Nine people are confirmed to have died and at least 440 have been infected in the outbreak of a new Sars-like virus that was first reported in the central Chinese city of Wuhan less than a month ago.
The World Health Organisation met on Wednesday to determine whether to declare the outbreak a public health emergency of international concern, after authorities in China confirmed the death toll had risen from six overnight.
The US reported one confirmed case of the novel coronavirus, designated 2019-nCoV, on Tuesday, and cases have also been confirmed in Korea and Thailand. It has also spread to 14 health workers in China, confirming human-to-human transmission.
But health authorities say there is no cause for public concern in Australia.
What is Australia doing?
Medical staff from the New South Wales Health department will be stationed alongside biosecurity staff at Sydney airport to meet the thrice-weekly direct flight from Wuhan, conduct an initial diagnosis of any people on the flight who are exhibiting flu-like symptoms, and if necessary send them to Westmead hospital for testing.
Authorities are also providing written information, in English and Chinese, to passengers on those flights about what to do if they develop respiratory symptoms.
“We are meeting every passenger, providing information to them, asking them to declare if they have got any symptoms, but we know that an incubation period for a virus like this could be seven days,” Australia’s chief medical officer, Prof Brendan Murphy, told the ABC. He said temperature scanners would not be used because they did not detect infected people who had not yet developed a fever.
“We know in our experience in swine flu and other epidemics that measuring temperature might pick up a few people but it also misses a lot of people, and it probably doesn’t add anything to the biosecurity measures that we’ve put in place,” he said.
What powers do health authorities have?
Under Australian law airlines are obliged to report sick passengers to biosecurity staff before the plane is unloaded. Coronavirus has also been made a notifiable condition in NSW, which means the state government must be notified of suspected cases. It also means health providers can use powers under the Public Health Act 2010 to isolate or place into quarantine people who are suspected of having the virus, but are not complying with health or biosecurity officers.
“Almost always we don’t need to do that because people are very sensible and cooperative, but we do have powers, if need be, under the Public Health Act to control the spread of diseases,” the NSW Health executive director, Dr Jeremy McAnulty, told reporters on Wednesday.
Most people can be relied upon to self-report unless their symptoms are so mild as to be mistakenly dismissed as a common cold, said Raina MacIntyre, a professor of global biosecurity at the University of New South Wales.
“Most people will self-report because they will be concerned,” MacIntyre said. “They will know that they have come from an area of concern and people do not want to die of a serious disease.”
Murphy said reports from China showed there “clearly seem to be a number of mild cases that just have a fever, a bit like a common cold”.
McAnulty said the virus did not appear to be as severe as Sars, but that it was “prudent to be cautious until we learn more about this situation”.
MacIntyre said severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) had fatality rates of 12% and 26% respectively, while the fatality rate for the novel coronavirus was currently about 2% to 5%. But she stressed there was no formal published data yet.
Will that work to prevent the disease spreading to Australia?
One suspected case has been reported in Australia, but tests showed he did not have the coronavirus. Queensland health authorities confirmed on Tuesday that a man who had recently visited Wuhan had presented with respiratory symptoms. He was released from home isolation after Queensland Health said he no longer had flu-like symptoms, and on Wednesday afternoon it was reported that test results were negative for the virus.
Australian authorities are still developing a rapid test for the virus. A laboratory in Melbourne has developed a PCR (polymerase chain reaction) test, using the virus sequence provided by Chinese authorities.
The incubation period for the virus is up to seven days, which means some people could be asymptomatic when assessed at the airport. Murphy said authorities did not have a “clear clinical picture” of whether people were infectious before they developed symptoms.
He told reporters on Tuesday that “you cannot absolutely prevent the spread of disease into the country”.
“So it’s about identifying those with a high risk and making sure those who have a high risk know about it and know how to get medical attention,” he said.
Who is at high risk?
Anyone is at risk who has recently been in Wuhan, or who has had close contact with someone who has been there, and has developed flu-like symptoms, such as a high temperature, sore throat, coughing or breathlessness.
People who suspect they may have the virus are advised to ring ahead to their general practitioner or local hospital, so precautions can be taken to protect other patients from infection and appropriately triage the at-risk patient.
The biggest risk to controlling the virus, MacIntyre said, was a failure to appropriately triage.
“We really want to focus on the healthcare system and make sure that detection is improved,” MacIntyre said. “You don’t want somebody sitting in the emergency department for three hours with a cough or fever and not being properly triaged.”
Hospitals and general practitioners have been provided with information and advice about the virus, but MacIntyre said failure to swiftly isolate at-risk patients could increase the spread of the infection.
“We see failure of triage all the time in Australia, such as with measles,” she said. “You have got to look at where you can make the biggest impact and if it’s anything like the Sars and Mers outbreaks it’s going to be hospitals that are at the highest risk of outbreaks.”