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2020-03-09 10:33:12
China,
and specifically Hubei province, is where the Covid-19 disease emerged; it’s
where 80 percent of the 110,000 cases known to date have been recorded; and it’s
where doctors and health authorities have been battling an epidemic for two
months using unprecedented public health measures, including a cordon sanitaire
and lockdowns that affected millions.
In recent weeks, though,
the number of new infections and deaths reported in China has been declining,
which suggests spread of the virus may have peaked there and that transmission
is slowing down.
At
the same time, cases are rapidly increasing in several other countries, with
major outbreaks in South Korea, Italy, and Iran. It’s now critical that the
rest of the world learn as much as it can from China’s efforts to respond to
and limit the spread of the virus.
That
was precisely the intention of a recent World Health Organization(WHO)
mission to China, led by the agency’s assistant director general and veteran
epidemiologist Bruce Aylward. Its major finding: “China’s bold approach
to contain the rapid spread of this new respiratory pathogen has changed the
course of a rapidly escalating and deadly epidemic.”
The
majority of the response in China, in 30 provinces, was about case finding,
contact tracing, and suspension of public gatherings. The lockdown was
concentrated in Wuhan and two or three other cities that also exploded with Covid-19
cases. These are places that got out of control in the beginning and China made
the decision to protect China and the rest of the world.
The
key learning from China is speed. The faster you can find the cases,
isolate the cases, and track their close contacts, the more successful you’re
going to be. Another big takeaway is that even when you have substantial transmission
with a lot of clusters, what China demonstrates is if you settle down, roll up
your sleeves, and begin that systematic work of case finding and contact
tracing, you definitely can change the shape of the outbreak, take the heat out
of it, and prevent a lot of people from getting sick and a lot of the most
vulnerable from dying.
So, No. 1, if you want to get speed of response, your population has to know this disease.
Your population is your surveillance system. Everybody has got a smartphone, everybody can get a thermometer. That is your surveillance system. Make sure the surveillance system is primed. Make sure you’re ready to act on the signals that come in from that surveillance system. You’ve got to be set up to rapidly assess whether or not they really have those symptoms, test those people, and, if necessary, isolate and trace their contacts.
In
China, they have set up a giant network of fever hospitals. In some areas, a
team can go to you and swab you and have an answer for you in four to seven
hours. But you’ve got to be set up — speed is everything.
So
make sure your people know about the virus. Make sure you have mechanisms for
working with them very quickly through your health system. Then enough public
health infrastructure to investigate cases, identify the close contacts, and
then make sure they remain under surveillance. That’s 90 percent of the Chinese
response.