Status:
Resolved
Health alert:
AL20005
Date Issued:
11 Feb 2020 - (update to Alert issued 4 February 2020)
Issued by:
Dr Brett Sutton, Chief Health Officer
Issued to:
Clinicians and the Victorian public

Key messages

  • The Guideline for Health Services and General Practitioners has been updated (Version 6) since the last Chief Health Officer Alert of 4 February.
  • Key changes include introduction of a new case definition, provision for testing at clinician discretion, further advice on infection control precautions and specimen collection.
  • It remains critical that clinicians identify cases, and notify the department on 1300 651 160, 24 hours. Be alert for cases, take a travel history and advise suspected cases to isolate until you provide the result to your patient.
  • There is a new quick reference guide and checklist for general practitioners and online factsheets for patients after an assessment by the clinician and the department.
  • People who have been in mainland China (excluding Hong Kong SAR, Macau and Taiwan) are advised to self-isolate if they were in mainland China on or after 1 February 2020.
  • The requirement to self-isolate continues to apply to people who have been in Hubei Province, China, for 14 days after they left Hubei Province.
  • Anyone who has been in close contact with a confirmed case of 2019-nCoV should also stay at home and avoid public settings until 14 days after their last contact.
  • The department has confirmed four cases of novel coronavirus in Victoria.
  • Stay informed of updates at https://www.dhhs.vic.gov.au/novelcoronavirus

What is the issue?

A novel coronavirus (2019-nCoV) outbreak first identified in Hubei Province, China, has been declared a Public Health Emergency of International Concern by the World Health Organisation. As of 11 February 2020, approximately 40,606 confirmed cases and 910 deaths have been reported. The majority of cases have been identified in mainland China. Approximately 375 confirmed cases have been reported from 27 countries and regions outside of mainland China.

As of 9 February 2020, the case definition for a person suspected to have contracted novel coronavirus (2019-nCoV) has been updated to include any person who has a fever or acute respiratory infection (for example, shortness of breath or cough) and has been in mainland China (including transit through) or had close or casual contact with a confirmed case of novel coronavirus in the 14 days prior to onset of illness.

There is now significant transmission of the infection in many other provinces across mainland China, and there are limited instances of transmission being reported in a number of countries and regions outside of mainland China.

The 2019 novel coronavirus (2019-nCoV) identified in this outbreak has not previously been identified in people. Coronaviruses are a large and diverse family of viruses that include viruses that are known to cause illness of variable severity in humans, including the common cold, severe acute respiratory syndrome (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV). They are also found in animals such as camels and bats.

Novel coronavirus 2019 is now a notifiable condition under the Public Health and Wellbeing Regulations 2019 and suspected cases are required to be notified by medical practitioners and pathology services as soon as practicable. The department is also available to advise on testing.

Who is at risk?

The situation is evolving rapidly as we find out more about this new virus.

Anyone who has been in Hubei Province, China or who has been in mainland China from 1 February 2020 or is a close or casual contact of a confirmed case of the novel coronavirus (2019-nCoV) is at risk of infection. See below and the website for a full case definition.

As of 11 February, there are an increasing number of countries where there may be community transmission of novel coronavirus. When a patient has an illness that is compatible with novel coronavirus infection and has travelled overseas, testing can be considered. The department can provide further advice on 1300 651 160.

Any person who is unwell and presents with a letter, email or other correspondence from a state or territory public health or communicable disease unit informing them they are a contact should be treated as a suspected case.

Symptoms and transmission

Reported symptoms include fever or respiratory symptoms such as cough, shortness of breath or breathing difficulties. Recent information on the transmission of the virus suggests that cases may be infectious up to 24 hours before the onset of symptoms, until at least 24 hours after symptoms resolve.

The World Health Organization have confirmed that the main driver of transmission is from symptomatic patients through coughing and sneezing. Transmission by people without symptoms is possible, but likely to be rare.

1. Confirmed case
A person tested for 2019-nCoV at the Victorian Infectious Diseases Reference Laboratory and found to have 2019-nCoV infection.

