Public health officials in a city in China were able to contain a COVID-19 outbreak and avoid a lockdown last month by using testing on a massive scale, according to a New England Journal of Medicine article.
“Testing millions of people in a short period is challenging and requires effective coordination and execution, along with cooperation of residents,” according to the article’s five authors from the Chinese University of Hong Kong, Qingdao University, the Municipal Center of Disease Control and Prevention of Qingdao, and Qingdao Women and Children’s Hospital. “But regular surveillance and testing of high-risk populations may identify infected people before widespread transmission occurs.”
An outbreak alarm was triggered on Oct. 11, when three cases of COVID-19 were reported in Qingdao, a coastal city in Shandong Province.
Since the initial epidemiologic evidence suggested that all of the cases were linked to Qingdao Chest Hospital, the authors said, it immediately stopped admitting new patients and providing outpatient services.
On the basis of prior experience in Wuhan, the suspected source of the virus, a government task force was established in response to the outbreak. The Qingdao health commission launched a citywide, grid-based, mass-screening protocol using reverse transcription polymerase chain reaction (RT-PCR) testing.
Trained medical staff from local hospitals, together with teams dispatched from other cities in Shandong Province, were sent to 4,090 testing locations in Qingdao and its suburbs.
Each resident was contacted for testing. To minimize processing time and conserve resources, the authors said, a pooled testing approach was used, with each pool containing samples from three to 10 people: three for household contacts of infected people, five for hospitalized patients or health care workers, and 10 for community members. If a pooled sample tested positive, individual testing was performed on each person in the pool.
By Oct. 16, 10.9 million people had been tested, the authors said, and another nine cases related to the initial cluster were identified using pooled testing, for a total of 12 cases. Since then, all testing has been completed, and no additional cases have been found, they said.
The outbreak was controlled without a lockdown, though there were heavy governmental regulations.
Residents were required to wear masks. They were allowed to move freely within the city during the testing process, the authors said, but they had to have a negative test result before they could use public transportation.
People leaving Qingdao also needed to have a negative PCR test result, and most other provincial governments required visitors from Qingdao to quarantine for one week and to have a second negative PCR test result before moving freely.
Dr. Katrina Armstrong, the lead author of a recent Journal of the American Medical Association article on the need for more and better testing for COVID-19, said the United States would do well to learn from Qingdao’s handling of the outbreak.
“The supply chain for testing broke down in this country. … It was chaos,” said Armstrong, physician in chief at Massachusetts General Hospital. “If we had been able to really invest in testing early on, hundreds of thousands of people would still be alive.”
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