Hong Kong: Doctors Asked To Look For `Atypical’ Signs Of nCoV

 

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A pair of reports out of Hong Kong this morning in the aftermath of this weekend’s revelations about the novel coronavirus in Saudi Arabia (see Saudi Arabia: MOH Coronavirus Twitter Updates) and France (see France: Second Coronavirus Case Confirmed).

 

While Hong Kong has tested a number of travelers returning from the Middle East for the novel coronavirus – so far – none have tested positive.

 

Hong Kong’s hyper-vigilance over infectious diseases comes as the direct result of the terrible toll that SARS took on Hong Kong a decade agp (see SARS And Remembrance). Between March 11th and June 6th of 2003, a total of 1750 cases were identified, and of those, 286 died.

 

Hong Kong’s respected Centre for Health Protection - which was created as a result of that epidemic – has since earned a solid reputation for taking a strong, open, and proactive stance against all communicable disease threats.

 

 

First, a briefing today by Centre for Health Protection  Controller Dr Leung Ting-hung, who warns that doctors ought to be alert for potential coronavirus cases who may `show atypical symptoms, such as diarrhoea’.

 

Coronavirus caution urged

May 13, 2013

Centre for Health Protection Controller Dr Leung Ting-hung has called on doctors to watch for patients with novel coronavirus signs, saying early symptoms may not be respiratory.

 

Dr Leung issued the caution at a press conference today, after Saudi Arabia and France reported coronavirus cases to the World Health Organisation last week.

 

He said those infected with coronavirus may initially show atypical symptoms, such as diarrhoea. He asked doctors to pay special attention to immunocompromised patients and those with underlying medical conditions.

 

The centre will write to public and private hospitals and practising doctors reminding them to be on high alert for suspected cases.

 

The French and Saudi Arabian cases were tied to an outbreak at a healthcare facility.

 

There have been 34 confirmed cases globally since September, including 20 deaths, with most cases occurring in the Middle East.

 

Hospital Authority Associate Consultant of the Chief Infection Control Officer's Office Dr Vivien Chuang said the authority has adopted an early-notification, early-detection and early-isolation strategy to handle suspected cases.

 

Medical staff will wear personal protective equipment when dealing with these patients, and isolation beds with individual toilets will be provided.

 

The pair advised travellers feeling ill after returning from coronavirus-affected areas to seek medical attention and reveal their travel history to doctors.

No human infection with the virus has so far been identified in Hong Kong.

 

 

The inclusion of gastrointestinal complaints with nCoV is a bit out of the ordinary, although the index case in France was reportedly hospitalized on April 23rd for what was characterized as a gastrointestinal illness. Whether that was due to, or ancillary to, his nCoV infection is unclear.

 

This from the WHO May 8th nCoV update.

 

The patient had an underlying medical condition, including an immunocompromised state. The patient became ill on 23 April 2013 and later developed respiratory symptoms. Laboratory confirmation with nCoV was confirmed on 7 May 2013 by Institut Pasteur. The laboratory confirmation was obtained from a bronchoalveolar lavage specimen (a medical procedure in which bronchoscope is passed through the mouth or nose into the lungs to obtain fluid for examination) after a nasopharyngeal specimen (secretion from the uppermost part of the throat) tested negative.

 

Although primarily known to produce respiratory illness, human coronaviruses (hCoV) have been linked to viral gastroenteritis as well (see Detection of human coronaviruses in children with acute gastroenteritis).

 

Until we have a much larger catalog of case reports, it is difficult to list with any certainty the full spectrum of symptoms that nCoV might produce.

 

With news of nosocomial spread of the virus to a number of patients in a Saudi hospital, and to at least one person in a French hospital, Hong Kong’s CHP today issued the following letter (slightly reformatted for readability) to local medical institutions.

 

13 May, 2013

Dear Medical Superintendent,

Latest Situation on Severe Respiratory Disease associated with Novel Coronavirus
Further to our letter to you dated 6 May 2013, we would like to provide you with the latest situation on Severe Respiratory Disease associated with Novel Coronavirus (NCoV).

 

As of 12 May, a total of 34 confirmed cases of human infection with NCoV have been reported worldwide, including 24 from the Kingdom of Saudi Arabia (KSA) (including 15 deaths), two from Qatar, two death cases from Jordan, three from the United Kingdom (UK) (including two deaths), two from France and one death case from the United Arab Emirates.

 

Of these 34 cases, most patients were male (81%; 32 of 34 cases with sex reported) with age range from 24 to 94 years (median 56 years). The first case had onset of illness in late March or early April 2012; whereas the most recent case reported had onset on 1 May 2013. Most patients presented with severe acute respiratory disease requiring hospitalization and eventually required mechanical ventilation or other advanced respiratory support. Among these 34 cases, 20 were fatal (case fatality rate = 59%).

 

Three clusters among close contacts were recorded (two in KSA in October 2012 and February 2013 and one in UK in February 2013), each cluster affected two to three persons. Separately, three clusters involved health care facilities were also identified, including a retrospectively identified cluster in Jordan in which occurred in April 2012, a cluster in KSA that affected 15 persons and the latest cluster in France that affected two persons so far.

 

These outbreaks illustrated the potential of NCoV to spread through health care facilities and close contacts. So far, there is no evidence that this virus has the capacity to sustain generalized transmission in communities. The outbreak in the health care facility in KSA suggested that patients with multiple comorbidities in health care facilities may have had increased susceptibility to infection or severe disease.

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At present, the reservoir, mode of transmission and the extent of infection in the community are still being investigated by the World Health Organization and relevant health authorities.

 

In view of the recent clusters occurred in health care facilities, health care workers and hospitals are reminded to maintain vigilance against NCoV infection and adhere to strict infection control practices when handling suspected cases.

 

Medical practitioners are reminded to notify the Department of Health any suspected cases of Severe Respiratory Disease associated with NCoV, fulfilling the reporting criteria (LINK) to the Central Notification Office (CENO) of the Centre for Health Protection (CHP) via fax (2477 2770), phone (2477 2772) or CENO On-line. Please also call our Medical Control Officer at 7116 3300 a/c 9179 outside office hour for prompt investigation.

 

Apart from the statutory notification of Severe Respiratory Disease associated with NCoV as mentioned above, please also consider testing for NCoV for unexplained pneumonia after exclusion of common causative agents, regardless of the travel history. Laboratory testing of NCoV is available in Public Health Laboratory Centre (PHLC) of CHP and please contact the Virology Division of PHLC for necessary arrangement.

 

Thank you for your ongoing support in combating communicable diseases.

Yours faithfully,
(Dr. SK CHUANG)
for Controller, Centre for Health