National Health Commission: no longer implement isolation measures, no longer determine close contacts, no longer delineate high and low risk areas

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The website of the National Health Commission released the “General Plan for the Implementation of “Category B” Management of Novel Coronavirus Infection”, which is explained in the following Q&A.

I. What is the background of the General Plan?

Since the outbreak of the new coronavirus infection, the Party Central Committee, with Comrade Xi Jinping at its core, has attached great importance to the prevention and control of the epidemic, comprehensively strengthened the centralized and unified leadership of the prevention and control work, adhered to the people first and life first, dynamically optimized and adjusted the prevention and control measures according to the time and situation, continuously improved the level of scientific and precise prevention and control, withstood the impact of the global epidemic rounds, and successfully avoided the relatively strong pathogenicity of the original strain, Delta variant The epidemic of the original strains and delta mutations with relatively strong pathogenicity were successfully prevented from becoming widespread in China, which greatly reduced serious illnesses and deaths, and gained valuable time for the development and application of vaccines and drugs as well as the preparation of medical and other resources. The epidemic prevalence and the number of disease deaths in China have remained at the lowest level in the world, the people’s health has steadily improved, and the integrated economic development and epidemic prevention and control have achieved the best results in the world.

Currently, experts at home and abroad generally agree that the general direction of the new coronavirus mutation is less pathogenic, more inclined to upper respiratory tract infection and shorter incubation period. Omicron mutant strain has become the dominant strain in the global epidemic, and although the number of infections is high, the pathogenicity is significantly lower than earlier, and the disease will gradually evolve into a common respiratory tract infectious disease. Taking into account the characteristics of the virus, the situation of the epidemic, vaccination, medical resources and experience in prevention and control, China has the basic conditions to adjust the new coronavirus infection from “category B A” to “category B B”. China’s new coronavirus infection prevention and control of the new situation and new tasks, prevention and control work into a new phase.

Why is the name of “New Coronavirus Pneumonia” changed to “New Coronavirus Infection” in the “General Plan”? What are the considerations?

On January 20, 2020, after the State Council’s approval, the National Health Commission issued an announcement to include the new coronavirus pneumonia (“new coronavirus pneumonia”) into the infectious disease category B under the Prevention and Control of Infectious Diseases Law of the People’s Republic of China, and to take preventive and control measures for infectious diseases in category A. At that time, the main reason for naming the disease “New Coronavirus Pneumonia” was that most of the cases at the beginning of the epidemic had pneumonic manifestations. After the mutant strain of Omicron became the main prevalent strain, the pathogenicity was reduced and only a very small number of cases showed pneumonia. Considering that pneumonia only reflects the more serious disease condition after virus infection and cannot summarize the clinical characteristics of all infected patients, the name of “new coronavirus pneumonia” was changed to “new coronavirus infection”, which is more in line with the current disease characteristics and hazards.

Third, what is the time schedule for the implementation of the “Category B B Control” in the General Plan? How to smooth and orderly transition? What adjustments will be made to the work objectives after the implementation of “Category B”?

The General Plan clearly states that “Category B” will be implemented for novel coronavirus infections from January 8, 2023. According to the Infectious Disease Prevention and Control Law, no more isolation measures will be implemented for people infected with the new coronavirus, no more close contacts will be determined; no more high- and low-risk areas will be designated; the classification and treatment of people infected with the new coronavirus will be implemented and the medical security policy will be adjusted in due course; the testing strategy will be adjusted to “testing as much as possible”; and the frequency and content of epidemic information release will be adjusted. According to the law on border health quarantine, no longer take quarantine infectious disease management measures for incoming personnel and goods.

All departments should be guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, give full play to the advantages of the system, adhere to the people first, life first, adhere to scientific prevention and control, precise measures, improve response preparations, adjust prevention and control measures, unified rules, classification guidance, risk prevention, to ensure the smooth and orderly implementation of “Category B B control”. After the implementation of “Class B B”, the goal of prevention and control work around the “health, prevention of serious illness”, to take appropriate measures to maximize the protection of people’s lives and health, and minimize the impact of the epidemic on economic and social development.

Fourth, the new coronavirus infection after the implementation of the “Class B B tube”, what are the main response measures?

