Reconfirmation of local diagnoses after 30 days in Henan: dining with asymptomatic infection
How to prevent "asymptomatic infection"?
After a zero-day increase in locally confirmed cases for 30 consecutive days, a new confirmed case of new coronary pneumonia occurred in Henan Province on March 29. According to the Henan Provincial Health and Health Commission website, on March 28, 2020, one new confirmed case of new coronary pneumonia was found in Henan Province. An epidemiological investigation showed that the new case had previously contacted a local hospital in Yixian, Pingdingshan A doctor named Zhang. The doctor and one of his colleagues were identified asymptomatic, and the other colleague was single positive. However, there are doubts as to whether the doctor is an asymptomatic infection and whether it needs to be included in the confirmed case report.
A Official Bulletin
Henan: 1 confirmed diagnosis and 2 asymptomatic infections
On March 28, Henan Province newly added a local confirmed case of new coronary pneumonia, which came from Luohe City.
The patient, Wang Moumou, said in an interview with reporters on March 29 that she was undergoing treatment at the hospital and that she was not feeling well at the moment. "The doctor said that CT (shows) a white spot on the lungs."
Wang Moumou said that he had returned to his hometown in Pingdingshan City, Pingdingshan City on March 21, and was infected by his classmate Zhang Moumou (Director of Pediatrics, Peng County People's Hospital).
Earlier, the Henan Health Commission announced at noon on March 29 that there was one new confirmed case of new coronary pneumonia in the province, and the patient was Wang Moumou of Luohe City. The investigation found that on March 21, Wang Moumou traveled and ate with Zhang Moumou, a doctor of the People's Hospital of She County, and Zhang Moumou was diagnosed with asymptomatic infection of new coronary pneumonia.
The above report stated that Wang Moumou, female, 59 years old, cleaning staff of Luohe City Library, living in Mingdu District, Yuanhui District, Luohe City. On the evening of March 24, he developed headache symptoms. At about 17:00 on the 26th, he took a self-test temperature of 38.5 ° C. At about 19:30, accompanied by his son, he went to the Luohe Central Hospital to have a hot clinic, followed by isolated observation. : 20 confirmed cases of new coronary pneumonia.
According to the investigation, Wang Moumou took a long-distance bus at Luohe Bus Station at about 10:00 on March 21 to Pingdingshan City East Bus Station, accompanied by his classmate Zhang Moumou (Doctor of People's Hospital of Pi County) I went down to the countryside to scan the grave, and ate with Zhang Moumou 3 times during Shexian County.
Wang Moumou said that on March 21, she saw Zhang Moumou, the other party said that she had a cold a few days ago, but it was already good, she did not see any symptoms of Zhang Moumou, and felt that the other party was very healthy.
The tune found that Zhang Moumou had dinner at the restaurant with Liu Moumou, Zhou Moumou (the two were also doctors of the People's Hospital of She County) on the evening of March 13. Liu Moumou had a travel history in Wuhan, and after his return to quarantine, he quarantined for 14 days and expired. On March 25, Shexian People's Hospital conducted a physical examination of frontline medical staff involved in the prevention and control of the epidemic. During the nucleic acid screening, Zhang Moumou and Zhou Moumou were found to be asymptomatic infection. Liu Moumou nucleic acid test was single positive, Asymptomatic, 3 people are undergoing centralized isolation medical observation.
At present, 15 close contacts of Wang Moumou and 53 close contacts of Liu Moumou, Zhang Moumou, and Zhou Moumou have been tracked. They are all under centralized medical observation.
Hubei: 1 case of asymptomatic infection found in Jingmen
On March 29, the reporter learned from the New Crown Pneumonia Epidemic Prevention and Control Headquarters in Jingmen City, Hubei Province. On March 27, a patient with thyroid disease went to a hospital (South District) in Jingmen City for treatment and admission. On March 28, a nucleic acid test was performed. The results were positive for new coronary pneumonia and diagnosed asymptomatic infection.
B Expert judgment
Zhong Nanshan: The number of asymptomatic infections in China is not high
Recently, news about asymptomatic infections has been receiving much attention. Many experts believe that China is now in the "second half" of epidemic prevention and control: we must be especially vigilant against imported cases and "asymptomatic infection". What exactly is an asymptomatic person? What percentage of them are they? What's the point of investigating asymptomatic people? Recently, Academician Zhong Nanshan answered one by one in an interview.
China does not have a large number of "asymptomatic infections"
Academician Zhong Nanshan said that at this stage, he does not believe that there are a large number of asymptomatic infections in China. If any, these asymptomatic infections will surely pass the virus to others, making the number of newly diagnosed new pneumonia patients in China higher. But in fact, the number of newly diagnosed patients in China has not increased since the recent period, but has fallen, and this number has been zero in some provinces. It can be concluded that the number of asymptomatic infections in China is not high.
What is asymptomatic infection?
