SCIO briefing on frontline medical workers' expertise on COVID-19 treatment

Speakers:

Du Bin, director of Medical Intensive Care Unit, Peking Union Medical College Hospital

Qiao Jie, academician of the Chinese Academy of Engineering and president of Peking University Third Hospital

Cao Bin, vice-president of China-Japan Friendship Hospital

Li Haichao, vice-president of Peking University First Hospital

Chairperson:

Xi Yanchun, spokesperson of the State Council Information Office of China

Date:

March 4, 2020

Xi Yanchun:

Ladies and gentlemen, friends from the media, good afternoon. Welcome to today’s briefing. Since the epidemic broke out, China has waged a united battle against the coronavirus with the most comprehensive, rigorous and thorough measures. Thanks to these arduous efforts, China has produced visible progress. Recently, my colleagues and I have received a lot of questions and interview requests concerning China’s response to COVID-19. In order to help you have a better understanding, today we’ve invited four experts who have participated in the frontline treatment work in Wuhan.

Let me present them to you: Professor and Doctor Du Bin, director of the Medical ICU, Peking Union Medical College Hospital; Ms. Qiao Jie, academician of the Chinese Academy of Engineering, and president of Peking University Third Hospital; Mr. Cao Bin, vice-president of China-Japan Friendship Hospital; and Mr. Li Haichao, vice-president of Peking University First Hospital.

In today’s briefing, we have set up special arrangements for foreign correspondents in Beijing to ask questions to the experts in Wuhan, with 5G connected telecommunications. The entire session will be conducted in English.

We will open from short introductions by the experts. First, let us invite Professor and Doctor Du Bin, please.

Du Bin:

Good afternoon, ladies and gentlemen, I am Dr. Du Bin, or Bin Du ­– either is fine. I’m from the Peking Union Medical College Hospital. I came here to Wuhan on Jan. 18, and have been working here since then. As a member of the national expert team, the responsibility of me and my colleagues is to review every individual case of people who are critically ill with COVID-19. We then discuss treatment plans with physicians, as well as provide feedback and suggestions to local and national healthcare authorities about treatment strategies and other coping strategies to fight against COVID-19. Thank you.

Xi Yanchun:

Thank you, Professor Du. Next, let’s invite Ms. Qiao Jie, please.

Qiao Jie:

I’m Professor Qiao Jie from the Peking University Third Hospital. Peking University Third Hospital is one of the top university hospitals and also a public hospital directly under the National Health Commission of China. At noon of Feb. 1, I received an instruction to travel to Wuhan as soon as possible. I left Beijing and arrived at Wuhan at 9 p.m. the same day. As the leader of this special task team, my responsibility was to organize doctors, nurses and supporting professionals to establish a new ICU ward. One day later, on Feb. 3, we successfully completed our preparations and were ready to serve and save lives. We have tried with our every effort to increase the treatment and cure rate, while reducing the rate of infection and mortality for severe COVID-19 patients.

For this mission, we, together with Peking University, and members from three top ranking comprehensive hospitals together, and I’m the chief, responsible for it, including 90 doctors and 360 nurses, provided medical services at Sino-French New City Branch of Tongji Hospital with more than 11,000 beds for the treatment of severe COVID-19 patients.

As you may be aware, I’m also the director of the National Center for Healthcare Quality Management in Obstetrics. So, I also have responsibility to survey the infection of pregnant women, guarantee delivery procedures, and prevent mother-baby vertical transmission.

So, I’m here and ready to answer your questions. Thank you.

Xi Yanchun:

Thank you very much, Professor Qiao. Professor Cao Bin, it’s your turn.

Cao Bin:

Thank you. Good afternoon, my name is Cao Bin. I’m a pulmonary physician, who focuses on respiratory tract infections. During the last 20 years, I have experienced the SARS pandemic, H1N1, and human infections caused by H5N1 and H7N9. We also have cases of adenovirus pneumonia. Today, we have another coronavirus infection: COVID-19.

I have been working in Wuhan for around two months. I have been proud to be a doctor and researcher working with my colleagues during this time. We have left our families, but we are honored. We have been working day and night, but we are honored. We are honored because we can help. China has encountered many disasters during its long history. So, again, I’m sure we can overcome this coronavirus, just as we have done previous times.

