Editor’s note:


Recently, the new pneumonia epidemic has attracted worldwide attention, and the bombing of information on social media has affected the hearts of the people across the country. To help you understand the dynamic changes of the epidemic, the WeChat public account “Huashan Infection” of the Department of Infection of Huashan Hospital Affiliated to Fudan University continues to update the relevant data of the epidemic, and invites experts such as Zhang Wenhong and Ai Jingwen from the Department of Infection of Huashan Hospital to discuss the trends and hot spots of the outbreak Questions and related precautions are specially interpreted for answering questions.

Since the outbreak of the New Coronary Pneumonia, experts such as Zhang Wenhong and Ai Jingwen have been tracking and have written many articles on “Huashan Infection”. It is also easy to understand, and the surging news is authorized to be forwarded. We hope that this group of articles on “Huashan Infection” will help readers to look at the epidemic more rationally and do a better job of self-protection.


What is the new normal?

The “new normal” is of course for the “old normal”. The old normal is the world before the outbreak. According to American anti-epidemic expert Fudge, “after the advent of the vaccine, it is difficult for us to return to the world before the epidemic.”

What if you have to go back? Even if the epidemic is not completely controlled, should we return to the good old days? That is naturally the “new normal”. In foreign countries, the “new normal” is accompanied by new cases every day, but I still start work, resume school, and resume the market. For China, it is to fully restore the economy, schools, and open public places, but it has to face the risk of imported epidemics and the corresponding great pressure for prevention and control.

Which countries have forcibly launched the “new normal”?

The global epidemic is currently not completely under control. Europe has just seen the dawn of a decline in new cases. New cases in the United States are still hovering high, Eurasia In Russia, South Asia, India, South America, Brazil, and African countries, the peak of the epidemic has not yet been seen, and it is still in a period of continuous climb.

East Asian scenery is unique, but the atmosphere is more tense. Countries in East Asia, such as China and South Korea, continue to strictly guard against death.

Europe generally accepts “posting with illness”, we also see that including Italy1. Some states and counties in the United States actively resume work on the premise that there are still hundreds or even thousands of cases every day.


Turn on reopening Italy. Image source Weibo (see watermark)

Why the atmosphere of the country where the epidemic was well controlled before was tense, for example, Singapore immediately closed the school after the outbreak of labor camp And Europe began to resume school when the epidemic was not completely controlled? What exactly is a normalized epidemic?

Under normalized epidemics, why do everyone ’s interpretations and actions be so different? Will there be some risks in an open society before the epidemic is fully controlled?


Analysis of the risks and control strategies faced by the resumption of disease in Europe and the United States

Well, some countries in Europe and America still have hundreds or even thousands of new issues every day In the case of a case, once the work is resumed, what are the risks?


Source: Huashan Infection

For the cases diagnosed have broken through millions and There are still 20,000+ new cases in the United States every day, and some states, such as Texas and Georgia, have announced partial recovery plans. In Italy, there are still 1000+ new cases yesterday, and part of the resumption of work began on May 4th, and officially entered the second stage of anti-epidemic coexistence with the virus. The reason behind itIt covers many factors including economy, politics, culture, health care system and so on. The first risk that comes with the resumption of work is the possible second outbreak of the epidemic and the threat to people’s health, followed by the huge pressure that the medical system may face again.


Multi-states in the United States require resumption of production and production. Image source: public account INSIGHT

How do anti-epidemic experts in European and American countries control the risk of rebound after the resumption of work and the risk of collapse of the medical system?

The author once held an international multidisciplinary anti-epidemic forum in March this year. German virologist Professor Lu Mengji introduced the German anti-epidemic strategy more clearly. Such a public health response strategy is actually not a temporary patchwork, but has a response plan before the outbreak. The overall goal is to control the epidemic situation within the “controllable range of the medical system” to avoid medical runs and excessive mortality.


Source: Public number “Medical Professional Learning Platform”

This strategy can be called the “Hammer and Dance (Hammer and Dance) combined adaptive trigger strategy” prevention and control model. In layman’s terms, active measures are taken when an outbreak occurs, including “slamming” methods that limit social distances, such as closure of cities and cities, to achieve the purpose of containing the outbreak and controlling the peak of the outbreak within the medical system’s scope. Once the epidemic is stopped, the case fatality rate gradually drops to an acceptable rangeWithin the siege, then the society will gradually let go, and gradually resume the “dancing” stage.