First, to further improve the rate of vaccination against new coronavirus in the elderly, and to promote the second dose of booster immunization in people at high risk of serious illness. The second is to prepare drugs and testing reagents related to the treatment of new coronavirus infection to meet the needs of patients for medication and testing. Third, increase investment in medical resource construction, focusing on the preparation of inpatient beds and critical care beds. Fourth, adjust the population testing strategy, community residents according to the need to “test as much as possible”, and no longer carry out full-scale nucleic acid screening. Fifth, according to the severity of the disease, the classification and treatment of patients. Sixth, the community health survey and grading services for key populations, to identify the combined basic diseases and vaccinations of the elderly aged 65 and above in the district, to provide classified and graded health services. Seventh, strengthen the prevention and control of key institutions such as elderly institutions, social welfare institutions, hospitals, schools, preschools and large enterprises, and prevent the risk of aggregated epidemics in the premises. Eight is to strengthen the prevention and control of epidemics in rural areas, to provide medical care for the elderly in rural areas, patients with basic diseases and other high-risk groups. Nine is to strengthen epidemic monitoring and response, study and judge the development of the epidemic, and take appropriate measures to suppress the peak of the epidemic such as restricting aggregated activities and movement of people in accordance with the dynamics of the law. Ten is to advocate adherence to personal protective measures and implement the concept that everyone is the first person responsible for his or her own health. Eleven is to do a good job of information dissemination and public education, comprehensive and objective publicity and interpretation of the purpose and scientific basis for adjusting the new coronavirus infection from “Category B A control” to “Category B B control”. Twelve is to optimize the management of Chinese and foreign personnel travel, incoming personnel in China in 48 hours before the trip for nucleic acid testing, the abolition of full nucleic acid testing and centralized quarantine after entry, the abolition of the “five one” and passenger seat rate restrictions and other measures to control the number of international passenger flights.

V. What is the arrangement of the General Plan to further promote the vaccination of elderly people against the new coronavirus?

Vaccination is one of the important measures for epidemic prevention and control, and is an effective means to prevent serious illnesses and reduce deaths. From an individual perspective, it can effectively protect the health and life safety of the elderly population; from a society-wide perspective, it can effectively reduce the risk of health care resource crowding. After the implementation of “Category B” control of novel coronavirus infection, high-risk groups such as the elderly continue to face the risk of being infected, and the General Plan once again deploys vaccination work, requiring further strengthening of organizational mobilization efforts, scientific assessment of contraindications to vaccination, and accelerating the increase of vaccination coverage, especially the coverage of the elderly population. .

What are the requirements for vaccine selection and time interval in the booster vaccination?

All 13 vaccines currently approved for conditional listing or emergency use can be used for the second dose of booster immunization, including the four new vaccines for emergency use, with priority recommended for sequential booster immunization, or vaccines containing Omicron strains or with good cross-immunity to Omicron strains. All regions will follow the deployment of the joint prevention and control mechanism of the State Council, organize the implementation carefully, optimize the form of services, and continue to do a good job of vaccinating the elderly against the new coronavirus. People at high risk of infection, elderly people aged 60 and above, people with more serious underlying diseases and people with low immunity may receive a second dose of booster immunization after completing the first dose of booster immunization for six months.

How to prepare drugs and testing reagents for the treatment of novel coronavirus infection in various medical and health institutions at all levels? How to improve the accessibility of drugs and antigen detection reagents?

Novel coronavirus infection-related drugs are indispensable in the treatment process and are an important safeguard for medical treatment. In order to prepare drugs and testing reagents for the treatment of novel coronavirus infection and to meet the needs of the public, the General Plan clearly requires that, on the one hand, medical institutions at the county level and above dynamically prepare novel coronavirus infection-related Chinese medicine, anti-neo-coronavirus small molecule drugs, symptomatic drugs such as antipyretic and anti-cough drugs in accordance with the daily use of three months; in accordance with the requirements of graded treatment, asymptomatic infected patients without serious underlying diseases, light cases, and patients with severe disease, and asymptomatic infected patients with severe disease. Asymptomatic infected persons without serious underlying diseases and light cases are to be cared for at home, grassroots health care institutions and drug retail institutions should also make corresponding preparations to ensure the accessibility of drugs. Local joint prevention and control mechanisms (leading groups and commands) should assume leadership responsibility for the preparation of drugs and reagents and guide medical and health institutions at all levels to prepare drugs and testing reagents. On the other hand, the provinces should be based on the population base, the development of the epidemic situation, the proportion of cases of each type and other factors, advance measurement of the demand for drugs, and will provide the results of the relevant departments to guide enterprises to actively do a good job related to drug supply, to guide a reasonable and orderly and precise placement, effectively alleviate the difficulties of patients to buy drugs, drugs and other problems, smoothly through the peak of the epidemic.

