1. Abstract
In the past century, five influenza pandemics have been witnessed globally. They are the Spanish flu of 1918, the Asian flu of 1957, the Hong Kong flu of 1968, the Russian flu of 1977, and the H1N1 of 2009. H1N1 was known as a severe acute respiratory syndrome or SARS. The five influenza outbreaks have had a lot of influence on Chinese policy towards dealing with pandemics. Three of the epidemics the Asia flu, the Hong Kong flu, and SARS all originated from China. The last two outbreaks that have occurred in recent history have been extensively characterized and study due to advances in modern virology. All the major influenza pandemics that have not been predicted or bear any similarities. Medical research has established that the source of many influenza outbreaks is the mutation of many hemagglutinin subtypes of some animal influenza strains. The previous pandemics have invoked a pandemic awareness through characterization and configuration of the outbreaks. Influenza strains exhibit different characteristics when it comes to morbidity and mortality. SARS was traced to cave bats in Yunnan province currently, the world is facing a pandemic caused by the novel coronavirus. The WHO reported pneumonia infections with unknown etiology in the Wuhan province of China. In January of 2020, the causative agent was identified as a coronavirus (covid_19). Various studies were done during the time of SARS to gather as much knowledge that will assist helps the governments handle future pandemics more effectively.
Table of Contents
3.1 The SARS fiasco in china. 4
3.2Government role in handling pandemic. 4
3.2.1 Framework preparedness. 4
4.1Why did this study settle for systematic research and meta-analysis. 5
4.2 review inclusion criteria. 6
6.1 effects of the lockdown. 9
6.2 successful dissemination of information and adherence to guidelines. 9
2. Introduction
Pandemics are referred to as epidemics on the scale of their spread, infection rates, and the number of people who succumb to it. The advancement of knowledge on different influenza strains, refinement of laboratory testing, and surveillance techniques has reduced the vulnerability of humanity to influenza strains. Although a number of patients lose their lives, the mortality rates have been brought down by the pandemic. Today humanity is not as hapless as they were during the Spanish flu. In order to manage pandemics are militate against their severity, the WHO is encouraging governments to set up and revamp influenza preparedness programs and response initiatives. These should work in tandem with influenza surveillance and early detection programs. Upon identification of a potential epidemic, the containment measures thereafter are vital in militating against a high peak of the epidemic. With each passing new strain, new data on preparedness, and response to the next strain is refined. China is the epicenter of the last two pandemics, has been improving on the strategies to enhance preparedness and preparedness to influenza epidemics at different stages. A lot of emphases should be laid on preparedness at different stages historically in regard to readiness for future outbreaks. This paper seeks to answer the question could the experience of dealing with Severe Acute Respiratory Syndrome (SARS) help the Chinese government to face the challenge of Coronavirus Disease 2019 (Covid-19) regarding the effectiveness of public policy, health system function and government transparency.
The last SARS outbreak emphasized the need for radical containment measures at the identified hotspot in order to prevent the spread of the epidemic. Fighting an influenza pandemic is not a matter to be left to the health workers only. It is an individual challenge. It, however, has to be accompanied by an effective and efficient public policy and government transparency in terms of information. China reported China had reported cases of 84888 of the coronavirus. China has restricted the coronavirus to one area geographically a fete no other country has been able to replicate. Looking at global figures of 17 million infections with 4.4 million cases in the USA alone, it is hard to comprehend the novel coronavirus began from a Wuhan province in china. Currently, the numbers of reported cases in china are too insignificant to show cause for alarm.
It has always been felt that the Chinese have manipulated the real figures of the virus.it is argued that the real numbers could be higher, but it’s the fall out that the Chinese authorities want to mitigate against. This is partially true. The Chinese authorities have severally evaded the calls for a scientific probe to study the real source of the coronavirus. However, these are only theories that cannot be proven. There is no evidence to suggest there is a cover-up or an attempt to misreport coronavirus figures in the country.
