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Asymptomatic is no longer announced, how to monitor the real infection situation?
December 14, 2022 19:58 China News Weekly
297
On the morning of December 14, 2022, the China Centers for Disease Control and Prevention announced that it will no longer publish data on asymptomatic infections from now on. Experts pointed out that this is the first step in the "de-disease" of asymptomatic infections, that is, asymptomatic infections rely more on self-management and do not need to go to the hospital for treatment. This also means that the epidemic prevention policy has since really turned to focus on severe cases.
The press conference of the joint prevention and control mechanism of the State Council held this afternoon stated that the current goal of epidemic prevention and control is to protect health and prevent severe illness.
Since January 28, 2020, the National Health and Medical Commission has included asymptomatic COVID-19 infections under prevention and control management. Since then, it has started to broadcast the number of new asymptomatic infections every day, and report them side by side with confirmed cases. Since Omicron began to spread, since most of the infected people are asymptomatic, the number of asymptomatic cases is far greater than the number of confirmed cases in the daily new data of various regions and the country. Earlier, some experts suggested that in order to prevent the public from panic and establish a correct understanding of the new coronavirus, the National Health and Medical Commission does not need to separately announce the number of asymptomatic patients every day.
"China News Weekly" found that in the latest national epidemic data released on December 13, there were only newly confirmed cases, deaths, suspected cases, cured and discharged patients, and severe patients. Among them, 2,249 new local cases were confirmed. The last single-day number of new asymptomatic infections announced in China stayed on December 12: 5,364 cases, including local and imported infections.
Experts pointed out that after asymptomatic statistics are no longer counted, it does not mean that the spread of the new coronavirus will no longer be monitored. With the cancellation of nucleic acid for all staff and the promotion of self-testing of antigens at home, some medical institutions have been run on, and the total number of people who have been screened for nucleic acid nationwide has dropped significantly recently. In the next step, the normalized monitoring of the community transmission of the new coronavirus is even more critical.
"Positive detection rate is a very useful and sensitive indicator"
Today, Li Qun, director of the Emergency Center of the China Centers for Disease Control and Prevention, explained that at present, the strategy of "willing to test all" is currently implemented in the nucleic acid testing of new coronary pneumonia. It is difficult to accurately grasp the actual number of asymptomatic infections, and the data on asymptomatic infections will no longer be released from December 14. Asymptomatic infected persons will continue to be guided by primary medical and health institutions for home health monitoring and provide corresponding services.
After the number of asymptomatic infections is no longer announced, how to adapt to the new situation and carry out regular monitoring of the epidemic?
On December 14, Li Qun said that in the future, relying on the national influenza-like case surveillance system, various forms of surveillance such as sentinel surveillance will be carried out, and the concentration of key institutions such as nursing homes, mental hospitals, welfare institutions, schools, and medical and health institutions will be strengthened. Surveillance and reporting of outbreaks. "That is to say, use the same system that used to monitor influenza to monitor the new coronavirus." A public health expert who did not want to be named told China News Weekly.
He explained that China has long established a complete influenza surveillance system, which is relatively mature and has a fixed team. The second is to establish sentinels in hospitals, schools, nursing homes and other places to timely study and judge the scale of the epidemic among key populations.
In this regard, Hong Kong's experience is also worth learning.
In the process of adjusting the epidemic prevention policy in Hong Kong, one of the key data for reference is the positive detection rate of samples from the whole population. The School of Public Health of the University of Hong Kong launched the "United Nations Epidemic Surveillance Plan" in February this year. 10,000 people were randomly selected from 18 administrative districts in Hong Kong and divided into 7 groups for daily antigen detection, so as to calculate the daily prevalence of new crowns, that is, the positive detection rate. . According to data from the School of Public Health of the University of Hong Kong, the epidemic situation in Hong Kong has been generally stable in the past three months. The positive detection rate was 2.92% on September 23, 0.81% on October 23, 0.39% on November 11, and 2.34% on December 7. %.
