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May 25, 2020

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Making the city safer at a time of global pandemic


China’s Two Sessions — the meetings of the national legislators and political advisers — were rescheduled from March to May due to the pandemic and started last week in Beijing. We look into some of the talking points that could herald changes in Shanghai.

At a time of global pandemic, Shanghai is still on its way to fulfil its ambition of becoming one of the world’s safest cities by 2025 in terms of public health.

And it is using COVID-19 response as a model to help prepare for the future.

The world’s most populous city after Tokyo and New Delhi — with 24 million people — and a crucial global transportation hub, Shanghai is working hard to cope with the novel coronavirus and its impact.

Through the extraordinary cooperation of the public and the hard work of health care experts and city leadership, Shanghai has had only 341 domestic cases of infection and seven deaths — one of the lowest rates in the world. Businesses, schools and most activities are now almost back to normal.

Shanghai is no stranger to public health crises. During the 2003 SARS epidemic, it accumulated solid experience in how to prevent the spread of a virus by integrating medical teams, managing systems and community mobilization.

Eight infected cases were confirmed at that time in a city of 17 million people.

Fu Chen, director of the Shanghai Center for Disease Control and Prevention, said China has a network to detect and report a total of 39 infectious diseases across the nation. But it is not yet effective enough to detect and report new diseases.

“Although we set up some effective measures 17 years ago, our health emergency system still has a weak spot,” said Li Yongkui, professor of the Economic Management Department at Tongji University.

Vice Mayor Zong Ming said: “Based on COVID-19, we need a well-rounded prevention and control system to cope with big health emergencies.”

In early April, Shanghai said that it will upgrade its strategies for public health emergencies and become one of the world’s safest cities for public health by 2025. The government also issued new guidelines to support the strategies.

“The new guidelines should not focus on containing one specific infectious disease, but rather improving all spectrums of the city’s systems for handling health emergencies,” said Dr Liu Zhongmin, president of the Shanghai East Hospital.

Community health centers and family doctors will take on a bigger role. Public health screening and early warning systems should be built, with monitoring sites established at local fever and intestinal clinics to detect food-borne diseases and novel contagions with unknown origins.

Shanghai has created a disease control system including local CDC centers and community health centers. They will eventually comprise a multi-level emergency alert and treatment system.

Fever clinics play a crucial role in the early detection of COVID-19, as data shows over 60 percent of confirmed cases in Shanghai were discovered by them. Early detection is essential to curb the spread of the virus and carry out successful treatment.

To spot suspected cases earlier, as well as lessen the burden on key hospitals, a total of 182 community health centers developed new fever screening units in April following the release of new guidelines. Previously, there were 117 fever clinics in higher-level hospitals across Shanghai.

At the Yinhang Community Health Center in Yangpu District, the fever unit has been in operation since April 1, receiving one or two patients every day with no suspected cases reported so far.

“We have always had our infectious disease and enteric clinics, but establishing special fever clinic can greatly improve the alert system from the grassroots,” said Cui Ming, director of the Yinhang Community Health Center. “The new fever units set a new milestone for curbing other contagious diseases in the future.”

Statistics from the Shanghai Health Commission show that 246 community health centers are open for outpatient consultations during the outbreak, with the highest number of outpatient visits reaching nearly 70 percent of the city’s total. More than 6,000 family doctor teams provide services for households and nursing homes and guide them with health management.

Family doctors have greatly helped communities manage residents returning to Shanghai and into quarantine. Through online communication with patients and follow-up visits, they enable local centers to reach out to the front line with health information.

“It will finally become a consensus that public health is the concern of the whole society,” said Bi Fangfang, director of Tianshan Community Health Center in Changning District.

“The epidemic shows that enterprises and institutions, company buildings and residential areas should play their own parts in the public health system.”

Family doctors, community services and health management of office buildings can establish a closer relationship with the community health center to enhance public participation and awareness.

Bi also suggested that the core institutions such as public security, subdistricts, community health service centers and many other grassroots organizations can further share the health database of the populace to better control and protect their safety.

Shanghai will also keep up with top international standards by establishing a smart command information system for public health emergencies.

Internet hospital services have already been put in place by many key medical institutions to stagger patients’ visits and trigger alerts. Patients can carry out normal matters including payment and ordering medicine through mobile phones, avoiding overcrowding hospitals.

“From the overall requirements to system construction, prevention and control mechanisms, capabilities and safeguards, the introduction of the new guidelines is a remodeling of the current situation, reflecting Shanghai’s innovation, goals and responsibilities,” Shanghai Health Commission director Wu Jinglei said.


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