[Breaking news] The National Health Commission has released a new epidemic prevention and control plan, with more changes than the previous eight versions!

The epidemic prevention and control policy has undergone major adjustments - the isolation policy for close contacts and incoming personnel, the division of closed control areas and medium- and high-risk areas, and the strategy for nucleic acid testing of all personnel have all changed.

On June 28, the official website of the National Health Commission released the "New Coronavirus Pneumonia Prevention and Control Plan (Ninth Edition)".

"Adjusting the epidemic prevention and control plan is a routine action. The scale of the adjustment this time is relatively large, especially in the centralized quarantine time for close contacts and inbound personnel, which has been shortened by half." Zhao Dahai, a professor at the School of International and Public Affairs of Shanghai Jiao Tong University, told Health World that these adjustments are more in line with the characteristics of the Omicron variant.

The ninth edition adds 30 pages of content, emphasizing the need to improve the sensitivity of monitoring and early warning, control the epidemic to the smallest scope in the shortest time and at the lowest cost, and coordinate epidemic prevention and control with economic and social development to the greatest extent possible.

On the afternoon of June 28, at a press conference held by the Joint Prevention and Control Mechanism of the State Council, Mi Feng, spokesperson of the National Health Commission and deputy director of the Publicity Department, said that the ninth edition of the prevention and control plan is an optimization of the prevention and control work and is by no means a relaxation of prevention and control. The goal is to be more scientific and precise.

So, what are the changes in the ninth edition of the epidemic prevention and control plan?

The ninth edition adjusts the quarantine and control period for close contacts and inbound personnel from the previous "14+7" to "7+3", but increases the number of nucleic acid tests;

Abolish the "three zones": lockdown zone, control zone, and prevention zone, and unify the standards for high, medium, and low risk areas;

The State Council's joint prevention and control mechanism will send a working group to supervise local epidemic prevention and control violations of the "Nine Prohibitions";

New vaccination standards are proposed, which prohibits receiving homologous booster immunization and sequential booster immunization at the same time.

In addition, the frequency of nucleic acid testing for people in risk occupations has increased, among which there are four types of standards related to medical personnel:

Staff of designated medical institutions shall be examined once a day during the working period;

Medical staff at fever clinics in general medical institutions should be tested once a day;

Medical staff in ordinary medical institutions, except for fever clinics, will be tested twice a week. If there is one or more local epidemics in the jurisdiction, the frequency of nucleic acid testing will be increased according to the risk of epidemic spread and local epidemic prevention and control requirements;

Psychiatric hospitals should promptly organize and complete a full-staff nucleic acid test when one or more local epidemics occur in their jurisdiction. Subsequently, nucleic acid tests can be carried out based on the test results and the risk of epidemic spread, with a sampling ratio of at least 20% per day or the jurisdiction's testing requirements.

Why is the epidemic prevention and control plan adjusted?

"Over the past month, the overall situation of epidemic prevention and control in my country has stabilized and improved, the number of positive infections has continued to decline, and the number of areas with epidemics has also decreased, creating a window period for optimizing and adjusting prevention and control plans." Lei Zhenglong, deputy director of the Disease Control and Prevention Bureau of the National Health Commission and first-level inspector, said at the above-mentioned press conference.

Since June 18, the number of infections reported nationwide has been below 50 cases per day, with an average of 25 cases reported per day in the past week.

In terms of the number of reporting provinces, June 25, 2022 was the lowest since February 12;

In terms of the number of reporting cities and territories, June 25, 2022 was the lowest since February 13;

In terms of the number of new cases per day, June 25, 2022 is the lowest since February 10!

In order to obtain a practical basis for policy adjustments, a pilot study was conducted in the early stage of this revision of the epidemic prevention and control plan. Lei Zhenglong introduced that according to the decision-making and deployment of the CPC Central Committee and the State Council, the State Council Joint Prevention and Control Mechanism Comprehensive Group conducted a four-week pilot study on the optimization of COVID-19 epidemic prevention and control measures in seven cities, including Dalian, Suzhou, Ningbo, Xiamen, Qingdao, Guangzhou and Chengdu, from April to May.

At the same time, the prevention and control plan was revised based on the prevention and control practices in various places, especially the experience of dealing with large-scale epidemics in Shanghai, Jilin and other places.

According to the "Shanghai News", Wu Huanyu, deputy director of the Shanghai Center for Disease Control and Prevention, said that the main basis for this adjustment is based on the large-scale research conducted in several provinces across the country in the early stage. Appropriately shortening the centralized isolation time can still timely detect positive infections and effectively control related risks to the greatest extent. In addition, Shanghai's early practice in local epidemic prevention and control also provided empirical data.

On April 13, according to Caixin.com, the Comprehensive Group of the Joint Prevention and Control Mechanism of the State Council selected Xiamen, Guangzhou, Chengdu, Dalian, Suzhou, Ningbo and Qingdao as pilot areas for the pilot research work on optimizing the prevention and control measures of the new crown epidemic. It was officially launched on April 11 for a period of four weeks.

The pilot plan adjusts the isolation and control measures for inbound personnel and close contacts from "14 days of centralized isolation + 7 days of home health monitoring" to "10 days of centralized isolation + 7 days of home health monitoring"; for people in the closed and controlled areas, the lifting standard is adjusted from "negative test results for 14 consecutive days" to "negative test results for 10 consecutive days."

