Published: February 28, 2020 From WHO
IV. Major Recommendations
1. Maintain an appropriate level of emergency management protocols, depending on the assessed risk in each area and recognizing the real risk of new cases and clusters of COVID-19 as economic activity resumes, movement restrictions are lifted, and schools reopen;
2. Carefully monitor the phased lifting of the current restrictions on movement and public gatherings, beginning with the return of workers and migrant labor, followed by the eventual reopening of schools and lifting other measures;
3. Further strengthen the readiness of emergency management mechanisms, public health institutions (e.g. CDCs), medical facilities, and community engagement mechanisms to ensure sustained capacity to immediately launch containment activities in response to any resurgence in cases;
4. Prioritize research that rapidly informs response and risk management decisions, particularly household and health care facility studies, age-stratified seroepidemiologic surveys and rigorous investigation of the animal-human interface; establish a centralized research program to fast-track the most promising rapid diagnostics and serologic assays, the testing of potential antivirals and vaccine candidates, and Chinese engagement in selected multi-country trials; and
5. As the country with the greatest knowledge on COVID-19, further enhance the systematic and real-time sharing of epidemiologic data, clinical results and experience to inform the global response.
For countries with imported cases and/or outbreaks of COVID-19
1. Immediately activate the highest level of national Response Management protocols to ensure the all-of-government and all-of-society approach needed to contain COVID-19 with non-pharmaceutical public health measures;
2. Prioritize active, exhaustive case finding and immediate testing and isolation, painstaking contact tracing and rigorous quarantine of close contacts;
3. Fully educate the general public on the seriousness of COVID-19 and their role in preventing its spread;
4. Immediately expand surveillance to detect COVID-19 transmission chains, by testing all patients with atypical pneumonias, conducting screening in some patients with upper respiratory illnesses and/or recent COVID-19 exposure, and adding testing for the COVID-19 virus to existing surveillance systems (e.g. systems for influenza-like-illness and SARI); and
5. Conduct multi-sector scenario planning and simulations for the deployment of even more stringent measures to interrupt transmission chains as needed (e.g. the suspension of large-scale gatherings and the closure of schools and workplaces).
For uninfected countries
1. Prepare to immediately activate the highest level of emergency response mechanisms to trigger the all-of-government and all-of society approach that is essential for early containment of a COVID-19 outbreak;
2. Rapidly test national preparedness plans in light of new knowledge on the effectiveness of non-pharmaceutical measures against COVID-19; incorporate rapid detection, largescale case isolation and respiratory support capacities, and rigorous contact tracing and management in national COVID-19 readiness and response plans and capacities;
3. Immediately enhance surveillance for COVID-19 as rapid detection is crucial to containing spread; consider testing all patients with atypical pneumonia for the COVID-19 virus, and adding testing for the virus to existing influenza surveillance systems;
4. Begin now to enforce rigorous application of infection prevention and control measures in all healthcare facilities, especially in emergency departments and outpatient clinics, as this is where COVID-19 will enter the health system; and
5. Rapidly assess the general population’s understanding of COVID-19, adjust national health promotion materials and activities accordingly, and engage clinical champions to communicate with the media.
For the public
1. Recognize that COVID-19 is a new and concerning disease, but that outbreaks can managed with the right response and that the vast majority of infected people will recover;
2. Begin now to adopt and rigorously practice the most important preventive measures for COVID-19 by frequent hand washing and always covering your mouth and nose when sneezing or coughing;
3. Continually update yourself on COVID-19 and its signs and symptoms (i.e. fever and dry cough), because the strategies and response activities will constantly improve as new information on this disease is accumulating every day; and
4. Be prepared to actively support a response to COVID-19 in a variety of ways, including the adoption of more stringent ‘social distancing’ practices and helping the high-risk elderly population.