Eight, the implementation of the new coronavirus infection “Class B B tube”, what medical resources need to make preparations? How can medical institutions at all levels do a good job in providing medical services?

China’s epidemic prevention and control faces a new situation and new tasks. Doing a good job of preparing medical treatment resources is the “first move”, “key move”. The General Plan calls for greater investment in construction and the completion of medical resource preparation as soon as possible, focusing on the preparation of inpatient beds and critical care beds. First, to further strengthen the fever clinic settings, fever clinics in hospitals above the second level “should be set up as much as possible, should be open as much as possible”, with the conditions of the primary health care institutions are open fever clinic (outpatient), equipped with sufficient medical forces to meet the needs of patients to seek medical care. Secondly, we should take prefecture-level cities as units, according to the size of the population, and quickly upgrade the eligible square cabin hospitals to sub (quasi) designated hospitals, and ensure adequate medical strength. Third, the designated hospitals to strengthen the critical care bed settings. Provincial capital cities and central cities that play the role of regional medical centers, their designated hospitals should also set up independent hemodialysis centers, delivery rooms, pediatric wards to meet the needs of special patient care. At the same time, the formation of multidisciplinary medical teams, the establishment of superior hospital counterparts to guide the relationship to ensure medical quality and safety. Fourth, secondary hospitals are required to build and renovate intensive care units according to standards to ensure that each intensive care unit is readily available and serves as a useful supplement to the critical care medical resources of tertiary hospitals. Fifth, tertiary hospitals are required to strengthen the preparation of critical care medical resources, reasonably equip critical care medical forces, ensure that comprehensive ICU monitoring units are readily available, and ensure that critical care resources are doubled within 24 hours through the construction of convertible critical care units. Organize medical and nursing staff in advance to conduct specialized training in critical care medicine and rapidly expand the strength of the critical care medicine team. Establish a mixed grouping of medical and nursing staff specializing in critical care medicine and other trained medical and nursing staff to ensure the orderly implementation of medical treatment for critically ill patients.

Nine, the new coronavirus infection “B class B tube” after which the population need to carry out antigen or nucleic acid testing?

The General Plan stipulates that community residents should be tested as much as they want to be tested, and that full nucleic acid screening should no longer be carried out. In order to ensure the demand for testing, the community is required to maintain a certain number of convenient nucleic acid testing points, retail pharmacies, drug network sales e-commerce and other adequate supply of antigen testing reagents.

At the same time, taking into account that medical institutions, elderly institutions, social welfare institutions and other places where vulnerable people are concentrated, the risk of serious illness in the vulnerable people concerned is high, and once the source of infection is introduced, it is easy to have an aggregated epidemic, so it is proposed to carry out antigen or nucleic acid testing for the following categories of people: First, for emergency outpatients with fever and respiratory infection symptoms admitted to medical institutions, inpatients with a high risk of serious illness, symptomatic During the epidemic, antigen or nucleic acid testing will be conducted regularly for staff and caregivers in vulnerable population centers such as elderly institutions and social welfare institutions; third, community residents at high risk of serious illness such as elderly people aged 65 and above, long-term hemodialysis patients, severe diabetes patients, and infants and children aged 3 and below will be instructed to conduct antigen testing after the onset of fever and other symptoms. Fourth, when foreigners enter the vulnerable gathering places, they should check the negative nucleic acid test certificate within 48 hours and carry out antigen testing on site.

X. How to implement graded treatment? How to make serious high-risk people get timely treatment?

The General Plan requires the construction of a hierarchical medical treatment system based on medical associations, and medical institutions of all levels and types in medical associations have their own functional positioning to meet patients’ medical needs. The primary medical and health institutions are mainly responsible for population health monitoring and health management, especially for the elderly combined with basic diseases and other serious high-risk groups to implement graded health services; the secondary hospitals in the medical consortium mainly provide technical support to improve the ability of primary doctors to identify, diagnose and deal with high-risk groups, and at the same time do a good job in the treatment of common and multiple diseases; the leading tertiary hospitals in the medical consortium are responsible for acute and critical The leading tertiary hospital in the medical association is responsible for the treatment of patients with acute and critical illnesses, and provides a green channel for the elderly people under primary health management when their conditions change and they need to seek medical treatment.

