International Protocol to response COVID-19 ( TUGAS LIBUR 16-21 MARET 2020 PART 3)


International Protocol to response COVID-19
The Global Response & Next Steps
1.       The COVID-19 virus is a new pathogen that is highly contagious, can spread quickly, and must be considered capable of causing enormous health, economic and societal impacts in any setting. It is not SARS and it is not influenza. Building scenarios and strategies only on the basis of well-known pathogens risks failing to exploit all possible measures to slow transmission of the COVID-19 virus, reduce disease and save lives.

COVID-19 is not SARS and it is not influenza. It is a new virus with its own characteristics. For example, COVID-19 transmission in children appears to be limited compared with influenza, while the clinical picture differs from SARS. Such differences, while based on limited data, may be playing a role in the apparent efficacy of rigorously 19 applied non-pharmaceutical, public health measures to interrupt chains of human-tohuman transmission in a range of settings in China. The COVID-19 virus is unique among human coronaviruses in its combination of high transmissibility, substantial fatal outcomes in some high-risk groups, and ability to cause huge societal and economic disruption. For planning purposes, it must be assumed that the global population is susceptible to this virus. As the animal origin of the COVID-19 virus is unknown at present, the risk of reintroduction into previously infected areas must be constantly considered. The novel nature, and our continuously evolving understanding, of this coronavirus demands a tremendous agility in our capacity to rapidly adapt and change our readiness and response planning as has been done continually in China. This is an extraordinary feat for a country of 1.4 billion people.

2.       China’s uncompromising and rigorous use of non-pharmaceutical measures to contain transmission of the COVID-19 virus in multiple settings provides vital lessons for the global response. This rather unique and unprecedented public health response in China reversed the escalating cases in both Hubei, where there has been widespread community transmission, and in the importation provinces, where family clusters appear to have driven the outbreak.

Although the timing of the outbreak in China has been relatively similar across the country, transmission chains were established in a wide diversity of settings, from megacities in the north and south of the country, to remote communities. However, the rapid adaptation and tailoring of China’s strategy demonstrated that containment can be adapted and successfully operationalized in a wide range of settings. China’s experience strongly supports the efficacy and effectiveness of anchoring COVID19 readiness and rapid response plans in a thorough assessment of local risks and of utilizing a differentiated risk-based containment strategy to manage the outbreak in areas with no cases vs. sporadic cases vs. clusters of cases vs. community-level transmission. Such a strategy is essential for ensuring a sustainable approach while minimizing the socio-economic impact.

3.       Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures.

Achieving the high quality of implementation needed to be successful with such measures requires an unusual and unprecedented speed of decision-making by top leaders, operational thoroughness by public health systems, and engagement of society. 20 Given the damage that can be caused by uncontrolled, community-level transmission of this virus, such an approach is warranted to save lives and to gain the weeks and months needed for the testing of therapeutics and vaccine development. Furthermore, as the majority of new cases outside of China are currently occurring in high and middleincome countries, a rigorous commitment to slowing transmission in such settings with non-pharmaceutical measures is vital to achieving a second line of defense to protect low income countries that have weaker health systems and coping capacities. The time that can be gained through the full application of these measures – even if just days or weeks – can be invaluable in ultimately reducing COVID-19 illness and deaths. This is apparent in the huge increase in knowledge, approaches and even tools that has taken place in just the 7 weeks since this virus was discovered through the rapid scientific work that has been done in China.

4.       The time gained by rigorously applying COVID-19 containment measures must be used more effectively to urgently enhance global readiness and rapidly develop the specific tools that are needed to ultimately stop this virus.