3. Literature review
This section examines the theoretical management of an influenza virus and this particular case severe acute respiratory syndrome SARS and the Chinese response to Coved 19
3.1 The SARS fiasco in china
In the year 2019, the wet markets of Guangdong were the epicenter of a new influenza strain called severe active respiratory syndrome SARS. The epidemic cost the lives of 774 people and spread to over 30 countries globally. SARS was an embarrassment to china with reports of massive cover-ups of the epidemic. It took the government five months to acknowledge the presence of SARS. Seventeen years later, after killing 440 people, the Chinese government confirmed the emergence of a new influenza strain that was caused by the coronavirus. It was named covid 19. Experts abroad have been watching the Chinese government release information on the coronavirus. The Chinese have been generous with information about corona more than they were with SARS. SARS exposed the institutional weakness of the center for disease control. It was poorly funded, had a shortage of manpower and equipment. What is the role of government in managing pandemics?
3.2Government role in handling pandemic
Given that a pandemic will have far-reaching repercussions to the whole society, it is imperative that the government and private sector establish a coordinated approach in the fight against any global epidemic. Due to the lack of early warning and surveillance systems, it most likely that most countries swill misses a pandemic at the incubation stage. Governments across the world are expected to spearhead the institutional preparedness, formulating, and updating the policy on containing pandemics.
3.2.1 Framework preparedness
A large scale or medium scale influenza pandemic will test the preparedness of the public and private sectors of a country. Preparedness for a pandemic cannot be left for only one institution. The readiness frame requires that a global approach be adopted by,
3.2.1.1 Entire society
The social, economic consequences of a pandemic will resonate across the entire economy and civil society. They will disrupt commerce, transport, sport, health, education, and leisure, among others. It is for this reason that disaster preparedness is a multi-agency necessity. Concerted and collaborative efforts led by the government are necessary if a successful containment effort is to be sustained. The preparedness should be scaled up to global levels. The pandemic easily transverse borders. It only took two weeks for the first corona case to be reported outside china, in Thailand.
3.2.1.2 Response
It is expected that the government will lead, coordinate the response to a response. The response involves various approaches. The front line response is composing of the health workers, the financial response, the policy legal and ethical response, and lastly, an infrastructural response. During the pandemic, health workers are expected to work long hours put their lives at risk in the containment of the disease. They will require to be kitted with personal protective equipment and as an incentive for improvement of remuneration terms. In the health sector, there are a number of interdependencies that need to be managed. There is the transport of personnel, medical supplies, equipment, and biohazardous material. The provision of energy, water, and communication is vital too.
The financial responsibility is a role that should be speared headed by the government. Managing a pandemic is an expensive affair. Each pandemic is unchartered territory. In order to avoid making haphazard decisions, a command center will be necessary, and experts from all sorts of life will be assembled. They will include research scientists, statisticians, and security expert doctors, for example. They will analyze various variables and formulate potential Responses to the epidemic. This is the expensive part. With each response they suggest, there is a financial implication. For instance, in order to prevent community spread of a virus, it may become necessary to impose a lockdown and a curfew. These measures have server financial implications on the vulnerable, and the government will be required to provide food rations to the most vulnerable.
Ethical and policy response is at the heart of any pandemic response. The government will be required to enact regulatory measures in the organization of the health sector, public order and liberties, labor, and economic activities. The formulation of policy issues should be cross-sectorial. Legal experts should be at hand to identify legal gaps that may slow down the enactment of the policies. At the same time, the government should be ready to adopt health protocols that have been announced by WHO. Management of pandemics, as noted, is uncharted territory. A lot of the measures taken will be drastic. However, the responses should be ethical and respectful of human rights. In addition, they should be equitable and practical.
3.2.1.3 Dissemination of information
The dissemination of information is a critical role of government. The government is expecting to inform the public on the new infections, recoveries, fatalities, and health protocols that are to be adopted by the public. Pandemic management protocols are coercive, and one way to win the public over is to have a constant flow of information. In the SARS outbreak, the Chinese government attempted to cover up. With the rising deaths and the global spread, local officials were forced to take responsibility and resigned.
3.2.1.4 Management of the business opportunities and supply chain
When a pandemic befalls a society, there is bound to be an increase in business opportunities to support the surge in the requirements of goods and services to support the containment measures. With the pandemic not limited tone one place, the requirement for goods and services may be spread over a large geographical area and may be required across several sites. Additionally, the usual supply chain requirements will still need to be maintained. A proper command chain will be vital to ensure continuity. Additionally, there may arise the need to support local manufactures in order to increase the capacity to meet the increased demand. The government may be required to provide additional funding or tax breaks to manufacturers.
