China - Expert: "Brief thread on containment vs mitigation. Summary point - I hope there's a plan for intense mitigation measures in China in the next

[sharon sanders]

Ben Cowling

@bencowling88
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2h
Brief thread on containment vs mitigation. Summary point - I hope there's a plan for intense mitigation measures in China in the next 1-2 months, as part of the transition to living-with-COVID (1/9)
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Ben Cowling


Ben Cowling

@bencowling88
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2h
Replying to
@bencowling88
In pandemic preparedness plans, this type of figure is often used to illustrate some key concepts. I have labelled the relevant periods. A is pre-pandemic preparation. B is containment, some countries will skip this if containment ... (2/9) (source: https://nyas.org/ebriefings/2020/pandemic-preparedness-and-response/…)

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Ben Cowling

@bencowling88
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...is judged to be infeasible. In the COVID pandemic, the best known term for containment is "Zero Covid". China has spent almost 3 years in period B in the figure above, and it worked well in preventing infections until recently, although at a high cost (3/9)
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Ben Cowling

@bencowling88
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Period C is mitigation, aiming to slow and flatten the green peak, so that peak healthcare demand is lower. Changing green curve to blue curve in this figure below. Most countries used a lot of mitigation measures in 2020 and early 2021. (4/9) (source: https://apps.who.int/iris/bitstream/handle/10665/329438/9789241516839-eng.pdf…)

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Ben Cowling

@bencowling88
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D is the suppression phase when most public health measures can be progressively relaxed, not sure why it's shown as a long period in the figure in second tweet, usually it would be a shorter period. E is a return to normal, also known as "living with COVID". (5/9)
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Ben Cowling

@bencowling88
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2h
Singapore have provided a good model of how to transition from "Zero Covid" to "living with COVID". Singapore spent almost a year progressively removing mitigation measures (initially C and then D, with a gap of almost a year between periods B and E) (6/9) https://gov.sg/article/further-easing-of-community-measures…
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Ben Cowling

@bencowling88
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In our large Omicron BA.2 wave in Hong Kong earlier this year, we had a lot of mitigation measures in place, slowing the doubling time from 2 days (seen with BA.2 elsewhere) to 3.1 days... (7/9) (source for figure: https://wwwnc.cdc.gov/eid/article/28/9/22-0613_article…)

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Ben Cowling

@bencowling88
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@bencowling88
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The situation in Hong Kong in March 2022 would have been even worse without those mitigation measures, which included a mask mandate (indoor masking particularly important), school closure, work-at-home policies, gathering limits, closure of leisure facilities, etc. (8/9)
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Ben Cowling

@bencowling88
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2h
I have a question / concern -- is China jumping from B (Zero Covid) to E (recovery/return-to-normal) without going through C and D first? (9/9)



nature.com
China is relaxing its zero-COVID policy — here’s what scientists think
Nature - Researchers say the rule changes will lead to a rise in infections that could overwhelm hospitals.
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[sharon sanders]

Edward Lawrence

@EP_Lawrence
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8h
Until last week, I knew just two people who'd contracted Covid-19 here in the past three years. Now I'm sat at home recovering from the virus and about half the people I know in both Shanghai and Beijing also have it. It is spreading super fast. #China
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Edward Lawrence

@EP_Lawrence
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Quote Tweet

James M Zimmerman
@jmzbeijing
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11h
All-hands video call with my Beijing office. 90% of people have Covid (up from 50% a few days ago). Some obviously miserable. Many nursing kids/parents at home. Our “work at home” policy is now “work at home if you’re well enough”. This thing came on like a runaway freight train.
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Edward Lawrence

@EP_Lawrence
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To give you an idea of how quickly things have changed, if I’d have caught covid just a week earlier, I’d have been hauled off to a quarantine camp or hospital and anyone I’ve been near for the previous week would have been quarantined as a ‘close contact’. Now, it’s stay at home
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Edward Lawrence

@EP_Lawrence
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#Beijing

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leen vervaeke
@leenvervaeke
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8h
Fever clinic of Beijing Children’s Hospital yesterday: lots of parents with sick children waiting (at 5pm displays called in patient nr 609), no separation of covid and non-covid patients, no testing, no medication. Medical worker said 70% of staff is sick + had to keep working.
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[sharon sanders]

The "return home wave" is coming, how to guarantee primary medical services?
22:55, December 15, 2022 China News Network
0
　　Chinanews.com, Beijing, December 15th (Wei Xianghui) At present, the focus of epidemic prevention and control has shifted from infection prevention and control to medical treatment. Communities and rural areas are the last mile of medical and health services, and family doctors and rural doctors are the gatekeepers of public health. On the 15th, the joint prevention and control mechanism of the State Council held a press conference to introduce the relevant situation of primary medical service guarantee.


