Updated 21 February 2020

Introduction

Coronavirus has so far dominated headlines in 2020. It has been reported that the number of mortalities from the virus has risen to over 2,300 in China. There are over 75,000 reported cases globally, mostly in China. A number of cases have been reported in over 28 countries across the world, including in the UK, Germany, France, the United States, Thailand, Taiwan, Japan, South Korea, Vietnam, Singapore, Malaysia, Nepal, France, Canada, Australia and Sri Lanka. The World Health Organisation (WHO) has stated that the outbreak now meets the criteria for a Public Health Emergency of International Concern.

In the UK, 9 cases have been confirmed with over 1,750 tests coming back as negative. An individual who recently flew into London from China became the 9th positive test in the UK. Furthermore, the UK Foreign Office have advised against all but essential travel to China and a number of airlines have suspended all direct flights to and from mainland China. Hundreds of foreign nationals have been evacuated from the city of Wuhan, the centre of the outbreak. And citizens from the UK and other nations have been advised to leave China if they can, to reduce exposure to the virus. The BBC has reported that UK nationals being flown back to the UK may be safely quarantined for up to two weeks with medical care and advice.

A primary care briefing was published by NHS England on 18 February. 

Coronavirus: a background

In late 2019, an outbreak of pneumonia due to unknown causes in Wuhan City, China was reported. Then in early January 2020, the cause of the outbreak was identified as a new coronavirus named Wuhan novel coronavirus (WN-CoV). While early cases were likely infected by an animal source in a ‘wet market’ in Wuhan, there is evidence that human-to-human transmission can also occur. It has also been reported as China or novel coronavirus in the media. On 11 February 2020, an official name for the coronavirus was agreed – Covid-19.

The outbreak of coronavirus has coincided with the Chinese New Year celebrations, when there is a significant increase of people travelling to and from China, as well as within the country. Chinese New Year celebrations officially began on 25 January and ended on 8 February.

Symptoms include:

  • Fever, fatigue and dry cough is likely in the early stage of illness, however some patients may not progress to more severe illness. WHO reports that 25% of confirmed cases are severe.
  • Dyspnoea is said to be common in hospitalised patients, while vital signs are reported to be generally stable at the time of admission. Older patients with an underlying health condition are more likely to progress to severe infection.
  • A variety of abnormalities may be expected on chest X Rays, but bilateral lung infiltrates appear to be common, similar to what is seen with other types of viral pneumonia. 

Professor Mark Woolhouse from the University of Edinburgh said: "When we see a new coronavirus, we want to know how severe are the symptoms. This is more than cold-like symptoms and that is a concern but it is not as severe as Sars".

Severe acute respiratory syndrome (Sars), which is caused by a coronavirus, resulted in the deaths of 774 of the 8,098 people infected in an outbreak that started in China in 2002. It has been reported that the number of cases of coronavirus has now overtaken Sars. 

International update: WHO

The WHO has published online a range of public health advice and information, including situation reports, technical guidance, travel advice, and advice for the public about how to protect themselves. 

The WHO reported that the main clinical signs and symptoms reported in this outbreak include fever, difficulty in breathing, and chest radiographs showing bilateral lung infiltrates. As of 27 January, human-to-human transmission has been confirmed largely in Wuhan city, but also other locations in China and internationally. Not enough is known about the epidemiology of coronavirus to draw definitive conclusions about the full clinical features of the disease, the intensity of the human-to-human transmission, and the original source of the outbreak.

During 20 January and 21 January, a World Health Organisation (WHO) delegation conducted a field visit to Wuhan to learn about the response to the coronavirus. The mission was part of the on-going close collaboration between WHO and Chinese national, provincial, and Wuhan health authorities in responding to coronavirus.

Data collected through detailed epidemiological investigation and through the deployment of the new test kit nationally suggests that human-to-human transmission is taking place in Wuhan. More analysis of the epidemiological data is needed to understand the full extent of human-to-human transmission. WHO advised that they stand ready to provide support to China to conduct further detailed analysis.

In terms of international travel, WHO advises that public health authorities should provide to travellers information to reduce the general risk of acute respiratory infections, via health practitioners, travel health clinics, travel agencies, conveyance operators and at Points of Entry. In case of symptoms suggestive of acute respiratory illness before, during or after travel, the travellers are encouraged to seek medical attention and share travel history with their health care provider.

