The EITF mission is to provide effective and efficient technical support for national response to COVID-19 outbreaks. For this mission, the EITF must provide timely data collection & analysis and risk awareness & assessment, and propose timely emergency response actions to control outbreaks — for example, whether and where to deploy resources or whether an airplane or train should be monitored and passengers traced.
The EITF essential framework ensures regular operations and includes a commander, an info-group, an epi-group, an integration-group, and a logistics-group (Figure 1). The four EITF groups collaborate closely, in parallel, and under a unified lead by the commander. Each group has specific tasks according to their responsibilities and works toward the EITF mission. The commander is supervised by China CDC and NHC leadership and supported by expert consultants in China CDC. He or she is responsible for coordination, management, maintenance, and quality of all outputs, including reports, recommendations, and suggestions.Figure 1. Framework and structure of EITF.
Note: Info denotes information. Epi denotes epidemiology.
Abbreviation: EITF=epidemiological intelligence task force; NHC=National Health Commission.
The info-group has a fundamental responsibility for surveillance data quality and is responsible for monitoring, collecting, cleaning, and managing surveillance data in the online national surveillance systems of China CDC (9-10), including the Notifiable Infectious Disease Reporting System (NIDRS) (10-11) and the COVID Screening Positive Reporting System (COVID SPRS).
The epi-group is fundamental to risk assessment, and is responsible for epidemiological field investigation findings and information collection, verification, clarification, and correction through coordination and cooperation with local CDC liaisons (Table 1). The epi-group is responsible for real-time analysis of case-patient descriptions, outbreak descriptions, original source of infection reports, and transmission chain descriptions, and is responsible for completing the daily analysis report of each PLAD.
Type of information Source of information Liaison group Time requirement Specific contents requirement Demographic and basic information of each PCR positive individual NIDRS, COVID SPRS Info-group Update in real-time Demographic information, illness onset information, sampling and testing information, date of admission and discharge, severity of illness, etc Field core information of each PCR positive individual Liaisons in local CDCs Epi-group Within 4 hours after report Case detection methods, exposure history by travelling or living in area with outbreaks, contact history of any positive individuals, etc Field investigation report of each PCR positive individual NIDRS, liaisons in local CDCs Epi-group Within 24 hours after report Detailed exposure history, potential sources of infection, risk assessment, control measures Gene sequencing analysis results National Institute of Viral Disease control and prevention (NIVD), China CDC Info-group Update in real-time Whole gene sequences, in comparison with the prior sequences in NIVD, GeneBank and GISAID Environmental test results Liaisons in local CDCs Epi-group Update
Nucleic acid test results of environmental samples collected from the living, working and visiting location and contacted items Nucleic acid screening results Liaisons in local CDCs Epi-group Update
Date, location and number of sampling and testing when implementing nucleic acid screening each time Movement track tracing Liaisons in relative departments of joint multisectoral mechanism, such as MIIT, MoPS, MoT, CAA, etc Epi-group Update
Mobile phone signal movement, electronic payment records, monitoring video records, etc. within the past 14 days before illness onset or testing positive, and spatiotemporal relationship of different cases by analyzing the movement tracks Note: Info denotes information. Epi denotes epidemiology.
Abbreviation: EITF=epidemiological intelligence task force; NIDRS=notifiable infectious disease reporting system; COVID SPRS=coronavirus disease screening positive reporting system; PCR=polymerase chain reaction; GISAID=global initiative of sharing all influenza data; MIIT=the Ministry of Industry and Information Technology; MoPS=the Ministry of Public Security; MoT=the Ministry of Transportation; CAA=the Civil Aviation Administration.
Table 1. Information requirements of EITF.
The integration-group is the core analytic group, and is responsible for integration and in-depth analysis of information, and original analyses from the EITF info-group and epi-group, occasionally combining with other COVID-19-relevant data and information outside of EITF, to complete risk assessment and recommendation reports for decision makers in China CDC and NHC.
The logistics-group is responsible for supporting living and working conditions to ensure normal operation of EITF and provides a strong foundation for the work of the other three groups and the entire EITF. Logistics-group duties include supporting working locations and environments, equipping computers and ensuring internet connectivity, providing safe dining conditions, and providing infection control and prevention measures as needed.
