Exclusive Interview With Vice President Of Shanghai Ruijin Hospital: China'S Prevention And Control Experience Is Difficult To Replicate, And Improving Global Vaccine Coverage Is The Focus Of Prevention And Control

"Generally speaking, our country has done a very good job in the prevention and control of the" three steps "in accordance with the infectious disease management law Recently, Chen Erzhen, vice president of Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College and member of the Shanghai expert group on the treatment of new crown pneumonia, said in an exclusive interview with 21st century economic reporter.

According to who data, there are more than 100 million confirmed cases and 2.1 million deaths worldwide, of which the United States accounts for about a quarter of the total cases.

In this global test to fight the new epidemic, China has delivered an extraordinary answer. Shanghai is also a model of "precise prevention and control". As an open city with a permanent population of 25 million, since the diagnosis of local cases, Shanghai has not taken the most stringent control measures in the city in several rounds of the epidemic, and only closed management has been carried out on the communities, streets and hotels where the cases occur. According to CCTV, Shanghai has only arranged more than 41000 people for nucleic acid testing so far.

Referring to the "Shanghai experience", Chen Erzhen said that Shanghai's epidemic prevention system is a systematic project. The government, medical institutions, communities and citizens cooperate with each other to truly achieve joint prevention and control. "The most important thing is that the level of fine management is relatively high." However, due to the different national system, urban operation mode and cultural background of residents, other international metropolises may not be able to copy the experience of Shanghai.

As an expert in critical emergency medicine in China, Chen Erzhen has participated in the rescue work of several public health events, such as SARS in 2003, avian influenza in 2008 and Wenchuan earthquake in 2008. On January 28 last year, he led a team to Wuhan to participate in the treatment of new crown pneumonia. After returning from Wuhan, Chen Erzhen joined the Shanghai expert group on the treatment of new crown pneumonia and continued to participate in the war against the epidemic. Chen Erzhen is a witness and participant in the field of epidemic prevention and control in Wuhan and Shanghai.

Looking forward to 2021, Chen Erzhen believes that although the domestic epidemic situation is controllable, the overseas epidemic situation has not yet reached an inflection point, so it is difficult to end the global epidemic situation. In the next stage of prevention and control, vaccination coverage is very important.

Increasing vaccine coverage is critical

The 21st century: since the outbreak of the epidemic, China's unique landscape has emerged in terms of prevention and control. Why does China's prevention and control work better than developed countries in Europe and America?

Chen Erzhen: in fact, it is very simple. The principles of prevention and control of infectious diseases are the same. Once an infectious disease occurs, the first thing is to control the source of infection, the second is to cut off the route of transmission, and the third is to protect the susceptible.

Controlling the source of infection is critical. According to the law of the people's Republic of China on the prevention and control of infectious diseases, we must control the patients with infectious diseases and not allow them to flow in the society. Because once it flows, it is a "seeder" that will pass the disease on to others. Last year, the decision of Wuhan City closure was to decisively close the entire channel for leaving the Han Dynasty, so as to prevent the patients in Wuhan from running to the whole country and spreading the epidemic situation throughout the country. Now, in the case of sporadic cases, we should isolate those sporadic cases at home or in designated medical institutions in time, including suspicious persons and close contacts, so as to control the infection.

The second is to cut off the route of transmission. The new pneumonia epidemic is transmitted through the respiratory tract, which means that the virus can spread through droplets, and can be blocked by wearing masks. Therefore, we call on people to wear masks and ensure personal hygiene. Wearing masks in crowded places can prevent infectious diseases.

The third is to protect the susceptible. Our country now introduces the new crown vaccination free of charge. Through the vaccine, we can increase the resistance of our group, thus playing a role of group immunity to the epidemic situation, so that we will not get this disease.

Generally speaking, our country has done a very good job in the prevention and control of the "three steps" in accordance with the infectious disease management law.

21st century: in fact, you have witnessed the change of our epidemic prevention policy along the way, from the closure of Wuhan to the precise prevention and control of Shanghai. What is the basis for this change?

Chen Erzhen: from the closure of Wuhan city to the promotion of precise prevention and control, it depends on the wisdom of the people and the strength of science and technology. We used a lot of technology in the whole process of prevention and control. For example, "itinerary code" is to solve the situation of the flow of people and the trajectory of people's activities by using scientific and technological methods.

In the process of game with virus and epidemic situation, we also constantly understand and master the characteristics of this virus and its epidemic characteristics, so as to make corresponding countermeasures. After we found that there was "human to human" in the early stage, we took measures to control the source of infection and cut off the route of transmission. Since then, in the process of external defense input, some cold chain foods have been found to carry new coronavirus, which can be transmitted to people, which has new challenges.

We are constantly fighting against the virus, constantly accumulating our experience and constantly adjusting our prevention and control strategy. However, we still do not have a good grasp of some aspects, so we are constantly learning and exploring the laws with new technologies, so that we can accumulate more rich experience in prevention and control.

