CORONAVIRUS/COVID-19

Timeline

• On 8 December 2019 initial descriptions of an unusual pneumonia were reported in Wuhan, Hubei province in China.
• On 31 December 2019, the World Health Organization was informed by the Chinese authorities that a new type of pneumonia had emerged.
• From 31 December 2019 to 3 January 2020, 44 case-patients with pneumonia of unknown aetiology were reported to WHO by the national authorities in China, the causal agent was still not identified.
• On 7 January 2020 The Chinese authorities identified a new type of coronavirus which was causing pneumonia.
• On 12 January 2020, China shared the genetic sequence of the novel coronavirus for countries to use in developing specific diagnostic kits.
• Since this time the virus has spread worldwide despite significant attempts at containment.
• On 12 February 2020, the novel coronavirus was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) while the disease associated with it is now referred to as COVID-19.

On 11 March the WHO advised that the situation was now a pandemic.¹

Background

Previous recent novel disease outbreaks have followed different patterns, but the following table provides a comparison with COVID-19, so far.

SARS, severe acute respiratory syndrome; MERS, Middle East respiratory syndrome-related coronavirus

*Mortality varied according to the region, but an estimated 205,000 died of H1N1-related illnesses²

In the last 100 years there have been four significant pandemics:

• Spanish flu (1918-20), estimated to have caused between 25 and 39 million deaths
• Asian flu (1957-58), estimated to have caused between 1.5 and 4 million deaths
• Hong Kong flu (1968-69), estimated to have caused between 1 and 4 million deaths
• Russian flu (1977-78), estimated to have caused 700,000 deaths.³

A typical flu season causes in the region of 400,000 deaths.

WHAT IS CORONAVIRUS?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new betacoronavirus. Genetic analysis suggests that bats may be the original host of this virus. It is also thought that an animal from the seafood market in Wuhan could be the intermediate host, leading to the emergence of the virus in humans.

The number of confirmed cases of COVID-19 is increasing daily.

WHAT IS THE SCALE OF THE PROBLEM?

The number of confirmed cases of COVID-19 is increasing daily. This topic will be updated regularly to provide new information as it becomes available in a rapidly changing landscape.

However, Johns Hopkins University has provided an interactive map of the spread of this disease on this publically available site: Coronavirus COVID-19 Global Cases

Mortality rates appear to be around 2-3%, with more physically vulnerable people more likely to die from the disease.

The initial outbreak was in mainland China but transmission is worldwide, with large outbreaks in Brazil (16 million cases), India (26.8 million cases) and the US (33.1 million cases). 

As of 24 May 2021, there have been 4.1 million confirmed cases in the UK, and 123,083 deaths.

Public Health England provides UK data that is updated daily, https://coronavirus.data.gov.uk

WHAT HAVE BEEN THE PUBLIC HEALTH RESPONSES?

As a result of widespread community transmission, many countries moved to national lockdowns. As cases reduced, lockdowns were gradually eased. The most recent lockdown in the UK is currently being relaxed in most areas, with some exceptions e.g. Glasgow, where case numbers remain high.   

WHAT ARE THE SYMPTOMS AND SIGNS OF COVID-19?

COVID-19 has a predilection for the upper and lower respiratory tract alveolar cells and is spread by droplets from sneezing and coughing.

The prodrome (pre-illness phase) lasts between 2-10 days. The reason for isolation of 14 days was to ensure a safe return to society to circumvent a slightly longer potential prodrome phase.

In a study of the first 99 patients diagnosed with COVID-19 in China it was found that the majority of people had fever or cough (83%) and a third of patients had shortness of breath.

Other symptoms included muscle ache, headache, confusion, chest pain, and vomiting and diarrhoea (3% and 5%).

Many patients presented with organ function damage, including ARDS, acute respiratory injury, acute kidney injury, sepsis, and  ventilator-associated pneumonia.

WHAT IS THE ADVICE FOR PEOPLE AT HIGH RISK OF COMPLICATIONS?

Public Health England has previously advised people at high risk of complications to undertake sheilding. The following groups were included: 

Those aged over 70 years of age, or

Aged under the age of 70

and with one of the following conditions

• Chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
• Chronic heart disease, such as heart failure
• Chronic kidney disease
• Chronic liver disease, such as hepatitis
• Chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
• Diabetes
• People with problems with their spleen such as sickle cell disease or who have had their spleens removed
• People with a BMI of over 40
• People with a deficient immune system as the result of conditions such as HIV and AIDS, or medicines such as oral corticosteroids or chemotherapy
• Women who are pregnant and who have significant heart disease, congenital or acquired

WHAT ARE YOUR RESPONSIBILITIES?

As a healthcare worker it is important that you can access and understand the latest advice from Public Health England

Currently the advice given is to:

• Identify potential cases
• Prevent transmission
• Avoid direct physical contact
• Isolate the patient and obtain specialist advice to determine if the patient is at risk

WHAT ARE YOUR RESPONSIBILITIES IN GENERAL PRACTICE?

When a telephone interview is being conducted with a patient located elsewhere and it determined that COVID-19 is possible (based on the PHE criteria for a possible case).  

Patient transfers

• If the patient is critically ill and requires an urgent ambulance transfer to a hospital, inform the ambulance call handler of the concerns about COVID-19.
• In all other instances, the case must be discussed with the hospital first so that they are aware that COVID-19 is being considered and the method of transport to secondary care agreed.
• Patients with suspected COVID-19 should be instructed not to use public transport or taxis to get to hospital.
• Following the patient transfer, the room should be closed and should not be used until further advice is provided by the local Health Protection Team (HPT).

After care

Ensure that people who have been discharged from hospital and are recovering from COVID-19 receive the appropriate after care in general practice. 

MAINTAINING SOCIAL DISTANCING 

GP practices should avoid crowding and minimise opportunities for the virus to spread by maintaining a distance of at least 2 metres between individuals wherever possible. 

Options include: 

• Reducing the number of people in waiting rooms 
• Spacing out chairs in waiting rooms/staff rooms 
• Marking off a 2 metre area around reception
• Where feasible, install Plexiglass barriers at points of regular interaction, e.g. reception 
• Consider asking people to wait in private vehicles, where possible, to reduce numbers in communal areas. 
• Staff working in reception and communal areas who are unable to social distance should where a fluid repellent mask. 
• Patients should wear face coverings when they attend the practice. 
• Practice should continue to use triage arrangements to minimise face-to-face contact. 

WHAT MIGHT HAPPEN NEXT?

A global pandemic was declared by WHO on 11 March 2020. Extensive monitoring is being conducted worldwide and disease pattern modelling undertaken by several centres. Many countries have moved to a wide scale lock-down.

The current total is 39,223 cases per million in the UK, but this is still rising.

The current total of deaths is 1106 per million, again rising.

In terms of prevention the most useful measures are social distancing for asymptomatic people, isolation for those with symptoms and simple hygiene approaches to coughs and sneezes, including the use of disposable tissues and frequent hand washing.

The use of face coverings was mandated by law in indoor settings and public spaces where social distancing is not possible, unless the individual is exempt or has a reasonable excuse. 

There is some evidence that use of dexamethasone can reduce mortality in people with severe COVID-19 pneumonia requiring ventilation. 

Vaccine roll-out started in December 2020. See COVID-19 vaccination