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On 31 December 2019, the World Health Organization (WHO) was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China.
On 12 January 2020 it was announced that a novel coronavirus had been identified in samples obtained from cases and that initial analysis of virus genetic sequences suggested that this was the cause of the outbreak. This virus is referred to as SARS-CoV-2, and the associated disease as COVID-19.
As of 27 March 2020 (10:00am), over 528,000 cases have been diagnosed globally with more than 23,500 fatalities. In the 15 days to 27 March 2020, ~401,000 cases were reported, representing 76% of the global total since 31 December 2019.
Coronaviruses are a large family of viruses with some causing less-severe disease, such as the common cold, and others causing more severe disease such as Middle East respiratory syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) coronaviruses.
2.1 Nomenclature and characterisation
The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses has designated the aetiological agent ‘severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2). Characterisation of SARS-CoV-2 is ongoing. Initial information shared by China and WHO indicates that SARS-CoV-2 is a beta-coronavirus that is genetically similar to SARS-like coronaviruses obtained from bats in Asia.
The source of the outbreak has yet to be determined. Preliminary investigations identified environmental samples positive for SARS-CoV-2 in Huanan Seafood Wholesale Market in Wuhan City, however some laboratory-confirmed patients did not report visiting this market. A zoonotic source to the outbreak has not been identified yet, but investigations are ongoing.
Although evidence is still emerging, information to date indicates human-to-human transmission is occurring. Hence, precautions to prevent human-to-human transmission are appropriate for both suspected and confirmed cases (see infection prevention and control guidance).
We do not know the routes of transmission of COVID-19; however, other coronaviruses are mainly transmitted by large respiratory droplets and direct or indirect contact with infected secretions. In addition to respiratory secretions, other coronaviruses have been detected in blood, faeces and urine.
Under certain circumstances, airborne transmission of other coronaviruses is thought to have occurred via unprotected exposure to aerosols of respiratory secretions and sometimes faecal material.
4. Clinical features
Initial clinical findings from patients to date have been shared by China and WHO. Fever, cough or chest tightness, and dyspnoea are the main symptoms reported. While most patients have a mild illness, severe cases are also being reported, some of whom require intensive care.
A variety of abnormalities may be expected on chest radiographs, but bilateral lung infiltrates appear to be common (similar to what is seen with other types of viral pneumonia).
Public Health England has issued guidance on the investigation and initial clinical management of possible cases.