Dr. Zhang Junhua Director-General Health Human Resources Development Center of National Health Commission, Apr 17, 2020 Global COVID-19 Outbreak Overview: almost 2 million confirmed cases and 131,037 deaths Chinese President calls on international cooperation to jointly respond to COVID-19

The international community must work together to build the strongest global network of control and treatment. China has set up its online COVID- 19 Knowledge Center that is open to all countries Live Webinars hosted by HHRDC with international community and Setting up the Knowledge Center for China’s Experiences in Response to COVID-19 The Knowledge Center for China’s Experiences in Response to COVID-19 Content of the knowledge center: Prevention and control protocol Diagnosis and treatment protocol Academic research progress & health education information Setting up the Internet Consulting Service Platform of COVID-19 Prevention and Control for Overseas Chinese To strengthen healthcare professionals training, promote international exchanges and cooperation are our common wishes. Please scan the QR code below to follow the latest activities within our center and on our platform!

中国新冠肺炎疫情防控知识中心 “一带一路” 新冠肺炎疫情防控海外华人华侨 医学人才培养联盟 互联网咨询服务平台 The Knowledge Center for China's Experiences in Internet Consulting Service B&R Health Professionals Platform of COVID-19 Prevention Development Alliance Response to COVID-19 and Control for Overseas Chinese https://covid19.alliancebrh.com https://covid19consulting.allian https://alliancebrh.com cebrh.com CIKD and ‘Fighting COVID-19 Knowledge Hub’ Dr. GONG Sen Executive Vice-President of CIKD and Secretary-General of Sustainable Development Forum(SDF) Dr. WANG Xiongjun Vice-President of CIKD

World Harmony House, Beijing, China April 17,2020 About CIKD CIKD strives to research and communicate with other countries on development theories and practices suitable to their respective national conditions with reference to China’s development experience. Its main mandates include: 1. To pool Chinese and international research resources 2. To undertake research on development theories and practices 3. To organise exchanges of research findings on international development issues, including the implementation of the UN 2030 Agenda for Sustainable Development and current global public health challenges and approaches About ‘Fighting COVID-19 Knowledge Hub’ 1.Chinese Knowledge -China’s Strategies, Actions and Insights in Addressing COVID-19 -Comparative research of anti-pandemic measures in China, and South Korea 2. 100 Questions and 100 Answers -China’s Basic Conditions -Understanding about the Virus and the Disease -Prevention and Control Strategies -Major Measures -Supporting Measures -Effects and Impacts -Preparing for potential 2nd Wave 3. Social Engagement • -Real-life stories of Chinese people • -Actions by Enterprises THANK YOU! [email protected] [email protected] How China Addresses COVID-19: Strategies, Actions and Insights

Dr. Sen Gong Dynamic Strategies aligned with health risk estimates

• High risk —— Level-1 response: Health security was the single most important item, most economic and social activities were paused. • Lower risk —— lower level response: Health security still on the top, meanwhile economic and social activities were phased in. Proactive strategy

Eradication：Minimizing infections and saving the infected Proactive strategy

Eradication：Minimizing infections and saving the infected → Zero cases as soon as possible;

Diagnosis: Nucleic Acid testing and CT screening

Mass testing is not easy • accuracy of testing; • safety concerns; • timeliness of testing; • financial constraints.

Diagnosis: Nucleic Acid testing and CT screening

CT screening at epicenter

Tracing close contacts: Epidemiological investigation and digital technology

• Close contacts and low- risk contacts • A broad definition in China: zero tolerance of risks • Use of digital technology in China: trade-off between public health, public awareness and private privacy

Targeting for Isolation: Geographical lockdown and personal quarantine

• City lockdown in Wuhan and neighboring municipalities: 70 percent of reduction in cases outside Hubei • Community lockdown: top-down decisions and bottom-up initiatives • Personal quarantine: from high-risk to low-risk groups Quarantine types

