Research status, countermeasures and recommendations of emergency management system for TCM prevention and control of major epidemics#

Song Du, Zheng Yu, Kaiwei Zhao, Wei Yang, Ming Li

1 Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medicine Science, Beijing 100700, China

2 Emergency Management Training Center, Party School of the Central Committee of C.P.C, Beijing 100089, China

Abstract

Key words: traditional Chinese medicine; major epidemics; emergency management system

Introduction

In recent years, global public health emergency events have constantly occurred in social development. Over 30 diseases such as AIDS, Legionnaires’ disease, Ebola disease, Lyme disease, SARS, and avian flu have spread as an epidemic outbreak to varying degrees around the world. Since the end of 2019, COVID-19 has been spreading worldwide. Compared with rapid spread in Europe, America and other countries, the epidemic situation in China has been preliminarily controlled at present. TCM has played an indispensable role in this fight against the epidemic. It is a major feature and highlight of the epidemic prevention and control. Different from the previous management against the epidemics, the present management is characterized by: firstly, a full participation of TCM in all procedures, covering the prevention and control as well as the treatment of mild, common, severe,and critically ill patients; secondly, a full participation of TCM at all stages, from the beginning of the outbreak to the prevention and control of the epidemic, especially in the treatment of critically ill patients. This is the first large-scale and well-organized early TCM intervention,the first attempt to comprehensively manage one hospital,the first takeover on a fully organized ward, the first fullprocess joint inspection and rounds by the combined use of TCM and Western medicine, the first deep intervention in the treatment of severe and critically ill patients, which contribute to a systemic protocol based on the TCM feature and the integrated TCM and Western medicine.TCM has been highly praised by international community:“The combined use of TCM and Western medicine is a critical protocol to control the epidemic and it is making a contribution to the global fight against the epidemic.”[1]The above-mentioned epidemic prevention and control work has indicate the necessity and significance of systematically summarizing the experience and lessons of TCM in responding to major epidemics, accelerating and improving the construction of emergency management system for TCM prevention and control of major epidemics. Researcher Hu Jingqing appeals the inclusion of TCM in the treatment system for public emergency events[2], so as to complement the advantages of TCM and Western medicine and comprehensively improve the efficacy of integrated TCM and Western medicine to treat major epidemic diseases. In summary, we have summarized the current status of the construction of TCM emergency management system in China from three research aspects: TCM prevention and control of epidemics, emergency management of public health emergencies and TCM emergency management system.In addition, the countermeasures and recommendations are proposed in order to promote and improve the construction of public health emergency management system in China.

Research on TCM Prevention and Control of Epidemic Diseases

1.1 Research on epidemic disease history

In field of TCM, there have been rich historical experience and theoretical basis for the prevention and control of epidemic diseases. In recent years, relevant researches have focused on the history of epidemic disease and corresponding prospect analysis for different types of diseases at different historical periods and regions. For example, the history of epidemic disease at a specific historical period[3], the history of epidemic disease in a certain region[4], the summary of principles and methods for epidemic prevention and control at different historical periods[5], and the history and prospects of prevention and control of specific epidemics[6]. A representative work named “History of Epidemic Prevention in China”,edited by Deng Tietao[7], is a chronology-based writings describing a detailed survey of past historical facts, such as the measures and processes regarding the occurrence,development, prevention and control of epidemics during past dynasties in China in an objective manner. It reveals the relationship with the development of TCM theory and the former political and social status, and reflects the TCM understanding of the plague and the corresponding epidemic prevention levels, historical experience and lessons at different historical stages. Different from other similar studies, this book has invested heavily in recording the crises response and management by governments and societies during the past dynasties, especially summarizes the experience on SARS epidemic prevention and control,which is one of the highlights; another example is “TCM Prevention and Control of SARS in 2003 Study 1 -Historical Epidemics in China”[8]compiled by the China Academy of Chinese Medical Sciences, which also focuses on epidemic prevention countermeasures and health care system, and has important reference value for the current research on the management system construction.

Research on epidemiological study of epidemic disease

Some previous studies on the epidemiology of epidemic disease are also included in the scope of the history of epidemic disease. With the advanced researches in recent years, related content is gradually refined and has become one of the research hotspots. By using official history, chorography and other information, the epidemic situation, characteristics and former understanding of the epidemics in the dynasties and historical stages involved may be verified, described and analyzed. Specifically, it includes the analysis of the epidemic situation at a specific historical period and the epidemiological data of a certain epidemic disease. For example, the epidemiological law of epidemic disease in specific areas at a specific period[9]and the summary analysis of epidemiological data[10],etc. A representative research achievement named “A Chronology of Chinese Ancient Epidemic”[11]edited by Zhang Zhibin, has collected 826 pieces of information on ancient epidemics recorded in the historical annals from 674 BC to 1840 AD. It comprehensively demonstrates the epidemic situation in ancient China, and accordingly proposes its views on the prevalence and control of infectious diseases, so as to provide a full range of ideas for discussing the prevention and control of infectious diseases and a valuable reference for fighting against the epidemics under the present social conditions.

