Efficient measures key to containment
Nation remains vigilant as outbreak worsens globally
Since Jan 23, when Wuhan, Hubei province, China’s core battlefield against the deadly novel coronavirus, came to a halt, the city has witnessed numerous sorrows, but also hope.
With spring arriving, it is gradually returning to normal, and the lockdown is to be lifted on Wednesday.
During the winter, China and its 1.4 billion people experienced the rapidly spreading COVID-19 outbreak. It has caused the most extensive infections and has been the most difficult disease to contain domestically since the founding of New China in 1949.
By Sunday, the pandemic has claimed the lives of 3,331 people and infected 81,708 on the Chinese mainland.
Although the country remains vigilant over imported infections and asymptomatic cases, the darkest moment seems to have passed.
“As China emerges from a twomonth containment phase and moves into the mitigation stage, its experience is helping countries currently at the start of the COVID-19 cycle to plan their responses better,” the World Health Organization said in its daily situation report for Sunday.
On Jan 23, when Wuhan imposed the lockdown, 259 confirmed new infections were reported on the mainland. The number continued to rise, peaking at 15,152 on Feb 12.
On Feb 19, the number dropped to three digits, and on March 6, to two digits — where it has remained, with most cases imported, according to the National Health Commission.
Zhang Wenhong, leader of the Shanghai team of experts treating COVID-19 cases, said, “We’ve managed to contain the outbreak in two to four months, which is unprecedented in the history of epidemics, and unprecedented in the annals of medical history.
“I feel proud of those brave ones, of our country and of our people.”
However, while local transmission of the virus has been basically stemmed in China, the outbreak continues to spread worldwide. In recent weeks, Chinese academics and medical workers have been communicating frequently with their foreign peers to see if the country can offer its experience to help contain the pandemic.
They believe the measures that have played a key role — including the Wuhan lockdown, massive testing, strict quarantine regulations and timely treatment — are all fundamental tools to break transmission of the virus.
Experts also point to several other crucial factors. These include: swift national mobilization, especially assistance to Wuhan on a huge scale; cooperation from the public, which made various isolation and social distancing policies a reality; and the country’s strong command system with President Xi Jinping as the core, which ensured efficient and synchronized policies in various regions.
It was not an easy decision to seal off Wuhan, a city of more than 11 million people and one of the country’s busiest traffic hubs.
Even before the lockdown was enforced, Wuhan had the majority of all confirmed COVID-19 cases on the mainland. By Jan 23, there were 495 confirmed infections in the city, accounting for 90 percent of the cases in Hubei, and about 60 percent of the total on the mainland. Nearly all the cases outside the city were found to be linked to Wuhan.
Zhong Nanshan, a member of the Chinese Academy of Engineering and a prominent respiratory disease expert, together with a group of other experts who made a field trip to Wuhan in January, suggested strict control of movement in and out of the city to curb the spread of the virus.
China was experiencing the Spring Festival travel rush, when billions of trips are usually made across the country. However, this would greatly increase the chances of infection nationwide.
On Jan 22, the central leadership ordered Hubei to impose strict controls on outbound travel — a decision Xi described as “very tough” and that took “huge political courage” to make.
On Jan 23, all outbound and inbound flights, rail, bus and ferry services to and from Wuhan were suspended — apart from those required for emergency purposes — effectively isolating the city from the rest of the country. All public transportation in the city, including the subway, buses and taxis were also suspended — a measure aimed at minimizing chances of the virus spreading.
It was an unprecedented move in China’s modern history, and other cities in Hubei took similar measures, with the lockdown swiftly extended to the whole province.
Chen Jianguo, vice-president of Huazhong University of Science and Technology and president of Tongji Medical College in Wuhan, said, “The Wuhan lockdown, one of the first major measures taken following the outbreak, has played a pivotal role in containing it.”
In the following two months, Wuhan remained the hardest-hit city, but the situation gradually stabilized and improved. On March 11, about 50 days after the lockdown was enforced, newly reported infections in the city dropped to a single digit for the first time.
