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Review | Open Access

Innovative public strategies in response to COVID‐19: A review of practices from China

You Wu1,2,3, Zijian Cao1,4, Jing Yang1,5, Xinran Bi1,4, Weiqing Xiong1,4, Xiaoru Feng1,4, Yue Yan1,4, Zeyu Zhang1, Zongjiu Zhang1()
School of Healthcare Management, Tsinghua Medicine, Tsinghua University, Beijing, China
School of Basic Medical Sciences, Tsinghua Medicine, Tsinghua University, Beijing, China
Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
School of Biomedical Engineering, Tsinghua Medicine, Tsinghua University, Beijing, China
Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China

You Wu and Zijian Cao contributed equally to the work.

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China's COVID‐19 response: infrastructure, medical care, prevention, resilience, and global health engagement. Highlighted China's top‐down command system, intersectoral coordination, and social governance effectiveness. Focused on coordinated emergency response, evidence‐based treatment, strategic vaccine rollout, and IT support in healthcare.

Abstract

The COVID‐19 pandemic presented unparalleled challenges to prompt and adaptive responses from nations worldwide. This review examines China's multifaceted approach to the crisis, focusing on five key areas of response: infrastructure and system design, medical care and treatment, disease prevention and control, economic and social resilience, and China's engagement in global health. This review demonstrates the effectiveness of a top‐down command system at the national level, intersectoral coordination, a legal framework, and public social governance. This study also examines medical care and treatment strategies, highlighting the importance of rapid emergency response, evidence‐based treatment, and well‐planned vaccination rollout. Further discussion on disease prevention and control measures emphasizes the importance of adaptive measures, timely infection control, transmission interruption, population herd immunity, and technology applications. Socioeconomic impact was also assessed, detailing strategies for disease prevention, material supply, livelihood preservation, and social economy revival. Lastly, we examine China's contributions to the global health community, with a focus on knowledge‐sharing, information exchange, and multilateral assistance. While it is true that each nation's response must be tailored to its own context, there are universal lessons to be drawn from China's approach. These insights are pivotal for enhancing global health security, especially as the world navigates evolving health crises.

Keywords

COVID‐19emergency responsehealth care managementpandemic

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Health Care Science
Volume 3 Issue 6,
December 2024
Pages 383-408
DOI: 10.1002/hcs2.122
Cite this article:
Wu Y, Cao Z, Yang J, et al. Innovative public strategies in response to COVID‐19: A review of practices from China. Health Care Science, 2024, 3(6): 383-408. https://doi.org/10.1002/hcs2.122
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COVID‐19 prevention and control strategies during three transitional phases in China [56, 84, 90].

