On March 15, the National Health Commission issued the Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial Version 9) (hereinafter referred to as the Plan). For the first time, the plan makes major adjustments to the mainland's epidemic prevention policy.
The revisions to the Plan mainly include:
1. Mild cases are subject to centralized isolation management and are no longer admitted to designated hospitals to avoid causing a shortage of beds in medical institutions.
2. The isolation management and discharge criteria are revised, and the ct value of nucleic acid test is changed from negative nucleic acid test to ≥35.
3. 14 days of isolation after discharge is changed to 7 days of home health testing.
4. When the Ct value of nucleic acid detection is greater than 35, it is not counted as positive for nucleic acid.
Two of them are of concern: 1. Nucleic acid Ct values greater than 35 are no longer counted as positive; 2. Mild patients do not need to be hospitalized.
What is the Nucleic Acid Ct value?
Nucleic acid detection "Ct value": The Ct value is the threshold cycle number (Thresholdcycle), also known as the Cq value, the number of PCR cycles when the fluorescence signal is greater than the fluorescence threshold.
Simply put, the Ct value represents the amount of virus in the human body. The criterion for judging whether the new crown nucleic acid test is negative or positive depends on the size of the Ct value.
The larger the value of ct value, the less viral content means that the less infectivity is, and the smaller the value of Ct value, the greater the virus content, the stronger the infectivity.
That is to say, the value of Ct value is inversely proportional to the virus content and infectivity. The higher the CT value, the safer it is.
The standard for nucleic acid detection of the new crown virus that the mainland has been using: the Ct value is > 40, and the nucleic acid is negative; the Ct value is reduced from 40 to 35 in the "Plan" of the Ct value this time. That is, the Ct value > 35, the nucleic acid test is negative, and it is no longer a confirmed case.
Seeing this, I believe everyone also understands: the standard of positive nucleic acid test has been lowered.
Zhang Wenhong interpretation
Regarding the "Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial Version 9)", Zhang Wenhong said that this is the most scientific and reasonable version of the diagnosis and treatment plan released by the mainland so far.
From the first edition to the ninth edition, from not knowing anything about the new crown virus, the earliest diagnosis and treatment protocols were based on medical experience. As more and more scientific evidence increases, eventually, the diagnosis and treatment plan must be based entirely on science to develop a most reasonable plan.
According to an interview with People's Daily and CCTV News, Zhang Wenhong, director of the National Center for Infectious Disease Medicine, interpreted the Plan as follows:
1. What is the most important adjustment of the Plan?
Zhang Wenhong: The clearer the understanding of this disease, the more precise our prevention and control principles will become. 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.
2. Why is the "Plan" adjusted to implement centralized isolation management for mild cases, and no longer emphasize centralized isolation and treatment in designated hospitals?
Zhang Wenhong: In the future, the focus on mild cases will be mainly focused on centralized isolation, and the need to receive designated hospitals will no longer be emphasized, because the proportion of patients with mild diseases progressing to severe disease is 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.
3. What does it mean that the Plan will lift the isolation management and the revision of the discharge standards?
The Plan modifies the management and discharge criteria for the release of isolation to "two consecutive nucleic acid detection N gene and ORF gene Ct values of the novel coronavirus ≥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, and the sampling time interval is at least 24 hours)".
Zhang Wenhong: International studies have found that after the nucleic acid is low to a certain level, the virus with transmission can no longer be detected, 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.
A professional in the field of nucleic acid testing interviewed by CBN explained as follows:
"Previously, ct values between 0 and 40 were considered positive, but the research data showed that when the Ct value is greater than 35, the close contacts will not be infected, so this part of the 'infected people' do not have the ability to spread, and then isolate them, which will involve more people and isolation resources."
The professional also said: Relevant domestic studies have shown that when the nucleic acid Ct value of the recovering infected person ≥ 35, the virus could not be isolated from the sample, and the close contacts were not found to be infected.
What the professional means is that a Ct value is greater than 35, there is no virus in the sample, and the close contacts will not be infected.
What does it mean to go from 40 to 35? In the latest version of the "Scheme", the Ct value is greater than or equal to 35, and the test result is negative and can be released from isolation.
4. If the isolation period is shortened, is there a risk of recurrence and secondary transmission?
1
The Plan amends "14 days of isolation management and health monitoring after discharge" to "7 days of home health monitoring after discharge from isolation management".
Zhang Wenhong: Based on the change of diagnostic criteria, the probability of returning to Yang after shortening the isolation period will be very low. According to our research, even if the fuyang is restored, the nucleic acid level is already very low, and there is basically no secondary transmission caused by the fuyang.
Zhang Wenhong said at the press conference that "the lower the nucleic acid CT value, the better" is not scientific, after the nucleic acid level is low to a certain level, the discharge is no longer contagious, the risk is low enough, that is safe. This discharge criterion has been adjusted significantly from before, meaning that the length of hospital stay will be shortened (the average length of hospital stay for COVID-19 patients in Shanghai is now 15 days, and the nucleic acid adjustment may be reduced to 10 days). You can be discharged early, which feels very different for a person who is isolated and a family who is isolated. At the same time, this 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.
5. Why does the Plan not mention "asymptomatic infected persons"?
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".
6. About stratified treatment and stratified treatment
In the latest diagnosis and treatment plan, the focus of medical institutions is on hierarchical treatment and stratified treatment. Zhang Wenhong said that patients should be stratified according to mild, severe and high-risk factors, light and ordinary, and mild and ordinary patients will be stratified, and mild patients and asymptomatic people will be isolated at designated isolation points with medical conditions for observation, leaving more medical resources to treat seriously ill patients.
"Through the formulation of these major standards, it will make room for our future fight against the epidemic." The hierarchical management method will promote the optimal use of medical resources and improve the redundancy of medical resources, and we will have a certainty in the future fight against the epidemic. ”
7. Three kinds of "weapons" for fighting the epidemic
Zhang Wenhong believes that in the face of the epidemic, people will hold three kinds of "weapons" in their hands in the future, the first is the full injection of vaccines; the second is the strong support of antiviral drugs and other drugs, including traditional Chinese medicine; and the third is a very sufficient degree of medical redundancy. These will be more beneficial to the future war epidemic.
Source: Voice of Europe and America, Lilac Garden, CCTV News
Edited by: Yeah Reviewer: Xiao Ran