Question: I heard an expert mention China’s “four earlies” strategy as a key approach for effective pandemic response/containment. What are the “four earlies”?
Answer: In response to the SARS outbreaks of 2003-04, China implemented the “4 earlies” strategy, which is about quick, timely response to curb viral spread and improve patient outcomes. The “four earlies” strategy, hailed by Dr. Zhong (China’s equivalent to America’s Dr. Fauci), continues to be a lynchpin of China’s response to COVID-19. The “four earlies” are–
- Early identification
- In practice, this is widespread testing with rapid results. Just last month, China tested an entire city of 4.7 million people to curb a regional outbreak. Thanks to massive testing capacity, results are generally returned in a matter of hours (though for such massive testing campaigns, the return time has been longer 2-4 days). China has also used widespread temperature checks, though I’m not sure if this strategy is still used as evidence of its effectiveness is lackluster. Just yesterday, research published in CDC’s MMWR concluded “Symptom-based screening programs are ineffective because of the nonspecific clinical presentation of COVID-19 and asymptomatic cases.”
- Early reporting
- This component is largely about contact tracing. In China, it includes interoperable systems and a huge digital infrastructure with loads of privacy concerns. (Figure 1)
- Early isolation
- Recognizing that isolation at home can put other household members at risk and that COVID symptoms can quickly progress from mild/moderate to severe, China set up isolation centers (Fangcang hospitals)– hospitals established within public venues such as stadiums and exhibition centres– where mild/moderate cases would isolate and be quickly transferred to medical services if symptoms became severe.
- Early management
- With regard to patient outcomes, the Report of the WHO-China Joint Mission summarizes, “early identification of cases and contacts allows for earlier treatment.” Connecting cases with care has been a key element of China’s approach, including (during the height of the epidemic) by having mild/moderate cases isolate in Fangcang hospitals to be monitored and treated and moving them to more intensive care as soon as needed.
Figure 1. China’s digital health system (from Mercator Institute for China Studies (MERICS))
