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Zhong Nanshan: The epidemic may end before April, and the peak of the return trip will not cause an epidemic peak!
Source: China Fund News 2020-02-12 08:30:43
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Forex Tianyan APP News: According to China News Agency, the prevention and control of the pneumonia epidemic is at a critical juncture. Academician Zhong Nanshan accepted an exclusive interview in Guangzhou, which released several important information about the epidemic.
Fund Jun organized the interview points for your reference.
Point 1: The epidemic of new coronavirus will peak this month (February).
Zhong Zhongshan said that the forecast is based on the epidemic situation in recent days and the measures taken by government departments. He revealed that the situation in some provinces has improved markedly and new cases have declined.
所以 "So, we estimate that, probably, the peak will come in the middle of this month (February) ... and then there will be a transition similar to a small platform period, and then it will decline." He said. And Wuhan's measures to curb the development of the epidemic are necessary. The state should also permanently ban wildlife trading, strengthen disease control, and establish a global early warning mechanism for infectious diseases.
Point 2: Epidemic of new coronavirus pneumonia is expected to end by April
Zhong Zhongshan said that new cases of new coronavirus pneumonia infection have declined in some areas and the epidemic is expected to ease. He expects the peak to occur in mid-to-late February and may end before April.
Zhong Zhongshan said that the predictions were made based on existing mathematical models, the recent epidemic situation, and measures taken by the government.
However, he acknowledged that there is still a lot of unknown about the new coronavirus. "We don't know why the virus is so contagious, this is the biggest problem," he said.
Point three: Wuhan "is still in a very difficult time"
Academician Zhong Nanshan said that we have encountered three coronavirus attacks in the 21st century: the first SARS virus in 2003 and the second MERS (Middle Eastern Respiratory Syndrome) in 2015. This is the third and new coronavirus in 2019. .
The fatality rate of this coronavirus attack is lower than that of SARS and MERS. SARS should be 8% -10%, MERS is more than 30%, which is as fast as 40%, and the statistics from this time to now are just over 2.2%.
"Of course, the situation in Wuhan is very different. Wuhan has not completely prevented people from passing on, and Wuhan has to work hard!" Academician Zhong Nanshan pointed out that he believes that there are correspondingly many (admission) places and so many doctors (support). With better protection tools, as well as the support and support of the army, the situation in Wuhan should be improved, but it is still in a very difficult time.
Zhong Zhongshan also pointed out that Wuhan local government and health departments did not take adequate measures early in the outbreak and should take responsibility for it. "They didn't do their job well." Zhong Nanshan said.
Point 4: The government is more powerful than previous measures
Zhong Zhongshan said that during the outbreak, the Chinese government has taken more powerful measures than during the SARS period, such as doing better in terms of transparency and cooperation with WHO. He also called on the government to take more measures, such as ending wildlife market transactions, increasing international cooperation in health technology, improving the operational capabilities of CDCs, and establishing a global early warning system for potential epidemics.
Zhong Nanshan did not make a timely statement about the early warning of the outbreak. "If we can work better together, we will be able to find 'people to people' earlier," he said.
Zhong Zhongshan said that the relevant departments still took some hospital isolation measures for some patients who had recovered because they did not want to take risks. "They don't know if these patients who have recovered will get infected again, so discharge rates do not look high at this time."
Zhong Nanshan responded to the "longest incubation period of 24 days":
仅 Only 1 out of 1099 samples were 24 days
On February 11, Zhong Nanshan accepted an exclusive interview with CCTV reporters and responded to a recent report via CCTV that "the latest paper by Zhong Nanshan found that the incubation period of new coronary pneumonia can be up to 24 days".
Zhong Nanshan: An article about the clinical characteristics of 1099 patients with new coronary pneumonia in our team. This study provided clinical data from a total of 552 hospitals in 30 provinces, autonomous regions and municipalities across the country. The research team analyzed the clinical characteristics of patients.
