How to prevent and control the entire process of overseas personnel when a local epidemic is recurring? Is it necessary to extend the "14+7" quarantine period?
Be wary of loopholes in epidemic prevention for immigration personnel
From 0:00 to 18:00 on September 21, 3 confirmed cases of new coronary pneumonia were found in Harbin, Heilongjiang Province, 2 of which were people who returned to Kazakhstan from the Philippines and were released from quarantine.
Not long ago, the China Centers for Disease Control and Prevention determined that the suspected source of the epidemic in Putian, Fujian may have been infected during isolation.
As of 24:00 on September 22, 11 cases have been confirmed in this round of the Harbin epidemic, and the source still needs further official research and judgment; Fujian Province has reported a total of 438 confirmed cases in this round, involving Putian, Quanzhou, Xiamen, and Zhangzhou.
With the effective control of the local epidemic in China, imported cases from abroad have become the main source of new cases, and loopholes in the health management of immigrants are also an important cause of local epidemics in many places.
How to do a good job in the prevention and control of the epidemic situation for overseas immigrants?
Is it necessary to extend the "14+7" quarantine period?
All kinds of problems have aroused social concern.
The suspected source cases of the Putian epidemic are most likely to be infected during the quarantine period, and the risk of re-spreading at the quarantine point must be vigilant.
On September 23, the Fujian Provincial Health Commission notified that from 0:00 to 24:00 on September 22, Fujian Province reported 20 new local confirmed cases, including 17 cases in Xiamen City and 3 cases in Putian City.
In this regard, experts from the National Health Commission's working group in Fujian currently judge that, although the overall epidemic prevention and control in Fujian Province has achieved certain results, there are still uncertainties and are in a state of stalemate.
On September 16, the State Council's Joint Prevention and Control Mechanism held a press conference.
At the press conference, in response to the situation where the suspected "patient 0" had multiple nucleic acid tests that were negative during the isolation period and turned positive after 21 days of release from isolation, Wang Huaqing, chief expert of the China Centers for Disease Control and Prevention's immunization program, said that according to the epidemiological investigation, There is antibody level testing, especially based on the comparative analysis of gene sequencing. It is very likely that the case was infected during the isolation period, which led to the subsequent outbreak.
In the official notification on September 10, Lin, who was suspected to be the source of the epidemic, entered the country from Xiamen Airport by plane from Singapore on August 4, and was quarantined at a designated hotel in Xiamen for 14 days, and then was transferred point-to-point on August 19 The centralized isolation point in Xianyou County, Putian City continued to isolate.
In accordance with the epidemic prevention requirements of Fujian Province, Lin Moumou completed a total of "14+7" days of centralized quarantine.
The medical observation certificate provided by Lin Moumou showed that during the 21 days of isolation, Lin Moumou performed 9 nucleic acid tests, all of which were negative.
"Since I returned to China, I have been actively cooperating with the government’s prevention and control work, quarantining strictly in accordance with the epidemic prevention and control policy. But I have always wondered: I have been quarantined for 21 days, my nucleic acid test The results are all negative, but how come a positive result is suddenly detected?" Lin said in a post on social media, hoping to get an explanation.
And now, the China Centers for Disease Control and Prevention's inference that “the possibility of infection during the isolation period is extremely high”, while answering public doubts, has once again put the safety issue of immigrants in the isolation period under the spotlight.
"Re-spreading at the isolation point must be vigilant. In the next step, the working group and Fujian Province will find the cause of this problem and carry out rectification, and resolutely avoid cross-infection in the isolation point." The experts of the National Health Commission's working group in Fujian pointed out .
There are differences in the management standards of centralized quarantine in different regions and different hotels, and infections caused by centralized quarantine have appeared many times at home and abroad.
What are the current requirements for the centralized isolation of immigrants?
According to the "New Coronavirus Pneumonia Prevention and Control Plan (Eighth Edition)" (hereinafter referred to as the "Plan"), immigrants need to implement 14-day isolation medical observation measures.
For immigrants who have completed remote nucleic acid testing (for those with a history of vaccination, only negative nucleic acid testing is required), those who have closed transfer management conditions, home isolation conditions (with separate rooms and separate toilets), and can carry out precise community control, can be voluntarily On the basis of the implementation of "7+7" isolation medical observation measures.
For the site selection of centralized isolation sites, the "Plan" also made clear requirements: follow the principles of low impact and high safety, relatively independent, with relatively complete urban infrastructure, and no centralized isolation sites should be set up in medical institutions.
In the isolation place, living area, medical observation area, and material guarantee supply area shall be set up according to needs, and physical isolation shall be adopted for isolation, and obvious signs shall be set up. Staff passages and quarantine passages cannot cross.
