The State Council Joint Prevention and Control Mechanism held a press conference on the afternoon of December 20th, inviting experts from immunization program, virology, respiratory and infectious diseases, children’s health and other fields to attend, introducing the medical services for key populations. Pay attention together!
—— About the treatment of illness—
Is it necessary for people to use COVID-19’s specific drugs, and can they take them by themselves?
Several antiviral drugs were recommended in the ninth edition of the diagnosis and treatment plan, including monoclonal antibodies, nematvir, and azvudine added later. The early use of these antiviral drugs may reduce the occurrence of severe diseases, shorten the course of disease and shorten the time of virus detoxification.At present, these three antiviral drugs are still emphasized to be used in medical institutions and under the guidance of doctors. In particular, monoclonal antibodies need to be administered intravenously and used during hospitalization, which is not suitable for use in outpatient clinics or at home.Naimatevir is a small molecule antiviral drug, which can effectively reduce the risk of severe illness, and the indications are mild and common.When using, we should pay special attention to the interaction between drugs. Some drugs, such as simvastatin and amiodarone, which are being used by the elderly with basic diseases, can’t use drugs such as nimatvir.Therefore, it is emphasized that this drug should also be used under the guidance of a doctor. Azvudine is also a small molecule antiviral drug, which is used to treat AIDS. It is found that it can shorten the course of disease, reduce the virus level and improve symptoms during the treatment in COVID-19, so it is also approved for marketing and can be used in COVID-19. Similarly,This drug also has some precautions, including that pregnant women can’t use it.,Use with caution if there is severe or moderate liver and kidney damage.Therefore, it is emphasized that it should be used under the guidance of a doctor.
What are the taboos in the use of common drugs after infection?
Generally, after being infected with Covid-19, people use more drugs called symptomatic drugs, that is, they have fever and general pain, and use some antipyretic and analgesic drugs. If you have sore throat, cough and expectoration, and gastrointestinal symptoms, use some corresponding symptomatic drugs. Some are prescribed by doctors, and some may be purchased by themselves.We must be optimistic about the instructions, dosage, frequency of use and other precautions.Some medicine,For example, acetaminophen is a commonly used antipyretic and analgesic, and its contraindication is that patients with severe liver and renal insufficiency should be banned.. For example, there are some people,People with recurrent digestive tract ulcers and bleeding, pregnant or lactating women or people who are allergic to certain antipyretic and analgesic drugs should also be cautious.. When you are advised to use these drugs again,Don’t drink alcohol or alcoholic beverages.. I hope that when you use these symptomatic drugs,Try to use simpler medicine.Because different drugs may sometimes interact with each other, which may increase the potential adverse side effects. There are also patients who have this tendency. In order to control the symptoms quickly, it is not recommended to double the dosage of the drug.Because doubling the dosage of the drug may not be effective, but it increases the burden on the liver and increases the side effects.Some Chinese patent medicines or soup medicines can also improve symptoms and have a certain rehabilitation effect. You can also choose them.
It is not recommended to cover the sweat to reduce the fever of the baby.
In fact, acetaminophen is the only antipyretic drug that children from 2 months to 6 months can choose. Children under 2 months cannot take antipyretics orally.Therefore, it has always been suggested that babies under 2 months, including newborns, must be sent to the hospital in time if they have a fever, so that medical staff can help the children.
It is not recommended to give a baby a fever by covering his sweat.The reason is that the development of baby’s thermoregulation center is not perfect, and skin heat dissipation is a very important way to reduce fever. If these children are covered with too many clothes or covers, they will have no way to dissipate heat through the skin. In the case of heat, their body temperature may be higher and higher, even reaching more than 40 degrees, which is not uncommon in clinic.And some children may have severe heat syndrome.Serious complications such as respiratory failure, dehydration, nervous system injury and even life-threatening may occur. Therefore, when these children have a fever, in addition to the help of medical staff,We should try our best to create a relatively cool and ventilated environment for children and reduce clothing appropriately to improve their comfort..
