A Chinese team has published its research on makeshift hospitals, highlighting the large-scale temporary hospital's significance in the national response to the COVID-19 outbreak as well as future epidemics and public health emergencies.

The makeshift hospitals (Fangcang in Chinese) are "large, temporary hospitals built by converting public venues, such as stadiums and exhibition centers, into health-care facilities to isolate patients with mild to moderate symptoms of an infectious disease from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities," said the paper published on the journal The Lancet.

The researchers explained why Chinese policymakers decided against home isolation of COVID-19 patients with mild to moderate symptoms. Early epidemiological evidence showed that more than half of COVID-19 patients in China had at least one family member with the disease, and 75 percent to 80 percent of clustered infections were within families.

Meanwhile, home isolation can be taxing for patients and the practice may not be strictly enforced. In addition, it is difficult to monitor disease progression at home. Statistics showed that before the introduction of makeshift hospitals in Wuhan, the time from onset of severe symptoms to admission for intensive care was up to 10 days. The makeshift hospitals have substantially reduced the delays. The researchers said that the makeshift hospitals have three distinct characteristics -- rapid construction, massive scale, and low cost -- and several functions that set them apart from facilities that have been previously used for the control of public health emergencies.

They pointed out that makeshift hospitals served an important triage function, separating patients by severity of symptoms, which was not a focus of previous makeshift and emergency field hospitals. The makeshift hospitals also became a national standard of care, rather than a temporary, emergency measure to bridge a gap until improved capacity for large-scale treatment became available.

Meanwhile, they were not only healthcare facilities, but also served as social spaces, providing an essential living, emotional support and social engagement for patients away from their families and communities. A total of 16 makeshift hospitals were built in Wuhan with 13,000 beds over a period of three weeks, providing care to about 12,000 patients by March 10. They also freed up the scarce medical infrastructure of higher-level hospitals, such as units providing respiratory support and intensive care, increasing the overall efficiency of care.

In Wuhan, the bed vacancy rate in traditional hospitals designated for the care of COVID-19 patients increased from 4 percent on Feb 4 to 16 percent on Feb 22, when 16 makeshift hospitals had started admitting patients.

The paper said that China has translated all policies, management manuals and clinical guidelines related to makeshift hospitals into the languages of countries facing rapidly growing COVID-19 outbreaks. China has also sent experts with direct experience in constructing and running makeshift hospitals to other countries to provide consultation.

一个中国研究小组发表了关于“方舱医院”的研究报告，强调了大规模临时医院对于新冠肺炎疫情，及未来流行病和突发公共卫生事件的重要意义。

根据《柳叶刀》杂志的介绍，临时医院（或“方舱医院”）主要是“将公共场所如体育馆、展览中心改造成用来收治和隔离轻症或中度症状患者的大型临时医院。这些临时医院同时为患者提供医疗保健、疾病监控、食物、居住场所和社会活动等。”

研究人员解释了为什么中国决策者决定不在家隔离新冠肺炎患者。早期流行病学证据显示，中国有一半以上的新冠肺炎患者至少有一名家庭成员染病，75%至80%的聚集性感染发生在家庭内部。

与此同时，在家隔离对病人来说是一种负担，而且这种做法可能不会得到很严格的执行。此外，在家中监测病情状况也比较困难。统计数据显示，在武汉方舱医院建立起来之前，从出现严重症状到入住重症监护的时间长达10天。方舱医院大大减少了这种延误。研究人员表示，这些方舱医院有三个明显的特征：建设速度快、规模大、成本低，而且部分功能也与之前用于控制突发卫生公共事件的设施有所不同。

研究人员指出，方舱医院有重要的分流功能，可以根据症状的严重程度不同将患者分开，而这并不是以前临时医院和应急野战医院的重点。方舱医院也成为了国家护理的标准，而不仅仅是用来弥补大规模治疗能力改善的临时急救措施。

与此同时，方舱医院不仅是医疗设施，同时也是社交空间，为远离家人和社区的患者提供基本的生活、情感支持和社交参与。在三周的时间内，武汉共建立了16家方舱医院，提供了1.3万张床位。截至3月10日，为约1.2万名患者提供了医疗服务。方舱医院还解放了更高级别医院医疗基础措施稀缺的问题，如提供呼吸支持和重症监护等，从而提高了整体医治效率。

2月4日至22日，武汉16家方舱医院的床位空置率从4%上升到16%。该研究报告称，中国已经将所有与方舱医院相关的政策、管理手册和临床指导方针等翻译成疫情快速疫情状况逐渐蔓延的国家的语言。中国还向其他国家派遣了有直接建设和运营方舱经验的专家提供咨询和指导。

(Executive Editor: Ye Ke)