The Strategic Plan

 

The Strategic Plan

I suspected that some sort of an SOP for Pandemics, crafted by the World Health Organization, is responsible for the way that Governments around the World are handling the Coronavirus outbreak, so I went looking for it.

It can be found at this web address:

https://www.who.int/publications-detail/strategic-preparedness-and-response-plan-for-the-new-coronavirus

They call it a Strategic Plan rather than an SOP (Standard Operating Procedure).

Give it a read.

Also, don’t bother blaming your local politicians for the actions they take, Republican or Democrat – remember they’re all following a Script that has been internationally agreed upon.  Of course there are going to be situations that are unique to certain Countries, and their Governments will have to make appropriate adjustments to the Plan to deal with them.   Otherwise, everybody is basically following the recommendations outlined in the Plan.

Here are some pull quotes I found interesting from the document:

 

From page 4…

Risk assessment

WHO assesses the risk to be very high for China, high at the regional level, and high at the global level.

Factors taken into consideration include:

  • Likelihood of further spread: Human-to-human transmission, including transmission within families and healthcare settings, has been confirmed within Wuhan, and in several cities outside China. The outbreak continues to grow within China at a rapid rate, and now affects all 31 provincial-level administrative regions. Ordinarily high volumes of domestic and international travel have been increased further by travel linked to Lunar New Year celebrations. Imported cases continue to be reported internationally, with several reported cases of secondary transmission now confirmed in countries outside of China. Limited testing capacity in many countries globally, non-specific symptoms of 2019nCoV acute respiratory disease (the disease caused by 2019nCoV infection), and co-circulation of other respiratory pathogens are factors that can complicate efforts to detect the virus quickly.
  • Potential impact on human health: The virus can cause severe illness and death, although most cases appear to be mild. However, many uncertainties remain, including the full extent of the current outbreak within China, and the full clinical spectrum of illness, including the prevalence of mildly symptomatic cases.
  • Effectiveness of current preparedness and response measures: China has dedicated substantial resources to public health control measures and clinical management, and has taken action that has included the quarantine of cities, and the widespread suspension of transport links between population centres. It will be important to continually assess the extent to which measures are effective and the need to adapt measures as the situation evolves. Up to now, countries that have reported an imported case have demonstrated efficient and effective disease surveillance and response measures. However, some countries are less prepared to detect and respond to an imported case. Rumours, misconceptions, and misinformation disseminated online via social media can have a negative impact on response measures and health-seeking behaviors. 

 

From page 5…

The overall goal of the strategic preparedness and response plan is to stop further transmission of 2019nCoV within China and to other countries, and to mitigate the impact of the outbreak in all countries.

RESPONSE STRATEGY

Taking the above into account, the strategic objectives of the plan are to: 

  • Limit human-to-human transmission, including reducing secondary infections among close contacts and healthcare workers, preventing transmission amplification events, and preventing further international spread from China. 
  • Identify, isolate, and care for patients early, including providing optimized care for infected patients.
  • Identify and reduce transmission from the animal source. 
  • Address crucial unknowns regarding clinical severity, extent of transmission and infection, treatment options, and accelerate the development of diagnostics, therapeutics, and vaccines. 
  • Communicate critical risk and event information to all communities, and counter misinformation.
  • Minimize social and economic impact through multisectoral partnerships.

 

These objectives can be achieved by:

  • Rapidly establishing international coordination to deliver strategic, technical, and operational support through existing mechanisms and partnerships;
  • Scaling up country preparedness and response operations, including strengthening readiness to rapidly identify, diagnose and treat cases; identification and follow-up of contacts when feasible (with priority given to high-risk settings such as healthcare facilities); infection prevention and control in healthcare settings; implementation of health measures for travelers; and awareness raising in the population though risk communication and community engagement.
  • Accelerating priority research and innovation to support a clear and transparent global process to set research and innovation priorities to fast track and scale-up research, development, and the equitable availability of candidate therapeutics, vaccines, and diagnostics. This will build a common platform for standardized processes, protocols and tools, to facilitate multidisciplinary and collaborative research integrated with the response.

The response strategy is based on several planning assumptions. Owing to the considerable uncertainty surrounding the extent of the outbreak within China, the transmissibility of the virus, and the clinical spectrum of the disease, it will be necessary to regularly update these assumptions as gaps in our knowledge of the disease are filled.