MRCP(UK) update

MRCP(UK) have advised the College that they are closely monitoring the global situation and are actively engaging with local partners to decide the most appropriate action in affected countries. They have further advised that safety of UK examiners, local examiners, candidates, patients and surrogates is their primary concern and that they are reviewing the availability of patients and surrogates, as well as the pressures on clinical space, time and personnel at the centres.

MRCP(UK) are also maintaining close contact with Diversity Travel who will alert them to any potential travel restrictions. More information including contact details can be found on the MRCP(UK) website.

Guidance and information for UK medical professionals

Over recent weeks, the College has participated in teleconferences with the Chief Medical Officers (CMO) for England and Scotland regarding coronavirus. Through this process, the College has been advised that Public Health England (PHE) have published a flow chart for management of a suspected case of Covid-19 acute respiratory disease.  

The UK Government has also made available a range of further information and guidance for clinicians on coronavirus.

And, the UK Government has announced a £20 million increase in coronavirus research funding. UK researchers are being invited to submit proposals for projects to develop vaccines, therapeutics, diagnostics or address the epidemiology, spread or underpinning knowledge of coronavirus.

It should be noted that according to the CMO for England, Chris Whitty, there are a number of trials which could reach phase 1 but it is unlikely that we will have an vaccine within the year; particularly one which could be ready for any possible first wave of coronavirus in the UK.

Public Health England (PHE) and Health Protection Scotland (HPS) have each produced clinical guidance for initial management of the coronavirus. The PHE guidance for clinicians is publicly available on their website, including for primary care and secondary care. The HPS guidance for primary care and secondary care is also online. A range of other information and guidance can be found on the HPS website.

In the UK, the public are being advised that if they develop respiratory symptoms within 14 days of travel to the area, and are now in the UK, they must call their GP or ring NHS 24 on 111 informing them of their symptoms and their recent travel to Wuhan. 

From 27 January, people in the UK who have returned from Wuhan City in the last 14 days were asked to self-isolate. That means staying indoors, avoiding contact with other people, and contacting NHS 24 on 111. Further guidance on self -isolation is being developed and will be issued in the coming days. 

In Scotland, NHS Boards must ensure that all front line healthcare professionals have access to HPS guidance and have a clear understanding of the management and investigation procedures for suspected cases of coronavirus. NHS Boards should also cascade the information to any non-NHS clinicians working in private healthcare settings if such establishments are located in their area.   

Information and updates from the Department of Health in Northern Ireland are also available. The Chief Medical Officer (CMO) for Northern Ireland, Michael McBride, said: “I am being kept fully informed about the steps being taken to protect the public by the Public Health Agency and I am providing the Minister with regular updates".

Update from the CMO for Scotland

The CMO for Scotland, Dr Catherine Calderwood, updated representatives from the Royal Colleges based in Scotland, including the Royal College of Physicians of Edinburgh. Below are the main highlights of the CMO's update:

  • The CMO's office is monitoring the situation and has provided guidance, information, and updates to NHS Boards as above.
  • Dr Calderwood advised that beyond China, a case of Chinese coronavirus in Germany has been reported to exhibit evidence of person to person transmission within Germany (as opposed to cases found in Germany where somebody caught the virus before entering the country). It has been advised that the R0 (the number of cases one case generates on average over the course of its infectious period) is 2-3, meaning that one person with coronavirus could infect another two or three people on average.  
  • As Dr Calderwood understands it, the phase 1 stage of developing a vaccine for coronavirus could be possible within a number of weeks, but it may take months to years for a full vaccine for coronavirus to be developed.
  • The mortality rate for coronavirus is estimated at 2-3% versus the Chinese Sars outbreak in 2002, which was 10%.

The CMO for Scotland also outlined the main scenarios being considered by HPS at this time. She advised it's most likely that coronavirus will either spread to an extent in China without causing large outbreaks, or it may spread beyond China significantly but become less transmissible over time. It is also possible that coronavirus could become more transmissible and adapt, although the CMO did not highlight this as a likely scenario.

What next?

The College has been advised that regular updates will be provided by relevant public health bodies and departments, including the CMOs for England and Scotland. At this stage, it is important that public health and health protection departments continue to keep the public and clinicians updated as much as possible.

We will continue to monitor coronavirus closely, and if you have any enquiries, please do get in touch.

Dr Conor Maguire, International Vice President