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Multiple megacities epidemic prevention "reduction", will relaxation pay a high price?

 Last Update: 2023-01-01
 Source: Internet
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In just five days towards December, several large cities and even provinces in China have successively released the latest epidemic prevention and control measures to jointly transmit the "loose" signal
.

According to incomplete statistics, large cities such as Guangzhou, Chengdu, Beijing, Chongqing, Zhengzhou, Tianjin, Shanghai, Shenzhen, and provinces such as Shandong Province have announced epidemic prevention "code reduction" -

On November 30, the first shots
were fired in Guangzhou and Chongqing.
Many districts in Guangzhou have successively issued notices to immediately lift the control measures of the temporary control area and manage risk according to the low risk
.
On the same day, Chongqing announced the gradual liberalization of the central urban area, and differentiated prevention and control by zoning classification;

On December 1, Chengdu announced that it would no longer show a negative nucleic acid certificate, show the green code of health code, measure body temperature, scan the venue code, and enter other public places and take public transportation such as buses and subways;

On December 2, Beijing announced that from December 5, buses and subways will not refuse passengers without a negative nucleic acid certificate within 48 hours;

On December 4, Shanghai announced that from December 5, it will no longer check the negative nucleic acid certificate when taking public transportation, parks, scenic spots and other outdoor public places.
.
.

Up to now, the five megacities of Chengdu, Guangzhou, Tianjin, Beijing and Chongqing have optimized epidemic prevention and control policies for travel, and some places can pass with a green code without nucleic acid test results
.

Although the "loose" measures reveal a hint of caution, the signals are growing
.

A "soft landing" experiment with relaxed epidemic prevention will be staged
everywhere.

After the rare "relaxing" policy adjustment, the increase in infected people will be an inescapable shock
.
The next thing to be tested is not only the level of urban governance, the response to the level of medical and health care, the efficiency of vaccination of the elderly, but also the exploration
of normal life.

"Loose" next, how do we get along with the new coronavirus? Will it be expensive?

"Small steps don't stop" in the city

The adjustment of epidemic prevention and control measures in various places seems sudden, but in fact there are traces to follow
.

Since the issuance of the "20 Articles", the change of prevention and control policies has extended from "civil" to "official"
.

As early as the last weekend of November, residents of several residential areas in Beijing negotiated with neighborhood committees and neighborhoods under the "20 Articles" to demand the lifting of unreasonable lockdowns, which attracted a lot of attention
after successive successes.

On November 29, at the press conference of the joint prevention and control mechanism of the State Council, the hints of "loosening" began to appear
.
At that press conference, a spokesperson made it clear that the Omicron variant and several of its evolutionary clades are significantly less virulent and virulent than the original and Delta variants
.

Sensitive experts sniff out the signal, which may mean that "eradicating the virus" is no longer the focus of the work, and finding an optimal mode of getting along with the virus under the premise of strengthening the protection of the most vulnerable people will be an important task next
.

On November 30 and December 1, Vice Premier Sun Chunlan held two symposiums on optimizing and improving prevention and control measures, and twice proposed to optimize and improve prevention and control policies
by "taking small steps without stopping".

In the following days, various localities responded quickly and adjusted epidemic prevention and control measures
.
Including but not limited to - lifting control in temporary control areas, adjusting the isolation and judgment rules for close contacts, relaxing the timeliness requirements for nucleic acid testing, no longer requiring nucleic acid testing for some personnel, and no longer checking nucleic acid test results on public transportation
.

Jin Dongyan, a professor of virology at the University of Hong Kong, believes that the intensive adjustment of prevention and control policies in many major cities in China is like a test of the waters, "We are trying to walk in small steps and cross the river
by feeling the stones.
" ”

Taking Hong Kong as an example, it can be considered that the new crown epidemic in Hong Kong has effectively come to an end, and there will be no more tsunamis
.
Although there are still many daily infections in Hong Kong, there are very few cases of severe illness and death, which will not affect people's normal life or social and economic development
.

A number of researchers in the field of public health believe that the current optimization of epidemic prevention and control policies in many places cannot be simply understood as "liberalization", but is adjusted more accurately and scientifically
.

