Strong effect of socioeconomic levels on the spread and treatment of the 2019 novel coronavirus (COVID-19) in China

BackgroundGlobal response to the COVID-19 epidemic presents strengths and weaknesses in national and regional social governance capacities to address public health challenges. The emergence, detection, spread, treatment and containment of infectious diseases shows the considerable political and economic impacts in a highly interconnected world. We aimed to estimate the effects of socioeconomic levels on the spread and treatment of COVID-19 in China. Methods We obtained daily COVID-19 cases at a city level in China. We used migration data from the major cities in Hubei Province, and macroeconomic data at city and province levels. We obtained social management measures in response to COVID-19 outbreak. We assessed the association between measures, migration and COVID-19 spread, and the association between socioeconomic levels and COVID-19 treatment capacity. FindingsOn January 1, 2020, COVID-19 spread that affected by management measures and migration started across China. After Wuhan lockdown, the case number reached peak in 12 days, and COVID-19 outbreak was basically contained in China in four weeks due to intensive measures. Guangdong, Jiangsu and Zhejiang Provinces showed the most excellent COVID-19 treatment capacities. Socioeconomic levels in these provinces ranked top in China. Guangdong achieved the largest decline in severe case rate by 22.1%. Jiangsu had the lowest average rate of severe cases (1.7%) and zero death. Among the regions with top case number, Zhejiang showed the highest rate of cured cases on confirmed cases (96.3%), the lowest average rate of severe cases (7.7%), and one death. The COVID-19 treatment capacities were strongly affected by regional economics and measures on control, detection and treatment. InterpretationSocioeconomic levels had strong effect on the spread and treatment of COVID-19 in China. Further investigations are needed on the effectiveness of Chinese measures and the effects of socioeconomic levels on COVID-19 treatment outside China. FundNone Research in context Evidence before this studyWe searched PubMed for articles published in any language up to April 24, 2020, with the search terms "COVID-19 AND (socioeconomic OR measure) AND (spread OR treatment)". We identified 334 articles. Some researchers are dedicated to debating the effect of social management measures on the spread of COVID-19 epidemic. All previous studies focused on the effect of the individual measure on COVID-19 spread over time. We identified several mathematical modelling studies exploring the effect of management measures, mainly focusing on Wuhan lockdown in China, on COVID-19 spread. However, social management measures not only involve prevention and control of virus spread, but also virus detection and patient treatment. No study used methods that would allow the assessment of effect of several management measures on the spread, detection, and treatment of COVID-19 at various time milestones over the entire course of COVID-19 outbreak. Some scholars advocated that health equity cannot be ignored to contain the global COVID-19 epidemic. They did not provide epidemical and economic data analysis to assess the effect of socioeconomic gradients in health at individual or regional levels. No study estimated the effects of socioeconomic levels on national and regional COVID-19 treatment. Added value of this studyWe found that on January 1, 2020, COVID-19 spread that affected by management measures and migration started across China. After Wuhan lockdown, COVID-19 outbreak was basically contained in China in four weeks due to intensive measures. The intensive measures mainly include movement restriction, wearing masks in public, nationwide joint prevention and control at a community level, four early strategies, and information disclosure. We, for the first time, estimated the effect of socioeconomic levels on spread and treatment of COVID-19 in China. The management measures, including Fangcang shelter hospitals, medical assistance nationwide, and continuously updated diagnosis and treatment plan for COVID-19, greatly improved COVID-19 treatment capacities in China, particularly in Hubei Province. The COVID-19 treatment capacities were strongly affected by regional economics and measures on control, detection and treatment. Implications of all the available evidenceThe Chinese experience provides important insights into how to design effective management strategies of COVID-19 or other epidemic. Further efforts are needed on the effectiveness of Chinese management measures and the effects of socioeconomic levels on COVID-19 treatment outside China.