Coronaviruses are a large family of viruses. Some coronaviruses cause illness in humans and others cause illness in animals, such as bats, camels, and civets. Human coronaviruses generally cause mild illness, such as the common cold. Rarely, animal coronaviruses can evolve to infect and spread among humans, causing severe diseases such as Severe Acute Respiratory Syndrome (SARS) which emerged in 2002, and Middle East Respiratory Syndrome (MERS) which emerged in 2012.

COVID-19 is a new strain of coronavirus that has not been previously identified in humans. It was first identified in Wuhan, Hubei Province, China, where it has caused a large and ongoing outbreak. It has since spread more widely in China. Cases have since been identified in several other countries. The COVID-19 virus is closely related to a bat coronavirus.

There is much more to learn about how COVID-19 is spread, its severity, and other features associated with the virus; epidemiological and clinical investigations are ongoing. Outbreaks of new coronavirus infections among people are always a public health concern. The situation is evolving rapidly

Human coronaviruses are spread from someone with confirmed coronavirus to other close contacts with that person through contaminated droplets spread by coughing or sneezing, or by contact with contaminated hands, surfaces or objects.

The time between when a person is exposed to the virus and when symptoms first appear is typically 5 to 6 days, although may range from 2 to 14 days. For this reason, people who might have been in contact with a confirmed case are being asked to self-isolate for 14 days.

Most COVID-19 cases appear to be spread from people who have symptoms. A small number of people may have been infectious before their symptoms developed.

According to the World Health Organization, it is not certain how long the virus that causes COVID-19 survives on surfaces, but it seems to behave like other coronaviruses. Studies suggest that coronaviruses (including preliminary information on the COVID-19 virus) may persist on surfaces for a few hours or up to several days. This may vary under different conditions (e.g. type of surface, temperature or humidity of the environment).

If you think a surface may be infected, clean it with a common household disinfectant to kill the virus and protect yourself and others. Clean your hands with an alcohol-based hand rub or wash them with soap and water. Avoid touching your eyes, mouth, or nose.

Patients may have fever, cough, runny nose, shortness of breath and other symptoms.

In more severe cases, infection can cause pneumonia with severe acute respiratory distress.

I have travelled to mainland China or Iran. What should I do? If you have been in, departed from, or transited through mainland China (excluding Macau and Taiwan), or you have travelled in or transited through Iran on or after 1 March 2020, you should:

• Self-isolate yourself from others for 14 days from the day you departed China or Iran and
• monitor yourself for symptoms

If you develop fever or respiratory symptoms, please call your doctor, or your local Emergency Department or Health Direct on 1800 022 222. Tell the person when you call that you have been where you have travelled. It is important if you have symptoms you should not go to work, school/university/childcare, the gym, or public areas, and you should not use public transport, taxis, or ride-sharing services. If you need to seek medical care wear a surgical mask if available when attending.

The risk of exposure to COVID-19 is believed to be highest for those people who have travelled through mainland China or Iran. People who have been in one of the other countries at risk of COVID-19 listed below are also considered to be at risk of exposure to COVID-19:
• Cambodia
• Hong Kong
• Indonesia
• Italy
• Japan
• Thailand
• Singapore
• South Korea

If you have travelled (including transit) through any of the above countries at risk of COVID-19 in the past 14 days you should monitor for symptoms, practice social distancing – avoid crowds and small gatherings in enclosed spaces, and keep a distance of 1.5 meters between yourself and others when out in public.

If you develop symptoms, you must immediately isolate yourself and medical attention. Please call your doctor, or your local Emergency Department or Health Direct on 1800 022 222. Tell the person when you call that you have been where you have travelled. It is important if you have symptoms you should not go to work, school/university/childcare, the gym, or public areas, and you should not use public transport, taxis, or ride-sharing services. If you need to seek medical care wear a surgical mask if available when attending.

The infection period for the virus will vary from person to person. Mild symptoms in an otherwise healthy individual may resolve over just a few days. Similar to influenza, for an individual with other ongoing health issues, such as a respiratory condition, recovery may take weeks and in severe cases could be potentially fatal.

