On September 9, the Headquarters for the Prevention and Control of the Novel Coronavirus Pneumonia Epidemic in Yangzhou City, Jiangsu Province, announced that the entire territory of Yangzhou City is low risk. Yangzhou has staged a more thrilling drama than a TV series in the past 45 days. Fortunately, in the end, they all turned the tide. However, the thinking left by Yangzhou's road is far from over.
Yangzhou, one of the nine prefectures in the world, ancient name Guangling, has the reputation of "Huaizuo Famous Capital, Zhuxi Jia". In 2015, it was 2500 years old, the only city the same age as the ancient canal. However, just this summer, the "good place" got into trouble, and the new crown pneumonia Delta mutation strain came.
Nucleic acid testing site in Yangzhou city
01 The city is quiet
On July 27, an important node was not only for Yangzhou, but also for the whole country. On this day, the epidemic in Yangzhou occurred. At this time, it has been one week since the detection of 9 positive cases at Nanjing Lukou International Airport on July 20, and the number of new local confirmed cases of new coronary pneumonia in Nanjing on the same day reached 47.
Marked by the first confirmed case in Yangzhou, Mrs. Mao, Jiangsu began a two-front battle.
As the capital city, Nanjing's population density, mobility and other factors determine that its prevention and control is relatively difficult. Although the population of Yangzhou Urban Area is less than 2 million, the first case was found late, concentrated in the elderly group, and the scope of activity is mostly in the mahjong hall, moxibustion hall and other crowded and poorly ventilated places, so it is difficult to get an effective solution in a small scale and in a short period of time.
The uneasiness of Yangzhou City began in the chess and card room. For more than a month, the people of Yangzhou truly felt the destructive power of Delta. Various announcements about it appear in all kinds of media and streets.
On July 21, when the midday sun was just a little westerly, Mrs. Mao rode an electric car to the Qiu Nanyuan Chess and Card Room in the Four Seasons Garden Community, not far from Niansi New Village. The chess and card room is underground, the area is not large, can set seven or eight tables, and the customers are mostly elderly. Everyone gathered around the table, sitting or standing, happily, arguing and arguing, and spending time.
In the morning, Mrs. Mao had just taken a public bus from Nanjing to a bus to her sister's house in Niansi New Village, Hanjiang District, Yangzhou City. At this time, the word "Nanjing" was actually very sensitive, and all localities were also very alert to the guests from Nanjing, and Yangzhou also issued a notice to find "Nanjing visitors". However, from July 21 to 27, this Nanjing visitor was frequently active in many highly crowded hotels, shops, clinics, chess and card rooms, farmers' markets, etc. in Yangzhou City, and did not take the initiative to report the history of Nanjing's residence to the community, and Yangzhou did not find and control her in time.
On the morning of August 9, the reporter followed the experts of the Jiangsu Working Group of the Comprehensive Group of the Joint Prevention and Control Mechanism of the State Council to the community where the Qiunanyuan Chess and Card Room was located, when the road had been blocked with ropes, and occasionally someone poked his head out of the window and shouted, "When to disinfect the corridor, can the nucleic acid be done several times?" Diagonally opposite the door of the chess and card room, a few loofahs hung on the shelves, and yellow flowers swayed with the wind. Next to the loofah rack, an aunt in her 50s was drying clothes, her hands were shaking up a shirt, and the splash of water accompanied by complaints came out " Every day until eleven or twelve o'clock, very noisy."
"As of 24:00 on August 2, Yangzhou has reported a total of 94 locally confirmed cases, with 64% of the mahjong hall exposed; 66 people aged 60 and above, accounting for 68.8%." Zhou Minghao, deputy director of the Jiangsu Provincial Health Commission, introduced the press conference on the prevention and control of the new crown pneumonia epidemic in Jiangsu Province on August 3.
There are many elderly people, which is one of the biggest difficulties encountered by the epidemic in Yangzhou. As of 21 August, 40% of the infections were over the age of 60. "The early percentage was higher, close to 70 percent. This proportion is probably the highest of any outbreak in the country. The working group expert said.
