What does it mean to cool the nucleic acid and stop the normalization test in many places?

Eight o'clock Health News2022-06-23 19:29:51

 picture source @ Vision China

picture source @ Vision China

Titanium media injection : This article is from the official account of WeChat Eight Jian Wen (ID:HealthInsight), author | Yu Huanhuan Chen Xin , Coordinating editor | Xuzhuojun , Authorized release of titanium media .  

Just yesterday , Hefei pressed the pause button for the seven day nucleic acid test , This is also the first provincial capital city to withdraw from normalized nucleic acid detection .

however , Hefei is not the first to withdraw from nucleic acid “ Group chat ” In the city , More than a week ago , Jiangsu Haian has stopped the normalization of nucleic acids “ On-Site Inspection ”.

Besides , Shandong Dezhou movie viewing is no longer required “48 Hour nucleic acid test certificate ”, Huizhou, Guangdong no longer requires travelers to hold 48 Hour nucleic acid test negative proof , Direct free flow in low-risk areas in Suzhou, Jiangsu Province …… In Anhui Province , huangshan 、 xuancheng 、 Huainan , The cities announced that they would cancel the regional nucleic acid testing work scheduled for the next day .
  This is far from the beginning of construction in a swarm all over the country 15 The minute nucleic acid sampling circle is less than two months .

5 month , Started to propose the establishment of walking in big cities 15 Minutes “ Sampling circle ”, But in practice , No matter the size of the city , Whether there is an epidemic situation , They are all devoted to the nucleic acid great leap forward :

Thousands of “ Nucleic acid sampling booth ” Springing up ; In Guangdong alone, there are more than... Nucleic acid samplers 44 ten thousand ; More than 10 billion person times of nucleic acid detection have been completed ;

China's nucleic acid detection capability has changed from 2020 year 3 Of the month 126 Wan Guan / God , Up to this year 5 Of the month 5700 Wan Guan / God , One year's time has increased 45 times .

After a short “ confusion ”, China has almost created the world's largest nucleic acid testing industry from scratch : According to the calculation of Soochow securities , All one 、 The annual cost of normalization in second tier cities is about 6700 Billion .

Even in cities without epidemics , having dinner 、 See a movie 、 have a stroll in the park , Nucleic acid negative certificate is also standard for going out . And the shelf life of nucleic acid , Nicknamed by netizens “ Better a loaf of bread ”.

But less than two months later , The nucleic acid tide suddenly cooled down .

Behind this , What happened ? What does that mean ?

Normalized nucleic acid detection is not an efficient anti epidemic tool

The pioneer of normalized nucleic acids , Shenzhen, which was affected by the fifth wave of epidemic in Hong Kong . At that time, Shenzhen was at a very fast speed , Total suspension of public transport 、 Show me 48 Hours to prove , It took a week to stop the epidemic .

since 2022 year 2 In January, Shenzhen first launched 15 Minute nucleic acid sampling circle has been 4 Months , thereafter , Any city with a large-scale epidemic , All followed suit .

But normalized nucleic acid is like Duanyu's six pulse sword , When the spirit is not the spirit —— Beijing and Shanghai also rely on the control and normalization of nucleic acids , But it hasn't been cleared yet .

Beijing and Shanghai have been under control , Less than a week ago , There was a rebound in the epidemic . Native land 30 After many days of no new social aspects , overnight , Shenzhen 6 month 18 Found in community screening 2 One infected person . Guangzhou Baiyun Airport , Once again, high-risk personnel were found to be positive .

In the words of jindongyan, a virologist at the University of Hong Kong , Nucleic acid testing does not prevent the spread of the virus , It has limited significance for prevention and control ,“ Just like the pregnancy test , Pregnancy test is not equal to contraception ”. Especially in low-risk areas, we will carry out normalized nucleic acid , like “ A woman of right age , No high-risk behaviors , Why do I have to have a pregnancy test every day ?”

Professor huangshenzhong of the school of statistics and data science of Nankai University once made a simple theoretical model to evaluate the role of normalized nucleic acids in early detection : Compared with the previous cases in which symptomatic infected persons took the initiative to seek medical treatment to expose the epidemic situation , Normalized nucleic acid detection can change the time of finding the first infected person from 7-10 Days ahead of schedule 4 God , And then reduce the scale of infection 3-4 times .

But theory is theory , The complexity of reality is far beyond the variables that the model can cover , In the real world , The effect of normalized nucleic acid is limited .

A few effective cases come from areas with new crown prevalence or areas with high import risk , President of Shenzhen Third People's Hospital 、 Luhongzhou, leader of the public health expert group for epidemic prevention and control in Shenzhen, took Shenzhen, which was the first to carry out normalized nucleic acid detection, as an example ,“ At present, most of the epidemic sources in China are imported , Immigration personnel 、 Cold chain 、 International logistics is a high risk factor , Especially the first tier cities and port cities with special geographical location like Shenzhen , There is a high risk of an imported epidemic ”.

