Speech of Mr Gao Qiang, Executive Vice Minister, Ministry of Health, People's Republic of China
Mr Chairman,
Six months has passed since the first SARS case was reported in the world. The international community, through unity and cooperation, has waged an unprecedented war against SARS and made significant progress. This WHO Global SARS Meeting is a major event in the global fight against SARS where delegates and experts from all over the world can share information and experience and discuss the strategy to win the final victory over SARS. The Chinese delegation wishes the meeting a complete success. Next I will take this opportunity to share our SARS control experience with delegates from other countries.
I. Development of the SARS epidemic in China
SARS was first reported in Guangdong Province of China in January this year. Then it spread to other parts of China. As of 10 am, June 16, apart from the 6 provinces of Hainan, Guizhou, Yunnan, Tibet, Qinghai and Heilongjiang, 25 provinces in the mainland of China have reported SARS probable cases. The cumulative number of probable cases reported was 5327, or which 969 were health care workers. The total number of recoveries is 4656 or 87%. The total number of deaths is 346 and the case fatality rate is 6.5%. There are still 50 suspected cases.
The SARS epidemic in China experienced three stages: onset stage, spread stage and decline stage. The first stage is the first three months of this year. The epidemic was mainly in Guangzhou city of Guangdong province. By the end of March, the total number of probable SARS cases was 1190, among which 1153 or 96.9% was in Guangdong Province. 1030 cases were in Guangzhou city. The second stage was in April. During this period, the epidemic spread to Beijing, Inner Mongolia, Shanxi, Tianjin, Hebei and many other provinces. By the end of April, a total of 3460 probable cases were reported. The third stage was May and June. The epidemic showed a national downward trend and was gradually put under control. The average number of new cases each day was 150 in the first 10 days of May; 45 cases in the second 10 days and 13 cases in the last 10 days. At the end of May, the number of recoveries exceeded that of new cases and the number of discarded cases exceeded that of new suspected cases. In the first 16 days of June, 4 days have reported less than 5 cases per day and the other 12 days have reported no probable cases. On June 13, WHO lifted the travel recommendations to Inner Mongolia, Shanxi, Hebei and Tianjin and removed all provinces that have reported SARS but Beijing from the list of areas with local transmission. This shows that the SARS control work in China has won international recognition.
II. Measures and strategies
Looking back, we have learned important lessons and also paid a heavy price. Our response at the very beginning was insufficient due to the lack of understanding of this deadly new disease, weaknesses in our public health system, inadequate preparedness for public health emergencies, fragmented organization and coordination, inadequate laws and regulations, slow communication of information and an inadequate alert system. With the development of the epidemic, the Chinese government soon realized the severity of the disease and acted quickly and responsibly to safeguard people’s health and safety. The decisive measures we have taken have achieved noticeable effects and we have accumulated valuable experience in the prevention and control of SARS. Our major interventions are:
1. Enhance government commitment and legislation
The Chinese government gives high priority to SARS. President Hu Jintao, Premier Wen Jiabao and other national leaders visited SARS affected areas and health care workers to provide guidance. They clearly instructed that people’s health and safety must be put in the first place and SARS be made No. 1 priority of government work. The State Council established the national SARS committee and Vice Premier Wu Yi is the chairperson. She is also appointed the Minister of Health. In this way the government enhanced leadership over health and established a unified, efficient SARS response system. The State Council has sent supervisory teams to all 31 provinces to examine the implementation of local control measures. Local governments at various levels have also established local SARS committees and work mechanisms. Different sectors work in their respective areas and cooperate with each other. SARS was made one of the notifiable infectious diseases and managed according to the Law of Prevention and Control of Infectious Diseases. The State Council passed the Regulations on Public Health Emergency Alert and Response and the Ministry of Health adopted the Circular on SARS Prevention and Control. Through these legislative efforts, SARS control was incorporated into the legal framework.
2. Improve surveillance and reporting
On February 11, China reported the epidemic to the public. The Ministry of Health started surveillance over SARS and developed the national SARS case definition and relevant technical protocols. In particular, after April 20, SARS data was reported, analyzed, feedback and managed through the national disease reporting and management information system. A national SARS surveillance system was established down to village level, connecting upward with township and county levels. Epidemiologists were organized to trace close contacts of cases and suspected cases. Close contacts were put under medical observation for two weeks to achieve early detection, early reporting, early isolation and early treatment. Daily reporting system and zero reporting system were established. The epidemic information was reported to WHO and the public on a daily basis.
