Pharmacists warned to be on alert for coronavirus infections

Clinical
By
Ruth Cooper
-
The SARS coronavirus

Pharmacists are encouraged to get a travel history for patients presenting with flu-like symptoms, with five cases so far in Australia1 of the novel coronavirus (2019-nCoV) first identified in China last month.

In a letter to the PSA on Monday, Australia’s Chief Medical Officer Professor Brendan Murphy asked pharmacists to ‘identify additional cases that may be in Australia or come to Australia in coming weeks’.2

He urged pharmacists to ask patients with flu-like symptoms whether they had been in the Hubei province of China – including the city of Wuhan where the virus may have originated – or had been in contact with people with the coronavirus infection.

‘If the answer is yes, please ask your patient to put on a surgical mask and present to their GP or emergency department (after first phoning ahead to warm them that they are coming),’ Professor Murphy wrote.2

There have been 106 confirmed deaths from the virus in China, with more than 4500 confirmed cases. The majority of cases are in Hubei, with small numbers reported in other Chinese provinces. Cases have also been reported in Hong Kong, Macau and Taiwan.2

Around the world, there have been 56 confirmed cases across 14 countries: Australia, Japan, South Korea, Vietnam, Singapore, Malaysia, Cambodia, Thailand, Nepal, Sri Lanka, the USA, Canada, France and Germany.3

‘Nearly all of these cases have reported travel to Hubei Province,’ Professor Murphy wrote.2

However, Japan has now reported its first case of human-to-human transmission, with a 60-year-old man who did not travel to Wuhan but drove buses full of tour groups from the city diagnosed with the virus.

Speaking to ABC Radio this morning, Professor Murphy said reports of human-to-human transmission outside of China was ‘a concern’.4

‘The thing that we are determined to avoid internationally and nationally is what we call sustained human-to-human transmission, where you go from one person to another,’ he said.4

‘These are isolated cases in Japan and Germany, but they are obviously of some concern and we are having that reviewed today by our peak communicable diseases advice panel, to have a look at those cases.’

He said the ‘major goal’ in Australia is to detect early cases in order to isolate them and ensure there is no sustained human-to-human transmission.4

Speaking to the media this afternoon, Professor Murphy confirmed experts believe the virus is contagious before people show symptoms. The update came after a meeting of the Australian Health Protection Principal committee (AHPPC).

‘The committee is aware of very recent cases of coronavirus who are at the time of diagnosis asymptomatic or minimally symptomatic,’ Professor Murphy said.

‘We’re also aware of one fairly convincing case of probable transmission from a pre-symptomatic case to other people two days prior to the onset of symptoms.’

In a statement,5 the AHPPC said it still believes ‘most infections are transmitted by people with symptomatic disease’. However, it said it was important to take a ‘highly precautionary approach’ and made two recommendations:

  1. People who have been in contact with any confirmed novel coronavirus cases must be isolated in their home for 14 days following exposure;
  2. Returned travellers who have been in Hubei Province of China must be isolated in their home for 14 days after leaving Hubei Province, other than for seeking individual medical care.

‘AHPPC recognises that the evidence for pre-symptomatic transmission is currently limited, and this policy is highly precautionary,’ the statement said.5

‘At this time, the aim of this policy is containment of novel coronavirus and the prevention of person to person transmission within Australia.’

Prime Minister Scott Morrison has also announced the Federal Government would try to evacuate about 600 isolated and vulnerable Australians registered as being in Hubei province in China for quarantine on Christmas Island.

What are the symptoms of a coronavirus infection?

The most common symptom is a fever.2,6 Other symptoms include a cough, sore throat and shortness of breath. In more severe cases, infection can cause pneumonia with severe acute respiratory distress.2,6,7

Tips for prevention

While confusion remains about transmission, other human coronavirus strains are spread from person to person through contaminated droplets from a person who is sick with the illness (through coughing or sneezing) or contaminated hands. It is likely this novel coronavirus spreads the same way.8

To minimise the risk of infection, NSW Health advises people8:

  • Clean hands with soap and water, or alcohol-based hand rub
  • Cover the nose and mouth when coughing and sneezing, with a tissue or flexed elbow
  • Avoid close contact with anyone with cold or flu-like symptoms

Local breakthrough

There is currently no vaccine for the 2019-nCoV, but a local breakthrough could help in the race to develop one. 