What should parents do if the child has febrile convulsion?
Febrile convulsion is a very common emergency in pediatric emergency. Respiratory infection caused by virus is the most common cause of febrile convulsion in our children.The age of children mainly involved is between 6 months and 5 years old, which usually occurs in the first 24 hours of fever, especially in the period of rapid temperature rise, and febrile convulsions are most likely to occur.Under normal circumstances, the child’s body temperature may reach above 38.5 degrees. Children with febrile convulsions usually show stiff limbs or shaking, clenched teeth, tilted eyes or upturned eyes, which may be accompanied by cyanosis of the lips. At this time, there may be no response to external stimuli. In the event of febrile convulsion, parents are advised to do the following.
First,Lay the child flat on a flat bed, table or floor.Don’t have sharp things around you, mainly to prevent the child from falling and secondary injury during the seizure.
Second,You can unbutton your child’s collar and keep his respiratory tract unobstructed..
Third, you can tilt your child’s head to one side. If possible,Keep the child lying on the right side,In case the child vomits, aspiration will lead to suffocation.
In the whole process, remind parents that there are several things not to do. First of all,Don’t put anything in your mouth when the child has a seizure., including spoon handles, chopsticks, fingers of adults, etc., because this may cause damage to children or adults themselves. Second, during the seizure,Don’t feed your child anything, including medicine and water.. Third, during the seizure,Don’t try to bind the child’s limbs.Don’t let his limbs twitch, because this may cause secondary injuries to his limbs. Fourth, so far,There is no evidence that pinching people can shorten the seizure time of children.On the contrary, parents may be particularly nervous and exert too much force during the seizure, thus causing soft tissue damage in this part of the child, so parents are not advised to pinch their children.
When the child has convulsions,To reduce unnecessary stimulation.. In general,The duration of children’s febrile convulsion is 3 to 5 minutes, and it can stop by itself. When the convulsion stops, the child can be sent to the hospital as soon as possible.However, if the child has had a state of convulsion in the past, or this episode has been more than 5 minutes, then in this process, the possibility of the child’s convulsion stopping on its own will be relatively small. Parents are advised to send the child to the hospital as soon as possible.
For the vast majority of children, febrile convulsions will not affect the development of the nervous system and will not leave behind sequelae of the nervous system, so parents need not worry too much.At present, there is no evidence that taking antipyretics in advance has a preventive effect on children with a history of febrile convulsions. At the same time, because the child’s body temperature rises very quickly, there is basically no way to prevent the occurrence of febrile convulsions.
Patients with chronic obstructive pulmonary disease should go to the hospital for further diagnosis and treatment after they are infected with COVID-19.
Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease in China. The common symptoms of patients are cough and expectoration, sometimes accompanied by dyspnea, and often upper respiratory tract infection leads to the aggravation of the original symptoms. So when should I go to the hospital for further treatment? The first rule isContinue to have a fever, take conventional antipyretic and analgesic drugs, and the body temperature will not drop for more than two days.; The second isThe patient has listlessness, lethargy, listlessness and even unconsciousness, or some signs, such as cyanosis of the lips and edema of the lower limbs;The third isThe patient developed dyspnea, shortness of breath, wheezing,If the breathing frequency exceeds 30 beats/min, this is a sign of shortness of breath; Fourth, if there is a home percutaneous oxygen saturation monitor,Monitoring indicates that the patient’s oxygen saturation is ≤93%.It also suggests that there may be hypoxia; Fifth, after using some emergency drugs, such as bronchodilators, the symptoms of patients are not relieved or further aggravated; Sixth, patients with other symptoms, such as severe gastrointestinal symptoms, inability to eat, weakness, inability to walk, etc., all need to go to the hospital for further treatment.
How should patients with respiratory diseases be treated at home once they are infected with COVID-19?
