Manipulation of the epidemic situation release

The tense work, day and night, during the SARS outbreak period still leaps before Mr Mao's eyes. In fact, before April 21, the MOH had irregular reports and press releases on the epidemic situation, sometimes once every five days and sometimes once a week. However, April 21 was a real watershed. Starting from that day, the MOH began to report the daily epidemic situation to the whole nation in a standardized form at 4 pm every day.

All hospitals at and above county-level across the country arranged special people to report on the SARS epidemic. The disease prevention and control departments at county-level and district-level of a city were in charge of collecting information within the area of their jurisdiction and then reporting to the provincial, autonomous regional and municipal health departments. All information was gathered and then reported to the MOH. In order to make sure the press conference on the SARS situation was held on time at 4 pm everyday, the MOH required all provinces, autonomous regions and municipalities to report their epidemic situation before 12 am, explained Mr Mao.

In order to guarantee that the numbers were complete and accurate, the MOH required all medical administrative authorities and disease prevention and control centers not to leave out one county or one village. The MOH had conducted a "zero reporting" system, that is to say, all hospitals reported their statistics on SARS cases even if there was no SARS case. After the MOH stopped releasing the epidemic situation to the public after August 16, all provinces, autonomous regions and municipalities still reported relative data to the MOH everyday according to requirements.

After receiving the data, expert teams of both MOH and Chinese Center for Disease Control and Prevention (CDC) respectively conducted analysis on the data. The Chinese CDC focused on statistics of numbers, age, sex, professions, location, the contact record, infectious resources and spread chains of patients and suspected cases as well as the possible trend of latter epidemic situation. The MOH experts were in charge of verifying numbers and sorting out material and research on what to do next as well as providing data to the information office for release.

Mao explained: "Actually, there is no certain format for the press release of the epidemic situation. Even during the 118 days of the SARS outbreak period, the release format were changed several times from releasing only the SARS cases, number of hospitalized patients, mortality at the beginning to releasing the number of suspected cases as well as their ages and distribution of their professions. In future, the release will be more detailed and improved, to include, for instance, health tips aiming at the daily life of the people.

Surveillance on the epidemic situation and report network

According to Mao, the existing epidemic monitoring network, the National Health Information Network, was built in 1998. In the summer of 1998, several provinces in south China suffered from disastrous floods. The severe disaster exposed the problem of obstructed communication in information during the work of disaster relief and disease prevention. Therefore, the government decided to set up a national health information network with one billion yuan (US$120.8 million) from central finance and one billion yuan from local finance. Due to unbalanced economic development in China at that time, funds from central finance mainly went to the western provinces so as to guarantee the network to cover all of the country. In 2001, the network was set up and put into operation.

However, when confronting a significant epidemic like SARS, the health information network exposed many short comings:

First, since the terminal of the information network was only available to counties, the statistics in villages had to depend on work staff to fill in epidemic report cards and report to various counties through fax or mail. When facing a sudden outbreak of an epidemic, the statistics and reports under county level could not quickly be put into the network.

Second, the given report content in the network was not perfect. For example, previously, reporting was required only when there was a confirmed disease. Diseases such as SARS which are not clearly diagnosed could not enter into the network. There were no clear regulations on how to report undiagnosed diseases.

Third, the report methods were not satisfying. It took a long time for the report to finally be available to the MOH via different levels, for instance, from village to county, to city, to province... Therefore, when a big epidemic occurs, the time-consuming reporting procedure would bungle the speed of decision-making.

According to Mao, the MOH has decided to improve the national health information network as soon as possible. At present, arguments on relative programs are still under way. Focusing on problems occurring in the anti-SARS period, the network will be greatly adjusted and improved. For instance, the terminal of future networks will spread to villages. "Symptom surveillance" will be added to report content, that is to say, those abnormal and unclear infectious diseases will also be reported to higher authorities.

Different from before, every piece of epidemic reporting, from villages to counties, will directly reach the MOH at the same time as it is reported to its higher authorities. It will not affect the verification at each level but will avoid leaving out or the delay in any reporting. It will help health administrative departments to master the epidemic situation at the first time, said Mao

Construction and improvement of public health system

The MOH is now engaged in speeding up and improving the construction of the public health system itself. According to the plan, it will take two to three years for China to improve the following systems: epidemic surveillance and reporting system, disease prevention and control system, medical aid system and establishment of emergency medical teams. In addition, it may take a longer time for China to establish a rural medical health system and the supervisory system on health law enforcement.

"Problems exposed during the SARS period show that investment in the public health system is far from enough," said Mao.

The construction of the public health system mainly depends on government investment. However, in recent years, although such investment has increased in numbers, its proportion in the total finance spending has decreased largely from 3 percent in the 1980s to 1.7 percent in 2002, according to Mao.

"It is really a thing to regret and needs to be seriously considered by relevant departments," said Mao.

(China.org.cn by staff reporter Chen Shan, translated by Wang Qian, September 15, 2003)