In a small town in Southwestern China’s Chongqing municipality in mid-March, the strident recorded voice from the loudspeaker which repeatedly asked residents to stay home and wash their hands finally stopped broadcasting. Pop music from small stores was back on the street after more than 50 days of business suspension.
By the middle of March, most provinces in China had lowered the level of emergency response to the Covid-19 pandemic. On March 12, the National Health Commission of China (NHC) announced that the current peak of the Covid-19 outbreak was over in China, with new confirmed cases down to less than 10 both inside and out of Hubei Province, the epicenter of the outbreak. Even in Beijing where the highest emergency response remains in place, people were excited to show in their social media feeds that streets empty for nearly two months were again experiencing traffic jams.
In Wuhan, the only place where a few new cases of domestic transmission were still detected each day by March 19, all the 16 makeshift hospitals in stadiums and convention centers where about 12,000 Covid-19 patients with mild symptoms were treated had stopped operation by March 10 after 35 days. All the patients were either discharged or moved to established local hospitals for further treatment, including the two new hospitals set up during the pandemic outbreak. On March 17, more than 8,000 medical professionals from other provinces who worked with their Wuhan colleagues in the temporary hospitals started going home.
About 42,000 medical personnel from other provinces and regions had been working in Hubei since the eve of the Chinese New Year on January 24. The others will stay in Hubei until the last Covid-19 patient is cured and medical services are back to normal, according to the NHC. By March 19, most of the some 6,000 patients in China still in hospital were in Hubei, and most of the nearly 9,000 people under medical observation were also there.
By enforcing a nationwide lockdown, treating all patients in designated hospitals and tracking suspect cases, China has been following the conventional principles of containing infectious disease with no effective drug to fight against the Covid-19 outbreak since the end of January. This formula has proved effective in cutting off the transmission chain.
The Covid-19 outbreak coincided with the annual massive flow of migrant workers who travel predominantly from urban areas to their hometowns in towns and villages, or who travel from city to city to spend the Chinese New Year with their family. This year, New Year’s Day fell on January 25. Wuhan, Hubei’s capital city where the outbreak started, has about 13 million residents and its location in Central China, astride the Yangtze River, makes it a key transportation hub for trains, flights and boats. Zhou Xianwang, mayor of Wuhan, who was later removed from office, said at a press conference on January 26 that more than five million people had traveled out of the city for the Spring Festival or to be away from the Covid-19 before the lockdown of the city was enforced on January 23.
In about two months by January 22, 571 cases of Covid-19 had been reported in 25 provincial regions in China, as well as nine overseas cases, according to the NHC. Gao Fu, head of the Chinese Center for Disease Control and Prevention, told State-run broadcaster China Global Television Network (CGTN) on January 24 that all confirmed cases outside Wuhan were related to Wuhan in some way, so prohibiting travel from Wuhan could stop the further spread of the virus.
In Wuhan, all public transportation was suspended. Private vehicles were banned. No trains or planes stopped at Wuhan. Nearly all cities in Hubei did the same later. In February, there were two rounds of door-to-door investigations among the 10 million remaining residents in Wuhan to track patients who were diagnosed Covid-19 positive but not hospitalized, their contacts, suspected patients and patients with a fever which could be Covid-19.
People in other provinces were also required to stay at home. Temperature checks were required in all public places. People without masks were not allowed to go out. In some cities and provinces, it was mandated that only one member of a household could go out every two or three days to buy daily necessities. Restaurants, museums and parks were closed. Intercity roads were cut off. Anyone who did not live in a residential neighborhood was not allowed in. Visitors from other parts of the country or local residents returning home from other areas were required to report to official local community organizations and were self-isolated for 14 days. Some places tried to outdo each other in how tough they could be. Some villages blocked the roads in out and with makeshift barricades, posting guards. People from Hubei faced discrimination. Landlords forced some tenants holding a Hubei ID to move out immediately. Although the official holiday for the extended Spring Festival ended on February 9, most people were afraid of going back to work in the following days.
Symptoms of the disease normally appear within 14 days of infection, according to health authorities. Due to this incubation period and much faster testing by more health institutions, between January 27 and February 18, thousands of cases were confirmed in Hubei each day, mostly in Wuhan. Hundreds outside Hubei were reported each day during this period. The number of new cases gradually started to decrease to the hundreds in Hubei and the tens in other regions.
By March 19, more than 80,000 cases were confirmed in China. Zhong Nanshan, the first Chinese scientist who told the public about human-to-human transmission of the disease on January 20, said in an interview on February 17 that if the lockdown of Wuhan had been delayed for five days, the number of patients in the country would have reached 170,000 by mid-February.
In the early days of the lockdown, patients with mild symptoms were advised to stay at home and leave the limited medical resources to those with severe symptoms. But it did not work. Wang Chen, president of the Chinese Academy of Medical Sciences, warned in interviews with CGTN and the Xinhua News Agency in early February that it was urgent to hospitalize all patients with mild symptoms immediately, otherwise they would infect more people around them, particularly their families, and put their own lives at risk.
