Steroids Therapy in Patients With Severe COVID-19: Association With Decreasing of Pneumonia Fibrotic Tissue Volume.

Background: We use longitudinal chest CT images to explore the effect of steroids therapy in COVID-19 pneumonia which caused pulmonary lesion progression. Materials and Methods: We retrospectively enrolled 78 patients with severe to critical COVID-19 pneumonia, among which 25 patients (32.1%) who received steroid therapy. Patients were further divided into two groups with severe and significant-severe illness based on clinical symptoms. Serial longitudinal chest CT scans were performed for each patient. Lung tissue was segmented into the five lung lobes and mapped into the five pulmonary tissue type categories based on Hounsfield unit value. The volume changes of normal tissue and pneumonia fibrotic tissue in the entire lung and each five lung lobes were the primary outcomes. In addition, this study calculated the changing percentage of tissue volume relative to baseline value to directly demonstrate the disease progress. Results: Steroid therapy was associated with the decrease of pneumonia fibrotic tissue (PFT) volume proportion. For example, after four CT cycles of treatment, the volume reduction percentage of PFT in the entire lung was -59.79[±12.4]% for the steroid-treated patients with severe illness, and its p-value was 0.000 compared to that (-27.54[±85.81]%) in non-steroid-treated ones. However, for the patient with a significant-severe illness, PFT reduction in steroid-treated patients was -41.92[±52.26]%, showing a 0.275 p-value compared to -37.18[±76.49]% in non-steroid-treated ones. The PFT evolution analysis in different lung lobes indicated consistent findings as well. Conclusion: Steroid therapy showed a positive effect on the COVID-19 recovery, and its effect was related to the disease severity.

Steroids Therapy in Patients With Severe COVID-19: Association With Decreasing of Pneumonia Fibrotic Tissue Volume

Background We use longitudinal chest CT images to explore the effect of steroids therapy in COVID-19 pneumonia which caused pulmonary lesion progression. Materials and Methods We retrospectively enrolled 78 patients with severe to critical COVID-19 pneumonia, among which 25 patients (32.1%) who received steroid therapy. Patients were further divided into two groups with severe and significant-severe illness based on clinical symptoms. Serial longitudinal chest CT scans were performed for each patient. Lung tissue was segmented into the five lung lobes and mapped into the five pulmonary tissue type categories based on Hounsfield unit value. The volume changes of normal tissue and pneumonia fibrotic tissue in the entire lung and each five lung lobes were the primary outcomes. In addition, this study calculated the changing percentage of tissue volume relative to baseline value to directly demonstrate the disease progress. Results Steroid therapy was associated with the decrease of pneumonia fibrotic tissue (PFT) volume proportion. For example, after four CT cycles of treatment, the volume reduction percentage of PFT in the entire lung was −59.79[±12.4]% for the steroid-treated patients with severe illness, and its p-value was 0.000 compared to that (−27.54[±85.81]%) in non-steroid-treated ones. However, for the patient with a significant-severe illness, PFT reduction in steroid-treated patients was −41.92[±52.26]%, showing a 0.275 p-value compared to −37.18[±76.49]% in non-steroid-treated ones. The PFT evolution analysis in different lung lobes indicated consistent findings as well. Conclusion Steroid therapy showed a positive effect on the COVID-19 recovery, and its effect was related to the disease severity.

Usage of compromised lung volume in monitoring steroid therapy on severe COVID-19.

