• Coronaviruses are a large family of viruses that are known to cause illness in humans and animals. Infections with coronaviruses can range from mild common colds, to severe respiratory distress syndrome.

• Novel coronavirus is a provisional name given to coronaviruses of medical significance, before a permanent name is applied.

• This guideline provides guidance for the management of COVID-19, SARS-CoV-1 (SARS) and MERS-CoV, and also applies to the care of other novel coronaviruses as yet undefined.

• This guideline provides trust-specific supplementary information to the guidance within the National Infection Prevention & Control Manual (England).

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition. Print copies must be destroyed after use.

Abbreviations

Coronaviruses are a large family of viruses that are known to cause illness in humans and animals. Coronaviruses primarily infect the upper respiratory and gastrointestinal tract and are believed to cause a significant proportion of common colds in human adults. Occasionally, coronaviruses are able to cause more significant lower respiratory tract infections in humans with pneumonia; this is more likely in immunocompromised individuals, people with cardiopulmonary illnesses, as well as elderly people and young children.

Novel coronavirus (nCoV) is a provisional name given to coronaviruses of medical significance, before a permanent name is applied. This guideline provides guidance for the management of COVID-19 (Coronavirus Disease 2019, first identified in December 2019, followed by a global pandemic), SARS-CoV-1 (the novel coronavirus which was first identified in 2003), and other novel coronaviruses (those which had not previously been identified in humans) such as the strain MERS-CoV (first identified in September 2012).

Coronavirus disease 2019 (COVID-19) is defined as illness caused by a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV), which was first identified amid an outbreak of respiratory illness cases in Wuhan City, Hubei Province, China. It was initially reported to the World Health Organization (WHO) on 31st December 2019. On 30th January 2020, the WHO declared the COVID-19 outbreak a global health emergency. On 11th March 2020, the WHO declared COVID-19 a global pandemic, its first such designation since declaring H1N1 influenza a pandemic in 2009.

Refer to the UKHSA and NHS England COVID-19 guidance collections for more information, including symptom presentation.

For guidance on COVID-19 treatment, refer to the Trust Microguide.

This coronavirus emerged in Asia in 2003 and is classified as a high consequence infectious disease (HCID). No confirmed or suspected human cases have been reported since 2004. The infection predominantly affected adults aged 25 to 70 years, although cases in individuals under 15 years had been reported. The case fatality among persons with illness meeting the current WHO case definition for probable and suspected cases of SARS is around 3%.

The incubation period of SARS is usually 2-7 days but may be as long as 10 days.

The first symptom of the illness is generally fever (>38°C), which is often high, and sometimes associated with chills and rigors. It may also be accompanied by other symptoms including headache, malaise, and muscle pain. At the onset of illness, some cases have mild respiratory symptoms. Typically, rash and neurologic or gastrointestinal findings are absent, although a few patients have reported diarrhoea during the early febrile stage.

After 3-7 days, a lower respiratory phase begins with the onset of a dry, non-productive cough or dyspnoea (shortness of breath) that may be accompanied by, or progress to, hypoxemia (low blood oxygen levels). In 10–20% of cases, the respiratory illness is severe enough to require intubation and mechanical ventilation. Chest radiographs may be normal throughout the course of illness, though not for all patients. The white blood cell count is often decreased early in the disease, and many people have low platelet counts at the peak of the disease.

There is no cure or vaccine for SARS and treatment should be supportive and based on the patient’s symptoms.

Refer to the WHO Health Topic pages for SARS, for further information.

The novel coronavirus (MERS-CoV) was discovered by Dutch researchers in September 2012 in lung tissue from a national from Saudi Arabia who had died from pneumonia. The name of the virus was standardised to MERS-CoV (Middle East Respiratory Syndrome coronavirus) in May 2013.