Jin Dongyan, a professor at the School of Biomedical Sciences of the University of Hong Kong and an expert in virology, told China News Weekly that this shows that since the implementation of "0+3" at the end of September in Hong Kong, although the number of imported cases has increased, the total number of people infected by the new coronavirus in the community has remained basically stable. The recent slight increase in the number of infections may be related to the recent decline of antibodies in the human body during the fifth wave of the tsunami in Hong Kong. Therefore, Hong Kong is stepping up vaccination of bivalent vaccines for the elderly. However, as long as the positive detection rate can be maintained at around 2%, that is, about 150,000 people in Hong Kong will be infected out of a population of 7.5 million. An important reason for the further liberalization of borders.
Just on December 13, Hong Kong announced that the 3 days of "0+3" will also be cancelled, that is, overseas immigrants will no longer have a 3-day "yellow code" restriction, which is equivalent to implementing "0+0". Lu Chongmao, director of the Hong Kong Medical and Health Bureau, cited positive detection rate figures when interpreting the policy adjustment. He said that in the past month, the proportion of people who entered the country infected with the new crown was about 3.8%, most of which were detected through the airport nucleic acid at the time of entry, and only 16 out of every 1,000 people were found to be infected three days after entering the country. It is already lower than the 2.5% test positive rate in the community."
Jin Dongyan explained that the positive detection rate is important because it is an important indicator for judging the epidemic situation, and it is also one of the scientific basis for deciding whether relevant epidemic prevention policies should be retracted in a timely manner. Taking Hong Kong as an example, after the fifth wave of the epidemic, Hong Kong society has basically formed herd immunity, but if the positive detection rate exceeds 2.5%, it is necessary to consider appropriately adding some public health measures such as maintaining social distance and limiting the flow of restaurants. "After the nucleic acid test of the whole people, we must know roughly how many people have been infected. Otherwise, when the epidemic tsunami has formed, we will not know. The whole society, especially the medical system, will face a very passive situation, and those who will bear the brunt It’s the elderly at high risk.”
The above-mentioned public health experts suggested that when testing the positive detection rate in the society, it is necessary to cover different groups of people as much as possible, especially those who are high-risk and susceptible to infection, and the sampling method for each group of people should be relatively fixed. In addition, the new crown spreads faster than the flu, so the frequency of sampling should be higher. The specific sampling plan should be adjusted according to the changes in the epidemic situation, and the sampling data must be released to the public regularly.
"The positive detection rate is a very useful and sensitive indicator. It is helpful to judge the trend of the overall epidemic during social monitoring. If the detection rate continues to rise, it means that the social infection is getting worse. If it is detected The decline in the rate may represent the beginning of an inflection point in the epidemic." He said.
A number of experts suggested that the positive detection rate should be used as the core indicator to draw an early warning line for epidemic prevention at the national level. When the detection rate exceeds a certain value, some peak pressure measures should be taken at the social level to temporarily control it Social mobility, or preparing to reopen some shelters, hospitals also need to increase ICU spare beds, drug reserves, etc. "Public health measures must be adjusted dynamically based on scientific and reasonable data, and should not be relaxed all at once. Now that the number of infections in society has surged, many measures have been relaxed, which is inappropriate." said the aforementioned public health experts. "The most important thing is that the public must be informed of the real situation of the spread of the epidemic in a timely manner, whether the situation is getting better or worse, so that people can take more preventive measures to protect their families."
Indicators that reflect the capacity of healthcare resources need to be monitored
Experts remind that for the monitoring of the new crown epidemic, sample collection and sentinel monitoring are only auxiliary means, and the understanding of the real infection situation must be combined with the real-time resources of the medical system. That is to say, it is necessary to be clear about the purpose of monitoring. "We know how far the current epidemic has developed in order to prevent medical runs. How many severe cases and deaths are there every day, how many hospital beds and ICU beds are left in each hospital, and how many severe cases are there?" When the ability will break through the limit, these numbers are much more important than the number of new confirmed cases every day." Jin Dongyan explained.
In his view, China's current daily epidemic reports are of limited significance for the number of confirmed, suspected, and discharged patients, and two key indicators that should be released to the outside world are: the number of new crown hospitalizations and the utilization rate of ICU beds. "These are the two most important indicators that reflect the capacity of medical resources. Generally speaking, if the occupancy rate of ICU beds has reached 60-70%, a warning must be issued."