2. Suspected case
Both clinical and epidemiological criteria need to be met for a person to be classified as a suspected case.

Clinical criteria:

Fever OR Acute respiratory infection (for example, shortness of breath or cough) with or without fever

AND

Epidemiological criteria:

Travel to (including transit through) mainland China* in the 14 days before onset of illness OR
Close or casual contact with a confirmed case of 2019-nCoV in the 14 days before onset of illness.

Notes:

*Mainland China excludes Hong Kong, Macau and Taiwan. Close contact and casual contact have a specific meaning as defined below.

If you suspect novel coronavirus infection you must notify the department as soon as practicable by calling 1300 651 160. Testing of patients who have been notified to the department and meet the suspected case definition will be prioritised.

Recommendations

Advice for clinicians

Clinicians are asked to be alert for patients of any age presenting with respiratory symptoms who meet the suspected case definition above. Please ensure that patients presenting with compatible symptoms, especially pneumonia, are asked about travel specific to mainland China. Detailed information for medical practitioners and the key guidance documents are the GP quick guide and checklist, and the more detailed Health Services and General Practitioner guide. 

If you have a patient who meets the suspected case definition above, key actions include:

  • Place a surgical mask on the patient and isolate the patient in a single room with door closed.
  • Use droplet and contact precautions (single-use surgical face mask, eye protection, gown and gloves).
  • Notify the department on 1300 651 160, 24 hours a day. Discuss next steps and testing.
  • Undertake testing in your hospital or with your primary pathology service for:
    • Respiratory specimens for coronavirus PCR/ 2019 n-Cov PCR – nasopharyngeal and throat swabs and sputum (if produced) and/or endotracheal aspirate or bronchoalveolar lavage where appropriate.
    • Blood (serum) - these samples are to be sent for novel coronavirus testing at the Victorian Infectious Diseases Reference Laboratory when a serology test is available.
  • Consider alternative causes, in particular consider testing for other respiratory viruses using a multiplex PCR if available.
  • After a national expert review, it has been determined that there is negligible risk of aerosolisation from taking a nose and throat swab in a patient with an acute respiratory infection. This means a single use surgical mask is now recommended for taking a nose and throat swab.
  • If the patient has symptoms and signs suggestive of pneumonia, however, there is a possibility that the viral load might be higher. These patients should be referred to hospital for treatment, and airborne precautions, including a P2 respirator, should be used when collecting nasopharyngeal or oropharyngeal samples.

Advice for patients

  • People who have been in mainland China (excluding Hong Kong SAR, Macau and Taiwan) are advised to self-isolate if they were in mainland China on or after 1 February 2020, when the risk of human to human transmission across many provinces of mainland China was identified to have significantly increased.
  • The requirement to self-isolate continues to apply to people who have been in Hubei Province, China, for 14 days after they left Hubei Province. If a person who has been in in Hubei province or mainland China (on or after 1 February 2020) begins to feel unwell and develop a fever or an acute respiratory illness (for example cough or shortness of breath) during the 14 days since they were last in mainland China, they should seek medical attention. Call ahead to your GP or emergency department and mention your travel to mainland China.
  • In line with this updated advice, students and teachers who have travelled to Mainland China should not attend school or university until 14 days after leaving mainland China.
  • Anyone who has been in close contact with a confirmed case of 2019-nCoV should also self-isolate at home until 14 days after their last contact. More information will be provided to close contacts by the department.
  • As the virus is spread by people with symptoms through coughing and sneezing. The best way to protect others is to practice good personal hygiene.

More information

Clinical information

https://www.dhhs.vic.gov.au/information-health-services-novel-coronavirus

Consumer information

https://www.dhhs.vic.gov.au/information-public-novel-coronavirus

https://www.who.int/health-topics/coronavirus

https://www.smartraveller.gov.au/destinations/asia/china

Contacts

Members of the public should call the public information hotline provided by Nurse-on-Call – 1800 675 398.

Medical practitioners needing more information can contact the Department of Health and Human Services Communicable Diseases Section on 1300 651 160 (24 hours).