Zhang Wenhong, Director of the Department of Infectious Diseases, Huashan Hospital, Fudan University:
China's disease control and direct reporting system is not a “flower rack”, but needs to be reformed
Late on the night of March 4, Dr. Zhang Wenhong, who has always been standing on the cusp of the wind, recently published a signed article on the “Huashan Infection” WeChat public account, reviewing the important process of the new crown pneumonia outbreak so far. After comparing the two similar control systems in China and the United States, but with completely different control points on key nodes, he believed that the Chinese disease control and direct reporting system that had previously been rated as a "flower rack" was "actually better than most countries in the world." .
Zhang Wenhong is the director of the Department of Infectious Diseases of Huashan Hospital affiliated to Fudan University. He has studied and visited at Shanghai Medical University (now Shanghai Medical College of Fudan University), Hong Kong University, Harvard Medical School, and Chicago State University. During the new crown pneumonia epidemic, Zhang Wenhong was praised by netizens as "the most accessible expert" for his professional and humorous expression.
"China's disease control and direct reporting system is not a flower rack. This system is better than most of the world for known pathogens (such as MERS, 2009 pandemic strain H1N1 influenza virus) or pathogens that are not spreading quickly and with limited transmission (such as H7N9 bird flu). Countries are powerful. "Zhang Wenhong said that one problem with this system is" can't stand the destruction of a lot of spam. "
For example, a large number of viral pneumonia cases are reported every year. "A winter, at least tens of thousands of cases in each city. This system must identify one by one, and finally tell you whether it is influenza, herpes virus, respiratory syncytial virus, adenovirus ... This is unrealistic. Therefore, an effective declaration system must first have valuable information. This shows that we must reform the current unexplained pneumonia declaration system. "
Zhang Wenhong said that every winter, a large number of patients with viral pneumonia arrive at the hospital, of which influenza virus accounts for a high proportion. For example, U.S. Centers for Disease Control and Surveillance data shows that as of February 15, 2020, more than 29 million people in the United States had been infected with the flu during this flu season (December 2019 to February 2020), of which approximately 280,000 were hospitalized. At least 16,000 people have died. "Most hospitals don't actually have the ability to detect flu and various viruses."
Zhang Wenhong believes that the construction of major hospital systems is the first hurdle, that is, the hospital has a department that has a strong ability to diagnose common pathogens. "Because pathogens may infect various parts, they are generally infected internationally. The department first conducted consultations on suspicious patients, and further cooperated with the clinical microbiology department to quickly identify pathogens. In this way, routine pathogen detection can all be identified first. "
As for the remaining unidentifiable pathogens, you can rely on a more authoritative infectious disease department to help identify them; if they can no longer be identified, they should report directly to the CDC. "Cluster-distributed unknown infections can be reported to the CDC. Disease control can launch a powerful direct reporting system. "
Compared with the United States' prevention and control measures, Zhang Wenhong found that the prevention and control of the new crown virus in the United States had previously been based on the principle of "not affecting the economy". For example, in the early stages of the epidemic in the United States, the main screening targets were "strictly controlled". Patients must have traveled to China, or had contact with a confirmed patient, or had severe symptoms. Such screening restrictions later attracted stigma from the local media, and some media reported that many patients with "cold" symptoms could not be screened. The total number of CDC tests in the United States is also very low, which has been criticized by many parties.
At the same time, due to the US government system and other reasons, all confirmed patients in the United States did not publish their life trajectories, including residential communities, workplaces, etc., but only the visiting hospitals. Of the information published in the United States, there is very little information about the patient's life track. It is still questionable whether such measures can effectively help block community transmission.
"This is why once a large-scale spread in the community occurs, the treatment of seasonal flu becomes an inevitable option, because every case cannot be completely tracked, and you hope that U.S. disease control personnel will be like our disease control brothers. Work day and night? I guess I ca n’t do it. "Zhang Wenhong said, at what time of the day and what decisions should be made to minimize the loss of life, economy, and society, it is inevitable for governments in the future to face emerging infectious diseases A difficult problem, "China adopted the current closure of the city, at the expense of China's economy, made every effort to reduce the input to the world, and won the world sufficient time to establish a diagnostic system, and at the same time assess the mortality rate of the disease objectively. It is said to be responsible. "
If everything can be repeated, Zhang Wenhong gives a bold "back to Wuhan" hypothesis.
Back in Wuhan, Zhang Wenhong believed that, first of all, there must be a strong system of infectious diseases and clinical microbiology. This system should have a network everywhere, and this network is equivalent to nearly 800 public health clinics in Singapore. "Once clustered cases occur, we immediately declare and isolate them. Waiting for the identification of disease control is one aspect. It is our hospital to establish the isolation system first." Zhang Wenhong believes that in the next stage, China should establish a strong The grass-roots hospital prevention and control system, "Once an abnormal situation is collected, it should be quarantined immediately when it is reported."
In addition to the isolation ward, this system also needs a team with solid knowledge of infectious disease prevention and control, and even early identification of pathogens. "At this point, the United States and Singapore are very strong. We should increase our investment in this area in the future so that we have a regular hospital public health unit." Zhang Wenhong said that the suspicious infectious diseases in the new crown pneumonia epidemic were first reported from ophthalmologists (Li Wenliang) and respiratory doctors (Zhang Jixian), which itself said that "we need to build a regular army and a standing army" and "put the enemy Block before the outbreak, and not let the disease control come to an end. "
Secondly, Zhang Wenhong believes that the valuable experience left by the two doctors Li Wenliang and Zhang Jixian must be kept in mind, "We should greatly strengthen the ability to identify diseases in frontline hospitals."
Zhang Wenhong said that some of the first doctors admitted in Wuhan had not been verified by their hospitals, so they did not adopt a formal reporting channel. If clinicians can identify various diseases with infection as the main cause, distinguish between various common viruses and bacteria, and discover infectious diseases such as SARS, in addition to reporting to disease control (generally received worldwide After the report, the processing will not be faster than China). The infectious disease department and clinical microbiology department can also rely on their own strength or the strength of the hospital network to analyze the virus. Isolate and avoid further spread.
"In this way, when disease control takes over, there will not be a two-week" hesitation period. "Zhang Wenhong said that this is the" first pass "in the public health system, and China is fully capable of building such a Network system, "because we have a very strong public hospital network, and basically have the equipment."
China Youth Daily · China Youth Daily reporter Wang Yijie Source: China Youth Daily