"The community explained to us that this infected person is an old man with a basic disease, and his family members who live with him have been transferred in a closed loop because of their positive nucleic acid test." Mr. Li recalled that on November 18, the unit building where he lived was designated as a high-risk area because of a positive case of social nucleic acid "ten mixed one", and he was placed under the control of "staying at home". During the period, according to the positive cases that appeared successively, three groups of "cross-flower" floor close contact groups were determined. At present, based on the time of the last positive case in the building, all the people who are not in close contact have been unsealed; People in the same floor and the same family who are not the home positive person will be unsealed after the nucleic acid test is completely negative today.
"As a close contact person of this home-infected person, we were told that we must wait until the antigen turned negative, and the disease control personnel will conduct two nucleic acid tests at intervals of more than 24 hours. After both times are negative, the relevant personnel can be released from isolation at the same time. In other words, our isolation may end in less than 7 days, or it may be longer than 1 days, and everything is unknown. " Mr. Li said.
He told CBN that it should be a good thing to let the light and asymptomatic COVID-19 infected people stay at home. However, due to the lack of a pre-plan, it will cause neglect of one thing and neighborhood disputes. "At present, we hope to optimize and solve two problems: First, in theory, aerosol propagation is a small probability event. Since we are classified as a close crowd based on this judgment, there should be professionals to judge the risks of building drainage pipes in time; Second, the positive home should be to reduce the impact on the economy and residents, but if more neighbors are allowed to run with them, it will be counterproductive. "
Mr. Li's experience is not an isolated case. CBN learned that at present, in Beijing, Guangzhou and other places, letting asymptomatic or mild COVID-19-positive people who meet special requirements stay at home has partially become the default mode, without the consent of neighbors; The number of people involved has also expanded, from the initial "asymptomatic and mild COVID-19 infected people who meet special conditions" to "asymptomatic and mild COVID-19 infected people who meet the conditions of home isolation".
However, since there is no systematic prevention and control plan involving positive households, there is still much room for refinement in the protection of the rights and safety of infected persons, close contacts and other personnel in the same building or unit.
Multiple rights must be balanced
Jiang Qingwu, a professor at Fudan University's School of Public Health, said in an interview with CBN that the continuous optimization of prevention and control policies is undoubtedly a gratifying thing, which makes qualified positive people isolated at home, more in line with public expectations, more conducive to the rehabilitation of infected people, and more conducive to effectively alleviating the pressure on the medical system.
"However, the implementation of this optimization plan still needs to ensure that people have sufficient information, understand the logic behind policy optimization, make adequate preparations, and reach a * * * knowledge, so as to achieve the expected effect of' positive home'." Jiang Qingwu said.
CBN understands that at present, in some communities that try to "avoid transferring the mild COVID-19 infected people who meet the conditions of home isolation", neighbors, infected people and their families have some concerns: for the former, the focus is on the probability of serial infection and whether it will be jointly controlled; For the latter, the focus is on whether they or their families are in the category of "meeting the conditions of home isolation", whether they will be discriminated against by their neighbors, and whether basic living and medical supplies can be met.
As mentioned by Mr. Li earlier, the "cross-flower" control principle is open to discussion by many virologists interviewed, because the non-contact transmission of aerosol in Covid-19 is a small probability event.
contact transmission can also be avoided. "Covid-19 carriers who are isolated at home have little detoxification and weak transmission. Generally speaking, the virus in exhaled aerosol is completely inactivated after 3 hours in vitro." Virology expert Chang Rongshan told CBN that, for example, if a positive family member opens the door to get a courier and wears a mask, as long as the distance from the courier is more than 2 meters, the probability of virus transmission is very small.
"People who live together do have the risk of infection. Therefore, it is best for home isolators to have rooms with independent bathrooms. At the same time, during the isolation period, infected people should keep as far away as possible from their roommates, try not to use items as much as possible, and kill them in time after using them, so as to reduce the risk of infecting people living together or accompanying them. " Chang Rongshan said.
He also said that once contact infection occurs, roommates need not be overly anxious. This is because asymptomatic or light COVID-19 infected people carry a low viral load, and the virus spreads. The infected close contact people are also asymptomatic or light infected people with a high probability of self-healing and do not need to be transferred for medical treatment.
according to the latest edition of "home care for COVID-19 patients with mild symptoms and management of their contacts" issued by who, if hospitalization is not available or unsafe, adults or children with COVID-19 confirmed or suspected patients can be considered for home care. There are three specific determinants: one is the clinical evaluation of COVID19 patients, the other is the evaluation of family environment, and the third is the ability to monitor the clinical evolution of COVID-19 patients at home.
The document clearly states that "asymptomatic patients or mild or moderate patients without adverse consequences risk factors may not need emergency intervention or hospitalization" and can be isolated and cared for at home, provided that the family environment meets certain requirements. But at the same time, the risk factors for the development of severe diseases, such as age, smoking, obesity and cardiovascular diseases, diabetes, chronic lung disease, chronic kidney disease, immunosuppression and cancer, should also be taken into account.
