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Date issued: 11 February 2020, Travel Health Advisory

A new outbreak of pneumonia was first seen in early December 2019 in Wuhan, Hubei Province, China. On 7 January 2020, this outbreak was identified as being caused by novel Coronavirus (2019-nCoV). As of 11 February 2020, there have been at least 43,146 total cases confirmed with 1,018 reported deaths; 4,347 have recovered.

In addition, Taiwan, Thailand, Japan, Singapore, Vietnam, Australia, Malaysia, Nepal, Republic of Korea, Macau, Cambodia, Philippines, Sri Lanka, India, Belgium, Finland, Germany, Italy, Russia, Spain, Sweden, United Kingdom, France, United Arab Emirates, Canada, and the United States of America (states of Washington, Wisconsin, Illinois, Arizona, Massachusetts, and California) have also confirmed positive Coronavirus infection in travelers, who recently returned from China.

On 30 January 2020, the World Health Organization (WHO) declared a global health emergency.

What is Coronavirus? Coronavirus refers to a family of respiratory viruses that can range from the common cold to a more severe disease, such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

The first Coronavirus was isolated in birds in 1937 and the first Human Coronavirus (HCoV) was identified in the nasal swab of patients with the common cold in the mid-1960s.

Until now, seven strains of Coronavirus infecting humans have been identified. The newest strain, known as novel Coronavirus (2019-nCoV), was identified in China on 7 January 2020. Mode of Transmission The virus is mainly zoonotic, which means that the disease normally exists amongst animals, but some of the viruses have the ability to spread to humans in what is known as a spillover event. There is limited research on the exact mode of transmission of Coronavirus, but the most likely route for a human-to-human transmission is via contact with an infected person’s secretions.

Depending on the virulence of the Human Coronaviruses, the most common transmission from an infected person to others would be through the air (coughing and sneezing), close personal contact (touching or shaking hands), touching an object or surface that an infected person has touched and then touching your mouth, nose, or eyes before washing your hands and, in some rare cases, via fecal contamination.

The novel Coronavirus was initially linked to the Wuhan food market, as many of the initial patients were customers of the market where a positive sample was isolated. However, despite the market being closed on 1 January 2020, there was still an increase in the number of cases, which suggests that person-to person transmission is taking place.

The common Human Coronaviruses mainly present as mild to moderate upper respiratory tract illnesses similar to the common cold. Symptoms may include runny nose, cough, fever, sore throat, headache and may progress to pneumonia or bronchitis with shortness of breath and easy fatigability.

Those at high risk of developing complications include those with underlying chronic conditions, such as respiratory and cardiac diseases, immunocompromised individuals, as well as those in extreme age groups (e.g. infants or the elderly). In addition, pregnant women are also at higher risk if infected by the Coronavirus. Diagnosis Diagnostic tests are normally performed only when a person is having more severe symptoms. This would include serum PCR assay, nasal swab, broncho-alveolar lavage, sputum and sometimes stool samples.

There is no specific treatment or vaccination for Coronaviruses and most mild cases are treated based on symptoms. Symptom relief may be achieved by taking pain and fever medication, using a room humidifier, drinking plenty of liquids and staying indoors as well as getting as much rest as possible. If symptoms are more severe, please seek treatment from your healthcare provider. All travelers who have returned from Wuhan after 1 December 2019 should seek treatment immediately if they: 1) have any respiratory symptoms or fever since their return; or 2) were in contact with any infected or unwell person during their travel.

On 10 January 2020, the World Health Organization (WHO) published an interim guideline for all countries to prepare for this new virus outbreak. However standard recommendations need to be followed for prevention of the spread of infection. These include: Wash hands with soap and water for at least 20 seconds. Use an alcohol-based sanitizer if soap and water are unavailable. Cover mouth and nose when sneezing and coughing and follow with hand hygiene. Avoid crowded places especially within a closed and confined space. Thoroughly cook meats and eggs. Avoid eating raw meat, fish and eggs. Avoid unnecessary exposure to animals and avoid petting animals. Avoid contact with people suffering from acute respiratory illnesses. Stay home when you are having symptoms of upper respiratory tract infection. Drink plenty of water and keep well hydrated. Regularly clean and disinfect objects and surfaces touched by an infected person. Travelers to and from Wuhan, China should avoid contact with sick people, animals (dead or alive) and animal markets.

The above measures are effective against all infectious agents, including Influenza A and B (“the flu”), which sickens millions of individual worldwide and kills thousands each year. At present, no travel ban has been imposed by WHO. However, WHO advised that if any traveler has symptoms suggestive of acute respiratory illness during their travel period or after returning, they should seek medical attention and highlight their recent travel to the medical personnel.

Several countries have imposed increased screening (and at least one outright ban) on travelers coming from the affected region in China. The Center for Disease Control (CDC) issued a travel health notice for travelers from China arriving in the U.S. On 2 February 2020, the U.S. Department of State issued a Level 4 Travel Advisory, which advises against all travel to China.

WHO has advised all worldwide healthcare personnel and airport security personnel to be extra vigilant and enact enhancement of surveillance at airports for early detection and prevention of spread of the disease.

Source: AIG / WHO