key: cord-0916837-yncda1us authors: Ruan, Linhui; Wen, Min; Zeng, Qingrun; Chen, Chengshui; Huang, Shengwei; Yang, Su; Yang, Jianjing; Wang, Jingqiang; Hu, Yuhuan; Ding, Saidan; Zhang, Ying; Zhang, Hongxia; Feng, Yuanjing; Jin, Kunlin; ZhuGe, Qichuan title: New measures for COVID-19 response: a lesson from the Wenzhou experience date: 2020-04-03 journal: Clin Infect Dis DOI: 10.1093/cid/ciaa386 sha: 870f882292822142740040d4b4f7cfd2e73c4fb2 doc_id: 916837 cord_uid: yncda1us As the outbreak of COVID-19 has spread globally, determining how to prevent the spread is of paramount importance. We reported the effectiveness of different responses of four affected cities in preventing the COVID-19 spread. We expect Wenzhou anti-COVID-19 measures may provide experience for cities around the world that are experiencing this epidemic. to prevent the spread is of paramount importance. Wenzhou, a coastal city in southern China with a resident population of 9.25 million, was the most heavily affected with respect to COVID-19 infections outside of Hubei Province. This is the result of the more than 90,000 people who return to Wenzhou from Wuhan during On January 17 when the first case of COVID-19 was confirmed, the Wenzhou New Coronavirus Pneumonia Prevention and Control Committee launched emergency epidemic prevention and control measures, which in general consisted of two phases. Wenzhou's first-phase prevention and control measures (first-phase measures) were moderate preventive measures undertaken from January 17 to January 30, 2020. The main measures included (1) centralizing the confirmed and suspected patients in designated hospitals for treatment, (2) identifying and investigating all returnees from Wuhan using a big data network and persuading them to undergo 14-day home quarantine, and (3) centralizing and medically observing individuals who had been exposed to a confirmed COVID-19 patient. Wenzhou's second-phase prevention and control measures (second-phase measures, also called "Wenzhou anti-COVID-19 measures") consisted of the most aggressive social distancing and quarantining measures and were carried out from January 31 to February 20, 2020. The measures were referred to as "25 emergency measures for Wenzhou epidemic prevention and control" and mainly focused on pinpointing the infection source and completely cutting off any transmission routes. The measures are summarized as follows: 1) Shutdown of city. All traffic in and around Wenzhou, including airports, high-speed rail stations and bus stations, was cut off. Only five access points to the expressway were open for transportation of prevention and control materials and necessities, and these were under strict monitoring. 2) Lockdown of communities. All places of public gatherings were shut down, including malls, public entertainment facilities, group meetings, restaurants and hotels. The committee enforced crowd-grid management using communities and villages as individual units; se Inspection stations were set up in major locations, and all entrants were interviewed and registered, with body temperature monitoring. In addition, all individuals were required to stay at home, and daily necessities were delivered in real time. 3) Tracking and inspection. A combination of mobile big data, network searches, screening at city entrances, etc. was used to track and investigate individuals at risk of infection in a timely manner. All COVID-19 contacts and suspected patients were isolated for quarantining. The confirmed cases were rapidly transferred to designated hospitals for treatment. The implementation of the first-phage measures significantly reduced the incidence of imported cases from other cities, suggesting that these measures were effective for import prevention, but did not block the COVID-19 outbreak in the city. Moderate preventive measures were also implemented in Huanggang, Xiaogan and Jingzhou, cities in the region surrounding Wuhan. The COVID-19 onset time and populations in these three cities were similar to those in Wenzhou, and thus the epidemic was occurring in parallel ( Figure 1A ). However, after January 31, the incidence curves in the four cities were notably different. Subsequent outbreaks were observed in Huanggang, Xiaogan and Jingzhou but not in Wenzhou. However, the numbers of new cases in these cities were meaningfully reduced after implementation of most aggressive social distancing and quarantining measures, which was similar to Wenzhou second-phase measures on February 10 ( Figure 1A) . These data suggest that the "Wenzhou Anti-COVID19 Measures" were effective in controlling the spread of COVID-19. Of the 504 patients in Wenzhou, 434 patients were mild, and 62 were severe and 8 were critically severe, 502 patients had been discharged and 1 patient (0.2% mortality) had died, 1 patient was still in critical condition. 268 (53.2%) were male, and the median patient age was 47 (range, 2-93). The average time to diagnosis for the patients was 5.5 days (range from 1-21 days A comparative analysis was conducted in four cities. The incidence curves in these cities were very similar before January 31. Wenzhou's first incidence peak appeared on January 29, and then it declined steadily. No second peak was found thereafter. However, Huanggang, Xiaogan and Jingzhou all had their second and even third incidence peaks after January 31 ( Figure 1B) . These three cities implemented rigorous measures that were similar to the "Wenzhou Anti-COVID19 measures" on February 10, 14 and 15, respectively. As a result, the outbreak of COVID-19 in these three cities was gradually placed under control. an R0 value of 3.11 (95% CI, 2.39-4.13), suggesting that COVID-19 is very contagious. In general, an epidemic will increase as long as R0 > 1, and control measures aim to reduce the R0 <1. The R0 of SARS has been estimated to be ~3 9 and SARS outbreaks has been successfully controlled by isolation of patients and careful infection control 10 . Therefore, Wenzhou anti-COVID-19 measures were the extremely rapidly response in COVID-19 crisis. These data suggest that the most aggressive social distancing and quarantining measures (Wenzhou anti-COVID19 measures) in the second phase were effective in controlling the COVID-19 spread. Wenzhou anti-COVID-19 measures may provide valuable experience for other cities around the world that are experiencing this epidemic. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia When will be the resumption of work in Wuhan and its surrounding areas during COVID-19 epidemic? A data-driven network modeling analysis (in Chinese) Update on the new coronavirus pneumonia outbreak as of 24:00 on 13 March National Health Commission of the People's Republic of China Update on the new coronavirus pneumonia outbreak as of 24:00 on 13 March Wenzhou Municipal Health Commission Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study Novel coronavirus 2019-nCoV: early estimation of epidemiological parameters and epidemic predictions Dynamically modeling SARS and other newly emerging respiratory ill-nesses: past, present, and future Coronavirus infections -more than just the common cold Hubei Province after implementation of the 1 st (black arrow) and 2 nd phase measures The effect of different anti-COVID-19 measures on the cumulative number of new cases of COVID-19 in Daily numbers of new cases by date of onset of symptoms (blue) after implementation of Wenzhou anti-COVID-19 measures and the number of estimated symptomatic cases (red line) without execution of Wenzhou anti-COVID-measures are plotted. Three basic reproduction numbers (R0) were estimated with three stages (first stage This work was supported by grants from National Natural Science Foundation of China (81771262，61976190) and International (Regional) Cooperation and Exchange Projects of the National Natural Science Foundation of China (81820108011), and the Key Project of Science Technology Department of Zhejiang Province (2017C03027) .