This article is a pre-print version. The pre-print version requires more peer comments. According to the official requirements of the pre-print version, its information cannot be cited, nor can it guide the clinic. Peer review. In the incubation period in the preprint version, we have a statistical method to record according to the patient's dictation. We calculate based on the patient's time of exposure to the source of infection and the earliest occurrence of symptoms, the longest is 24 days. But in fact there is only one patient with a true description of 24 days, that is to say only one out of 1099 patients. It is not scientific enough to use the time reported by this only patient as the longest incubation period for the disease. There have been precedents for other diseases, such as rabies. Our study shows that the median incubation period for all patients is 4 days. In addition, we will report the interquartile range in this article, which is 2 days and 7 days (that is, the gap is 5 days), which more scientifically reflects the population The overall situation.
Therefore, some information about unpublished articles should not be interpreted excessively.
Zhong Nanshan: The infected people are basically sick
I don't think there will be a higher peak
According to the Southern Report, academician Zhong Nanshan introduced that no one can make a rigorous inflection point prediction for the epidemic situation, but through the mathematical intelligent analysis model, combined with the correction of the actual situation in recent days, plus the current climate and other factors, and The central government has strengthened interventions in the entire epidemic situation, the number of confirmed new cases and the development trend of the country, and we can see that the number of new cases has decreased. According to the analysis of mathematical models, the epidemic situation in China is expected to start to fall after reaching the peak in mid-February.
Many people are worried that the peak of the return trip will cause the epidemic to rise again. Zhong Nanshan said that he does not think there will be a higher peak. First of all, because of the incubation period of new coronary pneumonia, after the Spring Festival and extended holidays, the infected people are basically sick. In addition, strict checkpoints are now set up in various cities, and planes, trains and other transportation are also strictly screened. Nucleic acid tests are performed for symptoms and proper isolation is required. "Early detection, early diagnosis, and early isolation are the most primitive and effective methods. Powerful intervention started on January 22, and it should be seen now."
Regarding the epidemic situation in Wuhan, Zhong Nanshan believes that the situation in Wuhan will take some time and there is no obvious reduction in new cases every day. Wuhan must first implement the plan to separate the sick and the non-ill, and solve the problem of person-to-person transmission. Now local medical staff has also received assistance from various quarters. About 10,000 medical staff across the country have supported Wuhan. Vulcan Mountain Hospital, Thunder Mountain Hospital, and Fangcai Hospital have added more than 5,000 beds to Wuhan.
In terms of patient treatment, Zhong Nanshan said that currently mild patients are relatively well accepted, but treatment of severe and critically ill patients admitted in large hospitals is still difficult. Although this virus is also a coronavirus, it is different from SARS in that it has its own pathology and physiological changes. But in general, even in critically ill patients, the density of the virus, especially in the lower respiratory tract, has gradually decreased after treatment.
药物 In terms of drugs, many experiments are being carried out, but most of them are still in clinical trials. The first thing is to see if they are effective. The current treatment focuses on anti-virus and the other is to address the inflammatory storm caused by the virus. Doctors are actively exploring and symptomatic treatment.
Zhong Zhongshan leads the latest papers:
Over half of the patients do not have fever in the early stage and the incubation period can reach 24 days
At a critical moment, Zhong Nanshan's team took another shot, the latest research on the new crown virus, and the largest sample analysis to date.
On February 9, the study of "Clinical Features of New Type Coronavirus Infections in China 2019" led by Zhong Nanshan, the leader of the high-level group of the National Health and Medical Commission and the Chinese Academy of Engineering, was published on the preprinted website medRxiv. (Note: medRxiv's papers have not been peer-reviewed)
Zhong Zhongshan et al. Conducted a retrospective study of the clinical characteristics of 1099 patients (as of January 29) diagnosed with new coronary pneumonia.
These conclusions have basically refreshed the current knowledge of the new crown virus, and brought new references to the fight against the new crown virus. It is also the first time that Zhong Nanshan's team has published research results in the form of a paper since the new crown virus epidemic.
Zhong Zhongshan's team disclosed the following research conclusions in the paper:
1. The median incubation period for new coronary pneumonia is 3.0 days, up to 24 days;
2, Only 43.8% showed fever symptoms in the early stage, but 87.9% had fever symptoms after hospitalization.
3. Only about 1% of the patients had direct contact with wild animals, and more than 3/4 of the patients were local residents of Wuhan, or had contact with personnel from Wuhan. This provides further evidence for human-to-human transmission of new coronary pneumonia.
