Correspondence The global community such measures but without lockdown or and many other technical guidance needs to swiftly ramp major social disruption by maximising documents. all efforts to interrupt new transmission We have seen that containment in Published Online up the response to chains and keeping clusters under China, Singapore,3 and Hong Kong March 18, 2020 https://doi.org/10.1016/ control.3 Countries with widespread is possible, but we have also seen contain COVID-19 S0140-6736(20)30679-6 community transmission need to follow settings where control was lost. For WHO’s technical guidance “Much of the global community is not the China approach, with wide-reaching Remarkably, South Korea lost control on COVID-19 see https://www. yet ready for COVID-19 [coronavirus (and possibly unpopular) mobility and regained it with no lockdown who.int/emergencies/diseases/ 1 novel-coronavirus-2019/ disease 2019]”. This is arguably one restrictions, limited social interaction, and simply strong application of the technical-guidance of the most resonating phrases in and cancelled gatherings. People should above principles, enhanced by using the Report of the WHO-China Joint be strongly encouraged to stay home novel digital technologies for contact Mission on Coronavirus Disease 2019,1 and work from home when possible. In tracing.4 The consequences of non- released publicly on Feb 28, 2020. addition, all countries need to continue containment will be measured in lives Major transmission hotspots were liberal testing, proactive case detection, lost and socioeconomic disruption, brought under control in China, but prompt isolation, rigorous contact which will be far worse than the cost of subsequently others sprouted across tracing, and enforcement of quarantine rigorously implemented containment the globe. Since late February, 2020, of all contacts, irrespective of which combined with mitigation efforts. the daily number of new cases has phase of the outbreak they are in. “Containment of COVID-19 is feasible been higher in other parts of the world. All countries should immediately and must remain the top priority for New major epicentres have established activate the highest level of National all countries”, WHO’s Director-General in South Korea, Japan, Iran, and Italy. Response Management protocols to said at a media briefing on COVID-19 By mid-March, 2020, Europe was ensure the all-of-government and all- on March 2, 2020.5 WHO still does declared the world’s major epicentre. of-society approach needed to contain not waver from this message. China implemented extraordinary COVID-19 with non-pharmaceutical DF is Chair of the Global Outbreak Alert and public health measures at great socio- measures. This includes fully engaging Response Network (GOARN). AW-S is co-Chair of economic cost, moving swiftly and the public on the seriousness of, and the Lancet Infectious Diseases Commission on Preparedness for Emerging Epidemic Threats. decisively to ensure early identification their role in, the response. Policy We declare no competing interests. of cases, prompt laboratory testing, makers need to ensure that trained Dale Fisher, *Annelies Wilder-Smith facility-based isolation of all cases, epidemiology teams are in place, along [email protected] contact tracing, and quarantine.2 In with quarantine facilities, revised Division of Infectious Diseases, National the community, mobility was at a hospital workflows, and laboratory University Hospital, Singapore, Singapore (DF); near standstill, with social distancing processes (who to test, how, and in Yong Loo Lin School of Medicine, National implemented at a grand scale. China’s which laboratory). Surveillance needs University of Singapore, Singapore (DF); massive transmission rates called for to be expanded to test all patients with Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, extreme measures, and the measures atypical pneumonias for COVID-19, UK (AW-S); and Heidelberg Institute of Global were successful. and COVID-19 testing needs to be Health, University of Heidelberg, Heidelberg, The call is now for the rest of the world added to existing surveillance systems Germany (AW-S) to ramp up its response, but regrettably, for influenza-like illness and severe 1 WHO. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). it is evident that the global community acute respiratory infections. The Feb 28, 2020. https://www.who.int/docs/ is not ready in its mindset or capacity. A demand on facilities, the number default-source/coronaviruse/who-china-joint- mission-on-covid-19-final-report.pdf differentiated risk-based containment of test kits, personal protective (accessed March 18, 2020). strategy is needed based on the dif- equipment, and medication stockpiles 2 Wilder-Smith A, Freedman DO. Isolation, ferent stages of the outbreak, with should be forecast to enable scale- quarantine, social distancing and community containment: pivotal role for old-style public different measures during the different up. Health systems vary whereby health measures in the novel coronavirus phases of the response. Countries people in under-resourced countries (2019-nCoV) outbreak. J Travel Med 2020; 27: taaa020. with no or few identified cases and will be particularly at risk. Vulnerable 3 Lee VJ, Chiew CJ, Khong WX. Interrupting only limited local transmission need countries will therefore need extra- transmission of COVID-19: lessons from containment efforts in Singapore. J Travel Med to invest in aggressive case detection ordinarily intensified support from 2020; published online March 13. by testing for COVID-19 in all atypical other countries. WHO freely provides DOI:10.1093/jtm/taaa039. pneumonias and all cases of acute online resources that include training 4 COVID-19 National Emergency Response Center, Epidemiology & Case Management Team, Korea Submissions should be respiratory infection. A wide net should courses, downloadable standardised Centers for Disease Control & Prevention. made via our electronic be cast on contact tracing with legally case report forms, guidance on clinical Contact transmission of COVID-19 in South submission system at enforced implementation. Singapore management and infection control, Korea: novel investigation techniques for tracing contacts. Osong Public Health Res Perspect 2020; http://ees.elsevier.com/ managed to contain COVID-19 with protection of health-care workers, 11: 60–63. thelancet/ www.thelancet.com Published online March 18, 2020 https://doi.org/10.1016/S0140-6736(20)30679-6 1 Correspondence 5 WHO. WHO Director-General’s opening remarks at the media briefing on COVID-19—2 March 2020. March 2, 2020. https://www.who.int/dg/speeches/detail/ who-director-general-s-opening-remarks-at- the-media-briefing-on-covid-19---2- march-2020 (accessed March 18, 2020). 2 www.thelancet.com Published online March 18, 2020 https://doi.org/10.1016/S0140-6736(20)30679-6.