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Coronavirus: NHS staff get power to keep patients in isolation as UK declares “serious threat”

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m550 (Published 10 February 2020) Cite this as: BMJ 2020;368:m550

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  1. Elisabeth Mahase
  1. The BMJ

The UK government has declared that the incidence or transmission of the novel coronavirus 2019-nCoV constitutes a serious and imminent threat to public health.

The announcement means that England’s health secretary, Matt Hancock, can enact regulations to ensure that the public is “protected as far as possible from the transmission of the virus.” This includes designating Arrowe Park Hospital, Merseyside, and the Kents Hill Park hotel and conference centre, Milton Keynes, as isolation facilities.

It also means that NHS staff members have “strengthened powers” to keep patients in isolation if public health professionals believe there to be a “reasonable risk an individual may have the virus.”

As at 10 February eight people in the UK had tested positive for 2019-nCoV. Globally, the virus has spread to 28 countries, with more than 40 000 cases and 900 deaths.

Hancock said, “Clinical advice has not changed about the risk to the public, which remains moderate. We are taking a belt and braces approach to all necessary precautions to ensure public safety.

“Our infection control procedures are world leading. What I am announcing today further strengthens our response.”

Meanwhile, Public Health England has announced it is rolling out its novel coronavirus diagnostic test to 12 laboratories in England, Scotland, Wales, and Northern Ireland over the next few weeks, bringing the total number of facilities with testing capability to 13. This will increase the testing capacity for England from 100 to 1000 people a day.

The test is performed on a sample from the nose, throat, and respiratory tract. A confirmatory test will continue to be conducted at PHE’s Colindale laboratories in London. PHE is also working with WHO to test samples from countries that do not have testing facilities.

These updates came as the Medical Research Council’s Centre for Global Infectious Disease Analysis at Imperial College London published its latest report, which estimated the case fatality ratio for 2019-nCoV as between 1% and 18%.1 The ratio is defined as the proportion of cases of a disease that will ultimately result in death from the disease. Though this is a simple calculation at the end of an epidemic, as all deaths and cases will have been ascertained, during an epidemic the ratio underestimates the true number owing to the time lag between onset of symptoms and death. The researchers have accounted for this in their estimates.

They said that in cases detected in Hubei (the Chinese province where the outbreak began) the case fatality ratio was estimated at 18% (95% credible interval 11% to 81%). Among cases detected in travellers from mainland China to other countries they estimated the ratio as between 1.2% and 5.6%, with substantial uncertainty around these central values.

Among all cases, they have estimated that the case fatality ratio to be around 1% (95% confidence interval 0.5% to 4%).

The report noted that the differences in these estimates did not reflect underlying differences in disease severity between countries but rather the varying sensitivity of surveillance systems to detect cases of differing levels of severity and the clinical care offered to severely ill patients.

Martin Hibberd, professor of emerging infectious disease at the London School of Hygiene and Tropical Medicine, said, “The new number crunching from the MRC Infectious Diseases group at Imperial has given some insights into the current case fatality rate estimates and shows how much these can vary at the moment (from 18% to 1%), with the numbers in general coming down over time, as more accurate estimates are made through the increased use of diagnostics in less severe cases.

“This is reminiscent of the 2009-nH1N1 influenza strain, where initial estimates were also much higher than the now more established less than 0.1% rate overall. It is worth noting, though, that despite this apparently low fatality rate for 2009-nH1N1, this pandemic caused serious additional problems (compared with typical seasonal influenzas) to healthcare systems worldwide, showing why governments have placed such importance on this new coronavirus even as the case fatality rate drops.”

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