On December 9, Academician Zhong Nanshan’s team communicated with the media on multiple topics of public concern, including epidemic prevention and control, medical treatment, vaccination, and self-protection.

On December 9, Academician Zhong Nanshan’s team communicated with the media on multiple topics of public concern, including epidemic prevention and control, medical treatment, vaccination, and self-protection.

When will the peak of this epidemic arrive? If the peak arrives, how to ensure that other non-COVID-19 infected people receive normal treatment? What should asymptomatic infections and patients with mild symptoms pay attention to in home isolation? Under what circumstances should you go to the hospital for medical treatment? How to return to school more safely in the future?

As the Joint Prevention and Control Mechanism of the State Council issued the "New Ten Measures to Further Optimize and Implement Measures for the Prevention and Control of the New Coronavirus Epidemic", topics of public concern such as the new epidemic situation, new characteristics of virus mutations , and new guidelines for prevention, control and treatment need to be answered urgently. On December 9, academician Zhong Nanshan’s team accepted an exclusive interview with the media in Guangzhou and made a series of important interpretations.

Interviewee:

Zhong Nanshan

Medal of the Republic winner, academician of the Chinese Academy of Engineering

Li Yimin

Party Committee Secretary of the First Affiliated Hospital of Guangzhou Medical University Party Committee Secretary, Department of Critical Care Medicine Discipline Leader

Yang Zifeng

Vice President of the Guangzhou Institute of Respiratory Health and Deputy Director of the State Key Laboratory of Respiratory Diseases

Talking about the interpretation of new measures

It is also necessary to prevent but not over-prevent, focusing on the prevention and control of severe cases

Reporter: Academician Zhong, how do you interpret the country’s latest measures to further optimize and implement epidemic prevention and control?

Zhong Nanshan: The introduction of policies relies on correct situation analysis. I believe that the new measures are to prevent, but not to over-prevent, and the focus changes to preventing and controlling severe cases.

Previously, we took strict infection prevention measures because the mortality rate from the wild strain of the new coronavirus to the Alpha strain and the Delta strain was as high as 4.6%, which is quite high. However, the new coronavirus continues to mutate, develop and evolve very rapidly, and its distinctive feature is its strong transmissibility. In the past, the spread of virus and was 1 to 1 and 1 to 4, but Omicron can reach 18 at the highest level.

Another more important feature of Omicron is that its pathogenicity is significantly weakened. We also know the etiological basis of this - the successful invasion of cells by the new coronavirus mainly depends on the interaction between the receptor-binding domain (RBD) of the spike protein (S protein) and the human receptor angiotensin-converting enzyme 2 (ACE2). Nearly 96% of the RBD has been mutated, leaving only 4% unmutated. In other words, the mutation of the virus is close to saturation.

Under the combined effect of these two characteristics, we have seen that there are hundreds of thousands or tens of thousands of people infected in several major cities, but only a few thousand are actually diagnosed, and the mortality rate is even less than 0.1%.

In fact, we have also obtained very important results from animal experiments and the real world. At present, most of the lesions caused by the Omicron strain are in the upper respiratory tract, and pneumonia is rarely diagnosed.

Most people can get better in 5 to 7 days

Zhong Nanshan: It is precisely based on this change in the epidemic situation that we have adopted new measures to prevent and control the highly transmissible and weakened pathogenic new coronavirus: we still need to prevent infection, but the main focus is on preventing and controlling severe cases.

To further optimize measures, what we essentially need to do is precise prevention and control. We also have a lot of elderly people and people with underlying medical conditions. Guangzhou attaches great importance to the prevention and control of eight special places such as nursing homes, and vigorously promotes vaccination to prevent special and vulnerable groups from developing severe or critical illness due to COVID-19 infection.

