新型コロナウイルス(36) 中国，潜伏期間，空港，WHO
● 新型コロナウイルス(36) 中国，空港，WHO
PRO/AH/EDR> Novel coronavirus (36): China, global, incubation, airport screen, ECDC，WHO
Archive Number: 20200207.6963294
In this update:
[1] 中国 - China National Health Commission 6 Feb 2020
[2] Global update - Johns Hopkins CSSE
[3] 潜伏期間 Incubation period of nCoV - Eurosurveillance
[4] Effectiveness of airport screening - Eurosurveillance
[5] Selected media reports of transmission outside of China
[6] 警告した武漢の医師の死亡 Death of physician whistle-blower in Wuhan
[7] WHO situation report 17 (as of 6 Feb 2020)
[8] WHO accelerated Research and Development for nCoV
[9] WHO open course, Critical Care Severe Acute Respiratory Infection Training
[1] 中国 - China National Health Commission 6 Feb 2020
Update on the epidemic situation of new coronavirus pneumonia as of 24:00 6 Feb 2020
情報源 China National Health Commission [in Chinese] 2020年2月7日
At 04:00 on [6 Feb 2020], 31 provinces (autonomous regions, municipalities) and the Xinjiang Production and Construction Corps reported 3143 newly confirmed cases (2447 in Hubei), and 387 newly recovered cases (184 in Hubei), which were [discharged] on the same day. There were 26 762 close contacts under medical observation. 962 new reports of severe cases (918 in Hubei), 73 new cases of death (69 in Hubei, 1 in Jilin, Henan, Guangdong, and Hainan), and 4833 suspected cases (2622 in Hubei).
As of 24:00 on [6 Feb 2020], 31 provinces (autonomous regions, municipalities) and the Xinjiang Production and Construction Corps had reported a total of 31 161 confirmed cases, a total of 1540 recovered and discharged, and 28 985 confirmed cases (among which 4821 were severe cases), with cumulative deaths. There are 636 cases and 26 359 suspected cases. A total of 314 028 close contacts were traced, and 186 045 close contacts were still under medical observation. ...
地図 A good map of China showing provinces
[2] Global update
情報源 Johns Hopkins CSSE 2020年2月7日
Confirmed cases
2 Feb/ 3 Feb/ 4 (early) / (end of day) / 5 Feb / 6 Feb / 7 Feb / Country/Region
17 187 / 19 693 / 20 636 / 23 746 / 27 396 / 31 130 / 31 487 / 中国
20 / 20 /20 / 22 / 22 / 86 / [86] / 日本 ... ほか。
Total reported deaths: 638
湖北省 Hubei Mainland China: 618 deaths ... 他省の死者は 0～３
Data sources: WHO, CDC, ECDC, NHC, and DXY.
[3] 潜伏期間 Incubation period of nCoV - Eurosurveillance
情報源 Eurosurveillance 2020; 25(5) 2020年2月6日
原著タイトル Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill. 2020; 25(5): pii=2000062
2019年12月に第 1例目が発症した，武漢市のウイルス肺炎アウトブレイクの原因は，1月前半に新型コロナウイルスと特定された。重症の急性呼吸器疾患に至るこの新たに発見されたウイルスは，the severe acute respiratory syndrome (SARS) coronavirus and Middle East respiratory syndrome (MERS) coronavirus の関連するウイルスではあるが，いずれとも区別される distinct 。重要な疫学的指標として潜伏期間があり，この新型ウイルスについても，直ちに流行中の症例報告をもとに研究が行われている。パラメーターの中でも重要なものの 1つが，潜伏期間の分布 the incubation period distribution である。潜伏期間の値の範囲は，疫学的症例定義に不可欠であり，また適切な隔離期間の決定に必要である。さらに，入国スクリーニングと接触者追跡の有効性の評価にも有用である。さらに The distribution of the incubation period は，流行の規模や感染伝播の潜在能力の評価にも用いられる。the 2019-nCoV incubation period がまだないため，本研究 では，incubation periods of SARS or MERS coronaviruses に従った。
アウトブレイク初期段階における，感染が確定診断された武漢からの渡航者について，渡航歴と発症日に基づき推察した the distribution of incubation periods を示す。 2020年1月，2019-nCoV 感染と確定診断された症例の増加が，武漢市以外でも確認された。between [20 and 28 Jan 2020] に診断された 88例について，武漢市との往来の渡航歴と，発症日が確認された。年齢は 2歳から 72歳 (4例については情報なし); 女性 31名，男性 57名。この流行の初期段階においては，渡航歴のあった患者らは武漢市内で感染した可能性が高い。従って，武漢市で過ごした時間が感染 (ウイルス) に暴露した期間と捉えることができる。渡航歴が確認できた 88例中，63例は他所を訪れた武漢市住民であり，25例は武漢市内で限定された期間を過ごした (武漢市への) 旅行者だった。発症日と渡航歴を合わせて考えれば，それぞれのケースについて，可能性のある潜伏期間を推察できる。
Figure 1 [Exposure to reporting timeline for confirmed 2019 novel coronavirus (2019-nCoV) cases with travel history from Wuhan ...
The Weibull distribution provided the best fit to the data (Table 1). The mean incubation period was estimated to be 6.4 days (95% credible interval (CI): 5.6-7.7). The incubation period ranges from 2.1 to 11.1 days (2.5th to 97.5th percentile) (Table 2 and Figure 2). ... Although the lognormal distribution provides the poorest fit to the data, the incubation period ranging from 2.4 to 15.5 days (2.5th to 97.5th percentile) may be relevant for a conservative choice of quarantine periods.
Table 1. Estimated incubation period for travellers infected with 2019 novel coronavirus (2019-nCoV) in Wuhan, China, for different parametric forms of the incubation period distribution, data 20-28 Jan 2020
Table 2. Percentiles of estimated incubation period for travellers infected with 2019 novel coronavirus (2019-nCoV) in Wuhan, China, for different parametric forms of the incubation period distribution, data 20-28 Jan 2020
Figure 2. The cumulative density function of the estimated Weibull incubation period distribution for travellers infected with the 2019 novel coronavirus (2019-nCoV) in Wuhan, China, data 20-28 Jan 2020
the estimated incubation period distribution for MERS (Table 3 and Figure 3) との比較において，the incubation period values の，平均値の差は最大で 1日，95th percentiles も最大 2日の違いで，かなり近いもの remarkably similar となった。The estimated mean incubation periods for SARS については，今回示した 2019-nCoV の値と比べ，より短かく，またはより長く，大きな差があった more variable。MERS or SARS に近い incubation period を想定していた従来の研究結果は，(2019-nCoV の潜伏期間は) a shorter or longer incubation period であることから，適合性がなくなる。
Table 3. Estimated incubation periods for coronaviruses from different studies
Figure 3. Box-and-whisker-plots of estimated incubation periods for coronaviruses from different studies
議論
2020年1月20日から28日までの間に報告された，2019-nCoV in Wuhan に感染した武漢からの旅行者の潜伏間の範囲について明らかにした。この結果は，暴露から 3ないし 6日間に家族のうちの 5人が発症した，家族内小集積の 1例についての報告を裏付ける，empirical evidence が得られ，within the range for the incubation period of 0 to 14 days assumed by WHO and of 2 to 12 days assumed by ECDC にも矛盾しない。平均の潜伏期間 the mean incubation period について，10例のデータから 5.2日以上，武漢と広東省の間の渡航歴のある 16例では 4.8日 (range: 2-11) となった。あとの報告は，3日間の暴露期間 a 3-day exposure window のある旅行者に限定した。閉じた暴露期間 a closed exposure window を持つ 25例の旅行者らだけに絞って再度解析し直したところ，a mean incubation period of 4.5日 となり，先の報告により近い値となったが，the 95th percentile は 8.0日となった。今回の解析において，武漢での滞在期間内に感染する可能性を一律 a uniform prior probability に設定した。滞在期間中にも流行は変化するので，滞在初期よりも終わりに近づくにつれてより感染しやすくなる。こうした傾向により a slight bias towards longer incubation periods を生じる可能性があることから，推定値は最大 11日間までに限定することが無難だろう。症例を選択したことから，報告される患者全体と比べ，男性が多く，年齢も若い。患者数も少ない ... さらに，より詳細な解析が必要 ...
［Mod.MPP 注－In summary, the 3 models support the present conclusion that the upward side of the incubation period may well be 14 days.]
[4] 空港でのスクリーニングの有効性 Effectiveness of airport screening - Eurosurveillance
情報源 Eurosurveillance 2020; 25(5) 2020年2月6日
原著タイトル Effectiveness of airport screening at detecting travellers infected with novel coronavirus (2019-nCoV) Euro Surveill. 2020; 25(5): :pii=2000080
... 有効性を示す証拠が限られているにもかかわらず，過去 during the 2003 SARS epidemic and 2009 influenza A(H1N1) pandemic において，入国時の空港でのスクリーニング検査 airport screening が実施された。今回我々は，潜伏期間，入院期間，無症候性感染の割合について得られるデータを用い，欧州内の入出国時のスクリーニングが，欧州内へ入国する，感染 2019-nCoV infection のある渡航者の特定にどれほど有効か評価した ...
Simulation of travellers at each stage of infection with 2019-nCoV
感染のある旅行者 2019-nCoV infected travellers で，航空機の搭乗客を計画し，新たな地域に感染を拡げるリスクがあると考えられる 100人を想定した。渡航時間は，フライト時間＋チェックインなどのための約 1時間とした。また発熱などの症状が現れるのは，潜伏期間 (平均 5.2日) の終わりで，さらに重症化し入院・隔離されるのはその数日後と仮定した。また，体温スキャンでは特定されず医療機関も受診しないが，他者への感染性は有する，無症候性感染の個人が存在する可能性と，到着時すでに重症化していて入院となりスクリーニングを通らない症例があることも考慮に入れた。exit and entry screening で捕捉される感染のある旅行者，旅行中に重症化する症例，および特定されない症例の割合を推定した。これには以下の様々な状況 (の影響) が想定される： (i) 旅行期間; (ii) スクリーニングの感度 the sensitivity of exit and entry screening; (iii) 無症候性感染の割合; (iv) 潜伏期間 and (v) 発症から入院までの期間 (Table).
