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[Beijing Forum 2020] Wu Zunyou on COVID-19's Control in the World

DEC . 08 2020
Peking University, December 9, 2020: The Beijing Forum 2020 opened at Peking University on December 5. Wu Zunyou, Chief Epidemiologist of the Chinese Center for Disease Control and Prevention, offered his take on "COVID-19: Current Situation and Control Strategies".


Dr. Wu has worked in infectious disease control for over 30 years and was actively involved in both response to the SARS outbreak in Beijing in 2003, and COVID-19 in China in 2020. Below is his full thought-provoking speech.

I am very delighted to join the Beijing Forum. Today, I will discuss with you the current situation of the Covid-19 pandemic in China and our prevention and control strategies. Since its outbreak at the beginning of the year, the pandemic has been of great concern to everyone. Now, the entire world is fighting against COVID-19. Some countries have achieved some victories in its containment, but the situation is still far from optimistic.

First of all, let's take a look. Different countries have different understandings of China's early response to Covid-19. Some people believe that China's early response was not good or effective. In the first few weeks of the epidemic, how was the epidemic discovered, how did it happen, and what response did China make?
 

On December 27, 2019, Dr. Zhang Jixian, of Hubei Provincial Hospital of Integrated Chinese and Western Medicine, first discovered cases of pneumonia of unknown etiology. These cases were very similar to the SARS cases he treated in 2003. He reported such cases immediately to the local CDC, and the local CDC also conducted a review. On December 30, the Wuhan Municipal Health Commission issued a notice, titled "Notice on Strengthening the Emergency Treatment of Pneumonia of Unknown Etiology". This "Notice" served to notify other hospitals that Hubei Provincial Hospital of Integrated Chinese and Western Medicine already had such cases and to inquire whether there were similar cases in other hospitals. The main purpose of the "Notice" was to call upon other hospitals to actively search for cases.

After such information was published online, on December 31, the National Health Commission of China and China CDC sent a working group and expert group to Wuhan to assist their work. On the morning and noon of December 31, after the two groups arrived in Wuhan by plane successively, they immediately went to work. At that time, only 40 cases were reported in Wuhan, so the expert team decided to close the Hua'nan Seafood Market on January 1. Such a decision was made very rapidly.
 

On January 3, China reported the epidemic to the World Health Organization and other countries around the world. At that time, it was still named as a pneumonia of unknown etiology. On January 7, China isolated the virus strain and identified it as a novel coronavirus. On January 9, the diagnostic reagents were shipped to Wuhan for diagnostics. On January 12, China shared the genome sequence of the novel coronavirus strain with the World Health Organization. On January 20, the novel coronavirus pneumonia was included on the list of National Notifiable Communicable Diseases. On January 23, Wuhan was locked down.

Let's take a look back at it. It only took around three weeks from the discovery of the epidemic to the lockdown of Wuhan. What were our important discoveries? First of all, it only took a week to isolate the virus after we identified the epidemic. This was the shortest time on record for scientists to recognize a new infectious disease. It only took a few days from the isolation of pathogens to the creation of diagnostic reagents for clinical diagnosis. This was also a record-breaking short time in history

And in about three weeks, we determined the main modes of transmission of this pneumonia of unknown etiology and the average incubation period. These four scientific discoveries, including virus isolation, genome sequencing, average incubation period, and main modes of transmission, laid a scientific foundation for our country to formulate the prevention and control strategies of Covid-19, which were also the most important contributions made by Chinese scientists to mankind.

Some people think that our early response was not fast enough. Let's take a look at how fast we were. From December 31 to January 1, the Hua'nan Seafood Market was closed. That decision took only a few hours. At that time, there were only 40 cases in Wuhan. Among the 40 cases, only 27 patients reported that they had been to the Hua'nan Seafood Market. When the teams of experts made the decision, they faced a huge challenge. There were only 40 patients and the main mode of transmission was not clear. Was it worthwhile to close the Hua'nan Seafood Market? At that time, there was a serious disagreement between the experts group sent by the state and the local experts in Hubei Province. The local experts in Hubei were also experts on respiratory diseases from all over the world. They believed that the closure of the Hua'nan Seafood Market on account of 40 cases would be making too much of a fuss and was not indicated. The meeting between the experts lasted till 4 o'clock in the morning. In the end, the team of national experts took the view that that the team should stick to the bottom line. Even if the decision to close the market was wrong, there would be a chance to reopen it. If they did not close it then and thereby missed the opportunity to contain the virus, then the Wuhan epidemic would have had an entirely different outcome.
 

Let's look at another major decision, which was the lockdown of Wuhan on January 23rd. When the decision was made, on the January 22nd, only 500 cases has been reported in Wuhan. Locking down a city of more than 10 million people was a very striking decision.

In retrospect, that decision was wise and decisive. Although the information at the time was very limited, the decision contributed to the reduced scale of China's Covid-19 epidemic. When I participated in the World Health Organization mission in February, I told Bruce Aylward that the lockdown of Wuhan prevented 1.5 million people from being infected with the virus and 60,000 people from dying from it in China. Therefore, these two decisions show that China made a scientific, wise, and decisive decision in response to the virus, even when full information was still limited. These two decisions reduced the scale of the epidemic in Wuhan and the country as a whole, and also delayed the spread of the virus around the world.

On January 12th, China shared the genome sequence of the virus with the world. Many people don't understand what it means to share the genome sequence. In fact, as long as you know the genome sequence, you can produce diagnostic reagents and develop vaccines. This was the first free public good provided by China to the world.

