On March 20, medical staff at the Third People's Hospital of Huai'an City, Jiangsu Province, tested nucleic acid samples in a PCR laboratory. Photo by Zhao Qirui
On March 17, the new crown antigen detection kit was sold on the shelves of the Tianjin People's Pharmacy, and the public purchased the kit and the sales staff introduced the use method. Photo by Zhou Wei
On March 20, students line up at Yantai Institute of Technology in Shandong Province for nucleic acid testing. Photo by Tang Ke (People's Vision)
The picture shows Wang Tan, a professor at the Affiliated Hospital of Changchun University of Traditional Chinese Medicine, taking the pulse of patients with mild COVID-19 at Changchun Tongyuan Fanggang Hospital on March 18. Xinhua News Agency
The picture shows workers of Shandong Kangli Medical Device Technology Co., Ltd. producing medical protective clothing in a strictly disinfectant environment on March 19. Photo by Sun Zhongzhe (People's Vision)
Pictured on March 15, in the Shanwan Garden Community of Tangwang Street, Guangling District, Yangzhou City, Jiangsu Province, party member volunteers help the elderly use smart phones to buy self-test kits for new crown antigens. Photo by Meng Delong (People's Vision)
Recently, China's local cluster epidemic situation has shown the characteristics of many points, wide coverage and frequent occurrence, and the prevention and control situation is severe and complex. What are the changes in China's response to this? How will the battle against the epidemic be fought next? The "Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia (Trial Version 9)" was recently announced, providing guidance for further improving the level of scientific and accurate prevention and control.
Increase antigen detection
Case detection is more timely
The new version of the "Diagnosis and Treatment Plan" proposes to add antigen detection as a supplement on the basis of nucleic acid detection to further improve the early detection capacity of cases.
"Antigen testing is characterized by its rapid and easy." Li Jinming, deputy director of the Clinical Laboratory Center of the National Health and Health Commission, introduced that the applicable groups for antigen testing include three categories: one is to go to primary medical and health institutions for treatment, accompanied by respiratory tract, fever and other symptoms and symptoms within 5 days; second, isolation and observation personnel, including home isolation observation, close contact and sub-close connection, entry isolation observation, sealing and control area and control area of personnel; third, community residents with antigen self-testing needs.
Jiao Yahui, director of the Medical Administration Bureau of the National Health and Health Commission, introduced that antigen detection, as an important means of screening, is an important supplement to nucleic acid testing, giving full play to the two advantages of antigen detection "early" and "fast", and can screen out possible infected people as soon as possible.
"Antigen testing should be used in high-risk, high-prevalence cluster infections, and the general population should not do antigen testing at will." Li Jinming said that nucleic acid testing is the "gold standard" for judging new crown infection, antigen detection as a supplementary means can not replace nucleic acid detection, when the antigen test is positive, we must take nucleic acid testing as confirmation.
"Remind residents who do home antigen testing, the most important point is that if the antigen test is positive, all used swabs, test tubes, and test cards must be packed in sealed plastic bags, and the staff must take this away to the medical institution when they come to the door, and dispose of it according to medical waste." Jiao Yahui reminded that residents do not need to file for the purchase of self-test antigen test products, once the self-test is found positive, it is necessary to report to the community in the territory in time, the community should arrange a special vehicle to transfer it to a medical institution with nucleic acid detection capacity for further confirmation, the entire processing should be closed-loop, if the nucleic acid test is positive, enter the management process of the infected person.
Implement classified admission
Epidemic prevention and control is more accurate
The new version of the "Diagnosis and Treatment Plan" makes it clear that cases are classified and treated: mild cases are subject to centralized isolation management, and ordinary, severe, critical cases and cases with severe high-risk factors should be treated centrally in designated hospitals.
Why implement classified admission? Li Xingwang, chief expert of the Infectious Disease Diagnosis and Treatment and Research Center of Beijing Ditan Hospital, said that at present, the Aomi Kerong variant strain has become the main epidemic strain, resulting in a large number of infected people in a short period of time. However, clinically, the symptoms of these infected people are relatively mild, more than 90% of the patients are mild, just some symptoms of upper respiratory tract infections, these patients do not need to be hospitalized.
"In the face of infected people who do not need to be hospitalized but are contagious, concentrating them in the hospital will cause a waste of medical resources, and the large number of infected people will cause a run on medical resources, so it is necessary to establish isolation points, concentrate them in isolation points for isolation, and be managed by medical personnel." Li Xingwang said that this is not only conducive to the health recovery of patients, but also conducive to the control of disease transmission.
"Centralized management is mainly to give mild cases a certain symptomatic treatment, because mild cases still have certain symptoms such as fever, cough, nasal congestion, etc., so medical staff should give corresponding symptomatic treatment such as integrated traditional Chinese and Western medicine." In addition, it is also necessary to observe the condition, if the condition of these asymptomatic infected people and mild cases changes, especially if there is an aggravating trend, it is necessary to refer them to the designated hospital for further treatment in time. Jiao Yahui said.