Table. Parameter values and assumptions for the baseline scenario estimating effectiveness of exit and entry screening at airports for detecting passengers infected with novel coronavirus (2019-nCoV)
Parameter / Value (baseline scenario) / Source
- 旅行期間 / 12 時間 / 北京－ロンドン [18]
- Sensitivity of exit screening / 86% / Sensitivity of infrared thermal image scanners [19]
- Sensitivity of entry screening / 86% / Sensitivity of infrared thermal image scanners [19]
- Proportion of asymptomatic infections undetectable by typical screening procedures / 17% / 1 of 6 reported asymptomatic in a 2019-nCoV family cluster [11]
- 潜伏期間/ Mean 5.2 days, variance 4.1 days / Reported Gamma distributed mean, variance estimated from uncertainty interval of mean [8]
- 発症から入院までの期間 / Mean 9.1 days, variance 14.7 days / Reported Gamma distributed mean, variance estimated from uncertainty interval of mean [8]
...
Effect of screening on detection
the baseline scenario では 44例 of 100 infected travellers が exit screening で捕捉され，旅行中に重症化する例は 0，entry screening でさらに 9例が特定され，the remaining 46例は検出できないという結果となった。
入国時のスクリーニングの有効性は，実施されている出国時のスクリーニングの有効性に大きく依存する。exit screening が行われていない場合の入国時スクリーニングで検出される症例数は，(行われている場合の 9 infected travellers に対し）53例となった。しかし，フライト中に発症する可能性も高くなるため，特に長時間フライトでは，exit screening の有効性が高い。
Figure 3. Probability of detecting travellers infected with novel coronavirus (2019-nCoV) at airport entry screening by travel duration and sensitivity of exit screening
...
Discussion and conclusions
--------------------------
As a response to the ongoing outbreak of the 2019-nCoV originating in Wuhan, exit screening has been implemented for international flights leaving China's major airports. Thermal scanning, which can identify passengers with fever (high external body temperature), allows for passengers exhibiting symptoms of 2019-nCoV infection to be tested before they board a plane. Similarly, entry screening for flights originating in the most affected regions may be under consideration at airports in regions in and outside China. We estimate that the key goal of syndromic screening at airports -- to prevent infected travellers from entering countries or regions with little or no ongoing transmission -- is only achievable if the rate of asymptomatic infections that are transmissible is negligible, screening sensitivity is almost perfect, and the incubation period is short. Based on early data from Li et al [8], 2019-nCoV appears to have a shorter incubation period than severe acute respiratory syndrome (SARS), and a higher rate of asymptomatic infections [11]. Under generally conservative assumptions on sensitivity, we find that 46 of 100 infected travellers will enter undetected.
Entry screening is an intuitive barrier for the prevention of infected people entering a country or region. However, evidence on its effectiveness remains limited and given its lack of specificity, it generates a high overhead of screened travellers uninfected with the targeted pathogen [5]. For example, when entry screening was implemented in Australia in response to the 2003 SARS outbreak, 1.84 million people were screened, 794 were quarantined, and no cases were confirmed [12]. While some cases of 2019-nCoV infection have been identified through airport screening in the current outbreak, our estimates indicate that likely more infected travellers have not been detected by screening.
It is important to note that our estimates are based on a number of key assumptions that cannot yet be informed directly by evidence from the ongoing 2019-nCoV outbreak. The current outbreak has spread rapidly and early evidence suggests that the average disease severity is lower than that of SARS. This may also suggest a substantial proportion of asymptomatic cases. A recent analysis of a family transmission cluster is based on a small sample size but one in 6 infections was asymptomatic [11]; this is a major impediment for the effectiveness of syndromic screening. However, if asymptomatic cases were not infectious they would not pose a risk for seeding infection chains on arrival. To allow easy adaptation of our results as new insight becomes available in the coming weeks, we developed a free interactive online tool, available at https://cmmid-lshtm.shinyapps.io/traveller_screening/.
While the most up-to-date data on the incubation period or the time until recovery from 2019-nCoV infection have been used in this analysis, these figures are likely to change over time as more data become available. Unless the incubation period is only a small fraction of the duration of infection in relation to that of symptomatic disease, and fever in particular, syndromic screening is likely to detect an insufficient fraction of infected cases to prevent local infections. In addition, the sensitivity of airport screening for the detection of 2019-nCoV has not been evaluated. However, we chose conservative estimates and show that with reduced sensitivity, the effectiveness of syndromic screening would further decline.
In many international airports, information is provided to travellers from affected regions recommending action if they develop symptoms on or after arrival [13-16]. Some countries, for example Japan, also require incoming passengers to complete forms detailing their past and future travel in order to aid tracing [17]. Due to the duration of the incubation period of 2019-nCoV infection, we find that exit or entry screening at airports for initial symptoms, via thermal scanners or similar, is unlikely to prevent passage of infected travellers into new countries or regions where they may seed local transmission.
[The complete article including tables, figures, and references can be accessed at the source URL above.]
［Mod.MPP 注－ ... One key question here is whether detection of 44% of infected individual justifies the expenditure. Another is whether this approach should be the only approach or should there be additional actions.]
[5] Selected media reports of transmission outside of China
A. 41 more 2019-nCoV positive on cruise ship, RFI
情報源 NHK News [in Japanese] 2020年2月7日
新型コロナウイルスの集団感染が確認されたクルーズ船で、新たに日本人21人を含む乗客41人の感染が確認されました。クルーズ船が横浜港沖に停泊して以降、乗員と乗客で感染が明らかになったのは61人となりました。厚生労働省はクルーズ船「ダイヤモンド・プリンセス」の船内で今月３日から乗客と乗員全員の合わせて3700人余りの検疫を行い、このうち、発熱やせきなどの症状があったり症状がある人と濃厚接触したりした合わせて273人から検体を採取してウイルス検査を実施してきました。そして７日、新たに171人の結果が判明し、41人の感染が明らかになりました。感染が確認された41人は全員が乗客で、このうち日本人は21人、年代別には20代から40代が３人、50代が３人、60代が８人、70代が21人、80代が６人だということです。また、重症者はいないということです。新たに感染が確認された41人は神奈川県のほか東京、埼玉、千葉、静岡の医療機関に搬送されることになっています。クルーズ船は先月20日に横浜を出たあと、香港に住む80歳の男性が香港で船を下りたあとに新型コロナウイルスへの感染が明らかになっていました。クルーズ船で感染が確認されたのは、香港の男性を除いて合わせて61人となりました。厚生労働省は残る3600人余りの乗客と乗員については、今後も引き続き船内にとどまり、原則として14日間、客室などで待機することを求めています。
● 新型コロナウイルス(36) 中国，空港，WHO
PRO/AH/EDR> Novel coronavirus (36): China, global, incubation, airport screen, ECDC，WHO
Archive Number: 20200207.6963294
In this update:
[1] 中国 - China National Health Commission 6 Feb 2020
[2] Global update - Johns Hopkins CSSE
[3] 潜伏期間 Incubation period of nCoV - Eurosurveillance
[4] Effectiveness of airport screening - Eurosurveillance
[5] Selected media reports of transmission outside of China
[6] 警告した武漢の医師の死亡 Death of physician whistle-blower in Wuhan
[7] WHO situation report 17 (as of 6 Feb 2020)
[8] WHO accelerated Research and Development for nCoV
[9] WHO open course, Critical Care Severe Acute Respiratory Infection Training
[1] 中国 - China National Health Commission 6 Feb 2020
Update on the epidemic situation of new coronavirus pneumonia as of 24:00 6 Feb 2020
情報源 China National Health Commission [in Chinese] 2020年2月7日
At 04:00 on [6 Feb 2020], 31 provinces (autonomous regions, municipalities) and the Xinjiang Production and Construction Corps reported 3143 newly confirmed cases (2447 in Hubei), and 387 newly recovered cases (184 in Hubei), which were [discharged] on the same day. There were 26 762 close contacts under medical observation. 962 new reports of severe cases (918 in Hubei), 73 new cases of death (69 in Hubei, 1 in Jilin, Henan, Guangdong, and Hainan), and 4833 suspected cases (2622 in Hubei).
As of 24:00 on [6 Feb 2020], 31 provinces (autonomous regions, municipalities) and the Xinjiang Production and Construction Corps had reported a total of 31 161 confirmed cases, a total of 1540 recovered and discharged, and 28 985 confirmed cases (among which 4821 were severe cases), with cumulative deaths. There are 636 cases and 26 359 suspected cases. A total of 314 028 close contacts were traced, and 186 045 close contacts were still under medical observation. ...
地図 A good map of China showing provinces
[2] Global update
情報源 Johns Hopkins CSSE 2020年2月7日
Confirmed cases
2 Feb/ 3 Feb/ 4 (early) / (end of day) / 5 Feb / 6 Feb / 7 Feb / Country/Region
17 187 / 19 693 / 20 636 / 23 746 / 27 396 / 31 130 / 31 487 / 中国
20 / 20 /20 / 22 / 22 / 86 / [86] / 日本 ... ほか。
Total reported deaths: 638
湖北省 Hubei Mainland China: 618 deaths ... 他省の死者は 0～３
Data sources: WHO, CDC, ECDC, NHC, and DXY.
