These guidelines basically integrate and summarize the ninth edition of the prevention and control plan and the contents of the "Twenty Articles", further clarify key issues such as how to normalize nucleic acids, degrade high-risk areas, and isolate objects at home, and provide policy basis for local governments to achieve accurate prevention and control.
At the press conference of the State Council Joint Prevention and Control Mechanism held in June165438+1October 17, Shen, deputy director of the National Bureau of Disease Control and Prevention, put forward the overall epidemic prevention goal after the policy adjustment: "The key risks of this control should be controlled, the implemented prevention and control measures should be implemented, and the cancellation should be resolutely cancelled", and the limited prevention and control resources should be used for the most important prevention and control.
According to the data of National Health Commission, 2 165438+ 10 -24 on June 26th, 3 1 provinces and Xinjiang production and construction corps reported 2 145 newly confirmed cases and 25754 asymptomatic infected people nationwide. The number of infected people in the country has been 20,000 for seven consecutive days. At present, the epidemic situation in Guangdong, Chongqing, Henan, Gansu, Beijing and other places is more severe, and it is still on the rise.
A data expert who has been monitoring the epidemic trend in COVID-19 for a long time pointed out to China Newsweek that by mid-June, the epidemic situation in China will be in a plateau period, and there may be a "double superposition of COVID-19 and influenza" this winter and next spring, which will put pressure on the existing medical resources. Judging from the current situation, an infected person can infect 5 ~ 6 people every 4 days on average, so we should be alert to the possible "super communicators" in some high-density places.
Citizens lined up for nucleic acid testing. Figure/vision china
How to arrange nucleic acid sampling points?
After the publication of Article 20, the setting of nucleic acid detection points was repeated in many places, and many detection points were cancelled in some places.
A person from the local CDC explained to China Newsweek that behind this vacillation and repetition, it reflected the mismatch between supply and demand of local nucleic acid testing. Many units or public places still require 48-hour or 72-hour nucleic acid testing when entering, which means that the demand is still there, but the supply is reduced after partial cancellation of nucleic acid sites.
With regard to the requirements of nucleic acid inspection in public places, at the press conference of the State Council Joint Prevention and Control Mechanism on June 5438+065438+ 10/7, Shen pointed out that cross-regional migrants need to fly, the high-speed train will be negative for 48 hours, and people staying in hotels and entering tourist attractions need to check their health codes and nucleic acids for 72 hours.
Since the publication of Article 20, with the increase of epidemic number in some provinces and cities, many areas have further tightened the requirements for nucleic acid testing, and the requirements for entering shopping malls, supermarkets, office buildings and other places have changed from 72 hours to 24 hours.
1at 8: 00 p.m. on October 20th, 165438, Zengcheng District of Guangzhou issued a notice on strengthening social control for the first time since this round of epidemic, demanding that the whole district stop eating and drinking, and primary and secondary schools and kindergartens suspend offline teaching or.
At the press conference of the State Council Joint Prevention and Control Mechanism on June 5438+065438+ 10/7, a reporter asked: "How to alleviate the contradiction between supply and demand of nucleic acid testing when the whole people don't do nucleic acid testing, but the results of nucleic acid testing are still checked?"
Guo Yanhong, director of National Health Commission Medical Emergency Department, said that the layout of nucleic acid detection points is actually an arrangement for the prevention and control of normalized epidemic situation, which is convenient for people to do what they want and should do. Sampling points should cover the service population within the jurisdiction; According to the needs of different groups of people, peak shifting provides sampling services; For communities and places with high population density and large population mobility, the supply of sampling services will be expanded by increasing sampling sites and sampling personnel.
At a convenient nucleic acid testing point, the staff scanned the code for citizens who came to conduct nucleic acid testing. Xinhua News Agency
On the other hand, Shen Zai, deputy director of the National Bureau of Disease Control and Prevention, pointed out at the press conference of 17 that when carrying out normalized nucleic acid testing in epidemic-free areas, it is only necessary to carry out nucleic acid testing for risk positions and key personnel, and the scope of nucleic acid testing should not be expanded. Generally speaking, all people are not required to carry out nucleic acid testing according to administrative regions.
