In the battle against the outbreak of COVID-19, if the city is "the main battlefield ", the grassroots are one by one "preparation units". On one hand, there are concentrated and crowed returning people is the during Spring Festival period, on the other hand, there is a relative shortage of quality medical resources, how to face the challenge at the grass-roots level?

In Zhejiang, both the "double sinking and two promotions" work and the county-level medical community construction which has been fully spread out in the whole Province manifest that a more reasonable, relatively balanced urban and rural medical and health system is being relocated.

Looking back at this battle against the epidemic, we find that it is a big test of the basic level treatment and public health system, and also a test of the periodic effect of the reform of the medical and health system in Zhejiang Province.

According to the list of hospitals for the diagnosis and treatment of COVID-19 released on February 8, of the 100 designated hospitals, more than 60% are county-level. Can these primary medical and health institutions deal with the important task of clinical treatment?

Presently, Zhejiang Province is quite confident about the improvement of the capacity of county-level hospital medical services. At the end of 2012, the Provincial Party Committee and the Provincial People’s Government pushed forward the policy of "double sinking and two promotions ", aiming for challenges such as weak grass-roots hospital, weak technology and skills and insufficient talents, closing the health gap between cities and townships for decades. For more than 7 years, 54 municipal 3A Hospitals and 122 county-level hospitals in Zhejiang Province have been implementing close cooperation, with more than 600 experts from urban hospitals are regular-stationed in county-level hospitals.  

Jinyun County People's Hospital, managed by the First Affiliated Hospital of Zhejiang University Medical School, quickly opened up a life channel after the outbreak: it vacated the isolation ward at the first time and opened the fever clinic strictly and leading the fever patients according to the standard of Infectious Disease Department of the Hospital; After the patients were tested confirmed, the Hospital successively contacted on line the Infectious Diseases Department of the First Affiliated Hospital of Zhejiang University and decided treatment solution for the patient by remote-consultation.

The Infectious Diseases Department of First Affiliated Hospital of Zhejiang University accumulated rich experience in the battle against SARS in 2003. After the incurring of the COVID-19, nine county-level hospitals in Beilun, Shengzhou, Yiwu, Jingning, Sanmen, Pujiang, Jinyun, Changshan, and Anji which are under the management of the Hospital have imported the above said treatment experience of the Hospital.

"Over the past seven years, a rational and orderly pattern of medical treatment, forming a provincial-municipal-county-rural medical network platform has been gradually constructed in Zhejiang Province, so that quality medical resources can serve all kinds of people at all levels," said Dong Hengjin.

More than four years after the work of "double sinking and two promotions " was advanced, the construction of county-level medical community also started in Zhejiang Province again, which is the reform of "sinking" medical resources of county-level hospitals to towns and villages again, is also known as "upgrade version" of "double sinking ".

In September 2017, the Project of the pilot building of county-level medical community launched in 11 counties (cities and districts); 2019, the Project was fully pushed forward in the whole Province. At present,70 counties (cities and districts) in Zhejiang Province have set up 161 medical communities consisting of 208 county hospitals and 1,063 township health centers or community health service centers.

With the sudden outbreak of COVID-19, how can the county medical community mechanism keep "small doors " of grass-roots hospitals?

Back to the afternoon of January 17, 2020, namely 6 days before Zhejiang launched a major public health emergency level response. Ma Yuefeng, president of the Medical Community Group of Changxing County People's Hospital, shared the grim situation of epidemic prevention and control with relevant personnel in Changxing, a small town after he had attended the meeting from Hangzhou.

On the same day, the eight townships (street) branch hospitals under the jurisdiction of Changxing County People's Hospital launched the “wartime mechanism” synchronously. On January 17th, more than 600 employees of the General Hospital and branches of the Medical Community Group gave up their leave. Eight townships (street) health centers adhered to the front line and followed up every day to monitor the health status of the local residents in quarantine. They entered the village to publicize the knowledge of prevention and control and even participated in the work of environmental elimination giving full play to the role of grass-roots public health and epidemic prevention.

"Without a well-established county medical community, a county-level hospital cannot play a leading role, and nor can township hospitals which are distributed in the towns quickly response as one." Ma Yuefeng said with emotion.

Now, in the critical stage of post-epidemic, namely labor and school resuming, economic and social recovery, the importance of the role of grass-roots doctors as "health gatekeeper" is more obvious.

Chen Lina, president of Traditional Chinese Medicine Hospital of Keqiao District, said:" A total of 43 medical workers have been deployed by the Medical Community as health instructors in enterprises. They inspect the health guidance work in enterprises on a regular basis and find that the hidden dangers of safety are reported in time, keeping the "small doors" at the grass-roots level.

In Zhejiang, the County Medical Community moves forward the epidemic prevention & control and medical treatment passes and leads the hospital intervened in the first time to realize the integration of epidemic situation monitoring, reporting, and treatment.

The linkage mechanism brought about by the reform of the medical and health system breaks the barriers between urban and rural areas and realized the "interconnection" between medical personnel and medical technology.

The small town of Rui’an withstood the "big test" of the epidemic. As the only county-wide new designated COVID-19 diagnosis and treatment hospital, Rui’an People's Hospital Treatment task is very heavy.

During this special period, the effect of up-and-down cooperation between hospitals and 20 medical community departments under their jurisdiction was very obvious. At the time of the most serious situation of the epidemic, the beds in the observation ward of the General Hospital were in serious shortage, and the inpatient wards of Feiyun and Ma Yu two branches were urgently transformed into isolated wards, which were used as reserve treatment hospitals. "The hospital has also undertaken a large number of cases screening work, namely when patients were diagnosed as suspected cases, they were transferred to the General Hospital by special ambulances for isolation treatment; the hospital has also transferred more than 50 medical workers from the branch hospital for support."

The internet has also become a very important link between the city and township. Family doctors help local patients with chronic diseases contact the general hospital experts for remote consultation through the internet diagnosis and treatment booking process, allowing villagers do not go out can also achieve home diagnosis and treatment.

Graded diagnosis & treatment system is one of the objectives of medical and health system reform. In Zhejiang Province, a pattern of "perform their respective duties" is gradually emerging in all kinds of medical and health institutions at all levels.

Another medical community in Rui’an —— General Hospital of Rui’an City Hospital of Traditional Chinese Medicine Medical Services Group takes the unique advantages of traditional Chinese medicine and it is responsible for 14 days of medical observation of the COVID-19 patients. Famous Chinese medicine physicians and other experts give Chinese medicine intervention to improve the physical fitness of the recovered patients according to the specific situation of each person.

The health situation of a recovered person who returned home after the observation period is monitored by each branch of Traditional Chinese Medicine Hospital in Rui’an. The doctors of these hospitals go to the recovered persons’ home every day to complete health condition monitoring of the recovered persons within the community during their quarantine including temperature tests and asking health conditions and so on.  

During the period of prevention and control of COVID-19, county-level hospitals and township health centers have carried out as possible as they can, so that medical resources can be used in an orderly and reasonable manner which finally benefits the people.