Coronavirus: How does the UK respond to an outbreak?

The coronavirus that shut down two cities and killed more than a dozen people in China has sparked fears of a global outbreak.

Airports around the world have stepped up screening of travellers arriving from affected regions but what’s the plan if the virus reaches the UK?

Here’s what you need to know.

What has Public Health England (PHE) said about the coronavirus?

The UK is said to be “well prepared” for new diseases and there are no confirmed cases of the coronavirus here. Four people are being tested in Scotland.

Dr Nick Phin, deputy director of PHE’s national infection service, said: “This is a new and rapidly evolving situation where information on cases and the virus is being gathered and assessed daily.

“Based on the available evidence, the current risk to the UK is considered low.

“We are working with the World Health Organisation (WHO) and other international partners, and we have also issued advice to the NHS and are keeping the situation under constant review.”

Is there a precedent for an outbreak like this in the UK?

You might remember the swine flu outbreak of 2009, when cases were first confirmed in passengers returning home from trips to Mexico in April.

The virus peaked in July, with the Health Protection Agency reporting more than 100,000 estimated cases.

While most suffered mild symptoms, the illness was linked to 457 deaths, according to a government report, and prompted a nationwide immunisation programme.

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Severe Acute Respiratory Syndrome (SARS), which killed nearly 800 people globally during a 2002/03 outbreak that also started in China, made its way to the UK too.

There were four cases in the UK before that global pandemic was brought under control.

Middle East respiratory syndrome (MERS), which was first identified in Saudi Arabia in 2012 and has since killed more than 800 people, was reported in the UK in the summer of 2018.

There was no onward transmission in that instance.

Who is responsible for identifying an outbreak?

According to PHE’s operational guidance on outbreaks of communicable diseases, PHE, NHS Trusts and local authorities can all recognise outbreaks.

Each has its own procedures when it comes to surveillance, detection and control.

They are required to make immediate contact as soon as an outbreak is apparent, with control measures to clarify the nature of the incident to begin within 24 hours.

These include forming a tentative diagnosis and confirming the characteristics of suspected cases, interviews to gather information about common factors, and carrying out an initial risk assessment.

PHE also set out a new five-year infectious diseases strategy last November, and has a dedicated intelligence team described as being “constantly on the lookout for emerging infections abroad”.

Professor Sharon Peacock, director of the national infection service, said infectious diseases were “evolving” and that the UK must be prepared for “when an unknown disease strikes”.

What is a risk assessment?

Risk assessments are agreed to by a dedicated outbreak control team.

They are dictated by where the outbreak is first identified and whether it crosses local authority boundaries, with good communication needed if it does.

If a national incident is on the cards, PHE coordinates a consistent response across devolved administrations.

PHE also must report incidents of potential international significance to the WHO, and EU-level outbreaks to the European Centre for Disease Prevention and Control.

What does the outbreak control team do?

The outbreak control team assesses the risk to public health and ensures the cause and source of the outbreak are investigated thoroughly and quickly.

They also agree to a case definition, which includes the time and place a suspected case was reported and details of whoever is carrying the infection.

Interviews are carried out with initial cases to establish any common factors, helping to form an early hypotheses and analytical study to project how the virus could potentially spread.

Relevant information to be considered about the host are their age, sex, ethnicity and recent travel.

How do we know how serious an outbreak might be?

PHE has five incident levels to convey how concerned we should be about an outbreak.

  • 1 – Local with limited public health impact.
  • 2 – The same as above, but may require greater management input.
  • 3 – Public health impact spans multiple regional boundaries and may require national coordination.
  • 4 – Severe public health impact requiring central direction and formal interaction with the government.
  • 5 – Catastrophic public health impact with central direction and “extensive commitment of resource” needed.

How do we know when an outbreak is over?

The outbreak control team is responsible for deciding when an outbreak is over and will make a statement.

It makes its assessment if there is no longer considered to be a risk to public health, the number of cases has declined, and the probable source has been identified and withdrawn.

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