The coronavirus disease 2019 (COVID-19) outbreak, caused by SARS-CoV-2, has rapidly escalated into a global pandemic. One of our significant concerns is that we have no data as to whether people, who acquired immunity against this deadly virus and recovered from COVID-19, are protected from further infections with the same virus. Moreover, we have no data as to whether this pandemic will persist in our societies and continue vexing us for long periods of time. Implementing science-based response strategy is essential to sustain containment of COVID-19 globally. Rapidly sharing scientific information means providing real-time research data and relevant findings. As an international academic journal, Global Health & Medicine publishes this special issue entitled "GHM Special Topic: COVID-19". It includes a range of articles describing COVID-19 based on frontline data from Japan, China, the United States, Italy, the United Kingdom, and other countries and areas worldwide. Our hope is that the rapid publication and sharing of information contribute, in whichever possible way, to this global fight against COVID-19.
In the face of COVID-19, the scientific community has rapidly come together to address this outbreak in an open and collaborative manner to support the global response to this outbreak by rapidly sharing and highlighting research data and relevant findings. COVID-19 research is being published at a furious pace. Over 6,000 articles have been published as of 20 April 2020, and at least 15 online resource centers/websites for COVID-19 have been created by publishers to enable fast and free access to the latest research, evidence, and data available. Moreover, many evidence-based guidelines for COVID-19 have been issued based on academic articles and summaries of the experiences of frontline medical personnel. Various academic medical associations are also actively sharing information and providing technical support. As an example, 93 guides/proposals/responses to COVID-19 have been issued so far by 50 medical associations in Japan. However, few publications and national situation reports have provided information on the number of infected healthcare workers (HCWs). More publications and national situation reports are urgently needed to provide scientific information to devise specific infection prevention and control measures in order to protect HCWs from infection.
The world is facing an unprecedented challenge in every place that is affected by the spreading COVID-19 pandemic. With China recording fewer and fewer cases, Europe and the Americas have become the epicenter of the pandemic since mid-March 2020, respectively accounting for 54.8% (621,407) and 27.8% (315,714) of 1,133,758 confirmed cases globally as of April 5. Moreover, the number of confirmed cases in the US (273,808), Spain (124,736), Italy (124,632), and Germany (91,714) has exceeded the number in China (82,930) so far. International cooperation and coordination are essential to tackling this pandemic in terms of both assistance with emergency medical supplies and medical technical assistance. Coordinated global action has been called for by the World Health Organization (WHO), G7, G20, the World Trade Organization (WTO), and other bodies. More effective actions are urgently needed to protect the most vulnerable, including older people and people with an underlying medical condition, as well as healthcare workers, who are most frequently exposed and who are vital to the response.
The event of the Diamond Princess, with a total of 712 (as of 17 March 2020) persons infected on the cruise ship, attracted global attention as the largest disease cluster outside China for the period 7 to 24 February 2020. Representing the Ministry of Health, Labour and Welfare, the authors were heavily engaged in the quarantine operation on the cruise ship ourselves. During the quarantine period from 5 to 23 February 2020, when the last group of the quarantined passengers left the ship, a series of measures have been conducted under the principles of i) zero deaths among all on board, ii) rapid establishment and thorough implementation of an infection control system, and iii) maintenance of health conditions and relief of anxieties among passengers and crew members. The case of Diamond Princess has implications of more than a cruise ship but deserves full scientific analysis to learn lessons from this operation as well as to study the characteristics, particularly the transmission of COVID-19.
With the deepening of the understanding and research in coronavirus disease 2019 (COVID-19), the diagnosis and treatment of COVID-19 have been constantly updated and improved. In China, since the implementation of "Guidelines for the Diagnosis and Treatment of COVID-19 (1st Trial Version)" on Jan. 15, 2020, 2nd to 7th versions (including revision of 5th version) was updated from Jan. 18, Jan. 22, Jan. 27, Feb. 4, Feb. 8, Feb. 18 and Mar. 3, respectively. Versions updated subsequently provide more detailed information in many ways than the 1st and 2nd versions, so this paper will introduce the development of the main contents of the 3rd to 7th versions of COVID-19 guidelines in China, which hopes to provide help for clinical medical staff in other countries fighting with this disease.