If patients with chronic respiratory diseases have COVID-19, first of all, don’t panic, have a normal rest, drink plenty of water, eat balanced and digestible foods such as vegetables and fruits, and so on. Second, do some symptomatic treatment, such as fever, body aches, sore throat, cough, expectoration, etc., that is, take analgesics or drugs to treat sore throat, cough and phlegm. After all, patients with respiratory diseases are people with basic diseases, so they need to monitor their symptoms at home, especially cough, expectoration, shortness of breath and dyspnea. Third, some respiratory symptoms sometimes get worse during infection, even if it is common flu, common cold or virus infection. At this time, some symptomatic drugs should be used first.For example, if the symptoms of dyspnea and dyspnea get worse at once, first use some short-acting bronchodilators for emergency treatment. You can spray 1-2 inhalations at a time, and then inhale 1-2 inhalations every 20 minutes, with no more than 6-8 inhalations in the first hour.. If the symptoms gradually improve or stabilize through this symptomatic treatment, you can continue to observe the symptoms at home. If the symptoms change further, you can go to the doctor again. Fourth,Routine medication must be adhered to.. Fifth,To monitor oxygen saturation at home in time,Know whether the condition has changed in time.
About vaccination—
What do you think of the saying that "it is better for young people to be vaccinated than to be infected with Omicron"?
Although the pathogenicity of Omicron strain which is popular at present is weakened compared with other variants which were popular in the past. However, after being infected with Omicron mutant, there is still the risk of serious illness and death.This risk of serious illness and death will be reflected at all ages.It’s just that the risk of serious illness and death of the elderly, which we emphasized in the past, will be higher in the whole population. In addition, the proportion of people with basic diseases will be higher.
At present, many studies have shown that,Compared with those who have completed the whole course or strengthened immunization with Covid-19 vaccine, the risk of hospitalization or severe illness and death of those who have not been vaccinated is quite different, including young people and adults. If this risk exists to a certain extent, it can be reduced by vaccination. Therefore, it is suggested that those who have not been vaccinated should be vaccinated, and those who have not completed the enhanced vaccination should complete the enhanced vaccination as soon as possible.Whether it is the elderly, adults or young people, the risk is reduced to a relatively low level..
Can people who have recently recovered from infection be vaccinated with COVID-19 vaccine?
If Covid-19 has been confirmed recently,Covid-19 vaccination is not recommended in the near future.. At present, the immune protection produced by simple infection is not as strong as the mixed immune protection produced by infection and vaccination, so if vaccination is needed in the later stage, it is recommended to vaccinate. How long is this interval? According to the current technical guidelines for vaccination in Covid-19,If Covid-19 is diagnosed, the time between infection and Covid-19 vaccination should be more than 6 months.Of course, our immunization strategy will be continuously improved and adjusted with the understanding of diseases, vaccines and the need for disease control.
Can cancer patients be vaccinated with COVID-19 vaccine?
As for cancer patients, due to illness and chemotherapy, the immunity of some people will be low, which will increase the risk of serious illness and death. So, in this case,These patients need to be vaccinated with Covid-19 vaccine to be protected, and they are also among the priority groups for vaccination..
The clinical manifestations of cancer are actually varied, and the treatment process is also very complicated.Whether cancer patients who are in the onset or in the treatment stage can be vaccinated depends on the judgment of relevant professionals.. Because of the low immune function, the immune protection reaction of cancer patients after vaccination with COVID-19 vaccine may not be as strong as that of healthy people. In the "Work Plan for Strengthening Vaccination in Covid-19 for the Elderly", it is also specifically mentioned that "all localities should scientifically evaluate contraindications, and the specific reasons for those who do have contraindications should be clarified one by one", which is also applicable to the current evaluation of contraindications for cancer patients.
It’s been a long time since the whole immunization was completed. Is it still useful to carry out intensive immunization now?
After vaccination in Covid-19, there is a protective effect, one is to produce antibodies, the other is to produce cellular immunity and immune memory. After vaccination, the antibody level will decrease with the passage of time. In addition, with the variation of the virus, the immune escape is also enhanced, which further weakens the role of antibodies. But,Cellular immunity, especially in preventing severe illness and death, plays a lasting role..
