Fight against Omikron and upgrade precise prevention and control
China News Weekly reporter / Du Wei
Published in the 1037th issue of "China News Weekly" on March 28, 2022
In the past week, the development of the domestic epidemic has remained at a high level.
This is a complex challenge faced by the normalization of domestic epidemic prevention and control after the Wuhan epidemic.
With the exception of more than 2,400 new local cases nationwide on March 16, the daily number of new cases in the rest of the days exceeded 3,000.
From March 17 to 21, the daily number of new cases nationwide was around 4,000.
Since March 1, more than 40,000 cases of new crown infections have been reported in China, affecting 28 provinces.
More than 20,000 cases have been reported in Jilin Province, and more than 1,000 cases have been reported in Shandong, Hebei, and Shanghai, and at least a dozen provinces have reported between 100 and 1,000 cases.
This round of epidemic is characterized by full bloom.
The National Health and Medical Commission stated at a press conference on March 19 that the local epidemic is in the developing stage, and many provinces are facing the prevention and control of the Omicron epidemic at the same time and in many cities.
Since December last year, the global new crown epidemic has entered the fourth wave of the epidemic, and the number of reported cases per week has exceeded 10 million for 11 consecutive weeks.
In the past week, the newly confirmed cases of the global new crown epidemic have rebounded again, and more than 40% of them are concentrated in countries and regions around China.
This has made the "pressure difference" between the domestic and neighboring countries and regions continue to increase.
Wang Hesheng, deputy director of the National Health Commission and director of the National Centers for Disease Control and Prevention, said that the current round of the global epidemic is still high and will not end in the near future.
This means that many countries in the country will continue to face encounters with the Omicron variant.
On the evening of March 15, the ninth edition of the new crown diagnosis and treatment plan was released, which was regarded as a major adjustment to deal with asymptomatic and mild cases of Omicron infected people.
The meeting of the Standing Committee of the Political Bureau of the Central Committee held on March 17 pointed out that it is necessary to adhere to dynamic clearing, improve the level of scientific and precise prevention and control, continuously optimize epidemic prevention and control measures, and strive to achieve the greatest prevention and control effect at the least cost, and minimize the epidemic. impact on economic and social development.
Wang Guangfa, director of the Department of Respiratory and Critical Care Medicine at Peking University First Hospital and a member of the New Coronary Pneumonia Expert Group, told China News Weekly that it is necessary to keep pace with the times and assess epidemiological risks based on international and domestic epidemics.
Although it is impossible to completely avoid the epidemic, it is possible to keep the epidemic at a low epidemic intensity to ensure the normal operation of the society and the life and health of the people as much as possible.
Major adjustments to the diagnosis and treatment plan
In the past week or so, apart from Jilin Province, which has more than 1,000 new infections per day, Shandong and Shanghai are still the "hardest-hit areas" for this round of epidemics, and Hebei and Fujian are the "latecomers".
As a new spread of the epidemic, Binzhou City, Shandong Province added nearly 400 new cases of local infections on March 19.
The number of new infections in Shanghai has repeatedly hit new highs in recent days. Nearly 900 positive cases were reported on March 21. Since March 1, the total number of new infections has been around 4,000.
Langfang City is the main outbreak site of the current round of the epidemic in Hebei. On March 19, there were 546 new positive cases.
From the first infected person on March 9 to 24:00 on the 21st, Langfang has reported more than 2,400 cases of infection.
The infected people in Fujian Province are mainly from Quanzhou.
Since March 16, the number of infected cases in Quanzhou has increased at a rate of hundreds of cases per day. Since March 13, more than 1,300 infected people have been reported.
The Omicron variant BA.2 evolutionary branch is the "culprit" of the epidemic in many places. Its weak pathogenicity and high vaccination rate make the infected people mainly mild and asymptomatic.
As of 24:00 on March 18, the total number of hospitalized infections in the country was 29,127, of which 95% were mild and asymptomatic, and less than 0.1% were severe and critical.
On March 18, the death rate reappeared in China after a lapse of more than a year.
The two deaths were from Jilin Province, both were over 60 years old, the new coronary pneumonia was mild, and the direct cause of death was an underlying disease.
In order to cope with the increasing number of infected people, in accordance with the newly promulgated ninth edition of the new coronary pneumonia diagnosis and treatment plan, Jilin Province has made Fangcang shelter hospitals as isolation places for mild patients.
As of March 19, there are 11,673 isolation rooms across the province, 9 makeshift hospitals have been built, 16,302 beds are provided, 8,538 beds have been used, and 6,993 beds will be delivered in the next three days.
Compared with the previous version, one of the biggest changes in the new version of the diagnosis and treatment plan is the classified treatment, which implements centralized isolation management for mild cases, and centralized treatment of ordinary, severe and high-risk patients to designated hospitals for treatment.
Asymptomatic infections, like mild cases, are managed in centralized isolation.
This can avoid taking up a lot of medical resources, and even causing waste and runs.
