How can Shanghai realize the social "dynamic clearing" as soon as possible? Suggestions from medical experts
At present, the current round of the epidemic in Shanghai is still running at a high level.
As a mega city, Shanghai has a large population density, frequent flow of people and logistics, and the task of realizing "dynamic clearing" is arduous.
How to further do a good job in epidemic prevention and control, and achieve social "dynamic clearing" as soon as possible?
How to treat confirmed cases and isolate and observe asymptomatic infections?
At an expert symposium held in Shanghai on April 11, some medical experts made suggestions.
Improve screening measures, and do a good job in prevention and control of key areas and key populations
"The Omicron variant spreads very fast and has a high concealment. Once positive infections are found, family gatherings, unit gatherings, and rapid spread." Xin believes that "screening, clearing, and controlling" is the key to the current epidemic prevention and control.
The combined screening strategy of "antigen + nucleic acid" should be dynamically optimized based on factors such as the epidemic level, regional geography, and population characteristics to improve the timeliness of detecting positive infections.
Improve the efficiency of nucleic acid detection and screening.
Lu Shan, a researcher at the Institute of Infectious Diseases of the Chinese Center for Disease Control and Prevention, suggested that on the basis of the existing nucleic acid detection and screening strategy, the key points should be further highlighted.
For example, the elite forces of local medical institutions, disease control departments, and third-party testing institutions focus on ensuring areas with severe epidemics, and testing nearby to ensure that the tracking and transfer of positive people are completed as soon as possible.
For urban villages, large enterprises, and construction sites with large clusters of epidemics, the strategy of "2 antigens + 1 nucleic acid detection" is adopted to carry out rapid screening.
"For the difficult points outside the community walls, old communities, rural rental houses, etc., each street and township should be classified and detailed, implement responsibilities, and increase management and control." Member of the expert group of the Shanghai Epidemic Prevention and Control Leading Group . Wu Fan, deputy dean of Shanghai Medical College of Fudan University, said that for communities and enterprises where the number of daily infections continues to be high or is still rising, organize professional forces to deeply analyze the reasons for the continuous increase in the number of new infections every day since the closure and control, including Aggregation characteristics of infected persons, possible transmission routes, implementation of prevention and control measures, etc.
After the implementation of the three-zone classification management, for the areas where the epidemic situation has declined, the frequency and method of screening will be appropriately reduced to save the screening force; for the areas where the epidemic situation is still at a high level, the screening force will be increased, and the speed of detection and transfer of positive persons will be improved.
Strengthen the management of epidemic prevention and control in centralized employers and suburban administrative villages.
Yuan Zhengan, Secretary of the Party Committee of the Shanghai Center for Disease Control and Prevention, believes that at present, there is a trend of increasing clustered epidemics in concentrated labor units and increased clustering in suburban administrative villages in Shanghai.
It is necessary to consolidate the main responsibilities of centralized employers, and strengthen the management of closure and control of administrative villages in suburban areas.
Effectively increase the vaccination rate of the new coronavirus among the elderly.
At present, the overall vaccination rate in Shanghai is very high, but the two-shot vaccination rate for people aged 60 to 69 is 78%, 61% for those aged 70 to 79, and only 15% for people over 80.
Liu Jue, a researcher at the School of Public Health at Peking University, believes that the elderly are at high risk of severe illness and death after infection with the Omicron variant.
Globally, the case fatality rate of the elderly population during the epidemic period of Omicron is significantly higher than that of other populations.
Vaccination efforts for the elderly should be accelerated, and the coverage of two-shot and booster vaccinations should be increased as soon as possible.
In addition, it is necessary to coordinate the treatment of elderly infected persons, and give priority to elderly infected persons in various links such as discovery, transfer, isolation, treatment, and health monitoring.
At the same time, it is necessary to formulate a special work plan for the treatment of elderly infected persons, and establish a special work mechanism to reduce severe cases and deaths as much as possible.
Revitalize the resources of designated hospitals and classify and treat the infected
Ning Guang, academician of the Chinese Academy of Engineering and president of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, analyzed that the pathogenicity of the Omicron variant is low, the proportion of severe and critical types is low, but the proportion of virus-positive patients with underlying diseases is high, and the underlying diseases May be aggravated or even fatal.
He suggested that asymptomatic infections, mild cases, basic disease infections, basic severe infections and severe cases should be classified and treated.
For designated hospitals, the recovered patients should be discharged as soon as possible and go to the community for home health observation. Some cases without underlying diseases can be transferred to makeshift hospitals, so as to revitalize the resources of designated hospitals and better treat other cases.
Make full use of the high-quality medical resources of designated hospitals.
According to Ning Guang, the northern branch of Ruijin Hospital has established an expert treatment group and an expert consultation group, and established a daily regular consultation system.
At the same time, senior medical staff and high-level medical staff were dispatched to the front line, and specialized teams were established to participate in daily shifts in the new coronary pneumonia ward with the directors of various specialized departments, so as to better treat the underlying diseases of the infected.
It is recommended that all designated hospitals make full use of their own high-quality medical resources, and open specialized wards in specialties with more underlying diseases, such as nephrology, respiratory, cardiovascular, and neurology, to improve their admission and treatment capabilities.
The platform disciplines of designated hospitals should also be fully opened, such as anesthesia, blood bank, laboratory department, pharmacy, intravenous distribution center, endoscopy and vascular intervention.
In addition, it is necessary to resume the treatment of patients with special needs such as ICU, emergency, hemodialysis, surgery, chemotherapy, and pregnancy as soon as possible.
Improve the ability to treat critically ill patients.
Ning Guang believes that there may be more critically ill patients who need to be admitted to the ICU in the future, so it is necessary to increase the number of ICU beds in designated hospitals, and appropriately open the ICU in non-designated hospitals in an orderly manner.
At the same time, increase the number of doctors and nurses in the intensive care unit, and strengthen training and guidance.
In addition, it is necessary to establish a screening system for critically ill patients, to monitor the at-risk groups as soon as possible, and once they become severe, they are immediately transferred to the intensive care unit for professional evaluation, diagnosis and treatment.
Strengthen the rescue force in isolation wards and makeshift hospitals.
Ning Guang suggested that experts should go deep into the clinical front line, enter the isolation ward, and conduct ward rounds and consultations for difficult and complicated cases.
Isolation wards and makeshift hospitals should be equipped with psychologists, clinical pharmacists, and traditional Chinese medicine practitioners, establish a daily joint shift system for medical treatment, nursing, hospital sense, security, and administration, and formulate a daily checklist system to improve treatment efficiency.
"Medical institutions must maintain the minimum and necessary public demand for medical treatment, but they should avoid nosocomial infections caused by infected people." Ning Guang said that medical institutions must strictly implement regional management, and the outpatient department, emergency department, and inpatient department should be separated and operated independently; The buildings are relatively independent, and there is no movement of personnel; each ward is relatively closed to reduce unnecessary flow; the public platform area is relatively independent.
Shen Shaotie