Sustaining Containment Of COVID-19 In China

Published:April 18, 2020DOI:https://doi.org/10.1016/S0140-6736(20)30864-3

On April 8, China lifted its 76-day lockdown of Wuhan, with trains and flights resumed and highways reopened. Shanghai will reopen its schools for many students from April 27. Given that most new COVID-19 cases in China are imported, the country is reopening businesses and schools gradually and cautiously.

The quick containment of COVID-19 in China is impressive and sets an encouraging example for other countries. What can be learnt from China? Aggressive public health interventions, such as early detection of cases, contact tracing, and population behavioural change, have contributed enormously to containing the epidemic. Kiesha Prem and colleagues found that a staggered relaxation of physical distancing measures in Wuhan in early April—such as school and workplace closures—is the most effective way to reduce the number of infections. To relieve the huge pressure on the health-care system, Fangcang shelter hospitals have also been crucial. Chen Wang and colleagues describe how these large temporary hospitals were built to isolate, treat, and triage patients with mild to moderate COVID-19. Such hospitals, built within 3 weeks, have provided care to around 12 000 patients in Wuhan as of March 10, 2020.

However, China's success has come with huge social and economic costs, and China must make difficult decisions to achieve an optimal balance between health and economic protection. Can China maintain containment? Kathy Leung and colleagues argue that the over-riding public health priority for China is to closely monitor the instantaneous reproduction number (Rt) and confirmed case-fatality risk. Restrictions should be relaxed gradually so that the Rt does not exceed 1. Otherwise, cases would increase exponentially again, unleashing a second wave of infection.

Implementing a science-based lockdown exit strategy is essential to sustain containment of COVID-19. China's experience will be watched closely, as other countries start considering—and, in some cases, implementing—their own exit strategies.