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Universal Health Coverage (UHC) and the Coronavirus Crisis – Challenges and Responses: maintaining essential health services for pregnant women and children while responding to COVID-19
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Time is set at EDT, please adjust according to your time zone ( 9 AM Brasilia – 8 AM New York – 8 PM Beijing ) Introduction
08:00 – 08:05 (5min)
Presentation 1 : Fighting against COVID-19 caring for pregnant women & newborns-How does China's MCH system provide services during the covid19 epidemic —— Prof. Wang Ailing Presentation 2 : Experiences in maternal and child health services delivery during COVID-19 epidemic—— Dr. Xia Huimin Presentation 3 : Risk communication mechanism and experiences during COVID-19 —— Dr. Cui Ying Presentation 4 : Treatment experience of pregnant women with COVID-19 —— Academician Qiao Jie Q&A Closing remarks
08:05 – 08:20 (15 min) 08:20– 08:35 (15 min) 08:35 – 08:50 (15 min) 08:50 – 09:05 (15min) 09:05 – 09:25 (20 min) 09:25 – 09:30 (5 min) Moderator
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Agenda 08:00 – 09:30 am (EDT)
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Universal Health Coverage (UHC) and the Coronavirus Crisis – Challenges and Responses: maintaining essential health services for pregnant women and children while responding to COVID-19
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◼ Deputy Director General of the International Health Exchange and Cooperation Centre, National Health Commission of the People's Republic of China
Commencing her career initially with Physician at the Cancer Hospital of Chinese Academy of Medical Sciences, she joined IHECC in 1997 where she worked as Project Manager in Medical Rescue Department (International Emergency Assistance Office of Ministry of health). From 2001, she was assigned the Deputy Director of Project Development Department, the Director of External Relations and Project Management Department II. Since 2014, she was assigned as Deputy Director General of IHECC, in charge of non-profit international health exchange and cooperation programs and Health Industry promotion.
◼ Deputy Representative UNICEF China
master’s degree and research doctorate in public health from Johns Hopkins and Queen Mary University of London, respectively. He has worked with the British Government in the Department of Health and Cabinet Office, the World Health Organization, and the Commonwealth Fund. He has honorary academic affiliations with the University of Oxford and Queen Mary University of London and has published 40 papers in academic and health service journals.
Kathmandu, Nepal. Dr. Douglas joined UNICEF China as the Deputy Representative in January 2017.
◼ Director of the Maternal Health Department of the National Center for Women and Children’s Health, China CDC.
Mainly engaged in maternal health care, prevention of mother-to-child transmission of HIV, syphilis and hepatitis B. As the team leader, she and her team are responsible for national maternal health management, HIV prevention, syphilis and hepatitis B mother-to-child transmission planning, technical guidance, training, supervision and evaluation, daily Management and other technical support work, participated in a number of research and international cooperation projects related to the prevention of HIV, syphilis and hepatitis B mother-to-child transmission.
Song Li Deputy Director General (DDG) Department of Women & Children health National Health Commission of China
Covid-19 epidemic
Song Li & Wang Ai-Ling
Wang Ai-Ling Director of Maternal Health Care Department, National Center for Women and Children's Health, China CDC
◆ Situation analysis on maternal and children’s health of Covid-19 ◆ Optimizing the operation of MCH service system to adapt the changing situation during the outbreak ➢ Policies ➢ Services
Situation analysis on maternal and children’s health of Covid-19
Changes from Health Providers 1.More prevention and control requirements ➢ Changes in procedures ➢ Requirements for protective equipment for medical personnel 2.There are fewer outpatient visits than before, but the need for deliveries and critical illness remained 3.Medical personnel to support the frontline of prevention and control 4.The protection of medical personnel themselves
◆ Situation analysis on maternal and children’s health of Covid-19 ◆ Optimizing the operation of MCH service system to adapt the changing situation during the outbreak ➢ Policies ➢ Services
Policy responses---Timely release national policies and technical guidelines on COVID-19 prevention and management among pregnant women and children
➢ “Notice on how to prevent and manage infected pregnant women and children during the
➢ “Notice on strengthening management of pregnant women and ensuring safety of motherhood during the outbreak of COVID-19”.
