Study on the COVID-19 infection status, prevention and control strategies among people entering Shenzhen

Background The novel coronavirus disease 2019 (COVID-19) confirmed cases overseas have continued to rise in the last months, and many people overseas have chosen to return to China. This increases the risk of a large number of imported cases which may cause a relapse of the COVID-19 outbreak. In order to prevent imported infection, the Shenzhen government has implemented a closed-loop management strategy using nucleic acid testing (NAT) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and requiring 14 days of medical observation for individuals with an overseas tour history (Hong Kong, Macao, Taiwan province and other countries). Our study aims to describe the status of COVID-19 infection among people entering Shenzhen, and to evaluate the effect of the closed-loop management strategy. Methods We undertook a descriptive study and risk analysis by the entry time, time of reporting, and local confirmed cases in countries of origin. The NAT were completed in Shenzhen Center for Disease Control and Prevention (CDC), ten district-level CDCs, and fever clinics. Results A total of 86,844 people from overseas entered Shenzhen from January 1 to April 18, 2020; there were 39 imported COVID cases and 293 close contacts. The infection rate of people entering was 4.49‰ [95% Confidence interval (CI): 3.26‰–6.05‰]. Fourteen imported cases (35.9%) came from the UK, and nine (23.08%) came from the USA. People entering from the USA since March 9 or from the UK since March 13 are the high-risk population. As of July 17, there have been no new confirmed cases in Shenzhen for 153 days, and the numbers of confirmed case, close contacts, and asymptomatic cases are 0. Conclusions The closed-loop management has been effective in preventing imported infection and controlling domestic relapse. The distribution of entry time and report time for imported cases overseas was similar. This shows that it is important to implement closed-loop management at the port of entry.

Public Support for Health Coverage for Migrant Populations in The COVID-19 Pandemic: The Roles of Infection Externalities and Impressions of Migrants' Home Place

Background: International population mobility is a significant challenge for the management of the coronavirus (COVID-19) pandemic. The suspension of flights and other traffic has been adopted to avoid more cases of imported infection by many countries, but these measures mean that most migrant populations, including immigrants, migrant and seasonal workers, international students, and others, have to stay in their host places. Therefore, equitable access to health services in the host places is crucial for them. Immigrant-receiving areas may encounter a dilemma when considering whether to extend health coverage of COVID-19 testing and treatment to immigrants. In this context, it is vital to understand public attitudes towards this issue since they explain and validate the policy responses. Methods: The data used in this study came from an survey conducted in March 2020. The survey targeted adults aged 18 and older who were local residents of nine cities in Guangdong province, China. The sample size was 1,040, and STATA 15.0 was used in the statistical analysis.Results: The results show that individuals with higher health security ratings, lower demand for health services, and greater concern about the risk of infectious diseases are more supportive of extending health services to immigrants. In addition, individuals who rate immigrants’ home place as more immigrant-friendly are also more supportive of it.Conclusions: Public support for health coverage for immigrants in the COVID-19 Pandemic is influenced by infection externalities and impression of immigrants’ home countries. This study attempts to contribute to the body of literature related to welfare attitudes and immigration. It also outlines a series of crucial implications for the global task of managing COVID-19.

High COVID-19 transmission potential associated with re-opening universities can be mitigated with layered interventions

Background: Re-opening universities while controlling COVID-19 transmission poses unique challenges. UK universities typically host 20,000 to 40,000 undergraduate students, with the majority moving away from home to attend. In the absence of realistic mixing patterns, previous models suggest that outbreaks associated with universities re-opening are an eventuality. Methods: We developed a stochastic transmission model based on realistic mixing patterns between students. We evaluated alternative mitigation interventions for a representative university. Results: Our model predicts, for a set of plausible parameter values, that if asymptomatic cases are half as infectious as symptomatic cases then 5,760 (3,940 - 7,430) out of 28,000 students, 20% (14% - 26%), could be infected during the first term, with 950 (656 - 1,209) cases infectious on the last day of term. If asymptomatic cases are as infectious as symptomatic cases then three times as many cases could occur, with 94% (93% - 94%) of the student population getting infected during the first term. We predict that one third of infected students are likely to be in their first year, and first year students are the main drivers of transmission due to high numbers of contacts in communal residences. We find that reducing face-to-face teaching is likely to be the single most effective intervention, and this conclusion is robust to varying assumptions about asymptomatic transmission. Supplementing reduced face-to-face testing with COVID-secure interactions and reduced living circles could reduce the percentage of infected students by 75%. Mass testing of students would need to occur at least fortnightly, is not the most effective option considered, and comes at a cost of high numbers of students requiring self-isolation. When transmission is controlled in the student population, limiting imported infection from the community is important. Conclusions: Priority should be given to understanding the role of asymptomatic transmission in the spread of COVID-19. Irrespective of assumptions about asymptomatic transmission, our findings suggest that additional outbreak control measures should be considered for the university setting. These might include reduced face-to-face teaching, management of student mixing and enhanced testing. Onward transmission to family members at the end of term is likely without interventions.

