Silent infections a new challenge
▶ Weak grassroots COVID-19 response mechanism blamed for virus resurgence in China
The Chinese mainland is facing a rising virus outbreak in multiple cities ahead of its biggest annual festival following the lockdown of a county in Northeast China’s Heilongjiang Province on Monday, after the de facto lockdown in Shijiazhuang, capital city of North China’s Hebei Province and the number of daily new cases reaching triple-digits in one day for the first time in five months.
Chinese health experts warned that the coronavirus spreading in China appears to be more infectious and transmissible, and asymptomatic infections, especially silent infections in villages, has become a new and big challenge for China, judging from the ongoing Shijiazhuang outbreak and previous outbreak in Northwest China’s Xinjiang Uygur Autonomous Region.
A weak and slow COVID-19 response at the grassroots level, which includes a failed surveillance and reporting system in villages, has spawned the recent domestic cluster infections, experts said.
Zhang Yuexin, a member of anti-epidemic group in Xinjiang, said that Shijiazhuang’s fresh outbreak was similar to Xinjiang’s, and in both situations the virus spread silently for some time before being detected, which shows that
asymptomatic patients have increasingly become a great challenge for China's epidemic prevention and control efforts.
The spread of asymptomatic infections during the epidemic is very limited, but asymptomatic infections may trigger an epidemic, because it depends on how early we find those silent virus carriers, said Wu Zunyou, the chief epidemiologist of the Chinese Center for Disease Control and Prevention.
“The novel coronavirus has a tendency to become influenza in China with its infectivity seemingly stronger than before, although the mortality rate is lower,” Zhang said.
Super spreaders have emerged in the Shijiazhuang outbreak, said Jin Dongyan, a biomedical professor at the University of Hong Kong, noting that super spreaders are likely to cause the second or third wave of virus spreads in the city if the city does not timely identify them and manage them.
The epidemic will affect regions during the Spring Festival holiday, which falls in February, and will see tightened restrictions on the movement of local people in these regions. But experts believe that the recent multiple outbreaks in China are controllable and will not lead to a second national outbreak, as China has formed a complete and effective response mechanism.
To guard the capital against the recent outbreaks in Hebei, the Beijing municipal government has adopted what some people believe to be the strictest traffic control measures on Monday.
The number of daily new cases is also a result of the expanded nucleic acid testing in the city, and Shijiazhuang is likely to control the epidemic in two to four weeks, Jin said.
Loopholes
The timely detection of the silent infections is a major problem facing China, and regular nucleic acid testing for key groups such as people working in cold chain imports sectors or customs has been implemented. But regular testing for ordinary people was unrealistic, experts said.
Zhang said it's necessary to train medics in villages on how to perform nucleic acid testing, and to include the village's medical warning and surveillance to the national mechanism so that suspicious cases could be monitored and reported.
The epidemic in Shijiazhuang and Wangkui county mostly occurred in rural areas where patients in both regions attended gatherings such as weddings, Jin said.
Rural residents are accustomed to visit clinics for medical treatment which is impossible to detect and treat cases in time due to low medical levels, Wang Guangfa, a respiratory expert at Peking University First Hospital, told the Global Times.
Some experts also pointed out that the vacancy of the post of mayor in Shijiazhuang could also be a factor resulting in slow response of the city government in epidemic control and prevention, which has seen the city's first press conference since the new outbreak delayed for two hours.
The post of mayor of Shijiazhuang had been vacant for at least half a month before Ma Yujun was appointed vice mayor and acting mayor on January 8. The former mayor, Deng Peiran, was under investigation for suspected severe violations of discipline and the law.
Wang Hongwei, a professor at Renmin University of China's School of Public Administration and Policy, said that the absence of a mayor in Shijiazhuang was likely to affect local epidemic control and prevention, but his role was not decisive, as the party secretary of the city, also the leader of the local leading group of epidemic prevention and control, could still run the group.
Wang said that on the administrative level, one of the lessons Shijiazhuang and other parts of the country should draw is that grassroots level governments, especially villagelevel governments, failed to play its role of monitor in epidemic control.
The recent domestic outbreaks in several cities have pointed to imported sources, mostly European strain.
Experts said that there was no clear evidence that the imported virus strain is more likely to cause asymptomatic infections or infections with longer incubation periods. But the imported virus strain is far more infectious and pathogenic than the virus spreading in Wuhan.
The novel coronavirus has a tendency to become influenza in China with its infectivity seemingly stronger than before, although the mortality rate is lower.