The author of this article: Zhang Zuofeng
Shanghai announced a new round of nucleic acid screening work in the city on March 27, and Pudong and Puxi will be closed for 4 days respectively.
This measure should be a game of chess for the whole country. The epidemic prevention in Shanghai is exploring a new way of domestic epidemic prevention. The prevention and control team in Shanghai has a strong sense of scientific epidemic prevention and can explore a new way of epidemic prevention suitable for Shanghai.
Considering that Omicron is highly contagious and Shanghai is a metropolis with a concentrated population, new ideas and methods can be considered for the new crown control method, I personally suggest:
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Self-sampling instead of group cluster sampling (the rapid detection kits for pathogens have been started);
Home isolation instead of centralized isolation for close contacts and mild patients (I discuss the rationale for the recommendation below);
Use effective vaccines to protect the elderly and high-risk groups and children, and reduce the number of moderate and severe patients;
Effective drugs should be used to strengthen the treatment of patients (it is recommended that the combination of Pfizer’s new coronavirus treatment drug nematevir tablets/ritonavir tablets, which has been urgently approved in my country, is packaged with Paxlovid for early infection. Timely treatment) to reduce the fatality rate and mortality rate of the new crown, turn the new crown pandemic into an endemic disease as a phased goal, and effectively protect the health of the population.
In this article, I will analyze the trend of the Shanghai epidemic, the new crown vaccine, home isolation, medical system capacity, self-testing and timely treatment.
The trend of the epidemic in Shanghai
From February 9th to December 15th last year, Shanghai had an average of less than five cases per day, which was at a stable low level.
Cases have been on the rise since December 15 last year, reaching an average of 30 cases per day on January 14 this year. This year, it started to decline on January 15, dropped to 9 cases per day by February 16, and then rose again to 36 cases per day on March 26.
There are two caveats here.
First, the cases mentioned so far are only confirmed cases of new coronary pneumonia, and do not include asymptomatic or mildly symptomatic new coronary infections. If you include this batch of new crown infections, according to Shanghai 98% are asymptomatic infections, you can divide the number of cases by 0.02. For example, the average daily number of new crown infections on March 26 is estimated to be 36/0.02=1600 cases.
Second, the decline that started on January 15th to the low point on February 16th was during the Shanghai Two Sessions and the Spring Festival.
Lilac Garden, Dr. Lilac Epidemic Map
Considering the very high proportion of asymptomatic infected persons (98%), we borrowed the recent information from Shanghai CDC “woman” Wu Fan (Note: Vice Dean of Shanghai Medical College of Fudan University). A paragraph: “The number of infections in Shanghai will continue to increase in the short term, which is in line with our expectations. The previous number of cases is only the tip of the iceberg.”
This is in line with my basic judgment. Because Shanghai’s data is relatively reliable, according to Shanghai’s data, it should be more credible.
The measures announced yesterday for the closure of Pudong and Puxi districts, coupled with the nucleic acid screening, may shift the peak of the incidence and infection to a stable level, and may also decrease to a certain extent. .
But if the community infection under the iceberg is not identified (perhaps impossible), the new crown epidemic will return, one after another.
Therefore, only an effective herd immunity barrier can be established to effectively reduce the harm of the virus. There is an old saying in China, it is better to go to the salary when the soup stops boiling. Nucleic acid testing and quarantine can cut off possible sources of infection, but the use of specific vaccines is the strongest way to get rid of wages.
COVID-19 vaccine
The most recent large sample study included more than 20,000 cases, half Delta, half Omicron, and more than 40,000 people without COVID-19.
The results of this nearly 70,000-person study showed that the three-dose vaccine protected 67% of infections in Omicron and 93.5% of infections in Delta. It shows that the vaccine still has a certain protective effect on the prevention of new crowns.
U.S. CDC results show that people who don’t get vaccinated are 20 times more likely to die from COVID-19 than those who get two doses. According to the data just released in Hong Kong, the protection rate of three injections of Sinovac for severe illness and death of the new crown for the elderly over 60 years old is 97.9% (the table below), so it is recommended that Shanghai elderly who have completed two doses of Sinovac receive a booster vaccine.
