1. What is the background for the introduction of the "Overall Plan"?
Since the outbreak of the new coronavirus infection , the Party Central Committee with Comrade Xi Jinping at its core has attached great importance to epidemic prevention and control, comprehensively strengthened centralized and unified leadership of prevention and control work, insisted on putting people first and life first, and dynamically optimized and adjusted according to the current situation. Prevention and control measures have continuously improved the level of scientific and precise prevention and control, and have withstood multiple rounds of impacts of the global epidemic, successfully avoiding the widespread spread of the original strain and delta variant strain with relatively strong pathogenicity in our country, greatly reducing severe illness and death, and also gained valuable time for the development and application of vaccines, drugs, and the preparation of medical and other resources. my country's epidemic prevalence and death toll have remained at the lowest level in the world, people's health has steadily improved, and China's overall economic development and epidemic prevention and control have achieved the best results in the world.
At present, experts at home and abroad generally believe that the general direction of the new coronavirus mutation is lower pathogenicity, more tendency to upper respiratory tract infection and shorter incubation period. The Omicron mutant strain has become the dominant strain in the world. Although a large number of people are infected, its pathogenicity has dropped significantly compared with the early stage, and the disease will gradually evolve into a common respiratory infectious disease. Taking into account factors such as the characteristics of the virus, the epidemic situation, vaccination, medical resource preparation and prevention and control experience, my country has the basic conditions to adjust the new coronavirus infection from "Category B A control" to "Category B B control". The prevention and control of novel coronavirus infection in my country is facing new situations and new tasks, and the prevention and control work has entered a new stage.
2. Why was “ new coronavirus pneumonia ” renamed “new coronavirus infection” in the “Overall Plan”? What are the considerations?
On January 20, 2020, after approval by the State Council, the National Health and Health Commission issued an announcement to include the new coronavirus pneumonia (hereinafter referred to as "COVID-19") as a Class B infectious disease under the "Law of the People's Republic of China on the Prevention and Control of Infectious Diseases", and to adopt prevention and control measures for Class A infectious diseases. It was named "new coronavirus pneumonia" at that time, mainly because most of the early cases of the epidemic had symptoms of pneumonia . After the Omicron variant became the main epidemic strain, its pathogenicity weakened, and only a few cases showed pneumonia. Considering that pneumonia only reflects the more serious illness after viral infection and cannot summarize the clinical characteristics of all infected people, "new coronavirus pneumonia" was renamed "new coronavirus infection" to be more in line with the current disease characteristics and hazards.
3. What is the time schedule for the implementation of “Category B and Pipe B” in the “Overall Plan”? How to make a smooth and orderly transition? How will the work objectives be adjusted after the implementation of "Category B and B Pipeline"?
The "Overall Plan" clearly states that starting from January 8, 2023, "Category B and B Control" will be implemented for new coronavirus infections. According to the Law on the Prevention and Control of Infectious Diseases, isolation measures will no longer be implemented for people infected with the new coronavirus, and close contacts will no longer be determined; high and low risk areas will no longer be delineated; people infected with the new coronavirus will be treated in a hierarchical and classified manner and medical security policies will be adjusted in a timely manner; the testing strategy will be adjusted to "willing to test and test all"; and the frequency and content of epidemic information release will be adjusted. In accordance with the Frontier Health and Quarantine Law, quarantine infectious disease management measures will no longer be implemented for entry personnel and goods.
All localities and departments must be guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, give full play to the advantages of the system, put people first and life first, insist on scientific prevention and precise policy implementation, improve response preparations, adjust prevention and control measures, unify rules, classify guidance, prevent risks, and ensure the smooth and orderly implementation of "Category B and B Management." After the implementation of "Category B and B Control", the prevention and control work goals must focus on "protecting health and preventing serious illness" and take corresponding measures to protect the people's life safety and health to the greatest extent and minimize the impact of the epidemic on economic and social development.
4. After the implementation of "Category B and B Control" for new coronavirus infection, what are the main response measures?
