Revealed – World Health Organization-China Joint Mission on Coronavirus Disease 2019 (COVID-19) Report

The overall goal of the Joint Mission was to rapidly inform national (China) and international planning on next steps in the response to the ongoing outbreak of the novel coronavirus disease (COVID-19) and on next steps in readiness and preparedness for geographic areas not yet affected.

The major objectives of the Joint Mission were as follows:
• To enhance understanding of the evolving COVID-19 outbreak in China and the nature and impact of ongoing containment measures;
• To share knowledge on COVID-19 response and preparedness measures being implemented in countries affected by or at risk of importations of COVID-19;
• To generate recommendations for adjusting COVID-19 containment and response measures in China and internationally; and
• To establish priorities for a collaborative programme of work, research and development to address critical gaps in knowledge and response and readiness tools and activities.

Members & Method of Work

The Joint Mission consisted of 25 national and international experts from China, Germany, Japan, Korea, Nigeria, Russia, Singapore, the United States of America and the World Health Organization (WHO). The Joint Mission was headed by Dr Bruce Aylward of WHO and Dr Wannian Liang of the People’s Republic of China. The full list of members and their affiliations is available in Annex A. The Joint Mission was implemented over a 9-day period from 16-24 February 2020. The schedule of work is available in Annex B.

The Joint Mission began with a detailed workshop with representatives of all of the principal ministries that are leading and/or contributing to the response in China through the National Prevention and Control Task Force. A series of in-depth meetings were then conducted with national level institutions responsible for the management, implementation and evaluation of the response, particularly the National Health Commission and the China Centers for Disease Control and Prevention (China CDC). To gain first-hand knowledge on the field level implementation and impact of the national and local response strategy, under a range of epidemiologic and provincial contexts, visits were conducted to Beijing Municipality and the provinces of Sichuan (Chengdu), Guangdong (Guangzhou, Shenzhen) and Hubei (Wuhan). The field visits included community centers and health clinics, country/district hospitals, COVID-19 designated hospitals, transportations hubs (air, rail, road), a wet market, pharmaceutical and personal protective equipment (PPE) stocks warehouses, research institutions, provincial health commissions, and local Centers for Disease Control (provincial and prefecture). During these visits, the team had detailed discussion and consultations with Provincial Governors, municipal Mayors, their emergency operations teams, senior scientists, frontline clinical, public health and community workers, and community neighbourhood administrators. The Joint Mission concluded with working sessions to consolidate findings, generate conclusions and propose suggested actions.

To achieve its goal, the Joint Mission gave particular focus to addressing key questions related to the natural history and severity of COVID-19, the transmission dynamics of the COVID-19 virus in different settings, and the impact of ongoing response measures in areas of high (community level), moderate (clusters) and low (sporadic cases or no cases) transmission.

The findings in this report are based on the Joint Mission’s review of national and local governmental reports, discussions on control and prevention measures with national and local experts and response teams, and observations made and insights gained during site visits. The figures have been produced using information and data collected during site visits and with the agreement of the relevant groups. References are available for any information in this report that has already been published in journals.

The final report of the Joint Mission was submitted on 28 February 2020.

The Global Response & Next Steps

1. The COVID-19 virus is a new pathogen that is highly contagious, can spread quickly, and must be considered capable of causing enormous health, economic and societal impacts in any setting. It is not SARS and it is not influenza. Building scenarios and strategies only on the basis of well-known pathogens risks failing to exploit all possible measures to slow transmission of the COVID-19 virus, reduce disease and save lives.

COVID-19 is not SARS and it is not influenza. It is a new virus with its own characteristics. For example, COVID-19 transmission in children appears to be limited compared with influenza, while the clinical picture differs from SARS. Such differences, while based on limited data, may be playing a role in the apparent efficacy of rigorously applied non-pharmaceutical, public health measures to interrupt chains of human-to-human transmission in a range of settings in China. The COVID-19 virus is unique among human coronaviruses in its combination of high transmissibility, substantial fatal outcomes in some high-risk groups, and ability to cause huge societal and economic disruption. For planning purposes, it must be assumed that the global population is susceptible to this virus. As the animal origin of the COVID-19 virus is unknown at present, the risk of reintroduction into previously infected areas must be constantly considered.

The novel nature, and our continuously evolving understanding, of this coronavirus demands a tremendous agility in our capacity to rapidly adapt and change our readiness and response planning as has been done continually in China. This is an extraordinary feat for a country of 1.4 billion people.

2. China’s uncompromising and rigorous use of non-pharmaceutical measures to contain transmission of the COVID-19 virus in multiple settings provides vital lessons for the global response. This rather unique and unprecedented public health response in China reversed the escalating cases in both Hubei, where there has been widespread community transmission, and in the importation provinces, where family clusters appear to have driven the outbreak.

Although the timing of the outbreak in China has been relatively similar across the country, transmission chains were established in a wide diversity of settings, from megacities in the north and south of the country, to remote communities. However, the rapid adaptation and tailoring of China’s strategy demonstrated that containment can be adapted and successfully operationalized in a wide range of settings.

China’s experience strongly supports the efficacy and effectiveness of anchoring COVID-19 readiness and rapid response plans in a thorough assessment of local risks and of utilizing a differentiated risk-based containment strategy to manage the outbreak in areas with no cases vs. sporadic cases vs. clusters of cases vs. community-level transmission. Such a strategy is essential for ensuring a sustainable approach while minimizing the socio-economic impact.

3. Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures.

Achieving the high quality of implementation needed to be successful with such measures requires an unusual and unprecedented speed of decision-making by top leaders, operational thoroughness by public health systems, and engagement of society.

Given the damage that can be caused by uncontrolled, community-level transmission of this virus, such an approach is warranted to save lives and to gain the weeks and months needed for the testing of therapeutics and vaccine development. Furthermore, as the majority of new cases outside of China are currently occurring in high and middle-income countries, a rigorous commitment to slowing transmission in such settings with non-pharmaceutical measures is vital to achieving a second line of defense to protect low income countries that have weaker health systems and coping capacities.

The time that can be gained through the full application of these measures – even if just days or weeks – can be invaluable in ultimately reducing COVID-19 illness and deaths. This is apparent in the huge increase in knowledge, approaches and even tools that has taken place in just the 7 weeks since this virus was discovered through the rapid scientific work that has been done in China.