At present, Shanghai has completed 55.49 million doses of the new crown vaccine, and the number of people who have completed the whole process of vaccination has reached 22.42 million, covering 95.1% of the city’s resident population, and 10.63 million people have received booster vaccinations. Needle.
Under the current high vaccination rate in Shanghai, the masses are encouraged to get the third shot, and at the same time, the vaccination rate and booster rate of the elderly high-risk groups are increased, and the protection against severe illness and death is already available. It is possible to consider home isolation for close contacts and asymptomatic infections.
The vaccination rate of the elderly in China is relatively low, which may be because some domestic inactivated vaccines are not included in the phase III clinical trials of the elderly, and some only have a small sample of the elderly. Therefore, when applying the results of the Phase III clinical trial to the elderly, there are many contraindications, resulting in some elderly people with chronic diseases not being able to be vaccinated in time.
This is also what I have been calling for fast approval of the 100 million doses of Fosun Pharma that Shanghai Fosun Pharma has ordered for the mRNA vaccine for Fubitx (Pfizer) to protect the elderly and children.
Phase 3 clinical trials of the Fubitx vaccine have included a significant proportion of the elderly and children, as well as people with chronic diseases. Therefore, there are relatively few contraindications, and it can be used to urgently protect the elderly and children over five years old who cannot be vaccinated due to contraindications. Protect these two groups of people well, and the society will open up smoothly.
Vaccines definitely have certain adverse reactions, but after weighing the pros and cons, if vaccination can save lives, you can still consider vaccination. Vaccination still has a significant protective effect on preventing death from new coronary disease.
Of course, not everyone can adapt to the vaccine, and people with immune system deficiencies and people prone to hypersensitivity reactions are not. Therefore, these people need to strengthen their protection from the virus.
Isolation at home
In order to reduce the burden on the medical system and avoid the collapse of the medical system, I suggest that close contacts, asymptomatic and mild patients should be isolated at home instead of centralized isolation. Moderate and severe patients should be hospitalized and treated in isolation.
The beds in the shelter are open and the distance between the beds is small. If the shelter is used to isolate close contacts (there may be positive patients), it may cause an outbreak in the shelter .
If the shelter is used to isolate new crown-positive patients (asymptomatic or mild patients), it may also lead to mixed infection of patients with different mutant strains of the new coronavirus, making it a hotbed for further mutation of the new coronavirus . So I recommend home isolation for close and light patients.
Let the infected person choose whether to be in a cabin or quarantine at home according to the specific situation at home. The necessary conditions for home quarantine include:
Have clear rules and requirements, and have standard home self-isolation protocols.
Each self-isolated person is provided with a oximeter and cough and phlegm relief, as well as oral medication for early treatment.
Have smooth channels to communicate with doctors and epidemic prevention personnel at any time. Once the condition worsens and the blood oxygen saturation is less than 90, you should go to the hospital immediately.
It is recommended to establish oxygen supply centers in various communities, so that patients with hypoxia can supply oxygen in time. If home isolation is considered, the centralized isolation method that causes cross-infection can be greatly reduced or eliminated, which is desirable from the perspective of public safety and health and social and economic development.
Health System Sustainability
If Shanghai chooses to stay at home for epidemic prevention, is it possible to cause the collapse of the medical system? According to the current situation in Shanghai and based on the information I can see, I have made an assessment of the recommendation for home isolation for asymptomatic infections.
In 2020, the total number of medical and health institutions at all levels and types in Shanghai will reach 5,905 (including village clinics), including 405 hospitals, 5,292 primary medical and health institutions, and 107 professional public health institutions. 101 other institutions. The city’s medical institutions actually opened 161,500 beds.
Shanghai can have 5,700 ICU beds if the number of ICU beds can be doubled in accordance with foreign emergencies. If 50% of the ICU beds can be used in an emergency, there can be 2,850 ICU beds and 48,500 new crown beds.
Of course, these are rough estimates, and some may not conform to the domestic situation. It is believed that the Shanghai New Crown Prevention and Control Team will have accurate data to support the number of beds available for new crown infection, and the number of ICUs. , the number of medical staff, and detailed records, please refer to the exact data in Shanghai.