First, we should further increase the vaccination rate of the new coronavirus vaccine among the elderly and promote the second dose of booster immunization among those at high risk of severe illness.The second is to prepare drugs and testing reagents related to the treatment of new coronavirus infection to meet the medication and testing needs of patients. The third is to increase investment in the construction of medical resources, focusing on preparing inpatient beds and critical illness beds. The fourth is to adjust the population testing strategy. Community residents are "willing to be tested as much as possible" as needed, and nucleic acid screening for all members will no longer be carried out. Fifth, patients are treated in hierarchical and classified categories according to the severity of the disease. The sixth is to conduct health surveys and graded services for key community groups, find out the relevant basic diseases and vaccination status of the elderly aged 65 and above in the jurisdiction, and provide classified and graded health services. Seventh, strengthen prevention and control in key institutions such as elderly care institutions, social welfare institutions, hospitals, schools, preschool education institutions, and large enterprises to strictly guard against the risk of clustered epidemics in places. The eighth is to strengthen epidemic prevention and control in rural areas and provide medical protection for high-risk groups such as rural elderly and patients with underlying diseases. The ninth is to strengthen epidemic monitoring and response, study and judge the development trend of the epidemic, and dynamically adopt appropriate measures to restrict gathering activities and personnel movements in accordance with the law to suppress the peak of the epidemic. Ten is to advocate and adhere to personal protective measures and implement the concept that everyone is the first person responsible for their own health. The eleventh is to do a good job in information disclosure, publicity and education, and comprehensively and objectively publicize and interpret the purpose and scientific basis for adjusting the new coronavirus infection from "B Category A Control" to "B Category B Control". The twelfth step is to optimize the management of personnel exchanges between China and foreign countries. Personnel coming to China will undergo nucleic acid testing 48 hours before departure, cancel the nucleic acid testing and centralized isolation of all personnel after entry, and cancel the "Five Ones" and passenger load rate restrictions and other international passenger flight quantity control measures.
5. How does the "Overall Plan" arrange for further promoting the new coronavirus vaccination of the elderly?
Vaccination is one of the important measures for epidemic prevention and control and an effective means to prevent severe illness and reduce deaths. From an individual perspective, it can effectively protect the health and life safety of the elderly; from a society-wide perspective, it can effectively reduce the risk of a run on medical and health resources. After the implementation of "Category B B" for new coronavirus infection, high-risk groups such as the elderly continue to face the risk of infection. The "Overall Plan" once again deploys the vaccination work, requiring further strengthening of organizational mobilization, scientific assessment of vaccination contraindications, and accelerating the increase in vaccine coverage, especially the coverage of the elderly.
6. When strengthening vaccination, what are the requirements for vaccine selection and time interval?
All 13 vaccines currently approved for conditional marketing or emergency use can be used for the second dose of booster immunity, including the 4 new vaccines for emergency use. Priority is given to recommending sequential boosters of immunity , or vaccines containing Omicron strain or having good cross-immunity against Omicron strains. All localities will follow the deployment of the Joint Prevention and Control Mechanism of the State Council, organize and implement it carefully, optimize service forms, and continue to do a good job in vaccinating the elderly against the new coronavirus. People at high risk of infection, people aged 60 and above, people with serious underlying diseases and people with low immunity can receive the second dose of booster vaccination 6 months after completing the first dose of booster immunization.
7. How do medical and health institutions at all levels prepare for the treatment of novel coronavirus infection and testing reagents? How to improve the accessibility of medicines and antigen detection reagents?
Drugs related to novel coronavirus infection are indispensable in the treatment process and are an important guarantee for medical treatment.In order to make preparations for novel coronavirus infection-related treatment drugs and testing reagents and meet the needs of the public, the "Overall Plan" clearly requires that, on the one hand, medical institutions at or above the county level dynamically prepare novel coronavirus infection-related traditional Chinese medicine, anti-new coronavirus small molecule drugs, antipyretics, cough relieving and other symptomatic treatment drugs based on three months of daily use; in accordance with the classification and classification of diagnosis and treatment requirements, serious underlying diseases are not combined For asymptomatic infected persons and mild cases to take care of themselves at home, grassroots medical and health institutions, drug retail institutions, etc. must also make corresponding preparations to ensure the accessibility of drugs. Grassroots medical and health institutions must dynamically prepare traditional Chinese medicines, symptomatic treatment drugs and antigen detection reagents related to new coronavirus infection according to 15-20% of the service population, and increase the number as appropriate in densely populated areas. The joint epidemic prevention and control mechanisms (leading groups and headquarters) in various regions must assume the leadership responsibility for the preparation of pharmaceutical reagents and guide all types of medical and health institutions at all levels to prepare pharmaceuticals and testing reagents. On the other hand, each province must calculate the demand for drugs in advance based on factors such as population base, epidemic development situation, proportion of various types of cases, etc., and provide the calculation results to relevant departments to guide enterprises to actively ensure the supply of drugs, guide reasonable, orderly and accurate delivery, effectively alleviate problems such as difficulty in buying and using drugs for patients, and smoothly pass the peak period of the epidemic.
