Seven months fight of COVID-19 in China

The COVID-19 is still spreading world wide, and a few imported cases emerged in China from time to time.

The situation report by WHO (World Health Organization) on July 12 says new confirmed cases exceed 230,000 in this single day globally, the biggest increase since the outbreak of this epidemic. Some of the fastest increases come from the United States, Brazil, India and South Africa.

Predictions on COVID-19 in the past

At the outbreak of the covid-19 epidemic, the British magazine Lancet made an analysis. They ranked Shanghai as the highest risk city in the world, because they believe Shanghai has more than 24 million permanent residents and over 30 million migrant populations. The city also has the most inbound and outbound flights in China.
Imperial College London used a mathematical model to estimate, if Shanghai fails to control the virus effectively, 800,000 people will be infected; if it controlled the epidemic, 80,000 people would be infected; if it contained the epidemic very well, the number of infected person would also get close to 30,000. As a matter of fact, confirmed cases in Shanghai by June are just around 350.
Zhang Wenhong (Doctor of Medicine, Director of infection department of Huashan Hospital Affiliated to Fudan University, a Chief physician and PhD supervisor) predicted in January 24, the epidemic would develop into three situations:. Put under control in two to four months, or get contained in about six months after some stalemate, or get out of control and become a global pandemic. That's what happened in the United States during the 2009 H1N1 flu pandemic. In the beginning, they also guarded the door tight, but eventually things got out of control.

To everyone's surprise, the China controlled the epidemic; the rest world was on pandemic.
 

Current situation in China

In July 19, there were 22 new confirmed cases in China, including 5 imported cases and 17 local cases.
Zhang Wenhong said in a forum, the China manages the imported cases with a closed-loop, and all imported cases are under management and should not be counted as epidemic cases.

From a scientific point of view, Zhang Wenhong believes the difference between US and China on the epidemic control shows in the capability to do community management, say, whether you test every community unit and clear the cases.

Zhang Wenhong gave an example, Beijing has such strong disease prevention and control ability to make such large scale extended testing, and the expanded testing is effective. In the United States, the expanded testing did not play a particularly important role to control the pandemic. Because there is only testing, no quarantine followed.

In July 6, there is zero new case, it is the first time since the outbreak of clusters of cases in the Xinfadi wholesale market in Beijing on June 11, Zhang Wenhong believes, under such new normal of "dynamic zero reset", the whole city will keep a normal operation with sporadic cases comes up. This Beijing approach could become a template.

Zeng Guang, member of a high-level expert group of NHS (the National Health Commission) and a Former Chief Scientist of the Epidemiology of China CDC (Chinese Center for Disease Control and Prevention), said in an interview with The Global Times on July 7, we need to treat COVID-19 with a normal mind and see what will happen in its natural state, "Don't get anxious". Many countries still have such a high number of confirmed cases. They still rush to resume work and reopen. China has contained the confirmed cases down to several cases or even zero. This is very good for work and life. Moreover, once confirmed cases goes to zero, it is like a blank paper, new emerged infections will be easy to identify and controlled. "Reduce confirmed cases to zero is actually the only choice for China, because it is actually least cost option."
Zhang Wenhong believes there are two kinds of "herd immunity". One kind is biological concept. You have to be infected or vaccinated to gain immunity. For now, there is no vaccine yet, if everyone in the country gets infected, the number of mortality will be unbearable. In our country, people are put in the first place. We can not allow disease spreads. We would rather slow down all other parts work, but to reduce the death as much as possible.
The other is a sociological concept. China controlled the epidemic in such a short time, under such complicated conditions. This is closely connected with measures of national mobilization. In this process, effective communication between experts and the public is very important. The core content delivered by medical experts is very scientific. Experts communication with the normal people with authority, science and accuracy. Only when the whole society knows the development of the epidemic, they can take effective personal protection, and show their responsibility to join the fight against the epidemic in the front line. In Shanghai, doctors, nurses, and community cadres in neighborhood, police officers, customs officers, etc, countless people form an barrier of immunity, stop the disease spreading. That is the real "herd immunity".

Correct prevention and control measures by government

In response to the corona epidemic, Shanghai set up an expert group immediately, and soon divided into two expert groups. Zhang Wenhong heads the medical rescue group. The other group is the public health group, headed by a former inspector of the Shanghai Municipal Health Bureau. That's to say, one team is for clinic doctors to cure diseases and save life; the other team is for disease control experts to control the epidemic. The two groups are connected. Zhuang Wenhong also attends in the meetings by the public health group. Shanghai city has officially issued a document to institutionalize the idea of "doctor and prevention integration". Both experts groups has two leaders, one is from the other group.
Before the "doctor and prevention integration", doctors were just doctors, prevention and control team did their prevention and control. When doctors identified a new case, they reported to prevention and control and waited for their response. There was a time lag. While the prevention and control group has the latest epidemic development that many hospitals do not know, especially doctors in the non-infectious department do not know. That's what happened when the doctors in Wuhan got infected.
"Doctor and prevention integration" is a very important point to reinforce the alarm, prevention and control system. The doctors and the prevention and control system should form into an organic integration in the face of epidemic that threatens the national security. That is what they did in Shanghai.