Theoretical and clinical study on the diagnosis and treatment of TCM for epidemics

Since the SARS in 2003, China has initiated a series of researches concerning the TCM prevention and control of infectious diseases. The relevant researches include the 2008 National Science and Technology Major Project“Prevention and Treatment of AIDS, Virus Hepatitis and Other Serious Infectious Diseases”, and the 2009 National Administration of Traditional Chinese Medicine Industry Special Project “Laws and Mechanisms of Diagnosis and Treatment of TCM Prevention and Control for H1N1 Influenza, Hand-Foot-Mouth Disease and Epidemic Encephalitis B in China”, the 2010 National Administration of Traditional Chinese Medicine “Plan for the Construction of Clinical Scientific Research System for TCM Prevention and Treatment of Infectious Diseases”, and the National Science and Technology Major Project during the Twelfth and Thirteenth Five-Year Plan “Establishing TCM Function against Emergent Infectious Diseases” Project, and “Research Platform for Clinical Treatment of Emerging and Emergent Infectious Diseases by the Integrated TCM and Western Medicine”jointly developed by 35 key laboratories of infectious disease in China. The main categories of diseases include plague, cholera, scarlet fever, malaria, lepriasis,epidemic hemorrhagic fever, epidemic encephalitis type B, influenza, SARS, hand-foot-mouth disease and other diseases that have posed major impacts on Chinese society in modern times, including theoretical and clinical study. In the theoretical study, a systematic analysis and in-depth discussion on the name, prevalence characteristics, diagnosis and treatment rules, syndrome characteristics, treatment methods and prescriptions,and prevention of these diseases is performed among the TCM theory and literature. For example, the literature analysis-based summary of diagnosis and treatment experience and theoretical improvement of epidemic diseases[12], research on the etiology and pathogenesis of epidemic diseases[12], research on the evolution of epidemic disease syndromes[12], analysis on medication characteristics and laws of epidemic diseases[13], research on epidemic disease prevention ideas and methods[14].These projects systematically promote the construction of TCM prevention and control of major infectious diseases, initially establish effective linkage mechanisms and emergency mechanisms among all-level prevention and control units of infectious disease in China, greatly promote the basis, network and platform construction,diagnosis and treatment protocol formation, and specialist team construction for TCM prevention and control of infectious diseases, and provide a good reservation of knowledge and professionals and a research foundation for the treatment of major epidemics with integrated TCM and Western medicine. However, rare content is reported for the construction of TCM emergency management system. Further explorations should be performed on the constructions of the institutions, specialist teams, college education and continuing education, clinical study base and experiments, as well as data support platform for TCM prevention and control of infectious diseases[15].Moreover, most of these studies are done by medical professionals and investigators, and focus mostly on the TCM theoretical understanding of the epidemics, such as the name, etiology and pathogenesis, diagnosis and treatment of the diseases, while the prevalence situation,the influencing factors, the impact on the society and the social response measures after the outbreak of the disease are rarely mentioned.

Research on the impact of previous epidemics on ancient societies and social response mechanisms

Relevant researches mainly take the interaction between the plague and ancient Chinese civilization as the basic clues and combine with major historical epidemic events,in order to introduce the social background, as well as the impact produced on society, politics, economy, military,technology, religion, culture and lifestyle. The impacts on the change of dynasties, social economy and population have been included. Most of these researches are rational analysis and summary of the epidemic prevalence,prevention and control at different historical stages and their relationship with the nations and society, from the perspective of sociology or social history of the epidemic,based on hygiene and epidemic prevention data[16].Different from similar results from the perspective of medical epidemic prevention, such researches focus on the impact of the epidemic as a public health emergency on the entire society and the overall response actions. In recent years, relevant researches has gradually increased,with representative works such as “Plague and Society in Southern Area of Yangtze River in Qing Dynasty”,“Sanitation and Epidemic Prevention Mechanism in Qing Dynasty and Its Modern Evolution”, “Social Rescue under the Plague - Research on Major Epidemic and Social Response in Modern China”[17]by Yu Xinzhong. Yu believes that the response to epidemic disease in ancient Chinese society has focused on avoiding and treating,rather than preventing, and lacks a proactive system and behavior under the justification of public power. For the introduction and implementation of modern quarantine system, the outbreak of the plague is a breakover point,and the root cause should be the internal factors from the nation and society. Most of the above-mentioned researches are not closely related to medical study, and emphasize on the elucidation of the problems from a sociological perspective.