I would like to share a poem with you all. The poem was written about 3,000 years ago. I believe that everyone in this room, in Wuhan, and in China can be moved and motivated by this poem. The poem is actually a battle song.

(Cao Bin reads a poem in Chinese)

The name of the poem is “If you have no clothes.” I will share with you a brief translation.

If you have no clothes,

my brother,

I will share with you.

If you have no food,

my brother,

I will share with you.

If you have problems, if you have an illness,

my brother,

I will always be together with you.

Today, I would like to salute every nurse and doctor, for their contribution, especially those who have lost their lives. Thank you.

Xi Yanchun:

Thank you very much, Professor Cao Bin. I’m sure your words represent how all of the doctors feel. So, thank you very much. Lastly, Professor Li Haichao, please.

Li Haichao:

Good afternoon, ladies and gentlemen, I’m Dr. Li Haichao from Peking University First Hospital. I arrived in Wuhan together with the third batch of the medical team from Peking University. I joined my colleagues who came here earlier and I am responsible for the treatment of critically ill patients in a ward of Tongji Hospital.

I have worked with Professor Qiao in the same building. I am a pulmonologist, and I had taken part in the SARS treatment in Beijing in 2003. I believe, because of my specialty and the experience of SARS, it might be helpful for me to fight against the new coronavirus.

The team of our hospital consists of 135 members, among which 30 are doctors who specialize in respiratory and critical care medicine, intensive care medicine, some other disciplines of internal medicine, infectious disease and thoracic surgery. We have two experts of infection control and one staff member in charge of logistic support and communication. We also have 102 nurses, some of whom have very good experience in respiratory and surgical intensive care units.

Until now, we have admitted 63 patients into our new ward. Fortunately, most of them have been discharged. Today, we only have 10 patients left in our ward, and all of them are in the recovery period. I believe that they will be discharged in the near future.

So, I’m very glad to be here to share my understanding about COVID-19 and my experience. Thank you.

Xi Yanchun:

Thank you very much, Professor Li. And great thanks to all of the experts. Thank you for what you have done for the patients here, and also what you have done for the people.

So now the floor is open for questions. May I remind you to please identify yourself before raising questions. Also, please speak clearly and slowly, because we are a thousand kilometers away. Okay, please raise your hands.

Xi Yanchun:

Okay, the gentleman in the first line in blue shirt.

Reuters:

Thank you. This is a question from Reuters. Actually, two questions. First, how many cases are there of people in Hubei who recovered and then were later were diagnosed with the virus again? Is there a chance that this will keep recurring? And my second question: last month, a 70-year-old man in Shennongjia was tested positive for the virus. He visited his sister in January, but did not show any symptoms until 27 days later. How should we deal with such cases that have long incubation periods? How many of such people are there? Thank you.

Du Bin:

Thank you, sir. Thank you for your questions. I’ll answer the second question first. Regarding the patient in Shennongjia, I actually have no idea as to how this patient behaved and the details of the case. But I will address the long incubation period, which hasn’t been reported nor discovered, either here in Wuhan, Hubei, other provinces or other countries. According to most publications, right now we understand that the median incubation period is five to seven days. The longest incubation period is 14 days, and there’s no data showing that an even longer incubation period has ever existed.

And for your first question, the answer is yes. There have been several cases reported about people who have tested positive for the novel coronavirus RNA after being discharged or after multiple negative results. We know that there are such cases in Hubei and Wuhan as well. But we have no idea how many of them are there. More importantly, according to current research results, there’s no evidence that these patients, after being tested positive again for the coronavirus RNA, have the ability to transmit the virus to other people or to their close contacts. There’s no evidence.

Xi Yanchun:

Thank you. Ok, next question. Please. The gentleman in the middle area in black suit, second row in the middle area.

CGTN:

Thank you. I’m from CGTN – China Global Television Network. So, my question is, it has been two months since the coronavirus was first reported in China, and we know that since then, a lot of measures have been taken by the government to contain the spread across the country.

Now, looking back, what kind of lessons can we draw from this fight against the disease? Thank you.

Qiao Jie:

Thank you for the question. Actually, in my opinion, two things are very important. First, it is key to mobilize all resources, and second, we must diagnose and control the disease scientifically.