Zhou Weisheng, a professor at the College of Policy Science at Ritsumeikan University in Kyoto, Japan, said: “If China had not imposed the lockdown in Wuhan and some other cities, the number of people infected with the virus may have been more than 10 times higher. Considering the lack of effective prevention and treatment methods for COVID-19, cutting off the source of infection (by locking down Wuhan and some other cities) resolutely and as soon as possible should be the first measure taken, despite the great cost.”
A number of published research studies have also illustrated the significance of the unprecedented measure.
According to a study published in the journal Science on March 31, the Wuhan lockdown, together with the national emergency response, reduced the number of confirmed COVID-19 cases outside Wuhan on the mainland by 96 percent within a month of being implemented. Without the lockdown, by Feb 19, the number of such confirmed cases would have reached more than 740,000, instead of fewer than 30,000, the study found.
Test, treat and isolate
After the outbreak emerged, China ordered all-out efforts to provide viral tests and treatment for all those in need, and imposed isolation measures on confirmed and suspected cases, and close contacts of confirmed infections. This was seen as another crucial measure that helped flatten the curve of new infections.
At the end of January, the outbreak had spread extensively in communities in Wuhan, according to Vice-Premier Sun Chunlan, who heads a central government work team for COVID-19 epidemic control in Hubei. A large number of patients kept moving between hospitals and their communities, posing a severe challenge for control and prevention work.
In early February, under the guidance of the team, the authorities in Wuhan intensified efforts to identify all cases and close contacts in residential communities and sent them to designated hospitals and other facilities for treatment or medical observation under isolation.
Given the high infection rate and the lack of medical resources at the time, this was an extremely arduous task.
In about two weeks, the authorities in Wuhan had inspected 4.2 million households in the city and identified 18,000 confirmed and suspected COVID-19 cases and close contacts of confirmed patients. They were all sent to hospitals and other designated facilities, according to official data.
Wang Chen, president of the Chinese Academy of Medical Sciences, said the central government’s decision to provide free tests and treatment for all people in need played the most important role in controlling the outbreak.
In the early stages of the outbreak in Wuhan, a major challenge to universal testing — a precondition for all cases being received by medical facilities — was the lack of capacity, which lagged behind the rapidly rising demand from patients, Wang said.
“In the beginning, only centers for disease control and prevention could provide viral nucleic acid tests,” he said. “Later, many hospitals could give the tests, which greatly eased the problem.”
However, with the fast-growing number of people needing medical treatment or to be quarantined, Wuhan faced another critical problem — the lack of hospital beds.
As the city’s medical resources were far from sufficient to cope with the peak of the outbreak, two temporary facilities — the Huoshenshan Hospital and Leishenshan Hospital — were completed within two weeks in early February, providing a total of more than 2,000 beds for patients in critical condition.
The city’s sports stadiums, exhibition halls and warehouses were also transformed into makeshift hospitals, or Fangcang shelter hospitals, to take patients with mild symptoms.
Wuhan resident Feng Bangli was cured of COVID-19 and discharged from a makeshift hospital at the end of February. “I could not find a bed at any designated regular hospital in Wuhan, as there were so many patients. So, in early February, I had to stay at a designated hotel for isolation,” he said. “When the Fangcang shelter hospital was set up, I saw hope.”
With temporary hospitals built and existing ones expanded, the shortage of beds was no longer a problem in Wuhan. All patients could now be admitted to hospitals, which helped effectively control the infection source, said Tang Zhouping, a professor of neurology at Tongji Hospital and also president of Guanggu Fangcang Shelter Hospital — a temporary facility transformed from an exhibition center.
Wang Chen, from the Chinese Academy of Medical Sciences, said building makeshift hospitals was a key decision made at a critical time when Wuhan faced a formidable task in epidemic control, and was also “a core measure” in implementing the policy to test, treat and isolate all those in need.
“In addition to providing treatment for patients, such hospitals are, first of all, ideal sites for quarantined patients so that they do not spread the disease,” he said. “In addition, as such hospitals only receive patients with mild symptoms, many of them will not end up in designated hospitals, so critically ill patients have more chances of being admitted.”
The 16 temporary hospitals, which offered about 14,000 beds, were all closed by March 10 due to a fall in the number of patients. The hospitals received more than 12,000 COVID-19 patients in Wuhan, accounting for nearly 25 percent of all those in the city, according to the National Health Commission.
