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CWA # 286, 13 May 2020

From detection to containment
How China fought the COVID-19 

  Boa Wang

In the face of a previously unknown virus, China has rolled out perhaps the most ambitious and aggressive disease containment effort in history. With concerted efforts of the Chinese government and its people, the pandemic is well curbed

In China, where the COVID-19 broke out late last year, cases of infection have steadily declined since the mid-February, and are now zeroing out. Achieving the high quality of emergency response requires swift and decisive measures by the government, operational thoroughness by public health systems, and engagement of society.

Tracing the Virus: From Wuhan to a National Plan
On 8 December 2019, the first case was identified in Wuhan Huanan market. Then patients started coming into the hospital; on 26 December, Dr Zhang Jixian first noticed that four of these cases seemed to be pneumonia of an unknown cause. Two days later, the hospital reported it to the Hubei Health Commission; an investigation began. Provincial, municipal and district disease control centres started getting reports. Quarantine started within 24 hours of the investigation. On 30 December, the Wuhan CDC reported the cluster of people to China CDC. 

One day later, the government announced to the people. China CDC sent more experts to Wuhan to help. The Wuhan Health Commission issued its first warning to the Chinese public. The same day China notified the WHO. 

At first, COVID-19 was included in the statutory report of Class B infectious diseases. ON 8 February, the State Council's issued the Notice on Orderly Resuming Production and Resuming Production in Enterprises; this indicated that China had entered a stage of overall epidemic prevention and control together with the restoration of normal social and economic operations.

Less than 60 days after the first COVID-19 case appeared, a national battle against this coronavirus began.

Swift and decisive national measures
Upon the detection of pneumonia cases in Wuhan, the CPC Central Committee and the State Council launched the national emergency response. A Central Leadership Group for Epidemic Response and the Joint Prevention and Control Mechanism of the State Council were established. 

While the fundamental principles of government strategy have been consistent since its launch, there has been a constant refinement of specific aspects to incorporate new knowledge as rapidly as that knowledge has emerged. The remarkable speed with which Chinese scientists and public health experts isolated the causative virus, established diagnostic tools, and determined key transmission parameters, such as the route of spread and incubation period, provided the vital evidence base for China's strategy, gaining invaluable time for the response.

Mobilizing the people
To help quell its outbreak, China embarked on one of the largest mass mobilization efforts in history, closing all schools, enforce stay-home policy, quickly building more than a dozen vast temporary hospitals, deploying thousands of extra medical staff to Wuhan and the surrounding Hubei province and meticulously testing and tracing anyone and everyone who may have encountered the virus. Remarkably, more than 40,000 healthcare workers have been deployed from other areas of China to support the response in Wuhan. 

China also implemented a softer side of its policy of "zero contact". It allowed neighbourhood committees to take charge of arrangements for shopping and deliveries. Highways were made toll-free, with no limits to the number of cars on the road. For those without a car, customized bus routes were set up and operated according to demand. Tickets could be purchased on a smartphone app. Many restaurants installed basic but effective pulley systems to maintain employee-customer distance.

Inviting the WHO Joint Mission
During 16-24 February 2020, the WHO Joint Mission was invited to China. 25 national and international experts paid field visits to Beijing Municipality and the provinces of Sichuan, Guangdong and Hubei, including community centers and health clinics, country/district hospitals, COVID-19 designated hospitals, transportations hubs and other places. In the final report of WHO-China Joint Mission on COVID-19, the Mission summarized three stages of Chinese measures.

Chinese Strategies during three stages
During the early stage of the outbreak, the primary strategy focused on preventing the exportation of cases from Wuhan. The second priority was preventing the transfer of cases to other provinces. The government made clear that testing for the new virus was free, and COVID-19-related charges that were not covered by a person's insurance would be paid for by the government. 

During the second stage of the outbreak, the primary strategy was to reduce the intensity of the epidemic and to slow down the increase in cases. In Wuhan and other priority areas of Hubei Province, the focus was on actively treating patients, reducing deaths, and preventing exportations. 

In late February, as coronavirus infections mounted in Wuhan, authorities went door-to-door for health checks - forcibly isolating every resident in makeshift hospitals and temporary quarantine shelters. Caretakers were pressed into service as ad hoc security guards, monitoring the temperatures of all residents, deciding who could come in and implementing inspections of delivered food and medicines. In Wuhan, more than 1800 teams of epidemiologists, with a minimum of 5 people/team, are tracing tens of thousands of contacts a day. 

The third stage of the outbreak focused on reducing clusters of cases, thoroughly controlling the epidemic, and striking a balance between epidemic prevention and control, sustainable economic and social development, the unified command, standardized guidance, and scientific evidence-based policy implementation. Relevant measures were strengthened in the areas of epidemiological investigation, case management and epidemic prevention in high-risk public places.

Maximum Protection and Minimum Disruption to Life
Other measures implemented included the extension of the Spring Festival holiday, traffic controls, and the control of transportation capacity to reduce the movement of people; mass gathering activities were also cancelled. Information about the epidemic and prevention and control measures was regularly released. Public risk communications and health education were strengthened; allocation of medical supplies was coordinated.

Efforts were made to maintain a stable supply of commodities and their prices to ensure the smooth operation of society. A comprehensive program of emergency scientific research is being carried out to develop diagnostics, therapeutics and vaccines, delineate the spectrum of the disease, and identify the source of the virus.

In the face of a previously unknown virus, China has rolled out perhaps the most ambitious and aggressive disease containment effort in history. With concerted efforts of the Chinese government and its people, the pandemic is well curbed.

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