Liao et al. Infectious Diseases of Poverty (2020) 9:112 https://doi.org/10.1186/s40249-020-00706-2 CASE STUDY Open Access Coronavirus disease 2019 epidemic in impoverished area: Liangshan Yi autonomous prefecture as an example Ru-Jun Liao1†, Chun-Nong Ji-Ke2†, Tao Zhang3, Qiang Liao2, Ling Li1, Tian-Yu Zhu2 and Shao-Yong Bian2* Abstract Background: The outbreak of coronavirus disease 2019 (COVID-19) had spread worldwide. Although the world has intensively focused on the epidemic center during this period of time, it is imperative to emphasize that more attention should also be paid to some impoverished areas in China since they are more vulnerable to disease outbreak due to their weak health service capacities. Therefore, this study took Liangshan Yi Autonomous Prefecture as an example to analyze the COVID-19 epidemic in the impoverished area, evaluate the control effect and explore future control strategies. Methods: In this study, we collected information including age, gender, nationality, occupation, and address of all COVID-19 cases reported from 25 January 2020 to 23 April 2020 in Liangshan Prefecture from the Nationwide Notifiable Infectious Diseases Reporting Information System (NIDRIS), which were used under license and not publicly available. Additionally, we retrieved other information of cases through epidemiological investigation reports reviewing. Data were analyzed using the software Excel 2010 and SPSS 17.0. The geographic distribution of cases was mapped using ArcGIS10.2. Results: By 23 April 2020, a total of 13 COVID-19 cases and two asymptomatic SARS-CoV-2 carriers were reported in Liangshan, in three family clusters. Among the cases, eight cases had a history of sojourning in Hubei Province (61.54%), of which six were related to Wuhan. Cases aged under 44 years accounted for 61.54%, with no child case. The delay of patients’ hospital visiting, and the low degree of cooperation in epidemiological investigation are problems. Conclusions: During the study period, Liangshan was well under control. This was mainly contributed to strict preventive strategies aimed at local culture, inter-sectoral coordination and highly degree of public cooperation. Besides, some possible environmentally and culturally preventive factors (e.g., rapid air flow and family concept) would affect disease prevention and control. In the next step, the health education about COVID-19 should be strengthened and carried out according to the special culture of ethnic minorities to enhance public awareness of timely medical treatment. Keywords: SARS-CoV-2, Coronavirus disease 2019, Impoverished area, Epidemiology * Correspondence: [email protected] †Ru-Jun Liao and Chun-Nong Ji-Ke contributed equally to this work. 2Liangshan Prefecture Center for Disease Control and Prevention, Xichang 615000, Sichuan Province, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Liao et al. Infectious Diseases of Poverty (2020) 9:112 Page 2 of 9 Background entertainment and most of the restaurants were closed The novel coronavirus — 2019-nCoV, later named as se- since 25 January 2020. Based on mobile operator data, vere acute respiratory syndrome coronavirus 2 (SARS- during 20 January–13 February 2020, the number of im- CoV-2), was identified on 7 January 2020 by Chinese sci- migrants fell by 62% compared with the same period last entists. Disease caused by this virus named COVID-19 year. The airport, railway station, expressway entrance by WHO. By 23 April 2020, COVID-19 has spread and exit have been set up inspection checkpoints. Cen- across over 160 countries and regions worldwide, in- tralized quarantine places have been set up in each fected 2 544 792 cases and caused 175 694 deaths [1]. county and city for close contacts, as well as for persons The most common symptoms of COVID-19 are fever, returning from areas affected by the outbreak. Dinner tiredness, and dry cough. Some patients may have aches parties are banned, catering packaging and takeout are and pains, nasal congestion, runny nose, sore throat or encouraged, and entertainment venues and factories diarrhea [2]. Older people, especially those with under- where people gather are closed. Residents are advised to lying medical problems like high blood pressure, heart take personal precautions and stay indoors. Judging from problems or diabetes, are more likely to develop serious the number of confirmed cases, the epidemic situation illness [2]. People with fever, cough and difficulty in in Liangshan Prefecture is not