LitCovid-sentences  

PMC:7026896 / 706-19607 JSONTXT 14 Projects

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Id Subject Object Predicate Lexical cue
T6 0-12 Sentence denotes Introduction
T7 13-281 Sentence denotes On 29 December 2019 clinicians in a hospital in Wuhan City, China noticed a clustering of cases of unusual pneumonia (with the first case identified at that time on 12 December) with an apparent link to a market that sells live fish, poultry and animals to the public.
T8 282-364 Sentence denotes This event was reported to the World Health Organisation (WHO) on 31 December [1].
T9 365-770 Sentence denotes Within 4 weeks, by 26 January 2020, the causative organism had been identified as a novel coronavirus, the genome of the virus had been sequenced and published, reverse transcription polymerase chain reaction tests had been developed, the WHO R&D Blueprint had been activated to accelerate diagnostics, therapeutics and vaccine development and a candidate vaccine was ready for initial laboratory testing.
T10 771-861 Sentence denotes Currently Chinese health authorities are building a 1000 bed hospital in Wuhan in 10 days.
T11 862-1171 Sentence denotes By 26 January also, almost 50 million people in Wuhan and neighbouring cities had effectively been placed in quarantine while the WHO had determined that the event should not yet be declared as a Public Health Emergency of International Concern (PHEIC) [2] and had recommended no specific travel restrictions.
T12 1172-1467 Sentence denotes The WHO have emphasised the importance of exit screening at ports in countries showing transmission of the novel coronavirus and have provided guidance for countries implementing entry screening at airports while acknowledging that evidence for the effectiveness of entry screening is equivocal.
T13 1468-1684 Sentence denotes This response is one of the swiftest, coordinated global responses to an emerging infectious disease the world has seen in modern times, but is it the appropriate response, will it be effective and is it sustainable?
T14 1686-1706 Sentence denotes Epidemiology summary
T15 1707-1951 Sentence denotes According to the situation report published by the WHO on 28 January 2020 [3], a total of 2798 confirmed 2019-nCoV cases have been reported globally; of these, 2761 cases were from China, including Hong Kong (8 cases), Macau (5) and Taipei (4).
T16 1952-2194 Sentence denotes Thirty-seven confirmed cases have been reported outside of China in eleven countries in Europe, North America, Australia and Asia; of these 37 exported cases, 36 had a travel history from China or an epidemiological link to a case from China.
T17 2195-2291 Sentence denotes Of the confirmed cases in China, 461 have been reported as severely ill, with 80 deaths to date.
T18 2293-2301 Sentence denotes Analysis
T19 2302-2588 Sentence denotes This outbreak and the response to it illustrate some key issues about how global preparedness and response capacity for outbreaks have evolved over almost two decades since the severe acute respiratory syndrome (SARS) epidemic of 2002/3 and what lessons have, or have not, been learned.
T20 2589-2791 Sentence denotes It also raises questions about the impact these lessons have had on the way agencies and governments respond to these events and about the role of the WHO and the International Health Regulations (IHR).
T21 2793-2805 Sentence denotes Coordination
T22 2806-3045 Sentence denotes One of the critical lessons from the SARS experience was the absolute necessity to be able to coordinate the international resources that are available in an outbreak and to get them focussed on identifying priorities and solving problems.
T23 3046-3225 Sentence denotes The WHO established the means to do this for SARS and it has since been further developed and integrated into global preparedness, especially after the West Africa Ebola epidemic.
T24 3226-3804 Sentence denotes Organisations such as the Global Outbreak Alert and Response Network (GOARN), the Coalition for Epidemic Preparedness Innovations (CEPI), the Global Research Collaboration For Infectious Disease Preparedness (GloPID-R) and the Global Initiative on Sharing All Influenza Data (GISAID) have been supported by the WHO Research Blueprint and its Global Coordinating Mechanism to provide a forum where those with the expertise and capacity to contribute to managing new threats can come together both between and during outbreaks to develop innovative solutions to emerging problems.
T25 3805-3880 Sentence denotes This global coordination has been active in the novel coronavirus outbreak.
T26 3881-4139 Sentence denotes WHO's response system includes three virtual groups based on those developed for SARS to collate real time information to inform real time guidelines, and a first candidate vaccine is ready for laboratory testing within 4 weeks of the virus being identified.
T27 4141-4150 Sentence denotes Reporting
T28 4151-4310 Sentence denotes Another key factor in successfully preventing and managing emerging threats is the rapid and transparent sharing of information between countries and agencies.
T29 4311-4502 Sentence denotes There was extensive criticism of China for its perceived failure to share information about the emerging SARS infection early enough in the outbreak to allow countries to prepare and respond.