[3] 潜伏期間 Incubation period of nCoV - Eurosurveillance
情報源 Eurosurveillance 2020; 25(5) 2020年2月6日
原著タイトル Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill. 2020; 25(5): pii=2000062
2019年12月に第 1例目が発症した，武漢市のウイルス肺炎アウトブレイクの原因は，1月前半に新型コロナウイルスと特定された。重症の急性呼吸器疾患に至るこの新たに発見されたウイルスは，the severe acute respiratory syndrome (SARS) coronavirus and Middle East respiratory syndrome (MERS) coronavirus の関連するウイルスではあるが，いずれとも区別される distinct 。重要な疫学的指標として潜伏期間があり，この新型ウイルスについても，直ちに流行中の症例報告をもとに研究が行われている。パラメーターの中でも重要なものの 1つが，潜伏期間の分布 the incubation period distribution である。潜伏期間の値の範囲は，疫学的症例定義に不可欠であり，また適切な隔離期間の決定に必要である。さらに，入国スクリーニングと接触者追跡の有効性の評価にも有用である。さらに The distribution of the incubation period は，流行の規模や感染伝播の潜在能力の評価にも用いられる。the 2019-nCoV incubation period がまだないため，本研究 では，incubation periods of SARS or MERS coronaviruses に従った。
アウトブレイク初期段階における，感染が確定診断された武漢からの渡航者について，渡航歴と発症日に基づき推察した the distribution of incubation periods を示す。 2020年1月，2019-nCoV 感染と確定診断された症例の増加が，武漢市以外でも確認された。between [20 and 28 Jan 2020] に診断された 88例について，武漢市との往来の渡航歴と，発症日が確認された。年齢は 2歳から 72歳 (4例については情報なし); 女性 31名，男性 57名。この流行の初期段階においては，渡航歴のあった患者らは武漢市内で感染した可能性が高い。従って，武漢市で過ごした時間が感染 (ウイルス) に暴露した期間と捉えることができる。渡航歴が確認できた 88例中，63例は他所を訪れた武漢市住民であり，25例は武漢市内で限定された期間を過ごした (武漢市への) 旅行者だった。発症日と渡航歴を合わせて考えれば，それぞれのケースについて，可能性のある潜伏期間を推察できる。
Figure 1 [Exposure to reporting timeline for confirmed 2019 novel coronavirus (2019-nCoV) cases with travel history from Wuhan ...
The Weibull distribution provided the best fit to the data (Table 1). The mean incubation period was estimated to be 6.4 days (95% credible interval (CI): 5.6-7.7). The incubation period ranges from 2.1 to 11.1 days (2.5th to 97.5th percentile) (Table 2 and Figure 2). ... Although the lognormal distribution provides the poorest fit to the data, the incubation period ranging from 2.4 to 15.5 days (2.5th to 97.5th percentile) may be relevant for a conservative choice of quarantine periods.
Table 1. Estimated incubation period for travellers infected with 2019 novel coronavirus (2019-nCoV) in Wuhan, China, for different parametric forms of the incubation period distribution, data 20-28 Jan 2020
Table 2. Percentiles of estimated incubation period for travellers infected with 2019 novel coronavirus (2019-nCoV) in Wuhan, China, for different parametric forms of the incubation period distribution, data 20-28 Jan 2020
Figure 2. The cumulative density function of the estimated Weibull incubation period distribution for travellers infected with the 2019 novel coronavirus (2019-nCoV) in Wuhan, China, data 20-28 Jan 2020
the estimated incubation period distribution for MERS (Table 3 and Figure 3) との比較において，the incubation period values の，平均値の差は最大で 1日，95th percentiles も最大 2日の違いで，かなり近いもの remarkably similar となった。The estimated mean incubation periods for SARS については，今回示した 2019-nCoV の値と比べ，より短かく，またはより長く，大きな差があった more variable。MERS or SARS に近い incubation period を想定していた従来の研究結果は，(2019-nCoV の潜伏期間は) a shorter or longer incubation period であることから，適合性がなくなる。
Table 3. Estimated incubation periods for coronaviruses from different studies
Figure 3. Box-and-whisker-plots of estimated incubation periods for coronaviruses from different studies
議論
2020年1月20日から28日までの間に報告された，2019-nCoV in Wuhan に感染した武漢からの旅行者の潜伏間の範囲について明らかにした。この結果は，暴露から 3ないし 6日間に家族のうちの 5人が発症した，家族内小集積の 1例についての報告を裏付ける，empirical evidence が得られ，within the range for the incubation period of 0 to 14 days assumed by WHO and of 2 to 12 days assumed by ECDC にも矛盾しない。平均の潜伏期間 the mean incubation period について，10例のデータから 5.2日以上，武漢と広東省の間の渡航歴のある 16例では 4.8日 (range: 2-11) となった。あとの報告は，3日間の暴露期間 a 3-day exposure window のある旅行者に限定した。閉じた暴露期間 a closed exposure window を持つ 25例の旅行者らだけに絞って再度解析し直したところ，a mean incubation period of 4.5日 となり，先の報告により近い値となったが，the 95th percentile は 8.0日となった。今回の解析において，武漢での滞在期間内に感染する可能性を一律 a uniform prior probability に設定した。滞在期間中にも流行は変化するので，滞在初期よりも終わりに近づくにつれてより感染しやすくなる。こうした傾向により a slight bias towards longer incubation periods を生じる可能性があることから，推定値は最大 11日間までに限定することが無難だろう。症例を選択したことから，報告される患者全体と比べ，男性が多く，年齢も若い。患者数も少ない ... さらに，より詳細な解析が必要 ...
［Mod.MPP 注－In summary, the 3 models support the present conclusion that the upward side of the incubation period may well be 14 days.]
[4] 空港でのスクリーニングの有効性 Effectiveness of airport screening - Eurosurveillance
情報源 Eurosurveillance 2020; 25(5) 2020年2月6日
原著タイトル Effectiveness of airport screening at detecting travellers infected with novel coronavirus (2019-nCoV) Euro Surveill. 2020; 25(5): :pii=2000080
... 有効性を示す証拠が限られているにもかかわらず，過去 during the 2003 SARS epidemic and 2009 influenza A(H1N1) pandemic において，入国時の空港でのスクリーニング検査 airport screening が実施された。今回我々は，潜伏期間，入院期間，無症候性感染の割合について得られるデータを用い，欧州内の入出国時のスクリーニングが，欧州内へ入国する，感染 2019-nCoV infection のある渡航者の特定にどれほど有効か評価した ...
Simulation of travellers at each stage of infection with 2019-nCoV
感染のある旅行者 2019-nCoV infected travellers で，航空機の搭乗客を計画し，新たな地域に感染を拡げるリスクがあると考えられる 100人を想定した。渡航時間は，フライト時間＋チェックインなどのための約 1時間とした。また発熱などの症状が現れるのは，潜伏期間 (平均 5.2日) の終わりで，さらに重症化し入院・隔離されるのはその数日後と仮定した。また，体温スキャンでは特定されず医療機関も受診しないが，他者への感染性は有する，無症候性感染の個人が存在する可能性と，到着時すでに重症化していて入院となりスクリーニングを通らない症例があることも考慮に入れた。exit and entry screening で捕捉される感染のある旅行者，旅行中に重症化する症例，および特定されない症例の割合を推定した。これには以下の様々な状況 (の影響) が想定される： (i) 旅行期間; (ii) スクリーニングの感度 the sensitivity of exit and entry screening; (iii) 無症候性感染の割合; (iv) 潜伏期間 and (v) 発症から入院までの期間 (Table).
Table. Parameter values and assumptions for the baseline scenario estimating effectiveness of exit and entry screening at airports for detecting passengers infected with novel coronavirus (2019-nCoV)
Parameter / Value (baseline scenario) / Source
- 旅行期間 / 12 時間 / 北京－ロンドン [18]
- Sensitivity of exit screening / 86% / Sensitivity of infrared thermal image scanners [19]
- Sensitivity of entry screening / 86% / Sensitivity of infrared thermal image scanners [19]
- Proportion of asymptomatic infections undetectable by typical screening procedures / 17% / 1 of 6 reported asymptomatic in a 2019-nCoV family cluster [11]
- 潜伏期間/ Mean 5.2 days, variance 4.1 days / Reported Gamma distributed mean, variance estimated from uncertainty interval of mean [8]
- 発症から入院までの期間 / Mean 9.1 days, variance 14.7 days / Reported Gamma distributed mean, variance estimated from uncertainty interval of mean [8]
...
Effect of screening on detection
the baseline scenario では 44例 of 100 infected travellers が exit screening で捕捉され，旅行中に重症化する例は 0，entry screening でさらに 9例が特定され，the remaining 46例は検出できないという結果となった。
入国時のスクリーニングの有効性は，実施されている出国時のスクリーニングの有効性に大きく依存する。exit screening が行われていない場合の入国時スクリーニングで検出される症例数は，(行われている場合の 9 infected travellers に対し）53例となった。しかし，フライト中に発症する可能性も高くなるため，特に長時間フライトでは，exit screening の有効性が高い。
Figure 3. Probability of detecting travellers infected with novel coronavirus (2019-nCoV) at airport entry screening by travel duration and sensitivity of exit screening
...
Discussion and conclusions
--------------------------
As a response to the ongoing outbreak of the 2019-nCoV originating in Wuhan, exit screening has been implemented for international flights leaving China's major airports. Thermal scanning, which can identify passengers with fever (high external body temperature), allows for passengers exhibiting symptoms of 2019-nCoV infection to be tested before they board a plane. Similarly, entry screening for flights originating in the most affected regions may be under consideration at airports in regions in and outside China. We estimate that the key goal of syndromic screening at airports -- to prevent infected travellers from entering countries or regions with little or no ongoing transmission -- is only achievable if the rate of asymptomatic infections that are transmissible is negligible, screening sensitivity is almost perfect, and the incubation period is short. Based on early data from Li et al [8], 2019-nCoV appears to have a shorter incubation period than severe acute respiratory syndrome (SARS), and a higher rate of asymptomatic infections [11]. Under generally conservative assumptions on sensitivity, we find that 46 of 100 infected travellers will enter undetected.
