On April 3, Changchun issued a letter to the public, and will use 5 days to fully implement the zero-clearing operation. On April 5, there were 817 new local confirmed cases and 1,682 new local asymptomatic infections in Changchun City.
As of 24:00 on April 5, Changchun City has reported a total of 21,421 local confirmed cases of new coronary pneumonia and 12,243 asymptomatic infections.
Since the announcement of closed management on the 11th, the Changchun epidemic has continued for nearly a month. Eight days after the local apologized for the difficulty of shopping for food, have citizens’ living conditions improved? Why has the number of cases in Changchun continued to increase for nearly a month of closed management?
Unavailable daily necessities, changing nucleic acid detection notice
Lou Ying’s community recently received a vegetable bag assisted by Baishan City, Jilin Province. Online platforms such as supermarkets still rely on squatting to grab it. There are also businesses who increase their prices under the banner of volunteers and grab them. Delivery may also be delayed due to road management. With the increase of the closed management time, the community stores are still closed. She said, “The rice, noodles and rapeseed communities can organize group purchases, and the meat, eggs, milk and daily necessities can only rely on themselves.”
Image source: user provided
Some residents who are inexperienced with the Internet get a lot of information with a lag, and it took many days to stumble upon a vegetable bag with volunteers. In the WeChat group, there have been cases of elderly people asking for help without food at home. The solution is to donate money from community residents.
On April 4th, Li Yun posted about this situation on Weibo, which has been forwarded by nearly 10,000 people. On the same day, the Commerce Bureau of her district contacted her and said that they would report the problems of residents buying daily necessities such as salt, soy sauce vinegar, sanitary napkins and toilet paper, infant milk powder diapers and so on, and help them solve them as soon as possible.
“If other districts have difficulties, they still need to ask the corresponding person in charge for help. Don’t give up asking for help.” Li Yun said.
In addition to grocery shopping, residents are always concerned about the notification of nucleic acid preparation. When Li Yun Community was first closed, it was said that nucleic acid tests were performed every 247 days, but the specific volunteers were not clear. At the beginning, the community implemented nucleic acid testing in different buildings. Since the nucleic acid test was notified by the loudspeaker downstairs, it often happened that everyone went downstairs together.
Regarding the management of community nucleic acid sampling, virologist Chang Rongshan emphasized the need for “double-layer masks, queuing intervals, and timely disinfection.” During the nucleic acid test, he encountered a sampler’s hand touching his lips, “this is not allowed, and it may spread through mucous membrane contact.”
Not only protection should be done during the sampling process, but also the standardization of the operation should be ensured. Disinfection once. The transmission power of Omicron is 4 times that of the original strain. The sampler is theoretically a close contact. The protective clothing of the sampler in the epidemic area should be changed after 8 hours of continuous use. Otherwise, it may pass through the object. The principle of surface contact transmission is the same as the surface disinfection of express delivery items. In an epidemic area like Changchun City, after more than 20 days of continuous nucleic acid testing, the number of confirmed cases has not decreased but is still increasing. The reasons are very complicated. It’s blocked and still, why is it still difficult to detect all positives? Any clustering link needs to be leaked.”
At the same time, he mentioned the method of nucleic acid detection, “The nucleic acid CT value of some asymptomatic infected persons gradually decreases from the first day to the third day after infection, and the nucleic acid detection of 20 mixed 1 may It is impossible to find all asymptomatic infected persons.” The current situation in Changchun should be adjusted to perform apheresis or 5 mixed 1.
On April 4th and 6th, Li Yun Community was adjusted to the volunteers supported by Songyuan to test nucleic acid at home, and on the 5th, it was home antigen self-test to “reduce contact and clear it as soon as possible” “.
Non-COVID patients: waiting for treatment
Lin Feng is a leukemia patient. On March 12, he had to be discharged from the hospital first because the blood bank was short of stock and could not use heavy chemotherapy drugs. “Once the treatment starts or the condition deteriorates, the absence of blood will be fatal.”
During the waiting time after being discharged from the hospital, he contacted the National Health Commission and received a reply, “I have asked the hospital, and the clinic is open as usual.” The hospital replied, “There is no hospital bed, so it cannot be admitted,” and there is no number to hang up.
On the evening of April 1st, Lin Feng waited for the good news that “the hospital has opened a leukemia channel”, followed by the news that he continued to wait, “may have to make the critically ill advanced.”
Wang Yuting and her uremic father are also waiting. Since March 26, her father has only received 2 dialysis treatments. At the same time, due to the high density of patients, the time to get on the machine was also forced to be discounted.
With the strengthening of control, the community where Wang Yuting’s father lives has become a closed area, they need to be diverted from the original hospital to other dialysis institutions for treatment. During this period, there were traffic restrictions in the whole city, and there was no car to get to the hospital, so they could only find a way to settle in a hotel near the hospital.
On the 29th, a positive patient appeared in the hotel. They became close contacts, and the dialysis the day after was canceled. Their dialysis site has returned to the Yellow Code Hospital, and “we went to dialysis directly from the hotel with our luggage.”