First, I’ll address mobilizing all resources. We actually not only need medical staff, such as doctors and nurses, but also social workers, logistics staff and construction workers, and so on. All are important for jobs like establishing mobile cabinet hospitals. It’s really amazing because there they can treat more mild patients. Most of the patients are mild and need to [be] isolated and observed the changing conditions. If changed from mild to severe, [patients] can transfer to our side, because our task is treatment for the severe patients.

We are happy for the treating and discharging of some patients back to home and back to health. And some severe patients became mild, but also some passed away. We need time to realize the mechanism of this virus infection.

And also we have already established different treatment methods like the oxygen giving and using of non-invasive and invasive ventilator and also tried to use some drugs and other treatments. But we need time to survey for that, so we organized specialists together and even the remote consultant for improved treatment results. So we need scientific control of the disease. Thank you.

Xi Yanchun:

Professor Cao.

Cao Bin:

Thank you. I think it is a good question.

In no more than two months, the disease, the COVID-19 is not only a Wuhan disease, and it's not only a China disease, but a global disease. The question is what lessons, but I want to say what achievement the Chinese doctors and the scientists made during the last two months! Not so many days. I think the most important and the first achievement is in science. If we want to control the disease, we have base on science. I believe that many doctors, researchers, and scientists in Wuhan, and in other cities of China, contributed a lot to the knowledge of the new disease.

Everyone has to remember that it's a new disease. If we have a new disease, it takes time for us to get to know the disease. We get to know the disease through several steps. The first step is that the doctors collect the clinical data, the clinical signs, the laboratory findings, and the chest X-ray and CT scans. This is the first step. The second step is the pathology. A good news is that the pathologists in Wuhan city have done autopsy, and the pathology data helps the clinicians to know more about the disease.

The third is the basic science. It's the first time that the Chinese scientists find the cause of the disease. When we look back to the end of December, nobody knew what the disease is. At that time we called the disease “viral pneumonia with unknown etiology.” But now we have the cause of disease. The disease is caused by a novel coronavirus, and now is named by the international society as SARS-CoV-2. And the disease, we call that COVID-19. I think it is the first achievement that China made during the last two months.

The second achievement is the openness of the Chinese government. From the very beginning, the Chinese government has had face-to-face connection with the WHO, and I'm the person to introduce our clinical findings to WHO from the first cohort of the cases. And I also got e-mails from foreign physicians, whom I’ve known for many years. They told me that, “Cao Bin, I got to know the disease through your publication.” They also told me I’ve helped them.

For example, I helped the American doctors to publish the first paper in “Blue Journal.” In “Blue Journal,” they introduced to the American citizens what the disease is like. I think it is what we have done during the last two months. Thank you.

Xi Yanchun:

Professor Li Haichao. Would you like to add some words?

Li Haichao:

The task of our team is to treat the critically ill patients. So my experiences are in the following aspects.

The first one, we must set up the multiple-discipline team, because it's a very severe pneumonia, and it can develop to be ARDS. The severe situation needs multiple-disciplined doctors to deal with the various situations.

The second one is to keep the oxygen supplement, which is very important. The oxygen therapy and the reasonable use of ventilator are very important.

And the third one, just as Professor Cao said, it's a new disease. So in this area, we set up a mechanism for sharing knowledge and experience between the colleagues from the different hospitals. It's very helpful for us to know about this disease. Thank you.

Xi Yanchun:

Professor Du, anything to share with us?

Du Bin:

It's a very difficult and tough question for me, because there are too many things and too little time to think about it. However, if I could have the chance to go back, I would say, I’ll try more aggressively the invasive mechanical ventilation in all patients with clinical deterioration in terms of the respiratory failure or hypoxemia.

In addition, I will try more aggressively to propose my suggestion to the local and national healthcare authorities to convene all my ICU colleagues, including the doctors and nurses, to work together in some designated hospitals to establish an intensive care unit to cope with the critical care search or the search of the critically ill patients.

And I do believe such kind of approach can help our patients, especially those critically ill patients to recover more rapidly. Thank you.

Qiao Jie:

COVID-19 gives us many lessons to learn. It is not only the respiratory tract disease. Actually, some patients had complications like vascular disease， hypertension, diabetes and kidney failure or something. So, we need to combine together specialists to treat this complicated condition.

