Can "dynamic clearing" be realized in a short time?
Liang Wannian explained the Shanghai epidemic in detail
What stage is the new crown pneumonia epidemic in Shanghai?
When what conditions are met, Shanghai can stop static management?
Can Shanghai achieve "dynamic clearing" in a short period of time?
On April 10, Professor Liang Wannian, head of the expert group of the National Health Commission's New Coronary Pneumonia Epidemic Response Leading Group and Executive Vice Dean of the Vanke School of Public Health and Health of Tsinghua University, was interviewed by China Youth Daily and other media. Detailed answers to questions related to the Shanghai epidemic.
"25 million people in Shanghai work together to complete a certain action within a certain period of time, which is a very big challenge to the government, epidemic prevention personnel, and the general public." Liang Wannian said that an outbreak has actually occurred in some parts of Shanghai, and in The implementation of some stricter control measures in Shanghai is in exchange for normal production and life on a larger scale across the country and a longer period of time in Shanghai.
Widespread community transmission has occurred in Shanghai
Q: What are the difficulties in preventing and controlling the epidemic in Shanghai?
At what stage?
Liang Wannian: First, the main epidemic strain of this outbreak in Shanghai is Omicron BA.2, which spreads very fast, faster than previous mutants such as Delta.
In addition, its concealment is particularly strong, that is, the proportion of asymptomatic infections and mild patients is very high, so it is very difficult to prevent and control.
Second, in the early days, the Shanghai transmission chain was relatively clear, but some community transmissions gradually emerged.
As of today, it can be said that there are patients in 16 districts in Shanghai, and most of the communities have cases, and the spread is very wide. This is already widespread community transmission.
This means that it is very difficult to fight the epidemic by fighting Delta alone, so more decisive and firm measures must be taken.
Third, Shanghai is a huge international city. No matter what measures are taken in epidemic prevention and control, such as nucleic acid testing for all employees, the city's organizational capabilities, management capabilities, and corresponding prevention and control capabilities are very high. requirements.
In addition, Shanghai's frequent traffic and international and domestic exchanges have brought pressure on three lines of defense: it is necessary to prevent proliferation in the city, prevent spillage, and prevent foreign imports.
At present, the most important thing is to prevent the spread and rebound within Shanghai.
This is the difficulty, and it is also the characteristic that distinguishes Shanghai from other places.
In terms of specific aspects, if Shanghai wants to do these things well, it needs systematic thinking and systematic methods to fight the epidemic, and it needs to be linked and connected - from the common people to grassroots organizations, to the district and city levels, an effective system must be formed. system.
To combat this ferocious major epidemic, we need to further unify our thinking and strengthen our confidence.
In the fight against the epidemic, in addition to fighting the harm to life and health caused by the virus, it is also a very important difficulty to effectively ensure the operation of the city and ensure the necessary production and normal living needs of the people.
How to achieve faster, more accurate and more effective management and control, and better balance epidemic prevention and control, social and economic development and the normal life of ordinary people, is an important proposition for the mega-city of Shanghai.
Can Shanghai achieve "dynamic clearing" in a short period of time?
Q: There are many interpretations of "dynamic clearing" in the society. How to understand it correctly?
Liang Wannian: "Dynamic clearing" is the general policy of our country to fight against the new crown pneumonia epidemic. Set of strategic play.
Many times in the fight against the new crown pneumonia epidemic, it has been proved that "dynamic clearing" is in line with China's actual situation, and it is also the best choice for China to fight the new crown pneumonia epidemic.
The core connotation of "dynamic clearing" is: when a case or epidemic occurs, it can be quickly discovered, and it can be quickly contained, cut off the chain of transmission, and finally found and eliminated, so that the new epidemic does not cause a continuous community. spread.
But it needs to be emphasized that "dynamic clearing" is not the pursuit of complete "zero infection" and "zero tolerance", because this virus has its uniqueness: it is very stealthy.
There may be no way for us to prevent cases from happening now, but we must find and deal with them quickly, find them together, and deal with them together.
Q: What should be done to achieve "dynamic clearing"?
Liang Wannian: The essence of "dynamic clearing" is fast and accurate.
"Fast", for different mutants, is faster than it runs.
In fact, the current situation in Shanghai is that we are in a time race with the Omicron BA.2 variant, and we need to “make fast”—to control it with a faster speed.
To be really fast, it is necessary to find out quickly and deal with it quickly.
