Background
The global spread of coronavirus disease 2019 (COVID-19) within a 12-week period had countries globally grappling to meet the demands of the unknowns of this pandemic. Health-care systems have been reeling with demands placing it in a critical state to meet the needs of the population. a
a https://covid19.who.int/ Accessed: June 1, 2020, 14:08 hours
As of August 6, 2020, 18.8 million cases of COVID-19 have been diagnosed worldwide of which 11.3 million (60.1%) have recovered and 706,000 deaths occurred, with 216 countries reporting active cases. The countries reporting more than 1 million confirmed cases are United States, Brazil, and India. The United States exhibits the lowest proportion of recovered patients (49.4%) compared to Brazil and India, each with 70% of confirmed cases recovered. India has the lowest percentage of confirmed cases who died (2.1%).On January 10, the World Health Organization (WHO) issued an advisory to all nations to prepare for a novel virus now known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing severe respiratory disease, which had been reported in Wuhan, China in December 2019. The call was for countries to revise their influenza plans and identify gaps, conduct risk assessments, and plan for investigation, prevention, and response in the event the country experiences an outbreak. On January 30, the WHO declared the COVID-19 outbreak a public health emergency of international concern meaning that there was the potential of global transmission of the virus. On March 11, the WHO declared COVID-19 a pandemic as COVID-19 was being reported by almost all countries.
Introduction
The WHO defines a pandemic as the worldwide spread of a new disease. In this case, a novel SARS-CoV emerged in Wuhan, China, and spreads around the world in less than 3 months, and most people do not have immunity. With the advances in information technology and research capacity, the global scientific community has invested efforts to obtain data on the SARS-CoV-2 virus to aid countries in their preparation and response to the pandemic. In recent years, the WHO has prompted countries to develop and implement their national influenza preparedness plans, and this has helped countries to fast track their response plan to the 2019 novel SARS-CoV-2 disease or COVID-19 pandemic.
National Response Plan to COVID-19 pandemic
Similarly, to the pandemic influenza plans, a comprehensive national response plan contains the following technical areas: b
b U.S. Department of Health and Human Services. Pandemic influenza plan. 2017 Update.
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oversight of the national response
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assessment of the readiness of the health system
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surveillance, epidemiology, and laboratory activities 2
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community empowerment and mitigation measures
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medical equipment and supplies for patient care
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infection prevention and control
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Clinical guidelines
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Risk communication plan
The national response to the COVID-19 pandemic and the learning of the characteristics of the 2019 novel SARS-CoV-2 demanded from countries to strengthen their multisectoral response and to use the rapidly changing evidence to make decisions and for the national and subnational response teams to be open to overwhelming flexibility in the response.
The national response to COVID-19, a national challenge
This section offers practical recommendations of each of the technical areas enlisted in the “Introduction” section.
National oversight committee
Countries learnt on the go that the impact of the COVID-19 pandemic is way beyond the health sector. Every citizen is affected by the consequences of the pandemic, especially in the economic sphere as some drastic lifesaving measures ought to be put in place to contain and mitigate the increase in morbidity and mortality; hence, the need to have a national oversight committee who is responsible for the multisector response to the pandemic. This committee is chaired by the highest governmental authorities from key sectors such as national security, economic development, human development, health and education, and ministry of finance. The decisions made at that level are then communicated to the population. Frequent press conferences allow the media and the population through social media to voice their concerns and to be offered an explanation to each of their questions. The committee meets on a weekly basis or as often needed.
The COVID-19 pandemic impels governments through their national oversight committees to take drastic measures as per legislative prerogatives. They are not known to be friendly, rather they are measures to contribute to the preservation of life. Examples of drastic measures that have short-, medium-, and long-term effects are Declaration of State of Emergency, curfew, closing of schools, closing of the borders, quarantined communities with high number of cases, and restriction of movement within and across districts.