Dialysis patient trapped in hotel due to positive appearance
Image source: user provided
In addition to the waiting time for transshipment, safety issues during transshipment are also worthy of attention. N95 masks or protective clothing were not provided during the transfer, and several dialysis patients were successively diagnosed.
Wang Yuting gets her next dialysis in 4 days. The number of transfer vehicles is limited, hospital resources are tight, and the dialysis interval is prolonged. “The patient’s self-control has reached the limit, and they hardly dare to eat too much food, a few slices of bread a day, and dare not drink water.”
Dialysis time, location, process, and the connection between each link need to be repeatedly asked by phone.
The handling of some conditions is unknown to them. Wang Yuting obtained more than a dozen contact numbers of the responsible department through 12345, but many of them were difficult to dial. Some phones had nearly a hundred people in front of them, and some phones had been turned off. The feedback she got the most was: will report, please wait.
“A patient’s community was positive, and it was upgraded to a closed-control community. She had no way to contact the Yellow Code Hospital immediately, and the non-Yellow Code Hospital needed her community to show that the building was not positive. Her community says there is no guarantee.” It’s a constant process of proof. In the end, the family provided a letter of commitment to ensure two points and one line, “the family will take on this responsibility.”
Wang Yuting is still concerned about whether the community where she lives can accept patients under centralized isolation after medical isolation as a close contact, and how patients living in remote areas can go to the hospital, including returning, when Changchun has not yet opened to traffic. , before admission to the hospital, a 24-hour nucleic acid negative certificate is required, and the second city hospital has to be tested the day before. “Some patients are exhausted.”
At the same time, an appointment for nucleic acid testing needs to be contacted by the community. Some communities make an appointment early, while others do not. The processing methods of different communities are not uniform.
In the process of repeatedly contacting the grass-roots epidemic prevention personnel, Wang Yuting also saw their helplessness and overloaded work. “There are many things they can’t decide, they can only ask for instructions.”
Wang Yuting talks to quarantine hotel staff
Image source: user provided
Senior man transported in protective suit for 10 hours
Liu Yuqi’s father lives in Kuancheng District. On the 24th, he received a call to inform him that he was positive. On the same day, her grandfather developed symptoms of cough, and sent out a self-test paper at 9 o’clock in the evening. The result showed: “Dad parallel bars, grandfather parallel bars, grandma weak Yang”.
The community responded to home sampling on the morning of the 25th and picked up positive patients in the afternoon. The actual sampling work was carried out at 5:00 pm on the 25th.
On the 26th, Liu Yuqi’s grandmother began to show symptoms, and there was no news of transfer. In the absence of volunteers to help buy medicines, the community did not provide treatment medicines. I am currently in Changchun, and I cannot buy the “two antibodies and one withdrawal” drugs. Liu Yuqi asked a friend to send some drugs from home on the afternoon of the 27th.
Image source: user provided
From the evening of the 24th to the 28th, Liu Yuqi and his family have been contacting the mayor’s hotline, the provincial governor’s hotline, the CDC, the Health Bureau and other departments, and the response is that the matter “returned to the community” “. The answer to contacting the community was “waiting”.
There was also some confusion during transit. On the evening of the 28th, after the transfer car arrived at the expressway intersection, the person in charge of the transfer asked Liu Yuqi’s grandparents to get off the car, on the grounds that “over 80 years old should be treated nearby.” They did not know the hospital they went to after getting off the bus. “One of the grandparents is in a wheelchair and the other cannot walk more than ten meters.” After negotiation, they were still transported together with Liu Yuqi’s father.
Changchun to Meihekou, Liu Yuqi’s family boarded the bus at around 8 pm and arrived at 6 am the next day. During the period, everyone on the bus was wearing protective clothing.
“Around 11 o’clock, a patient suffered a heart attack, and the bus stopped for more than 2 hours.” After arriving at the intersection of Changchun Expressway, I waited for more than 2 hours, because “you have to wait for all the transit buses to arrive before you can cross the expressway.”
The doctor at the health center said that my grandfather was in a bad condition and could not be accepted. He was transferred to a top-three hospital in Meihekou around 8:00.
On the evening of the 29th, Liu Yuqi’s father, grandfather and grandmother were admitted to a tertiary hospital in Changchun. Grandpa went directly to the ICU for observation, and the next day, grandma also entered the ICU for observation.
Image source: user provided
Liu Yuqi said that doctors tried their best to play their role in this process. “The two hospitals in Meihe provide oxygen, medicines and breakfast.” The hospital in Changchun gave her father and grandmother special medicine for the new crown on the 30th, but her grandfather did not use it because of underlying diseases. Another situation is that only the father’s nucleic acid result came out of the nucleic acid test on the same day. When he arrived at the Changchun New Crown Designated Hospital, he was required to provide a nucleic acid certificate. The doctor said, “Since people come to their hospital, they have to be responsible.”
As for the overnight transfer, Liu Yuqi’s grandfather already needed a cardiac injection when he returned to Changchun, and he was “sometimes awake and sometimes confused” when he arrived at the hospital. On April 5, Liu Yuqi reposted his request for help on Weibo on March 26 because he had no medical treatment at home, and wrote “Grandpa died.”
