Globally, there has been an unprecedented increase in the number of coronavirus disease (COVID-19) casessince it was initially reported on 31st December 2019. In Brunei, the first COVID-19 case was detected on 9thMarch 2020, who developed symptoms after returning from Malaysia. Since then, the Ministry of Health(MoH) has made efforts to contain the disease spread within the community through intensive contacttracing, testing of suspected cases and isolating positive cases. The first wave of the epidemic lastedbetween early March to early April (see Figure), after which subsequent cases detected were mainlyimported from abroad. Since March 2020, PAPRSB IHS’s faculty members (Dr. Liling Chaw - Epidemiology & Biostatics lecturer, andProfessor Ayub Mohd Sadiq - Professor in Biostatistics) have actively participated in analysing data fromboth cases and their contacts, collected by the Disease Control Division (DCD). The aims for this analysiswere to provide a general picture of the epidemic situation to MoH to help them to decide on betterstrategies to handle the situation at the time, and also to find research opportunities for generatingpublications.Upon further discussions with the MoH medical officers, certain epidemiological and transmissioncharacteristics of the disease were identified. This includes: (1) the explosive nature of disease spread whenit was introduced into the country, as shown by the high basic reproduction number during the first 6 days ofthe epidemic (between 3.9 to 6.0), (2) the presence of laboratory confirmed cases who either displayed nosymptoms either at the time of testing (referred to as pre-symptomatic), or throughout their admission untildischarge (referred to as a-symptomatic), (3) evidence showing more effective transmission at crowded andenclosed spaces for prolonged time periods, as shown in the high attack rate among household membersand religious gathering attendees. To record these findings, a total of 4 journal articles (2 research articles,1 letter to the Editor & 1 rapid communication) were written, in close collaboration with MoH and the Centreof Strategic and Policy Studies (CSPS). B E Y O N D | J U L . T O S E P T . 2 0 2 0 | I S S U E 2 1 4E P I D E M I O L O G Y O F C O V I D - 1 9 I N B R U N E ID A R U S S A L A MThe epidemic curve for the first 135 COVID-19 cases inBrunei Darussalam. Imported cases (red bars) andlocally transmitted cases (blue bars)Chaw L, Koh WC, Jamaludin SA, Naing L, Alikhan MF, Wong J. Analysis of SARS-CoV-2 transmission in different settings,Brunei. Emerging Infectious Diseases Journal. 2020;26(11) – In press Wong J, Chaw L, Koh WC, Alikhan MF, Jamaludin SA, Poh WWP, et al. Epidemiological Investigation of the First 135 COVID-19Cases in Brunei: Implications for Surveillance, Control, and Travel Restrictions. Am J Trop Med Hyg [Internet]. 2020 Aug 14[cited 2020 Aug 21];tpmd200771. Available from: http://www.ajtmh.org/content/journals/10.4269/ajtmh.20-0771Wong J, Jamaludin SA, Alikhan MF, and Chaw L. (2020), Asymptomatic transmission of SARS‐CoV‐2 and implications formass gatherings. Influenza Other Respi Viruses, 14: 596-598. doi:10.1111/irv.12767Wong J, Abdul Aziz ABZ, Chaw L, Mahamud A, Griffith MM, Lo Y-R, et al. High proportion of asymptomatic andpresymptomatic COVID-19 infections in air passengers to Brunei. Journal of Travel Medicine. Journal of Travel Medicine,Volume 27, Issue 5, July 2020, taaa066, https://doi.org/10.1093/jtm/taaa066Cited articlesDissemination of these findings to the local andglobal community is important as a lot is stilluncertain about the epidemiology of this noveldisease. And this gives a chance for Brunei toshare its experience in controlling the epidemic tothe global scientific community. An epidemicinvestigation of this event into a naïve populationcan provide insights into its transmission dynamicsand the effectiveness of epidemic controlmeasures. Importantly, Brunei’s thorough contacttracing has provided a rare opportunity to studythe epidemiologic and transmission characteristicsof the disease in the local setting. The public health programme at PAPRSB IHS hasbeen collaborating closely with MoH in terms ofteaching and research for at least 10 years, andthis project adds to the list of successful researchcollaboration between the 2 institutions. It ishoped that this close relationship can continue toserve as a platform for future research in emerginginfectious diseases, as well as address importanthealth issues in the country.Dr. Li Ling Chaw, Lecturer
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