In the special report, Feng Zijian made a judgment on the current and future epidemic situation. Feng Zijian said, "No matter what form the policy is adjusted, most of us will inevitably encounter infection."
In Feng Zijian's view, the arrival time of the impact of the first wave of large-scale epidemic is closely related to the way of policy adjustment in different regions, the number of infected people before adjustment, population flow and other factors.
"According to the mathematical model, when the first wave of large-scale shocks reaches its peak, the infection rate in China may reach about 60%, and then it will gradually fall back to a stable period. In the end, 80%-90% of us may experience infection. " Feng Zijian said.
He also mentioned that in the process of dealing with the first wave of large-scale shocks, there are three things that need to be done well, including taking appropriate measures to curb the peak of epidemic infection; The medical system should be prepared for stress in advance; Further accelerate vaccination, especially for the elderly with chronic diseases.
"Take appropriate measures to curb the peak, including reducing crowd gathering, reducing people flow, reducing meals, reducing entertainment activities, and encouraging non-critical positions to work at home, so as to reduce the pressure on the medical system from the peak of the epidemic." Feng Zijian said, "Of course, the price of suppressing the peak is to prolong the epidemic and bring greater pressure to the social economy and people's lives. This requires each city to weigh according to its own situation. "
In view of the problem that the epidemic peak may bring great pressure to the medical system, Feng Zijian believes that it is necessary to prepare for the transformation of medical service process and mode in advance, so that medical staff who have not been exposed to severe cases in COVID-19 can familiarize themselves with the diagnosis and treatment rules and processes in COVID-19 as soon as possible, and can quickly identify patients with serious illness and tendency. In addition, it is necessary to improve the management mode of the hospital, protect other types of inpatients and minimize the pressure caused by the infection of medical staff.
Feng Zijian also suggested that the elderly who have not completed vaccination should be vaccinated as soon as possible. "Vaccines have a very significant effect on reducing the risk of serious diseases in high-risk elderly people."
Extended reading
Jin Dongyan, a virologist at the University of Hong Kong: It is realistic for COVID-19 to return to the "B-class B tube"
Recently, many places in China have intensively adjusted the prevention and control measures of COVID-19 epidemic, and many cities such as Guangzhou, Shenzhen, Chongqing, Chengdu and Shanghai have issued notices announcing that they will no longer check the negative certificates of nucleic acid testing and take public transport. In addition, measures taken in Guangzhou, Beijing and other places to allow home isolation for some close contacts or special people with positive infection also show that "20" measures to optimize epidemic prevention and control are being gradually implemented.
On June 20th, 2020, 65438, National Health Commission announced that novel coronavirus's pneumonia was listed as a Class B infectious disease under the Law on the Prevention and Control of Infectious Diseases, and measures were taken to prevent and control Class A infectious diseases. Under the current situation, is it necessary to return the new management mode of prevention and control of coronary pneumonia to "B and B-like management"? What is the impact on epidemic prevention and control measures after returning to "B and B management"?
On February 5th, 65438, Jin Dongyan, a professor and virologist at the School of Biomedical Sciences of Hong Kong University, said in an interview with the reporter of National Business Daily that it is completely feasible to return the management mode of new coronary pneumonia to "B and B-like tube", and the biggest difference after returning to "B and B-like tube" is that centralized isolation can be changed to home isolation. Jin Dongyan also said that from the experience of Hong Kong, it is necessary to do a good job of accurate prevention and control to prevent medical runs.
Data Map Image Source: Xinhua News Agency
It is practical to return to "B and B management".
According to the provisions of the Law on the Prevention and Control of Infectious Diseases, legal infectious diseases are divided into Class A, Class B and Class C according to the outbreak, epidemic situation and harm degree of infectious diseases. Among them, Class A infectious diseases include plague and cholera, Class B infectious diseases include SARS, AIDS and viral hepatitis, and Class C infectious diseases include influenza, mumps and rubella. On June 20th, 2020, 65438, National Health Commission announced that novel coronavirus's pneumonia was listed as a Class B infectious disease under the Law on the Prevention and Control of Infectious Diseases, and measures were taken to prevent and control Class A infectious diseases.