Entry screening is an intuitive barrier for the prevention of infected people entering a country or region. However, evidence on its effectiveness remains limited and given its lack of specificity, it generates a high overhead of screened travellers uninfected with the targeted pathogen [5]. For example, when entry screening was implemented in Australia in response to the 2003 SARS outbreak, 1.84 million people were screened, 794 were quarantined, and no cases were confirmed [12]. While some cases of 2019-nCoV infection have been identified through airport screening in the current outbreak, our estimates indicate that likely more infected travellers have not been detected by screening.
It is important to note that our estimates are based on a number of key assumptions that cannot yet be informed directly by evidence from the ongoing 2019-nCoV outbreak. The current outbreak has spread rapidly and early evidence suggests that the average disease severity is lower than that of SARS. This may also suggest a substantial proportion of asymptomatic cases. A recent analysis of a family transmission cluster is based on a small sample size but one in 6 infections was asymptomatic [11]; this is a major impediment for the effectiveness of syndromic screening. However, if asymptomatic cases were not infectious they would not pose a risk for seeding infection chains on arrival. To allow easy adaptation of our results as new insight becomes available in the coming weeks, we developed a free interactive online tool, available at https://cmmid-lshtm.shinyapps.io/traveller_screening/.
While the most up-to-date data on the incubation period or the time until recovery from 2019-nCoV infection have been used in this analysis, these figures are likely to change over time as more data become available. Unless the incubation period is only a small fraction of the duration of infection in relation to that of symptomatic disease, and fever in particular, syndromic screening is likely to detect an insufficient fraction of infected cases to prevent local infections. In addition, the sensitivity of airport screening for the detection of 2019-nCoV has not been evaluated. However, we chose conservative estimates and show that with reduced sensitivity, the effectiveness of syndromic screening would further decline.
In many international airports, information is provided to travellers from affected regions recommending action if they develop symptoms on or after arrival [13-16]. Some countries, for example Japan, also require incoming passengers to complete forms detailing their past and future travel in order to aid tracing [17]. Due to the duration of the incubation period of 2019-nCoV infection, we find that exit or entry screening at airports for initial symptoms, via thermal scanners or similar, is unlikely to prevent passage of infected travellers into new countries or regions where they may seed local transmission.
[The complete article including tables, figures, and references can be accessed at the source URL above.]
［Mod.MPP 注－ ... One key question here is whether detection of 44% of infected individual justifies the expenditure. Another is whether this approach should be the only approach or should there be additional actions.]
[5] Selected media reports of transmission outside of China
A. 41 more 2019-nCoV positive on cruise ship, RFI
情報源 NHK News [in Japanese] 2020年2月7日
新型コロナウイルスの集団感染が確認されたクルーズ船で、新たに日本人21人を含む乗客41人の感染が確認されました。クルーズ船が横浜港沖に停泊して以降、乗員と乗客で感染が明らかになったのは61人となりました。厚生労働省はクルーズ船「ダイヤモンド・プリンセス」の船内で今月３日から乗客と乗員全員の合わせて3700人余りの検疫を行い、このうち、発熱やせきなどの症状があったり症状がある人と濃厚接触したりした合わせて273人から検体を採取してウイルス検査を実施してきました。そして７日、新たに171人の結果が判明し、41人の感染が明らかになりました。感染が確認された41人は全員が乗客で、このうち日本人は21人、年代別には20代から40代が３人、50代が３人、60代が８人、70代が21人、80代が６人だということです。また、重症者はいないということです。新たに感染が確認された41人は神奈川県のほか東京、埼玉、千葉、静岡の医療機関に搬送されることになっています。クルーズ船は先月20日に横浜を出たあと、香港に住む80歳の男性が香港で船を下りたあとに新型コロナウイルスへの感染が明らかになっていました。クルーズ船で感染が確認されたのは、香港の男性を除いて合わせて61人となりました。厚生労働省は残る3600人余りの乗客と乗員については、今後も引き続き船内にとどまり、原則として14日間、客室などで待機することを求めています。
[Mod.MPP 注－Age distribution of the 41 newly confirmed cases:
20s-40s: 3，50s: 3，60s: 8，70s: 21，80s: 6]
B. Nationalities of newly confirmed 2019-nCoV positive passengers on cruise ship
情報源 Kyodo [in Japanese] 2020年2月7日厚生労働省によると、41人の国籍は日本21人、米国8人、オーストラリア5人、カナダ5人、アルゼンチン1人、英国1人。
C. Singapore local transmission
情報源 The Straits Times 2020年2月5日
Another 4 cases of the coronavirus infection were confirmed by the Ministry of Health (MoH) on [Wed 5 Feb 2020], including the youngest patient confirmed so far, a 6 month old baby who is the child of an infected couple. Of the new cases, 3 are linked to the cluster of local transmissions announced on [Tue 4 Feb 2020], and 1 is an imported case involving a Chinese tourist from China's Wuhan city.
On [Tue 4 Feb 2020], MoH announced 6 confirmed cases of the coronavirus, with 4 women here infected who had not travelled to Wuhan, the epicentre of the virus outbreak.
These 4 cases are linked to a group of 20 tourists from Guangxi, China, that visited health products shop Yong Thai Hang in Cavan Road in Lavender. With the cases announced on [Wed 5 Feb 2020], the number of cases linked to the tour group is now 7. MoH said the Chinese health authorities have confirmed that 2 travellers from the tour group have the coronavirus infection.
It reiterated that there is no evidence of widespread community transmission in Singapore for now. Wednesday's [5 Feb 2020] announcement means that the total number of confirmed cases in Singapore is 28. All 4 new cases are in stable condition, while 22 cases confirmed earlier are stable or improving, and 1 case has been discharged, said MoH. The remaining case needs extra oxygen support, but is not in the intensive care unit.
Outside China, Singapore has the 2nd highest number of confirmed cases of the coronavirus. Japan has the most with 33 cases so far.
Details of new cases
--------------------
The 4 new cases announced here on [Wed 5 Feb 2020] include a father and son -- a Singaporean man and his baby boy. His wife and their maid were earlier confirmed to be infected. The 3rd new case is the Singaporean husband of an infected tour guide, while the 4th is a tourist from China. The father and son, as well as the husband of the tour guide, are among the 7 confirmed cases linked to a tour group that visited the Yong Thai Hang shop.
1st case: The baby boy, who is Singaporean and 6 months old, is the son of a woman who works at Yong Thai Hang, which caters to Chinese tour groups. He is warded in an isolation room at KK Women's and Children's Hospital. MoH said the baby was not in any infant care facility before he was hospitalised -- he was cared for at home. His 28 year old mother is a Singapore permanent resident who did not recently travel to China. On [Tue 4 Feb 2020], MoH confirmed that she and their foreign domestic helper, a 44 year old Indonesian woman, were infected with the coronavirus. This was after Yong Thai Hang was visited by a tour group from Guangxi on [23 Jan 2020]. The Singaporean tour guide of the group was later confirmed to be infected.
2nd case: The baby's father was also one of the confirmed cases announced on [Wed 5 Feb 2020] with no recent travel history to China. The 45 year old Singaporean man is warded in an isolation room at the National Centre for Infectious Diseases (NCID).
3rd case: Another case confirmed on [Wed 5 Feb 2020] linked to the Chinese tour group that visited the shop is the husband of the group's infected tour guide. The 40 year old Singaporean man also had not travelled to China recently, and is currently warded in an isolation room at NCID. He developed a fever on [24 Jan 2020] and visited Hougang Polyclinic with his wife, a 32 year old Singaporean woman, on [30 Jan 2020]. He went to NCID on [Mon 3 Feb 2020]. Before the man was admitted to hospital, he was at his home in Buangkok Green and worked at Diamond Industries Jewellery Company at Harbour Drive which was visited by the same tour group from Guangxi. The man also visited Pasir Panjang Hawker Centre and used public transport. MOH said that the risk of infection from transient contact, such as on public transport or in public places, is assessed to be low.
4th case: The last confirmed case announced on [Wed 5 Feb 2020] is a 42 year old Chinese national who arrived in Singapore from Wuhan on [21 Jan 2020]. She is the daughter of one of the earlier confirmed cases, a 73 year old woman who is also a Chinese national. As the 42 year old showed symptoms, she was taken by ambulance to NCID on the same day as her mother, immediately isolated, and is now warded in an isolation room at the centre.
Tour group from Guangxi
-----------------------
Regarding the tour group from Guangxi that visited the Yong Thai Hang shop, MOH said that the group was in Singapore from [22-23 Jan 2020], and also transited here for 3 hours on [27 Jan 2020] before leaving the country. The group also visited 5 other places here: Diamond Industries Jewellery Company in Harbour Drive; Meeting You Restaurant in Hamilton Road; Royal Dragon Restaurant in Havelock Road; T Galleria by DFS in Scotts Road; and D'Resort at Downtown East in Pasir Ris. Almost 14 days have passed since the tourists visited these places, and MoH has communicated with 142 contacts. All of these contacts are well except for one who has been isolated as a suspected case. Test results for this person are pending.
The ministry has also done contact tracing for the crew and passengers of the flight that left Singapore with the Chinese tour group on [27 Jan 2020]. 5 of them are still in Singapore and have been quarantined.