Assessment of the readiness of the health system
The COVID-19 causes an upper respiratory infection that progresses to a systemic illness and eventually death for those who have negative risk factors. The following documents are available to help countries to assess their health system readiness and technical guides for preparation of the national response to COVID-19: reagent calculator (August 3, 2020), guidance for conducting a country COVID-19 intra-action review (July 23, 2020), practical actions in cities to strengthen preparedness for the COVID-19 pandemic and beyond (July 17, 2020), investing in and building long-term health emergency preparedness during the COVID-19 pandemic (July 6, 2020), monitoring and evaluation plan (June 5, 2020), operational planning guidance to support country preparedness and response (May 22, 2020), strategic preparedness and response plan (April 14, 2020); assessment tool for laboratories implementing COVID-19 virus testing: interim guidance (April 8, 2020), national capacities review tool for a novel coronavirus (January 9, 2020), and preparing for a large-scale community transmission of COVID-19 (February 28, 2020), among others. The systematic assessment of the readiness of the health system allows for early identification of needs and actions to close the gaps in an orderly and phased manner, from most to less critical gaps. The systematic assessment allows for the documentation of the process followed in preparing the health system for an effective response.
National COVID-19 surveillance system
The WHO prepared and shared the case definitions of COVID-19 since January 11, 2020 which was updated four times. The last update was August 7, 2020 ( Figs. 1 and 2 ). It can be found at: https://www.who.int/publications/i/item/WHO-2019-nCoV-Surveillance:Case_Definition-2020.1
The surveillance system for COVID-19 should be geographically comprehensive and includes all persons and communities at risk, combined across different sites to collect data comprehensively. The objective of the COVID-19 surveillance is to enable rapid detection, isolation, testing, and management of suspected cases; guide the implementation of control measures; detect and contain outbreaks among vulnerable populations; evaluate the impact of the pandemic on the health-care system and society; monitor long-term epidemiologic trends and evolution of COVID-19 virus; and understand the co-circulation of COVID-19 virus, influenza, and other respiratory viruses. Table 1 outlines the combination of type of surveillance with surveillance sites, which serves as a guide to countries. c
c WHO. Surveillance strategies for COVID-19 human infection. Coronavirus (COVID-19) update No. 29, June 5, 2020.
| Type of surveillance | Surveillance sites | |||||
|---|---|---|---|---|---|---|
| Individuals in the community | Primary care sites (non-sentinel ILI/SARI) | Hospitals (non-sentinel ILI/SARI) | Sentinel ILI/SARI | Residential facilities and vulnerable groups | Vital statistics office | |
| Immediate case notification system | × | × | × | × | × | |
| Contact tracing system | × | |||||
| Sentinel virus surveillance | × | × | ||||
| Sentinel case surveillance | × | × | ||||
| Cluster investigations | × | × | × | × | ||
| Special settings | × | × | ||||
| Mortality | × | × | × | × | × | |
The COVID-19 surveillance system is the cornerstone for the containment and mitigation of COVID-19 pandemic. For it to be effective, all other technical areas are required, for example, risk communication, laboratory services, human resources for health, enhanced infection prevention and control, among others.
The generic contacts risk classification shared by the global public health specialists needs to be tailored to the country’s context. The risk classification is a group of standards to aid the frontline workers to make decisions regarding the case management. It also contributes to the effective use of resources and effective active search for potential cases. Table 2 shows the contacts risk classification used in Belize.
| High-risk contacts |
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| Medium-risk contacts |
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| Low-risk contacts |
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| No identifiable risk |
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The contact tracing allows the epidemiological surveillance teams to identify cases and their contacts to halt the transmission of the virus at community level, workstations, and other settings. It allows for indirect measurement of compliance with recommended public health measures. Fig. 3 depicts the number of cases and the number of identified contacts of each case in a small group of infected persons.
Preparatory works to face the COVID-19 pandemic must include the ports of entry. Knowing who enters a country, their whereabouts, and determining their status will facilitate the tracking of persons under investigation or persons with a confirmed SARS-CoV-2 diagnosis. All employees coming in contact with persons entering the country (Immigration and Customs) must be knowledgeable of the process to follow for the receipt and screening and the case management of their nationals, residents, and tourists. A plan must be in place to track their movement within the country for at least 14 days or more if positive until recovery. The port of entry staff must be trained on how to use the different forms of documentation (application, tablet, software, or hard copy). All these must have a written process to be shared and standardized among staff. Table 3 shows the port of entry activities during 60 days prior to the closing of the borders.