The data of new crown hospitalized patients in Singapore by age group in the past month. Image source: Singapore Ministry of Health website The data of new crown hospitalized patients in Singapore by age group in the past month. Image source: Singapore Ministry of Health website
The Ministry of Health of Singapore no longer releases the daily number of new confirmed cases separately, but regularly publishes weekly reports on the epidemic. In addition to the daily number of confirmed cases, it will publish the seven-day average number of confirmed cases. More importantly, the daily number of new crown hospitalizations, the number of people requiring oxygen inhalation in general wards, the number of ICU patients and the number of deaths will also be announced. Each type of data will release figures by age group. For the elderly group over the age of 60 that needs special attention, the seven-day average number of ICU patients and deaths per 100,000 people will be additionally released, and the corresponding data on vaccination of different age groups will be published separately. In addition, for the ICU utilization rate of the new crown, a week-to-week change chart will be released at the same time to more accurately reflect the trend of critical resource use.
Huang Yanzhong, a senior researcher for global health at the US Council on Foreign Relations, told China News Weekly that China can learn from Singapore's practice and first change the daily newspaper to a weekly newspaper, which will not only help reduce panic, but also better display the overall transmission trend.
Monitoring indicators for the level of community transmission of the new crown in the United States. Image source: US cdc websiteMonitoring indicators for the level of community transmission of the new crown in the United States. Image source: US cdc website
Similar to Singapore, the United States also counts the seven-day average of the new crown hospitalization rate on a weekly basis. The US Centers for Disease Control and Prevention (CDC) has a hospitalization data monitoring network that includes more than 250 hospitals in 14 states. The information includes not only specific hospitalization numbers, but also multiple clinical data such as age group, gender, race and underlying health conditions.
The most powerful tool for CDC epidemic monitoring is a set of indicators used to assess the level of community transmission of the new crown, including three indicators. First, take the number of newly diagnosed cases per 100,000 people in the community in the past seven days as the baseline. If it is greater than 200, then look at two other indicators: the number of new crown admissions per 100,000 people in seven days and the bed utilization rate. The number of new confirmed cases mainly comes from nucleic acid positive cases reported by medical institutions and positive self-test data uploaded by residents through the antigen declaration system. This set of indicators is based on the premise of improving the immunity of the population and reducing the pathogenicity of Omicron. In August this year, the CDC updated this set of indicators.
According to the index system, if the number of new hospitalizations is greater than 10, or the bed occupancy rate is greater than 10%, the level of transmission in the community is judged to be high, otherwise it is medium. If the number of new confirmed cases is less than 200, and the number of hospitalizations and bed occupancy rates are both below 10% or less, it is considered low-level. CDC has given corresponding public health measures for each risk level. For example, it is recommended that in communities with high transmission levels, individuals should wear masks in public places, and people with underlying diseases or immunodeficiency should avoid inappropriate use in public places. For necessary activities, the community can formulate a special rapid antigen detection plan according to the local situation, and the local hospital should consider whether to increase the reserve of medical resources.
The CDC website pointed out that the number of new hospitalizations per 100,000 people reflects the number of cases with severe new crown symptoms in the community, and the bed utilization rate is an indicator representing the utilization and remaining capacity of the local medical system. Together, these two indicators reflect when local healthcare systems may be overloaded or require urgent public health interventions.
Chen Xi, an associate professor of global health policy and economics at Yale University in the United States, told China News Weekly that since the spread of Omicron, there has been basically no shortage of severe resources in the United States at the beginning of the epidemic. Every state will monitor its own new crown hospitalization rate and ICU bed occupancy, these figures are updated daily.
He pointed out that opening up is a systematic project, especially for developing countries with relatively weak medical systems. The conditions for gradual liberalization need to be based on the vaccination rate and take into account the capabilities of local medical resources. "The core challenge after liberalization is to prevent the medical system from being overwhelmed. At present, there are only partial figures or official general descriptions of severe cases, death data, and ICU occupancy rates in China."
The above-mentioned public health experts suggested that at least several key new crown designated hospitals should conduct investigations at present to calculate the proportion of severe new crown patients in the recent period, how many people need oxygen inhalation, rescue, the number of deaths, and the specific cause of death. What, and what about the vaccination status. A unified statistical standard should also be established at the national level, and it should be released to the public regularly or an independent third-party agency should be invited to intervene to ensure the accuracy of the data.
zhttps://news.sina.com.cn/c/2022-12-14/doc-imxwryyr9737363.shtml#/
December 14, 2022 19:58 China News Weekly
297
On the morning of December 14, 2022, the China Centers for Disease Control and Prevention announced that it will no longer publish data on asymptomatic infections from now on. Experts pointed out that this is the first step in the "de-disease" of asymptomatic infections, that is, asymptomatic infections rely more on self-management and do not need to go to the hospital for treatment. This also means that the epidemic prevention policy has since really turned to focus on severe cases.
