In terms of geographical distribution, until March 18, the cumulative number of confirmed patients in Nanjing, Xuzhou, and Suzhou ranked the top three in the province. According to the transportation network map of Jiangsu Province (Fig. 1D), Nanjing and Xuzhou are the largest road and railway transportation hub in Jiangsu province, and Suzhou has extremely convenient railway and road traffic with Shanghai, the international transportation hub. The above data suggested that the convenience of transportation of the region was relative to the number of imported cases. The epidemic prevention work at airports, stations, and railways would have the top priority. The timely first-level response of Jiangsu Province greatly reduced the input of imported cases.
In terms of time distribution, for the ‘low-speed growth-high-speed growth-low-speed growth’ model shown by the cumulative diagnosis curve, the inflection points of the growth rate of the cumulative number of cured persons were on February 12 and February 26, respectively(Fig. 4D). After February 12, the number of cured people increased significantly and the growth rate was significantly improved. The continuous increase in the cumulative number of confirmed cases was a possible acceleration factor. Another possible reason is due to optimized treatment plan recommended by < Novel Coronavirus Infected Pneumonia Diagnosis and Treatment Program (Trial Version 5) > on February 8[4]. After February 26, the growth rate of the number of cured patients slowed down was possibly due to the discharge of mild patients and common patients from the existing patients, the structure of the patients changed, and the proportion of severe patients increased. The severe and critically patients’ discharged was considered as the use of chloroquine phosphate and other drugs, which was suggested in < Trial Seventh Edition> [5–6]. Lung transplantation and the application of artificial cardiopulmonary circulation were also considered had the contribution for the discharged of severe patients [7]. Meanwhile, Jiangsu Province completed 100% patient cure, which may due to the traditional Chinese medicine widely used and timely consultation taken by provincial expert team—89% patients were treated by integrated Chinese and western medicine and 100% patients were diagnosed by professional expert team in Nanjing [2].
The Sigmoid function was also used to fit the cumulative number of cured cases in Hubei and Beijing respectively as a supplement and comparative study [8]. It was found that the increase in the number of cured people in Hubei and Beijing also showed a slow-fast situation, and the first inflection point of their growth rate was around February 21, when was about 2 weeks after the plan ‘upgrade the dosage of ribavirin to Adults 500 mg/time, 2 to 3 times a day intravenously’ (Fig. 7). Therefore, this study speculated that high-dose application of ribavirin has a positive effect on the treatment of novel coronary pneumonia, and patients with novel coronary pneumonia could obtain benefice from it after 1–2 weeks of comprehensive treatment including high-dose ribavirin. Since this study did not collect detailed clinical features and treatment options for each case, this inference still needed to be confirmed by further studies. The first inflection point about Hubei and Beijing appeared 5 days behind Jiangsu. The proportion of severe patients was higher [3, 8, 9], the total number of diagnosed patients was larger, and the medical resources were tight, etc, all of above were considered as possible factors.
There were still some limitations in this study. Because the epidemic data were collected from the official websites of the National Commission of Health and Jiangsu Commission of Health, the information provided was limited, since we were not able to get the information of the specific onset time, exposure history, and past history of each case, clinical manifestations, diagnosis and treatment plans, treatment effects and personal basic conditions, etc., we failed to do a more in-depth study on the population distribution, susceptibility factors and so on. At the same time, all the treatment methods and epidemic prevention measures in this study came from the official website of the People's Government of Jiangsu Province and the National Novel Coronavirus Pneumonia Medical Treatment Expert Group, which may be some bias. Furthermore, in the context of the international outbreak of novel pneumonia, until March 18, 2020, Jiangsu Province had reported none new case in the province for 27 consecutive days, and no new imported cases have been found. It can be considered that the epidemic in this province was close to disappearing. However, the epidemic prevention work still needed to be highly valued, guarded against the importation of foreign cases.
In the early stage of the outbreak of Novel Coronary Pneumonia, the People’s Government of Jiangsu Province successively initiated the first-level response to public health emergencies according to the < Emergency Response Plan for Public Health Emergencies in Jiangsu Province > on January 24. It also highlighted the focus of work to strictly preventing imported epidemics, including strictly managing the agricultural market, doing a good job in the ventilation, disinfection, temperature detection, and health quarantine of personnel-intensive places such as airports, stations, and docks, and public transportation. The hospital strengthened emergency protocols, and medical personnel improved their own safety protection to effectively ensure early detection, early reporting, early diagnosis, early isolation, and centralized treatment measures. It was forbidden to assemble, and it was necessary to close large entertainment venues, continue to track close contacts, etc., cut off the chain of communication in time, and require residents to reduce going out and wear masks in public places (Fig. 8). At the same time, on January 27, the Jiangsu Health Committee issued a document, proposing ‘strengthen epidemic surveillance and implement a reporting system. standardize medical treatment and ensure patient safety [10]. manage in accordance with laws and regulations to prevent the spread of the epidemic; promptly disclose information and strengthen propaganda and guidance. Actively strive for support and strengthen logistics support.’ and further eight specific requirements. All of above affirmed the timeliness of the previous epidemic prevention work, and made a more detailed system of arranging epidemic prevention work from the aspects of mission, monitoring, treatment, logistics, etc.at the same time.
In addition, the Jiangsu Provincial Government and the Jiangsu Health Committee attached great importance to possible imported cases. On March 5th and 26th, they issued a document to emphasize the procedures for handling the epidemic situation after travelers arriving in Nanjing. Work links such as screening of fevered passengers, determination of close contacts, retention of fevered passengers, etc., make clear requirements for the entire work flow of fever passengers for inspection and medical treatment [2]. At the same time, high attention was paid to the safety issues in the work of returning to work.