China CDC Weekly
Commentary
Strengthening Community Defenses to Prevent and Control
the Spread of COVID-19 in China
Xia Li1,2; Zhuona Zhang1,2; Keyang Lyu1; Dongqun Xu1,#
ABSTRACT situation abroad is serious, and it is difficult to avoid
carrying the virus in the outer package of express
In light of the severity of coronavirus disease delivery or even cold chain food (5). People working in
(COVID-19) around the world, it is an arduous task the cold chain or receiving deliveries are at risk of
for China to prevent COVID-19 from being imported infection. A previous study suggested that poor
ventilation and insufficient hygiene facilities may
from abroad and proliferating domestically. The
increase the risks of infectious disease outbreaks (6).
community is the first and most effective line of
Supermarkets, shopping malls, restaurants, and other
defense and can effectively cut off the channels of
public places have a large flow of people, but code
spread of the epidemic. In order to reduce risks of
scanning and body temperature measurement under
COVID-19 transmission in the community, it is normal epidemic prevention and control conditions are
necessary to sort out the loopholes in risk and not carefully implemented. During holidays, weddings,
management, as well as investigate previous epidemic or funerals, it is traditional for Chinese families and
transmission events in the community. friends to have dinner together, especially in rural
areas. Once there is a source of infection, the epidemic
will likely spread rapidly.
If community workers cannot conduct contact
In the first week of 2022, more than 15 million new tracing accurately at the time of the outbreak, it is
cases of coronavirus disease (COVID-19) were difficult to implement large-scale nucleic acid screening
reported to the World Health Organization (WHO) sampling without missing anyone. In addition, if close
from around the world (1). From December 2021 to contacts failed to be transferred to quarantine as fast as
January 2022, clusters of cases were reported in Shanxi, possible, there would be risks of social transmission.
Henan, Tianjin, and Beijing. Currently, China’s
epidemic prevention focuses on people from overseas RISKS IN AN OUTBREAK
and domestic high-risk areas, as well as imports of
cold-chain items. While vaccines remain highly The complex rental housing structure along with an
effective at preventing severe disease and death (2–3), unclear number of tenants made nucleic acid screening
they do not fully prevent transmission (4). After the and sampling difficult without missing someone. For
community finds a positive infected person, it is example, if someone quarantined at home was not
important to determine the close contacts and sub- sampled for several days or large communities being
close contacts as soon as possible and transfer them as unable to test all residents in one day, etc. In addition,
soon as possible. Consolidating the defense line of the some individual nucleic acid sampling methods were
community prevention relies on a series of rapid, not standardized or reasonably laid out. Disinfection
scientific, and precise prevention and control measures. and medical evaluations were not performed in a
As such, we made a series of these recommendations. timely manner after the confirmed COVID-19
patients were transferred, and most communities had
RISKS DURING NORMAL incomplete preventive disinfection records. In some
EPIDEMIC CONDITIONS communities, medical waste and domestic waste were
improperly mixed together.
With the increase of e-commerce, more people buy In some areas, the health monitoring records were
foods that need cold chain transportation from lacking or incomplete. Special groups such as the
overseas online shopping platforms. The epidemic elderly and pregnant women in some communities had
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difficulties seeking medical treatment and purchasing temperature taken before entering. Wholesale and
medicine. In some control areas, low-income residents retail outlets should shift toward online shopping,
did not have basic living conditions and supplies contactless delivery, pickup, etc. Gatherings such as
guaranteed. weddings and funerals need to be simple, with people
During the epidemic, basic medical care and other wearing surgical masks and adhering to hand hygiene
public health services could not be delivered in a timely and social distance to avoid potential infection.
and effective manner. There was no professional team Community (village) grid members should stay
for disinfection and effect evaluation. Urban villages informed of the actual situation of COVID-19
have high house density, poor sanitary conditions, and infections within their village. Pharmacies are
arbitrarily modified sewage pipes and toilets — which prohibited from selling medicines for symptoms related
do not meet the sanitation requirements. The complex to COVID-19, and if someone bought one of these
composition of public health personnel further drugs, the health code would pop up, indicating that a
complicated the management of epidemic prevention. nucleic acid test is needed as soon as possible.
Close contacts of COVID-19 cases could not be
accurately identified in some containment areas. Some PREVENTION AND CONTROL
groups in the containment area did not have
independent bathrooms or kitchens, so it was difficult
MEASURES IN CASE OF OUTBREAK
to truly isolate at home and there was a risk of cross-
Community epidemic prevention and control needs
infection.
to be carried out in three aspects: “containment,
Larger-scale residential areas in cities have high
screening, and isolation.” Epidemiological
population density, and the number of residents is not
investigations should be sped up and data should be
always clear. Elevator cars and buttons, stair handrails,
unit door handles, and other high-frequency use and immediately shared to identify the close contacts of
closed environment of public facilities were likely to COVID-19 cases and transfer those patients to
cause virus transmission (7–8). It was difficult to centralized quarantined sites as soon as possible. In the
control the flow of people in and out of commercial containment area, sampling should be carried out
and residential buildings that faced the street. Some directly at households to ensure that no one is missing.