21st century: how should the prevention and control work be carried out? What are the suggestions for the common people?

Chen Erzhen: as mentioned just now, we should abide by the three principles of prevention and control of infectious diseases. In the next step, the pressure of external defense input is not great, and the most important thing is to strengthen the prevention and control of "material to human". If the prevention and control work of "material to human" is not in place, it may cause a rebound of the epidemic situation in our country and revive. We must be vigilant. We must not lose the experience we have learned before.

In addition, the state is promoting universal free vaccination, which is also the full embodiment of the idea that the country really puts people's life and health in the first place. It should be said that our epidemic situation is well controlled, but it is impossible for our country not to open. If the door is further opened, many people from epidemic areas may become communicators after they come to China. How should our citizens be protected? Vaccines are a weapon.

I think that as long as our people do not have contraindications for vaccination, we suggest that we should still accept vaccination. If the vaccination rate reaches a certain percentage, group immunity can be formed in the whole population of China, which can help us control the epidemic situation.

Vaccination is to protect ourselves first, then to protect all our people, and also to protect the security of the country.

21st century: many people are concerned about the effectiveness of vaccines. What's the difference between 75% and 98%?

Chen Erzhen: first of all, there must be differences in numbers. The vaccinated population can range from children born to old people, but in fact, there are differences among individuals.

Now, the effectiveness of the vaccine we are talking about is about 80% more than that of the domestic vaccine, which is indeed lower than that of the foreign vaccine. We admit this fact, but the samples may be different.

Is it the rate of young people getting vaccinated, or is it representative of the whole age group? This can't be determined, because the current data can't explain the problem. We also hope to further expand the sample size to verify its effectiveness through universal vaccination. After the sample is expanded, the validity data may be updated, so that the data will be more convincing.

Speaking with big data, it's critical, so we can't be biased.

Precise prevention and control is the core of "Shanghai experience"

21st century: Shanghai is known as the excellent student of epidemic prevention. Under the pressure of so many overseas imports, there are no clustering cases. Why is Shanghai's epidemic prevention policy so successful?

Chen Erzhen: first of all, the Shanghai municipal government attaches great importance to it. Secondly, the government's various prevention and control measures are in place and timely. Third, the overall quality of citizens in Shanghai is relatively high. Fourth, Shanghai has concentrated a lot of high-quality medical resources and made a lot of contributions to the epidemic prevention. Fifth, science popularization should be in place. Through science popularization, the common people can master the basic knowledge of epidemic prevention, supervise each other, wear masks according to the requirements of epidemic prevention, do a good job of personal protection, and avoid the occurrence of undesirable gathering phenomenon.

In fact, the overall epidemic prevention in Shanghai is a systematic project. One is that the medical staff concentrated in various medical institutions, play their role, timely discover patients, timely "early detection, early report, early isolation, early treatment".

In addition, Shanghai's community prevention and control has been in place and accurate. In the community prevention and control, to truly achieve joint prevention and control, residents in each community are very consciously in accordance with the requirements of prevention and control, do a good job in home isolation, which also makes the virus no chance of transmission.

Generally speaking, the "network" of precise prevention and control in Shanghai has been done very well, because there are specific measures from mobile monitoring points to various links in the flow. Everyone has maintained this vigilance, and has always had a good mechanism. In addition, a good sentinel has been established and a very perfect medical force has also been established. It should be said that Shanghai is relatively safe at present.

21st century: is Shanghai's anti epidemic experience also related to historical experience? For example, hepatitis A in the 1980s and SARS in 2003.

Chen Erzhen: hepatitis A is different from Xinguan pneumonia. It is an intestinal infectious disease. In the 1980s, 300000 people were infected with hepatitis A in Shanghai. At that time, it was mainly Shanghai people who liked to eat clams, which contained hepatitis A virus. At that time, the patients were infected because they ate the contaminated Scapharca subcrenata. After knowing this result, Shanghai immediately cancelled the business of clam. Since then, there have been no new cases. This shows that it is important to cut off the route of transmission.

However, new crown pneumonia and SARS in 2003 are respiratory infectious diseases. It's impossible not to breathe. Microorganisms drifting in the air will definitely be inhaled into the body, so it is relatively difficult to cut off the route of transmission.

In fact, at that time, SARS was not as serious as the new coronal pneumonia epidemic, but the mortality rate was higher. There are only 8 cases in Shanghai, which can only be said that Shanghai is lucky. After the outbreak, the earliest case did not occur in Shanghai. The first case in Shanghai was discovered in May. Shanghai was also very vigilant at that time, and all medical institutions were well prepared. All the 8 cases came to Shanghai from other places. The first time they were found in Shanghai, they were immediately sent to the designated hospital for isolation treatment. Therefore, he had no chance to contact other people in the society, that is to say, the source of infection has been controlled by us.

