SCIO briefing on white paper 'Fighting COVID-19: China in Action'
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E-mail China.org.cn, June 10, 2020
CCTV:
We have seen that the white paper mentions certain ideas about medical treatment such as "improving the patient admission and cure rates and reducing the infection and fatality rates" and that "the infected were treated in dedicated medical facilities where medical specialists from all over the country and all the necessary medical resources were concentrated." Which of these measures can be shared with the international community? Are there other measures that may be followed in future epidemic treatment? Thank you.
Ma Xiaowei:
In the medical response to COVID-19, the Chinese government has put the people's interests first — nothing is more precious than people's lives. The government introduced the strategy of "early detection, reporting, quarantine and treatment" and the principle of ensuring that "the infected were treated in dedicated medical facilities where medical specialists from all over the country and all the necessary medical resources were concentrated." We have focused on improving the patient admission and cure rates and reducing infection and fatality rates as a major task. Through the strenuous efforts of medical workers, all COVID-19 patients in Wuhan were discharged from hospital by April 26. As of June 2, the recovery rate of COVID-19 patients in the country reached 94.3%, surpassing the average cure rate of viral pneumonia. Since the treatment of COVID-19 patients, we have raised that of severe cases of viral pneumonia to a new level.
The main measures we have taken are as follows:
First, we have taken resolute and strong measures to control sources of infection and lower the infection rate. We have developed a COVID-19 prevention and control protocol, and this has been updated five times. We have implemented rigorous quarantine and management measures among four categories of people – confirmed cases, suspected cases, febrile patients who might be carriers, and close contacts, making sure that all those in need are tested, isolated, hospitalized or treated in some other away. Under the guidance of the Central Working Group, Wuhan conducted community-based mass screenings twice across the city, leaving no person or household unchecked. This was done in order to rule out all potential sources of infection and make sure all patients and sources of infection among residents and mobile personnel were included, hospitalized and under control where necessary. This played a very important role in the prevention and control of the epidemic. According to the general law of epidemiology, once the source of infection is brought under control, the situation will be hugely different after two recognized latent periods. The measures we have taken have proved to be effective.
Second, we have speeded up testing. In modern medicine, the testing capacity is essential for identifying and stemming any epidemic. After arriving in Wuhan, the working group on the frontline strengthened guidance in this regard, let China CDC devolve the authority for testing to all hospitals of Grade B and above, expanded laboratories, trained personnel, and involved qualified third parties to enhance testing. The testing period was shortened from two days to four to six hours in Wuhan, and the daily capacity expanded from 300 samples to more than 50,000. A closed-loop system was established, with online reports of cases identified at the fever clinics of medical facilities being submitted to higher authorities within two hours, the test results of such cases being sent back to reporting clinics within 12 hours, and on-site epidemiological investigation being completed within 24 hours. This played a big role in controlling sources of infection. In the early stage of the epidemic, the average time to diagnose a patient was 15.4 days. By the middle stage, it had been shortened to three days. The possibility of transmission was thus reduced significantly. The establishment of the closed-loop system combining epidemiological investigation and testing helped us to have the initiative of epidemic control.
Third, we have used all available means to guarantee the supply of medical services and improve the cure rate. Across the country, more than 2,000 medical institutions and hospitals for treating severe cases were designated for the treatment of the disease, along with over 10,000 fever clinics. In Wuhan, the Central Steering Group pushed for an increase in hospital beds and the establishment of a network for emergency treatment layered with designated hospitals, temporary treatment centers and isolation points. We built the Huoshenshan Hospital and the Leishenshan Hospital, and transformed a group of general hospitals such as the Tongji Hospital, the Union Hospital and the Hubei General Hospital. The number of designated hospitals increased from 35 to 86. During the prevention and control of the epidemic, we built temporary treatment centers, or Fangcang shelter hospitals, which played a very important role in admitting huge numbers of patients with mild conditions. Because of the construction of temporary treatment centers, we were able to provide hospital beds for confirmed cases identified during community-based screenings. We decided to build temporary treatment centers on Feb. 3. On Feb. 5, the treatment centers started to admit patients. By Feb. 16, we had built 16 such facilities and added 12,000 hospital beds, enabling all those in need at that time to be hospitalized. We realized the goal for available hospital beds to outnumber patients on Feb. 16, and had got the initiative to control the epidemic since then. On Feb. 19, the number of patients discharged from hospitals equaled the number of confirmed cases, thus establishing a turning point.
Fourth, we have added a group of isolation points. More than 630 guesthouses, schools, training centers and medical facilities were remodeled to host close contacts and suspected cases under isolation. In order to implement epidemic prevention and control work, we have taken effective measures for isolation. Increasing beds was a very important task we have conducted to ensure service provision in the early stage.
Fifth, we have pulled out all the stops to treat and cure patients, improving the cure rate and lowering the fatality rate. Minister Xu Lin just said that we have conducted a massive task of medical care. A total of 346 national medical teams that comprised 42,000 medical workers including 19,000 for treating severe cases were dispatched to Wuhan. The national medical teams took charge of all severe cases and administered the wards as a whole. We let doctors of intensive care unit, respiratory department, cardiovascular department, and infectious disease department take the lead. Large numbers of nurses for intensive care were dispatched to Wuhan. Every patient with severe conditions was looked after by three nurses. We put severe cases together for treatment and continued to improve the level of care. While treating patients with mild conditions at temporary treatment centers, we combined traditional Chinese medicine with Western medicine so as to prevent them from turning into severe cases. With these measures, we significantly improved the level of medical treatment.
Regarding medical treatment for COVID-19 patients, integrated efforts have been made in the following five aspects. First, the treatment applied has involved a mix of basic medical science and clinical medicine. COVID-19 cases have been studied jointly by doctors and clinicians in virology, anatomical pathology, immunology, and pharmacology. The research in anatomical pathology has played an important role in this aspect. Second, frontline and rear-based medics have made coordinated efforts. When frontline medics encounter problems, those in the rear provided multi-disciplinary support via videoconferencing. Efforts in major medical disciplines throughout China have been organized to support Wuhan. Third, both medical treatment and nursing have been well applied. Nursing is utterly important for patients with severe respiratory diseases. Nursing cares at the early stage to keep the respiratory tract smooth can greatly relieve symptoms amongst COVID-19 patients. Fourth, the combination of medical treatment and management is a very important characteristic. Over 42,000 medics carried out medical treatment in an orderly manner, which demonstrated strong professionalism and administrative and command abilities. Five systems for critically-ill patients were established within a week. The first was a 24-hour report system of critically ill patients. The second was a discussion system of COVID-19 deaths. The third was an inspection system by top experts covering critically-ill patients not only in Wuhan, but also in another 19 cities. The fourth was the management system concerning medical nursing care. A set of unified standards and procedures were applied to nursing care. The fifth was a vertical administrative command system, under which hospitals established medical affairs, nursing and hospital-acquired infection control departments. There were no infections among the 42,000 medics, and no deaths, infections, or relapses among the patients treated in the temporary treatment centers. China's medical treatment in this regard made remarkable progress.
I also want to mention that traditional Chinese medicine has played a very important role in treating both mild and critical COVID-19 patients. This is one aspect that should be thoroughly reviewed and learnt at this time. In addition, when treating COVID-19 patients, medics have fearlessly devoted themselves to saving lives. This reflects the long-built achievement of our medical teams, and it should be inherited. That's all for my introduction. Thank you.
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