85.5% of people infected with the Hebei epidemic came from rural areas

Rural shortcomings in epidemic prevention and control

  Compared with previous rounds of scattered epidemics in China, the epidemic in Hebei has a distinctive feature: it spreads in rural areas.

  Compared with cities, the prevention and control of epidemics in rural areas is unique and requires special attention to work methods.

As the Spring Festival is approaching, population flows will increase, and the risk of epidemic spread will increase, and epidemic prevention and control in rural areas may face greater pressure.

  It is urgent to fight the epidemic prevention and control war in rural areas.

High concentration, strong correlation, 85.5% of the infected people come from rural areas

  On January 10, Hebei Province added 82 newly confirmed local cases. Among them, Shijiazhuang City reported 77 cases (27 cases of asymptomatic infection were converted to confirmed cases), and Xingtai City reported 5 cases.

As of 24:00 on January 10, there are currently 265 local confirmed cases in Hebei Province, and 203 local asymptomatic infections are still under medical observation.

  On the afternoon of January 11, Shijiazhuang City held a press conference on epidemic prevention and control. From 0:00 to 12:00 on January 11, Shijiazhuang City had 16 newly confirmed cases and 5 asymptomatic infections.

  This round of the epidemic in Hebei has developed rapidly and the prevention and control situation is severe.

On January 9, the second press conference on the prevention and control of the new crown pneumonia epidemic in Hebei Province reported that 85.5% of the infected people were from rural areas and were generally older, with a median age of 46.5 years old. Community transmission and multigenerational transmission occurred.

  On January 2, Hebei Province reported the first confirmed case of the current round of the epidemic-a 61-year-old female villager in Xiaoguozhuang Village, Zengcun Town.

Subsequently, more confirmed cases were found in Xiaoguozhuang Village, and people in the neighboring Liujiazuo Village, Dongqiao Village, Beiqiao Village, Nanqiao Village, etc. were also confirmed one after another. In addition to Shijiazhuang, there were also cases in Nangong City, Xingtai City.

  At present, Shijiazhuang and Xingtai have completed the first round of nucleic acid tests for all employees, with a total of more than 13 million people tested. As of 24:00 on January 9th, a total of 364 positive tests were screened, showing two characteristics: high concentration and relevance Strong.

  Shijiazhuang City and Xingtai City are the two areas involved in the current confirmed cases in Hebei, while Gaocheng District, Shijiazhuang, is the "severe disaster area".

The positive persons found in the test were distributed in 12 counties and cities in Shijiazhuang City, but mainly concentrated in Gaocheng District.

Since January 6, the entire Gaocheng District has been adjusted to a high-risk area.

  So far, this round of the epidemic has not seen a clear turning point, the risk of proliferation still exists, and the traceability work is still in progress.

The airport is very likely to be imported, and high-frequency words in the activity track of cases such as wedding banquets and full moon wine

  Whether it was the Wuhan epidemic that broke out at the beginning of last year or the local epidemics that have spread in various places, most of the epidemics occurred and spread in cities.

However, the place where the Hebei epidemic broke out was a rural village that was originally thought to be “safe”.

  From a geographical point of view, Zengcun Town is close to Shijiazhuang Zhengding International Airport and High-speed Railway Zhengding Airport Station. The former is also one of the ports of entry, which seems to provide "convenient transportation" for the introduction of the virus.

Shi Jian, director of the Emergency Office of the Hebei Provincial Center for Disease Control and Prevention, said that according to the comprehensive investigation, the current round of the epidemic in Hebei has no relevance to other areas in China that have experienced epidemics. According to the current situation, the possibility of the virus being imported through the airport Big.

  What kind of chain does the epidemic spread?

At present, the "case zero" of the Hebei epidemic has not been found.

Based on the time of onset of early cases, it is preliminary estimated that "Case Zero" was as early as December 15, 2020.

  The reporter combed through the trajectories of confirmed patients announced by relevant departments and could see some "clues" of the spread of the virus.

  Xiaoguozhuang Village, Zengcun Township, is the center of the current epidemic.

As of 24:00 on January 9, among the 172 confirmed cases in Shijiazhuang City officially announced, nearly 60 people were villagers in Xiaoguozhuang Village, and more than 30 people had experience in Xiaoguozhuang Village related activities, including regular visits to Xiaoguozhuang Village to participate in activities , Go shopping in a supermarket in Xiaoguozhuang Village, and get a haircut in Xiaoguozhuang Village.

