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On June 27, the comprehensive group of the joint prevention and control mechanism of the State Council in response to the new coronavirus pneumonia epidemic released the ninth edition of the “New Coronavirus Pneumonia Prevention and Control Plan”. In an instant, netizens paid attention to the key points such as “14+7” being changed to “7+3”, “no longer delineating the three zones of blockade control, control and prevention, and unified delineation of low, medium and high risk zones”, which made many airlines and airports And travel business stocks soared. The author compares the eighth edition released in May 2021 with the just-released ninth edition out of rigorous consideration, in order to provide readers with an interpretation perspective.
Preface, general requirements, etiological and epidemiological characteristics and public epidemic prevention measures
The main changes in the preamble are “two plus one minus”: the first is the removal of the word “normalization” and the simplification of the wording; the second is the addition of the general policy of “dynamic clearing”; the third is the addition of “combination”. my country’s experience in epidemic prevention and control and emergency response”. Overall, this means that China will maintain a “dynamic zero” strategy for at least a year (until the next version is released).
In the ninth edition of the general requirements, “adhere to scientific and precise prevention and control”, “further strengthen source control”, “improve the sensitivity of detection and early warning”, “control the epidemic to the smallest extent in the shortest time and at the lowest cost”, “maximize overall planning”. Epidemic prevention and control and economic and social development” five expressions, and the original “personal protection” was changed to “people, things, and the environment.” What needs to be noted here is “further strengthening source control”.
At the same time, in terms of etiological and epidemiological characteristics, the ninth edition confirmed “transmission by aerosol” (the eighth edition considered “possible”), and introduced the basic characteristics of Omicron variant strains.
In the public epidemic prevention measures (divided into three parts: “publicity and education”, “vaccination”, and “patriotic health campaign”), the main change is that “vaccination” has been lowered to “over 3 years old” according to the actual situation, and started Carry out “homologous and sequential booster immunization”, focusing on increasing the “full-course vaccination rate and booster immunization rate of the elderly population aged 60 and above and other high-risk groups of severe disease”. This is a change in response to the progress of vaccine research; at the same time, in the “Patriotic Health Movement” chapter, it is proposed to establish a “public health committee” in the village (neighborhood) committee.
Epidemic monitoring
The “epidemic monitoring” section is where there are many revisions.
The first major modification is that in response to the popularization of antigen detection technology, expressions involving antigen detection have been added in many places. For medical establishments with nucleic acid detection capabilities, the recommended practice is “antigen detection can be performed simultaneously”; while for “primary medical and health institutions without nucleic acid detection capabilities”, it is recommended that “antigen detection can be performed on the above-mentioned personnel”.
At the same time, the ninth edition changed the definition of “clustered epidemics” from “5 cases within 14 days” to “2 cases within 7 days”, and in the detection method, “personnel and key groups in key institutions and places”, except the existing ones. “Nucleic acid detection” has been added to “health monitoring”. This acknowledges the rationality of local nucleic acid testing for personnel and key populations in key institutions and venues. At the same time, in the “multi-channel monitoring and early warning” below, the expression “symptom monitoring combined with nucleic acid detection” has also been added.
For “risk occupational groups”, the frequency of nucleic acid testing has been revised and clarified—persons who have direct contact with inbound personnel, cross-border transportation vehicles, imported goods, staff in centralized isolation places and designated medical institutions, and medical personnel in fever clinics in general medical institutions At the same time, it is aimed at “employees with dense working environments, frequent contacts, and strong mobility” (specific examples include express delivery, takeaway, hotels, decoration loading and unloading, transportation, shopping malls, supermarkets, and farmers’ market staff. etc.), port management service personnel, and staff of other departments in general medical institutions except fever clinics, require nucleic acid testing twice a week. This should be a rationalization of the adjustments made after the lessons learned from the infection of service workers in Beijing, Shanghai and other cities, and there is a trend of nationwide promotion.
In the “Items and Environment” module, the ninth edition deleted the nucleic acid test description of “imported cold chain food” in sales places; and in “Monitoring of personnel in key institutions and places”, it added that when the local epidemic occurs, schools, Key institutions such as kindergarten, old-age care, child welfare services, psychiatric hospitals, and training institutions, as well as supervision sites, production workshops, construction sites and other densely populated places should complete a nucleic acid test for all employees in a timely manner.
Epidemic handling
The “epidemic handling” section has also been revised a lot, and the ninth edition has added a lot of content.
After the confirmed cases are cured and discharged from the hospital, the control measures have been changed from “isolated medical observation for 14 days” to “home health monitoring for 7 days”; during the inspection of suspected cases, the requirements for IgM and IgG antibodies have been deleted in accordance with the reality of universal vaccination. The eighth edition has specified that “a history of vaccination is not used as an exclusion indicator”).