Zhong Nanshan said that the so-called "asymptomatic infection" is not anyone who has no symptoms, but those who have close contact with patients who have already been infected, and who have been infected by the new crown virus but have no symptoms. They have no clinical symptoms, but positive for E.coli virus in the respiratory tract.
It makes sense to do an asymptomatic investigation
How many people are asymptomatic at this stage? What is the percentage? Zhong Nanshan said that the current understanding is very limited: neither specific figures nor detailed research. Zhong Nanshan said that asymptomatic infection is highly contagious, and even where the isolation policy is implemented, the RO value may reach 3 or even 3.5, which means that one person can infect 3 to 3.5 people. This number is very high. The United States is conducting related investigations, which is very meaningful because the US epidemic is in a period of rapid growth.
Two lines of defence ensure early detection of asymptomatic infections
A few days ago, Zhang Wenhong, the leader of the Shanghai New Crown Pneumonia Medical Treatment Expert Team and the director of the Department of Infectious Diseases of Huashan Hospital affiliated to Fudan University, answered online students and overseas Chinese about epidemic prevention. They said that asymptomatic infection is not the mainstream of the infected people, so why is China attaching great importance to this? What about infected people? He explained that China is currently in the "second half" of epidemic prevention and control, with few local cases, so more and more attention is paid to asymptomatic infection. Many European and American countries are in the "first half" of epidemic prevention and control, mainly dealing with symptomatic infection. This difference in degree of emphasis is determined by the different prevention and control stages.
"Asymptomatic carriers will carry the virus for more than three weeks." Zhang Wenhong said that such people will not be found if they do not go to the hospital for treatment; if they return from overseas, they will not be detected or quarantined. Or he was isolated, and within two weeks he did not get sick. "He went out in the third week. When he went out, the virus was positive, which would cause a great risk of transmission."
Zhang Wenhong said that this is exactly the trickiness of the new crown virus, so Shanghai has been taking strict measures for screening. "Implementing 100% Newcomer Virus Nucleic Acid Test on Entry Personnel" is necessary to maximize the screening of asymptomatic infections from abroad. Even if there is a "missing fish", so many hospitals under the Shanghai Health and Medical Commission can actually screen for missing cases. Then, the CDC will track related cases, so I believe that Shanghai's entire system is relatively complete.
At the same time, he said that the world's epidemic was not under control, and it was unscientific to say that no case would be leaked in. We need to be prepared so that if a case comes in, we don't have to be surprised.
C a question
Why are asymptomatic infections not included in confirmed cases?
As early as the early morning of March 22, the Wuhan Municipal Government rumored that there was a new case in Wuhan's Lishui Kangcheng District. After investigation, Zhang Moumou, a resident of the community, is asymptomatic and does not count confirmed cases. This practice of "asymptomatic infection is not included in confirmed cases" has caused controversy.
In response, Wuhan Health Commission responded that according to the seventh edition of the National Health Commission's diagnostic and treatment plan, suspected and confirmed cases need to have clinical manifestations. If an asymptomatic person develops symptoms during quarantine, they are reported as a confirmed case and published.
Some immunology experts said, "From the definition of clinical medicine, this should not be controversial, because patients and asymptomatic infections are two different concepts. Asymptomatic infections are just infected with pathogens but not diseased. Still belong to the category of healthy people, patients are people who have symptoms. But from the perspective of immunology and etiology, infected people and uninfected people must be different, because infected people belong to the source of infection, people who are not infected with the virus Are susceptible. "
According to the briefing released by the Wuhan government, the infected people in Lishui Kangcheng District of Wuhan were negative for the first new crown virus nucleic acid test, positive for the second time and negative for the third time.
As for the results of this test, some virologists have pointed out, "I think the second positive result is a false positive. Therefore, it is correct that the patient is not counted as a confirmed case locally. It has an impact on the prevention and control of the epidemic. On the contrary, accurate judgment can effectively reduce the waste of medical resources and reduce the risk of infection in the infected patients themselves. "
D How to prevent and control
Further strengthen surveillance and isolation of asymptomatic infections
The sixth edition of the prevention and control program states that asymptomatic infection can also be a source of infection. So, how to manage and treat asymptomatic patients?
According to an infectious physician in Wuhan, asymptomatic infection is not unique to the new crown pneumonia virus. In fact, most infectious diseases are divided into dominant infections and recessive infections. For asymptomatic patients with new crown virus, active prevention and control policies such as quarantine are currently adopted. Huang Chaolin, deputy director of Jinyintan Hospital, said that in the actual rescue work, people with asymptomatic infection should be isolated first to prevent them from becoming a source of infection.
Many doctors believe that the issue of asymptomatic infection should be taken seriously, and further strengthening of surveillance and isolation should be included in future work priorities.
The manuscripts of this group are integrated with Xinhua News Agency, Surging News, Client of People's Daily, and WeChat Public Account of Guangming Daily.