The press conference of the joint prevention and control mechanism of the State Council held this afternoon stated that the current goal of epidemic prevention and control is to protect health and prevent severe illness.
Since January 28, 2020, the National Health and Medical Commission has included asymptomatic COVID-19 infections under prevention and control management. Since then, it has started to broadcast the number of new asymptomatic infections every day, and report them side by side with confirmed cases. Since Omicron began to spread, since most of the infected people are asymptomatic, the number of asymptomatic cases is far greater than the number of confirmed cases in the daily new data of various regions and the country. Earlier, some experts suggested that in order to prevent the public from panic and establish a correct understanding of the new coronavirus, the National Health and Medical Commission does not need to separately announce the number of asymptomatic patients every day.
"China News Weekly" found that in the latest national epidemic data released on December 13, there were only newly confirmed cases, deaths, suspected cases, cured and discharged patients, and severe patients. Among them, 2,249 new local cases were confirmed. The last single-day number of new asymptomatic infections announced in China stayed on December 12: 5,364 cases, including local and imported infections.
Experts pointed out that after asymptomatic statistics are no longer counted, it does not mean that the spread of the new coronavirus will no longer be monitored. With the cancellation of nucleic acid for all staff and the promotion of self-testing of antigens at home, some medical institutions have been run on, and the total number of people who have been screened for nucleic acid nationwide has dropped significantly recently. In the next step, the normalized monitoring of the community transmission of the new coronavirus is even more critical.
"Positive detection rate is a very useful and sensitive indicator"
Today, Li Qun, director of the Emergency Center of the China Centers for Disease Control and Prevention, explained that at present, the strategy of "willing to test all" is currently implemented in the nucleic acid testing of new coronary pneumonia. It is difficult to accurately grasp the actual number of asymptomatic infections, and the data on asymptomatic infections will no longer be released from December 14. Asymptomatic infected persons will continue to be guided by primary medical and health institutions for home health monitoring and provide corresponding services.
After the number of asymptomatic infections is no longer announced, how to adapt to the new situation and carry out regular monitoring of the epidemic?
On December 14, Li Qun said that in the future, relying on the national influenza-like case surveillance system, various forms of surveillance such as sentinel surveillance will be carried out, and the concentration of key institutions such as nursing homes, mental hospitals, welfare institutions, schools, and medical and health institutions will be strengthened. Surveillance and reporting of outbreaks. "That is to say, use the same system that used to monitor influenza to monitor the new coronavirus." A public health expert who did not want to be named told China News Weekly.
He explained that China has long established a complete influenza surveillance system, which is relatively mature and has a fixed team. The second is to establish sentinels in hospitals, schools, nursing homes and other places to timely study and judge the scale of the epidemic among key populations.
In this regard, Hong Kong's experience is also worth learning.
In the process of adjusting the epidemic prevention policy in Hong Kong, one of the key data for reference is the positive detection rate of samples from the whole population. The School of Public Health of the University of Hong Kong launched the "United Nations Epidemic Surveillance Plan" in February this year. 10,000 people were randomly selected from 18 administrative districts in Hong Kong and divided into 7 groups for daily antigen detection, so as to calculate the daily prevalence of new crowns, that is, the positive detection rate. . According to data from the School of Public Health of the University of Hong Kong, the epidemic situation in Hong Kong has been generally stable in the past three months. The positive detection rate was 2.92% on September 23, 0.81% on October 23, 0.39% on November 11, and 2.34% on December 7. %.
