2019 Novel Coronavirus (2019‑nCoV): STRATEGIC PREPAREDNESS .

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Draft as of 3 February 20202019 Novel Coronavirus (2019‑nCoV):STRATEGIC PREPAREDNESSAND RESPONSE PLAN

World Health Organization 2020 Some rights reserved. This work is availableunder the Creative Commons Attribution-NonCommercialShareAlike 3.0 IGO licence(CC BY-NC-SA 3.0 IGO; igo)Under the terms of this licence, you may copy, redistribute and adapt the work fornon-commercial purposes, provided the work is appropriately cited, as indicatedbelow. In any use of this work, there should be no suggestion that WHO endorsesany specific organization, products or services. The use of the WHO logo is notpermitted. If you adapt the work, then you must license your work under thesame or equivalent Creative Commons licence. If you create a translation of thiswork, you should add the following disclaimer along with the suggested citation:“This translation was not created by the World Health Organization (WHO). WHOis not responsible for the content or accuracy of this translation. The originalEnglish edition shall be the binding and authentic edition”.Any mediation relating to disputes arising under the licence shall be conductedin accordance with the mediation rules of the World Intellectual PropertyOrganization.The designations employed and the presentation of the material in thispublication do not imply the expression of any opinion whatsoever on the partof WHO concerning the legal status of any country, territory, city or area orof its authorities, or concerning the delimitation of its frontiers or boundaries.Dotted and dashed lines on maps represent approximate border lines for whichthere may not yet be full agreement. The mention of specific companies orof certain manufacturers’ products does not imply that they are endorsed orrecommended by WHO in preference to others of a similar nature that are notmentioned. Errors and omissions excepted, the names of proprietary productsare distinguished by initial capital letters. All reasonable precautions have beentaken by WHO to verify the information contained in this publication. However,the published material is being distributed without warranty of any kind, eitherexpressed or implied. The responsibility for the interpretation and use of thematerial lies with the reader. In no event shall WHO be liable for damagesarising from its use.Printed in Geneva, Switzerland.Cover photo: iStock.com/Hydromet

CONTENTSABOUT THIS DOCUMENT 01SITUATION ASSESSMENT 03Epidemiological overview as of 1 February 2020 Risk assessment Recommendations of the Emergency Committee RESPONSE STRATEGY A) Rapidly establishing international coordinationand operational support Partner coordination Epidemiological analysis and forecasting Risk communication and managing the infodemic Laboratory and diagnostics Technical expertise and guidance Pandemic supply chain coordination Travel and trade B) Scaling up country readiness and response operations 03040405060607070708081011Country-level coordination 12Risk communication and community engagement 12Surveillance 12Points of entry 13Rapid response teams 13National laboratory system 13Infection prevention and control 13Case management and continuity of essential services 14Logistics, procurement, and supply management 16C) Accelerating priority research and innovation 17Enhancing global coordination of all relevant stakeholders 17 Support a clear and transparent global researchand innovation priority setting process 17 Build common platforms for standardized processes, protocolsand tools, as well as for sharing specimens, data, and information 17MONITORING FRAMEWORK 19RESOURCE REQUIREMENTS 21

