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Strategy for Success

By adopting a ‘dynamic eradication’ strategy that focuses on Covid-19 cases at the community level, China has managed to keep the coronavirus under control

By NewsChina Updated Feb.1

The raging Covid-19 pandemic has caused grave medical, economic and societal damage around the world. Despite several small outbreaks in the past few months, China essentially brought the pandemic under control. Adopting what experts called a “dynamic eradication” strategy, China managed to keep locally transmitted cases at a very low level, which allowed the country to get back to business as usual, particularly in the domestic economy.  

But concerns linger as winter approaches in the northern hemisphere and the situation worsens in many countries. NewsChina interviewed leading infectious disease expert Zhang Wenhong, director of the Department of Infectious Disease at the Shanghai-based Huashan Hospital who led Shanghai’s efforts to contain the coronavirus, to gain his insights into China’s overall strategy and the approaches of different countries. Dubbed “China’s Dr Fauci,” Zhang is considered among the most trusted and prominent figures in China’s fight against the pandemic. 

NewsChina: China has brought the coronavirus pandemic under control. Despite local outbreaks in the past months and the coming of winter, most experts believe that the risk of a second wave of the pandemic is rather low. What are your predictions for China in the next months? 

Zhang Wenhong: Winter or summer, it actually doesn’t matter. The coronavirus pandemic in China ended on April 8 when Wuhan lifted its lockdown. Since then, there have been several limited outbreaks in Beijing, Qingdao, [Shandong Province], Dalian, [Liaoning Province], Yunnan Province, Urumqi, [Xinjiang Uygur Autonomous Region], and more recently in Shanghai. But none of these outbreaks posed a real threat to China’s overall situation.  

But as long as the pandemic still rages around the globe, China will continue to record imported cases. If local health authorities fail to take the apparent low number of imported cases seriously, the virus could spread rapidly and cause another outbreak.  

Given the unpredictability of imported cases, it would be hard for any expert to make a prediction on China’s Covid-19 situation for the coming months. Whether China will prevent another outbreak depends on the capabilities of local authorities to conduct a three-step strategy in fighting the virus: swift response, precise prevention, and control and dynamic eradication. If these strategies are used effectively, China can enter a ‘new normal.’  

NC: You have talked about ‘dynamic eradication’ for some time. Would you elaborate on this strategy? 

ZW: I first raised the idea of ‘dynamic eradication’ in June after the Xinfadi wholesale market outbreak in Beijing. The focus of the strategy is to control the spread when the first cases emerge as quickly as possible. In every regional outbreak in the past months, local health authorities have proven capable of eradicating all active cases within four weeks. The key is that the earlier you mobilize control and prevention measures, the less time is needed to eradicate the outbreak. In some cases, an outbreak was over even before the public noticed.  

NC: You mentioned the importance of precise prevention and control. In previous outbreaks, authorities conducted mass testing of local residents. Should that be standard prevention and control practice? 

ZW: I would say that standard practices should be like those adopted by the Beijing government in tackling the Xinfadi market outbreak in June. At the time, Beijing authorities adopted a tiered classification system for the surrounding areas of the market, with some listed as high-risk areas and others as medium-risk. By precise, I mean that we should focus on individual cases. In the recent outbreak in Shanghai when there was one community-level case in the Pudong area, the municipal government listed one adjacent village as medium risk. 

Another key component of any effective prevention and control system is to conduct precise contact tracing, then carry out tests and quarantine measures based on those results. If a positive case is found outside the identified risk areas, we can conduct another round of what we call targeted elimination.  

NC: The Covid-19 pandemic has plagued the world for almost a year. A common perception is that the disease appears to be less deadly than in the first months of 2020 with reported fatality rates declining throughout the world. Has the virus weakened over time? 

ZW: If you look at the weekly fatality rate reported around the globe, you may get the impression that the overall fatality rate is declining. But that is an illusion. There are three reasons behind the apparent decline.  

First, in the past months, countries around the world have been stepping up their testing capability, which has revealed many asymptomatic carriers of Covid-19. By comparison, in the early stages of the Covid-19 pandemic, only those showing severe symptoms were tested. Therefore, fatality rates differed between periods and population groups. Comparing them is like comparing apples with oranges.  

Also, we all know that the elderly are most vulnerable to Covid-19. In the past months, governments around the world have taken measures to better protect the elderly. As many countries restart their economies, most of the latest cases involve younger people. The fatality rate for these groups is much lower than for the elderly, which led to lower reported fatality rates.  

Finally, we must be aware that the fatality rate is directly related to the availability of medical resources. For example, in the past few weeks, the fatality rate in the UK rebounded slightly. The reason is that hospitals in the UK were overwhelmed. A similar phenomenon occurred in the early months of the pandemic when the high fatality rate was largely due to inadequate medical services. In many European countries such as France, Germany and the UK, a major motivating factor behind their regional lockdown measures was to prevent hospitals from being overwhelmed.  

The perception that the fatality rate of Covid-19 has declined only exists among the general public. To medical professionals, Covid-19 is as dangerous as it has ever been.  

NC: To combat the pandemic, different countries have adopted different approaches. Which countries do you think are successful in combating the coronavirus, and what can we learn from them?  

ZW: I think that South Korea and Singapore have done a pretty good job. While they are struggling to completely eradicate Covid-19 at the community level, they managed to keep the number of community-transmitted cases very low. That is why they could open their economies. 

The measures they are taking are quite similar to those in China. The only difference is that they are less aggressive in their contact tracing and quarantine measures. For example, if they find a case in a residential building, they only quarantine those considered to be close contacts rather than lock down the entire building.  

One reason behind this approach is that the public in these countries can accept that the pandemic will persist at a relatively low level. By implementing other preventive measures including mandatory mask-wearing and social distancing, authorities can keep the virus under control. They cannot eradicate the coronavirus from their communities, but they can maintain the normal operation of their economies.  

But a disadvantage to this approach is that in these countries, the authorities still lack the confidence to allow events involving mass gatherings to resume. By comparison, with a strategy focusing on eradicating the virus at the community level, China is permitting mass gatherings to be held. The China International Import Expo held in Shanghai in early November, for example, saw more than one million people participate.  

Different approaches have different pros and cons, so it’s hard to generalize which approach is better. As every country has their own circumstances, they may have different considerations.