What need to be done in dealing with COVID-19 in China - A Conversation with Lincoln Chen, President
Lincoln C. Chen, President, China Medical Board
Jing Ma, President, U.S.-China Health Summit; Associate Professor, Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute
From Dec. 1st, 2019, when the Lancet paper reported the symptom onset of the first identified patient, to the 4 cases of suspicious SARS-like patients reported by Dr. Jixian Zhang of Wuhan Chinese-Western Medicine Hospital on Dec. 26, 2019, and from the close down of Wuhan city on Jan 23, 2020 to the ~20,000 health professionals being sent to Wuhan and the Hubei Province to help local medical institutes deal with the pandemic of what is now officially named COVID-19, more than two months have passed. As of Feb. 22, 2020, 8:00 am (EST), there are a total of 76,396 COVID-19 cases, with 20,768 being cured, 11,477 severe, and 2,348 fatal. The correspondent numbers in Hubei are 63,454 COVID-19 total cases (83% of national data) and 2,250 deaths (96% of national data). In turn, Wuhan has 45,660 cases (60% of national data) and 1,774 deaths (76% of national data), which excels the total number of cases and deaths from the 2003 SARS outbreak worldwide.
To combat the COVID-19, Dr. Jing Ma, President of the U.S.-China Health Summit, together with Dr. Yuanli Liu, the Dean of School of Public Health, Peking Union Medical College (PUMC), have been leading a team of 30+ volunteers working closely with global public health experts and Chinese healthcare leaders on monitoring the spread and virulence of the virus within and outside China, tracking international scientific research findings and experiences, and submitting public health recommendations to Chinese healthcare policymakers.
As the president of China Medical Board (CMB), Dr. Lincoln C. Chen is dedicated to bringing world-class medical knowledge to China. He underscores that through mutual cooperation and two-way exchanges there are win-win opportunities for both the U.S. and China. During the dialogue, both speakers discuss the outbreak in the past 2 months and touched on questions such as how China could've respond more promptly to the outbreak, how can we ensure a more unimpeded Infectious disease monitoring and reporting system, and how should the public health system be further strengthened to better protect health professionals, both in emergencies and in routine operations.
Current actions: Besides treating patients within hospitals, China need to detect, isolate, and quarantine patients and people with close contacts to patients. In addition to sending doctors and nurses to Wuhan and Hubei, China needs to mobilize public health experts from local and national CDCs to help address the epidemiological investigation, prevention and provide on-site training and ensure proper supplies to protect doctors and nurses working in the front line. Moreover, public education and proper communication with the public are also very important.
Healthcare and public health information system: Since SARS, China has made progress in upgrading the surveillance system, i.e. the online real-time infectious disease reporting system. In China, the CDC and hospital are two separate operating systems, but they need to find a way to work together. A single public health system needs to be developed and doctors need to be trained for such a system.
Strengthening trainings for healthcare professionals: All the above proposals require both short-term proper actions and long-term strategic planning. CMB has been working with many Chinese medical schools and hospitals and provide support on training for healthcare workers.
Lincoln: It seems that China has done everything right so far. When these novel viruses broke out, nobody knew who was infected and who wasn't. But the clinicians picked up caseloads, as Dr. Wenliang Li did. China then isolated the virus and genetically decoded it in a very short time. But there are two noticeable problems.
First, how quickly and widely were the test kits produced and available to diagnose positive cases? My guess is that many cases that could have been diagnosed were missed due to the limited availability of detection equipment and the long wait time. This is nobody's fault. It's a time consuming process. Now the Chinese have changed the clinical definition of what is a case, which is proper because so many of these cases are positive, but they haven't been adequately tested and treated.
The second problem is how to deal with patients flooding into hospitals. Infected patients should be put into a safe environment so that they're not passing on the infection to other patients and health workers. And more importantly, proper medical procedures with protective gear for the health workers are needed. Are our short-term training programs, as well as executive programs, provided to all the new workers going into the area? What is the proper procedure when dealing with case-patients? Did the government set up procedures and a good system to guide these external doctors and nurses who are dealing with highly infected patients?
Jing: That’s exactly what I am worried about. I am not sure whether China central or local CDC has clear guidance. Our volunteers have been working diligently on collecting and translating up-to-date publicly available guidance and information from WHO and U.S. CDC. to share them with China on a daily basis.