On the 4th, according to Xinhua News Agency, the expert of the national medical treatment team in Jilin, and the president of West China Tianfu Hospital of Sichuan University, Kang Yan’s Omicron variant strain was used to treat elderly patients, patients with severe underlying diseases, etc. Special populations pose a serious threat, especially for those with poor basic conditions and low immunity, such as long-term bedridden patients and hemodialysis patients.
Manpower gap in frontline epidemic prevention
Whether it is patient care or transport or community service, the common gap in these links is manpower.
Li Yun’s friend’s home is in Meihe District. “She received a notice at 2:00 a.m. and packed her things at 4:00 a.m.. She took a bus to Changchun City and started collecting nucleic acids around 11:00 a.m. until around 7 p.m.”. When they were about to finish work, their group was pulled to another community, because the previous team had not finished collecting. Li Yun’s friend began to wear protective clothing again, and it was past 11 p.m. after the nucleic acid was done.
No accommodation was arranged for this support, they had to go back and forth the same day, and it was nearly 3 am when they returned to Meihekou.
In addition, the need for volunteers has increased during the pandemic. On March 29, Weibo Chaohua opened the Changchun anti-epidemic help channel. As a volunteer, Wang Lin collected network information and transferred it to the volunteers behind to help contact relevant departments for feedback.
The volunteer charitable organization she participated in was initiated by Li Runze, a former doctor who had hundreds of experience in responding to natural disasters.
On-site need not only doctors to do nucleic acid, but also volunteers and community staff to cooperate and coordinate. For example, Li Runze said, “In a community of 10,000 people in Shanghai, about 200 volunteers need to be recruited, and each position requires a large number of volunteers.”
Workers are at risk of infection during nucleic acid sampling. “Simply showing the volunteers the video training will not achieve the desired effect. The medical staff at the scene are also very tight, and they may not have time to fully consider the management of the scene. If no one manages the follow-up, the on-site meeting will be carried out. There are many factors that are not well controlled and may become a path of infection.” Li Runze told Lilac Garden that his non-profit organization is also providing better online services and guarantees for volunteers.
He organized an offline volunteer team during the epidemic in Xi’an last year, and none of the more than 6,000 volunteers mobilized were infected. He believes that one of the key factors is “Team management, finding the right team leader and safety officer”. Volunteers have to undergo preliminary resume screening, operational training, and division of labor among members. “This is not a job that counts people after a simple notification.”
Image source: Screenshot of volunteer registration form
In addition to ensuring safety, it is also important for volunteers to provide emotional support, “The simple and crude volunteer use model and disrespectful attitude make the volunteer experience too bad , which reduces their motivation to participate again.”
Li Runze mentioned the phenomenon of “run on resources at the grassroots level in the community”, and it was difficult for community staff to deal with all needs in a timely manner. They also connect the trained volunteers with the community to establish a group chat to help with scheduling. But at present, they have not received many tasks from the community. “Maybe the community has so much work that there is no way to devote its energy to adapting to our volunteer model.”
Expert Recommendations: Improve Detection Processes
For Changchun’s current situation where the epidemic has been developing for a long time and the number of cases has increased, Chang Rongshan suggested that “if a building with 10 floors and about 30 or 40 households has 1 ~2 people are positive or a community with 3000 to 5000 people, in more than 20 days of multiple rounds of testing, there will be 5~10 positives each time, Similar to such high-risk areas, nucleic acid testing can be suspended for 10~14 Days.During the period, all living needs of residents should be guaranteed, and patients with symptoms or other non-COVID-19 patients should be guaranteed medical treatment, and the rest of the staff should remain at home and not go out, and nucleic acid testing should be performed after 10 to 14 days.
At present, the infection cycle of Omicron BA.2 is mostly 5~7 days, and the asymptomatic conversion to negative rarely exceeds 10 days, which is very different from the original strain. ; The main infection is in the upper respiratory tract, and the proportion of asymptomatic infection is very high. It has been tested continuously for more than 20 days in the designated sealing and control area, and there is still a positive result. The testing process needs to be improved to achieve a digital zero. ”
In the Hong Kong epidemic, some people proposed that Hong Kong follow Shenzhen and conduct three consecutive rounds of nucleic acid testing on everyone within a three-week or nine-day period. For situations where gatherings need to be avoided, isolation facilities are insufficient, and there are too many infected people, due to the large number of infected people, it is difficult to find all infected people through only three rounds of nucleic acid testing, and it is also difficult to achieve zero after that.
Published in the journal Emerging Microbes & Infections’ review article “6 Lessons from Hong Kong’s Fifth Wave of Outbreaks: A Journal Review” suggests an alternative recommendation: “Have everyone take an antigen test every day for 5 to 10 days. This move can also Performed multiple times to achieve different goals, such as reducing infections and eliminating the virus from the community.”
Lin Feng, Lou Ying, Li Runze, Li Yun, Wang Yuting, Liu Yuting are all pseudonyms in the text
Planning: Y^OH
Producer: gyouza
Image source: Visual China