Chinese health official tell it straight on status quo of battle against Covid

Happy new year Beijing Channel subscribers!

Recently Jiao Yahui, head of the Bureau of Medical Administration under the National Health Commission, and Tong Chaohui, Vice President of Beijing Chaoyang Hospital and Director of Beijing Institute of Respiratory Diseases gave the most comprehensive interview to date on the status quo of China’s battle against Covid.

The duo gave mostly straight, informative answers and did not shy away from the problems China is facing. Your host thought it would be useful to present their views on Beijing Channel. The interview is slightly abridged for a better reading experience.

The interview is originally conducted by CMG, China’s state broadcaster. A full Chinese text of the interview can be read here.

Text in [ ] brackets are background information provided in the broadcast interview.

Q: [The NHC announced on Dec. 26 that beginning Jan. 8, Covid-19 will be categorized and treated as a category B disease, instead of categorized as category B but treated as a category A disease.] At that time, did you check available resources and figure out whether the resources you had in hand could meet the medical needs of the people?

Jiao: According to the infection rate in China in the past three years, and referencing the infection rates of other countries around the world, we estimated at the time that if we did nothing and left the infection completely alone, the resources at hand would definitely be insufficient. Therefore we decided it was necessary to take certain restrictive measures to slow the number of infections. If we can slow down the spread and suppress the peak, those infected and those requiring hospitalization can be stretched out in time. If we achieve that, the supply of our medical resources will be sufficient.

[In early December, many cities began to see heightened infection numbers. First to feel the shockwave are the fever clinics. According to media reports, some hospitals saw a 10-fold surge in patients seeking treatment at fever clinics, with one doctor treating as many as 150 patients in one night.]

Jiao: We had predicted that there would be an increase in the demand for fever treatments among the general public, so fever clinics were the top priority of our plan at the time. We told all hospitals to open fever clinics and meet the public's demand to the best of their abilities.

In accordance with the principle of opening and setting up as many fever clinics as possible, medical institutions at all levels are opening fever clinics. We also streamlined the protocol for treating fever patients and stocked them up with medicine to improve their efficiency. According to statistics, as of December 25, there were more than 16,000 fever clinics in hospitals among and above level 2 * hospitals and more than 41,000 fever clinics in primary healthcare institutions nationwide.

*According to Chinese health regulations, Chinese hospitals are classified into six levels. From top to bottom are Level 3A, 3B, 2A, 2B, 1A and 1B. As of the end of 2021, there are 3275 level 3 hospitals, 10848 level 2 hospitals, 12649 level 1 hospitals and 9798 unclassified hospitals in China.

Q: Will these provisions meet people's need to get medical treatment?

Jiao: If we rely on these fever clinics alone, it is definitely not enough. In Beijing, we set up makeshift fever clinics at sports facilities and fangcang hospitals. If someone only needs medicine to treat fever, they can visit these makeshift venues and only need to wait more than 10 minutes. At that time, there was a statistic in Beijing that the number of fever patients seen at the makeshift venues in one district was more than the number of fever patients seen at all level 3 hospitals in that district. This was an effective way to divert pressure away from hospitals.

[As the outbreak progresses, the pressure for treatment shifts from fever clinics to emergency and critical care units.]

Jiao: According to the characteristics and patterns of the virus and the disease, critical cases tend to emerge around the second week. When the demand for fever clinics decreases, the pressure on emergency wards starts to appear. The pressure on emergency care set off a series of chain reactions. As people have witnessed, we have seen a huge spike in demand for emergency calls and beds for critical care and inpatients. Many people and people faced difficulty securing a hospital bed.

Q: At this time did you evaluate how many resources are at hand to cope with this sharp rise in demand?

Jiao: In fact, at the beginning of December 2022, we issued a directive for hospitals to prepare and expand their emergency wards. Those that had ICUs need to increase bed counts. In addition, We told hospitals to set up convertible ICUs. That way when critical cases reach capacity, those convertible ICUs can make the conversion within 24 hours.

Take Beijing Chaoyang Hospital as an example. The hospital set up 15 comprehensive care wards with 538 beds, including 69 ICUs, to deal with the influx of critical cases.

Q: Did you think the hospitals were able to cope?

Tong: At first, much medical staff was infected, and there were not enough doctors and nurses. As a medical staff, I can fully feel the tensity of the epidemic.

Q: To use an analogy, it is like fighting a war. Preparation for men, weapons and supplies have been made, but upon arriving at the battlefield, you find the enemy to outnumber your expectation. How do you fight that battle?

Jiao: We asked the hospital to coordinate all resources, including equipment, beds, and medical staff. When the fever clinic has a large number of patients, the whole hospital supports the fever clinic; now as the emergency ward has a large volume, the whole hospital has to support the emergency wards.

The emergency room beds should be turned around as soon as possible. So although we see that beds are full in emergency rooms, the patients are moving through quickly. Because we now require that patients admitted to the emergency room for observation to vacate within 24 hours.

