WHO raises coronavirus risk level

A Lancet study by Chinese researchers has suggested that people can be symptom-free for three to six days while the dangerous coronavirus is incubating, making transmission more likely.
 
Director of the National Health Commission in China Ma Xiaowei said the findings would make the disease much more difficult to control, according to The New York Times.  
 
But Australian authorities have rejected that finding.
 
In a press conference earlier this week, Chief Medical Officer Professor Brendan Murphy said his expert panels were ‘not convinced that evidence is being presented’.
 
‘It would be very unusual because this virus is similar to the SARS and MERS viruses and they were not infectious before symptoms,’ he said. ‘But we’re urgently seeking urgent advice from the World Health Organization [WHO] and international experts because if that were to be the case, it would have implications for how we do contact tracing.’
 
The news has heightened concern about the new virus, which has seen more than 56 million people effectively locked down in China in a bid to stop its spread.
 
The news comes as the WHO revised its global risk assessment upwards to ‘high’, after acknowledging the virus has now undergone at least four generations of spread.
 
That news undercuts previous reports suggesting transmission is confined to people in close proximity to others with the infection.  
 
University of East Anglia Professor Paul Hunter said the news, if confirmed, is surprising and concerning.
 
‘If person-to-person spread from people without symptoms became common then this would be extremely worrying. It would also be very surprising,’ he said.
 
‘The consensus from the SARS outbreak was that only patients with symptoms spread the infection.’ 
 
University of Nottingham Professor of Molecular Virology Jonathan Ball said that if this was confirmed, it would make control of the outbreak more difficult to manage.
 
‘It’s looking like this coronavirus is behaving very differently to SARS and MERS, and this is a big concern,’ he said. ‘I would be surprised if WHO do not declare this as a Public Health Emergency of International Concern.’
 
The news comes as Australia braces for a surge in people with coronavirus, with more suspected cases being treated in Victorian hospitals and potential cases in nearly every state and territory.
 
The US Centers for Disease Control and Prevention said person-to-person spread is now likely in the US.
 
The virus is the newest of three betacoronaviruses known to seriously affect humans, in contrast to the mildness of most common coronaviruses. SARS and MERS, the other two betacoronaviruses, have killed more than 1600 people. 
 
SARS and MERS were both able to be contained, but concerns are rising regarding the rapid spread of the new virus, first described just two months ago.
 
While the death rate of 3–4% appears significantly lower than both SARS (10%) and MERS (35%), Australian experts have told newsGP the fear is that the new virus may be more easily transmissible in a community setting.
 
Most human-to-human transmission of SARS took place in healthcare settings with inadequate infection control, while MERS had very limited human-to-human transmission, according to the WHO.
 
The new coronavirus has now killed 106 people in China – with one death in Beijing – and infected 4200. To date, the deaths tend to occur among older men with comorbidities.
 
US and UK researchers have suggested in a Medrxiv preprint preliminary paper that the number of confirmed cases may represent only 5% of the actual number of people infected, and predicted the virus may spread significantly in February.
 
‘Our work suggests that a basic reproductive number for this 2019-nCoV outbreak is higher compared to other emergent coronaviruses, suggesting that containment or control of this pathogen may be substantially more difficult,’ the researchers state.

The Australian Government has said face masks will be distributed from a national stockpile as necessary to ensure availability. 
 
The emergence of the virus in Wuhan, China, has seen a mass quarantine imposed over the city and surrounding areas, covering a population more than double that of Australia.
 
Despite the lockdown, Wuhan’s mayor has estimated around five million people have already left the city.
 
Many countries are preparing to evacuate their citizens from affected areas.
 
The virus has infected five people in Australia so far, with new cases reported in Germany, Sri Lanka, South Korea, Japan, Taiwan and other nations. Human transmission has prompted nations like Australia to place confirmed cases in quarantine for 14 days.
 
The WHO estimates the coronavirus has a reproduction number (R0) of between 1.4–2.5, which means one infected person has the ability to infect 1.4–2.5 susceptible people.
 
The Medrxiv paper suggests a higher R0 number of 3.8, while a WHO working group has suggested a figure of 3.0, according to reports in The Age.  
 
The US is calling on its citizens to ‘reconsider travel’ to China due to the virus and the unprecedented shutdown of Wuhan and neighbouring cities.
 
Harvard epidemiologist Dr Eric Feigl-Ding has warned that the virus could be just as dangerous as SARS, if not worse.
 
‘We don’t know if it will ultimately kill more people as SARS, but the vitality and the transmission parameter so far makes us think it’s just as dangerous as SARS, if not worse,’ he told 3AW.
 
‘It’s a brave new world; we have not seen a virus hitting like this in a long time.’
 
In response, the Australian Government has called on GPs to wear masks when seeing potential coronavirus cases. Masks will be distributed from the national stockpile to ensure availability after the summer’s bushfire smoke saw huge demand. 
 
Professor of Medicine at James Cook University John McBride told newsGP one reason the WHO has not yet declared the virus a public health emergency is that person-to-person transmission has so far only occurred in China.
 
‘The virus progressed fairly rapidly before we knew much about it, which is not surprising,’ he said. ‘But if the measures instituted in other countries stop person-to-person transmission, we could start to be a little bit more relaxed.
 
‘But if it is exported to a country with poor public health systems and no diagnostic capacity, it could be a bad [outbreak].’
 
Professor McBride said it now seems the virus is less lethal than SARS, but might spread more easily in the community.
 
‘The spread of SARS was largely confined to hospitals. People were sicker so they went to hospital, which helped contain it,’ he said. ‘Because this is less severe, it may spread better in the community and increase the challenge. It might spread more.’
 
The Department of Health has issued a new version of its coronavirus fact sheet for GPs, stressing the need to isolate and mask patients who may have the virus, while ensuring high levels of protection such as a P2 mask and eye protection while collecting specimens.
 
The RACGP has more information on coronavirus available on its website.
 
Log in below to join the conversation.

coronavirus epidemiology infectious disease public health