4. In addition to droplet transmission and direct contact, researchers have also detected new coronavirus in stool samples of some patients, as well as in the gastrointestinal tract, saliva or urine, and esophageal erosion and bleeding. Therefore, health protection should be considered through Transmission of gastrointestinal secretions.
The latest paper was jointly completed by Zhong Nanshan and 37 authors from the front line of the national epidemic. Authors include Guangzhou Institute of Respiratory Health, Wuhan Jinyintan Hospital, Huanggang Central Hospital and so on. The First Affiliated Hospital of Zhejiang University School of Medicine, where Academician Li Lanjuan of the Chinese Academy of Engineering is located is also among them.
Zhong Zhongshan is the corresponding author of this paper.
The paper proposes that although the new crown pneumonia is still spreading rapidly worldwide, the clinical characteristics of acute respiratory disease (ARD) caused by the new crown virus remain unclear.
To this end, Zhong Nanshan et al. Conducted a retrospective study of the clinical characteristics of 1099 patients with new coronary pneumonia diagnosed in China. These cases came from 552 hospitals in 31 provinces / municipalities across the country.
These patients were confirmed by high-throughput sequencing or real-time reverse transcriptase polymerase chain reaction (RT-PCR) tests on nasal and throat swab samples.
主要 The main contents of the thesis research are as follows
Age:
The median age was 47.0 years, of which women accounted for 41.90%, of which patients under 15 years old accounted for 0.9%.
Contact history:
92.09% are medical workers; 1.18% of patients have a history of exposure to wildlife; 31.30% have recently visited Wuhan; 71.80% have been exposed to Wuhan.
Latent period:
The median incubation period is 3.0 days (range 0 to 24.0 days).
Clinical symptoms:
The most common symptoms are fever (87.9%) and cough (67.7%). Diarrhea and vomiting occur less frequently, accounting for 3.7% and 5.0%, respectively;
25.2% of patients were combined with at least one underlying disease (such as hypertension, chronic obstructive pulmonary disease, etc.), and 15.74% (173/1099) of patients were severely ill.
Film degree exam:
When 840 patients were admitted to the hospital, a chest CT scan was performed, of which 76.4% showed pneumonia;
Typical radiological findings are ground glass-like shadows (50.00%) and bilateral patchy shadows (46.0%).
Experimental inspection:
82.1% and 36.2% of patients had lymphopenia and thrombocytopenia, leukopenia was observed in 33.7% of patients, and most patients showed elevated C-reactive protein levels.
Treatment and complications:
38.0% of patients received oxygen therapy, 6.1% of patients were ventilated by machine, 57.5% of patients were given intravenous antibiotics, 35.8% of patients were given oseltamivir antiviral therapy, and 5 severe cases were treated with ECMO.
The most common complications were pneumonia (79.1%), ARDS (3.37%), and shock (1.00%).
Clinical prognosis:
55 patients (5.00%) were admitted to the intensive care unit, 2.18% required invasive ventilator-assisted ventilation, and 15 patients (1.36%) died;
症状 The number of cases with symptoms plus reverse transcriptase polymerase chain reaction without radiological abnormalities was significantly higher than that of mild cases (23.87% vs. 5.20%, P <0.001);
Lymphocyte reduction accounted for 82.1%;
多元 In the multiple competitive risk model, severe pneumonia was not significantly associated with admission to the intensive care unit (ICU), mechanical intubation, or death (sub-distribution hazard ratio 9.80; 95% confidence interval 4.06 to 23.67).
Zhong Nanshan and others stated in the paper that compared with the two previous studies published in The Lancet, the mortality rate of new coronary pneumonia in the latest study has significantly changed based on a larger sample size and cases recruited across the country. Low (1.4%). When including the pilot data from Guangdong Province, the case fatality rate was even lower (0.88%).
According to Nanfang Daily, Zhong Nanshan said on the 9th that the new coronavirus is a kind of coronavirus, which is "parallel" with SARS coronavirus. According to the current observations, the mortality rate of neo-coronary pneumonia is about 2.7%, and the patients are mostly middle-aged and elderly. Although the mortality rate is stronger than ordinary influenza, it is far lower than SARS coronavirus, Ebola virus or H7N9 influenza virus.
