Battling against the Novel Coronavirus: Control Strategies for and Clinical Management of the 2019 Novel Coronavirus Infection in Shanghai, China
At the end of 2019, a novel coronavirus, later named the 2019 novel coronavirus (2019-nCoV), emerged in Wuhan, Hubei Province, China, causing a cluster of viral pneumonia cases. This virus, responsible for coronavirus disease 2019 (COVID-19), quickly became a significant threat to global health. By March 11, 2020, Shanghai, China’s economic metropolis, had reported 344 confirmed cases, 320 recoveries, and three deaths, making it a region with relatively low COVID-19 incidence. This article outlines the control strategies and clinical management approaches implemented in Shanghai, which played a crucial role in mitigating the spread and impact of the disease. These strategies offer valuable insights for other regions worldwide.
Establishment of Fever Clinics and Telemedicine Services
One of the most effective strategies in controlling COVID-19 in Shanghai was the establishment of fever clinics for triaging patients. In areas with low infection incidence, most confirmed cases were imported. Patients presenting with symptoms of acute respiratory tract infections, such as fever and cough, often lacked specific exposure history, making it challenging to distinguish COVID-19 from other common respiratory infections like the flu or bacterial infections. Non-selectively admitting these patients into fever clinics would have led to unnecessary medical resource consumption and increased the risk of cross-infections.
To address this, Shanghai leveraged its telemedicine platform to provide online consultation services. Patients were advised to self-isolate at home or seek medical advice based on their epidemiological history and symptoms. This approach not only reduced the burden on offline clinics and emergency departments but also ensured equitable allocation of healthcare resources. As a result, the median duration from disease onset to hospital admission in Shanghai was 5.5 days, significantly shorter than the 12.5 days initially reported in Wuhan. This improvement can be attributed to the effective diagnostic workflow based on local epidemiology.
Diagnostic Workflow and Pathogen Identification
Accurate and timely pathogen identification is the gold standard for diagnosing infectious diseases. In Shanghai, designated hospitals widely used quick reverse transcription-polymerase chain reaction (RT-PCR) kits for COVID-19 detection, significantly shortening the diagnostic time frame. Fever clinics in most hospitals employed a comprehensive diagnostic approach, including complete blood count, C-reactive protein measurements, and chest computed tomography (CT) scans for screening suspected cases. Patients with characteristic imaging findings underwent respiratory viral tests. If the initial pathogen identification result was negative, RT-PCR testing for COVID-19 and chest CT scans were repeated within 48 to 72 hours.
Prediction Models for Disease Severity and Prognosis
Various prediction models, such as the pneumonia severity index and the CURB-65 score, have been widely used in the clinical diagnosis and treatment of community-acquired pneumonia. However, these models lack specific indicators for viral infections and exhibit poor sensitivity in predicting the severity and prognosis of viral pneumonia. To address this, an early warning model for predicting mortality in patients with viral pneumonia, known as the MuLBSTA score, was developed. This model, based on the clinical data of 528 patients diagnosed with viral pneumonia, was found to align with the characteristics and prognosis of 99 COVID-19 patients in Wuhan, as detailed in a Lancet article published on January 30, 2020.
Clinical Management and Treatment Strategies
The Shanghai Public Health Clinical Center served as the designated center for treating COVID-19 patients. All diagnosed patients were safely transferred to this center and admitted to general wards or intensive care units (ICUs). By March 2020, the cure rate in Shanghai had reached 80%. The Shanghai Expert Consensus on the Comprehensive Treatment of COVID-19, officially released on March 2, 2020, highlighted early indicators of disease progression. These included advanced age, complications with other systemic diseases, progressive worsening of lung parenchymal pathology exceeding 50% over 2 to 3 days, CD4+ T cell counts below 250/mL, significantly increased serum interleukin-6 levels, lactate dehydrogenase levels greater than twice the upper limit of normal, serum lactic acid levels of 3 mmol/L or higher, and metabolic alkalosis.
Medical experts in Shanghai emphasized personalized and precise therapies based on individual patient characteristics. High-risk patients were continuously monitored for changes in vital signs, laboratory parameters, and chest imaging findings. Early interventions to prevent the development of severe disease included the administration of antiviral drugs (with hydroxychloroquine recommended), effective oxygen therapy, immune system maintenance, enhanced supportive care, and a focus on internal homeostasis. Patients without significant risk factors were admitted to general wards with minimally intensive but essential surveillance and support, ensuring equitable allocation of medical resources.
Prevention of Nosocomial Infections
Preventing nosocomial infections was a key component of epidemic control in Shanghai hospitals. Health authorities implemented integrated management measures for both medical staff and patients. Training programs were organized to improve knowledge of COVID-19 and protective skills, particularly for staff in high-risk departments such as fever clinics, emergency departments, ICUs, and respiratory departments. Sufficient protective equipment and reasonable distribution of medical resources were ensured. Additionally, doctors and nurses were provided with nutrients and drugs to strengthen their immune systems and prevent infection.
For patients, the Shanghai government introduced a color-based Quick Response (QR) code system as a dynamic and real-time health status certificate for every citizen. Traditional questionnaires were replaced by electronic ones, which provided more accurate epidemiological information. Family visits to patients were strictly restricted to reduce the risk of nosocomial infection spread.
Societal Measures and Community Involvement
A decreasing trend in COVID-19 cases was observed in Shanghai starting from February 4, 2020. From February 19 to March 11, only 11 new cases were reported, and no new cases were reported after March 7. This success can be attributed to effective prevention and control measures implemented throughout society. The epidemic emerged around the Spring Festival, China’s most important traditional festival, making it particularly challenging to control its dissemination.
The Shanghai government canceled all rallies and events, imposed strict limitations on business hours and customer visits to public areas, reduced passenger flow, and launched strong public awareness campaigns. The public was educated on wearing masks and practicing hand hygiene through the internet and social media. Public transportation, including flights, trains, and buses, was reduced, and all airports, train stations, and entrances to Shanghai were closely monitored. Individuals suspected of having the disease were isolated for observation, and those presenting with fever were referred to designated fever clinics. According to data from the National Transportation Department, passenger flow in Shanghai decreased by approximately 70% during the 2020 Spring Festival.
Communities played a vital role in epidemic control by screening residents for symptoms such as fever and cough before allowing entry, conducting door-to-door checks to identify infected or suspected individuals, and providing assistance to those quarantined at home. Asymptomatic infections were recognized as an important source of transmission, and sufficient testing was conducted to detect COVID-19 in individuals with epidemiological risk or suspected exposure, even if they exhibited mild or no symptoms.
Conclusion
The strategies and measures implemented in Shanghai for controlling and managing COVID-19 have proven highly effective. From the establishment of fever clinics and telemedicine services to the use of advanced diagnostic tools and prediction models, Shanghai’s approach has significantly reduced the spread and impact of the disease. Personalized treatment strategies, prevention of nosocomial infections, and extensive societal measures have further contributed to the success. These experiences offer valuable lessons for other regions worldwide in their efforts to combat COVID-19.
doi.org/10.1097/CM9.0000000000000904
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