(Original title: “Positive home” is implemented in many places, experts explain the risk of neighbors’ infection)
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Mr. Li, who lives in Chaoyang, Beijing, found that last Sunday (November 27), a neighbor who was in close contact with Zhuanyang in the same building was not transferred to the Fangcai Hospital, but arranged to rest at home and distributed by “Dabai”. Material packages and rapid antigen test reagents, “the treatment is the same as that of close contacts at home.”
“The community staff explained to us that the infected person was an elderly person with underlying diseases, and the family members who lived with him had been transferred in a closed loop because the nucleic acid test was positive.” Mr. Li recalled that on November 18 On the 1st, the unit building where he lived was designated as a high-risk area due to a positive case of “ten mixed and one” positive social nucleic acid, and it was placed under the control of “staying at home”. During the period, based on the positive cases that appeared successively, three groups of close contact groups on the “cross flower” floor were identified. At present, based on the time when the last positive case appeared in the building, all non-close-contact people have been unsealed; people who are not on the same floor and in the same household as the positive person at home will be tested today (December 1) after the nucleic acid test is all negative. unblock.
“As the close contacts of this home-infected person, we were told that we had to wait until the antigen turned negative, and then the disease control personnel would conduct two nucleic acid tests at intervals of more than 24 hours. Only after the two tests were negative, the relevant personnel could be released at the same time. Quarantine. In other words, the end of our quarantine may be less than 7 days, or it may be longer than 10 days, everything is unknown.” Mr. Li said.
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He told China Business News that keeping light and asymptomatic COVID-19 patients who do not have the conditions for transshipment at home should be a good thing that accords with the sympathy of the public, but due to the lack of a plan, it has caused disputes among neighbors and neighbors. “At present, we hope to optimize and solve two points: First, theoretically speaking, aerosol transmission is a low-probability event. Since based on this judgment, we have been classified as a close-contact group, then there should be professionals in time. Second, the positive home should be to reduce the impact on the economy and residents, but if more neighbors are allowed to run with them, it will be counterproductive.”
Mr. Li’s experience is not alone. China Business News learned that at present, in Beijing, Guangzhou and other places, keeping asymptomatic or light COVID-positive patients who meet special requirements at home has partially become the default mode, without the need for neighbors to sign and agree; the number of people involved has also expanded, from The initial “asymptomatic, mild new crown infection who meets special conditions” has gradually expanded to “asymptomatic, mild new crown infection who meets home isolation conditions.”
However, since there is no systematic prevention and control plan involving the positive home, there is still a lot of room for refinement in terms of the protection of the rights and safety of the infected, close contacts, and other people in the same building or unit.
Multi-party rights must be balanced
Jiang Qingwu, a professor at the School of Public Health of Fudan University, said in an interview with China Business News that the continuous optimization of prevention and control policies is undoubtedly a gratifying event. It is more in line with public expectations and conducive to infection if eligible positive persons are isolated at home. The recovery of patients is more conducive to effectively relieving the pressure on the medical system.
“However, the implementation of this optimization plan still needs to ensure that the public has sufficient information, understands the logic behind the policy optimization, makes sufficient preparations, and reaches a consensus to achieve the expected effect of ‘positive home’.” Jiang Qingwu said.
Yicai Global understands that at present, in some communities that are trying to “eligible home isolation patients with mild COVID-19 infection do not need to be transferred”, neighbors, infected patients and families (or accompanying staff) all have some concerns: For the former, pay attention The focus is on the probability of serial infection and whether it will be jointly controlled; for the latter, the focus is on whether you or your family members are within the scope of “meeting the conditions for home isolation”, whether they will be discriminated against by neighbors, whether basic life and medical supplies can Whether it is satisfied, etc.
As Mr. Li mentioned above, the “cross flower” control principle, many interviewed virology experts believe that it needs to be discussed, because the non-contact transmission of the new coronavirus through aerosol is a small probability event.
Contact transmission can also be avoided. “Carriers of the new coronavirus who are isolated at home have very little detoxification and are not strong in transmission. Generally speaking, the virus in the exhaled aerosol is completely inactivated after 3 hours from the body.” Virology expert Chang Rong Shan told China Business News that, for example, if a positive person at home opens the door to pick up the courier and wears a mask, as long as there is a distance of more than 2 meters between the courier and the courier, the probability of virus transmission is very small.
“People who live together do have the risk of being infected. Therefore, it is best for those who are isolated at home to have a room with a private bathroom. At the same time, during the isolation period, the infected person should keep as far away as possible from the co-resident and try not to share Items should be sterilized in time after using shared items, so as to reduce the risk of infecting co-residents or accompanying personnel.” Chang Rongshan said.
He also said,In the event of contact infection, the co-residents do not need to be overly anxious. This is because asymptomatic or mildly infected persons carry a very low viral load and spread the virus, and the infected close contacts are also likely to be asymptomatic or mildly infected who can recover on their own, and do not need to be transferred for medical treatment.
According to the latest version of “Household care of patients with mild symptoms of COVID-19 and management of their contacts” (interim guidance document) published by WHO, if hospital care is not available or When meeting the needs of health care services), consider home care for adults or children with confirmed or suspected COVID-19. There are three specific determinants: one is the clinical assessment of the COVID-19 patient, the other is the assessment of the home environment, and the third is the ability to monitor the clinical evolution of the COVID-19 patient at home.
