Top Ten Interventions China Used to Dominate Covid-19: Lessons for the World

1- Lockdowns, quarantine, travel bans, holiday extensions

China's biggest weapon in its battle against Covid-19, the disease caused by SARS-CoV-2 (also known as the novel coronavirus), is its proactive approach to lockdowns, quarantines, travel bans and holiday extensions. Outside of the outbreak epicenter, Wuhan, data shows very few new cases, with 27 of the 31 "outbreak cities" reporting no new cases and somewhat ironically of the several cases reported in other cities, many were actually attributable to cases imported from Europe. Inside Hubei, things are trending in a very reassuring direction with just 121 new cases today, a diminishing attack rate, diminishing case fatality rate, and increasing cure/hospital discharge rate.

The discovery of the index case in Wuhan occurred before China’s spring festival. As the largest human migration in the world, the potential movement of some 600 million people was a huge issue for Chinese authorities battling the virus. To buy some time and delay the post Spring festival return to work, Chinese authorities extended Spring Festival initially by several days. After this, the closures of schools, offices, factories, etc. during Spring festival was extended indefinitely. This allowed China time to understand a rapidly evolving situation and implement risk assessment to guide a strategy towards the resumption of normal life.

Initially, on Jan 22nd the CPC Central Committee put the city of Wuhan on lockdown followed by a lockdown on all of Hubei province (some 96 million people). On the 23rd all urban transportation was suspended and all outbound travel lines including airports, buses and rail were closed. Other cities (31) in neighboring provinces were placed on level 1 emergency status (the highest level) and are also subject to major restrictions. The impact of these interventions has been truly remarkable.

So what does all this mean? China’s containment strategy works. It is modelable and can be adapted by local health authorities around the world.

2. Specialist medical teams, free treatment, and equipment sent to disease epicenter and new diagnostic criteria

More than 330 specialist medical teams consisting of 41600 medical personnel from the public, private sector, and the military were dispatched to Hubei. New ventilators and other vital medical equipment for emergency rooms and care of critically ill patients were also sent using military air transports. China also treated all patients for free and tested all suspected cases (no tricky insurance systems to navigate or doctors having to "justify" testing a patient like in private healthcare).

Initially, China relied on RT-PCR testing but quickly it became apparent that the lack of sensitivity (70%) and false-negative rate of the RT-PCR was a major problem stymying efforts to control the disease. A consensus protocol combining radiological and clinical diagnostic criteria was developed and implemented nationwide with a sensitivity of greater than 96%, helping doctors to correctly identify and treat infected patients and stem the spread of the virus.

3. Building 2 mega hospitals in 10 days and development of temporary and mobile treatment facilities

Probably the most impressive feats that have garnered worldwide attention was the construction of the 1000 bed Huoshenshan and Leishenshan hospitals, specifically designated for treating severe and critical care patients. Of equal importance has been China’s retrofitting of community centers, gymnasiums, etc. to serve as temporary testing facilities, freeing up the capacities of hospitals to deal with critically ill patients and helping minimize the risk of nosocomial spread (hospital-acquired SARS-CoV-2 infection - which would place individuals with the highest risk of developing severe complications at great risk.)

4. Mobilizing the military

China’s military took over the management of supply chains including food, medical supplies, equipment, etc. inside Hubei province. The military was also instrumental in ensuring the integrity of China’s containment strategy by upholding province and city-wide lockdowns. 

5. Policy support and interim emergency regulations

China enacted several interim regulatory measures to expedite the entry of vital supplies from outside of China. NMPA, a subdepartment of the State Administration for Market Regulation (China’s version of the FDA) introduced temporary exemptions from registration requirements for medical devices (includes face masks, respirators, and medical equipment). China’s Ministry of Agriculture and Rural Affairs has also rolled out interim regulatory measures to facilitate the entry of imported disinfectant products. China also implemented a new emergency public health program (the emergency response health passport) facilitating nationwide data collection on the health status of all. Under the system, each citizen traveling back to work is required to undergo mandatory self-quarantine. China also extended significant tax reductions on imported medical supplies, medical devices, and pharmaceutical drugs.

