Trajectory of COVID-19 response and management strategy in China: scientific rationale driven strategy adjustments

Abstract

The pneumonia caused by novel coronavirus SARS-CoV-2 infection in early December 2019, which was later named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO), rapidly spread across the world. China has made extraordinary efforts to this unprecedented pandemic, put its response and control at a very high level of infectious disease management (Category B but with measures for Category A), given top priority to the people and their lives, and balanced the pandemic control and socio-economic development. After more than three years’ fighting against this disease, China downgraded the management of COVID-19 to Category B infectious disease on January 8, 2023 and the WHO declared the end of public health emergency on May 5, 2023. However, the ending of pandemic does not mean that the disease is no longer a health threat. Experiences against COVID-19 from China and the whole world should be learned to prepare well for the future public health emergencies. This article gives a systematic review of the trajectory of COVID-19 development in China, summarizes the critical policy arrangements and provides evidence for the adjustment during policy making process, so as to share experiences with international community and contribute to the global health for all humanity.

Keywords

COVID-19 / public health / response and control strategy / science-based policy making

References

[1] Zhou G, Chen S, Chen Z. Back to the spring of 2020: facts and hope of COVID-19 outbreak. Front Med 2020; 14(2): 113–116

[2] China’s State Council Joint Prevention and Control Mechanism against COVID-19. Notice on the general plan for the implementation of Class B management of novel coronavirus infection. 2022. Available at the website of the State Council of the People’s Republic of China

[3] National Bureau of Statistics of China. Preliminary accounting results of GDP for the fourth quarter and the whole year of 2022. 2023. Available at the website of National Bureau of Statistics of China

[4] McCloskey B, Dar O, Zumla A, Heymann DL. Emerging infectious diseases and pandemic potential: status quo and reducing risk of global spread. Lancet Infect Dis 2014; 14(10): 1001–1010

[5] Zhang Z, Wu Y. Scientific and targeted prevention and control measures to optimize COVID-19 response. Health Care Sci 2023; 1(2): 1–6

[6] Zhang Z, Wu Y. Prevention and control measures to further optimize COVID-19 response. Health Care Sci 2023; 1(2): 7–9

[7] Xinhua News. Timeline of China releasing information on COVID-19 and advancing international cooperation. 2020. Available at the website of China Daily

[8] China’s State Council Information Office. Fighting COVID-19: China in action. 2020. Available at the website of the State Council Information Office of China

[9] The Lancet. Sustaining containment of COVID-19 in China. Lancet 2020; 395(10232): 1230

[10] National Health Commission. Notification of COVID-19 pandemic. 2022. Available at the website of the National Health Commission of China

[11] WHO−China Joint Mission on Coronavirus Disease 2019. Report of the WHO−China Joint Mission on Coronavirus Disease 2019 (COVID-19). 2020

[12] Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, Huang J, He N, Yu H, Lin X, Wei S, Wu T. Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China. JAMA 2020; 323(19): 1915–1923

[13] Zhang Z, Fu W, Tian C, Zhang F, Zhao B, Mao J, Saligan LN. Professional identity of Chinese nursing students during the COVID-19 pandemic outbreak: a nation-wide cross-sectional study. Nurse Educ Pract 2021; 52: 103040

[14] Xinhua News. Liang Wannian: the rapid rise of the epidemic in Wuhan has been curbed. 2020. Available at the website of Xinhuanet

[15] Chen S, Zhang Z, Yang J, Wang J, Zhai X, Bärnighausen T, Wang C. Fangcang shelter hospitals: a novel concept for responding to public health emergencies. Lancet 2020; 395(10232): 1305–1314

[16] Zhou G, Chen S, Zhang Z, Chen Z. Revisiting China’s response to coronavirus disease 2019. Front Med 2023; 17(6): 1011–1013

[17] Li QS, Jia YW, Li MY, Gao P, Shang WJ, Kang LY, Liu J, Liu M. Analysis of disease characteristics and key points of epidemic prevention and control among key populations, during the normalization stage of prevention and control of COVID-19 in China. Chin Prev Med (Zhongguo Yu Fang Yi Xue Za Zhi) 2022; 23(10): 737–740

[18] Xinhua News. Guidelines on scientific, precise regional and tiered prevention and control measures of COVID-19. 2020. Available at the website of the State Council of the People’s Republic of China

[19] ShengLY. Review and reading of Statistical Bulletin of National Economic and Social Development 2020. 2021. Available at the website of the State Council of the People’s Republic of China

[20] World Health Organization. Coronavirus disease (COVID-19): how is it transmitted? 2021. Available at the website of World Health Organization

