The admission standards for new crown patients have been greatly adjusted, and classified admission and treatment have been implemented to liberate the medical resources of designated hospitals

The "Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial Version 9)" (hereinafter referred to as the "Plan") was released last night. For the first time, it was proposed that mild cases should not be admitted to designated hospitals for treatment, but only need to implement centralized isolation management.

Jiang Rongmeng, vice president of Beijing Ditan Hospital and an expert on infectious diseases, said that with the decline in the pathogenicity of mutant strains, the proportion of asymptomatic and mild patients in the new local epidemic has increased, and these patients do not need hospitalization, and classified admission can liberate the medical resources of designated hospitals.

The threshold for admission to the hospital has been raised and the threshold for discharge has been lowered. According to the new plan, patients no longer need isolation management after discharge, and can return to daily work and life faster.

However, the adjustment of the admission and treatment strategy has also put forward new requirements for the construction of isolation points and the allocation of medical personnel. Experts said that the landing of the plan will not be achieved overnight, and all localities should promote it according to local conditions.

Focus 1

What has changed the protocol? Why change it?

Last night, the latest version of the new crown pneumonia diagnosis and treatment plan was announced.

Compared with the eighth edition, the new Plan has been revised in five aspects, including optimizing case detection and reporting procedures, proposing case classification and treatment, standardizing antiviral treatment, and adjusting discharge criteria.

Of particular concern is the adjustment of the criteria for admission and admission of cases: all cases are no longer required to be admitted to designated hospitals, and the discharge threshold and post-discharge isolation management requirements have also been reduced.

"Mild cases are subject to centralized isolation management, and ordinary, severe, critical cases and cases with severe high-risk factors should be treated in designated hospitals" This is a specific expression of the new plan's criteria for the admission and treatment of cases, and in the eighth version of the diagnosis and treatment plan, all confirmed cases must be admitted to the designated hospital.

The National Health Commission said that the "Plan" was formed on the basis of careful study of the transmission characteristics and case characteristics of mutated strains such as Delta and Omicron, and in-depth analysis of relevant research results.

"The invasion of the lower respiratory tract by Aumechon has decreased, and the virulence has weakened. We have also seen a decline in severe illness rates and an increasing number of mild patients in recent local outbreaks. There is no need for this part of the patient to be treated in a designated hospital, and classified admission can liberate medical resources. Jiang Rongmeng, vice president of Beijing Ditan Hospital affiliated to Capital Medical University and chief physician of infectious diseases, introduced.

At yesterday's joint prevention and control press conference of the State Council, Jiao Yahui, director of the Medical Administration Bureau of the National Health commission, said that in this round of epidemics, a total of 8201 cases were in the hospital in Jilin Province as of the morning of March 15, of which the cases were mainly concentrated in Jilin and Changchun, and there were only 6 severe and critically ill patients in total, accounting for about 4% of the ordinary type, and more than 95% of the patients were asymptomatic infected and mild cases.

The Plan points out that those who have been vaccinated and infected with the Omiljung variant are mainly asymptomatic and mild.

Some experts also believe that the "Plan" takes into account the characteristics and forms of new virus transmission, scientific hierarchical management, can be more targeted for the treatment of severe diseases, to avoid the medical system in individual areas due to the rapid increase in infected people and overwhelmed, and even the phenomenon of medical run.

Lei Zhenglong, deputy director of the Disease Control Bureau of the National Health and Health Commission, said on the 15th that from March 1 to 14, the cumulative number of reported infected people in the local epidemic has exceeded 15,000, affecting 28 provinces. At present, the local cluster epidemic situation shows the characteristics of many points, wide coverage and frequent occurrence, and the situation of epidemic prevention and control in the mainland is severe and complex, and the difficulty of epidemic prevention and control has increased.

Focus 2

How can a confirmed patient be judged to be mild?

Mild and severe are placed in different places, but who will determine the severity of the disease? After the news was released, many netizens raised questions about the specific judgment and execution.

The reporter learned that after the nucleic acid is positive, the new crown infected person will undergo a series of medical examinations such as lung CT, and the classification will be determined by clinical experts. The diagnosis and treatment plan has specific criteria for case classification.

Among them, the mild type is "mild clinical symptoms, imaging does not see pneumonia manifestations", ordinary type has clinical manifestations at the same time, imaging can see pneumonia manifestations; severe to appear resting air intake refers to oxygen saturation ≤ 93% and other manifestations; critical cases will appear respiratory failure, shock and other conditions.

Jiang Rongmeng introduced that in the division of light and ordinary and more severe, it is mainly based on whether pneumonia occurs. Mild patients may present with low-grade fever, mild fatigue, olfactory and taste disturbances, and no pneumonia. There may also be no obvious clinical symptoms after infection with the novel coronavirus. Patients with clinical symptoms mainly present with symptoms of upper respiratory tract infections such as moderate and low fever, dry throat, sore throat, nasal congestion, and runny nose.

Focus 3

How to solve the problem of non-hospitalization for mild patients?

Netizens are also concerned about the question that when mild patients do not enter the hospital, does it mean that treatment and isolation management are not given to this part of the patients?

Jiang Rongmeng said that mild patients can no longer be sent to designated hospitals, which does not mean that they are left alone, and light patients still have to be centrally isolated and managed in centralized isolation places.

According to the plan, for mild patients, symptomatic treatment and disease monitoring should be done during isolation and management, and if the condition is aggravated, they should be transferred to a designated hospital for treatment. Therefore, the isolation point will also be equipped with a certain proportion of medical personnel to provide the necessary medical services. It is also necessary to meet the criteria for decommissioning before it can be released.

Focus 4

The local epidemic is still developing When will the new plan be implemented?

Jiang Rongmeng said that the isolation point for receiving mild patients also needs to meet a series of regulations. For example, centralized isolation places should meet the requirements of hospital infection prevention and control, and "three districts and two passages" should be set up to avoid staff infection; other groups such as inbound personnel and close contacts cannot be isolated at the same time; and medical waste generated should be professionally treated.

Therefore, all localities need to make full preparations for the construction of isolation points, personnel allocation, management systems and other aspects. The implementation of the new plan will not be achieved overnight, and all localities should promote it according to local conditions.

Focus 5

How to adjust the threshold for discharge?

At the same time as the admission criteria are adjusted, the discharge criteria are also further lowered.

The new version of the diagnosis and treatment plan modifies the "negative nucleic acid test of two consecutive respiratory specimens (sampling time interval of at least 24 hours)" in the criteria for dissociation management and discharge to "two consecutive nucleic acid detection N gene and ORF gene Ct values are ≥35 (fluorescence quantitative PCR method, the limit value is 40, the sampling time interval is at least 24 hours), or two consecutive negative nucleic acid tests for the new coronavirus (fluorescence quantitative PCR method, the limit value is less than 35, the sampling interval is at least 24 hours) ”。 Revise "Continue 14 days of isolation management and health monitoring after discharge" to "release from isolation management or continue home health monitoring after discharge".

Jiang Rongmeng introduced that this revision means that new crown patients can shorten the hospitalization time, discharge faster, and further reduce the occupation of medical resources. After the patient is discharged from the hospital, home health monitoring can be done, and there is no need for centralized isolation and management, and it can return to normal working life faster.

Reporter | Dai Xuan

Edit | Liu Xixian Proofreading | Chen Diyan