Clinicians’ Corner: Observations from Wuhan’s experience with COVID-19

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March 27, 2020

HRI spoke with Dr. Grace Shao, PwC Strategy& director, about her observations on how providers in Wuhan, China, responded to the outbreak of COVID-19 and what measures helped to reduce the number of cases reported over time. Shao received medical training in Wuhan and has been monitoring the situation there closely from the US. The measures described below were not in place during the earliest days of the outbreak, but helped control the spread once they were adopted.

In this occasional series, HRI talks with PwC leaders who are also clinicians.

PwC Health Research Institute (HRI)

Overall, what lessons can we draw from the experience in Wuhan, which saw significant numbers of COVID-19 cases?

Dr. Grace Shao, Director, PwC Strategy&

Currently, two types of strategies exist to treat the virus: containment and mitigation. Wuhan is a good example of the containment class. 

Containment means early prevention, early detection, early diagnosis, and early isolation. It involves rigorous screening, testing and isolation of suspected cases. In Wuhan, the strategy, at least for part of the time, was to admit patients into hospitals and care facilities and to quarantine personnel in close contact in single units until diagnosed or confirmed negative. 

HRI: What role did triage protocols play?

Dr. Grace Shao: Triage protocol seemed to be a very important factor in containing the spread. In Wuhan, once containment measures were put in place, a person identified as a PUI (person under investigation) would be isolated in a clinic to wait for test results.

The individual’s family and other people with close contact history were quarantined individually (i.e., one person, one room) at designated hotels or community apartments.

If positive, the person would get triaged based on the severity of the case. In Wuhan and China, they admitted patients; you don’t go home. 

Mild cases were triaged to the newly-built hospital, and stadiums were transformed into care facilities with single-patient cubicles. Severe or critical cases were transferred to an advanced hospital with a critical care unit and ICU that was designated to treat COVID-19. Cases that came in for emergency surgery or other main complaints were also directed to designated hospitals.

No patients were discharged to their homes; they were discharged to hotels or community housing for a 14-day quarantine period. Follow-up was required for two weeks and four weeks post-discharge.

HRI: How were population scans used to identify other COVID-19 cases in the outbreak area?

Dr. Grace Shao: People had to stay at home. Virtually nobody was allowed on the street except for police, community volunteers, doctors and delivery people delivering essential supplies. With volunteers from business and government, we saw that they would do a carpet city scan, going door to door to take temperatures and inquire about symptoms and contact history. If they identified a PUI, they triaged based on what I just described. Volunteers did the grocery shopping, and families would be notified when to pick up their supplies at a certain time.

People had to stay at home. Virtually nobody was allowed on the street except for police, community volunteers, doctors and delivery people delivering essential supplies. With volunteers from business and government, we saw that they would do a carpet city scan, going door to door to take temperatures and inquire about symptoms and contact history. If they identified a PUI, they triaged based on what I just described. Volunteers did the grocery shopping, and families would be notified when to pick up their supplies at a certain time.

HRI: What steps were put in place to improve the protection of healthcare workers?

Dr. Grace Shao: With a huge infusion of medical staff from all over the country, the management team aggregated the latest information and conducted constant training on prevention, clinical guidelines, triaging and self-protection. Not all of the medical staff were familiar with Level 3 protection measures, so they were retrained to apply protection measures correctly.

They also had staff in a buffer area to make sure medical staff were all gowned up and protected correctly. Medical staff would keep masks on even if they were out of the ward and in common areas such as offices and cafeterias.

After their shifts, the medical staff would go to hotels to stay in separate rooms. After they came off the “front lines,” they were quarantined for 14 days.

Non-front-line staff who were seeing non-COVID-19 patients took measures to set up zones in the clinics and offices to maintain space and prevent crowding. 

HRI: What steps were put in place to try to avoid burnout?

Dr. Grace Shao: Medical staff took four- to six-hour shifts in the wards every 24 hours. Shifts were not supposed to exceed six hours, which is why they also had a large team.

Because of so many unknowns—unknowns about the virus, the treatment, the outcome—it was important to keep information fluent and up to date to front-line staff.

They also had mental health specialists there for patients and the front-line staff. It’s a tough situation to be in, so they needed someone to talk to. 

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