[21] Liu Q, Liu J, Liu M. Role and containment of asymptomatic cases in COVID-19 transmission. Chin Gen Pract (Zhongguo Quan Ke Yi Xue) 2021; 24(8): 917–922

[22] Ra SH, Lim JS, Kim GU, Kim MJ, Jung J, Kim SH. Upper respiratory viral load in asymptomatic individuals and mildly symptomatic patients with SARS-CoV-2 infection. Thorax 2021; 76(1): 61–63

[23] He X, Lau EHY, Wu P, Deng X, Wang J, Hao X, Lau YC, Wong JY, Guan Y, Tan X, Mo X, Chen Y, Liao B, Chen W, Hu F, Zhang Q, Zhong M, Wu Y, Zhao L, Zhang F, Cowling BJ, Li F, Leung GM. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med 2020; 26(5): 672–675

[24] Li HN, Zhang H. Health economics evaluation of timely prevention and control of COVID-19 and mass nucleic acid testing. Mod Prev Med (Xian Dai Yu Fang Yi Xue) 2022; 49(7): 1252–1258

[25] Li B, Deng A, Li K, Hu Y, Li Z, Shi Y, Xiong Q, Liu Z, Guo Q, Zou L, Zhang H, Zhang M, Ouyang F, Su J, Su W, Xu J, Lin H, Sun J, Peng J, Jiang H, Zhou P, Hu T, Luo M, Zhang Y, Zheng H, Xiao J, Liu T, Tan M, Che R, Zeng H, Zheng Z, Huang Y, Yu J, Yi L, Wu J, Chen J, Zhong H, Deng X, Kang M, Pybus OG, Hall M, Lythgoe KA, Li Y, Yuan J, He J, Lu J. Viral infection and transmission in a large, well-traced outbreak caused by the SARS-CoV-2 Delta variant. Nat Commun 2022; 13(1): 460

[26] Zhang M, Xiao J, Deng A, Zhang Y, Zhuang Y, Hu T, Li J, Tu H, Li B, Zhou Y, Yuan J, Luo L, Liang Z, Huang Y, Ye G, Cai M, Li G, Yang B, Xu B, Huang X, Cui Y, Ren D, Zhang Y, Kang M, Li Y. Transmission dynamics of an outbreak of the COVID-19 Delta variant B.1.617.2—Guangdong Province, China, May–June 2021. China CDC Wkly 2021; 3(27): 584–586

[27] Del Rio C, Malani PN, Omer SB. Confronting the delta variant of SARS-CoV-2, summer 2021. JAMA 2021; 326(11): 1001–1002

[28] Liang WN, Liu M, Liu J, Wang YD, Wu J, Liu X. The dynamic COVID-zero strategy on prevention and control of COVID-19 in China. Natl Med J China (Zhonghua Yi Xue Za Zhi) 2022; 102(4): 239–242

[29] Gao EX. Balanced governance: how the TCE strategy succeeds to prevent and control the COVID-19? —A case study of a Chinese megacity. J Public Manag (Gong Gong Guan Li Xue Bao) 2022; 19(1): 1–12,164

[30] Zhang Y, You C, Gai X, Zhou X. On coexistence with COVID-19: estimations and perspectives. China CDC Wkly 2021; 3(50): 1057–1061

[31] Thangaraj JWV, Yadav P, Kumar CG, Shete A, Nyayanit DA, Rani DS, Kumar A, Kumar MS, Sabarinathan R, Saravana Kumar V, Jagadeesan M, Murhekar M. Predominance of delta variant among the COVID-19 vaccinated and unvaccinated individuals, India, May 2021. J Infect 2022; 84(1): 94–118

[32] Public Health England. SARS-CoV-2 variants of concern and variants under investigation in England: technical briefing 20. 2020. Available at the website of Public Health England

[33] Wang S, Zhang F, Wang Z, Du Z, Gao C. Reproduction numbers of SARS-CoV-2 Omicron subvariants. J Travel Med 2022; 29(8): taac108

[34] No authors listed. Assessment of Omicron outbreak in Hong Kong after reimplementation of some of the toughest social distancing measures effective from 7 January. 2022. Available at the website of CU Medicine

[35] China’s National Health Commission. The average incubation period of the Omicron variant is usually 2–4 days. 2022. Available at the website of CCTV

[36] Nyberg T, Ferguson NM, Nash SG, Webster HH, Flaxman S, Andrews N, Hinsley W, Bernal JL, Kall M, Bhatt S, Blomquist P, Zaidi A, Volz E, Aziz NA, Harman K, Funk S, Abbott S; COVID-19 Genomics UK (COG-UK) consortium; Hope R, Charlett A, Chand M, Ghani AC, Seaman SR, Dabrera G, De Angelis D, Presanis AM, Thelwall S. Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study. Lancet 2022; 399(10332): 1303–1312