According to the latest implementation measures of nucleic acid detection for epidemic prevention and control in COVID-19 issued by 2 1, this kind of population mainly includes two types: one is high-risk population, such as medical personnel, cross-border transport drivers, cleaners, customs officers and workers in centralized isolation places. , need 1 nucleic acid detection every day. The other is the key group with strong mobility, such as express delivery, take-away, hotel staff, decoration stevedores and so on. You need to do nucleic acid testing twice a week.
In addition, for schools, nursing homes, factories, hospitals and other key places, we should also do a good job of normalized nucleic acid detection, that is, "after the occurrence of 1 cases and above in the jurisdiction, we should organize and complete 1 full-time nucleic acid detection in time, and then carry out nucleic acid detection according to the detection results and the risk of epidemic spread, according to the sampling ratio of at least 20% per day or the detection requirements of the jurisdiction".
A public health expert, who did not want to be named, pointed out to China Newsweek that the setting of nucleic acid spots, on the surface, is a problem of resource optimization, and the more essential thing is how to normalize nucleic acid. The goal is to narrow the scope of nucleic acid detection and reduce the frequency as much as possible while ensuring effective and accurate monitoring of the epidemic situation. For example, in non-epidemic areas, if the future nucleic acid sampling is only for high-risk groups and key groups, is it necessary to set up sampling points in each community? If so, what density should be distributed?
The above-mentioned local disease control personnel believe that at present, all localities can only make "limited adjustment" on how many nucleic acid spots should be set and how to adjust the distribution, and then slowly explore in practice and evaluate how many nucleic acid spots to keep according to the demand. Moreover, this will be a dynamic adjustment process. "It may be collected, put it aside, and add it if it is not enough."
How to accurately detect tissue nucleic acid?
At the beginning of the publication of "Article 20", many experts believed that the most "burden reduction" for grass-roots epidemic prevention was to make it clear for the first time that all the people's nucleic acid testing was generally not carried out according to administrative regions, but only when the source of infection and transmission chain were unclear and the community spread for a long time.
Experts pointed out that this adjustment came at the right time. On the one hand, at present, it is difficult for many local governments to support round after round of omnipotent nucleic acids, as evidenced by the recent charging of nucleic acids; On the other hand, with the popularization of standardized nucleic acids in the past, nucleic acid detection in some places has actually fallen into inefficiency or even ineffectiveness.
However, with the recent large-scale cluster epidemic in many places across the country, the prevention and control situation in various places has become increasingly severe and complicated, and a new round of regional full-caliber nucleic acids has been reopened in many places.
Because of the severe epidemic situation, six districts in Guangzhou recently announced the implementation of full-scale nucleic acid testing. 1 65438+1 October 12, Chongqing announced that it would carry out all-staff nucleic acid testing in the central city, and implement "1day1testing" because "the source of infection of the epidemic is unknown, the transmission chain is unclear and the community transmission time is long".
A residential area in Haizhu District was closed. Source/China Economic Weekly Photo: He Yushuai
1 65438+1October 12, Tieli, a county-level city at the southern foot of Xiaoxing 'an Mountains in Heilongjiang Province, found that the initial screening result was positive1person. In order to quickly block the spread of the epidemic and prevent spillover, the epidemic prevention and control headquarters of tieli city decided that from 0: 00 on June 1 13, 2022 to 14, 3 cases of positive cases were found in tieli city, and 2 cases of positive cases were found in.
According to the latest implementation method of nucleic acid detection for epidemic prevention and control in COVID-19, if the transmission chain is not clear, there are many risk sites and risk personnel, and the risk personnel are highly mobile, then all personnel should be tested 1 time a day. After three consecutive nucleic acid tests without social infection, all employees should be tested every three days 1 time. If there is no social infection, you can stop it all. In addition, the scope of all nucleic acids is limited to epidemic areas.
The above-mentioned local disease control personnel pointed out that according to the policy requirements, the premise of not carrying out the total amount of nucleic acid is that the local epidemic transmission chain is clear and can be traced back in time, which is directly related to the local epidemic control ability. But in fact, the levels of epidemic investigation, virus tracking and traceability vary greatly from place to place. For ordinary medium-sized cities, especially some counties that lack the ability to investigate the epidemic situation, it is almost impossible to quickly find out the transmission chain and find the source in a short time in the face of the spread of Omicron. In this way, it is likely that there will be social transmission, more flowers will bloom, and all regional nucleic acids will have to be restarted.