Yangzhou is indeed a veritable aging city. The results of the seventh national census released in Yangzhou this year show that yangzhou's aging level is higher than the national average. From the perspective of age structure, among the city's permanent population, the population aged 60 and above is 1186199, accounting for 26.01%; of which the population aged 65 and above is 911673, accounting for 19.99%.
At noon on July 31, the reporter followed the experts of the working group from Nanjing to Yangzhou. On the highway, it took more than half an hour to flash a car. Entering the Yangzhou boundary, the street is quiet, occasionally speeding past a few cars, and many shops on the roadside are chained to the outermost iron fence doors. People on electric vehicles and pedestrians on the road wear eye-catching blue masks. At least from the periphery, at the time, the city was quiet.
What corroborates the reporter's feelings is a notice issued by Yangzhou on the night of July 31: blocking roads from the main urban area to other parts of the city and suspending public transportation in the main urban area. In addition to high-risk and medium-risk areas, low-risk communities in the main urban areas have also been sealed and controlled. Roads outside Yangzhou city that are not in the main urban area are also under control, and they need to hold a 48-hour negative nucleic acid test certificate for drivers and their vehicles to enter and exit. The introduction of a series of measures means that from August 1, the main urban area of Yangzhou is basically in a state of "lockdown".
Facts have also proved that yangzhou's control of external traffic has quickly blocked the spillover of cases outside Yangzhou. From the discovery of the epidemic on July 27 to 24:00 on August 10, only one case was exported to Suqian City. In addition, in addition to Jiangdu District, there were no case reports in suburban counties such as Baoying County, Gaoyou City, and Yizheng City, which further shows that the traffic control measures between counties have blocked the spread of the epidemic from the main urban area to the surrounding districts and counties to a certain extent.
02 Lockdown but out of control
Wu Zhenglong, governor of Jiangsu Province, said on August 1 that the epidemic in Yangzhou occurred early and was found relatively late, and in the closed places where people gathered, most of the elderly were elderly, and the situation has not yet bottomed out.
The case data is very intuitive: from July 29 to August 4, the daily confirmed cases in Yangzhou were 4 cases, 10 cases, 12 cases, 26 cases, 40 cases, 32 cases and 36 cases, respectively, and the highest value of this round of epidemic was 58 cases on August 5. From 6 to 12 August, there was also no improvement, with 52 cases, 36 cases, 38 cases, 48 cases, 54 cases, 37 cases and 25 cases respectively. Such a situation is worrying.
The earliest outbreak and spread was the chess and card room where the first case went, and since then the epidemic has continued to spread to other places, resulting in clusters of outbreaks in places such as moxibustion halls, physiotherapy halls, collective units, restaurants, homes, nucleic acid sampling points, and other places. Among them, the number of family clusters of cases is high, especially since August 1, and the number of reports has increased rapidly.
On July 26, Uncle Ming (pseudonym), who played cards in the chess and card room of Qiu Nanyuan, was still immersed in the joy of entertainment, and did not know that he had been targeted by the new crown virus. On the evening of the 30th, Uncle Ming began to cough; on the afternoon of the 31st, he had a low-grade fever; on August 1, he was weak and drowsy. On August 2, he dialed the phone of his community, and then the "120" negative pressure ambulance transferred him to the Northern Jiangsu People's Hospital, and the initial screening result was positive.
After Mrs. Mao was diagnosed on July 27, whether in time or space, according to the relevant regulations of the state, Uncle Ming should be judged to be a close connection and need to be centrally isolated and managed. However, it did not.
Propaganda slogans were posted at the door of a community in Yangzhou
"If you and your family have been to the Qiu Nan Yuan Chess and Card Room of Four Seasons Garden after July 21, please immediately report to your community or police station." On July 29 and August 1, Yangzhou City issued consecutive notices. The reporter saw in the Qiu Nanyuan community and the surrounding communities that almost every community has announcement posters on the door and wall. However, for the Uncles of The Minh, it did not seem to have the desired effect. In the early days of the epidemic, national mobilization was not an easy task, and most people did not realize that the virus and themselves may only be half a step away.