◼ Changes in procedures
In response to the physical and psychological characteristics of pregnant women during the outbreak
health, which were done through various channels, such as online consultation, WeChat and other social media APPs, hotline, and video.
Services responses--- providing services through different channels and platforms
More targeted services were provided to pregnant women and newborns.
16
Screening and assessment of risk of pregnancy
Systematic management of high-risk pregnant women Management of near-miss pregnancies Accountability of maternal and infant safety Case reporting of individual maternal death
◼Health facilities were requested to set up separate route for antenatal care clinics and
◼ For low-risk pregnant women, they were advised to adjust their schedule for antenatal care
visits, and consult with their doctors on how to protect themselves and conduct health monitoring at home.
◼ For pregnant women with complications, suggestions were provided on how to conduct
antenatal care visits as scheduled, and under what situation they should go to hospitals.
◼ In order to ensure timely detection and treatment of infected pregnant women, a service provision
system for screening, diagnosis and treatment of pregnant women with COVID-19 was established based on the existing MCH system.
19
Infected pregnant women and children
◼ All should follow the protocol of management: treatment and follow-up ◼ Expert groups composed of obstetricians, pediatricians, physicians specialized in respiratory,
infectious diseases and ICU were established in all areas across the country, and they participated the management of near-miss pregnancies with COVID-19 infection.
◼ For newborns of women with confirmed infection, isolation and specific newborn care were
required, and newborns under severe condition were requested to be referred to designated hospitals for further treatment.
and management among pregnant women and children
during the outbreak
channels and platforms
◼ Chairman, Guangzhou Women and Children’s Medical Center ◼ Director, Provincial Clinical Research Center for Children’s Health and Diseases of Guangdong ◼ Director, Provincial Key Laboratory of Birth Defects of Guangdong
Published more than 50 papers in SCI journals with a research direction focusing on the field of pediatric surgery
2nd July, 2020
Experiences in Maternal and Child Health Services Delivery during COVID-19 Epidemic
Guangzhou Women and Children’s Medical Center
Licensed Beds
1700
Outpatient Visits
4.89 million
Inpatient Admission
145,000
Campuses cover approximately 100 million people, 16% (about 12 million) are children from Guangdong province. A pointed treatment center for COVID-19 infection in pediatrics
Overview of GWCMC
From 19th January to 16th June, 2020 COVID-19 laboratory tests (RT-PCR): 85,797 (800 tests per day) Fever clinic：914 Medical observations: 193 Suspected pediatric cases：65 Confirmed pediatric cases：24
COVID-19 related services
Key epidemiological & clinical characteristics of pediatric patients 1. Viral excretion from gastrointestinal tract lasts longer than respiratory tract 2. CT scan presents more definite signs of pneumonia compared to chest X-ray, especially in asymptomatic or mild cases 3. Most from familial clusters, presented with mild symptoms or even asymptomatic
What we have learnt from 24 pediatric cases?
GWCMC published a manuscript in Nature Medicine entitled “Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding”
prevention and control
Comprehensive Strategy
Closed-loop management of diagnosis and treatment developed and optimized for COVID-19 epidemic
Outpatient services
Update standard-based triage process Improve procedure directing patients to fever clinic Maintain a distance of at least 1 m
Facilities for COVID-19 services
Quarantined areas (a separated building)
RT-PCR tests; Rapid testing results (6-8hrs) Inpatient services Laboratory
Infection prevention and control (IPC) strategy
IPC team
81.34% in 2019
Ensuring PPE supply Systematic training
cleaners and support staff.
Change in GWCMC outpatient & inpatient service volumes
From Jan to May 2020, GWCMC’s outpatient and inpatient service volume has dropped 50.95% and 29.12%, compared to the same period of 2019.
Pediatric outpatient volume Pediatric discharge volume
Change in Pediatric Services Volume
COVID-19 pandemic poses huge impact on pediatric services in Guangzhou.