Most people that are not eligible for Medicare will have health or travel insurance. For those that do not have adequate insurance coverage, NSW Health will waive these costs. This includes the waiving of payment and debt recovery procedures for ambulance transfers of people suspected to have COVID-19 infection, who are taken to NSW Health facilities for assessment.

These arrangements have been put in place to ensure payment issues are not a barrier for people from overseas with respiratory symptoms seeking early medical advice.

Infection with COVID-19 is diagnosed by finding evidence of the virus in respiratory samples such as swabs from the back of the nose and throat or fluid from the lungs. Testing for COVID-19 is done in public health laboratories.

If you have been identified as a contact of a person with confirmed COVID-19 infection in Australia, the local public health unit will contact you with advice. You need to isolate yourself at home for 14 days after contact with the infected person, and to monitor your health and report any symptoms.

Person to person spread of coronaviruses generally occurs between people who are close contacts with one another. A close contact is typically someone who has been face to face for at least 15 minutes, or been in the same closed space for at least 2 hours, with a person that was infectious. The public health unit will keep in touch with people who are close contacts of patients with COVID-19 infection. If any symptoms develop contacts must call the public health unit to report those symptoms.

If your contact with the person was less than this, there is a much smaller risk of you being infected. However, as a precaution you must still monitor your health until 14 days after you were last exposed to the infectious person. If you develop symptoms including a fever and/or respiratory signs, please call ahead to talk to a doctor or call Health Direct on 1800 022 222. Tell your doctor that you have been in contact with someone with COVID-19. The doctor may tell you to attend your nearest emergency department, if so call ahead before attending.
More information about home isolation is available for:

• people suspected or confirmed to have COVID-19 infection
• close contacts and recently returned travellers from mainland China or Iran.

Practice simple hygiene by:

• making sure to clean your hands thoroughly for at least 20 seconds with soap and water, or use an alcohol-based hand rub (see attached diagram)
• cover your nose and mouth when coughing and sneezing with tissue or a flexed elbow.

People who have:

• been in contact with a person with COVID-19
• visited or transited through mainland China (excluding Macau, or Taiwan) in the previous 14 days
• been in or transited through Iran in the previous 14 days
• visited another country at risk of COVID-19 in the previous 14 day.

People with underlying illnesses that make them more vulnerable to respiratory disease, including those with diabetes, chronic lung disease, kidney failure, people with suppressed immune systems and older people are at a higher risk of serious disease.

• Clean your hands with soap and water for 20 seconds, or an alcohol-based hand rub.
• Cover your nose and mouth when coughing and sneezing with tissue or a flexed elbow
• Avoid close contact with anyone with cold or flu-like symptoms.
• Practice cough etiquette (keep away from other people, cover coughs and sneezes with disposable tissues or clothing, and clean your hands.
• Travellers to Asia should not visit live bird and animal markets, including ‘wet’ markets.

There are no vaccines that protect against COVID-19. There is no specific treatment for COVID-19. Early diagnosis and general supportive care are important. Most of the time, symptoms will resolve on their own. People who have serious disease with complications can be cared for in hospital.

Health workers in NSW public hospital emergency departments as well as community-based general practitioners have already been issued advice on symptoms and actions to prevent the spread of COVID-19 through careful infection control measures.

If you are after medical advice and your general practitioner is not able to speak with you, you can call Health Direct on 1800 022 222. They will be able to discuss your symptoms and travel history with you, to help decide if COVID-19 testing is recommended.

Testing can be ordered by your GP, or at a hospital emergency department.

How are other coronaviruses tested?

COVID-19 is one kind of coronavirus, but there are other kinds of coronaviruses that have infected people for many years around the world, including in Australia. If you are sick with a respiratory infection (for example you have a cough, runny nose, sore throat or fever), the doctor may order a swab from the back of your nose or throat for testing. Many laboratories will test the swab for several different viruses. This test is called a multiplex viral respiratory panel, which often include tests for these other coronaviruses. These tests currently do not test for COVID-19 and do not indicate whether it is present or absent.

