Comment

Taking the right measures to control COVID-19

19), which originated in Wuhan, China, in December, International Health Regulations.6 Similarly, in Published Online March
5, 2020
2019, has been declared a public health emergency community prevention and control of the disease, the https://doi.org/10.1016/
of international concern by WHO.1 By March 2, 2020, measures taken by individual villages and communities S1473-3099(20)30152-3

80 026 confirmed cases had been reported in China, to seal off roads are of no value7. Such measures could
causing 2009 deaths, and the epidemic had spread to result in civil unrest and reduce compliance with infection
25 countries around the world.2 On Jan 20, 2020, prevention and control advice.
China declared the disease a second-class infectious Fourth, public health education must be based on
disease but has introduced management measures scientific evidence to reduce the anxiety and distress
for a first-class infectious disease (considered the caused by misinformation. In particular,
most dangerous category of infection). Most areas of epidemiological findings need to be reported in a
the country have adopted public health first-level timely and objective manner so that they can be
response measures (considered the highest level of accurately assessed and interpreted. The risk of
response). In the face of the rapidly spreading transmission with brief contact (less than 15 min face-
disease and a large number of infected people, there to-face contact) or infection onset after 14 days of
is an urgent need for effective infection prevention exposure to a known infected person (the estimated
and control measures. However, some of the maximum incubation period) is low and should not be
measures that have been introduced have no over-exaggerated. Misinformation spreads panic
scientific basis and have proven to be ineffective. among the general population and is not conducive to
First, although COVID-19 is spread by the airborne implementation of epidemic control measures.8
route, air disinfection of cities and communities is not Fifth, WHO has made it clear that there are
known to be effective for disease control and needs to currently no known effective treatments for COVID-19
be stopped. The widespread practice of spraying and does not recommend the use of antiviral drugs,
disinfectant and alcohol in the sky, on roads, vehicles, antibiotics, glucocorticoids, or traditional Chinese
and personnel has no value; moreover, large quantities medicine. Despite this, there have been reports of the
of alcohol and disinfectant are potentially harmful to use of oseltamivir, lopinavir/ritonavir, prednisone,
humans and should be avoided.3,4 antibiotics, and traditional Chinese medicine for the
Second, in the use of personal protective equipment, treatment of patients with COVID-19.9 Care should be
we should try to distinguish different risk factors, adopt taken to not give patients drugs of unknown efficacy,
different epidemic prevention measures, and reduce the which might be detrimental to critically ill patients with
waste of personal protective equipment, as these COVID-19; clinical trials are urgently required in this
resources are already in short supply. Although surgical context.10 Likewise, the development of a vaccine is
masks are in widespread use by the general population, an urgent public health priority.
there is no evidence that these masks prevent the COVID-19 is an emerging infectious disease of global
acquisition of COVID-19, although they might slightly public health concern. Efforts to control the COVID-19
reduce the spread from an infected patient. High-filtration epidemic are likely to require an evidence-based,
masks such as N95 masks and protective clothing multifactorial approach. First, there is a need to limit
(goggles and gowns) should be used in hospitals where human-to-human transmission, including reducing
health-care workers are in direct contact with infected secondary infections among close contacts and health-
patients.5 care workers, preventing transmission amplification
Third, the practice of blocking traffic and lockdown of events, and preventing further international spread.
villages is of no value for the prevention and control of Second, there is a need to rapidly identify, isolate, and
COVID-19. Since the outbreak of COVID-19, some provide optimised care for patients. Third, we need to
countries have suspended flights to and from China, identify and reduce transmission from the animal source
and prevented Chinese people from travelling or sources. Fourth, we need to address

www.thelancet.com/infection Published online March 5, 2020 https://doi.org/10.1016/S1473-3099(20)30152-3 1

crucial uncertainties such as clinical severity, extent of 3 National Health Commission of the People’s Republic of China. Notice of
the General Office of the National Health and Health Commission on
transmission and infection, and treatment options, and issuing a new coronavirus pneumonia prevention and control plan (fourth
accelerate the development of diagnostics, therapeutics, edition). Feb 7, 2020. http://www.nhc.gov.cn/xcs/zhengcwj/20200
2/573340613ab243b3a7f61df260551dd4.shtml (accessed Feb 17, 2020).
and vaccines. We also need to minimise social 4 WHO. Coronavirus disease (COVID-19) technical guidance: infection
prevention and control. https://www.who.int/emergencies/diseases/novel-
disruption and economic impact through international,
coronavirus-2019/technical-guidance/infection-prevention-and-control
collaborative and multisectoral approaches. Most (accessed Feb 17, 2020).
5 National Health Commission of the People’s Republic of China. Notice of
importantly, we need to communicate the epidemiology the General Office of the National Health and Health Commission on
and risks of COVID-19 clearly, both to health-care issuing the guidelines for the use of common medical protective products
in the prevention and control of pneumonia infected by new coronavirus
workers and to the general population, and to implement (trial). Jan 27, 2020. http://www.nhc.gov.cn/xcs/zhengcwj/202001/
e71c5de925a64eafbe1ce790debab5c6.shtml (accessed Feb 25, 2020).
infection prevention and control measures that are 6 Habibi R, Burci GL, de Campos TC, et al. Do not violate the International
based on sound scientific principles. Health Regulations during the COVID-19 outbreak. Lancet 2020;
published online Feb 13. https://doi.org/10.1016/S0140-6736(20)30373-1.
We declare no competing interests. This work was supported by the 7 Ruyi L. Ministry of Communications: it is strictly forbidden to seal
National Key Research & Development Program of China (grant highways, highways, and quarantine stations. Beijing Daily Client; Feb
number 017YFC1200203) and the Mega-project of Science 11, 2020. https://baijiahao.baidu.com/s?id=1658210115200722778&wfr=
Research of China (grant number 2018ZX10733402-004). spider&for=pc (accessed Feb 17, 2020).
8 Lili F. Why is the incubation period of the new corona
*Yonghong Xiao, Mili Estee Torok virus from 3 to 24 days? Science and Technology Daily;
[email protected] Feb 14, 2020. http://www. xinhuanet.com//science/2020-
02/14/c_138782675.htm (accessed Feb 17, 2020).
Collaborative Innovation Centre for Diagnosis and Treatment of Infectious
9 Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients
Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA
Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, 2020; published online Feb 7. DOI:10.1001/jama.2020.1585.
Hangzhou, 310003, China (YX); and University of Cambridge, Department of 10 WHO. Clinical management of severe acute respiratory infection
Medicine, Addenbrooke’s Hospital, Cambridge, UK (MET) when novel coronavirus (nCoV) infection is suspected. Jan 28,
1 WHO. Novel coronavirus (2019-nCoV) situation report 11. 2020. https://www.who.int/publications-detail/clinical-management-
Jan 31, 2020. https://www.who.int/docs/default- of-severe-acute-respiratory-infection-when-novel-coronavirus-
source/coronaviruse/situation-reports/20200131-sitrep-11- (ncov)-infection-is-suspected (accessed Feb 17, 2020).
ncov.pdf?sfvrsn=de7c0f7_4 (accessed Feb 18, 2020).
2 WHO. Coronavirus disease 2019 (COVID-19) situation report 29.
Jan 31, 2020. https://www.who.int/docs/default-
source/coronaviruse/ situation-reports/20200218-sitrep-29-
covid-19.pdf?sfvrsn=6262de9e_2 (accessed Feb 29, 2020)

2 www.thelancet.com/infection Published online March 5, 2020 https://doi.org/10.1016/S1473-3099(20)30152-3