Source: Tomas Pueyo, Coronavirus: The Hammer and the Dance

American Tomas Pueyo first proposed the name “hammer and dance”, but the concept of adaptive triggering strategy stems from a study of the Imperial College of Technology in the United Kingdom, which first adopted severe hammer-like suppression measures during the outbreak. Including family orders, strict social isolation, etc. As the epidemic situation improves, if the epidemic in the region cannot be completely eliminated within a short period of time, then certain specific indicators can be set as threshold trigger points. These specific indicators are mainly the number of new cases, the number of severely hospitalized cases and the number of beds that can be accommodated in the local area. If the number of severely discharged patients exceeds the number of seriously admitted patients, the society can gradually open up. That is to say, if these variables fall to a certain threshold, the government will relax some of the epidemic prevention measures, and if the variable rises to this threshold again, reaching the trigger point, that is to say, exceeding a certain rate of incidence, the local medical ability If it can be tolerated again, and the fatality rate may rise sharply, then the severity of the epidemic prevention measures must be further increased immediately (this threshold is mostly related to the local medical capacity limit). In this way, the epidemic situation in the whole area can be controlled by the initial stage, and it shows a sense of fluctuation similar to “dance”, which has been maintained within a range of the largest load of local medical and health resources.


“Restart with disease” will extend the time point for global epidemic elimination

The control of this epidemic, the measures taken globally are essentially the same The difference is the emphasis on social distance. The difference is the timing and implementation of measures taken by various countries, leading to different results. All measures, including family orders, closing public places, wearing masks, etc., are to reduce the chance of close contact between people. The earlier, the more thorough and the more determined, the better the effect, as in China. But if the implementation is discounted, or unwilling to pay the economyAt the cost of Shanghe ’s personal freedom of travel, if he encounters a difficult virus like the new crown, it will be difficult to win a victory against the epidemic in a short period of time.

But it should be pointed out that when these areas still have more daily new cases to start full work, the local government has decided to adopt “hammer and dance” Strategy, which also means that they have no possibility of completely eliminating the local epidemic in the short term. They will definitely face a second rise in the epidemic in the future. The only thing they can do is to control the extent of the increase. The outbreak of the epidemic once again “outbreak”, that is, to adopt a strategy of “recurring” but not constitute an “outbreak”.

In this way, the possibility of ending the outbreak in summer is really gone.



The United States also has different opinions on whether to resume work immediately or resume production


When can the global public health emergency be eliminated?

With the new crown epidemic continuing to present a globalized multi-country cluster outbreak, some European and American countries have actually entered the “new normal”. Some European countries began to accept masks in public places and return to work. The society began to resume full production and production. At this time, there will be an increase in the number of cases and a rise in severe cases.


After resuming work in Italy, masks became a must-have. Image source Weibo (see watermark)

On the other hand, countries have greatly improved their detection capabilities, a large number of mild and asymptomatic patients will Detected, and at the same time, the elderly in high-risk state will adopt a method of reducing social density, two-pronged approach, the mortality rate in Europe and the United States will further decline. When the case fatality rate is lower than that of the regular influenza season, the world may emerge from a public health emergency. At the same time, it means that there must be exchanges between regions and countries. Under such circumstances, countries will gradually open their borders.

As the epidemic in Europe and the United States is gradually controlled and maintained at a low level, South America, South Asia and Russia will gradually come out of strict control measures because of It is difficult to reach a level where countries such as China and South Korea are close to complete control, and it may have to follow Europe and the United States into a “new normal” with a low level and the epidemic situation.

When the epidemic situation in all countries is reduced to a controllable low level but the virus has not been completely eliminated, the world will gradually reopen, once the World Health Organization When the degree of control of the epidemic is cancelled, the international public health emergency state indicates that the world has entered a “new normal” simultaneously.

The impact of the global “new normal” on China and countermeasures Three months or half a year later, when the world enters the “new normal” and the International Health Organization will no longer continue the “public health emergency”, countries with well-controlled epidemics, including China, will face pressure to restart port importation. Dozens of times more input today. At this point, our “new normal” may have just begun. We still have a 3-6 month response period. We must prepare for the global “new normal”.


Image source network

At this time, there are occasional distributions in many areas of the country Cases, even small-scale cluster transmission is very possible. However, as long as there are few sporadic cases in a community in a region, and most of them can be quickly diagnosed and traced, and the close contacts can be quickly isolated, it means that the community transmission in this area is still under good control. Among them, Asia, China, South Korea and other places are currently at this stage.

