Thread by @juliaoftoronto

.@WHO press briefing just stared. Bruce Aylward, who led WHO's #covid19 mission to China, is sharing findings of what they saw there.

@WHO Team started in Beijing, met with people at diff levels of government to get a sense of how the response was working.

From there, team went in 2 directions: Guandong province, and another group went to Sichuan. And then at end of mission, some went to Wuhan.

@WHO What has China done?

"They've approached a brand new virus... taken standard, old-fashioned, basic public health tools and applied these with a rigor and innovation of approach on a scale we've never seen in history."

@WHO That includes contact tracing, social distancing, quarantine, etc.

"Chinese took a very pragmatic approach and decided we are going to go after containment of this virus using that set of tools," Alyward said.

@WHO A lot of people on the team were concerned about whether you can stop this kind of virus, Aylward says, but they made it work. They had a few key fundamentals:

1) differentiated approach - if 0 cases, scattered cases, community transmission, they adapted their response ...

@WHO 2) instilled sense of responsibility and accountability in the society -- collective action.

3) they repurposed people's roles to respond to the outbreak

4) "tech turbocharged response" -- using big data and AI in places...

@WHO moved lots of things online: because of the number of cases, had to take hospitals out of general service and repurposed them for the response... and shifted "a whole chunk of work" online to keep regular health services going -- like prescriptions.

@WHO 5) science driven response: China has already 6 guidelines for health providers

They applied all this to a "rapidly escalating epidemic."

"What China demonstrates is where this goes is in the control of our decisions to apply this kind of rigor and approach to this disease."

@WHO Aylward: "There was a lot of latitude ... provinces, counties, towns could adapt [response] as they need it to make it work for them."

@WHO Aylward says "China changed the course of this outbreak."

All these measures, he says, are what led to the #covid19 epidemic curve coming down in China.

@WHO How many cases prevented or delayed? "It's hundreds of thousands of people in China did not get Covid-19 because of this aggressive response," says Aylward.

And they reduced the chances of it going elsewhere.

@WHO Aylward says there's a question of whether this response really brought the outbreak down? Is the China effect real?

"It can... that's the core message."

@WHO Again, message is that countries need to be ready, do practical things to respond and be ready for pandemic.

My question: is what China did really practical for other countries? Maybe some aspects of response are but how about the concerns about human rights violations?

@WHO Aylward: "Cases are down but they're not zero.. .still a lot of disease in the country that's gotta be dealt with."

People who get sick end up in hospital anywhere from 2-6 weeks — so still thousands in hospital.

@WHO Numbers in China can tell rest of world how many hospital beds/ventilators etc they need to plan for.

Nice breakdown here:
jamanetwork.com/journals/jama/…

@WHO As soon as countries see cases, he says, they have to be ready to stop this at a larger scale.

The world "is simply not ready."

@WHO Public health officials need to get population involved -- hand washing, etc.

"Things are going to change rapidly" and need trust to keep people engaged and ways to communicate.

World also needs "access to expertise of China."

@WHO Aylward: "What China did... you can effect the course of this disease, you can change the shape of this, but it takes a very aggressive, tough program."

Reminder about the human rights concerns over China's response: vox.com/2020/2/10/2112…

@WHO Important finding: not huge transmission beyond what you can see clinically, Aylward says. I think that means subclinical/asymp transmission is not that significant.

Also: "Main driver is not widespread community transmission;" it's transmission in households.

#covid19

@WHO Reminder from Aylward: "Young people do die of this disease and they die in industrialized countries."

(Risk increases with age but there are deaths in young.)

He says death rate in China might be low relative to other countries since they are doing good job keeping ppl alive

@WHO Aylward on #covid19 healthcare worker infections: in China, "most got infected in the community..." not in hospital

Interesting.

@WHO Aylward clarifies point on not finding more mild #covid19 cases in China: says they didn't find a lot of evidence of mild cases, but serology tests needed to help clarify.

Only knew this disease for 7 weeks...

And on asymptomatic cases: "doesn't look like it's a big part of the picture" of spread of #covid19 <-- this makes sense since it's true 4 other similar viruses.

Warning to countries: "Think this virus is going to show up tomorrow," Aylward... "we're so much more connected."

How can countries prepare for #covid19? Need beds to isolate people, plan to quarantine the really close contacts, oxygen support, lab capacity to test thousands of people per day, Aylward says

(note, doesn't mention a China-like cordon sanitaire)

Also says countries should talk to their populations:

Wash hands
Don't run on masks
Let them know you'll take care for them
Talk to people who have responded (like China)

Two antibody tests were just licensed in China (to test population for antibodies of #covid19 virus), Aylward says, but he's thin on the details

This means, though, we may soon have a sense of how widely virus is spreading, what the actual case fatality rate is, etc.

"This is the time for a Manhattan project," Aylward says of #covid19. "Get ready."