The first change in wind direction that Peng Chang felt came from residents.

She is a community doctor in the suburbs of Shanghai. In the past week, the average daily number of people vaccinated against COVID-19 in her area was about seven times the previous number.

What made her sigh was that many elderly people who "have been working for a long time but were unwilling to get vaccinated" also came over, saying that "I was afraid of the risks of getting vaccinated in the past, but now I feel that not getting vaccinated is even more risky."

Under the new situation of epidemic prevention, on November 29, the Joint Prevention and Control Mechanism of the State Council issued the "Work Plan for Strengthening the New Coronavirus Vaccination for the Elderly", which requires that the elderly over 60 years old be the focus and the vaccination rate be increased.

Compared with other age groups, the basic immunity and booster vaccination rates for the elderly in my country are lower. Data from the National Administration of Disease Control and Prevention show that as of November 28, the number of people over 60 years old who have been fully vaccinated accounted for 86.42% of the elderly population, while the number of fully vaccinated people over 80 years old only accounts for 65.8% of the population over 80 years old.

In the view of public health expert Feng Zijian, the elderly who have not been vaccinated are precisely those who need vaccine protection the most. Old age and chronic diseases are independent risk factors for developing severe illness or even death after being infected with the new coronavirus.

“A bloody lesson,” virologist Jin Dongyan said when recalling the epidemic in Hong Kong during the Spring Festival this year. Among the 10,000 local people who died from the new coronavirus, 70% had not been vaccinated, 90% had underlying diseases, and their age The median age is 86 years old.

Perhaps the key to getting out of the epidemic lies in protecting our "weaknesses."

"Vaccine Hesitancy"

Since December, Chen Guanghua has been busy counting the vaccination rates of the elderly in his jurisdiction, divided into two age groups: 60 to 79 years old, and those over 80 years old. , statistics on the first shot, full vaccination and booster immunization.

He is a grassroots epidemic prevention worker in Chongqing. His street includes 6 communities and 7 villages. There are 4,682 elderly people over 60 years old. The first dose vaccination rate for those over 80 years old is 75.76%. In recent years, it has not been easy to persuade the elderly to get vaccinated.

He told reporters that some rural elderly people feel that they do not go out much and there is no need for vaccination; some elderly people asked him to sign a guarantee letter and bear the consequences before agreeing to be vaccinated. What adverse reactions?"

According to his observation, some elderly people walked two hours away and took the initiative to take nucleic acid tests, but were very hesitant when it came to vaccination.

Medical staff at Chen Guanghua’s town health center vaccinate the elderly.

One of Chen Guanghua’s assistance recipients is a pair of empty-nest elderly people. Their daughter married in another province and has not returned home for many years. He often visits the elderly at their homes, and the elderly are always smiling. But last summer, when he suggested that the elderly go to the health center to get vaccinated, the grandfather's face "all of a sudden fell down."

The old man said that he had a heart disease, "If there is an accident, will I come to you? My child is out of town."

Although Chen Guanghua repeatedly explained that he was not in the acute attack stage If your symptoms do not affect vaccination, you can "call the doctor over and see the specific situation before making a decision." But the old man did not change his mind.

Feng Zijian, executive vice president and secretary-general of the Chinese Society of Preventive Medicine, told The Paper in an interview that earlier vaccine contraindications and cautions were strictly controlled, and many elderly people and patients with chronic diseases are excluded from vaccination.

Chen Guanghua recalled that most rural elderly people have basic diseases such as hypertension and diabetes. They have a reference value for vaccination, but there is also a certain degree of flexibility in implementation. For people over 80 years old, they will assess their physical condition to see if they are suitable for vaccination, and provide door-to-door vaccination for those with limited mobility.

84-year-old Zheng Qiang from Chongqing suffers from cataracts and osteoporosis. His son Zheng Zhijun told reporters that except for a trip to the hospital due to shingles in 2019, his father rarely went out. Last year, he reported his father's underlying disease to the community, and the community told him that he could skip vaccinations in this case. Therefore, his father has not been vaccinated so far.

Compared with the previous vaccination plan for the elderly, the scope of contraindications in the latest vaccination plan for the elderly has been greatly narrowed, and only severe allergic reactions to vaccines are listed as absolute contraindications. Zheng Zhongwei, director of the Science and Technology Development Center of the National Health Commission and leader of the vaccine research and development team, said on December 7 that chronic diseases such as diabetes and hypertension in the elderly are not absolute contraindications for COVID-19 vaccination. As long as they are in a stable period, they can be vaccinated. .