Q: What does that mean?

Jiao: That is to say, people in emergency rooms must be transferred to other wards so that the emergency room can be vacated to receive more patients.

Q: 24 hours as a cycle?

Jiao: The turnaround must be under 24 hours. In fact, the turnaround is much less than 24 hours at many hospitals. In addition, we are doing more preventive work. If we just wait passively for all the patients to become critical cases and then come to hospitals, then the resources will never be sufficient. So now we are also proposing - it is also a lesson learned from our experience of the past three years - that we should do more to prevent cases from developing to critical phases, such as conducting early intervention and treatments.

Jiao: One thing we are doing is telling community health clinics to make an inventory of high-risk people in their communities, such as the elderly with underlying conditions, pregnant women, and children, and assign them a risk level. Red is the highest risk, yellow is the medium level, and green means relatively safe. Through health monitoring with a health profile, we can watch their health conditions.

Q: What should be done if an elderly person in his seventies or eighties with underlying conditions develops some symptoms?

Jiao: If someone with red risk develops symptoms, we would immediately transfer the person to a level 3 hospital because only a level 3 hospital can palliative serious illnesses.

[As the Chinese New Year approaches, there will be a massive movement of people between urban and rural areas, inevitably leading to a rapid spread of Covid 19. Because of the vast geographical area, huge population, and limited medical resources per capita in rural areas, it becomes a huge challenge to cope with the peak of infection in the vast rural areas.]

Jiao: Lots of people haven’t been back home for three years, and our biggest concern is that pent-up demand will be released this year and people will flock to the countryside to visit their relatives for Spring Festival. That is why we are more worried about the epidemic in the countryside.

Our work for Covid control in the countryside has two focuses, one is to ensure that medicines can make it the last mile, and the supply must cover the time period of the Spring Festival or even longer. The other is that patients in critical condition must be able to be transferred to at least the county hospital for treatment.

Q: Who will do the work?

Jiao: One, we ask local governments to prepare vehicles so that when people get really sick, there’s transportation for them to get to a hospital. Two, hospitals in cities need to divest some of their medical resources to the rural regions. Three, experienced doctors should stand by to treat these rural patients, either online or in person.

To cope with the coming peak of coronavirus infections, the country's healthcare system is on standby, doing its best to be prepared for all aspects. The country can now adjust the classification of Covid-19 from a "Category A disease" to a "Category B disease" based on a comprehensive assessment.

Q: Why is it that even with all the preparation, it still feels like we were caught off guard?

Jiao: I have been paying attention to sentiments online, and I found that most people were upset with the shortage of medicine. In the early days, when many people came down with a fever, the shortage of medicine was prominent. Medicine was sold out, and people couldn’t obtain medicine. At that time, we proposed stocking up medical facilities with medicine, but in reality, when the fever clinics opened, the supply couldn’t meet the demand.

Q: And what caused the drug to be out of supply?

Jiao: There are many reasons. One, retail pharmacies sold out their stock very quickly because some people were hoarding. Two, drug manufacturers decide their output based on demand, and when demand shows a sudden spike, it will take some time before they adjust their output. Three, infections among pharmaceutical company workers also hindered drug production.

Now the focus has turned to treat critical cases. China is aging, and many elderly have underlying conditions, so there are many critical cases. Most want to be treated at a Level 3 hospital, especially the famous 3A hospitals. Since the Chinese hospital system is like a pyramid, such a large number seeking treatment at the pinnacle will surely result in an acute mismatch of supply and demand.

Q: You were on the front lines in Wuhan during the early stages of Covid. Do you feel different now from the time when you were in Wuhan?

Tong: Yes. This time in Beijing, the clinical treatment is much less difficult than in Wuhan. Omicron is highly contagious and highly transmissible. Many people are infected and the percentage of people who actually need to go to the hospital or need to be admitted to the ICU is low. According to my statistics at two hospitals, serious and critical cases account for 3-4%.

Q: Many people have heard of the story of some friends losing a loved one. There seemed to be more of those stories than in previous years.

Tong: There will definitely be more. That we have to admit. But think about it, how many people around you are infected? Or how many critical cases are there when a family may all be infected? Or how many are cases of pneumonia? We probably have a number of these in mind.

Q: What is the cure rate of this wave of cases?

Jiao: The cure rate in our country has been above 90% since Wuhan, even in the most serious time. and later it was 93%, 94%. But people are not registering the high cure rate. They are occupied with the absolute number of serious and critical cases and even deaths.

Q: How long will it take for the medical staff and the patients to get through this most difficult time?

Jiao: Acute infectious disease has its pattern. The first and second weeks after the peak is the toughest. Different cities are experiencing the peak of serious and critical cases, which is probably our most difficult period. After the peak passes, there will be a downward trend. When we reach a stage when the virus can’t spread anymore, we will have passed the difficult time.

Li Chunmiao, and Lu Jia’nan, who intern for Beijing Channel, have contributed to the newsletter.