Q & A on novel coronavirus

1. What is the novel Coronavirus 2019-nCov?

The 2019 novel coronavirus, temporarily named 2019-nCoV, was identified in China at the end of 2019 and is a new strain of coronavirus that has not been previously identified in humans.

2. Where do Coronaviruses come from?

Coronaviruses are viruses that circulate among animals but some of them are also known to affect humans. After they have infected humans, they can eventually be transmitted to humans.

A wide range of animals is known to be the source of coronaviruses. For instance, the Middle East respiratory syndrome coronavirus (MERS-CoV) originated from camels and the Severe Acute Respiratory Syndrome (SARS) originated from civet cats.

More information on coronaviruses can be found on the ECDC factsheet

3. Is this virus comparable to SARS or to the seasonal flu (influenza)?

This novel coronavirus detected in China is genetically closely related to the 2003 SARS virus and appears to have similar characteristics, although there is still limited data available on this virus.

SARS emerged at the end of 2002 in China and more than 8 000 SARS-cases were reported by 33 countries over a period of eight months. At the time, one in ten people who contracted SARS died.

The current 2019-nCoV outbreak has caused around 10 000 reported cases in China since the end of December 2019 (as of end of January 2020.) Other countries have also reported cases of 2019-nCoV, including some in the EU/EEA. At this point, there is too little data available to say for sure how deadly 2019-nCoV is but preliminary findings indicate that it is less fatal than SARS-CoV.

While both 2019-nCoV and influenza viruses are transmitted from person-to-person and may cause similar symptoms, the two viruses are very different and consequently behave differently. It is still very early to draw conclusions on how 2019-nCoV spreads, but preliminary information indicates that 2019-nCoV is as transmissible as SARS and some other pandemic influenza strains have been. ECDC estimates that each year, up to 40 000 people in the EU/EEA die prematurely due to causes associated with influenza.

4. What is the mode of transmission? How (easily) does it spread?

While animals are the source of the virus, this virus is now spreading from one person to another (human-to-human transmission). There is currently not enough epidemiological information to determine how easily and sustainably this virus is spreading between people. The virus seems to be transmitted mainly via respiratory droplets that people sneeze, cough, or exhale.

The incubation period for 2019-nCov (i.e. the time between exposure to the virus and onset of symptoms) is currently estimated at between two and 12 days. While people are mostly infectious when they present (flu-like) symptoms, there are indications that some people maybe be able to transmit the virus without presenting any symptoms or before the symptoms appear. If this is confirmed, it would make early detection of 2019-nCoV infections more difficult. However, it is not unusual for viral infections of this type, as is also seen with measles, for example.

If people with 2019-nCoV are tested and diagnosed in a timely manner and rigorous infection control measures are applied, the likelihood of sustained human-to-human transmission in community settings in the EU/EEA is low. Systematic implementation of infection prevention and control measures were effective in controlling SARS-CoV and MERS-CoV.

Medical information

1. What are the symptoms of 2019-nCoV

From what we know so far, the virus can cause mild, flu-like symptoms such as

• fever
• cough
• difficulty breathing
• pain in the muscles and
• tiredness.

More serious cases develop severe pneumonia, acute respiratory distress syndrome, sepsis and septic shock that can lead to the death of the patient. People with existing chronic conditions seem to be more vulnerable to severe illness.

2. Are some people more at risk than others?

Generally, young children, elderly people and those with underlying conditions (e.g. hypertension, heart disorders, diabetes, liver disorders, and respiratory disease) are expected to be more at risk of developing severe symptoms. As this is an emerging disease and there is only limited data available, we do not yet know which groups of people might be prone to a more severe outcome following infection with 2019-nCoV.

3. Is there a treatment for the disease caused by 2019-nCoV?

There is no specific treatment for this disease so the approach used to treat patients with coronavirus-related infections is to treat the clinical symptoms (e.g. fever). Supportive care (e.g. supportive therapy and monitoring – oxygen therapy, fluid management and antivirals) can be highly effective for those infected.