Vaccination Volume
100000 200000 300000 400000 500000 600000 700000 2019年第一季度 2020年第一季度
Q1,2019 Q1,2020 388,782
Catch-up immunization schedule:
BCG, polio, measles, pertussis diphtheria tetanus, Japanese encephalitis, meningococcal, hepatitis A.
according to vaccination intervals. Current monitoring data (coverage rate)
Change in deliveries services
16.75% decrease in Guangzhou (2020 vs. 2019)
Hospital-community priority strategy
1. name-list at community-level 2. telephone follow-up by hospitals 3. transport/transfer services
Isolation at home or in a repurposed facilities Pregnancy with severe complications (code red): 2% Women ≥36 weeks of gestations
confirmed cases in Guangzhou.
transmission
Management of High-risk Pregnancy
Internet hospital- online maternity and pediatric services
Intelligent inquiry
Screen and evaluate diseases Homepage
Enhance service capability of online consultation and treatment
远程胎监
Internet hospital- online maternity and pediatric services
Blood glucose monitoring Dietary guidance Pregnancy Exercise Guidelines Psychological guidance Remote fetal heart rate (FHR) monitoring
Statistics of internet hospital services
Launched: 29th Jan, 2020 Operation data
27% 26% 18% 14% 15%
Top 5 departments and their proportion
OB outpatient Fever clinics Child health service GYN outpatien Pediatrics (Respiratory and Gastroenterology)
t
Resumption of work and production
Ongoing Prevention and Control Separated building (3rd-4th Floor) with 70 beds for the COVID-19 cases at Children’s Hospital Campus. Reopening outpatient and inpatient services
Service volume (May, 2020)
1. Nation-wide support and mobilization by the Chinese government for COVID-19 treatment. 2. Ongoing hospital capacity building for COVID-19 prevention and control. 3. Offering healthcare trainings specific to the demands of the epidemic and related tasks. 4. Enhancement of maternal and child health services based on well-organized monitoring, health education, and telemedicine. 5. A bench-to-bedside collaborative mechanism to provide strong scientific and technological support. 6. Society-wide efforts against the COVID-19 epidemic.
Summary
Guangzhou Women and Children’s Medical Center
◼ Director of Health Communication Center, China Center for Disease Control and Prevention
With the goal of "spreading knowledge about healthy living, advocating healthy lifestyle, and sharing healthy life concept", she has played an important role in promoting the in-depth development of health communication, health promotion and mobile health. She is responsible for the top-level design of disease control science popularization and guide the development direction of health science popularization. Build a national health expert team of health sciences with technical experts in various fields as the core. Build the core competitiveness of health sciences in the disease control center, and cultivate health science talents at all levels who can face the society, media, and the public, and actively promote the team building. Take the "Internet +" as an opportunity and use new media as a means to continuously innovate the concept of health communication; in the emergency response to health incidents, provide authoritative science to the public to prevent rumors and correctly guide public opinion. She has carried out more than 40 international and domestic cooperation projects .She has published more than 70 articles in core magazines.
Risk communication mechanism and experiences during COVID-19
Cui Ying PHD，Director The Center for Health Communication of China CDC Chinese Center for Disease Control and Prevention
CONTENTS 1
Needs assessment and monitoring
2
Risk communication strategy
3
Risk communication impact
4
Conclusion
Feb.26 28617 June 8. 12554
Needs assessment and monitoring
topics
Top public concerns reflected by hot-topic key words, analyzed through Big Data——From “Big data Analysis Daily Report”, Feb. 7
Symptoms and manifestation Personal protection Hubei Red Cross Society Epidemic development Epidemic impact on economy Shuanghuanglian Incident (a TCM claimed with curative effect but hyped up as a preventative drug) COVID-19 hospitals Antiviral drugs Modes of transmission Avian flu Public donation for Wuhan Extension of the Chinese New Year Holiday Viable duration for COVID-19 virus
Hubei Hunan Henan Jiangsu Zhejiang Guangdong Beijing
concerned among the high-, middle- and low-risk areas
Needs assessment and monitoring
Early phase What are the clinical symptoms of COVID-19? Is it under control?
What preventive measures are there? How to wear a mask properly?