　　Key groups are divided into three categories to carry out health services

　　Nie Chunlei, Director of the Primary Health Department of the National Health and Health Commission, introduced that providing classified and graded services for elderly people with underlying diseases can use limited medical resources for the most needy groups, avoid unnecessary waste of medical resources, and improve medical care. Efficiency and quality of service. Regarding the classification criteria, it is mainly based on factors such as age, underlying disease conditions, whether to be vaccinated, and the degree of risk after infection.

　　According to the above criteria, the elderly can be divided into three categories. The first category is the general population, which is low-risk. For this group of people, health education should be strengthened, and those who have not been vaccinated should be mobilized to get vaccinated in time. The second category is sub-key groups, that is, people with certain risks. On the basis of first-level services, this group of people should strengthen home observation and provide timely medication guidance. If there are problems that cannot be solved by the grassroots, they must be referred in time. .

　　The third group of people is mainly people with relatively high risk. They are older, over 80 years old, and have underlying diseases. They are not very stable. They may not have strengthened immunization in the past. For this group of people, it is found that there is a new crown , it is necessary to conduct an assessment and transfer to a higher-level hospital in a timely manner as needed.


　　How does primary care respond to the "return to hometown"?

　　Chen Jingjing, director of the community health service center in Liulimiao Town, Huairou District, Beijing, said that with the upcoming wave of returning home on New Year's Day and Spring Festival, rural grassroots medical and health institutions are indeed facing certain pressures in carrying out health management work.

　　She introduced that in view of the large number of key populations in rural areas, at present, it mainly relies on the existing family doctor contracted service team. After several years of construction and training, the family doctor service team has achieved the scale of full coverage of the grid in the region. Anyone can participate in health management. Under the guidance of family doctors, they can give some health consultations to residents, and they can also give timely feedback after understanding the needs of residents.

　　In terms of working methods and methods, we should adapt measures to local conditions. For example, the residents of her town are more accustomed to broadcasting through "big horns". When the loudspeakers sound, all residents can hear them. Recently, they have been using loudspeakers to broadcast knowledge about medication in a loop. In addition, the volunteers and rural doctors in the service grid originally lived in the village. Through the relationship with the villagers in the village, some knowledge can be passed on orally, and the needs of residents can be collected and fed back in time to facilitate early response and resolution.

The picture shows a citizen passing through the CT facility of the shelter fever clinic. Photo by China News Agency reporter Hou YuThe picture shows a citizen passing through the CT facility of the shelter fever clinic. Photo by China News Agency reporter Hou Yu
　　Mainly improve the grassroots coping ability from four aspects

　　Nie Chunlei said that under the new situation and new tasks, new requirements and challenges have been put forward for grassroots medical and health institutions. The grassroots must be a good health gatekeeper and receive these patients. In order to improve the coping capacity of the grassroots, the following aspects should be considered:


　　First, local prevention and control leadership mechanisms must effectively play a role. Mobilize all forces to support the work of community and rural medical and health institutions, especially to strengthen security and form a joint force for epidemic prevention and control.

　　The second is to provide the necessary equipment conditions for the grassroots. In particular, adequate supplies of medicines and antigen detection kits should be provided to the grassroots, and reserves should be prepared in advance.

　　The third is to effectively increase grassroots manpower. It is difficult to train manpower in a short period of time. In the short term, secondary and tertiary hospitals can send personnel to support some practices at the grassroots level. They can also recruit staff who have retired in the past five years to enrich grassroots medical and health institutions. There are also some medical and health personnel in other positions, which can be recruited to enrich grassroots institutions and relieve pressure. At the same time, it is necessary to give full play to the role of family doctors, promote contracted services for key groups, strive for full coverage, and ensure that family doctors can be contacted when needed.