For the international community
1. Recognize that true solidarity and collaboration is essential between nations to tackle the common threat that COVID-19 represents and operationalize this principle;
2. Rapidly share information as required under the International Health Regulations (IHR) including detailed information about imported cases to facilitate contact tracing and inform containment measures that span countries;
3. Recognize the rapidly changing risk profile of COVID-19 affected countries and continually monitor outbreak trends and control capacities to reassess any ‘additional health measures’ that significantly interfere with international travel and trade.
A. WHO-China Joint Mission Members
B. Summary Agenda of the Mission
C. Detailed Technical Findings
Response management, case and contact management, risk communication and community engagement
The response structures in China were rapidly put in place according to existing emergency plans and aligned from the top to the bottom. This was replicated at the four levels of government (national provincial, prefecture and county/district).
Organizational structure and response mechanism
Response activation at the national level: COVID-19 prevention and control mechanisms were initiated immediately after the outbreak was declared and nine working groups were set up to coordinate the response: a) Coordination b) Epidemic prevention and control c) Medical treatment d) Research e) Public communication f) Foreign affairs g) Medical material support h) Life maintenance supplies and i) Social stability. Each working group has a ministerial level leader. Emergency response laws and regulations for the emergency response to public health emergencies, prevention and control of infectious diseases have been developed or updated to guide the response.
Response activation in provinces: Each province set up a similar structure to manage the outbreak. The response is organized at the levels of national, provincial, prefecture, county/district and the community. By 29 January, all provinces across China had launched the highest level of response for major public health emergencies.
A clear strategy was developed, and goals were well articulated and communicated across the entire response architecture. This strategy was rapidly adapted and adjusted to the outbreak, both in terms of the epidemiological situation over time and in different parts of the country.
The epidemiological situation has been used to define location into four areas:
● In areas without cases, the strategy in these areas is to “strictly prevent introduction”. This includes quarantine arrangements in transportation hubs, monitoring for temperature changes, strengthening of triage arrangements, use of fever clinics, and ensuring normal economic and social operations.
● In areas with sporadic cases, the strategy is focused on “reducing importation, stopping transmission and providing appropriate treatment”.
● In areas with community clusters, the strategy is focussed on “stopping transmission, preventing exportation, and strengthening treatment”.
● In areas with community transmission, the strictest prevention and control strategies are being implemented, the entry and exit of people from these areas has been stopped and public health and medical treatment measures are comprehensively strengthened.
Main control measures implemented in China
The main control measures implemented in China are as follows and are illustrated in Figures 6A-6D, representing the national level response and examples of the response at the Provincial and municipal levels:
Monitoring and reporting: COVID-19 was included in the statutory reporting of infectious diseases on 20 January and plans were formulated to strengthen diagnosis, monitoring, and reporting.
Strengthening ports of entry and quarantine: The Customs Department launched the emergency plan for public health emergencies at ports across the country and restarted the health declaration card system for entry and exit into cities as well as strict monitoring of the temperature of entry and exit passengers.
Treatment: For severe or critical patients, the principle of “Four Concentrations” was implemented: i.e. concentrating patients, medical experts, resources and treatment into special centres. All cities and districts transformed relevant hospitals, increased the number of designated hospitals, dispatched medical staff, and set up expert groups for consultation, so as to minimise mortality of severe patients. Medical resources from all over China have been mobilized to support the medical treatment of patients in Wuhan.
Epidemiological investigation and close contact management: Strong epidemiological investigations are being carried out for cases, clusters, and contacts to identify the source of infection and implement targeted control measures, such as contact tracing.
Social distancing: At the national level, the State Council extended the Spring Festival holiday in 2020, all parts of the country actively cancelled or suspended activities like sport events, cinema, theatre, and schools and colleges in all parts of the country postponed reopening after the holiday. Enterprises and institutions have staggered their return to work. Transportation Departments setup thousands of health and quarantine stations in national service areas, and in entrances and exits for passengers at stations. Hubei Province adopted the most stringent traffic control measures, such as suspension of urban public transport, including subway, ferry and long-distance passenger transport. Every citizen has to wear a mask in public. Home support mechanisms were established. As a consequence of all of these measures, public life is very reduced.