Time periods20th January 2020 to 10th November 202211th November 2022 to 7th January 20238th January 2023 to date
PhaseWhen COVID‐19 was classified as a Class B infectious disease but subject to the preventive and control measures of Class A infectious diseasesTransitional periodWhen COVID‐19 is managed with measures of Class B infectious diseases
Prevention and Control PolicyDynamic zero‐Covid policyFocusing on ensuring public health and preventing severe cases
Timely control of infection sourcesTesting and detectionNucleic acid & antigen testing(1) Conducting regular nucleic acid testing for the general population(2) Conducting testing for all those in need, especially for at‐risk populations and institutions 2–7 times/week(3) Determining the scope of the population to be tested according to the risk level, and conducting regional nucleic acid testing if necessary(4) Nucleic acid testing as the primary testing method, supplemented by antigen testing(1) Reducing frequency of nucleic acid testing(2) Increasing use of antigen testing(1) Detecting infected cases mainly through clinic visits(2) Health monitoring at home(3) Testing of key populations
Surveillance and early warning systems(1) Multi‐departments joint prevention and control measures such as ventilation disinfection and body temperature measurement in public gathering places(2) Nucleic acid testing at key stalls in large markets (especially seafood markets)(3) Routine sewage testing(4) Surveillance at sentinel sites such as pharmacies and fever clinics(5) Close monitoring of variant strains
Case reportingImmediate report required for suspected cases, clinically diagnosed cases, confirmed cases, and asymptomatic carriers through the Emergency Public Reporting System (EPRS) within 2 hReporting required for suspected cases, clinically diagnosed cases, confirmed cases, and asymptomatic carriers through the Emergency Public Reporting System (EPRS) within 24 h
Management of peopleConfirmed casesBeing transferred to designated medical institutions or fangcang shelter hospitals for medical treatment or applying medical observation in a centralized isolation siteAsymptomatic and mild cases being isolated at home if home‐based protocols were met(1) Taking necessary treatment and measures to control transmission according to the condition(2) Confirmed cases shall not go out unless necessary
Suspected casesIndividual isolation and immediate nucleic acid confirmationImmediate nucleic acid and antigen testingVoluntary at‐home health monitoring
Close contact7 days of quarantine at designated facilities and 3 days of at‐home health monitoringGradual transition from 5‐day centralized quarantine and 3‐day home quarantine to 5‐day at‐home or voluntary centralized quarantine
Secondary contact7 days of self‐quarantine at homeNo longer identified
People from high‐risk areas7 days of quarantine at designated facilities7 days of self‐quarantine at home
Workers in high‐risk positions exiting closed‐loop operations7 days of quarantine at designated facilities or at home5 days of at‐home health monitoring
Border controlInbound flights(1) Circuit breaker bans for incoming flights(2) Requirement of 2 negative nucleic acid tests within 48 h before boarding(1) Scraping circuit breaker bans for incoming flights(2) Requirement of 1 negative nucleic acid tests within 48 h before boarding(1) Closed‐loop transfer and centralized quarantine measures no longer being implemented(2) Incoming personnel being required by customs to fill in a health declaration card ‐ those with normal declarations and no abnormalities in routine quarantine at customs ports being allowed to enter directly
Inbound arrivals7 days of quarantine at designated facilities and 3 days of at‐home health monitoring5 days of quarantine at designated facilities and 3 days of at‐home health monitoring
Inbound goodsPerforming preventive disinfection to all inbound items, as well as implementing sampling and monitoring of imported cold‐chain productsNo longer implementing preventive disinfection to all inbound items nor sampling or monitoring of imported cold chain food
Interruption of transmission routesEpidemiological investigationBig data, artificial intelligence and other technologies applied to identify every infected person and track every close contact for quarantinePrecise epidemiological investigations no longer being mandatory
Management of areas(1) Classifying risk areas as high, medium or low(2) High‐risk areas: staying at home, door‐to‐door service(3) Medium‐risk areas: staying within the area, avoiding gathering(4) Low‐risk areas: individuals protection, avoiding gathering(1) The regional classifications adjusted from “high, medium, and low risk” to “high and low risk” to minimize the number of restricted persons(2) High risk areas mostly confined to residential units or blocks, and not being extended at will(3) Mass nucleic acid testing no longer organized at the level of administrative areasPrevention and control measures focused on critical places, institutions, and groups of people
Non‐pharmaceutical interventionPromoting mask wearing, proper social distancing, avoiding crowds, frequent handwashing, and regular ventilation
Building population immunity barrierVaccination(1) Promoting vaccination among the elderly, people with chronic illnesses, and children(2) Expanding coverage of booster shots and rolling out sequential booster immunization based on technologies different from those used in initial inoculations(3) Continuously promoting vaccine development and optimizing vaccination strategies based on progress of research development and clinical trials
Protecting vulnerable groupsEmphasizing on the protection of nursing homes, schools, childcare institutions and medical institutions, etc. Some of these institutions having more stringent restrictions on the mobility of peopleEmphasizing on protecting places in which vulnerable people are located, but with reduced mobility restrictions

Timeline of COVID‐19 vaccine and drug development in China.