"Precision" must be accurate on the basis of effectiveness, and this effectiveness must ensure that the epidemic can be controlled in time.
How to accurately detect infected people?
The combination of nucleic acid and antigen detection is now used to detect infected persons more quickly.
How to quickly identify close contacts, or even close contacts, after an infected person is discovered?
Protecting these groups of people who may have been infected and preventing more insidious transmission involves how to carry out more accurate epidemiological investigations to discover the transmission paths and transmission factors of possible infected people.
Precise clinical treatment and "one person, one strategy" to prevent the progression and deterioration of the disease.
The last and most important precision is how to accurately balance epidemic prevention and control with normal production and life, as well as social and economic development.
To achieve these precisions, it is necessary to scientifically and truly implement the relevant prevention and control measures.
Q: Can Shanghai achieve "dynamic clearing" in a short period of time?
Liang Wannian: The "dynamic clearing" policy that China has formed in the fight against the epidemic in recent years is relatively mature in the specific process, because we have a set of toolboxes to carry out this work.
"Dynamic clearing" is still the general policy of Shanghai's anti-epidemic policy, which must be firmly implemented.
"Dynamic clearing" is the best choice for Shanghai to fight the epidemic, and it is also the best solution.
The current situation in Shanghai is severe and complicated.
I think that as long as the control of the source of infection, the cutting off of the transmission route, and the protection of susceptible people can be effectively implemented in place, "dynamic clearing" can still be achieved.
So we have to strengthen our faith.
We still have a foundation.
In the control of infectious diseases, the main means is to find, manage and treat. Shanghai has this ability.
The combination of the past nucleic acid detection technology and the now widely used antigen self-test technology makes the "weapon" more powerful and can identify infected people at an early stage.
Shanghai has relatively rich medical resources, coupled with the support of the whole country, it can effectively treat and isolate infected people or those who may be infected, and strengthen their management, which can effectively prevent further spread and cut off the transmission route.
This virus is mainly transmitted through the respiratory tract, and it will not continue to spread without contact.
On the other hand, exposure of susceptible populations is decreasing and vaccinations are being ramped up.
Controlling the source of infection, cutting off the transmission route, and protecting the susceptible population—if these three tasks are done well, we can defeat any infectious disease.
The series of comprehensive measures that Shanghai is taking are based on these three links, and they have technology and capabilities.
The people of Shanghai have a high degree of understanding and support in fighting the epidemic.
I came here for a while and was very impressed.
Our common people are very cooperative with the government in fighting the epidemic, whether it is closed or controlled, whether it is participating in nucleic acid testing, everyone is actively cooperating.
With this culture and the quality of Shanghai citizens, I don't think there is any difficulty that we cannot overcome.
Abandoning the perception that Omicron is the "big flu"
Q: How dangerous is Omicron?
Liang Wannian: From the perspective of some international and domestic epidemic areas, the overall degree of harm is higher than that of influenza. Especially for the elderly, the fatality rate is dozens of times higher than that of ordinary influenza. The elderly over 80 years old People are even 100 times higher.
With such a large population in our country, there are 25 million people in Shanghai, with the advancement of time, the infection of the elderly is inevitable. A little careless prevention and control will cause great health damage to the elderly and some other vulnerable groups. , must be given great attention.
When measuring the harm of the virus, it is generally necessary to consider how much it spreads, that is, how many people are infected in a region and a city, which is a feature to measure its harm.
The severity of the disease is further divided into two levels: for individuals, what is the proportion of severe illness or even death after infection; for groups, that is, how many people die and become seriously ill among the infected people in an area .
From the perspective of public health, we pay more attention to the harm to the group after the widespread epidemic of the disease. Of course, we need to consider the harm to the individual, but when measuring the harm of a disease, the perspective of the group is the most important.
Another important feature of Omicron is that it is also a feature of the new coronavirus: it is always mutating, and the direction of mutation is not clear.
With such a large-scale epidemic and spread, if it mutates or mutates in a bad direction, it will do more harm to our health.
From an international point of view, some countries in Europe and the United States have experienced the spread or prevalence of the new crown variant Omicron. Looking back, they evaluate the degree of harm. One indicator is the excess mortality rate. The excess mortality rate is the same as the average of last year or previous years. Compared with the number of deaths in the segment, the excess is simply called the excess mortality rate.
In many countries its excess mortality rate is high.
Q: Is Omicron the "big flu"?