Funding and material support: Payment of health insurance was taken over by the state, as well as the work to improve accessibility and affordability of medical materials, provide personal protection materials, and ensure basic living materials for affected people.
Emergency material support: The government restored production and expanded production capacity, organized key enterprises that have already started to exceed current production capacity, supported local enterprises to expand imports, and used cross-border e-commerce platforms and enterprises to help import medical materials and improve the ability to guarantee supplies.
Figure 6. COVID-19 epidemic curves and major intervention measures in China as implemented at a) the national level b) in Guangdong province, c) in Shenzhen municipality and d) in Sichuan province
Risk communications (information release, public and media communications)
International and interregional cooperation and information sharing: From 3 January 2020, information on COVID-19 cases has been reported to WHO daily. Full genome sequences of the new virus were shared with WHO and the international community immediately after the pathogen was identified on 7 January. On 10 January, an expert group involving Hong Kong, Macao and Taiwanese technical experts and a World Health Organization team was invited to visit Wuhan. A set of nucleic acid primers and probes for PCR detection for COVID-19 was released on 21 January.
Daily updates: The National Health Commission announces the epidemic situation every day and holds daily press conferences to respond to emerging issues. The government also frequently invites experts to share scientific knowledge on COVID-19 and to address public concerns.
Psychological care: This is provided to patients and the public. Governments at all levels, NGOs and all sectors of society developed guidelines for emergency psychological crisis intervention and guidelines for public psychological self-support and counselling. A hotline for mental health services has been established for the public.
IT platform: China has capitalized on the use of technology, big data and AI for COVID-19 preparedness, readiness and response. Authoritative and reliable information, medical guidance, access to online services, provision of educational tools and remote work tools have been developed in and used across China. These services have increased accessibility to health services, reduced misinformation and minimized the impact of fake news.
Social mobilization and community engagement
Civil society organizations (community centers and public health centers) have been mobilized to support prevention and response activities. The community has largely accepted the prevention and control measures and is fully participating in the management of self-isolation and enhancement of public compliance. Community volunteers are organized to support self-isolation and help isolated residents at home to solve practical life difficulties. Measures were taken to limit the movement of the population through homebased support. Up to now, outside of Hubei, 30 provinces have registered and managed more than 5 million people coming from Wuhan.
Clinical case management and infection prevention and control
The main signs and symptoms of COVID-19 include fever, dry cough, fatigue, sputum production, shortness of breath, myalgia or arthralgia, sore throat, and headache. Nausea or vomiting has been reported in a small percentage of patients (5%). On 14 February, China CDC described the clinical features, outcomes, laboratory and radiologic findings of 44672 laboratory-confirmed cases. Only 965 (2.2%) were under 20 years of age and there is just one recorded death (0.1%) in this age group. Most patients (77.8%) were aged 30 to 69 years. Patients aged over 80 years had a CFR of 14.8%. The CFR was highest in those with comorbidities including cardiovascular, diabetes, chronic respiratory disease, hypertension and cancer.
As opposed to Influenza A(H1N1)pdm09, pregnant women do not appear to be at higher risk of severe disease. In an investigation of 147 pregnant women (64 confirmed, 82 suspected and 1 asymptomatic), 8% had severe disease and 1% were critical.
Severe cases are defined as tachypnoea (≧30 breaths/ min) or oxygen saturation ≤93% at rest, or PaO2/FIO2 <300 mmHg. Critical cases are defined as respiratory failure requiring mechanical ventilation, shock or other organ failure that requires intensive care. About a quarter of severe and critical cases require mechanical ventilation while the remaining 75% require only oxygen supplementation.