The current response plan assumes that human-to-human transmission takes place, and that it may be amplified in specific settings, including healthcare facilities. We also assume that human-to-human transmission is widespread within Hubei, and possibly other population centres in China.

It is expected that cases will continue to be exported to other countries while the outbreak continues in China. While the response emphasis will be to rapidly identify and isolate imported cases, there is a risk of clusters of cases caused by localized community transmission outside China. In some cases, countries may require operational assistance to strengthen their capacity to detect and respond to these imported cases. However, there remain significant uncertainties around the potential for more widespread transmission outside China, and it will therefore be necessary to have contingency plans in place to mitigate the challenges this would present.

 

From page 6…

Partner coordination

To ensure effective coordination of international partners and stakeholders outlined above at global, regional and country levels, WHO will establish integrated incident management teams at the global, regional and country levels, as required. These teams ensure regular communication between incident managers at different geographical levels of the response, and close operational coordination with national governments, partners across all sectors, and services at all levels. More specific details of the coordinating mechanisms are given below, grouped by partner type and geographical breadth of activity. 

Global level

The United Nations (UN) Inter-Agency Standing Committee (IASC) will meet on 4 February, and may decide to activate its standard operating procedures for Humanitarian SystemWide Scale-Up Activation — Protocol for the Control of Infectious Disease Events (April 2019), under which the UN response to the situation would be coordinated by WHO through the mechanisms established under its governance programme.  

WHO has established an Incident Management Support Team (IMST) together with key operational partners under the leadership of the Director-General. The Director-General will bring together key technical and operational partners to meet on a regular basis to provide updates on the outbreak and take decisions.

At working level, operational partner coordination will be managed through the Global Outbreak Alert and Response Network (GOARN), which includes technical agencies, NGOs, and Red Cross and Red Crescent organizations. GOARN will coordinate global work on surveillance, epidemiology, modelling, diagnostics, clinical care and treatment, and other ways to identify, manage, and limit onward transmission of the virus. The GOARN network manager will chair these meetings.

 

 A) Rapidly establishing international coordination and operational support Global GOARN & EMTs 

Regional level 

WHO regional offices have established regional IMSTs under the leadership of Regional Directors of the different regions. The IMSTs will coordinate the overall preparedness and response in their respective regions under the different functions. The IMSTs at regional level will work closely with the global level IMSTs to mobilize resources to support and monitor the implementation of activities in countries. 

Country level

WHO will work through the regional IMSTs to provide guidance and assist national crisis management authorities to implement: enhanced surveillance recommendations; risk communications for the public regarding trade and travel; management of imported cases; and response to local outbreaks.

In countries where the IASC Humanitarian System-Wide Scale-Up Activation for Infectious Disease Events protocols are activated, a Humanitarian Country Team will be established with context-appropriate coordination structures of which the UN contributions and support is coordinated by the UN Resident Coordinator with the WHO Head of Country Office as overall technical lead, if need be supported by a WHO incident manager. Sub-national coordination hubs will be deployed, including space for non-governmental organizations/civil society involvement, and immediate surge capacity deployments will be requested from IASC member organizations. A package of technical guidance, essential supplies, and operational support will also be provided in such circumstances.

 

From page 7…

Risk communication and managing the infodemic 

The 2019nCoV outbreak and response has been accompanied by an “infodemic:” an over-abundance of information — some accurate and some not — that makes it hard for people to find trustworthy sources and reliable guidance when they need it. Due to the high demand for timely and trustworthy information about 2019nCoV, WHO technical risk communication and social media teams have been working closely to track and respond to myths and rumours. WHO and partners are working 24 hours a day to identify the most prevalent rumours that can potentially harm the public’s health, such as false prevention measures or cures. These myths are then refuted with evidencebased information. WHO and partners are making public health information and advice on the 2019nCoV, including mythbusters, available on social media channels (including Weibo, Twitter, Facebook, Instagram, LinkedIn, Pinterest) and organizational websites.

In addition, an expanding group of global response organizations such as the United Nations Children’s Fund (UNICEF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) are coordinating efforts with WHO to ensure that biomedical recommendations can be applied at the community level. These organizations are active at the global, regional, and country level to ensure that affected populations have a voice and are part of the response. Ensuring that global recommendations and communication are tested, adapted, and localized will help countries better control the 2019nCoV outbreak.

