Zhong Nanshan’s latest statement: China’s CDC status is too low

At 10:00 on February 27, the Guangzhou Municipal Government Information Office held a special news conference on epidemic prevention and control in Guangzhou Medical University. Dr. Zhong Nanshan said at the meeting that one of the shortcomings (of China’s epidemic containment) is that China’s CDC status is too low. It is only a technical department, and the status of CDC has not received enough attention.

1. When will the epidemic be brought under control?

Zhong Nanshan:

Our own team added two influencing factors to the traditional model (strong national intervention, elimination of peak return trips after the lunar new year), and built a new prediction model. We predict that the peak of the epidemic situation should be in mid-February, near the end of February.

As far as China is concerned, we are confident that the epidemic will be basically controlled by the end of April.

At the beginning of the epidemic outbreak, an authoritative test model was used by epidemiologists outside of China. It is predicted that by the beginning of February, the number of people infected with new crown pneumonia in China will reach 160,000. This did not take China’s strong intervention into account, nor did it take into account the postponement of interventions. We put our team’s prediction results in an authoritative foreign journal, but (the article was) returned, and someone sent me a WeChat message saying, “Your words will be crushed within a few days.”(This sentence could be interpreted in many ways even in the original Chinese language.)

2. How do you see the rapid spread of the epidemic in the international community?

Zhong Nanshan: At present, the number of new cases in China is less than that in foreign countries.

The most prominent foreign countries are South Korea, Iran, Italy, and Japan. So I have been invited to present a video report to the European Respiratory Society this weekend. This is a disease (that should be confronted and handled by ) all humans, not a single nation.

In order to prevent output cases from transforming into imported cases, we must strengthen international cooperation, communicate with each other, share experiences, and establish a joint prevention and control mechanism.

It should be noted that more than 85% of patients who had been discovered earlier with the disease would improve, and the mortality rate of critically ill patients is several times higher than that of ordinary patients, so we must achieve (the combinational objectives of) early detection, early isolation, and early treatment.

At the moment of crisis, Japan and South Korea did not forget to support us; now that their epidemic is developing rapidly, we will not forget to support them. It is hoped that we will be able to grasp foreign conditions and treatment methods in time to jointly curb the spread of the epidemic.

3. What practices can Guangzhou share to fight the epidemic?

Zhong Nanshan: For all acute infectious diseases, the first point is to control its upstream. Good prevention(effective precautions), early detection and early isolation can collectively avoid a big outbreak.

Second, patients should be admitted to designated hospitals. As soon as they arrive at a general hospital, they will consume a lot of human and financial resources. As such, there should be a certain degree of professionalism in the treatment of these acute infectious diseases.

There is also the need for a comprehensive treatment of critically ill patients rather than treating infectious diseases alone. Infectious diseases do need treatment and prevention methods, but the provision of life support also matters. Many diseases, including neo-coronary pneumonia, seem to me to be a constant decline in viral load with constant care and vital signs. Given good life support, patients are likely to pass (the danger). When unidentified infectious diseases occur, supportive care should be taken.

Large cities like Guangzhou need international cooperation. Most scholars in most countries sincerely hope to cooperate with us so that good treatment can be shared.

4. What lessons have been displayed during the epidemic prevention and control work?

Zhong Nanshan: Sudden public health events are not a one-time event, and input in this area is definitely more than output. The disease was identified on December 31, isolated (virus) on January 3, and reported to the United Nations on January 7. In the early stages of the epidemic, human-to-human transmission and medical staff infections had already occurred.

The status of our CDC (China Centers for Disease Control and Prevention) is too low. It is only a technical department under the leadership of the Health and Medical Commission. Its special status has not received enough attention.

The CDC should have certain administrative powers and the right to announce the epidemic situation to the society; otherwise similar situations may occur in the future. Dr. Li Wenliang, for instance, also sent out information about the epidemic early. It is necessary to make a change. [As an ophthalmologist at Wuhan Central Hospital, Dr. Li Wenliang was summoned for a dressing-down at Wuhan Central Hospital and subsequently to the local police station after warning a SARS-like epidemic in a WeChat group; he then died of COVID-19. Details refer to The Economist Obituary Article.)

In addition, people did not pay enough attention to infectious diseases. SARS is an accident, and since then, there has been no continuous scientific research. So this time, I feel that everyone is a little helpless in the treatment of new coronary pneumonia, and we can only use the existing medicine to develop a new drug in such a dozen days, twenty days, or even one month based on its basic principles. A new drug is simply impossible. This requires long-term accumulation.

There is also a great lesson: whenever a coronavirus infection is found, it is necessary to strictly prevent its spread. If we could take strict prevention and control measures at the beginning of December, or even at the beginning of January, our patients would be greatly reduced; and according to our estimates, if we implemented them after January 25 (such as the closure of cities), patients would increase to more than 100,000 people.

5. What are the symptoms of Re-positive in nucleic acid test in cured patients?

Zhong Nanshan: At present, we cannot make an absolute conclusion. Generally speaking, the infection rules of the virus are the same. As long as IgG antibodies appear in the body and the (number) increases a lot, the patient will not be infected again. It is not that patients are re-infected as soon as virus residues are found. When a sufficient amount of antibodies has been produced in the body, the person will not be infected.

It remains to be seen whether the remnants contained in the intestines and feces will be transmitted to others.

6. How to prevent and control the epidemic when work resumes?

Zhong Nanshan: Now it is is the peak of returning to work (in China after the extended lunar new year holiday). Our prediction model shows that after this (returning), a new peak will appear. Today is the 27th. The peak we predicted has not yet appeared (in China).

At present, trains and other transportation vehicles have to be inspected, and the spread of the virus will be interrupted naturally, so we will resume work, but everything must be under strict control measures.

For example, Foxconn has tens of thousands of employees returning to work in a 3,000-square-meter area. The approach we take is for workers to perform dual tests, one for nucleic acid testing and the other for IgM testing.

In addition, all faucets and sewers in the factory must be very smooth. There is no evidence that the virus is transmitted through the digestive tract, so it is still necessary to protect the respiratory tract.

 

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