As for asymptomatic infections and even mild patients, they can be quarantined at home according to the situation. This approach is actually based on the foundation. Currently in Guangzhou, the Omicron strains are mainly BA.4 and BA.5, which have a low morbidity rate. Most of them do not require treatment. As long as they rest, they can get better in 5 to 7 days, and the harm is very small. This approach ensures that medical institutions have sufficient capacity to deal with patients who may become seriously ill.

Here, what I also want to say is that it is of little significance at this stage to do a large number of nucleic acid tests and to find those asymptomatic infections.Where does asymptomatic infection apply? It is suitable for very pathogenic diseases, such as smallpox with a mortality rate of 30%, poliomyelitis, plague, etc., which require strong isolation.

One more thing I want to say is that what we did in the past was completely correct. Otherwise, how could we have the lowest disease rate and lowest death rate in the world? You know, compared with the global average, our mortality rate is only 1/300 to 1/200; compared with the United States, our death rate is only 1/860 of theirs.

Guangzhou is good at “summarizing while doing”

Zhong Nanshan: Guangzhou adheres to the ninth version of the prevention and control plan, implements 20 optimization measures, and 10 further optimization measures. There are some very good practices that ensure the normal social life in Guangzhou.

The Omicron strain is passed from one generation to another in 24 to 48 hours, and the infection is very fast. It has been 9 days since November 30. So far, there have been 8 severe cases and 1 critical case in this round of epidemic, and there has been no significant increase in confirmed patients. This is a good result summarized while working.

Talking about infection response

Pay more attention to keeping distance and reducing public gatherings

Reporter: Academician Zhong, at present, what suggestions do you have for ordinary people in terms of personal protection? What should we do once infected?

Zhong Nanshan: For individuals, we must pay more attention to wearing masks, keeping distance, and reducing public gatherings. Even if you are infected, you can still be quarantined at home unless you have serious underlying diseases.

When isolating at home, family members and neighbors may have concerns. I don’t think it’s terrible. In fact, most people will get better in 5 to 7 days. It is difficult to get infected again after getting better, just like getting another shot of vaccine - of course, I am not encouraging everyone to get this disease. We can’t just consider ourselves, but also consider groups such as the elderly. So we need to strengthen protection.

Don’t be afraid of infection, let alone discriminate against infected people

Zhong Nanshan: People should not be afraid of being infected with the new coronavirus, let alone be discriminated against. Omicron is highly contagious. If your relatives, friends or colleagues are infected with COVID-19, do not treat them as the "god of plague". If you are infected, go home, take a good rest, and take a test. If it comes back negative, go back to work.

We must do a good job in prevention and control to avoid interrupting the work rhythm of hospitals and other places, and to avoid being like some countries where the social and economic order of life is severely affected by the epidemic within a month.

Talking about the treatment of COVID-19

Most people do not need to go to the hospital

Reporter: You just mentioned that the morbidity and mortality rates are already very low. If you are infected with COVID-19, do you still need to go to the hospital? Asymptomatic infections and patients with mild symptoms are now generally quarantined at home. What should they do during home quarantine? What should I pay attention to?

Zhong Nanshan: This depends on the situation. For example, if a person with serious underlying diseases is infected with COVID-19, the underlying diseases will easily become aggravated. At this time, you should observe closely and contact the corresponding medical staff. If your condition changes, you should go to the hospital for treatment.

However, for most people, there is no need to go to the hospital and they can stay at home. There are a few things you should pay attention to at home: First, be sure to wear an N95 mask to minimize the risk of infecting your family members. Second, always use antigen test strips for testing. If you still have symptoms after two or three days, go see a doctor; if the test strips test negative after a few days, ignore it.

If you have persistent fever recently, you must see a doctor

Reporter: What advice do you have for people who have had fever recently?

Zhong Nanshan: Fever is an important manifestation of the upper respiratory tract infection of the new coronavirus. Of course, it may also be influenza. The general rule is that the number of patients with influenza fever in Guangzhou clinics will also increase in winter and spring.

Therefore, at this stage, fever may be caused by COVID-19, influenza, or a rare dual infection of COVID-19 and influenza.

