines produced by the Communicable Diseases Network Australia (CDNA), recommends clinicians consider testing people with ‘a clinically compatible illness’ who have previously travelled to Hong Kong, Indonesia, Japan, Singapore, Thailand, Iran, South Korea, Italy or Cambodia within 14 days of symptom onset.
Passengers who have only been in transit through an airport in these countries should not be considered as a ‘person under investigation’.
The original update came more than two weeks after a Sydney GP, who helped identify one of the first confirmed cases in Australia, called for expanded testing criteria after they had multiple requests for coronavirus testing denied on the basis of travel history.
‘My fear is that the number of cases in Australia is getting much, much higher. But, unfortunately, we have set an artificial barrier for confirming the actual number,’ the GP said at the time.
‘The policy needs to be changed.’

The new list is based on the volume of travel between the listed countries, Australia and China, and the current epidemiology of COVID-19 (coronavirus). At the time of publication on Friday 28 February, South Korea had the highest number of confirmed cases outside of China (1766), followed by Italy (655), Iran (245) and Japan (207). Singapore, Hong Kong and Thailand all had fewer than 100.

Japan has temporarily closed schools and urged people to avoid crowds and ‘non-essential gatherings’, after Health Minister Katsunobu Kato warned the outbreak had entered ‘a new phase’. The island nation confirmed its first death due to the virus earlier this month, and people with no travel history or direct connections to China have also been infected.

Indonesia and Cambodia have not had any confirmed cases; however, there are doubts as to whether this is an accurate representation of the situation, given Indonesian authorities have only tested 134 people and there are reports of a confirmed case travelling within Bali while possibly contagious.

Meanwhile, Cambodia allowed hundreds of passengers to disembark from a cruise ship that had recently been to Hong Kong and Singapore, despite numerous other countries previously barring the ship from docking over coronavirus fears.

The number of new cases in China appears to have slowed somewhat and its government recently ordered all people returning to Beijing from extended Lunar New Year holidays to undergo a self-imposed two-week quarantine to help curb the spread of the virus. However, question regarding its shifting methods for documenting news cases, combined with a slight recent uptick in cases, means the situation remains ‘complex and serious’, its National Health Commission said.

According to the ABC, around 500 million people in China have been affected by policies put in place to restrict movement in an effort to contain the outbreak.
At the time of publication, there had been nearly 83,000 confirmed cases and more than 2800 deaths.
The RACGP has more information on coronavirus available on its website.
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Dr Alvin Kian Chung Chua   18/02/2020 9:33:11 AM

How many mixed messages do we as GPs need? NSW and Victoria have updated testing criteria yet Federal Dept of Health has not? SA? QLD? High time we get a National CDC to get a uniform message for the whole country!

Dr Dileep Singh   18/02/2020 10:12:51 AM

Criteria is expanded to screen if person travelled from these countries . Is there any strict screening happening at airports . What about screening for patients presenting with flu or cold symptoms and did not travel overseas . Is this required to rule out local spread ?

A.Prof Christopher David Hogan   18/02/2020 11:49:50 AM

This is not a mixed message. It is the nature of large scale novel infections that the screening criteria will expand as the disease progresses & spreads>
The first advice on screening was for the initial phase. Now that there is secondary spread outside China (although it is considerably less than would be expected) the advice adapts to the circumstances.
Might I suggest that all article be date stamped- in the article?

Prof C Sense (call me Common)   18/02/2020 3:02:41 PM

This is absolutely mixed messages. Different health departments within the same country have different messages. It’s not that the message is changing due to a reaction to new events that raises the issue of mixed messages. Come to think of it, we are talking about prevention. What we have is not prevention but a wait and see approach. This is WRONG! 2 weeks ago, a GP at the coal face, seeing patients with symptoms who had travelled through China had already raised the alarm to expand testing - at that time, the GP was advocating expanding to include travel within China and not just in Wuhan. This was ignored by our public health “experts”. We need common sense in our approach. We also need people who will take this seriously. Not least we need people who are politically aware of international politics.

Dr Robyn Maree Hughes   22/02/2020 11:19:47 AM

Is the incubation period 42 days?

Dr Dileep Singh   22/02/2020 5:30:33 PM

(In news )In Uk person suspected of having infection can ring NHS and then they are planning to send home team to collect swab at person home instead if asking person to go to GP clinics or hospital .The reason is to avoid exposure to other patient in gp clinic or hospital which looks like much better planning

Dr George Al-Horani   29/02/2020 7:16:18 AM

Our waiting rooms already full of people including children and elderly , ( the high risk group , also the Same at hospital ED , so if a patient is suspected to carry the virus and symptomatic then it’s still okay to go to GP clinic !! We train our reception staff although they are not nurses to triage patients and identify the high risk by asking questions and give masks and notify the practice RN and doctors if they have a suspected case !!!
The other problem we have ( what if we don’t have an empty room to isolate the patient in ??!! We can’t use the treatment room as an isolation room since we need it all the time for other patients !!
I think our government needs to take more serious actions and stop all flights from areas with high risk even if travelers go transient in high risk countries !!
General practice are already suffering from lack of support from government, red tape , and constant confusing messages !! We are trying to do Our best but we can’t cope with all this .

Dr Fiona Jane Henneuse-Blunt   29/02/2020 6:59:29 PM

I have seen three of four patients with "bad flu" symptoms. None fit any criteria to test for Coronavirus. But I wonder if they have had it . All managed to recover slowly. All tested negative for viral flu/cold etc. I suspect it's already freely circulating in the community and without more screening of sick patients with no travel history we won't know. The net result could be many more cases than previously recorded with a much lower morbidity and mortality rate. This might avert mass hysteria and global financial crash. My thoughts of course. Not anything official!

Dr Cho Oo Maung   2/03/2020 9:15:27 AM

This Corona Virus ...Outbreak or Outrage ? Death rate 2800 in 83000. Means 1:3333 chance of death. Need to know more the demographic pictures of the death. Extreme ages, people with commodities ? May be.

Practicing healthy life style. No smoking . No drugs , no drinking alcohol. Sleep well. Eat well. Meditation , 30 min. physical exercise. Early identification and treatment of URTI and LRTI . Not to dismiss secondary Bacterial infection requiring treatment with Amoxycillin and Doxy as needed. That may bring down the morbidity and mortality.

My trail management for URTI is eating half of Raw Onion/a clove of Garlic/ 1 cm of Ginger having everyday , Vit C 1 G /day keep the viruses away. That's the way surviving as GP for 35 years with no sickness.