Why was the new type of coronary pneumonia listed as "type B nail tube" at that time? Jin Dongyan said that at the beginning of the outbreak, the virus was highly contagious and pathogenic, and there were many unknown factors. The actual number of infected people in the local area was already very large. Decisive measures must be taken to curb the rapid spread of the virus among people. In addition, there are no COVID-19 vaccines and antiviral drugs.
"At that time, we properly judged its harmfulness as a Class B infectious disease and did not classify it as a Class A infectious disease. The biggest difference between Class A and Class B is the intensity of isolation. To manage according to Grade A means to use strong isolation measures, hoping to receive good prevention and control effects. " Jin Dongyan said that at that time, the domestic epidemic prevention and control achieved a staged victory, and the prevention and control effect was very good. He was also an outstanding student in the world.
Jin Dongyan pointed out that it is absolutely necessary to let novel coronavirus's prevention and control management model return to "B and B-like tube": First, the virus itself has changed greatly compared with the original strain, and its pathogenicity has been greatly reduced; Second, the vaccination rate in China has been quite high, and a certain group immunity has been obtained through vaccination; Thirdly, our understanding of COVID-19 has made great progress, and we have a good understanding of its transmission, pathogenicity, variation and immune escape characteristics.
"We also have weapons to deal with COVID-19 now. We have several vaccines and oral antiviral drugs. Moreover, after epidemic prevention practices around the world, countries have many effective epidemic prevention measures. " Jin Dongyan believes that under the current circumstances, it is both conditional and necessary for us to return the new management mode of prevention and control of coronary pneumonia to "B-like B and B-like management", which is completely in line with China's actual situation.
Jin Dongyan also said that the current isolation measures can be optimized on the basis of summing up experiences and lessons, such as changing centralized isolation into home isolation, which is an important direction.
COVID-19 Image Source: Picture Network -40 1679 155.
It is necessary to do a good job of accurate prevention and control to prevent medical troubles.
While optimizing prevention and control measures, the public is also worried about whether there will be a large-scale nosocomial infection.
Jin Dongyan said that nosocomial infection is relatively common for the prevention and treatment of infectious diseases. To prevent nosocomial infection, we must first control the infection. "Hospitals that specialize in receiving infectious patients should not cause large-scale nosocomial infections or cluster infections. Other infectious diseases, such as tuberculosis, measles and mumps. It is also a normal and arduous task to pay attention to nosocomial infection. "
Jin Dongyan said that the occurrence of hospital infection is related to the loopholes in infection control and needs to be plugged, but it does not mean that the hospital will be closed as soon as it feels hospitable, which will seriously affect the treatment of non-COVID-19 patients. "This year, more than 65,438+00,000 people died in COVID-19, which is a very painful lesson. However, 50,000 to 60,000 people die in China and Hongkong every year. If other patients are not treated because of the COVID-19 epidemic, more people may die. Therefore, it is necessary to achieve scientific and accurate prevention and control in the hospital. Even if the hospital is to be closed, it will be partially sealed up if necessary. "
Jin Dongyan said that China and Hongkong have never taken measures to close hospitals in response to the epidemic. During the SARS epidemic in Taiwan Province Province, China, because the hospital had been infected in a large area, doctors, nurses and patients were infected, so the hospital was closed and more decisive measures were taken.
Jin Dongyan believes that after sporadic and small-scale hospital feeling, we should not just take measures to close the hospital, but should take accurate prevention and control measures. For example, we can take control measures for medical staff who have close contact with infected people, but unrelated departments do not need to stop.