BACKGROUND: Quantitative computed tomography (QCT) analysis may serve as a tool for assessing the severity of coronavirus disease 2019 (COVID-19) and for monitoring its progress. The present study aimed to assess the association between steroid therapy and quantitative CT parameters in a longitudinal cohort with COVID-19. METHODS: Between February 7 and February 17, 2020, 72 patients with severe COVID-19 were retrospectively enrolled. All 300 chest CT scans from these patients were collected and classified into five stages according to the interval between hospital admission and follow-up CT scans: Stage 1 (at admission); Stage 2 (3-7 days); Stage 3 (8-14 days); Stage 4 (15-21 days); and Stage 5 (22-31 days). QCT was performed using a threshold-based quantitative analysis to segment the lung according to different Hounsfield unit (HU) intervals. The primary outcomes were changes in percentage of compromised lung volume (%CL, - 500 to 100 HU) at different stages. Multivariate Generalized Estimating Equations were performed after adjusting for potential confounders. RESULTS: Of 72 patients, 31 patients (43.1%) received steroid therapy. Steroid therapy was associated with a decrease in %CL (- 3.27% [95% CI, - 5.86 to - 0.68, P = 0.01]) after adjusting for duration and baseline %CL. Associations between steroid therapy and changes in %CL varied between different stages or baseline %CL (all interactions, P < 0.01). Steroid therapy was associated with decrease in %CL after stage 3 (all P < 0.05), but not at stage 2. Similarly, steroid therapy was associated with a more significant decrease in %CL in the high CL group (P < 0.05), but not in the low CL group. CONCLUSIONS: Steroid administration was independently associated with a decrease in %CL, with interaction by duration or disease severity in a longitudinal cohort. The quantitative CT parameters, particularly compromised lung volume, may provide a useful tool to monitor COVID-19 progression during the treatment process. Trial registration Clinicaltrials.gov, NCT04953247. Registered July 7, 2021, https://clinicaltrials.gov/ct2/show/NCT04953247.

Comparison of Public Health Containment Measures of COVID-19 in China and India.

OBJECTIVE: This study aimed to make a comparative analysis of the public health containment measures between China and India, explore the causes of the serious COVID-19 epidemic in India, and eventually to improve global infectious disease control. METHODS: We extracted publicly available data from official websites, summarized the containment measures implemented in China and India, and assessed their effectiveness. RESULTS: China has responded to the COVID-19 outbreak with strict public health containment measures, including lockdown of Wuhan city, active case tracing, and large-scale testing, ultimately preventing a large increase in daily new cases and maintaining a low mortality rate per million population (as of May 5, 2021, daily new cases were 11 and mortality rate per million population was 3.37). India, although imposing a national lockdown to control the pandemic, has not implemented strict testing, tracking, and quarantine measures due to the overburdened healthcare system. Combined with massive lockdown, it has accelerated human mobility and exacerbated the epidemic, resulting in a rapid increase in daily new cases and a high mortality rate per million population (as of May 5, 2021, daily new cases were 412,431 and mortality rate per million population was 166.79). CONCLUSION: China and India implemented public health containment measures to contain the spread of the COVID-19 pandemic based on their national situations. Meanwhile, daily new cases and mortality of COVID-19 also were affected by environmental and socioeconomic. Countries make a comprehensive strategy not only in terms of the biological, pharmaceutical, health, and sanitation sectors but also based on sustainability science and environmental science.

Core policies disparity response to COVID-19 among BRICS countries.

OBJECTIVE: To provide experience for formulating prevention and control policies, this study analyzed the effectiveness of the Coronavirus disease 2019(COVID-19) prevention and control policies, and evaluated health equity and epidemic cooperation among BRICS countries. METHODS: This study summarized the pandemic prevention and control policies in BRICS countries and evaluated the effectiveness of those policies by extracting COVID-19 related data from official websites. RESULT: As of May 4, 2021, responding to COVID-19. China adopted containment strategies. China's total confirmed cases (102,560) were stable, without a second pandemic peak, and the total deaths per million (3.37) were much lower than others. India and South Africa who adopted intermediate strategies have similar pandemic curves, total confirmed cases in India (20,664,979) surpassed South Africa (1,586,148) as the highest in five countries, but total deaths per million (163.90) lower than South Africa (919.11). Brazil and Russia adopted mitigation strategies. Total confirmed cases in Brazil (14,856,888) and Russia (4,784,497) continued to increase, and Brazil's total deaths per million (1,936.34) is higher than Russia (751.50) and other countries. CONCLUSION: This study shows BRICS countries implemented different epidemic interventions. Containment strategy is more effective than intermediate strategy and mitigation strategy in limiting the spread of COVID-19. Especially when a strict containment strategy is implemented in an early stage, but premature relaxation of restrictions may lead to rebounding. It is a good choice to combat COVID-19 by improving the inclusiveness of intervention policies, deepening BRICS epidemic cooperation, and increasing health equities.

A Comparative Retrospective Study of COVID-19 Responses in Four Representative Asian Countries.