I remember that when the HIV virus was isolated, the expert who did it applied for a patent. We did not apply for such an intellectual property, but shared it with all countries in the world free of charge. In the first three weeks of the epidemic, China's response to it was scientific, timely and transparent, and it also laid a scientific foundation for the global control of the pandemic.

 

After the epidemic in Wuhan was brought under control, several waves of the virus resurging were identified in China. In summary, including Wuhan, there have been a total of seven waves.

In April and May, there was local transmission caused by imported cases in the northeast of China, which was called the second wave. This was mainly caused by the lack of proper management of patients after imported cases entered China and caused local transmission.

The third wave was the cluster of cases at Xinfadi Market in Beijing in June.

The fourth wave occurred in Urumqi, Xinjiang, in July and August.

The fifth wave, in Dalian, also took place at the same time, a little later than Urumqi, and ended a little earlier.

The sixth wave occurred in Qingdao before and after the National Day (October 1). The scale was very small, with only a dozen cases.

The seventh wave was the cluster of cases that occurred in Kashi, Xinjiang. I just came back from Kashi yesterday after I handled the epidemic there.
 

A review of China's strategies against Covid-19 reveals several aspects that were very important. The first aspect was the importance of the "four earlies": early detection, early reporting, early isolation, and early treatment. These are important strategies in responding to acute infectious diseases.

Second, when dealing with the epidemic, China focused on epidemiological investigations of patients, using reported cases as a source to identify the patient's close contacts. Such contact tracing involves identifying the upstream and downstream of the infection. Only by clarifying the transmission chain can transmission be curtailed. China has done a good job in this area, so it has been able to control the epidemic in an expeditious way.

The third aspect was nucleic acid testing. At the beginning, China's nucleic acid testing capabilities were insufficient to meet the needs of clinical diagnosis, especially in the early stages of the Wuhan epidemic. Then we optimized the technology and the nucleic acid testing capabilities were greatly improved. By the time the second wave occurred in Beijing, our testing capabilities had improved substantially. Therefore, 10 million people were screened in Beijing and we were able to quickly determine the scale of the epidemic, and any newly infected patients could be detected in a timely way.

The fourth effective strategy was to isolate and treat patients in a timely manner, and treatment of patients is free, so that the source of infection can be controlled in the hospital and its spread in the community can be reduced. These four measures were the most important and effective measures for China to control Covid-19.
 

We can take Beijing as an example to review this response process. In Beijing, a confirmed case was reported on June 11, after 56 days of no local reported cases. After the case was identified, Beijing paid great attention to it. Epidemiological investigation revealed that the patient had not left Beijing or contacted any suspected cases in the past two weeks. The patient had been to 23 places in the previous 14 days. We immediately collected samples of the environments in the 23 places. It was found that the sample from Xinfadi Market was positive after nucleic acid testing. The Beijing CDC quickly turned its attention to Xinfadi, re-sampled the environment of Xinfadi, collected samples from the vendors in Xinfadi, and found more positive nucleic acid results. At noon on June 12, the underground trading hall of Xinfadi was closed, and all the vendors as well as the people who purchased goods there were immediately isolated for observation. These quick measures cut off the main modes of transmission at once.


Subsequently, Beijing has divided its areas into the levels of high, medium, and low risk, restricting close contacts of cases and people who have been to areas with high risk from leaving Beijing. I live in Xicheng District, which is separated by a moat from Fengtai District. Although Huaxiang in Fengtai District is a high-risk area, our life in Xicheng is basically unaffected. This shows that Beijing implements precise control and scientific policies.

Beijing then carried out nucleic acid screening for people living in the peripheral area of Xinfadi. When the tested population showed no nucleic acid positives, nucleic acid testing was stopped. In the end, more than 10 million people were tested, and the epidemic in Beijing was brought under control. As a result of this series of combined strategies, China has implemented a set of methods for detecting and controlling the epidemic in a timely manner. These methods have been appropriately applied in several cities, including Dalian, in Xinjiang, and Qingdao, and these local outbreaks were brought under control in a relatively short period of time.

Now, China has returned to a new period of zero cases of local transmission.


Let's take a look at the world situation. The outlook for control of the pandemic globally is far from optimistic. The number of cases reported grew from 50,000 daily in late March to more than 100,000 daily in late May. By the beginning of July, the number of global daily reported cases exceeded 200,000. By September, the number of daily reported cases increased to 300,000. At the end of October, the number of global daily cases exceeded 500,000. After November, the number further increased to 600,000. The global situation is very severe, especially as we enter winter. Most countries in Europe have seen a rebound in cases and the United States has witnessed daily reported cases exceeding 100,000, 150,000, and even 200,000.

Winter has just begun, and the epidemic will become more complicated later down the track. Although China has successfully contained the virus, to be honest, we cannot have a turnaround until the global pandemic is under control. Only when China joins hands with countries around the world to control the global pandemic, can we have a safer social environment.

At present, the most serious problem facing the world is how to control the pandemic in various countries. From the perspective of prevention and control strategies, public health measures such as wearing masks, maintaining social distancing, washing hands frequently, and frequent ventilation, are very effective, but they can only achieve effective results with the coordinated actions of all countries. In Europe and in many other countries in the world, there are many policy and cultural obstacles to taking concerted actions like China. Under such circumstances, we need a stronger global organization and coordination. At the same time, we also need to rely on biotechnology. Especially in the last few months, everyone is paying great attention to the new vaccines for Covid-19. More results for the different vaccines will soon be available. We hope that the new vaccines can control the epidemic as soon as possible for the world, and can play a very important role as a biotechnological intervention, allowing people around the world to share the benefits of biotechnology and return to normal life and work as soon as possible.

That sums up my presentation, thank you.