Zhang Wenhong interprets the latest "Diagnosis and Treatment Plan": Coping with the epidemic is more relaxed

According to people's daily news, on the night of March 15, the National Health Commission issued the "Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial Ninth Edition)" (hereinafter referred to as the "Plan"), which aroused widespread public concern. In order to respond to social concerns, Dajiangdong Studio exclusively interviewed Zhang Wenhong, director of the National Infectious Disease Medical Center and head of the Shanghai Municipal Covid-19 Medical Treatment Expert Group.

Reporter: From the perspective of treatment experts, what is the most important adjustment of the "Plan"? At a time when the number of new coronavirus infections in China is surging, what impact will the release of the "Plan" have on the prevention and control of the epidemic?

Zhang Wenhong: Based on the current deepening of scientific understanding of the new crown virus disease, the Plan has made major adjustments in many aspects, advocating the redundancy of medical resources through optimizing the diagnosis and treatment plan, and reducing the negative impact of isolation on normal life by shortening the isolation period. Including adjusting the nucleic acid testing criteria for discharge, implementing classified admission of cases, and directly isolating at home after discharge, and shortening the time to 7 days. The clearer the understanding of this disease, the more precise our prevention and control principles will be. The change of standards has greatly reduced the isolation time of infected people, which not only allows infected people to return to normal life as soon as possible, but also avoids the waste or even run of medical resources.

Reporter: The "Plan" mentions that the implementation of centralized isolation management for mild cases and no emphasis on centralized isolation and treatment in designated hospitals is related to the trend of the new crown virus mutation? At present, what treatment is usually carried out for patients with mild diseases at the Shanghai Public Health Center? What is the basis for no centralized treatment in the future, and is there a risk of being delayed and isolated from each other?

Zhang Wenhong: For the management of mild patients, the "Plan" further simplifies treatment, focusing on the observation of the disease. With the epidemic of Omikejong becoming the current mainstream infection strain, the patients of the Omiljung mutant strain are mainly asymptomatic infected and mild cases, and the clinically specific treatment needs are significantly reduced, and more as long as symptomatic treatment and disease observation are given. Therefore, at isolation points with certain medical conditions, the isolation and basic medical needs of infected people can be completed. At the same time, a large number of medical resources of designated hospitals can be released. Our Shanghai Public Health Center treats patients with mild diseases mainly with symptomatic supportive treatment, while closely monitoring the disease.

In the future, the focus on mild cases will be mainly focused on centralized isolation, and the emphasis on receiving designated hospitals is because the proportion of patients with mild diseases progressing to severe disease is now very low. However, for some people who may have disease progression, such as advanced age and underlying disease, the new crown centralized isolation point will still be equipped with professional medical resources to provide medical observation, risk assessment and treatment of pre-existing underlying diseases. As soon as there is a risk of progression, it can be transferred to a designated hospital immediately.

Reporter: The "Plan" will revise the release isolation management and discharge criteria to "two consecutive nucleic acid detection N gene and ORF gene Ct values are ≥35 (fluorescence quantitative PCR method, the limit value is 40, 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, and the sampling time interval is at least 24 hours)". Can you tell us about the change in the new discharge criteria compared to the previous negative nucleic acid test twice every 24 hours?

Zhang Wenhong: The change of this standard has established earlier and more accurate safe discharge standards, and strives for patients to get out of isolation earlier and faster. Our understanding of Aumechjong is also gradually deepening. International studies have found that after careful verification by Chinese experts, after the nucleic acid is low to a certain level, it has not been detected to have a transmissible virus, so it is almost impossible to be contagious. Therefore, our nucleic acid positive criteria, from the stricter evaluation criteria, have now begun to synchronize with the international standard, and the standard length of hospital stay has been reduced. More patients can be discharged early, which greatly relieves the pressure on our medical resources. This change is therefore of important positive significance.

Reporter: The "Plan" modifies "continue to isolate management and health monitoring for 14 days after discharge" to "lift isolation management or continue home health monitoring for 7 days after discharge". Is there an adjustment to cope with the high number of infected patients due to the reduction in the stricter management of discharged patients due to the limitation of medical resources? In the past two years, especially in the recent shanghai, how has the post-discharge management of the new crown pneumonia cases been? The isolation period is shortened, is there a risk of recurrence and secondary transmission?