In the management of asymptomatic infected persons, the rigid requirements of “blood routine, CT and antibody testing” were deleted and replaced by soft “condition monitoring”, and the control measures after release of isolation were changed from “home medical observation for 14 days + 2 weeks”. , Twice follow-up visits in 4 weeks” to “7-day home health monitoring”. At the same time, the monitoring requirements for “Fuyang personnel” were added.
In terms of epidemiological investigation and source tracing, the subject has been upgraded from “county and district level” to “prefecture and city level”, and has put forward requirements for specific time and different stages of investigation methods.
The investigation of close contacts has been adjusted from “centralized isolation 14 + home health test 7″ to “7 + 3”, and the number of nucleic acids has been adjusted from “1/4/7/14, 2/7” six times to “1/2/ 3/5/7, 3” six times. This should be a change in response to the short incubation period of the Omicron strain – if the person is fine for the first seven days, it will probably be fine for the next seven days; and reducing the number of isolation days can significantly increase the capacity of the isolation facility. At the same time, in response to insufficient centralized isolation resources during large-scale epidemics, alternative “5+5” and “1/2/3/5, 2/5” can be implemented for close contact.
At the same time, a clear definition has also been put forward for the group that was briefly mentioned before (close contact with close contacts with a higher risk of infection, shared meals, shared work (study), shared entertainment (such as chess and cards, karaoke) and other long-term close contact) and requirements: “stay at home for seven days” and “1/4/7” three nucleic acid tests; Among the personnel in crowded and closed places such as markets, those who have a higher risk of infection after risk assessment” also put forward nucleic acid testing requirements.
One of the biggest changes is the addition of the “Risk Area Delimitation and Prevention and Control” section. The original definition of “medium and high risk areas” was determined according to “the number of infected people within 14 days”, but now it is determined according to the relevant locations of “cases and asymptomatic infections”, and it has been determined that the previous places are divided into “blocking and control, management and control”. Some practices in the three zones:
Implement normalized prevention and control measures.
In other words, the current epidemic prevention and control measures can only be carried out at the county and district level at most, and cannot be controlled at the local city level; at the same time, “low-risk areas” and “normalized prevention and control areas” are separated.
However, the method still retains the method of “do not delineate risk areas”: “In the process of epidemic disposal, for example, individual cases and asymptomatic infected persons have a low risk of transmission to the place of residence, work place, and activity area, and close contacts have been controlled in a timely manner. , it is judged that there is no risk of community transmission, so the risk area may not be demarcated.”
Corresponding to the “risk area division”, the ninth edition also added the “risk personnel assistance investigation and control” requirement. For those who have a history of living in low, medium and high risk areas within 7 days after the risk area is delineated (the original local area is usually implemented for 14 days), the method requires that isolation medical observation be performed “from the time of leaving the risk area” (that is, “filling in” commonly known in various places. Strategy): high-risk areas are quarantined during collection, and perform five nucleic acid tests on “1/2/3/5/7”; medium-risk areas are quarantined at home, and perform “1/4/7” three nucleic acid tests; low-risk areas The district adopts “two inspections in three days”.
Another major change in the ninth edition is the deletion of the “community (village) control” measures in the eighth edition, which include “rural areas and urban-rural junctions should improve the county and village three-level guarantee mechanism, and strengthen the return of people during holidays. registration and health monitoring, and implement various control measures” and other regulations.
However, the ninth edition also raises some requirements. For example, in the “Isolation Management Section”, a requirement is put forward that “sufficient centralized isolation rooms should be reserved in accordance with the local resident population ratio of 60/10,000 population”. The ninth edition also made some technical adjustments (such as requiring the release of risk areas within 5 hours).
The sixth part, “Laboratory Testing”, is the testing requirements for medical laboratories, which is omitted here.
Overseas imported epidemic prevention and control
A lot of content has also been added to the section “Prevention and Control of Overseas Imported Epidemic”. In the section on “Inbound Personnel Control”, the ninth edition puts forward the expression “strengthen remote prevention and control measures, strengthen the examination of health certificates for those who intend to enter the country, and carry out health notification; remind passengers to comply with health management measures and personal protection requirements”. This shows that China will have embassies and consulates in overseas countries guide airlines to carry out remote prevention and control work in advance. This acknowledges the rationality of the “seven-day health monitoring/closed-loop control” measures carried out by Chinese embassies, consulates and airlines overseas.
