Wuhan epidemic escalates: hospital fevers increase sharply, prevention and control encounters a key difficulty …

After the epidemic was determined to be “human-to-human”, this afternoon, Wuhan officials issued two regulations to show their determination to prevent and control: the government will pay for the treatment of patients with new types of coronavirus infections, and will strengthen the control of personnel entering and leaving Wuhan.

Today, the number of fever clinics in hospitals in Wuhan has increased sharply. At the triage desk of the Puren Hospital in Wuhan, a visitor was numbered 114 and was told by the doctor to “come again at 9 pm”.

Medical staff are working overtime, but Zhong Nanshan described that the epidemic is still in the “initial phase” and “climbing phase”. In other words, cases will continue to increase in the future.

At present, more than 95% of the patients are related to Wuhan. Coincident with the arrival of the Spring Festival, Wuhan, as a hub of nine provinces and a transportation hub, has raised public anxiety.

After SARS in 2003, how China responded to this viral epidemic this time has attracted worldwide attention.

From calm to erupting

From the 18th, the outbreak and spread of the new coronavirus in Wuhan showed a sharp increase in the number of cases. The number of confirmed cases spread to 5 provinces, cities, and regions in China, and the suspected cases spread to 14 provinces, cities, and regions. South Korea, Japan, and Thailand. Confirmed cases have also occurred in overseas countries.

As of 12:00 today, a total of 292 confirmed cases of pneumonitis with new coronavirus infection have been reported (270 in Hubei, 5 in Beijing, 14 in Guangdong, 2 in Shanghai, and 1 in Zhejiang). Suspected cases have been reported in 14 provinces (autonomous regions and municipalities). 53 cases (11 in Hubei, 7 in Guangdong, 3 in Sichuan, 1 in Yunnan, 7 in Shanghai, 1 in Guangxi, 1 in Shandong, 1 in Jilin, 1 in Anhui, 15 in Zhejiang, 2 in Jiangxi, and 1 in Hainan 1 case in Guizhou and 1 case in Ningxia).

In addition, one confirmed case was reported in Japan and has been cured and discharged. Two confirmed cases were reported in Thailand. One confirmed case was reported in South Korea. One suspected case was the Philippines, one in Australia, two in Vietnam, and one in Singapore.

Time back to 5 days ago, that is, January 16. Contrary to the current heightened public anxiety, from January 11th to 16th, 41 cases of infection persisted for several days, and the public mood was relatively optimistic.

Guan Yi, director of the State Key Laboratory of Emerging Infectious Diseases and virology expert at the University of Hong Kong, said in an interview with Caixin on the 20th that “there were no new cases reported for a few days before. I was still a little optimistic at that time. In a few days, no new cases in more than 12 days, we will win this tough battle. “

However, after the 18th, the epidemic situation has plummeted and new cases have surged.

Corresponding to the surge in the number of cases, relevant official notifications from Wuhan and the National Health and Medical Commission also update the frequency and wording of information.

12On December 31, 2019, the Wuhan Municipal Health and Health Commission officially released the notification on pneumonia for the first time. According to statistics from the “medical community”, only three official notices were issued by the Wuhan Health and Construction Commission in the next 11 days. However, since the 11th, the Wuhan Health and Health Commission has updated the epidemic situation daily, and has issued a total of 15 notifications on the latest progress and prevention and control of the epidemic.

Take the viral infection route that the public is most concerned about as an example. On December 31, 2019, the Wuhan Municipal Health and Health Commission reported for the first time that “the investigation did not find any obvious human-to-human transmission, and no medical staff infection was found.”

On the 14th, the Wuhan Municipal Health and Health Commission stated that “there is no clear evidence of human-to-human transmission, but the possibility of limited ‘human-to-human transmission’ cannot be ruled out.”

This statement aroused some doubt. On the same day, Wang Yuedan, deputy director of the Department of Immunology at Peking University who had been engaged in SARS research, bluntly said in an interview with the BBC that the possibility of “person to person” is extremely high.

He said that SARS and MERS, which are also coronaviruses, can be transmitted from person to person. Moreover, several patients, including those diagnosed in Japan, have claimed that they have not visited the seafood market. Among the cases published in China, there was a case of spouse and the wife denied that he had a history of exposure to the South China Seafood Wholesale Market.

On the 19th, the National Health Commissioner issued an official announcement for the first time on the prevention and control of the epidemic, stating, “Experts have concluded that the current epidemic situation is still preventable and controllable. However, the source of new coronavirus infection has not yet been found, the epidemic transmission route has not been fully grasped, and the virus has mutated Close monitoring is still needed. “

Just after the National Health and Medical Commission publicly stated that “the current epidemic situation is preventable and controllable,” in the early morning of the 20th, the Wuhan Health and Medical Commission updated the number of new cases for two days at a time-a total of two new ones on January 18 and 19 Increase of 136 confirmed patients.

