Chapter 3 Development and Revisions of the Prevention and Control Plan of Corona Virus Disease 2019

(First to Fourth Editions)

A number of cases with novel coronavirus pneumonia(officially named as COVID-19)have been found in Wuhan, Hubei Province since December 2019. As the outbreak spread, such cases have also been found in other parts of China and abroad. In order to guide the scientific and effective prevention and control work in each region, with the approval of the State Council, the National Health Commission of the People’s Republic of China included this disease into the Class B communicable diseases and managed as a Class A communicable disease stipulated in the Law of the People’s Republic of China on the Prevention and Treatment of Infections Diseases on January 20th, 2020, and organized China CDC and other related institutions to dynamically analyze the development of the epidemic situations and grasp the progress of prevention and control in each region. According to changes of the prevention and control situation, including the increase in clustered outbreaks in Hubei Province and Wuhan, the spread of outbreaks in provinces outside Hubei, and the detection of asymptomatic carriers, as well as the related research progress of the etiology and transmission routes of 2019-nCoV, four versions of the prevention and control plan have been revised and updated. On February 6th, 2020, the General Office of National Health Commission of the People’s Republic of China issued the Prevention and Control Plan of Corona Virus Disease 2019(Fourth Edition)(hereinafter referred to as the Prevention and Control Plan(Fourth Edition)). From the First Edition to the Fourth Edition of the Prevention and Control Plan, the whole number of prevention and control measures has been increased from 9 to 12 and the number of appendixes has been increased from 4 to 6. The epidemiological histories and judgment principles of cases in the“Definition of Surveillance” section, the epidemiological investigation contents, as well as the judgment principles and management measures for close contacts have been major adjusted. A definition of surveillance has been added for Hubei province, and the management of possible sources of infection is more stringent. The detailed comparative analysis tables are shown(Tables 3.1–3.4).

Compared with the previous three editions, the fourth edition is revised from the perspectives of effective detecting source of infection, cutting off route of transmission and protecting susceptible individuals according to the actual work at the frontline. First, descriptions of pathogenic and epidemiological characteristics have been added in this edition for grassroots medical personnel to better understand the transmission characteristics of 2019-nCoV, to take scientific and effective measures, and to implement prevention, control and self-protection. Second, the sensitivity of detecting the confirmed and potential source of infection is improved to a large extent. In the surveillance plan of the fourth edition, the epidemiology description and judgment principles of suspected cases have been adjusted in the “Definition of Surveillance” section for provinces except Hubei. The description of that “Wuhan or other areas where local cases continue to spread”in the third edition has been changed to “Wuhan and its surrounding areas or other communities with case reports” in the fourth edition. Besides, the judgment principle of “satisfying any one of the epidemiological histories and two of the clinical manifestations(item 1 and item 2, or item 2 and item 3)” is adjusted to “satisfying any one of the epidemiological exposure histories as well as any two of the clinical manifestations”, which further increases the sensitivity of surveillance for suspected cases. “Having the imaging features of pneumonia”is no longer a requirement for the judgement of suspected cases with epidemiological exposure history. Thus, omissive mild cases can be avoided and the possibility of detecting suspected cases can be improved in basic medical institutions. As for Hubei province, the criteria of determining suspected cases are further extended and meanwhile, a category of “clinically diagnosed cases” is added, which can improve the sensitivity of detecting suspected cases significantly. Third, the management measures of potential source of infection have been strengthened to effectively reduce the incidence of cluster cases. To reduce the spread of diseases caused by lax home quarantine, the Prevention and Control Plan(Fourth Edition)requires intensive isolation of close contacts and asymptomatic carriers, and home quarantine is only allowed in areas where conditions are not available.Fourth, the risk of fecal-oral transmission has been fully considered. The corresponding measures and requirements are put forward to laboratory examinations, close contacts management, specific population protection and specific sites disinfection. It is required to focus on environmental and personal hygiene, conducting excreta disinfection of the cases, conducting disinfection of medical institutions, homes, toilets and public places, and to prevent contamination of water and food by patients’ stool. Fifth, the workload of case report at the grass-roots level has been reduced. The fourth edition indicated suspected cases are not required for network report on epidemiological investigation before confirmation, and raised the number requirement of clustered cases from 2 to 5, whose specimens need to be sent to the China CDC for review and confirmation.

With the in-depth understanding of 2019-nCoV and the experience accumulated in disease prevention and control, experts from the China CDC will continue to scientifically evaluate the situation of epidemic prevention and control, constantly improve the prevention and control plan, and ensure that the prevention and control work in the country is scientific, orderly,powerful and effective.

Liping WANG

Chinese Center for Disease Control and Prevention, Beijing, China