She also pointed out that after the "20 articles" are no longer closely connected, the pressure of grassroots epidemic adjustment can be alleviated to some extent. However, when a large-scale epidemic broke out, more and more newly diagnosed patients and their secret contacts remained a great pressure on the grassroots epidemic adjustment team. "The problem at the grassroots level is not only the lack of people, but also the lack of professional epidemic adjusters."
Shen pointed out that nucleic acid detection is an important means for early detection of epidemic situation and an important prerequisite for assessing epidemic risk and taking timely measures to prevent epidemic spread. All localities should scientifically and accurately organize nucleic acid testing according to the risk of epidemic situation, "neither adding code layer by layer nor randomly reducing code".
The precision of sealing control can be further improved.
Article 20 of the optimization policy, in addition to the restrictions on all nucleic acids, there are two adjustments that have a great impact on the epidemic prevention effect: first, it is no longer necessary to judge the sub-dense junction; The second is to redefine the risk area, cancel the medium risk area and narrow the scope of the high risk area, from residential areas to units and buildings.
The above-mentioned local disease control personnel said that in the delineation of risk areas, it used to be a surface, but now it is a point, and the scope of sealing control is smaller, but the accuracy of sealing control has improved. Disease control personnel should define the risk point according to the action track, living habits and exposure of the diagnosed patients, which requires professional judgment, and the ultimate test is the mobility of the grassroots.
She said: "Recently, when the National Health and Family Planning Commission's supervision team guided the epidemic prevention work in the local area, it was suggested that in the future, the scope of sealing control may be further narrowed, and it will no longer be a unit, or even narrowed to the neighbors of infected people, and only a few households need to be sealed."
It is worth noting that in the Plan for Delineation and Control of Epidemic Risk Areas in COVID-19 newly issued on June 5438+065438+1October 2 1, Article 20 of the conditions for the degradation of high-risk areas were "patched".
The "20" measures stipulate that no new infections have been found for five consecutive days, and the high-risk area will be reduced to a low-risk area. However, the "Program" further clarified that no new infections were found in the high-risk area for five consecutive days, and all the personnel in the high-risk area were negative after completing a round of nucleic acid screening on the fifth day, and they were reduced to low-risk areas. Experts pointed out that this is to prevent some places from being unsealed "across the board", which is equivalent to "installing a valve".
In the "Guidelines for Medical Observation of Home Isolation of COVID-19 Epidemic" issued on June 2 1 65438+1October 21,it is further clarified that the objects of home isolation include the following categories: special people among close contacts, close contacts and outsiders after centralized isolation is lifted, spillover personnel in high-risk areas and other personnel who cannot be subjected to centralized isolation medical observation after professional evaluation.
Since the publication of "Article 20", many people, such as sub-close contact population and overflow population in high-risk areas, have changed from centralized isolation to home isolation, and the pressure of community prevention and control has increased, which has brought challenges to grassroots epidemiological investigation, nucleic acid detection and risk area management. "In the past, few people wanted to be isolated at home, but now they have to stay at home except for close contact." The aforementioned disease control people said with emotion.
A virologist pointed out to China Newsweek that home isolation needs to meet certain conditions, such as having a separate room, not sharing the bathroom and kitchen with people who don't live together, the family area should not be too small, and the family members who live together should not have high-risk groups. The community needs to investigate whether the isolated person meets the conditions of home first, and give detailed education and guidance on the isolated life at home, such as how to kill after using the bathroom and how to avoid contact between family members.
However, the aforementioned CDC revealed that because there are too many people who need to be isolated at home in the short term, it is difficult for the community to have the energy to evaluate all family environments and then classify them. "As far as I know, most people who are isolated at home are materially self-reliant, and many family members are not shy about this during the isolation period."
Another expert close to Beijing CDC told China Newsweek that home isolation puts great pressure on medical staff because they need to go home to do nucleic acid. Many experts suggest that antigen testing can be supplemented during home isolation, and it is required to continuously detect nucleic acids and self-test antigens every day and report the results.
Author: Holsey