Lessons from Shanghai, China: Strategy for containment & care during Covid-19

Recently, CABS, the Chinese American Biopharmaceutical Society hosted a webinar on the topic,  “COVID-19 Clinical Treatment and Research Experiences from China”, with Dr. Wenhong Zhang. Dr. Zhang is Director of the Department of Infectious Diseases in Shanghai and leader of Anti-Covid-19 team. He is also on Chinese Society of Infectious Disease and with Chinese Association of Internal Medicine. During the fight against Covid-19, Dr. Zhang led the Shanghai team to formulate a clinical treatment and containment plan.

 

An article in scientific publication Lancet predicted in late January that after Wuhan, Shanghai can be the epicenter of the virus with as many as 800,000 cases. However, with very early focus on containment and reasonable social distancing (even without complete lockdown measures), Shanghai managed to restrict the spread to about 4,000 cases. The key was that the healthcare system went on full alert when they had their very first case of a person traveling from Wuhan.

 

Dr. Zhang shared many details of their process for containing the spread and answered questions sent by the audience members. I have captured a few of the nuggets from his talk and I am sharing them below.

Diagnosis: Immediately they optimized diagnostics and did all needed tests for suspected patients. Shanghai made separate fever clinics and all patients who met 1 epidemiology criteria plus one clinical criteria were encouraged to go to these clinics. Suspected Covid-19 patients were sent to separate quarantine wards for full testing, and while they awaited results.  If the results came back positive, they were sent to separate hospitals for quarantine stay and were tested again, before release.

 

Further, while in the US some hospitals first tested for flu and other viruses and if the patient tested positive for any of them then they were not tested for coronavirus, Shanghai tested all suspect cases for coronavirus. Dr. Zhang said that they have found that there are a lot of co-infections so a person can have regular flu virus plus coronavirus. Additionally, they found a high negative rate in PCR testing, while a positive rate was around 70%. Therefore, despite negative test results, if the patient was highly suspect than they did more testing. They did not rely on CT scans because they found that a chest CT cannot precisely confirm Covid and all cases needed molecular diagnosis.

 

Detailed process in place: Shanghai had a very detailed process in place for the steps to be taken for patients in the first screen, then first test, then when tested positive, if tested negative, and for followup.  Timely diagnosis and timely distancing and quarantine is very important, said Dr. Zhang. Immediate separation and early control of local transmission is the key to stop the Covid-19 disease spread, said Dr. Zhang.  This is something that did not happen in Italy. Almost all of their early cases were of foreigners. Eventually all of their cases and high death toll has been among the local population.

 

Treatment Options: Dr. Zhang shared that over 95% of the patients recovered and eventually were released. One patient died. There has been debate around anti-viral treatments. Dr. Zhang said, these treatments don’t seem to be effective. China also used hydroxychloroquine (widely touted malaria drug) to treat Covid patients and did not find it to be effective. However, it can have compassionate use since it shows little lasting side effects, said Dr. Zhang. Although he did not observe clinical evidence of anticoagulants, he said, it is possible that early anticoagulation may block clotting and eventually reduce the risk of major organ damage.

 

Respiratory Treatment: Dr. Zhang shared that the most fundamental treatment in keeping patients alive is respiratory treatment. We have a narrow window to stop progression from mild symptoms to severe symptoms, said Dr. Zhang. Low and short duration corticosteroids may stop progression and we need more studies to find that out. Life support for critically ill patients is crucial. Timely intervention with mask oxygen inhalation, nasal cannula oxygen therapy, mechanical ventilation etc. can prolong life until the body’s immune system gets critical time to fight off the virus.

 

Medical Personnel: In Shanghai, strict following of protocol, translated into not a single infection spreading into the healthcare professionals. Highly qualified and standardized process included appropriate PPE (personal protective equipment) with gowns, goggles, masks, double layer gloves and shoe covers. Healthcare professionals were asked to never share a meal with others at home, during the time this contagion was active. As far as possible, the patients were kept in negative pressure wards and surfaces were cleaned with disinfectants every 4 hours.

My Comments
Stay tuned for my next article on how China effectively used high tech, specifically big data and coupled it with public awareness and public participation to contain the virus. Please note: I am not a fan of, or in any way endorsing communism or authoritarianism. And yet, perhaps there are lessons even for Western democracies, to pay heed to early signs and implement containment strategies. And that is exactly what Bill Gates was referring in 2015, when he spoke at TedTalks and warned us about a virus pandemic that can possibly kill millions. That is what various scientists have been warning of, for years.

2015 EPPIC Annual Conference Keynote by Vivek Wadhwa

English: A photo of a robotic surgery facility taken by Tewari’s lab members in Weill Cornell Medical College. (Photo credit: Wikipedia)

“Technology will eat medicine”.  EPPICon 2015 Annual Conference began with this prophetic reminder of what is to come, from the opening keynote, Vivek Wadhwa, Fellow at Arthur & Toni Rembe Rock Center for Corporate Governance at Stanford University.  Wadhwa shared the history of technology and stressed the mind boggling exponential growth that has happened in computing.  Now medicine will be transformed dramatically, said Wadhwa.  Also wide access has empowered innovation.  For instance, robots are built today by google and also by kids and with advance in microfluidics, we now have humans on a chip and Tesla (http://bit.ly/1Fw2qgt) will be driving itself, as robots become our companions (Review of play “Build” with robot companion http://bit.ly/165BOEd).  Perhaps the greatest challenge we will face in the years to come is what do we do with our time on this planet!

English: IBM’s Watson computer, Yorktown Heights, NY (Photo credit: Wikipedia)

Not only IBM’s Watson (http://bit.ly/JOZmwH, http://bit.ly/wCobOK), will deliver flawless diagnosis, in the years to come, but patients themselves now buy glucose meter, heart monitor, otoscope and more devices to diagnose themselves to find what ails them, as their phones now have become the most powerful medical research tools. Robotic surgeries are more precise and cost of genomic sequencing has dropped dramatically.  Medical innovation has globalized as access to technology is no more a privilage of the few.  In fact, said Wadhwa, “this is the most innovative period in history; today entrepreneurs can do what only governments could do earlier; solving humanity’s grand challenges”.

Here are some additional blog links for your convenience
“EPPICon 2015 Digital Health Panel Preview” http://bit.ly/1EQtd5y
“EPPICon 2015 Preview of Keynote by Kim Bush on “Tackling Global Health at Gates Foundation” http://bit.ly/18SV1cx
Feel free to browse my blog for past EPPIC conferences and other articles.