This coronavirus (MERS-CoV) emerged in the Middle East, discovered by Dutch researchers in September 2012 in lung tissue from a national from Saudi Arabia who had died from pneumonia. The infection is classed as a high consequence infectious disease (HCID). The virus causes severe viral respiratory disease. Symptoms include fever and cough that commonly progresses to a severe pneumonia, sometimes requiring mechanical ventilation. Pneumonia is more likely in immunocompromised individuals, people with cardiopulmonary illnesses, as well as the elderly and young children. In some cases, a diarrhoeal illness has been the first symptom to appear. Those at risk of contracting MERS-CoV include travellers to the Arabian Peninsula (or those in close contact with travellers to this region). The camel is a host species for the virus and those in contact with camels or camel products may also be at risk of contracting the disease.

Refer to the UK Health Security Agency guidance for MERS-CoV clinical management and guidance webpages for further information, including case definitions.

Patients meeting the case definition for specific coronavirus infections, should be tested to aide diagnosis and appropriate treatment.

6.1 Airborne Precautions

Coronaviruses identified to date are transmitted partially, if not wholly by the airborne route.

SARS-CoV-2 (COVID-19) Isolation in a single room, with designated toilet facilities (ideally en-suite). Refer to IPC04: Guidelines for the Isolation of Patients.

Respiratory protective equipment (a minimum of a fit-tested FFP3 respirator and eye protection) must be worn for staff providing care of patients with COVID-19. Refer to both IPC28a: Personal Protective Equipment use for Infection Prevention & Control), and the NIPCM (NHSE 2024b) transmission-based precautions guidance.

SARS-CoV-1 (SARS)

SARS is categorised as HCID. Suspected and confirmed cases must be isolated in negative pressure isolation rooms prior to transfer to a specialist HCID unit.

Refer to the NIPCM (NHSE 2024b) Addendum on high consequence infection disease (HCID) personal protective equipment (PPE) for guidance on PPE required for care of patients with SARS.

MERS-CoV

MERS-CoV is categorised as HCID. Suspected and confirmed cases must be isolated in negative pressure isolation rooms prior to transfer to a specialist HCID unit.

Refer to the NIPCM (NHSE 2024b) Addendum on high consequence infection disease (HCID) personal protective equipment (PPE) for guidance on PPE required for care of patients with confirmed MERS.

Standard precautions (NHSE 2024b) apply for the care of patients with human coronavirus OC43, HKU1, 229E, or NL63 infection (ie. non-COVID-19, non-MERS, non-SARS), however isolation should be considered in settings that care for severely immunosuppressed patients.

Patients with symptoms of an acute respiratory virus infection, should be advised and encouraged to wear a surgical face mask whilst outside of their isolation room, to reduce the risk of transmission.

6.2 Duration of Isolation/ Exclusion

Monitoring of this guideline is through the Annual IPC Audit and Surveillance programme. Cases of a HCID would be monitored through Emergency Preparedness Resilience and Response as a major incident.

Department of Health & Social Care 2022 The Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance. Available at: https://www.gov.uk/government/publications/the-health-and-social-care-act-2008-code-of-practice-on-the-prevention-and-control-of-infections-and-related-guidance/health-and-social-care-act-2008-code-of-practice-on-the-prevention-and-control-of-infections-and-related-guidance

NHS England 2024a Coronavirus guidance for clinicians and NHS managers webpages. Available at: https://www.england.nhs.uk/coronavirus/

NHS England 2024b National Infection Prevention and Control Manual (NIPCM) for England. Available at: https://www.england.nhs.uk/national-infection-prevention-and-control-manual-nipcm-for-england/

UK Health Security Agency 2024 MERS-CoV: clinical management and guidance Collection. Available at: https://www.gov.uk/government/collections/middle-east-respiratory-syndrome-coronavirus-mers-cov-clinical-management-and-guidance

UK Health Security Agency 2024 COVID-19 webpages. Available at : https://www.gov.uk/coronavirus

World Health Organisation 2024 Severe Acute Respiratory Syndrome (SARS) webpages. Available at: https://www.who.int/health-topics/severe-acute-respiratory-syndrome#tab=tab_1

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date. This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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