The close missed judgment helped to stage "the needle tip of the hole through the big wind" in reality: Uncle Ming's wife, grandson, son, and daughter-in-law were all diagnosed on the third and fourth days. In fact, when Uncle Minn reported to the community, his wife was already suffering from fever. That is to say, after Uncle Ming was diagnosed, although the people who lived with him were judged to be close contacts, they did not implement the requirement of "should be isolated", but stayed at home. By this time, family transmission had already begun. One of the most obvious pieces of evidence is that Uncle Minh's wife had symptoms on the same day as him, but it didn't attract attention at the time.
More data also suggests that there is more than one "Uncle Minh". As of 20:00 on August 19, a total of 566 cases were reported in Yangzhou, of which 149 cases had a cluster of epidemics in the family, resulting in the onset of illness in 260 family members, involving a total of 409 cases, accounting for 72.3% of the total number of cases in the epidemic.
From July 29 to August 1, Sun Chunlan, member of the Political Bureau of the CPC Central Committee and vice premier of the State Council, investigated the prevention and control of the epidemic in Nanjing. Sun Chunlan pointed out that it is necessary to coordinate the prevention and control of the epidemic in Nanjing and the whole province, increase the intensity of epidemic prevention and control in Yangzhou, and send more experts such as testing and circulation to achieve a "chess game" for epidemic prevention and control in the province. On August 11, Sun Chunlan came to Yangzhou again, and only left on August 15. This action trajectory reflects the complexity and difficulty of the epidemic in Yangzhou.
On August 12, in the conference hall of a hotel in Yangzhou City, the three-level circulation experts of the national provinces and cities were working intensely and busily
Why is Yangzhou, which is "locked down", out of control?
The working group found that although many prevention and control measures have been taken in the main urban area, the "closed community" in the early stage has not achieved "staying at home", and the close connection and sub-density have not been centralized and isolated in time, and the extensive isolation at home is the mainstay, coupled with the lack of effective control, resulting in a high number of daily reported cases, frequent clusters of cases in places, families, and units, and an increase in cases of unexplained infection routes. This issue was raised at the three-level dispatch meeting of the national provinces and cities for many consecutive days.
"The first time I went to a neighborhood, there were already 3 positive cases there, and it increased every day for the next few days. Unfortunately, it was decided a week later that the community would be quarantined. If it is isolated as soon as it is found, there may not be so many cases. In the early days of August, the reporter met with a number of working group experts, and the most nagged was that "it should be a few days earlier than the interval."
The "just do it a few days earlier" doesn't stop there.
On the evening of August 3, at a three-level dispatch meeting held in Yangzhou, experts from the working group showed a photo of people walking back and forth in a certain community. This is a community with 7 positive infections, which began to be closed on July 31. However, on August 3, the working group saw at the scene of the community that although more than a dozen staff members were waiting at the entrance of the community, the flow of people in the community was continuous: walking dogs, picking vegetables, walking bends, chatting, taking couriers...
At the three-level dispatch meeting on the evening of August 16, similar problems still existed. "From August 11 to 15, 24 new communities were added that did not originally have positive infected people. In these communities, the rule of 'one family going out shopping' is not well implemented, and many families go out at the same time. The working group said bluntly that in the control outside the closed area, the surface is large enough, but the quality is not high.
"The control is not in place, and the most critical thing is that the last kilometer or even a few kilometers are deserted." The problem is obvious, the remedies are actually in order, but the actual implementation is "turtle speed forward". "If the requirements such as staying at home and centralized isolation are put forward, they must be strictly implemented and must be put in place in one step." We can't ask for a little stricter because there are cases again and feel that the situation has escalated, and one more case can be demanded. ”
Many experts have a common feeling: not only Yangzhou, but also many places at the beginning of the epidemic, there will be a kind of "not very serious" fluke psychology, measures are often written on paper fast, but fall on the ground is very slow, and even want to "wait, take a look".