PURPOSE: This study compared the government policies and non-pharmaceutical interventions adopted by South Korea, Japan, India, and China in response to COVID-19 during 2020-2021 and assessed their effectiveness. We hope that our research will help control the COVID-19 waves and a future crisis of this nature. METHODS: COVID-19 case data were obtained from Our World in Data database. Combined with case data, we made a retrospective study by analyzing the government policies and non-pharmaceutical interventions taken during this pandemic in these four representative Asian countries (South Korea, Japan, India, and China). RESULTS: From January 2020 to May 18, 2021, South Korea and Japan experienced three waves of COVID-19 outbreaks, but the number of daily new confirmed cases per million people was relatively small in both countries, and South Korea had fewer daily new confirmed cases per million than Japan. Following the COVID-19 outbreak in Wuhan in late 2019, China successfully contained the first wave of the outbreak and was not currently experiencing a large-scale resurgence of the epidemic (Until May 18, 2021). India is experiencing a grim second wave of the epidemic, with far more daily new confirmed cases per million people than South Korea and Japan. CONCLUSION: Successful practices in China and South Korea show that case identification and management, coupled with close contact tracing and isolation, is a powerful strategy. The lessons of Japan and India show that social distancing is an effective measure, but only if it is rigor and persistent. Finally, in both developed and developing countries, the development of health care systems and coordinated government leadership play a key role in overcoming epidemics.

Response to the COVID-19 Pandemic: Comparison of Strategies in Six Countries.

Objective: This study aimed to examine the effectiveness of containment strategies and mitigation strategies to provide a reference for controlling the ongoing global spread of the pandemic. Methods: We extracted publicly available data from various official websites between January 1 and December 31, 2020, summarized the strategies implemented in China, South Korea, Singapore, the United States, the United Kingdom, and France, and assessed the effectiveness of the prevention and control measures adopted by these countries with the daily new cases and mortality rate per 100,000 population. Results: China, South Korea, and Singapore adopted containment strategies, which maintained a proactive approach by identifying and managing cases, tracking and isolating close contacts. China and Singapore had a similar epidemic curve and the new daily cases. As of December 31, 2020, the new daily cases of China and Singapore were below 100 with the mortality rates per 100,000 population of 0.3 and 0.5, respectively. But the new daily case of South Korea was as high as 1,029, with a mortality rate per 100,000 population of 1.8. In contrast, the United States, the United Kingdom, and France responded with mitigation strategies that focus on treating severe cases and those with underlying conditions. They had similar epidemic curves and mortality rates per 100,000 population. The United States had up to 234,133 new confirmed cases per day, and the mortality rate per 100,000 population was 107, while the United Kingdom had 56,029 new confirmed cases per day and the mortality rate per 100,000 population was 108, and France had 20,042 new cases per day, with a mortality rate per 100,000 population of 99. Conclusions: China, Korea, and Singapore, which implemented strict containment measures, had significant outbreak control. Meanwhile, the successful practices in China, Singapore, and South Korea show that the containment strategies were practices that work especially at the individual level identifying and managing the infected patients and their close contacts. In the United States, the United Kingdom, and France, which implemented the mitigation policies, the effect of epidemic prevention and control was not significant that the epidemic continued or even increased epidemic relatively quickly.

Epidemiological Characteristics and Core Containment Measures of Imported COVID-19 Cases from Abroad in Early Phase in Guangdong, China.

OBJECTIVE: This study aimed to analyze the distribution characteristics and influencing factors for the interval between entering mainland China and the diagnosis of imported COVID-19 cases in Guangdong province, in order to provide valuable experience for global pandemic in prevention and control. METHODS: We collected publicly reported data between March 1 and June 2, 2020. Univariate and multivariate regression analyses were performed to identify the significant associated factors with the interval between entering mainland China and diagnosis of imported COVID-19 cases. RESULTS: As of June 2, 2020, a total of 200 imported cases were reported in Guangdong province. The average interval time was 4.25 days with a median of 2 days, the interval time of 68% cases was between 1 and 3 days. The multivariate model results show that the three following factors were critical influencing factors: nationality was foreign nationality (P = 0.037), results of initial nucleic acid detection were negative (P = 0.000) and the interval between entering mainland China and the detection of positive results (T) exceeded two days (P = 0.008). CONCLUSION: The results suggested that all travelers and returning resident should be taken strict sampling and testing, and isolation measures, improved the accuracy of the initial nucleic acid test results, and the detection efficiency and shortening the interval between entering mainland China and detection of positive results.