In addition, a few cases come from people in epidemic areas who radiate into cities , For example, Shenzhen, which is adjacent to Hong Kong 、 Hangzhou, which is closely linked with Shanghai .

But Huang senzhong told eight o'clock Jianwen , These cases are special cases , Instead of “ Normal behavior ”, Enter high-risk focus areas 、 Key personnel and “ War zones ” This is within the scope of key monitoring , Shenzhen strengthens the detection under the concept of key population in key areas , Other cities with low risk are “ Normal behavior ” There is no need to carry out a normalized screening in this period , Just check the key groups .

“ Whether it is necessary to build 15min Nucleic acid sampling circle , According to the local epidemic risk 、 Population size 、 Comprehensive evaluation of factors such as the frequency of nucleic acid detection , Blindly following the trend is more likely to cause unnecessary waste of resources ,” Luhongzhou told eight o'clock Jianwen .

The frequency of nucleic acid detection in key areas can also be discussed , A number of experts told the eight points news , In key areas , Once a week 1-2 A second large-scale nucleic acid is sufficient for the detection of an epidemic , And luhongzhou reminded , In the strictest case , A two-day nucleic acid screening frequency is sufficient , Every day 1 The detection frequency of times belongs to unreasonable population screening strategy .

Virology expert changrongshan explained , A common sense is , The epidemic outbreak of infectious diseases has stages , yes “ Abnormal ”, There is an introduction , There is diffusion , There will be an outbreak , Only infection can be detected , Do high-frequency screening in areas where the epidemic risk of new crown is very low and there is virtually no epidemic , Finally, oneortwo abnormal cases of nucleic acid without head, tail and continuous transmission were screened out , The probability of this case is false Yang , The greater the absolute amount of screening , The absolute number of false positives will increase accordingly , Belong to “ Nothing to ask for ”.

therefore , Huangshenzhong concluded , Large scale nucleic acids , For most cities , The most reasonable use is after the outbreak is found , Quickly screen out infected people , In the screening stage , Compared with the previous hospital 、 The outpatient service is compared with the key crowd type test , Not very useful .

But now , Round after round of nucleic acid testing has become the focus of officials everywhere “ ' ”, At eight, Jianwen learned that , In addition to normalizing nucleic acids , Some of the cities with abundant funds will be around the holidays 、 Holidays, school seasons and other densely populated mobile periods , From time to time, we should also stand still and have a round of nucleic acid detection for all staff , After confirming that there are no abnormal results , Relevant officials will feel at ease .

Invisible cost

What is worth pondering , The change of attitude towards nucleic acid in different regions occurred after the announcement of refusal of payment by medical insurance .

In various places where normalized nucleic acid detection is gradually carried out , The expenses will eventually be paid by the government , But the one-way capital inflow is endless , At eight, Jianwen learned that , Many financial payments are delayed or in arrears . Even if it is as rich as Shanghai , Also in the 5 Announce at the end of the month , The free testing service of the city's normalized nucleic acid testing sites will be maintained until 6 month 30 Japan .

There are many different cost budgets for normalized nucleic acid detection in different cities , According to Huang senzhong's calculation , In Tianjin, which is rich in nucleic acid detection resources , The service cost of a large screen is only 300 ten thousand , Excluding personnel 、 Consumables, etc . However, Shanghai has gradually supplemented the nucleic acid detection resources during this epidemic , The cost of nucleic acid detection during the epidemic period is about 134 Billion , Zhang Yiping, the investment promotion macro manager, has calculated that 4 month 6 Japan -6 month 5 The cost of carrying out normalized nucleic acid detection in Shenzhen on the th is about 31.6 One hundred million yuan .

Beyond these visible costs , There are also some invisible changes taking place .

According to Jingbao APP reports , We continue to carry out normalized nucleic acid detection and 3 Shenzhen, which ended the last round of major epidemic at the end of this month , Its subway passenger volume is 6 It only recovered to the average daily passenger flow level of last year , Take the peak passenger flow on weekdays on Friday as an example ,3 month 25 Japan , The passenger volume of the whole network in Shenzhen is only 383 Thousands of people , Only 0.5% of the average daily passenger volume last year 64%,4 month 1 The daily passenger traffic volume of the whole network increased to 487 Thousands of people , About% of the average daily passenger volume last year 81%, And until 6 At the beginning of , The passenger traffic volume on Saturday and Sunday with active consumption has not returned to last year's level ——6 month 11 Day and 12 Japan , The epidemic has been 2 A weekend of more than months , The passenger traffic volume of Shenzhen Metro network is 423 Million people and 403.97 Thousands of people , The average daily passenger volume of last year is only 70% and 67.6%.

