Recently, the epidemic situation across the country has shown a multi-point local outbreak and dot-like scattering. To achieve the goal of dynamically clearing in , the epidemic prevention and control situation is not optimistic.
In order to quickly achieve continuous clearance of the social situation, some places have required to go to the edge, take advantage of the situation to chase and outperform the virus, and have also upgraded control measures in the management of discharged patients and discharged personnel. For example, people leaving the cabin are required to implement "7-day centralized isolation + 3-day home health monitoring".
In this way, some people must enter the centralized isolation point when they walk out of the cabin.
So should people out of the cabin be quarantined for another 7 days? What management measures should be implemented? Is there any risk of infection after the infection regains positive?
These issues not only involve the personal rights and interests of those infected with the new coronavirus , but also affect the society's acceptance of those infected with the new coronavirus. Today, Lao Xu will talk to you.
Who was arranged to enter the temporary cabin for isolation, observation and treatment?
In the past three years, my country has explored and formed a complete set of control measures in epidemic prevention and control. Not only has a large number of designated hospitals been identified, but reserve designated hospitals are also required, and centralized isolation points and temporary cabins have played an important role.
In the classification management of various types of personnel, the centralized isolation point is a building and its supporting facilities for people required by relevant regulations such as confirmed cases of new coronary pneumonia, suspected cases, close contacts of asymptomatic infected persons, close contacts of close contacts (close contacts), incoming personnel and high-risk occupational groups, etc.
Standard Cabin Hospital is a building and supporting facilities that quickly, large and concentratedly treat patients with mild COVID-19 and asymptomatic infections.
According to the new coronavirus pneumonia prevention and control plan (Ninth Edition) issued on June 28, for asymptomatic infections, the management of mild cases is carried out in the temporary hospital for 7 days of centralized isolation and medical observation. During the period, nasopharyngeal swabs were collected on the 6th and 7th days of each nucleic acid test (sampling time is at least 24 hours apart). If the Ct values of the N gene and ORF gene were both ≥35 (fluorescence quantitative PCR detection method, limit value is 40), or the test is negative (fluorescence quantitative PCR detection method, limit value is less than 35), centralized isolation and medical observation in the temporary hospital can be lifted; if the above conditions are not met, centralized isolation in the temporary hospital will continue to meet the exit standards.
9th edition prevention and control plan stipulates that the management objects of centralized isolation points, including close contacts, inbound personnel, spillover personnel in high-risk areas, and other personnel should be isolated as required according to prevention and control work.
The management objects of home isolation medical observation include special groups among close contacts, close contacts, spillovers in medium-risk areas and other people who cannot undergo centralized isolation medical observation after being evaluated by professionals.
According to the diagnosis and treatment plan for the novel coronavirus pneumonia issued on March 15 (the ninth edition of the trial), the new coronavirus is divided into mild (the clinical symptoms are mild, no pneumonia is seen in imaging), ordinary (with the above clinical symptoms, and pneumonia is visible in imaging), and severe (adults meet any of the following: 1. Shortness of breath occurs, RR ≥30 times/min; 2. In a resting state, the oxygen saturation is ≤93% when inhaling air; 3. Arterial blood oxygen partial pressure (PaO2)/oxygen concentration (FiO2) ≤300mmHg (1mmHg=0.133kPa); areas with high altitude (altitude exceeding 1,000 meters) should be subject to the following formula. PaO2/FiO2 was corrected:PaO2/FiO2×[760/atmospheric pressure (mmHg)]. 4. Clinical symptoms worsen progressively, and lung imaging showed that 50% of the lesions were significantly progressed within 24-48 hours. Children met any of the following: 1. Continuous high fever for more than 3 days; 2. Shortness of breath (＜2 months, RR ≥60 times/min; 2-12 months, RR ≥50 times/min; 1-5 years, RR ≥40 times/min; ＞5 years, RR ≥30 times/min/ ) , excluding the effects of fever and crying; 3. In the resting state, the oxygen saturation when inhaling air is ≤93%; 4. Assisted breathing (nosal wing fan, three-concave sign); 5. drowsiness , convulsion ; 6. Refusal to eat or feed, and symptoms of dehydration), critical (for one of the following conditions: 1. respiratory failure , and mechanical ventilation is required; 2. shock ; 3. ICU monitoring and treatment is required for other organ failure.)
For isolation management and treatment sites, the ninth edition of the diagnosis and treatment plan is clear and determined based on the condition. For mild cases, centralized isolation management is implemented, and relevant centralized isolation places cannot isolate incoming people, close contacts and other groups at the same time. Symptom-oriented treatment and condition monitoring should be done during the isolation management period. If the condition worsens, you should be transferred to a designated hospital for treatment. Ordinary, severe, critical cases and cases with severe and high-risk factors should be treated in designated hospitals, among which severe and critical cases should be paid for ICU as soon as possible. Patients with high-risk factors and tendency to be paid for ICU treatment should also be paid for ICU treatment.
In summary, those who enter the temporary hospital for isolation and observation and treatment are mild cases of asymptomatic infections and confirmed cases of COVID-19.
