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Viral infections

Everything you should know about the coronavirus outbreak

The latest information about the novel coronavirus identified in Wuhan, China, and advice on how pharmacists can help concerned patients and the public.

Open access article

The Royal Pharmaceutical Society has made this feature article free to access in order to help healthcare professionals stay informed about an issue of national importance.

To learn more about coronavirus, please visit: https://www.rpharms.com/resources/pharmacy-guides/wuhan-novel-coronavirus.

Sick man on subway wearing mask

Source: Shutterstock.com

Measures to guard against the infection work under the current assumption that the 2019-nCoV is spread by respiratory droplets 

A novel strain of coronavirus (temporarily named ‘2019-nCoV’ by the World Health Organization [WHO]) was first detected in December 2019 in Wuhan, a city in China’s Hubei province with a population of 11 million, after an outbreak of pneumonia without an obvious cause. The virus has now spread to countries across the globe [1],[2].

As of 31 January 2020, there were 9,834 laboratory-confirmed cases of novel coronavirus 2019-nCoV infection, with 213 reported deaths. The vast majority of cases (9,723) have been reported in China[3].

As of 31 January 2020, there were two confirmed cases of the virus in the UK.

Pharmacists are likely to come across worried patients, and/or those with cold and flu symptoms which may appear similar to those of 2019-nCoV. This article gives a brief overview of the new virus and what to look out for.

What are coronaviruses?

2019-nCoV belongs to a family of single-stranded RNA viruses known as coronaviridae, a common type of virus which affects mammals, birds and reptiles.

In humans, it commonly causes mild infections, similar to the common cold, and accounts for 10-30% of upper respiratory tract infections in adults [4]. More serious infections are rare, although coronaviruses can cause enteric and neurological disease[5]. The incubation period of a coronavirus varies but is generally up to two weeks[6].

Previous coronavirus outbreaks include Middle East Respiratory Syndrome (MERS), first reported in Saudi Arabia in September 2012, and severe acute respiratory syndrome (SARS), identified in southern China in 2003[7],[8]. MERS infected around 2,500 people and led to more than 850 deaths while SARS infected more than 8,000 people and resulted in nearly 800 deaths[9],[10]. The case fatality rates for these conditions were 35% and 10%, respectively.

2019-nCoV is a new strain of coronavirus that has not been previously identified in humans. Although the incubation period of the 2019-nCoV strain is currently unknown, the United States Centre for Disease Control indicates that symptoms may appear in as few as 2 days or as long as 14 days after exposure[6]. Media reports indicate that 2019-nCoV may be infectious during its incubation period[11].

It is important to explain to patients that the infection has not originated from the UK and is only likely to be present in travellers that have recently returned from Wuhan

Where has the new coronavirus come from?

It is currently unclear where the virus has come from. Originally, the virus was understood to have originated in a food market in Wuhan and subsequently spread from animal to human. Some research has claimed that the cross-species transmission may be between snake and human, however, this claim has been contested[12],[13].

Mammals such as camels and bats have been implicated in previous coronavirus outbreaks, but it is not yet clear the exact animal origin, if any, of the 2019-nCoV[14].

How contagious is it?

Increasing numbers of confirmed diagnoses, including in healthcare professionals, has indicated that person-to-person spread of 2019-nCoV is occurring[15]. The preliminary reproduction number (i.e. the average number of cases a single case generates over the course of its infectious period) is currently estimated to be between 1.4 to 2.5, meaning that each infected individual could infect between 1.4 and 2.5 people[16].

Similarly to other common respiratory tract infections, MERS and SARS are spread by respiratory droplets produced by an infected person when they sneeze or cough[17]. Measures to guard against the infection work under the current assumption that the 2019-nCoV is spread in the same manner.

How is it diagnosed?

As this coronavirus affects the respiratory tract, common presenting symptoms include fever and dry cough, with some patients presenting with respiratory symptoms (e.g. sore throat, nasal congestion, malaise, headache and myalgia) or even struggling for breath.

In severe cases, the coronavirus can cause pneumonia, severe acute respiratory syndrome, kidney failure and death[18].

Diagnosis is suspected in patients with signs and symptoms of pneumonia who have reported travel to an affected location, or who have had contact with a person with confirmed or suspected 2019-CoV (see Box 1). A diagnostic test has been developed, and countries are quarantining and testing suspected cases[19].

