New Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Ninth Edition) (hereinafter referred to as the "program") was released last night. For the first time, light cases do not need to be hospitalized in designated hospitals for treatment, but only need to implement centralized isolation management.
Jiang Rongmang, vice president of Beijing Ditan Hospital and an expert in infectious diseases, said that with the decline in the pathogenicity of the mutated strain, the proportion of asymptomatic and light patients in the new local outbreaks has increased, and this part of the patients do not need to be hospitalized for treatment, and the categorization of the admissions and treatment can liberate the medical resources of the designated hospitals.
The threshold for admission is raised and the threshold for discharge is lowered. Under the new program, patients no longer need to be isolated and managed after discharge, and can return to their daily work and life more quickly.
However, the adjustment of the admission strategy also puts forward new requirements for the construction of isolation points and medical staffing. Experts said that the program will not be implemented overnight, and local conditions should be adapted to promote.
Focus 1: What has been changed in the treatment program? Why change?
Last night, the latest version of the new crown pneumonia treatment program was announced.
Compared with the eighth edition, the new program has been revised in five areas, including optimizing case detection and reporting procedures, proposing case classification and admission, standardizing antiviral treatment, and adjusting discharge criteria.
What has attracted particular attention is the adjustment of the criteria for admission and discharge of cases: it is no longer required that all cases be admitted and treated in designated hospitals, and the threshold for discharge and the requirements for post-discharge isolation and management have also been lowered.
"Light cases of centralized isolation management, ordinary, heavy, critical cases and cases with heavy high-risk factors should be centralized treatment in designated hospitals," this is the new program on the case of the admission criteria for specific expressions, and in the eighth edition of the diagnostic and treatment program, all diagnosed cases should be admitted to designated hospitals.
The National Health Commission said the Program was formed on the basis of careful study of the transmission characteristics of Delta, Omicron and other mutated strains and the characteristics of cases, and in-depth analysis of relevant research results.
"Omicron has reduced its invasion of the lower respiratory tract and weakened its virulence. We have also seen a decrease in the rate of severe disease and an increasing number of light patients in recent local outbreaks. There is no need for this group of patients to be treated at a designated hospital, and categorized admissions can free up medical resources." Jiang Rongmeng, vice president and chief physician of infectious diseases at Beijing Ditan Hospital affiliated with Capital Medical University, explained.
At yesterday's State Council joint prevention and control news conference, Jiao Yahui, director of the Medical Affairs Bureau of the National Health Commission, said that the current round of the epidemic, Jilin Province, as of the morning of March 15, in the hospital cases*** 8201 cases, of which, the main concentration of cases in Jilin and Changchun, the total number of patients with heavy, critical type*** only 6, the ordinary type accounted for about 4% of the total number of patients, and more than 95% of the patients are asymptomatic infected and light cases.
The program noted that those who had been vaccinated and those infected with the Omicron variant strain were predominantly asymptomatic and mild.
Also, some experts believe that the Program takes into account the characteristics and forms of the new virus transmission, and the scientific hierarchical management, which can put effective medical resources more targeted to the treatment of severe cases above, to avoid individual areas of the health care system because of the rapid increase in the number of infected people and overwhelmed, and even the phenomenon of medical squeeze.
Lei Zhengrong, deputy director of the National Health Commission's disease control bureau, said on March 15 that the cumulative number of reported infections in the indigenous outbreak had exceeded 15,000 from March 1 to 14, affecting 28 provinces. The current indigenous aggregated epidemic presents the characteristics of more points, extensive and frequent, the situation of epidemic prevention and control in China is grim and complex, and the difficulty of epidemic prevention and control has increased.
Focus 2: how to determine the diagnosed patients belong to the light type?
Light and heavy placed in different places, but the severity of the disease who to determine? After the release of the news, many netizens on the specific determination and implementation of questions.
The reporter learned that after the nucleic acid positive, the new crown infected people will receive a series of medical examinations such as lung CT, by clinical experts to determine the typing. And the diagnosis and treatment program has specific criteria for case typing.
The light type is "mild clinical symptoms, imaging did not see pneumonia manifestations", ordinary type in the clinical manifestations at the same time, imaging can be seen in pneumonia manifestations; heavy to appear in the resting state of the inhalation of air refers to the oxygen saturation ≤ 93% and other manifestations; critical type of respiratory failure, shock and other conditions.
Jiang Rongmeng introduced, in the light and ordinary type and more serious type of division, mainly to whether the emergence of pneumonia for the separation. Mild patients may show low fever, slight fatigue, smell and taste impairment, etc., without pneumonia. There may also be no obvious clinical symptoms after infection with the novel coronavirus. Those with clinical symptoms mainly show symptoms of upper respiratory tract infection such as low to moderate fever, dry throat, sore throat, nasal congestion and runny nose.
Focus 3: light patients are not hospitalized How to solve the treatment problem?
Web users are also concerned about a question is, when light patients do not enter the hospital, does it mean that this part of the patient does not give treatment and isolation management?
Jiang Rongmeng said, light patients can no longer be sent to the designated hospitals, does not mean that let go, light patients still have to be in the centralized isolation place for centralized isolation management.
According to the program, for light patients, isolation management should be done during the symptomatic treatment and condition monitoring, such as aggravation of the condition, should be transferred to a designated hospital treatment. Therefore, the isolation site will also be equipped with a certain proportion of medical staff to provide the necessary medical services. And also to meet the criteria for lifting the quarantine before lifting the quarantine.
Focus 4: The local epidemic is still developing When will the new program be implemented?
Jiang Rongmeng said the quarantine sites that receive lightweight patients also have to meet a series of regulations. Such as centralized isolation sites to meet the requirements of hospital infection prevention and control, to set up "three areas and two channels" to avoid the occurrence of staff infection; can not be isolated at the same time the entry of other groups of people, such as close contacts; for the generation of medical waste to be handled professionally, and so on.
As a result, localities need to be fully prepared in the construction of isolation points, staffing, management system and other aspects. The new program will not be implemented overnight, and localities will have to adapt to local conditions to promote it.
Focus 5: admission standards increased How to adjust the threshold for discharge?
At the same time as the adjustment of the admission standard, the discharge standard also further reduces the threshold.
The new version of the diagnosis and treatment program will be released from isolation management and discharge criteria in the "two consecutive respiratory specimens nucleic acid test negative (sampling time interval of at least 24 hours)" modified to "two consecutive new coronavirus nucleic acid test N gene and ORF gene Ct value are ≥ 35 (fluorescence quantitative PCR method, the Ct value of the N gene and ORF gene). Fluorescent quantitative PCR method with a cut-off value of 40 and a sampling interval of at least 24 hours), or two consecutive negative novel coronavirus nucleic acid tests (fluorescent quantitative PCR method with a cut-off value of less than 35 and a sampling interval of at least 24 hours)". Revise the phrase "continue isolation management and health status monitoring for 14 days after discharge from the hospital" to "continue home health monitoring for 7 days after release from isolation management or discharge from the hospital".
Jiang Rongmeng introduced this amendment, which means that the new crown patients can shorten the hospitalization time, faster discharge, and further reduce the occupation of medical resources. Patients can be discharged from the hospital home health monitoring, do not have to centralized isolation management, can return to normal work life faster.