(China Focus Face to Face) How to "run" to win the new crown virus this winter? Zhang Wenhong gives an authoritative answer
China News Agency, Beijing, November 16th. Question: How to "run" to win against the new crown virus this winter? Zhang Wenhong gives an authoritative answer
China News Agency reporter Qian Wei
Right now, the global new crown epidemic is still spreading. Imported cases have been found in many places in China, and small-scale epidemics have occurred locally. How to deal with the spread risk brought by imported cases? Will there be a second wave of epidemics in China this winter? In response to these problems, Zhang Wenhong, director of the Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, accepted an exclusive interview with China News Agency "Focus on China" to give an authoritative interpretation
Excerpts from the interview are as follows:
"Run" to win the new crown virus, how to do it?
China News Agency reporter: Recently, Shanghai Pudong reported a new crown case, which caused concern. Your presence in our studio today means that the scope of the epidemic is limited?
Zhang Wenhong: The case of Shanghai Pudong has aroused public attention, but for our expert team, such an accidental case is expected. Six months ago, we also repeatedly said at the expert group meeting that this epidemic may continue for many years. Not only will it not be stopped this summer, (and) it will spread to the end of the year, or even the next year. Recently, everyone has slowly accepted this view.
China is not a country independent of the world. We are very open to the world. Whether it is importing or exporting goods, as well as various economic transactions, China is one of the centers of world economic activity. Under such circumstances, it is practically impossible to completely eliminate imported epidemics. Some imported cases were not brought in (by) personnel, but came in with cargo logistics. With more and more logistics, this possibility will increase. China's current foreign ports, whether they are land ports or air ports, will face this risk.
In this case, you can only do two things. The first is to sever contact with the world; if you can’t, the second is to (make) adequate plans to deal with the occurrence of such a spreading epidemic. . Once it appears, the plan will start immediately.
The method of the plan is to always "run" in front of the virus. For the first such index case, how was it found? For this reason, the first thing Shanghai did in the first half of this year was to expand the layout of fever clinics and sentinel clinics in Shanghai. We have more than 400 fever clinics and sentinel clinics. A city has such a grid of fever clinics. The establishment of a sensitive fever clinic system will always allow you to find the first-time patients in time.
Many people will ask, what about asymptomatic infected people? When the first patient with a fever is found, it means that there may be multiple asymptomatic infections. This requires us to do the second step, which is to expand the test, center on the fever, and follow up close contacts. In order to be able to "run" to the front of the virus, testing must be further expanded to track close contacts of close contacts. At the same time, with this index case as the core, the detection area must be expanded. As long as these two points are achieved, in fact, it will not "run" behind the virus.
This time, for an isolated case closely related to cargo contact that occurred at the (Shanghai Pudong) airport, to be honest, we have never made a fuss about this incident. For the Shanghai Health Commission, the entire Shanghai hospital system and the disease Control system, this is nothing but another actual combat in our countless exercises.
So far, only a close colleague of this case has also been found to be infected with the virus, and no new cases have been found in other expanded tests. I believe that with further tracking of the virus, this problem should be resolved soon.
China News Service reporter: What is the origin of the Shanghai epidemic? Do you have any new information to share?
Zhang Wenhong: At this stage, it has become extremely difficult for us to find the most primitive origin in the process of the spread of a virus in the world. Similarly, it is meaningless to find out which one of the thousands of goods is. This virus is alive, basically (can survive) about two weeks. Therefore, prevention and control experts must control the spread of the virus during its effective life cycle.
The second point is that since the virus is related to logistics, we must pay more attention to logistics in the future. But with so much logistics coming in, sampling and testing must be sampling testing, not full inspection. Therefore, for future prevention and control strategies, customs sampling is still very important, especially when batches of goods come in. But more importantly, we must have a very good protection strategy. Specifically, first, all customs personnel should be vaccinated to strengthen self-protection. Second, when people receive foreign goods, they must have a handling mechanism, such as spraying the surface of the goods with alcohol, washing hands after unpacking, or not removing the outer packaging.
Also, always follow up closely. In the future, as the world's door is reopened, sporadic cases will gradually become a trend that everyone has to accept. But how to provide maximum protection to healthy people when sporadic cases enter society and pose risks to everyone, this is the main point.
In this case, humans have the wisdom to coexist with viruses. The virus has existed in the world for about 3.8 billion years, and the history of the earth is 4.6 billion years. For the future, we have to learn how to coexist with such a virus, that is, how to reduce the mortality rate of the new crown to a very low level.
Is there a second wave of epidemics? What does it depend on?
China News Agency reporter: Previously, many domestic experts said that there will be no second wave of epidemics in China this winter. However, there have been some scattered cases in various places recently. In view of this new situation, what is your judgment on the epidemic situation this winter?
Zhang Wenhong: There is actually no difference between winter and summer this year. The actual end of the epidemic in China, or the preliminary end, should be on April 8th this year when Wuhan announced its unblocking. Later, one after another appeared, including Beijing, Qingdao, Dalian, Yunnan, and Urumqi, etc. These epidemics did not have a major impact on the country.