Overseas cases linked to Grand Hyatt Singapore
----------------------------------------------
On [Wed 5 Feb 2020], 3 business travellers -- a Malaysian and 2 South Koreans -- linked to a conference at the Grand Hyatt Singapore they attended last month [January 2020], were reported to have tested positive for the coronavirus. The 2 South Korean men had come into contact with the Malaysian, who was infected. Details on how, where and when the Malaysian man became infected were not revealed by MoH. The ministry said that this private business meeting at the hotel from [20-22 Jan 2020] involved 109 people from the same company. Of the 15 Singapore residents at this event, 11 are well. 4 have reported symptoms and were referred to NCID for assessment. The event's remaining 94 overseas participants have since left Singapore and MoH has informed the relevant health authorities abroad.
In Singapore, measures to combat the outbreak include mask distribution at residents' committee centres and community centres islandwide, which began last [Sat 1 Feb 2020]. The government announced on [30 Jan 2020] that all 1.3 million households in Singapore would be given a pack of 4 masks each amid reports of shops running out of stock. On [Tue 4 Feb 2020], it also said that large gatherings and communal activities, such as assemblies and excursions, will be suspended at schools, pre-schools and eldercare facilities here from [Wed 5 Feb 2020], after the 1st local transmissions of the coronavirus were reported.
MoH said on [Wed 5 Feb 2020] that 295 suspected cases have tested negative for the virus so far. Test results for 62 more cases are pending. The ministry has identified 379 close contacts of the confirmed cases. Of these, 304 are still in Singapore, with 299 contacted and being quarantined or isolated. Efforts are being made to contact the remaining 5 close contacts.
MoH continues to advise Singaporeans to defer all travel to Hubei province and all non-essential travel to mainland China. Members of the public should also observe good personal hygiene such as frequently washing their hands with soap. They should also wear a mask if they have respiratory symptoms such as a cough or shortness of breath, and seek medical attention promptly if they are feeling unwell.
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[Local transmission is occurring in Singapore. It awaits to see if it can be interrupted. - Mod.MPP]
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[6] Death of physician whistle-blower in Wuhan
Date: Fri 7 Feb 2020
Source: The New York Times [edited]
https://www.nytimes.com/2020/02/06/world/asia/Li-Wenliang-coronavirus.html
Chinese doctor, silenced after warning of outbreak, dies from coronavirus
-------------------------------------------------------------
Dr Li Wenliang issued a warning about a strange new virus. Then the authorities summoned him for questioning. He was the doctor who tried to sound a warning that a troubling cluster of viral infections in a Chinese province could grow out of control -- and was then summoned for a middle-of-the-night reprimand over his candor.
On [Fri 7 Feb 2020], the doctor died after contracting the very illness he had told medical school classmates about in an online chat room, the coronavirus. He joined the more than 600 other Chinese who have died in an outbreak that has now spread across the globe.
Dr Li "had the misfortune to be infected during the fight against the novel coronavirus pneumonia epidemic, and all-out efforts to save him failed," the Wuhan City Central Hospital said on Weibo, the Chinese social media service. "We express our deep regret and condolences."
Even before his death, Dr Li had become a hero to many Chinese after word of his treatment at the hands of the authorities emerged. In early January [2020], he was called in by both medical officials and the police, and forced to sign a statement denouncing his warning as an unfounded and illegal rumor.
Dr Li, who was 34 and expecting a 2nd child with his wife, had been a relatively obscure ophthalmologist in Wuhan, the capital of Hubei Province and the epicenter of the coronavirus epidemic. Dr Li's death has also exposed a troubling aspect of the epidemic that goes unmentioned in official statistics: the number of doctors, nurses, and medical workers infected by the virus.
Some unverified pictures of what appear to be government data have indicated that hundreds of hospital workers may have been infected in Wuhan. Earlier in the outbreak, a prominent infectious disease expert said that a single patient had infected 14 medical workers at one hospital.
Dr Li was also unusually young to be afflicted by the virus, at least according to the data gathered so far. The median of patients is between 49 and 56, researchers say.
When Dr Li posted his chat room warning on [30 Dec 2020], the new coronavirus had not yet been identified. He said it resembled severe acute respiratory syndrome, or SARS, an earlier coronavirus that ravaged China nearly 2 decades ago. Not long after his reprimand, Dr Li was vindicated as thousands of Wuhan residents fell ill with fever and pneumonia symptoms. He joined their number after contracting the virus from a patient he was treating for glaucoma.
Dr Li's death came after a night of speculation about his fate, including an online outpouring of grief in China prompted by premature reports that he had died. Just hours before confirming that he had died, the hospital said on Weibo that it was still fighting to save him. Soon after Dr Li's death was announced, the Hubei Province Health Commission issued a brief message offering condolences, and so did the health authorities of the city of Wuhan. Global Times, a reliably pro-government tabloid, also mourned the death, while also urging readers to support the government's fight against the epidemic. "That Li Wenliang could not escape having his life snatched away shows that this is an arduous and complex battle," an online article in Global Times said. "At this critical juncture, all of us must be united."
Dr Li's death appeared unlikely to inspire protests in Wuhan, which has been under lockdown for just over 2 weeks in an unprecedented effort to extinguish the epidemic. In Wuhan and other heavily restricted areas of Hubei, residents mostly stay inside their homes and avoid socializing for fear of catching the virus. Much of the rest of China is also under tight restrictions that make mass displays of mourning unlikely. Dr Li continued to speak out during his own illness.
[byline: Chris Buckley]
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[7] WHO situation report 17 (as of 6 Feb 2020)
Date: Thu 6 Feb 2020
Source: WHO [edited]
https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200206-sitrep-17-ncov.pdf
Highlights
----------
- No new countries reported cases of 2019-nCoV in the past 24 hours.
- WHO is working with partners to strengthen global diagnostic capacity for 2019- nCoV detection to improve surveillance and track the spread of disease. WHO and partners have activated a network of specialized referral laboratories with demonstrated expertise in the molecular detection of coronaviruses. These international labs can support national labs to confirm new cases and troubleshoot their molecular assays.
- WHO is convening a global research and innovation forum to mobilize international action in response to the new coronavirus, covering a broad spectrum of research areas including epidemiology, clinical care, vaccines, therapeutics, diagnostics, animal health, social sciences, and other topics. More details can be found in section [7] below.
[The figures provided in the report are the figures from the National Health Commission of China from 5 Feb 2020. The 6-7 Feb 2020 figures are included in section [1] above. They are posted at approximately 7 PM (GMT-5) which is 1 AM (GMT+1) in Geneva. - Mod.MPP]
Technical focus: establishing global/regional coordination and technical guidance
--------------------------------------------------------------
WHO is working with partners to strengthen global diagnostic capacity for 2019-nCoV detection to improve surveillance and track the spread of disease. Public health efforts to control the spread of disease in countries with imported cases depend critically on the ability to detect the pathogen quickly. WHO and partners have activated a network of specialized referral laboratories with demonstrated expertise in the molecular detection of coronaviruses. These international labs can support national labs to confirm new cases and troubleshoot their molecular assays.
Currently, there are 15 laboratories have been identified to provide reference testing support for 2019-nCoV. These laboratories include:
1. Armed Forces Research Institute of Medical Sciences, Thailand
2. Erasmus Medical Center, The Netherlands
3. Hong Kong University, Hong Kong SAR, China
4. Institute of Tropical Medicine, Nagasaki University, Japan
5. Institute of Virology, Charité, Robert Koch Institute, Germany
6. National Institute for Communicable Diseases, South Africa
7. National Institute of Health, Thailand
8. National Institute of Virology, India
9. National Public Health Laboratory, Singapore
10. Institut Pasteur Dakar, Senegal
11. Institut Pasteur, Paris
12. Public Health England, UK
13. State Research Center for Virology and Biotechnology, Vector Institute, Russia
14. United States Center for Disease Control and Prevention, USA
15. Victorian Infectious Diseases Reference Laboratory, Australia
WHO is working to ensure 2019-nCoV test availability, including:
a. screening of 2019-nCoV PCR protocols from academic laboratories for validation data,
b. evaluation of the potential to use existing commercial coronavirus assays (for example, SARS-CoV. to detect 2019-nCoV with high sensitivity, and
c. working with commercial and noncommercial agencies with capacity to manufacture and distribute newly-developed 2019-nCoV PCR assays.
To increase regional testing capacity, efforts to increase national capacity and provide regional reference laboratory support is ongoing. WHO has made 250,000 tests available to WHO Regional Offices and national laboratories. These tests are being shipped to 159 laboratories across all WHO regions.
WHO will also utilize the Shipping Fund Programme established by the Global Influenza Surveillance and Response System as a mechanism to send clinical samples from patients meeting the case definition of suspected 2019-nCoV infection to international referral laboratories.
National capacity for detection of 2019-nCoV must be strengthened so that diagnostic testing can be performed rapidly without the need for overseas shipping. One way this will be achieved is by working with existing global networks for detection of respiratory pathogens, such as National Influenza Centres.