It is recommended that patients pay attention to the duration of fever and how they feel. From a medical point of view, the fever symptoms of Omicron strain infection generally last for 2 to 3 days, and the same is true for influenza. If it lasts for a long time, it is recommended to see a doctor and not to bear it.

Li Yimin: On the one hand, various medical institutions are expanding the capacity of fever clinics to take care of more fever patients; on the other hand, they are strictly implementing measures to keep fever clinics from closing.

As far as I know, in Guangzhou, there will be diversion measures for fever patients. Community Health Service Center and other grassroots medical institutions have also implemented corresponding measures. I personally believe that we have the ability to deal with it.

Hospitals must not be closed

Reporter: Some of the people who are positive for COVID-19 have underlying diseases. How does the hospital help such patients recover as soon as possible? How to ensure that other non-COVID-19 infected people receive normal treatment at the same time?

Li Yimin: For these patients, the first step is to treat their underlying diseases. Antiviral drugs will also be given to some early mild patients. A more common approach is to improve the patient's basic condition, such as ensuring nutrition, ensuring rest, etc. If the patient has a fever and is sweating, they will be asked to take extra fluids. Some patients will experience psychological stress, and designated hospitals have organized special teams to provide psychological counseling to patients.

Zhong Nanshan: In treating COVID-19 infection, it is more important to pay attention to the overall situation. COVID-19 infection is a disease, and other non-COVID-19 infections are also diseases, and they also need to be treated well. Hospitals must not close their doors, and normal patient diagnosis and treatment cannot be stopped just because a patient is infected with COVID-19.

Under such circumstances, I suggest building isolation areas in large hospitals to specifically treat COVID-19 patients with other diseases. In this way, the new coronavirus can be treated, and the patient's other diseases can also receive more targeted treatment.

Li Yimin: We have set up general observation wards and treatment wards last week, including severe and critical illness treatment areas, forming a certain area in the hospital to treat patients with new coronavirus infection and clinical severe disease.

Most severe cases are caused by aggravation of underlying diseases

Reporter: What are the characteristics of severe patients in this round of epidemic in Guangzhou? What targeted measures are taken during the treatment process?

Li Yimin: Judging from the current epidemic in Guangzhou, most severe patients are still aggravated due to underlying diseases, not because of Omicron.

Omicron focuses on attacking the upper respiratory tract and does not directly attack the lungs. It is different from the new coronavirus pneumonia caused by the wild strain and delta strain .

Therefore, for severe and critically ill patients, in addition to providing life support, we also mainly treat basic diseases, such as tumors.

Currently, there are basically no drugs for treating severe cases of COVID-19. Of course, last year we used neutralizing antibody drugs against patients with the Delta strain. The early application effect was very good and it also effectively reduced the occurrence of severe disease. Patients who are prone to severe symptoms will recover faster after treatment.

Talking about medical protection

Regular self-test, if the antigen is negative, feel free to work

Reporter: What should be done to protect special groups and medical personnel?

Zhong Nanshan: For self-protection of medical staff, on the one hand, it is best to wear N95 masks when seeing a doctor in outpatient clinics and other work, and the protection is better;

; On the other hand, regular self-testing of antigen is a good way. As long as it is negative, you can work with confidence;

; Thirdly, there are drugs currently on the market and being tested, such as nasal spray preparations, which have proven to have good protective power.

For hospitals, if medical staff are well protected, they can avoid closing the hospital due to self-isolation after infection. More importantly, the treatment of patients will not be affected.

Li Yimin: In terms of protection for special groups, in addition to wearing masks and reducing gatherings like the general population, it is very important to seek medical treatment and treatment in time if you have underlying diseases.

For example, high blood pressure , diabetes , renal insufficiency, etc. The disease is treatable and medication should be taken on time. You cannot avoid seeking medical treatment or reducing medication by yourself because you are afraid of COVID-19 infection. If you are an elderly person who has not been fully vaccinated or strengthened with vaccination, the protection is weak, and the risk of harm to your health will be higher. Doing these things well is also in line with our current focus on protecting several groups of people who are prone to severe illness.