Today, the epidemic situation and the characteristics of the virus have changed, and the previous prevention and control methods are not sustainable, and even caused many secondary disasters
.
The purpose of these measures is to reduce the losses suffered by people in the process of epidemic prevention and control and promote economic and social development
.

The rapid change in urban prevention and control policies has whetted everyone's appetite, but it has also raised concerns among some scholars about whether the next step is ready
.

Some experts have suggested that loose epidemic prevention and control policies will inevitably bring about a continuous increase in infected people, which may bring a lot of social impact, especially to the medical system
.

In the international community, China may have no object to refer to and learn from
.
Thanks to the high-intensity prevention and control strategy of "whack-a-mole" in the early stage of the epidemic, China's infection rate and death toll are at a very low level, protecting people's health
.

But objectively, the rest of the world has experienced a wave of infections and completed high-level vaccination of the most vulnerable groups
.
An immunity gap has formed between China and other countries and regions, and given the fact that the new coronavirus may not be eliminated, it is inevitable that China will experience a major wave of infections
.

However, how to reduce the impact of this round of infection is a big challenge
to social governance capacity and medical and health level.

Eight Points Jianwen noted that many cities are actively promoting the use of
antigen detection reagents.
Jin Dongyan stressed that in the pandemic stage, stopping large-scale nucleic acid testing and actively using antigen testing can effectively slow down and level the peak
of infection.

If you dispel the panic, there will be no medical run

Previously, whenever the epidemic prevention policy was loosened, another must-talk topic was "medical run"
.

Today, fears of a "run" are weakening
in large cities trying to ease the "soft landing" of epidemic prevention.

According to Tao Lina, a vaccine science expert, at present, the policy is mainly to prevent medical crowding at two levels: one is to prevent people from "crowding" medical institutions due to psychological factors, and the other is to reduce the excessive demand for medical treatment due to the epidemic through vaccines, drugs, etc
.

For patients with mild disease, it is necessary to dispel everyone's panic about the new crown epidemic and misperceptions
about the so-called "long-term complications".

Peng Zhiyong, director of the Department of Critical Care Medicine at Zhongnan Hospital of Wuhan University, said, "Contracting the new crown is not terrible
.
If the panic of the people is dispelled, there will be no medical run
.
”

For example, when there are suspected symptoms, the infection cannot be determined or whether it will develop severe disease after infection, then medical institutions should help the public or train a group of responsible community doctors
.

"This will help people respond quickly and reduce the pressure
on health facilities.
" Lu Mengji, a professor at the Institute of Virology at the University of Essen in Germany, told Eight Points Jianwen
.

Lu Jiahai, director of the Key Laboratory of Quality Monitoring and Evaluation of Vaccines and Biological Products of the State Medical Products Administration, reasoned that the next step in scientific and precise prevention and control may be to promote home isolation of infected people or infected people with mild symptoms, while seeking guidance
from medical departments.

In addition, the "long-term complications (long new crown)" of new crown pneumonia, which has been highly concerned, is also a potential cause
of panic and medical run.

After following up with the first batch of new crown pneumonia patients in Hubei, Peng Zhiyong found that most of the patients who had been infected with the new crown, including many elderly patients, had returned to their previous state, "those who should go to work, those who did not go to work after retirement, and those who took their children
at home.
" Some people have some psychological pressure at first, afraid that society will not accept them, but then nothing happens
.
So this thing is not so scary
.
”

In the hospital, the hospital is making some preparations for risk control, such as preparing some anti-epidemic drugs, training and construction for severe diseases, and preparing
beds.

As early as June this year, a large sample data study published in the weekly report of the Chinese Center for Disease Control and Prevention showed that among the 33816 early non-severe Omicron infections between March 22 ~ May 3 this year, a total of 22 people progressed to severe disease, the overall severe disease rate was 0.
065% (22/33816), the severe disease rate in the high-risk group was 0.
238% (22/9260), and the severe disease rate in the non-high-risk group was 0% (0/24556).

According to many epidemiologists, the low rate of severe disease also means that in large cities with abundant medical resources, medical runs are less likely
.