T30 4503-4734 Sentence denotes There were similar concerns about information sharing as Middle East Respiratory Syndrome (MERS) emerged and evolved in the Middle East in 2012, particularly in Saudi Arabia, and about the emergence of Ebola in West Africa in 2014.
T31 4735-4949 Sentence denotes On this occasion information sharing seems to have been rapid and effective (while recognising that the information available in the early stages of an outbreak is always less than the global community would like).
T32 4950-5126 Sentence denotes The WHO was notified of the original clustering within days and the full genomic sequence of the new virus was published less than 2 weeks after the cluster was first detected.
T33 5127-5246 Sentence denotes The WHO has expressed its satisfaction with the actions of the Chinese authorities in sharing information with the WHO.
T34 5248-5282 Sentence denotes Journalists and risk communication
T35 5283-5503 Sentence denotes Working with journalists and the media to help them understand the science and epidemiology, particularly in a fast moving event, will improve risk communication to the public and reduce inappropriate concerns and panic.
T36 5504-5762 Sentence denotes While reporting of this outbreak shows signs of the efforts of epidemiologists, infectious disease experts, national and international public health agencies and others engaging with journalists, there are also signs that this is not yet achieving it's goal.
T37 5763-6123 Sentence denotes For example, the public perception is that the increase in case numbers reported daily by the Chinese authorities represents a daily escalation in the epidemic while the reality is that these numbers are also the result of active, aggressive, case finding in China and some of these cases are ‘old’ cases newly recognised as being due to the novel coronavirus.
T38 6124-6363 Sentence denotes Similarly the virus is usually described by the media as ‘deadly’ and although this is true in the sense that it has caused deaths, the nuances of uncertain case fatality rates in the early stages of an outbreak are not being communicated.
T39 6364-6517 Sentence denotes The current estimated case fatality rate seems to be around 3% which is significant but not comparable to the 10% rate for SARS or 34% reported for MERS.
T40 6518-6572 Sentence denotes These misperceptions are still driving public anxiety.
T41 6574-6592 Sentence denotes Informal reporting
T42 6593-6807 Sentence denotes To supplement formal reporting mechanisms between countries and with WHO (including the IHR), the use of informal mechanisms such as media and social media reports was advocated in the light of the SARS experience.
T43 6808-6974 Sentence denotes There are now globally several systems that provide collated information from informal reporting including networks of experts and scanning of media and social media.
T44 6975-7109 Sentence denotes These contribute to, and amplify, epidemic intelligence and are being integrated with national and international surveillance systems.
T45 7110-7223 Sentence denotes The value, and the challenges, of this additional source of information has been evident in the current outbreak.
T46 7224-7432 Sentence denotes The value comes from ensuring that early indications of cases beyond the initial outbreak city have been detected and can supplement the global risk assessment and monitoring of the evolution of the outbreak.
T47 7433-7745 Sentence denotes The challenges lie in the volume and diversity of the information available and the relative lack of verification mechanisms, such that one of these systems (ProMed) has commented that it was becoming increasingly difficult to assimilate the information being supplied [4] and to make meaningful interpretations.
T48 7747-7781 Sentence denotes Health care workers & hospital IPC
T49 7782-7862 Sentence denotes Early in the outbreak it was reported that health workers had not been infected.
T50 7863-7968 Sentence denotes This was reassuring because it is health workers who many times, and inadvertently, amplify transmission.
T51 7969-8147 Sentence denotes Failure to wash hands between patients, for example, can result not only in autoinfection, but also in infection of patients hospitalised for other causes when they provide care.
T52 8148-8332 Sentence denotes Autoinfection is not only a risk for the health worker, but also for their families and the communities in which they live, depending on the transmissibility and means of transmission.
T53 8333-8419 Sentence denotes More recently infection, and at least one death, in health workers has been confirmed.
T54 8420-8486 Sentence denotes Although not unexpected this does add to the epidemiological risk.
T55 8488-8509 Sentence denotes Superspreading events
T56 8510-8715 Sentence denotes A characteristic of the SARS outbreak was the variability of transmissibility between cases and the occurrence of ‘superspreading events’ where a case infected significantly more contacts than the average.
T57 8716-8792 Sentence denotes This was also seen with MERS in the outbreak in the Republic of Korea (RoK).
T58 8793-8929 Sentence denotes In this current novel coronavirus outbreak, such superspreading events have not been documented but the epidemiology is still not clear.
T59 8930-9027 Sentence denotes Confirming whether or not this is happening must be an urgent task for the Chinese investigation.