Richard Horton, editor-in-chief of The Lancet, a medical journal based in the United Kingdom, wrote on his Twitter account on April 3: “Fangcang shelter hospitals were critical elements in China’s successful response to SARS-COV-2. They were large, quickly repurposed and cost-effective. They stopped intrafamilial transmission, reduced hospital pressures and enabled efficient triage.”
Meanwhile, Tang said the measure to isolate all patients who recovered, suspected cases and close contacts of all confirmed patients for 14 days at designated quarantine sites, and require self-observation at home for another 14 days, was also an important factor.
Official data show that more than 530 hotels, training centers and recreational venues in Wuhan have been transformed into quarantine sites.
While there is still no specific medicine or vaccine to treat COVID19, Chinese health experts are exploring a treatment that combines traditional Chinese medicine and Western medicine.
Of all confirmed cases on the mainland, more than 90 percent have received TCM treatment, and this has been effective in over 90 percent of them, according to the National Administration of Traditional Chinese Medicine.
Yu Yanhong, Party chief of the administration, said late last month TCM treatment could significantly relieve symptoms in COVID-19 patients, while preventing the condition worsening among those with mild symptoms. “It has been proven that TCM can improve the recovery rate, while reducing the death rate effectively,” Yu said.
Resource allocation
For more than two months, Wuhan has been the core battlefield in fighting the outbreak in China, but it has not been doing so alone.
Unlike other areas of the country, which have witnessed far fewer COVID-19 cases, the city’s healthcare system faced an excessive burden during the initial period of the outbreak.
Faced with this grim situation, the PLA Air Force began using its transport planes to send military medics and materials to Wuhan on Jan 24. Three aircraft carried 450 medical workers and supplies to the city before midnight that day — Lunar New Year’s Eve.
More than 42,000 medical professionals from across the country went to Hubei to help their local peers battle the disease.
Meanwhile, the daily supply of protective medical gowns to Hubei rose from about 21,000 before Jan 27 to 270,000 at the peak on Feb 29, while the daily supply of N95 face masks had risen nearly eightfold by March 1, according to official data.
Jiao Yahui, an official responsible for medical administration and supervision at the National Health Commission, said medical teams from outside Hubei have played a crucial role.
She said that during the peak of the outbreak, the shortage of medical workers in Hubei reached about 10,000 a day as the number of patients rose rapidly. Due to the assistance of medical workers from outside Hubei, all patients received treatment, and the mortality rate in the province dropped significantly.
Wang Zhen, vice-president of Shanghai Mental Health Center, who led a medical team from the metropolis to aid Hubei, said that thanks to the country’s rapid response system and mobilization ability, doctors and nurses from across the nation were sent to Hubei quickly.
“China does not have very prominent advantages in medical technologies, but it performed remarkably well in pooling medical resources for rescue efforts in the fight against the epidemic,” he said.
Li Yiping, an economics professor at Renmin University of China in Beijing, said the central government can mobilize national resources quickly, such as marshaling enterprises to produce masks in large quantities and send them to hospitals and other places where they are urgently needed.
He said these efforts prevented speculation about medical materials, and ensured “scientific allocation” so that demand from frontline medical workers and the public for self-protection could be met.
In addition to medical resources, a coordination mechanism between Hubei and eight other regions — Shandong, Anhui, Jiangxi, Henan, Hunan and Yunnan provinces, Chongqing and Guangxi Zhuang autonomous region — was set up on Jan 23 to ensure daily necessities reached residents in Hubei.
By March 27, about 72,000 metric tons of daily supplies, such as vegetables, fruit and instant food, had been sent to the province to meet demand, according to official data.
Social distancing
When Wuhan was sealed off, a range of measures was taken in the rest of the country to prevent local transmission of the virus.
By Jan 30, all 31 provincial-level regions on the mainland had activated the first-level emergency response to contain the spread of COVID-19.
Authorities and medical experts kept appealing to the public to comply with the measures, such as staying at home as much as possible, maintaining social distancing, wearing a mask when going outside and washing hands frequently.