However, the virus will not wait. If you are closely isolated at home, but there is no strict protection in place, it is a large internal potential transmission risk. "So you will see that although it is a closed area, there will be two cases today, one case tomorrow, and the day after tomorrow... When the mouth could not be pierced, it was decided to isolate all the remaining personnel in a centralized manner, and the price to be paid in the follow-up would be very large. The working group expert said.
03 Reflections brought about by "typical cities"
The small size of the city, the relatively active urban environment, and the moderate size of economic development have made Yangzhou a typical representative of "ordinary" cities, and have also inspired the handling of the epidemic in most cities. Experts give a few examples.
First, one of the characteristics of the yangzhou epidemic is that it is aging. Most of the infected groups, mainly middle-aged and elderly people, have underlying diseases and are very prone to severe and critical populations. In Yangzhou, a patient was diagnosed with a critical illness 3 hours after being sent to the hospital, and experts worked all night to make the patient turn the corner.
"It is impossible to track the movement trajectory of the elderly, and it is easy for the missed infected people to continue to expand the scope of transmission." Experts sigh more than once in the flow tone. The most difficult thing in the flow is that there is no trace of close contacts, especially in the elderly. For example, who is the close connection? Uncle Minn was sure. But why wasn't it decided at the time? There are many elderly people represented by Uncle Ming who do not have smart phones or do not have to bring, nor do they need electronic payments, and it is very challenging to check the trajectory of the past 14 days based on personal memories. Experts suggest that if the elderly do not have a smartphone when entering a public place, they can use the way of registering ID cards and residence information to ensure that traces are left.
In addition, the first recognized ability of all parties in the handling of the epidemic is epidemiological investigation. Ensuring the size of people with public health literacy is key. In Yangzhou, this time relevant personnel were mobilized from the province to rush to the rescue. This is a contingency approach. Experts from the working group also provided another line of thinking: When dealing with the epidemic last year, Shantou City, Guangdong Province, and the Kashgar region of the Xinjiang Uygur Autonomous Region quickly surveyed local people who had studied public health to see which units they were scattered in, gathered together, and those who were willing to stay after the epidemic ended and prioritized work in the CDC. "The existing CDC staffing does not meet the minimum staffing standard of 1.75/10,000 required by the state. Without building a strong CDC infectious disease control team, it will certainly not be able to meet the requirements of normalized epidemic prevention and control and emergency response. ”
On August 5, Xupu Community Hospital in Zhenzhou Town, Yizheng City, Yangzhou City, conducted a fever patient transfer drill
Second, how can the community manage and manage well? "Where the epidemic lasts for a long time and has a relatively large impact, most of them are problems with community grid control." There are loopholes in community personnel screening, home isolation, door-to-door follow-up, crowd monitoring, etc. This judgment of experts stems from the experience of epidemic management in nearly 20 cities.
Multiple clusters have exposed deficiencies in community prevention and control. For example, after a cluster of new crown pneumonia outbreaks occurred in a village in Guangling District, it spread and continued to cluster in two enterprises. As of 24:00 on August 9, the village has reported a total of 50 local cases of new crown pneumonia infection.
"The base number of personnel must be clear. At least to know who lives in a certain range, whether they are tenants or residents, etc., these issues need to be controlled and mastered through community grids. Experts suggest that we should draw a grid when normalizing, clarify the control personnel, and not wait until after the epidemic to form a team, at that time, the eyebrows will already be burned."
Third, how should nucleic acid testing be done? On August 8, the Yangzhou Municipal Commission for Discipline Inspection issued the "Circular on Accountability for Typical Problems of Formalism and Bureaucracy in Epidemic Prevention and Control", which has such a detail: On August 1, Wang Qiang, a staff member of the Financial Settlement Center of Wantou Town, Guangling District (who has been investigated and suspended for serious violations of the law), was diagnosed as a new crown pneumonia case, and caused serious consequences for 23 people. The Wang Qiang incident has made many people question the necessity and danger of nucleic acid testing for all employees.
