Due to increases in international travel and commerce, global infectious disease epidemiology is rapidly evolving. For example, travel between most places in the world takes less time than the incubation period for many infectious diseases (Wilson, 2003). From an infectious disease perspective, globalisation has resulted in a world without borders where control of infections necessitates international cooperation and coordination. Currently we are experiencing this first-hand with the outbreak of a new coronavirus in the city of Wuhan in China, resulting in immense concern regarding a severe global public health threat.
The World Health Organization (WHO) coordinates the international response to major outbreaks of infectious disease based on its International Health Regulations (2005) (WHO, 2016). From a European perspective the overarching body responsible for communicable disease control and response to health threats is the European Centre for Disease Prevention and Control (ECDC) (https://www.ecdc.europa.eu). With the UK departing the European Union it is essential to agree a future joint coordination mechanism for a robust, coordinated approach to global public health threats at points of entry (Boland and O'Riordan, 2019). Infectious diseases do not respect borders and, to control them, neither should we.
A new virus
The reported outbreak in December 2019 of a newly discovered coronavirus in Wuhan, Hubei province, has a possible common exposure link to Wuhan's South China Seafood City market (ECDC, 2020). Lu et al (2020) advise that this is a fish and wild animal market that also sold live animals such as poultry, bats, marmots, and snakes. Public Health England (PHE) referred to the new virus as Wuhan novel coronavirus (WN-CoV) ahead of an internationally accepted term; however, WHO now recommends that the interim name of the disease in the current outbreak should be ‘2019-nCoV acute respiratory disease’ (the ‘n’ is for novel and ‘CoV’ is for coronavirus). This name complies with the WHO (2015) best practices for naming of new human infectious diseases. WHO (2020a) is also proposing ‘2019-nCoV’ as an interim name for the virus.
Coronaviruses are a large family of respiratory viruses that can cause diseases ranging from the common cold to the Middle East respiratory syndrome (MERS) and the severe acute respiratory syndrome (SARS). Some coronaviruses circulate among animals, including camels, cats, and bats. The animal coronaviruses can evolve and infect humans and then spread between people. However, based on the latest statement from WHO on 23 January 2020, the source virus is still unknown (WHO, 2020b). Clinical data from the initial 41 cases showed symptoms with similarities to SARS and seemed to be capable of human transmission (Chan et al, 2020; Huang et al, 2020). Symptoms of a coronavirus infection usually start up to 14 days after catching the infection. Most people with the current virus have had a fever, a cough and problems breathing (Fitfortravel, 2020).
Staying informed
Numerous statistics relating to cases are reported in the world media with ongoing frequency, showing the difficulty of keeping abreast of the development of an infectious disease on a global scale. By 31 January 2020 more than 9600 people were reported to have been infected in China, with around 200 deaths, and cases have also been reported elsewhere in Asia and in North America, Australia, and Europe, including France, Finland, Germany, and now the UK (Mahase, 2020; WHO, 2020a).
This is a new and rapidly evolving situation with information about the virus and the cases collected and assessed daily. On 30 January 2020 WHO declared the outbreak a public health emergency of international concern (WHO, 2020c) to strengthen the international measures to contain the spread of the coronavirus. PHE has been collaborating with international colleagues and WHO in monitoring the situation. Due to an increasing number of cases in China, and using existing and widely tested models, the UK chief medical officers have escalated planning and preparation in case of a more widespread outbreak. The UK risk level has been raised from low to moderate (Department of Health and Social Care and PHE, 2020). Many cities in China have closed public transport systems and the Foreign and Commonwealth Office has advised against all travel to Hubei province.
There is currently no effective therapy or vaccination to treat this new infection, therefore we must control the source of infection, provide early diagnosis, isolation and supportive treatments, tracing contacts with reporting and full data sharing with WHO. The links in Box 1 give further wide-ranging information useful for healthcare practitioners. Health professionals are on the frontline of this new, emerging infectious disease and have a duty to educate and apply advised standards of care and evidence-based practice to assist in containing its spread. In a world where infections do not respect borders, the new strain of coronavirus exemplifies that international collaboration is vital to control the spread of disease while populations must also heed the professional advice offered.