Delta strain spreads to 17 provinces in China, should we consider long-term coexistence with the virus?

Written by Yu Huanhuan, Chen Guangjing, Fang Shuchen, Chen Xin

When the delta strain came aggressively and quickly spread to 17 provinces, municipalities, and autonomous regions within three weeks, China, which has been pursuing "zeroing", began a fierce confrontation about whether to "coexist with the virus for a long time"

First, on July 31, Zhang Wenhong, an infection doctor at Shanghai Huashan Hospital, posted a Weibo, calling the epidemic a "stress test" and mentioning that "What we have ever had is not the hardest, and what is even more difficult is the need.

In fact, Zhang Wenhong is not the first to mention "experts coexisting with viruses

Earlier this year, Gao Fu, director of the China Centers for Disease Control and Prevention, also said that the new crown epidemic is becoming more and more flu-like, and humans may gradually get used to living peacefully with the virus

For more than a year, we have become accustomed to quickly extinguishing the epidemic and zeroing out local infections through nucleic acid testing of all employees, suspension of production and even closure of the city after a small-scale outbreak

Therefore, when he was on the front line of the fight against the epidemic, Dr.

So some netizens left a message: We can clear, why choose "coexistence"?

The heavier opposition came from the former Minister of Health Gao Qiang.

Feng Zijian, a researcher at the Chinese Center for Disease Control and Prevention, expressed his concern from a technical perspective.

He worries that after the release of control, once the number of infected people increases sharply, it will cause a run on medical resources

The controversy continues

Infectious infection doctor and former vice president of Shanghai Changzheng Hospital, Miao Xiaohui also issued a long article to express his support for Zhang Wenhong.

In a speech in early July, Liu Guoen, a distinguished professor of Peking University's Boya Distinguished Professor and Dean of the Global Health Development Institute, also mentioned that no matter what measures are taken in the anti-epidemic process of various countries, a certain opportunity cost will be incurred

According to the statistics of "Finance and Health", since the current round of the epidemic, only 19 cities that have initiated full-employment testing and all-employment testing in main urban areas have consumed more than 1.

According to Liu Guoen, since the 2020 epidemic, the year-on-year GDP growth rate of various countries has declined to varying degrees.

If the severe illness rate and death rate have dropped significantly, is it necessary to continue regardless of the cost?

A person close to the health care system also revealed tothat related people are also considering that the previous epidemic prevention and control strategy has always been from a medical perspective, and experts in social governance and economics should also be introduced in the future

As the global epidemic enters a new stage, whether China's anti-epidemic policy goals need to be changed is also the time to make a decision

Clearing, coexisting with viruses and flu

In the fierce discussion about whether it is necessary to accept "coexistence with the virus", a concept that is often targeted by opponents is "influenzaization".
Critics often equate it with accepting the new coronavirus in the population like an influenza virus, and then Extends: Don't intervene, fend for itself
.

At the beginning of the epidemic, people had imagined that the new crown would suddenly disappear like SARS, and they had hoped that all countries and regions would be cleared like China
.
Under the assumption that the epidemic can be ended in a short period of time, the new crown is just a encounter
.
During this period, all other factors can temporarily make way for the prevention and control of the new crown
.

"China actually gave a very clear answer in Wuhan, that is to say (clearing) this thing can be done", but "not every country can do this, such as the United States, he did not have it at first.
Any kind of protection came out in many states all of a sudden, and he thought (clearing) was actually very difficult.
” Zhang Hongtao, associate professor of the Pennsylvania School of Medicine, believes that such a difference makes the world miss the window to completely eliminate the new crown virus.
Period
.

After the global pandemic, people hope to rely on vaccines to achieve herd immunity.
Therefore, when a variety of safe and effective vaccines are developed in a short time and can be supplied in large quantities, people once again see the hope of defeating the new crown.
Time-only need to produce and vaccinate enough vaccines, and in the process, protect the unvaccinated people
.

But the prevalence of the delta strain once again shattered this hope.
The effect of multiple vaccines has changed from preventing infection to preventing severe illness.
.
.
Relying on vaccines to resist infection and defeat the virus in a short period of time has once again become a fantasy
.

A recent "New Yorker" article quoted Professor Jesse Bloom, a virologist at the Fred Hutchinson Cancer Research Center in the United States: "The possibility that the new coronavirus will be completely eradicated is zero
.
"

From the current reality, the new coronavirus will not disappear mysteriously like the previous SARS virus.
The current international situation seems to be almost impossible to eradicate with vaccines or other means, and learn to "coexist with the virus".
Become the only possible choice
.

From the point of view of the virus, in the process of continuously infecting the human community and spreading, it gradually becomes low-toxic, and eventually becomes a small trouble similar to frequent visits of influenza viruses
.

So flu is actually the best outcome that humans can get when facing a virus that cannot be eliminated-that is, ordinary people can prevent or recover by relying on their own immunity or flu vaccine, and the rate of severe illness is low.
Causes a medical run, and there is no need for isolation and screening
.

Of course, it may be too early to talk about influenzaization now, considering the characteristics of the current virus alone
.