• Home quarantine: only at early stage for mild patients and close contacts • Community quarantine: for close contacts and discharged patients (/convalescents) • Hospital quarantine: lower-level/shelter hospitals for mild patients, upper-level hospitals for severe and critical patients Medical treatment: Trying all means of saving lives

• Traditional medicine: particularly for mild cases • Integration between Chinese medicines and Western Medicines • Other treatments such as convalescent plasma therapy

• Best resources concentrated in the upper-level hospitals for the most needed at the epicentre: e.g.10% top experts and ¾ ECMO Preparing for potential second wave: Trying all possible research routes for vaccines

• Preparing for the worst, while hoping the best • Five technical routes to vaccines

A Simplified and transparent accountability line

• Supervision Groups from the Central to local levels • Disclosure of information • Fast internet access for the general public to make complaints • Several senior officials at the epicenter discharged due to their incompetence Some takeaway points

1. Make reasonable trade-offs: • Health security, economic development and personal freedom; • Public awareness, and privacy 2 Use what you have and best-fit, not necessarily most advanced 3 Implementation is as important as the policy itself.

THANK YOU

Looking at China’s COVID-19 responses through a comparative lens

Bingqin Li, Professor & Director of Chinese Social Policy Social Policy Research Centre UNSW, Australia [email protected] Multi-sectoral Interaction and Cooperation

• Lead and coordinate • Strategy and plans Government • Public communication • Resource deployment • Compliance • Resolving social conflicts Individuals, Firms and Community • Misinformation management • Secure life support

• Testing and tracing Public Health • Monitor and sorting System • Reporting • Non-COVID-19 support

• Testing and monitoring Clinical System • Triage and treatment • Protect medical workers • Other patients Basic conditions in China, South Korea and Singapore Populatio Population GDP per capita Hospital beds per Critical care beds n density (USD) 1000 persons per 100,000 (million) (person/km2) persons China National 1,438.1 153.0 10,121.3 5.64 3.6 (2019) Hubei 59.17 318 11,218 6.77 Province Wuhan 11.21 13798 20,960 7.56 (2018) South National 51.3 505.1 31,430 12.27 10.6 Korea (2018) Daegu 2.5 2,818 23,794

Singapore 5.8 8,702.8 56,679 2.8 11.4 (2018) Phua, J., Faruq, M. O., Kulkarni, A. P., Redjeki, I. S., Detleuxay, K., Mendsaikhan, N., ... & Haniffa, R. (2020). Critical Care Bed Capacity in Asian Countries and Regions. Critical Care Medicine. & Three country report Proactive and coordinated Proactive

Most traditional approach—social distancing Self disciplined Human enforced + no lockdown Lockdown + face mask --China “Cutting edge” approach—IT supported social distancing Good tracing capacity Loss of privacy Not suitable for countries that suffer from serious digital divide—Latin America? Coordination Intersectoral collaboration • Interdepartmental tasks force (working groups) • Strong community support Interregional coordination • Nationwide lockdown though controversial but has a core benefit • Allows concentration of resources in the most needed region • 42000 medical professionals travelled to Wuhan • Quality healthcare equipment go together Suitable when there is a shortage of medical resources Take away points • There is not one way of fighting against COVID-19 • The strategy adopted by China is not arbitrary • Some Latin American countries facing constraints in resources, with strong community support can benefit from looking at China’s experience • e.g. setting up communities supporting structure in case • Mixing and matching policies is key. Thank you! Augment ICU capacity for centralized management of surging critically ill patients with COVID-2019 Jian-cang ZHOU, MD

Vice President of Jiangshan Hospital affiliated to Sir Run Run Shaw Hospital, University School of medicine COVID-19 Global situation Clinical Characteristics of Coronavirus

