HEPL blog series: Country Responses to the Covid19 Pandemic

 

China’s Response to the Coronavirus Pandemic

 

Xiaolin Wei

Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
xiaolin.wei@utoronto.ca
http://www.dlsph.utoronto.ca/faculty-profile/wei-xiaolin/

 

COVID-19 in China
Wuhan, a city of 11 million residents, first reported a cluster of unknown pneumonia cases on December 30, 2019, and then Chinese health officials reported this to the World Health Organization (WHO) within two days. In January 2020, Chinese scientists published the genetic sequence of a novel coronavirus identified from samples from the Wuhan Seafood Market. However, this unknown pneumonia did not raise Government concern until January 20. Swift action was prompted by Dr. Nanshan Zhong, a national hero during the Severe Acute Respiratory Syndrome (SARS) outbreak, who led the second national investigation team and declared “definite human-to-human” transmission. On January 23, Wuhan implemented a complete travel ban and effectively locked down its 11 million residents. The WHO declared a global public health emergency on January 30. The infection grew exponentially in Wuhan, and Hubei province, and spread to all provinces in China. Until March 13, China was the epicentre of COVID-19 and as of April 6th has a total of 82,988 cumulative cases and 3,338 deaths.

 

National coordinated efforts
Since January 23, the government of China has responded decisively with sweeping measures. In six days, all provinces declared a Level 1 Emergency Response. China’s President Xi Jinping declared a “People’s War” to mobilize the country, including the army, to fight COVID-19. On January 25, a Central Leadership Group for Epidemic Response headed by Premier Li Keqiang was established to coordinate national efforts across different sectors. China’s State Council set up the Joint Prevention and Control Mechanism, headed by the National Health Commission, to manage social and health system responses and equipment supplies.

 

Social distancing and community responses
Within two weeks of Wuhan’s lockdown, all cities in Hubei province adopted travel bans and lockdown policies, effectively confining over 50 million people to their homes. These policies enacted the “strictest, around-the-clock, closed management” of all residential complexes in the province. Residents were only allowed to leave their homes to purchase medicines and groceries. Use of private vehicles was prohibited and use of masks and temperature checks were mandatory before entering public places and residential complexes. In cities outside of Hubei, a softer lockdown was implemented, which required residents to stay home but did not completely ban travel. Residents had to obtain a paper pass, and later an electronic code on their mobile phones, when leaving or entering their housing complex. Also, migrants coming back to work were turned away or quarantined in hotels before returning to their rented accommodation. In rural areas, roads to villages were blocked with vehicles or barriers to prevent travel.

A large number of community officials, primary care health workers, and volunteers were mobilised to establish Community Health Working Groups. These Groups monitored entry and exit to residential complexes, shared real-time information regarding recent policies, tasks, and number of confirmed or suspected cases in the city and their communities. These Groups also provided support for community quarantine, monitored close contacts, and people returning from epidemic areas and overseas. In some cases, Groups also supplied medicines and groceries to elders unable to shop for themselves.

New technologies have been quickly deployed in China to manage community quarantine and social distancing. These include WeChat generated QR health codes based on a person’s health status, travel history and diagnosis. Other smart phone-based apps required users to register their identity and share locations to initiate fast contact tracing. Drones were reportedly used to monitor physical distancing on streets, or entries to highways. Early in the outbreak, before widespread test kit availability, hospitals in Wuhan used artificial intelligence-assisted radiological image interpretation.

 

Health system measures
China mobilized resources in an unprecedented way. The National Health Commission called to Wuhan a total of 42,600 doctors, nurses and public health specialists, including one tenth of the country’s intensive care specialists. Within two weeks, two new infectious disease hospitals were built in Wuhan, and 86 existing hospitals became designated fever hospitals. Early in the outbreak, patients with mild or moderate symptoms were sent home due to a shortage of hospital beds. However, this led to a surge in at-home transmission. To address this, Wuhan converted stadiums and exhibition halls, to isolate COVID-19 patients with mild to moderate symptoms. These ‘Fangcang Hospitals’ were opened in early February and have since closed after the last patient was discharged. In total, the 16 Fangcang hospitals provided service to a total of 12,000 patients.

Primary care facilities remained open to patients but did not treat COVID-19 patients. Those who were febrile during consultation were immediately isolated before transfer to hospital for testing.  Primary care doctors collaborated with psychologists and social workers to provide consultation via telephone or WeChat to patients or suspects under home isolation.

In early February there was a COVID-19 test kit shortage and only patients with severe symptoms were tested. Test results had to be confirmed by China’s Centre for Disease Control and Prevention before reporting. However, China has ramped up approval and production for mass testing. By 5 March, 15 million tests have been provided and all patients suspected of having COVID-19 were tested. By March 20, China has approved 12 nucleic acid tests and eight antibody tests for clinical use. However, there has not been official evidence regarding the sensitivity or specificity of the testing toolkits given the ambiguity of diagnoses.

 

Do China’s measures work?
Under these unprecedented measures, China has effectively controlled its COVID-19 epidemic within a month of the Wuhan lockdown. The number of daily new confirmed cases in China has declined to below 100 since 7 March 2020.  Within the first seven days of lockdown, the reproductive rate was believed to be reduced to almost below 1.  Subsequent modeling studies suggest that travel bans and city lockdowns delayed the average transmission period and averted hundreds of thousands of cases across China. Other studies found the travel ban stopped 80% of cases internationally. Shenzhen, which has close links with Wuhan, successfully contained the epidemic. A study from Shenzhen found that intensified community response, such as isolation and contact tracing, substantially reduced reproduction rate, and prevented sustained community transmission. Evidence from Wuhan suggests Fangcang Hospitals played an important role in patient isolation, triage, providing medical care to patients with moderate symptoms and rapidly blocked community transmission.

 

Reflection on COVID-19 response in China
Since January 23, the government of China has acted rapidly and collectively towards a COVID-19 response. As the WHO-China Joint Mission reported, China’s success in cutting the epidemic curve was only possible “due to the deep commitment of the Chinese people to collective action”. This included coordinated efforts on social distancing and rapid mobilization of medical and other resources such as building new hospitals, providing mass amounts of personal protection equipment, and testing, as well as maintaining a high level of community monitoring and support.  Such efforts require decisive governmental action to consolidate resources and enact drastic measures. Many of these actions, such as city lockdowns are now practiced globally; however, when first implemented in China they were regarded as “unimaginable” elsewhere. As the devastating impact of the COVID-19 pandemic progresses rapidly worldwide, governments can benefit from the knowledge gained in China and use these experiences to make their own hard decisions based on their resources and contexts.

 

 

Health Economics, Policy and Law serves as a forum for scholarship on health and social care policy issues from these perspectives, and is of use to academics, policy makers and practitioners. HEPL is international in scope and publishes both theoretical and applied work.