Professor Miao Xiaohui: For the 7 suggestions for epidemic prevention and control, it is urgent to pay attention to and solve the problem of additional deaths

This article is written by Miao Xiaohui

In February 2021, BMJ published a study from the Team of Zhou Mageng of the Chinese Center for Disease Control and Prevention analyzing excess mortality in Wuhan city and other parts of China during the three months of the covid-19 outbreak: findings from nationwide mortality registries）。

For COVID-19, additional deaths are defined as new deaths or deaths after the number of direct deaths from non-COVID-19 diseases during a certain period of the COVID-19 pandemic compared with the number of deaths during the same period (during the period when the new coronavirus epidemic) is compared.

Note several important figures: a 21% increase in mortality due to chronic noncommunicable diseases, an 83% increase in diabetes mortality (46/100,000 vs 25/100,000), and a 66% increase in suicide mortality.

From January 1 to March 31, 2020, weekly observations (orange dotted lines) and predicted (solid blue lines) trends in major diseases at disease surveillance points in different regions. (Source: References)

Take diabetes as an example to deduce: between 2010 and 2020, the standardized mortality rate of diabetes in Pudong New Area of Shanghai was 16.9/100,000. It should be noted that the incidence and mortality of diabetes are increasing year by year, according to this speculation, the incidence of diabetes deaths in Pudong New Area after 2020 should not be lower than the data of Wuhan in that year (25/100,000).

After the outbreak of the epidemic in Shanghai, the run on medical resources is quite serious. If you calculate the 25 million permanent population, what is the total number of additional deaths due to diabetes in this month or so?

According to reports, Shanghai 35 years of age and older, the prevalence of diabetes is 21.6%, the number of people aged 35 and over is roughly estimated at 14 million, according to the 25/100,000 mortality rate given by Wuhan, the number of diabetes deaths in Shanghai in one month may be 14000000× 25/100000÷ 3 = 1170 (person), due to the new crown epidemic after the full closure of the additional number of deaths may be: 1170 ×83% + 1170 = 2141 (person).

These increased unfortunate people, because of the run on medical resources, or can not see a doctor, or can not take medicine, or can not be properly monitored, or can not be correctly medicated, the result is poor blood sugar control, resulting in a variety of acute and chronic serious complications and not treated.

What is described above is nothing more than a chronic noncommunicable disease diabetes that may add an additional number of deaths in a month, while the additional mortality rate for all chronic noncommunicable diseases is 21%, which I cannot calculate in absolute terms.

The authors of the paper did not record additional deaths from various other acute and chronic infectious diseases, and the additional mortality rate of acute and chronic infectious diseases, such as influenza (flu, influenza, influenza), five acute and chronic hepatitis, various intestinal infectious diseases, insect-borne infectious diseases, tuberculosis, measles, hand-foot-and-mouth disease, AIDS, encephalitis, meningitis, HPV infection, shingles, various sexually transmitted diseases, etc., is not a small number and cannot be ignored.

In addition, the authors only count chronic non-communicable diseases, so what about various acute diseases? For example, stroke, acute myocardial infarction, fatal arrhythmias, cardiac respiratory arrest, acute heart failure, hypertensive crisis, thyroid crisis, gastrointestinal bleeding, respiratory hemoptysis, acute abdomen (especially acute organ perforation), severe allergic reactions, various acute severe infections, cancer rupture... If these emergencies are not rescued in the short term, they will certainly be life-threatening in the short term, and if they are not treated in time, the case fatality rate is very high.

There is also suicide. The study reported a 66% increase in additional mortality from suicide, and the mental health problems of quarantined people needed urgent attention.

What we need to look at more rationally is that the case fatality rate of people infected with the Omicron virus strain is very low, less than one in a thousand. But don't misunderstand, this denominator refers to all infected people, not the total population.

According to the information currently released, the cumulative number of infections in Shanghai has exceeded 120,000, while the number of deaths due to the new crown is currently less than 10, far less than the estimated additional deaths of diabetics 2141.

I am a 40-year-old medical physician and infectious disease specialist, and I was shocked to read this paper. I highly recommend that experts read this paper, focus on the concept of additional deaths and related data, and compare the mortality caused by infection with Omicron virus with the additional deaths mentioned in this article, which should not be ignored.

For epidemic prevention and control, I have 7 comments and suggestions for reference.

First, about home isolation.