The second wave epidemic in the future

Wu Zunyou, the Chief Expert of the Epidemiology of China CDC, made his new judgment at the forum " How to prevent and control the epidemic in autumn and winter " on the 12th, "the global pandemic will continue at a high level, and get worse on a continued high level pandemic."

Zhang Wenhong said in a special lecture on "understanding the future" virus in July, "If a respiratory infection disease has not reached herd immunity and its epidemic has not been completely terminated, when winter comes, the virus reproduction increases, and indoor activities also increase, the risk of a second wave gets big.  But for the U.S, Brazil, and India, their peaks have not yet come, they are still in the first wave."
Zhang Wenhong said: "after this epidemic fight, China's public health system got stronger than before, and is capable of dealing with imported risks." "So there would be a (global) second wave, but our goal is not (second wave) in China."
In the CCTV News program "Relativity", Zhang Wenhong said, "Beijing has set an example for us, and China will reject the second wave. Whether it is an imported or a local rebound, we will respond quickly, accurately control it. We will not allow the second wave happen. 

Preventive measures

Tong Zhaohui, an expert from corona virus medical rescue team of National Health Commission and vice president of Beijing Chaoyang Hospital affiliated to Capital Medical University, introduces at a press conference on July 7, that asymptomatic infections include two groups of people, some are truly asymptomatic and some are in the incubation phase. The real asymptomatic infected person is only nucleic acid test positive, but no symptoms, no characteristics of a COVID-19 patients, and requires no treatment. We should draw attention to those asymptomatic infections in incubation phase.
Zhang Wenhong: "If we seek zero cases, the pressure will be very high, should we never open our country again. If once few random cases happen then the whole city stop, it would be too costly. The current method is to keep the epidemic under control as much as possible." "Avoiding crowds gathering, keep social distancing, wear a mask, if these measure are all done, I personally believe we will gradually move into dynamic epidemic prevention in the future."
Beijing has made complete testing in key areas, and voluntary testing in non-key areas this time, it has achieved quite good results. "The testing in the United States is also very large, but there is no sufficient quarantine, that is not enough for the infection control. The increase in testing is useful only when work with effective quarantine and tracking."
Public health is a big system, not just for health alone, but involving the whole society. In the future, the epidemic prevention experts should cross the clinical and prevention, and also spread into various fields. When an epidemic comes, they can better evaluate how the economy works, when sports events could open and how to protect when opened, etc.

Guidance for the future

Zhong Nanshan (Academician of Chinese Academy of Engineering and famous respiratory expert) said at the Symposium of the First Affiliated Hospital of Guangzhou Medical University in July 10 that we should pay attention to two aspects of work in the next step, the first is to study how to strengthen cooperation in the world, and the second is to focus on comforting people's hearts.

Academician Zhong Nanshan said, "The international COVID-19 has still not been effectively relieved, which has a greater impact on human psychology than on the body. Now we need a way to improve morale, or psychological counseling."

Chen Zhengming, tenured professor of John Radcliffe Hospital and an expert in epidemiology, said in an online forum on "How to prevent and control autumn and winter COVID-19" on July 12. Firstly, it is impossible for this virus to disappear, and we have to fight with the disease for a long time. Secondly, China's experience tells us that this virus is preventable and controllable.

Chen Zhengming said, "Some countries that have done well, if COVID-19 prevention and control once relaxed there will be a rebound. Japan, Australia, Israel and Britain also fully opened last week. I am sure that the epidemic will rebound. However, the experience of Beijing is very important. There is a sporadic rebound. How to stop a single spark not to start a prairie fire? Countries can gain valuable experience from the prevention and control of Beijing."

Sources cited

https://baijiahao.baidu.com/s?id=1672706571598839979&wfr=spider&for=pcSource: National Health Commission (NHS) official website

https://view.inews.qq.com/w2/20200708A02X1400?tbkt=B0&strategy=&uid=100146563417
World Wide Web 2020-07-08 07:25:15
【https://baijiahao.baidu.com/s?id=1672165866962407750&wfr=spider&for=pc】Source: Beijing Daily, People's Daily Client, China Youth Daily, Financial Network

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