Jin Dongyan expressed optimism
about medical resources in big cities.
"It's not that everyone who has the new crown will be hospitalized and will be seriously ill
.
" Even in the event of a "tsunami" of infection, there are measures to mitigate and smooth out the impact of the surge in the air
.
Let large-scale infections occur over a longer period of time, so that the proportion of severe disease at each point in time is reduced
.

In addition, along with the policy, there is also a change
in the concept of work.

Today, it is very difficult to quickly extinguish the epidemic, and reducing severe illness and death due to new crown infection is the most important task
at present.

"For patients who are really seriously ill with pneumonia caused by the new coronavirus, our intensive care department should be prepared
.
" Peng Zhiyong said, "But for patients admitted to the hospital for other underlying diseases and found to be positive for the new crown, as long as the new crown infection is mild, they should get treatment
for the underlying diseases in the corresponding department.
" ”

He said that the hospital can open a separate area to put these patients together, but don't frighten patients too soon as they find out that they are positive for the new crown, whether they are mild or severe, and transfer them to the ICU
.
"We've suffered a lot in this area before," he said
.
"But if hierarchical management is achieved, then even if the number of new crown patients increases tenfold, it will not cause serious pressure
on the ICU.
"

From the perspective of hospitals, Peng Zhiyong believes that hierarchical management
needs to be strengthened.
In the early days of the new crown epidemic in Shanghai this year, in the official death information, the overall death patients were mostly the elderly, and the deaths of these cases were described as: "The direct cause is the underlying disease
.
" ” Wang Xingpeng, director of the Development Center of Shanghai Shenkang Hospital, explained at the press conference that these basic diseases include: cardiovascular and cerebrovascular diseases, kidney diseases, metabolic diseases, respiratory diseases, nervous system diseases and malignant tumors
.

Some experts have expressed concern that even if there is no run on medical resources, they must be prepared
for pressure in the short term.

Lu Mengji reminded, "Even if the rate of severe disease and mortality decreases, the medical pressure will be relatively obvious
for a period of time.
" ” He said that it can be seen that the current loose "experiments" are in large cities, but if it is applied to some small and medium-sized cities, the lack of medical resources and pressure may be revealed
.

Lu Mengji told Eight Points that if the "20 Rules" management norms can be achieved, coupled with the promotion of immunization, graded and classified diagnosis and treatment, and facing up to the possible severe illness and death, the harm caused by all problems can be minimized
.

Vaccination of the elderly has reached the most urgent moment

Some cities have relaxed epidemic prevention and control measures, and the premise of "soft landing" is to protect the elderly
with underlying medical conditions.

This time, speeding up the vaccination of the elderly against the new crown has reached the most urgent moment
.

On November 29, the joint prevention and control mechanism of the State Council issued the "Work Plan for Strengthening the Vaccination of the Elderly against the New Coronavirus", requiring a variety of measures to accelerate the vaccination rate of people over 80 years old and continue to increase the vaccination rate
of people aged 60 to 79.

Work targets have also been issued for the vaccination of the elderly: by the end of January 2023, the first dose of the new crown virus vaccine vaccination rate for people over 80 years old will reach 90%, and the full vaccination rate and booster immunization rate of eligible target groups will reach 90%; 95%
of eligible target population aged 60-79 years achieved full vaccination and booster immunization coverage.

A number of interviewed experts pointed out to Eight Points that at this stage, the focus of epidemic prevention has clearly shifted from emphasizing nucleic acid testing and zero infection to emphasizing vaccination and medical resource preparation
for the elderly.

However, there are less than two months
left to reach the 90%, 95% target.

Previously, the vaccination rate of the elderly in China was lower than that of the whole age group, and the higher the age of the elderly, the lower
the vaccination rate.

According to data from the National Health Commission, as of November 28, the first vaccination rate of the elderly over 60 years old in China was 90.
68%, the full vaccination rate (two doses of inactivated vaccine or one shot of adenovirus vaccine) was 86.
42%, and the booster vaccination rate was 68.
75%.