Box 1: Who qualifies as a suspected coronavirus 2019-CoV case?

Epidemiological criteria:

  • Those who have travelled to Wuhan, Hubei province, China in the 14 days before the onset of illness; or
  • Those who have come into contact (such as living in the same household) with confirmed cases of 2019-nCoV.

Clinical criteria:

  • Severe acute respiratory infection requiring admission to hospital with clinical or radiological evidence of pneumonia or acute respiratory distress syndrome OR
  • Acute respiratory infection of any degree of severity (including at least one of: shortness of breath, cough or sore throat).

If the patient satisfies epidemiological and clinical criteria, they are classified as a possible case. Clinicians should be alert to the possibility of atypical presentations in patients who are immunocompromised.

Source: Investigation and initial clinical management of possible cases of Wuhan novel coronavirus (WN-CoV) infection. Department of Health and Social Care, Jan 2019

Are there likely to be more UK cases of coronavirus? 

Public Health England (PHE) states that the risk to the UK population is ‘moderate’. This has been raised from ‘very low’ and ‘low’ after the World Health Organization’s declaration that this is a public health emergency of international concern[20].

Since 22 January 2020, enhanced monitoring for the virus has been in place for all direct flights from Wuhan to the UK, in which healthcare teams are checking for symptoms of coronavirus and providing information to all passengers about symptoms and advice on what to do if they become ill[20]

What should I do if a patient thinks they have coronavirus?

Given the outbreak has coincided with the cold and flu season, it is likely that patients may present in the pharmacy with queries about the virus, or with concerns about their cold or flu symptoms.

Eliciting a travel history is an essential part of helping identify a patient’s relative risk of 2019-nCoV. It is important to explain to patients that the infection has not originated from the UK and is only likely to be present in travellers that have recently returned from Wuhan, to help alleviate their concerns[21].

There is no pharmacy-specific advice on what to do if a patient with symptoms suggestive of infection and a relevant travel history presents in a pharmacy. But advice for primary care issued by PHE recommends isolating the patient, not physically examining them and seeking specialist advice[21].

Anna Murphy, consultant respiratory pharmacist at University Hospitals of Leicester NHS Trust and honorary visiting professor at DeMontfort University School of Pharmacy, said: “Patients, especially those with an underlying respiratory condition are likely to be concerned and have questions. The advice from PHE is that any patient experiencing symptoms should contact 111 for advice rather than presenting at the community pharmacy, and this message should be promoted to patients.”

Those with cold and flu symptoms, who have not travelled to an affected area, should be managed as usual, or using the pathway developed by The Pharmaceutical Journal.

How can cross-infection be prevented?

The WHO has created a range of infographics to illustrate how patients can protect themselves and others from getting sick; however, most of the advice is similar to what would be provided for colds and flu (see Figure)[22].

Infographic showing how to reduce risk of coronavirus infection

Figure: Infographic – How to reduce the risk of coronavirus infection

Source: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

There is no specific treatment for 2019-nCoV. Although vaccines can be developed to treat viruses, owing to the novel nature of this infection, no vaccine has currently been developed and the process to develop one may take several years[18]. As an example, many antiviral agents have been identified to inhibit SARS in vitro, but there are currently no approved antiviral agents or vaccines available to tackle any potential SARS or SARS-like outbreaks, such as MERS or 2019-nCoV[23].

Box 2: In quotes

Matt Hancock, health and social care secretary: “The public can be assured that the whole of the UK is always well-prepared for these types of outbreaks and will remain vigilant and keep our response under constant review in the light of emerging scientific evidence.” 

A spokesperson for Public Health England: “Our advice is that people phone NHS 111 or call their GP rather than presenting at healthcare settings like a pharmacy.”

Professor Chris Whitty, chief medical officer for England, in a statement (31 January 2020): “We can confirm that two patients in England, who are members of the same family, have tested positive for coronavirus. The patients are receiving specialist NHS care, and we are using tried and tested infection control procedures to prevent further spread of the virus.”

  • This article was updated on 31 January 2020 to reflect relevant information that has been made available. This includes: information on the number of cases of coronavirus 2019-nCoV globally and in the UK; an update from Public Health England on the risk to the UK population; the World Health Organization’s declaration that the coronavirus outbreak is now classified as a national emergency; and a statement from the chief medical officer for England.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20207629

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