On the evening of December 26, the National Health Commission announced that it would adjust new coronavirus infection from "Category B A control" to "Category B B control" on January 8, 2023. In addition, " new coronavirus pneumonia " would be renamed "new coronavirus infection".
On the other hand, the epidemic situation in the country is becoming increasingly severe, and many places are ushering in the peak of the epidemic.
On December 23, the Health Commission of Qingdao, Shandong Province reported that Qingdao is in the rapid stage before the peak. According to data, the number of new infections in Qingdao per day is 490,000 to 530,000, and will increase at a 10% growth rate on December 24 and 25. Also on the same day on the 23rd, the "Jiangxi Release" WeChat public account announced that the first wave of the epidemic in Jiangxi Province will reach the peak of infection in early January 2023. The epidemic will last for about 3 months, by which time the cumulative infection rate will be close to 80%. In addition, some provinces, such as Anhui, predict that some areas with high population density and large flow of people will reach their peak earlier; some provinces, such as Sichuan, point out that the local area is experiencing a wave of peaks.
Words such as "peak", "climbing peak" and "peak" are frequently used in the media. What is the peak of the epidemic? What factors affect the peak value? In the absence of nucleic acid testing of for all employees, how to statistically predict the scale of infection? What kind of pressure will the upcoming Spring Festival bring?
Public health expert Ning Yi said that "reaching the peak" is not a strict academic concept and has many meanings. The most important factor in "peaking" is the characteristics of virus . Other factors include whether preventive measures are in place, the protection of vaccine , the management of the source of infection, the physical distance of interpersonal communication, the frequency of population movement and other factors. This time the disease epidemic in the northern region is indeed different from previous epidemics. The severity, symptom characteristics and transmissibility of the disease are very different.
He said that after canceling the nucleic acid test for all employees, more emphasis will be placed on "monitoring" to judge the epidemic. By analyzing survey data from medical institutions, monitoring points, and community populations, all aspects of data are integrated to make analysis and comprehensive judgments. Regarding the upcoming Spring Festival travel rush, Ning Yi is worried that "it will intensify the epidemic situation in low-endemic areas, and these areas may be areas where medical resources are in short supply." He said that even if the proportion of personnel movement can be reduced by 10% or 20%, it will be very useful for controlling the spread of the epidemic nationwide.
"How to 'relax' epidemic prevention and control work to better reflect public health technology", mainly to reduce the peak, delay the peak, and stagger the peak. Ning Yi believes that in the current stage of rapid spread of the epidemic, it is necessary to "press the brake" appropriately, "lower the incidence curve" to lower the peak of the first wave and delay the arrival of the peak. He told the Beijing News reporter that not only during the critical period of the peak of the epidemic, but also in the process of the disease epidemic, it is necessary to pay special attention to "prevention", and even strengthen the first line of "prevention" according to the severity of the epidemic, and strengthen protection from individuals to institutions. Even just some detailed improvements can suppress the first wave peak and delay the arrival of the peak. At the same time, taking into account the upcoming festivals, etc., we must also consider peak shifting, break down the peak incidence, and try our best to avoid and reduce medical runs.
The picture shows public health expert Ning Yi. The picture comes from the website of Hainan Medical College
The following is a conversation between the Beijing News and Ning Yi:
The Beijing News: Recently, many places have issued epidemic notices mentioning that the peak of the epidemic is coming. Can you introduce what can be called a "peak" in infectious diseases? What factors influence the peak of virus transmission in a region?
Ning Yi: Strictly speaking, the definition of "Dafeng" is vague. My understanding is that it has different meanings. The first level of meaning is that from the perspective of new positive cases, the number of new positive cases on that day is the highest; the second level of meaning is from the number of sick people, how many people are currently infected (excluding people who have recovered), and the largest number of people are infected at a certain time period; the third level of meaning is that infected people have symptoms and need medical treatment, such as people with severe illness who need to enter ICU, and the cumulative number of hospitalizations and severe cases is the highest at a certain point in time. Medical institutions have different response measures for different situations.
