Travel Medicine and Infectious Disease 39 (2021) 101913
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Travel Medicine and Infectious Disease
journal homepage: www.elsevier.com/locate/tmaid
Correspondence
To halt the spread of imported coronavirus disease 2019 cases in China: Action and challenges
Dear editor
The ongoing pandemic of coronavirus disease 2019 (COVID-19) has
expanded rapidly to more than 200 countries, resulting in 5,934,936
cases and at least 367,166 deaths as of May 31, 2020 [1]. By imple­
menting combined non-pharmacological interventions, China has
brought the outbreak under control. However, with locally-infected
cases decreased substantially, the growing number of imported cases
has raised major concern. Since released first on March 4, this number
has risen to 1756 as of May 31 [2], covering 28 provincial jurisdictions
in mainland China (Fig. 1 panel A and B) and peaking on April 12 before
declining substantially. Of those reported before April, 618 (76.7%)
were from Iran, Italy, Spain, United Kingdom, France, and United States
(Fig. 1 panel C), where the number of cases promptly increased during
the same period.
Foreign guest workers, residents, and Chinese tourists and interna­
tional students returning from overseas consisted of these cases. As
imported cases might create new chains of transmission and result in a
second wave of outbreak, if not responded effectively, coordinated and
combination interventions have been in place, in addition to routine
measures, such as isolation of cases, contacts tracing, and infection
prevention and control in health facilities. First, coordinated mecha­
nism. Since established during the 2002–2003 SARS outbreak and with
30 relevant departments of government involved in 2015 [3], it has
played a key role in response to the COVID-19 outbreak, mainly by
coordinating response activities, releasing guidance and notification on
control of COVID-19, holding press conference regarding public con­
cerns, and supervising control measures implemented at the subnational
level. In addition, relevant departments and local authorities imple­
mented response activities in a seamless, collaborative manner to ensure
the interventions in place.
Second, board control strategy. According to the International Health
Regulation and the Chinese Frontier Health and Quarantine Law, active
surveillance of COVID-19 has been implemented at each international
entry point since January 24. Suspected cases or those with symptoms
resembling COVID-19 are detected through screening and medical in­
spection upon arrival at the entry ports. Those who are identified posi­
tive will be transported to designated hospital for further evaluation.
Third, health screening, quarantine, and testing. In response to im­
ported cases, each provincial authority has converted hotels into quar­
antine centers to house individuals back from abroad. Since March 3,
international travelers entering mainland China, initially from the
severely-affected countries, were required to receive temperature and
respiratory symptoms screening upon arrival at airport checkpoint.
From March 20, these measures expanded to all entering individuals.
Persons screening positive will be transferred to designated hospitals
and assessed, and those negative will proceed a 14-day quarantine at
https://doi.org/10.1016/j.tmaid.2020.101913
Received 22 April 2020; Received in revised form 2 July 2020; Accepted 4 November 2020
Available online 7 November 2020
1477-8939/© 2020 Elsevier Ltd. All rights reserved.
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collective points. Since March 25, in addition to be quarantined, in­
dividuals should also receive testing for the virus at the third and fifth
day during quarantine and those who have fever, symptoms, or tested
positive would receive further evaluation. Additionally, enhanced sur­
veillance has been implemented in fever clinics nationwide. When pa­
tients with fever or respiratory symptoms seek medical care, they will be
sampled and under epidemiological investigation.
Fourth, educational interventions. The Ministry of Foreign Affairs
has posted bulletin of health precautions through the official website of
each embassy, in addition to disseminating health package to each
Chinese international student. On the other hand, clinical expert was
invited to join the communications with the representatives of inter­
national students about the prevention of COVID-19, as well as consult
platform was online on April 7 to the overseas Chinese, on which in­
dividuals can find information on prevention of COVID-19 by submitting
a query and by reading postings.
Fifth, closing borders and travel restrictions. As the COVID-19
pandemic spread further, suspending borders as conducted by
Singapore [4] appeared to be critical and effective to prevent the disease
spreading across border. On March 26, the Ministry of Foreign Affairs
and Immigrant Department released an announcement that borders
would be suspended from March 28, and non-Chinese citizens would be
barred entry. In addition, the Ministry of Foreign Affairs has recom­
mended that individuals should avoid unessential international travel.
Sixth, prevention measures at the individual level, such as mask
wearing, social distancing, hand hygiene, and following the guidance of
authority, have been strictly implemented since the declaration of the
COVID-19 outbreak in January 2020.
Finally, the laws and regulations guaranteeing the response activities
implemented. On January 20, the COVID-19 was brought by the Na­
tional Health Commission into the national notifiable diseases items as
category B, which was taken as category A for control strategy. Ac­
cording to these laws, any individual and group are required to comply
strictly with the interventions in place, such as isolation, quarantine,
treatment, and medical observation measures; violators face fines and
jail terms.
Despite continued efforts in China to control the imported COVID-19
cases, three challenges still remain. First, more research is needed to
closely monitor the evolution of SARS-CoV-2, particularly isolated from
samples of imported cases, including pathogenicity, virulence, and
transmissibility. Second, accelerate research, development, and trial of
COVID-19 vaccine. Although six vaccines are in development in China,
even some enter phase III clinical trial [5], more well-designed trials are
needed to evaluate efficacy of the vaccine in those who are at increased
risk for severe illness. Finally, all individuals should constantly follow
the government’s order and advice from the public health authorities,
until the pandemic is under control.
Correspondence
With extensive measures implemented and whole society engage­
ment, China together with other countries and international partners
will make sustainable efforts to draw ultimately the pandemic to the end
in the future.
Authors’ contribution
J. Fu: study design, data collection, drafting of the manuscript. C
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For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
Travel Medicine and Infectious Disease 39 (2021) 101913
Jiang: study design, study supervision. Y. Li: data collection. Analysis
and interpretation of data: all authors.
Approval of the final manuscript: all authors.
Funding
This work did not receive any specific grant from funding agencies in
the public, commercial, or not-for-profit sectors.
Fig. 1. Geographic distribution and time curve of
imported coronavirus disease 2019 (COVID-19) cases
across China, as of May 31, 2020. Panel A shown are
the official statistics of all documental imported
COVID-19 cases across China, as of May 31, 2020.
Data are from the national and provincial health
commissions, which are open to the public on the
corresponding websites. Circles denote the number of
imported COVID-19 cases for the provinces, autono­
mous regions, or provincial municipalities that have
imported cases, with size proportional to the number
of cases. Panel B shown are number of local cases and
imported cases reported in China mainland as of May
31, 2020. Panel C shown are number of cases in the
countries from which they are imported as of March
31, 2020.
Correspondence
Declaration of competing interest
We declare no competing interests.
References
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Downloaded for Ida Bagus Gede Anom Sattwika Anom (anomsattwika@gmail.com) at University of Warmadewa from ClinicalKey.com by Elsevier on March 19, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
Travel Medicine and Infectious Disease 39 (2021) 101913
[4] Government of Singapore. COVID-19: travel restrictions for foreign visitors entering
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[5] Chinese COVID-19 vaccine candidate the first to start phase 3 clinical trials
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Jiye Fu*, Chu Jiang, Juguang Wang, Yulian Li, Huaqing Ying
Bejing Haidian District Center for Disease Control and Prevention, Beijing,
China
*
Corresponding author. Bejing Haidian District Center for Disease
Control and Prevention, No. 5, Xibeiwang 2nd Road, Haidian District,
Beijing, 100094, China.
E-mail address: fu-jiye@163.com (J. Fu).