"We must formulate the graded diagnosis and treatment measures to deal with the COVID-19 epidemic in advance. If there is a shortage of medical resources, it may not be because COVID-19 has caused many serious cases and deaths, but because our response measures are unreasonable. Treating too many patients without bringing too much risk to the negative pressure ward has affected the treatment of other non-COVID-19 patients. This is a problem of resource allocation and graded diagnosis and treatment. " Jin Dongyan said.
Jin Dongyan said that influenza, tuberculosis and hand, foot and mouth disease in Class B infectious diseases are also harmful, but they have not caused a run on medical resources. "Of course, there are relatively few cases of these infectious diseases, and the other is that we have not taken unnecessary measures. We may actually treat COVID-19 like seasonal flu. "
Jin Dongyan believes that after being infected, medical staff can resume their work with a short rest, and there is no need to investigate a large number of close contacts for tracking and isolation. "A doctor is infected. If you isolate a dozen doctors around him as close contacts, medical resources will be affected. This is actually unnecessary. " Jin Dongyan said that we only need to pick out the most high-risk groups, carry out routine tests through antigen testing, and wait until they are really diagnosed as positive, and then let them go home and isolate, thus protecting our medical resources.
"During the tsunami of the last epidemic in Hong Kong, about half of the employees of the Hong Kong Hospital Authority were infected, and they all let the infected employees have a good rest before coming back. Although it was a wave of infection, there was no run and collapse of medical resources. " Jin Dongyan believes that if excessive control measures are taken against infected people, the possibility of a run on medical resources will increase.
Data Map Image Source: Xinhua News Agency
Encourage residents to carry out antigen testing.
What lessons can we learn from China and Hongkong when dealing with the The 5th Wave epidemic this year? Jin Dongyan had previously told reporters that residents should be encouraged to do more antigen testing at home. It is reported that there are three main detection methods in COVID-19, namely, nucleic acid detection, antibody detection and antigen detection. The source of antigen detection samples is usually nasal cavity, throat or saliva, and the operation is relatively simple. Residents can complete the test at home, and the results can be obtained in 15 minutes.
"There is little difference between the sensitivity of antigen detection and that of nucleic acid detection. Those nucleic acid tests can be detected, and antigen tests cannot be detected. The virus titer is relatively low and the infectivity is relatively weak. " Jin Dongyan said.
At present, domestic COVID-19 drugs have been approved, and many domestic oral drugs are in clinical trials. Jin Dongyan said that COVID-19's oral drugs should compete with the virus. If you take it too late, the therapeutic effect of the drug will decline, so how to get patients to take it as soon as possible is a great challenge. "In the United States, Pfizer's paciclovir is also a prescription drug, but it can be directly prescribed to patients by some licensed pharmacists; In Hongkong, China, after a patient tests positive for COVID-19 antigen, the doctor will prescribe medicine for the patient immediately, and the patient will not buy it himself. It's free. " Jin Dongyan said that how to get patients to take medicine in the Mainland as soon as possible requires creative solutions.
"In fact, the best way to prevent and treat COVID-19 is vaccination. Singapore's experience is that if residents don't get vaccinated, they will prescribe drugs if they are infected with COVID-19 in the future, but they need to pay their own expenses. Only those who have been vaccinated can get the drugs free of charge. Now COVID-19's oral medicine is free in China Mainland and Hong Kong, and it may be the same in the Mainland in the future. " Jin Dongyan said, in fact, after the COVID-19 vaccine, the effect of these oral drugs is very limited, and oral drugs are mainly used for the elderly who have not been vaccinated.
Jin Dongyan believes that most cases in COVID-19 are mild and asymptomatic, and patients with mild and asymptomatic symptoms do not need oral medication. Jin Dongyan also mentioned that the key is that the state should reserve an appropriate amount of effective oral drugs. "China is so big, how many people to feed and how many medicines to reserve, which requires relevant departments to make plans in advance. In addition, decisive measures should be taken to ensure the production of antigen detection reagents to ensure adequate use. "