Comprehensive Community Epidemic Prevention and Control Models to Repel COVID-19 Pandemic-Grid-based management and digital response Experience from Four Provinces of China Nianshi Wang1, Ye Li1, Zhixin Fan1, Meiyan Ma1, Baoguo Shi1, Wanxin Tian1, Qi Xia1, Xiyu Zhang1, Qunhong Wu1, Tao Sun2, Mingli Jiao1 & Linghan Shan1 1 Harbin Medical University 1 Hang Zhou Normal University Correspondence to: (Submitted: 3 April 2020 – Published online: 6 April 2020) DISCLAIMER This paper was submitted to the Bulletin of the World Health Organization and was posted to the COVID-19 open site, according to the protocol for public health emergencies for international concern as described in Vasee Moorthy et al. (http://dx.doi.org/10.2471/BLT.20.251561). The information herein is available for unrestricted use, distribution and reproduction in any medium, provided that the original work is properly cited as indicated by the Creative Commons Attribution 3.0 Intergovernmental Organizations licence (CC BY IGO 3.0). RECOMMENDED CITATION Wang N, Li Y, Fan Z, Ma M, Shi B, Tian W, Xia Q, Zhang X, Wu Q, Sun T, Jiao M & Shan L. Comprehensive Community Epidemic Prevention and Control Models to Repel COVID-19 Pandemic-Grid-based management and digital response Experience from Four Provinces of China. [Preprint]. Bull World Health Organ. E-pub: 6 April 2020. doi: http://dx.doi.org/10.2471/BLT.20.258053 Introduction The re-emergency of infectious disease are making a comeback in worldwide, bringing unprecedented threats to human survival and development. At the end of 2019, an unknown infectious disease epidemic quietly broke out in Wuhan, China, knocking on the door of the Chinese Gengzi Year and covering a heavy white fear for the whole country.[1] As the number increase of patients with unexplained pneumonia due to high fever by unknown virus, a survey by the National Health Commission of the People’s Republic of China had been urgently conducted and found that most of the pneumonia cases were from operators in Huanan Wholesale Seafood Market. On January 8 of 2020, the mysterious veil of this virus was lifted and Chinese expert group locked it to be a new coronavirus.[2]With the timely supplementation of virus detection technology and resources, the number of confirmed cases in China continues to increase rapidly. On January 25, Chinese government required the implementation of comprehensive measures focusing on community prevention and control, including community grid management, carpet-type investigators, health promotion and other work, which aimed to lay a solid foundation for subsequent epidemic control work.[3] In the next day, the National Health Commission of the People’s Republic of China announced 30 provinces, municipalities and autonomous regions quickly launched a first-level response to major public health emergencies and launched an outbreak prevention and control campaign.[4] By February 28, the confirmed cases dramatically increased to 66,337 in Hubei Province.[5] As of March 15, 2020, China has accumulated a total of 80844 confirmed cases and 3199 deaths.[6]However, the cumulative number of cured cases has reached 66911, and new confirmed cases have been reported in some regions. As of March 19, there were no new indigenous cases reported in mainland China for the first time, which indicates that the trend of outbreaks in mainland China is improving. [7]The World Health Organization praises this as an amazing achievement. With the novel corona virus epidemic causing shock waves and panic across the world, the World Health Organization (WHO) officially named it COVID-19 and announced it as a Public Health Emergency of International Concern(PHEIC) on January 31.[8]The WHO has only declared such emergency incidents 6 times. Immediately after, in just 40 days, the WHO announced that the COVID-19 has entered a global pandemic state. [9]As March 27, 2020, there are 145,047 confirmed cases in Asia beyond China. A total of 290,066 confirmed cases have been diagnosed in Europe and 92,337 cases have been diagnosed in North America,7,728 people in South America,3508 people in South America,3405 people in Oceania.[10]The number of confirmed cases worldwide has exceeded 542,803, with the exception of China, the number of deaths worldwide has reached 20,663, and the epidemic has spread to 206 Countries, areas or territories.