8 Takeaways from China’s COVID-19 Response

On March 13^th, I had a call with three Chinese doctors who are currently leading the coronavirus response in China, organized by my good friend Li Lu. Here are eight takeaways from the most experienced physician-leaders in the world addressing today’s crisis.

1. Early control of local transmission depends on rapid diagnosis and hospitalization of those with the disease, as was done in Shanghai. Failure to do this will result in a huge spike in total  cases that will overwhelm current health care resources and capacity… as we are seeing in Italy.
2. Shanghai’s excellent public health response was grounded in stringent social distancing measures that resulted in closure of all non-essential functions in society. With this disciplined approach, the number of cases peaked ten days after the first case was reported in the city. The number of new cases then remained elevated for six days, after which there was a rapid fall in the number of new cases and regular work could be resumed.
3. The most common feature of serious infection appears to be fever (which 98.6% of hospitalized COVID-19 pneumonia cases reported in Wuhan). Fatigue, dry cough, and muscle soreness were the next most likely symptoms, in that order.
4. Viral load, that is the measured amount of virus in the bloodstream, has a direct impact on the severity of the disease. Pneumonia along with respiratory failure is most widely reported… sometimes with viral sepsis and damage to the heart and kidneys.
5. COVID-19 infection in China was confirmed with two positive PCR tests, performed one after the other.
6. Chest X-rays and CT scans have not been precise in identifying COVID-19 in China.
7. The mean incubation period, meaning the average time from initial infection to onset of symptoms, in China was about six and a half days. For those hospitalized, the average time from symptom onset to admission was about five and a half days.
8. While no antiviral agent has been proven effective so far, trials in China are underway to evaluate lopinavir/ritonavir and remdesivir for combatting this virus.

I know some of these points are somewhat technical. But what’s important is that you, and all of us, are aware that critical conversations like this are occurring between doctors in China, who have the most experience and American doctors, who have yet to see what will inevitably come.  Thanks to my friend Li Lu for organizing this discussion.