Wuhan, China —On April 10, 2020, the famed medical journal JAMA publishes the research paper entitled “Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China”, the production of which was led by the team of School of Public Health of Huazhong University of Science and Technology (HUST). The research results have revealed that public health interventions play an important role in the prevention and control of emerging infectious diseases. A series of improved public health measures taken in Wuhan have effectively controlled the spread of COVID-19, and the experience can be the Chinese wisdom contributed to the international community for the pandemic prevention and control worldwide. The editorial comments published in JAMA have fully affirmed the importance of anti-COVID-19 measures in Wuhan.
According to the research team, some research has been conducted through the model simulation and other methods to assess the contribution of Wuhan travel ban and other measures towards slowing the peak of the pandemic in China and beyond. However, the actual data in Wuhan have not been utilized to evaluate the impact of the improved public health intervention measures on the epidemic spread in Wuhan in a systematic and complete manner.
Therefore, the research team has collected the confirmed case data of the municipal Notifiable Disease Reporting System as of March 8 and 5 periods were classified according to the key timing of public health interventions. The first period was before January 10, 2020, which was the early stage of the pandemic. The second period was January 10 to 22, 2020, when massive population movement occurred during Chunyun (massive migration for the Chinese Lunar New Year). During the third period, between January 23 and February 1, Wuhan government blocked all outbound transportation from the city, subsequently suspended public transit and banned all vehicular traffic within the city. People were required to wear masks in public places, with social gatherings cancelled. The construction of Huoshenshan Hospital and Leishenshan Hospital began consecutively. Hospitals scrambled to transform wards to provide more beds, while hospital laboratories and some commercial laboratories quickly launched testing services, thus significantly improving testing capabilities. The fourth period was February 2 to 16. With marked improvement in medical resources, four types of persons were subject to centralized quarantine and treatment, while more measures were taken to manage and control residential communities and average citizens, including community shutdown, stay-at-home isolation and delivery of daily essentials in a centralized manner, thus further reducing the risks of community infections. The fifth period was after February 17. Wuhan government initiated door-to-door and individual-to-individual symptom screening for all residents during a three-day campaign, with an increasing number of nucleic acid tests and the stringent control measures still in place.
The team has analyzed the case counts, average daily attack rate of confirmed cases, the ratio of mild to severe cases and the effective reproduction number Rt among other indicators. The research has shown that with the control measures strengthened and perfected, the number and daily attack rate of confirmed cases peaked during the third period and then declined promptly. The effective reproduction number Rt reached 3.82 on January 24, the highest point, and then began to fall. It dipped below 1.0 on February 6, which meant that the pandemic was under effective control. It further dropped below 0.3 in March. According to the statistical analysis, as time passed by, the proportion of severe and critical cases was dropping, from 53.1% during the first period to 10.3% during the fifth period.
Meanwhile, the research indicates that the attack rate of cases in health care workers was higher than in the general population, especially during the second and third periods, three times higher than the general public. That rate witnessed a drastic reduction during the fourth and fifth periods, close to the rate of confirmed case in the general population during the fifth period. However, none of the health care workers from other provinces were infected, which means medical staff in the hot spots can protect themselves against the virus with proper awareness, sufficient personal protective equipment and a reasonable recess. Measures to protect medical workers against COVID-19 is key to the system of pandemic prevention and control, which can avert a larger disaster resulting from the collapse of the medical system.
The team believes that public health interventions play a decisive role in halting the spread and deterioration of COVID-19, given the absence of specific vaccines and effective drugs against the global COVID-19 pandemic. A series of improved public health interventions in Wuhan can be chronologically correlated to the better control of COVID-19 in Wuhan, China. These findings may inform the public health policies in other countries and regions in response to the global COVID-19 pandemic.
Team members include Professor Wu Tangchun, Professor Wei Sheng, Professor Pan An, Professor Wang Chaolong, Professor Guo Huan, Associate Professor Liu Li, Associate Professor Wang Qi, Doctor Hao Xingjie, Doctor Huang Jiao of School of Public Health, Tongji Medical College, HUST, as well as Professor He Na and Professor Yu Hongjie of School of Public Health, Fudan University, and Professor Lin Xihong of Harvard T.H. Chan School of Public Health.