China has a principle of early identification, early isolation, early diagnosis and early treatment. Early identification of suspect cases is critical to containment efforts and occurs via a process of temperature screening and questioning at entrances to many institutions, communities, travel venues (airports, train stations) and hospitals. Many hospitals have fever clinics that were established and maintained since the SARS outbreak. In China, laboratory tests were originally requested according to the case definitions, which included an epidemiological link to Hubei or other confirmed cases. However, more recently, a more liberal clinical testing regimen allows clinicians to test with a low index of suspicion.
Suspect cases are isolated in normal pressure single rooms, wear a surgical mask (for source control). Staff in China wear a cap, eye protection, n95 masks, gown and gloves (single use only). In Wuhan it is necessary for most suspects to be cohorted in a normal pressure isolation ward. Staff wear PPE continuously, changing it only when they leave the ward.
PCR test results are returned the same day. If positive, patients are transported to designated hospitals (including negative pressure ambulances in some cities). All patients, including the mild and asymptomatic, with a positive test are admitted. The designated hospitals are known and are strategically placed with at least one per district/county. Positive cases are cohorted by gender. Negative tested patients are managed based on clinical needs. All patients are evaluated with a respiratory multiplex to look for other diagnoses. This can add to the reassurance that a negative COVID-19 test reflects a lack of infection with COVID-19.
In Wuhan, there are 45 designated hospitals, 6 of which are designated for critical patients, and 39 for severe patients and/or any patients >65 years old. There are an additional 10 temporary hospitals reconstructed from gymnasium and exhibition centers, which are for mild patients. Other surge measures undertaken in Wuhan include two new temporary hospitals with 2600 beds, plus many makeshift hospitals to increase bed capacity. Bed capacity within Wuhan has increased to >50,000.
Patients are treated according to the National Clinical guidelines (edition 6) released by the China National Health Commission (NHC). There are no specific antiviral or immune modulating agents proven (or recommended) to improve outcomes. All patients are monitored by regular pulse oximetry. The guidelines include supportive care by clinical category (mild, moderate, severe and critical), as well as the role of investigational treatments such as chloroquine, phosphate, lopinavir/ritonavir, alpha interferon, ribavirin, arbidol. The application of intubation/invasive ventilation and ECMO in critically ill patients can improve survival. The Joint Mission Team was told of ECMO use in four patients at one hospital with one death and three who appeared to be improving. Clearly, though ECMO is very resource consumptive, any health system would need to carefully weigh the benefits. There is widespread use of Traditional Chinese Medicines (TCM), for which the affects must
be fully evaluated.
Patients with COVID-19 are not permitted visitors. Staff use coveralls, masks, eye cover, and gloves, removing PPE only when they leave the ward.
Patients are discharged after clinical recovery (afebrile >3 days, resolution of symptoms and radiologic improvement) and 2 negative PCR tests taken 24 hours apart. Upon discharge, they are asked to minimise family and social contact and to wear a mask. There are expectations of clinical trial results within a matter of weeks, which will see further opportunities for treatment.
There are guidelines for elderly care specifically targeting prevention in individuals and introduction of COVID-19 to nursing homes.
Training programmes by video conference nationally are scaled up to inform staff of best practice and to ensure PPE usage. Clinical champions are created to disperse knowledge and provide local expertise.
Maintenance of usual healthcare activities is maintained by hospital zoning (e.g. clean/contaminated sections of the healthcare facility).
Laboratory, diagnostics and virology
The virus found to cause COVID-19 was initially isolated from a clinical sample on 7 January. It is notable that within weeks following the identification of the virus, a series of reliable and sensitive diagnostic tools were developed and deployed. On 16 January, the first RTPCR assays for COVID-19 were distributed to Hubei. Real-time PCR kits were distributed to all the provinces on 19 January and were provided to Hong Kong SAR and Macao SAR on 21 January. Information regarding viral sequences and PCR primers and probes was shared with WHO and the international community by China CDC on 12 January 2020. To facilitate product development and research on the new virus, COVID-19 virus sequences were uploaded to the GISAID Database by China.