This is some experience of Shanghai management and control. The most important thing is that the level of fine management is relatively high. Because Shanghai is the highland of talent gathering, a lot of excellent talents are gathered and their wisdom is brought into full play. Therefore, things are done more carefully and well.

21st century: epidemic prevention is not a matter for one city, and it needs to cooperate with other cities. How does Shanghai cooperate with other cities in the Yangtze River Delta to form an integrated joint defense and control system?

Chen Erzhen: in fact, at the beginning of the outbreak of the epidemic, Shanghai had already started its operations early. First of all, we should control the flow of personnel, that is to reduce the flow of personnel in the Yangtze River Delta region at the first time. This requires the government departments in the Yangtze River Delta to work out relevant strategies. After that, health code sharing, medical staff sharing, information exchange, management and control information exchange, emergency materials sharing, and finally realize the integration of prevention and control in the Yangtze River Delta. In the process of epidemic prevention and control, we all have the same pace and common goal, which can help.

The experience of Shanghai in this epidemic can be extended to Wuxi, Changzhou, Hangzhou, Nanjing, Hefei and other cities, and their experience can also be used for reference. The exchange of information and experience helps us to make the whole epidemic prevention and control network of the Yangtze River Delta more encrypted and make this wall more powerful.

On the whole, the prevention and control of the epidemic situation in the Yangtze River Delta has been well done.

It is difficult for the global epidemic to end in 2021

21st century: do you think it is possible for other international metropolises to learn from the experience of Shanghai?

Chen Erzhen: it's hard to say. Of course, under the socialist system in China, we can learn from each other. In fact, we have done a good job in epidemic prevention and control in Beijing, Shanghai and Guangzhou. However, most of the world's (cities) should learn from Shanghai's experience because of different national systems, different urban operation modes, different residents, different beliefs and different cultural backgrounds, so they may not be able to accept our experience.

Many countries treat us with an arrogant and prejudiced attitude. When we had a very serious epidemic in Wuhan in the early days, they were secretly laughing; when the fire burned on themselves, they also felt indifferent and had a lot of prejudice against us. Most other countries in the world want to learn from our experience. I don't think we can learn from their system.

At present, the number of patients in some international metropolises is very large, there is no time for treatment, there is also a run on medical resources, there is a high mortality rate, but their governments do not pay attention to it. For example, they call "closing the city" and the closure will end in two weeks. Therefore, they can not form a long-term normal control mechanism.

On the contrary, our country is now accumulating the experience of epidemic prevention and control and turning it into a normal and long-term control mechanism without affecting our normal life. This is really conducive to people's health.

21st century: as you said, in fact, the door of our country will certainly be further opened. How should we strengthen cooperation between countries?

Chen Erzhen: in the fight against the epidemic, because mankind has a common destiny, countries must cooperate with each other for win-win cooperation. We have always stressed this, but to some extent, some western countries are biased against us, even arrogant and unwilling to cooperate with us.

In the early days, we constantly summed up our experience and wanted to share with them our anti epidemic experience, including the experience of treating patients, but they always felt that "you will not, we will". In the end, we think, we should use facts to talk about who will and who will not. On the whole, we should look at these problems rationally. We also hope to share our experience with you, so that we can do a good job in epidemic prevention and control, so that the world will not stop and return to normal life earlier.

21st century: finally, please look forward to the epidemic trend in 2021.

Chen Erzhen: the new coronavirus is different from SARS virus. At least, it likes cold and is not afraid of heat, so it can spread globally.

The domestic epidemic situation in 2021 is controllable at present, but there is no turning point in the world. This year, I don't think it is possible to eliminate the epidemic. To eliminate the epidemic, the world needs to learn from China's experience, but they may not do so, and they will not learn from it. If you can, the global epidemic will not be what it is now.

In fact, the world hopes to curb the spread of the virus through vaccines. In a short period of time, many kinds of vaccines have been launched internationally, including our domestic vaccines. Through vaccination, some people's immunity can be established, especially when a certain vaccination rate is reached, which may be a good way to stop the epidemic.

However, there are 7.5 billion people in the world, and it is a difficult task to achieve a mass immunization coverage rate of more than 70%.

Therefore, first, we hope that the vaccine is effective; second, the vaccination rate is up to standard; third, the vaccine can produce antibodies. Only in this way can we really form group immunity to curb the spread of the virus.

Another possibility is that we would like to see the emergence of specific drugs. With specific drugs, new crown pneumonia may be like a common cold fever, after taking medicine can kill the virus. However, new drug development has a long way to go. At present, I think the most effective way is to vaccinate. It is the personal protection in the prevention and control of the epidemic situation. Everyone can follow the strict prevention and control requirements. This is the most critical way to cut off the transmission path. Let the virus not spread in the world, but also let it die out in the nature because there is no biological chain. However, China can do (personal protection), foreign countries can not do it, the world can not do it, this is a pity. (Editor: Hejia)

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