Predictive Model for National Minimal CFR during Spontaneous Initial Outbreak of Emerging Infectious Disease: Lessons from COVID-19 Pandemic in 214 Nations and Regions.

The minimal case fatality rate (CFR) is one of the essential fundaments for the establishment of a diverse national response strategy against the COVID-19 epidemic, but cannot be quantitatively predicted. The aim of the present study was to explore the applicable quantitative parameters labeling integrating responding capacity from national daily CFR curves, and whether the minimal CFR during initial emerging epidemic outbreaks can be predicted. We analyzed data from 214 nations and regions during the initial 2020 COVID-19 epidemic and found similar falling zones marked with two turning points within a fitting three-day-moving CFR curve which occurred for many nations and regions. The turning points can be quantified with parameters for the day duration (T1, T2, and ΔT) and for the three-day moving arithmetic average CFRs (CFR1, CFR2, and ΔCFR) under wave theory for 71 nations and regions after screening. Two prediction models of minimal CFR were established with multiple linear regressions (M1) and multi-order curve regressions (M2) after internal and external evaluation. Three kinds of falling zones could be classified in the other 71 nations and regions. Only the minimal CFR showed significant correlations with nine independent national indicators in 65 nations and regions with CFRs less than 7%. Model M1 showed that logarithmic population, births per 1000 people, and household size made significant positive contributions, and logarithmic GDP, percentage of population aged 65+ years, domestic general government health expenditure, physicians per 1000 people, nurses per 1000 people, and body mass index made negative contributions to the minimal CFR against COVID-19 epidemics for most nations and regions. The spontaneous minimal CFR was predicted well with model M1 for 57 nations and regions based on the nine national indicators (R2 = 0.5074), or with model M2 for 59 nations and regions based on the nine national indicators (R2 = 0.8008) at internal evaluation. The study confirmed that national spontaneous minimal CFR could be predicted with models successfully for most nations and regions against COVID-19 epidemics, which provides a critical method to predict the essential early evidence to evaluate the integrating responding capacity and establish national responding strategies reasonably for other emerging infectious diseases in the future.

Facilities for Centralized Isolation and Quarantine for the Observation and Treatment of Patients with COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic increased the burden on many healthcare systems and in the process, exposed the need for medical resources and physical space. While few studies discussed the efficient utilization of medical resources and physical space so far. Therefore, this study aimed to summarize experiences related to facilities used for centralized isolation for medical observation and treatment during the COVID-19 pandemic in China and to provide suggestions to further improve the management of confirmed cases, suspected cases, and close contacts. In China, three types of facilities for centralized isolation (Fangcang shelter hospitals, refitted non-designated hospitals, and quarantine hotels) underwent retrofitting for the treatment and isolation of confirmed and suspected cases. These facilities mitigated the immediate high demand for space. Moreover, in order to minimize infection risks in these facilities, regulators and governmental agencies implemented new designs, management measures, and precautionary measures to minimize infection risk. Other countries and regions could refer to China's experience in optimally allocating social resources in response to the COVID-19 pandemic. As a conclusion, government should allocate social resources and construct centralized isolation and quarantine facilities for an emergency response, health authorities should issue regulations for centralized isolation facilities and pay strict attention to the daily management of these facilities, a multidisciplinary administration team is required to support the daily operation of a centralized isolation facility, in-depth studies and international collaboration on the centralized isolation policy are encouraged.

Prevention and control of coronavirus disease 2019 (COVID-19) in public places.

Public places favor the transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) due to dense population, large personal mobility, and higher contact opportunities. In order to protect the health of general public in operating public places during COVID-19 pandemic, this study proposed general precautions and control strategies from perspective of operation management, social distancing, cleaning and disinfection, and personal protection. In addition, with regard of risk level, specific precautions and control strategies were proposed for living service places, outdoor places, and confined places. The comprehensive application of above recommendations could effectively interrupt the spread of COVID-19, and protect the health of general public in public places. This study proposed general and specific precautions and control strategies in public places during COVID-19, and suggested further improvement of pandemic response.

Prevention and control of COVID-19 in public transportation: Experience from China.

Due to continuous spread of coronavirus disease 2019 (COVID-19) worldwide, long-term effective prevention and control measures should be adopted for public transport facilities, as they are increasing in popularity and serve as the principal modes for travel of many people. The human infection risk could be extremely high due to length of exposure time window, transmission routes and structural characteristics during travel or work. This can result in the rapid spread of the infection. Based on the transmission characteristics of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the nature of public transport sites, we identified comprehensive countermeasures toward the prevention and control of COVID-19, including the strengthening of personnel management, personal protection, environmental cleaning and disinfection, and health education. Multi-pronged strategies can enhance safety of public transportation. The prevention and control of the disease during the use of public transportation will be particularly important when all countries in the world resume production. The aim of this study is to introduce experience of the prevention and control measures for public transportation in China to promote the global response to COVID-19.

Prevention and control of COVID-19 in nursing homes, orphanages, and prisons.

As the number of Coronavirus Disease (2019) (COVID-19) cases increase globally, countries are taking more aggressive preventive measures against this pandemic. Transmission routes of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) include droplet and contact transmissions. There are also evidence of transmission through aerosol generating procedures (AGP) in specific circumstances and settings. Institutionalized populations without mobility and living in close proximity with unavoidable contact are especially vulnerable to higher risks of COVID-19 infection, such as the elderly in nursing homes, children in orphanages, and inmates in prisons. In these places, higher prevention and control measures are needed. In this study, we proposed prevention and control strategies for these facilities and provided practical guidance for general measures, health management, personal protection measures, and prevention measures in nursing homes, orphanages, and prisons, respectively.