3.2.1.5 Funding research
In the course of a pandemic, the probability of information being scarce is always a big risk. To counter this, the government will be required to fund numerous studies in order to understand the epidemiology of the pandemic. Initially, research will be on testing methods, then understanding the pandemic and later on possible cures and vaccines. Research is expensive, and although the government facilities may not possess the ability to engage in the research, partnering with private research companies is the best option.
3.3 Conclusion
When a community is hit by a pandemic, the nature of the response will determine the success of the failure of the containment measures. The best possible way to prevent a pandemic is to establish robust surveillance centers. This may not be possible due to a shortage of personnel and infrastructure. However, the existing medical facilities can compensate for this. The capacity building of doctors on the ground is of great importance more than ever. It is said the coronavirus is here for a long time, and this is the new way of life. However, it provides an important opportunity for humanity to learn effective ways to handle a pandemic.
4. Methodology
4.1Why did this study settle for a systematic study and meta-analysis
Systematic analysis study is bests suited for that intend to identify, appraise, and criticize the leading research to a specific question. It has a stack difference from traditional research that involves the use of studies to produce outcomes that have no bias and can be replicated elsewhere. This study analyses literature systematically and incisively criticizes the literature. The study allows for a cross-study probe that invokes the use of meta-analysis. The data collected from several primary studies are processed using statistical data processing methods.
Systematic reviews have several advantages as they are tools that will greatly enhance mastery of program efficacy, evidence-backed policy formulation, and suggesting areas from potential research in the future. The risks behind, depending on the results of a single or two researches cannot be reemphasized. A single study can be rich in context and specifics but it could be a chance finding as well systematic studies will present an array of evidence on the selected topic and include some positive and negative results. The resources used in a systematic study are too widely scatted for an individual reorganization to keep track of. Systematic policies are good for the formulation of new government policies. They can be used to direct funding into new research frontiers. Particular they will prevent the use of research funding on areas that have already been extensively researched.
4.2 review inclusion criteria
The benchmarks for including a study in this review are substantive and standard in order to fit the research design. Any country that has had corona virus or SARS or both was eligible for the study.
4.3 study design
This is a quasi- experimental study. This type of a study attempts to critically demonstrate the relationship between different variables. Once an independent variable has been identified in this study, it cannot be manipulated during the study. This research will compare the Chinese government’s handling of corona and SARs and make compare the two epidemics.
4.4 intervention
Interventions during this study will be used to examine the cost effectiveness and efficiency of the measures. The aim of the interventions is to generate recommendations after the study.
4.5 outcomes
Studies that have demonstrated the effectiveness of public policy, health system function and government transparency have been included. The study has identified multiple outcomes. This is an acknowledgment of the complicity of the challenge it is to formulate effective solutions.
4.6 search
The primary sources of data for this review are papers in major medical journals. The systematic research in the referenced sources provided a comprehensive list for literature review. The articles ha to be peer reviewed in the case of SARS but for covid 19 it was not a prerequisite
4.7 methods of analysis
4.7.1Data extraction
Data that was retrieved from various studies for meta-analysis and qualitative analysis had to have the following criteria. The authors and publishers had been identified, the aim of the study had to be in the same context as this study, the design of that study informed on the risk of bias, and the data analysis was from effect size data. The larger the effect size the more robust the findings of the finding were.
4.7.2 Critical evaluation
The studies that have been referenced have the risk being partisan. The possibility of casual claims being include was noted which in turn would throw into contention the validity of statistical conclusions.
4.7.3 Methods of synthesis
Where it was possible, the use of inverse weighted was employed. This was alongside random affect analysis. The use of meta-analysis allows the study to examine the strength of the evidence adduced and to adequately ascertain the effect is positive or negative. Essentially meta-analysis will be used to determine a summary effect of the study.