Xi Yanchun:

Thank you. Next question, please. The gentleman in the first line in black shirt.

Hindustan Times:

From the Hindustan Times newspaper. In the last couple of days, there have been spike in cases in India. Keeping in mind that both India and China have similarly densely populated cities and regions, what advice would the doctors have for their colleagues back in India, [and] the health authorities that are looking into this? How can this be tackled and stopped from being escalating into an epidemic in India?

Qiao Jie:

Thank you for the question. Actually, China and India are the two most important countries in Asia. And we have some similarities, aspects like the large population and habits of people like [family activities together]. And also the medical system and technique—there is some room to improve. So, I think we have something to share. In my experience in hospital treatment, actually we have no enough medical staff to deal with the infection disease. Most of staff have no or lacked the experience for treating the infection disease combined together with this pneumonia and other complicated conditions.

So, first we need to train more medical staff for facing this special COVID-19 disease—mild and severe, different [types of] training. And also how to protect themselves. Even putting on and taking off protective clothing also need education and training. And as for the equipment—need to prepare first, invasive or non-invasive. [The equipment] we need for treatment of different diseases need to be prepared first.

The third thing is room preparation, like the negative pressure ward. It’s difficult to change completely, but [we] can practically. For example, by using high power and exhausted fan in the ward, we can change the airflow and [increase] safety for the patient and the medical doctor and nurse.

And as for the training, for the community populations, even wearing mask and washing hands, need step-by-step training, and it can isolate the disease epidemic. It's all very important. Thank you.

Xi Yanchun:

Next question. The middle area, the gentleman in the fourth line.

TBS:

Hello, I'm from TBS. Japanese TV station. I'm sorry, I have three questions. First one is that, unfortunately, doctors in Wuhan passed away, even though some of them are very young. How would you analyze the reason? Second one is, it's been reported in Japan, that infection in the hospital is occurring in some places. With your experience, how do you prevent the infection in hospital? Third one is, if you have experience to cure such patients, is there any difference varying coronavirus and SARS? Thank you very much.

Du Bin:

I’ll take the first two questions and leave the last one to my colleague, Dr. Li.

As to your first question. Yes, we know that among all the non-survivors of COVID-19, that although most of them are elderly people, there are some younger deaths, including doctors and [people in the] general public.

We know that although they are not elderly—which is the well-recognized risk factor—but some of them, if not all, do have some comorbidities, or underlying diseases, such as hypertension and diabetes, which are very common even among the younger generation in China, according to the previous studies.

Moreover, as I mentioned before to the last question, that the unnecessary prolongation of the non-invasive mechanical ventilation, as well as prolonged, or long-term, high dose corticosteroids are, in my mind, the major reason of deaths in this younger generation. Because there are more harms than benefits, such as the nosocomial infection, such as the weakness, such as the barotrauma, or high hyperglycemia, et cetera.

As [for] you second question concerning the infection control within the hospital. I think the key word is “plan.” You must have a plan for hospitals in Japan. I would say you must have a plan for every suspected patient going to a fever clinic, going to the general outpatient clinic, or even inpatient department. And you must have a plan for how to detect the suspected cases according to the clinical manifestations, [according] to the laboratory tests such as lymphopenia, or according to the CT scan, as mentioned by Dr. Cao. And you must be able to perform laboratory confirmation for suspected cases. You must have a plan to isolate suspected individual cases before confirming or ruling out the diagnosis. You must have a plan to educate and train health care workers within individual hospitals to prepare themselves for the cases. And you must have a plan to prepare not only space but also supplies, such as personal protection equipment for all health care workers involved or those who may come in contact with suspected cases. Thank you.

Cao Bin:

Thank you for the question. Your third question is what is the difference between SARS-CoV and this new coronavirus? I will start with the similarities. Both SARS-CoV and the new virus belong to the coronavirus family. From the genetic sequencing analysis, we have found that the viruses are about 78% similar. When you look at the clinical features of the two diseases (SARS and COVID-19), both viruses can mainly cause pneumonia.

When we look at pneumonia, the similarity is there. They are both viral pneumonia, which means that when we look at a chest CT scan, both diseases cause ground glass opacity of both lungs. This is the similarity. When we look at the clinical features and laboratory findings, both diseases have common features, such as the normal white blood cells and, more commonly, we find lymphopenia and the increased liver enzyme, or that some of them may develop respiratory distress syndrome.