COVID-19, that emerged in December 2019 in the city of Wuhan, China and is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly evolved into a pandemic. Italy has become one of the largest epicentres outside Asia, accounting now for at least 80,539 infections (cumulative incidence of 95.9/100,000) and 8,165 deaths (case fatality rate 10.1%). It has seriously affected people above the age of 60 years. The International Health Regulations (IHR) revised in 2005 bind governments to disclose vital information regarding the identification and detection of new disease outbreaks regardless of its causative agent. In contrast to the previous SARS epidemic, China timely informed the world about the onset of a new outbreak. It also soon disclosed the clinical characteristics of patients with COVID-19. Unfortunately, despite the fast recognition of the Chinese epidemic, the application of the 2005 IHR was not followed by an effective response in every country and most health authorities failed to rapidly perceive the threat posed by COVID-19. To further complicate matters, IHR implementation, which relies primarily on self-reporting data rather than on an external review mechanism, was limited in speed and further hindered by high costs. The response in Italy suffered from several limitations within the health system and services. The action against this threat must instead be quick, firm and at the highest trans-national level. The solution lies in further strengthening countries' preparedness through a clear political commitment, mobilization of proper resources and implementation of a strict surveillance and monitoring process.
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by SARS-CoV-2. As of March 30, 2020, there have been 693,224 reported patients with COVID-19 worldwide, with 1,446 in Japan. Currently, although aspects of the route of transmission are unclear, infection by contact and by inhaling droplets is considered to be the dominant transmission route. Inflammatory symptoms in the upper respiratory tract persist for several days to 1 week after onset, and in some patients symptoms of pneumonia worsen and become severe. The presence of underlying diseases and advanced age are risk factors for increased severity. Diagnosis is based on detection of SARS-CoV-2 by polymerase chain reaction (PCR) testing of nasopharyngeal swabs or sputum. Symptomatic management is the main treatment for this disease. Although the efficacy of several agents is currently being tested, at present there is no effective therapeutic agent. To prevent infection, in addition to standard preventive measures, measures that counteract infection by contact and droplet inhalation are important. In addition, if procedures that cause aerosolization of virus are used, then measures that prevent airborne infection should be implemented.
In the fight against the COVID-19 epidemic, the Chinese Government has enhanced its use of Internet-based healthcare. A large number of online medical platforms designed for COVID-19 have emerged in China. These platforms can be categorized according to the entity operating them, mainly the government, hospitals, and companies. Online medical platforms run by public hospitals provide follow-up consultations for common ailments and frequent ailments based on the hospital's offline services. Online diagnosis and treatment platforms provided by companies cover most of the regions in China. In terms of offering pandemic-related services, corporate platforms provide at least 1,636,440 doctors for online care, 1.685 billion consultations, and 109 million remote consultations. In terms of regular medical care, those platforms provide at least 940,182 doctors for online care and 13.7 million remote consultations; more than 84,916 specialists have provided online care during this period. During the prevention and control of this epidemic, online diagnosis and treatment has filled the gap of family doctors in epidemic prevention and control, it has reduced the chance of cross-infection of patients with a mild infection, and it has overcome the geographical limitations of medical resources. However, online diagnosis and treatment still faces challenges in terms of resource allocation and industry supervision.
The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a serious threat to global public health and economies. Currently, hundreds of clinical trials on a wide variety of treatments against COVID-19 are being conducted around the world. Here, we conducted a search for ongoing clinical trials for the treatment of COVID-19 at the clinicaltrials.gov database on April 2, 2020. In total, 48 clinical trials were identified, and of these, 41 trials adopted drug intervention and the other 7 trials utilized biological intervention. The number of trials stratified by a chief country conducting the investigation were 18 in China, 5 in the United States, 4 in Canada, 3 in Italy, 2 in France and Brazil, and 4 trials are being performed multinationally. The drugs utilized in more than one trials were remdesivir (6 trials), lopinavir/ritonavir (6 trials), hydroxychloroquine (6 trials), interferon (5 trials), methylprednisolone (3 trials), nitric oxide gas (3 trials), oseltamivir (2 trials), arbidol (2 trials), and vitamin C (2 trials). We also described the Japanese trials which are now being conducted or scheduled, utilizing lopinavir/ritonavir, remdesivir, favipiravir, ciclesonide and nafamostat.