Studies have shown that,Vaccination with booster needles can arouse the immune memory cells of the body on the one hand, and improve the antibody level on the other hand, further consolidating the preventive effect on severe illness and death.. Therefore, it is emphasized that those who have not completed the booster immunization should complete the booster immunization as soon as possible in accordance with the provisions of the immunization program as long as they meet the vaccination conditions.
About strain variation—
If a new mutant appears, there is still the risk of reinfection.
Now we are infected with BF.7 and BA.5.2,If a new mutant appears, there is still the risk of reinfection.. At present, from the data,The risk of reinfection or reinfection of Omicron strain is higher than that of the original strain, including higher than Delta and the original strain.. Judging from the time when the secondary infection appears, there is usually an interval, and it will not be said that it will be reinfected soon after infection.The probability of reinfection of the same strain is extremely low. Even if infected, there will be no obvious symptoms, which are generally mild.. Secondary infection mainly refers to the breakthrough infection of mutant, and the time interval of breakthrough infection is closely related to clinical manifestations. The shorter the interval, the lighter the symptoms, and the more severe the symptoms after the interval, which is directly related to the antibody immunity in the body. A study in Sweden also found that,After being infected with Omicron strain, the symptoms of secondary infection or tertiary infection with different strains in Omicron are very mild, and they are basically asymptomatic infected people or mild cases..
Of course, we should also pay attention to some elderly people. For example, we have done a study on American veterans. Among the elderly veterans, after the second infection, some patients do get worse or even die.Therefore, despite the infection, after the emergence of a new virus epidemic strain, personal protection should be done, especially for the elderly and those with basic diseases.In addition, it is very clear that vaccination in Covid-19 can effectively reduce the risk of severe illness and death. A study in Italy found that vaccination can reduce the incidence of secondary infection and reduce the probability of hospitalization after infection. So,The elderly and those with basic diseases should also emphasize vaccination..
What is the pathogenicity of BQ.1 and XBB strains, and will it trigger a new round of epidemic in China?
BQ.1 and XBB are new branches of variation in Omicron. Internationally, it has been gradually shown in some European and American countries that they are dominant strains.The main manifestation is the increase of transmission ability and immune escape ability, but its pathogenicity is not obviously different from other series of variants in Omicron.The severe illness rate and mortality rate have not increased significantly in these countries where BQ.1 and XBB are prevalent.In recent three months, BF.7, BQ.1 and XBB have been detected in China.A total of more than 130 subfamilies from Omicron were imported into China, and these 50 subfamilies caused related local cases or outbreaks.The whole BQ.1 and XBB have not yet formed a dominant communication in China (at present, BA.5.2 and BF.7 are still the main ones).However, its propagation advantages will gradually increase, and it may form a common cycle with BA.5.2 and BF.7, as well as other sub-branches with more than 50 inputs.
The prevention of BQ.1 and XBB is actually the same as other Omicron mutants, that is, to monitor whether its pathogenicity has changed or not, and whether its genome has further variation. If its clinical characteristics have changed, we will link it with the genome characteristics for judgment.However, there is no report that BQ.1 and XBB cause serious illness and death at home and abroad..
It is less likely that a highly contagious and highly pathogenic strain will appear.
From the appearance of Omicron in November 2021 to December 18, 2022,There are 709 sub-branches in the world, which have evolved from the five branches of BA.1 to BA.5., including recombinant strains, there are 72 strains produced by recombination between these subfamilies, and XBB is one of these 72 strains. Therefore, the variation of Omicron will continue. As long as it circulates in the crowd, it will replicate, and replication will mutate. The genetic variation of the virus itself may lead to the change of some antigenic epitopes and increase its immune escape ability. So the variation trend in Omicron is,Those with strong immune escape ability are dominant.. Immune escape makes people susceptible to this strain, even if its spreading power is not enhanced, its spreading advantage will still increase.