Re-open phase
Cautions to take for those back to work and resuming production, and information about relevant policies? Mid-phase How to prevent it? How to deal with the suspected cases?
Changing public demands for information over different phases
Needs assessment and monitoring
Established mechanism and experts team Evaluation → generation → adaptation → communication → re- development Experts mobilization
Risk communication strategy——Demand-oriented
Coordinating with experts Interfacing with the public
Accurately and timely respond to public needs Actively push information according to the needs of prevention and control
Risk communication strategy——Accuracy
Public（publication） Children （video） Different occupations and groups（poster） Special population （graphic text）
Needs oriented, provide various types of public health communication products Segment the audience and deliver the content accurately
Joined forces with UNICEF 41 Q&As related to pregnant women and children 20 Q&As, 4 videos, 12 posters on Back-to-school Page views: 130 million +
Risk communication strategy ——Pregnant women and children
Risk communication strategy ——Strengthen engagement with partners
National Health Commission. Ministry of Foreign Affairs and the Ministry of Education. Platform: Baidu, Ali and Tencent, etc. South-South Cooperation. A number of public health communication products have been translated and released in Cambodia, Indonesia, North Korea, Laos, Malaysia, Mongolia, Myanmar, Papua New Guinea, the Philippines, Thailand, Timor-Leste, Vietnam, Iran and other countries.
Risk communication strategy——Feedback mechanism
Experts interviewed on television
Experts in the People's Network webcast
Public——understand the needs and communication effects through various channels Experts——timely interpretation of COVID 19 prevention and control measures Media——disseminate information on multiple platforms to magnify the communication effects
Risk communication impact
248 public health communication products were published over 100 days, which clocked in almost 200 million views in Weibo and WeChat .
Popular science products formats contents Special groups(pregnant women, children and the elderly), special places (offices, nursing homes, kindergartens, factories and mining enterprises, etc.) and protective measures(disinfection, the use of disinfectants, air conditioning system etc.) are included The number of popular science products published by CDC (by June 15, 2020)
Video
Graphic text
Poster Publications Webcast
38 248 22 2 1
Risk communication impact
mask all the time when they stayed
March 18. Survey on mask wearing
hands for more than 20s is 132.8% more than before the epidemic. March 21. Survey on hand cleaning
increased for 37.9% compared with before the outbreak of the epidemic. April 22. Survey on respiratory etiquettes
Online surveys were launched through the official WeChat platform to learn about changes in public perception and behavior.
Changes of the health behaviors of children’s caregivers before and after the outbreak of COVID 19 Among the 1,325 caregivers of children under 5 years in the survey. 95.8% of the caregivers responded that the health information was helpful, and the recognition rate was high The rate of child caregivers' use of disposable hand sanitizer or disinfectant wipes during treatment, wearing masks when going out, washing hands, and changing their coats at home all increased
Risk communication impact ——Changes of awareness and behaviors among the children’s
caregivers
Change of the guardians’ health behavior towards their children before and after the outbreak of COVID 19
Percentage of children’s caregivers regularly disinfecting toys and tableware increases; The percentage of those sharing tableware with children, cooling the food with breaths, and chewing food to feed children decreased.
Continue to obtain feedbacks of the public needs through the platform and create public health communication products.
Risk communication impact ——Changes of awareness and behaviors among the children’s caregivers
Conclusion
Establish monitoring system to accurately gauge the needs of the public; Multi-format products, multi-channel communication, and multi-platform interaction, to maximize the influence and reach of public health core messages; The communication of public health information for pregnant women and children has improved the public's awareness of protective measures and promoted changes in public behaviors; Leverage the big brand of the CDC through the small lever of health communication and an enabling environment for public health communication created through the series of health communication initiatives around the COVID-19 period.
