Management and Treatment of COVID-19: The Chinese Experience

Abstract

With more than 1,800,000 cases and 110,000 deaths globally, COVID-19 is one of worst infectious disease outbreaks in history. This paper provides a critical review of the available evidence regarding the lessons learned from the Chinese experience with COVID-19 prevention and management. The steps that have led to a near disappearance of new cases in China included rapid sequencing of the virus to establish testing kits, which allowed tracking of infected persons in and out of Wuhan. In addition, aggressive quarantine measures included the complete isolation of Wuhan and then later Hubei Province and the rest of the country, as well as closure of all schools and nonessential businesses. Other measures included the rapid construction of two new hospitals and the establishment of "Fangcang" shelter hospitals. In the absence of a vaccine, the management of COVID-19 included antivirals, high-flow oxygen, mechanical ventilation, corticosteroids, hydroxychloroquine, tocilizumab, interferons, intravenous immunoglobulin, and convalescent plasma infusions. These measures appeared to provide only moderate success. Although some measures have been supported by weak descriptive data, their effectiveness is still unclear pending well controlled clinical trials. In the end, it was the enforcement of drastic quarantine measures that stopped SARS-CoV-2 from spreading. The earlier the implementation, the less likely resources will be depleted. The most critical factors in stopping a pandemic are early recognition of infected individuals, carriers, and contacts and early implementation of quarantine measures with an organised, proactive, and unified strategy at a national level. Delays result in significantly higher death tolls.

Figure 1

COVID-19 epidemiology curves and major intervention measures implemented in China. China CDC, Chinese Center for Disease Control and Prevention; NHC, National Health Commission of China; WHC, Wuhan Health Commission; WHO, World Health Organization. Data from the NHC, excluding Hong Kong and Macau Special Administrative Regions and Taiwan.

Figure 2

The daily number of nucleic acid tests performed in Wuhan. Data from the Wuhan Municipal Health Commission.

Figure 3

Epidemic curves of the confirmed cases of COVID-19 in various countries. Left, timeline of breakouts of SARS-CoV-2. Right, daily numbers of increasing cases. Data for China were obtained from the National Health Commission of China, which excluded Hong Kong and Macau Special Administrative Regions and Taiwan. Data for the remaining countries were obtained from the World Health Organisation.