Talking about vaccination

Elderly people suffering from common chronic diseases are also encouraged to get vaccinated

Reporter: What suggestions do you have for vaccination, especially for the elderly?

Zhong Nanshan: Now we attach great importance to the vaccine strengthening program. In general, our country has done a good job in promoting vaccination of the elderly. However, there are some misunderstandings that elderly people are taboo on vaccinations as long as they have chronic diseases.

In fact, unless there are serious diseases such as organ transplantation, severe rheumatism, heart failure , tumors, etc., which are not suitable for vaccination, the elderly suffering from general chronic diseases should be encouraged to get vaccinated. After the elderly are vaccinated, they have a good preventive effect against severe disease.

The antibodies are gone? The cellular immune function is still there.

Reporter: Many people are worried that the previously administered vaccines will become ineffective over time. What do you think?

Zhong Nanshan: "The so-and-so vaccine is effective, but has serious side effects; the domestic vaccine is not very effective, but it is safe." I have also noticed such remarks.

In fact, some scholars have conducted research and confirmed that no matter what vaccine, three injections have similar protection against severe disease.

In our country, many people are vaccinated with the inactivated vaccine , which is very good from the perspective of immunity . It mobilizes the body from all aspects, not just how much anti-viral antibodies are produced. It has been a long time since the vaccination, and the antibodies are basically gone, but the cellular immune function is still there, so it has a strong protective effect on avoiding severe disease.

We need to strengthen the vaccination and immunity of the elderly and vulnerable groups. From the data provided by the Guangzhou laboratory, it can be seen that the effect of preventing infection will not be enhanced if the same type of vaccine is continued to be immunized, but the effect of preventing severe disease will still exist. However, laboratory data and data from real-world populations show that the effect of using heterogeneous vaccines (subunit protein vaccine/adenovirus vaccine/mRNA vaccine on the basis of two doses of inactivated vaccine) is significantly improved.

Compared with homologous inactivated vaccine immune boosting, heterologous immune boosting induces higher neutralizing antibody levels and enhances the protection against various mutant strains. It is recommended to strengthen vaccine protection for medical personnel (such as nasal spray, inhalation, etc.), and accelerate the development and approval of nasal spray and inhalation vaccines.

Talking about returning to school and resuming classes

There is a higher chance of resuming classes after being fully vaccinated

Reporter: Parents are very concerned about the return to school and class resumption in Guangzhou. Can you give some suggestions to schools, parents and children?

Zhong Nanshan: I think the most important thing is to fully encourage students to be fully vaccinated. If students are fully vaccinated, they will have a greater chance of resuming classes.

In addition, students must undergo frequent antigen tests after returning to school. In addition, it is recommended that schools set up isolation areas. Once infection is discovered after resumption of school, students should immediately go home for isolation. The surrounding children or classes will be tested again. If there are no problems, they can continue to attend classes.

Talking about epidemic prediction

The peak of infection will appear in late January and February next year, and will level off in early March

Reporter: Can you predict when the epidemic will level off?

Yang Zifeng: Using the transmission dynamics model and combining the artificial intelligence algorithm, scientific early warning and prediction of the epidemic can be achieved. After Guangzhou further optimized its epidemic prevention and control measures, the Guangzhou laboratory team teamed up with Guangzhou Medical University, the Provincial and Municipal Centers for Disease Control and Prevention, and Macau University of Science and Technology to study and judge the epidemic development of the Omicron variant.

Based on comprehensive research, first, the model shows that the peak number of daily infections will occur at the end of January and February next year. Based on this, the country also has many peak reduction measures. Second, it is believed that it will enter a relatively stable stage in early to early March.