"Isolated hotel cannot be selected, just like opening a'blind box'." Wang Ruonan is a recent overseas student returning from the United States. She told reporters that the conditions of the isolation hotel she lives in are very good, and the daily accommodation cost is 350 yuan, plus Meals and 14 days of quarantine cost a total of 6,300 yuan.
During Wang Ruonan's quarantine, staff in protective clothing came to measure body temperature and disinfect public areas such as corridors every day.
Meals are placed at the door for quarantine personnel to pick up.
The hotel's key card cannot be taken out, so she never goes out, "being locked out, she can't get in."
However, in Wang Ruonan's view, there is also the possibility of cross-infection among quarantined personnel.
"Some hotel facilities are relatively old and poor ventilation. Some quarantine personnel are not sufficiently vigilant and fail to carry out daily disinfection and epidemic prevention measures. Some people even try to find someone to'stop in' because they have been holding back for a long time."
Wang Ruonan told reporters that even in the same area, the management standards of different isolated hotels are not exactly the same.
"I can order takeaways at the hotel where I'm staying, but some students are prohibited from ordering takeaways during the quarantine period and can only order food from the hotel. Some hotels also have an infrared exit alarm system installed, which will call the police as soon as they leave the house."
In fact, infections caused by centralized quarantine have appeared several times in China.
At the beginning of this year, an epidemic occurred in the Pidu District of Chengdu City, Sichuan Province. The flow survey showed that the source of the epidemic was an imported case from outside Nepal, and the first case may be infected by contact with garbage at the isolation point.
On September 4, a new case of asymptomatic infection with new coronary pneumonia was added in Yuexiu District, Guangzhou City, Guangdong Province, who was an entry quarantine hotel worker.
According to the traceability results, it is determined that the infection was caused by accidental exposure during garbage collection.
Internationally, there have also been cases where "isolation points" have become "risk points", which has repeatedly led to serious consequences.
From the beginning of the new crown pneumonia epidemic to the beginning of June this year, the source of the infection of at least 21,000 people in Australia can be traced back to the isolation hotel. The main reasons include management loopholes, inadequate protection and problems with the fresh air system.
A study conducted by researchers from the University of Otago and the University of Melbourne showed that as of June 15, 2021, Australia and New Zealand had 32 infections caused by problems with the isolation system, resulting in about 800 deaths and triggers The city was "closed" 9 times.
Researchers calculated that for every 1,000 COVID-19 positive cases quarantined, there will be 6.1 infections.
The researcher said: "The life and economic costs of the isolation system are very high, and improvements are necessary, including vaccination or other options to replace hotel isolation."
The amount of virus in the body, whether the sampling method is correct, and differences in individual factors may all lead to "false negatives" in nucleic acid testing.
In addition to the possible loopholes in the isolation point, there is also a certain risk of "yin to yang" for immigrants during the quarantine period.
At the beginning of this year, a case in Dalian only tested positive for 11 nucleic acid tests, and some close contacts in Beijing Shunyi tested positive after 14 days of isolation, which caused concern.
On September 10, Guangzhou City added a new positive case of new coronavirus nucleic acid from a close contact.
The case began to undergo centralized isolation medical observation on September 4. During the isolation period, the nucleic acid test results of the new coronavirus were all negative, and the nucleic acid test was positive on September 10.
Why multiple nucleic acid tests still cannot ensure the accuracy of the results?
Zhan Yuxiao, a psychologist at the First Affiliated Hospital of Zhengzhou University, believes that multiple nucleic acid tests are only positive, which may be related to the amount of virus in the body at that time, whether the sampling method is correct, and individual factors.
Tang Meifang, the technical director of the BGI Gene Delivery Center, analyzed that the "false negative" in the nucleic acid test may be due to the fact that it was not collected at the time of sampling.
For example, when collecting throat swabs, the collection depth or contact time is not enough, resulting in the collected cells may contain less virus.
"In addition, because the tested sample is the RNA of the new coronavirus, and the RNA is unstable and very easily degraded, if the sample transportation and sample storage conditions are improper, such as the temperature is too high, it may degrade the RNA, resulting in'false negatives'."
Jiang Qingwu, an epidemiology expert and professor at the School of Public Health of Fudan University, told reporters that for immigrants, we must focus on them and allow enough time for isolation and observation.
He particularly emphasized: "For the sake of safety, even if the centralized isolation is over, relatives should not rush around or visit during the home isolation period."
Some experts pointed out that after the completion of home observation, the community should also pay close attention to the health of the individual and other family members. Once abnormal symptoms appear, they should seek medical treatment in a timely manner, and there must be no fluke psychology.