[37] World Health Organization. Update on Omicron. 2021. Available at the website of World Health Organization

[38] Cao Y, Yisimayi A, Jian F, Song W, Xiao T, Wang L, Du S, Wang J, Li Q, Chen X, Yu Y, Wang P, Zhang Z, Liu P, An R, Hao X, Wang Y, Wang J, Feng R, Sun H, Zhao L, Zhang W, Zhao D, Zheng J, Yu L, Li C, Zhang N, Wang R, Niu X, Yang S, Song X, Chai Y, Hu Y, Shi Y, Zheng L, Li Z, Gu Q, Shao F, Huang W, Jin R, Shen Z, Wang Y, Wang X, Xiao J, Xie XS. BA.2.12.1, BA.4 and BA.5 escape antibodies elicited by Omicron infection. Nature 2022; 608(7923): 593–602

[39] Kim S, Nguyen TT, Taitt AS, Jhun H, Park HY, Kim SH, Kim YG, Song EY, Lee Y, Yum H, Shin KC, Choi YK, Song CS, Yeom SC, Kim B, Netea M, Kim S. SARS-CoV-2 Omicron mutation is faster than the chase: multiple mutations on spike/ACE2 interaction residues. Immune Netw 2021; 21(6): e38

[40] Joint Prevention and Control Mechanism of the State Council. Press conference on the Joint Prevention and Control Mechanism of the State Council on November 30th, 2021. 2021. Available at the website of the State Council of the People’s Republic of China

[41] Centers for Disease Control and Prevention of the United States. Morbidity and mortality weekly report. 2024. Available at the website of Centers for Disease Control and Prevention of the United States

[42] The United Kingdom Health Security Agency. COVID-19 vaccine surveillance report. 2024. Available at the website of the United Kingdom Health Security Agency

[43] The Government of the HK Special Administrative Region Hong Kong. Archive of statistics on 5th wave of COVID-19. 2024. Available at the website of the Government of the HK Special Administrative Region Hong Kong

[44] Singapore Ministry of Health. COVID-19 statistics. 2024. Available at the website of Singapore Ministry of Health

[45] Joint Prevention and Control Mechanism of the State Council. Press conference on the Joint Prevention and Control Mechanism of the State Council on October 13th, 2022. 2022. Available at the website of the State Council of the People’s Republic of China

[46] WangX. Wu Zunyou: severe and critical cases are decreasing year by year, and the time for the introduction of the “new Ten” is just right. 2022. Available at the website of thepaper.cn

[47] Joint Prevention and Control Mechanism of the State Council. Press conference of the Joint Prevention and Control Mechanism of the State Council. 2023. Available at the website of the State Council of the People’s Republic of China

[48] World Health Organization. WHO coronavirus (COVID-19) dashboard. 2023. Available at the website of World Health Organization

[49] Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, Hu Y, Tao ZW, Tian JH, Pei YY, Yuan ML, Zhang YL, Dai FH, Liu Y, Wang QM, Zheng JJ, Xu L, Holmes EC, Zhang YZ. A new coronavirus associated with human respiratory disease in China. Nature 2020; 579(7798): 265–269

[50] Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KSM, Lau EHY, Wong JY, Xing X, Xiang N, Wu Y, Li C, Chen Q, Li D, Liu T, Zhao J, Liu M, Tu W, Chen C, Jin L, Yang R, Wang Q, Zhou S, Wang R, Liu H, Luo Y, Liu Y, Shao G, Li H, Tao Z, Yang Y, Deng Z, Liu B, Ma Z, Zhang Y, Shi G, Lam TTY, Wu JT, Gao GF, Cowling BJ, Yang B, Leung GM, Feng Z. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; 382(13): 1199–1207

[51] Hou T, Zeng W, Yang M, Chen W, Ren L, Ai J, Wu J, Liao Y, Gou X, Li Y, Wang X, Su H, Gu B, Wang J, Xu T. Development and evaluation of a rapid CRISPR-based diagnostic for COVID-19. PLoS Pathog 2020; 16(8): e1008705

[52] Wu Y, Feng X, Gong M, Han J, Jiao Y, Li S, Li T, Shen C, Wang HY, Yu X, Zhang Z, Zhang Z, Zhao Y, Zhou P, Wang H, Zhang Z. Evolution and major changes of the diagnosis and treatment protocol for COVID-19 patients in China 2020–2023. Health Care Sci 2023; 2(3): 135–152

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