5. Case Study
5.1 Corona in Wuhan
In December of 2019 Doctor Lin wenliang noticed a SARS like virus in Wuhan hospital and tried to warn the public. He suspected that there was an outbreak of flu epidemic in Wuhan province. Although his efforts were dismissed by state officials, a report by CNN suggested that satellite data gathered from Wuhan, suggested otherwise. The report suggests that there was an over flow of patients into the public facilities. The official reporting date of the first case was December 8 but many scholars feel there could have been other unreported cases. The majority of the cases were predominantly in the traditional market “South China Seafood City”. Between December 2019 and Apr 2020 the covid 19 epidemic exhibited four distinct stages. Incubation, outbreak, control and decline of the corona virus. After the novel corona virus had been identified, the Chinese government, research facilities and Centers for Disease Control and drug manufacturers in a concerted took on the disease. Unlike in the SRARs outbreak, the government led the efforts in terms of policy and funding. Although the government controlled the media briefings, collection of and dissemination of data, there was a sense of coordination unlike in the SARS outbreak.
5.2 The interventions
5.2.1 Initial response
Immediately after the first case was reported, the response of from the government was slow. The government was officially informed of the first case in January but state officials in Wuhan province had been withholding information for more than a month. The government officials in Hubei province appeared to be reluctant for two reasons. One, lack of enough knowledge on the corona virus. For the very first cases, there was no diagnosis kit or key scientific data on transmission or pathogens that could support the doctors’ theories. It was therefore easy for the local officials to dismiss corona virus as ordinary influenza flu. Ordinary influenza flus can be managed by improving ventilation in public spaces. The second reason was the failure of the to implement adequate and effective control measures. The steps taken were not as effective. The main Wuhan market was closed but corona virus patients were not identified and isolated. Furthermore, for those cases in hospital, there was no contact tracing put in place. As result there was community spread of the virus and the hospitals quickly became overwhelmed. There was an acute shortage of isolation wards, ICU beds and ventilators. The government recommended that patients with flu like symptoms wear face masks but their movement was not restricted. Testing capabilities were still at the infancy. For this reasons, corona flourished to an outbreak.
5.2.2Emergency response
After the Chinese center for disease control identified corona virus had symptoms similar to the severe acute respiratory syndrome of 2013, there was mass hysteria among the Chinese public and the international community focused its attention on china. Across the entire country, corona centers were established- in the provinces and in the counties. Corona virus was accorded a level 1kind of response. Level 1 gives the government access all personnel infrastructure and related goods for the sole purpose of containing epidemic. All forms of public gatherings were suspended and this was extended to commerce too. The level 1 designation enabled the government to take far much reaching and effective measures.
5.2.3Curfews
On January 23 2020 the municipality of Wuhan was put under a lockdown. Movement to and fro Wuhan was heavily restricted and residents were put under curfew. Movement was limited only for search of essentials, food and medical assistance. Across china different cities imposed curfews and lockdowns albeit at different levels. Social distancing rules were imposed in public spaces, face masks became mandatory and temperature checks became widespread. The spring festival holiday was extended to curtail infection at the workplace.
5.2.4Medical intervention
Due to the stigma associated with corona virus, the Chinese government waived all medical expenses associated with corona treatment in order to encourage more patients seek treatment. At the time of making this announcement, Wuhan city had a bed capacity of only 4000 beds. In order to handle the huge influx of patients expected, the government constructed two mobile field hospitals in a fortnight. Leishenshan Hospital and Huoshenshan Hospital with additional bed capacity of 2600. These two field hospitals were equipped with ICU beds that could provide respiratory support. Additionally, public spaces that included bus stations were converted to temporary centers mainly to handle asymptomatic patients. The government assumed control of universities and hotels which were converted to isolation centers. As the pandemic progressed the medical doctors risked being overwhelmed. Over 54000 military doctors were deployed to assist in the containment effort. Contact tracing measures were up scaled and the identified contacts were put under isolation. These same measures were replicated across the country in other cities on need basis. However, surveillance and testing measures were in place. By April the pandemic had spread globally and Chinese citizens flying back into the country from abroad were required to undergo mandatory testing and isolation.
5.2.5 Funding corona research
In order to adequately combat the corona virus, the government in china invested in research, development and capacity building for corona related interventions. The first was to build local capacity of local manufacturers to produce N95 mask, personal protective equipment (PPE) testing kits and reagents. Manufacturers were extended loans and tax cuts to scale up production. The government also funded Chinese Academy of Medical Sciences among other research facilities to develop testing kits as well as reagent identification. . Other research facilities accelerated the formulation of vaccines. Two Chinese vaccines are at in the third stage of human testing.
