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Covid-19 exposes weaknesses in European response to outbreaks

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1075 (Published 18 March 2020) Cite this as: BMJ 2020;368:m1075

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Rapid Response:

Energetic action against global pandemic of Covid-19 in China

Dear Editor,

In this editorial, we were deeply impressed by the stringent comment by Anderson et al that European countries must work together against Covid-19.[1] Presently, it is not a challenge to one country or region alone but to the whole of humanity. Promising strategies for anti-Covid-19 in China may be valuable in this complex situation.

Since Covid-19 was first reported in Wuhan, China, it has become a public health emergency of international concern. Human transmission of SARS-CoV-2 occurred in 166 countries and territories or areas on all continents with above 20,7860 cases and 8657 deaths as of March 19, 2020. [2 ] The global pandemic of Covid-19 is inevitably ongoing. After delaying the human-to-human alert in Wuhan, China has been recognized by WHO for its stage victory against Covid-19 outbreak rather than too little too late, facing above 80,000 confirmed and suspected cases. [3]

While the global SARS-CoV-2 situation is rapidly evolving, the rapid progress against Covid-19 in China depends on the following reasons.

First, China has kickstarted a national anti-epidemic and home isolation since the closure policy of Wuhan. Following the continuous improvement in personal protective equipment, trip tracking and case traceability ensure efficient screening of infected individuals, early quarantine of different generations of cases, and effective reduction of R0 value of SARS-CoV-2 with the aid of national electronic information network.

Second, Huo Shenshan Hospital and Lei Shenshan Hospital were built within 10 days, 12 converted cabin hospitals were quickly built, hundreds of designated hospitals and medical points rebuilt successively to meet the needs of Covid-19 layered and batch treatment regarding the arrangements put in place by the Chinese Government.

Third, under the impetus of a national high-level medical expert group to combat Covid-19, 42,322 medical staff of 344 medical teams from outside of Hubei province rushed to the rescue in Wuhan, providing technical support for effectively reversing the epidemic spread.

Fourth, based on clinical front-line therapeutic practices, the National Health Commission of China successively promulgated seven kinds of "novel coronavirus pneumonia diagnosis and treatment plan" (trial version) [4] for lack of clinically approved drugs and vaccines within 40 days, and strived to standardize the clinical management and improve treatment effectiveness, laying the foundation for evidence-based Covid-19 therapies.

Fifth, through a large sample epidemiological survey, clinical efficacy feedback and pathological biopsy and autopsy, [5,6] a deep understanding of Covid-19 susceptibility, incubation period, clinical characteristics, diagnosis and treatment effects, morbidity and mortality was gained, alerting early identification, stratified treatment, course prewarning and follow-ups.

Sixth, the rapid isolation and identification of SARS-CoV-2 by genome sequencing, [7] development of nucleic acid and serological testing kits, and use of AI-aided Covid-19 rapid diagnosis and management system improved the diagnostic efficiency and precision treatment level of front-line medical staff as well as nationwide homogeneity in Covid-19 therapy.

Seventh, by data sharing within the world's top journals (Lancet, NEJM, BMJ, Cell, Nature, Science) and China Medical Databases of Covid-19, its basic and clinical research (aetiology, epidemiology, pathogenesis, therapeutic evaluation) is ongoing at breakneck speed, providing first-hand data for long-term surveillance and prospective treatment of the epidemic.

Eighth, treatment of all patients with Covid-19 in China was included in the national free medical system on January 23, 2020. Use of online triage promotes the shunts of Covid-19 and non-Cv-19 while online follow-up measures for patients discharged from rehabilitation is working. Meanwhile, based on the dynamic recognition of Covid-19, the protection knowledge (social distancing, hand washing, wearing a mask, home ventilation) is widely disseminated to the public through various channels such as official media, communities, work organizations, and mobile phones.

Ninth, most domestic manufacturers continue to expand the production scale of medical protective materials. The maximum daily output of Chinese protective clothing, masks and N95 masks reached 500,000, 116 million and 1.6 million pieces respectively.

Finally, China's fight against Covid-19 has received strong assistance from many other countries and international organizations in protective facilities, technical forces and morality, which has helped China reverse the spread of Covid-19 epidemic, and provides countries around the world precious time for the possible arrival of SARS-CoV-2 inside their borders. [8]

In the global context of jointly combating SARS-CoV-2, China experienced nearly 50% of total cases, effective mass quarantines, high-risk population care with front-line medical staff, and optimal diagnosis, therapeutics and follow-ups. Chinese program for anti-Covid-19 brings a forthcoming light for the world's epidemic. Relying on wisdom, solidarity and responsibility, China will gather with other epidemic countries in surveillance, cooperation, coordination and communication, and further consolidate the global power for epidemic prevention. It is in great need to help other countries trapped in the epidemic swamp to build an early defense line to combat Covid-19, and work with the international partners to maintain global public health security.

We declare no competing interests.

Jie Gao 1, Zhilan Chen 2, Yuan Liu 1, Ce Yang 1

Author Affiliations: 1 State Key Laboratory of Trauma, Burns and Combined Injury, Department of Research Institute of Surgery, Daping Hospital, Army Military Medical University, Chongqing 400042, P.R.China; 2 Reproductive Medical Centre, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China.

Corresponding Author: Ce Yang, MD, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, the Third Military Medical University, Chongqing 400042, China (sepsismd@126.com).

REFERENCES
1 Anderson M, Mckee M, Brian Abel-Smith EM. Covid-19 exposes weaknesses in European response to outbreaks. BMJ 2020; 368: m1075. doi: https://doi.org/10.1136/bmj.m1075.
2 Coronavirus disease 2019 (COVID-19) situation report – 43. WHO main website. https://www.who.int (accessed accessed Mar 19th, 2020).
3 The Chinese Center for Control and Prevention on 2019-nCoV. http://2019ncov.chinacdc.cn/2019-nCoV/(accessed March 19th, 2020).
4 National Health Commission of the People’s Republic of China. The notice of launching guideline on diagnosis and treatment of the novel coronavirus pneumonia (NCP). 7th edition. http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb19... (accessed Mar 4th, 2020; in Chinese).
5 Guan WJ, Ni ZY, Hu Yu, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020 February 28. doi: 10.1056/NEJMoa2002032.
6 Xu Z, Shi L, Wang YJ, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. https://doi.org/10.1016/S2213-2600(20)30076-X.
7 Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Jan 24. doi: 10.1056/NEJMoa2001017.
8 Ghebreyesus TA, Swaminathan S. Scientists are sprinting to outpace the novel coronavirus. Lancet. 2020, https://doi.org/10.1016/S0140-6736(20)30420-7.

Competing interests: No competing interests

19 March 2020
Yang Ce
Professor
Jie Gao, Zhilan Chen, Yuan Liu
State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, the Third Military Medical University
Changjiang Zhilu, Daping, Chongqing