　　The fourth is to actively play the role of medical associations and medical communities. In particular, it is necessary to play the role of leading hospitals and strengthen guidance on the construction and operation of fever clinics in member units. It is necessary to coordinate the deployment of personnel in the medical alliance, smooth the two-way referral channel, strengthen technical support, training and guidance for the grassroots, and strengthen quality control. (Finish)

zhttps://news.sina.com.cn/c/2022-12-15/doc-imxwuqpf5931128.shtml#/

 

[sharon sanders]

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[sharon sanders]

Ali H. Mokdad
@AliHMokdad
@IHME_UW
projects about 323,000 total #COVID19 deaths in China by April 1st as a result of the shift in policy (about 293,000 reported deaths). 1/

11:15 AM · Dec 19, 2022
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Ali H. Mokdad
@AliHMokdad
·
Dec 19
Replying to
@AliHMokdad
We have included a no mandate scenario which suggests that without social distancing mandates the death toll could exceed 500,000 by April 1st. 2/

covid19.healthdata.org
IHME | COVID-19 Projections
Explore forecasts of COVID-19 cases, deaths, and hospital resource use.
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Ali H. Mokdad
@AliHMokdad
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Dec 19
Even though infection would peak in our models around April 1st, we expect the number of susceptibles at that point to sustain ongoing transmission many months after April 1st. 3/
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Ali H. Mokdad
@AliHMokdad
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Dec 19
Our long range models predict over 1 million #COVID19 deaths in 2023 in the country. 4/

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Ali H. Mokdad
@AliHMokdad
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Dec 19
Although there is high rates of vaccination in China, comparatively low effectiveness of the vaccines against omicron and the long duration since vaccination for many individuals means that 80% of the population is susceptible to #Omicron infection. 5/
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Ali H. Mokdad
@AliHMokdad
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Dec 19
The experience in Hong Kong, where 10,000 died in the first months of the #Omicron wave would suggest a large death toll in China. 6/
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Ali H. Mokdad
@AliHMokdad
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Dec 19
Hong Kong is a good indicator of what is likely to unfold in China with similar levels of vaccination with a comparatively poor vaccine and low levels of vaccination in the over 80 population at highest risk of death. 7/




Ali H. Mokdad
@AliHMokdad
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Dec 19
Hospitals will likely be overwhelmed. Strategies to greatly avoid the death toll have been available but not used: switching to the more effective mRNA vaccines and producing or acquiring Paxlovid to manage disease in the vulnerable populations. 8/
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Ali H. Mokdad
@AliHMokdad
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Dec 19
As the epidemic begins to take off in mid-January according to our models, local governments will have to take measures to support hospitals as the number of individuals affected will be extraordinary. 9/
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Ali H. Mokdad
@AliHMokdad
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Dec 19
Use of social distancing mandates including mask mandates, gathering restrictions, business restrictions can slow transmission and spread the burden on hospitals over the rest of the year. 10/
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Ali H. Mokdad
@AliHMokdad
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Dec 19
These restrictions however may not substantially change the outcome by the end of 2023 without improvements in vaccination or the use of effective antivirals. 11/
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Ali H. Mokdad
@AliHMokdad
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Dec 19
By any account, the Chinese government faces extremely hard choices in the coming months balancing economic and schooling outcomes against the real prospect of substantial death particularly in the over 80 population. 12/
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Ali H. Mokdad
@AliHMokdad
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Dec 19
Using vaccines and drugs developed outside of China could save many lives. Supporting China with vaccines and drugs will save lives. We are not safe until all of us are safe. end/

 

[sharon sanders]

Nature Medicine article by Benjamin Cowling

The impact of ending ‘zero COVID’ in China

As China amends its ‘zero COVID’ strategy, mitigation measures are needed to reduce transmission.

• 05 January 2023

snip


One important lesson from other locations is the need to manage outbreaks in long-term residential care facilities for older adults. Hospitals are unlikely to have sufficient capacity to isolate patients with milder COVID-19, so protocols for within-facility isolation could help to reduce outbreaks if designated isolation facilities are not available. This could involve the provision of rapid antigen tests and personal protective equipment, combined with regular surveillance of staff and residents, which would help to identify outbreaks as early as possible and, ideally, also facilitate early antiviral treatment.

One final issue recognized elsewhere is the likelihood of disruption to supply chains and essential services due to high rates of infection in essential workers, including healthcare staff. This can be mitigated to some extent by slowing community transmission with public health and social measures, as outlined above. Shorter isolation periods, ending as soon as a daily rapid test is negative, could be used to reduce isolation periods.

China faces a major public health threat this winter, with a nationwide exit wave that will probably result in a large number of infections and more severe cases than hospitals can accommodate. Mitigating this exit wave will save lives. In the longer term, the transition to endemicity will have further ups and downs, as has been seen elsewhere. The pandemic is not yet over for China — or for the world.

doi: https://doi.org/10.1038/d41591-023-00001-1


https://www.nature.com/articles/d41591-023-00001-1