Will it increase its spreading power and lethality? This possibility is relatively small.The cases of hospitalization, death and severe illness caused by Omicron were significantly lower than those caused by early Delta strain and other VOC variants. Therefore, no significant increase in severity and death was observed throughout more than 700 branches.Therefore, on the whole, it is less likely that the pathogenicity will increase significantly. It is even less likely that it will have a more infectious and lethal strain. Nowadays, people have obtained a certain degree of immunity through vaccines or natural infections, which has good protection for people. Even if the virus mutates again, the risk of transmission will increase unless some subversive recombination leads to complete immune escape, but this possibility is relatively small.Therefore, on the whole, it is unlikely that there will be strains with high infectivity and high pathogenicity.
What are the monitoring methods for epidemic mutant strains in China at present?
After the optimization of the national COVID-19 epidemic prevention and control strategy, China CDC Institute of Virology formulated the Work Plan for Monitoring Covid-19 Mutant in Chinese Population according to the co-circulation of several Covid-19 subtypes in China. Scheme requirementsChoose three cities in each province and one sentinel hospital in each city. Each sentinel hospital takes samples of 15 emergency cases, 10 severe cases and all deaths every week for genome sequencing and analysis, and uploads the sequencing data to CDC Virology Institute in China within one week, and we establish the national Covid-19 genome database.. Through the implementation of this scheme, the epidemic dynamics of Covid-19 Omicron series mutants in China and the composition ratio of each subtype can be dynamically monitored in real time, and new mutants with potential biological characteristics change, including clinical manifestations, transmission power, pathogenicity and so on. It provides scientific basis for vaccine development and diagnostic reagent evaluation (including nucleic acid and antigen, etc.).
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How to treat the saying that "Erwin Engst is good early"?
Although Omicron is highly contagious, most of it is self-limited after infection, and its pathogenicity or severity is relatively low, butIntentional infection is not advocated or recommended.. Also emphasize that,The elderly, those with basic diseases, especially those who have not been vaccinated, must be well protected from infection in the first round of epidemic peak.. At this epidemic peak, there may be problems of uneven distribution of medical resources or a run, which will lead to the failure of timely and effective treatment for critically ill patients. We still hope that these elderly people will be well protected, including those in nursing homes and those who are bedridden with basic diseases. Everyone should pay special attention to avoid infection. At the same time, those who have not been vaccinated will continue to be vaccinated.
At the stage of the first round of rapid epidemic growth, with the passage of time, the number of infected people will increase, and the rapid upward trend will slow down, which is a universal law. But,After a period of time, with the extensive development of large-scale social activities, including Spring Festival travel rush or various social activities, there may be a new round of epidemic. The wave appearance of this epidemic may eventually form a certain group immune barrier, and the incidence rate will drop significantly..
What are the criteria for judging COVID-19’s death at present?
Different from the epidemic situation in Wuhan in early 2020, most patients died of respiratory failure in COVID-19 at that time. Now, after Omicron virus infection, the proportion of pneumonia in upper respiratory tract and lower respiratory tract is relatively low, and some patients have pneumonia, but the cases leading to respiratory failure are rare. As seen from clinical practice,At present, the main cause of death after Omicron virus infection is basic disease, and respiratory failure caused by Covid-19 infection is rare..
In order to reflect the deaths caused by the COVID-19 epidemic scientifically, objectively and realistically, National Health Commission recently organized experts to demonstrate and issued a notice, clearly classifying the related deaths scientifically. Mainly in two aspects,Pneumonia and respiratory failure caused by Covid-19 are the primary diagnosis of death, which is classified as death caused by Covid-19 infection.; Death caused by other diseases and basic diseases, such as cardiovascular and cerebrovascular diseases and myocardial infarction, is not classified as death caused by COVID-19. In order to better standardize the judgment of death caused by COVID-19 epidemic, it is required to adopt the way of consultation and death case discussion to finally judge whether the patient died of COVID-19 or other basic diseases.