Jin Dongyan, a professor at the School of Biomedical Sciences of the University of Hong Kong and an expert in virology, told China News Weekly that this shows that since the implementation of "0+3" at the end of September in Hong Kong, although the number of imported cases has increased, the total number of people infected by the new coronavirus in the community has remained basically stable. The recent slight increase in the number of infections may be related to the recent decline of antibodies in the human body during the fifth wave of the tsunami in Hong Kong. Therefore, Hong Kong is stepping up vaccination of bivalent vaccines for the elderly. However, as long as the positive detection rate can be maintained at around 2%, that is, about 150,000 people in Hong Kong will be infected out of a population of 7.5 million. An important reason for the further liberalization of borders.
Just on December 13, Hong Kong announced that the 3 days of "0+3" will also be cancelled, that is, overseas immigrants will no longer have a 3-day "yellow code" restriction, which is equivalent to implementing "0+0". Lu Chongmao, director of the Hong Kong Medical and Health Bureau, cited positive detection rate figures when interpreting the policy adjustment. He said that in the past month, the proportion of people who entered the country infected with the new crown was about 3.8%, most of which were detected through the airport nucleic acid at the time of entry, and only 16 out of every 1,000 people were found to be infected three days after entering the country. It is already lower than the 2.5% test positive rate in the community."
Jin Dongyan explained that the positive detection rate is important because it is an important indicator for judging the epidemic situation, and it is also one of the scientific basis for deciding whether relevant epidemic prevention policies should be retracted in a timely manner. Taking Hong Kong as an example, after the fifth wave of the epidemic, Hong Kong society has basically formed herd immunity, but if the positive detection rate exceeds 2.5%, it is necessary to consider appropriately adding some public health measures such as maintaining social distance and limiting the flow of restaurants. "After the nucleic acid test of the whole people, we must know roughly how many people have been infected. Otherwise, when the epidemic tsunami has formed, we will not know. The whole society, especially the medical system, will face a very passive situation, and those who will bear the brunt It’s the elderly at high risk.”
The above-mentioned public health experts suggested that when testing the positive detection rate in the society, it is necessary to cover different groups of people as much as possible, especially those who are high-risk and susceptible to infection, and the sampling method for each group of people should be relatively fixed. In addition, the new crown spreads faster than the flu, so the frequency of sampling should be higher. The specific sampling plan should be adjusted according to the changes in the epidemic situation, and the sampling data must be released to the public regularly.
"The positive detection rate is a very useful and sensitive indicator. It is helpful to judge the trend of the overall epidemic during social monitoring. If the detection rate continues to rise, it means that the social infection is getting worse. If it is detected The decline in the rate may represent the beginning of an inflection point in the epidemic." He said.
A number of experts suggested that the positive detection rate should be used as the core indicator to draw an early warning line for epidemic prevention at the national level. When the detection rate exceeds a certain value, some peak pressure measures should be taken at the social level to temporarily control it Social mobility, or preparing to reopen some shelters, hospitals also need to increase ICU spare beds, drug reserves, etc. "Public health measures must be adjusted dynamically based on scientific and reasonable data, and should not be relaxed all at once. Now that the number of infections in society has surged, many measures have been relaxed, which is inappropriate." said the aforementioned public health experts. "The most important thing is that the public must be informed of the real situation of the spread of the epidemic in a timely manner, whether the situation is getting better or worse, so that people can take more preventive measures to protect their families."
Indicators that reflect the capacity of healthcare resources need to be monitored
Experts remind that for the monitoring of the new crown epidemic, sample collection and sentinel monitoring are only auxiliary means, and the understanding of the real infection situation must be combined with the real-time resources of the medical system. That is to say, it is necessary to be clear about the purpose of monitoring. "We know how far the current epidemic has developed in order to prevent medical runs. How many severe cases and deaths are there every day, how many hospital beds and ICU beds are left in each hospital, and how many severe cases are there?" When the ability will break through the limit, these numbers are much more important than the number of new confirmed cases every day." Jin Dongyan explained.
In his view, China's current daily epidemic reports are of limited significance for the number of confirmed, suspected, and discharged patients, and two key indicators that should be released to the outside world are: the number of new crown hospitalizations and the utilization rate of ICU beds. "These are the two most important indicators that reflect the capacity of medical resources. Generally speaking, if the occupancy rate of ICU beds has reached 60-70%, a warning must be issued."
