On the night of March 15, 2022, the National Commission of Health and Medicine of China released the "New Plan for the Diagnosis and Treatment of Coronavirus Pneumonia (Trial Version)" (hereinafter referred to as the "Plan"), which caused a wide public outcry.
The director of the National Center for Infectious Disease Medicine and head of the Shanghai Novel Coronary Pneumonia Treatment Expert Group answered a series of questions from Chinese media to clarify the new rules.
QUESTION 1. From the point of view of treatment professionals, what is the most important adjustment in the "Plan"? What impact will the release of the “Plan” have on epidemic prevention and control at a time when the number of cases of infection with the new corona virus has skyrocketed in the country?
Answer: Based on the current deepening of scientific understanding of the new coronavirus disease, the Plan has been seriously adjusted in many aspects. isolation to normal life by shortening the period of isolation is a negative impact.
This includes adjusting nucleic acid detection criteria at discharge, classifying and treating cases, and direct home isolation after discharge, and the time is reduced to 7 days. The clearer the understanding of this disease, the more precise our principles of prevention and control will be.
The change to the standard has significantly reduced the isolation time for the infected, which not only allows the infected to return to normal as quickly as possible, but also avoids wasting medical resources or even running around.
QUESTION 2: The Plan mentioned that central isolation and management of mild cases should be introduced, and central isolation and treatment in designated hospitals are no longer emphasized. How is this related to the mutation trend of the new coronavirus?
What treatment is currently given at the Shanghai Public Health Center for patients with mild symptoms? What are the grounds for refusing centralized treatment in the future, and will there be a risk of disease delay, centralized isolation and cross-contamination?
A: The "plan" for managing mild cases further simplifies treatment by focusing on monitoring the disease. Since the prevalence of Omicron has become the current main strain of infection, patients with Omicron variant strains are mostly asymptomatic infections and mild cases, and the need for clinical specific treatment is greatly reduced and more symptomatic treatment is required.
Thus, in the isolation point, under certain medical conditions, isolation can be completed and the basic medical needs of an infected person can be met. At the same time, it can free up a large amount of medical resources of designated hospitals. The treatment of mild patients in our Shanghai Public Health Center is mainly based on symptomatic and supportive treatment, and at the same time, careful monitoring of the disease is carried out.
In the future, the focus in mild cases will be on centralized isolation rather than designated hospitals, as the proportion of patients with mild disease progressing to severe is very low.
However, for some groups of people who may have disease progression, such as advanced age and comorbidities, professional medical resources will continue to be provided at a centralized new crown isolation facility to provide medical supervision, risk assessment, and treatment of the original underlying disease. . illness. As soon as there is a risk of progression, he can be immediately transferred to the designated hospital.
QUESTION 3: The “plan” changed the isolation and discharge management standards to “two consecutive newly discovered novel coronavirus nucleic acids with N gene and ORF gene Ct values ≥ 35 (fluorescence qPCR method, cut-off value is 40, and sampling time is ≥ 35 ). at least 24 hours apart) or two consecutive negative nucleic acid tests for novel coronavirus (fluorescent quantitative PCR method, cut-off less than 35 and sampling time of at least 24 hours).” Could you explain to us, compared to the previous two negative nucleic acid tests 24 hours apart, what does the change in the new discharge rates mean?
Answer: The change to this standard is to set an earlier and more accurate standard for safe discharge and to aim for patients to emerge from isolation sooner and faster. Our understanding of the Omicron is also gradually deepening.
International studies have identified and carefully confirmed by Chinese experts that when the nucleic acid reaches a certain level, the infectious virus can no longer be detected, so it is practically not contagious.
Thus, our nucleic acid positive evaluation criteria, from more stringent criteria to current international synchronization, have also reduced the standard hospital stay. More patients can be discharged early, greatly reducing the strain on our medical resources. Therefore, this change is of great positive significance.
QUESTION 4: In the Plan, "continue to conduct 14 days of isolation and health monitoring after discharge" was changed to "continue to conduct 7 days of home health monitoring after isolation or discharge." Is the management of discharged patients less stringent due to lack of medical resources, adjustments made due to the high number of infections? Over the past two years, especially recently, how was the management of new cases of coronary pneumonia in Shanghai after discharge? The isolation period is shortening, is there a risk of re-infection and secondary transmission?
Answer: The standard of home health care for 7 days after discharge from the hospital was explained earlier. This is based on medical evidence. This not only allows the infected person to return to normal as soon as possible, but also reduces the economic burden during the isolation period, but also saves the appropriate isolation room and other social resources, which will further improve the ability of the whole society to respond to the epidemic without causing exhaustion. isolation resources.
Based on changes in diagnostic criteria, the likelihood of a repeat positive result after a shortening of the isolation period will be very low; according to our research, even in the case of a repeated positive result, the level of nucleic acids is already very low, and there is practically no secondary transmission. due to repeated positive results.
QUESTION 5: Why doesn't the Plan mention "asymptomatic infected persons"? Doesn't the current high number of asymptomatic infections require treatment?
Answer: Asymptomatic infections are not highly contagious and the disease can still progress, which should be monitored in centralized isolation.
The Diagnosis and Treatment Plan is for cases, and asymptomatic infections are not listed in the Diagnosis and Treatment Plan because they are asymptomatic, but will be specified in the Novel Coronavirus Pneumonia Prevention and Control Plan.
In asymptomatic infections, the risk of infection and disease progression is the same as in very mild cases. Thus, it is equivalent to treating an asymptomatic disease as a mild case. The ninth edition of the "Plan" recommends centralized control of isolation for mild cases.
Symptomatic treatment and monitoring of the condition should be well carried out during the period of isolation management. If his condition worsens, he should be transferred to a designated hospital for treatment.
There is no clear regulation for centralized isolation and management of mild cases, which may be medical facilities or places of isolation such as makeshift hospitals, isolation wards, etc. Centralized isolation management still requires medical personnel to provide necessary symptomatic treatment, such as fever, sore throat, cough and other symptoms.
For those infected in isolation and management, monitoring is more important. Mild and asymptomatic cases may be at an early stage of the disease. As soon as a tendency to deterioration is detected, he should be immediately transferred to a medical institution. specified hospital. Considering that asymptomatic infected and mildly ill patients are still contagious, and at the same time, medical supervision, risk assessment and treatment of other major diseases are required, if there are beds in a medical institution in the region or city, they can still be treated, he was hospitalized in a medical institution for isolated treatment.