Completely asymptomatic infected people (the definition of "asymptomatic infected person" will be discussed later) I recommend home isolation, young patients with mild diseases without underlying diseases are recommended to be isolated at home, those who are not infected and whose underlying diseases are not effectively controlled, and the elderly over 70 years old are recommended to adopt reverse isolation within the family. This can greatly reduce the number of beds in the square cabin hospital and greatly reduce the run on medical resources.

Second, on the national nucleic acid test.

Whether the national nucleic acid test is absolutely necessary, I dare not easily answer the question of yes or no. But other issues raised by nucleic acid testing require attention. Is the sampling process standardized? Is the capacity of the test sufficient? Are the test reagents qualified? Are the inspectors qualified? Does the testing laboratory have quality control?

I also recommend that tuners do one important thing: understand the likelihood of "secondary infection" during sampling. If possible, what are the probabilities? At present, the number of infection cases of volunteers in various communities has gradually increased, and many residents who have been closed for more than two 14 days have become positive infected people after one month.

Third, hospitals must not close their doors.

Hospitals are completely closed and should not be allowed once. The previous practice of finding a COVID-19 positive person "walking around" in the hospital and shutting down the entire hospital was highly inappropriate. I suggest that zoning control can be taken, and which ward has a positive person, the ward can be closed; the outpatient clinic can be gradually opened after the killing is divided into periods.

The simultaneous closure of more than 20 large hospitals, even for more than 3 days, the emptying of wards, the suspension of operating rooms, etc., are inappropriate practices, which artificially increase additional mortality. In the early days, some places required "zero infection" in hospitals treating covid-19, which was also unscientific, and we could try to move toward zero, but we could not achieve absolute zero. Medical institutions are responsible for saving lives and helping the injured, and cannot be "afraid of death and pushing injuries" at this time.

Fourth, about vaccination.

We can't guarantee that any vaccine will achieve a protection rate close to 100%, but there is a global understanding that vaccination can reduce severe illness and mortality, which has achieved some protective purposes. We can silence a city of 25 million people, and we should be able to vaccinate as many people as possible without contraindications.

Fifth, about the square cabin hospital.

How to exert the power of the neighborhood committee and the volunteer team of the street and its leaders to isolate the infected people at home should be preferred for Omicron strain infection.

In addition, in terms of the current situation analysis, how many square cabin hospital beds are needed to meet the demand? The current epidemic of Omicron is not the strain that was circulated in the early days of the epidemic, and according to the current momentum, the construction speed of the square cabin hospital cannot keep up with the increase in the number of infected people.

Sixth, about the "lockdown".

Since March 28, Shanghai has adopted a policy of zoning and batching nucleic acid screening bounded by the Huangpu River, which has greatly exceeded the incubation period of Omicron (the median incubation period of the new crown virus is estimated to be about 5.1 days in the early case analysis in Wuhan, and the incubation period of the later Delta is shortened to 4.3 days, and from the norwegian and Korean studies, the incubation period of Omicron is shortened to 3.0 to 4.2 days).

Up to now, shanghai has seen more than 20,000 new cases in a single day, and then Shanghai has opened a new round of national nucleic acid testing. There are also some communities that have been sealed for more than 1 month, that is, more than two 14 days, and still have new infections every day.

Where do these new infections come from? It is recommended to conduct in-depth epidemiological investigation and research on this issue, and at the same time, we should also carefully view the necessity and cost of "backwater war" and "breaking the boat". To do so, it is necessary to consider the various secondary disasters, both medical and non-medical, during the closure period. The old way of solving new problems cannot always be used.

Seventh, the psychological disorders brought about by sealing and control.

According to the above study, the suicide mortality rate increased by 66% during the Epidemic in Wuhan, and this percentage may not be directly deduced to Shanghai, but it should be pointed out that psychological disorders, as a secondary injury, are not a simple problem of medical psychology, psychological counseling can only solve a small number of people's psychological disorders caused by fear of infection, and completely unrelated psychological disorders cannot be solved through medical intervention.

For example, small business owners can't operate and lose money, such as 24-hour intimate contact with family members, or more extreme hunger problems, can not be underestimated. Suicide is "contagious" and must be taken seriously.

Author's statement: This article is only a simple interpretation of the academic papers published by mainland scientific and technological workers in international medical journals, and it is necessary to pay attention to the problem of additional deaths during the large-scale epidemic of the new crown virus. At the same time, 7 personal suggestions or opinions are proposed for reference. Other non-medical issues are not discussed in this article.

This article was first published on Professor Miao Xiaohui's personal public account "Miao Xiaohui on Health", and was authorized to be published by Lilac Garden

Image source: Visual China | Planning: gyouza