Based on his proposal, some big buildings in Wuhan, including stadiums and exhibition centers, were turned into makeshift hospitals to treat patients with mild symptoms in early February. Some were moved to designated hospitals if there were signs of their symptoms getting worse. These temporary hospitals are seen as one of the key steps for the success of the fight against Covid-19. Wang described the temporary quarantine centers as a “Noah’s Ark” for patients who otherwise would not have been treated.
Meanwhile, suspected cases and people who had close contact with confirmed cases were also identified, tested or put under medical observation in designated places so they did not mix with healthy people.
A lot of effort was put into tracking people who had close contact with confirmed cases. Big data was used. Professor Li Lanjuan, an academician at the Chinese Academy of Engineering, told CGTN on January 28 about a case in which the technology helped her team find out when and where a patient got infected without knowing three patients around him. The big data also mapped out the main destinations of the five million people who had left Wuhan before the lockdown.
Professor Du Bin, director of the medical intensive care unit at Peking Union Medical College Hospital in Beijing, stressed at a press conference in Wuhan on March 16 that prevention should always come first and foremost, and testing was the best way of prevention. He believed the turning point in Hubei and Wuhan did not come until all four groups-confirmed cases, suspected cases, those with close contact with confirmed cases and those with a fever-were all tracked and quarantined.
According to research published in the journal Science on March 16 by scientists from Columbia University, Imperial College London, University of California Davis and the University of Hong Kong, the explosive spread of the virus in China in January was mainly caused by people who had either mild or no symptoms, proving the importance of broad testing and isolation. The World Health Organization has repeatedly stressed the same message.
By February 3, mortality rates among confirmed Covid-19 patients in Hubei and Wuhan were 3.1 percent and 4.9 percent, much higher than the 0.16 percent outside Hubei. Chinese experts pointed out several reasons for this. First, there were not nearly enough hospitals specialized in treating patients with severe symptoms in Hubei and Wuhan. It was too late for some patients to be admitted to these hospitals for proper treatment. Medical resources outside Hubei, given the lower number of cases, were sufficient. Second, it took time for doctors to find the right way to deal with the new disease.
Two new hospitals were built in Wuhan within 12 days by February 8, providing more than 3,000 beds for Covid-19 patients. Another one based on a half-built hospital in the city of Huanggang near Wuhan was put into use within 48 hours at the end of January. The new hospitals, along with the temporary quarantine centers, provided enough beds for all patients in Hubei.
However, it was clearly impossible for Hubei or Wuhan to deal with such a large number of patients alone, although Wuhan has some of the best hospitals in China. Medical resources around the country were mobilized to help Hubei. According to the NHC, from January 24 to March 8, 42,600 medical staff went to Hubei, 68 percent of them nurses. Many medical teams even brought their own equipment. Professor Zhang Wenhong, director of the Infectious Diseases Department, Huashan Hospital affiliated to Fudan University in Shanghai, noted at an online forum on March 7 that the key to saving lives in the fight against Covid-19 was the coordination of all medical departments, as the virus attacks human organs.
On February 7, the NHC appointed each province to provide medical assistance to designated cities in Hubei, where medical resources were much weaker than Wuhan. For example, teams from Shandong and Hunan provinces helped Huanggang. Healthcare workers from Jiangsu Province were deployed to the city of Huangshi. Their help not only saved more lives, but also improved the standard of local medical services in the long run. Since March 5, there has been no confirmed case in cities other than Wuhan in Hubei.
After the strict lockdown was enforced in Wuhan, a joint working mechanism was set up by the central government in early February to make sure that local supplies around the country were sufficient and stable. Ministries worked together to keep supplies of medical equipment and daily necessities flowing in Hubei. The Ministry of Commerce built a coordination platform which helped match demand and supply between Hubei and nine other provinces. At the grassroots level, staff from local community offices were assigned multiple tasks, from checking the health conditions of each household to delivering food to seniors living alone. Volunteers played an important role, particularly in the chaos of the early days of the lockdown. They included people driving their own cars to get key workers to where they needed to be, particularly as there was no public transit.
Countries including China, the US, the UK and Germany are developing vaccines against Covid-19. CanSino Biologics, a biopharmaceutical company in Tianjin, declared on March 17 that it had got approval for a Phase I clinical trial in Wuhan for a vaccine developed with the Beijing Institute of Biotechnology. The first batch of 108 volunteers received the first vaccines on March 22 in Wuhan.
Since March 5, most confirmed cases in the Chinese mainland were people, like overseas students, returning from other countries and regions where the pandemic is severe, such as Italy, Iran or Spain. Chinese cities announced strict measures at the end of March. All travelers entering the mainland will be ordered to remain in designated quarantine centers at their own cost for 14 days. Although there were mostly zero cases of domestic transmission in the mainland by March 23, as the risk of the virus is growing overseas, more residents are returning, increasing the risks of imported cases, therefore measures to contain secondary outbreaks will continue to be strict.