By 23 February, there were 10 kits for detection of COVID-19 approved in China by the NMPA, including 6 RT-PCR kits, 1 isothermal amplification kit, 1 virus sequencing product and 2 colloidal gold antibody detection kits. Several other tests are entered in the emergency approval procedure. Currently, there are at least 6 local producers of PCR test kits approved by NMPA. Overall, producers have the capacity to produce and distribute as many as 1,650,000 tests/week.
Specimens from both the upper respiratory tract (URT; nasopharyngeal and oropharyngeal) and lower respiratory tract (LRT; expectorated sputum, endotracheal aspirate, or bronchoalveolar lavage) are collected for COVID-19 testing by PCR.
COVID-19 virus has been detected in respiratory, fecal and blood specimens. According to preliminary data from Guangzhou CDC as of 20 February, virus can initially be detected in upper respiratory samples 1-2 days prior to symptom onset and persist for 7-12 days in moderate cases and up to 2 weeks in severe cases. Viral RNA has been detected in feces in up to 30% of patients from day 5 following onset of symptoms and has been noted for up to 4-5 weeks in moderate cases. However, it is not clear whether this correlates with the presence of infectious virus. While live virus has been cultured from stool in some cases, the role of fecal-oral transmission is not yet well understood. COVID-19 has been isolated from the clinical specimens using human airway epithelial cells, Vero E6 and Huh-7 cell lines.
Serological diagnostics are rapidly being developed but are not yet widely used. Joint Mission members met with local research teams at the China CDC, Guangzhou Regenerative Medicine and Health Guangdong Laboratory. The teams reported on the development of tests for IgM, IgG and IgM+IgG using rapid test platforms utilizing chemiluminiscence. ELISA assays are also under development.
Research & Development
The government of China has initiated a series of major emergency research programs on virus genomics, antivirals, traditional Chinese medicines, clinical trials, vaccines, diagnostics and animal models. Research includes fundamental basic research and human subjects research. For the purpose of this report, human studies are limited to those involving IRB approval and informed consent. Other forms of human subjects investigations are included in the sections on epidemiology in this report. Well-focused, robust research conducted in the setting of an outbreak has the potential of saving many lives by identifying the most effective ways to prevent, diagnose and treat disease.
Since the COVID-19 virus has a genome identity of 96% to a bat SARS-like coronavirus and 86%-92% to a pangolin SARS-like coronavirus, an animal source for COVID-19 is highly likely. This was corroborated by the high number of RT-PCR positive environmental samples taken from the Huanan Seafood Market in Wuhan.
At least 8 nucleic acid-based methods for direct detection of COVID-19 and two colloidal gold antibody detection kits have been approved in China by the NMPA. Several other tests are close to approval. It will be important to compare the sensitivities and specificities of these and future serologic tests. Development of rapid and accurate point-of-care tests which perform well in field settings are especially useful if the test can be incorporated into presently commercially available multiplex respiratory virus panels. This would markedly improve early detection and isolation of infected patients and, by extension, identification of contacts. Rapid IgM and IgG antibody testing are also important ways to facilitate early diagnosis. Standard serologic testing can be used for retrospective diagnoses in the context of serosurveys that help better understand the full spectrum of COVID-19 infection.
A variety of repurposed drugs and investigational drugs have been identified. Screening NMPA approved drug libraries and other chemical libraries have identified novel agents. Hundreds of clinical trials involving remdesivir, chloroquine, favipiravir, chloroquine, convalescent plasma, TCM and other interventions are planned or underway. Rapid completion of the most important of these studies is critical to identifying truly effective therapies. However, evaluation of investigational agents requires adequately powered, randomized, controlled trials with realistic eligibility criteria and appropriate stratification of patients. It is important for there to be a degree of coordination between those conducting studies within and beyond China.
