Two country doctors head for a village in Hubei Province, central China, on March 10 (XINHUA)
Zhang Wei has fought two difficult battles in her career as a doctor. In 2003, she was selected to lead a team to combat the severe acute respiratory syndrome (SARS) in her hometown in Jiangxi Province in east China. Seventeen years later, she again served as the leader of a team of specialists fighting the novel coronavirus (COVID-19) in the province.
President of the First Affiliated Hospital of Nanchang University in Jiangxi, Zhang is also a deputy to the National People's Congress (NPC). "The pandemic was more severe than the SARS one in 2003," Zhang told Jiangxi Daily. "But our country is more experienced this time in dealing with these situations."
As the annual meetings of the NPC and the National Committee of the Chinese People's Political Consultative Conference (CPPCC), the top advisory body, collectively known as Two Sessions, began on May 22 and May 21 respectively, after their postponement in March, deputies from the frontline of the battle were ready with their prevention and control proposals.
Zhang Wei (left), the President of the First Affiliated Hospital of Nanchang University in Jiangxi Province and a deputy to the National People's Congress, talks with a discharged patient in the hospital on January 27 (XINHUA)
When the Wuhan Center for Disease Control and Prevention in Hubei Province in central China detected cases of pneumonia of unknown cause in late December 2019, the National Health Commission (NHC) sent a working group and an expert team to the city to evaluate the response and conduct onsite investigations on December 31.
Two days later, the NHC came up with a set of guidelines on early discovery, diagnosis and quarantine for the prevention and control of the viral pneumonia. Starting on January 3, China began regularly informing the World Health Organization and relevant countries and regions about the pneumonia outbreak.
For Zhang, her previous experience with SARS made her more alert to the situation. In early January, she organized a team of experts in the hospital and after the NHC unveiled the first set of guidelines, launched an emergency plan for prevention and control in the hospital.
She also submitted more than 10 suggestions to the province including setting up designated hospitals at provincial, prefectural and county levels. She suggested that for patients with severe symptoms, hospitals tailor treatment plans to each patient's condition and organize a medical team to monitor them. All her suggestions were adopted.
In addition, she submitted five suggestions to the NPC, including setting up public healthcare clinical centers and enhancing the combination of treatment and nursing care. "After going through SARS and COVID-19, every province, municipality and region should set up a public healthcare clinical center," Zhang said. "It can help us explore abnormal symptoms in advance and get ready ahead of time."
Public healthcare clinical centers can both serve during epidemics and normal times. "They perform functions such as infectious disease diagnosis and treatment, public health education and medical material reserve," Zhang said. "During an epidemic, they can carry out emergency treatment and scientific research."
Hu Yu (second left), President of Wuhan Union Hospital and a member of the 13th National Committee of the Chinese People's Political Consultative Conference, talks with medical staff in the hospital In Wuhan on January 28 (XINHUA)
Hu Yu, President of Wuhan Union Hospital affiliated with the Tongji Medical College of Huazhong University of Science and Technology, had many similar ideas after fighting on the frontline for over 50 days. As a member of the 13th National Committee of the CPPCC, he knows that the prevention and control of the epidemic is a hot topic at the Two Sessions.
In a provincial capital like Wuhan, there were not enough hospitals for infectious diseases to deal with the magnitude of the outbreak.
Since fever detection is an important part of screening for infectious diseases, Wuhan Union Hospital took the lead in Wuhan by opening a 24-hour fever outpatient service. On its first day, it received about 50 patients, but the number increased rapidly in the following days, creating long lines and extremely crowded conditions on a daily basis.
The hospital had to expand the area by five times, and even then, it was still overloaded. At the peak of the epidemic, it received nearly 1,000 patients a day. The isolation ward also had to expand from one floor to three, but still the number of beds couldn't meet the demand of the surging amount of confirmed cases.
"In the initial stage of the epidemic, we took some time to adapt ourselves to the situation," Hu said. He proposed some hospitals enhance their technical force to treat patients with severe symptoms and strengthen the construction of comprehensive intensive care units. The extreme shortage of materials in the early stage also indicated that some adjustments need to be made in hospital layout and material reserve.
Hu's suggestion is that hospitals should set up a branch in a suburban area which can accept patients with infectious diseases in emergency cases. Wuhan Union Hospital adjusted its layout for a new branch in suburban Wuhan, which is now under construction. A new building specifically for infectious diseases has been added, thus the branch can better meet future emergencies.
Makeshift hospitals played an important role in accepting patients with minor symptoms, which gave Hu more inspiration. "Since venues such as stadiums were not designed for this purpose, in the beginning it took time to modify their functions to meet the medical demand," Hu said. "In the future, stadiums and classrooms can take this into consideration while designing their layout."
Hu has shared his experiences and ideas with his peers in foreign countries at video conferences. "Our country has done a great job in giving priority to people's lives and covering medical costs for every patient," Hu said. "The government has also adopted a series of measures to ensure all these efforts are consolidated."
On March 5, the Communist Party of China Central Committee and the State Council unveiled a guideline on deepening the reform of the insurance system. The goal of the reform is to set up a medical security system by 2030 that centers on basic medical insurance and is underpinned by medical aid.
A notice released by the NHC on May 13 included some of the rehabilitation therapies, including psychological treatment, in the chronic and idiopathic disease medical insurance catalog. As of May 20, many provinces had announced they will include nuclear acid test in medical insurance.
The 13th National Committee of the CPPCC revealed that a fast track for handling the proposals from its members has been set up to ensure that epidemic-related proposals or those with high priority are dealt with promptly. By May 17, it had received over 400 proposals on epidemic prevention and control.
Yang Linhua, a deputy to the NPC and a doctor with the Second Hospital of Shanxi Medical University, said there are opportunities for improvement through training. She said official figures showed that at the end of 2018, the number of certified doctors for every 1,000 people was 2.59 on average, while in developed countries, the number is more than four.
The shortage was felt even more deeply during the epidemic. "Some of our doctors were sent to support Wuhan, some were sent to support other hospitals in our province," Yang said. "Only a third of the doctors remained in our hospital." Educational institutions responded to this problem. This year, Shanxi Medical University is planning to enroll more postgraduate students as medical reserve talent.
Moreover, patients with other diseases couldn't get regular treatment, especially people with chronic diseases, while medical staff was sent elsewhere. "We should also make allowances for these patients to ensure they get prompt treatment," Yang added.
In 2019, she set up a training base for rural doctors in Wuxiang County in Changzhi in Shanxi. During the epidemic, Yang and over 100 of these doctors launched medical services via WeChat, helping many locals with their medical issues.
In 2012, Shanxi set up a remote consultation center at the Second Hospital, which played a key role in offering services to patients that couldn't manage to come to the hospital during the epidemic.
Currently, many hospitals in China have remote consultation centers, but some haven't played their due role. Yang suggested the NHC release more measures to activate these centers to benefit more people.
Xie Liangdi, a member of the 13th National Committee of the CPPCC and Deputy President of the First Affiliated Hospital of Fujian Medical University, identified the same problem in Fujian Province in east China.
"Facilities in many hospitals have been updated but have not been put into full use," Xie said. "It is the cultivation of talent that is most important now."
(Print Edition: Experience into Action)
Copyedited by Rebeca Toledo
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