The public health response to the COVID-19 outbreak in mainland China: a narrative review

Abstract

The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused nations to adopt unprecedented control measures in order to curb its spread.As the first nation to respond, China's aggressive control measures appeared to have been effective in suppressing the first wave and keeping new cases under control. Here, we provide the historical context and details of China's public health response to COVID-19. We highlight the lessons and impact of the 2002-2003 SARS outbreak, which demonstrated the importance of transparency, surveillance and testing laboratories during an outbreak. We provide an overview of China's response strategy that was based on the principles of early detection, isolation, management and treatment and involved not only the largescale coordination of multiple governmental bodies but also grass-root community participation throughout the country. These community-based organizations conducted active surveillance for febrile cases and provided support for those in quarantine and communities in lockdown. Importantly, these broader measures were supported by digital technology, including the extensive use of internet-based platforms and mobile applications (APPs). While there have been no significant increases in case numbers since April, there is still much concern over a second wave, considering the resumption of work and school, the lifting of travel restrictions and the outbreaks occurring globally. Control measures has since been implemented by provincial authorities, which includes continued surveillance and rapid testing. Although China's strict control measures may not suit every nation, the principles of early detection and isolation continue to hold true and have been a cornerstone of the initial and ongoing response to the COVID-19.

State Capacity in Responding to COVID-19

“…The centralized decision-making, the lack of public debates, and unrestricted powers in authoritarian regimes appeared to contribute to undertaking more expeditious and stringent policy responses. China, for example, rapidly implemented the strictest isolation and control measures, including traffic control of people and monitoring of its citizens to ensure the effectiveness of quarantine efforts (Kang et al (2020); Zanin et al (2020)). The response system implemented in Vietnam, another authoritarian country, included fast reactions in the form of suspending flights from and to epidemic areas, and limiting crowds of people, as well as a strong leadership and a clear policy communication (Ha et al (2020)).…”

COVID-19 in Germany and China: mitigation versus elimination strategy

“…The Chinese multi-sectoral response has been overseen from the beginning by the highest political level [ 33 , 34 ]. By the end of January, intense lockdowns were implemented first in Wuhan, then in the Hubei Province and finally in nearly all of China [ 7 , 31 ]. The lockdowns were accompanied by a very rapid construction of new hospitals in Wuhan, the re-allocation of several thousand medical staff from other parts of China to Hubei Province, intense surveillance and isolation/quarantine measures, and by severe travel restrictions in the whole country [ 7 , 25 ].…”

“…While countries in Europe and the Americas are now waiting for the vaccines, China has demonstrated that SARS-CoV-2 elimination is feasible even in a 1.4 billion population country [ 7 , 16 , 31 ]. Similarly, New Zealand has opted for elimination early on and has been largely successful with this strategy [ 22 ].…”

“…In addition, strongly enforced travel restrictions were regularly employed, including mandatory 14-day state-supervised quarantine, supplemented by SARS-CoV-2 testing procedures, for everybody entering a country [ 20 , 67 ]. In China, this has allowed the economy to recover in the second and third quarter of 2020, and the social life to return to normal [ 20 , 31 , 67 ]. However, China is a profoundly different society with different priorities and much less emphasis on personal freedoms compared to Western societies.…”

Transmission of SARS-CoV-2 before and after symptom onset: impact of nonpharmaceutical interventions in China

“…Other cities throughout Hubei province (of which Wuhan is capital) announced similar lockdowns over the next few days [1]. The rest of China was subject to social distancing measures: mass transit and public gatherings were severely curtailed, and the New Year holiday (Chunyun) was extended, which kept most schools, workplaces, and businesses closed [1][2][3]. In addition, numerous measures were implemented to rapidly identify and isolate suspected cases.…”