Thank you all for listening！ Dr.Cuiying cuiying@chinacdc.cn
Academician Qiao Jie
◼ Academician of Chinese Academy of Engineering ◼ President of the Third Hospital to Peking University
Her reproductive research focus on the molecular mechanism of human gametogenesis and embryo development, infertility causes and clinical treatments, the protection and preservation of female fertility as well as developing new pre-implantation diagnosis methods. Qiao Jie and her team made many landmark contributions to the development of reproductive medicine. During this pandemic, Qiao Jie, as the leader of the National medical aid team for Hubei of Peking University. She led the team to establish critical care wards and ensure the efficient and high-quality operation of the ward. Improved the mechanism of emergency support to make zero infection among medical staff in her team came true. Her team also investigated the risk of mother to child vertical transmission at the first time, and timely published comments and clinical research results in international top journals. Moreover, the suggestions she provided on diagnosis and treatment of pregnant women have added in the Guidelines on the Novel Coronavirus-Infected Pneumonia Diagnosis and Treatment (Provisional 7th Edition) in China, which had great significance to guide perinatal health care and formulate corresponding prevention and treatment measures.
Peking Uiversity Third Hospital Jie Qiao July 2nd Beijing，P .R.CHINA
团结/奉献/求实/创新
61
Pandemic Situation of COVID-19 World Wide
More than 100 thousands new confirmed cases every day around the world
New cases 178,328 Confirmed cases 10021,401 Deaths cases 499,913
Nearly 5 thousands new deaths cases every day around the world Data last updated: 2020/6/29 3:15pm CEST
团结/奉献/求实/创新
62
团结/奉献/求实/创新
Clinical characteristics of pregnant women with COVID-19
63
Published Online: 18th April, 2020 Chen L … Qiao J, et al. NEJM, 2020
团结/奉献/求实/创新
Clinical characteristics of pregnant women with COVID-19
64
Methods
Union Hospital; 30 Hubei General Hospital; 19 Zhongnan Hospital ; 21 Tongji Hospital; 15 The Central Hospital
Hospitals of all COIVD-19 confirmed cases Chinese Clinical Guidance for Covid-19 Pneumonia Diagnosis and Treatment Laboratory- diagnosed (N=84, 71.2%) Clinically- diagnosed (N=34, 28.8%)
(Manifestations with pneumonia image features on CT)
Chen L … Qiao J, et al. NEJM, 2020
团结/奉献/求实/创新
Clinical characteristics of pregnant women with COVID-19
65
Results
118 pregnant women with Covid-19 in Wuhan
Wuhan
Hubei Province
✓ 0.24% of all 50,005 confirmed patients with Covid-19 ✓ Median age: 31 years (IQR:28-34) ✓ 52% were nulliparous ✓ 64% had been infected in the third trimester ✓ Most common symptoms: Fever (75%), Cough (73%) ; Diarrhea: 7% ✓ 44% presented lymphopenia ✓ 79% had infiltrates in both lungs Chen L … Qiao J, et al. NEJM, 2020
团结/奉献/求实/创新
Clinical characteristics of pregnant women with COVID-19
66
Results
Severe disease (hypoxemia)
➢ Severe disease developed in 6 of the 9 after delivery ➢ 1 of 9 received noninvasive mechanical ventilation (critical disease) Chen L … Qiao J, et al. NEJM, 2020
团结/奉献/求实/创新
Clinical characteristics of pregnant women with COVID-19
67
Results
➢3 spontaneous abortions, 2 ectopic pregnancies, and 4 induced abortions (all owing to patients’ concerns about Covid-19) ➢68 (58%) patients delivered, accounting for 0.56% of all 12,195 deliveries in Wuhan ➢63 patients (93%) underwent a cesarean section (61% concerned about the effects of Covid-19) ➢21% deliveries were premature; 7 were induced due to concern about Covid-19 ➢No babies had neonatal asphyxia or death
Delivery
Chen L … Qiao J, et al. NEJM, 2020
团结/奉献/求实/创新
68
◆Risk of severe disease in pregnant population (8%) compared favorably with general population (15.7%) ◆The present data do not suggest an increased risk of severe disease among pregnant women ◆Exacerbations of disease during the postpartum are relate to pathophysiological changes ◆Up to March 20th, 94% (109) had been discharged and there we no deaths
Clinical characteristics of pregnant women with COVID-19
