After passing through such a disturbing time in 2003, the term
"SARS"
(severe acute respiratory syndrome) will remain an unforgettable
acronym for most Chinese people. Meanwhile, press releases on the
SARS situation, as a matter of routine, were made part of the
government?information release system each day. How was the
"daily press release of the SARS situation" operated? How will this
be regulated and improved in the future? With these questions in
mind, China.org.cn recently interviewed Mr Mao Qunan, spokesman of
the Ministry of Health (MOH) and vice director of the ministry's
general affair office.
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)
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