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Review
. 2020 Jun;36(6):915-930.
doi: 10.1016/j.cjca.2020.04.010. Epub 2020 Apr 17.

Management and Treatment of COVID-19: The Chinese Experience

Fujun Peng  1 , Lei Tu  2 , Yongshi Yang  3 , Peng Hu  4 , Runsheng Wang  4 , Qinyong Hu  5 , Feng Cao  4 , Taijiao Jiang  6 , Jinlyu Sun  7 , Guogang Xu  8 , Christopher Chang  9
Affiliations
Review

Management and Treatment of COVID-19: The Chinese Experience

Fujun Peng et al. Can J Cardiol. 2020 Jun.

Abstract
in English, French

With more than 1,800,000 cases and 110,000 deaths globally, COVID-19 is one of worst infectious disease outbreaks in history. This paper provides a critical review of the available evidence regarding the lessons learned from the Chinese experience with COVID-19 prevention and management. The steps that have led to a near disappearance of new cases in China included rapid sequencing of the virus to establish testing kits, which allowed tracking of infected persons in and out of Wuhan. In addition, aggressive quarantine measures included the complete isolation of Wuhan and then later Hubei Province and the rest of the country, as well as closure of all schools and nonessential businesses. Other measures included the rapid construction of two new hospitals and the establishment of "Fangcang" shelter hospitals. In the absence of a vaccine, the management of COVID-19 included antivirals, high-flow oxygen, mechanical ventilation, corticosteroids, hydroxychloroquine, tocilizumab, interferons, intravenous immunoglobulin, and convalescent plasma infusions. These measures appeared to provide only moderate success. Although some measures have been supported by weak descriptive data, their effectiveness is still unclear pending well controlled clinical trials. In the end, it was the enforcement of drastic quarantine measures that stopped SARS-CoV-2 from spreading. The earlier the implementation, the less likely resources will be depleted. The most critical factors in stopping a pandemic are early recognition of infected individuals, carriers, and contacts and early implementation of quarantine measures with an organised, proactive, and unified strategy at a national level. Delays result in significantly higher death tolls.

Avec plus de 1 800 000 cas et 110 000 décès dans le monde, la COVID-19 est l'une des pires éclosions de maladies infectieuses de l'histoire. Ce document présente un examen critique des constats disponibles concernant les leçons tirées de l'expérience chinoise en matière de prévention et de gestion de la COVID-19. Les mesures qui ont conduit à la quasi-disparition des nouveaux cas en Chine comprenaient le séquençage rapide du virus pour établir des trousses de tests, ce qui a permis de suivre les personnes infectées à l'intérieur et à l'extérieur de Wuhan. En outre, des mesures agressives de quarantaine ont consisté à isoler complètement Wuhan, puis la province de Hubei et le reste du pays, ainsi qu'à fermer toutes les écoles et les entreprises non essentielles. D'autres mesures ont été prises, notamment la construction rapide de deux nouveaux hôpitaux et la création d'hôpitaux provisoires de type « Fangcang ». En l'absence de vaccin, la gestion de la COVID-19 a compris des antiviraux, de l'oxygène à haut débit, de la ventilation mécanique, des corticostéroïdes, de l'hydroxychloroquine, du tocilizumab, des interférons, des immunoglobulines en intraveineuses et des perfusions de plasma de patients convalescents. Ces mesures ne semblent avoir apporté qu'un succès modéré. Bien que certaines mesures aient été soutenues par des données descriptives modestes, leur efficacité n'est pas encore évidente, en attendant de meilleurs essais cliniques contrôlés. En fin de compte, c'est l'application de mesures de quarantaine drastiques qui a permis d'arrêter la propagation du SARS-CoV-2. Plus la mise en œuvre est précoce, moins il est probable que les limites des ressources soient atteintes. Les facteurs les plus critiques pour stopper une pandémie sont l’identification précoce des personnes infectées, des porteurs et des contacts et la mise en œuvre rapide de mesures de quarantaine grâce à une stratégie organisée, proactive et unifiée au niveau national. Tout retard entraîne une augmentation significative du nombre de décès.

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Figures

Figure 1
Figure 1
COVID-19 epidemiology curves and major intervention measures implemented in China. China CDC, Chinese Center for Disease Control and Prevention; NHC, National Health Commission of China; WHC, Wuhan Health Commission; WHO, World Health Organization. Data from the NHC, excluding Hong Kong and Macau Special Administrative Regions and Taiwan.
Figure 2
Figure 2
The daily number of nucleic acid tests performed in Wuhan. Data from the Wuhan Municipal Health Commission.
Figure 3
Figure 3
Epidemic curves of the confirmed cases of COVID-19 in various countries. Left, timeline of breakouts of SARS-CoV-2. Right, daily numbers of increasing cases. Data for China were obtained from the National Health Commission of China, which excluded Hong Kong and Macau Special Administrative Regions and Taiwan. Data for the remaining countries were obtained from the World Health Organisation.
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