In response to the discoloration of new coronary pneumonia in some places in Guangdong, Zhong Nanshan said that most people will not have any problems as long as they find adequate rest and cooperate with treatment after early detection. "It is important to pay attention, but no need to be afraid . "
2626% of patients in the study had no exposure to Wuhan
哪里 Where does the research data come from?
As of January 29, 2020, the research team extracted data from 1,099 laboratory-confirmed patients with acute respiratory disease (ARD) caused by 2019-nCoV from 552 hospitals in 31 provinces and municipalities.
Analysis found that the median age of the patients was 47 years. It is distributed in all age groups, with 0.9% of those under 15 years old. Women are 41.9%. Among them, 25.2% of patients had at least one underlying disease (such as hypertension, chronic obstructive pulmonary disease, etc.).
The study continues to confirm human-to-human transmission. Only 1.18% of patients had direct contact with wild animals, while 31.30% of patients had visited Wuhan, and 71.80% of patients had contact with people in Wuhan. Of these 1099 patients, 2.09% were medical workers, 43.95% were Wuhan residents, and 26% of the patients had not been to Wuhan or had contact with people who came back from Wuhan. These results corroborate previous reports, such as familial cluster onset and transmission of asymptomatic infection.
The study found that the median incubation period was 3.0 days (ranging from 0 to 24 days), which was lower than the previously expected 5.2 days. This helps guide the close time of close contacts.
The infected person may not have fever at the time of consultation
In terms of symptoms, fever (87.9%) and cough (67.7%) are the most common symptoms. Gastrointestinal symptoms such as diarrhea (3.7%) and vomiting (5%) are rare. 20.9% of patients had only new-type coronavirus infections in 2019 before the occurrence of viral pneumonia or without viral pneumonia.
It is worth noting that the study found that only 43.8% of the infected people had a fever at the time of consultation, but the fever rate after hospitalization reached 87.9%. Severe pneumonia occurred in 15.7% of patients. Among patients with acute respiratory disease caused by neo-coronary pneumonia, there are more patients without fever than those infected with SARS and MERS. The paper says that if surveillance focuses on fever or not, those infected may be missed.
In addition, in terms of the route of transmission of the virus, the research team found that in addition to droplets and direct contact, 4 of the 62 fecal specimens (6.5%) were positive for the new crown pneumonia virus, and 4 patients had stomach Positive reactions were detected in the intestines, saliva, and urine. The research team recommends that, in terms of health measures, consideration should be given to the defense of the transmission pathways of pollutants secreted by the gastrointestinal tract.
Oxygen is currently the main therapy
In terms of treatment, 38.0%, 6.1%, 57.5%, and 35.8% of patients received oxygen inhalation, mechanical ventilation, intravenous antibiotics, and oseltamivir, respectively. In the study, 15.74% of patients were critically ill. Only severely ill patients received mechanical ventilation.
18.6% of patients used glucocorticoids, and the rate of application in severe patients (44.5%) was higher than that in non-critical patients (13.7%). Five severe patients received extracorporeal membrane oxygenation.
During hospitalization, the most common complication was pneumonia (79.1%), followed by acute respiratory distress syndrome (3.37%) and shock (1%).
Based on a larger sample size and data from across China, the research team found that compared with previous reports, the mortality rate of new coronary pneumonia was lower, about 1.4%. According to official data released nationwide on February 6, the mortality rate of 28,018 patients across the country was 2.01%.
The research team concluded that 2019-nCoV spread rapidly through interpersonal transmission, with a median incubation period of 3 days and a relatively low mortality rate. In some 2019-nCoV-infected patients, radiological findings are normal, fever may not be present, and diarrhea is rare. The severity of the disease, including blood oxygen saturation, respiratory rate, white blood cell / lymphocyte count, and chest X-ray / CT findings, predicts poor clinical outcomes.
Adopting strict and timely epidemiological measures is essential to curb the rapid spread of the epidemic. Efforts to effectively treat diseases still need to be continuously explored.
