Via Caixin Global: Opinion: Five Lessons for Other Nations from China’s Fight Against Covid-19.
The novel coronavirus outbreak will soon become a pandemic. China has paid a heavy price to learn five key lessons in trying to control Covid-19, which could help inform other countries' own efforts. They include the use of shelter hospitals for mild cases, and the need for total transparency. Here they are:
1. Prioritize prevention of hospital infections
Hospital infections are the biggest threat. Hospitals are the best place for the virus to easily infect a great number of people. This can turn healthcare workers into nodes of infection and break down the system’s ability to treat patients. Preventing hospital infections is of the utmost importance; if you cannot prevent hospital infections then nothing else is worth discussing.
When the initial situation is unclear, hospital infections come mostly from pneumonia-related departments, and once the risk is clear, everybody from the fever clinic to specialized centers should be ready. At this point, other hospital departments may become the weak link. Guard against hospital infections, don’t let them get out of hand.
2. Without a cure, intensive care beds save lives
Between 10% and 15% of Covid-19 patients will develop into severe cases. Patients with severe illness must be hospitalized, or they risk falling critically ill and dying. There is not yet any specific treatment for the Covid-19 virus; intensive care means providing patients with life-sustaining equipment, giving the body the time it needs to fight off the virus. Ventilators, iron lungs and other equipment are very important. They could be the difference between life and death. Life is that fragile.
3. Low-tech “shelter hospitals” help prevent spread
Shelter hospitals are an important new development in the prevention and control of the coronavirus. Patients with mild symptoms do not need much treatment, and there is no effective treatment to give them. If these mild cases pile up in hospitals, not only will they take up medical resources needed by the seriously ill, they will also increase the risk of hospital infections.
Sending them home for isolation and observation can have consequences: they may infect family members or others on the way between their homes and the hospital, spreading the disease in transit. If they take a turn for the worse, their access to treatment may be delayed.
Concentrating patients with mild symptoms in a shelter hospital solves two major problems. It gathers and quarantines all patients to reduce transmission and facilitates care by medical staff, while also allowing patients to be rapidly transferred to a fully equipped hospital if their condition deteriorates.
4. Suspected cases must be quarantined
The gold standard for diagnosis is a positive nucleic acid test. However, test kits range in quality and this, combined with sampling errors, means a considerable number result in false negatives. If the patient is symptomatic but the nucleic acid test comes back negative, they are initially classified as suspected and could later be diagnosed. They should be quarantined regardless of how they are categorized.
Home isolation is easy to execute and low cost. But the risks of home isolation for suspected cases are basically as high as for confirmed patients with mild symptoms. From the perspective of epidemic prevention, designated special quarantine centers are more effective.
Unlike mild cases, which have been confirmed and can be brought together for treatment, suspected cases are uncertain. To prevent cross-infection, quarantine measures for patients suspected of having the virus must be more detailed and demanding, as they must be isolated both from the rest of society and from each other.
It is not easy to put adequate, reliable isolation arrangements in place on short notice, so good preparations should be made in advance.
5. Total transparency is needed
Transparency comes last — not because it is the least important, but because it is the most important.
In fact, the above set of prevention and control lessons, although all linked to each other, are just a framework. Each country must make its own choices according to its own situation, including whether to use shelter hospitals and isolate suspected cases.
The Japanese government, for instance, may have confidence in its people’s self-discipline, and let both mild and suspected cases perform home isolation and self-observation. Personally, I think it is risky, but these things must be judged by the results. It goes without saying, but controlling the impact of the epidemic in Japan to an endurable level will come down to the choices of the Japanese government and people.
The Japanese government’s plan is transparent. The government has clearly announced what it will do, explained why, provided suggestions and advice on how to live at home, how to observe, and when to go to the hospital. The whole process is transparent, which can slow the rate of transmission, reduce public panic, and reduce pressure on the medical system.
Understanding its people, trusting its people, informing its people, and crafting prevention and control strategies on that basis is what a government should do. I wish Japan success.