The development of a safe and effective vaccine for this highly communicable respiratory virus is an important epidemic control measure. Recombinant protein, mRNA, DNA, inactivated whole virus and recombinant adenovirus vaccines are being developed and some are now entering animal studies. Vaccine safety is of prime concern in the area of coronavirus infection in view of the past experience of disease enhancement by inactivated whole virus measles vaccine and similar reports in animal experiments with SARS coronavirus vaccines. It will be important that these vaccine candidates rapidly move into appropriate clinical trials.
The ideal animal model for studying routes of virus transmission, pathogenesis, antiviral therapy, vaccine and immune responses has yet to be found. The ACE2 transgenic mouse model and Macaca Rhesus model are already used in research laboratories. Systematically addressing which models can accurately mimic human infection is required.
There is a global rush for masks, hand hygiene products and other personal protective equipment. The relative importance of non-pharmaceutical control measures including masks, hand hygiene, and social distancing require further research to quantify their impact.
There are distinct patterns of intra-familial transmission of COVID-19. It is unclear whether or not there are host factors, including genetic factors, that influence susceptibility or disease course. COVID-19 has a varied clinical course and a precise description of that course is not available. In addition, the long-term consequences of COVID-19 are unknown. An observational cohort study of patients with COVID-19 enrolled from the time of diagnosis (with appropriate controls) could provide in-depth information about clinical, virologic and immunologic characteristics of COVID-19. Table 1 summarizes priority research areas with immediate to longer term goals.
Table 1 Priority research areas with immediate, intermediate and longer-term goals
D. Knowledge Gaps
Knowledge gaps and key questions to be answered to guide control strategies include:
Source of infection
• Animal origin and natural reservoir of the virus
• Human-animal interface of the original event
• Early cases whose exposure could not be identified
The pathogenesis and virulence evolution of the virus
• Modes of Transmission:
○ Role of aerosol transmission in non-health care settings
○ Role of fecal-oral transmission
• Viral shedding in various periods of the clinical course in different biological samples (i.e. upper and lower respiratory tract, saliva, faeces, urine)
○ Before symptom onset and among asymptomatic cases
○ During the symptomatic period
○ After the symptomatic period / during clinical recovery
Risk factors for infection
• Behavioral and socio-economic risk factors for infection in
○ Households / institutions
○ the Community
• Risk factors for asymptomatic infection
• Risk factors for nosocomial infection
○ among health care workers
○ among patients
Surveillance and monitoring
• Monitoring community transmission through existing
○ ILI surveillance
○ SARI surveillance
• The outbreak trend and intervention dynamics
○ Basic reproduction numbers in various stages of the epidemic
○ The epidemic’s relation to seasonality
Laboratory and diagnostics
• Sensitivity and specificity of different nucleic acid (PCR, NAATs and rapid tests), antibody and antigen tests
• Post-infection antibody titers and the duration of protection
• Sero-prevalence among
▪ Health care workers
▪ General population
Clinical management of severe and critically ill patients
• Value of ECMO in the management of critically ill patients
• Best practice using mechanical ventilation in the management of critically ill patients
• Re-evaluation of the role of steroids in the management of severe and critically ill patients
• Identification of factors associated with successful clinical management and outcome
• Determination of the effectiveness of Traditional Chinese Medicines (TCM)
• Determination the effectiveness of additional investigational treatment options (e.g. intravenous immunoglobulin/IVIg, convalescent plasma)
Prevention and control measures
• Key epidemic indicators that inform evidence-based control strategy decision making and adjustments
• Effectiveness of infection prevention and control (IPC) measures in various health care settings
• Effectiveness of entry and exit screening
• Effectiveness of the public health control measures and their socio-economic impact
○ Restriction of movement
○ Social distancing
○ School and workplace closures
○ Wearing mask in general public
○ Mandatory quarantine
○ Voluntary quarantine with active surveillance
E. Operational & Technical Recommendations
• Reassess risk and capacities based on different stages of the outbreak; approve different measures during the different phases of the response; assess different stages of the response; reach a balance between response and social development