T60 9028-9223 Sentence denotes Modellers have suggested reproductive rates (R0) of 3.8 (95% confidence interval, 3.6–4.0) [5] and 2.6 (1.5–3.5) [6]; R0 for SARS was estimated at around 3 in the absence of control measures [7].
T61 9225-9234 Sentence denotes Economics
T62 9235-9318 Sentence denotes The economic impact of major outbreaks can be substantial for the affected country.
T63 9319-9387 Sentence denotes This was seen clearly in SARS, MERS in RoK and Ebola in West Africa.
T64 9388-9607 Sentence denotes One analyst estimates that the current coronavirus outbreak's likely impact will range from a 0.8% cut to real GDP if the epidemic is controlled within 3 months, to a 1.9% cost to GDP if the epidemic lasts 9 months [8].
T65 9608-9742 Sentence denotes This may increase substantially in the light of the extended restrictions on movement, and therefore trade and commerce, within China.
T66 9744-9754 Sentence denotes Discussion
T67 9755-9922 Sentence denotes The emergence of a significant respiratory illness linked to a novel coronavirus represents a test of the global capacity to detect and mange emerging disease threats.
T68 9923-10021 Sentence denotes Its emergence in China adds an additional dimension in the light of previous experience with SARS.
T69 10022-10179 Sentence denotes The timing of the outbreak immediately before the Chinese Lunar New Year with its attendant population movements adds extra risk and urgency to the response.
T70 10180-10390 Sentence denotes The rapid sharing of information in this outbreak and the speed of the coordinated response both in the country and internationally suggest that lessons have been learned from SARS that improve global capacity.
T71 10391-10584 Sentence denotes The international networks and forums that now exist have facilitated the bringing together of expertise from around the world to focus research and development efforts and maximise the impact.
T72 10585-10892 Sentence denotes At this early stage in the outbreak information remains incomplete and key clinical and epidemiological questions have not yet been answered, but the deficit seems to be due more to the constraints of investigating an emerging disease than to any unwillingness to engage and share information with partners.
T73 10893-10968 Sentence denotes There are some indications of areas where further improvement is necessary.
T74 10969-11355 Sentence denotes The global media response to the unfolding events has been relatively balanced and informed but the nuances of the evolving situation have not been critically examined in partnership with the media and as a result the public perception of the risk may be exaggerated – although it of course remains possible that the outbreak will develop in a way that matches up to the perceived risk.
T75 11356-11645 Sentence denotes The lack of appreciation of the uncertainties in determining a meaningful case fatality rate and the significance of ascertainment bias at the beginning of an outbreak, along with the impact of aggressive case finding on case numbers, are examples of where understanding could be improved.
T76 11646-12040 Sentence denotes This is always a challenging process when balancing the resources focussed on analysing the situation on the ground with resources directed at interpreting the information for journalists but in SARS, the R0 was seen to decrease in response to information reaching the public and the public then adopting risk reduction actions [6]; so accurate public risk communication is critical to success.
T77 12041-12145 Sentence denotes It would be helpful to find a forum where this can be explored with the media community after the event.
T78 12146-12382 Sentence denotes The increase in access to early information from diverse sources including media and social media adds an important dimension to identifying and tracking new events globally and is a key part of the overall epidemic intelligence system.
T79 12383-12440 Sentence denotes However, it is also a potential source of disinformation.
T80 12441-12710 Sentence denotes When, as has been seen in this outbreak, the volume of information coming in exceeds any capacity to collate and analyse it and to attempt to cross-reference and verify separate items, there is a risk that the information fuels speculation and media and public concern.
T81 12711-12955 Sentence denotes Again there is a fine balance between information that encourages appropriate risk avoidance actions and information that encourages inappropriate actions; however the public health is usually better served by more information rather than less.
T82 12956-13174 Sentence denotes The role of a declaration of a PHEIC in managing a serious outbreak has been questioned in the light of Ebola in West Africa and in the Democratic Republic of Congo [9] and has been challenged again with this outbreak.
T83 13175-13458 Sentence denotes The binary nature of a PHEIC declaration (either an event is a PHEIC or it isn't – there are no intermediate options) and the specificity of the three defined criteria for a PHEIC have caused difficulty for Emergency Committees in considering whether a given event should be a PHEIC.
T84 13459-13693 Sentence denotes The lack of a clear understanding of what a PHEIC declaration is meant to achieve adds to the Emergency Committee's difficulties, as does the relative paucity of clinical and epidemiological answers at this stage of the investigation.
T85 13694-13890 Sentence denotes In this instance the Emergency Committee were divided in coming to a conclusion but decided on balance that the current situation, although an emergency, should not as yet be declared a PHEIC [2].