Liang Wannian: I still want to emphasize that the Omicron variant is not influenza, and the current epidemic cannot be regarded as an "influenza-like epidemic".
It is significantly different from the flu: it spreads faster than the flu virus, it spreads more stealthily than the flu, and it is more likely to spread widely.
Omicron is susceptible to everyone, especially to some vulnerable groups and the elderly. Shanghai has a large proportion of the elderly population.
Vulnerable groups in Shanghai, such as patients with underlying diseases, have a large absolute number.
Once infected, even if the incidence of individual severe illness and death is small, it adds up to a huge number.
At the same time, from the perspective of the law of the epidemic itself, under normal circumstances, we may only consider the harm and impact caused by the epidemic itself. Once it spreads widely, it will also affect other normal medical service needs.
Because once the disease increases, people will inevitably panic and run on medical resources.
After a run on medical resources, normal medical and health needs cannot be guaranteed, which in turn will affect the timely supply of other medical needs.
Therefore, other hazards caused must be taken into account.
All things considered, we can't think that Omicron is a "big flu", or we should abandon this understanding that there is no complete scientific evidence at present.
We must believe that this strategy and measure of Omicron is scientific and a decision based on the understanding of the disease, rather than blindly or without any evidence and basis.
Shanghai is now in exchange for a wider and longer normal production and life
Q: Is it possible to lie flat like in Western countries?
Liang Wannian: From the global point of view, there have been some strategic debates in response to the new crown pneumonia epidemic from the early days to now.
In the first half of 2020, the new crown pneumonia epidemic has been widely spread around the world. From a professional point of view, its prevention and control strategy choices are two major parts, one is containment and the other is epidemic mitigation.
The so-called containment is to surround it when it is found, and then cut it off.
Epidemic mitigation means stepping back from a position and standing on the goal line that medical and health resources will not be run on to decide epidemic prevention measures.
Some foreign countries and regions decide the intensity and scope of prevention and control on the premise that medical resources will not be run on.
These strategies are different from the concept of prevention and control. From the very beginning, our country has resolutely implemented an important strategy - "to prevent import from outside and prevent rebound from within". We have taken relatively firm measures to contain the spread of the epidemic. .
The concept is what General Secretary Xi Jinping said, "people first, life first", which is our most important concept.
Globally, some countries are not adhering to this philosophy.
It should be emphasized that different ideas determine different strategies.
As of today, there are two directions for dealing with Omikron. One is to lie down and let it infect; the other is China's current "dynamic clearing".
You can also see the impact of lying down in some countries and regions.
But in this case, China insists on "dynamic clearing" and the concept of "people first, life first". At the same time, we are also very confident that we have the ability, the toolkit, and the foundation.
In fact, it has been said many times that "dynamic clearing" does not pursue "zero infection". "Dynamic clearing" pursues timely detection, rapid elimination, and elimination at the same time, so that it does not cause continuous community transmission and large-scale infection. The epidemic has rebounded, and we need to find the most suitable way to balance it, so lying flat is definitely not China's choice.
If we make good use of "dynamic clearing", we will get the maximum benefit at a minimal cost.
Q: Why haven't some western countries implemented similar "dynamic clearing" measures?
Liang Wannian: I have always said in the past that our country is generally clean. Some countries do not do "dynamic clearing". It is very likely that their homeland is not clean, and the opportunity for "dynamic clearing" has been lost.
We still have this time window and opportunity, including now Shanghai.
More importantly, China has strong institutional advantages, and the cultural views of our people are unique to China. We can combine them very well to implement this strategy.
Scientifically speaking, letting the virus spread and occur without infection is definitely the greatest protection for life. If you lie down, the biggest risk is definitely the price of life and health.
What needs to be emphasized in particular is that for "dynamic clearing", everyone thinks that its big problem is that it affects economic development and the normal production and life of ordinary people.
In my opinion, it is incomplete and unscientific to treat it as a causal relationship.
After the epidemic comes, it is a kind of harm to all countries and all mankind. In fact, a series of prevention and control strategies and measures adopted by various countries are aimed at reducing this kind of harm. No country or region wants to have an epidemic and want to increase its harm.
But what kind of strategy and what kind of measures to use to mitigate, then this is the choice of each country.
Philosophy, politics, culture, and system are a comprehensive choice.
Then look at China, what we choose now is "dynamic clearing", which is to do everything possible to reduce the impact on the health and life safety of ordinary people, and at the same time do everything possible to effectively and accurately balance epidemic prevention and control with normal production and life. relation.