When you look at the similarities, you may find that SARS is very similar to COVID-19, but there are differences between the two viruses. And there are differences between the two diseases. First, let's look at the case fatality ratio for SARS. The case fatality ratio is round about 10%. But if you look at COVID-19, if we look at the cases outside Hubei province, the case fatality ratio is less than 1%.

When we look at the case fatality ratio in Hubei province, the number is around 3% to 4%. So, it seems that COVID-19 is less severe compared to SARS. But the bad news is that COVID-19 is easily transmitted. And when we look at the documented cases of SARS and COVID-19, we can easily find that the new virus is more “successful” compared to the SARS-CoV.

I don't know the exact number of confirmed cases in Japan, but I learned that in Korea, the case number is over three thousand. There is a rapid increase in cases in Europe, including Italy, Spain, and Germany. We can also find cases in the Middle East, such as Iran. You can find that COVID-19 is more widely distributed around the world. When we look at the pathology, and when we look at the mechanism of the disease, it seems that the SARS-Cov-2 virus can easily invade the lungs and can easily invade other organs, including the heart and liver. This new virus is a real threat to human beings. Nobody knows if the disease will spread to other areas of the world. But I believe that doctors, researchers, and scientists all over the world should work together to fight against this new disease. The war is not over. Thank you.

Xi Yanchun:

Okay, Professor Li.

Li Haichao:

Regarding the question about SARS and COVID-19, I have very deep memories of SARS, which happened 17 years ago. I worked in a hospital in the suburb of Beijing. We had totally124 beds in the hospital, and six ICU beds. In my opinion, there are some differences between COVID-19 and SARS. Now, in our ward, most of the patients are above 60 years old and some of them are above 50 years old, there are a few young people. During the SARS, in our ward there were a lot of young people, so the first characteristic of COVID-19 is that the patients are older than those with SARS. The second characteristic is that some COVID-19 patients have very severe illnesses, because they are middle age and old persons, and they have complications. They have very severe hypoxaemia and severe ARDS. A lot of them need non-invasive ventilation or mechanical ventilation for a long time. The patients have a lot of preexisting conditions, such as hypertension, coronary heart disease, diabetes, and COPD. It is also very common with disorders of electrolyte and imbalance of acid-base. There are so many problems you must face. It’s very severe. The 3rd character is [I call it] “slow”. One “slow” is that some of them have a very slow onset. They might have a mild fever or mild symptoms of respiratory tract, such as a mild cough, but 10 days later, or maybe more than two weeks later, they have exacerbations. The situation goes bad rapidly. The onset is slow, but exacerbation is quick. Another “slow” is that some patients became better, and the situation had been controlled, but they still have exertional dyspnea. When they do some exercises, saturation of oxygen decreases rapidly. They need a long time to recover. Maybe I think it's due to their old age and some comorbidities.

So it's very important to care for the patients with hypoxaemia, because you don't know when and how there could be an exacerbation. So you must keep a close eye on symptoms, saturation of oxygen, CT scan, and some other factors about the inflammation. If the situation gets worse, you must pay more attention to them. Thank you.

Xi Yanchun:

Ok, next question. The gentleman in the fourth line in the middle area, it is your turn to raise the question. Just now, you already have the mic.

Wall Street Journal:

Yes, thank you very much from the Wall Street Journal. First, a question for Mr. Cao Bin. You co-wrote a study that was published in The Lancet medical journal, which gave December 1 as the date for the symptoms’ onset in the earliest recorded case. I'm sure that you know that the Wuhan government has said that December 8 was the date for the symptoms’ onset in the first confirmed case, and a few other studies have also cited December 8. I was wondering if you could just clarify the difference between those dates. Is it that the December 1 case was just clinically diagnosed and not confirmed? And the second question for all of you is: What have you had been able to learn from the samples that were taken from the Huanan Market early on? And is it correct that some of that evidence was lost when the wild animals and the meat from them were destroyed at the time when the market was closed? Thank you.