Surveillance on schistosomiasis in five provinces of the People’s Republic of China in the post-elimination era

Background: The People’s Republic of China (P. R. China) has made significant progress on schistosomiasis control. Among the 12 provinces (municipality, autonomous region) with schistosomiasis endemic in P.R. China, Guangdong, Shanghai, Fujian, Guangxi and Zhejiang provinces (following called as five provinces) had successively eliminated schistosomiasis during 1985-1995. However, given the increasing mobilization of the population and goods, wetland protection, climate changes etc., consolidation of the schistosomiasis elimination in these five provinces remains challenging. In the current study, we sought to understand the epidemic situation in these post-elimination areas and their surveillance capabilities on schistosomiasis. Methods: (Ⅰ) Through the national schistosomiasis reporting system, annual data reflecting the interventions and surveillance on human beings, cattle and snails based on county level from 2005 to 2016 were collected and analyzed to understand the epidemic status of schistosomiasis in five provinces. (Ⅱ) A standardized score sheet was designed to assess the surveillance capacity for schistosomiasis of selected disease control agencies in five provinces and ten counties. Assessment on surveillance capacity consisted of two parts: the first part focused on the capacity of testing skills including schistosomiasis diagnostic skills, identification of snails’ living and infection status; the second part was to assess the knowledge level about schistosomiasis and its control.Results: The comprehensive assessments showed that no local cases in humans and cattle or infected snail were found in these five provinces from 2005, and the surveillance abilities on schistosomiasis of the prevention and control institutions in five provinces were appropriate. However, from 2005 to 2016, a total of 221 imported cases were detected in Zhejiang, Shanghai and Fujian provinces, and 11.98 hm2 of new snail habitats were found in Zhejiang, Shanghai and Guangxi provinces. In addition, snail infestation reoccurred in 247.55 hm2 of former snail habitats since 2011.Conclusions: Elimination of schistosomiasis was consolidated successfully in five provinces of P.R. China due to effective and strong post-elimination surveillance. Comprehensive consolidation strategies should be focused on the elimination of residual snails and the prevention of imported infection sources among the five provinces to consolidate the achievements of schistosomiasis control.

Study on the COVID-19 infection status, prevention and control strategies among entry people in Shenzhen

Background The overseas COVID-19 confirmed cases continue to rise for months, while people overseas prefer to return China at present. It is risky to have a large number of imported cases which may cause a relapse of COVID-19 outbreak. In order to prevent imported infection, Shenzhen government has implemented the closed-loop management strategy by taking nucleic acid testing (NAT) for severe acute respiratory syndromes coronavirus 2 (SARS-CoV-2) and requiring14-days medical observation for individuals with overseas tour history (Hong Kong, Macao, Taiwan province and other countries) within 14 days. Our study aim to describe the status of COVID-19 infection among entry people in Shenzhen, and evaluate the effect of closed-loop management strategy. Methods We made a descriptive study and risk analyze by the entry time, reported time, local confirmed cases in origin countries. The NAT were completed in Shenzhen center for disease control and prevention (CDC), ten district-level CDCs, as well as fever clinics. Results A total of 86,844 people overseas entered Shenzhen from January 1 to April 18, 2020, there were 39 imported cases and 293 closed contacts. The infection rate of entry people was 4.49‰ (95% CI: 3.26‰ − 6.05‰). 14 imported cases (35.9%) came from the UK, 9 (23.08%) came from the US. Entry people from the US since Mar 9 or from the UK since Mar 13 are the high-risk population. As of July 17, there have been no new confirmed cases in Shenzhen for 153 days, and the number of confirmed case, close contact, and asymptomatic case are 0. So the closed-loop management is effective to prevent imported infection and control domestic relapse. The distribution of entry time and report time for imported cases overseas was similar. So it is important to take closed-loop management at the port. Conclusions The risk of imported infection from the US and UK were higher that other countries and regions in Shenzhen. The closed-loop management is effective to prevent imported infection and control domestic relapse. Every country is closely connected under the background of globalization. In order to control COVID-19 outbreak, we need the collaboration and cooperation at the global, national, and subnational levels to prevent, detect, and respond effectively.