Chen L … Qiao J, et al. NEJM, 2020
Results
69
团结/奉献/求实/创新
Different Isolation Categories and designated hospitals provide medical services for uninfected or suspected/infected pregnancy women
Suspected cases/ Confirmed mild cases Confirmed severe cases
Home isolation Designated hospitals for regular prenatal examination Fangcang shelter hospitals Designated Ob & Gy Hospitals Designated Ob & Gy Hospitals
70
团结/奉献/求实/创新
Exclude suspected
Also need much attention
Flow chart of diagnosis and treatment for suspected cases
71
团结/奉献/求实/创新
Consultation Room
Management strategy for suspected cases and those confirmed cases who cannot be transfered to designated hospitals timely
In outpatient area In inpatient area
Infected
72
团结/奉献/求实/创新
73
◆ Every staff should monitor their temperature and report their symptoms every day ◆ Warnings for staff to keep distance when working, eating, or having a rest ◆ Provide training and guidance for the all medical staff
Protection of medical staff
团结/奉献/求实/创新
① Screening for suspected patient
Management if infected during first/second/third trimester
adults around the same age
paid more attention
fetuses should be seriously evaluated during the treatment
indicators
termination of pregnancy, and the best choice is caesarean section
74
团结/奉献/求实/创新
Gestational weeks and adverse effects of drugs on pregnant women and fetuses should be seriously evaluated during the treatment
Alpha-interferon inhalation
pregnancy has the risk of hindering fetal growth and development
5 million U or equivalent for adult, add 2 ml of sterile water, 2 times daily inhalation
It is relatively safe to use in the second/third trimester
75
① Screening for suspected patient
Management if infected during first/second/third trimester
Lopinavir/ritonavir （C）
（200 mg / 50 mg, per capsule) 2 capsules each time for adults, twice a day The course of treatment should not exceed 10days
and the data show no significant teratogenicity
lopinavir/ritonavir is detected in breastfed infants
团结/奉献/求实/创新
Choice of delivery mode: Vaginal delivery or CS Regardless of Delivery Mode
Need ed Emer ergen gency cy CS CS
In Labor CO COVI VID-19 19 with th pregn egnancy ancy at at unde designate signated hos
ital: if if en enco countered ntered
ctivate vate CS CS proc
ess?
ctivate vate labor proce cess ss
76
77
团结/奉献/求实/创新
➢Nine confirmed pregnant women, all in the third trimester ➢Six newborns : Amniotic fluid, cord blood, breast milk and throat swab samples (All samples tested SARS-CoV-2 negative)
Is there vertical transmission from mothers to babies?
Not Sure Not Sure
78
Qiao J. Lancet, 2020
Comment Comment
团结/奉献/求实/创新
Published Online February 10, 2020
➢ Nine pregnant women (10 newborns) All neonatal throat swab samples tested SARS-CoV-2 negative
Not Sure Not Sure
79
➢ 3 cases of placenta nucleic acid test positive ➢ Neonatal nucleic acid test negative ➢ positive in placenta, negative in amniotic fluid and vaginal secretion ➢ Negative in blood, feces, liver, lung, armpit and thymus
Is there vertical transmission from mothers to babies?
团结/奉献/求实/创新
➢ Newborn SARS-CoV-2 IgM antibody increased 2 hours after birth ➢ 5 newborns with elevated SARS-CoV-2 IgG levels ➢ 2 newborns with SARS-CoV-2 IgM antibody
80
Is there vertical transmission from mothers to babies?
Have possi Have possibi bility lity
团结/奉献/求实/创新
positive and false-negative results
patient could represent artifact
➢ 2h after birth IgM 45.83 AU/ml ➢ 14d after birth IgM 11.75 AU/ml
test negative
81
Comment Comment
More Definitive Evidence is needed
placenta
Is there vertical transmission from mothers to babies?
团结/奉献/求实/创新
Further clinical and basic studies are needed
Time
82
Is there vertical transmission from mothers to babies?
团结/奉献/求实/创新
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Critical issues for protecting pregnancy women
83
Adaptación de programas de transferencias deefectivo en América Latina y el Caribe para responder a la pandemia COVID-19
Tuesday, 7 July - 10 AM EDT/GMT-4
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