Zhang Wenhong's interpretation of the latest diagnosis and treatment plan: dealing with the epidemic more calmly
2022-03-17
On the night of 15 March, the National Health Council released the New Coronavirus pneumonia diagnosis and treatment plan (trial version ninth) (hereinafter referred to as the "scheme"), causing widespread public concern. In response to novel coronavirus pneumonia, the grand Jiangdong studio interviewed Zhang Wenhong, director of the national infectious disease medical center and head of the medical treatment expert group of Shanghai new crown pneumonia. Reporter: from the perspective of treatment experts, what is the most important adjustment of the plan? What is the impact of COVID-19 on the epidemic prevention and control? Zhang Wenhong: Based on the deepening of scientific understanding of COVID-19 disease, the plan has made major adjustments in many aspects, advocating that the redundancy of medical resources can be promoted by optimizing the diagnosis and treatment plan, and the negative effects of isolation on normal life can be reduced by shortening the isolation period. Including adjusting the nucleic acid test judgment standard of discharge, and implementing classified treatment for cases. After discharge, they can be isolated at home directly, and the time can be shortened to 7 days. With a clearer understanding of the disease, our prevention and control principles will become more and more accurate. 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. Reporter: the plan mentioned that centralized isolation management for light cases will no longer emphasize centralized isolation treatment in designated hospitals. How does this relate to the trend of COVID-19 mutation? At present, in Shanghai public health center, what are the usual treatments for mild patients? What is the basis for no more centralized treatment in the future, and will there be a risk of delay, centralized isolation and mutual infection? Zhang Wenhong: for the management of light patients, the plan further simplifies the treatment and focuses on the observation of the condition. With the prevalence of Omicron becoming the current mainstream infection virus strain, the patients with Omicron variant virus strain are mainly asymptomatic infections and mild cases, and the demand for clinical specific treatment is significantly reduced. More patients can only be given symptomatic treatment and condition observation. Therefore, in the isolation point with certain medical conditions, the isolation and basic medical needs of infected persons can be completed. At the same time, it can release a large number of medical resources of designated hospitals. Our Shanghai public health center mainly supports the treatment of mild patients with symptomatic symptoms, and closely monitors the disease at the same time. In the future, light cases will mainly focus on centralized isolation and no longer emphasize receiving designated hospitals, because the proportion of light patients progressing to severe cases is very low. However, for some people who may have disease progression, such as the elderly and basic diseases, professional medical resources will still be equipped at the centralized isolation point of Xinguan to provide medical observation, risk assessment and treatment of original basic diseases. Once there is a risk of progress, you can immediately transfer to the designated hospital. Reporter: the plan will change the isolation management and discharge standards to "two consecutive New Coronavirus nucleic acid detection N genes and ORF gene Ct values are all equal to 35 (fluorescent quantitative PCR method, the limit value is 40, the sampling time is at least 24 hours"), or two times New Coronavirus nucleic acid detection negative. (fluorescence quantitative PCR method, the limit value is lower than 35, and the sampling time is at least 24 hours) ". Please give us a general introduction. Compared with the previous negative nucleic acid test twice every 24 hours, what does the change of the new discharge standard mean? Zhang Wenhong: the change of this standard has established an earlier and more accurate safe discharge standard to strive for patients to get out of isolation earlier and faster. Our understanding of Omicron is also gradually deepened. According to international research findings and careful verification by Chinese experts, when the nucleic acid is low to a certain level, no transmissible virus can be detected, so it is almost non infectious. Therefore, our nucleic acid positive judgment standard has been synchronized with the international standard since the stricter judgment standard, and the standard hospital stay has been reduced. More patients can be discharged early, which will greatly relieve the pressure on our medical resources. Therefore, this change has important positive significance. Reporter: in the plan, "14 days of isolation management and health status monitoring after discharge" is revised to "7 days of home health monitoring after release of isolation management or discharge". Is there any adjustment to cope with the high number of infected patients due to the limitation of medical resources? How is the novel coronavirus