4. When should I be tested for 2019-nCoV?

If you have

• an acute respiratory infection (sudden onset of at least one of a cough, sore throat, or shortness of breath),

AND

in the 14 days before the start of your symptoms, you were either:

• in close contact [1] with a confirmed or probable case of 2019-nCoV infection, or travelled to an area where there is ongoing community transmission of 2019-nCoV,
• or worked in or attended a healthcare facility where patients with 2019-nCoV infections were being treated, you should contact your doctor by phone for advice.

ECDC has developed guidance on how to identify suspected cases and when to initiate testing:

[1] A close contact would be someone living in the same household as a person who has been diagnosed with 2019-nCoV, a person who had face-to-face contact or stayed in a closed environment with a 2019-nCoV case, or a healthcare worker or other person providing direct care for a 2019-nCoV case, or laboratory workers handling 2019-nCoV specimens.

5. Where can I get tested?

If your doctor believes there is a need for a laboratory test for 2019-nCoV, he/she will inform you of the procedure to follow and advise which laboratory can perform the test. Several laboratories in Europe can process 2019-nCoV samples.

Prevention

1. How can I avoid getting infected?

When visiting China:

• avoid contact with sick people, in particular those with a cough;
• avoid visiting markets and places where live or dead animals are handled;
• general rules governing hand hygiene and food hygiene apply;
• wash your hands with soap and water OR use an alcohol-based disinfectant solution before eating, after using the toilet and after any contact with animals;
• avoid contact with animals, their excretions or droppings.

Wherever you travel, apply general rules governing hand and food hygiene.

2. What should I do if I have had close contact with someone who has 2019-nCoV?

Monitor yourself from the time that you had contact with that person and if you develop any symptoms, call your healthcare provider for advice, mentioning that you were in China.

More information is available in the guidance:

3. What are the rules for infection/hand washing?

Hand washing and disinfection is the key to preventing infection. You should wash your hands often and thoroughly with soap and water for at least 20 seconds. If soap and water are not available, you can also use alcohol-based hand sanitiser with at least 60% alcohol. The virus enters your body via your eyes, nose and mouth, so avoid touching them with unwashed hands.

4. Are face masks effective in protecting against 2019-nCoV?

Face masks help prevent further spread of infection from those who are sick to others around them., Face masks do not seem to be as effective in protecting those who are not infected.

5. Is there a vaccine against 2019-nCov?

There are currently no vaccines against coronaviruses, including 2019-nCoV. That is why it is very important to prevent infection or contain further spread after an infection.

6. Am I protected against 2019-nCoV if I had the influenza vaccine this year?

Influenza and 2019-nCoV are two very different viruses and the seasonal influenza vaccine would not protect against disease caused by 2019-nCoV.

However, as the European influenza season is still underway, the influenza vaccine is the best available protection against seasonal influenza and it is not too late to get vaccinated.

What is the current situation in the EU regarding 2019-nCov?

1. How prepared is Europe for 2019-nCoV and what is the EU doing?

The European Centre for Disease Prevention and Control (ECDC) is in continuous contact with the European Commission, the public health authorities in China and the World Health Organization for the assessment of this outbreak. To inform the European Commission and the public health authorities in Member States of the ongoing situation, ECDC publishes daily summaries and continuously assesses the risk for EU citizens. ECDC and WHO have developed technical guidance to support the EU Member States in their response. The European Commission is ensuring the coordination of the risk management activities at EU level.

2. Am I at risk of contracting 2019-nCoV infection in the EU?

This outbreak is evolving rapidly and the risk assessment is changing accordingly. ECDC is continuously assessing the risk for EU citizens and you can find the latest information in the most recent ECDC Rapid Risk Assessment. (see above)

3. Has anyone in the EU become infected?

Several cases have been reported in the EU since the beginning of the outbreak. Given the extensive movement of people and the fact that the virus is transmitted from one person to another, it is expected that further cases will be reported in the EU.