In summary, the current researches on TCM in epidemic prevention and social response mechanisms have attracted extensive attention in recent years, and the relevant research results are also various and sufficient,involving the epidemic prevention and treatment ideas in ancient Chinese medical classics, the impact of the epidemic on ancient Chinese society, the social response mechanism and rescue measures after the outbreak of the epidemic. From the perspective of the development of TCM epidemiology, the above studies have systematically summarized and analyzed the epidemiological data of epidemic disease, and have inherited and innovated traditional TCM disease theories from practice. These retrospective analyses from different perspectives have further consolidated the theoretical system of TCM response to major epidemics, improve the TCM function on responding to major epidemics, strongly and promote the in-depth development of relevant researches; from the perspective of sociology, these researches, mostly based on the scope and view of historical and sociological data, have provided realistic warnings for the future prevention and control of epidemics in the nations and society. However, these two aspects of researches have not been organically combined.How to use the existing research base and achievements to effectively improve the TCM emergency treatment of major epidemic diseases and apply to the system improvement and construction of TCM response to public health emergencies, is the ongoing priority for us.

Research on Emergency Management of Public Health Emergency Events in China

At present, national emergency management system in China has been initially established, and plays an indispensable role in responding to various public emergency events. Since the SARS outbreak in 2003,China has quickly established a legal structure system,health emergency plan and network surveillance system for public health emergency events, these systems fully embody the advanced concept of “continuously improving the emergency management system in disasters”.The research directions and hotspots of emergency management in China include the emergency events,emergency management system and functions, and toplevel design. How to improve the emergency response capabilities of the public health system is one of its core issues. At present, the research on emergency management of public health emergency events in China mainly includes the following aspects:

Research on government management policyIt

includes the investigation and analysis of policy guarantees,plan formulation, legal system construction, mechanism construction, and command and decision-making systems in the construction of the health emergency management system at the provincial, municipal and county levels[18].Sun Mei[19]has summarized the changes in emergency response policies for public health emergencies in China during the past decade, and proposes that relevant policies are gradually refined and improved, including the content of emergency plans, the composition of emergency teams and the content of team training, the construction of emergency materials guarantee system, the responsibilities of all parties involved in emergency on-site disposal, and evaluation of emergency disposal.

Research on the construction of public health emergency management system

It includes emergency rescue mechanism and response strategy, emergency command system construction[20],emergency management technology support system,emergency function improvement construction,emergency function evaluation system construction[21],emergency resource guarantee and configuration optimization, existing problems in emergency management,and countermeasures and recommendations[22-23].Researchers have conducted a more detailed discussion concerning the strategic research on the construction of emergency management system, research on the mechanism of classical public emergency crisis/disaster, research on surveillance and early warning of public emergency, research on emergency resource management theory and technology,research on cognition and decision-making behavior of public emergency, research on the simulation and phantom of public emergency, research on the emergency management system of public emergency, and postoutbreak evaluation and reconstruction[24]. In addition,research theories and methods of other related disciplines,such as crisis management and disaster economics, have also been applied to research in this field[25]. At the same time, the concept of Emergency Medical Assistance[26]was developed by combining emergency management with the medicine. Researchers have carried out researches and related policy recommendations from perfecting the decision-making system, improving the early warning system, enhancing emergency treatment functions,perfecting the security system, and educing the role of non-governmental organizations[27]. Meanwhile, a series of evaluation systems, evaluation indicators and methods have been established for health emergency functions[21].Some researchers have also conducted comparative studies on the construction of emergency management systems in China and abroad[20,28]. According to researchers, the main existing problems in the current public health emergency response system include, to a certain extent, the idea of “emphasizing rescue and neglecting prevention”, insufficient early warning and precontrol functions, and no authoritative comprehensive professional departments responsible for public emergency response. They recommend to strengthen the constructions in response preparation, early warning management, emergency response, and post-epidemic treatment[29]. The above studies have posed problems and formulated the corresponding solutions from different perspectives, and have promoted the construction of public health emergency management system in China to varying extents. Notably, with the continuous economic and social development and the continuous improvement of the national governance system, emergency management in China have been greatly changed in terms of management concepts, management methods,management bodies, management processes, management systems, and management guarantees. The modernization goal of emergency management system and emergency management function is approaching[30], of which the public health emergency management system is also steadily developing.