Zhang Wenhong: The standard of home health monitoring for 7 days after discharge, as explained earlier, is based on medical evidence, which not only allows infected people to return to normal life as soon as possible, reduces the economic burden during the isolation period, but also saves the corresponding isolation housing and other social resources, so that the ability of the whole society to cope with the epidemic is further improved, and it does not cause a run on isolation resources. Based on the change of diagnostic criteria, the probability of re-yang after shortening the isolation period will be very low; according to our research, even if the re-yang is restored, the nucleic acid level is already very low, and there is basically no secondary transmission caused by the re-yang.

Reporter: Why does the "Plan" not mention "asymptomatic infected people"? Do the current large numbers of asymptomatic infected people do not need treatment?

Zhang Wenhong: The infectivity of asymptomatic infected people is not low, and there may still be disease progression, which needs to be observed in centralized isolation.

The diagnosis and treatment plan is for cases, and the asymptomatic infected person is not introduced in the "Diagnosis and Treatment Plan" in terms of management, but will be specified in the "Novel Coronavirus Pneumonia Prevention and Control Plan". For asymptomatic infected people, it is similar to very mild cases in terms of contagiousness and risk of disease progression. Therefore, it is equivalent to treating asymptomatic as a clinical mild case of management. The ninth edition of the "Plan" recommends that mild cases be centralized isolation management, and during the isolation management period, symptomatic treatment and disease monitoring should be done, and if the condition is aggravated, it should be transferred to a designated hospital for treatment. There are no clear provisions on the centralized isolation management sites for mild cases, which can be medical institutions or isolation places, such as square cabin hospitals, isolation hotels, etc. Centralized isolation management still requires medical staff to give necessary symptomatic treatment, such as fever, sore throat, cough and other symptoms. For the infection of isolation management, it is more important to monitor the condition, mild and asymptomatic may be the early stage of the disease, once found to have a trend of aggravation, it is necessary to refer to the designated hospital in time. Considering that asymptomatic infected people and mildly ill patients are still infectious, and at the same time, they need medical observation, risk assessment and treatment of other underlying diseases, if the medical institutions in the provinces and cities still have bed resources, they can still be admitted to medical institutions for isolation treatment.

Reporter: In the past two days, Shanghai is implementing large-scale block-type, grid management, and nucleic acid testing in stages, and many citizens feel that it is inconvenient to travel. What is the significance of this grid management strategy for the prevention and control of the epidemic in Shanghai?

Zhang Wenhong: The challenges facing the epidemic in Shanghai are the highest since the fight against the epidemic. Shanghai's anti-epidemic strategy is based on accurate judgment of the impact of the epidemic and taking corresponding emergency response. If it is only an individual case, the transmission chain is clear, as long as the starting point and the line of accurate prevention and control, isolation of a small number of people, do a limited range of testing can be done. If there are new cases in multi-site communities and some of the sources are unclear, the epidemic prevention and control will expand from points and lines to the surface, there will be screening in key high-risk areas, and at the same time, step-by-step and phased nucleic acid testing will be achieved for areas with slightly lower risk. If the epidemic continues, the prevention and control strategy may be adjusted accordingly.

At present, in order to achieve the goal of zero social coverage as soon as possible, the scope of screening has been expanded in prevention and control, and more communities and people will definitely be affected. However, without extended screening, the epidemic will certainly be difficult to control, and the final result may be out of control. Therefore, at this stage, there will certainly be more individuals, families and communities who will feel inconvenienced by this, and normal life will be greatly affected. At the beginning of the expanded screening, it may be a bit hectic, but I still believe that there will be more improvements in management of how to arrange the grid and cascade screening arrangements in the next stage, so that the public feels predictable and warmer. I think that the arrival of the epidemic is difficult to predict, the measures to eliminate the epidemic should be predictable, I believe that Shanghai will better carry forward the concept of accurate anti-epidemic, so that citizens can also feel the temperature of Shanghai when cooperating with the fight against the epidemic and sacrificing normal life.

Edited by Xin Jing