One of the most outstanding outstanding performances of many regions and countries in Asia in this epidemic is the timely and strong prevention and control measures adopted in the early stage, making the epidemic finally There are no large-scale outbreaks in the community, so it is still possible to control the spread of the epidemic to a lower order of magnitude through prevention, control, and screening. After the epidemic peak period is under control, although there are still a small number of cases every day, through the comprehensive detection system, epidemiological traceability, imported case prevention and control and continuous social isolation, etc., various regions can resume the background Maintain a small number of daily cases for a longer period of time without causing further community outbreaks.

It can be said that for the people in these regions and countries, as long as we continue to focus on social isolation measures and cooperate with the government ’s relevant epidemic prevention policies, even if there are sporadic cases, the epidemic situation will be repeated. The risk of a major outbreak is also low.


Social isolation will be an important part of the new normalization, picture source network

< / div> Therefore, for our country, when we have thoroughly controlled the epidemic through the power of the country in the early days, how can we maintain zero daily cases or a small number of traceable cases for a longer period of time in the context of resuming production and then avoid causing Further outbreaks in the community are crucialImportant. This is also an issue that China needs to think about under normalization. In China, a number of measures have been launched and implemented.


China ’s strategic reserve for the “new normal”

This May Day, Shanghai Municipal Party Secretary Li Qiang visited the Shanghai Shopping Festival in person, leading many provinces across the country “Bringing the goods” in person, the country actively launched the “Consumption Day Resumption of Work, Production, School, Tourism, and Resumption of Consumption” activities, and the country’s economic society and life are rapidly “recovering normal” actions.


Shanghai is actively resuming work and resuming production, picture source: Shanghai release


It is easy to “complex normal”, but difficult to maintain “new normal”.

Especially under the global “new normal”, how do we maintain perfect control of the epidemic without large-scale community transmission and without affecting the normal A life of change has put a great test on the public health system in the post-epidemic era in our country. At this time, East Asian countries, China, South Korea, Japan and other countries are a starting line, European and American countries are a starting line, and South Asia and South America and Africa and other emerging countries are also a starting line. Global epidemic control has never been as good as today. complex. The new coronavirus will greatly subvert everyone’s perception of infectious diseases and even affect the attitudes of various countries towards globalization. In a sense, whether we can win this “new normal” anti-epidemic war has already been related to the globalization process and the future territory of the world.

The epidemic prevention and control will enter normalization. How will China ’s future public health system be deployed? All over the country have also launched the goal of building a public health system, providing China with a solution to the global “new normal”. This solution will face the test of a global epidemic in the next 1 to 2 years.

The Shanghai Municipal Party Committee and Municipal Government recently proposed a public health system at the city ’s public health conferenceFive goals of construction: first, build a centralized, intelligent and efficient public health emergency command system; second, build a coordinated, comprehensive, sensitive and reliable public health monitoring and early warning system; third, build a leading domestic and international advanced modern disease prevention Control system; Fourth, build an emergency medical treatment system with clear positioning and combination of peace and war; Fifth, build a public health social governance system under the leadership of the party committee, government responsibility, and multi-party participation.

Various cities across the country should build and improve public health prevention and control systems based on local conditions and continue to strengthen them. In the “new normal” period, there must be a strong network system for capturing cases, a strong case tracking system after a case is discovered, and a complete emergency treatment system after a local outbreak. On this basis, we will further benchmark the highest international standards and the best level, scientifically build a prevention and control system, use big data and other technologies to assess public health safety risks by region and level, and achieve accurate and efficient emergency work, reducing normal production and life. The influence of order. At the same time, scientific prevention and control puts high demands on the capacity of scientific and technological reserves and scientific and technological breakthroughs. In the future, China needs to reach a higher level in diagnosis, medicine, vaccines, basic research, and clinical integrated treatment. The outbreak of the epidemic makes full technical reserves.


Image source network

If we won an outbreak in the previous stage The war of resistance depends on the great determination of the Chinese government, the hard work of the medical staff, the dedication of the grassroots staff, and the cooperation and understanding of the general public. Then the “new normal” anti-epidemic war is the national resilience and wisdom. Too.

Writing and drawing: Ai Jingwen, Zhang Wenhong

Editor: Yu Yiqi, Zhang Haocheng < br>

(The original title of this article is “We must prepare for the global” new normal “risk”, the authors Ai Jingwen and Zhang Wenhong are physicians in the Department of Infectious Diseases of Huashan Hospital WeChat first appeared on the public account “Huashan Infection”, the copyright belongs to Fudan UniversityOwned by the Department of Infection of Huashan Hospital Affiliated, Surging News was authorized to forward it. )