The size of the four groups was scaled according to epidemic situation and EITF needs — for example, EITF was expanded in March 2022 in response to Omicron outbreaks and Omicron’s more rapid transmission. To closely track changes in COVID-19 epidemic situations in one or more PLADs or areas, the epi-group usually required several small epi-teams. When EITF was established in July 2021, it included one commander, a 5-person info-group, a 10-person epi-group, a 5-person integration-group, and a 3-person logistics-group. The original 24-person EITF was able to deal with sporadic and small scale COVID-19 outbreaks occurring in no more than 10 PLADs simultaneously. However, to manage the COVID-19 resurgence and the more contagious Omicron importations into the mainland of China, in March 2022, EITF was expanded to 74 persons — the largest thus far — consisting of one commander, a 15-person info-group, a 57-person epi-group divided into 6 epi-teams, a 7-person integration-group, and a 4-person logistics-group.
The essence of EITF workflow is data and information streaming, which was developed into a cycle in EITF for highly efficient data sharing (Figure 2). For example, when an individual tested positive for SARS-CoV-2, he or she was firstly reported to COVID SPRS and subsequently to NIDRS. Info-group staff extracted data on all reported cases from COVID SPRS and NIDRS several times per day and shared the data extracts with the epi-group. When receiving data from the info-group, responsible epi-group staff contacted their provincial CDC liaisons to obtain core information and the field investigation case reports in a timely manner, completed or updated the daily report of the PLADs, and shared the up-to-date data with the integration-group the following morning. Normally, the integration-group summarized information from the info-group and the epi-group, updating the national situation report and providing summarized information to the commander every morning. In some emergencies, the integration-group or the commander would work directly with the info-group and the epi-group to complete an urgent analysis.Figure 2. Workflow of EITF.
Note: Info denotes information. Epi denotes epidemiology.
Abbreviation: EITF=epidemiological intelligence task force; NIDRS=notifiable infectious disease reporting system; COVID SPRS=coronavirus disease screening positive reporting system; MIIT=the Ministry of Industry and Information Technology; MoPS=the Ministry of Public Security; MoT=the Ministry of Transportation; CAA=the Civil Aviation Administration.
EITF received seven types of data and information as essential input (Table 1) and produced three major types of regular outputs, including several types of reports, meetings with local CDCs, and recommendations to decision makers (Figure 3). Inputs and outputs were coordinated among the three major working groups in EITF — the info-group, the epi-group, and the integration-group.Figure 3. Dataflow in EITF. Abbreviation: EITF=epidemiological intelligence task force; NHC=National Health Commission; NIDRS=notifiable infectious disease reporting system; COVID SPRS=coronavirus disease screening positive reporting system.
There were 5 mechanisms to ensure normal operation of EITF: 1) EITF could directly report to decision makers in China CDC and NHC; 2) an EITF liaison could directly coordinate and cooperate with liaisons of other departments, such as Ministry of Industry and Information Technology, Ministry of Public Security, Ministry of Transportation, Civil Aviation Administration, and State Administration of Railways under the National Joint Multisectoral Mechanism; 3) EITF could directly coordinate and cooperate with departments in NHC; 4) EITF liaisons could directly contact designated provincial liaisons in local CDCs for any needs on behalf of NHC; and 5) EITF could directly coordinate and cooperate with national working groups in the field that was deployed by NHC to affected PLADs.
In the past year, EITF has dealt with approximately 70 domestic outbreaks, collected and processed the information on more than 30,000 individuals who screened positive for COVID-19, raised approximately 4,000 alarms, coordinated over 180 joint multisectoral tracings, completed more than 1,500 technical reports, and held over 100 meetings with local CDCs and national working groups. For example, in Shandong Province, the local CDC and government urgently terminated unnecessary control measures against a train upon a decision based on an EITF risk assessment that indicated there was no risk of virus transmission or spread on the train because the individual was not infectious while on the train (12).
EITF outputs provided effective and efficient technical support to NHC and China’s COVID-19 response. For example, control measures — especially the at-risk population tracing measures — were strengthened and accelerated as needed, while the overly strict and ineffective tracing and management measures were stopped in a timely manner (13). Risk periods for virus spread and transmission were able to be pinpointed, especially when transmission was associated with crowded indoor places like restaurants, pubs, bars, cinemas, or public transportation.
Mission and Responsibilities
Workflow and Mechanisms
Effectiveness and Efficiency