Chang Rongshan further said that if there are some special people such as 7 years old and above who are vaccinated or unvaccinated in the families of positive infected people, it is suggested that the positive infected people take the initiative to transfer and isolate. Because once such elderly people are exposed to infection, there is a greater risk of serious illness and death. "In the long run, with the increase in the vaccination rate of the elderly in China, the probability of this happening will be greatly reduced." Chang Rongshan added.
Although there is little risk of virus transmission in home isolation of light positive infected people, whether the management can keep up with it is related to the landing effect of the optimization scheme.
according to Mr. Li's description, at present, the management measures of the community are not much different from those of other close contacts, that is, "Dabai" comes to the house to test nucleic acids or distribute antigens, and regularly distributes food packages.
"On the one hand, for home-positive people, especially the elderly and other special groups, the community or disease control departments need to ensure that the work is done properly and make a good transfer plan. For example, regularly register the antigen status of relevant personnel, ask whether they have persistent high fever and other phenomena, and carry out psychological care and emotional relief; On the other hand, we should try to use antigen self-test or nucleic acid self-collection instead of household nucleic acid to reduce the possibility of' Dabai' being infected and even infecting other people. " Chang Rongshan said.
Mr. Du, who now lives in Hong Kong, told the reporter that the Hong Kong SAR Government will distribute anti-epidemic kits for home-infected people, including rapid anti-epidemic test cards, isolation manuals, masks, antipyretics and Chinese patent medicines.
However, regarding whether it is necessary to distribute drugs in home isolation and whether other people in the same building need to reserve drugs, Jiang Qingwu thinks that there is no need for treatment without symptoms, so this is not a necessary option.
Chang Rongshan has a similar attitude. He also reminded that community personnel should keep records of the basic diseases of the close contact and positive infected people in home isolation, especially for the elderly COVID-19 infected people who choose home isolation and have basic diseases, community personnel need to evaluate their COVID-19 clinical evolution in time, and they need to keep continuous attention to their basic diseases.
Another virologist told CBN that the asymptomatic or mild infected people at home can take some officially recommended Chinese medicines, but there is no need to prepare special anti-Covid-19 drugs. For special groups, drugs should be considered.
how to "manage" the positive family members?
in some areas, after the optimization and adjustment of nucleic acid and isolation policies, do asymptomatic and mild infected people need and be able to report in time? How to restrain the range of activities of positive housekeepers? These problems have aroused some public doubts.
Chang Rongshan believes that reducing the frequency of nucleic acids and allowing positive people to stay at home are aimed at making epidemic prevention more accurate and humanized, but they do not mean solving the epidemic. At this stage, no matter who is positive for nucleic acid detection or initial screening, or who is positive for antigen self-test, it should be reported to the relevant government departments. Light positive personnel who meet the conditions of home isolation should sign an agreement with the government, so that the health administrative department can take the initiative to provide all kinds of protection for home isolation and implement supervision.
for those who have been diagnosed, although the virus load of those who meet the conditions of home isolation is not high, if they are allowed to leave their homes, it will still bring risks to others. Some people think that overseas and some foreign regions require infected people at home to wear electronic bracelets, or they can learn from them.
according to the "handbook for 219 coronavirus-positive people" updated by the hong kong department of health on November 21st, 222, the government will arrange staff to visit the homes of the infected people, send and assist them to wear electronic bracelets and install the "home anti-epidemic" APP. During the quarantine period, government personnel will monitor through electronic bracelets to determine whether they stay at home.
Although this kind of bracelet does not collect personal data and does not have GPS positioning function, Chang Rongshan believes that it is not necessary to implement it in the Mainland. According to the Plan for Delineation and Control of Epidemic Risk Zones in COVID-19 recently issued by the Comprehensive Group of Joint Prevention and Control Mechanism of the State Council, "management can be strengthened by installing monitoring equipment and electronic door magnets to prevent people from going out and flowing, which is strictly beyond the ninth edition of the prevention and control plan and twenty optimization measures, and the supervision of high-risk personnel can be strengthened by installing electronic door magnets at the entrance". This method is also suitable for positive family members.
"If the positive infected person walks out of the house and does not wear a mask, the aerosol transmission of the virus will easily occur in the closed space such as the corridor, which will lead to the infection of neighbors going up and down the stairs. However, this situation can be basically eliminated through electronic door magnetism. " Chang Rongshan said.
Jiang Qingwu also disapproves of adopting the electronic bracelet for epidemic prevention, and thinks that it should be based on personal self-discipline first, and then consider adopting the bottom-up measures if you deliberately refuse to cooperate.
He believes that the focus of prevention and control of COVID-19 in the future should be shifted from positive infected people to public places, especially public transportation and indoor public places including hospitals. By improving the sanitation and ventilation conditions of these places and doing a good job in the protection and management of people entering and leaving, the prevention and control effect can be achieved in a more economical and effective way.