Coronavirus - COVID 19 Is your business prepared?

On January 30th the WHO declared a World Public Health Emergency in response to a reported outbreak of a new strain of Coronavirus. The Epicentre (start -point) of the virus was the city of Hubei, a city of nearly 60 million people, landlocked in Chinas South-East. The first reported death from China on December 31was a patient with multiple co-morbidities and 41 reported confirmed cases. Eight weeks later China has 78,000 confirmed cases and nearly 2800 deaths, a virus that has now spread to over 50 countries. So how, as business people, do we prepare for a rapid spreading contagious viral infection?

COVID 19, as this new disease has been named, is a relative of the common cold. It is a viral infection that requires a host to reproduce. A virus is essentially an infectious particle made up of DNA/RNA inside a protein shell. Some viruses have an external membrane called an 'envelope'. Viruses survive by infecting a host and having the host reproduce the virus. Coronavirus is an enveloped, single-stranded ribonucleic acid (RNA) resembling the solar corona (the surface of the sun) with surface spikes of 9-12 nanometers long. There are four major structural proteins in the virus, one being a surface spike (S) that binds to an enzyme in the lungs (ACE-2 receptors) where it fuses with the patient's cell membrane and is one of the mechanisms of infection. CT scans identify a ground-glass appearance in the lungs of infected patients and have a higher sensitivity than the current reverse transcription Polymerase Chain Reaction (RT-PCR) viral testing that is underway, that is reporting high false-negative results.

Coronaviruses are a zoonotic disease, meaning they can pass from animals to humans. A variant of the COVID 19 has been identified in bats and it is believed that the initial outbreak may have been transmitted from pangolin (scaly mammal) at a seafood market. Historically outbreaks of coronavirus such as SARS and MERS have been well contained due to their early identification from high death (mortality) rates. With a virus that mimics the common cold or flu in most healthy people, and is believed to be transmitted in the asymptomatic stages, it is the most difficult type of infection to contain and control. Thankfully, despite this, the death rate is not in the realm of SARS or MERS at around an estimated 2%, but as it is highly infectious the mass numbers of the infected population the death rate continues to climb. Putting things in perspective is important by understanding that the season flu causes between 250,000 to 500,000 deaths per year. So why are we concerned?

Symptoms mimic the common cold and flu such as fever, cough and muscle aches or fatigue. Some patients have presented with gastrointestinal symptoms a few days prior to fever and a small number of patients with headache and coughing up blood (hemoptysis). Blood tests can show low white cell count and an elevated inflammatory marker - both non-specific markers of infection an immuno-compromisation. Essentially any person who has a fever and respiratory tract symptoms who have travelled to an infected area in the past 14 days is at risk of being a transmission risk for coronavirus. These non-specific and common symptoms add to the complexities of early identification and isolation of patients until they are tested and excluded from coronavirus infection.

Understanding transmission, infection, disease progress, diagnosis and treatment will assist the health sector better manage patients and provide information to the public that will provide them with effective, safe preventative and quarantine advice to slow the progress of the disease. Small outbreaks of cases that are contained will be relatively easily managed by health services, but a mass outbreak strains resources and leaves patients at risk. This is what we have seen in other countries and hence the need to know more about the disease and how we can manage our businesses during a potential epidemic. Our last epidemic in Australia was H1N1 in 2009 there were just over 37,000 cases and 191 reported deaths, we continued to work, the businesses stayed open and we continued to provide health services to the highest standard. So what can we do as a business owner?

As a business owner understanding your responsibilities to your employees and customers is an important aspect of planning. Safety and wellbeing are foremost, before profits. Simple measures should be undertaken early. Limit all unnecessary international travel and request quarantine periods for staff who have had potential exposure from overseas exposure. This could be done by having staff working from home if they have recently returned from overseas areas that are infected with the virus. The suggested quarantine period is 14 days. The Australian government has suggested transit travel does not raise a concern at this stage. Persons returning from overseas who may have been in contact with CV in the outbreak areas who develop cold or flu-like symptoms should stay at home and call the hotline number, seeking advice on swabbing and accessing medical treatment if required. Checking with your workers' compensation insurance policy to what is covered for quarantine periods and exclusions from face-to-face work may be of benefit.

Hand hygiene is vital to combat viral infections. Many viruses are resistant to alcohol handwash and this should not be relied upon when handwashing options are available. Proper handwashing techniques are required, which involve TWENTY seconds of hand washing, proper rinsing and drying. The action of rubbing assist with removing the virus. Using alcohol preparation with more than 60 per cent of alcohol can assist with reducing viral transmission. Wearing a mask is not necessary unless you are symptomatic or in close proximity to someone who is symptomatic. Masks should be conserved for these situations. Protective clothing and hazmat suits are not required during the day to day activities for normal businesses. These would be reserved for those caring for patients and working in the health care sector.

Coronavirus is a surface pathogen which can remain of surfaces for up to 9 days in ideal conditions. Regular cleaning of surfaces that are contacted by multiple people may help reduce the transmission rate. As a medical centre owner, we will remove toys from the clinic play areas once the virus is present, and clean the surface areas three times per day with alcohol-based disinfectant. We have signed our doors asking those with symptoms to not enter the building if they are at risk from recent travel and have educated the staff on how to manage symptomatic patients. We are coordinating with local health services in relation to early identification of possible coronavirus patients and expediating test results to allow timely contract tracing. Protecting staff from infection who are at higher risk is an important part of our safety plan, and we will move staff with medical conditions into non-contact areas to reduce their risk of infection.

Extrapolating data from countries that are currently infected it appears the infection to the peak of the virus is going to be about two months, even with all the precautions in place. Although as daily new data becomes available from Italy and Iran we will have more information on the virus. Based on the current date this indicated that Australia will potential have the peak of the virus during our seasonal flu peak. Recommendations are that consideration for influenza vaccines to be given to those people now who have not had the 2019 influenza vaccine and immunise as soon as possible for the 2020 strains. There will not be an immunisation for coronavirus to cover the 2020 flu season.

Writing an action plan today and discussing with management and staff on how and when you will limit travel and contact with potentially infected patients is essential. With many large organisations acting promptly by reducing international and domestic travel it highlights the need for small to medium businesses to start thinking and acting now. This will allow you to continue to provide services to your customers (or patients in our case) and minimise the reputational, financial and service impact of the virus on your business.