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Special Episode: Coronavirus with Dr. Wenhong Zhang

Today on A Second Opinion, we bring you our fifth special episode on the Coronavirus. In times of crisis, it’s critical to learn from those with the most experience and in today’s episode we do just that. We bring you trusted information from Dr. Wenhong Zhang, the leading Chinese physician who has successfully spearheaded public health efforts to prevent the spread of COVID-19 in Shanghai.

Dr. Zhang is the head of infectious disease at [Washon Hospital 00:00:54] of Fudan University in Shanghai. He is considered the gatekeeper of Shanghai for his heavy involvement in creating the public health policies that worked and kept the city safe.

One model had predicted Shanghai would see 800,000 cases, but through their extraordinary early efforts to limit travel, to end large gatherings and immediately implement social distancing and testing, they limited cases to just 300. And Dr. Zhang and his team have cured 95% of their COVID-19 patients in his hospital.

Exclusive COVID-19 Conversations from Chinese Physicians on the Ground

Submit your email below to access extended and exclusive content around this COVID-19 discussion. This conversation was recorded On Friday, March 13th, and we had the unique opportunity to hear directly from the leading physicians on the ground in China, spearheading the response to COVID-19.

To access this conversation and content, enter your email in the form below and you will be redirected to this exclusive conversation:

PHYSICIAN DATA & PRESENTATIONS

“What we learned from COVID-19 outbreak in Wuhan?”
-Zhiyong Peng, MD, PhD,

“Mega city public health policy and Hospital management of COVID-19 -Experience from Shanghai”
-Wenhong Zhang, MD, Ph

“SARS-CoV-2 viral sepsis: from bedside to bench”
-Bin Cao, MD

Dr. Zhang:         It’s a paper published in the [inaudible] Gazette predicted that maybe there is almost 800,000 cases will happen in Shanghai, but after the very strict measures taken by Shanghai, actually up to now we have 350.

Bill Frist:           Today on A Second Opinion, we bring you our fifth special episode on the Coronavirus. In times of crisis, it’s critical to learn from those with the most experience and in today’s episode we do just that. We bring you trusted information from Dr. Wenhong Zhang, the leading Chinese physician who has successfully spearheaded public health efforts to prevent the spread of COVID-19 in Shanghai.

Bill Frist:           Dr. Zhang is the head of infectious disease at [Washon Hospital 00:00:54] of Fudan University in Shanghai. He is considered the gatekeeper of Shanghai for his heavy involvement in creating the public health policies that worked and kept the city safe.

Bill Frist:           One model had predicted Shanghai would see 800,000 cases, but through their extraordinary early efforts to limit travel, to end large gatherings and immediately implement social distancing and testing, they limited cases to just 300. And Dr. Zhang and his team have cured 95% of their COVID-19 patients in his hospital.

Bill Frist:           We have much to learn from his experience to make us safe here at home. Dr. Zhang’s remarks that you’re about to hear were part of a 90 minute virtual meeting that was conducted minutes ago on March 13th. It was organized by my good friend Li Lu, whose foundation has been actively assisting in getting needed medical supplies into [Wuhan’s] hospitals.

Bill Frist:           If you’d like to listen and view the entire 90 minute meeting, which in addition includes remarks from two other highly experienced top Chinese physicians responding to the crisis, please visit our website, asecondopinionpodcast.com. I’m your host Senator Bill Frist, and now please join me for this important special edition of A Second Opinion.

Li Lu:                We’re going to turn the floor to Dr. Zhang who is as I introduced as the head of infectious diseases at Fudan University Hospital, is also independently involved in devising the mega city defense system and to the outset of this outbreak, most optimistic projection that Shanghai of a 30 million people would have a minimal of 80,000 infections to as high as perhaps 800,000 cases. But the result is, through a very carefully devised plan and strict implementation, as of today, there are only slight over 300 cases and only two deaths. And so Dr. Zhang is going to share with how that is accomplished. The floor is yours.