The first vaccination rate for the elderly over 80 years old is 76.
6%, the full vaccination rate is 65.
8%, and the booster vaccination rate is about 40%.

The data reveals a worrying reality, with about 25 million people over the age of 60 currently unvaccinated
.

In less than two months, how to increase the first vaccination rate (76.
6%) of the elderly over 80 years old, the full vaccination rate that meets the vaccination interval and the booster vaccination rate to 90%.

It is extremely challenging to perform primary
care.

There is an intersection between the grassroots performers of epidemic prevention and vaccination work
.
During the outbreak in the first half of the year, a number of grassroots workers said that their focus shifted from vaccination to nucleic acid testing, and in some areas even suspended vaccination.

There is also the question
of contraindications to vaccination.
Elderly people with underlying diseases should be given priority to receive the new crown vaccine, but the contraindications screening standards are not completely consistent in various places, and in practice, many medical staff are reluctant to vaccinate
the elderly with underlying diseases.

A grassroots worker once left a message to Eight Points Jianwen, "The elderly have many basic diseases, many people have cancer and stroke, they all think that it is caused by receiving vaccines, and they will require free treatment and compensation from vaccination institutions.

In June this year, the grandparents of vaccine expert Taurina went to receive the adenovirus vector new crown vaccine, and the vaccination site had not previously vaccinated the 90-year-old, and they were not sure
.
Taurina contacted the person in charge of the vaccination site and explained that the elderly could be fully vaccinated
.
After such a toss, the elderly were vaccinated
.

The "Work Plan for Strengthening the New Coronavirus Vaccination of the Elderly" specifically proposes to "guide medical staff to scientifically determine vaccination contraindications", and lists four vaccination contraindications
.
including severe allergic reactions such as anaphylactic shock and laryngeal oedema during previous vaccination; Acute infectious disease in the febrile phase; Due to serious chronic diseases, life has entered the terminal stage, etc
.

Taurina said that strictly speaking, the only contraindications to vaccination are "severe allergic reactions during previous vaccinations", and the remaining three are because of "avoiding suspicion"
.
"After being vaccinated, it is possible to make you think that this is a vaccine by changing your condition
.
"

Zhang Wenhong's team from Huashan Hospital affiliated to Fudan University recently issued an article pointing out that according to their sample study of "hundreds to thousands of patients", in patients with fatty liver, chronic hepatitis, liver cirrhosis, liver tumors, etc.
, the serious adverse events caused by domestic vaccines are 0.

For patients with tumors, patients with only malignant tumors and in the stage of organ failure, vaccination may increase adverse effects, vaccination is recommended with caution
.

"The internal emphasis is strictly forbidden to expand the scope of taboos on their own, and it cannot be decided by the medical staff themselves, but in accordance with national regulations
.
" Medical blogger Zhuang Shilihe told Eight Points Jianwen, "When it is implemented, the state still has to come up with a (supporting policy) to protect medical staff, if there are really any symptoms, although it is basically some coupling syndrome, but he will find trouble with doctors
.
" ”

As of May 30 this year, the country has reported more than 3.
38 billion doses of new crown vaccine, and a total of 238215 cases of adverse events after vaccination have been reported, with an overall reported incidence of 70.
45 per 1 million
.
Adverse effects were reported at a slightly lower
rate than with vaccines routinely administered each year.

On November 30, for the training of the new crown vaccination work for the elderly in the national health system, the CDC proposed three measures to solve the difficulties of vaccination, including "forming vaccination teams to provide door-to-door services"
.

"I used to tell an elderly man with high blood pressure that he could not be vaccinated, and (now) he told people that he could be vaccinated, and the inconsistency will definitely encounter difficulties
in reality.
" Zhuang Shilihe said that it is more important to let the elderly know the benefits of vaccination, and the problem he is worried about does not exist, "Giving eggs and money are useless
.
" ”

Taurina believes that the vaccination team needs a higher level of organization in terms of door-to-door vaccination, "In a situation like my grandparents, it was not originally a refusal to be vaccinated, but the family is afraid of tossing, and if you can provide door-to-door services, the possibility of vaccination is still very large
.
" ”

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