How are health agencies reacting?
There is uncertainty regarding transmissibility and severity – more information is emerging about the spectrum of disease, especially mild disease, which is not identified using many current case definitions, and about the ease of transmission from person to person. Health agencies are unsure how to model this and estimates vary depending on the variables being used. For instance, SARS was essentially spread later in the disease from patients with more significant clinical pictures, and it was contained by infection control measures particularly in hospitals. The limited spread to family members of health workers and the community was contained by usual outbreak control measures including early identification and management of persons with infection, tracing of contacts with monitoring for onset of fever and/or symptoms, and active engagement of communities.
Most modelling suggests that the severity of illness is more like influenza than SARS, and there is concern among the public health community because the transmissibility of COVID-19 is not yet fully understood, and the potential for it to become endemic like other respiratory pathogens is unknown.
Because of the many unknowns, the initial reaction by health agencies is still valid: to brace for the first wave as the virus reaches a completely naïve population and to make maximum effort to interrupt transmission [4, 5].
Experience with managing this outbreak will be very heterogenous across the world. Countries closely connected with China, such as Singapore, will be ahead in this regard. As the outbreak moves across regions, there is opportunity to support those affected later both in terms of readiness and response. Mechanisms available to outbreak response organisations, particularly through the Global Outbreak Alert and Response Network (GOARN), can be valuable in skills- and knowledge-sharing. Therefore, there should be a deliberate effort to utilise knowledge from early affected countries in later affected countries.