3 Prevention and Control Measures

3.1 Improve the Prevention and Control Mechanism, Strengthen Organizational Leadership

The prevention and control of COVID-19 should be attached with great importance. Health administrative departments at all levels should follow the administrative government and strengthen the guidance of local epidemic prevention and control work, set up expert groups for COVID-19 prevention and control. In accordance with the “prevention in the first place,integrating prevention with control, scientific guidance, timely treatment”work principle, relevant departments should be organized to formulate and improve relative work and technological solutions, and standardize the COVID-19 prevention and control work. Strengthen joint prevention and control, improve inter-communication and cooperation among departments,conduct regular consultations to analyze epidemic development and discuss prevention and control policies.

Health administrative department at all levels should be responsible for the overall guidance of epidemic control and the implementation of funds and materials.

The responsibility of CDC at all levels includes organizing, coordinating,supervising and evaluating surveillance, for collecting, analyzing, reporting and providing feedback of monitoring data; conducting training of field investigations, laboratory examinations and other professional knowledge;carrying out public health education and risk evaluation, providing personal protection methods guidelines for the public and specific people, and guiding disinfection of special places.

Medical institutions of all levels and types should be responsible for case detection, reporting, isolation, diagnosis, treatment and clinical management,as well as sample collection. Training medical staff to prevent and control nosocomial infections is also part of each institution’s responsibility.

3.2 Detection and Report of Case and Public Health Emergency

All levels and types of medical institutions and disease control organizations should impose the surveillance, detection and report of COVID-19 cases and asymptomatic carriers according to the Surveillance Plan of Corona Virus Disease 2019 Cases(Fourth Edition)(Appendix 1).

3.2.1 Case Detection

All levels and types of medical institutions should raise awareness of the diagnosis and report of new cases during the COVID-19 surveillance and routine diagnosis and treatment. For cases with unexplained fever, cough or breathless, etc., the following information should be collected: whether the case traveled or lived in Wuhan and surrounding areas, or communities reported confirmed cases, 14 days before disease onset; whether the case has any contact with patients with fever or respiratory symptoms in areas or communities mentioned above; whether clustered onset is observed; and whether the case has contacted with any COVID-19 case.

Relevant primary organizations should organize sample test performed by professional institutions to screen high risk people who have a travel or residence history in Wuhan and surrounding areas, or other case-reported communities within the past 14 days, and have respiratory symptoms, fever,chills, fatigue, diarrhea, conjunctival congestion, etc.

3.2.2 Case Report

Detected suspected cases, clinically diagnosed cases(only in Hubei Province), confirmed cases, and asymptomatic carriers of COVID-19 should be immediately reported online by medical institutions that have established the report system, or be reported to the county(district)level CDC and send infectious disease report cards within 2 hours to other organizations without this system and local CDC is required to report the case online immediately.Medical institutions or CDCs that are responsible for direct online report should comply with the Surveillance Plan of Corona Virus Disease 2019 Cases(Fourth Edition)to modify case classification, clinical severity, and other information in time based on laboratory examination results and disease progress.

3.2.3 Emergency Detection and Report

Local CDC should conduct online report through the Emergency Public Reporting System(EPRS)within 2 hours once the first COVID-19 case is confirmed, or a clustered epidemic confirmed by Surveillance Plan of Corona Virus Disease 2019 Cases (Fourth Edition). The severity level could be“unclassified” at the beginning and later modified by health administrative department based on results of incidence investigation, risk assessment and further development.

3.3 Epidemiological Investigation

According to the Epidemiological Investigation Plan of Corona Virus Disease 2019 Cases(Fourth Edition)(Appendix 2), the county(district)level CDCs should complete the epidemiology investigation within 24 hours once report of suspected cases, clinically diagnosed cases(only in Hubei Province),confirmed cases, or asymptomatic carriers of 2019-nCoV by medical institutions or medical staff is received .

The county(district)level CDC should report the case questionnaire through the National Notifiable Disease Report System(NNDRS)within 2 hours, and submit the epidemiological investigation and analysis report to local health administration department and the senior CDC after completing case investigation of confirmed cases and asymptomatic carriers.

3.4 Specimen Collection and Examination

Clinical specimens of each case collected by a medical institution should be sent to a local designated laboratory, or CDC, or a third-party testing institution for pathogen test as soon as possible(see Appendix 4 for technical guidelines for laboratory examination).

Clinical specimens include patients’ upper respiratory tract specimens(such as throat swabs, nasal swabs, etc.), lower respiratory tract specimens(such as respiratory tract aspirates, bronchial lavage fluid, alveolar lavage fluid, deep sputum, etc.), eye conjunctiva swabs, stool specimens,anticoagulant and serum specimens, etc. Efforts should be made to collect respiratory specimens(especially lower respiratory tract specimens)at early stage of disease onset, and serum at acute phase within 7 days of disease onset, as well as serum of recovery period at 3 to 4 weeks after disease onset.

Specimen collection, transportation, storage and test are temporarily managed as the Class B high pathogenicity pathogenic microorganisms, and should comply with the Biosafety Management Regulation of Laboratories for Micro-organisms, Regulations on the Management and Transportation of Human Infectious High Pathogenicity Pathogenic Microorganism Strains or Samples(No.45,issued by the Former Ministry of Health) and other relevant requirements.

