Face mask advisory as coronavirus case rate climbs

Pharmacists have been urged to limit the sales of face masks, with reports of consumers bulk-buying P2 masks from pharmacies, intending to ship them to relatives overseas or resell them online at inflated prices.

PSA National President Associate Professor Chris Freeman said yesterday that pharmacists should exercise judgement about how many masks they sell, and to whom.

‘While there is limited stock available from suppliers, we encourage pharmacists to only supply limited quantities of face masks to consumers, consistent with the immediate health needs of an individual person,’ A/Prof Freeman said.

His advice comes as an eight-year-old boy was identified as Australia’s 13th case of the 2019 novel coronavirus (2019-nCoV) overnight, amid continuing concern about the spread of the disease globally. 

The boy, a Chinese citizen from Wuhan, remains in isolation in a stable condition at Gold Coast University Hospital.

The World Health Organization last week declared the 2019 n-CoV an international emergency and numerous countries have instituted rigorous travel bans in an attempt to limit its spread from China. Several countries, including Australia, have evacuated citizens from the epicentre in Wuhan. 

There are now more than 24,000 confirmed cases of 2019-nCoV worldwide at the time of writing, the majority in China. Following Hong Kong reporting its first fatality yesterday the death toll has risen to just under 500 since the outbreak began in December.

Key points

  • 24,505 confirmed cases worldwide
  • 493 deaths: 490 in Mainland China, 1 in Philippines, 1 in Hong Kong
  • Countries affected: China (including Hong Kong, Macau and Taiwan), Japan, Thailand, Singapore, Korea, Australia, USA, Germany, Malaysia, Vietnam, France, United Arab Emirates, Canada, India, Italy, Russia, the UK, Philippines, Nepal, Sri Lanka, Spain, Sweden, Cambodia, Finland Belgium. 
  • In Australia: 4 cases in NSW, 4 in Victoria, 3 in Queensland and 2 in South Australia.
  • Fatality rate: 2.07%. This compares to other coronavirus outbreaks:

    How does 2019-nCoV cause severe illness?

    Writing in The Conversation, Monash University Professor of Infectious Diseases Epidemiology, Allen Cheng said some people develop a mild infection from 2019-nCoV while others become critically ill.

    ‘Of those infected, around 2% are reported to have died, but the true mortality rate is unknown,’ Professor Cheng wrote.

    He outlined four key ways the virus can cause severe disease, noting that some can occur at the same time:

        1. Direct viral damage 
        2. Pneumonia
        3. Sepsis
        4. Complications of hospital care, such as infections from intravenous lines or catheters, pneumonia, or non-infectious complications such as pressure sores.

    ‘Of the first 99 people with severe infection, three-quarters had pneumonia involving both lungs,’ Professor Cheng wrote.

    ‘Around 14% appeared to have lung damage caused by the immune system, while 11% suffered from multi-organ system failure, or sepsis.’

    Update for pharmacists

    In an updated information sheet for pharmacists and other health professionals this week, the Department of Health reiterated previous advice to consider patients’ travel history and symptoms, and recommended professional judgement is used as the full clinical spectrum of illness is not known. 

    A person is suspected of having coronavirus infection if:

        • they have travelled to (including transit through) mainland China in the 14 days before the onset of illness, or there has been close contact in 14 days before illness onset with a confirmed or suspected case of 2019-nCoV, and
        • symptoms are of acute respiratory infection (respiratory infection with at least one of: shortness of breath, cough or sore throat) with or without fever or history of fever.

    A/Prof Freeman encouraged pharmacists to share current government information on the virus with patients, including that the risk in Australia remains low.

    ‘Standard infection control precautions, such as regular hand hygiene and wiping down of surfaces, remain appropriate for limiting the spread of infectious diseases in Australian pharmacies and within the Australian community,’ he said.

    ‘If a person becomes unwell and you suspect they may have symptoms of coronavirus, you should direct them to seek medical attention. This includes phoning ahead to the facility, usually an emergency department, that you are referring them to.’

    Advice on face masks

    Professor Raina MacIntyre, Head of the Biosecurity Research Program at the University of NSW’s Kirby Institute, said there was currently no need for Australians to wear face masks in public.

    ‘We need to ensure there is no panic buying, as this will lead to shortages of supplies,’ Professor MacIntyre told Australian Pharmacist.

    ‘Face masks may be useful in communities where there is sustained transmission of infection, such as in Wuhan. At this stage there is no need to wear a mask in Australia. P2 masks should be reserved for health workers, who are at higher risk.’

    Prime Minister Scott Morrison announced last week the Federal Government would release 1 million masks – including P2 and surgical masks – from the national medical stockpile through the Public Health Network, including to pharmacists.

    Pharmacists who receive masks from the national stockpile must supply them free of charge to approved patients and medical practitioners. 

    Local measures

    Australia has border, isolation, surveillance and case tracing mechanisms in place, according to the Federal Department of Health.

    The advice of the Department of Foreign Affairs and Trade for travel to mainland China is ‘level 4 – do not travel’.

    Meanwhile, the following travel restrictions apply to people entering Australia having left mainland China after 1 February 2020:

        • foreign nationals (excluding permanent residents of Australia) who are in mainland China will not be allowed to enter Australia until 14 days after they have left or transited through mainland China
        • Australian citizens, permanent residents and their immediate family will still be able to enter Australia, as well as airline crews who have been using appropriate personal protective equipment.

    Consumers concerned about family overseas can contact DFAT: 1300 555 135