[11]Statistics from WHO indicated that it took 67 days from the first report case to reach the 100,000 cases, 11 days for the second 100,000 cases, and just 4 days for the third 100,000 cases, [12]which indicating that the pandemic is extremely accelerating and the prevention and control situation is not optimistic. Defensive measures such as physical distancing measures are taken as a useful way to slow down the spread of COVID-19. Moreover, aggressive and targeted tactics such as tracing and quarantining close contact also should be adopted to attack the COVID-19. It obviously demonstrated that effective epidemic prevention and control has become the first task. The community is the foundation for implementing grid-based emergency management and the first defense lines for infectious disease prevention and control. Risk communication and community engagement (RCCE) is particularly important for public health. This sudden and deadly new acute infectious disease epidemic has plunged countries around the world into the predicament of emergency response, who are struggling with the capacity to carry out offensive measures for fighting the epidemic. The Chinese society has shown unprecedented efforts in this epidemic, and has been appreciated by the World Health Organization, who said that China curbed the spread of the epidemic from the source. [13]Although China itself has paid a huge price, it has gained time for the world and slowed the spread of the virus to the world. However, after unremitting efforts, China's epidemic situation has improved, and even in Hubei, 14 places have achieved zero new cases for 14 consecutive days. [14]More than 15 provinces (autonomous regions) nationwide achieved 0 existing confirmed cases.[10] Community prevention and control in China has contributed a lot for this progress. This study summarizes the model of community epidemic prevention and control in typical provinces of China in order to provide experience for other countries in the world. With a view to helping the rest of the world win the COVID-19 at an early date . Methods Sample selection This study selected four provinces in China as samples including Zhejiang Province. Guangdong Province. Sichuan Province, and Hubei Province. The first three provinces show good experiences with their excellent epidemic prevention and control measures. As the earliest and most severe area of COVID-19 in China, Hubei Province has achieved no new confirmed cases and no new suspected cases on March 18 .Therefore, the summary of experience in community prevention and control in these four provinces is selected to provide reference for other countries or regions. Information capture and summary From the official website and report of China’s epidemic prevention and control, the World Health Organization’s epidemic information and documents, the study extracted the basic information of community organization, the epidemic situation and community response measures. The quantitative analysis was used to make a comparative analysis of epidemic situation of COVID-19 in the four provinces. The qualitative methods were adopted to summarize the community epidemic response models and characteristics of the four provinces. After searching for the official news, documents and literatures on the epidemic response in the four provinces, we made a further systematic summary and integration as follows: extracting the key fragmented information on community prevention and control; classifying all the selected information into different response functions and measures; by focus group discussion, further screening and integrating the functions and measures of prevention and control; finally forming a complete model of community epidemic prevention and control in four provinces. Basic Information 1. Basic Information of Community in four povinces Zhejiang Guangdong Sichuan Hubei Community Health Service Centers 5312 2602 980 1161 village clinic 11483 25996 56019 24411 Residents committee 4680 6794 7482 4528 Village committee 24711 19792 45524 233922 Sub-district office 467 467 353 310 Table 1 Basic community information Table 1 summarizes the situation of grass-roots community organizations in various provinces. Community Health Service Centers, it is a place where residents are provided with prevention, medical treatment, rehabilitation and health promotion. There are 5,312 community service centers in Zhejiang Province, 2602 in Guangdong Province, 980 in Sichuan Province, and 1161 in Hubei. The village clinic is a medical institution at the village level. Compared to Si Chuang Province (56019), there are only 11,483 in Zhejiang. Residents 'Committee is a grassroots mass autonomous organization for residents' self-management, self-education and self-service, with the largest number of 7482 in Sichuan Province. Villagers' committees are mass self-government organizations elected by villagers under the jurisdiction of townships (towns) in mainland China which all have exceeded 10,000 in four provinces. The sub-district office is the management organization of sub-districts in China's township-level administrative regions, with the similar numbers in four provinces. 2020/3/15 2020/3/10 2020/3/5 2020/2/29 2020/2/24 2020/2/19 2020/2/14 2020/2/9 2020/2/4 2020/1/30 2020/1/25 2020/1/20 2020/1/15 123456 Zhejiang Guangdong Sichuan Hubei Figure 1 Time of epidemic prevention measures by province Note: 1: Start time of first-level plan 2: Earliest time for health promotion 3: Time for passenger control 4: Start time of health code for epidemic control 5: Time for Community online psychological consultation 6:Time for Online teaching Among the four provinces, Guangdong took the lead in launching the first-level response to public health emergencies (2020/1/23), and the next day, Zhejiang, Hubei, and Sichuan also started accordingly.