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.
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.
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.
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 and cough.
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 may 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. This is not unusual for viral infections, as is also seen with measles, for example. However, there is still no clear evidence that 2019-nCoV can be transmitted before symptom onset.
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.
1. What are the symptoms of 2019-nCoV
From what we know so far, the virus can cause mild, flu-like symptoms such as
- difficulty breathing
- pain in the muscles and
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 of infectious diseases. 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. 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. At this moment, diagnostics are performed only at University Hospital for Infectious Diseases in Zagreb.
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?
A person who was in close contact with someone with 2019-nCoV infection during the past 14 days will be placed under close health monitoring in self-quarantine. This means that the person will be confined in their home, with temperature measurement and contact with their designated epidemiologist on a daily basis. If the monitored person develops symptoms of respiratory disease, their epidemiologist will take action in accordance with suspected 2019-nCoV infection (arrange transfer to a hospital for diagnostics and treatment) and the person’s contacts will be monitored. If, after completion of monitoring the person does not develop symptoms of respiratory disease, the epidemiologist will notify the relevant institutions.
3. What are the rules for disinfection/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. However, in casual contact, face masks, in addition to keeping distance (at least one meter) can add to prevention of infection. Health care professionals treating patients with suspected or confirmed 2019-nCoV infections are advised to wear special equipment (disposable apron, disposable gloves, goggles and minimally surgical masks or FFP2 masks), when performing aerosol-generating procedures a well-fitted FFP3 respirator is required.
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.
What is the current situation in Croatia regarding 2019-nCoV?
1. What measures are being taken in Croatia?
The Croatian Institute of Public Health in cooperation with University Hospital for Infectious Diseases in Zagreb has issued guidelines for health workers in suspected cases of 2019-nCoV. The guidelines provide detailed criteria for determining a suspected infection, guidance for handling a person with suspected infection, procedure for collecting and transferring samples for diagnostics and measures for prevention of disease spreading in health care institutions in suspected cases of 2019-nCoV. The guidelines are regularly updated in accordance with new findings on the epidemic and the disease.
On its website, the Croatian Institute of Public Health publishes information on 2019-nCoV so that the public can stay informed at all times. More information available here .
Leaflets in Croatian, English and Chinese language have also been issued for travellers to and from the affected areas. The leaflets contain guidelines on prevention measures when travelling and actions to be taken in the case of infection symptoms, as well as contact information of local epidemiologists on call. Leaflets available here .
Detailed instructions for border crossing management of passengers who have been in the areas affected by the 2019-nCoV epidemics in the previous 14 days have also been issued.
On its website, the Croatian Institute of Public Health regularly updates the information on the number of cases, with recommendations regarding population safety and protection which can be found here .
2. 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.
3. 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.
2. What if I have recently been to China and have become ill?
A person who has beent o Cihna in the past 14 days and develops sudden symptoms indicative of respiratory disease (fever, cough, sore throat, shortness of breath) should contact their physician or nearest emergency department by telephone and mention travel history to China.
Persons who visited areas affected by the epidemic caused by 2019-nCoV 14 days before returning to Croatia will be closely monitored upon their return. This means that, if they do not show disease symptoms when entering the country, the border crossing sanitary inspector will present them with a Notice on health monitoring and they will remain in contact with their designated epidemiologist during monitoring period. If the person develops symptoms of respiratory disease or fever during health monitoring, their epidemiologist will act in accordance with suspected 2019-nCoV case (arrange transfer to a hospital for diagnostics and treatment) and the person’s contacts will be monitored.
3. What about on a plane or in an airport?
If a passenger shows disease symptoms during flight, crewmembers will distribute questionnaires for all passengers (passenger locator cards) to fill in. Crewmembers will collect the cards before landing and hand them to the sanitary inspector at border crossing after landing. Based on the cards and the questionnaire, the border crossing sanitary inspector will issue a Notice on health monitoring and refer the passengers to their local designated epidemiologist. The epidemiologist will remain in contact with the passengers and collect additional information on infection probability, depending on the type of contact with the affected passenger and implement appropriate health monitoring. If, after completion of monitoring, the person does not develop symptoms of respiratory disease, the epidemiologist notifies relevant institutions on completion of health monitoring. The ill person will be transferred from the airplane to a hospital for further treatment. If before completion of health monitoring the ill person is revealed not to be infected with 2019-nCoV, health monitoring of his contacts is ceased.
The risk of being infected in an airport is similar to any other place where many people gather.
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 in China, 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.
4. Safety of shipments arriving from China
Based on the currently available information on 2019-nCoV and the already known coronaviruses, we believe that the risk of transmission of the novel coronavirus from parcels to humans is negligible. In fact, there are no recorded cases of virus transmission from parcels. Although modes of transmission of 2019-nCoV have not been entirely clarified yet, all the available information indicate that human-to-human transmission occurs after close physical contact, such as contact with family members (caring for the ill person), or patient management at health care facilities.
All the currently known coronaviruses, including the virus that caused SARS 18 years ago and the virus that has been causing MERS for the past seven years, are transferred through direct close contact (respiratory droplets) and are highly sensitive to environmental conditions (they remain infectious for a very brief time outside the human body), and there are no recorded cases of their transmission from parcels.