The outbreak of coronavirus disease 2019 (COVID-19) on the cruise ship Diamond Princess docked at Yokohama, Japan was highlighted due to its number of cases in the early stage of the global epidemic when the picture of the virus itself, as well as epidemiological characteristics, were being established. We conducted an observational epidemiological study of the outbreak, focusing on a total of 403 individuals who developed a fever of ≥ 37.5°C from 20 January to 22 February 2020. Quarantine measures are also discussed with a descriptive method. Of a total of 3,711 individuals (2,031 males) from 57 countries, 2,666 (71.8%) and 1,045 (28.2%) were passengers and crew with mean age of 66.0 (range: 2-98) and 36.6 (range: 19-64), respectively. Among 403 febrile individuals, 165 passengers and 58 crew members were diagnosed as laboratory-confirmed COVID-19 cases. Until 6 February, the number of confirmed cases was three or less per day. However, distribution of thermometers on 7 February revealed 43 confirmed cases, and it then started decreasing. The outbreak was initiated from decks for passengers and expanded to areas for crew. As of 17 March, when more than14 days had passed after disembarkation of all passengers and crew, there was no report of forming a cluster of infections in Japan from them. At the time of the initiation of quarantine, the outbreak had already expanded to most of the decks from those for passengers, and the results might suggest the contribution of the set of quarantine measures in unprecedented challenges of the control operation.
Due to the significant spread of a new type of coronavirus (SARS-CoV-2) infection (COVID-19) in China, the Chinese government blockaded several cities in Hubei Province. Japanese citizens lost a means of transportation to return back to Japan. The National Center for Global Health and Medicine (NCGM) helped the operation of charter flights for evacuation of Japanese residents from Hubei Province, and this article outlines our experiences. A total of five charter flights were dispatched, and the majority of returnees (793/829 [95.7%]) were handled at NCGM. A large number of personnel from various departments participated in this operation; 107 physicians, 115 nurses, 110 clerical staff, and 45 laboratory technicians in total. Several medical translators were also involved. In this operation, we conducted airborne precautions in addition to contact precautions. Eye shields were also used. The doctors collecting the pharyngeal swab used a coverall to minimize the risk of body surface contamination from secretions and droplets. Enhanced hand hygiene using alcohol hand sanitizer was performed. Forty-eight persons were ultimately hospitalized after the triage at NCGM operation, which was more than the number of persons triaged at the airport (n = 34). Of those hospitalized after NCGM triage, 8.3% (4/48 patients) ultimately tested positive for SARS-CoV-2, significantly higher than the positive rate among subjects not triaged (4/48 [8.3%] vs. 9/745 [1.2%]: p = 0.0057). NCGM participated in a large-scale operation to evacuate Japanese nationals from the COVID-19 epidemic area. We were able to establish a scheme through this experience that can be used in the future.
The ongoing spread of coronavirus disease (COVID-19) is a worldwide crisis. Hokkaido Prefecture in Japan promptly declared a state of emergency following the rapid increase of COVID-19 cases, and the policy became an example to mitigate the spread of COVID-19. We herein report 15 cases of COVID-19 including 3 cases requiring mechanical ventilation. Based on review of our cases, among patients over 50 years of age with underlying diseases such as hypertension and diabetes mellitus, and those who required oxygen administration tended to deteriorate. These cases highlight the importance of understanding the background and clinical course of severe cases to predict prognosis.
