A review of the resilience of Chinese hospitals to the COVID-19 pandemic

The COVID-19 pandemic has had a tremendous impact on the world’s healthcare systems. The rapid spread of the severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) has caused an overwhelming increase in the occupancy of the hospitals’ ICU (intensive care unit) beds and an exponential enhancement on the workload of the hospital staff.

In early 2020, the response of the hospitals to the rapid spread of SARS-COV-2 infection in China, especially in Wuhan, had been highly publicized. Many feared that hospitals in Wuhan and other regions of China would struggle to cope with the shock of the first large nosocomial outbreak. However, due to effective national effort (e.g., strict lockdown measures, forceful restrictions on movement and association) as well as hospital strategies, the number of COVID-19 cases became negligible by March 2020, and the last COVID-19 patient was released on 5 June 2020.

China continued to follow certain restrictions throughout 2020. They experienced economic losses in the first half of the year, and how the country fought SARS-COV-2 is regarded as a comparative success story.

Resilience is a term that describes how a system modifies its functioning to absorb a shock and recover from adverse events. This phenomenon is increasingly discussed within the international health and development literature. Still, it is not much used to address the hospital and healthcare system issues related to China and how they tackled the COVID-19 crisis.

A new review article, published on the medRxiv* preprint server, deals with several different aspects such as medical response capability, disaster health management, disaster preparedness, and health infrastructure safety, in China, by which they survived the COVID-19 crisis. Previously, the same team of researchers had also developed a quantitative conceptual framework highlighting the hospital strategies in achieving hospital resilience following the first SARS pandemic in 2003 in China.

Conceptual Framework
Conceptual Framework

The previous study was based on questionnaires addressed to tertiary hospitals across the Shandong province. Researchers had identified four vital factors, namely, (a) hospital safety, (b) disaster management mechanisms, (c) disaster resources, and (d) disaster medical care capability, on which disaster resilience depends. These factors were compared to the strategies that a particular hospital had followed while battling a crisis. In the current COVID-19 scenario, researchers found that the success of China’s strategy is a collaborative effort of the government, public health officials, and the attitudes of the general public. However, there is a gap in the literature regarding the role of hospital resilience in this achievement. The main objective of this review article is to fill this gap. This would help improve responses to the current and future pandemics.

This article has identified fifty-nine studies related to resilience in hospital settings across China, associated with the initial SARS-CoV-2 outbreak in early 2020. This study revealed a wealth of important strategies directly concerned with the management of human resources, communication, security, hygiene, and planning. They also found these hospitals had provided training to their staff, focused on the well-being of healthcare workers, implemented sophisticated technologies, and also had involved various healthcare organizations while handling the first wave of the COVID-19 crisis. This article also revealed that e-health, telemedicine, and internet hospital interventions made healthcare more approachable and affordable for many vulnerable groups across the country. However, more research is needed in this area to understand if these resilient processes, developed during the pandemic, will continue to enable the vulnerable groups to access the facilities of Chinese hospitals post the pandemic.

Researchers in the current study not only discussed the methodology, effects and strategies followed while dealing with the crisis but also highlighted the limitations. For example, several papers lacked systematic and rigorous analysis of particular strategies. Many articles, particularly those in Chinese, failed to consider methodological limitations. Researchers of the current study also found that some of the research articles considered in the current review article were biased due to political influence, which, in turn, led to the omission of negative results obtained in these studies. Some of the papers have emphasized the physical and mental health issues of nurses but neglected similar issues faced by other healthcare providers like doctors. Lastly, many of the studies ignored inequalities and gender biases.

The scientists associated with the current article have offered several recommendations to healthcare practitioners and researchers. This involves an improvement in patient awareness of online healthcare services. Additionally, more use of artificial intelligence and internet technologies for online assessment of patients is encouraged.  Robots can be used to guide patients and deliver medicines within hospitals.

This review concludes that insufficient evidence is available to determine the effectiveness of specific strategies adopted in China that lead to hospital resilience.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Dr. Priyom Bose

Written by

Dr. Priyom Bose

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.


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