According to the data released by the Ministry of transport ,2022 year 5 month , The national 51 Cities that have opened and operated urban rail transit lines have completed a total of 13.3 Million people , Increase in chain ratio 0.38 Million people , Last year 5 Monthly decrease 8.5 Million people 、 Declined 39.0%.

This data is supported by the consumption data of Shenzhen , Official account “ Urban data group ” Statistics , At the beginning of the year, the entertainment catering index was higher than that of the same period last year 20% Shenzhen at the beginning of the year , During the outbreak, the index began to decline , The minimum period of sealing and control is the same period last year 47%, In the following two months, it did not fully recover to the level of the same period last year , stay 5 End of month , This index is 80% of that of the same period last year .

In the same way, the author compared the development of normalized nucleic acid in Taiyuan 、 wuhan 、 wuxi 、 Suzhou 、 Hangzhou 、 zhengzhou , Without exception , Even cities without large-scale epidemics , Its entertainment and catering consumption index is also lower than that of the same period last year . 

The author determined the effect of normalized nucleic acid detection on entertainment and catering consumption index by double difference method “ contribution ”—— Cities that have implemented normalized nucleic acid , stay 5 The entertainment and catering index at the end of the month was lower than that of the same period last year 28.7%, Cities that have not taken normalization measures , Lower than the same period last year 20.6%.

The reason is , The author thinks that , Normalized nucleic acid detection has changed people's travel habits and consumption behavior ,“ People who can normally go out and consume , Some of them are under the normalized nucleic acid , May give up or reduce consumption plans , Become more “ house ”, So as to change the consumption structure of the city ”.

Nucleic acid detection , It also increases the time cost of intercity communication . An entrepreneur in Nanjing was interviewed by 8:00 Jianwen , In order to meet the 72 Requirements for entering Beijing for hours , He was on a business trip to Beijing before the current round of epidemic , For fear that the nucleic acid will expire , From landing to return in a hurry, it only took 15 Hours , Before the outbreak , On average, he goes to Beijing on business once a month .

6 month 2 Japan , Xuhejian, spokesman of the Beijing municipal government, announced , Beijing has communicated with relevant departments in Hebei , A rapid sharing mechanism for nucleic acid detection data will be established , Realization “ One place detection 、 Use in two places ”, It is convenient for commuters to go to the nearest toilet for detection , Before that , Commuting between Yanjiao and Beijing 、 Medical personnel , Because nucleic acid detection takes a long time 、 The results of Beijing Hebei nucleic acid were not universal and went through a long period of confusion .

In Shenzhen, where the normalized nucleic acid detection is implemented ,6 month 10 Japan , Shenzhen Airport disclosed 5 Monthly production and operation data , company 5 Monthly passenger throughput 185.63 Thousands of people , Year-on-year decline in 52.51%; Number of flights taking off and landing 2.09 Ten thousand sorties , Year-on-year decline in 28.1%.

But the cost is smaller than other cities , According to Zhang Yiping's calculation and Analysis , After the end of the epidemic 4 month , Shenzhen industrial production Co., Ltd 、 investment 、 Foreign trade and credit supply have improved to varying degrees , But the repair of consumption lags behind , In the epidemic 、 employment 、 In case of uncertain income prospects , Residents' willingness to consume is low .

future , How should nucleic acids be used ?

A practical problem that has to be considered is , Nucleic acid test was positive , It doesn't mean there are symptoms , It doesn't mean you have pneumonia , It is not equal to developing into critical illness .

Chang Rongshan said , In the future, a more effective and cost-effective zeroing scheme is to rely on the folk forces who have fully recognized COVID-19 , Help super 95% Of asymptomatic infected people are better able to heal themselves , And accurately screen out those infected with critical and severe factors , Provide them with timely diagnosis and treatment services .

The screening criteria for this protocol are symptoms , That is, the epidemic situation is found through the active medical treatment of people with suspected symptoms , And dispose by layers , Many experts remind me , In view of the fact that Omicron's virulence has been greatly reduced , Policymakers everywhere need to overcome fear , Protect the elderly, children and other vulnerable groups , Start quickly after the outbreak is found 、 Accurate disposal is enough .

It has been two months since the outbreak in Beijing , There are more than 2000 cases of infection ,6 month 22 Japan , Wangxiaoe, member of the Party committee of the Beijing Municipal Commission of health, made a briefing at the press conference , So far, there have been no severe and dangerous cases in Beijing .

Various phenomena have sent out signals : Normalized nucleic acid and full screening , When the outbreak shows signs , Is an effective means of containment , It is also an effective measure to help medium and high-risk areas recover to normalcy as soon as possible . But where there are sporadic cases , It can be said to be a waste of people and money , Even with little effect .