Cao Bin:

Thank you for your questions. I appreciate your interest in our paper published in The Lancet. The paper was published on January 24, on the day of the Spring Festival. Yes, many foreign doctors have told me that they got to know the disease through our publication in The Lancet. In this paper, we introduced the clinical features of the first 41 cases hospitalized during December and early January.

As a pulmonary physician, my job is to collect clinical data. Why did we collect these clinical data? The aim of our job is to prepare the first version of the treatment guideline for this new disease. When we wrote the first version of the guidelines, we used the name “viral pneumonia with unknown etiology.”

But since then, as you may already know, China has published seven versions of the guidelines. All the serial guidelines were based on our first-line observations, collection of clinical data, laboratory findings, chest x-rays, and CT scans. When we collected clinical data of the onset of symptoms, it was self-reported by the patient. From our cohort, I have double-checked my database with the patient’s record, which noted that he felt ill on December 1.

I'm not sure if we are talking about the same case. But for a new disease, as I have mentioned, it will take many days to get to know the illness, including its incubation, severity, and optimal treatment choice. There are many angles to answer a scientific question.

I'm a clinician and pulmonary physician. This is what I can tell you now, but I would like to introduce more of our research in the future. Thank you.

Xi Yanchun:

Okay. For the second question, Professor Du would like to give an answer.

Du Bin:

Sure. Thank you for your second question concerning the closing of the Huanan Seafood Market. As far as I know, the decision to close the Huanan Seafood Market is based on clinical information, such as that provided by Professor Cao just now.

In the initial cohorts of patients, at least 60% of them had a history of contact, or visited the seafood market. And as far as I understand, the decision to close the seafood market goes along with the evidence. Although, subsequently, I think the CDC staff found that the animals, the wildlife in the seafood market, were tested positive for the RNA of the novel coronavirus. I'm not aware of any evidence to show if they kept all the meat or animals within the market, or if some of them have been destroyed or not. I think if you have the chance, you'd better go to the government to get more detailed information. Thank you.

Xi Yanchun:

Okay, because time is limited, let's give the very two last chances to raise questions: one to a foreign journalist, another to a Chinese journalist. The lady standing up, you have the chance.

ITV News:

Thank you. Debi Edward from ITV News. How confident are you that China has turned a corner in its battle against the coronavirus? And is it still possible that we could see another spike?

Secondly, I know you've answered a couple of questions on this nature already, but what would be your advice to the United Kingdom, as we see a rise in cases starting there?

Du Bin:

I'll take the question. As for the first question, if my interpretation is correct, you are asking whether or not there will be another spike of new cases. I would say, there's always a possibility. However, according to what has been reported by the Chinese government, or even local governments, we understand that it is not only in Wuhan, in Hubei, but also in other provinces in China, that the numbers of newly diagnosed as well as suspected cases have been decreasing sharply and consistently.

Another piece of evidence is that when we had the chance to visit a lot of hospitals – designated hospitals, as well as non-designated hospitals – almost all our colleagues told us that they have vacancies or empty beds. They have more and more empty beds, after discharging patients who recovered from the illness. So, according to my own judgment, it is true that we have fewer and fewer patients, even in Wuhan and Hubei province.

As for your second question: Do we have any suggestions for the United Kingdom or other countries with rising numbers of new cases? Again, “plan.” The keyword is “plan.” Know how many cases you have. And what is the plan to cope with the disease or the patients – the laboratory confirmed cases, as well as their close contacts. Where should close contacts be kept and how should you identify probable or definite cases amongst the close contacts? I do believe it's a very tough job, but it has to be done. And it has to be done not only by the health care workers, but also by the government. The government means not only the health care authorities. Other departments have to be involved, such as public security — I mean the police — such as the transportation department or other departments. They have to work together. I think that's the only way to control the epidemic, not only in China, but also in other countries. Thank you.

Xi Yanchun:

Okay. Any more comments? No? Okay. Okay, the last question please. The gentleman in the middle area, in the third line. Yes, in the middle area.

China Daily:

A question from China Daily. Considering the declining trend of new cases and the rising numbers of recovered patients in China are positive signs, what can China share with the world in terms of fighting the coronavirus? And currently, what can China do to help the international community contain the epidemic? Thank you.

