Analysis and Research on the Characteristics of COVID-19 Epidemic in Urban Village and Its Prevention and Control Strategies in Primary Care Institutions
For a period of time, the outbreak of the COVID-19 outbreak in many urban villages in our country had caused concern. The dense and complex population structure of urban villages, with their inter-regional mobility, posed a challenge to the prevention and control of the epidemic.
Urban village areasare more prone to regional outbreaks of infectious diseases because of their spatial environment, demographic characteristics, cross-regional mobility and the characteristics of residents' medical treatment behavior. The purpose of this study was tounderstand the characteristics of the COVID-19 epidemic situation in urban villages and the current situation and difficulties of primary care institutions in carrying out COVID-19 epidemic prevention and control measures, in order to provide references for primary care institutions to deal with normalized prevention and control, social dynamic clearing work and future infectious disease prevention and control.
By using public opinion analysis, literature retrieval, online interviews with epidemic prevention and control personnel and experts in urban village, the epidemic situation, prevention and control status of urban village were summarized, and the existing weak links and important loopholes were analyzed.
Based on the relevant information, a total of six points of concern were extracted: (1) The number of mapping and screening objects was large, which was the focus and difficulty of epidemic prevention and control work in urban villages. (2) There was not strict closed-loop management lead to virus carriers who were not timely controlled, which caused a risk of spreading the epidemic. (3) The prevention and control of nosocomial infection in primary care institutions was not in place. (4) There were loopholes in the inspection of close contacts in the principle of territorial management; close contacts who did not live and work in the same administrative area but only screened in their living places, which may lead to the spread of the epidemic in workplaces where secondary close contacts may be at risk of infection were not screened in a timely manner. (5) Overload had become the norm, highlighting the large gap in primary health care manpower. (6) During the normalization of epidemic prevention and control, residents were paralyzed and careless, and the phenomenon of not wearing masks in public places and crowd gathering was common. Health education still needs to be strengthened and emphasized that residents were the first responsible for their own health.
Primary care providers played an important role in the prevention and control of COVID-19 in urban village by undertaking community management, outpatient treatment, public health services, health education, vaccination, quarantine hotel stationing, joint prevention and control, etc. It was recommended that additional fever sentinel clinics be set up for early detection and isolation to avoid further spread of the epidemic, rental houses be requisitioned to meet the demand for isolated medical observation, primary care institutions be strengthened for hospitalization and prevention, green relief channels be opened to protect special groups from medical treatment, volunteers be organized to reinforce primary care institutions, and health education emphasized that residents were the first to be responsible for maintaining their own health and raised personal awareness of the risk of COVID-19 prevention and control.
Rural Physicians' Duties and Responsibilities in COVID-19 Pandemic Containment：an Empirical Study from the Perspective of Governance in Primary Care
COVID-19 pandemic containment in rural areas is the frontline for containing COVID-19 and a key part of response system for public health emergencies in China, during which rural physicians play an important role as the "gatekeeper" of rural residents' health and rural pandemic prevention and control. However, rural physicians have demonstrated some work-related problems during the COVID-19 pandemic containment, which have affected the implementation effectiveness of their duties and responsibilities.
To investigate the duties and responsibilities of rural physicians during COVID-19 pandemic containment in rural areas, and to identify the problems, then put forward relevant suggestions.
An on-site semi-structured interview using non-participant observation approach was carried out in Beijing's Huairou District from April to July, 2021. Eighteen rural physicians were selected to attend the interview as stakeholders. The interview was guided by an outline developed based on a literature review and an expert consultation, including three parts: (1) demographic characteristics (practice location, sex, age) , (2) practicing qualifications (education level, starting time of practicing, professional qualifications) , (3) involvement in COVID-19 pandemic prevention and control (awareness of the 10 instructions for COVID-19 pandemic containment in village clinics, participation in COVID-19 pandemic containment, and personal protective equipment materials for COVID-19) . The interview was continued until data saturation.
Among the 18 rural physicians, 14 (77.8%) were certified as rural physicians, 3 (16.7%) were certified as rural assistant general practitioners, 2 (11.1%) had a certificate of licensed physician and 1 (5.6%) had a certificate of licensed assistant physician. Except for one (5.6%) , the rural physicians〔17 (94.4%) 〕 indicated that they knew the 10 instructions for COVID-19 pandemic containment in the village clinic. The top three services about COVID-19 pandemic containment most frequently provided by the rural physicians were health education (94.4%) , information reporting (72.2%) and diagnosis and treatment (64.7%) , and the least provided was throat swab sampling〔only one case (5.6%) 〕. In addition, three rural physicians participated in providing other services, which included screening suspected COVID-19 cases in the village, guiding COVID-19 pandemic containment in the village, and purchasing food for villagers. Ten physicians (55.6%) indicated that personal protective equipment materials for COVID-19 were adequate, but other 8 (44.4%) expressed that such materials were inadequate during the first response phase. During the regular COVID-19 pandemic containment phase, 16 physicians (88.9%) indicated that personal protective equipment materials for COVID-19 were adequate, but other 2 (11.1%) still indicated that such materials were inadequate. The top four personal protective equipment materials for COVID-19 owned by the physicians in regular COVID-19 pandemic containment phase were 84 Disinfectant (72.2%) , ordinary disposable medical masks (66.7%) , disposable gloves (66.7%) and medical surgical masks (61.1%) , and the least owned were medical protective clothing (38.9%) and goggles (11.1%) .