T86 13891-14083 Sentence denotes As with Ebola in the DRC, there has been criticism of the WHO for this decision but, as with Ebola, it is not immediately clear what would be different in the response if a PHEIC was declared.
T87 14084-14393 Sentence denotes The WHO is working on improving the way in which Emergency Committees develop their advice for the Director General but, as recommended by this Emergency Committee and the post-Ebola IHR Review Committee in 2015, the development of an intermediate alert alongside WHO's risk assessment process may be helpful.
T88 14394-14587 Sentence denotes A key function of a PHEIC declaration is that it is the (only) gateway to the WHO Temporary Recommendations on possible travel and trade restrictions to limit international spread of a disease.
T89 14588-14809 Sentence denotes In this case several countries globally had already implemented entry screening at airports and China had begun closing down international travel from Wuhan before the Emergency Committee had finished their deliberations.
T90 14810-14983 Sentence denotes While the WHO would not, and could not, interfere with the sovereign decisions of member states, the lack of influence on travel and trade decisions could prove problematic.
T91 14984-15097 Sentence denotes Alongside the speed of the response in this outbreak, we have seen dramatic changes in the scale of the response.
T92 15098-15243 Sentence denotes The imposition of very extensive quarantine measures on millions of people as an attempt to break the transmission of the virus is unprecedented.
T93 15244-15440 Sentence denotes We do not know whether they will be effective; indeed we do not know how we will determine if they have been effective – what end point can we measure that will provide an answer to that question?
T94 15441-15730 Sentence denotes If recent suggestions that people infected with this coronavirus may be infectious while incubating or asymptomatic, and the reports that up to 5 m people left Wuhan before the travel restrictions were imposed, are confirmed, the efficacy of these control measures will be more challenged.
T95 15731-15941 Sentence denotes Given the likely impact on at least the Chinese economy and probably the global economy, it will be important to understand the role and the effectiveness of public health measures on this scale for the future.
T96 15942-16132 Sentence denotes However, the imposition of these dramatic measures does also raise a wider question: if there is an impact from these measures, what other countries would (or could) implement such measures?
T97 16133-16252 Sentence denotes Would other countries accept the self-imposed economic damage that China has accepted to try and contain this outbreak?
T98 16253-16470 Sentence denotes Is it reasonable to consider that national governments would close down public transport into and out of London, New York or Paris in the week before Christmas even if it were shown to be an effective control measure?
T99 16471-16565 Sentence denotes These decisions and questions cross the interface between public health, science and politics.
T100 16566-16762 Sentence denotes The response to this outbreak in China was inevitably influenced by the historical reaction to the country's response to SARS and the world's suspicion of China's lack of cooperation at that time.
T101 16763-16894 Sentence denotes The current response is therefore framed within a context of not wanting to be seen to be behaving in the same way with this event.
T102 16895-17114 Sentence denotes This may indicate another impact of the SARS (and MERS and Ebola) experience on the response to subsequent outbreaks – a tendency to look at worst case scenarios and respond accordingly and a fear of ‘getting it wrong’.
T103 17115-17368 Sentence denotes This can deter leaders at all levels, from outbreak teams to national governments, from making judgements when all the information they would like is not available in case those judgments turn out to be wrong when the full information becomes available.
T104 17369-17507 Sentence denotes In emergency response it is generally better to over-react and then scale back if necessary rather than under-react and then act too late.
T105 17508-17746 Sentence denotes Response should be on a ‘no regrets’ basis – make the best decisions possible on the basis of the best information and science available at the time but do not judge or criticise if later information suggests a different course of action.
T106 17747-17968 Sentence denotes The early response must recognise what is known and what is not known and look at what of the unknowns can reasonably be estimated by reference to previous outbreaks, similar pathogens, early reporting and modelling, etc.
T107 17969-18074 Sentence denotes The risk assessment and response can then be modified and refined as information on the unknowns evolves.
T108 18075-18214 Sentence denotes Key to that approach, however, is confidence that decisions will not be criticised based on information that was not available at the time.
T109 18215-18375 Sentence denotes It is also important to be ready to change decisions when the available information changes – something that both scientists and politicians can find difficult.
T110 18376-18616 Sentence denotes In that context, China should not be judged for implementing what might appear to be extreme measures but China should also be prepared to discontinue the measures quickly if evidence suggests they are not the best way to solve the problem.
T111 18617-18848 Sentence denotes By closing airports the international spread from Wuhan may be decreased, but success will depend on how effective the measures really are at stopping people moving out of the affected area as well as on the behaviour of the virus.
T112 18849-18901 Sentence denotes As always, only time will tell – but time is scarce.