pneumonia management in Shanghai in recent two years? If the isolation period is shortened, is there a risk of Yang recovery and secondary transmission? Zhang Wenhong: the standard of home health monitoring seven days after discharge has been explained above, which has medical basis. It not only allows the infected to return to normal life as soon as possible, reduces the economic burden during isolation, but also saves the corresponding isolation room and other social resources, so as to further improve the ability of the whole society to deal with the epidemic situation and avoid running on isolation resources. Based on the change of diagnostic criteria, the probability of Yang recovery after shortening the isolation period will be very low; According to our research, even if Yang is restored, the nucleic acid level has been very low, and there has been no secondary transmission due to Yang restoration. Reporter: why does the plan not mention "asymptomatic infected persons"? Is there a large number of asymptomatic infected people who do not need treatment? 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 the case, and asymptomatic infection is not introduced in the diagnosis and treatment plan because of asymptomatic management, but it will be clear in the New Coronavirus pneumonia prevention and control plan. For asymptomatic infections, the risk of infectious and disease progression is similar to that of very mild cases. Therefore, it is equivalent to managing asymptomatic cases as mild clinical cases. The ninth edition of the plan suggests that light cases should be subject to centralized isolation management. During the isolation management, symptomatic treatment and condition monitoring should be done well. If the condition worsens, they should be transferred to designated hospitals for treatment. The centralized isolation management place for light cases is not clearly defined. It can be a medical institution or an isolation place, such as shelter hospital, isolation Hotel, etc. Centralized isolation management still requires medical staff to give necessary symptomatic treatment, such as fever, sore throat, cough and other symptoms. For the infected persons under isolation management, it is more important to monitor their condition. Mild and asymptomatic may be the early stage of their condition. Once they are found to have a tendency to become serious, they should be referred to the designated hospital in time. Considering that asymptomatic infected persons and patients with mild diseases are still infectious, at the same time, they need medical observation, risk assessment and treatment of other basic diseases. If the provincial and municipal medical institutions still have bed resources, they can still be admitted to medical institutions for isolation treatment. Reporter: in the past two days, Shanghai is implementing block and grid management on a large scale and conducting nucleic acid detection in stages. Many citizens feel it is inconvenient to travel. What is the significance of this grid management strategy for epidemic prevention and control in Shanghai? Zhang Wenhong: the challenge faced by the epidemic in Shanghai is the highest since the anti epidemic. Shanghai's anti epidemic strategy is based on the accurate judgment of the affected area of the epidemic and the corresponding emergency response. If there are only individual cases and the transmission chain is clear, as long as the precise prevention and control at the starting point and online, isolate a few people and do a limited range of testing. If there are new cases in multi-point communities and some sources are unclear, epidemic prevention and control should be expanded from point to line. There will be screening in key high-risk areas. At the same time, step-by-step and phased nucleic acid detection will be realized for areas with slightly low risk. If the epidemic continues, the prevention and control strategy may also be adjusted accordingly. At present, in order to achieve the goal of social clearance as soon as possible, the screening scope has been expanded in prevention and control, and more communities and personnel will be affected. However, without expanded screening, the epidemic will certainly be difficult to control, and the final result may be out of control. Therefore, at this stage, more individuals, families and communities will feel inconvenient and their normal life will be greatly affected. At the beginning of the expanded screening, there may be some confusion, but I still believe that there will be more improvements in the management of how to arrange the grid and echelon screening in the next stage, so that the public can feel predictable and more warm. I think it is difficult to predict the arrival of the epidemic, and the measures to eliminate the epidemic should be predictable. I believe that Shanghai will better carry forward the concept of accurate anti epidemic, so that citizens can feel the temperature of Shanghai when they cooperate with the anti epidemic and sacrifice their normal life. (Xinhua News Agency)
Edit：Li Ling Responsible editor：Chen Jie
Source：The Beijing News
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