Health Times reporter Qiu Yue
On the evening of March 15, the National Health Commission issued the “New Coronavirus Pneumonia Diagnosis and Treatment Plan (Trial Version 9)”. The new version of the diagnosis and treatment plan carefully studies the transmission characteristics and case characteristics of mutant strains such as Delta and Omicron, and on the basis of in-depth analysis of relevant research results, the case discovery and reporting procedures, case classification and admission, release management and discharge standards, etc. Adjusted and optimized.
Liu Lei, director of Shenzhen National Clinical Research Center for Infectious Diseases and secretary of the Party Committee of Shenzhen Third People’s Hospital, said in an interview with a Health Times reporter that these adjustments are based on changes in the epidemic situation and infections. It is the embodiment of scientific anti-epidemic that is adjusted according to the condition of the case.
Antigen test, photo by Xinhua News Agency reporter Ji Chunpeng.
Increase antigen detection to further improve early detection of cases
The new version of the diagnosis and treatment plan has optimized the case discovery and reporting procedures. On the basis of nucleic acid testing, antigen testing has been added as a supplement. Suspected cases or those with positive antigen testing results are required to undergo nucleic acid testing immediately. Or closed-loop transfer to qualified higher-level medical institutions for nucleic acid testing.
According to the “New Coronavirus Antigen Detection Application Plan (Trial)” that has been formulated and issued, the applicable groups of antigen detection are: First, those who go to primary medical and health institutions for treatment, accompanied by symptoms such as respiratory tract and fever And those who have symptoms within 5 days; the second is isolation and observation personnel, including home isolation observation, close contact and sub-close contact, entry isolation observation, people in closed control areas and control areas; the third is community residents who need antigen self-testing.
Liu Lei said that on the one hand, antigen testing provides a new method for the screening of new crown cases, and on the other hand, it is more convenient. Its significance is to screen positive cases earlier and more widely, and to improve the efficiency of diagnosis or exclusion of suspected cases.
“But antigen testing cannot be used as a basis for diagnosis, it is only a means of pre-screening. Because it has false negatives, it may lead to missed tests, so the final diagnosis is still based on nucleic acid The test results shall prevail.” Liu Lei said.
Isolate patients with mild symptoms to avoid running on medical resources
“New Coronary Virus Pneumonia Diagnosis and Treatment Plan (Trial Version 9)” further improved the case classification and admission measures: centralized isolation management is implemented for mild cases, and relevant centralized isolation places cannot simultaneously isolate inbound personnel, close contacts contacts, etc. During the isolation management period, symptomatic treatment and condition monitoring should be done. If the condition worsens, it should be transferred to a designated hospital for treatment.
According to Liu Lei, in the global epidemic of new coronary pneumonia, the main infection is the Omicron strain, and the same is true in China. Especially those infected with Omicron who have been vaccinated against the new crown vaccine are mainly mild and asymptomatic infections, mainly with moderate to low fever, smoke, sore throat, dry throat, nasal congestion, and runny nose. The disease is milder and shorter in duration, and it can be recovered without much treatment, and it is not necessary to be admitted to the hospital for all of it. In this way, more medical resources can be freed up to provide patients with more needs, and a run on medical resources can be avoided.
“For these mildly ill patients, as long as they are isolated and the source of transmission is cut off, this method is both economical and effective, and it is also an important measure for scientific anti-epidemic measures.” Liu Lei said .
In addition, Liu Lei also pointed out that patients with mild symptoms should not be in the same isolation place as inbound personnel and close contacts, in order to avoid cross-infection of cases infected with different strains, and even derive new viruses. strains.
Release isolation and hospital discharge standard adjustment, epidemic prevention is more scientific
“New Coronary Virus Pneumonia Diagnosis and Treatment Plan (Trial Ninth Edition)” revised the criteria for release from isolation and hospital discharge to “two consecutive new coronavirus nucleic acid detection N gene and ORF gene Ct values ≥ 35 or two consecutive negative nucleic acid tests for novel coronavirus. At the same time, after release from isolation management or discharge from hospital, you only need to continue home health monitoring for 7 days instead of the past 14 days.
“The higher the Ct value, the lower the disease load. It turns out that my country adopts the strictest discharge standard in the world, namely Ct
Value ≥40. However, in our clinical work, we found that people with CT values above 35 are not infectious, so this standard was lowered. In addition, the adjustment of home health monitoring for 7 days after the release of isolation or discharge from the hospital has greatly facilitated the common people. said Liu Lei.
However, Liu Lei emphasized that during the 7-day home health monitoring period, the recovered patients must strictly abide by the regulations, cannot go out, and wear masks to avoid repeated indicators and unnecessary transmission.
In addition, the new version of the diagnosis and treatment plan divides the clinical classification of patients with new coronary pneumonia into mild, common, severe, and critical, and there is no “asymptomatic infection” classification. The Health Times reporter checked the original text of the “New Coronary Virus Pneumonia Diagnosis and Treatment Program (Trial Eighth Edition)” and found that there were no “asymptomatic infections” in the clinical classification of this version of the diagnosis and treatment program.
“This classification is completely in line with international standards. In fact, asymptomatic infections are merged into the mild classification, and they are managed ‘equally’ with mild patients, because Asymptomatic infected people are highly contagious like mildly ill patients, and they are more insidious, and the risk of transmission may be greater, so they must not be taken lightly,” Liu Lei said.
