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Coronavirus disease (COVID-19) ……. WHO issues new guidance on surveillance strategies & contact tracing

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  • Releases a new development on contact tracing
    • Requests National authorities should consider including COVID-19 as a mandatory notifiable disease with requirements for immediate reporting.
    • New measures require a combination of surveillance systems including contact tracing in the entire health care system, at the community level, as well as in closed residential settings and for vulnerable groups.
    • New regulation aims at ensuring that surveillance for COVID-19 limits the spread of disease, enable public health authorities to manage the risk of COVID-19, and thereby enable economic and social activity to resume to the extent possible
    • Communication about contact tracing should emphasize solidarity, reciprocity, and the common good.

  Summary on new guidance on Surveillance strategies for COVID-19 human infection: One of the kernels of the Report is an advice to National authorities should consider including COVID-19 as a mandatory notifiable disease with requirements for immediate reporting. Surveillance systems should be geographically comprehensive and include all persons and communities at risk. Surveillance for vulnerable or high-risk populations should be enhanced. This will require a combination of surveillance systems including contact tracing in the entire health care system, at the community level, as well as in closed residential settings and for vulnerable groups.

The document provides an overview of surveillance strategies that Member States should consider as part of comprehensive national surveillance for COVID-19. It also emphasise the need to adapt and reinforce existing national systems where appropriate and to scale-up surveillance capacities as needed. WHO has published new guidance on Contact tracing in the context of COVID-19. When systematically applied, the guidance will help break the chains of transmission of COVID-19 and other infectious disease and is thus an essential public health tool for controlling infectious disease outbreaks. In today’s ‘Subject in Focus’, WHO provides an update on the work of the Emergency Medical Teams, the Global Outbreak Alert and Response Network, and Risk Communication and Community Engagement.

Background COVID-19 has spread rapidly around the world, affecting every community directly or indirectly. Stringent public health and social measures (PHSM) have been put in place by all countries to slow the spread of COVID-19. These include limitations on domestic and international travel; stay-at-home orders; closing of schools, shops, and religious centers; among other measures. As public health authorities consider the lifting some of these measures, it is critical that robust surveillance is in place or put in place to control the spread of COVID-19 and guide ongoing implementation of control measures. The aim of surveillance for COVID-19 is to limit the spread of disease, enable public health authorities to manage the risk of COVID-19, and thereby enable economic and social activity to resume to the extent possible. Surveillance is also necessary to monitor the longer-term trends of COVID-19 transmission and the changes in the virus

 This guidance should be read in conjunction with WHO’s guidance on preparedness, readiness and response actions.

1 Purpose of the document:  This document provides an overview of surveillance strategies that Member States should consider as part of comprehensive national surveillance for COVID-19. This document emphasises the need to adapt and reinforce existing national systems where appropriate and to scale-up surveillance capacities as needed. WHO previously published a guidance document for the “Global Surveillance for COVID-19 caused by human Infection with COVID-19 virus”  that includes recommendations and tools for international reporting (accessible here). When reviewing national strategies for surveillance, Member States should provide sufficient capacity to report to WHO for global surveillance of COVID19.

 Aims and objectives of surveillance for COVID-19 The aim of surveillance for COVID-19 is to limit the spread of disease, enable public health authorities to manage the risk of COVID-19, and thereby enable economic and social activity to resume to the extent possible. The objectives of COVID-19 surveillance include:

  • enable rapid detection, isolation, testing, and management of suspected cases
  • identify and follow up contacts • guide the implementation of control measures
  • detect and contain outbreaks among vulnerable populations
  • evaluate the impact of the pandemic on health-care systems and society • monitor longer term epidemiologic trends and evolution of COVID-19 virus
  • understand the co-circulation of COVID-19 virus, influenza and other respiratory viruses Case definitions for surveillance of COVID-19 See the most up-to-date WHO COVID-19 case definitions at: Global Surveillance for human infection with coronavirus disease (COVID-19).
  • ATTENTION — MEDICAL EXPERTS ILI and SARI case definitions can be found at: (https://www.who.int/influenza/surveillance_monitoring/ili_ sari_surveillance_case_definition/en/

General considerations Most countries will need to significantly strengthen surveillance capacities to rapidly identify cases of COVID‑19, follow-up their contacts, and to monitor disease trends over time. Comprehensive national surveillance for COVID-19 will require the adaptation and reinforcement of existing national systems where appropriate and the scale-up of additional surveillance capacities as needed. Digital technologies for rapid reporting, data management, and analysis will be helpful. Robust comprehensive surveillance once in place, should be maintained even in areas where there are few or no cases; it is critical that new cases and clusters of COVID-19 are detected rapidly and before widespread disease transmission occurs.