The data of new crown hospitalized patients in Singapore by age group in the past month. Image source: Singapore Ministry of Health website The data of new crown hospitalized patients in Singapore by age group in the past month. Image source: Singapore Ministry of Health website
The Ministry of Health of Singapore no longer releases the daily number of new confirmed cases separately, but regularly publishes weekly reports on the epidemic. In addition to the daily number of confirmed cases, it will publish the seven-day average number of confirmed cases. More importantly, the daily number of new crown hospitalizations, the number of people requiring oxygen inhalation in general wards, the number of ICU patients and the number of deaths will also be announced. Each type of data will release figures by age group. For the elderly group over the age of 60 that needs special attention, the seven-day average number of ICU patients and deaths per 100,000 people will be additionally released, and the corresponding data on vaccination of different age groups will be published separately. In addition, for the ICU utilization rate of the new crown, a week-to-week change chart will be released at the same time to more accurately reflect the trend of critical resource use.
Huang Yanzhong, a senior researcher for global health at the US Council on Foreign Relations, told China News Weekly that China can learn from Singapore's practice and first change the daily newspaper to a weekly newspaper, which will not only help reduce panic, but also better display the overall transmission trend.
Monitoring indicators for the level of community transmission of the new crown in the United States. Image source: US cdc websiteMonitoring indicators for the level of community transmission of the new crown in the United States. Image source: US cdc website
Similar to Singapore, the United States also counts the seven-day average of the new crown hospitalization rate on a weekly basis. The US Centers for Disease Control and Prevention (CDC) has a hospitalization data monitoring network that includes more than 250 hospitals in 14 states. The information includes not only specific hospitalization numbers, but also multiple clinical data such as age group, gender, race and underlying health conditions.
The most powerful tool for CDC epidemic monitoring is a set of indicators used to assess the level of community transmission of the new crown, including three indicators. First, take the number of newly diagnosed cases per 100,000 people in the community in the past seven days as the baseline. If it is greater than 200, then look at two other indicators: the number of new crown admissions per 100,000 people in seven days and the bed utilization rate. The number of new confirmed cases mainly comes from nucleic acid positive cases reported by medical institutions and positive self-test data uploaded by residents through the antigen declaration system. This set of indicators is based on the premise of improving the immunity of the population and reducing the pathogenicity of Omicron. In August this year, the CDC updated this set of indicators.
According to the index system, if the number of new hospitalizations is greater than 10, or the bed occupancy rate is greater than 10%, the level of transmission in the community is judged to be high, otherwise it is medium. If the number of new confirmed cases is less than 200, and the number of hospitalizations and bed occupancy rates are both below 10% or less, it is considered low-level. CDC has given corresponding public health measures for each risk level. For example, it is recommended that in communities with high transmission levels, individuals should wear masks in public places, and people with underlying diseases or immunodeficiency should avoid inappropriate use in public places. For necessary activities, the community can formulate a special rapid antigen detection plan according to the local situation, and the local hospital should consider whether to increase the reserve of medical resources.
The CDC website pointed out that the number of new hospitalizations per 100,000 people reflects the number of cases with severe new crown symptoms in the community, and the bed utilization rate is an indicator representing the utilization and remaining capacity of the local medical system. Together, these two indicators reflect when local healthcare systems may be overloaded or require urgent public health interventions.
Chen Xi, an associate professor of global health policy and economics at Yale University in the United States, told China News Weekly that since the spread of Omicron, there has been basically no shortage of severe resources in the United States at the beginning of the epidemic. Every state will monitor its own new crown hospitalization rate and ICU bed occupancy, these figures are updated daily.
He pointed out that opening up is a systematic project, especially for developing countries with relatively weak medical systems. The conditions for gradual liberalization need to be based on the vaccination rate and take into account the capabilities of local medical resources. "The core challenge after liberalization is to prevent the medical system from being overwhelmed. At present, there are only partial figures or official general descriptions of severe cases, death data, and ICU occupancy rates in China."
The above-mentioned public health experts suggested that at least several key new crown designated hospitals should conduct investigations at present to calculate the proportion of severe new crown patients in the recent period, how many people need oxygen inhalation, rescue, the number of deaths, and the specific cause of death. What, and what about the vaccination status. A unified statistical standard should also be established at the national level, and it should be released to the public regularly or an independent third-party agency should be invited to intervene to ensure the accuracy of the data.
zhttps://news.sina.com.cn/c/2022-12-14/doc-imxwryyr9737363.shtml#/