2020202120222023
Note: Timeline of COVID‐19 vaccine and drug development in China. aSinopharm (Beijing): Inactivated COVID‐19 Vaccine (Vero Cell), developed by Beijing Institute of Biological Products. bSinopharm (Wuhan): Inactivated COVID‐19 Vaccine (Vero Cell), developed by Wuhan Institute of Biological Products. cSinovac‐CoronaVac: Sinovac COVID‐19 vaccine, developed by Sinovac Biotech. dAd5‐nCoV: Trade‐named Convidecia, developed by CanSino Biologics. eZF2001: Trade‐named Zifivax or ZF‐UZ‐VAC‐2001, developed by Anhui Zhifei Longcom in collaboration with the Institute of Microbiology at the Chinese Academy of Sciences. fKCONVAC: Minhai COVID‐19 vaccine, developed by Shenzhen Kangtai Biological Products Co., Ltd and its subsidiary, Beijing Minhai Biotechnology Co., Ltd. gIMBCAMS: a COVID‐19 vaccine developed by Institute of Medical Biology, Chinese Academy of Medical Sciences. hLikang V‐01: a COVID‐19 vaccine developed by a subsidiary of Livzon Pharmaceutical Group Inc. iSCB‐2019: a COVID‐19 vaccine developed by Clover Biopharmaceuticals. jSCTV01C: a COVID‐19 vaccine developed by Sinocelltech. kWSK‐V101: a COVID‐19 vaccine candidate developed by WestVac BioPharma Co., Ltd. and West China Hospita, Sichuan University. ldNS1‐RBD: CA4‐dNS1‐nCoV‐RBD, developed by Xiamen University, the University of Hong Kong, and Beijing Wantai Biological Pharmacy Enterprise. mSCTV01E: a COVID‐19 vaccine developed by SinoCellTech. nSYS6006: a SARS‐CoV‐2 mRNA vaccine developed by Zhongqi Pharmaceutical Technology Co., Ltd. of CSPC Pharmaceutical Group. oWSK‐V102C: a trivalent recombinant protein vaccines targeting XBB.1.5 developed by WestVac BioPharma Co., Ltd and West China Hospita, Sichuan University. pBRII‐196 and BRII‐198 are investigational, neutralizing monoclonal antibodies manufactured by Brii Biosciences. qVV116 is an oral drug of nucleoside analog against SARS‐CoV‐2, developed by Junshi Biosciences. rSIM0417 is an oral small‐mol‐ecule antiviral agent that targets the SARS‐CoV‐2 3CLpro, developed by Simcere Pharmaceutical Co., Ltd. sRAY1216 is a novel α‐ketoamide based peptidomimetic inhibitor of SARS‐CoV‐2 main protease, developed by Guangdong Zhongsheng Pharmaceutical Co., Ltd.
Inactivated vaccinesSinopharm (Beijing) (Jun 30),Sinovac‐CoronaVac (Feb 15),
Sinopharm (Wuhan) (Dec 30)KCONVAC (May 14),
IMBCAMS (Jun 6)
Adenovirus‐vectored vaccinesAd5‐nCoV (Intramuscular injection) (Feb 24)Ad5‐nCoV (aerosolise) (Sep 15)
Protein subunit vaccinesZifivax (Mar 18)Likang V‐01 (Sep 15),SCTV01E (Mar 22)
SCTV01C (Dec 4),
SCB‐2019 (Dec 4),
WestVac Biopharma (Dec 5)
Vaccines using attenuated influenza virus as vectorsdNS1‐RBD (Dec 5)
Nucleic acid vaccinesSYS6006 (Mar 23)
Neutralizing antibodyBRII‐196/BRII‐198 (Dec 8)
Small‐molecular drugAzovudine approved for the treatment of COVID‐19 infection (Jul 25)VV116 (Jan 29),
SIM0417 (Jan 29),
RAY1216 (Mar 23)

International assistance initiated by China during the COVID‐19 pandemic.

China\'s global engagementReceiverQuantity
Source: Seventy‐Sixth World Health Assembly held in Geneva, Switzerland, from May 21 to 30, 2023 (2023 marks the 60th anniversary of the dispatch of Chinese medical teams to foreign countries). Abbreviation: WHO, World Health Organization.
Financial assistance
WHO50 million dollars
COVID‐19 Vaccines Global Access (COVAX)100 million dollars
Supply assistance
  Protective suits153 Countries4.6 billion
  Face masks15+430 billion
  Testing ReagentsIntl. Organizations18 billion
  Doses of vaccine120+ CountriesMore than 2.2 billion
& Intl. Organizations
Medical support
  COVID‐19 Expert groups34 Countries38 groups
  Introduce the diagnosis & treatment plan of traditional Chinese medicine150+Depends on their demand
  Provide Chinese medicine productsCountries & Regions
Knowledge sharing
  Training courses56 Countries400+
  Exchanging views at high level180+ Countries & Regions,50+
  Technical exchange activities10+ Intl. Organizations300+

Laws and regulations related to infectious disease prevention and control in The People\'s Republic of China (PRC).

TitleEnactment Date
LawLaw of the PRC on the Prevention and Treatment of Infectious Diseases1989/9/1
Law of the PRC on Public Security Administration Punishments (excerpt)1987/1/1
Law of the PRC on Wildlife Protection (excerpt)1989/3/1
Law of the PRC on Criminal Offenses (excerpt)1997/10/1
Law of the PRC on Emergency Response2007/11/1
Law of the PRC on Basic Healthcare and Health Promotion2020/6/1
Law of the PRC on Animal Epidemic Prevention (excerpt)2021/5/1
Administrative regulationsImplementation Measures of the Law of the PRC on Prevention and Treatment of Infectious Diseases1991/12/6
Implementation Rules of the Law of the PRC on Border Health Quarantine1989/3/6
Regulations on Hygiene Management of Public Places1987/4/1
Regulations on Health Quarantine for Domestic Transport1999/3/1
Regulations on the Emergency Response to Public Health Emergencies2003/5/9
Regulations on the Emergency Response to Major Animal Epidemics2005/11/16