“ In Hong Kong , Normalized nucleic acids have been discarded , Now we have a sentry system .” Jindongyan explains , One 750 Ten thousand cities , Daily from 18 A total of... Were randomly selected from the areas 1 Ten thousand people tested for antigens , You can see from the small , Effectively grasp the urban epidemic situation .

In the fifth wave of epidemic in Hong Kong , Omicron finally broke through the critical point between dynamic clearing and mass immunization . According to the medical school of the University of Hong Kong 3 The calculation published in May , There are about 440 Ten thousand people have been infected with novel coronavirus , Nearly 60% of the population , Expert consultants of the Hong Kong Government 、 Leung Cheuk Wai, Dean of the Faculty of medicine at HKU, said earlier that , The sixth wave of epidemic is bound to come , It will eventually turn into “ Endemic disease ”.

For more than a week , The epidemic situation in Hong Kong has picked up to a thousand new cases a day . Jin Dongyan pointed out , In fact, such a situation will not cause further spread ,“ The number of retransmitted cases has also fallen ”.

The experience of Hong Kong shows that , Most people are vaccinated , More than half of the population is infected , An immune barrier has been formed in the community population ,“ Even if you put the virus in , It will only infect a small number of people ”.

A few weeks ago , Jindongyan participated in a 100 Multi person meetings , After two meals, some people took off their masks to eat during the tea break , Afterwards, it was found that a colleague who had received three shots of vaccine was infected , But the participants, including him, closely tested several rounds of antigen plus a round of nucleic acid , In the end, no one was infected .

In Hong Kong , Nucleic acid detection is no longer the most important prevention and control measures , Instead, it takes place where there are cases or risks , First, carry out antigen detection for several days , Nucleic acid is just a confirmation of infection . For key industries 、 Important posts , By making antigens every day , Screen out infected persons in time , Home isolation for a week , Continue to work after turning overcast .

A key measure to adjust , Is nucleic acid detection from “ passive ” To “ Take the initiative ”.

That is, for key areas 、 Nucleic acid detection for key groups , Like in a hospital 、 Catering and other industry requirements , At the transportation hub , Such as airport 、 Train station 、 Bus stations can be set , Passengers can voluntarily check in and out , And the government will pay for it at its own expense .

“ at present , We also lack effective vaccines and antiviral drugs , At present, the prevention and control strategy based on strict control and normalized nucleic acid detection will continue for some time . Be efficient 、 After the successful development of broad-spectrum vaccines and highly effective small molecule antiviral drugs , Our prevention and control strategies will also change .” Luhongzhou said .

Many experts interviewed said , Both vaccines and antiviral drugs , Is the effective measure to deal with the epidemic .

Xuguangjian, Professor of the school of public administration of Renmin University of China, believes that , It is not time to discuss the idle hardware , Nucleic acid sampling kiosks are unlikely to be withdrawn or stopped in a short time . At present, the epidemic situation cannot be said to be completely victorious , Spent money on nucleic acid sampling facilities and personnel , Even if the operation is not carried out this month , It is also necessary to ensure that the key moment can be enabled at any time , And maintain a fixed 、 Nucleic acid sampling team that can be mobilized at any time .

At least in the next few months , Nucleic acid sampling kiosks may be idle , But it won't go away ; Working hours may be adjusted , For example, from full day to half day , However, this facility and corresponding personnel will not quit immediately . Just slow down the frequency , Or turn to personnel service in key industries .

Luhongzhou thinks , High risk areas and populations , It is necessary to carry out regular detection and normalized nucleic acid detection . Non risk areas and populations , In the absence of an epidemic, it is not necessary to carry out continuous and high-intensity normalized nucleic acid detection .

But when the epidemic goes from peacetime to wartime , When nucleic acid screening is required , These facilities and personnel will be available immediately , To provide you with convenient and fast nucleic acid detection services , Let's take the initiative to do nucleic acid testing “ Laborious ”, Willing to actively screen .

Luhongzhou suggested , The normalized nucleic acid detection should also achieve accurate prevention and control . At the time of the outbreak , Relevant risk areas can achieve “ Should be inspected ”, And the detection frequency shall be determined according to the risk 、 Duration to make specific decisions . But the epidemic is stable , It should be graded according to the risk situation , do as far as possible “ It should not be checked ”.

But in the long run , Nucleic acid sampling kiosks will eventually be abandoned , Nucleic acid samplers will eventually be lost , The future of normalized nucleic acid is just a historical term . In the larger history of infectious diseases , Human beings have to learn to reconcile with nature , Finally accept the fact that the new crown has become an epidemic .

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