3. Strict infection control to prevent the spread of the disease
Preventing SARS from spreading to rural areas has always been a top priority due to the large population, low economic level and poor health services in rural areas. We established a strong prevention and control system by mobilizing the farmers. Towns and villages built prevention defense lines and enhanced quarantine measures. Up till now, only 242 or 4.5% of the cases are farmers. To reduce hospital infection, we have adopted comprehensive hospital infection measures focusing on the control of source of infection. National guidelines on hospital infection control and protection of health care workers were developed. Feces, secretions and bodies of SARS patients and other medical waste were disinfected strictly, incinerated and properly disposed of. In the meantime, sites of SARS clusters were sealed off; surveillance over mobile populations enhanced; body temperature screened for students in schools each morning; some schools temporarily closed; affected sites and contaminated areas disinfected; SARS health education carried out to publicize SARS knowledge; patriotic health campaign organized and quarantine measures were taken in major transport control points. Passenger monitoring, registration, observation and follow-up systems were established in civil aviation, railway, long distance bus, boat and other public transport systems. Health declaration cards were distributed. All these measures have effectively prevented the further spread of SARS.
4. Make all efforts to treat patients
Fever clinics and designated SARS hospitals were set up in all provinces and medical infrastructure and technical expertise were improved. Based on the national case definition, recommended treatment regimens, discharge criteria and other technical protocols, all provinces have converted some of the tertiary hospitals and medical centers into SARS hospitals, improved ICU facilities, and disseminated treatment regimens combining both western medicine and traditional Chinese medicine. Priority was given to the care of severe cases and elderly cases. This has helped to reduce the case fatality rate. Probable cases and suspected cases are isolated and treated separately in designated hospitals. Close contacts are quarantined either at home or in designated places. Expert group consultation was organized to reduce misdiagnosis and underdiagnosis. Central government allocated special budget to provide free treatment to farmers and urban residents who have financial difficulties.
5. Enhance scientific research
The Ministry of Science and Technology is coordinating the national scientific research into SARS, including etiology, routes of transmission, prevention measures, rapid diagnosis, clinical treatment, rehabilitation and sources of the virus, in cooperation with the international community. Progress and results have been achieved in etiology, epidemiological features, diagnostic reagents and treatment with the integration of western medicine and traditional Chinese medicine through multi-disciplinary cooperation. Technical protocols were revised based on scientific findings.
III. Experience and Lessons
SARS is a common disaster for mankind and China is its largest victim. We lost a lot and also learned a lot. We are willing to share with the delegates our experiences and lessons. They are:
1. Strong government leadership. Prevention and control of infectious diseases is a major component of public health and a major responsibility of the government. SARS can only be defeated by government acting in a responsible way to safeguard health and life of its people, exercising unified leadership, multi-sectoral cooperation and establishing a strong commanding system.
2. Improving legislations. Running a country according to law is our national policy and managing government work according to law is a basic requirement of the government. The prevention and control of infectious diseases must be based on law. Different sectors and levels of governments must honor their duties, implement their respective responsibilities, stand unified in mind and action and manage SARS in a standardized and orderly way.
3. Relying on science and technology. The history of mankind defeating infectious diseases is also a history of scientific development. In today’s world of rapid scientific advancement, control and elimination of SARS as a public health threat needs to rely on scientific breakthroughs in prevention, diagnosis and treatment. In the short period of the past few months, science has played an important role. The causative agent was found with unprecedented speed and rapid development was achieved in effective diagnosis and control measures. Exploration was also made in vaccine and specific treatment. Science is the most powerful weapon to completely eradicate SARS.
4. Mobilizing the whole society. People are owners of a country. Once they master the SARS knowledge, they will become fighters to protect their own health and prevent and contain the spread of SARS. In the past few months, the Chinese people were not frightened by SARS, instead, at the call of the government, they united in heart and mind and invented many ways to control SARS both individually and collectively. The mobilization of the public has played an indispensable role in containing the spread of SARS.
5. Extensive international cooperation. SARS has no boundaries. The complete control and eradication of SARS relies on the common efforts of all mankind. The prevention and control of SARS in China has won the understanding, support and assistance of the international community, especially WHO. In this process, WHO has sent a large number of officials and experts to China to work in the fields of surveillance and response, information technology, communication with the media, clinical management, hospital infection control, laboratory testing, engineering and travel management. Here, on behalf of the Chinese government, I’d like to express heartfelt thanks to WHO for its support.
Ladies and gentlemen,
At present, SARS prevention and control in China have been standardized and become part of our regular work. Our control efforts have achieved noticeable effects. Socioeconomic life is gradually returning to normal and we are working towards the elimination of SARS. However, we clearly know that the work of eliminating SARS is far from completed and the task of preventing the resurgence and spread of SARS is still heavy. We must continue our vigilance, keep on high alert, and continue cost-effective control measures until we win the final victory over SARS.
In the meantime, we will strengthen government responsibilities in public health and control of infectious diseases, increase government inputs, improve the public health emergency alert and response system, disease control system and outbreak reporting system, strengthen the medical treatment system, particularly the rural health care system, and strengthen international cooperation to so as to make more contributions to the health of the Chinese people and people all over the world.
Thank you.