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2019-nCoV Coronavirus: Advice for clinicians and Emergency Departments RSS

1.The objective of the 2019-nCoV response in NSW is to detect all infected people and prevent transmission of the virus to others 2.There are reports of 2019-nCoV infection in people with no history of fever and who were afebrile at presentation 3.Test for2019-nCoVin patients withrespiratory symptoms, including mild respiratory symptoms,with or without fever,who have travelled toor transited throughmainland China (excluding Hong Kong, Macau and Taiwan) in the 14 days before illness onset 4.Patients can be discharged home in isolation while awaiting results

Situation update:

Infection can cause severe acute respiratory illness, but there is a spectrum of disease. Some confirmed cases have no history of fever and no fever at presentation, but there is no information about how commonly this occurs.

The current strategy is to broaden the testing criteria to test people who have been in mainland China (excluding Hong Kong, Macau and Taiwan) with symptoms of respiratory infection.

While the large majority of patients are likely tobe infectious after onset of illness, there is preliminary evidence of a very small number of people being infectious before their symptoms developed. There is no information about how commonly this occurs.

Contacts of confirmed cases and people who have travelled to Hubei Province must isolate themselves at home for 14 days following last contact or date of departurefrom Hubei Province.

People who have travelled to or transited through mainland China (excluding Hong Kong, Macau and Taiwan) must isolate themselves at home for 14 days after departing China

Identify possible cases of 2019-nCOV:

1.Test patients who present with:

• A history of travel in, or transit through,mainland China (excluding Hong Kong, Macau and Taiwan) in the 14 days before illness onset, OR close contact with a confirmed case of 2019-nCoV,


• Acute respiratory infection (with at least one of the following symptoms: shortness of breath, cough or sore throat)regardless of fever.

Isolate and apply infection control precautions:

• Isolate suspect cases in a single room with negative pressure air-handling (if available).

• Use standard and transmission-based precautions (contact and airborne), including the use of a P2mask, disposable gown, gloves and eye protection when entering a patient care area.

Arrange testing:

• Take combined nose and throat viral swabs or nasopharyngeal viral swabs; alower respiratory tract sample (if obtainable) -sputum or an endotracheal tube aspirate; and EDTA blood and serum.

• Test for alternative causes, includingrespiratory viruses using multiplex PCR. Do not wait for local results before sending the 2019-nCoV sample for testing. Even if local testing returns a positive result 2019-nCoV testing should still be attended.

• Arrange for the specimens to be sent to Hospital.

• Seek specialist infectious diseaseadviceon patient treatment.

Discharge hometo self-isolation if admission not necessary clinically:

•Patients who clinically do not require admission who are tested can go home with advice to isolate wear a face mask and isolate themselves at home while awaiting test results. Where the home environment may not be suitable for this, discuss the situation with your local Public Health Unit. Provide the patient with information on home isolation

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