3.5 Cases Treatment & Nosocomial Infection Prevention and Control

All cases should be treated by designated medical institutions. These institutions should ensure sufficient supply of manpower, drugs, facilities,equipment, protective appliances and so on.

Medical institutions should, in accordance with the Technical Guidelines for Prevention and Control of 2019-nCoV Infections in Medical Institutions(First Edition), pay attention to and strengthen the isolation, disinfection and protection work, fully implement various measures to prevent nosocomial infection, complete appointed examination and grade diagnosis procedures,and control nosocomial infection in fever clinics, emergency departments and other general wards. Suspected cases, clinically diagnosed cases(only for Hubei Province)and confirmed cases should be isolated and treated in designated hospitals with effective isolation and protective conditions.Asymptomatic infected persons should be isolated for 14 days and the isolation can be released if the nucleic acid test is negative after 7 days.

Medical institutions should strictly comply with the Technical Standards for Disinfection in Medical Institutions (First Edition)to clean and disinfect medical devices, polluted items, object surfaces, floors, etc., and complete air disinfection according to the requirements of Hospital Air Purification Management Standards. Medical wastes generated during case diagnosis and treatment should be disposed and managed in accordance with Medical Waste Management Regulations and Medical Waste Management Measures of Medical and Health Institutions.

3.6 Close Contact Tracing and Management

The county(district)level health administrative departments need to organize and implement tracing and management of close contacts with relevant departments. People who have close contact with suspected or clinically diagnosed cases(only in Hubei Province), or confirmed cases, or asymptomatic carriers, should be implemented with centralized isolation medical observations. Regions that do not meet the requirements can adopt home-based isolation medical observation. For details, please refer to Management Plan for Close Contacts of Corona Virus Disease 2019 Cases (Fourth Edition)(Appendix 3). Record body temperature at least twice per day and monitor whether close contacts show acute respiratory symptoms or other related symptoms and monitor disease progression. The observation period for close contacts is 14 days since the last contact with COVID-19 case or asymptomatic carriers.

3.7 Health Education and Risk Communication

The government should actively carry out public opinion monitor,popularize knowledge of epidemic prevention and control, impose mass prevention and control, timely respond to public doubts and social concerns,and make an effort to conduct epidemic prevention and control and risk communication. Strengthen health education and risk communication for specific populations, key places and large-scaled gathering activities,especially strengthen the guidance on personal protection for the public and specific groups by various methods to reduce possible contact or exposure(see Appendix 5: Individual Protection Guidelines for Specific Populations(Second Edition)). Health education strategies should be adjusted timely at different stages of epidemic development based on analysis of the public psychological changes and key information, and corresponding popular science propaganda should also be organized timely. Health reminder and management should be well performed when returning to school or work.

3.8 Training Healthcare Providers

Staff in medical and health institutions should be trained for COVID-19 case detection and report, epidemiological investigation, specimen collection,laboratory examination, medical treatment, nosocomial infection prevention and control, close contact management, personal protection and other contents to improve their prevention and treatment capabilities.

3.9 Improve Laboratory Examination Ability and Biological Safety Awareness

All provincial CDCs, county(district)level CDCs with laboratory examination equipment, designated medical and health institutions,and third-party test institutions should establish laboratory diagnostic methods and reserve reagents and technologies, and carry out various laboratory examinations at any time in accordance with laboratory biosafety regulations.

3.10 Timely Disinfection of Specific Places

Specific places where cases and asymptomatic infected persons have lived, such as patients’ homes, isolation wards of medical institutions,transport tools and medical observation places should be disinfected timely.Assess disinfection effects of object surfaces, air and hands if necessary(see Appendix 6: Technical Plan for Disinfection in Specific Places(Second Edition)).

3.11 Strengthen the Prevention and Control Work of Key Places,Institutions and Populations

Strengthen the multi-departments joint prevention and control work mechanism to minimize public gathering activities, and implement measures such as ventilation, disinfection and body temperature measurement in public gathering places including stations, airports, docks, shopping malls and closed transportation vehicles such as automobiles, trains and airplanes according to local conditions.

To strengthen the COVID-19 prevention and control in collective living units, such as schools and nurseries, morning examination system and absence registration system due to illness should be established. Strengthen the prevention and control work in cities with more movable people, and prepare for prevention and control of high COVID-19 risk after the Spring Festival holiday. Health education targeted for rural farmers, students,businessmen should also be strengthened.

3.12 Scientific Classification and Community Prevention and Control Strategies

Different prevention and control strategies should be adopted by communities in different epidemic situations. Communities without any case should follow the strategy of “prevention of imported external cases”, while communities with reported cases or outbreaks are suggested to comply with the strategy of “preventing cases from proliferating inwards and outputting outwards”. For communities where the epidemic spreads, the strategy of“preventing the epidemic from spreading inwards and outputting outwards”should be adopted. For details, please refer to the Prevention and Control Plan for Corona Virus Disease 2019 in Community (Tentative Edition)in the Notice on Strengthening Prevention and Control of Corona Virus Disease 2019 in Community(No.5 [2020] of the Pneumonia Mechanism).