serious. breathing should seek medical attention (https://www. This study analyzed the epidemiological characteristics who.int/news-room/q-a-detail/q-a-coronaviruses). of COVID-19 cases and family clusters in Liangshan Like SARS coronavirus (SARS-CoV) and Middle East- Prefecture, evaluated the prevention and control effect ern respiratory syndrome (MERS)-CoV, SARS-CoV-2 is on COVID-19, and proposed the next step of prevention a coronavirus that can be transmitted to humans, and and control measures. Meanwhile, in-depth analysis of these viruses are all related to high mortality in critically some epidemiological characteristics was conducted to ill patients [3]. The COVID-19 now is a Category B in- explore the possible reasons. fectious disease that has being managed as a Category A (most severe) infectious disease in China [4], requested Methods network reporting in 2 h right after diagnosis. Study area Liangshan prefecture is the largest Yi community and Liangshan Prefecture is a Yi autonomous prefecture in one of the most impoverished areas in China, with back- Sichuan Province, China, including both majority (Han) ward infrastructure (except Xichang City) and weak pub- and minority (Yi, Tibetan) areas. Liangshan Prefecture is lic health condition, which has always been the main located in latitude 26°03′–29°18′N and longitude battlefield for the prevention and control of infectious 100°03′–103°52′E, measures 60 400 km2 and consists of diseases such as HIV. Because of the pleasant climate 1 city and 16 counties. The city is named as Xichang, of and high temperature in winter, Liangshan Prefecture at- which residents are mainly Han people. The counties are tracts a large number of tourists during the Spring Festi- named as follows: (1) Yanyuan, (2) Dechang; (3) Huili; val holidays in China. In addition, there are a large (4) Huidong; (5) Ningnan; (6) Puge; (7) Butuo; (8) number of labor imports and exports in Liangshan Pre- Jinyang; (9) Zhaojue; (10) Xide; (11) Mianning; (12) fecture, which brings the tide of returning home during Yuexi; (13) Ganluo; (14) Meigu; (15) Leibo; (16) Muli. the Spring Festival, and more challenges for the COVID- Among them, residents in Yanyuan, Puge, Butuo, 19 prevention and control. To date, several strategies Jinyang, Zhaojue, Xide, Yuexi, Ganluo, Meigu, Leibo have been implemented to reduce transmission and counties are mainly Yi minority people. Residents in mitigate epidemic impact in Liangshan Prefecture. Three Dechang, Huili, Huidong, Ningnan, Mianning counties steps are necessary to take once an infectious disease are mainly Han people. And Muli is a Tibetan autono- outbreaks in certain regions, including controlling infec- mous county. Those 11 minority counties also defined tious sources, blocking the transmission routes, and pro- as state-level poverty-stricken counties. tecting the susceptive population [5]. The confirmed cases and close contacts were quarantined to break the Data sources chain of infection. Site-specific disinfection was con- All cases of COVID-19 reported from 25 January to 23 ducted to eliminate pathogens in the environment, so as April 2020 in Liangshan Prefecture were involved in this to block the transmission by contact. People coming study. And information including the patient’sage,sex, from high prevalence areas were tracked based on big nationality, occupation, and address were extracted from data and were requested for daily health reporting. In re- the Nationwide Notifiable Infectious Diseases Reporting sponse to this nationwide level one public health emer- Information System (NIDRIS) which were used under li- gency, all scenic spots in Liangshan Prefecture were cense and not publicly available. Additionally, we retrieved closed since 25 January 2020, and gradually re-opened other case information by epidemiological investigation from 24 February 2020. All public places of reports review. Maps of Liangshan Prefecture were Liao et al. Infectious Diseases of Poverty (2020) 9:112 Page 3 of 9 downloaded from Data Sharing Infrastructure of Earth Results System Science (http://www.geodata.cn/). Demographic characteristics By 23 April 2020, a total of 13 diagnosed COVID-19 cases were reported in Liangshan Prefecture during the COVID-19 case definition epidemic, who were all included in the analysis. Since The diagnosis of COVID-19 is based on the Diagnosis and most of the cases were imported, the incidence rate was Treatment Scheme of Pneumonia Caused by Novel Cor- not calculated.