Feng Zijian said that for the sake of caution, several items have been added to the new vaccination plan: for example, acute infectious diseases are in the fever stage, serious chronic diseases are in the acute attack stage, or life with severe chronic diseases has entered the end stage. In the final stage, vaccination should be delayed.

“There are very few contraindications for being unable to vaccinate or not suitable for vaccination, especially for inactivated vaccines, which are very, very rare and are determined by doctors.” According to Jin Dongyan, a professor at the Li Ka Shing School of Medicine at the University of Hong Kong, Around the world, the elderly and those with underlying medical conditions are listed as priority groups for vaccination.

Jin Dongyan told The Paper that Hong Kong has also experienced public distrust of vaccines before. "We-media articles say that people who have been vaccinated have leukemia or diabetes, which is nonsense. Because more people have been vaccinated, some will get sick or even die. This is a coincidence."

To this end, the Hong Kong SAR government has made public a list of the incidence rates of diabetes among vaccinated and non-vaccinated people, "making it clear at once."

In Jin Dongyan’s view, now is a period of change, and we must first do a good job in citizen education and policy propaganda. "For people over 80 years old, if vaccination is implemented, death can be completely avoided." He gave an example. After Hong Kong increased the vaccination rate in May, the death rate from the new crown dropped to one-fifth to one-sixth of the original rate. ; After the antigen is positive, oral antiviral drugs are given promptly, and the mortality rate can be reduced by 76%.

"There are many observations now. After taking the booster shot for 12 months, it still has a good protective effect in preventing severe illness and death." Feng Zijian told reporters that preventing severe illness can also be done during the rising stage of the epidemic. , alleviating resource constraints in medical institutions.

"The most vulnerable people"

After the optimization of epidemic prevention, Zhou Guangjun felt even more pressure.

He is a nursing home manager in a prefecture-level city in Henan. There are more than 200 elderly people living in the hospital, 80% of whom are over 80 years old. Last year, the local area vigorously promoted vaccination. When the elderly in the hospital heard that it was free, most of them were willing. Even the elderly were not opposed to it and they all hoped to "travel freely after being vaccinated."

Unexpectedly, almost all the children were opposed to the fact that vaccinations for the elderly in nursing homes require their children to sign an informed consent form. "Some said there is no need to vaccinate the elderly because they are older, some said that the elderly have chronic diseases and cannot be vaccinated, and some were worried that the vaccine was not safe and did not agree to vaccinate."

In the end, some elderly people decided to bypass their children and get vaccinated themselves. Went to the hospital and got vaccinated. Today, there are about 30 elderly people vaccinated in the nursing home. According to Zhou Guangjun, it is already considered a local nursing home with a high vaccination rate. His 85-year-old grandmother also did not get vaccinated because of her advanced age and suffering from heart failure and pulmonary edema.

Nosocomial infection is like a sword hanging over Zhou Guangjun’s head. There are several elderly people in the hospital who like to ride tricycles to go out to meet friends. "Once infected with the new coronavirus and brought back to the hospital, the consequences will be disastrous." In addition, there are also many disabled elderly people living in the hospital who need nursing care for their daily life and have not been vaccinated. vaccine.

Also worried is Li Yang, the head of a senior care company in Shanghai. In the past three years, the nursing home he managed has had "zero infections" and the vaccination rate for the elderly has reached 70%-80%. After the recent adjustment of epidemic prevention policies, he is very worried about the elderly who have not yet been vaccinated.

Many of these elderly people are over 80 years old and have underlying diseases. Previously, relevant departments did not recommend vaccination, and their children also had concerns. Recently, Li Yang received a notice from his superiors to increase the vaccination rate in the hospital, and he is working hard to communicate with the elderly and their families.

As of November 28, the number of fully vaccinated people over 60 years old accounted for 86.42% of the elderly population, while the number of fully vaccinated people over 80 years old accounted for only 65.8% of the population over 80 years old. Data map

At this time, Gan Mei, who lives in Lanzhou, is still hesitant about vaccinating her mother.

Her mother is 75 years old and suffers from diabetes. At the same time, her lung tumor has metastasized and she is being treated with targeted drugs. Recently, after the lockdown in her community was lifted, several relatives and friends around her became positive.

She wants to vaccinate her mother, but doesn’t know if she can. Previously, she saw a popular science Q&A from the hospital in her circle of friends, which mentioned that vaccines can be vaccinated for malignant tumors in the stable stage. If the disease is in the progressive stage, vaccination is not recommended. This made her very confused. She didn’t know which category her mother’s condition fell into. kind.