5.26 formulation of policy
Apart from formulated the protocols to combat the novel corona virus, the Chinese National Health Commission has published seven articles which have formed the background for the management of corona virus worldwide. They range from diseases etiology and epidemiological features, symptoms and clinical support protocols, treatment and the eventual declaration of a patient is free of corona. China Center for Disease Control and Prevention has published social distancing rules under eight policy papers for the management of corona virus in public. Among other guidelines published is the management and transportation of specimen, disposal of bodies, training of medical personnel and lab testing guides. The availing of this information has reduced the stigma and hysteria associated with virus.
6. Evaluation
6.1 effects of the lockdown
Outbreaks of infectious diseases in china are becoming frequent. The next pandemic cannot be predicted but based on emerging trends the severity is gaining traction. Having missed the first stage of isolation of the disease, the Chinese government went for hard measure immediately it was identified as a SARS like virus. The lockdown and curfew were the first effective measures the government took. Restricting the disease to Wuhan province would make it easier to contain the pandemic as opposed to having several hotspots across the country. Also this containment measure didn’t segregate the sick from the healthy. This greatly reduced the stigma associated with corona virus. Asymptomatic patients were encouraged to follow a strict home based care protocol that ensured they got well. Healthy individuals were advised on measures to take in order not to get infected. Sanitizing, washing hands and maintaining social distance. The large scale lockdown was a logistical nightmare for the Chinese government but eventually the citizens complied and the end result was a success.
6.2 successful dissemination of information and adherence to guidelines
Dissemination of information is not a strong point of the Chinese government. However during this pandemic there was a lot of information from the local officials. This could be attributed to experiences from SARS outbreak. Due to the bungled SARS interventions, man ordinary Chinese were terrified of infectious diseases as a result, many Chinese put on face masks and followed social distancing rules. Government officials including the police, party officials and community officials ensured that residents stayed and worked from home where possible. This meant that residents had nowhere to go.
7. Reflection
Corona virus has been suspected to originate from wild animals. Therefore going forward into the future handling of animals in china has to be improved. More surveillance is need in to enhance food inspection especially among breeders. There is a great demand for meat products. The price of food in china is highly controlled and therefore the only way to realize a profit is to reduce the cost of running the business. Breeders are going to great lengths to reduce breeding time including the use of growth hormones. Food sources need to be protected by the government. Secondly inspection of meat and meat products in the Chinese markets needs to be improved too. The Chinese even the affluent have a for wild meat. This has given rise to a flourishing trade in illegal game meat.
Secondly the Center for Disease control needs to set up surveillance centers across the provinces. Training of public officials on how to escalate health information upwards needs to have well laid procedures. There may be many false but trends show that after corona virus the probability of another global pandemic happening are very real. Identifying the influenza strains in good time gives the authorities ample time to come up with effective containment measures.
Thirdly the development of the health system needs to be a continuous event. The Chinese people are growing extremely wealthy due to their innovation and aggressiveness in business. However the health system is not growing in tandem. The health system has invested heavily in research and treatment of heart disease and tumors. After SARs many researchers abandoned virology for research that was income generating. Virology involves the use statistics testing hypothesis. Not many Chinese doctors fancy continuous research.
Fourthly, the management of hospitals in china has come under a lot of focus. Hospitals have been transformed to affiliates of universities. They are not managed by the local governments. When the pandemic first struck, local officials could not expand the facilities without a tedious bureaucracy in the hospital management.
Lastly the procurement and distribution of personal protective equipment for from line workers drew sharp criticism. Furthermore distribution was shroud in mystery with some hospitals at the epicenter unable to access PPEs.
8. Conclusion
The study has established that lessons from the SARS pandemic caused the Chinese government to handle corona virus differently in terms of the effectiveness of public policy, health system function and government transparency. The Chinese government adopted strict raft of measures that ranged from strict lockdowns and curfews to contact tracing and isolation. The health system could not bear the huge load and massive investments are needed to scale it up. The foundation of the Chinese initiate lays in the earliest identification of an epidemic. After this corona, more studies will be commissioned to analyze the lessons from corona; this will refine containment measures further.