The document clarifies that under the premise that the home environment meets certain requirements, “asymptomatic patients or mild or moderate patients without adverse outcome risk factors may not require emergency intervention or hospitalization” and can be isolated and cared for at home. But at the same time, risk factors for developing severe disease, such as age (> 60 years), smoking, obesity and non-communicable diseases such as cardiovascular disease, diabetes, chronic lung disease, chronic kidney disease, immunosuppression and cancer, should also be taken into consideration.
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Chang Rongshan further stated that if the positive infected person’s family has special populations such as 70 years old and above who are partially vaccinated or not vaccinated, it is recommended that the positive infected person take the initiative to transfer and isolate. Because once such elderly people are exposed to infection, they are at greater risk of severe illness and death. “In the long run, as the booster vaccination rate of the elderly in our country increases, the probability of this happening will be greatly reduced.” Chang Rongshan added.
Although the risk of virus transmission in home isolation of light positive infected persons is not great, whether the management can keep up is related to the implementation effect of the optimization plan.
According to Mr. Li’s description, at present, for the old man who is isolated at home alone in this building, the management measures of the community are not much different from those of other close contacts, that is, “Dabai” enters the house to test nucleic acid or distribute antigens, and regularly distributes food packages. .
“On the one hand, for people who are positive at home, especially for special groups such as the elderly, the protection work of the community or disease control department needs to be in place, and a transfer plan should be made. For example, regularly register the antigen status of relevant personnel and ask them whether they have persistent symptoms. on the other hand, try to use antigen self-test or nucleic acid self-collection instead of household nucleic acid to reduce the possibility of ‘Dabai’ being infected and even infecting other people.” Chang Rong Mountain said.
Mr. Du, who currently lives in Hong Kong, told reporters that the Hong Kong Special Administrative Region government will distribute anti-epidemic material packages to those who are positively infected at home, including rapid anti-epidemic test cards, isolation manuals, masks, antipyretics, and Chinese patent medicines.
However, as to whether it is necessary to distribute drugs for home isolation and whether other people in the same building need to stockpile drugs, Jiang Qingwu believes that no treatment is required if there are no symptoms, so this is not a must.
Chang Rongshan held a similar attitude. He also reminded that community personnel should record the basic diseases of close contacts and positive infections in home isolation, especially for elderly patients with new crown infection who choose home isolation and have underlying diseases, community personnel need to evaluate the clinical evolution of the new crown in a timely manner , it is even more necessary to maintain continuous attention to its underlying diseases.
Another virology expert told China Business News,For those who are asymptomatic or mildly infected at home, they can take some officially recommended traditional Chinese medicine, but there is no need to prepare special anti-new coronavirus drugs. Supplementary drugs should be considered for special groups (with underlying diseases and the elderly).
How to “manage” positive people at home?
In some areas, after the optimization and adjustment of nucleic acid and isolation policies, do asymptomatic and mildly infected people need and be able to report in time? How to restrict the scope of activities of positive home-based people? These questions have caused some doubts in the public.
Chang Rongshan believes that reducing the frequency of nucleic acid and allowing positive people to stay at home is aimed at making epidemic prevention more accurate and humane, but it does not mean that the prevention is relieved. At this stage, whether it is a positive nucleic acid test or a positive initial screening, or a positive antigen self-test, it should be reported to the relevant government departments. Light positive persons who meet the conditions for home isolation should sign an agreement with the government so that the health administrative department can take the initiative to provide various guarantees for home isolation and implement supervision.
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For those who have been diagnosed, although those who are eligible for home isolation have a low viral load, they will still pose a risk to others if they are allowed to leave their residences. Some people think that the method of requiring home-infected people to wear electronic wristbands abroad and in some foreign regions may be used for reference.
According to the “Handbook for Persons Positive for 2019 Coronavirus Disease 2019″ updated by the Hong Kong Department of Health on November 21, 2022, the government will arrange staff to visit the residences of positive infected persons, deliver and assist in wearing electronic wristbands, and install “home anti-epidemic “APP application. During the isolation period, government personnel will monitor through electronic wristbands to determine whether they are staying in the residence.
Although this type of wristband does not collect personal data and does not have GPS positioning functions, Chang Rongshan believes that there is no need to implement it in the mainland. According to the “New Coronary Pneumonia Epidemic Risk Area Delineation and Control Plan” recently issued by the Comprehensive Group of the Joint Prevention and Control Mechanism of the State Council, “management can be strengthened by installing monitoring equipment, electronic door sensors, etc., to prevent people from going out and to strictly ensure that they stay at home In the ninth edition of the prevention and control plan and the 20 optimization measures, there is a form of installing electronic door magnets at the entrance of high-risk personnel to strengthen supervision.” This method is also applicable to positive household personnel.
“If a positive infected person walks out of the residence and does not wear a mask, aerosol transmission of the virus is prone to occur in confined spaces such as corridors, which will lead to infection of neighbors going up and down the stairs. But through electronic door magnets, this situation can be basically eliminated.” Chang Rongshan said.
Jiang Qingwu also disagrees with the use of electronic wristbands for epidemic prevention. He believes that it should be based on personal self-discipline first, and if he deliberately does not cooperate, then consider adopting bottom-line measures.
he thinks,The focus of future prevention and control of the new crown should be shifted from positive infections to public places, especially public transportation, indoor public places including hospitals, etc.. By improving the sanitation and ventilation conditions of these places, and doing a good job in the protection and management of personnel entering and exiting, the prevention and control effect can be achieved in a more economical and effective way.