This shows that more than half of the confirmed cases are directly or indirectly related to Xiaoguozhuang Village.

  Gathering activities such as wedding banquets, full moon wine, going to the fair, and dinner parties are high-frequency words in the trajectory of cases.

Feng Zijian, deputy director of the China Centers for Disease Control and Prevention, said in an interview that winter is a season conducive to the spread of respiratory infectious diseases, and that social activities such as weddings and funerals in the affected areas of Hebei are very intensive, which has aggravated the spread of the epidemic.

  According to the information released, Xiaoguozhuang Village and surrounding villages held a number of wedding banquets at the end of last year and early this year. Currently, nearly one-fifth of the confirmed cases have participated. Among them, a 44-year-old female confirmed case attended 4 days. In addition, many villagers lack protection awareness and take it lightly, which has accelerated the spread of the epidemic.

A villager in Xiaoguozhuang village recalled in an interview with the media that at the end of December last year, when he attended a wedding banquet for a relative, he saw that almost no one was wearing a mask.

  Village clinics and clinics are the places where many confirmed cases in Zengcun Town have symptoms such as fever and fatigue after inquiring, prescribing medicine and infusion.

During the 2020 new crown pneumonia epidemic, pharmacies in many places across the country suspended the sale of antipyretics and cough medicines. Clinics forbid the admission of fever patients and require patients with fever and cough symptoms to go to the hospital for treatment.

However, as the epidemic prevention and control situation in most parts of the country has stabilized, people have gradually relaxed their vigilance. When symptoms such as fever and cough appear, they have chosen to "buy some medicine" and "carry a burden."

  In fact, in this wave of epidemics, village clinics, clinics and other grassroots medical institutions did not play the role of "probes" in detecting infected persons.

A 52-year-old male in Liujiazuo Village has a confirmed case. He has had fever symptoms since December 26, 2020. He went to a clinic in Xiaoguozhuang Village on the 27th, 29th, and 30th, but went to Xinxin on the afternoon of January 2nd. After Le City People's Hospital went to the hospital for a nucleic acid test, the result was found to be positive.

From the onset of symptoms to the final nucleic acid test, the time span is more than one week.

  Feng Zijian said in an interview that at present, the number of patients is still increasing, indicating that the virus has been spreading in secret for some time.

Judging from the trajectory of the action, the virus has spread in this village. Many confirmed cases had only been active in Xiaoguozhuang Village for the previous half month, and did not go out.

  With insufficient protection awareness and weak resistance, the elderly in the village have become targets of the virus.

According to Wu Hao, an expert of the National Health Commission’s Disease Prevention and Control Advisory Committee and director of the Beijing Fangzhuang Community Health Service Center, rural medical conditions are relatively poor, and there are many elderly and children among the residents, and their personal protection awareness and health knowledge are relatively good. Weak, more vulnerable to virus "threat."

The large floating population, vast area and poor villagers’ awareness of epidemic prevention make it difficult to prevent epidemics in rural areas

  Currently, there are about 600 million people living in rural areas in my country.

Compared with urban communities, the large number of floating population in rural areas, inconvenient transportation and wide geographical area, weak awareness of prevention and control of the resident population, weaker ability to receive information, and low levels of human and material resources for prevention and control are important factors that make epidemic prevention more difficult.

  However, due to the importance of prevention and control work in various places, the new crown pneumonia epidemic did not eventually break out in large-scale rural areas.

Based on this, people once believed that due to the low population density and good air environment in rural areas, the risk of virus transmission in rural areas is less than that in cities.

  "The severe situation of Hebei's epidemic prevention and control has broken this expectation." said Liang Jialin, executive director of the China Value Medical Research Center.

  From the risk of spreading the virus in rural areas less than in cities to rural areas becoming a weak point of epidemic prevention, what work has been done in rural epidemic prevention, and what loopholes have appeared?

  "Early detection, early reporting, early isolation, and early treatment are very important strategic measures to deal with infectious diseases, especially acute infectious diseases." In reviewing the Wuhan epidemic and the subsequent waves, the Chinese Center for Disease Control and Prevention Epidemic Chief expert Wu Zunyou summarized a series of effective strategies, the most important of which is the "four mornings".