The coronavirus disease 2019 (COVID-19) has spread rapidly across the globe, presenting severe challenges to societies. Gaining a better understanding of patient demographics is essential to develop measures to counteract such spreading. In this context, from a viewpoint of occupational health, we analyzed the publicly available data on patients diagnosed with COVID-19 in Tokyo, which reported the highest number of cases in Japan. A total of 243 cases aged 20 years or older (excluding students) were recorded between January 14 and March 27, 2020. Of 233 cases excluding 10 cases of the first cluster, 162 were men and 176 were of working age (20 to 69 years). Of 203 cases with valid information on employment status, 151 (74%) were workers: 114 employees, 31 self-employed, and 6 medical staff. Of the working patients, the majority were male: 72% in employed and 87% in self-employed. These data suggest the importance of occupational health in controlling the spread of COVID-19. In April 2020, a state of emergency was declared in response to a surge in the number of cases, especially in metropolitan areas. A working schedule associated with lower risks of infection, including telework and flexible working hours, should be rigorously promoted to minimize human-to-human contact. Such policies, along with the implementation of effective measures to protect essential workers from infection, overwork, and stigma, would ensure the smooth running of society amidst the present crisis.
The first COVID-19 patient in New York (NY) was reported on March 1, 2020. Since then NY has become one of the largest epicenters in the world where the disease has been overwhelming the healthcare system. Here I report how rapidly COVID-19 spread, and how the community responded during the first 30 days in NY. Gathering reliable information quickly was important in the evolving situation. Shortage of beds, personal protective equipment, ventilators, and staffing was observed. Reducing the number of infections and increasing the efficiency of medical resource allocation have been two major strategies taken in NY. It is important for Japan to accurately analyze the current situation, refer to answers in other parts of the world, and quickly establish strategy for clear goals that will lead to a "New Normal".
In Japan, four medical facilities including our own - the National Center for Global health and Medicine (NCGM) - have been designated for the treatment of specified infectious diseases by the Minister of Health, Labour, and Welfare. Here, we report our nursing care for patients with severe COVID-19 on extracorporeal membrane oxygenation (ECMO) support. In addition to infection control measures in the form of an N95 mask, a water-repellent isolation gown, a cap, a shielded mask on top of the N95, and double-layered gloves, nurses were required to wear one-piece suits (DuPont™ Tyvek®) and use powered air-purifying respirators (PAPRs). While closed system catheters are normally changed once a day to limit aerosol exposure, they are now changed once every 4 days. Nursing care included equipment checks, monitoring of hemodynamics and respiratory status, management of anticoagulants, observation of the patient’s general condition, management of sedatives and analgesics, prevention of medical device-related pressure ulcers and bedsores, and maintenance of hygiene. Fundamentally sound nursing remains the best practice for patient treatment and management. During nursing care for patients with COVID-19 on ECMO, infection control measures should be faithfully and properly followed.
Despite substantial inflow of infected cases at the early stage of the pandemic, as of the end of April, Japan manages the outbreak of COVID-19 without systematic breakdown of health care. This Japanese paradox – limited fatality despite loose restriction – may have multiple contributing factors, including general hygiene practice of the population, customs such as not shaking hands or hugging, lower prevalence of obesity and other risk factors. Along with these societal and epidemiological conditions, health policy options, which are characteristic to Japan, would be considered as one of the contribution factors. Some health policy factors relatively unique to Japan are described in this article.
The whole world is now facing an unprecedented pandemic with over 1.8 million confirmed cases and more than one hundred thousand deaths. To counter the pandemic, Shenzhen created a central command and control structure based on the only designated hospital- Shenzhen Third People's Hospital which is a large general hospital specialized on infectious diseases in the bay area. The hospital has taken many decisive and effective actions to respond to the epidemic. Here, we will describe and share healthcare experiences from Shenzhen and call for international cooperation and collaboration.
