ABSTRACT
BACKGROUND: The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic demonstrates the value of regional cooperation in infectious disease prevention and control. We explored the literature on regional infectious disease control bodies, to identify lessons, barriers and enablers to inform operationalisation of a regional infectious disease control body or network in southeast Asia. METHODS: We conducted a scoping review to examine existing literature on regional infectious disease control bodies and networks, and to identify lessons that can be learned that will be useful for operationalisation of a regional infectious disease control body such as the Association of Southeast Asian Nations (ASEAN) Center for Public Health Emergency and Emerging Diseases. RESULTS: Of the 57 articles included, 53 (93%) were in English, with two (3%) in Spanish and one (2%) each in Dutch and French. Most were commentaries or review articles describing programme initiatives. Sixteen (28%) publications focused on organisations in the Asian continent, with 14 (25%) focused on Africa, and 14 (25%) primarily focused on the European region. Key lessons focused on organisational factors, diagnosis and detection, human resources, communication, accreditation, funding, and sustainability. Enablers and constraints were consistent across regions/ organisations. A clear understanding of the regional context, budgets, cultural or language issues, staffing capacity and governmental priorities, is pivotal. An initial workshop inclusive of the various bodies involved in the design, implementation, monitoring or evaluation of programmes is essential. Clear governance structure, with individual responsibilities clear from the beginning, will reduce friction. Secure, long-term funding is also a key aspect of the success of any programme. CONCLUSION: Operationalisation of regional infectious disease bodies and networks is complicated, but with extensive groundwork, and focus on organisational factors, diagnosis and detection, human resources, communication, accreditation, funding, and sustainability, it is achievable. Ways to promote success are to include as many stakeholders as possible from the beginning, to ensure that context-specific factors are considered, and to encourage employees through capacity building and mentoring, to ensure they feel valued and reduce staff turnover.
ABSTRACT
Background: An understanding of key differences in epidemiological and clinical characteristics between geographical regions and populations is limited. This systematic review and meta-analysis aims to compare clinical presentation, outcomes, and care management of different COVID-19 patient groups globally. Methods: The search strategy involved peer-reviewed studies published between 1st January and 9th April 2020 in Pubmed, Google scholar, and Chinese Medical Journal database. Pooled prevalence and means with 95% confidence intervals were computed using a random effects model. Subgroup analyses were performed between different geographies, clinical severities, and age groups. Results: A total of 77 publications were identified after full-text screening. Subsequently, data from 40 non-overlapping studies, comprising 4,884 patients from seven countries, were summarized. Wuhan patients were older (mean age: 54·3) and had higher rates of dyspnea (39·5%), compared to patients in other cities of China (mean age: 43·6; dyspnea: 9·7%) and outside of China (mean age: 50·5; dyspnea: 13·4%). Myalgia, fatigue, acute respiratory distress syndrome (ARDS) and fatalities were also significantly more prevalent amongst Wuhan patients compared to other geographical subgroups (p<0·01). There was a significant dose-response increase in prevalence of diabetes, D-dimer, white blood cells, neutrophil levels and ARDS from non-severe to severe and fatal outcomes (p<0·01). A higher proportion of asymptomatic cases in children (20%) as compared to adults (2.4%) was observed in Chinese hospitals. Interpretation: COVID-19 patients had more severe clinical disease in Wuhan compared to patients outside of Wuhan and beyond China. Pediatric cases had less severe disease compared to adults. Biomarkers at admission may be useful for prognosis among COVID-19 patients.Funding Statement: Ministry of Defence, SingaporeDeclaration of Interests: The authors declare no competing interests.