Ongoing surveillance for COVID-19 is also important to understand longer-term trends in the disease and the evolution of the virus. It is important to maintain surveillance for another respiratory disease through existing surveillance systems for influenza-like-illness (ILI), severe acute respiratory infection (SARI), atypical pneumonia, and other such syndromes. Understanding trends in other respiratory diseases within a population is needed for clinicians and health services managers to ensure that the appropriate resources are in place to diagnose and manage patients with other respiratory infections. Key considerations for comprehensive COVID-19 surveillance include:

  • Use, adapt and strengthen existing surveillance systems
  • Include COVID-19 as a mandatory notifiable disease
  • Implement immediate reporting where feasible
  • Conduct surveillance at different levels of the health care system
  • Establish population denominators to aid in data interpretation
  • Establish laboratory testing denominatorsSurveillance strategies for COVID-19 human infection:

Interim Guidance -2- like-illness (ILI), severe acute respiratory infection (SARI),atypical pneumonia, and other such syndromes. Understanding trends in other respiratory diseases within a population is needed for clinicians and health services managers to ensure that the appropriate resources are in place to diagnose and manage patients with other respiratory infections. Key considerations for comprehensive COVID-19 surveillance include:

  • Use, adapt and strengthen existing surveillance systems
  • Include COVID-19 as a mandatory notifiable disease
  • Implement immediate reporting where feasible
  • Conduct surveillance at different levels of the health care system
  • Establish population denominators to aid in data interpretation
  • Establish laboratory testing denominators
  • Ensure that existing surveillance of respiratory disease such as ILI/SARI are maintained. Essential surveillance for COVID-19 Considering the potential for rapid exponential growth of COVID-19 cases in populations, new cases should be identified, reported, and data included in epidemiological analysis within 24 hours.

National authorities should consider including COVID-19 as a mandatory notifiable disease with requirements for immediate reporting. Surveillance systems should be geographically comprehensive and include all persons and communities at risk. Surveillance for vulnerable or high-risk populations should be enhanced. This will require a combination of surveillance systems including contact tracing in the entire health care system, at the community level, as well as in closed residential settings and for vulnerable groups.

CONTACT TRACING: To control the spread of COVID-19, interventions need to break the chains of human-to-human transmission, ensuring that the number of new cases generated by each confirmed case is maintained below 1 (effective reproduction number < 1). As part of a comprehensive strategy, case identification, isolation, testing and care, and contact tracing and quarantine, are critical activities to reduce transmission and control the epidemic. 1 Contact tracing is the process of identifying, assessing, and managing people who have been exposed to a disease to prevent onward transmission. When systematically applied, contact tracing will break the chains of transmission of infectious disease and is thus an essential public health tool for controlling infectious disease outbreaks. Contact tracing for COVID-19 requires identifying persons who may have been exposed to COVID-19 and following them up daily for 14 days from the last point of exposure. This document provides guidance on how to establish contact tracing capacity for the control of COVID-19.  It builds upon WHO considerations in the investigation of cases and clusters of COVID-19.

2 Critical elements of the implementation of contact tracing are community engagement and public support; careful planning and consideration of local contexts, communities, and cultures; a workforce of trained contact tracers and supervisors; logistics support to contact tracing teams; and a system to collate, compile, and analyse data in real-time. For contact tracing to be effective, countries must have adequate capacity to test suspect cases in a timely manner. Where this is not possible, testing and,

3 contact tracing strategies may instead focus on specific high-risk settings with vulnerable individuals, such as hospitals, care homes, or other closed settings (e.g. dormitories). Because individuals may transmit COVID-19 while pre-symptomatic or asymptomatic, this guidance also emphasizes the importance of quarantining contacts to further reduce the potential for secondary transmission.

4 Engaging communities Contact tracing begins with engaging communities about the disease, how to protect individuals and their communities, and how to suppress transmission. Contact tracing requires individuals to agree to daily monitoring, to be willing to report signs or symptoms of COVID-19 promptly, and to be prepared to go into quarantine for at least 14 days or into isolation if they become symptomatic. Engagement with communities and their leaders should help identify potential challenges for contact tracing including language and literacy, access to food and medical care for other illnesses, education, information, as well as stigma and marginalization. Special consideration should be given to planning contact tracing for at-risk and vulnerable groups, including, but not limited to, minority groups, homeless persons, migrant workers, refugees, and others.

Communication about contact tracing should emphasize solidarity, reciprocity, and the common good. By participating in contact tracing, communities will contribute to controlling local spread of COVID-19, vulnerable people will be protected, and more restrictive measures, such as general stay-at-home orders, might be avoided or minimized. All communities are likely to express concerns about privacy and confidentiality of their personal health information. Public health agencies implementing contact tracing for COVID-19 should be prepared to communicate how information will be used, stored, and accessed, and how individuals will be protected from harmful disclosure or identification. It is critical that contact tracing and associated steps, such as quarantine of contacts and isolation of cases, not be used punitively or associated with security measures, immigration issues, or other concerns outside the realm of public health. Contact tracing activities should be available to all communities. As such, WHO recommends voluntary participation by cases and their contacts.

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