Du Bin:

Thank you very much again for your question. It actually reminds me of a message sent to me by one of my high school classmates earlier today, which was a quotation from a French novel named La Peste, or The Plague, by a French novelist whose name is Albert Camus back in the 1940s. During conversation or discussion with a journalist, the leading character in the novel Dr. Rieux, said it's nothing about heroism, but honesty. With that in my mind, the only approach, the only way or the only weapon to fight against the plague is honesty. This can be defined as doing your job.

Doing your job might mean different things. From the government’s point of view, it means to share detailed information of newly identified cases and suspected cases with the general public; to educate the general public about the disease and how to prevent it; and to coordinate or to organize all the resources, including human resources and all other equipment and devices that are necessary for treating or preventing the disease. Doing your job, from a physician’s point of view, means to try our best to make the correct diagnosis and to treat patients in the correct way in order to save their lives. Doing your job, from the general public’s point of view, means to comply with the professional guidance, such as: to stay at home to self-quarantine if you are a close contact, to obey all the regulations and rules set by not only the government, but also the health care professionals in order to control the epidemic. It is my belief that the combination of all these efforts from all aspects is crucial to the successful control of the epidemic, not only in China, but also across the whole world. Thank you very much.

Cao Bin:

Thank you for your question. I think that the Chinese clinicians have confidence in sharing our latest clinical research data with the international society. As all of you know the WHO R&D Blueprint, the priority of anti-viral therapeutics. On the list, there are three priorities: First is remdesivir; second is lopinavir; and third is the monoclonal antibody to this new coronavirus. Chinese doctors are leading the top-two priority antivirals.

I believe that the whole international society, including the WHO, is eager to know the results of the clinical trials in the Chinese mainland. The good news is that the first trial – the lopinavir clinical trial – has finished. Chinese doctors will share the new results with the WHO and the international society as soon as possible.

There are two remdesivir trials – remdesivir-1 and remdesivir-2. In remdesivir-1, we include those with mild to moderate pneumonia cases. And in remdesivir-2, we enrolled the severe and critical pneumonia cases. It seems that both trials are progressing successfully. As soon as we have finished the trials, we will very happily share the data with the international society.

I believe that the clinical trials are a great contribution by Chinese doctors to the international community. Thank you.

Qiao Jie:

Okay, just a few words because time is limited. Thank you for the question. Professors Du Bin and Cao Bin already mentioned the key points. I’d just like to add one because big data sharing is also very important, given the different kinds of patients and limited numbers.

One example is pregnant women, which is my field. Until now, we have gradually accumulated a hundred cases. Now we can see the good news that pregnant women are usually mild cases if without complications like pregnancy-induced hypertension. Another good news is neonatal throat swabs are negative, so there is no evidence for mother-to-baby vertical transmission. But, we also have a few neonatal infections because of close contact with infected relatives. So, we also need to isolate newborns for two weeks for safety concerns. I believe that as more and more cases accumulate and we analyze the cases, more evidence can show us how to treat and also give the right recommendations and suggestions for the patients. We cooperate together, then the fight will be a success.

Xi Yanchun:

Lastly, Professor Li, please.

Li Haichao:

I think we are facing a situation similar to 17 years ago. It (SARS) is also a virus infection without effective anti-virus drugs, without vaccine. So, the old methods are very useful: such as keeping strict isolation when the community epidemic occurred. You must set up methods to cut down transmissions. You must decrease the total number of patients, because if the number is too large, that means there are a lot of ill patients. That means you may have higher mortality. And also, if there are too many patients, I think centralized management for these patients is useful, because you must keep the patients in the area — you can make a close observation of the patients and identify the severe and very severe patients in time, then to pick up them and to treat. That’s my suggestion. Thank you.

Xi Yanchun:

Okay, great. Thanks again.

Finally, I'd like to say that we need to be aware that the situation in China remains complicated. We will work relentlessly to consolidate our current results. We are confident that we can and will win the fight. On the other hand, the coronavirus is now becoming a common challenge facing all mankind all around the world.

While fighting the epidemic at home, China will continue to strengthen cooperation with the international community to jointly respond and play an active role in the global fight against the epidemic. Today, our four professors shared and introduced much professional and valuable advice.

Thanks again to all of you for taking time to join us during your very intense work in Wuhan, and also take care of yourself.

Thanks, and thank you all. That's the end of the briefing. Thanks.