Dr. Zhang:         Okay, thank you Li Lu and I’m very glad to share our experience in a big city like Shanghai with 30 million people and when we have lots of imported cases from Wuhan.

Dr. Zhang:         So here is the slides and we can see the curves that represent all of the cases from Wuhan. We can see here after the lockdown of Wuhan to deal with other some cases of Wuhan imported to Shanghai. After that, maybe the first case in Shanghai we can see here is almost as the same case in United States at January 20th. And after that, the lockdown date of Wuhan is January 23 and after that, there’s some people from Wuhan enter Shanghai. And in Shanghai we picked the top level response to the major public health emergency.

Dr. Zhang:         So as the paper published in the [Landseer Gazette 00:04:29] predicted that there may be almost 800,000 cases will happen in Shanghai, but after the very strict measures taken by the Shanghai government and all the Shanghai people actually up to now, we have 350. So therefore today, that’s the one to share some experience of what we have done in our hospital. And if we have some input cases, what we will do in our patient clinic and what we have done in our ICU.

Dr. Zhang:         So this is the curve I just mentioned about this paper. This is a paper we pre-published in the Internet about the epidemic trend of Shanghai. We can see here is the three curves. The highest curve is the predicted cases about the epidemic trend prediction of Shanghai I once study published in [Leziate 00:05:39], that it’s all predicted, it may be there were 800,000 cases would be having in our city with a bigger city with 7 million people.

Dr. Zhang:         So the second curve is about this is a conservative prediction about the predicted cases in Shanghai maybe 80,000 cases in Shanghai. But actually, lastly, we can see that only 350 cases in our city. So actually, we just want to share some experience, what we have done in our hospital and all the hospitals in Shanghai to stop the transmission of the cases run among the population in Shanghai and also we stop the transmission of the disease in our hospitals.

Dr. Zhang:         So actually we take a lot of measures by the government and also by the our colleagues in hospitals in the very early stage of the epidemics. The population traveling or to live in Shanghai has a significant decrease by approximately 50% after we take the very top response to the public health emergency. All gathering activities and the most of the recreational sites including restaurants, theaters and et cetera, closed during the several weeks after we take the emergency.

Dr. Zhang:         Shanghai extended the spring festival holidays to 17 days from January 21st until February 9th to minimize the possible infections from patients their incubation period. So all citizens were encouraged to stay at home at least for unnecessary working, shopping or medical treatment. So actually, in the very early stage of the epidemics, all the city slowed down. During the two weeks of their first stage of this epidemics actually, so all the population in Shanghai slow down, stay at home and all the hospitals now work for are finding the cases and they’re quarantine the cases. This is what we have done in our city.

Dr. Zhang:         We can see what we have done in our city about as the order measures that we take in the medical and the health control of the disease. Shanghai, this city, we opened 110 designated fever clinics. So all the designated fever clinics was published in the Internet for all the population in Shanghai if they have fever or any symptoms related to the ways that disease, they can find the nearest site for the checking and the diagnoses of the disease. All the patients who met one epidemiology criteria, so in the very early stage, we just are things that if the person came from Wuhan, we can their disease is the epidemiology criteria match. So if the physicians in our hospitals, we thought as a patient who met one epidemiology criteria, plus one clinical relevant symptoms, we think as a patient who meet the criteria of suspected case and as a patient would be admitted to the quarantine ward. And there’s a CDC staff would come for sampling and do the epidemiological question. So if the nucleic acid test turn out the positive, all the patients were enrolled into the designated hospital in Shanghai.

Dr. Zhang:         So in Shanghai, we aggregate all the medical force in one designated hospital outside of the city. So actually, I am the chairman of the expert committee. I always stay in the designated hospital for almost two months. So recently, we almost cured 95% of the patients. Now still we have five patients who very critical air now still stay in the hospitals.