 

From page 8…

Technical expertise and guidance

On 10 January, WHO published a range of information for all countries on how they can prepare for and respond cases and clusters of 2019nCoV, including handling possible cases, how to identify and monitor sick people, collect and test samples, treat patients, prevent onward spread, control transmission in healthcare facilities, maintain adequate stocks of supplies, and communicate with the public about 2019nCoV infection.

Guidance was developed from existing materials for MERSCoV and updated with input from a global network of partners from affected countries, and global partners with expertise in laboratory, clinical management, infection prevention and control, mathematical modelling, risk communication, and community engagement. 

The full WHO technical guidance pack including the following guidance materials is reviewed and updated regularly as new information becomes available:

  • Surveillance case definitions for human infection with 2019nCoV;
  • Interim guidance on laboratory testing of human cases suspected of 2019nCoV infection, and protocols for molecular testing for 2019nCoV;
  • Clinical management of severe acute respiratory infection when 2019nCoV infection is suspected;
  • Infection prevention and control during healthcare when 2019nCoV infection is suspected;
  • Home care for patients with suspected 2019nCoV infection presenting with mild symptoms and management of contacts;
  • Guidance on risk communication and community engagement and initial response;
  • Recommendations on the prevention of transmission from animals to humans;
  • Early investigations of suspected cases.

 

A country readiness checklist was also made available to support teams to review their capacities to detect, manage, and respond to suspect cases and clusters. A disease commodity package for 2019nCoV outlines the supplies needed for surveillance, laboratory analysis, clinical management, and infection prevention and control.

Global coordination of technical expertise for laboratory, clinical management, infection prevention and control, risk communication and community engagement, and mathematical modelling will continue to gather real-time information and be incorporated into available guidance.

 

From page 10…

Travel and trade

Evidence has shown that restricting the movement of people and goods during public health emergencies may be ineffective, and may interrupt vital aid and technical support, disrupt businesses, and have a negative impact on the economies of affected countries and their trading partners. However, in certain specific circumstances, such as uncertainty about the severity of a disease and its transmissibility, measures that restrict the movement of people may prove temporarily useful at the beginning of an outbreak to allow time to implement preparedness activities, and to limit the international spread of potentially highly infectious cases. In such situations, countries should perform risk and cost-benefit analyses before implementing such restrictions, to assess whether the benefits outweigh the drawbacks.

WHO has published and will regularly update advice for international travel and trade, which includes advice for international travelers, as well as measures for international travel such as entry or exit screening.

WHO will continue to monitor additional health measures under IHR (2005) that countries implement in response to the current outbreak. In the event of measures that interfere significantly with international traffic (travel bans, refusal of entry or exit of passengers or cargo for more than 24 hours), in accordance with Article 43 of IHR (2005), States Parties are obliged to send WHO the public health rationale for any such measures, and WHO is obliged to share this information with other States Parties. 

WHO and partners will maintain communication with representatives of airlines and international tourism organizations to exchange information (with a focus on case management on-board aircraft) and reporting should a traveler with respiratory disease symptoms be detected. This will be done in accordance with the International Air Transport Association guidance for cabin crew to manage suspected communicable diseases on board an aircraft.

 

From page 12…

Country-level coordination

In national risk management, the government is the natural leader for overall coordination and communication efforts. Building on global risk assessments to inform national risk assessments and to decide on actions needed, the national government should help public and private agencies and organizations by providing guidance, planning assumptions and making appropriate modifications to the laws or regulations at all levels and sectors to enable an effective response. These efforts are supported by WHO and other UN organizations under IHR (2005), and through the Cluster-coordination approach where relevant. The process should build on existing public health emergency contingency, preparedness and response plans, including for pandemic influenza. A key step is the activation of existing national emergency response committee(s) to take the lead in coordination of these functions, and to provide the forum for partners to be involved in response operations.

A Public Health Emergency of International Concern will test the resilience of nations, businesses, and communities, depending on their capacity to respond. No single agency or organization can prepare for or respond to such an event on its own. Inadequate or uncoordinated preparedness of interdependent public and private organizations will reduce the ability of the health sector to control disease spread. A comprehensive approach to risk management is therefore required and must take a whole-of-society and whole-of government approach. All entities need to consider supportive financial resources for response operations, and to develop plans for essential service continuity and recovery operations.