Where should people who leave the warehouse go? How to manage it?
According to the ninth edition of the diagnosis and treatment plan, whether it is discharged from the hospital or the warehouse, it is necessary to continue to conduct 7 days of home health monitoring, wear a mask, and live in a well-ventilated single room with conditions to reduce close contact with the family, divide the meals and eat well, do a good job of hand hygiene, and avoid going out.
. Among the applicable objects of "home health monitoring", this plan also clearly states: close contacts and incoming personnel who have completed centralized isolation, discharged (cabin) people infected with COVID-19 and those who need to undergo home health monitoring after being evaluated by professionals. Therefore, the right way is to go home directly to perform 7-day home health monitoring. The same is required in the Ninth Edition prevention and control plan. People with travel history in high-risk areas do not need to undergo "7-day centralized isolation + 3-day home health monitoring".
Is there any risk of re-positivity among new coronavirus infections and confirmed cases?
Of course, we understand that some places have all measures to upgrade and control, with only one purpose: to clear zero as soon as possible, prevent recurrence, and worry about reopening. Therefore, we focus on the two stable lines of rope binding and three words to carry out an upgrade management. But in fact, the results of doing so are not scientific. It not only causes unnecessary harm to the new crown infected person himself, his family, and his friends, but also causes unnecessary social panic, because now, the whole society is very afraid of the new crown infected person.
So, are there any contagious cases of new coronavirus infections and confirmed cases after they are discharged from the hospital (cabin)? What if it regains positive?
As early as August 17, 2020, Zhang Wenhong, director of the Department of Infectious Diseases at Huashan Hospital Affiliated to Fudan University, walked into the Shanghai Trade Union's "May Day Lecture Hall". Zhang Wenhong specifically mentioned a Fuyang patient who came to Shanghai a few days ago.
"This scared everyone very much. I specially checked the patient's medical record the next day. When I saw that he had been negative for more than three consecutive months. This time he was found to be positive in Shanghai, which also shows that the nucleic acid test in Shanghai is extremely serious. The cotton swab is poked very deeply and needs to be scraped a few more times. At this time, some dead virus residues left in it will be scraped out. These nucleic acids are not contagious."
"So I took this opportunity to tell you today that if there is another patient with repository, don't be surprised or not? It doesn't matter!" Zhang Wenhong explained that repository is very common. The positive nucleic acid test is related to sampling at different times. The key is that the isolation time should be long enough. This virus has been isolated for more than 4 weeks. If the immune function is normal, even if the nucleic acid is positive, its infectivity is basically minimal.
Chinese Center for Disease Control and Prevention Chief Epidemiology Expert Wu Zunyou said that some related patients found positive nucleic acid during follow-up after discharge, and there are three possibilities for this phenomenon.
limited research suggests that this patient is not very contagious and no cases of transmission have been observed. For reinfection in the third case, its contagiousness is similar to other patients with first infection. Overall, the proportion of patients who reappeared nucleic acid positive during follow-up is not high, about 5%.
Feng Zijian, deputy director of the Chinese Center for Disease Control and Prevention, said that the re-positive phenomenon is a low-probability event among infected people. Moreover, he said that the re-positive patients found now, whether they are patients or infected, are rare, causing continued transmission.
It is worth noting that not only experts say this, but the Nine-Paper Prevention and Control Plan also has such regulations.
Regarding people who have positive nucleic acid tests after discharge (cabin), the Ninth Edition of the Prevention and Control Plan stipulates that after discharge (cabin), the nucleic acid test of the respiratory specimen is positive. If no symptoms and signs appear and the nucleic acid test Ct value is ≥35, no longer manage and determine close contacts; if there is no risk of nucleic acid test Ct value <35,>Ct value . If there is a risk of transmission, it is managed as the infected person. If there is a frequent contact with close contacts such as living and working together, there is no need to determine close contacts of close contacts; if there is no risk of transmission, no longer manage and determine close contacts.
If there is clinical manifestations such as fever and cough, or if CT imaging shows that the lung lesions are worsened, it should be transferred to a designated medical institution immediately and classified management and treatment should be carried out according to the condition.
If the nucleic acid detection Ct value is ≥35, there is no need to trace or control the close contacts; if the nucleic acid detection Ct value is <35,>
At the same time, the Ninth Edition Prevention and Control Plan also stipulates that confirmed cases and asymptomatic infections in
who have the following situations will not be included in the risk area judgment.
4. People who have positive nucleic acid tests after discharge (cabin) will be investigated and evaluated without any transmission risk.
5. Entering personnel who have tested positive for nucleic acid after being released from isolation and holds certificates for COVID-19 infection within 90 days.
Article 4 indicates that if a person with positive nucleic acid test after discharge (cabin) is not included in the risk area if there is no risk of transmission after investigation and assessment.
expects scientific prevention and control of the whole society, strictly follow the nine-version prevention and control plan and the nine-version diagnosis and treatment plan, and do not raise the "level" of prevention and control to avoid unnecessary harm to infected people and unnecessary panic to society.
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