The occurrence of sporadic cases in individual areas of China does not mean that other cities must quarantine people from these places. Instead, normal traffic will be granted according to the level of our security code and health code.
The world's epidemic has not ended, and China will always have imported sporadic cases. If the fever diagnosis system of the disease control system is not sensitive enough, this 1 case will change to 2 cases, and 2 cases to 4 cases. When there are 10 cases and 20 cases, the city should really enter a "wartime" state if it cannot be detected.
So the key now is whether we have a good way to deal with these imported epidemics. This is not something that any expert can predict. The final decision on whether this wave of epidemics is or not depends on whether each province and city has the three capabilities of rapid response, precise prevention and control, and dynamic zeroing. If you have these three capabilities, imported epidemics will be included in the management system of the "new normal".
China News Agency reporter: The second wave of epidemics we are talking about refers to large-scale epidemics. Yesterday, Li Bin, deputy director of the National Health Commission, also said at a press conference that this winter he believes that a local cluster of epidemics may occur in my country.
Zhang Wenhong: There are always risks, so Director Li Bin said that such a warning is extremely important. Why is this warning raised at this moment, because with the approach of winter, we will have a huge risk of imported cases.
Now, you ask me if there are (no) cases in Shanghai, and I said yes, there is a local case. You ask where is the Shanghai case? I said you can't find him. Why can't I find him? Because this case is in a closed loop after we are isolated, and there are no (other) cases in the entire society. So this is a "dynamic reset" strategy, which is the essence of our prevention and control this year and even next year.
China News Agency reporter: You summarize the epidemic prevention strategy as "dynamic reset". Can we say that the term "dynamic reset" is the first one you put forward?
Zhang Wenhong: I dare not say that this was the first one I proposed. I just said that, according to China’s existing prevention and control strategy, after a new outbreak in Beijing, I made this point of view. There is an epidemic in Beijing. Let’s not worry about it. Say, we allow individual cases to appear in a small area, but we will control this case in a very short time.
According to China’s current prevention and control capabilities in various regions, we have seen that in several places where the epidemic has occurred (spread), it can basically be cleared within 4 weeks. If there is no special accident in Shanghai this time, I believe it should be cleared within two weeks, and in a sense, it is gone now. Because the discovery of our case belongs to an extremely early case, the earlier it is detected, the shorter the time for dynamic resetting, so that you may not even notice.
China News Agency reporter: You just mentioned a term called "precise prevention and control", but in fact, in dealing with some sporadic epidemics this year, many places have carried out large-scale nucleic acid tests. Will such large-scale nucleic acid testing become a standard practice in future epidemic management? Is it consistent with the "precision prevention and control" you mentioned?
Zhang Wenhong: I think a typical case of precision prevention and control first appeared in the new place in Beijing. When dealing with this matter, Beijing adopted a strategy of precise prevention and control. Because at that time, Beijing's prevention and control areas were divided into zones. Everyone is based on the location of the surrounding patients in the new outbreak, marking it whether it is medium risk or high risk.
If the prevention and control capabilities of this place are very strong, in fact, precise prevention and control can be achieved; to what extent you know your own prevention and control capabilities, what level of precision prevention and control you can achieve. Therefore, for this case in Shanghai, we only coded a village in Pudong, which is a medium-risk area.
The key is to accurately track the contacts of close contacts, and conduct comprehensive testing and isolation of the surrounding environment. We should conduct all staff inspections in the quarantine area. But everyone can't help but cause a problem. What if an individual case comes out and you are not detected? We adopt the second round of "fixed-point removal" to remove close contacts and other areas of activity, which can in fact be grasped.
Is the new crown virus less severe than before?
China News Agency reporter: With the spread of the global epidemic, our subjective feeling now seems to be that there are more and more asymptomatic infections, and there seem to be not so many deaths. So according to your understanding, has the virulence of the new coronavirus and its spreading power changed? Is there any new knowledge about the fatality rate caused by the new coronavirus?
Zhang Wenhong: The cumulative number of confirmed cases of new crowns worldwide (November 9) exceeded 50 million, and the number of deaths reached 1.2 million. However, the rate of increase in the number of cases is not consistent with the rate of increase in deaths, that is to say, worldwide In fact, the fatality rate of new patients in China has actually fallen. On a global scale, there is another data called the weekly case fatality rate. You will see that it has also declined. This can easily give everyone the illusion that the virus is not as poisonous as before.
The fatality rate calculation model is the crux of the problem. Because the diagnostic capabilities in various parts of the world are greatly improving, many asymptomatic people will be tested, and then many asymptomatic infections will be found. In the early stage, our diagnostic ability could not cover asymptomatic people, so in the early stage, the onset of the disease was severe. Among the patients we reported, the fatality rate was naturally higher. Now people who have no symptoms are also tested, and the fatality rate is only It will be very low, which is normal because you are not choosing the same group of people.