8. What medical resource preparations are needed to implement the “Category B B Control” for novel coronavirus infection? How do medical institutions at all levels and types provide good medical services?
China’s epidemic prevention and control is facing new situations and new tasks. Preparing medical treatment resources is a "first move" and a "key move". The "Master Plan" requires all localities to increase investment in construction, complete the task of preparing medical resources as soon as possible, and focus on preparing inpatient beds and critical illness beds. The first is to further strengthen the establishment of fever clinics. Fever clinics in secondary hospitals and above "should be set up and opened as much as possible". Qualified grassroots medical and health institutions should all open fever clinics (outpatient clinics), equipped with sufficient medical strength to meet the medical needs of patients. The second is to quickly upgrade and transform qualified mobile cabin hospitals into sub- (quasi-) designated hospitals based on population size in prefecture-level cities and ensure sufficient medical strength. The third is to strengthen the establishment of critical illness beds in designated hospitals. Designated hospitals in provincial capital cities and central cities that play the role of regional medical centers should also set up independent hemodialysis centers, delivery rooms , and pediatric wards to meet the treatment needs of special patients. At the same time, it is necessary to form a multidisciplinary medical team and establish a counterpart guidance relationship with higher-level hospitals to ensure medical quality and safety. The fourth is to require hospitals in secondary hospitals to build and renovate intensive care units according to standards to ensure that each intensive care unit can be used at any time as a useful supplement to the critical medical resources in primary tertiary hospitals. Fifth, tertiary hospitals are required to strengthen the preparation of critical medical resources, rationally allocate critical care forces, ensure that comprehensive ICU care units can be used at any time, and ensure that critical care resources are doubled within 24 hours by building convertible intensive care units. Organize medical staff in advance to carry out professional training in critical care medicine and rapidly expand the strength of the critical care medical team. Establish a working model of mixed grouping of professional medical staff in critical care medicine and other trained medical staff to ensure the orderly development of medical treatment for critically ill patients.
9. Which groups of people need to undergo antigen or nucleic acid testing after the new coronavirus is infected with "Category B"?
The "Master Plan" stipulates that community residents "will be tested as necessary" and nucleic acid screening for all members will no longer be carried out. In order to ensure the testing needs of residents, communities are required to retain a certain number of convenient nucleic acid testing points, and retail pharmacies, online drug sales e-commerce, etc. must provide sufficient supply of antigen testing reagents.
At the same time, considering that medical institutions, elderly care institutions, social welfare institutions and other places where vulnerable people are concentrated, the risk of serious illness is higher for the vulnerable groups. Once the source of infection is introduced, cluster epidemics are prone to occur. Therefore, it is proposed to carry out antigen or nucleic acid testing for the following groups of people: First, carry out antigen or nucleic acid testing for outpatient and emergency patients with fever and respiratory infection symptoms admitted to medical institutions, inpatients with high risk of severe illness, and symptomatic medical staff; second, during the epidemic period, carry out antigen or nucleic acid testing for nursing homes, social welfare institutions, etc. Regular antigen or nucleic acid testing should be carried out for staff and caretakers in places where vulnerable groups gather; third, community residents aged 65 and above, long-term hemodialysis patients, patients with severe diabetes and other community residents at high risk of severe illness For infants and young children aged 3 years and under, if they develop symptoms such as fever, they will be promptly instructed to carry out antigen testing, or go to a convenient nucleic acid testing point set up in the community for nucleic acid testing; fourth, when outsiders enter a gathering place for vulnerable groups, check the negative nucleic acid test certificate within 48 hours and conduct antigen testing on site.
10. How to implement hierarchical and classified diagnosis and treatment? How to ensure that people at high risk of severe illness receive timely treatment?
The "Overall Plan" requires the establishment of a hierarchical diagnosis and treatment system based on the medical consortium. All types of medical institutions within the medical consortium have their own functional positioning to meet the medical needs of patients. Primary medical and health institutions mainly do a good job in population health monitoring and health management , especially for the elderly with underlying diseases and other high-risk groups of severe diseases, and implement hierarchical health services; second-level hospitals within the medical consortium mainly provide technical support to improve primary-level doctors' ability to identify, diagnose and treat high-risk groups, and at the same time do a good job in the diagnosis and treatment of common and frequently-occurring diseases among residents; the leading tertiary hospital in the medical consortium is responsible for the treatment of critical and severe patients, and provides a green channel for the elderly under primary health management when their conditions change and require medical treatment.
While improving the ability to treat severe cases at the grassroots level, it is also necessary to improve the ability of grassroots doctors to identify, diagnose and treat high-risk groups, strengthen the classification and classification of admissions and treatment, and guide local governments to establish a fragmented responsibility system. It requires prefecture-level cities as a unit to establish a fragmented responsibility system for tertiary general hospitals. In accordance with the principle of zoning and coverage, the scope of responsibility is defined for each tertiary general hospital, and the corresponding treatment of elderly severe and critical patients with new coronavirus infection in the designated area is achieved to achieve "full coverage" of the management of elderly severe patients. It should be pointed out that zoning coverage delineates the scope of responsibility and does not mean that it is only responsible for the admission and treatment of patients in the demarcated area. No hospital may use the demarcated area as a reason to shirk or refuse to admit severe patients transferred from other areas. For tertiary hospitals, delineating areas of responsibility is relative, while implementing first-diagnosis responsibility and emergency and critical care systems is absolute. The medical treatment team of the Joint Prevention and Control Mechanism of the State Council will improve the supervision and assessment mechanism for the admission of elderly critically ill patients in tertiary hospitals, establish a "daily reporting" system for the admission of elderly severe patients and -positive patients in tertiary hospitals, and incorporate the admissions into the performance assessment of tertiary public hospitals.
11. The "Overall Plan" clearly specifies which groups of people will be subject to health surveys? How to promote classified and hierarchical health services?
The main purpose is to conduct a thorough survey of the elderly people aged 65 and above, especially those with underlying diseases (including coronary heart disease, stroke, hypertension, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, tumors, immune deficiencies, etc.) and their vaccination status against the new coronavirus. The classification comprehensively considers basic diseases, new coronavirus vaccination status, and post-infection risk levels, etc., and is a standard formulated by experts through comprehensive research and judgment. The first-level service mainly provides health education to the general population and guides the elderly who have not received the booster vaccine to receive the vaccine as soon as possible after being evaluated by a doctor and meeting the vaccination requirements.The second-level service is based on the first-level service. For sub-key groups and asymptomatic or mildly symptomatic infected persons who are treated at home, primary medical and health institutions provide guidance through the Internet, video, telephone, remote or offline methods to carry out antigen testing and health monitoring based on actual conditions, and provide health consultation , medication guidance , etc. If you have persistent high fever, difficulty breathing, or oxygen saturation less than 93%, you should be referred as soon as possible. Primary medical and health institutions will conduct follow-up visits as needed until the home treatment and observation is completed. Communities (villages) assist in the implementation of management of home-based treatment of infected persons, provide guidance and assistance in seeking medical treatment for those who need regular medical treatment, and assist in providing services such as the purchase and delivery of medicines. The third-level service is mainly for key groups. On the basis of the second-level service, for disabled elderly people or elderly people with limited mobility, the treatment method will be decided after evaluation by an expert team determined by the county (city, district) health department or a higher-level hospital. Community (village) and grassroots medical and health institutions will assist in the referral of infected people in key groups and those with urgent medical needs.
12. What provisions does the "Overall Plan" make for epidemic prevention and control in key institutions?
The "Overall Plan" requires that elderly care institutions, social welfare institutions, psychiatric hospitals and other crowded places adopt internal zoning management measures based on facility conditions. When the epidemic is serious, the local party committee and government or the joint prevention and control mechanism shall adopt closed management in a timely manner after scientific assessment and report to the superior authorities to prevent the risk of introduction and spread of the epidemic, promptly discover, treat and manage infected persons, establish and improve the transfer mechanism for infected persons and a green channel mechanism for treatment with medical institutions, transfer and prioritize the treatment of infected persons in institutions as soon as possible, and control clustered epidemics in places. Medical institutions should strengthen personal protection guidance for medical staff and patients, strengthen daily disinfection and ventilation in the premises, and reduce the risk of virus transmission in the premises. Schools, preschool education institutions, large enterprises and other key institutions where people gather should monitor the health of personnel and promptly take measures to reduce interpersonal contact after an epidemic occurs to slow down the development of the epidemic. When the epidemic is serious, key party and government agencies and key industries should in principle require staff to "two points and one line" and establish a personnel rotation mechanism.
13. What requirements does the "Overall Plan" put forward for rural areas to prepare for epidemic response? What are the considerations?
Taking into account the actual situation such as the relatively weak foundation of epidemic prevention and control in rural areas and the relative shortage of medical and health resources, in order to minimize the impact of the epidemic peak on rural areas and protect the life safety and health of rural residents to the greatest extent, the "Overall Plan" regards epidemic prevention and control in rural areas as an important aspect and refines and implements various epidemic response preparations. We will do a good job in educating and guiding rural residents, give full play to the role of the three-level medical and health network at the county, township and village levels, conduct health surveys of key groups, strengthen the allocation of medical resources, and provide sufficient relevant treatment drugs and equipment. Rely on the county medical community to improve the medical support capacity of new coronavirus infection in rural areas, establish convenient channels for medical referral of severe patients, coordinate urban and rural medical resources, establish and improve the counterpart assistance mechanism between general hospitals and county hospitals, and provide medical protection for high-risk groups such as rural elderly and patients with chronic basic diseases. According to the regional epidemic situation and the wishes of residents, the scale and frequency of gathering activities such as rural fairs, temple fairs, and theatrical performances should be appropriately controlled.
14. What requirements does the "Overall Plan" put forward for epidemic monitoring? What issues should be paid attention to during the epidemic response?
In accordance with the requirements of the "Master Plan", after the implementation of the "Category B B Control" for new coronavirus infections, we must continue to dynamically track the mutation of the virus at home and abroad, evaluate the changes in virus transmissibility, pathogenicity, immune escape ability and other characteristics, timely follow up and make judgments and take targeted measures. At the same time, it is necessary to monitor the infection level of the community population, monitor the outbreak situation in key institutions, dynamically grasp the scale, scope, intensity and virus mutation of the epidemic, and study and judge the development trend of the epidemic. In addition, we will continue to rely on the national direct reporting system for infectious diseases to conduct real-time and online monitoring of individual cases of notifiable infectious diseases.During the epidemic response process, we must pay special attention to the real-time and comprehensive assessment of the intensity of the epidemic, the load of medical resources, and social operations, and dynamically adopt appropriate measures to restrict gathering activities and movement of people in accordance with the law to suppress the peak of the epidemic, protect people's life safety and health to the greatest extent, and minimize the impact of the epidemic on economic and social development.
15. What requirements does the "Overall Plan" have for how to be the first person responsible for one's own health?
After the implementation of "Category B and B Control" for new coronavirus infections, individuals are encouraged to continue to maintain good hygiene habits, strengthen personal protection, and seek medical treatment in accordance with the requirements. The "Master Plan" points out that everyone is the first person responsible for their own health. Everyone should continue to adhere to good hygiene habits such as wearing masks and washing hands frequently, maintain interpersonal distance in public places, and complete vaccines and booster immunizations in a timely manner. When the epidemic is serious, the elderly, pregnant women, children, etc. with underlying diseases should try to avoid going to crowded places. Asymptomatic infections and mild cases should implement self-care at home, reduce contact with people they live with, rationally use symptomatic treatment drugs in accordance with relevant guidelines, monitor their health, and go to medical institutions in a timely manner if their condition worsens.
16. What optimizations have been made in the "Overall Plan" to the management of Chinese and foreign personnel exchanges?
In accordance with the requirements of the "Master Plan", firstly, people coming to China should take a nucleic acid test 48 hours before departure. Those with negative results can come to China without applying for a health code from our embassy or consulate abroad. The results will be filled in the customs health declaration card. If tested positive, relevant personnel should wait until they turn negative before coming to China. The second is to cancel the nucleic acid testing and centralized isolation of all personnel after entry. Those whose health declaration is normal and there are no abnormalities in routine quarantine at customs ports can be released into the public. The third is to cancel the "Five Ones" and passenger load factor restrictions and other international passenger flight quantity control measures. Fourth, all airlines will continue to take preventive measures on board the aircraft, and passengers must wear masks when boarding. The fifth is to further optimize arrangements for foreigners coming to China for resumption of work and production, business, study abroad, family visits, reunions, etc., and provide corresponding visa convenience. Gradually resume passenger transport through waterways and land ports. In accordance with the international epidemic situation and various service support capabilities, outbound tourism for Chinese citizens will be resumed in an orderly manner.
Source: National Health Commission official website