There are many factors that affect the peak value of virus transmission in a region. The most important one is the characteristics of the virus. There are also other factors, such as whether preventive measures are in place, the degree of protection of the vaccine, the management of the source of infection, the physical distance between people, population density, climate temperature, and the frequency of people's interactions, etc. may affect the peak value. For example, gatherings in the north in winter must be held in indoor confined spaces, which will undoubtedly promote the spread of the virus. If we can do a good job of suppressing, delaying and staggering the peak, we can take the initiative to control the epidemic.
Beijing News: Nucleic acid testing is no longer advocated. If positive results are not reported, how can we obtain scientific statistical data? How are infection sizes and peaks calculated?
Ning Yi: We used to have large-scale nucleic acid testing, which was relatively easy to understand the scale and peak of the infection. Now, more emphasis should be placed on monitoring.
conducts monitoring by referring to different data resources. For example, the nucleic acid monitoring results of various groups of people may also investigate the health conditions of some key or representative areas, including remote areas or groups, to understand the current status of the epidemic. At present, there is a shift from individual testing to monitoring the scale of the occurrence and development of the disease and even possible mutations of the virus, and through monitoring to predict the occurrence and development of the epidemic.
surveillance is a methodology of public health epidemiology. The data sources include data from medical institutions, data from monitoring points, and survey data from various groups. It is a basic judgment obtained by integrating all the above data, such as the scale of infection, various peaks and time, etc., and to do a good job in response.
Beijing News: According to public subjective feelings, this wave of epidemic seems to be spreading very fast and the situation is very serious. What are your basic judgments on this epidemic? Why is this happening?
Ning Yi: This epidemic occurred in winter. Cold weather can easily induce various common respiratory diseases. Many disease mortality rates are relatively high in this season. If the new coronavirus is superimposed on many diseases, it will be more serious. Judging from the situation of this epidemic, the transmissibility, pathogenicity, and symptoms of the disease in some areas are very different from those in the past, which requires attention and in-depth study.
Beijing News: What data indicators need special attention during the first wave of peaks? Is there a time difference between the peak of severe illness and death and the peak of infection?
Ning Yi: Judging from the situation of this epidemic, the transmissibility, pathogenicity, and symptoms of the disease in some areas are very different from those in the past. While paying attention to the characteristics of the disease, we must also pay attention to a series of issues, including medical treatment, hospitalization, and severe illness after the disease occurs. Generally speaking, it takes one to three days for symptoms to appear after infection. After the onset of the disease, the disease may get better or get worse. If it gets worse, it may require hospitalization or even worsen to become severe. These require prediction and careful management. From a group perspective, there is a time lag in the infection of different groups of people. For example, medical staff are often the group that faces the first wave of infections. Then, industries that need to deal with many people, such as riders and couriers, will be affected. Finally, it will be transmitted to the elderly group who have less contact with the outside world. The elderly group is often accompanied by underlying diseases, which are more likely to cause severe illness and death.
Beijing News: How do you think we can get through the peak smoothly? Is it necessary to take measures to suppress or delay the first peak?
Ning Yi: There is a professional term in the public health field called "lowering the incidence curve." It is very necessary for us to lower the curve for symptomatic people. When the infection is close to its peak, prevention and control need to be tightened. If we use the analogy of driving, it is more vivid. This kind of control is called "point brake". When the pressure of medical treatment is high and the infection speed is fast, it needs to be appropriately tightened to slow down the epidemic.
Our current situation requires a "branch". Compared with a one-size-fits-all "death prevention", the current epidemic prevention and control actually embodies public health technology.A mature infectious disease prevention and control system is nothing more than "combination of prevention and treatment." In the early days of the Wuhan epidemic in 2020, our focus was on "treatment." Later, we focused on combining prevention and treatment, which effectively controlled the epidemic. In the next two or three years, we pursued "prevention" to the extreme, and now let go and shifted the focus to treatment. However, I think it is necessary to regain the first line of defense of "prevention" and gradually relax.
regaining the first line of "prevention" does not mean returning to the previous blockade, but that the protection from individuals to institutions needs to be further strengthened. For example, if we also wear masks, do we wear masks when entering closed places? For example, hands cannot touch the surface of the mask. Can we strictly abide by these details? From an institutional perspective, can non-essential entertainment venues such as bars, KTVs, and online entertainment venues be opened to a limited extent? Are alcohol disinfectants provided in public places in place, are seats in public places spaced apart, etc.?