  In the early stage of the new crown pneumonia outbreak, my country's nucleic acid testing capabilities were insufficient, and rural areas, in particular, could not meet the needs of clinical diagnosis.

Therefore, the rural epidemic prevention and control at that time mainly adopted two physical isolation technologies: road control and population control.

  "In the early days of the epidemic, the spontaneous'hard-core' prevention and control models of'blocking villages and blocking roads' in some rural areas spread widely." Lu Dewen, a researcher at the China Rural Governance Research Center of Wuhan University, believes that with the further development of the epidemic, The level of traffic control has been generally improved, and "Bayonet" has been widely used.

It is through the physical device of the "bayonet" that different types and levels of governance forces such as township cadres, village cadres, health personnel, and police officers can be reassembled; each "bayonet" through the communication lines builds a mechanism for the prevention and control of rural epidemics. The capillaries have compiled an epidemic prevention and control network that "strictly guard against the dead."

  On the other hand, it is the management and control of personnel, including strict control of infected persons, suspected infections, fevers that cannot be ruled out, and close contacts, and monitoring and control of persons who have been to and from the affected areas during the outbreak. , Implement management and control of all personnel, advocate no going out, no gatherings, and strict restrictions on personnel going out in combination with closed management measures where conditions permit.

Lu Dewen said that in the actual operation process, the rural areas are mainly to check the floating population from the epidemic area or the local people who have been to the epidemic area during the epidemic. In most areas, full coverage of the population has been achieved.

  It is through in-depth social mobilization that road control and population control have been implemented to achieve "early detection, early reporting, and early isolation" in the early stages of the outbreak, and many rural areas have accomplished their prevention and control tasks well.

After a long period of "clearing" and having nothing to do with each other, as epidemic prevention and control become normal today, some places will inevitably appear paralyzed, making "early detection, early reporting, and early isolation" delayed.

  The Hebei epidemic has sounded the alarm.

"We believe that the risk of virus transmission in cities is high and the countryside is neglected." Wu Hao said that delay means that when the virus is discovered to spread in rural areas, the second or third generation may have begun, so early detection is still the top priority.

"We must warn the whole society that the virus is by our side anytime and anywhere, and we must do a good job of self-protection and self-monitoring, and rural areas are no exception."

  Gathering activities aggravated the spread of the epidemic, the villagers' health awareness was low, and the grassroots "health gatekeepers" were lost, causing the virus to spread secretly

  "The abnormal Hebei epidemic has exposed the rural "shortcomings" of epidemic prevention and control."

Li Xiaoyun, a professor at China Agricultural University, thinks.

  On the afternoon of January 11, the Beijing Municipal Government Information Office held a press conference on epidemic prevention and control to report on the epidemic situation. A family of 7 in Lianzhuang Village, Zhaoquanying Town, Shunyi District, was diagnosed with new coronavirus infections.

Beijing officials pointed out that the new cluster of cases in rural households means that there are weak links in the management of epidemic prevention for the floating population in the urban-rural fringe.

  During the epidemic, we must resolutely prevent clustering risks.

"There is currently no evidence that the source of the epidemic is directly related to religious gatherings. However, before the outbreak, some religious people had gathered in a household in the village. Like other gatherings, it is likely to cause the epidemic to spread." A few days ago, Shijiazhuang In an interview with the media, Li Zhanzhu, director of the Municipal Bureau of Ethnic and Religious Affairs, said that after the outbreak, the locality immediately temporarily closed all religious venues.

The prevention and control of the epidemic in the religious field in Beijing has also been comprehensively upgraded. All 155 religious venues have been closed to the outside world and collective religious activities have been suspended.

  The low health awareness of villagers is one of the weak points of epidemic prevention in rural areas.

According to monitoring data from the National Health Commission, the health literacy level of urban residents nationwide in 2019 was 24.81%, and the level of rural residents was only 15.67%. The health literacy levels of rural residents, residents in central and western regions, and the elderly are still relatively low.

  "This round of'super spreaders' in rural Hebei are'elderly people in underdeveloped rural areas' with the above characteristics." Liang Jialin said that compared with common chronic diseases such as high blood pressure and diabetes, the symptoms of new coronary pneumonia infection are more complicated, and some people suffer from it. Rural residents who are not well-educated in implementing the new coronary pneumonia diagnosis and treatment regulations have brought huge challenges.