数量 The number of cases has soared, and the National Health Commission’s previous statement that the current epidemic is preventable and controllable has caused some controversy. Accepting Caixin, Guan Yi said, “Whether we need to further explain How, how to prevent, how to control, and how to treat this problem.” He added, “The sudden increase in the number of cases now means that we are preventing, There are loopholes in the control, and the source of the infection has not been found and cut off. “

On 19th, Wuhan hosted a high-level expert group headed by Academician Zhong Nanshan. In the evening, the expert group finally responded to many issues of public concern.

Zhong Zhongshan confirmed that the new coronavirus is “definitely transmitted from person to person” and notified that 14 medical staff had been infected. Today, the number of medical personnel infected has increased to 15.

Is there any delay in reporting

On January 20th, local time, the “South China Morning Post” published an analysis of why the new coronavirus infection in Wuhan takes so long to be diagnosed. The article states that after SARS, China has established a strict infectious disease testing and reporting system. This may best explain why it takes a long time to diagnose a new coronavirus infection in Wuhan.

讲座 David Hui Shu-cheong, Chair Professor of Respiratory Medicine and Infectious Diseases Specialist at the Chinese University of Hong Kong, said that he was not aware of the current reporting mechanism in Mainland China. “But I know that the virus gene sequence was not available to the World Health Organization until January 12. Two days later, the diagnostic kit was distributed to the local public health agency. This is why we suddenly saw a confirmed diagnosis in mainland China on the weekend. Cases have suddenly increased. “

“Delayed reporting exists. Before we release confirmed cases to the public, we need to get positive results from two independent laboratories. In China, it may be more complicated because it involves different administrative levels.” Xu Shuchang said.

A Guangdong-based health official, speaking on condition of anonymity, told the South China Morning Post that all medical practitioners must follow a three-step confirmation process. “These three steps are completed before we can publicly confirm the case to the public.”

In response to the surge in cases, in the afternoon of the 20th, when answering a reporter’s question about new coronavirus pneumonia, Zhong Nanshan also explained. He emphasized that there is a certain process of understanding the disease. There are more than 100 cases. Is it increasing very rapidly? It cannot be said that a new disease has a process in the early stages. “

“Affirmation from person to person”

It is worth noting that Guangdong has become the province with the highest number of cases except Wuhan.

According to the official notification from the Guangdong Health Commission, on the 20th, 13 cases of new coronavirus were diagnosed in Guangdong, 11 of which had a history of living or traveling in Wuhan, and 2 had a history of close contact with the cases.

接受 In an interview with CCTV News Live, Zhong Nanshan specifically mentioned two cases of close contacts in Guangdong who had not yet arrived in Wuhan. These two cases may be the key evidence for judging the “human-to-human transmission” of the virus.

珠 On the 20th, Zhuhai City, Guangdong Province also confirmed a case of “person-to-person”. A pair of parents visited Wuhan’s Zhuhai daughter’s home from Wuhan, and the family of three was infected with “new coronavirus”.

“Infection of medical staff is an important sign of (interpersonal transmission),” Zhong Nanshan said.

传 “Person-to-person” has increased public and international anxiety. “If the virus is transmitted from person to person, the problem we face is even more serious.” On January 20, local time, William Schaffner, an infectious disease expert at Vanderbilt University Medical Center, told CBS News.

On January 20, the WHO stated that the organization ’s director-general, Tan Desai, will convene an emergency committee meeting in Geneva on January 22 to assess whether the recent outbreak of the new coronavirus in China and neighboring countries constitutes an “emergency public concern of international concern”. Health incidents “and make recommendations on how to control the spread of the outbreak.

According to the WHO International Health Regulations, “public health emergencies of international concern” means “unusual events that pose public health risks to other countries through the international spread of disease and may require a coordinated international response.”

罕见 This rare name is used only for the most severe epidemics. The definition implies a situation that is serious, sudden, unusual, unexpected; the impact on public health is likely to extend beyond the borders of affected countries; and immediate international action may be required.

When answering a reporter ’s question about new coronavirus pneumonia on the afternoon of the 20th, Gao Fu, director of the China Centers for Disease Control and Prevention, explained why the virus is now “human-to-human.” From animal to human, there are adaptive mutations, and there are limited human-to-human transmissions. “

The Chief Scientist of Epidemiology of the Chinese Center for Disease Control and Prevention said that although it was confirmed that the virus could be transmitted from person to person, reinfection of imported cases in Wuhan has not yet been found. “I think this is a node. We want to control the second-generation transmission. Quickly put an end to the epidemic. “

Although “person-to-person” has been identified, there are still many questions to be answered. An SARS expert who requested anonymity told the “medical community” that “the methods and routes of interpersonal transmission are unclear, such as whether the incubation period is contagious, whether patients with severe symptoms of pneumonia are infected, and what infectious periods are more contagious. None of these know.”