Dr. Zhang:         So this is a case, so what one of the hospital in Shanghai. This is Huashan Hospital in Shanghai. A very big hospital with almost a 2,000 beds in this hospital. This hospital, I actually, I am the head of the ID department of this hospital. So I just give the case about how to do the screening the cases in that.

Dr. Zhang:         So the key points of the medical and the health control in Shanghai and Chine, I think is very similar. All the suspected of patients should be tested at least or twice by CDC or nucleic tests and the treatment are free. All diagnosed patients should be admitted to the designated hospital, which has the one to stop the transmission during the hospital in other hospitals. So in Shanghai we just had one designated hospital. So it’s very easy for us to manage all the patients and to stop the transmission of the patients in the hospitals.

Dr. Zhang:         All the close contacts of the diagnosed patients were traced and quarantined for 14 days. So all close contacts of the diagnosed patients received the PCR test to rule out the real case. I think this is the most important strategy that we can take. It’s a very quick detection of the case and very quick to quarantine the case and trace the cause contact as them, we stop the circulation of the disease during our community.

Dr. Zhang:         In Italy, the first several cases transmitted from China. But later, we can see here, all the other cases in Italy now they’re local cases are not imported cases. So I think the key to stop the disease spreading is very, very important. If there’s a lot of local cases, actually we cannot stop the transmission further. So this is what I think is the most important experience in our city. If we want to stop the transmission, we will decrease the increasing cases and make the curve not so sharp. I think is the only way that we can do to do the good diagnosis, very quick diagnosis, I think it’s very, very important. So therefore, I think if we do not do the very quick and the immediate diagnose a positive patient, if the patient stays outside the hospitals for a very long duration, the outbreak in the community cannot be avoided.

Dr. Zhang:         I will give some conclusions. So according to my, our experience, we’re finders, there’s some supporting reasons for Shanghai management. If not controlled at that very early stage, I think the medical resources, especially the ICU resources might in the end face severe shortage and then causing sharp rising of mortality rate. The percentage of COVID in China now hovers around 10 to 20%.

Dr. Zhang:         In one city without effective control in the very early stage. We can see that. There are 5,000 critically ill patients right now, in Wuhan. Right now, we still have 5,000 in the city. So it’s a very huge disease burden. Now, on the contrary, only five critical care patient in Shanghai today. So I think if we give the early stage control of the disease, we will have the brilliant future.

Dr. Zhang:         So however, if the pandemic failed to the controlled globally, how will we cope with COVID is a strong question? Management is similar to that of the seasonal flu. I think maybe there’s not so similar. When was the vaccine come out? I don’t know. How to balance between the epidemics control to avoid a medical or especially the ICU resources, shortage and the social vitality? So it’s really very difficult to give the balance.

Dr. Zhang:         In the end, each country and every stage should adapt to its own suitable methods. This is all the experience I share with you. Thank you very much.

Li Lu:                Thank you Dr. Zhang. There is a real good reason why you are called the gatekeeper of Shanghai.

Bill Frist:           Thank you for tuning into this special broadcast of A Second Opinion. As developments occur, we will continue to keep you up to date with episodes from trusted sources coming right to your phone.

Bill Frist:           Make sure to subscribe to get the most current information on the Coronavirus and be sure to listen to our regular Monday broadcast. Next week, we are joined by Brent Shafer, chairman and CEO of Cerner, the largest electronic health record company in the world.

Bill Frist:           This episode of A Second Opinion was produced by Todd Schlosser, the Modus Creative Group and Snapshot Interactive. You can subscribe to A Second Opinion on Apple podcasts, Spotify, or wherever you are listening right now. You can also watch our interviews on YouTube and on our website. And be sure to rate and review A Second Opinion so we can continue to bring you great content.

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Bill Frist:           A Second Opinion broadcast from Nashville, Tennessee. The nation’s Silicon Valley of health services where we engage at the intersection of policy, medicine, and innovation.