Written by: Haoyue Guo
Edited by: Elly Chaw
Following the start of an outbreak of pneumonia cases in Wuhan, China, 217 cases of the novel coronavirus infection have been diagnosed up to 20th January 2020, and that includes a spike of 136 new cases due to the distribution of rapid testing kits that are designed to detect this infection to hospitals. Sporadic cases have also been reported among travellers from Wuhan to other major cities in China, and to Japan, Thailand, and Korea. Although a method of transmission has not been fully established at the time of writing, human-to-human transmission is a heavy suspect and public health measures must be implemented to minimise the spread of the disease.
It is important to acknowledge that the current outbreak coincides with the Chinese New Year period, a time during which a large number of people travel in three main patterns: between major cities in China, from urban to rural areas, and from China to other countries for tourism.
Transportation between major cities in China mostly take the forms of aviation and rail. At such a crucial time, it is important to inform travellers of preventive measures and personal hygiene practices especially in places with high population density — airports, train stations, and in confined spaces such as aircraft. Given that the epidemiological characteristics of this novel coronavirus are not clear at the moment, preventives can be adapted from the previous SARS and MERS outbreaks which occurred in 2003 and 2015, respectively. The World Health Organisation (WHO) has also released interim guidelines accordingly, and that includes offering medical masks to suspected patients and cleaning the hands after contact with respiratory secretions.
A large flow of population from urban to rural areas is also expected, as many who live and work in cities return to their hometowns for the celebration of the New Year. Previously in Wuhan during this outbreak, there have been reports of cases within family clusters. Since the celebration of the New Year involves a lot of family gatherings and visitation between households, raising public awareness on the current outbreak and preventives is critical during this period. Clinics and hospitals should thus be prepared with surveillance programs on new cases and stockpiles of diagnostic tools and treatment resources in response to any possible outbreak within their region. Communication between local hospitals with local public health authorities and national authorities ought to be reinforced to keep information up to date.
While border screening for international travelers has been implemented by many countries during the previous SARS epidemic to keep the disease from crossing borders, there remained very limited data on how effective this intervention worked back in 2003. It is thus suggested that efforts should not be steered away from conventional methods such as quarantine and social distancing of cases. Nonetheless, this outbreak provides an opportunity to evaluate public health measures on borders for the sake of similar situations in the future. On a wider scale, the WHO also suggests that countries and cities with major tourist attractions should also be prepared for contingencies such as, vast human-to-human disease transmission.
To conclude, this emerging situation of the novel coronavirus outbreak needs to be carefully monitored and prepared for, taking into strong account the consequences and insights gained from the previous SARS and MERS epidemics. Governmental efforts should be focused on the massive flow of travelers during the Chinese New Year to avoid large-scale outbreaks, and more epidemiological data is urgently required to ascertain the route of transmission and risk factors. This will aid in generating guidelines specific to the virus, and at the receiving end, the public ought to be rightly informed to prevent the disease from spreading before it potentially becomes a full-blown pandemic.
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