The case fatality rate of influenza is 0.
1%, and the overall case fatality rate of new coronary pneumonia in the past year and a half is 2.
2%.
However, because the number of confirmed cases of new coronary pneumonia is seriously underestimated, most epidemiologists believe that the current case fatality rate of new coronary pneumonia is 1 % Or so, which is still 10 times that of influenza
.

An infectious disease expert said to the eight-point health news: “The current COVID-19 is very different from influenza
.
It is not seasonal and can also break out during the hottest summer.
From the perspective of transmission efficiency, the current Delta The transmission efficiency of the Ta virus strain has almost surpassed that of the flu; in addition, the morbidity and mortality rates of the new crown are also much higher than that of the flu
.
"

He also added: "Influenza has been circulating for at least 100 years.
With annual vaccination, the population has a wide range of pre-existing immunity.
Pre-existing immunity has played a very important role in blocking the pandemic.
However, the current pre-existing immunity of the new crown is still poor.
too far
" .

But no matter whether it’s the time to become flu, for a virus that cannot be eliminated but is difficult to get rid of, once discovered, the city’s nucleic acid and the city’s closed management are required to be cleared to return to normal.
This is obviously not suitable as a normal state
.

A virologist mentioned to Badian Jianwen: “The current full-staff testing has too many loopholes
.
For example, this time in Yangzhou, there may be scattered detections a month later, so the entire city will not be able to detect them.
Back to normal
.
"

We need to learn to "coexist with viruses", which means that our production and life will not be completely changed because of the existence of a small amount of viruses
.

Accept that even if there are a few positive cases of COVID-19 in the city, the city can operate as usual and people can live as usual, instead of falling into frequent nucleic acid and long lockdowns as long as there are local COVID-19 cases
.

Of course, "coexisting with the virus" does not blindly "do not intervene", but on the basis of an accurate understanding of the medical resources of various regions, and make management plans tailored to local conditions
.

China is at a crossroads

The real problem behind the domestic "flu-ization", "coexistence theory" and "zero tolerance" technology disputes is whether we can find a sustainable one under the reality that the new crown will not disappear in the short term and the high incidence of respiratory infectious diseases is coming.
The best solution that takes into account the health of the people and economic and social life
.

The new crown prevention and control strategy is directly related to the prosperity of import and export trade, transportation, tourism, catering services and consumer manufacturing, as well as the direction of the regional economy
.

Although China is the only major economy to maintain positive economic growth in 2020, Hu Xianchun and others from the China Economic and Social Data Research Center of Tsinghua University analyzed that affected by the epidemic, the accommodation and catering industry, leasing and business service industries will increase in 2020 The value for the whole year is still negative growth of -13.
1% and -5.
3%
.

Different cities have different pressure-bearing capabilities to maintain the zero tolerance goal.
An extreme example is Yunnan Ruili, where the import pressure is relatively high.
There were 5 epidemics, 4 lockdowns, and 5 home quarantines.
Various measures were strict.
Without leaving a little room, medical staff and grassroots workers have been working under high pressure, and even some local residents have difficulty maintaining their livelihoods
.

"China's own embattled time, outside of China it has been," and Zhang Hongtao think, "Now it is clear that the world is divided into two - one side is China, one side is outside of China"
.
But if the experiments in Europe, America and Singapore are successful, and in the context of globalization, if the world chooses to coexist with the virus, then China will not be able to insist on zero tolerance on its own, and it will inevitably connect with the world
.

Moreover, China’s previous zero-tolerance policy goal was based on the expectation of high vaccine protection rates
.
However, the emergence of the delta strain has caused the protection rate of the vaccine to begin to decline
.

Feng Zijian, a researcher at the Chinese Center for Disease Control and Prevention and Secretary-General of the Chinese Preventive Medicine Association, said in an exclusive interview with China News Weekly that China will continue to maintain its existing prevention and control policies in consideration of the actual situation
.
He evaluated the unblocking of the United Kingdom and Singapore’s no longer confirmed cases but focused on strategic adjustments to severe cases.
He believes that “the scale of the epidemic will no longer impose an excessive burden on the medical systems and medical service systems of these countries with high vaccination rates, and will not lead to them.
The medical system is overloaded.
This is the bottom line for them to adjust their anti-epidemic strategies
.
” China’s immunity is not strong enough and medical resources are limited.
“The system redundancy in major hospitals is very limited.
A small increase in the number of patients will put a lot of pressure on hospitals.
At that time, whether we can have a better referral system to relieve the pressure of large hospitals, this is a big question
.
”

However, the prevention and control strategy is not a multiple-choice question of "break the can, lie flat, or clear it at all costs".
There is a huge room for calculation between these two options
.
At present, China is facing the problem of strategic optimization, that is, under the premise of zeroing, how can various costs be reduced to maintain the sustainability of the strategy?

Many experts interviewed by Jianwen at 8:00 believe that China's epidemic prevention and control has the ability to take one step forward
.

