Abstract
Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; named 2019 novel coronavirus or 2019-nCoV) disease in China at the end of 2019 has led to pandemic. A robust surveillance system is required for true estimation of burden of the disease. This study was conducted to identify the strengths and weaknesses of laboratory-based COVID-19 surveillance system in Pakistan and to propose some doable actions for improvement.Method: An evaluative study was conducted from February to March, 2020 at National Institute of Health (NIH) Islamabad, Pakistan. CDC’s “Updated Guidelines for Evaluation Public Health Surveillance System-2001” were used to evaluate the COVID-19 disease surveillance system. Information was gathered and analyzed on different system attributes using qualitative and quantitative methods.Results: System found simple, stable and readily acceptable at all public and private sectors with flexibility to incorporate other respiratory pathogens detection. Reporting was timely, typically within 24-48 hours of sample reception, using electronic as well as paper based management system. All stakeholders contributed in this health emergency. With evolving cases definition and unknown prevalence till first week of April, sensitivity and predictive value positive was found 1.25% and 4.50% respectively. Representativeness was good since it is a reference lab with few sentinel sites for COVID-19 specific testing.Conclusion: Based on the findings of this study, system meets the initial objectives of the surveillance but rapid expansion of sentinel sites along with continuous provision of logistics, supplies and trained human resources is needed to meet the increasing need of detection in wake of rapidly spreading pandemic.
Highlights
Public health surveillance of communicable diseases is a major cornerstone in International Health Regulations’ (IHR) detection, response and containment strategy adopted by all countries
Based on the findings of this study, system meets the initial objectives of the surveillance but rapid expansion of sentinel sites along with continuous provision of logistics, supplies and trained human resources is needed to meet the increasing need of detection in wake of rapidly spreading pandemic
Since the first case appeared in China in December 2019, emerging novel coronavirus disease (COVID-19) has evolved as a rapidly spreading pandemic with high morbidity and mortality rates across the world
Summary
Public health surveillance of communicable diseases is a major cornerstone in International Health Regulations’ (IHR) detection, response and containment strategy adopted by all countries. Since emerging infections like COVID-19 are major threats to human lives, showing high prevalence and incident rates within a short time span [1], an effective, comprehensive and integrated disease surveillance system is required for timely detection and response. Whether it is an indicator based or event based surveillance, an integration with public health laboratories is a must to fully understand disease evolution [2]. This study was conducted to identify the strengths and weaknesses of laboratory-based COVID-19 surveillance system in Pakistan and to propose some doable actions for improvement
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