ABOUT THIS DOCUMENTOn 31 December 2019, WHO was alerted to a cluster of pneumonia patients in WuhanCity, Hubei Province of China. One week later, on 7 January 2020, Chinese authoritiesconfirmed that they had identified a novel (new) coronavirus as the cause of the pneumonia(figure 1). The proposed interim name of the virus is 2019‑nCoV.Since the first cases were reported, WHO and its partners have been working with Chineseauthorities and global experts to learn more about the virus, including how it is transmitted,the populations most at risk, the spectrum of clinical disease, and the most effective waysto detect, interrupt, and contain human-to-human transmission.This strategic preparedness and response plan outlines the public health measures thatthe international community stands ready to provide to support all countries to preparefor and respond to 2019‑nCoV. The document takes what we have learned so far aboutthe virus and translates that knowledge into strategic action that can guide the effortsof all national and international partners when developing context-specific national andregional operational plans.Figure 1 Timeline of early stages of 2019‑nCoV outbreak30/12/2019Cluster of cases of pneumonia ofunknown origin reported in Wuhanto China National Health Commission07/01/2020Novel coronavirus isolated11/01/2020First fatal case reported01/01/2020Huanan Seafood Wholesale marketclosed1Draft as of 3 February 202013/01/2020First case reported from Thailand24/01/2020835 cases reported in China(549 from Hubei province).Further cases reported fromall but one province.19/01/2020First case reported in Republicof Korea; two cases in Beijingand one case in Guandong16/01/2020First case reported inJapan12/01/2020Whole genome sequence sharedwith WHO and public; virusdesignated 2019‑nCoV20/01/2020First reports of infection inhealthcare workers caring forpatients with 2019‑nCoV2019 Novel Coronavirus (2019-nCoV): Strategic Preparedness and Response Plan

iStock.com/Robert WeiDraft as of 3 February 20202019 Novel Coronavirus (2019-nCoV): Strategic Preparedness and Response Plan2

SITUATION ASSESSMENTEpidemiological overview as of 1 February 2020 A total of 11953 confirmed cases of 2019‑nCoV have been reported worldwide (figure 2);Of the total cases reported, 11821 cases have been reported from China;In China, 60.5% of all cases since the start of the outbreak have been reported from Hubei Province. The remaining39.5% of cases have been reported from 33 provinces, regions, and cities. After Hubei Province, the second largestnumber of cases has been reported from Zhejiang Province (599 cases);132 confirmed cases have been reported outside of China in 23 countries (figure 2);Of the cases reported outside China, 14 are due to secondary transmission;259 deaths have been reported to date.Epidemiological evidence shows that 2019‑nCoV can be transmitted from one individual to another. During previous outbreaksdue to other coronaviruses, including Middle-East respiratory syndrome coronavirus (MERS-CoV) and the Severe AcuteRespiratory Syndrome coronavirus (SARS-CoV), human-to-human transmission most commonly occurred through droplets,personal contact, and contaminated objects (fomites). The modes of transmission of 2019‑nCoV are likely to be similar.The precise zoonotic (animal) origin of the 2019‑nCoV is still uncertain. The virus has been identified in environmental samplesfrom a live animal market in Wuhan, and some human cases have been epidemiologically linked to this market. Othercoronavirus, such as SARS and MERS, are also zoonotic, and can be transmitted from animals (civet cats and dromedarycamels, respectively) to humans.Figure 2  Distribution of 2019‑nCoV cases as of 01 February 2020The boundaries and names shown ans the designationsused on this map do not imply the expression of anyopinion whatsoever on the part of the World HealthOrganization concerning the legal status of any country,territory, city or area or of its authorities, or concerningthe delimitation of its frontiers or boundaries. Dotted anddashed lines on maps represent approximate border linesfor which there may not yet be full agreement.3Data Source: World Health Organization, National HealthCommission of the People’s Republic of China World Health Organization 2020, All rights reserved.Map Production: WHO Health Emergencies ProgrammeDraft as of 3 February 20202019 Novel Coronavirus (2019-nCoV): Strategic Preparedness and Response Plan

