The Novel Coronavirus Originating in Wuhan, China Challenges for Global Health Governance (2020/01/30)+中文摘要轉譯

隨著新冠肺炎的延燒,各國皆拉起警戒線。然,獲得民眾的信任是公衛手段中最重要的一環。健康系統應鼓勵民眾立即就醫並配合隔離或疫情調查,非自願性的限制措施可能會破壞社區間的互信,並降低與主管機關的配合度。除了公共衛生,無限制的強制隔離有可能違反人權,包括自尊、隱私、及移動的自由。The International Health Regulations強調「最少限制」措施來保障公共衛生。(國衛院莊淑鈞博士整理)

On December 31, 2019, China reported to the World Health Organization (WHO) cases of pneumonia in Wuhan, Hubei Province, China, caused by a novel coronavirus, currently designated 2019-nCoV. Mounting cases and deaths pose major public health and governance challenges. China’s imposition of an unprecedented cordon sanitaire (a guarded area preventing anyone from leaving) in Hubei Province has also sparked controversy concerning its implementation and effectiveness. Cases have now spread to at least 4 continents. As of January 28, there are more than 4500 confirmed cases (98% in China) and more than 100 deaths.1 In this Viewpoint, we describe the current status of 2019-nCoV, assess the response, and offer proposals for strategies to bring the outbreak under control.

 
Current Status

China rapidly isolated the novel coronavirus on January 7 and shared viral genome data with the international community 3 days later. Since that time, China has reported increasing numbers of cases and deaths, partly attributable to wider diagnostic testing as awareness of the outbreak grows. Health officials have identified evidence of transmission along a chain of 4 “generations” (a person who originally contracted the virus from a nonhuman source infected someone else, who infected another individual, who then infected another individual), suggesting sustained human-to-human transmission. Current estimates are that 2019-nCoV has an incubation period of 2 to 14 days, with potential asymptomatic transmission.1,2

Multiple countries have confirmed travel-associated cases, including Australia, Cambodia, Canada, France, Germany, Japan, Nepal, Singapore, South Korea, Taiwan, Thailand, United Arab Emirates, United States, and Vietnam. Vietnam identified the first human-to-human transmission outside China. Yet fundamental knowledge gaps exist on how to accurately characterize the risk, including confirmation of the zoonotic source, efficiency of transmission, precise clinical symptoms, and the range of disease severity and case fatalities.

Control Measures in China

The Chinese Lunar New Year is the largest annual mass travel event worldwide, risking amplification of the spread of 2019-nCoV. In response, China severely restricted movement across Hubei Province in 16 cities, affecting more than 50 million people.3 Authorities have closed public transit and canceled outbound transportation (air, train, and long-haul buses). Vehicular traffic in Wuhan was banned. China also imposed a ban on overseas travel with tour groups and suspended sale of flight and hotel packages. Authorities canceled Lunar New Year gatherings in Beijing as well as intraprovince bus service into the nation’s capital. China’s Finance Ministry announced ¥1 billion (US $145 million) to fund the response as well as the rapid construction of 2 hospitals in Wuhan to treat those affected.

The Hong Kong Special Administrative Region declared its highest-tier emergency, curtailed public events, and barred travelers from Hubei Province. Travelers from mainland China must complete health declarations. Hong Kong has also closed schools and universities at least until mid-February.4

Author: Alexandra L. Phelan, Rebecca Katz, Lawrence O. Gostin

Link: https://jamanetwork.com/journals/jama/fullarticle/2760500