In addition to improving the ability to treat critical illnesses at the grassroots level, it is also necessary to improve the ability of grassroots doctors to identify, diagnose and dispose of high-risk populations, strengthen the work of graded and classified admissions, and guide localities to establish a sub-partitioning responsibility system, requiring the establishment of a sub-partitioning responsibility system for tertiary general hospitals, with prefecture-level cities as the units. In accordance with the principle of zoning package, each tertiary general hospital to delineate the scope of responsibility for the admission of heavy, critical type of patients of advanced age combined with new coronavirus infection in the delineated area, to achieve “full coverage” of the management of elderly patients with serious illnesses package. It is important to note that the zoning package is the scope of responsibility, does not mean that only responsible for the admission and treatment of patients in the designated area, any hospital may not use the designated area as a reason to shirk or refuse to accept serious patients transferred from other areas. For tertiary hospitals, the delineation of the area of responsibility is relative, and the implementation of the system of first consultation responsibility and emergency critical care rescue is absolute. The State Council Joint Prevention and Control Mechanism Medical Treatment Group will improve the supervision and assessment mechanism for tertiary hospitals to treat elderly patients with serious illnesses, establish a “daily report” system for tertiary hospitals to treat elderly patients with serious illnesses and positive patients, and incorporate the treatment status into the performance assessment of tertiary public hospitals.

Eleven, “the overall plan” to carry out health surveys on which groups of people? How to promote the classification and grading of health services?

The main focus is on mapping the elderly aged 65 and above, especially those with combined underlying diseases (including coronary heart disease, stroke, hypertension, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, tumors, immune deficiency, etc.) and their new coronavirus vaccination status. The classification takes into account the underlying disease status, the status of vaccination against the new coronavirus, and the degree of risk after infection, and is a standard developed by a comprehensive study conducted by experts. The primary service is mainly for the general population, providing health education and guiding elderly people who have not received the booster vaccine and who are eligible for vaccination after assessment by doctors to receive the vaccine as soon as possible. The secondary service is based on the primary service, for the secondary priority population, for asymptomatic or mildly symptomatic infected people treated at home, primary medical and health institutions combine with the actual guidance through the Internet, video, telephone, remote or offline methods to carry out antigen testing, health monitoring, provide health consultation, medication guidance, etc. In case of persistent high fever, respiratory distress, finger oxygen saturation less than 93%, etc. should be referred as soon as possible. Primary health care institutions follow up as needed until the end of home treatment and observation. The community (village) assists in the implementation of the management of infected persons on home treatment, provides guidance and assistance in seeking medical treatment for those with regular medical needs, and assists in providing services such as drug purchase and delivery. Tertiary services are mainly for key populations, and on the basis of secondary services, for infected persons who are disabled elderly or elderly with limited mobility, the admission method will be decided after assessment by the expert team determined by the county (city or district) health and wellness department or by the higher level hospital. For key populations of infected people and those with urgent medical needs, community (village) and primary health care institutions to assist in referrals.

Twelve, “the overall plan” on the prevention and control of epidemics in key institutions to do what provisions?

The “General Plan” requires that places with concentrated populations, such as elderly institutions, social welfare institutions, psychiatric hospitals, etc., take internal zoning management measures in conjunction with facility conditions. When the epidemic is serious, the local party government or joint prevention and control mechanism by scientific assessment of the appropriate time to take closed management, and reported to higher authorities, to prevent the introduction of epidemic and the risk of proliferation, timely detection, treatment and management of infected persons, the establishment of a perfect mechanism for the transfer of infected persons, and medical institutions to treat the green channel mechanism, the first time the infected persons in the institution to transfer and priority treatment, to control the gathering of epidemic in the premises. Medical institutions should strengthen personal protection guidance for medical staff and patients attending the clinic, strengthen the daily disinfection and ventilation in the premises to reduce the risk of virus transmission in the premises. Schools, preschools, large enterprises and other key institutions where people gather should do a good job of monitoring the health of personnel and take timely measures to reduce interpersonal contact after an outbreak to slow down the development of the epidemic. In the event of a serious epidemic, key party and government agencies and key industries should, in principle, require staff to be “two points one line” and establish a staff rotation mechanism.