6. Minimizing economic impact for worst-hit sectors

China has injected billions of dollars of financial aid and subsidies in the fight against Sars-CoV2. China also instructed banks to offer billions of dollars in loans at extremely low-interest rates. Landlords have been instructed to extend a grace period of free rent or low rent periods to businesses and tenants. China has also extended tax deferrals to companies affected by the epidemic. Social insurance payments for citizens have increased and China is offering a large housing fund for employees. 

7. Free masks and protective equipment:

All provinces and major cities have daily allocations of face masks. Municipal authorities are using apps where citizens can register and using QR codes to go and collect their masks each day. Although many "experts" have downplayed the utility of masks, there is still not enough data on the efficacy of masks. The virus is spread in sneezes and coughs, and there is also not enough data on how far the virus can be carried by air currents or in ventilation systems. Therefore masks just make sense.

8. Leveraging the capacities of its tech, telecommunications, pharma and biotech sectors

Wechat (China’s social media Swiss army knife) was quickly adopted by the government as a key means to disseminate the latest information and advice to the public. Wechat has over a billion users and almost full penetration amongst smartphone users in China. At any given moment during the epidemic, there were on average, some half a billion people logged in to check out the number of infected, case fatality rate, geographical distribution, etc. Additionally, we have seen community bonds cemented through the use of Wechat groups which allow people to communicate, check on each other, and help conveniently distribute supplies and food and much more.

Cashless payments – Currency is a fomite (inanimate object capable of being contaminated and spreading a disease). The government immediately withdrew huge amounts of paper and metal currency from circulation particularly in Hubei province (the virus epicenter). No biggie though, as cashless payment systems have pretty much full penetration in China's major urban hubs.

E-commerce: Although the wheels of Chinese industry have been somewhat buckled by the epidemic they have been kept spinning by the efforts of China’s vast e-commerce ecosystem which has seen a massive spike in demand with the concomitant decline in bricks and mortar retail as consumers wait in both forced and self-imposed isolation. China’s monster food delivery app Meituan has about 700,000 delivery people working around the clock primarily engaging in contactless delivery, in which deliveries are left in designated areas for customers to pick up thereby reducing the risk of transmission. Couriers are clad in full protective gear and their equipment regularly sprayed with disinfectant. JD.com and Alibaba both took on thousands of extra workers to deal with increased e-commerce demand.

China also called upon its state-owned telecommunications firms to digitalize the contact tracing for people infected or exposed to serious risk of infection. The movements of millions of people were tracked and each case individually addressed.

China’s e-commerce giants have also been instrumental in fighting the disease. Alibaba has made roughly 100 million available to aid in the fight of the disease and has leveraged its vast global network to aid in the procurement of vital medical supplies. Jingdong has donated over 50 million units of various medical supplies and is offering a 24-hour online medical consultation service, connecting China with over 30000 doctors. 

Within several days of the epidemic labs in China had sequenced and analyzed the genome of the Sars-COV-2 virus. Additionally, several clinical trials and major studies were initiated in Wuhan to help understand the disease, test out the efficacy of different medicines and to better understand how the epidemiology. 

9. Use of Risk Assessment and Stratification to Guide Containment Strategy

When it comes to addressing an epidemic of China sized proportions, risk assessment and stratification have been necessary. Using this strategy China has been able to definitively deal with the SARS-CoV2 outbreak whilst minimizing the impact on the wider economy. Low-risk areas have seen a resumption of normal life while high-risk areas are still subject to more stringent containment protocols.

10. The people

As remarkable as the response of China’s government has been, the greatest accolades need to be given to its people. It’s hard to find the words to describe how the whole country has come together to fight the coronavirus. Citizens have stuck rigorously to government advice on self-imposed lockdown. The bare streets of China’s megacities are a testament to this. All around the country people have come together to battle the virus. National cohesion is at an all-time high and everybody has been pulling together with donations, volunteering or just simple solidarity in the face of a very grave situation. Medical staff have been working tirelessly around the clock. 14-day mandatory quarantine on staff traveling back to work has also been imposed, and China has also implemented a national health passport scheme, requiring people to log their daily health data, body temp, contacts, etc. Cooperation and compliance with these schemes have been truly remarkable.