Study on the COVID-19 infection status, prevention and control strategies among entry people in Shenzhen

Background The COVID-19 confirmed cases overseas continue to rise for months, while people overseas prefer to return at present. It is risky to have a large number of infected imported cases which may cause COVID-19 spread to China and even lead to outbreak again. In order to prevent imported infection, Shenzhen implemented the losed-loop management strategy by taking nucleic acid testing (NAT) for severe acute respiratory syndromes coronavirus 2 (SARS-CoV-2) and medical observation for 14 days among individuals who have epidemic history (Hong Kong, Macao, Taiwan province and other countries) within 14 days. Our study described the status of COVID-19 infection among entry people in Shenzhen, and also evaluated the effect of closed-loop management strategy.Methods A total of 86,844 people overseas entered Shenzhen from January 1 to April 18, 2020, and there were 39 imported cases. We made a descriptive study by analyzing the entry time, reported time, local confirmed cases in origin countries, and the number of entry people from abroad. The NAT were completed in Shenzhen center for disease control and prevention (CDC), ten district-level CDCs, as well as fever clinics.Results The infection rate of entry people was 4.49‰ (95% CI: 3.26‰ − 6.05‰). Most of the entry people or imported cases have Chinese nationality. The number of entry people and imported cases in Nanshan and Futian districts were larger than others. 15.73% of the entry people came from the US, and 12.67% came from the UK. 14 imported cases (35.9%) came from the UK, 9 (23.08%) came from the US. The imported risks from the US and UK in Shenzhen were higher than other countries or regions. According to the 14-days’ incubation period and the number of entry people, individuals from the US since Mar 9 were the high-risk population. Accordingly, entry people from the UK since Mar 13 were the high-risk population. It is important to evaluate the imported risk by analyzing local confirmed cases status in origin countries or regions and the number of entry people from these countries or regions to Shenzhen. The distribution of entry time and report time for imported cases in Shenzhen were similar. So it is important to prevent and control COVID-19 imported infection by taking NAT and medical observation at port.Conclusions It is effective to implement closed-loop management strategy for individuals who have epidemic history (Hong Kong, Macao, Taiwan province and other countries) within 14 days. In order to control COVID-19 outbreak, we need the collaboration and cooperation at the global, national, and subnational levels to prevent, detect, and respond effectively.

Surveillance on schistosomiasis in five provinces of the People's Republic of China in post-elimination era

Background: The People’s Republic of China (P. R. China) had made significant progress on schistosomiasis control. Among the 12 provinces (municipality, autonomous region with schistosomiasis endemic) in P.R. China, Guangdong, Shanghai, Fujian, Guangxi and Zhejiang provinces (following called as five provinces) had successively eliminated schistosomiasis during 1985-1995. However, given the increasing mobilization of the population and goods, wetland protection, climate changes etc., consolidation of the schistosomiasis elimination in these five provinces remain challenges. In the current study, we sought to understand the epidemic situation in these post-elimination areas and their surveillance capabilities on schistosomiasis. Methods: (Ⅰ) Through the national schistosomiasis reporting system, annual data reflecting the interventions and surveillance on human beings, cattle and snails based on county level from 2005 to 2016 were collected and analyzed to understand the epidemic status of schistosomiasis in five provinces. (Ⅱ) A standardized score sheet was designed to assess the surveillance capacity for schistosomiasis of selected disease control agencies in five provinces and ten counties. Assessment on surveillance capacity consisted of two parts: the first part focused on the capacity of testing skills including schistosomiasis diagnostic skills, identification of snails’ living and infection status; the second part was to assess the knowledge level about schistosomiasis and its control.Results: The comprehensive assessments showed that no local cases in humans and cattle or infected snail were found in these five provinces from 2005, and the surveillance abilities on schistosomiasis of the prevention and control institutions in five provinces were appropriate. However, from 2005 to 2016, a total of 221 imported cases were detected in Zhejiang, Shanghai and Fujian provinces, and 11.98 hm2 of new snail habitats were found in Zhejiang, Shanghai and Guangxi provinces. In addition, snail infestation was reoccurred in 247.55 hm2 of former snail habitats since 2011.Conclusions: Elimination of schistosomiasis was consolidated successfully in five provinces of P.R. China due to effective and strong post-elimination surveillance. Comprehensive consolidation strategies should be focused on the elimination of residual snails and the prevention of imported infection sources among the five provinces to consolidate the achievements of schistosomiasis control.

Case 35

Malaria is among the most common imported infection brought into the United Kingdom . Recognition of malaria is crucial given the potential severe consequences including death, particularly from Plasmodium falciparum infection. Prompt diagnosis and correct treatment improves outcome and malaria must be considered in the differential diagnosis of fever in all travellers with an appropriate exposure history.