XIII. What are the requirements of the General Plan for rural areas to be prepared for the epidemic? What are the considerations?

Considering the actual situation that the foundation of epidemic prevention and control in rural areas is relatively weak and the medical and health resources are relatively insufficient, in order to minimize the impact of epidemic peaks on rural areas and to protect the lives and health of rural residents to the greatest extent possible, the General Plan takes epidemic prevention and control in rural areas as an important aspect and refines the preparations for epidemic response. We will do a good job of educating and guiding rural residents, give full play to the role of the medical and health network at the county, township and village levels, conduct health surveys of key populations, strengthen the allocation of medical resources, and allocate sufficient relevant treatment drugs and equipment. Rely on county medical communities to improve the medical security capacity of rural areas for new coronavirus infections, establish convenient referral channels for seriously ill patients, coordinate urban and rural medical resources, establish and improve the mechanism of counterpart support between comprehensive hospitals and county hospitals, and provide medical care protection for rural elderly people, patients with chronic basic diseases and other high-risk groups. According to the regional epidemic situation and residents’ wishes, the scale and frequency of gathering activities such as rural fairs, temple fairs and cultural performances will be appropriately controlled.

What are the requirements for epidemic surveillance in the General Plan? What issues should be noted in the process of epidemic response?

According to the “overall plan” requirements, after the implementation of the new coronavirus infection “category B B management”, we must continue to dynamically track the virus variation at home and abroad, assess the virus transmission, pathogenicity, immune escape ability and other characteristics of change, timely tracking and research and take targeted measures. At the same time, we should monitor the level of infection in the community, monitor outbreaks in key institutions, dynamically grasp the scale, scope, intensity and virus variation of the epidemic, and study and judge the development of the epidemic. In addition, continue to rely on the National Infectious Disease Network Direct Reporting System for real-time, online monitoring of information on cases of statutory infectious diseases. During the epidemic response process, special attention should be paid to real-time comprehensive assessment of the epidemic intensity, medical resource load and social operation, etc., and take appropriate measures to suppress the peak of the epidemic by dynamically limiting the gathering activities and movement of people in accordance with the law, so as to maximize the protection of people’s lives and health and minimize the impact of the epidemic on economic and social development.

Fifteen, “the overall plan” on how to do their own health first responsible for what requirements?

After the implementation of the new coronavirus infection “category B,” we advocate that individuals continue to maintain good hygiene habits, strengthen personal protection, and follow the requirements of graded classification of medical treatment. The General Plan states that each individual is the first person responsible for his or her own health, and that everyone should continue to adhere to good hygiene habits such as wearing masks, washing hands regularly, maintaining interpersonal distances in public places, and completing vaccinations and booster immunizations in a timely manner. When the epidemic is severe, elderly people with underlying diseases, pregnant women and children should minimize their visits to crowded places. Asymptomatic infected persons and light cases should implement self-care at home, reduce contact with fellow residents, use symptomatic treatment drugs reasonably in accordance with relevant guidelines, monitor their health well, and seek medical consultation in a timely manner if their condition worsens.

What has the “General Plan” done to optimize the management of Chinese and foreign personnel travel?

According to the “General Plan” requirements, first, the nucleic acid test is conducted 48 hours before the trip, and those with negative results can come to China without applying for a health code from our embassies and consulates abroad, and the results are entered into the customs health declaration card. If the result is positive, the person concerned should come to China after turning negative. Second, cancel the full nucleic acid test and centralized quarantine after entry. Health declaration is normal and no abnormal customs port routine quarantine, can be released into the social side. Third, the abolition of the “five one” and passenger seat rate restrictions on the number of international passenger flights control measures. Fourth, the airline companies continue to do a good job of in-flight epidemic prevention, passengers must wear masks when flying. Fifth, further optimize the arrangements for foreigners coming to China for resumption of work and production, business, study, family visits and reunion, and provide corresponding visa convenience. Gradually resume the entry and exit of passengers at waterways and land ports. Resume Chinese citizens’ outbound travel in an orderly manner according to the international epidemic situation and the capacity of various services.