Disease 2019 in China (Overall pts) Zhong et al. 2020 NEJM Complications&Treatm All Patients Nonsevere Severe ents (N = 1099) (N = 926) (N = 173) Septic shock — no. (%) 12 (1.1) 1 (0.1) 11 (6.4) Acute respiratory distress 37 (3.4) 10 (1.1) 27 (15.6) syndrome — no. (%) Acute kidney injury — no. (%) 6 (0.5) 1 (0.1) 5 (2.9) Invasive mechanical 25 (2.3) 0 25 (14.5) ventilation — no. (%) Use of extracorporeal 5 (0.5) 0 5 (2.9) membrane oxygenation — no. (%) Use of continuous renal- 9 (0.8) 0 9 (5.2) replacement therapy — no. (%) Admission to intensive care 55 (5.0) 22 (2.4) 33 (19.1) unit — no. (%) Death 15 (1.4) 1 (0.1) 14 (8.1) Clinical Characteristics of Coronavirus Disease 2019 in China (Critically ill pts)

➢ retrospective, multicenter ➢ Laboratory confirmed COVID-19 from 2 hospitals ➢ 191 patients ➢ explore the risk factors associated with in-hospital death.

Cao et al, Lancet 2020. March 9th Patients need ICU admission • China: approximate 5.0% laboratory- confirmed patients with COVID-19 required ICU admission • Italy:12% of the total positive cases, and 16% of all hospitalized patients with COVID-19.

Guan et al. N Engl J Med. 2020 Wu et al. JAMA. 2020. Grasselli et al. JAMA. 2020 Mar 13. ICU capacity varies among countries ➢ 2.3 beds per 100 000 population in ten low-income and lower- middle-income countries, ➢ 4.6 beds per 100 000 population in five upper middle- income countries ➢ 12.3 beds per 100 000 population eight high-income countries ➢ 9.6 beds per 100 000 population in 28 European high income countries in 2012 ➢ USA：Approximately 95 000 critical care beds ➢ China, 3.6 ICU beds per 100 000 population Staffing ➢critical care providers and non-ICU physicians ➢set aside a “business as usual” mentality ➢provide appropriate and standardized short courses training of these external staff ➢check-list of daily goal Infection- control practitioners (ICPs) guided staff personal protection

➢ principle of “three zones and two passages” ➢ contaminated zone, a potentially contaminated zone and a clean zone, ➢ the potentially contaminated zone was further divided into three buffer zones. Treatment for the COVID-19 ➢ supportive care for patients is typically the standard protocol. ➢ Evidence-based treatment guidelines ➢ including conservative fluid strategies for patients without shock following initial resuscitation, empirical early antibiotics for suspected bacterial co-infection until a specific diagnosis is made, lung-protective ventilation, prone positioning, and consideration of extracorporeal membrane oxygenation for refractory hypoxemia ➢ decision to provide very advanced care for fewer patients should be balanced against the requirement to provide less advanced care for more patients Trend of cumulative mortality and ranking of Jingmen city and Hubei province Ranking Cum Mortality Centralized management of critically ill pts First ICU admission

Hubei Jingmen city Ranking province THANK YOU 20 An Alert Alert 21 Wuhan Health Epidemiological Authority 22 & NHC China CDC involved raised by

23 in the investigation December 2019 24 25 Huanan Seafood

26 Market closed 27 28 29 30 31

1 WHO & other countries 2 informed Early Events Early pathogen 7 days Identify 3 4 5 SARS 6 identified - 7 CoV -

8 2 test kits Develop 4 days 9 10 SARS 11 shared with WHO etc. - CoV January 2020 12 1st 1st PCR test kits 13 - sent to Wuhan 2 2 sequences 14 15 16 17 18 COVID notifiable added to 19 diseases 20 - 19 21 “shutdown” Wuhan City 22 23 15 15 other cities 24 “shutdown” 25 26 27 Epidemic of COVID-19 in China

Lab confirmed (as of April 13) Imported cases ▪ Cumulative cases: 82249 • Jan 31, the 1st imported case ▪ Cumulative recovered: 77738 ▪ Cumulative deaths: 3341 • By April 13, 1464 confirmed cases ▪ Crude CFR: 4.06%