The relationship between and SARS

Since the outbreak, speculation about the relationship between the new coronavirus and SARS virus has never stopped.

On the 11th, China announced the viral gene sequence to the WHO, and experts analyzed that it could initially determine that its similarity to the entire genome of SARS was around 80%.

Guan Guanyi said in an interview with Caixin that the ability of the new coronavirus to spread and adapt to the population, as well as its incidence and pathogenicity, are highly similar to the early SARS development curve.

He analyzed, “The first official onset of new coronavirus pneumonia in Wuhan was on December 12, when the protective system may not be so sensitive, and the actual early cases may be pushed forward by about half a month to a month in medicine. Therefore, the initial outbreak may be from November 20 to December 1. In 2003, the first SARS outbreak occurred on November 16, 2002, and the first ‘super communicator’ appeared at the end of January of the following year. . “

Zhong Nanshan stated in an interview with CCTV on the 20th that the new coronavirus is parallel to SARS virus, although it has many similarities. He made it clear that infection with the new coronavirus is climbing, but is less infectious than SARS.

He emphasized that the new coronavirus and SARS virus are not the same in nature.

At present, scientists have confirmed that the new coronavirus belongs to the beta coronavirus genus. Coronaviruses are divided into four genera, of which two coronaviruses have a high infection rate and a high mortality rate. They are SARS coronavirus and MERS virus, both of which belong to the beta coronavirus genus.

Regarding the severity of the new coronavirus, the “medical community” consulted an infectious disease expert in China. He said that with what he knew so far, “whether the symptoms caused by the previously discovered coronavirus are lighter, are still under investigation.”

But Arnaud Fontanet, director of the Institute of Epidemiology at the Paris Pasteur Institute (Institut Pasteur), warned in an interview with Agence France-Presse that although the new coronavirus appears to be “weaker than SARS”, it may still mutate into a more deadly virus Strain.

“We have no evidence that the virus will mutate, but SARS is born like this. But the virus has only just begun to spread for a short time, so it is too early to say.”

What is a Class A prevention and control

号 On the 20th, the National Health and Medical Commission issued Announcement No. 1 to incorporate pneumonia infected with the new coronavirus into the Class B infectious diseases stipulated in the Law of the People’s Republic of China on the Prevention and Control of Infectious Diseases, and take measures for the prevention and control of Class A infectious diseases.

According to Article 39 of the Prevention and Control Law, Category A prevention and control means-mandatory isolation measures. When a medical institution finds an infectious patient, it should promptly isolate and treat the patient and the pathogen carrier, and the isolation period is determined according to the results of the medical examination; for suspected patients, separate isolation and treatment at a designated place before diagnosis; carry the patient and pathogen within the medical institution And close contacts of suspected patients, perform medical observations and take other necessary precautions at designated places.

Although there are compulsory isolation measures, at present, there are still difficulties in the prevention and control of medical institutions that need to be broken.

The aforementioned infectious disease expert, who asked not to be named, told the “medical community” that at present, the difficulty in the prevention and treatment of the new coronavirus is that the symptoms it causes are not “specific”, may cause severe pneumonia, or may only manifest as cold symptoms. ” How to identify patients with mild symptoms is the current difficulty in prevention and treatment. “

“Patients with mild infection or asymptomatic infection may be coughing for two days. They will not go to the hospital for treatment, but the proportion of these patients and how infectious are currently under investigation.”

Experts reminded that the medical staff of medical institutions should raise awareness of prevention, especially to improve the ability of outpatient triage.

“The national document clearly states that it is a Class B infectious disease, but according to the Class A preventive control, this is very wise and reflects the change in national countermeasures.” The SARS expert told the “medical community”, “If necessary, killing chickens also requires Use a bull’s knife. But whether to use more stringent control measures, it is also necessary to determine based on observations. “

The world pays attention to China

是否 Whether China has learned anything from the SARS epidemic has become the focus of public opinion discussions in the past two days.

During SARS, CBS News correspondent Ramy Inocencio lives and works in Beijing. He said Wuhan’s new coronavirus pneumonia will be a “test” and “it will reflect whether China has learned from past events to protect the health and future of the people.”

Arnaud Fontanet, director of the Epidemiology Department at the Paris Pasteur Institute, praised the transparency of the outbreak in China. This is different from when SARS first began to spread. Chinese health workers immediately tested the patients and investigated whether the cases were related to the seafood market involved. The prompt follow-up was appreciated. “We have learned a few lessons from SARS. We have better preparedness and a faster response.”

Over the past 17 years, leaders in many countries, including China, have realized that SARS is a painful lesson. Prior to the emergence of SARS in southern China in the fall of 2002, most governments regarded infectious diseases as internal affairs, and details were kept secret from the outside world.

劳 Laurie Ga, author of Approaching Plague