Table 2. Countries, territories or areas with reported confirmed 2019-nCoV cases and deaths. Data as of [5 Feb 2020]
Excerpted to show confirmed cases outside of mainland China:
WHO Region:
Country / Territory / Area:
Total confirmed (new cases in past 24 hours)* / Total (new) with travel history to China / Total (new) cases with possible or confirmed transmission outside of China** / Total (new) case with site of transmission under investigation / Total (new) deaths
Western Pacific Region:
China***: 28 060 (3697) / / / / 564 (73)
Japan: 25 (2) / (1) / 4 (1) / 0 / 0
Republic of Korea: 23 (5) /10 (1) / 11 (3) / 2 (1) / 0
Viet Nam: 10 / 7 / 3 / 0 / 0
Singapore: 28 (4) / 21 (1) / 7 (3) / 0 / 0
Australia: 14 (1) / 14 (1) / 0 / 0 / 0
Malaysia: 12 (2) / 9 (2) / 2 / 1 / 0
Cambodia: 1 / 1 / 0 / 0 / 0
Philippines: 3 / 2 / 0 / 1 / 0
South-East Asia Region:
Thailand: 25 / 21 / 4 / 0 / 0
Nepal: 1 / 1 / 0 / 0 / 0
Sri Lanka: 1 / 1 / 0 / 0 / 0
India: 3 / 3 / 0 / 0 / 0
Region of the Americas:
United States of America: 11 (1) / 10 (1) / 2 / 0 / 0
Canada: 5 / 3 / 0 / 2 / 0
European Region:
France: 6 / 5 / 1 / 0 / 0
Finland: 1 / 1 / 0 / 0 / 0
Germany: 12 / 2 / 10 / 0 / 0
Italy: 2 / 2 / 0 / 0 / 0
Russian Federation: 2 / 2 / 0 / 0 / 0
Spain: 1 / 0 / 1**** / 0 / 0
Sweden: 1 / 1 / 0 / 0 / 0
United Kingdom: 2 / 1 / 1 / 0 / 0
Belgium: 1 (1) / 1 (1) / 0 / 0 / 0
Eastern Mediterranean Region:
United Arab Emirates: 5 / 5 / 0 / 0 / 0
Other: Cases on an international conveyance (Japan): 20***** (10) / 0 / 0 / 20 (10) / 0
*Case classifications are based on WHO case definitions [https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov) for 2019-nCoV.
**Location of transmission is classified based on WHO analysis of available official data, and may be subject to reclassification as additional data become available.
***Confirmed cases in China include cases confirmed in Hong Kong SAR (21 confirmed cases, 1 death), Macao SAR (10 confirmed cases), and Taipei and environs (11 confirmed cases).
****The exposure occurred in Germany.
*****Cases identified on a cruise ship currently in Japanese territorial waters.
[There are excellent graphs and a map available at the source URL, as well as strategic objectives and preparedness and response information.
- Figure 1. Countries, territories or areas with reported confirmed cases of 2019-nCoV, 6 Feb 2020
- Figure 2: Epidemic curve of 2019-nCoV cases (n=109) identified outside of China, by date of onset of symptoms and travel history, 6 Feb 2020
- Figure 3: Epidemic curve of 2019-nCoV cases (n=216) identified outside of China, by date of reporting and travel history, 6 Feb 2020. - Mod.MPP]
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[The number of countries reporting confirmed cases of the 2019-nCoV with transmission occurring outside of China remains at 10 (Japan, South Korea, Viet Nam, Malaysia, Thailand, USA, France, Germany, Spain, and the UK), with Japan adding 41 new cases related to the cruise ship off the coast of Yokahama (see Novel coronavirus (33): China, global, epidemic modeling interactive tool available 20200204.6954575, section [3]C)/ - Mod.MPP]
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[8] WHO accelerated research and development for nCoV
Date: Thu 6 Feb 2020
Source: WHO News release [abridged, edited]
https://www.who.int/news-room/detail/06-02-2020-who-to-accelerate-research-and-innovation-for-new-coronavirus
WHO to accelerate research and innovation for new coronavirus
-------------------------------------------------------------
WHO is convening a global research and innovation forum to mobilize international action in response to the new coronavirus (2019-nCoV).
"Harnessing the power of science is critical for bringing this outbreak under control," said WHO director-general Dr Tedros Adhanom Ghebreyesus. "There are questions we need answers to, and tools we need developed as quickly as possible. WHO is playing an important coordinating role by bringing the scientific community together to identify research priorities and accelerate progress."
The forum, to be held [11-12 Feb 2020] in Geneva, is organized in collaboration with the Global Research Collaboration for Infectious Disease Preparedness. The forum will bring together key players including leading scientists as well as public health agencies, ministries of health and research funders pursuing 2019-nCoV critical animal health and public health research and the development of vaccines, therapeutics and diagnostics, among other innovations.
Participants will discuss several areas of research, including identifying the source of the virus as well as sharing of biological samples and genetic sequences. Experts will build on existing SARS and MERS coronavirus research and identify knowledge gaps and research priorities in order to accelerate scientific information and medical products most needed to minimize the impact of the 2019-nCoV outbreak.
The meeting is expected to produce a global research agenda for the new coronavirus, setting priorities and frameworks that can guide which projects are undertaken first. "Understanding the disease, its reservoirs, transmission and clinical severity and then developing effective counter-measures is critical for the control of the outbreak, to reduce deaths and minimize the economic impact," said Dr Soumya Swaminathan, WHO chief scientist.
This will also fast-track the development and evaluation of effective diagnostic tests, vaccines and medicines, while establishing mechanisms for affordable access to vulnerable populations and facilitating community engagement.
"The WHO R&D Blueprint is a global strategy and preparedness platform that drives coordinated development of drugs and vaccines before epidemics, and allows the rapid activation of R&D activities during epidemics. It speeds up the availability of the diagnostics, vaccines and treatments and technologies that ultimately save lives," added Dr Michael Ryan, executive director, WHO Health Emergencies Programme. Setting clear global research priorities for the novel coronavirus should lead to more efficient investments, high-quality research and synergies among global researchers.
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[9] WHO open course, Critical Care Severe Acute Respiratory Infection Training
Date: 6 Feb 2020
Source: WHO [edited]
https://openwho.org/courses/severe-acute-respiratory-infection
Course information
------------------
The WHO Critical Care Training Short Course for Severe Acute Respiratory Infection (SARI) includes content on clinical management of patients with a severe acute respiratory infection.
This course is intended for clinicians who are working in intensive care units (ICUs) in low and middle-income countries and managing adult and pediatric patients with severe forms of acute respiratory infection (SARI), including severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis and septic shock. It is a hands-on practical guide to be used by health care professionals involved in critical care management during outbreaks of influenza virus (seasonal) human infection due avian influenza virus (H5N1, H7N9), MERS-CoV, nCoV or other emerging respiratory viral epidemics.
Learning objectives. By the end of this course, participants should possess some of the necessary tools that can be used to care for the critically ill patient from hospital entry to hospital discharge.
Course duration. Approximately 10 hours
Target audience. This course is intended for clinicians who are working in intensive care units (ICUs) in low and middle-income countries.
Certificates. There are no certificates available at this time.
Course contents. There are 14 modules:
- Module 1: Introduction to nCoV and IPC
- Module 2: Clinical Syndromes and Pathophysiology of Sepsis and ARDS
- Module 3: Triage
- Module 4: Monitoring
- Module 5: Diagnostics
- Module 6: Oxygen Therapy
- Module 7: Antimicrobials
- Module 8: Sepsis
- Module 9: Mechanical Ventilation
- Module 10: Sedation
- Module 11: Best Practices to Prevent Complications
- Module 12: Liberation from Mechanical Ventilation
- Module 13: Quality in Critical Care
- Module 14: Pandemic Preparedness and Ethical Considerations
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See Also
Novel coronavirus (35): China, global, health workers, cruise, WHO, RFI 20200206.6959291
B. Nationalities of newly confirmed 2019-nCoV positive passengers on cruise ship
情報源 Kyodo [in Japanese] 2020年2月7日厚生労働省によると、41人の国籍は日本21人、米国8人、オーストラリア5人、カナダ5人、アルゼンチン1人、英国1人。
C. Singapore local transmission
情報源 The Straits Times 2020年2月5日
Another 4 cases of the coronavirus infection were confirmed by the Ministry of Health (MoH) on [Wed 5 Feb 2020], including the youngest patient confirmed so far, a 6 month old baby who is the child of an infected couple. Of the new cases, 3 are linked to the cluster of local transmissions announced on [Tue 4 Feb 2020], and 1 is an imported case involving a Chinese tourist from China's Wuhan city.
On [Tue 4 Feb 2020], MoH announced 6 confirmed cases of the coronavirus, with 4 women here infected who had not travelled to Wuhan, the epicentre of the virus outbreak.
These 4 cases are linked to a group of 20 tourists from Guangxi, China, that visited health products shop Yong Thai Hang in Cavan Road in Lavender. With the cases announced on [Wed 5 Feb 2020], the number of cases linked to the tour group is now 7. MoH said the Chinese health authorities have confirmed that 2 travellers from the tour group have the coronavirus infection.
It reiterated that there is no evidence of widespread community transmission in Singapore for now. Wednesday's [5 Feb 2020] announcement means that the total number of confirmed cases in Singapore is 28. All 4 new cases are in stable condition, while 22 cases confirmed earlier are stable or improving, and 1 case has been discharged, said MoH. The remaining case needs extra oxygen support, but is not in the intensive care unit.
Outside China, Singapore has the 2nd highest number of confirmed cases of the coronavirus. Japan has the most with 33 cases so far.
Details of new cases
--------------------
The 4 new cases announced here on [Wed 5 Feb 2020] include a father and son -- a Singaporean man and his baby boy. His wife and their maid were earlier confirmed to be infected. The 3rd new case is the Singaporean husband of an infected tour guide, while the 4th is a tourist from China. The father and son, as well as the husband of the tour guide, are among the 7 confirmed cases linked to a tour group that visited the Yong Thai Hang shop.
1st case: The baby boy, who is Singaporean and 6 months old, is the son of a woman who works at Yong Thai Hang, which caters to Chinese tour groups. He is warded in an isolation room at KK Women's and Children's Hospital. MoH said the baby was not in any infant care facility before he was hospitalised -- he was cared for at home. His 28 year old mother is a Singapore permanent resident who did not recently travel to China. On [Tue 4 Feb 2020], MoH confirmed that she and their foreign domestic helper, a 44 year old Indonesian woman, were infected with the coronavirus. This was after Yong Thai Hang was visited by a tour group from Guangxi on [23 Jan 2020]. The Singaporean tour guide of the group was later confirmed to be infected.
