As China's Covid-19 outbreak comes largely under control and economic activities gradually resume, the pandemic has spread explosively worldwide. The total number of cases exceeded 1.5 million as of Saturday, and experts warn that for domestic prevention purposes China needs to remain vigilant.

The current outbreak is at a critical stage, with the disease in Europe and the U.S. not effectively controlled and new cases increasing exponentially in less developed and underserved areas such as Africa, South America and India, bringing great uncertainty to the global fight against the disease, Zhang Wenhong, known for his work leading Shanghai's Covid-19 clinical expert team, told Caixin in an interview.

"Although China has made some achievements in the earlier stages, we need to remain prudent and determined to fight the pandemic for an extended time," said Zhang, who is also director of the infectious diseases department at Huashan Hospital of Fudan University in Shanghai.

He said it's unlikely that the outbreak will end this summer, and it's very likely that a second wave will take place after the fall. China needs to control imported cases to prevent a new round of contagion. In addition to practicing social distancing, wearing masks in public places, and frequent hand-washing, China should focus on three lines of defense -- customs, communities and hospitals.

Here's a transcript of the interview:

What is the current situation of the global pandemic? How to judge the future trend?

Zhang: At present, the pandemic has reached a critical stage. Globally, Europe and the U.S. have not been effectively controlled for the time being. However, in Africa, South America and India, where the economy is less developed and medical resources are insufficient, new cases have increased exponentially, which brings great uncertainty to the global fight against the epidemic.

I said repeatedly two weeks ago that it's unlikely the pandemic will be over by the summer, that it will largely last till the next year. Recent developments have confirmed that. The number of new cases in Europe and the U.S. is expected to gradually peak and reach a turning point, but the outbreaks have just started in other places. Assuming it can be contained in three to four months, it will be at the end of summer. But after the fall, the second wave could come. There is a high probability of a second international outbreak.

The outbreak in China has gradually stabilized. How to determine the risk of imported cases in the future?

Zhang: Authorities in Beijing said April 5 that the prevention and control situation is still grim and complicated, and it is likely to remain cautious for a long time. When Beijing fights a protracted war, it means that the whole country fights a protracted war. Now, at the national level, this is the consensus.

Recently, we have actually taken control measures on aviation, but they can't last forever. After the outbreaks in Europe and the U.S. are under initial control, it is expected that global aviation will be gradually opened up again. But the spread has already begun in India, Africa and South America, where the rise of new cases has been the fastest, posing great risks to the world.

China is now well under control, and we are confident. However, the emergence of a second wave of outbreaks abroad means that we will be under great pressure to prevent and control imported cases. China now needs to plan for the second peak of imported infections. The goal is to avoid a second wave.

The difficulty ahead for China is to resume the economy and to prevent the outbreak from rebounding at the same time. At present, there are basically no local cases in China, with only one or two cases reported in a few provinces. We have the best internal environment for economic development in the world. If we don't develop the economy and resume production, till when should we wait? Meanwhile, the imported cases will persist. For a long time in the future, this will test the capabilities of disease control authorities.

How should China prepare for the current imported outbreak and the possible second wave?

Zhang: In the first stage, we need to maintain our epidemic-fighting achievements. Businesses that have resumed operation need to make sure their workers keep social distance. People should wear masks in public and wash their hands frequently. When eating out, people should avoid sharing dishes. For the public, keeping vigilant in the process of returning to work should be fine.

There are three invisible defense lines: customs, communities, and the disease control and hospital system, which are the key for a protracted war in the future. Communities need to monitor people from overseas regularly and keep them under monitoring for at least two weeks upon arrival. At the hospital defense line, now all the major hospitals are strengthening the fever outpatient service. Shanghai is doing so. Once detecting local patients with Covid-19 symptoms, the hospital and the disease control system will quickly move to put off any potential threat.

In terms of execution, can these three defense lines withstand such challenges at the local level?

Zhang: I believe so. During this outbreak, Chinese hospitals' fever outpatient system was under great challenge but has also gained experience. The National Health Commission has laid out plans to increase establishing fever outpatient and infectious disease surveillance systems across the country. Now all we need to do is to maintain the system and never relax even if there are no new cases.

A few defense lines can't 100% prevent risk of imported cases. In case there are asymptomatic patients or people with false negative tests, or if there are omissions in community quarantine, these patients will eventually show symptoms. In the future, fever clinics and emergency rooms should be connected. The fever clinic should avoid missing such patients. Meanwhile, the disease control system should track every person with close contact to Covid-19 patients without any blind spots.

Are there enough medical staff available?

Zhang: In the first wave of the outbreak, there was a shortage of medics in China. Now there are no more local cases, but we can't relax. The key is to continue to maintain the system and keep alert. Once the system shows laxness, there may be missed cases. What is needed now is to maintain the existing prevention and control system and make it a new norm. Respond quickly as soon as new cases are detected.

Now the fatality rate of Covid-19 is relatively high in other countries. How can we cure the disease?

Zhang: The fatality rates vary in each country for complicated reasons. The fatality rate is the ratio of the number of deaths to the number of all cases reported. If a country prioritizes severe patients in testing and treatment, its fatality rate will be high. In a country where testing is more common and a lot of mild patients are tested and quarantined at home, the overall fatality rate will be reduced. Of course, the fatality rate is also related to the burden on medical resources caused by a large number of severe cases.

You did a lot of analysis during the outbreak, offering your own unique thinking. What do you think of the different perspectives people have on the pandemic?

Zhang: There are always different voices in the evaluation process. For example, experts may have different predictions on when the pandemic will end. Most of the top Chinese experts on the front line of the domestic fight have similar predictions.

Why do some people have different views? First of all, we make predictions at different stages, and the global development has been changing all the time. I had initially predicted the epidemic could be over in two to four weeks. But now it's a pandemic, and the battle will be hard to end soon. It is normal for experts to have different opinions at different stages, and it does not mean that some are in conflict with others.

What do you think of using traditional Chinese medicine in the treatment of Covid-19?

Zhang: First, all parts of China, including Shanghai, have adopted treatments combining traditional Chinese and Western medicines. Second, it's obvious that the combination treatment has achieved good results. Thirdly, no obvious adverse reactions were observed in the treatment. Fourth, the effect of such treatment should be supported by clinical evidence. Whether it is traditional Chinese medicine or Western medicine, it is necessary for experts from respective fields to make a responsible judgment so that the evaluation is scientific.

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