Shanghai Released the Several Opinions on Improving Major Disease Prevention Mechanisms and the Public Health Emergency Response Management System Professionals Explain 20 Measures for Improving the Public Health System in Shanghai For a mega city, a sound public health system is essential to the wellbeing of people, economic development, social stability and national security. Hence the building of such system is a paramount and urgent strategic task. On April 8, Shanghai issued the Several Opinions on Improving Major Disease Prevention Mechanisms and the Public Health Emergency Response Management System (hereinafter referred to as the "Several Opinions") in a period when containing the virus at home continues to improve despite the pressures and risks. The aim of the Several Opinions is to build Shanghai into a city with the most comprehensive public health system in the world. These opinions cover 20 measures in four aspects. How will they help Shanghai build up a defense against an outbreak of new infectious disease? And what are the highlights of the 20 measures when the city is developing a sound public health system? On April 8, we had some professionals explain in details. It is of symbolic significance to put the development of a public health emergency command system on the top agenda. How should Shanghai act to cope with the risks and challenges of new and imported diseases of unknown causes as a mega city? In the fight against the virus, our experience showed that only with a strong prevention and control system can we respond to major epidemics and public health emergencies more effectively and quickly, said Zong Ming, deputy mayor of Shanghai, at the press conference of the Shanghai Municipal People’s Government on April 8. That is why the Several Opinions put the establishment of a public health emergency command system in the first place among all the 20 measures. Shanghai Public Health Emergency Command Center should be developed with higher standards so as to be more sensible and quicker to respond. According to Prof. Zhang Wenhong, director of the Department of Infectious Disease at Huashan Hospital Affiliated to Fudan University, Shanghai's public health system is an invisible one for most ordinary people though it is just around us. "The system has been rooted in communities and general hospitals. One can perceive it by very careful investigation. In the review of our fight against the virus, controlling the first wave of the epidemic is just a very major test to the system. The fever clinics across Shanghai are the first level of the public health system, which is activated at the first moment when a person with fever consults a doctor.” Prof. Zhang added that how to update and improve our public health system was also reflected in the Several Opinions. He viewed that the experience gained in the fight against the epidemic would help Shanghai build a world-class public health system, which includes the establishment of more capable fever clinics and sentinel fever clinics for a more responsive network. The Several Opinions highlight the "system development”, indicated Prof. Liu Zhongmin, President of Shanghai East Hospital Affiliated to Tongji University in an interview on people.cn. The system development firstly includes "establishing a centralized, unified, intelligent and efficient public health emergency command system". The meaning of the key word “system” emphasized here has been extended to the building of a municipal-level public health center for Shanghai citizens instead of a health management and command system that may only be used to cope with a certain infectious disease within the health management system in the past. From this point of view, the shift of the meaning is of landmark significance to emergency response in face of major disasters in the future, and this helps improve the command system. A public health command system is of vital importance. Shanghai’s proposal to build a public health emergency command center this time is a brand new initiative to develop a unified command system in response to major health emergencies in the future, said Prof. Zhang Lufa, associate dean of School of International and Public Affairs, associate dean of China Institute for Urban Governance, and executive dean of Healthy Yangtze River Delta Institute, Shanghai Jiao Tong University. In case of any major event in the future, we will act under the unified command instead of responding with different ways. For example, the Several Opinions explicitly state that efforts will be made to build an emergency medical treatment system that covers municipal-level designated hospitals, district-level hospitals and regional medical centers as well as community health service centers for both peacetime and wartime purposes. It is the first time in China to establish a weather and climate-based benchmark early warning and forecasting system for infectious diseases. The COVID-19 outbreak underscores the importance of infectious disease monitoring and early warning at fever clinics. According to Fu Chen, director of the Shanghai Center for Disease Control and Prevention (Shanghai CDC), a direct online reporting system for infectious diseases was created after the SARS outbreak in China in 2003, and it was introduced nationwide in 2004. The system, however, covers 39 infectious diseases which are classified as notifiable. It is still not sensitive enough to emerging diseases or those with unknown causes. In view of this, Shanghai has improved its infectious disease monitoring and early warning system in the following three aspects. First, a syndrome monitoring system has been established to further improve the monitoring sensitivity. Second, efforts have been made to develop smart public health plug-ins to be applied in medical institutions. These plug-ins will enable medical institutions to trigger infectious disease reporting by resorting to smart technology, and improve the reporting accuracy and rate of infectious disease cases. Third, a mechanism for reporting emerging public health threats has been put in place. Actions should be taken earlier to prevent “any small flame” from turning into a “disastrous inferno”. The Several Opinions have raised higher requirements for the infectious disease monitoring and early warning system of Shanghai, according to Fu Chen. Shanghai CDC will improve the system by taking the following actions. First, a big data-based comprehensive monitoring system for public health will be built on the existing case and syndrome monitoring systems. The aim is to build a dynamic, responsive alarm and analysis model that can trigger a public health response at multiple levels. Second, the monitoring information system for emerging public health threats will be improved to strengthen their proactive identification and early warning. Third, attempts will be made to mine the maximum value of the monitoring data in depth, and the intelligent diagnosis and treatment technology for infectious diseases will be developed based on artificial intelligence. In addition, Shanghai CDC will develop a comprehensive index of infectious diseases and provide early warning and prediction of them based on weather and climate data. Prof. Liu Zhongmin also spoke highly of the initiative in the Several Opinions to develop a public health monitoring and pre-alarm system that is coordinated, comprehensive, responsive and reliable. As he said, public health