Policy disparities in response to COVID-19 between Singapore and China.

OBJECTIVE: The study analyzed the common points and discrepancies of COVID-19 control measures of the two countries in order to provide appropriate coping experiences for countries all over the world. METHOD: This study examined the associations between the epidemic prevention and control policies adopted in the first 70 days after the outbreak and the number of confirmed cases in China and Singapore using the generalized linear model. Policy comparisons and disparities between the two countries were also discussed. RESULTS: The regression models show that factors influencing the cumulative number of confirmed cases in China: Locking down epicenter; activating Level One public health emergency response in all localities; the central government set up a leading group; classified management of "four categories of personnel"; launching makeshift hospitals; digital management for a matrix of urban communities; counterpart assistance. The following four factors were the key influencing factors of the cumulative confirmed cases in Singapore: The National Centre for Infectious Diseases screening center opens; border control measures; surveillance measures; Public Health Preparedness Clinics launched. CONCLUSIONS: Through analyzing the key epidemic prevention and control policies of the two countries, we found that the following factors are critical to combat COVID-19: active case detection, early detection of patients, timely isolation, and treatment, and increasing of medical capabilities. Countries should choose appropriate response strategies with health equity in mind to ultimately control effectively the spread of COVID-19 worldwide.

The re-emergence from the COVID-19 epidemic of Beijing Xinfadi Market.

ABSTRACT: To provide references for global pandemic prevention and control, this study aimed to analyze the epidemiological characteristics and clinical manifestations of 103 new confirmed cases between June 12 and June 15, 2020, in Beijing. All confirmed cases in this study were tested with a positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction and extracting data from the Beijing Municipal Health Commission (June 11 to July 6, 2020). We selected the 103 typical confirmed cases (excluding imported cases) between June 12 and June 15 for statistical analysis and explored differences among different clinical cases. A cluster of COVID-19 was reported in Beijing between June 12 and June 15, 2020, involving 103 confirmed cases. Patients aged 21 to 65 years old and the mean age was 42.38 ±â€Š11.507, the male-to-female sex ratio was 1.40:1. All confirmed cases had a direct or indirect exposure history in the Beijing Xinfadi Market (BXM), and the clinical manifestations of 97% confirmed cases was diagnosed as mild or moderate. Different clinical classification in age (P = .041), exposure history (P = .025), fever (P = .020), and cough (P = .000) were the statistically significant difference, but there was no statistically significant difference in gender (P = .501), the type of diagnosis (P = .478), expectoration (P = .979), fatigue (P = .906), dizziness or headache (P = .848), muscle pain (P = .825), sore throat or throat discomfort (P = .852), chills (P = .933), diarrhea (P = .431) and runny nose or nasal congestion (P = .898). This study shows that Beijing's epidemic scope was mainly concentrated in the Xinfadi Market. The initial cases were epidemiologically related to the BXM, the clinical classification of most cases was mild and moderate, and the differences in age, exposure history, fever, and cough among different clinical cases were statistically significant.

Hubei's Core Response Policies in the Early Stage of COVID-19.

BACKGROUND: This study is aimed at confirming the effectiveness of nonpharmaceutical interventions during the COVID-19 outbreak in Hubei, China. METHODS: The data are all from the epidemic information released by the National Health Commission of the People's Republic of China and the Health Commission of Hubei Province. We used the multivariable linear regression by the SPSS 19.0 software: the cumulative number of confirmed cases, the cumulative number of cured cases, and the number of daily severe cases were taken as dependent variables, and the six policies, including the Joint Prevention and Control Mechanism of the State Council, lockdown Wuhan city, the first-level response to public health emergencies, the expansion of medical insurance coverage to suspected patients, mobile cabin hospitals, and counterpart assistance in Hubei province, were gradually entered into multiple linear regression models as independent variables. RESULTS: The factors influencing the cumulative number of diagnosed cases ranged from large to small: mobile cabin hospitals and the expansion of medical insurance coverage to suspected patients. The factors influencing the cumulative number of cured cases ranged from large to small: counterpart support medical teams in Hubei province and mobile cabin hospitals. The factors influencing the number of daily severe cases ranged from large to small: mobile cabin hospitals and the expansion of medical insurance coverage to suspected patients. CONCLUSION: The mobile cabin hospital is a major reason for the successfully defeating COVID-19 in China. As COVID-19 pandemic spreads globally, the mobile cabin hospital is a successful experience in formulating policies to defeat COVID-19 for other countries in the outbreak phase.