Feng Zijian once suggested in an interview that for the elderly hospitalized in medical institutions, doctors should prescribe vaccines and provide vaccinations in the hospital. At the same time, door-to-door services should be provided for elderly people who are inconvenient to go to vaccination sites. "We need to tell the public that our risk of infection will greatly increase in the future. We should seize the time to get vaccinated and get protection."

"We are in a race against the virus, especially those who do not get vaccinated. "Jin Dongyan said that how to get the medicine to those who need it as quickly as possible and prevent people who don't need it from hoarding it in large quantities also requires wisdom.

He suggested that when necessary, reverse isolation should be provided to the elderly. “The shelters can be partially converted into nursing homes. When there is an epidemic, there are no vaccinations, and there is no opportunity to take medicine, reverse isolation can be used.” Isolation can also save some lives."

Compared with the elderly, active elderly people around 60 years old are more willing to be vaccinated. At the beginning of the epidemic in 2020, Zhou Guangjun's nursing home was closed for management for the first time. The elderly people in the hospital around 60 years old were a little agitated because it affected their activities outside the home. Now the nursing home has been under closed or semi-closed management for three years.

“They hope to return to normal life as soon as possible and are willing to get vaccinated.” Li Yang’s senior care company also manages a community service center for the elderly, providing daily services to nearly 20,000 elderly people in the community. These elderly people are aged 60 to 70, and the vaccination rate last month was about 40%.

Recently, the service center has been calling elderly people who have not yet been vaccinated one by one to encourage them to get vaccinated. "Some people went to get vaccinated as soon as they received the call, fearing to be infected." The elderly mainly visited the service center during the day. Now, Li Yang has prepared antigens and administered them to the elderly who come in and out. "They dare not relax."

On December 5, Zhou Guangjun also received a request from his superior department to continue closed management of the nursing home. He is still waiting for the next step of notification.

The "capillaries" of epidemic prevention

After December, more and more villagers came to Zhou Chunhua's clinic to consult on epidemic prevention. Most of them were "worried that the elderly and children at home would not be able to bear it."

Zhou Chunhua is a rural doctor in Hebei. There are more than 400 people in her village. In the past three years, strict prevention and control measures have been implemented, and the whole village takes nucleic acid tests twice a week. "The villagers are afraid of the virus." After the adjustment of epidemic prevention, they are familiar with the characteristics of the virus and related policies. Don't quite understand.

Zhou Chunhua communicated with villagers who came to consult on how to protect their homes.

Zhou Chunhua said that some people started to stock up on cold medicines. “In the past, no one bought them, so the clinic only stocked one or two boxes. Now people always ask, asking for 10 boxes and 8 boxes, saying they want to stock up for the elderly at home. "

Lianhua Qingwen capsules are sold out. In the past two months, the upstream supplier has increased the purchase price from 11 yuan to 18 yuan per box. Zhou Chunhua said helplessly to the villagers, "It's really gone. It's better for you to relax yourself than anything else."

Similar to Zhou Chunhua, Peng Chang, a doctor at a community health service center in Shanghai, has also been very busy recently.

There are about 8,000 people over the age of 65 in the area where she works, and the vaccination rate is about 95%. Recently, the number of people vaccinated has been rising sharply.

In the outpatient department, she often hears the residents’ discussions. Some people are worried that they or the elderly will not be able to handle it after the epidemic prevention is optimized; others think that the symptoms of Omicron are so mild that they do not need attention.

What she and her colleagues talk about is that "Omicron is characterized by mainly mild symptoms, and the symptoms may be more obvious in the elderly and children", "prepare antipyretics and thermometers in advance", "psychological "Don't worry too much"

Recently, the community health center's influenza investigation team no longer needs to track the trajectory of close contacts, but the number of residents in home isolation in the community has increased. In order to deal with emergencies, medical care has been transferred to medical security. In early December, Peng Chang and others set up an emergency response team, and the medical staff returned to two points and one line, with all staff on standby.

“Sometimes I don’t dare to sleep too deeply in the middle of the night for fear of not hearing the phone call.” Although it is still very hard, Peng Chang feels that the team’s “psychological pressure is reduced.”

In the past, door sensors were required for close-connected homes, but now there is no need to install them, and residents welcome them. "After completing the new process, the residents' attitude towards us has become much better, and the situation on both sides has eased a lot." Peng Chang said.

At this time, in Chongqing, the health center where Chen Guanghua worked also formed a family medicine team. Each team is composed of a doctor, nurse, and village doctor, and one team corresponds to one family, explaining virus knowledge and vaccination to the villagers.

"Currently, there are only a few people here who are eligible but have not been vaccinated."