Research on Emergency Management System of TCM

Compared with researches on the emergency management system of public health emergencies in China, the construction of TCM emergency management system is relatively weak in terms of theory and practice. Although increasing concerns have been paid in recent years, the width and depth of relevant researches need further exploration. As a representative view, Su Rui et al[31-32]have discussed the formulation of TCM emergency decisionmaking system from the perspective of formulating TCM diagnosis and treatment plans for emergent acute infectious diseases, and analyzed the current situation of TCM emergency function construction and the related policies. They demonstrate that, establishing a stable and professional TCM health emergency team is the premise for establishing a long-action mechanism of TCM emergency treatment and an important way to effectively improve TCM emergency response functions. Yang Jing et al[33-34]have analyzed the current situation and existing problems of TCM involving in the construction of the emergency response system based on management level,and explored the relationship between TCM institutions and health emergency competent institutions and other emergency response institutions. They demonstrate that,in order to improve the level of emergency management in the TCM industry, especially the construction and improvement of emergency management systems and mechanisms, TCM involvement in the system construction, mechanism construction and plan construction of the emergency management system for public emergencies has great practical significance. Some researchers[35-36]have also analyzed the current emergency support situation of TCM, and summarized the strategy of improving TCM emergency response from the advantages of TCM applied in modern emergency rescue, the system construction and reserve construction of TCM emergency support, and the guarantee research of Chinese patent medicine. They believe that the health emergency rescue should pay equal attention to Chinese and Western medicine. The above researches indicate that increasing attention has been paid on further improvement of TCM emergency management system, and it is imperative to initiate special research, and only in this way we better use integrated TCM and Western medicine to fight against major epidemics.

Regarding the relevant policy and system, the National Administration of Traditional Chinese Medicine has established a leading group for TCM emergency response to public emergencies in 2012, functioning to coordinate and arrange TCM emergency treatment for public emergencies. However, in fight against major epidemics,the TCM team for preventing and controlling the emergent acute infectious diseases has not yet been fully included in the national infectious disease emergency system, and the construction of the TCM emergency system for infectious disease is still starting. Although the TCM emergency team and the expert database have been preliminarily established, the reserves of materials, equipment, facilities,technology and professionals are below the levels of the national emergency team. In the current epoch, it is urgent to further improve TCM emergency response functions,establish a long-action mechanism for TCM emergency treatment, serve as a permanent member of the emergency treatment team, and thoroughly exhibit its important role in emergency medical rescue.

Countermeasures and Recommendations

There are still many problems existing in emergency response system for public health emergencies in China,and TCM has not yet been fully enrolled into the national emergency response system for public health emergencies.After the outbreak, many experts in the TCM community have advocated “a thorough solution to the problem of equal emphasis on Chinese and Western medicine in the governance system” and propose to integrate TCM into the public health emergency management system[2,14,37].However, insufficient researches have investigated the construction of TCM emergency management system in response to major epidemics. The specific response mechanism, guarantee mechanism, and relevant policies and regulations concerning the TCM in public emergency events are not stipulated. It is imperative to further demonstrate the advantages of TCM in responding to major epidemics and truly integrate TCM into the national public health emergency management system. Our recommendations are as follows:

First, researches should focus on the construction of TCM emergency management system. With the intensification of the epidemic, infectious diseases induce huge risks to the society and an increasingly prominent specificity and complexity. The advantageous role of TCM in previous epidemic prevention process has indicated the significance of further strengthening the construction of TCM emergency management system. This will strongly ensure a better application of integrated TCM and Western medicine in fight against major epidemics.

Secondly, a widening thinking is encouraged to emphasize on the comprehensive application of multi-disciplinary and multi-system research methods. The construction of the TCM emergency management system should emphasize on the mutual learning and integration of multiple disciplines. For cross- and integrated applications of multiple disciplines such as emergency management,risk management, sociology, statistical analysis, the construction of TCM emergency management system requires the cooperation of researchers with multidisciplinary backgrounds, to improve the national prevention and control functions to treat major epidemics and obtain satisfactory achievements.

Finally, an emergency management system framework for TCM should be constructed to prevent and control major epidemics. It is necessary to establish a comprehensive,stereoscopic and multi-level emergency management system framework for TCM preventing and controlling major epidemics from different dimensions such as objects, subjects, stages, scales and elements. This is of great supportive significance for improving the national public health emergency management system.

In summary, it is recommended to re-review the weak links of the TCM emergency management system for the prevention and control of major epidemics based on the existing researches on the TCM prevention and treatment of epidemics and the TCM emergency management of public health emergencies. While accelerating the construction of TCM prevention and control of infectious disease, a targeted and orderly construction of TCM emergency management system, and an overall framework and model mechanism of TCM emergency management system for the prevention and control of major epidemics will contribute to provide policy recommendation and reference for exploring the construction of TCM emergency management system in the mature national emergency management system and constructing a public health emergency response system with Chinese characteristics. This also helps formulate a scientific public health emergency management framework of “equal emphasis and cooperation of both Chinese and Western medicine” and a scientific and efficient prevention and control management system, which is of great practical significance for improving the national public health emergency management system.