Second, who is the population with the highest fatality rate worldwide? Everyone knows it is an elderly person. Therefore, this high-risk group began to do very good self-protection. The case fatality rate of young people is inherently extremely low. The global epidemic is characterized by (mainly) infections of young people after the restart of society, and their case fatality rate is also low.
Third, in the 10 months from January to the present, a large number of new crown rescue supplies worldwide have been continuously replenished. The new crown epidemic is a battle. The better the logistical support, the more successful the battle and the higher the success rate of patient rescue. Therefore, with the enormous abundance of epidemic prevention materials, the fatality rate has been drastically reduced.
Fourth, when you see a phenomenon, you can guess the cause at will. It is often wrong. Just as we saw a sharp drop in the fatality rate today, if you are not in the medical system, it is easy to think that the virus is not as powerful as before.
We should pay more attention to the virus. Let me tell you another piece of data. Recently, the weekly case fatality rate in the UK has started to rise again, because the number of cases is increasing, and there has been a mild medical run. Once there is a medical run, the fatality rate will rise sharply. Therefore, in the past month, Britain, France, and Germany have all started partial lockdowns in order to prevent a run on medical institutions.
Reporter from China News Service: In the early stage of the domestic epidemic, some shortcomings in the infection department and disease control system were exposed. At present, all parts of the country are planning or already strengthening the construction of infectious diseases and disease control systems, but we also know that the disease control system has also been strengthened in the short term, just like after SARS. Long-term idle or weakened again for some other reasons, how can we avoid this problem from happening again today?
Zhang Wenhong: In fact, the social and economic losses caused by new infectious diseases are far beyond your imagination. Now on a global scale, the financial and material losses (caused by) this epidemic should be calculated in trillions.
Looking back, on a global scale, if there is a very good layout of the public health system and a permanent force, this force will (can) "combine peace and war", and respond to the epidemic more quickly. With more precise prevention and control, the final mortality rate will be lower.
In addition to the disease control system, there is also a public health force in the hospital system, which is the infectious disease department. Due to the particularity of the medical system, our army, whose income is often relatively low, is difficult to maintain. After this epidemic, the country has made a series of arrangements to provide regular support to this force, and then train this force through "combination of peace and war."
Reporter from China News Service: According to your observation, which country is doing better in the prevention and control of the epidemic in the world, or has some reference significance for our country?
Zhang Wenhong: We now see Singapore and South Korea. Although there is no guarantee that there will be no local cases, the epidemics are basically controlled at a very low level and can basically be opened internally. The strategies adopted by these countries are in fact very close to those of China.
Their approach is to screen his close contacts after the case is discovered, but the scope of screening has not been expanded. For example, if a confirmed patient is found in a building, colleagues who are in close contact will be screened, but everyone in the entire building will not be screened, nor will all people in the entire building be isolated. Our scope is smaller. However, there is a risk if it is smaller, and there may be "fish that slip through the net". When it is discovered, a second round of tracking and screening will be conducted.
The advantage of this is that the whole society recognizes the low-level epidemic of the virus, adopts prevention and control strategies, maintains a certain social distance, and wears a mask. Even if there is a "fish that slips through the net", it will not cause an outbreak. Therefore, these countries basically cannot hold very large gatherings, but society can maintain normalization for a long time.
We in China are dynamically cleared, basically there are no cases, but once there are cases, we will strictly screen. Our screening scope is slightly enlarged than theirs. What are the benefits? When the relevant cases of confirmed patients are cleared, we can immediately expand our social activities. So now, many large-scale gatherings across the country that properly maintain social distancing have resumed. Including this Shanghai International Import Expo, a large-scale event of more than 1 million people, we have also resumed.
So various prevention and control strategies have their own advantages and disadvantages. What strategy this country should adopt depends on its own circumstances.
China News Agency reporter: Now the global vaccine research and development war is full and the competition is fierce. Compared with the past, the vaccine development time has been greatly shortened. But at the same time, recently (foreign) some vaccines have had adverse events in experiments. In your opinion, is the current global vaccine development speed at an appropriate pace, is it too fast or not fast enough? Why?
Zhang Wenhong: After a new infectious disease comes out, the development of vaccines is all under emergency conditions, and the speed will be accelerated. In 2009, the H1N1 outbreak was in the first half of the year. By October, a new vaccine for influenza was also available. So this time the epidemic has reached today, and all countries in the world are stepping up vaccine research and development, which is also a very important technical reserve for the epidemic (prevention and control).
At the end of this year or early next year, the world will basically start vaccination. Therefore, the speed of research and development is accelerated this time. In the entire history of human infectious diseases, it is only a regular and expedited research and development process, but now the technical force is better than before, so the speed of research and development will be faster. For example, China can produce a large number of inactivated vaccines in a short period of time and enter Phase III clinical studies. In the United States, mRNA vaccines can be made in a very short time, and applications for emergency use can be started.
This shows that our human science and technology is constantly developing, and it will only become faster and more precise at an unimaginable speed. It is precisely because of this that I have strong confidence that the new crown epidemic will eventually be controlled. (Finish)
