{"id":816,"date":"2020-11-14T10:09:28","date_gmt":"2020-11-14T15:09:28","guid":{"rendered":"https:\/\/covidqanda.org\/?p=816"},"modified":"2020-11-14T10:09:28","modified_gmt":"2020-11-14T15:09:28","slug":"what-are-the-four-earlies","status":"publish","type":"post","link":"https:\/\/covidqanda.org\/?p=816","title":{"rendered":"What are the &#8220;four earlies&#8221;?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Question:<\/strong>\u00a0I heard an expert mention China&#8217;s &#8220;four earlies&#8221; strategy as a key approach for effective pandemic response\/containment.\u00a0 What are the &#8220;four earlies&#8221;?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Answer:\u00a0<\/strong>In response to the SARS outbreaks of 2003-04, China <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1550436\/\">implemented the &#8220;4 earlies&#8221;<\/a> strategy, which is about quick, timely response to curb viral spread and improve patient outcomes.\u00a0 The &#8220;four earlies&#8221; strategy, hailed by <a href=\"https:\/\/www.interacademies.org\/person\/nanshan-zhong\">Dr. Zhong<\/a> (China&#8217;s equivalent to America&#8217;s Dr. Fauci),\u00a0<a href=\"https:\/\/www.ccpwatch.org\/single-post\/2020\/04\/06\/Weekly-Report-323-3212020-3272020\">continues<\/a> to be a lynchpin of China&#8217;s response to COVID-19.\u00a0 The &#8220;four earlies&#8221; are&#8211;<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><strong>Early identification&nbsp;<\/strong><ul><li>In practice, this is widespread testing with rapid results.&nbsp; Just last month, <a href=\"https:\/\/www.bbc.com\/news\/world-asia-china-54687533\">China tested an&nbsp;entire city <\/a>of 4.7 million people to curb a regional outbreak.&nbsp; Thanks to <a href=\"https:\/\/www.reuters.com\/article\/us-health-coronavirus-china-idUSKBN27F1DY\">massive testing capacity<\/a>, <a href=\"https:\/\/www.reuters.com\/article\/us-health-coronavirus-china-testing\/slowly-but-steadily-china-strives-to-make-widespread-virus-testing-the-new-normal-idUSKBN22P0NT\">results are generally returned in a matter of hours<\/a>&nbsp;(though for such massive testing campaigns, the return time has been longer <a href=\"https:\/\/www.nytimes.com\/2020\/05\/26\/world\/asia\/coronavirus-wuhan-tests.html\">2-4 days<\/a>).&nbsp; China has also used widespread <a href=\"https:\/\/www.washingtonpost.com\/world\/coronavirus-temperature-screening\/2020\/03\/14\/24185be0-6563-11ea-912d-d98032ec8e25_story.html\">temperature checks<\/a>, though I&#8217;m not sure if this strategy is still used as evidence of its effectiveness is lackluster.&nbsp; Just yesterday, research <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/69\/wr\/mm6945a4.htm?s_cid=mm6945a4_x\">published<\/a><a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/69\/wr\/mm6945a4.htm?s_cid=mm6945a4_x\">&nbsp;in CDC&#8217;s <em>MMWR<\/em><\/a>&nbsp;concluded &#8220;Symptom-based screening programs are ineffective because of the nonspecific clinical presentation of COVID-19 and asymptomatic cases.&#8221;&nbsp;&nbsp;<\/li><\/ul><\/li><li><strong>Early reporting<\/strong><ul><li>This component is largely about contact tracing. In China, it includes <a href=\"https:\/\/merics.org\/en\/report\/tracing-testing-tweaking\">interoperable systems<\/a>&nbsp;and a huge&nbsp;<a href=\"https:\/\/hbr.org\/2020\/04\/how-digital-contact-tracing-slowed-covid-19-in-east-asia\">digital infrastructure<\/a>&nbsp;with loads of privacy concerns.&nbsp;(<strong>Figure 1<\/strong>)<\/li><\/ul><\/li><li><strong>Early isolation<\/strong><ul><li>Recognizing that isolation at home can put other household members at risk and that COVID symptoms can quickly progress from mild\/moderate to severe, <a href=\"https:\/\/www.thelancet.com\/journals\/laninf\/article\/PIIS1473-3099(20)30800-8\/fulltext\">China set up isolation centers<\/a>&nbsp;(Fangcang hospitals)&#8211; &nbsp;hospitals established within public venues such as stadiums and exhibition centres&#8211; where mild\/moderate cases would isolate and be quickly transferred to medical services if symptoms became severe.<\/li><\/ul><\/li><li><strong>Early management &nbsp;<\/strong><ul><li>With regard to patient outcomes, the <a href=\"https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/who-china-joint-mission-on-covid-19-final-report.pdf\">Report of the WHO-China Joint Mission<\/a>&nbsp;summarizes, &#8220;early identification of cases and contacts allows for earlier treatment.&#8221;&nbsp; Connecting cases with care has been a key element of China&#8217;s approach, including (during the height of the epidemic) by having mild\/moderate cases isolate in Fangcang&nbsp;hospitals to be monitored and treated and moving them to more intensive care as soon as needed.&nbsp; &nbsp;&nbsp;<\/li><\/ul><\/li><\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Figure 1. China&#8217;s digital health system (<\/strong>from\u00a0\u00a0<a href=\"https:\/\/merics.org\/en\/report\/tracing-testing-tweaking\">Mercator Institute for China Studies (MERICS)<\/a>)<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"723\" height=\"470\" src=\"https:\/\/i0.wp.com\/covidqanda.org\/wp-content\/uploads\/2020\/11\/image-1.png?resize=723%2C470&#038;ssl=1\" alt=\"\" class=\"wp-image-817\" srcset=\"https:\/\/i0.wp.com\/covidqanda.org\/wp-content\/uploads\/2020\/11\/image-1.png?w=970&amp;ssl=1 970w, https:\/\/i0.wp.com\/covidqanda.org\/wp-content\/uploads\/2020\/11\/image-1.png?resize=300%2C195&amp;ssl=1 300w, https:\/\/i0.wp.com\/covidqanda.org\/wp-content\/uploads\/2020\/11\/image-1.png?resize=768%2C500&amp;ssl=1 768w\" sizes=\"auto, (max-width: 723px) 100vw, 723px\" \/><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Question:\u00a0I heard an expert mention China&#8217;s &#8220;four earlies&#8221; strategy as a key approach for effective pandemic response\/containment.\u00a0 What are the &#8220;four earlies&#8221;? Answer:\u00a0In response to the SARS outbreaks of 2003-04, China implemented the &#8220;4 earlies&#8221; strategy, which is about quick, timely response to curb viral spread and improve patient outcomes.\u00a0 The &#8220;four earlies&#8221; strategy, hailed [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":818,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[50,5,6,81,67],"tags":[148],"class_list":["post-816","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guidelines","category-self-quarantine","category-testing","category-tracing","category-treatment","tag-china","fallback-thumbnail"],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/i0.wp.com\/covidqanda.org\/wp-content\/uploads\/2020\/11\/November-14.jpg?fit=450%2C329&ssl=1","_links":{"self":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/816","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=816"}],"version-history":[{"count":1,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/816\/revisions"}],"predecessor-version":[{"id":819,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/816\/revisions\/819"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/media\/818"}],"wp:attachment":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=816"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=816"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=816"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}