Wall Street Journal:

Thank you very much. I'm from the Wall Street Journal. Thank you doctors for sparing the time to do this. Dr. Du, you mentioned the importance of preventing and controlling the disease rather than treating it. I was wondering if you could go into a bit more detail about what you think were the most effective steps that were taken in Wuhan to prevent and control the spread of the epidemic, and at what point those came into effect. I was also wondering, you spoke a little about the fatality rate and I take the point that it's a little early to calculate that. But, given the evidence that the fatality rate does seem to have been higher in Wuhan, I was wondering if you could go into some more detail about why you think that was, particularly amongst medical workers. You spoke a little in the last briefing about treatment with steroids and invasive ventilation and I wonder if you could elaborate on that a little? With hindsight, is there anything that could have been done to avoid that or was it simply inevitable? Is there anything that you could advise other countries facing similar problems now? Thank you. 

Du Bin:

Okay, thank you very much for the questions. The first question was concerning the specific measures to control the epidemic. I'm not an expert for this, but anyway: test, test and test. Whenever you fail to do the nucleic acid test for COVID-19, you don't know who is the carrier, who is the patient, who should be quarantined and who are close contacts. 

I know there are different approaches than here in China, like what you're doing in the States. I'm not the one who make the judgment about which is right and which is wrong. But, apart from testing, I just have no idea how you can identify suspected cases and quarantine close contacts. I mean, there was just a question to Dr. Cao about what is the turning point. In my opinion, the major reason or decision that led to a turning point was when we had the opportunity to isolate all suspected patients and close contacts. That was the turning point of the outbreak here in Wuhan, and in Hubei.

Now for the second question about what specific factors contributing to the higher case fatality rates in Wuhan. I would say that a strong belief of mine is that delayed mechanical ventilation, delayed endotracheal intubation and long-term cortical steroids make a difference. I mean, they are major risk factors for mortality rates. I have seen dozens of cases who tried inappropriately or failed, an NIV trial – NIV meaning noninvasive ventilation. 

They failed the NIV trial, but doctors maintained the noninvasive ventilator. They doctors did not intubate them. But eventually, even after endotracheal intubation, after the initiation of mechanical ventilation, the patients still died. So, we can actually make a huge difference, at the later stage, by encouraging every physician to intubate their patients as soon as possible – as soon as they see their patients fail an NIV trial. There's one study, although not a large one, from my colleagues in Tongji hospital. They found that an aggressive approach for endotracheal intubation will significantly improve the patient outcome. 

I believe the paper has been submitted, but I have no idea whether it's accepted or not. Thanks. 

Xi Yanchun:

Ok, the last question, please. Okay. Right area second line, the lady, please.