Lincoln: I don't think passing on guidance is enough. Training people physically is more important. All these healthcare workers have flooded into Wuhan and Hubei—are they well trained and prepared? You need people who have been dealing with this to go on-site and train them physically, because it's very difficult to capture this in a manual. One should be able to set up training teams to go in there and pull these workers aside to say, look, gowns and gloves are here in the basket, this is how you put this equipment on, and when you walk in, you have to do the following things, like triaging patients.
People are now working hard on anti-viral drugs and vaccine. But those are months, if not over a year, away. So, what we should do now is to detect, isolate, and quarantine patients, as well as protect and change the behavior of the population.
Jing: That's a wonderful suggestion! In fact, there are different levels of CDC centers and offices at each level within Wuhan and Hubei, from provincial, cities and each county level. However, over the whole course of the epidemic of COVID-19, I haven't seen any public actions from China CDC, either the central or the local.
Over the past couple of years. I saw a decrease in collaboration between U.S. CDC and China CDC. Many of my friends who worked at the U.S. CDC China office have left. Now, according to the U.S. CDC website, only three U.S. assignees and eleven local employees work at the U.S. CDC China office. According to recent CDC news briefings, the U.S. CDC offered help at least four times, as far as I know, but they were not invited by the Chinese government. This is unfortunate since the U.S. CDC has the most sophisticated system in terms of training and field experience, and the support provided by WHO is not quite on par.
Lincoln: It’s an emergency and the government needs to figure out what's the best for its people. It’s high time we think about what's the best public health system for China and the world at large. We need to connect the CDC with the hospitals and the medical system, which are currently completely separate systems.
Jing: It seems that the China CDC has been marginalized and most local hospitals lack preparation and protocols for any kind of outbreak. That's why, early on during the outbreak, I heard that many health professionals got infected or sick. And that's why the government sent over two hundred thousand health professionals around China to Wuhan, Hubei. If these doctors and nurses are not well prepared, equipped and protected. more people could get sick. There is a short-term need of actions and long-term need for training and system changes.
About Dr. Jing Ma
Together with Dr. Yuanli Liu, Dean of School of Public Health, Peking Union Medical College, Dr. Ma co-established the U.S.-China Health Summit in 2011, which has been alternated between U.S. and China annually. It becomes the major platform for exchanging ideas, communication and collaboration among top leaders in academia, medical services, policy makers and healthcare industries between the two countries. In 2018, Dr. Ma created the China Center at the Department of Population Health, Harvard Medical School and Harvard Pilgrim Health Care Institute and serves as the founding Director.
About Dr. Lincoln C. Chen
Lincoln C. Chen is the President of China Medical Board. Started in 1914, China Medical Board was endowed by John D. Rockefeller as an independent American foundation to advance health in China and Asia by strengthening medical education, research, and policies.
Dr. Chen was the Taro Takemi Professor of International Health at the Harvard School of Public Health, Director of the University-wide Harvard Center for Population and Development Studies, and the founding Director of the Harvard Global Equity Initiative. Earlier, Dr. Chen served as Executive Vice-President of the Rockefeller Foundation, and he represented the Ford Foundation in India and Bangladesh. In addition to serving on many boards, Dr. Chen was the Special Envoy of the WHO Director-General in Human Resources for Health, the Founding Chair of the WHO-based Global Health Workforce Alliance, and a founding member of Advisory Board to the UN Secretary-General of the UN Fund for International Partnerships.
Dr. Chen is a member of the National Academy of Sciences’ Institute of Medicine, the American Academy of Arts and Sciences, the World Academy of Arts and Sciences, and the Council on Foreign Relations. He graduated from Princeton University (BA), Harvard Medical School (MD), and the Johns Hopkins School of Hygiene and Public Health (MPH).
About China Medical Board
The Rockefeller-endowed China Medical Board (CMB), an independent American foundation, aims to advance health in China and neighboring Asian countries through strengthening medical, nursing and public health research and education. CMB is a highly focused foundation targeting its grant and support activities to carefully selected Asian grantees.
CMB has an analytical board to provide purification air filters for the fever rooms in nine hospitals we work with. CMB staff are importing the equipment down the road to see bases from Finland. And these will hopefully prevent the virus from airborne transmission, protecting both the patient and the health worker.