Novel coronavirus (COVID-19) was first identified in Wuhan, Hubei Province, China, where it has caused a large and ongoing outbreak. It has since spread more widely in China, Iran and in several other countries.

NSW Health has developed and exercised a range of procedures for case finding, diagnosis, and contact tracing for high consequence infectious diseases (such as pandemic influenza, SARS, MERS, and emerging infections) should they occur in NSW. These procedures are being used to identify contacts of any confirmed cases of COVID-19 in NSW.

The Australian Government has put in place protective measures at all international ports. For the most recent advice from the Australian Government, please visit Department of Health -Coronavirus (COVID-19).

For each cruise ship arriving into NSW from overseas, a NSW Health expert panel conducts a risk assessment based on the ports visited, whether passengers and crew have a risk of exposure to COVID-19, whether the ship’s doctor has identified a respiratory outbreak on board, and the results of test results done on board the ship.

Following this risk assessment, further assessment may be done when the ship docks, including checking people with fever and respiratory symptoms or who have risk of exposure to COVID-19, and testing them for respiratory infections, including COVID-19. As there is an incubation period (before symptoms develop and tests are positive) for all infections including COVID-19, screening people for disease is not a failsafe, and is only one piece of the assessment.

Cruise ships have large number of passengers (often thousands), many of whom are older and have chronic medical conditions. Respiratory infections (unrelated to COVID-19) among passengers and crew are common on cruise ships. Cruise ships are responsible for, and have policies to prevent and manage outbreaks of disease on board.

Australians on cruise ships
An outbreak of COVID-19 occurred on the Diamond Princess cruise ship which was docked in Japan. Although initial reports indicated that a person on the Westerdam ship in Cambodia had been infected, the infection has not been confirmed.

If you are concerned about someone on one of the Diamond Princess, please call the DFAT consular emergency line. For more information see the Australian Department of Health novel coronavirus website.

Infection with COVID-19 is a notifiable condition under the NSW Public Health Act 2010, so doctors and pathology laboratories are required to notify NSW Health of all people suspected or confirmed to have the infection.

Public health unit staff will investigate all cases to find out how the infection occurred, identify other people at risk of infection, implement control measures and provide other advice.

The best way to protect yourself is the same as you would against any respiratory infection.
Practice good hygiene by:

• making sure to clean your hands thoroughly for at least 20 seconds with soap and water, or an
  alcohol-based hand rub
• cover your nose and mouth when coughing and sneezing with tissue or a flexed elbow
• avoid close contact with anyone with cold or flu-like symptoms.
• Make sure you stay home if you are sick.

Face masks are not recommended for the general population.

People who have symptoms and might be infected with COVID-19 are required to stay in isolation at home and should wear a surgical face mask when in the same room as another person and when seeking medical advice to reduce the risk of transmitting COVID-19 to anyone else.

Health care workers who are caring for patients with suspected COVID-19 should use appropriate personal protective equipment to protect themselves against COVID-19. For more information refer to Clinical Excellence Commission (CEC) - Novel coronavirus (COVID-19) website.

Additional supplies of face masks have been distributed for specific health workers by NSW Health and the Australian Government to meet current demand. NSW Health will continue to monitor supplies of face masks in NSW.

Hospitals ensure surfaces are cleaned and disinfected after each suspected case, as are ambulances. There is an Infection Prevention and Control Practice Handbook that outlines the appropriate steps for cleaning a room to ensure there are no viruses remaining. Staff also wear protective gear when cleaning to protect themselves and limit any spread of infection.

NSW Health works with its hospitals to maintain high infection control standards. NSW hospitals and clinicians are well trained in caring for people with infectious diseases, and in preventing their transmission to other patients.

