Control and challenge of COVID-19: lessons from China's experience.

Abstract

EditorialControl and challenge of COVID-19: lessons from China’s experienceNa Zhu and Wenjie TanNa ZhuNHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center For Disease Control and Prevention, Beijing, China and Wenjie TanNHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center For Disease Control and Prevention, Beijing, ChinaCenter for Biosafety Mega-Science, Chinese Academy of Sciences, Beijing, ChinaPublished Online:08 Nov 2021https://doi.org/10.1152/ajplung.00412.2021This is the final version - click for previous versionMoreSectionsPDF (200 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat INTRODUCTIONWe have now been living with coronavirus disease 2019 (COVID-19) for nearly 2 years. COVID-19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first identified and reported to the World Health Organization (WHO) by the China Novel Coronavirus Investigating and Research Team (1). Globally, as of September 24, 2021, there have been 230,418,451 confirmed cases of COVID-19, including 4,724,876 deaths, reported to WHO (2). Although there remain a few points of indigenous transmission in individual cities, COVID-19 is currently under control in China, successfully supported by containment and suppression strategies based on combining comprehensive large-scale polymerase chain reaction (PCR)-based testing (LSPT) and nonpharmaceutical interventions (NPIs) for control and prevention (3, 4).LARGE-SCALE PCR-BASED TESTINGAfter the initial outbreak of COVID-19 in Wuhan city, Chinese public health, clinical, and scientific communities responded rapidly. Zhu and colleagues (1) identified the pathogen of this outbreak as a novel coronavirus that falls within the subgenus β-coronavirus and the first SARS-CoV-2 stock was isolated from human airway epithelial cells. Subsequently, specific viral nucleic acid assays using RT-PCR were quickly developed for the diagnosis of SARS-CoV-2 infection (5). These assays have been widely used for detection in both laboratory and community settings and written into the national technical guidelines of China (6).“Early detection, Early reporting, Early isolation/quarantine, and Early treatment” is the mission of “4 Earlies” given by Chinese officials and were implemented quickly and thoroughly in mainland China since the COVID-19 outbreak (4, 7). The most crucial is early detection for active case finding with case management to control and sustain containment of COVID-19. Research was conducted on SARS-CoV-2 excretion and transmission to propose optimized sample collection norms for nucleic acid testing, and implementing the strategy of the “4 Earlies” through nucleic acid screening. Comprehensive, routine, and active LSPT were widely used and played a critically important role in mainland China. Once an indicator case was found or a local outbreak was identified, LSPT combined with pooled and individual sample testing was carried out population-wide (at the whole community or city level) as well as testing samples of imported goods (3). With cost-saving, readily available, and rapid PCR testing, case-finding capacity was developed in the communities of mainland China to support full reopening of local socioeconomic activities (3, 8).NONPHARMACEUTICAL INTERVENTIONSThe Chinese Center for Disease Control and Prevention (China CDC) for COVID-19 Emergency Response Strategy Team described the NPIs strategies that included containment and suppression (8). A combination of self-isolation, quarantine of close contacts, and social distancing is necessary to prevent the local transmission of SARS-CoV-2 (9). Strict movement restrictions in the outbreak area and other measures (including case isolation and quarantine) began to be introduced from January 2020 in China. The use of face masks was protective for both healthcare workers and people in the community exposed to infection by SARS-CoV-2 as well as seasonal influenza (10). Guidelines from the China CDC recommend the wearing of face masks to prevent the spread of COVID-19 in crowded public areas or transportation. With everyone wearing face masks, China has used this simple and low-cost method to successfully cutoff the path of transmission and to block off the invisible infection sources of COVID-19. Mandatory and centralized quarantine was implemented for persons detected as SARS-CoV-2 positive and their close contacts. This regulation was supported by LSPT, risk assessment and early warning, cluster epidemic analysis, and analysis of the epidemiological characteristics of asymptomatic SARS-CoV-2 infections. The 5G network has made a major contribution to nationwide epidemiological risk assessment by tracking health codes, a mobile app conducted in mainland China for more information about personal exposure to risk, and mandatory health screening in public places to curb the spread of the SARS-CoV-2 (11). Big data technology for COVID-19 has played an important role in personal tracking, surveillance, and early warning (12). So the close contacts were precisely quarantined for a reasonable period. The effectiveness of outbreak containment strategies in China based on NPIs is remarkable (13).CHALLENGESLSPT and NPI were two overarching strategies used in China to prevent the spread of SARS-CoV-2 infection. The current successful control of the epidemic of COVID-19 in mainland China has benefited from the implementation of these strategies (3, 4, 8). Although case identification and management, coupled with identification and quarantine of close contacts work well, the socioeconomic costs were very high and unsustainable in the long term (14).Emerging variants result in increased transmissibility, morbidity and mortality, and breakthrough infections (15). Now China has entered the long-term prevention stage, which maintains no or minimal indigenous transmission of SARS-CoV-2 until the population is protected through immunization with safe and effective COVID-19 vaccines. There have been recent outbreaks of indigenous transmission in Nanjing City and Yangzhou City in Jiangsu province caused by breakthrough infection of the SARS-CoV-2 Delta variant (16). Hence, continuation of long-term containment measures is necessary. Vaccine effectiveness and vaccine hesitancy will be great challenges in the future. Vaccination efforts have to contend with rapidly spreading SARS-CoV-2 variants. Furthermore, as a member of the global village, China should work hand in hand with other countries, share resources and experience, strengthen cooperation, and strive to achieve the final victory in the fight against the COVID-19.GRANTSThis work was suppored by the National Natural Science Foundation of China (Grant 82072296).DISCLOSURESNo conflicts of interest, financial or otherwise, are declared by the authors.AUTHOR CONTRIBUTIONSN.Z. drafted manuscript; N.Z. and W.T. edited and revised manuscript; N.Z. and W.T. approved final version of manuscript.REFERENCES1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. 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