According to Shanghai data on March 26, among all 2676 nucleic acid positive cases, asymptomatic infections accounted for 2631 (98.32%) and 45 (1.68%) were confirmed cases.
If most asymptomatic infections are kept at home, assuming that the number of cases in the outbreak period is 150-200 times the current number, the current number of beds and ICU beds in Shanghai can still be relaxed. Handle.
Based on the average hospital stay of 7 days, it is acceptable for Shanghai to have no more than 6,000 to 7,000 confirmed cases per day (the current seven-day average daily number of confirmed cases is 36). The data here is a rough estimate, and the Shanghai New Crown Prevention and Control Team should have detailed records and accurate data.
The key is to formulate rules and regulations for home isolation, so that close contacts and asymptomatic infected people can be isolated at home, and at the same time, measures must be taken to strictly protect medical staff and medical care The human infection rate has remained at a fairly low level. This greatly reduces the risk of medical runs and the collapse of the medical system during periods of high outbreaks.
Self-test and prompt treatment
Since the mutated virus is highly contagious, group sampling and testing will increase the risk of group infection. The method of isolating patients based on group testing may not be applicable to new mutated viruses, and may cause new outbreaks. New ideas and methods are needed to deal with highly infectious mutated viruses .
Self-sampling is recommended for nucleic acid testing. Self-taken saliva samples are recommended, if there is an effective testing method. Saliva testing is very mature abroad. There should be no problem with the current technical situation in China.
Home-based rapid self-test antigen test kits have been distributed in large numbers in Shanghai. Once positive, report it in time and self-isolate at home. If you have symptoms, you can consider self-sampling for nucleic acid testing to confirm the diagnosis, and isolate at home according to the condition or go to the hospital for timely diagnosis and treatment.
Image source: Basic requirements and procedures for self-testing of novel coronavirus antigens
The drug can be used to treat adults with mild to moderate COVID-19 patients with high risk factors for progression to severe disease, with advanced age, chronic kidney disease, diabetes, cardiovascular disease, chronic lung disease and other severe diseases patients with high risk factors. Taking the medicine within five days of the onset and using it for five consecutive days has a protection rate of more than 90% in preventing severe disease and death of new crown infection.
Summary
After more than two years of world pandemics, we have a full understanding of the new crown epidemic, there are effective and safe vaccines to prevent severe and death, and there are effective vaccines against mild and Medium and severe treatment drugs and means.
It is hoped that Shanghai will be guided by science and explore new ideas and methods for the control of the new crown according to the actual situation in Shanghai. However, the sampling and testing of the whole population may not be effective for those with short incubation periods and strong contagiousness. Omicron BA.2, the effect will not be very good, and it may also cause cross-infection in the population.
It is recommended to use self-sampling for testing; considering the significant impact of centralized isolation on the society, economy, psychology and life of the population, it is recommended to isolate asymptomatic and mildly infected people at home.
According to my estimation, Shanghai could avoid the collapse of the hospital system in the midst of a large number of outbreaks of COVID-19 if home isolation was implemented. Urgent approval is recommended for the 100 million doses of Fubitx (Pfizer) mRNA vaccine that Shanghai Fosun Pharma has ordered to protect the elderly and children.
Effective vaccines are used to protect elderly high-risk groups and children, and reduce the number of moderate and severe patients. It is recommended to use Pfizer oral effective drugs to strengthen early treatment of patients to reduce the mortality and mortality of the new crown.
In this way, Shanghai can successfully turn the COVID-19 pandemic into an endemic disease, effectively protect the health of the population, and create a new epidemic prevention model for other cities across the country.
Author Conflict of Interest Statement:
1. This article was completed in my spare time and has not received any financial assistance to complete this article.
2. The vaccines and therapeutic drugs introduced in this article are based on three conditions: one is that they are supported by large-scale Phase III clinical trial data, and the other is that they are the most effective in terms of prevention and treatment. 3. Compared with other foreign medicines, it is easy to obtain in China.
3. I have no investment in Pfizer or any other pharmaceutical company.
This article was first published on Professor Zhang Zuofeng’s personal “Meipian” account, authorized to publish by Lilac Garden
The source of the title map: Tu Wo Creative｜Planning: gyouza