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Coronavirus criteria expand as numbers grow

Matt Woodley 3/02/2020 3:53:17 PM The Australian Government has banned almost all people with a recent history of travel in China from entering the country, as new local cases emerge.

The expanded definition for suspected cases of coronavirus applies to people who have recently returned from all of mainland China, not just Hubei province. (Image: AAP)

At the time of publication, Australia had 15 confirmed cases of the potentially deadly virus, while the global number has surpassed 30,000.



The first death outside of China – a 44-year-old man from Wuhan who recently arrived in the Philippines – has also been confirmed, with the number of fatalities now surpassing 300.



The ongoing crisis has prompted the Australian Government to join the US in banning all recent travellers to mainland China – other than Australian citizens and permanent residents – from entering the country.



It has also expanded the definition for suspected cases of coronavirus to apply to people who have recently returned from all of mainland China, not just Hubei province.



The updated case definition comes days after some GPs expressed concerns that the initial criteria, which limited coronavirus testing to patients with a history of travel in Hubei province only, was allowing suspected cases to slip through the cracks.



GPs from NSW, Victoria and Queensland all reported having requests for coronavirus testing denied, and RACGP President Dr Harry Nespolon has said any coronavirus test ordered by a GP should take place.



‘GPs are taking the coronavirus very seriously and are fully prepared to manage patients who present with symptoms consistent with the virus,’ he said.



‘GPs don’t order tests unnecessarily and it would be disappointing if pathologists, who don’t have the full picture of a person’s health, were making decisions on which tests to process without consulting the GP.’



China has gone to extreme measures to try and control the spread of the virus, including constructing a brand new 1000-bed hospital in just eight days specifically for coronavirus patients, with a second also due to be completed within the fortnight.



Australian Deputy Chief Medical Officer Professor Paul Kelly previously told reporters the virus is not an airborne disease like measles, and is instead being spread by ‘droplets’ when infected people cough and sneeze.



This means people who have had greater than 15 minutes’ face-to-face contact in any setting with a confirmed case, or who shared a closed space with a confirmed case for a prolonged period (ie more than two hours) are at risk.



The virus can also be spread via contaminated surfaces if someone touches their nose or mouth after touching a surface on which an infected person has coughed or sneezed.



Chinese state media has reported virus genetic material has been discovered in patient stool and rectal swabs, but stopped short of declaring it can be transmitted along the faecal–oral route.



China’s National Health Commission (NHC) has, however, banned funerals for all coronavirus victims and ordered their bodies be cremated immediately. Reports from within China claim crematoriums have been used to hide the true number of deaths from the virus, but these remain unconfirmed.



Meanwhile, conflicting reports of the virus’ death rate have also emerged.



The World Health Organization representative in Beijing, Dr Gauden Galea, told reporters the mortality rate in China is falling and ‘at a much lower level’ than previously thought, whereas a study in The Lancet suggested the rate could be closer to 11% – higher than SARS and significantly higher than the 3–4% rate first reported for coronavirus.



However, US epidemiologist Dr Eric Feigl-Ding expressed caution at the results reported in The Lancet, pointing to a small sample size and the fact it only included patients seen in a Wuhan hospital, not all infected patients.



‘The total percent case fatality is likely lower because [a] lot of infected patients with less severe symptoms might not be in this hospital pool,’ he said.



The research also indicated men appear more susceptible to the disease than women.



At the time of publication, 636 people had died from the virus, which has now spread to 28 countries.



The RACGP has more information on coronavirus available on its website.



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