People with confirmed COVID-19 infection stay in isolation under the care of medical specialists until they are no longer experiencing symptoms of COVID-19 infection. Before they are released from isolation, they have tests to see if they still have COVID-19 and the specialist care team assesses they are no longer infectious. Once they are discharged, they have a follow up assessment by the medical team to make sure they remain well.

The Australian Government provides up-to-date information and advice for safe travel overseas. If you are heading overseas to destinations which may have been affected, check the advice on Smart Traveller.

Any student or staff member who over the last 14 days has visited mainland China or has travelled to or transited through Iran on or after 1 March 2020 should be in self-isolation for 14 days after they departed mainland China or Iran. They are excluded from school and should not return to school or child care services for a period of 14 days after leaving China or Iran, as the COVID-19 incubation period can be as long as two weeks.

Staff and students who have been identified as close contacts of a person diagnosed with COVID-19 during their infectious period must also self-isolate at home, and should not attend school or childcare settings until 14 days after their last contact with the infected person.

No. If you do not have any symptoms there is no testing that can be done to predict whether or not you will become unwell. It is not possible to issue a ‘medical clearance certificate’.

Once 14 days have passed since you left mainland China or Iran, you have passed the time in which you would become sick if you were exposed to COVID-19 when you were in China or Iran. If you are still completely well 14 days after you left China or Iran then you will not get COVID-19 from your time in China or Iran, and you can cease self-isolation and return to work, school and university.

If you have been in mainland China or Iran in the last 14 days or you have travelled in or transited, you should stay at home and isolate yourself for 14 days after you left China or Iran. You should watch out for symptoms.

If you develop a fever, a cough, sore throat or shortness of breath within 14 days of travel to an affected area, you should call your GP, emergency department or call Health Direct 1800 022 222 and seek medical attention as soon as possible.

It is important to phone ahead so that the practice or emergency department can make appropriate preparations and protect others.

When seeking medical care wear a surgical mask (if available) otherwise ask for one when you arrive.

If you develop fever, cough, runny nose, shortness of breath and other symptoms and have travelled in Mainland China or Iran or another country at risk of COVID-19, you should see your GP or visit your local Emergency Department to be tested for COVID-19.

If you are become unwell with these symptoms without travel you should see your local GP and discuss your symptoms. There are other illnesses such as Influenza that your GP may wish to test you for that can cause your symptoms.

There is no need for you to be tested unless you develop fever, cough, runny nose, shortness of breath or other symptoms and have travelled mainland China, Iran or to a country at risk of COVID-19.

You should see your GP or visit your local Emergency Department to be tested for COVID-19. You should self-isolate and exclude yourself from work until your test result is available.

If you are become unwell with these symptoms without travel you should see your local GP and discuss your symptoms. There are other illnesses such as influenza that your GP may wish to test you for that can cause your symptoms.

Yes. If you are sharing your home with others, you should stay in a different room from other people or be separated as much as possible. Wear a surgical mask when you are in the same room as another person, and when seeking medical care. Use a separate bathroom, if available.

Make sure that you do not share a room with people who are at risk of severe disease, such as elderly people and those who have heart, lung or kidney conditions, and diabetes.

Visitors who do not have an essential need to be in the home should not visit while you are isolating.

More information about home isolation is available for:

• people suspected or confirmed to have COVID-19 infection
• close contacts and recently returned travellers from mainland China or Iran.

Other members of the household are not required to be isolated unless they have also:

• been in or transited through mainland China (excluding Macau and Taiwan) in the last 14 days
• have travelled in or transited through Iran in the last 14 days
• been a close contact of a confirmed COVID-19 case.

If you need groceries or medicines (including prescription medicines), ask a family member or friend (who is not in isolation) to deliver them to your home or shop for groceries online. To prevent infecting other people, make sure you wear a mask when receiving a delivery or have the groceries left at your door.

If you are well at the end of 14 days self-isolation, you can resume your normal lifestyle.

APAN clinical safety policy infection control protocols

National Coronavirus Health Information Line 1800 020 080

Visit NSW Health - Novel coronavirus

Visit the World Health Organization