Policy Disparities in Response to COVID-19 between China and South Korea.

OBJECTIVES: This study analyzed the effects of COVID-19 non-pharmaceutical measures between China and South Korea to share experiences with other countries in the struggle against SARS-CoV-2. METHODS: We used the generalized linear model to examine the associations between non-pharmaceutical measures adopted by China and South Korea and the number of confirmed cases. Policy disparities were also discussed between these two countries. RESULTS: The results show that the following factors influence the number of confirmed cases in China: lockdown of Wuhan city (LWC); establishment of a Leading Group by the Central Government; raising the public health emergency response to the highest level in all localities; classifying management of "four categories of personnel"; makeshift hospitals in operation (MHIO); pairing assistance (PA); launching massive community screening (LMCS). In South Korea, these following factors were the key influencing factors of the cumulative confirmed cases: raising the public alert level to orange (three out of four levels); raising the public alert to the highest level; launching drive-through screening centers (LDSC); screening all members of Shincheonji religious group; launching Community Treatment Center (LCTC); distributing public face masks nationwide and quarantining all travelers from overseas countries for 14 days. CONCLUSION: Based on the analysis of the generalized linear model, we found that a series of non-pharmaceutical measures were associated with contain of the COVID-19 outbreak in China and South Korea. The following measures were crucial for both of them to fight against the COVID-19 epidemic: a strong national response system, expanding diagnostic tests, establishing makeshift hospitals, and quarantine or lockdown affected areas.

COVID-19 pandemic and firm performance: Cross-country evidence

Using financial data on firms worldwide, we assess the impact of COVID-19 on corporate performance. We show that firm performance deteriorates during the COVID-19 pandemic. The adverse effects of COVID-19 on firm performance are less pronounced in countries with better healthcare systems, more advanced financial systems, and better institutions. Finally, uncertainty avoidance strengthens the adverse effect of the COVID-19 pandemic.

Policy disparities in response to the first wave of COVID-19 between China and Germany.

OBJECTIVE: Our research summarized policy disparities in response to the first wave of COVID-19 between China and Germany. We look forward to providing policy experience for other countries still in severe epidemics. METHODS: We analyzed data provided by National Health Commission of the People's Republic of China and Johns Hopkins University Coronavirus Resource Center for the period 10 January 2020 to 25 May 252,020. We used generalized linear model to evaluate the associations between the main control policies and the number of confirmed cases and the policy disparities in response to the first wave of COVID-19 between China and Germany. RESULTS: The generalized linear models show that the following factors influence the cumulative number of confirmed cases in China: the Joint Prevention and Control Mechanism; locking down the worst-hit areas; the highest level response to public health emergencies; the expansion of medical insurance coverage to suspected patients; makeshift hospitals; residential closed management; counterpart assistance. The following factors influence the cumulative number of confirmed cases in Germany: the Novel Coronavirus Crisis Command; large gathering cancelled; real-time COVID-19 risk assessment; the medical emergency plan; schools closure; restrictions on the import of overseas epidemics; the no-contact protocol. CONCLUSIONS: There are two differences between China and Germany in non-pharmaceutical interventions: China adopted the blocking strategy, and Germany adopted the first mitigation and then blocking strategy; China's goal is to eliminate the virus, and Germany's goal is to protect high-risk groups to reduce losses. At the same time, the policies implemented by the two countries have similarities: strict blockade is a key measure to control the source of infection, and improving medical response capabilities is an important way to reduce mortality.

Coping with COVID-19: Core Elements of Lockdown Wuhan City Policy.

In order to describe the Chinese experience for the purposes of global epidemic control, the study analyzed the impact on the COVID-19 pandemic of policies adopted during the lockdown of Wuhan city. Descriptive analysis and stepwise regression analysis were performed using the official case data from January 10, 2020 to April 8, 2020. The results show that the prevention and control policies of Lockdown Wuhan City (LWC) has played a significant role in reducing new case numbers, improving COVID-19's cure rate and reducing mortality. Among the policies of LWC, stay at home, centralized isolation of convalescent patients, launching makeshift hospitals, and centralized isolation of "the four types of personnel" that play a decisive role. As the COVID-19 pandemic progresses, this study provides valuable experience for other countries.

