Authors: Siyu Chen, Shanghai and Minh Cuong Duong, UNSW
COVID-19 emerged in Wuhan in December 2019, a few days before the Chinese Spring Festival. The three billion trips via China’s mass transit system during the Spring Festival travel rush may have contributed to its spread across the country. But in late March, China declared its COVID-19 peak over as Wuhan reported zero new cases for seven consecutive days. This was followed by the lifting of Wuhan’s lockdown on 8 April. However, a majority of China’s new cases are now imported, prompting a two-pronged strategy to control both imported cases and potential domestic transmission after lifting lockdown.
In the effort to resume production, lifting the lockdown of Wuhan was based on risk evaluation. Local authorities continue to publish outbreak information to reduce the risk of a COVID-19 resurgence. Awareness has been increasingly raised about the ongoing spread of the pandemic and risks of regional outbreaks. There are continued efforts to uncover confirmed and asymptomatic cases. Hubei province continues to practice timely treatment of severe patients and conducts epidemiological investigations. People engaged in teaching, medical work, public services and transportation are required to undertake nucleic acid tests before leaving Wuhan, while other groups are encouraged to be tested.
To curb domestic spread, a QR-based health code was developed and integrated into a mobile phone application used by one billion Chinese citizens. This colour-coded system requires people to have a green code — indicating little chance of being infected after the quarantine — to travel domestically. A yellow code indicates a medium risk of being infected and a red code indicates high risk. People with yellow codes must undertake a 14-day quarantine at home and report their health condition daily, while those with a red code must undertake a 14-day quarantine in isolation centres.
Health codes are also used for residents to enter public areas or public transportation. Despite the effectiveness of the health code in controlling COVID-19, there are concerns about privacy. It is likely that relevant measures are in place to secure personal information in accordance with the Internet Security Law.
Mask-wearing, temperature checking and social distancing policies still remain. Factories and offices require staff to report health conditions daily, disinfect hands and shoes before entering buildings and ensure fresh air ventilation for enclosed spaces. Disinfection of public places is conducted twice daily.
Although there is serious legal punishment for non-compliance with preventative measures like ignoring compulsory quarantine and social distancing orders, many are still non-compliant. Maintaining community compliance with preventative measures requires ongoing community education and strategies to address impacts on mental health and wellbeing arising from social distancing.
Strict measures remain at international airports and unnecessary personnel flow is minimised. Prior to arriving in China, passengers must submit online their travel history and health conditions. Incoming travellers arriving in major or border cities are subject to a mandatory 14-day quarantine with free daily supplies. Two free nucleic acid tests and one serum antibody test are performed and those who test positive are immediately transferred to treatment centres.
Non-infected people are also required to undertake a 14-day self-isolation at home after leaving the isolation centres. Foreign entry was suspended on 28 March to curb imported cases. Medical experts continue to be dispatched to border provinces to support disease control. Harsh punishments are also applied for non-qualified production and price gouging of preventative equipment to ensure adequate supply and quality of essential medical supplies.
Despite efforts, the city of Suifenhe on the China–Russia border has experienced a spike in imported cases. This led to the closing of China’s border with Russia and implementing a lockdown in Suifenhe. Lifting lockdowns does not mean entirely lifting containment measures. Ensuring community compliance remains crucial but challenging.
It is also important to mitigate fear and discrimination directed toward persons affected by COVID-19 — a lesson learned from the previous SARS outbreak. China also acknowledges the importance of support being given to Wuhan graduates and minimising discrimination among job hunters within hard-hit areas.
Communities can also be protected against COVID-19 through herd immunity induced by either widespread vaccination, which is unavailable at this stage, or individuals recovering from COVID-19 developing natural immunity against the virus. But this option seems unreliable as the numbers of COVID-19 cases and deaths in Sweden — a country that aimed to achieve herd immunity — are much higher than neighbouring Norway and Denmark, where stringent approaches are being taken.
Given China’s effective response to the pandemic, it is likely that healthcare will become a new strength in China. This includes healthcare human resources, infrastructure, training, big data, research and technology development required to meet future health crises.
Siyu Chen is a clinical doctor based in Shanghai and graduate of the School of Public Health and Community Medicine, The University of New South Wales, Sydney.
Minh Cuong Duong, a physician and epidemiologist based in Sydney, is an Associate Lecturer at the School of Public Health and Community Medicine, The University of New South Wales, Sydney.
This article is part of an EAF special feature series on the novel coronavirus crisis and its impact.