Scientists from The Peter Doherty Institute for Infection and Immunity in Melbourne have become the first outside China to successfully grow the virus in a lab.9 

Dr Julian Druce, Virus Identification Laboratory Head at the Doherty Institute, said it was a significant development as it will allow accurate investigation and diagnosis of the virus globally.

‘Chinese officials released the genome sequence of this novel coronavirus, which is helpful for diagnosis’ he said. 

‘However, having the real virus means we now have the ability to actually validate and verify all test methods, and compare their sensitivities and specificities – it will be a game changer for diagnosis.’

The Doherty Institute-grown virus will be passed on to the World Health Organisation in Europe, which will share it with other labs involved in creating a vaccine, including the University of Queensland. It is also expected to be used to generate an antibody test, which allows detection of the virus in patients who haven’t displayed symptoms and were therefore unaware they had the virus.

Doherty Institute Deputy Director Dr Mike Catton said possession of a virus isolate extended what could be achieved with molecular technology in the fight against this virus.

‘An antibody test will enable us to retrospectively test suspected patients so we can gather a more accurate picture of how widespread the virus is, and consequently, among other things, the true mortality rate,’ he said.9

‘It will also assist in the assessment of effectiveness of trial vaccines.’

Combined response needed

Professor Murphy encouraged all stakeholders, including government agencies, health and medical practitioners, and members of the public, to work together to respond to the coronavirus. However, he said pharmacists were particularly well placed to assist. 

‘I know that people with flu-like symptoms, such as those seen with this coronavirus, will often seek advice from their pharmacist’, he said.2

‘Pharmacists play a vital role in our health system, and I think you have an important role to play in our response to the coronavirus.’2

Further reading

  • The Lancet has created a hub for clinical articles on the novel coronavirus.10
  • Academic publisher Wiley is providing free access to all Wiley-published articles related to coronavirus until April 2020.11
  • Consumers can visit the Department of Health website.12

References

    1. Australian Government Department of Health. Canberra. Doorstop interview at the Peter MacCallum Cancer Centre. 2020 January 28. At: www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/doorstop-interview-at-the-peter-maccallum-cancer-centre
    2. Murphy B. Chief Medical Officer communique to pharmacies. 2020 January 26.
    3. World Health Organisation. Novel Coronavirus (2019-nCoV) situation report – 8. 2020 January 28. At: www.who.int/docs/default-source/coronaviruse/situation-reports/20200128-sitrep-8-ncov-cleared.pdf?sfvrsn=8b671ce5_2
    4. Lane S. 5 confirmed cases of Coronavirus in Australia. 2020 January 29. At: www.abc.net.au/radio/sydney/programs/am/5-confirmed-cases-of-coronavirus-in-australia/11909032
    5. Australian Government Department of Health. Statement on Novel Coronavirus on behalf of the Australian Health Protection Principal Committee. 2020 January 29. At: www.health.gov.au/news/statement-on-novel-coronavirus-on-behalf-of-the-australian-health-protection-principal-committee-ahppc 
    6. NSW Health Department. Novel coronavirus 2019 (2019 n-CoV). 2020. At: www.health.nsw.gov.au/Infectious/factsheets/Pages/novel-coronavirus.aspx
    7. World Health Organization. Health topics: coronavirus. At: www.who.int/health-topics/coronavirus
    8. NSW Health Department. Novel coronavirus – Frequently asked questions. 2020. At: www.health.nsw.gov.au/Infectious/alerts/Pages/coronavirus-faqs.aspx#1-3
    9. Doherty Institute. Melbourne. Doherty Institute scientists first to grow and share Wuhan virus. 2020 January 29. At: www.doherty.edu.au/news-events/news/coronavirus
    10. The Lancet. Coronavirus. 2020. At: www.thelancet.com/coronavirus
    11. Wiley. Coronavirus research from Wiley. 2020. At: secure.wiley.com/Coronavirus2020
    12. Australian Government Department of Health. Canberra. Novel coronavirus (2019-nCoV). 2020. At: www.health.gov.au/health-topics/novel-coronavirus-2019-ncov