Precisely balancing the relationship between epidemic prevention and control and economic and social development is a choice.
For example, our ordinary people may have some inconvenience in their lives because of the static state, and the economy of some enterprises has been affected to a certain extent. Then the emergence of this situation is mainly caused by the epidemic.
If we say that some measures taken, such as closure and control, may have an impact on ordinary people, but the root cause of this impact is the epidemic, and the short-term closure and control is in exchange for a longer period of normal production and life .
The implementation of some stricter control measures in Shanghai is in exchange for normal production and life in a wider area across the country and a longer period of time in Shanghai.
Therefore, when calculating this balance, we must have a broader vision, a more systematic approach, and a higher vision to see and lose in the long run.
This is very important, it is not a simple zero and flat two extremes.
When will Shanghai stop static management?
Q: What do you think of the phenomenon of so many asymptomatic infected people?
Liang Wannian: Indeed, a very important feature of the new mutant bead of Omicron is that the proportion of asymptomatic infections is relatively high. The Shanghai epidemic also fully demonstrated this feature of Omicron.
The main reasons for this high ratio are many. In addition to the characteristics of the virus itself, such as extensive vaccination, effective resistance is formed. There is no way to prevent infection, but infection can make the disease milder or even asymptomatic. The effectiveness of epidemic prevention.
For example, extensive antigen and nucleic acid screening is now carried out, which will be detected at an early stage, which can stop the epidemic.
It should be noted that in the diagnosis of a disease, how to follow the diagnosis and treatment plan and diagnosis and treatment guidelines in a more scientific and standardized way to classify and analyze the disease, I think it should also be considered.
Because this disease is a very important feature, its symptoms are not specific, such as fever, muscle aches, or other related symptoms and signs, lack of specificity, how to strictly standardize when classifying and judging Follow the guidelines of the diagnosis and treatment plan determined by the state, which requires attention.
Of course, I think this problem exists all over the world, which is why we need to strengthen the training of medical staff and emphasize some important issues of regulating medical care.
These aspects are the reasons for the relatively high number of asymptomatic infections and mild cases in Shanghai. Of course, it is mainly due to the characteristics of the virus itself and the effectiveness of our epidemic prevention.
After Omicron mutated, we had been fighting it for a while, and the feeling was that it came too fast.
One of my deep feelings: the past play style can't run it, and there must be a faster speed.
This faster speed is the measure. Start fast and make fast with fast.
Second, its transmission is too strong. Once it comes in, if there is no intervention, 1 confirmed patient will spread to 9.5 people.
Internationally, this is the accepted figure, that at least 9 to 10 people are infected.
If the measures are not firm and thorough, the infection will not be less than 1. We take these measures to push it down from 9 and 10.
Even if the pressure reaches 5, it is very powerful. One person passes 5 people, and everyone passes 5, which is an exponential rise.
Therefore, the measures we are taking now, whether it is nucleic acid testing or global static management, we must do everything possible to reduce its transmission value to below 1. Once it is below 1, it means that one person cannot spread to one person. The "inflection point" has appeared, and it will not continue to spread.
We have to hold back, although it is difficult.
Moreover, the intergenerational interval of virus transmission is very short now.
In the past week, the intergenerational gap was only about 3 days, and each generation grew exponentially.
One can imagine how difficult it is for our prevention and control.
Infected people do not necessarily have symptoms immediately. For example, if 5 people are infected, in theory, these 5 people will have symptoms. According to 3 days, some will have symptoms, and some can be detected. Then add its hidden infection. , When there are no symptoms, they will not take the initiative to check.
It is very likely that he has been in contact with people again within these 3 days, and the person he has contacted is infected again... When he finds out that he has symptoms, he may have passed it on to people for two or even three generations. I think this is prevention and control. The most difficult thing is that if the intergenerational interval is long, it is still too late to manage and control it when it is discovered. Once it is a little slower, it is probably not a problem of one generation and two generations.
Why don't the people in Shanghai understand?
How to turn the nucleic acid from left to right?
We still want to fish it out.
Try to expand the scope as much as possible, find out possible sources of infection, and then manage and cut them off.
As long as there is a little leakage, there will be rapid exponential growth, and it will spread quickly. This is the biggest difficulty in prevention and control at present.
Q: When what conditions are met, Shanghai stops static management?