A cross-country core strategy comparison in China, Japan, Singapore and South Korea during the early COVID-19 pandemic.

BACKGROUND: The study aimed to analyze the effectiveness of COVID-19 strategies adopted by China, Japan, Singapore, and South Korea. METHODS: We extracted publicly available data from various official websites, summarized the strategies implemented in these four countries, and assessed the effectiveness of the prevention and control measures adopted by these countries. RESULTS: As of October 28, 2020, the growth of daily new confirmed cases has stabilized in China, Singapore, and South Korea. In Japan, the daily new confirmed cases increased sharply since it lifted a state of emergency, but case-fatality maintains at a lower level. The growth of total cases is near stagnant in China and Singapore, with a case-fatality of 5.39 and 0.05% respectively. The case-fatality rate between Japan and South Korea is identical at 1.76%, however, Japan's growth rate of cases has increased more rapidly than South Korea. CONCLUSION: This study found that China, Japan, Singapore, and South Korea accessed the situation within their own borders and implemented different intervention strategies to curb the spread of COVID-19 and maintain lower rates of case-fatality. China, Singapore, and South Korea adopted the containment strategy, while Japan adopted the mitigation strategy. Although Japan's case-fatality maintained at a low level, daily new cases increased faster than the other three countries. This result indicated that a mitigation strategy could be inferior to a containment strategy.

Policy disparities in fighting COVID-19 among Japan, Italy, Singapore and China.

OBJECTIVE: In order to provide experiences for international epidemic control, this study systematically summarized the Coronavirus disease 2019 (COVID-19) prevention and control policies in Japan, Italy, China and Singapore, and also analyzed the possible inequalities that exist in these response approaches to improve global infectious disease control. METHODS: We summarized the epidemic prevention and control policies in Japan, Italy, China, and Singapore, and analyzed the policy effects of these four countries by using the data published by Johns Hopkins Coronavirus Resource Center. RESULTS: As of May 27, 2020, the growing trend of new cases in Japan, Italy, China and Singapore has stabilized. However, the cumulative number of confirmed cases (231139) and case-fatality rate (14.3%) in Italy far exceeded those in the other three countries, and the effect of epidemic control was inferior. Singapore began to experience a domestic resurgence after April 5, with a cumulative number of confirmed cases reaching 32,876, but the case-fatality rate remained extremely low (0.1%). The growth of cumulative confirmed cases in China (84547) was almost stagnant, and the case-fatality rate was low (5.5%). The growth of cumulative confirmed cases in Japan (16661) increased slowly, and the case-fatality rate (4.8%) was slightly lower than that in China. CONCLUSION: This study divided the epidemic prevention and control policies of the four countries into two categories: the blocking measures adopted by China and Singapore, and the mitigation measures adopted by Japan and Italy. According to the Epidemic control results of these four countries, we can conclude that the blocking measures were generally effective. As the core strategy of blocking measures, admitting mild patients into hospital and cases tracing helped curb the spread of the outbreak in Singapore and China. Countries should choose appropriate response strategies on the premise of considering their own situation, increase investment in health resources to ensure global health equity, and eventually control the spread of infectious diseases in the world effectively.

Wuhan mobile cabin hospital: A critical health policy at a critical time in China.

ABSTRACT: This study aimed to systematically analyze the effect of Wuhan mobile cabin hospitals (WMCHs) on the novel coronavirus-caused pneumonia (COVID-19) prevention and control in China. Between February 5, 2020 and March 10, 2020, a total of 16 mobile cabin hospitals were constructed in 3 batches to offer over 13,000 beds and admitted more than 12,000 patients in Wuhan City. The strategy of implementing WMCHs in 3 batches played a key role in fighting against COVID-19 in China. (1) The first batch of WMCHs increased hospital admission capacity of COVID-19 patients in Wuhan, which showed initial effect on COVID-19 epidemic control. (2) The operation of the second batch of WMCHs greatly contributed to the rapid growth in discharged patients. (3) After launching the third batch of WMCHs, the COVID-19 epidemic situation in Wuhan improved considerably. The last batch of WMCHs made a substantial contribution to defeating the COVID-19 epidemic in Wuhan.