English Project
English Project
English Project
3. ACTIONABLE RECOMMENDATIONS
7. CONCLUSIONS
INTRODUCTION
Control Strategies
Different strategies have been implemented to combat the pandemic in
different countries. Some countries (e.g., Sweden) initially tried so-called
herd immunity by natural infections and some used mitigation or
suppression, but in general these approaches had minimal effects on
stopping the spread of the disease within and between countries. Generally,
most countries across the globe tried to limit the spread of the pathogen
through various non-pharmaceutical interventions (NPIs), including the
implementation of lockdowns of varying intensity and geographic scope.
However, it has been noted that the inadequate (e.g., United States and
India) or delayed (e.g., Russia, United Kingdom, and France) implementation
of lockdowns could have reduced their efficacy in impeding the spread of
infections in many countries . Just as delays in implementing lockdowns
have increased pathogen spread, the premature lifting of these restrictions
can also cause a resurgence in case numbers as has been observed recently
in India . One of the most effective implementations of NPIs was undertaken
by China, which took immediate and stringent measures to prevent
pathogen spread, including the lock-down of the city of Wuhan, where the
virus was first identified, and suppression measures for the rest of the
country . The WHO-China Joint Mission on COVID-19 revealed that the
immediate prevention and control measures that China took to curtail the
epidemic were implemented in three main phases. The first stage focused
primarily on preventing cases from being exported from Wuhan in
conjunction with closing wet markets and enhanced surveillance to try to
identify the zoonotic source. The second stage focused on controlling the
impacts of the epidemic through medical intervention, improved diagnostics
for rapid identification of infected individuals, and critically on reducing the
rate of spread by curtailing the movement of people, restriction of mass
gatherings, contact tracing, increased quarantine measures, and enhanced
border security. Finally, in the third stage the focus shifted to controlling
isolated and/or sporadic case clusters. In this stage there was a critical effort
to strike a balance between effective disease control and sustainable
economic/social development. The effective implementation of these
policies made China one of the most successful countries in terms of COVID-
19 control. The effectiveness of China's control measures is evidenced in
terms of the per-capita cases reported. Thus, as of May 6, 2021, the global
infection rate was about 20,022/million persons, with considerable variation
amongst various countries (e.g., 98,503 and 15,573 cases/million persons in
USA and India, respectively). However, China's cumulative infection rates
remained one of the lowest globally (71 cases/million persons). It is
important to note that after Wuhan outbreak which was cleared on April 8,
2020 , China has experienced many small waves of outbreak with local
transmission due to imported cases, but all the viruses are “stable” strains
(with single imported case of both 501Y.V1 and 501Y.V2 but no local spread)
and there are no new variants arising from China, indicating the successful
suppression of virus circulation. For both containment and suppression
strategies, lock-down of the city/region (the areas could be very small), lock-
down of the household and isolation/quarantine are the three important
factors for the success. Looking to the future, with no recurrent outbreaks in
China even in the winter season (as of Feb 23, 2021), we might consider
such a mitigation strategy to ensure meeting public health goals, while
keeping the society socially active and economically strong. It is also
important to recognize the need for better international coordination in
terms of reducing transmission (e.g., restriction of social gatherings and
mask ordinances) and the timely identification of potential spread (e.g.,
contact tracing). Early in the pandemic these measures, in conjunction with
stricter limitations of international travel, would have helped reduce the
initial global spread of the virus. However, in these late stages of the
pandemic, localized lockdowns (e.g., at city or county scale) are likely to be
more effective than large-scale lockdowns at national or regional levels.
Actionable Recommendations
Protecting healthcare workers for their own safety and that of the affected
community should be central to disease response strategy. Urgent provision
of practical safeguards, particularly personal protective equipment and
knowledge of how to use it, are key to safeguarding healthcare workers. For
most of the Start Network disease response programmes, this was a priority.
As a result, the knowledge and capacity of the Ministry of Health (MOH)
team involved in the outbreak significantly improved, especially in terms of
prevention and ensuring safe health facilities for the patients.
For the COVID-19 pandemic, where the available scientific knowledge and
information is still quite limited and is evolving almost every day, national
health professionals may have very limited knowledge and information.
Therefore, prioritising their training and support needs to be central to any
response plan. Also, it is worth noting that the response to a disease
outbreak is multi-fold and includes many services to effectively prevent,
contain the spread, and manage cases—medical care, surveillance, Infection
Prevention and Control (IPC), communication, logistic, psycho-social
support, safe and dignified burials, vaccination, etc. Facilitating strong
coordination between different response pillars is highly recommended.
Conclusions