COVID-19 is spreading with astonishing speed; COVID-19 outbreaks in any setting have very serious consequences; and there is now strong evidence that non-pharmaceutical interventions can reduce and even interrupt transmission. Concerningly, global and national preparedness planning is often ambivalent about such interventions. However, to reduce COVID-19 illness and death, near-term readiness planning must embrace the large-scale implementation of high-quality, non-pharmaceutical public health measures. These measures must fully incorporate immediate case detection and isolation, rigorous close contact tracing and monitoring/quarantine, and direct population/community engagement. A huge array of COVID-19 studies, scientific research projects and product R&D efforts are ongoing in China and globally. This is essential and to be encouraged and supported. However, such a large number of projects and products needs to be prioritized. Without prioritizing, this risks compromising the concentration of attention and resources and collaboration required to cut timelines by precious weeks and months. While progress has been made, the urgency of the COVID-19 situation supports an even more ruthless prioritization of research in the areas of diagnostics, therapeutics and vaccines. Similarly, there is a long list of proposed studies on the origins of COVID-19, the natural history of the disease, and the virus’s transmission dynamics. However, the urgency of responding to cases and saving lives makes it difficult for policy makers to consider and act on such comprehensive lists. This can be addressed by balancing studies with the immediate public health and clinical needs of the response. Studies can be prioritized in terms of the largest knowledge gaps that can be most rapidly addressed to have greatest immediate impact on response operations and patient management. This suggests prioritizing studies to identify risk factors for transmission in households, institutions and the community; convenience sampling for this virus in the population using existing surveillance systems; age-stratified sero-epidemiologic surveys; the analysis of clinical case series; and cluster investigations.
For countries with imported cases and/or outbreaks of COVID-19
1.       Immediately activate the highest level of national Response Management protocols to ensure the all-of-government and all-of-society approach needed to contain COVID-19 with non-pharmaceutical public health measures;
2.       Prioritize active, exhaustive case finding and immediate testing and isolation, painstaking contact tracing and rigorous quarantine of close contacts;
3.       Fully educate the general public on the seriousness of COVID-19 and their role in preventing its spread;
4.       Immediately expand surveillance to detect COVID-19 transmission chains, by testing all patients with atypical pneumonias, conducting screening in some patients with upper respiratory illnesses and/or recent COVID-19 exposure, and adding testing for the COVID-19 virus to existing surveillance systems (e.g. systems for influenza-like-illness and SARI); and 22
5.       Conduct multi-sector scenario planning and simulations for the deployment of even more stringent measures to interrupt transmission chains as needed (e.g. the suspension of large-scale gatherings and the closure of schools and workplaces).
For uninfected countries
1.       Prepare to immediately activate the highest level of emergency response mechanisms to trigger the all-of-government and all-of society approach that is essential for early containment of a COVID-19 outbreak;
2.       Rapidly test national preparedness plans in light of new knowledge on the effectiveness of non-pharmaceutical measures against COVID-19; incorporate rapid detection, largescale case isolation and respiratory support capacities, and rigorous contact tracing and management in national COVID-19 readiness and response plans and capacities;
3.       Immediately enhance surveillance for COVID-19 as rapid detection is crucial to containing spread; consider testing all patients with atypical pneumonia for the COVID-19 virus, and adding testing for the virus to existing influenza surveillance systems;
4.       Begin now to enforce rigorous application of infection prevention and control measures in all healthcare facilities, especially in emergency departments and outpatient clinics, as this is where COVID-19 will enter the health system; and
5.       Rapidly assess the general population’s understanding of COVID-19, adjust national health promotion materials and activities accordingly, and engage clinical champions to communicate with the media.
For the public
1.       Recognize that COVID-19 is a new and concerning disease, but that outbreaks can managed with the right response and that the vast majority of infected people will recover;
2.       Begin now to adopt and rigorously practice the most important preventive measures for COVID-19 by frequent hand washing and always covering your mouth and nose when sneezing or coughing;
3.       Continually update yourself on COVID-19 and its signs and symptoms (i.e. fever and dry cough), because the strategies and response activities will constantly improve as new information on this disease is accumulating every day; and
4.       Be prepared to actively support a response to COVID-19 in a variety of ways, including the adoption of more stringent ‘social distancing’ practices and helping the high-risk elderly population. 23
For the international community
1.       Recognize that true solidarity and collaboration is essential between nations to tackle the common threat that COVID-19 represents and operationalize this principle;
2.       Rapidly share information as required under the International Health Regulations (IHR) including detailed information about imported cases to facilitate contact tracing and inform containment measures that span countries;
3.       Recognize the rapidly changing risk profile of COVID-19 affected countries and continually monitor outbreak trends and control capacities to reassess any ‘additional health measures’ that significantly interfere with international travel and trade.

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