Risk assessmentWHO assesses the risk to be very high for China,high at the regional level, and high at the global level.Factors taken into consideration include: Likelihood of further spread: Human-to-humantransmission, including transmission within families andhealthcare settings, has been confirmed within Wuhan,and in several cities outside China. The outbreak continuesto grow within China at a rapid rate, and now affectsall 31 provincial-level administrative regions. Ordinarilyhigh volumes of domestic and international travel havebeen increased further by travel linked to Lunar New Yearcelebrations. Imported cases continue to be reportedinternationally, with several reported cases of secondarytransmission now confirmed in countries outside ofChina. Limited testing capacity in many countries globally,non-specific symptoms of 2019‑nCoV acute respiratorydisease (the disease caused by 2019‑nCoV infection), andco-circulation of other respiratory pathogens are factorsthat can complicate efforts to detect the virus quickly.Potential impact on human health: The virus cancause severe illness and death, although most casesappear to be mild. However, many uncertainties remain,including the full extent of the current outbreak withinChina, and the full clinical spectrum of illness, includingthe prevalence of mildly symptomatic cases.Effectiveness of current preparedness and responsemeasures: China has dedicated substantial resourcesto public health control measures and clinicalmanagement, and has taken action that has includedthe quarantine of cities, and the widespread suspensionof transport links between population centres. It willbe important to continually assess the extent to whichmeasures are effective and the need to adapt measuresas the situation evolves. Up to now, countries that havereported an imported case have demonstrated efficientand effective disease surveillance and response measures.However, some countries are less prepared to detect andrespond to an imported case. Rumours, misconceptions,and misinformation disseminated online via social mediacan have a negative impact on response measures andhealth-seeking behaviors.Recommendations ofthe Emergency CommitteeOn 30 January 2020, the Director-General of WHOdeclared the 2019‑nCoV outbreak a public healthemergency of international concern under the InternationalHealth Regulations (IHR) (2005), following advice fromthe Emergency Committee. The Director-General andEmergency Committee issued temporary recommendations1to the People’s Republic of China and to other countries.The Emergency Committee also provided advice to WHO,and welcomed a forthcoming WHO-led multidisciplinaryand multi-partner technical mission to China. The missionwill review and support efforts to investigate the animalsource of the outbreak, the clinical spectrum of the diseaseand its severity, the extent of human-to-human transmissionin the community and in healthcare facilities, and effortsto control the outbreak. This mission will provide informationto the international community to aid in understandingthe situation, its impact, and effective public health measuresto respond to the virus. The Committee recommended thatWHO should continue to use its networks of technical expertsto assess how best this outbreak can be contained globally,and intensify support for preparation and response, especiallyin vulnerable countries and regions.iStock.com/izzetugutmen1  Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV), ncov) (accessed 04.02.2020)Draft as of 3 February 20202019 Novel Coronavirus (2019-nCoV): Strategic Preparedness and Response Plan4

RESPONSE STRATEGYThe overall goal of the strategic preparedness and response plan is to stop furthertransmission of 2019‑nCoV within China and to other countries, and to mitigatethe impact of the outbreak in all countries.Taking the above into account, the strategic objectivesof the plan are to: Limit human-to-human transmission, including reducingsecondary infections among close contacts and healthcareworkers, preventing transmission amplification events,and preventing further international spread from China;Identify, isolate, and care for patients early, includingproviding optimized care for infected patients;Identify and reduce transmission from the animal source;Address crucial unknowns regarding clinical severity,extent of transmission and infection, treatment options,and accelerate the development of diagnostics,therapeutics, and vaccines;Communicate critical risk and event informationto all communities, and counter misinformation;Minimize social and economic impact throughmultisectoral partnerships.These objectives can be achieved by:A) Rapidly establishing international coordination to deliverstrategic, technical, and operational support throughexisting mechanisms and partnerships;B) Scaling up country preparedness and responseoperations, including strengthening readiness to rapidlyidentify, diagnose and treat cases; identification andfollow-up of contacts when feasible (with priority givento high-risk settings such as healthcare facilities);infection prevention and control in healthcare settings;implementation of health measures for travelers;and awareness raising in the population thoughrisk communication and community engagement.C) Accelerating priority research and innovation to supporta clear and transparent global process to set researchand innovation priorities to fast track and scale-upresearch, development, and the equitable availabilityof

3 Draft as of 3 ebruary 2020 2019 Novel Coronavirus (2019-nCoV): Strategic Preparedness and Response Plan Epidemiological overview as of 1 February 2020 A total of 11953 confirmed cases of 2019‑nCoV have been reported worldwide (figure 2); Of the total cases reported, 11821 cases have been reported from China; In China, 60.5% of all cases since the start of the outbreak have been .

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