Internationally, it is generally believed that the seriousness rate of Omicron is one to three thousandths. At present, we have optimized the vaccine strategy to provide an immune barrier for people at risk of severe disease, and at the same time, focused more medical resources on people at risk of severe disease.

If there is a rapid increase in confirmed cases, there are many internationally proven effective peak-suppressing measures, including reducing excessive gatherings and more reasonable medical diversion.We believe that the epidemic will generally level off.

The new measures will further reduce the severe illness rate and mortality rate in Omicron

Reporter: It is predicted that more than 60% of the people will be infected. If a particularly large-scale infection does occur in a short period of time, and the severity and mortality rates increase, will it return to the original state of tightening prevention and control?

Zhong Nanshan: We predict that there will be no large-scale infections in the mainland like Hong Kong at the beginning of this year. First of all, at that time, the vaccination rate for people over 60 years old in Hong Kong did not exceed 20%. Now the proportion of full vaccination has exceeded 60%, so Hong Kong is now in a better situation than before. Some people extrapolated the data from Hong Kong to the whole country and speculated that there would be hundreds of thousands of deaths and hundreds of millions of infections in the mainland. I don't think this inference is correct.

The vaccination rate in the mainland has been increasing, and vaccinations are also being strengthened for the elderly and groups with underlying diseases. These measures will further reduce the severe illness rate and mortality rate in Omicron.

From the beginning to the end, China’s fundamental purpose in fighting the epidemic is “people first, life first.” Moreover, the "New Ten Rules" do not give up on the prevention of infection and severe disease. So I believe this won't happen.

The toxicity of the new coronavirus is likely to weaken in the future

Reporter: Will the pathogenicity of new coronavirus variants in the future increase or decrease?

Zhong Nanshan: Currently, there are two trends in the development of mutant strains. One is XBB and the other is BQ.1.1. XBB has become mainstream in Singapore, with a transmission coefficient as high as 20. The current official news from Singapore is that XBB is more transmissible and less pathogenic, with a mortality rate of only 62% of that of ordinary seasonal influenza.

BQ.1.1 has appeared in some places in the United States, but the situation is still unclear. But I discussed with experts who specialize in etiology and virus evolution, and what they said is this: the evolutionary development trend of the new coronavirus is that the toxicity is likely to weaken. We should also think about response measures in accordance with the most important and common laws and trends, rather than thinking about what to do once it is strengthened.

There is a high probability that Omicron will not be reinfected

Reporter: People are worried about reinfection. What do you think?

Zhong Nanshan: According to data from Qatar , after being infected with Omicron, 78% of people will not be re-infected for a long period of time. According to data from Denmark on tens of thousands of people, 98% of people infected with Omicron can avoid a second Omicron infection. So in this sense, if you are asymptomatic or have mild symptoms after being infected with Omicron, it is actually equivalent to getting a vaccine.

Talking about drug reserve

There is no need to stockpile drugs. "New uses of old drugs" must undergo rigorous experiments

Reporter: Many ordinary people are currently stocking up on drugs, including , ursodeoxycholic acid, and other "old drugs, new uses" that are still in the academic discussion stage. News about "new uses of old drugs" have also attracted attention. What do you think about the necessity of stocking up on medicine?

Zhong Nanshan: Regarding "new uses of old drugs", scientific research is needed. In particular, many patients recover on their own after being infected with Omicron, so whether the drugs are useful or useless requires strict observation.

China’s drug and vaccine research is no slower than abroad, but why are we a few months behind? Because there are very few patients in China, most clinical trials of drugs and vaccines are completed abroad. Under such difficult circumstances, some domestic drug research is progressing.

As for whether it is necessary to stock up on medicines, I don’t think it is necessary. As I just said, the vast majority of patients can get better on their own, but hoarding medicine can cause panic. The same should be true for traditional Chinese medicine. Traditional Chinese medicine now plays a lot of roles, and strict double-blind comparative experiments need to be done to see whether it is effective and whether it can quickly reduce the viral load of and . You cannot rely on impressions.