"We found that mild patients get better very quickly. As long as isolation and intervention are done, such patients can not occupy medical beds, so why not do this? Wu Hao, dean of the College of General Medicine and Continuing Education of Capital Medical University, said that this is not the so-called "lying flat", but more scientific, more accurate and more resource-saving.
Adjust discharge criteria
Resource allocation is more rational
The new version of the "Diagnosis and Treatment Plan" adjusts the Ct value of nucleic acid detection in the lifting of isolation management and discharge standards from the past 40 to 35 of the international standard, which has aroused widespread concern.
"The reason for this adjustment is based on practical research." Jiao Yahui said that the study proved that when the patient in the recovery phase ≥ 35 with a nucleic acid Ct value, the live virus could not be isolated from the sample, which meant that some patients were no longer infectious and could be discharged home. In addition, based on the domestic research on Fuyang patients, the circulation data shows that Fuyang patients have not caused the spread and infection of the epidemic again. Therefore, patients can be discharged after the nucleic acid Ct value reaches 35.
"This change in standard means that we will save a lot of medical resources and reduce the pressure on community prevention and control." Wu Hao said that this is conducive to the rational allocation of medical resources, and there will be more adequate medical resources to provide medical security and medical services for the masses.
"The new version of the "Diagnosis and Treatment Plan" lowered the Ct value for lifting isolation and discharge to 35, which is still the most stringent measure standard in the world." Jiang Rongmeng, a member of the National Expert Group for Novel Coronavirus Pneumonia who participated in the revision of the diagnosis and treatment plan and vice president of Beijing Ditan Hospital affiliated to Capital Medical University, said that when adjusting the prevention and control policy, the state has always been cautious and rigorous, and the return of infected people who meet the criteria for lifting isolation and discharge from isolation is not contagious to the family and society, and everyone does not have to worry.
It is worth noting that the new version of the "Diagnosis and Treatment Plan" modifies "continue to carry out isolation management and health monitoring for 14 days after discharge" to "lift isolation management or continue to carry out home health monitoring for 7 days after discharge".
"Originally, we were more based on experience, 14 days to carry out isolation management or admission to a rehabilitation hospital. Now that it is confirmed that discharged patients are not contagious, isolation management can be changed to home health monitoring. Jiao Yahui explained that the shortening from 14 days to 7 days is because from the observation of all the convalescent patients of delta and Omiljung strains in the rehabilitation hospital, basically within 7 days, the entire body function returned to normal.
Dynamic clean-up of the outbreak
China is more confident in fighting the epidemic
At the press conference of the State Council New Office held recently, Wang Hesheng, deputy director of the National Health Commission and director of the National Bureau of Disease Control and Prevention, said that the general strategy of "external prevention of imports and internal prevention of rebound" and the general policy of "dynamic zeroing" will not waver.
"'Dynamic zeroing' is not about eliminating the virus, it's about dynamically cleaning up the epidemic." Wu Hao pointed out that from a scientific point of view, it is impossible for human beings to eliminate all viruses in nature, but they cannot allow the virus to spread among the population and form an epidemic, especially a large-scale epidemic, if it cannot be controlled, it will affect social stability, and the last to suffer is the people. Therefore, the key is to achieve the greatest prevention and control effect at the minimum cost, which requires research to find the most appropriate and appropriate solution according to the changing trend of the epidemic and the characteristics of the virus.
Wang Hesheng pointed out that "dynamic zeroing" is a prevention and control practice put forward on the basis of conscientiously summarizing lessons learned on the premise of the overall strategy of prevention and control of "external prevention of imports and internal prevention and rebound", that is, to base on grasping the foundation of grasping small and grasping early, improving the ability of epidemic prevention and early detection, quickly and early detection of infected people and epidemic situations, so that the discovery is extinguished together, the transmission chain is cut off, and the number of infected people is cleared.
"The goal of 'dynamic zeroing' is to pursue the minimum social cost and control the epidemic in the shortest possible time." Wang Hesheng stressed that the core of "dynamic zero clearance" is rapid response, precise prevention and control, "rapid" is reflected in rapid discovery, rapid disposal, rapid blocking, and "precision" is reflected in all aspects of the whole chain such as circulation investigation, isolation and control, community prevention and control, and clinical treatment of epidemic prevention and control.
"The mainland's prevention and control practices have better balanced the relationship between epidemic prevention and control and economic and social development, and have become the only major economy in the world with positive economic growth, which is a hard-won achievement." Wang Hesheng said that facts have proved that the "Chinese experience" of the prevention and control of the new crown epidemic has guaranteed the life and health of the people and promoted economic growth. Adhering to the "dynamic clearance" is the epidemic defense line that we must defend in a country with a population of more than 1.4 billion, which is the best practice of the concept of people first and life first, and the greatest contribution to the global fight against the epidemic.