Jiao Yahui, director of the Medical Administration and Medical Administration Bureau of the National Health and Medical Commission, explained that for mild cases and asymptomatic infections, there is no need to take excessive medical treatment and intervention measures, so that medical resources can be provided to patients who really need new crowns. With more precise treatment, medical resources can also play a more scientific role.
Jiao Yahui also emphasized that positive infections are contagious, so isolation management facilities should be strictly separated from isolation places for close contacts to avoid cross-infection.
The adjustment of nucleic acid Ct value in the discharge standard is also a major feature of the new version of the diagnosis and treatment plan.
The Ct value is a key indicator for judging whether the nucleic acid test is positive.
Generally speaking, samples with Ct values between 0 and 40 are considered positive, and those above 40 are negative.
The Ct value is a sign of the local virus concentration and infectivity. The higher the Ct value, the lower the virus concentration in the patient's body and the lower the infectivity.
A Ct value of 20 means a higher viral load, and patients above 30 are less infectious.
According to the new version of the plan, a nucleic acid Ct value greater than or equal to 35 can be discharged from the hospital.
Li Xingwang, chief expert of the Infectious Diseases Diagnosis and Research Center of Beijing Ditan Hospital, said in response to questions from the media that in the past two years, virological studies have found that almost no live virus can be isolated from patient specimens with a Ct value above 35, which means that there is no infection. sex.
At the same time, it was found in epidemiological studies that there were many so-called "returning positive" cases in the early stage, the Ct value was basically above 35, and there was no infection of close contacts after returning to society.
In many hospitalized patients during the recovery period, the Ct value rose to above 35 in about a week.
Although they did not meet the negative standard, these patients were not contagious, and "living in the hospital is a waste of medical resources."
Therefore, the new version of the diagnosis and treatment plan has adjusted the standard of nucleic acid detection Ct value at discharge and release from isolation.
On the evening of March 19, 101 patients with new coronary pneumonia in Jilin Province were discharged from a number of designated hospitals in Jilin City and Changchun City.
The new version of the diagnosis and treatment plan changes the management of patients after discharge from the previous 14-day isolation to 7-day home health monitoring.
Jiao Yahui analyzed that in this regard, considering that the patient was no longer infectious after discharge, the isolation management was changed to home.
On the other hand, through the observation of the previously infected Delta and Omicron, basically within 7 days, the patient's entire body function returned to a normal state.
Jiao Yahui believes that the adjustment of the ninth version of the plan "does not mean that the prevention and control policy is relaxed, but more scientific, more accurate, and more targeted."
Towards more precise prevention and control
The emergence of the Omicron variant has brought great challenges to the prevention and control of the epidemic in various places.
As a domestic "anti-epidemic top student", Shanghai's precise prevention and control policies have also been adjusted.
From March 12, Shanghai began to implement the "2+12" model of large-scale nucleic acid screening, that is, the community first implemented a two-day closed management, during which two nucleic acid tests were carried out at an interval of more than 24 hours, and the community related personnel were then carried out for 12 days at home. Observed.
Screening is carried out in batches and grids to achieve social clearance as soon as possible.
On March 16, the "2+12" mode was fine-tuned, and the 12-day home health observation was no longer required.
In an interview with the media, Wu Jinglei, director of the Shanghai Municipal Health Commission, said that in view of the strong transmission power, fast transmission speed, and concealment of the Omicron variant, the overall screening scope has been significantly expanded, and resource investment has increased.
Screening is not limited to the previous close contact, sub-close contact and risk groups, but includes the combination of key industry groups and delineated key regional groups.
From March 16th to 17th, more than 14 million nucleic acid samples were collected from key areas in Shanghai. From March 18 to 20, more than 10 million people were screened in non-key areas.
The resident population of Shanghai is 24.8 million.
During this round of epidemic, Jilin City and Changchun City have also carried out several rounds of nucleic acid testing for all employees.
On March 21, Zhang Li, deputy director of the Jilin Provincial Health and Health Commission, said that the province has continued to carry out "clearance" operations, and Changchun and Jilin are carrying out nucleic acid testing for all employees for three consecutive days.
The arrival of the Omicron variant has also made the epidemic prevention measures in many places as strict as in early 2020.
Since March 21, Shanghai Disney Resort has been closed due to the epidemic.
Prior to this, the long-term closure of the park only occurred during the Wuhan epidemic. From January 25, 2020, it was temporarily suspended until May of that year.
After Halloween last year, Disney was only briefly closed for two days after conducting the acclaimed "nucleic acid test under fireworks" due to a visit from a confirmed case.
From the same day to March 25, Jilin City implemented static management of the whole area. Personnel in the closed control area are prohibited from leaving their homes, and personnel in the control area are prohibited from leaving the unit.
Xiamen City suspends the business of confined spaces.
The latest announcement on epidemic prevention and control issued by Nanjing City on March 20 stated that entry into the community must be based on a negative nucleic acid certificate within 48 hours.
