Abstract
With over five million confirmed cases worldwide of COVID-19, 1 and many more probably undetected, China’s contribution of less than 100,000 cases mainly restricted to Wuhan 2 seems low considering the size of the population. There may well be undetected cases in China as elsewhere, but a series of measures contributed to rapidly controlling the spread of the virus.3–6
Among these, the role of community was fundamental. Local communities were strictly managed by officials, with Wuhan implementing the firmest regime of community isolation. Entry and exit to communities was forbidden except for medical treatment and activities related to epidemic prevention. All the details about people entering a community as well as those being visited were registered, and the temperatures of people entering and leaving a community were taken at checkpoints. Community workers took responsibility for providing daily supplies and monitoring health status. Special attention was paid to nursing homes, welfare institutions and mental health institutions.
People across China self-isolated for work and education. Importantly, a 14-day home quarantine was strictly implemented for people travelling between regions, and non-essential travel was disallowed, even after the end of the isolation period, helping control virus transmission. National key opinion leaders publicly promoted simple but effective self-protection measures, such as mask wearing, hand washing and room ventilation.
Community workers also helped enforce these measures. For example, they monitored people passing through checkpoints to ensure that they wore face masks and observed the rules for physical distancing. They participated in dragnet screening of potential virus carriers and isolated those with positive results. They made sure every corner was disinfected. Community workers also used social media to disseminate official information from different government agencies. Community data platforms and a mobile app were built to monitor the health status of residents via self-reporting.
Psychological help was available through established hotlines in universities, online hospitals and related companies. Digital media helped relieve people's fear and anxiety by releasing a large amount of trusted information about infections, while community workers gave psychological and logistic support at home. Returnees from outside China are still quarantined locally on arrival in a specialised hotel, or sent directly back to their communities by government officials and quarantined at home.
In order to ensure an orderly resumption of work, health surveillance systems such as health QR codes and communication itinerary cards were integrated with social media. These display different colours according to a person’s health status and their epidemiological history, such as whether they have been in close contact with COVID-19 patients. Community workers allow or deny a citizen entry to a residential area according to the colour of their communication itinerary card.
In China’s response to COVID-19, the community is the intersection and the bridge between government institutions, businesses, social organisations, volunteer groups, families and individuals. The role of community workers seems unique to China. They are not medical practitioners but do perform some of the tasks that belong to general practitioners in Europe.