2nd case: The baby's father was also one of the confirmed cases announced on [Wed 5 Feb 2020] with no recent travel history to China. The 45 year old Singaporean man is warded in an isolation room at the National Centre for Infectious Diseases (NCID).
3rd case: Another case confirmed on [Wed 5 Feb 2020] linked to the Chinese tour group that visited the shop is the husband of the group's infected tour guide. The 40 year old Singaporean man also had not travelled to China recently, and is currently warded in an isolation room at NCID. He developed a fever on [24 Jan 2020] and visited Hougang Polyclinic with his wife, a 32 year old Singaporean woman, on [30 Jan 2020]. He went to NCID on [Mon 3 Feb 2020]. Before the man was admitted to hospital, he was at his home in Buangkok Green and worked at Diamond Industries Jewellery Company at Harbour Drive which was visited by the same tour group from Guangxi. The man also visited Pasir Panjang Hawker Centre and used public transport. MOH said that the risk of infection from transient contact, such as on public transport or in public places, is assessed to be low.
4th case: The last confirmed case announced on [Wed 5 Feb 2020] is a 42 year old Chinese national who arrived in Singapore from Wuhan on [21 Jan 2020]. She is the daughter of one of the earlier confirmed cases, a 73 year old woman who is also a Chinese national. As the 42 year old showed symptoms, she was taken by ambulance to NCID on the same day as her mother, immediately isolated, and is now warded in an isolation room at the centre.
Tour group from Guangxi
-----------------------
Regarding the tour group from Guangxi that visited the Yong Thai Hang shop, MOH said that the group was in Singapore from [22-23 Jan 2020], and also transited here for 3 hours on [27 Jan 2020] before leaving the country. The group also visited 5 other places here: Diamond Industries Jewellery Company in Harbour Drive; Meeting You Restaurant in Hamilton Road; Royal Dragon Restaurant in Havelock Road; T Galleria by DFS in Scotts Road; and D'Resort at Downtown East in Pasir Ris. Almost 14 days have passed since the tourists visited these places, and MoH has communicated with 142 contacts. All of these contacts are well except for one who has been isolated as a suspected case. Test results for this person are pending.
The ministry has also done contact tracing for the crew and passengers of the flight that left Singapore with the Chinese tour group on [27 Jan 2020]. 5 of them are still in Singapore and have been quarantined.
Overseas cases linked to Grand Hyatt Singapore
----------------------------------------------
On [Wed 5 Feb 2020], 3 business travellers -- a Malaysian and 2 South Koreans -- linked to a conference at the Grand Hyatt Singapore they attended last month [January 2020], were reported to have tested positive for the coronavirus. The 2 South Korean men had come into contact with the Malaysian, who was infected. Details on how, where and when the Malaysian man became infected were not revealed by MoH. The ministry said that this private business meeting at the hotel from [20-22 Jan 2020] involved 109 people from the same company. Of the 15 Singapore residents at this event, 11 are well. 4 have reported symptoms and were referred to NCID for assessment. The event's remaining 94 overseas participants have since left Singapore and MoH has informed the relevant health authorities abroad.
In Singapore, measures to combat the outbreak include mask distribution at residents' committee centres and community centres islandwide, which began last [Sat 1 Feb 2020]. The government announced on [30 Jan 2020] that all 1.3 million households in Singapore would be given a pack of 4 masks each amid reports of shops running out of stock. On [Tue 4 Feb 2020], it also said that large gatherings and communal activities, such as assemblies and excursions, will be suspended at schools, pre-schools and eldercare facilities here from [Wed 5 Feb 2020], after the 1st local transmissions of the coronavirus were reported.
MoH said on [Wed 5 Feb 2020] that 295 suspected cases have tested negative for the virus so far. Test results for 62 more cases are pending. The ministry has identified 379 close contacts of the confirmed cases. Of these, 304 are still in Singapore, with 299 contacted and being quarantined or isolated. Efforts are being made to contact the remaining 5 close contacts.
MoH continues to advise Singaporeans to defer all travel to Hubei province and all non-essential travel to mainland China. Members of the public should also observe good personal hygiene such as frequently washing their hands with soap. They should also wear a mask if they have respiratory symptoms such as a cough or shortness of breath, and seek medical attention promptly if they are feeling unwell.
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[Local transmission is occurring in Singapore. It awaits to see if it can be interrupted. - Mod.MPP]
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[6] Death of physician whistle-blower in Wuhan
Date: Fri 7 Feb 2020
Source: The New York Times [edited]
https://www.nytimes.com/2020/02/06/world/asia/Li-Wenliang-coronavirus.html
Chinese doctor, silenced after warning of outbreak, dies from coronavirus
-------------------------------------------------------------
Dr Li Wenliang issued a warning about a strange new virus. Then the authorities summoned him for questioning. He was the doctor who tried to sound a warning that a troubling cluster of viral infections in a Chinese province could grow out of control -- and was then summoned for a middle-of-the-night reprimand over his candor.
On [Fri 7 Feb 2020], the doctor died after contracting the very illness he had told medical school classmates about in an online chat room, the coronavirus. He joined the more than 600 other Chinese who have died in an outbreak that has now spread across the globe.
Dr Li "had the misfortune to be infected during the fight against the novel coronavirus pneumonia epidemic, and all-out efforts to save him failed," the Wuhan City Central Hospital said on Weibo, the Chinese social media service. "We express our deep regret and condolences."
Even before his death, Dr Li had become a hero to many Chinese after word of his treatment at the hands of the authorities emerged. In early January [2020], he was called in by both medical officials and the police, and forced to sign a statement denouncing his warning as an unfounded and illegal rumor.
Dr Li, who was 34 and expecting a 2nd child with his wife, had been a relatively obscure ophthalmologist in Wuhan, the capital of Hubei Province and the epicenter of the coronavirus epidemic. Dr Li's death has also exposed a troubling aspect of the epidemic that goes unmentioned in official statistics: the number of doctors, nurses, and medical workers infected by the virus.
Some unverified pictures of what appear to be government data have indicated that hundreds of hospital workers may have been infected in Wuhan. Earlier in the outbreak, a prominent infectious disease expert said that a single patient had infected 14 medical workers at one hospital.
Dr Li was also unusually young to be afflicted by the virus, at least according to the data gathered so far. The median of patients is between 49 and 56, researchers say.
When Dr Li posted his chat room warning on [30 Dec 2020], the new coronavirus had not yet been identified. He said it resembled severe acute respiratory syndrome, or SARS, an earlier coronavirus that ravaged China nearly 2 decades ago. Not long after his reprimand, Dr Li was vindicated as thousands of Wuhan residents fell ill with fever and pneumonia symptoms. He joined their number after contracting the virus from a patient he was treating for glaucoma.
Dr Li's death came after a night of speculation about his fate, including an online outpouring of grief in China prompted by premature reports that he had died. Just hours before confirming that he had died, the hospital said on Weibo that it was still fighting to save him. Soon after Dr Li's death was announced, the Hubei Province Health Commission issued a brief message offering condolences, and so did the health authorities of the city of Wuhan. Global Times, a reliably pro-government tabloid, also mourned the death, while also urging readers to support the government's fight against the epidemic. "That Li Wenliang could not escape having his life snatched away shows that this is an arduous and complex battle," an online article in Global Times said. "At this critical juncture, all of us must be united."
Dr Li's death appeared unlikely to inspire protests in Wuhan, which has been under lockdown for just over 2 weeks in an unprecedented effort to extinguish the epidemic. In Wuhan and other heavily restricted areas of Hubei, residents mostly stay inside their homes and avoid socializing for fear of catching the virus. Much of the rest of China is also under tight restrictions that make mass displays of mourning unlikely. Dr Li continued to speak out during his own illness.
[byline: Chris Buckley]
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[7] WHO situation report 17 (as of 6 Feb 2020)
Date: Thu 6 Feb 2020
Source: WHO [edited]
https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200206-sitrep-17-ncov.pdf
Highlights
----------
- No new countries reported cases of 2019-nCoV in the past 24 hours.
- WHO is working with partners to strengthen global diagnostic capacity for 2019- nCoV detection to improve surveillance and track the spread of disease. WHO and partners have activated a network of specialized referral laboratories with demonstrated expertise in the molecular detection of coronaviruses. These international labs can support national labs to confirm new cases and troubleshoot their molecular assays.
- WHO is convening a global research and innovation forum to mobilize international action in response to the new coronavirus, covering a broad spectrum of research areas including epidemiology, clinical care, vaccines, therapeutics, diagnostics, animal health, social sciences, and other topics. More details can be found in section [7] below.
[The figures provided in the report are the figures from the National Health Commission of China from 5 Feb 2020. The 6-7 Feb 2020 figures are included in section [1] above. They are posted at approximately 7 PM (GMT-5) which is 1 AM (GMT+1) in Geneva. - Mod.MPP]
Technical focus: establishing global/regional coordination and technical guidance
--------------------------------------------------------------
WHO is working with partners to strengthen global diagnostic capacity for 2019-nCoV detection to improve surveillance and track the spread of disease. Public health efforts to control the spread of disease in countries with imported cases depend critically on the ability to detect the pathogen quickly. WHO and partners have activated a network of specialized referral laboratories with demonstrated expertise in the molecular detection of coronaviruses. These international labs can support national labs to confirm new cases and troubleshoot their molecular assays.
