Better reporting systems eyed for quicker disease response: expert

Doctors guide the treatment of severe COVID-19 patients at Wuhan Leishenshan Hospital in early April. Photo: Courtesy of Guan Xiangdong

As China's most important political events are around the corner, during which the government will subject itself to public oversight and pool the wisdom of national legislators and political advisers, participants of the events and the general public are ready to seize the opportunity to review and reflect on China's response to COVID-19 at the early stage, and make proposals to improve China's overall emergency warning and reporting system to better cope with the possible resurgence of COVID-19 and future infectious diseases.

The annual two sessions are designed to summarize the achievements and problems in the past year, and this year, after the major public health emergency that has engulfed China and other countries around the world, reflecting on the experience and lessons learned from handling it is a must.

The National Committee of the Chinese People's Political Consultative Conference (CPPCC) has received nearly 300 proposals related to epidemic response from political advisers as of Wednesday.

A fast track for handling the proposals has been set up to ensure that epidemic-related proposals or those with high priority are dealt with promptly.

The third annual session of the 13th National People's Congress (NPC), the country's top legislature, will open on May 22 in Beijing, and the third annual session of the 13th National Committee of the CPPCC, the nation's top political advisory body, will start on May 21.

Reporting and warning system

Many NPC deputies and CPPCC National Committee members proposed the establishment of a mechanism for direct communication between the central and local governments over major public health emergencies and to improve the current infectious disease reporting system, as the heavily-invested system, built after the SARS outbreak in 2003, was largely believed to fail to properly function during the early stage of the COVID-19 epidemic.

Zhang Boli, an NPC deputy and a key expert-consultant in the epidemic fight in Central China's Hubei Province, sorted out the timeline of COVID-19 reporting in Wuhan.

He said Zhang Jixian, a local doctor who was the first to report the cases of pneumonia of unknown cause before the outbreak, reported the cases to the hospital on December 27, then the hospital reported it to local centers for disease control and prevention (CDC) and then to the Wuhan city government and provincial government. At that point, different level governments arranged inspections at hospitals, the China Youth Daily reported Tuesday.

The reporting procedure was not incorrect in this case according to the current system, but it wasted time. Zhang Boli said the grass-roots level governments should be authorized to report to the central government directly in the future.

NPC deputy Li Weimin, President of West China Hospital of Sichuan University and one of the team leaders of the local medical staff battling COVID-19, told the Global Times that his proposal to this year's two sessions will focus on the establishment of a direct and long-term reporting system for public health emergencies.

In China, medical institutions lack alertness to public health emergencies such as major infectious diseases. When clinical medical staff find early clues of the epidemic, they are not clear about the reporting process, and fail to use the direct reporting system to inform the possible epidemic the first time, Li said.

He noted that the current direct reporting system still has the intermediate link of manual examination and approval after the medical institutions report the information of infectious diseases, which will delay the reports.

"The system is capable of monitoring known diseases, but is not capable of providing an early warning for new and major infectious diseases unknown to us," he said.

Under the current reporting system, it is too late to report important information after the identification of the local CDC, Li said. It will delay the time for hospitals to conduct detections, such as pathogenic bacteria detection, making it difficult to detect the epidemic, he said.

While reporting unknown coronavirus cases, a doctor has to write down the case on a reporting record card after detecting a possible infection, and then hand the card to the infectious disease unit of the hospital. The medics from the unit would include it in the electronic reporting system to report to the higher level administrative organ, Wu Hao, a CPPCC National Committee member and head of the Fangzhuang community health service center in Beijing, told the Global Times.

Wu plans to propose linking the infectious disease reporting system to the electronic patient record system, which could automatically intercept infectious diseases, tumors and deaths, and report and warn of unexplained or newly emerging diseases.

Wu, who is also the head of the expert team on community prevention and control of the COVID-19 sent to Wuhan in February, said we could develop a testing machine that could automatically report patients' test results to the infectious diseases system to reduce underreporting by medics' manual entries.

Huang Xihua, an NPC deputy from South China's Guangdong Province, pointed out that in the beginning of the outbreak, the reporting and approval system revealed obvious deficiencies in rapid emergency response, which affected the emergency response and failed to achieve "effective prevention and timely control."

For example, the emergency response law clearly states that "when necessary, the report can be submitted beyond that level." But in practice, due to the constraints of the administrative system, it is difficult to apply, Huang said.

She told the Global Times that she proposed the establishment of a mechanism for direct communication between the central and local governments.

For example, in the case of public health emergencies, all levels of health emergency offices or public health emergency centers, apart from reporting to their superior departments, should also report important information, through a direct mechanism, to the health administrative department under the State Council or national public health emergency command center.

Some advisers also suggested that the National Health Commission come up with a detailed warning system of infectious diseases, especially unknown diseases, and classification standards of warnings on different levels, and then include them in China's infectious diseases prevention law.

Former NPC deputy Guo Qiyong, who is the former president of Shengjing Hospital of China Medical University, told the Global Times that China has encouraged the use of big data, artificial intelligence, cloud computing and other digital technologies to play a better role in epidemic monitoring and analysis, virus tracing, prevention, control and treatment.

Guo, chief expert of ViewHigh, a research center dedicated to studying hospital information technology and data services, suggested that the relevant government departments strengthen the construction of a public health emergency response system and establish a database through which big data monitoring technology can be used to effectively prevent an epidemic and scientific decisions can be made in a timely manner.

The Chinese government has been improving its response after detecting shortcomings. The Wuhan government corrected its COVID-19 death toll in April to include deaths which were not reported and misreported as medics were busy saving lives at the peak of the COVID-19.

China has started to discipline officials for mishandling the epidemic as early as February. More than 3,000 officials in Hubei Province have been punished since the epidemic outbreak for delayed reporting of confirmed cases, and failing to properly separate suspected patients, according to a magazine affiliated to the Communist Party of China Central Commission for Discipline Inspection.

Enough medical reserves

The lack of laboratories to run tests, test kits, medical protective gear and professional healthcare workers was also exposed by the inadequate COVID-19 response in Wuhan and Hubei Province in the early stage, legislators and advisers said.

The Chinese central government has realized and addressed these problems in several of its central guiding group meetings in the past months.

Chinese Vice Premier Sun Chunlan, head of the central guiding group overseeing the epidemic control work in Hubei, stressed the need to enhance medical emergency supplies in a meeting on April 2. She called for focus to address the shortage in material support in major public health emergencies, improve the variety and size of emergency medical supplies in reserve, and innovate the way they are stored to effectively enhance China's capacity for emergency response.

Wu said that China needs to train more public health professionals to prepare for future emergencies, adjust the personnel structure in health management administration and governments on different levels to include more health professionals.

Guo said a material management database could be established, which could help the government to obtain data on material reserves and suppliers. When an epidemic occurs, this would allow authorities to allocate and manage materials effectively. A similar database could also be used to manage medical staff.

Zeng Guang, the chief epidemiologist of the Chinese Center for Disease Control and Prevention, said in an interview with news portal ifeng.com last week that the past 10 years saw China's public health sector steadily slide despite the country's enhanced public health construction after the SARS outbreak in 2003.

He said that many public health professionals moved to other fields, but the public health system needs them to communicate with policymakers wisely and mobilize the public.

Wu said we need to regularly invest in public health sectors, attach greater importance to professionals in the sector so that we could better handle future emergencies like COVID-19.