monitoring used to rely on hospital data. There was a lack of early warning mechanisms for fever of unknown causes or other symptoms of potential infectious diseases. These diseases were reported only when they occurred. Now an early warning system can live up to the requirement for "early detection, reporting, isolation and treatment" in case of infectious diseases. In this way, a joint prevention and control early warning system can be established for regional collaboration. Moreover, the Several Opinions propose to establish an early warning and prediction system for acute infectious diseases based on weather and climate data, which associates environmental factors with infectious disease occurrence to predict what kind of diseases may occur in a certain season. This is the first attempt to introduce such a health system in China. Integrating prevention with medical treatment, optimizing the distribution of sentinel inspection sites and strengthening the construction of grass-roots facilities Proactive prevention and effective response are equally pivotal in dealing with public health emergencies. Prof. Wu Fan, deputy dean of the Shanghai Medical College of Fudan University, expressed that to build a more professional and efficient disease prevention and control network in the future, Shanghai should first uphold a sound disease prevention and control network and steadily improve its system and mechanism. "At present, Shanghai has developed a disease prevention and control network consisting of urban secondary disease prevention and control centers, medical institutions and scientific research institutions at all levels, as well as community health service centers." Wu Fan said that a sound network for preventing and controlling public health diseases depends on the constant improvement of community health service centers. Based on pertinent requirements, Shanghai will optimize the distribution of monitoring sites. On top of the existing citywide 117 fever clinics, 182 sentinel fever clinics in the community health service centers will be built to screen, register, transfer and trace patients with fever. According to Prof. Liu Zhongmin, the Several Opinions put forward that Shanghai will develop a modern disease prevention and control system in line with the advanced level both in China and abroad. It can be said that the goal of the CPC Shanghai Municipal Committee and the Shanghai Municipal People’s Government has been explicitly stated in the Several Opinions – establishment of a prevention and control system that is advanced both at home and abroad. The Several Opinions have shown Shanghai's capacity of forward-looking planning and benchmarking as a metropolis, and the high quality and standards expressed in the document demonstrate Shanghai's competence, confidence and sources of energy. As Prof. Liu Zhongmin said, a purpose-built emergency medical treatment system for both peacetime and wartime situations has never been found in the development of public health systems before. In the past, infections were only regarded as diseases that should be treated rather than prevented. Now the target has been made clear: disease treatment and prevention for both peacetime and wartime situations. It is not that we will manage to cure a disease when it breaks out, but that we shall develop an emergency medical treatment system. Therefore, it is concerned not only with "treatment", but also with "preparedness". The outbreak of the epidemic has exposed the obvious inadequacy of our medical supply reserve. Both professionals and material reserves such as face masks are all in short supply. Therefore, the Several Opinions have clearly stated that we should reserve more resources for emergency medical treatment, and also develop the capacity to convert large public facilities into emergency medical treatment facilities. I especially appreciate the last sentence of the document, that is, "establishing a system of preparedness for emergency medical treatment in case of public health events". This is a forward-looking decision. Benchmarking against the highest and best international standards, and building "one of the safest cities" powered by technology The Several Opinions have also made it clear that Shanghai will establish a science-based prevention and control system by benchmarking against the highest and best international standards. Only by applying big data and other technologies for the region-based and tiered evaluation of public health and safety risks can we provide accurate and efficient response to emergencies and reduce their impact on our normal work and life. Science-based prevention and control poses high requirements for sci-tech preparedness and research, said Mr. Wu Jinglei, director of Shanghai Municipal Health Commission. In the future, Shanghai will select the best of all municipal key laboratories, engineering technology centers, enterprise technology centers and new research and development institutions for preparedness and research. Besides, Shanghai will promote the construction of major innovation platforms such as national laboratories, national key laboratories, national clinical research centers, and national medical centers to better serve the national strategy. The science and technology talent plan should give priority to supporting public health researchers and accelerating the commercialization and application of sci-tech achievements in public health. According to Prof. Wu Fan, the core to win the fight against the epidemic is the application of technology, and the key lies in our regular strategic layout and reserve when we apply the technology to the disease prevention and control. Efforts should be made to build major scientific research facilities and platforms, plan basic and applied scientific research projects, and pool advanced technology resources and leading talent. On top of that, measures should be taken to formulate emergency response guidelines and establish coordinated mechanisms for sci-tech research, so as to ensure that sci-tech research is carried out in an orderly manner with coordinated efforts and effective support in time of emergency. The Several Opinions state that Shanghai aims to be one of the world's safest cities in public health by benchmarking against the highest and best international standards. Prof. Zhang Lufa indicated that it would be tough to fulfill as it is never easy to reach "the safest" standards. Nowadays, "the safest" standard is rarely mentioned in China or even around the world. But Shanghai aims to reach the target by 2025, with only five years left. Meanwhile, Prof. Zhang said that the use of smart technology is highlighted throughout the Several Opinions. In recent years, Shanghai has been dedicated to promoting the "one-stop government service" and the "one-stop urban management". This is a major work of the city. In fact, the "one-stop government service" has been introduced in several parts of China, such as Zhejiang with its "handling matters without the need for a second visit". The tough task for Shanghai is not to implement the "one-stop government service", but "one-stop urban management". This year, the No. 1 research project of the CPC Shanghai Municipal Committee is to advance "one-stop urban management" for city operations. "So, new smart technology has been incorporated into and reflected in every aspect of the several opinions. This is a particularly new feature."

Source: People.cn