On August 6, at the nucleic acid testing sampling point of Mingzhu Community in Xiannu Town, Yangzhou City, a mother and her child tested nucleic acid together
Experts from the working group said that regarding nucleic acid screening, it is not necessary to do all staff, but there is a premise, if the infection relationship can be made very clear, and it is in the early stage of infection, nucleic acid screening and close contact management can be carried out in a limited population. However, it is often too late to find the epidemic situation in various places, and the infection relationship is not particularly clear, and it is not possible to rule out whether there is a risk in other communities and other villages, so it is still necessary to do nucleic acid screening for all employees. There is no right and wrong distinction between the two, that is, to see at what stage the epidemic is found, how many people are affected by the infection, and then the unknown is not in their own hands, whether it is clear, so many places need to carry out a larger range of nucleic acid screening.
On September 14, the Comprehensive Group of the Joint Prevention and Control Mechanism of the State Council issued the Guidelines for the Organization and Implementation of Nucleic Acid Testing for the Novel Coronavirus for All Employees (Second Edition), which clarified that in the early stage of the epidemic, at least three rounds of nucleic acid testing should be carried out for all employees in the case of unknown sources of risk.
In the face of the new crown pneumonia epidemic, how to integrate forces and fight with all efforts in a relatively short period of time is indeed a big challenge. "Looking back at so many times of epidemic disposal, the key links are nothing more than a few: community prevention and control, nucleic acid testing, fixed-point admission, centralized isolation, emergency transport, etc., as long as these main contradictions or the main aspects of the contradiction are grasped, the disposal must be confident." And these our countries already have clear rules and requirements. Experts said.
In fact, no matter how many there are, the final direction is basically two points: is the normalization of epidemic prevention and control solid or not? Once an outbreak occurs, how can I quickly switch to an emergency state?
Taking the isolation room as an example, most places undertake the community to check out the serious shortage of close isolation rooms. Each prefecture and city, especially the port city, should actually build a large-scale centralized isolation observation point as appropriate, 1,000 or even 2,000, which is also the ability to reserve the normalization of epidemic prevention and control.
In the interview, experts concluded that if an epidemic is to have an inflection point, on the one hand, the local party committee and government must make practical moves, truly realize that the old measures are unsustainable, and must implement more effective methods without compromise. In fact, one specific treatment, prevention and control measures seem to be "professional" and "technical", and behind them are condensed leadership, organization, coordination and supervision forces at all levels. As experts said, in the early stage of the fight against the epidemic, some local and individual chaos made people feel sad, mostly because the distinction between the various blocks was more obvious, each managed a stall, coupled with the slow start of the command system, it was more difficult to truly form a joint force in a short period of time. On the other hand, epidemic prevention and control is a process of national mobilization, and when the whole people are mobilized and the situation of mass prevention and group control is formed, they will strive for the initiative and reduce the opportunity for the spread of the virus.
"When the above two phenomena appear, there is hope for the stable control of the epidemic."
Yangzhou has two landmark policies to calm the city: one is Circular No. 5 issued on the evening of July 31 to control external traffic; the other is Circular No. 44 issued on August 17 to comprehensively strengthen the control of residential areas in the main urban area. "There are only 3 points left in the problem, indicating that the work is getting better and better." At the national provincial and municipal three-level scheduling meeting on August 20, the participants were in a good mood and rarely saw a few smiling faces. On August 23, the first members of the working group were evacuated from Jiangsu. Three days later, all the remaining personnel were evacuated.
When I first entered Yangzhou or in the summer, I looked at the layers of green leaves on the osmanthus tree and began to fantasize about the taste of osmanthus flowers. When I left, the autumn wind had risen and the autumn rain had fallen. When the experts returned to their hometowns, Jiangsu friends sent a message: Osmanthus flowers are fragrant.
Text/Photo: Yao Changfang, chief reporter of Health News
Editor: Bingnan Xu
Review: Yan Gong Chen Huiyang