people stranded in the office areas stored food in Nucleic acid sampling locations should be
advance and hid inside, unwilling to come out for standardized: rational layout, single entry and single
nucleic acid testing. Stranded workers at construction exit, with spacing greater than two meters between
sites with poor environmental conditions risked being sampling stations. It is necessary to strengthen the
part of a cluster infection of COVID-19 cases. training of nucleic acid sampling personnel, guarantee
their protection and hand disinfection, increase
sampling personnel and supplies, add sampling
PREVENTION AND CONTROL locations, transfer samples in accordance to the
MEASURES DURING NORMAL standard protocol, and release the test results as soon as
EPIDEMIC CONDITIONS possible. Health monitoring is carried out for all
personnel every day in the containment and controlled
Regular nucleic acid testing should be carried out for areas.
cold-chain food and goods moving through airports, After a confirmed COVID-19 case is transferred, a
ports, transportation, storage, markets, and retail professional disinfection institution must be arranged
stores. We need to fully test, sterilize and trace the to carry out terminal disinfection in accordance with
imported cargo and cold chain food. Also, personal “COVID-19 Prevention and Control Plan (Eighth
protection and health management of key personnel Edition).” At the same time, the disease control
must be strengthened. Daily random inspections of institution should coordinate the processing and
cold-chain food entering the customs at the port and in disinfection. In communities or villages where
the market is recommended. Wholesale markets selling confirmed COVID-19 cases are found, disinfectants
frozen, chilled, and fresh products should be operated should be added to the septic tank and, only after
in well-ventilated places, and the frequency of routine passing a test, can the sewage be discharged into
disinfection practices should be increased. Customers municipal pipelines. Fixed temporary storage points for
must validate their health code and get their medical waste should be set up and the frequency of
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China CDC Weekly
disinfection should be increased so as to achieve or residence community; 5) when the infected person
“double bags, double seals, and double elimination.” A or the close contact person is transported, the closed
roster of special personnel and a health service loop and protective measures are not strictly taken,
mechanism should be established to deal with this which may increase the risk of transmission in the
medical waste. The community should announce the community; and 6) other situations that may cause the
channels for medical treatment to the public, including spillover of the epidemic in the community.
helping coordinate vehicles and contact medical Scenarios to consider escalating controls: 1) it is
institutions to ensure patients seek medical treatment difficult to track and determine close and sub-close
in a timely fashion. A guarantee mechanism for the contacts; 2) the close contacts and sub-close contacts
supply of basic living supplies should be established quarantined at home and have not been transferred to
and distributed. the isolation point; 3) the communities have not taken
Improving the primary healthcare system and sufficient technical defense for those quarantining at
building healthcare capacity requires giving primary home to prevent them from going out; 4) there are
health institutions important roles in epidemic phenomena such as irregular crowd protections,
prevention and control. The district (county) CDC gatherings, frequent access to buildings (residences),
should set up a disinfection department to guide third- etc.; 5) urban-rural junctions or rural areas with
party disinfection institutions together with the health insufficient sanitary conditions, difficult management,
supervision center to carry out and evaluate the and high risk of transmission; and 6) other situations
disinfection process and quality. that may cause the spread of the epidemic in the
It is necessary to strengthen the supervision of community.
housing construction in villages to avoid “illegal In conclusion, a zero-COVID strategy is the current
construction”, especially the random modification of policy for the prevention and control of the epidemic
sanitary pipes. Through carrying out “knock-on” in China (9). When local COVID-19 cases appear,
actions, the number of personnel was identified, and comprehensive actions should be taken immediately to
the personnel roster was established. The flow of ensure timely detection, rapid disposal, precise control
people during the epidemic should be controlled, and of spread, and effective treatment. Guiding the
those who do not have quarantined conditions at home community to carry out epidemic management in a
need to be transferred to a centralized quarantined site. scientific and orderly manner can successfully curb the
The roster of personnel in residential buildings should spread of COVID-19 in the community — one of the
be established. Attention should be paid to the most effective ways to minimize the harm caused by
management and control of stranded people in the epidemic to people’s health and livelihood.
commercial shops and construction projects. We Conflicts of interest: No conflicts of interest
should increase the number of inspections of reported.
commercial and residential buildings to keep track of Acknowledgments: All experts from Community
the number of stranded personnel. Prevention and Control Team of Xi’an Epidemic.
In order to adhere to precise scientific requirements, Funding: Supported by the Key Program of
it is necessary to implement prevention and control National Natural Science Foundation of China (No.
measures with high standards and further reduce the 92043201).
risk of epidemic transmission in the community; doi: 10.46234/ccdcw2022.030
control measures can be upgraded if necessary. The #
Corresponding author: Dongqun Xu, [email protected].
following conditions should be considered for
1
expanding the scope of the containment and controlled Key Laboratory of Environment and Population Health, National
Institute of Environmental Health, Chinese Center for Disease Control
areas: 1) the transmission chain is unclear and the and Prevention, Beijing, China; 2 Department of Environmental
source of infection is unknown; 2) infected persons Microbiology, National Institute of Environmental Health, Chinese
have complex movement trajectories, and they have Center for Disease Control and Prevention, Beijing, China.
contact with other people at workplaces, activities, Submitted: January 27, 2022; Accepted: February 20, 2022
residences, etc., resulting in a high possibility of
transmission; 3) there are multiple infected persons in
different buildings in the community or residence
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