Currently, there are 15 laboratories have been identified to provide reference testing support for 2019-nCoV. These laboratories include:
1. Armed Forces Research Institute of Medical Sciences, Thailand
2. Erasmus Medical Center, The Netherlands
3. Hong Kong University, Hong Kong SAR, China
4. Institute of Tropical Medicine, Nagasaki University, Japan
5. Institute of Virology, Charité, Robert Koch Institute, Germany
6. National Institute for Communicable Diseases, South Africa
7. National Institute of Health, Thailand
8. National Institute of Virology, India
9. National Public Health Laboratory, Singapore
10. Institut Pasteur Dakar, Senegal
11. Institut Pasteur, Paris
12. Public Health England, UK
13. State Research Center for Virology and Biotechnology, Vector Institute, Russia
14. United States Center for Disease Control and Prevention, USA
15. Victorian Infectious Diseases Reference Laboratory, Australia
WHO is working to ensure 2019-nCoV test availability, including:
a. screening of 2019-nCoV PCR protocols from academic laboratories for validation data,
b. evaluation of the potential to use existing commercial coronavirus assays (for example, SARS-CoV. to detect 2019-nCoV with high sensitivity, and
c. working with commercial and noncommercial agencies with capacity to manufacture and distribute newly-developed 2019-nCoV PCR assays.
To increase regional testing capacity, efforts to increase national capacity and provide regional reference laboratory support is ongoing. WHO has made 250,000 tests available to WHO Regional Offices and national laboratories. These tests are being shipped to 159 laboratories across all WHO regions.
WHO will also utilize the Shipping Fund Programme established by the Global Influenza Surveillance and Response System as a mechanism to send clinical samples from patients meeting the case definition of suspected 2019-nCoV infection to international referral laboratories.
National capacity for detection of 2019-nCoV must be strengthened so that diagnostic testing can be performed rapidly without the need for overseas shipping. One way this will be achieved is by working with existing global networks for detection of respiratory pathogens, such as National Influenza Centres.
Table 2. Countries, territories or areas with reported confirmed 2019-nCoV cases and deaths. Data as of [5 Feb 2020]
Excerpted to show confirmed cases outside of mainland China:
WHO Region:
Country / Territory / Area:
Total confirmed (new cases in past 24 hours)* / Total (new) with travel history to China / Total (new) cases with possible or confirmed transmission outside of China** / Total (new) case with site of transmission under investigation / Total (new) deaths
Western Pacific Region:
China***: 28 060 (3697) / / / / 564 (73)
Japan: 25 (2) / (1) / 4 (1) / 0 / 0
Republic of Korea: 23 (5) /10 (1) / 11 (3) / 2 (1) / 0
Viet Nam: 10 / 7 / 3 / 0 / 0
Singapore: 28 (4) / 21 (1) / 7 (3) / 0 / 0
Australia: 14 (1) / 14 (1) / 0 / 0 / 0
Malaysia: 12 (2) / 9 (2) / 2 / 1 / 0
Cambodia: 1 / 1 / 0 / 0 / 0
Philippines: 3 / 2 / 0 / 1 / 0
South-East Asia Region:
Thailand: 25 / 21 / 4 / 0 / 0
Nepal: 1 / 1 / 0 / 0 / 0
Sri Lanka: 1 / 1 / 0 / 0 / 0
India: 3 / 3 / 0 / 0 / 0
Region of the Americas:
United States of America: 11 (1) / 10 (1) / 2 / 0 / 0
Canada: 5 / 3 / 0 / 2 / 0
European Region:
France: 6 / 5 / 1 / 0 / 0
Finland: 1 / 1 / 0 / 0 / 0
Germany: 12 / 2 / 10 / 0 / 0
Italy: 2 / 2 / 0 / 0 / 0
Russian Federation: 2 / 2 / 0 / 0 / 0
Spain: 1 / 0 / 1**** / 0 / 0
Sweden: 1 / 1 / 0 / 0 / 0
United Kingdom: 2 / 1 / 1 / 0 / 0
Belgium: 1 (1) / 1 (1) / 0 / 0 / 0
Eastern Mediterranean Region:
United Arab Emirates: 5 / 5 / 0 / 0 / 0
Other: Cases on an international conveyance (Japan): 20***** (10) / 0 / 0 / 20 (10) / 0
*Case classifications are based on WHO case definitions [https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov) for 2019-nCoV.
**Location of transmission is classified based on WHO analysis of available official data, and may be subject to reclassification as additional data become available.
***Confirmed cases in China include cases confirmed in Hong Kong SAR (21 confirmed cases, 1 death), Macao SAR (10 confirmed cases), and Taipei and environs (11 confirmed cases).
****The exposure occurred in Germany.
*****Cases identified on a cruise ship currently in Japanese territorial waters.
[There are excellent graphs and a map available at the source URL, as well as strategic objectives and preparedness and response information.
- Figure 1. Countries, territories or areas with reported confirmed cases of 2019-nCoV, 6 Feb 2020
- Figure 2: Epidemic curve of 2019-nCoV cases (n=109) identified outside of China, by date of onset of symptoms and travel history, 6 Feb 2020
- Figure 3: Epidemic curve of 2019-nCoV cases (n=216) identified outside of China, by date of reporting and travel history, 6 Feb 2020. - Mod.MPP]
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[The number of countries reporting confirmed cases of the 2019-nCoV with transmission occurring outside of China remains at 10 (Japan, South Korea, Viet Nam, Malaysia, Thailand, USA, France, Germany, Spain, and the UK), with Japan adding 41 new cases related to the cruise ship off the coast of Yokahama (see Novel coronavirus (33): China, global, epidemic modeling interactive tool available 20200204.6954575, section [3]C)/ - Mod.MPP]
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[8] WHO accelerated research and development for nCoV
Date: Thu 6 Feb 2020
Source: WHO News release [abridged, edited]
https://www.who.int/news-room/detail/06-02-2020-who-to-accelerate-research-and-innovation-for-new-coronavirus
WHO to accelerate research and innovation for new coronavirus
-------------------------------------------------------------
WHO is convening a global research and innovation forum to mobilize international action in response to the new coronavirus (2019-nCoV).
"Harnessing the power of science is critical for bringing this outbreak under control," said WHO director-general Dr Tedros Adhanom Ghebreyesus. "There are questions we need answers to, and tools we need developed as quickly as possible. WHO is playing an important coordinating role by bringing the scientific community together to identify research priorities and accelerate progress."
The forum, to be held [11-12 Feb 2020] in Geneva, is organized in collaboration with the Global Research Collaboration for Infectious Disease Preparedness. The forum will bring together key players including leading scientists as well as public health agencies, ministries of health and research funders pursuing 2019-nCoV critical animal health and public health research and the development of vaccines, therapeutics and diagnostics, among other innovations.
Participants will discuss several areas of research, including identifying the source of the virus as well as sharing of biological samples and genetic sequences. Experts will build on existing SARS and MERS coronavirus research and identify knowledge gaps and research priorities in order to accelerate scientific information and medical products most needed to minimize the impact of the 2019-nCoV outbreak.
The meeting is expected to produce a global research agenda for the new coronavirus, setting priorities and frameworks that can guide which projects are undertaken first. "Understanding the disease, its reservoirs, transmission and clinical severity and then developing effective counter-measures is critical for the control of the outbreak, to reduce deaths and minimize the economic impact," said Dr Soumya Swaminathan, WHO chief scientist.
This will also fast-track the development and evaluation of effective diagnostic tests, vaccines and medicines, while establishing mechanisms for affordable access to vulnerable populations and facilitating community engagement.
"The WHO R&D Blueprint is a global strategy and preparedness platform that drives coordinated development of drugs and vaccines before epidemics, and allows the rapid activation of R&D activities during epidemics. It speeds up the availability of the diagnostics, vaccines and treatments and technologies that ultimately save lives," added Dr Michael Ryan, executive director, WHO Health Emergencies Programme. Setting clear global research priorities for the novel coronavirus should lead to more efficient investments, high-quality research and synergies among global researchers.
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[9] WHO open course, Critical Care Severe Acute Respiratory Infection Training
Date: 6 Feb 2020
Source: WHO [edited]
https://openwho.org/courses/severe-acute-respiratory-infection
Course information
------------------
The WHO Critical Care Training Short Course for Severe Acute Respiratory Infection (SARI) includes content on clinical management of patients with a severe acute respiratory infection.
This course is intended for clinicians who are working in intensive care units (ICUs) in low and middle-income countries and managing adult and pediatric patients with severe forms of acute respiratory infection (SARI), including severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis and septic shock. It is a hands-on practical guide to be used by health care professionals involved in critical care management during outbreaks of influenza virus (seasonal) human infection due avian influenza virus (H5N1, H7N9), MERS-CoV, nCoV or other emerging respiratory viral epidemics.
Learning objectives. By the end of this course, participants should possess some of the necessary tools that can be used to care for the critically ill patient from hospital entry to hospital discharge.
Course duration. Approximately 10 hours
Target audience. This course is intended for clinicians who are working in intensive care units (ICUs) in low and middle-income countries.
Certificates. There are no certificates available at this time.
Course contents. There are 14 modules:
- Module 1: Introduction to nCoV and IPC
- Module 2: Clinical Syndromes and Pathophysiology of Sepsis and ARDS
- Module 3: Triage
- Module 4: Monitoring
- Module 5: Diagnostics
- Module 6: Oxygen Therapy
- Module 7: Antimicrobials
- Module 8: Sepsis
- Module 9: Mechanical Ventilation
- Module 10: Sedation
- Module 11: Best Practices to Prevent Complications
- Module 12: Liberation from Mechanical Ventilation
- Module 13: Quality in Critical Care
- Module 14: Pandemic Preparedness and Ethical Considerations
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See Also
Novel coronavirus (35): China, global, health workers, cruise, WHO, RFI 20200206.6959291