According to the reported epidemiological investigation information, many confirmed cases chose to “take their own medicine” and “see a doctor” when they were unable to determine whether they had contracted new coronary pneumonia, which not only delayed their treatment process, but also increased the risk of cross-infection.

  The villagers relaxed their vigilance, and the grassroots "health gatekeepers" also fell behind.

"According to the latest report, the zero case of the Hebei epidemic was earlier than December 15, 2020. From the first confirmed case on January 2, 2021, it has not been detected for more than half a month." Tianjin TEDA Professor Li Qing from the hospital said, “A number of confirmed cases go to village clinics and pharmacies to purchase medicines on their own. If these medical centers can do nucleic acid testing, it may not take so long to be discovered.”

  In this regard, Wu Hao said that the sentinel role of grassroots township hospitals, village clinics, and individual clinics should be played, monitoring and investigation functions should be played, problems should be reported in time, and the people should be told to seek medical treatment in time.

"The National Health Commission issued a document last year to build fever clinics and fever sentinels in towns and community health service centers, and to mark the people and play an early warning role."

  Wu Hao believes that during the epidemic, there were problems in which patients went to pharmacies to purchase drugs on their own, prompting the need to strengthen the supervision of clinics and pharmacies, and do a good job in information sharing to play an early warning and monitoring role.

Many provinces have made every effort to arrange the prevention and control of the Spring Festival epidemic to ensure that the epidemic does not spread due to the Spring Festival.

  The Spring Festival is approaching again.

In Li Xiaoyun’s view, although the rural population is scattered, once the people who go out return to their hometown, coupled with the Chinese New Year etiquette to visit relatives and friends, participate in wedding banquets, entertains, etc., the degree of flow and gathering is often better than that of the city, and the acceleration caused by group gathering The propagation effect can easily offset the isolation propagation effect brought about by the scattered residence.

  In the past year, since the local epidemic has been basically brought under control, people's mentality will inevitably change and even relax their vigilance.

However, the initiation of the Spring Festival transportation means the flow of returning from the city to the hometown. Once a virus transmission pattern similar to Hebei occurs during the Spring Festival, limited by the level of rural medical care, it will likely bring both rural and urban epidemic prevention and control after the holiday. pressure.

  A few days ago, the Beijing Municipal Center for Disease Control and Prevention issued guidelines for epidemic prevention and control in rural areas.

The guidelines require that the migrant population should also be included in the scope of personnel control in the jurisdiction, and migrants in towns and villages will all do "health treasure" inspection and scan code registration.

Gathering activities in the village should be strictly controlled, and activities such as large gatherings in rural areas that easily cause gatherings of people should be held under strict implementation of prevention and control measures.

  In the face of the severe and complicated winter epidemic prevention and control situation, in order to reduce the large-scale movement of personnel during the Spring Festival, on January 10, the State Council’s joint prevention and control mechanism established a special class for the Spring Festival travel, requiring the reduction of unnecessary travel and ensuring that the epidemic does not spread due to the Spring Festival. Guide the off-peak travel.

The transportation department shall actively cooperate with relevant departments to do a good job in peak-shifting holidays, peak-avoidance school opening, and limited appointments in scenic spots for peak-shift reception.

  Recently, Beijing, Shanghai, Ningxia, Shandong, Henan, Anhui, Hubei and other places have successively issued the "non-essential non-return home during the Spring Festival" initiative to encourage enterprises and institutions to arrange flexible vacations and meet the conditions for local Chinese New Year.

  "This year's Spring Festival, I hope everyone will stick to the original strategy of fighting the epidemic together and face up to the risks. Avoidable gatherings should be minimized, and gatherings with too many people should not be held." Zhang Wenhong, director of the Department of Infectious Diseases, Huashan Hospital affiliated to Fudan University, said in an interview.

  Person-to-person, person-to-person, person-to-person transmission, from auto parts with positive nucleic acid tests, to cold chains with frequent thunderstorms, and this time when it broke out in rural areas, the new crown virus seems to be pervasive.

Although the epidemic has occurred for more than a year, humans’ understanding of the new coronavirus is still limited, and the awareness of epidemic prevention cannot tolerate carelessness.

(Our reporter Li Yunshu, Huang Hui, Chai Yaxin)