在本期Lancet期刊中,Dr. Gilbert及其團隊預測,埃及、阿爾及利亞、及南非最有機會成為非洲武漢肺炎的破口,但他們也較有能力來對付這個疾病;奈及利亞、埃塞俄比亞、蘇丹、安哥拉、坦尚尼亞、迦納、及肯亞成為破口的機會較小,但他們也較無能力對付。非洲國家應善用這項研究結果備戰武漢肺炎。首先,非洲需要一個整個洲的準備及應變措施。會員國、資助者、及合作者應釋出經濟資源以支援各個國家的計畫。目前,非洲聯盟委員會、非洲CDC、WHO及非洲各國已建立了一個「非洲冠狀病毒防範和應對工作團隊」(AFTCOR),這個工作團隊主要六個工作項目:實驗室診斷及分類、監測,包括機場港口等入口點及邊境、醫療照顧機構的感染預防及控制、武漢肺炎重症者之臨床處置、風險溝通、及供應鏈的管理與庫存。第二,有效的防範與應對措施需要各國在政策上強力支持。第三,資助者及合作者之經濟資源應在危機抵達非洲之前到位。第四,國家、地區、及國際組織應通力合作,使用政府資源,以確保物資。第五,各會員國應盡速制訂隔離及感染控制方案,包括社會隔離的措施。最後,由非洲CDC及WHO主導之人員訓練應盡速執行並導入各國醫療系統。如同WHO秘書長所言,機會之窗正在縮小,非洲需要馬上行動。

(財團法人國家衛生研究院 莊淑鈞博士摘要整理)

Because of the high volume of air traffic and trade between China and Africa, Africa is at a high risk for the introduction and spread of the novel coronavirus disease 2019 (COVID-19); although only Egypt has reported the first case, from a non-national. The greatest concern for public health experts is whether COVID-19 will become a pandemic, with sustained year-round transmission, similar to influenza, as is now being observed in several countries. What might happen to Africa—where most countries have weak health-care systems, including inadequate surveillance and laboratory capacity, scarcity of public health human resources, and limited financial means—if a pandemic occurs? With neither treatment nor vaccines, and without pre-existing immunity, the effect might be devastating because of the multiple health challenges the continent already faces: rapid population growth and increased movement of people; existing endemic diseases, such as human immunodeficiency virus, tuberculosis, and malaria; remerging and emerging infectious pathogens such as Ebola virus disease, Lassa haemorrhagic fever, and others; and increasing incidence of non-communicable diseases.

Models that enable the continent to better allocate scarce resources to better prepare and respond to the COVID-19 epidemic are crucial. The modelling study by Marius Gilbert and colleagues in The Lancet  identifies each African country’s risk of importation of COVID-19 from China, using data on the volume of air travel from three airports in provinces in China to African countries. Gilbert and colleagues use two indicators to determine the capacity of countries to detect and respond to cases: preparedness, using the WHO International Health Regulations Monitoring and Evaluation Framework; and vulnerability, using the Infectious Disease Vulnerability Index. Based on their analysis, Egypt, Algeria, and South Africa had the highest importation risk, and a moderate to high capacity to respond to outbreaks. Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya had moderate risk with variable capacity and high vulnerability. In the model, the risk mainly originates from Guangdong, Fujian, and Beijing. The study provides a valuable tool that can help countries in Africa prioritise and allocate resources as they prepare to respond to the potential introduction and spread of COVID-19.

The study should also be interpreted in light of the fast-evolving nature of the COVID-19 outbreak. First, with the exception of Ethiopian airlines, all African airlines have suspended flights to China. Although these measures might delay, but not stop, the importation risk of COVID-19 into Africa, their implementation is still worthwhile. Second, although Beijing, Shanghai, and Fujian do not report the highest number of cases of COVID-19 in China, the volume of travel from these cities to Africa is high, which might increase the risk of exporting cases to Africa. Lastly, almost half of the flights from Africa to China are operated by Ethiopian Airlines, so it is possible that cases might pass through Ethiopia and affect destination countries.

The report by Gilbert and colleagues provides an important tool to map out the continental risk for the spread of COVID-19 in Africa, which should be used to inform a framework of action to prepare the continent for any potential importation and spread of COVID-19. First, collectively, Africa needs a unified continent-wide strategy for preparedness and response. The strategy must be comprehensive, and member states, donors, and partners should immediately commit to releasing financial resources to support country-customised implementation plans derived from the strategy. To help develop a common strategy that will allow for effective coordination, collaboration, and communication, the African Union Commission, Africa Centres for Disease Control and Prevention (Africa CDC), and WHO, in partnership with African countries, have established the Africa Taskforce for Coronavirus Preparedness and Response (AFTCOR). The partnership has six work streams: laboratory diagnosis and subtyping; surveillance, including screening at points of entry and cross-border activities; infection prevention and control in health-care facilities; clinical management of people with severe COVID-19; risk communication; and supply-chain management and stockpiles. Because mitigating the potential spread of COVID-19 in Africa will require rapid detection and containment, the laboratory work streams of AFTCOR, Africa CDC, and WHO are working closely to expeditiously scale up diagnostic testing capacity linked to enhanced surveillance and monitoring—eg, at the beginning of February, only two countries in Africa had the diagnostic capacity to test for COVID-19. However, as of Feb 25, 2020, more than 40 countries would have been capacitated to accurately diagnose COVID-19 infection, thanks to the coordination efforts of AFTCOR. As testing becomes more available, it is possible that more cases might be detected. Second, any effective preparedness and response strategy for COVID-19 requires a committed political will; as such, the African Union Commission, Africa CDC, and WHO convened, on Feb 22, 2020, in Addis Ababa, Ethiopia, an emergency meeting of all ministers of health of 55 member states to commit to acting fast and collectively to develop and implement a coordinated continent-wide strategy. AFTCOR taskforce was formed, and a continent-wide strategy was endorsed at the end of the emergency meeting, with a call for strong coordination of efforts. To prevent the occurrence of a social, health security, and economic tragedy, actions agreed at the emergency ministerial meeting will need to be acted on quickly, before any additional COVID-19 cases are introduced to the continent, and result in sustained human-to-human transmission. The potential social, economic, and security devastation that COVID-19 could cause in Africa should be enough of an incentive for African governments to invest immediately in preparedness for the worst-case scenario. Third, commitment and release of financial resources from partners and donors before a crisis hits Africa will help anticipate demand and address supply chain management, mapping, and stockpiling of COVID-19 response needs, such as large quantities of personal protective equipment, gloves, surgical masks, coveralls, and hoods, and medical countermeasures like antiviral agents. Supplies of these items will be limited in Africa because of reduced manufacturing capacity.

Author:John N Nkengasong, Wessam Mankoula
原文連結:https://is.gd/xeIVcK

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