ALERT # 7 Novel coronavirus (2019-nCoV)

Dear Clinicians,

Here is an update about the novel coronavirus (2019-nCoV) outbreak. This advice may change depending on the progression of the outbreak.

What is the aim?
The aim of the response is to attempt to detect all people with the virus and prevent transmission of the virus to others.

What is happening with case numbers in the NT and Australia and globally?
There are no confirmed or suspect cases in the NT to date and 9 people have tested negative. There are 15 confirmed cases in Australia with 5 in Qld, 4 in NSW, 4 in Vic and 2 in SA. Numbers globally continue to climb with the majority being from mainland China.

Who requires testing?
All suspect cases should be tested. There has been a slight change to the case definition (in red) to include casual contacts in the epidemiological criteria for a suspect case.

Case definition
Suspect case – requires epidemiological and clinical criteria to be met
As the full clinical spectrum of illness is not known, clinical and public health judgement should also be used to determine the need for testing in patients who do not meet the epidemiological or clinical criteria below.
Epidemiological criteria
Travel to (including transit through) mainland China in the 14 days before the onset of illness
OR
Close or casual contact* in the 14 days before illness onset with a confirmed case of 2019-nCoV.
Clinical criteria
Fever
OR
Acute respiratory infection (e.g. shortness of breath or cough) with or without fever or history of fever
Confirmed case
A person who tests positive to a specific 2019-nCoV PCR test (when available) or has the virus identified by electron microscopy or vial culture, at a reference laboratory.
* For close or casual contact definition see Novel Coronavirus 2019 (2019-nCoV) CDNA National Guidelines for Public Health Units

For people who meet the above case definition CALL NT CDC 08 8922 8044 (or via RDH switch 08 8922 8888 after hours and at weekends) for testing and isolation advice.
If you think a patient who doesn’t fulfil the case definition should be tested, contact CDC as above.

Who is recommended for quarantine or isolation?
Returned travellers who are well who have left or transited through mainland China (excluding Hubei) on or after 1 February 2020, should self-quarantine at home for 14 days after leaving mainland China.
Returned travellers from Hubei province, should self-quarantine at home for 14 days after leaving Hubei.
People who have been in close contact with a confirmed case in the last 14 days should self-quarantine at home for 14 days after last contact with a confirmed case.

People who need to self-quarantine should remain within 3 hours drive (preferably by sealed road) from Alice Springs, Katherine, Nhulunbuy or Darwin. They should NOT go to remote Aboriginal communities. Those who reside further than 3 hours away from these towns or in remote Aboriginal communities should seek accommodation elsewhere. Call NT CDC Public Health Unit on 08 89228044 to discuss.

Casual contacts do not need to self-quarantine but should monitor their health for 14 days. If they do develop symptoms they need to self-quarantine and report any symptoms immediately to the local public health unit.
Returned travellers or people who have been in close or casual contact with a confirmed case who fulfil the suspect case definition should be isolated and managed according to the recommendations for a suspect case – see below.

How do you manage a suspect case?
If you suspect a patient has 2019-nCoV you should:

  • Routine tests for acute pneumonia/pneumonitis should be performed where indicated, including bacterial cultures, acute and convalescent serology, urinary antigen testing and extended virus PCR panel for respiratory viruses.
  • Place a surgical mask on the patient.
  • Use contact and droplet precautions, including close attention to hand hygiene.
  • Use a P2/N95 mask, if available (being very precautionary), or surgical mask if not available.
  • Isolate the patient in a single room with the door closed, or if in hospital in a negative pressure room where available.
  • Seek advice from the NT CDC on 08 8922 8044 or after hours through the Royal Darwin Hospital (RDH) switchboard on 08 8922 8888 and you may be advised to take samples for 2019- nCoV testing.
  • For respiratory specimen collection use airborne transmission precautions with a P2/N95 mask and disposable gown, gloves and eye protection. See National Guidelines for details.
  • Patients with clinical signs suggestive of pneumonia should have specimen collection done in a negative pressure room in a hospital.

What specimens are best?

  • Upper respiratory samples (combined nose and throat swabs, or nasopharyngeal swabs).
  • Lower respiratory tract sample if the lower tract is involved (sputum, tracheal aspirate, bronchoalveolar lavage, pleural fluid).
  • Whole blood/serum.

Samples are to be sent for testing to RDH pathology laboratory. For GPs this also involves contacting your usual specimen collector who will then transport the specimens to RDH.

Make sure you have called NT CDC on 08 8922 8044 or after hours through RDH switchboard on 08 8922 8888 so NT CDC staff are aware of suspect cases and the RDH laboratory is prepared for testing.

Suspect case patients not requiring hospitalisation who are awaiting laboratory results will need to be within 1 hour drive (preferably by sealed road) from Alice Springs, Katherine, Nhulunbuy or Darwin and should NOT go to remote Aboriginal communities and should seek accommodation elsewhere. Call NT CDC on 08 89228044 to discuss.

For more information:

Yours sincerely

Dr Vicki Krause
Director, Centre for Disease Control-Environmental Health, Public Health Unit, TEHS, Darwin