An epidemiologist bluntly said, "This is not good city management.
The current strategy is not scientific, because there is no epidemic prevention and control and public health policy to support
.
"

Lu Mengji, a professor at the Institute of Virology at the University of Essen School of Medicine in Germany, also believes that "the current management model is still the same as that of a year ago, and there was not even a vaccine at that time
.
"

All previous short-term strategies are based on public health goals.
If long-term strategies are incorporated into social management and economic factors, there is still room for exploration even under China's zero-clearing strategy
.
In addition to the new crown, economic and social costs and sustainability issues must also be considered
.
An expert close to the National Health Commission told that it is time to take social management costs into consideration for long-term prevention and control strategies
.

If adjustments are not made, "to protect the black hats, the grassroots will only increase the size of the grassroots.
" An official from the local health and health commission who has dealt with the epidemic in a timely manner is very confused
.
Another border epidemic prevention worker even felt "desperate
.
"

Autumn and winter are the seasons for the high incidence of respiratory diseases, coupled with the rapid increase in delta transmission, if the policy inertia is continued and the goal is zero tolerance, cities of all sizes will have to pay a greater price
.

Coexistence with viruses is a technological activity

Compared with the current "clearing" and "suffocating" the virus, "coexisting with the virus" is obviously more difficult and requires more refined management
.

The core of keeping "coexisting with the virus" from becoming a "foster and self-destruction" for residents is to put the diagnosis and treatment pressure caused by the new crown within the diagnosis and treatment capacity of the local medical system
.

Li Tong, chief physician of the Department of Respiratory and Infectious Diseases of Beijing You'an Hospital, also said: “Our main concern is the impact of the epidemic on the medical system.
It may run on medical resources in a short period of time
.
In addition, these patients occupy the ward, occupy the intensive care unit, and it is more difficult for other people to stay in the hospital
.
Then a large number of medical staff are involved.
".
.
.

He mentioned: "The strategy of many countries is to slow down this rate.
As long as the number of infected people who appear every day is within a certain range, and the number of severe cases is within a certain range, the society can accept it and the hospital can afford it
.
"

Lu Mengji mentioned that Germany's judgment on the current degree of prevention and control mainly depends on the capacity of medical services and the vaccination rate
.
At the same time, it will be dynamically adjusted according to the actual situation
.

Germany has made an estimate, "If the contact rate reaches 75%, 85% or 95%, how many deaths will there be, how many severe cases, how many people need to be hospitalized, how many people will be infected? Where do they all happen? Allocate medical resources
.
"

He introduced that the high-level control measures taken by Germany before are suitable models for the absence of vaccines, but the emergence of vaccines has changed the rules and made it possible to relax prevention and control
.
"A country cannot be isolated from the world forever
.
" He said
.

For China, Lu Mengji suggested: "Many places where the economic conditions are not very good and the level of medical services are not very high, you can purposefully expand the medical capacity and increase the possibility of medical services
.
" For example, the treatment of targeted new coronary pneumonia, Specially to train medical staff with sufficient ability and experience, to store relevant materials in a planned way, and also have a plan
.

Li Tong once also put forward suggestions for refined management
.
He believes that China has a vast territory and great differences between regions
.
"Is it possible to appropriately delegate the power to formulate prevention and control strategies to each province or each city, and then each region can have its own consideration
.
"

"For example, in an area where the number of beds in hospitals is small, and the number of beds in intensive care units is small, then the policy will be tighter; areas with abundant medical resources will be slightly looser
.
" Li Tong once cited the political center, or wants For large-scale sports games, the policy may be relatively tight; areas that focus on economic development may be considered to be allowed to bear more cases
.

"Coexistence with the virus" also means a comprehensive change of concepts and elimination of panic about the new crown.
The government manages based on data more rationally and finely, and the public will not run on medical resources due to panic
.

Jin Dongyan, a virologist at the University of Hong Kong, mentioned some countries where medical resources have not been cleared, but medical resources have not been severely run, and the medical system has not collapsed.
"They are actually looking at the average number of infections per million people.
This number is within a controllable range.
Within, it is considered acceptable
.
"

However, such refined measures obviously require more data support
.
"Decision makers should give a feasible and instructive standard and strategy based on the previous situation in various places-how many unrelated infected persons appear, should be tested by the whole city
.
If it is less than one or two, it may be There is no need (full-staff nucleic acid), just need to do the flow adjustment, in this way, the overall cost of prevention and control will be reduced
.
"

Under the goal of dynamic zeroing, there is also room for cost reduction
.
"It is necessary to reduce the total social cost in the process of gradually unblocking risk-free areas.
" The virologist mentioned above suggested that "the strategy needs to be changed, and the clearing of large cities can usually be done within 30 days
.
Middle and high areas can be closed for management.
For about 20 days, if there were no detections of nucleic acid in other urban areas for three consecutive rounds, and after 14 days of closed management, it immediately returned to normal.
In most cases of clearing, the high school risk area islands can be closed for management
.
"

Coexisting with the virus is never a simple slogan, but to find a possible balance in restoring social life, the normal operation of the medical system, and reducing the mortality rate
.

Zhu Xueqi also contributed to this article