In view of the fact that the current detection methods are insufficient for various mutant strains, the next step should be to optimize the development of better antibody detection reagents.
After the quarantine is lifted, health monitoring measures should be strictly implemented to prevent the occurrence of disconnection, leakage, loss of control, etc.
Many of the local epidemics in Harbin and the previous multiple cases were caused by re-yang infection after the 14-day quarantine period expired.
So, how long is the quarantine period for insurance?
Is it necessary to continue to extend the quarantine period for immigrants?
"Delta mutant virus has the characteristics of strong transmission and slow recovery. Some patients have very mild symptoms. If you do not ask carefully, they may have no obvious symptoms, or even simple fatigue. Therefore, after the 14-day centralized quarantine is lifted, at least it needs to be at least During the 7-day home isolation medical observation, the community should continue to strengthen management, and carry out regular nucleic acid testing and daily health monitoring of the immigrants at home.” Li Hang, director of the medical department of the Affiliated Hospital of Putian University, told reporters.
As required by the "Plan", 14-day quarantine medical observation measures will be implemented for immigrants, and home health monitoring will be carried out for 7 days after the quarantine is lifted. Body temperature and symptoms will be monitored during the period to reduce mobility, personal protection when going out, and not participating in gathering activities , And carry out a nucleic acid test on the 2nd day and the 7th day.
"'Home isolation' is different from'health monitoring'. It is strictly prohibited to go out during home isolation. Health monitoring usually requires entry personnel to monitor their temperature and symptoms, and not go out unless necessary." A community worker in Cangshan District, Fuzhou City, Fujian Province The staff told reporters that the latter relied more on the self-consciousness of relevant personnel, but after the quarantine was lifted, some people had relaxed mentally and were very resistant to reminders not to have dinner together or to go to crowded areas. The requirements for home health monitoring were relatively limited. It is difficult for community workers to keep abreast of the actions of immigrants.
In response to the challenge of the "extra-long incubation period" to the length of isolation, some regions have changed the health management policies for immigrants.
For example, Dalian City, Liaoning Province, implements "14+7+7" isolation control for immigrants, that is, "14 days of centralized isolation medical observation + 7 days of home medical observation + 7 days of community health monitoring".
Since August 13th, Guangzhou City has required all persons entering Guangzhou from a foreign country to return to Guangzhou after the expiry of the 14-day centralized quarantine period, from the original “7-day home health monitoring” to “7-day home quarantine management”. It takes 7 days to stay home.
On June 25, Zhong Nanshan, an academician of the Chinese Academy of Engineering, was interviewed by the media. When asked about the question of "whether the '14+7' isolation observation period needs to be extended", he believed that there was no need to extend the isolation period.
He said that the incubation period of most of the new coronaviruses is not long. If the isolation and observation time when entering China is further extended, the harm will outweigh the benefits, and it will bring more difficulties to our communication and exchanges with foreign countries.
"We can strengthen the frequency of health monitoring for immigrants from high-risk countries during the isolation period. This is an effective way."
In Li Hang's view, in addition to the need to ensure the length of isolation, strict implementation of health monitoring measures is also the focus.
"Removing the quarantine does not mean you can'free yourself'. Personal protection should be done when going out, avoid participating in some gathering activities, personal protection and abnormal situations should be reported in time, and nucleic acid testing should be carried out on time. The community should prevent escape and leakage , Loss of control, etc. occurred."
In response to the situation where a nucleic acid test is positive after the expiration of the quarantine period of immigrants, my country has strengthened in many ways on the basis of "personal defense."
For example, in terms of the quality of nucleic acid testing for entry personnel, it is required that nasopharyngeal swabs be collected for nucleic acid testing for entry personnel during isolation. At least two reagents should be used on the 14th day. In principle, different testing agencies should conduct the testing.
"One of the benefits of this is to maximize the sensitivity and accuracy of nucleic acid testing." said Wang Bin, the inspector of the National Health Commission for Disease Control.
How can the general population strengthen protection against "extra-long incubation period" cases?
Relevant experts said that strengthening vaccination and personal daily protection is still the top priority.
The faster and more vaccinations, the more we can keep pace with the future world and remain active in the overall epidemic prevention and control war of mankind.
With the gradual deepening of human understanding of the new crown virus, continuous consideration and improvement are needed between preventing foreign imports and maintaining international mobility. It is necessary to ensure the flow and do a good job in epidemic prevention and health services for immigrants.
Under normalized prevention and control conditions, it is even more necessary to guard against paralysis and be vigilant against loopholes in epidemic prevention.
(Our reporter Li Yunshu Guan Xiaopu)