In the past week, residents of a community in Zibo, Shandong had a physical conflict with community epidemic prevention and control personnel because they were prevented from going out to seek medical treatment.
Due to the closure and control of the community where Shenzhen's food delivery riders live, in order not to affect their livelihoods, they can only sleep on the streets.
People in Yanjiao were blocked from entering Beijing because of the blockade of the community.
There was also a shortage of medical supplies in Jilin Province.
At the press conference of the State Council's Joint Prevention and Control Mechanism held on March 22, Liang Wannian, head of the expert group of the National Health Commission's Leading Group for Epidemic Response and Disposal, said that with regard to community control, some corresponding interventions were not implemented accurately enough, often " One-size-fits-all", or "flooding".
In the future, the training of community prevention and control personnel and the linkage with professional institutions need to be further strengthened to make prevention and control more accurate and scientific.
Previously, Jiao Yahui also said that in order to solve the "last meter" problem for people to see a doctor, the key is to solve "one in and one out", so that people who need medical treatment can get out of the community and enter the hospital." Nucleic acid testing must not be used as a precondition, and any hospital must strictly implement the system of responsibility for the first diagnosis and emergency and critical care."
Wang Guangfa believes that what we need to do at this stage is to try to clear the domestic epidemic situation as much as possible.
"We still have a chance now, in a manageable time window."
The reason why it cannot lie flat like some other countries is that it will cause a sudden increase in the number of infections, impact medical resources, and increase the fatality rate of high-risk groups, which will greatly affect people's normal lives.
The most important thing at the moment is how to achieve a balance between epidemic prevention and control and economic and social development in the face of the strong concealment and difficult monitoring of the Omicron variant.
In Wang Guangfa's view, summarizing the experience and lessons of the past two years in the fight against the epidemic, "Sometimes we take prevention and control measures very quickly, but when we release it, it is half a beat slower. This is what we should pay attention to in the future. Some industries are very dependent on As for the flow of people, one more day of control will result in one more day of losses. In the case of low risk, extending the control will not bring much benefit, and the frequency of nucleic acid testing should be moderate. These all reflect the idea of precise prevention and control.” Shenzhen Self 3 From January 14th, all non-essential flows will be stopped for a week, and after the completion of three rounds of nucleic acid testing for all staff, the social dynamic will be basically cleared.
From March 21, the city will resume normal work order in an orderly manner.
The meeting of the Standing Committee of the Political Bureau of the Central Committee held on March 17 pointed out that it is necessary to strengthen scientific and technological research and development of vaccines, rapid detection reagents and drug research and development to make prevention and control work more targeted.
The new version of the diagnosis and treatment plan provides the combined detection of nucleic acid and antigen for the toolbox of epidemic prevention and control, as well as new options for two new coronavirus antiviral drugs, including Pfizer's small molecule drugs.
Because the sensitivity and specificity of antigen detection are inferior to nucleic acid detection, its application is mainly in high-risk, high-prevalence clustered infection populations.
As of 19:00 on March 20, the Jilin Provincial Department of Industry and Information Technology had ordered 48.106 million antigen detection kits nationwide.
Up to now, a total of 40.821 million antigen detection kits have been allocated and sent to key areas such as Changchun and Jilin as well as key units such as designated hospitals and schools in the province.
Wang Guangfa said that the biggest advantage of antigen testing is that people can test at home.
Although the sensitivity is not 100%, it is conducive to early detection of cases.
According to the previously released "New Coronavirus Antigen Detection Application Plan (Trial)", if the antigen test is positive, residents should immediately report to the community (village and town) where they live.
At a press conference held by the State Council Information Office last week, Jiao Yahui said that the "Law on the Prevention and Treatment of Infectious Diseases" and other laws and regulations clearly state that citizens have the responsibility and obligation to report infectious diseases. corresponding legal responsibilities.
Wang Guangfa believes that in the future, all localities should strengthen the monitoring of key populations, and the whole society should form a consensus, "Once ordinary people have new respiratory symptoms, they should go for antigen and nucleic acid testing. For the academic community, what we need most at present is Epidemiological risk assessment, under various epidemic prevention strategies, how many patients will there be? How quickly can the patients be discharged from the hospital? How high the epidemic peak can the existing medical system withstand." He also said that localities should also make corresponding assessments, Where are the weak links in epidemic prevention, who are the key groups, and what level of strict prevention and control should be, on this basis, targeted measures should be taken.
"If the risk is very high, measures should be taken resolutely and quickly, and if the risk is very low, it should be appropriately released", to ensure the prevention and control of the epidemic at a controllable cost, while maintaining the normal operation of society and the normal life of the people.
At the press conference on March 22, Liang Wannian said, "I look forward to the day when the virus becomes softer and weaker, our effective and special drugs have appeared, and our vaccines are more effective, including international Some epidemics have also declined. In this case, we will comprehensively consider the situation of the epidemic in China, the harm of the virus and the disease, and our prevention and control capabilities, and then take more adaptive measures to deal with the disease.”
"China News Weekly" Issue 11, 2022
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