Insufficient quantity
Compared to other countries, the number of fever clinics is substantially insufficient to triage patients and prevent nosocomial infection in China. For example, Singapore that has a population of 5.7 million, sets up a total of approximately 900 public health preparedness clinics (similar to fever clinics in China). All of them were activated to fight the COVID-19. By contrast, Wuhan, once the epicenter of the pandemic in China, has only 61 fever clinics to serve over nine million residents (as of January 20, 2020), which is far from meeting the public needs. For instance, on February 3, the peak number of outpatient visits in fever clinics across Wuhan reached 12,568, which severely exceeded the maximum load of fever clinics 8. Insufficient quantity of fever clinics led to a sizable proportion of suspected cases who were not examined, diagnosed or isolated, which therefore increased the risk of widespread of SARS-CoV-2 in hospitals and communities.
Lack of infectious disease professionals in fever clinics is another major problem in this pandemic. Given the high risk of exposure to SARS-CoV-2, healthcare providers in fever clinics are required to be skilled and experienced in infectious disease or related specialties. However, since fever clinics were substantially overloaded, physicians and nurses from other departments who did not receive formal training or expertise in infectious diseases had to be deployed for support, thus having considerably high risk of being infected. It was even the first time for some healthcare professionals to put on and take off protective equipment when on duty in fever clinics, especially in rural and remote areas in China 9. The shortage of adequately skilled professionals therefore compromised the anticipated function of fever clinics against the COVID-19 outbreak.