4. Why is the number of cases increasing so rapidly?

Two main reasons for the rapid increase in the number of cases are that the virus is spreading from one person to another and that the capacity to detect cases is improving. A sudden increase in the number of cases is often observed during the initial phase of an outbreak of emerging disease.

Information for travellers

1. Should I reconsider travelling to Asia at present, privately or for business?

At present, most cases are being reported in China and only sporadic cases have been reported outside of China. The likelihood of becoming infected in other countries across Asia is currently low. However, the outbreak is evolving very rapidly and the risk of infection is therefore changing. See the list of areas with presumed community transmission. Follow the travel advice provided by public health authorities in your country of residence.

2. What should I be most cautious of when travelling abroad, including trips to China?

When visiting China:

• avoid contact with sick people, in particular those with a cough;
• avoid visiting markets and places where live or dead animals are handled;
• Apply general rules of hand hygiene and food hygiene;
• wash your hands with soap and water OR use an alcohol-based disinfectant solution before eating, after using the toilet and after any contact with animals;
• avoid contact with animals, their excretions or droppings.

Wherever you travel, apply general hand hygiene and food hygiene rules.

3. What if I have recently been to China and have become ill?

If you were in China and within 14 days of your return you feel sick or have a fever, cough, or experience shortness of breath, you should:

• Seek immediate medical attention. Before you go to a doctor’s office or emergency room, call them and tell them about your recent travel and your symptoms.
• Avoid contact with others.
• Ensure you do not travel while sick.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing. If you have easy access to surgical face masks, use one, and dispose of it after safely. Remember to wash your hands after disposing of a mask.
• Follow appropriate disinfection/hand washing rules to avoid spreading the virus to others.

4. What about on a plane or in an airport?

If it is established that a case of 2019-nCoV has been on an airplane, the people who were at risk will be contacted by the public health authorities for advice.  Should you have questions about a flight you have taken, please contact your local health authority for advice. The risk of being infected on an airplane cannot be excluded but is currently considered to be low for an individual traveller. 

The risk of being infected in an airport is similar to any other place where many people gather.

5. Why are people arriving from China not being checked for 2019-nCoV at the airport?

Evidence that checking people at the airport (known as entry screening) is not very effective in preventing the spread of the virus, especially when people may not be presenting symptoms or the symptoms of the disease are very similar to those for other illnesses and the timeline coincides with the increased activity in seasonal influenza across the EU and in China. It is generally considered more useful to provide those arriving at airports with clear information explaining what to do if they develop symptoms after arrival.

2019-nCoV and animals and food products

1. What about animals or animal products imported from China?

Due to the animal health situation in China, notably the presence of contagious animal diseases, only a few live animals and unprocessed animal products from China are authorised for import into the European Union. There is no evidence that any of the animals or animal products authorised for entry into the European Union pose a risk to the health of EU citizens as a result of the presence of 2019-nCoV in China.

2. What about food products imported from China?

As with the imports of animals and animal products, due to the animal health situation in China, only a few products of animal origin are authorised for import into the EU from China, on the condition that they meet strict health requirements and have been subjected to controls. For the same reasons, travellers entering the EU customs territory are not allowed to carry any meat, meat products, milk or dairy products in their luggage.

There has been no report of transmission of the 2019-nCoV via food and therefore there is no evidence that food items imported into the European Union in accordance with the applicable animal and public health regulations governing imports from China pose a risk for the health of EU citizens in relation to 2019-nCoV. The main mode of transmission is from one person to another.

3. What about contact with pets and other animals in the EU?

Current research links 2019-nCoV to certain types of bat, but does not exclude the involvement of other animals. Several types of coronaviruses can infect animals and be transmitted to other animals and people. There is no evidence that companion animals (e.g. dogs or cats)  pose a greater risk of infection than humans. As a general precaution, observe basic principles of hygiene when in contact with animals.