Human coronaviruses are common throughout the world. The name corona refers to a crown because these viruses have crown-like spikes on their surface when viewed under an electron microscope. There are many different coronaviruses identified in animals but only a small number of these can cause disease in humans. Some coronaviruses such as 229E, NL63, OC43 and HKU1 are common causes of illness, including respiratory illness, in humans throughout the world. Sometimes coronaviruses infecting animals can evolve to cause disease in humans and become a new (novel) coronavirus for humans. Examples of this are the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), first reported from Saudi Arabia in 2012, and the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), first recognized in China in 2002. On 7 January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed as the causative agent of coronavirus disease 2019 (COVID-19). The majority of the case-patients initially identified were dealers and vendors at a seafood, poultry and live wildlife market (Huanan Seafood Wholesale Market) in Jianghan District of Hubei Province. This suggests that the novel coronavirus has a possible zoonotic origin. However, there has been ongoing sustained transmission of COVID-19 in countries to date. The specific source of the virus is not yet known.
Currently travellers to areas where there is ongoing sustained transmission of COVID-19 including Mainland China (all provinces), Hong Kong, Japan, Republic of Korea, Singapore, Vietnam, Taiwan, Italy and the Islamic Republic of Iran are at greatest risk of infection with COVID-19. Furthermore, the elderly, individuals with co-morbidities and healthcare workers have been found to be at a higher risk of morbidity and mortality associated with the SARS-CoV-2. Please consult the latest guidance for information on which countries are experiencing outbreaks of COVID-19. Information can be accessed at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation- reports.
There have been no cases of COVID-19 reported in South Africa. Active surveillance is in place to identify an imported case should one occur. People who develop symptoms of respiratory illness including cough, fever and shortness of breath within 14 days of travel to countries where there is ongoing sustained transmission of COVID-19 should seek medical care early and share information about travel history with their doctors.
While the first cases probably involved exposure to an animal source, the virus now seems to be spreading from person-to-person. It is thought to happen mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. Thus far the majority of cases have occurred in people with close physical contact to cases and healthcare workers caring for patients with COVID-19.
Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness with cough, sore throat, shortness of breath or fever [≥ 38°C (measured) or history of fever (subjective). The complete clinical picture with regard to COVID-19 is still not fully clear. Reported illnesses have ranged from infected people with little to no symptoms to people being severely ill and dying.
COVID-19 is diagnosed by a laboratory test, polymerase chain reaction (PCR) molecular test, on a respiratory tract sample (e.g. sample from nose, throat or chest). For specific guidance on sample collection and transport please visit the NICD’s website: http://www.nicd.ac.za/diseases-a-z-index/covid-19/
Treatment is supportive (e.g. provide oxygen for patients with shortness of breath or treatment for fever). There is no specific antiviral treatment available. Antibiotics do not treat viral infections. However, antibiotics may be required if a bacterial secondary infection develops.
Currently, there is no vaccine for COVID-19. Officials in China have intensified efforts to contain the spread of the virus. There are no specific measures currently recommended to prevent COVID-19 but the following can provide protection against infection with coronaviruses and many other viruses that are more common in South Africa:
- Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitiser.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Avoid close contact with people who are sick.
- Stay at home when you are sick and try and keep distance from others at home.
- Cover your cough or sneeze with a flexed elbow or a tissue, then throw the tissue in the bin.
- Clean and disinfect frequently touched objects and surfaces.
- Avoid contact with farm or wild animals (alive or dead), animal markets, and products that come from animals (such as uncooked meat).
Fever screening is in place at international airports. If there is a suspected case, procedures are in place for case isolation and management as well as rapid specimen collection and transport so that the diagnosis can quickly be made. Suspected cases will be managed at designated hospitals with isolation facilities. Protocols are in place for follow up of case contacts to ensure that the virus does not spread.
It has been recommended that travellers should avoid all nonessential travel to areas with ongoing sustained transmission of COVID-19 including Mainland China (all provinces), Hong Kong, Japan, Republic of Korea, Singapore, Vietnam, Taiwan, Italy and the Islamic Republic of Iran. People who travel to China or areas ongoing sustained transmission of COVID-19 should avoid visiting the animal markets (avoid contact with farm or wild animals), products that come from animals (such as uncooked meat) and avoid contact with sick people.
The NICD offers a range of training opportunities and with partnerships from various institutions and universities across South Africa and abroad. Click on Training to learn more about the training opportunities offered.Visit the NICD website at www.nicd.ac.za for further information. For medical/clinical related queries by health care professionals only, contact the NICD Hotline +27 (0) 82 883 9920 (for use by healthcare professionals only). For laboratory related queries call the Centre for Respiratory Diseases and Meningitis (011-555- 0315/7/8 or 011-555-0488).
Guidelines and case definitions are available on the NICD website http://www.nicd.ac.za/wp- content/uploads/2020/01/COVID-19-Quick-reference-27-01-2020-Final.pdf