Rural physicians play a necessary role in COVID-19 pandemic containment in rural areas, but the effectiveness of their services has been affected by limited personal capabilities in delivering COVID-19 pandemic containment services (including pharyngeal swab sampling) , lack of a legal right to provide home-based isolation and monitoring services, and inadequate personal protective equipment materials. Therefore, it is recommended that relevant laws and regulations should be improved to provide a legal right for rural physicians to perform their duties and responsibilities in COVID-19 pandemic containment, recruit them to the public health team of the village committee, and ensure the provision of emergency materials for village physicians to help them to realize their potential in pandemic containment.
Roles of Primary Care in Response to the COVID-19 Pandemic Defined in Policy Documents
The major promise for promoting primary care intuitions to take the initiative to play an active role in containing the COVID-19 pandemic is defining the duties and roles that they should undertake.
To review the policy documents related to COVID-19 issued by China's health administrative departments to make a systematic summary of the responsibilities and duties that should be undertaken by primary care institutions, offering guidance for COVID-19 containment in various regions of China.
In August 2021, we searched the official websites of the National Health Commission of the People's Republic of China (PRC) and its subordinate institutions for policy documents related to COVID-19 using "primary careinstitutions" "prevention and control at the community level" "COVID-19" and "COVID-19 prevention and control" as the main search terms. The policy documents containing "COVID-19 prevention and control" and "primary careinstitutions" were sorted out in chronological order of publication, and their contents were intensively reviewed, organized, summarized and analyzed.
Thirty-four policy documents extracted from the official websites of the National Health Commission of the PRC and its three subordinate institutions (Department of Primary Health, the former Bureau of Medical Administration and the former Bureau of Disease Prevention and Control) were finally enrolled. They were mainly formulated by the Joint Prevention and Control Mechanism of the State Council in Response to the COVID-19, General Office and Department of Primary Health of the National Health Commission of the PRC. According to these policy documents, the major responsibilities of primary care institutions in containing COVID-19 include: early detection and reporting the suspected COVID-19 cases; receiving trainings regarding knowledge related to COVID-19 containment and emergency preparedness drills for coping with the pandemic; strengthening nosocomial COVID-19 infection containment and personal protection against the pandemic; cooperating with the community in fighting the COVID-19 pandemic; implementing health education about COVID-19 containmentusing a scientific approach; health management of priority populations; collecting and submitting nucleic acid samples; COVID vaccination.
Primary care institutions play a vital role in containing COVID-19 in China. The local governments should follow policy guidelines, and take measures according to the local conditions to facilitate the primary care in stitutions to better their performance in response to COVID-19 as frontline responders.
Expert Advice on Community-based Grid Containment of COVID-19 Pandemic by the General Practice Network & Regional Medical Consortium
The COVID-19 containment has become a top global public health concern. China has obtained a phased achievement in containing COVID-19 pandemic, during the process, primary medical institutions and general practitioner teams in regional medical consortiums have played a key role. To better guide and standardize the development of regional medical consortiums, give full play to the bridge role and grid management of general medicine in COVID-19 pandemic containment, and consolidate the achievements of COVID-19 pandemic containment further, we invited a group of related experts to develop the Expert Advice on Community-based Grid Containment of COVID-19 Pandemic by the General Practice Network & Regional Medical Consortium (the First Version for Trial Implementation) (hereinafter referred to as the Expert Advice) following in-depth analysis and thorough consideration of literature review results, suggestions extensively collected and practical evidence, which mainly includes the following aspects: the essential characters of the general practice network & regional medical consortium, organizational structure, contents and separation of responsibilities and duties, operation mechanism, content of the work, workflow, training and assessment. We hope the Expert Advice will contribute to the construction and operation of the general practice network & regional medical consortium in various regions for COVID-19 containment.
Policies Implemented in Beijing for Guaranteeing Healthcare for Community-dwelling Patients with Noncommunicable Diseases during the COVID-19 Pandemic
The COVID-19 pandemic brings about influence and challenge for ensuring healthcare services for non-communicable diseases. To guarantee the healthcare services for community-living patients with non-communicable diseases and to meet their healthcare needs, the Beijing municipal government issued a series of policies and relevant supporting measures, including five parts: promoting the implementation of the extended prescription policy, providing Internet-based medical services, further implementing the hierarchical medical system, giving full play to the role of family doctors, and carrying out the service of doorstep delivery of medicines. We reviewed and summarized policies and corresponding measures implemented in Beijing for guaranteeing healthcare for community-dwelling non-communicable disease patients during COVID-19 early response period and ongoing containment period. By evaluating the implementation effect of the policies and comparing with those at home and abroad, it is found that the community chronic disease management under the continuous epidemic situation can be further optimized in the future from the aspects of strengthening the training of grass-roots medical personnel, paying attention to the monitoring of chronic diseases and their risk factors, accurate health management, continuing to implement the hierarchical diagnosis and treatment system, and exploring the whole cycle health management of chronic diseases.
