mega city public health policy and hospital management ... dr. wenhong zhang.pdf · multiple...

Mega city public health policy and Hospital management ofCOVID-19-Experience from Shanghai

DR. WENHONG ZHANG

FUDAN UNIVERSITY, SHANGHAI,CHINA

The epidemic trend in Shanghai

Sources: HZ Lu, JW Ai, WH Zhanget al. medRxiv2020.02.19.20025031;doi:https://doi.org/10.1101/2020.02.19.2002503

The epidemics trend of Shanghai (actual vs. predicted)

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Shanghai actual cases after prevention and control Shanghai predicted cases if no measures were taken #1 (Read et al.)

Shanghai predicted cases if no measures were taken #2 (Wu et al.)

• The previous epidemics trend prediction of Shanghai by several studies if the transmission was not stopped.

• Shanghai has indeed managed to stopped the exponential growth in less than 2 weeks.


Multiple measures taken by the Shanghai government in the early stage of the epidemics

The population travelling to or leaving Shanghai has significantly decreased by approximately 50%.

All gathering activities and most of the recreational sites including restaurants, theatres and etc. were closed.

Shanghai extended the Spring Festival holidays to 17 days from Jan 24th until Feb 9th to minimize the possible infections from patients in their incubation period.

All citizens were encouraged to stay at home unless for necessary working , shopping, or medical treatment.

Multiple measures in medical and health control

Shanghai opened 110 designated fever clinics.

ALL patients who met 1 epidemiology criteria+1 clinical relevant symptoms can go to these clinics.

If the physicians thought the patient to meet the criteria of suspected COVID-19 infections, the patient would be admitted in to the quarantine ward and CDC staff would come for sampling and epidemiological question.If nucleic acid test turned our positive, all patients were enrolled into the designated hospital in Shanghai

COVID-19 positive cases（N=20） COVID-19 negative case（N=33） P

Age, median (Range) 37(26-66) 39 (22-88) 0.882

Sex

Male 10 (50.0%) 16 (48.5%)

Signs and symptoms (Range)

Fever 16 (80.0%） 17 (51.5%)

Dry cough 11 (55.0%) 19 (57.6%)

Diarrhea 3 (15.0%) 4 (12.1%)

Fatigue 2 (10.0%) 2 (6.1%)

Headache 3 (15.0%) 1 (3.0%)

Vomiting 1 (5.0%) 0 (0.0%)

Abdominal pain 1 (5%) 0 (0.0%)

Laboratory Findings (Range)

White blood cell count, ×109/L 4.21 (2.79-11.32) 8.05 (5.41-11.91) 0.001

Neutrophil count, ×109/L 2.88 (0.99-7.95) 5.25 (2.83-11.22) 0.000

Lymphocyte count, ×109/L 1.21 (0.30-3.32) 1.58 (0.21-4.64) 0.077

A cohort study from Huashan Hospital, Shanghai

Use of chest CT, SARS-CoV-2 RT-PCR and multi-plex PCR (or rapid influenza antigen or flu RT-PCR tests ) in Huashan Hospital Shanghai

Diagnostic methods Laboratory-confirmed cases（n=20）

Laboratory-confirmed non-COVID (n=33)

2019-nCoV identification

Suspected chest CT signs 20/20 20/33

First time SARS-CoV-2 PCR positive

14/20 0/33

Second time SARS-CoV-2 PCR positive

3/6 0/33

mNGS positive for SARS-CoV-2

20/20 0/33

Other respiratory infection

pathogens

Direct antigen Flu A+B test positive

0/20 0/33

Multiplex PCR positive for other pathogens

5/20 7/20

mNGS positive for other pathogens

11/20 23/33

JW Ai, HC Zhang et al. medRxiv2020.02.13.20022673; doi: https://doi.org/10.1101/2020.02.13.20022673

https://doi.org/10.1101/2020.02.13.20022673

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Rhinovirus/Enterovirus H3N2

Influenza B Respiratory Syncytial Virus

Haemophilus parainfluenzae Candida albicans

Klebsiella aerogenes Non-coinfection cases

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10Haemophilus parainfluenzae

Candida albicans

Rhinovirus/Enterovirus

Respiratory Syncytial Virus

Parainfluenza virus

Mycoplasma

Human metapneumovirus

Epstein-Barr virus

Unknown pathogen

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novel coronavirus (2019-nCoV) pneumonianon-novel coronavirus (2019-nCoV) pneumonia

Non NCP cases

NCP Cases with co-infection statusCo-infections in the COVID-19 patients

JW Ai, HC Zhang et al. medRxiv 2020. 02. 13.20022673; doi: https://doi.org/10.1101/2020.02.13.20022673

https://doi.org/10.1101/2020.02.13.20022673

MycoplasmaNo.193

Respiratory Syncytial ViralNo. 102

COVID-2019No. 46

Chest CT alone could not precisely diagnose COVID-2019 due to sometimes similar radiological presentations.

COVID-2019No. 92

COVID-2019No. 38

Parainfluenza virusNo.146


https://doi.org/10.1101/2020.02.13.20022673

Recommended diagnostic flow diagram (1).


https://doi.org/10.1101/2020.02.13.20022673

Recommended diagnostic flow diagram (2).


https://doi.org/10.1101/2020.02.13.20022673

Timely diagnosis would lead to timely admission ofthe patients to prevent further local transmission

Days from Suspected Contact to Symptoms Onset

The mean incubation period is 6.4 days (95% CI 5.3 to 7.6)，and the mean onset-admission interval was 5.5 days (95% CI, 5.1 to 5.9, SD 3.5) in Shanghai.


KEY POINTS of medical and health control in Shanghai and China

All suspected patients should be tested at least twice by CDC

All nucleic tests and treatment are free

All diagnosed patients should be admitted to designated hospital

All close contacts of the diagnosed patients were traced and quarantined for 14 days, and all close contacts of the diagnosed patients received SARS-CoV-2 RT-PCR tests

Early control of the local transmission is the key to stop the diseases spreading

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Travel history of Hubei Province Travel history of Other Province Others

Shanghai’s data showed effective control of the local cases (green bars)


Early control of the local transmission is the key to stop the diseases spreadingItaly’s data showed epidemics mainly due to local transmission

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Imported cases in Italy Local cases in Italy

Sources: Huashan Hospital

Failure to control local transmission could lead to spikes in total cases

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Disease trend among different regions after a total of 50 cases were reported

Hubei province（Population more than 60 million） Italy（Population more than 60 million） Shanghai（Population more than 30 million）


Death cases could sharply increase if epidemics control failed and cause medical resources shortage

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Death cases trend among different regions after the first case was reported

Hubei province（Population more than 60 million） Italy（Population more than 60 million） Shanghai（Population more than 30 million）


Some supporting reasons for Shanghaimanagement

If not controlled at the early stage, medical resources (especially ICU resources) might in the end face severe shortage, and causing sharp rising of mortality rate ( the percentage of severe cases of COVID-19 is around 10-20%)

In Wuhan city without effective control in the early stage, there are 5000 critically ill patients right now. On the contrary, only 5 critically ill patients in Shanghai today.

However ……

If the pandemics failed to be controlled globally, how will we cope with COVID-19?

Management similar to that of seasonal flu? Vaccine?

How to balance between epidemics control to avoid medical (ICU especially) resources shortage and social vitality?

In the end, each country and every state should adapt to its own suitable methods

Thank you!

mega city public health policy and hospital management ... dr. wenhong zhang.pdf · multiple...

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