With the advancement of remote epidemic prevention and control, domestic testing has been relaxed from “centralized isolation 14 + home isolation 0 + home health monitoring 7″ to “7 + 0 + 3” (simultaneously imposed 1/2/3/5/7 /10 six nucleic acid tests) to reduce the pressure on domestic isolation facilities. The eighth edition once allowed inbound personnel who have completed remote nucleic acid testing (with a history of vaccination only need to have a negative nucleic acid test), meet the conditions for closed transfer management, home isolation conditions (with separate rooms and separate toilets), and can perform precise community control. The “7+7+7” isolation medical observation measures are implemented on a voluntary basis, but there seems to be no place to implement them in practice.
At the same time, a lot of content has been added to the ninth edition of “Inbound Item Control”. On the one hand, for “imported cold chain food”, a risk source with a certain history, the ninth edition proposes to build a centralized supervision warehouse in “port cities with a large amount of imported cold chain food” to unify the storage of imported cold chain food. Disinfection and unified testing; at the same time, for “non-cold chain items”, the risk level of contamination should be judged according to the epidemic situation in the source country (region), the category and characteristics of the item, the mode and duration of transportation, and the method of loading and unloading, and the classification and classification should be preventive. Disinfection or release measures. The ninth edition affirms the rationality of the disinfection measures that have been generally implemented by various cities in the past period of time on imported goods.
In the ninth edition, a separate chapter on “Port Cities Epidemic Prevention and Control” was added, and in the “Notice on Strengthening the New Coronary Pneumonia Epidemic Prevention and Control Work in Port Cities” last November, “Leaving land border port cities requires a 48-hour nucleic acid test negative certificate. ” requirements are integrated. It should be noted that this requirement does not exclude Shenzhen and Zhuhai as “except those with ports connected to Hong Kong and Macau” like the “Notice”. However, considering that these two cities have begun to implement normalized nucleic acid testing, the problem is not big.
Strengthen the prevention and control of key links
The link of “Strengthening the Prevention and Control of Key Links” is a major revision. The ninth edition deletes the requirements for “cold chain food production and operation sites” (that is, no longer controls domestic cold chain food), and at the same time, the definitions and suggested measures for “key groups”, “key institutions” and “key places” are carried out. Significantly revised.
In terms of key groups of people, the ninth edition adds two suggestions: “After a local epidemic occurs in this county (district), try to avoid gatherings such as gatherings, gatherings, weddings, funerals, and other gatherings” and “Elderly people with underlying diseases.” , pregnant women, children, etc. should minimize going out and avoid going to places with dense crowds, especially confined spaces with poor ventilation.”
In terms of key institutions, the definition has been revised from “institutions that are densely populated and prone to cluster epidemics” to “key institutions that maintain normal social operations or are prone to cluster epidemics”, and retain prevention and control measures such as “internal control”. In terms of specific measures in response to the local epidemic situation in the jurisdiction, in addition to the existing nursing homes, nursing homes, child welfare institutions and supervision places, it is also stated that mental health medical institutions and major construction project construction companies can adopt “closed management” measures; In addition to saying that schools can “stop offline teaching”, it also said that colleges and universities can adopt “closed management”. At the same time, the ninth edition also stated that “large enterprises and government agencies and institutions” can adopt a flexible working system. By including “schools, large enterprises, and government institutions” in specific examples, the ninth edition recognizes the rationality of their implementation of internal control and other preventive measures to some extent.
At the same time, in terms of key places, the revised definition is “places that are prone to clustered epidemics such as densely populated and confined spaces”, and “logistics parks”, “fitness and entertainment places”, “barber and bathing places” and “logistics parks” are added to the specific examples. “Confinement Center”. In the specific measures for the occurrence of local epidemics, the item “avoiding gathering activities, large-scale conferences and training” has been added.
Summary: Reduce the pressure of epidemic prevention and maintain epidemic prevention efforts
We can summarize the revisions of the ninth edition into three pieces:
1. Revise anti-epidemic measures according to the characteristics and anti-epidemic capabilities of epidemic strains, and reduce the occupation of domestic anti-epidemic resources. The short incubation period of Omicron makes the isolation period generally changed from 14 days to 7 days, which can theoretically reduce the cost by half; at the same time popularize antigen testing and reduce the age of vaccination.
2. Removal of the past practice and experience of epidemic prevention in various places: Retain the measures that have proved effective in practice, such as “closed management of colleges and universities, large enterprises, government agencies and institutions”, and remove the “local city” and “returning personnel to monitor and control” and other unreasonable promotion and control practices.
3. Add “source control” and “remote control” to the prevention and control of inbound epidemics to further reduce the pressure of domestic epidemics.
(This article only represents the author’s own views, editor in charge: Yan Man [email protected])