Public health officials issue coronavirus guidance for primary care

Public Health England (PHE) has issued interim guidance for primary care clinicians on what to do if they suspect a patient is infected with the Wuhan novel coronavirus (WN-CoV).

Staff at a Wuhan railway station monitor screens for signs of fever detected in passengers by infrared detectors (Photo: Barcroft Media/Getty Images)
Staff at a Wuhan railway station monitor screens for signs of fever detected in passengers by infrared detectors (Photo: Barcroft Media/Getty Images)

The new guidance comes as the government introduced enhanced monitoring of direct flights into the UK from the city of Wuhan in eastern China, where the virus originated. Health teams will meet each flight to check for symptoms of coronavirus and provide passengers with leaflets detailing what they should do if they become unwell.

The government said that the measures were precautionary and the risk to the UK population of the virus has been assessed as low.

There are currently no known cases of the virus in the UK, which was first identified in Wuhan in December. Latest information suggests that the virus can be transmitted from human-to-human and infections have been reported in health workers in China.

Primary care guidance on coronavirus

Fever, cough or chest tightness, and dyspnoea are the main symptoms reported by affected patients. PHE's primary care guidance says WN-CoV may cause mild to moderate illness as well as pneumonia or severe acute respiratory infection.

It says that if the infection does present in the UK it is most likely to occur in travellers who have recently returned from Wuhan and advises clinicians to take an accurate travel history.

Patients suspected of having the virus should be isolated as quickly as possible and not allowed to use communal toilet facilities. If GPs suspect a patient of having WN-CoV during a consultation they should leave the room and conduct the remainder of the consultation by phone if necessary.

Anyone who comes into contact with the patient should wash their hands thoroughly with soap and water and healthcare professionals should obtain specialist advice from a local microbiologist, virologist or infectious diseases physician and inform their local Health Protection Team.

Critically ill patients

If a patient is critically ill and requires an ambulance transfer to hospital, the call handler should be informed of the concerns about WN-CoV. Any other transfer to secondary care should be discussed with the hospital first. Once a patient has left the surgery, the room they were isolated in should not be used until further advice is obtained from the Health Protection Team.

News outlets have reported today that China's National Health Commission has confirmed nine people have died and over 400 people across 13 provinces in the country have been infected with WN-CoV. Cases have also been reported in Thailand, Japan, South Korea and Taiwan, while the US reported its first case this week in an American citizen returning from a trip to China.

Like other coronaviruses, including severe acute respiratory syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS), Wn-CoV it is thought to have originated in animals. A source for the outbreak has yet to be identified, however preliminary investigations suggest it may have originated in a seafood market.

Deputy director of PHE's National Infection Service Dr Nick Phin said: 'This is a new and rapidly evolving situation where information on cases and the virus is being gathered and assessed daily. Based on the available evidence, the current risk to the UK is considered low. We are working with the WHO and other international partners, have issued advice to the NHS and are keeping the situation under constant review.'

Interim definition of possible cases

If the patient satisfies epidemiological and clinical criteria, they are classified as a possible case.

Epidemiological criteria
In the 14 days before the onset of illness:

travel to Wuhan, Hubei Province, China

OR

contact with confirmed cases of WN-CoV

Clinical criteria
severe acute respiratory infection requiring admission to hospital with clinical or radiological evidence of pneumonia or acute respiratory distress syndrome

OR

acute respiratory infection of any degree of severity (including at least one of: shortness of breath, cough or sore throat)

Clinicians should be alert to the possibility of atypical presentations in patients who are immunocompromised. Any individual reporting any contact with a confirmed case of WN-CoV, even if asymptomatic, should be reported to the local Health Protection Team immediately.

Source: PHE guidance

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