In the pandemic of severe acute respiratory syndrome due to coronavirus-2 (SARS-CoV-2), United States (U.S.) also experienced the spread of coronavirus disease 2019 (COVID-19). Here, we report the current status of Houston, Texas and the response to COVID-19 at MD Anderson Cancer Center (MDACC) and in the Department of Surgical Oncology. MDACC has taken the institutional measures in order to prevent its employees and patients from COVID-19. Furthermore, surgeons have also responded aggressively in the outpatient setting, operating room and inpatient care. The predicted peak in Texas is on April 29 and our mitigation measures appear to be effective at the time of writing, however there still remain a lot of unknowns about SARS-CoV-2 and the performance of cancer operations remains an ongoing and delicate issue. In order to minimize the risks to patients, our healthcare system, and our community, MDACC has navigated the countering pressures through honest and open communication with patients, judicious use of alternative treatment strategies, and thoughtful selection of surgical cases.
The UK government was arguably slow to take action against the COVID-19 pandemic. However, since switching their policy from "mitigation" to "suppression", swift changes have been implemented to all aspects of life. In this unprecedented crisis healthcare has been on the battlefront across the globe. Every effort has been made in the UK to stop the National Health Service (NHS) from being overwhelmed, leading to the national slogan: "Stay at home. Protect the NHS. Save lives". In this article, a consultant general and colorectal surgeon in Southampton reports on the NHS response to the COVID-19 pandemic.
The COVID-19 affects vulnerable groups disproportionally in a society where inequities are long-standing issue. Weak health system, especially the shortage and maldistribution of capable health workforce will be the main challenge in lower income countries to fight against the COVID-19. Applying the lesson learned and success from the Ebola outbreak in West Africa is important. International collaboration with already well functioned local mechanisms, such as the Network of Managers of Health Workforce in Francophone Africa is the key to provide prompt support. This approach contributes not only to the short-term COVID-19 control but also long-term strengthening of the sustainable and resilient health system in the lower income countries.
Since mid-February, 2020, coronavirus disease-2019 (COVID-19) has been spreading in Cambodia and, as of April 9, 2020, the Ministry of Health has identified 119 polymerase chain reaction (PCR)-positive cases. However, the PCR test is available in only two specialized institutes in the capital city Phnom Penh; therefore, exact and adequate identification of the cases remains still limited. Many vulnerable newborn infants have been admitted to the neonatal care unit (NCU) at the National Maternal and Child Health Center in Phnom Penh. Although the staff have implemented strict infection prevention and control measures, formidable gaps in neonatal care between Cambodia and Japan exist. Due to the shortages in professional workforce, one family member of sick newborn(s) should stay for 24 hours in the NCU to care for the baby. This situation, however, may lead to several errors, including hospital-acquired infection. It is crucial not only to make all efforts to prevent infections but also to strengthen the professional healthcare workforce instead of relying on task sharing with family members.
The importance of laboratory diagnostic capacity for effective infectious disease control has been widely recognized in recent years, but many of the countries still struggled to establish it when the newly discovered diseases was happened, such as coronavirus disease 2019 (COVID-19). Even in the country that the laboratory system was highly evaluated by Global Health Security Index like Myanmar, support from external partners is essential to establish the diagnostic capacity for COVID-19. WHO and other contributors, including Japan, have been supporting the establishment of a diagnostic system for SARS-CoV-2 in response to the disease outbreak. The testing laboratory was established in Myanmar on February 20, 2020. The first confirmed diagnosis was reported on March 23, and 15 positive cases as of March 31. Since it is difficult to control the outbreak in a given country without controlling it in the neighboring countries, continuous international cooperation for establishing the coronavirus disease 2019 diagnostic capacity was crucial despite the challenges of fighting the outbreak in home countries.
Due to the COVID-19 pandemic, Japanese technical experts who have been supporting health in low- and middle- income countries (LMICs) are facing unprecedented travel restrictions. As of 11 April 2020, of 195 countries Japan has diplomatic relationship with, 181 countries have entry restrictions and 69 countries have post-entry movement restrictions (self-quarantine) for Japanese nationals or travellers from Japan. In order for technical experts to assist LMICs technically from Japan to meet the increased demand and needs in the health sector due to COVID-19, it is important to prioritize and reorganize the project activities in accordance with the local situation in particular to address three challenges i) to communicate from Japan; ii) to prioritize activities to match to the increased COVID-19 related tasks; and iii) to advocate health workers' rights and working environment.