Liang Wannian: I said "dynamic clearing" just now, but it does not mean that it is "zero infection", because Shanghai has its uniqueness and is a window for external exchanges. In theory, clearing, "dynamic clearing", There are several concepts of zero in society.
To clear it means to control it to zero in this transmission chain, so that the transmission in this field will not continue.
"Dynamic clearing", it is likely that in this city, there are different chains of transmission. In the early days, we may know that I infect you, you infect him, but why is Shanghai called extensive community transmission now?
It is no longer possible to figure out who the upper house is, and many patients do not know their upper house at all.
In this case, we just need to consider what kind of standard we meet from the perspective of society as a whole, and we think that the epidemic has been suppressed and the continuous spread of society will not occur.
When measuring this effect, a very important indicator, in addition to the number of reported occurrences per day, or the number of new occurrences per day, is to see whether the continuity of transmission has been cut off. This is a very important point of view. Biography - this is one of our pursuits.
In terms of phenomena, the number of daily reports and the number of new cases per day are declining. To what extent does it drop? This and the actual infected person are two different concepts.
One is the number that everyone sees and is reported every day.
However, the number of cases reported today is likely to be an infection that occurred a few days ago. It has a time lag and does not fully indicate that the number of infections is rising or falling.
A very important number is to look at the incidence curve.
Looking back, countries around the world were analyzed based on the reported curve and the incidence curve.
The incidence curve depends on which day it is issued, and it is used as a base to see the entire epidemic situation.
However, Omicron is very cunning. Most of them are asymptomatic. The onset curve and onset time are difficult to define scientifically. They can only be determined according to the time of testing and sampling.
Judging from the incidence curve, the number of infected people drops to a certain level. This certain level does not mean that the whole of Shanghai is "dynamically cleared", the social aspect is cleared, and there are no more patients, it is called clearing.
Sustained social transmission is cut off, which is a very important criterion.
The second aspect is that the new patients we have discovered are all within sight and under control.
Shanghai has not yet reached this stage.
For the number of cases reported every day, some people were screened in the community and in key populations.
If one day, all new cases are found among close contacts, or these key groups in the field of vision are found through active screening.
At this time, the goal of "dynamic clearing" in the social aspect has been achieved.
Now everyone is looking forward to a faster and earlier turning point of decline in Shanghai, which is based on the further implementation and implementation of our prevention and control measures.
I believe that with the joint efforts of all of us, Shanghai will definitely have a turning point of decline as soon as possible.
Shanghai has curbed the exponential rise
Q: How do you view residents' exhaustion from rounds of screening?
Liang Wannian: It is very difficult to find out the source of infection. You may have already felt that we are going all out to screen from left to right. That is the purpose.
So I hope people can understand.
I also noticed that some ordinary people may be screened many times, that is to find it out, early detection means early isolation, asymptomatic infected people have to enter the cabin, or even go to a designated hospital.
The main thing is to cut off the transmission route.
Shanghai is still at the peak of the epidemic, and outbreaks have actually occurred in some areas.
The entire prevention and control situation is extremely severe and complicated, but according to the epidemic parameters of the variant strain of Omicron, we have not seen an exponential increase in the number of daily infections in Shanghai, which indicates that the The prevention and control strategies and measures of China are playing an important role in curbing the momentum of the exponential rise.
This is very important, so let's not panic, it shows that our efforts are playing an important role.
Now Shanghai is still at the critical moment of implementing "dynamic clearing".
Epidemic prevention and control is in a stalemate and at the most critical moment. If we do not advance, we will retreat.
We must firmly grasp this time window. From government departments to all walks of life, especially the general public, we should closely form a joint force. The core requirement of forming a joint force is that we must have a unified understanding.
We must get rid of the misconceptions that "Omicron is the big flu, you don't want to make big moves", not "make big moves", because science requires us to do so.
Some countries don't do it because of different concepts, and it can even be said that it has differences in basic conditions and capabilities.
We have this idea, this ability, and this condition and foundation, why don't we do it?
Everyone must have firm confidence, believe in our party, believe in our government, and believe in the strategies and measures we are taking now.
Once we gradually classify them according to prevention areas, control areas, and closed control areas in the future, everyone can move in a certain range, and we must minimize unnecessary gatherings.
More importantly, it is still necessary to not believe or spread rumors, form a joint force, and stick to it for a period of time. I think the dawn will soon appear.
Newspaper Shanghai, April 10th
China Youth Daily, China Youth Daily reporter Geng Xueqing Source: China Youth Daily