In fact, the epidemic prevention and control measures in many countries have been to slow down and then apply the brakes, and to try to ensure that medical resources can deal with the epidemic as calmly as possible. Some dine-in restaurants in Japan have done a better job. There is a transparent curtain between the kitchen staff and diners, or they still maintain separate seats, etc. Don't underestimate these details. Personal and institutional protective measures can slow down the disease to a certain extent.
Beijing News: As the end of the year approaches, the country is about to usher in large-scale population movements such as the Spring Festival. This is the first Spring Festival since the COVID-19 epidemic in which epidemic control is relatively relaxed. What changes do you think the epidemic may undergo during the Spring Festival? Is it possible that new strains may develop?
Ning Yi: With the large-scale population movement during the Spring Festival, the epidemic situation will definitely become more serious. Some places have passed the peak of infection, for example, 70 to 80 percent have been infected. Such areas may be less affected; some places may have lower infection rates and insufficient medical resources. Large-scale population movements will definitely bring about new infection peaks. The mutation of the virus has never stopped, and the speed of population movement will affect the iterative changes of the virus. Large-scale population movement during the Spring Festival is a risk factor.
Beijing News: What preparations do you think can be made for the upcoming Spring Festival travel season?
Ning Yi: Many people may not have gone home to celebrate the New Year in three or more years. It is understandable that they want to go home for reunion. But I think we need to guide through measures or policies and not encourage large-scale movement of people. Even if we can reduce the proportion of people movement by 10% or 20%, it will be very helpful for the control of the national epidemic. During the Spring Festival, reduce the frequency and number of gatherings to visit relatives and friends as much as possible to avoid exacerbating the epidemic and to protect relatives and friends. When the epidemic has completely subsided and stabilized, we will completely return to normalcy.
Beijing News: Judging from foreign experience, what is the trend after each wave of epidemics? Is it possible to form a herd immunity barrier?
Ning Yi: After each round of infection, the infected people can obtain antibody protection to a certain extent, which can prevent the next epidemic. Although the virus continues to mutate over time, and some people may be infected again, the overall chance of infection is getting lower and lower.
In other words, among the people who were infected in the first round, there will be fewer people infected in the second round, and they will gradually reach a stable state. Many countries also experienced very difficult times when they first liberalized. Facing an epidemic that is like a war, how we end this war with the minimum cost actually requires strategic and tactical skills and detailed management.
As for herd immunity , the current virus is very transmissible and the herd immunity barrier is very fragile. It is also difficult to establish herd immunity through vaccines to block the spread. At present, it is difficult to completely block the spread through vaccines like polio , which is difficult to achieve at the moment.
Beijing News: There are reports abroad that the new crown is becoming a "endemic disease". What is an endemic disease? Is this the development trend of the new crown? What do you think?
Ning Yi: "Endemic disease" may refer to local epidemics. Mainland China rarely uses this concept, and Hong Kong will use it more often.The first wave after liberalization was more difficult. Epidemic prevention and control required technical skills and could not be like discharging floods. I think that after this wave of epidemics, if the epidemic spreads again in China, it will only spread in a small area and fluctuate attenuation.
Beijing News: Why has the new coronavirus not disappeared like SARS in 2003? How should we live with COVID-19 in the long term in the future?
Ning Yi: Viruses are far more complex and cunning than we imagined. Why SARS disappeared in 2003 is still a mystery. We expect that the new coronavirus will disappear like SARS in 2003, but it is unlikely from now on. From another perspective, we still have many technological means that we can rely on, such as vaccines and drugs. If more effective vaccines appear in the future, we may be able to control major infectious diseases like smallpox, polio, measles ; or very effective special drugs will appear, and even if the disease occurs, it can be cured quickly and no longer pose a threat. Vaccines are for "prevention" and drugs are for "treatment". We lack effective weapons on both ends of prevention and treatment, but the new coronavirus will always exist with only certain effects. It has many complex characteristics, with certainties and some uncertainties. What we have to do is to always find the balance point between prevention and treatment, actively face and solve problems, and protect people's health.
Beijing News reporter Li Zhao Editor Chen Xiaoshu Proofreading Li Lijun
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