• Initiate a timely scientific evidence based, efficient and flexible joint multi-sectoral mechanism, which is driven by strong government leadership
Epidemiology and transmission
• Continue enhanced surveillance across the country through existing respiratory disease systems, including ILI, SARI or pneumonia surveillance systems
• Prioritize early investigations, including household transmission studies, agestratified sero-epidemiologic surveys including children, case-control studies, cluster investigations, and serologic studies in health care workers
• Continue to share information on patient management, disease progression and factors leading to severe disease and favorable outcomes
• Review and analyze the possible factors associated with the disease severity, which may include:
○ natural history studies to better understand disease progression in mild, severe and fatal patients
○ medical chart reviews about disease severity among vulnerable groups, (e.g. those with underlying conditions, older age groups, pregnant women and children) to develop appropriate standards of care
○ evaluation of factors leading to favorable outcomes (e.g. early identification and care)
Clinical care and infection prevention and control
• Suspect patients who have not yet been tested should be isolated in single normal pressure rooms; cohorting of positive cases is acceptable
• Physicians and all health care workers need to maintain a high level of clinical alert for COVID-19
• For affected countries, standardize training for clinical care and IPC and scale with the development of local (e.g. district level) experts
• Ensure concurrent testing for other viral pathogens to support a negative COVID-19 test
• Ensure maintenance of usual and essential services during the outbreak
• Ensure processes are in place for infection prevention among the most vulnerable, including the elderly
• Ensure readiness to provide clinical care and to meet IPC needs, including:
a. anticipated respiratory support requirements (e.g. pulse oximeters, oxygen, and invasive support where appropriate)
b. national guidelines for clinical care and IPC, revised for COVID-19
c. nationally standardised trainings for disease understanding and PPE use for HCWs
d. community engagement
e. PPE and Medication stockpiles
f. early identification protocols; triage, temperature screening, holding bays (triage, including pulse oximetry)
g. treatment protocols including designated facilities, patient transportation
h. enhanced uptake of influenza and pneumococcal vaccine according to national guidelines
i. laboratory testing
j. rapid response teams
Laboratory and virology
• Continue to perform whole genome analysis of COVID-19 viruses isolated from different times and places, to evaluate virus evolution
• Conduct pathogenesis studies using biopsy/post-mortem specimens of COVID-19 patients or infected animal models
• Evaluate available nucleic acid PCR diagnostics
• Rapidly develop and evaluate rapid/point-of-care diagnostics and serologic assays
• Conduct further study to interpret the result of positive COVID-19 RNA detection in feces in patients recovering from COVID-19
• Enhance international cooperation, especially in terms of biosafety and information sharing for increased understanding of the COVID-19 virus and traceability of the virus
• Consider monitoring proinflammatory cytokines via multiplex assays to predict the development of “cytokine storm”
Research and development
• Additional effort should be made to find the animal source, including the natural reservoir and any intermediate amplification host, to prevent any new epidemic foci or resurgence of similar epidemics
• Efforts should be made to consistently evaluate existing and future diagnostic tests for detection of COVID-19 using a harmonized set of standards for laboratory tests and a biorepository that can be used for evaluating these tests
• Consider the establishment of a centralized research program in China to oversee that portfolio and ensure the most promising research (vaccines, treatments, pathogenesis) are adequately supported and studied first; program staff dedicated
to the clinical research would work at the clinical research site(s) to decrease the research workload of the clinicians at the site
• Consider including one or more sites within China in the ongoing and future multicenter, international trials; Chinese investigators should be actively engaged in international trials
• Continue to develop additional animal models, making every effort to ensure these mimic human infection and virus transmission as closely as possible
• Conduct studies to determine which of the commonly used forms of PPE are most effective in controlling the spread of COVID-19
Link : https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf