On December 17, 2020, in Tokyo, Japan, street electronic placards remind people to pay attention to epidemic prevention measures Picture/People's vision. Bloomberg has launched the COVID-19 resilience list since November 2021, using 11 indicators including vaccination rate, infec

December 17, 2020, Tokyo, Japan, street electronic placards remind people to pay attention to epidemic prevention measures Picture/People's visual

In the process of opening up of epidemic prevention policies of countries around the world, trust and cooperation are the most important factors. Opening up is not just an action, but also a process of going through repeated callbacks and and pain in the policy.

This article was first published in Southern People Weekly

article / Southern People Weekly reporter Yang Nan

editor / Li Zimiao lishenmiao1989@126.com

COVID-19 resilience

Bloomberg has launched the COVID-19 resilience list since November 2021 (Covid Resilience Ranking, using 11 indicators including the vaccine vaccination rate, infection rate, mortality rate, lockdown, universal health care coverage, GDP prediction, etc., to analyze 53 countries with an economic volume of more than US$200 billion before the outbreak of the new crown epidemic through the "maximum-minimum standard", to capture how , the world's largest economy, handled the COVID-19 crisis while controlling social and economic damage.

The rankings of most countries on this list fluctuate drastically. The epidemic prevention curve of the United States is a large M-shaped shape, Vietnam is a fat U-shaped shape, and France is a fold-fold wavy line. In two years, Asia-Pacific countries such as South Korea, Singapore, , New Zealand, and Australia have better epidemic prevention strategies and effects.

Professor Zhang Hui of the Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, summarized the anti-epidemic strategies of other countries outside China into three categories: First, a large number of people and poor areas have adopted a real "laying strategy" to complete the herd immunity with a mortality rate of about 1.5%; the second is the Flatten the curve adopted by most Western countries, with the main means to enhance medical (vaccine and drug) capabilities and reduce population contact (public policy for epidemic prevention). Different efforts are used to suppress the total number of infected people in society who needed medical assistance at that time, and try to control it within the medical capacity to avoid medical runs and reduce the humanitarian disaster. The third category of

was described by Zhang Hui as "staying up and down", mainly in Asia-Pacific countries such as Singapore, Vietnam, Japan, South Korea, Australia, and New Zealand. They adopted a policy of strictly preventing and defending the zeroing policy in the first half of the fight against the epidemic, and quickly changed the policy in the later stage and changed it to the intermediate policies of the above two categories: moving towards national immunity with flexible policies.

COVID-19 Resilience List ended on June 28, 2022. Bloomberg said that after two years of fluctuations, most countries have become stable in fighting the epidemic. "All the best performing countries have implemented strategies that most countries in the world have accepted: accepting the fact that the virus will continue to exist, actively vaccinate the most vulnerable groups, and try to restore economic and social activities to 2019 levels."

Bloomberg data tracking revealed some of the determinants of countries around the world in fighting the epidemic. The best performers are wealthy countries, who are able to supply vaccines and arrange later work such as injections. On this list, three countries have never fallen to the lower half of the rankings: the UAE, Canada and , Finland , all of which are wealthy countries with low population density. The second is the degree of social trust and social cohesion, which are the decisive factors that different governments can effectively mobilize their citizens at different stages: more people in countries such as Singapore have always followed the mask order and social restrictions, and a large number of people are actively vaccinated. "The new crown era has left a clear lesson that countries with strong social trust and social cohesion are most likely to survive a crisis of this scale," concluded Bloomberg. From this perspective, although the United States and the United Kingdom are wealthy and have top scientific powers – they play an important role in developing vaccines and sell them to countries around the world – the two countries rank among the best in the developed countries. In the final ranking of the COVID-19 resilience list, Britain and the United States ranked 22nd and 36th.

July 12, 2022, Sydney , Australian Prime Minister Anthony Albanese is preparing to receive his fourth dose of COVID-19 vaccine at Adore compound preparation pharmacy Photo/ Visual China

The most commonly used Australian epidemic prevention experience in the United States is compared with itself: they are all English-speaking countries and their population structure is quite similar, but Australia's COVID-19 mortality rate is only one-tenth of that in the United States. Intuitively, Australia restricted interpersonal communication and travel before the popularization of vaccines, carried out regional blockades in the country many times, and once closed its borders and state borders. When vigorously promoting vaccines, the most vulnerable groups were given priority and then gradually opened up. Although Australia has also increased the number of deaths due to irregular epidemic prevention in nursing homes or the lack of tightening of controls when the Omickron mutant strain spreads.

But in the eyes of some American intellectuals, what is more important is the trust of Australians in science and institutions, as well as their trust in each other. According to the Australian Bureau of Statistics survey, 76% of Australians said they trust the health system (compared to about 34% for Americans); 93% of Australians reported that they could get support from outside their families in the event of a crisis. At this point, the authoritative survey of global values ​​WVS shows that Australians rank very high on the option “most people can trust”.

The Lancet published a survey of 177 countries around the world on February 1, 2022, and found that among the factors affecting the infection rate and mortality of the new crown, trust is more important than smoking rate, medical expenditure or government forms. It is a key factor in allowing people to reduce their activities, wear masks and get vaccinated, thereby more effectively controlling the spread of the virus. Repeated callbacks to the

policy

Singapore is one of the earliest countries in the world to propose a route of coexistence, and its government is also one of the most trusted governments in the world. At the end of May 2021, Singapore Prime Minister Lee Hsien Loong first explained that Singapore would turn to coexist with the new coronavirus, and the public responded in a mixed manner.

At the same time, Bloomberg added a category of open progress to the COVID-19 resilience list, using air traffic volume, travel restrictions, vaccination rate and lockdown as indicators. "As of early 2021, eliminating local virus transmission through lockdowns is one of the best results. But as more and more places can use vaccines to limit severe illness and death, and being able to safely make progress in lifting restrictions on social and commercial activities (including global travel) is an important manifestation of recovery from the epidemic."

March 26, 2022, Singapore, citizens wearing masks, travel Photo/Visual China

Singapore's opening roadmap shows that they have decided to take small steps towards opening up. Britain and the United States were the first to open in mid-2021, but the death toll in both countries did not drop significantly due to failure to achieve the ideal vaccination rate. The number of deaths in the United States before and after the promotion of the vaccine is almost consistent, which is believed to be the price of severe political differences hindering vaccination.

After Lee Hsien Loong explained at the end of May 2021 that Singapore would turn to coexist with the new coronavirus, in mid-June, Singapore relaxed its epidemic prevention policies with a vaccination rate of 35%, entering the third stage of "high vigilance and liberalization". Less than a month after that, Singapore pulled back to the second phase of "high alert opening" under the pressure of rapid increase in infection rates, and took another half a month to increase the vaccination rate from 48% to 65%. On August 6, Singapore announced that it would officially embark on the road of "covid resilience". On October 9, Lee Hsien Loong said in his national speech that Singapore must adhere to a coexistence strategy, and the next few months will be the key.

Another important shift in Singapore's epidemic prevention policy is to allow eligible confirmed COVID-19 patients to recuperate and recover at home. Starting from September 15, 2021, confirmed patients under the age of 50 who have completed two vaccinations, as well as children over the age of 5 who have completed two vaccinations, but asymptomatic or mild symptoms, can recuperate at home after being evaluated by the hospital. Singapore has added ventilators to its community medical system and requires patients to wear monitoring bracelets as required to ensure that they do not leave the designated room during home rehabilitation.If you violate the quarantine order, you will be fined 10,000 SGD or 6 months in prison, or both.

From June 2021 to the end of the year, Singapore's epidemic prevention policy has been several times, either because of concerns about the impact of the delta mutant strain on the medical system's tolerance, or because of the surge in infections caused by the Omickron mutant strain. Such cautious repeated adjustments to policies have also been criticized. Associate Professor and Health Policy Expert Jeremy Lim, National University of Singapore , believes that politicians should not wait for the perfect conditions to open up, because the world will never be perfect. But the Singapore government insists on using the vaccination rate as a key condition for whether to relax: Only when the vaccination rate of two shots reaches 80%, will Singapore carefully lift the lockdown.

labor pain

South Korea's long-term performance on the Bloomberg COVID-19 resilience list is very high, but compared with Singapore, South Korea's process of opening up is slightly passive.

Before 2022, South Korea's 3T strategy - "test, epidemiological investigation and isolation treatment (Test, Trace and Treat)" - is considered a successful example of the response to the new crown epidemic. When the Omickron mutant strain spread in South Korea, South Korea tightened social restrictions, allowed only gatherings of less than four people, and imposed a curfew after 9 p.m. on businesses and other public places. However, this restriction has little effect. Before Omickron, South Korea, which has a population of nearly 52 million, has never more than 7,849 new confirmed cases of new crown every day. However, since January 24, 2022, South Korea's daily increase has continued to exceed 10,000, and began to increase by more than 100,000 per day.

South Korea began its policy shift in early February 2022. South Korea's Minister of Health and Welfare Kwon De-chol said that South Korea must make more effective use of limited resources and focus on protecting critically ill patients and reducing deaths. Since Omickron could overwhelm the public health system, the 3T strategy is unsustainable and even meaningless. Starting from February 9, South Korea will relax the isolation regulations for confirmed cases and their close contacts with , allowing infected people to be treated at home. General home-based treatments with mild symptoms and asymptomatic treatments shall be managed by themselves, but must be isolated for 7 days in accordance with regulations. Government management is carried out for home treatment patients over 60 years old and over 50 years old who suffer from underlying diseases. South Korea has invested 650 medical institutions to manage patients at home: for proportional doctors and full-time nurses, 1-2 phone calls are made to confirm the patient's status every day, and home treatment instruments such as oxygen saturation measuring instruments are distributed. As South Korea has rolled out an application for tracking cases and mandatory quarantine, the majority of the 60,000 staff arranged by the government to turn to help vulnerable people who are at home treatment, including providing medicines, answering calls, etc.

Although the South Korean government continues to communicate with the people, informing them that the policy shift is inevitable and that resources must be used to care for the most vulnerable populations, the shift has triggered brief riots in South Korea. According to reports from South Korean media and media such as " New York Times ", " Wall Street Journal ", many Korean respondents are uneasy about the sudden loss of the government's strict virus prevention and control measures. They kept complaining that they lacked some medical necessities, such as thermometers, hand sanitizers, oxygen meters, , etc., and felt as if they were abandoned. South Korea took two months to complete the transition from sending every new coronavirus infection to only sending vulnerable people to hospital. intensive care units in various places have always maintained empty beds to deal with emergencies.

"In the process of transitioning from pandemic to endemic diseases, it is necessary to experience huge storms." said Sun Ying, senior health official of the Disaster Management Office of the Ministry of Health and Welfare, South Korea. After the

policy shifted, South Korea's confirmed COVID-19 patients quickly increased by more than 300,000 per day in March. However, as South Korea's adult vaccination rate exceeds 96%, the damage of the Omickron mutant strain was reduced to a low point. The overall mortality rate for Omickron is 0.18%, but for those under the age of 60, Omickron brings nearly 0%. Overall, South Korea has always been one of the countries with the lowest COVID-19 death rate in the world, about one-tenth of that in the UK and the United States.

After completing the public policy shift, South Korea accelerated the development of local vaccines and drugs at the end of March to better provide continuous vaccination and help elderly people recover.

Monica Gandhi, professor of infectious diseases at the University of California, San Francisco, once predicted that South Korea will become the first country to downgrade the COVID-19 pandemic to endemic diseases, based on South Korea's highest adult vaccination rate, high national trust in the public health system, and the right route to get out of the epidemic.

On April 25, 2022, after nearly five months of Omickron, South Korea lowered the infectious disease level of the new coronavirus from Class A to Class B, and comprehensively promoted the work of epidemic prevention and medical system restoration. At this point, South Korea's new coronavirus infections are no longer required to be quarantined at home, hospitals no longer need to report positive cases immediately, and the national health care system will no longer pay full treatment costs. Patients infected with the new coronavirus, like patients with other diseases, must pay some of their medical expenses themselves, but the vaccine continues to be free.

Although the number of confirmed cases announced daily in South Korea still fluctuates: it increased by more than 100,000 in mid-August, and after the decline, it still increased by more than 10,000 per day, and has continued to rise since mid-October, but the number of hospitalizations and deaths in South Korea has always remained at a low level. The process of opening up of

will inevitably be accompanied by pain. For Singapore, it is to deal with the Delta mutant strain, and for South Korea, it is to deal with the Omickron mutant strain. For India, their hastily opened up with insufficient vaccines and the Delta mutant strain entering the country, which brought about a fatal tragedy. From mid-April to the end of May 2021, India's death toll exceeded 140,000: the virus overwhelmed the medical system and millions were at a loss. It should be noted that because there is no large-scale national testing and a complete reporting system, the new crown data released by India is considered to be far lower than the reality.

On May 30, 2021, Indian Amritsar , people received new coronavirus test Photo/People's Vision

India experienced the third round of infection peak brought by Omickron in February 2022. After just over a month, the number of new infections per day dropped to less than 10,000 for three consecutive days - this was the level before Omickron's rapid spread - India began to gradually lift restrictions, including lifting curfews, opening up restaurants, cinemas, game halls and other places, allowing intercity mobility, etc. The Indian government said that the decline in cases and the milder damage to the human body by Omickron are the reasons that prompted India to gradually return to normal.

In this regard, a study led by Padmanabha Shenoy, a well-known immunology expert in India pointed out that Omickron has little impact on India because more than 70% of Indians have been infected with the Delta mutant strain, and because more than 80% of Indian adults have been vaccinated, the antibody level brought by this mixed immunity is 30 times higher than that of people who receive two shots of vaccines. The view of "hybrid immune wall" is widely accepted in India. Another Indian virologist, Gagandeep Kang, believes that this is India's advantage, which means that the possibility of large-scale national infections in India in the future is very low, at most, there are sporadic outbreaks and surges in local cases.

United States Council on Foreign Relations Global Health Senior Researcher Huang Yanzhong pointed out that India's total reliance on natural immunity is a very unique situation. But he communicated with Indian scholars and learned that India had overcome the pain and returned to normal.

On November 21, 2022, the Indian government issued an announcement stating that due to the "continuous decline of the development trajectory of the new crown, and the significant increase in the coverage rate of the new crown vaccine in the world and India itself", India has canceled all mandatory entry requirements related to the new crown, and the Omickron epidemic has entered the final stage.

As for Singapore, one and a half years after the first announcement of the blueprint for coexistence, it truly regarded the new crown as a common epidemic on November 7, 2022, and no longer specifically responded: the number of new new crown cases will no longer be announced, and the seven-day average will be converted; beds will no longer be reserved for new crown patients. Whether it is other Asia-Pacific countries or European and American countries, no government promises to deal with the new coronavirus has completely ended: these countries say that they will still adjust their prevention and control policies at any time according to the fluctuations in the epidemic.

We are and the upcoming

2. In early November 2022, the number of positive COVID-19 infections in my country increased sharply.An expert who has been involved in the prevention and control of the new crown epidemic for a long time and has supported the epidemic prevention work in multiple cities told Southern People Weekly that the winter of 2022 is very important to China. He judged at the time that through various measures, the curve should be flattened as much as possible and the winter of 2022 will be passed through slow mass infection, and China will truly enter the final stage of the new crown epidemic.

On November 11, the State Council’s Joint Prevention and Control Mechanism announced the “Twenty” measures to further optimize epidemic prevention and control.

On November 29, the State Council’s Joint Prevention and Control Mechanism issued the “Work Plan for Strengthening the Vaccination of the New Coronavirus for the Elderly”, which is considered a key step towards opening up. The plan adheres to the principle of "receiving all those who should be received", adheres to the government's leadership, departments' linkage, implements local responsibilities, accurately surveys, optimizes services, accelerates the increase in the vaccination rate of people over 80 years old, and continues to increase the vaccination rate of people aged 60-79 years old.

On December 7, the "New Ten Articles" of " Notice on Further Optimizing and Implementing the Prevention and Control Measures for the New Coronavirus Pneumonia Epidemic" was issued. Asymptomatic infections in and mild cases were encouraged to be treated at home and no longer track close contacts. The notice requires the acceleration of the promotion of COVID-19 vaccination for the elderly, and the health status of the elderly who suffer from cardiovascular and cerebrovascular diseases , COPD , diabetes , chronic kidney disease , tumors, immune function defects and other diseases, and provide health services in a graded and classified manner. On the same day, the "Plan for Graded Diagnosis and Treatment of New Coronavirus Pneumonia with Medical Alliances as a Carrier" was issued, aiming to ensure timely treatment of infected people with high risk of severe illness such as elderly people with high risk of severe illness, minimize the severe illness rate and mortality rate, ensure normal medical services, and build a more scientific and orderly medical treatment order.

In an interview with Southern People Weekly, many medical experts believe that this winter will have a great challenge to the medical system, and the next one to two months will be a pain period for different cities across the country.

"An important consideration in deciding whether to adjust the prevention and control policy is whether to endure this pain period and bear the consequences of the pain. From the perspective of the "New Ten Articles", for the long-term consideration, China is ready to deal with the consequences of this pain." Huang Yanzhong said in an interview with the media.

An expert in the Department of Infectious Disease Department of Shanghai Grade A Hospital who did not want to be named emphasized that the first infection was the middle-aged and young people, and in one to two weeks, it may affect vulnerable groups such as the elderly and patients with underlying diseases. We must avoid large-scale infections of vulnerable people and avoid a large number of severe patients, resulting in runs of medical resources and rescue resources, and then affect all patients who need treatment.

Director of the Department of Infectious Diseases of Zhongshan Hospital Affiliated to Fudan University and Director of the Department of Infectious Diseases of Hospitals Professor Hu Bijie gave a speech entitled "How medical institutions can scientifically respond to the Omickron epidemic" to Shanghai medical staff in early December. He analyzed using theoretical models that with the characteristics of the Omickron mutant strain, without any prevention and control measures, the virus spreads one generation in 3 days, and R0 ( basic infection number ) is 10. In theory, more than 20 million people may be infected in just 18 days. If the prevention and control can be done appropriately, R0 will be reduced to 5, and the virus will be transmitted for one generation in 3 days, and it will take one month to infect more than 20 million people; if the prevention and control measures are done better, R0 will be reduced to 3, and this cycle will be extended to two months. As R0 decreases, the infection cycle will be extended.

Take Shanghai as an example, Zhang Wenhong believes that Shanghai will reach the peak of social infection within 3 or 4 weeks, and will gradually emerge from this wave of epidemic in 3 months. Extending the infection cycle of the entire vulnerable population can alleviate or avoid the serious consequences of runs in medical resources. Based on this, Zhang Wenhong's team recently wrote an article calling for the purpose of doing everything possible to delay the infection time of the elderly and minimize the number of elderly infected people at the peak of the first wave of the epidemic. "Even if it is only delayed by 1-2 months, the entire society's vaccine immune barrier will be stronger, and medical resources will be more sufficient and calm after the peak of the first wave of the epidemic, and the elderly in nursing homes will be more abundant after the outbreak." The article wrote.

For any country, trust and collaboration are the key to getting out of the shadow of the new crown epidemic. "After walking in the long anti-epidemic tunnel for 3 years, we are about to walk out of the tunnel. The air, sunshine, and free travel are all waiting for us.But in the last journey, we need mobilization from the whole society. The new coronavirus is not a disease targeting individuals, but a test of each family. It is a test of our society. We need every member of each family to take action, be the person in charge of their own health, and be the guardian of the elderly in the family, to support and protect them. ”