key: cord-0935912-veouy5ht
authors: Wong, Martin CS; Teoh, Jeremy YC; Huang, Junjie; Wong, Sunny H
title: Strengthening early testing and surveillance of COVID-19 to enhance identification of asymptomatic patients
date: 2020-05-27
journal: J Infect
DOI: 10.1016/j.jinf.2020.05.048
sha: 485f3d076c6f90aeeacb55247c8ade233beea593
doc_id: 935912
cord_uid: veouy5ht

nan

Martin CS Wong MD, MBChB, MPH, FRCP (Edin) 1 . We read with great interest a study performed by Huang and colleagues [1] , which described the epidemiological and clinical characteristics of 22 close contacts of a 22-year-old man with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). They found that SARS-CoV-2 shown stronger infectivity in the incubation-period with more rapid transmission in the younger population. COVID-19 identified in this population had faster onset and different non-specific and not typical manifestations and were much milder than those in the older population. This makes early detection, surveillance and diagnosis of these asymptomatic patients particularly difficult among this population, especially if they have no travel or contact history. In other words, they pose a particular challenge to various control measures which are crucial to mitigate the COVID-19 pandemic [2, 3] . Some of the major limitations of the study include the small sample size and the convenience sampling of patients in a single institution with no control group. Nevertheless, the authors should be commended for their meticulous analysis of the various sociodemographic, clinical and laboratory parameters that enable important though preliminary observations to be reported. In another study on the clinical characteristics of 24 asymptomatic COVID-19 patients in Nanjing, China, it was shown that the communicable could be up to three weeks, and their cohabiting family members can be infected which could potentially be complicated by severe COVID-19 pneumonia [4] .

This challenge of absence of symptomatology has also been echoed by Luo and colleagues, who investigated the case of a physician with symptomatic COVID-19 in Wuhan, China. All five of the physician's immediate family members living in the same household were asymptomatic, and subsequently found to have laboratory evidence of SARS-CoV-2 infection [5] . Identifying patients with COVID-19 is extremely important to facilitate isolation of COVID-19 cases and quarantine of close contacts. Hence, physicians should consider COVID-19 tests for patients with mild influenza like illnesses (ILI) in settings offering first-contact care to reduce the risk of community transmission.

There is yet another significant implication from the study [1] , where provision of COVID-19

tests and its regular surveillance should be regularly reviewed at a country level. Here, the authors reviewed the latest literature and offered practical recommendations. Table 1 presents a series of healthcare policy suggestions that could prepare a country for early detection, surveillance and reporting for infectious pandemics of international concern. These were mainly based on the Global Health Security (GHS) index, which has been a comprehensive evaluation of the GHS capabilities worldwide and jointly composed by the Nuclear Threat Initiative (NTI), the Johns Hopkins Centre for Health Security (JHU) and The Economist Intelligence Unit (EIU) [6] . In addition, we also retrieved standards from the International Health Regulations [7] and the Joint External Evaluation tool [8] that have been used to examine the capacity of countries in their prevention, detection, assessment, notification and response to population risks of global concern. We believe these constructs ( Table 1) will be essential to be revisited by policy-makers to enable early identification of the COVID-19where we are still uncertain about its future transmission to the global communities. 

Rapid asymptomatic transmission of COVID-19 during the incubation period demonstrating strong infectivity in a cluster of youngsters aged 16-23 years outside Wuhan and characteristics of young patients with COVID-19: A prospective contact-tracing study

Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia

World Health Organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19)

Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing

Asymptomatic SARS-CoV-2 infection in household contacts of a healthcare provider

SPAR State Party annual report

External Evaluation tool (JEE tool) -second edition. IHR (2005) Monitoring and Evaluation framework

Participation of countries in regional or international laboratory network (GHS 2.1.2a

National laboratory that serves as an accredited reference facility

3). WHO. Joint External Evaluation tool (JEE tool) -second edition. IHR (2005) Monitoring and Evaluation framework

We declared no conflict of interests. Funding: None