"If the pilot results are good, this measure will be promoted nationwide. However, if problems are found in the pilot, such as an increase in positive cases after relaxation, the possibility of termination of the pilot at any time cannot be ruled out." In April, an industry expert told Health World regarding the above policy.

Undoubtedly, large-scale studies conducted in several provinces support the nationwide expansion of this policy.

The quarantine and control time for close contacts and inbound personnel has been shortened by half

As soon as the ninth version of the plan came out, the quarantine time for close contacts and entry was significantly shortened, which became one of the biggest concerns.

The plan adjusts the isolation and control time for close contacts and inbound personnel from "14 days of centralized isolation medical observation + 7 days of home health monitoring" to "7 days of centralized isolation medical observation + 3 days of home health monitoring". Compared with the eighth edition, the isolation time is reduced by nearly half.

The control measures for close contacts of close contacts have been adjusted from "7-day centralized quarantine medical observation" to "7-day home quarantine medical observation." In addition, double sampling and double testing are not required before the centralized quarantine medical observation is lifted.

Can the adjustment of the isolation management period and methods for high-risk individuals be understood as prevention and control measures being more relaxed than before?

Wang Liping, a researcher at the Department of Communicable Disease Prevention and Control of the Chinese Center for Disease Control and Prevention, introduced that during the period from March to May 2022, the Comprehensive Group of the Joint Prevention and Control Mechanism of the State Council selected some areas across the country to carry out pilot research on optimizing the prevention and control measures of the new coronavirus pneumonia epidemic. The study found that the average incubation period of the Omicron variant was shortened, mostly to 2-4 days; most of them can be detected within 7 days.

Based on the research results and the prevention and control practices in many parts of China, the ninth edition has been optimized. Wang Liping said that such adjustments do not mean "relaxation" of prevention and control measures, but further optimization of prevention and control measures based on the epidemic characteristics of the Omicron variant, which will not increase the risk of epidemic spread and is a manifestation of precise prevention and control.

Previously, Liang Jialin, Secretary-General of the Value Medical Advisory Expert Committee and Editor-in-Chief of the "Healthy National Policy 2050" academic platform, interpreted the significance of shortening the centralized isolation time for close contacts as follows:

First, shorten the time of centralized quarantine and reduce the occupancy rate of quarantine hotels and designated catering institutions, thereby releasing a batch of productivity in the catering and hotel industries;

Second, it reduces the cost of quarantine and avoids the burden of quarantined people being burdened with out-of-pocket expenses, thereby releasing the consumption power of urban and rural residents;

Third, although close contacts still need home health monitoring, most people working in the productive service industry can still go out to work when necessary, or work more flexibly at home, thereby releasing a group of social labor force.

"Little by little, we can accumulate a lot and trade time for space - this is the greatest value of scientifically adjusting the time of isolation and control," said Liang Jialin.

Cancel the "three zones" and unify the standards for defining medium and high risk areas

In September 2021, the Comprehensive Group of the Joint Prevention and Control Mechanism of the State Council clearly required in the "Community Prevention and Control Plan for the New Coronavirus Pneumonia Epidemic" that once a local epidemic occurs, the community (including administrative villages) must be accurately divided into three types of prevention and control areas as soon as possible: lockdown areas, control areas, and prevention areas.

With the release of the ninth edition, the standards for demarcating closed and controlled areas and medium- and high-risk areas have been unified.

"In the past, we had two types of risk zone demarcation standards, one was the standard for demarcating high-, medium- and low-risk areas, and the other was the standard for demarcating containment areas, control areas, and prevention and control areas." Lei Zhenglong introduced that the ninth edition of the prevention and control plan connected and matched the two types of risk area demarcation standards and prevention and control measures, integrated and unified the concepts of high, medium and low risk areas, and formed a new risk zone demarcation and control plan.
Self-control in medium, high and low risk areas:
High-risk areas: implement "stay at home, door-to-door service"; medium-risk areas: implement "stay in the area, staggered collection"; low-risk areas: implement "personal protection, avoid gathering". Other areas control personnel in medium-, high- and low-risk areas:
For those who have traveled to low-risk areas in the past 7 days, they are required to complete 2 nucleic acid tests within 3 days; for those who have traveled to medium-risk areas in the past 7 days, they are required to take 7 days of home medical observation measures; for those who have traveled to high-risk areas in the past 7 days, they are required to take 7 days of centralized isolation medical observation measures. Conversion between high, medium and low risk areas:

High-risk areas: if there are no new infections for 7 consecutive days, they will be downgraded to medium-risk areas; medium-risk areas: if there are no new infections for 3 consecutive days, they will be downgraded to low-risk areas; medium-risk areas: if there are no new infections for 7 consecutive days, they will be downgraded to low-risk areas; low-risk areas refer to other areas of counties (cities, districts, banners) where medium- and high-risk areas are located. In other words, even if the itinerary code has a star, as long as there is no travel history in medium- and high-risk areas, other areas of counties (cities, districts, banners) where medium- and high-risk areas are located only need to complete 2 nucleic acid tests within 3 days when going out across regions, and no isolation and control measures are required.

At the same time, the ninth edition of the prevention and control plan also clearly stipulates that during the epidemic response process, if the transmission risk of individual cases and asymptomatic infections to residence, work, and activity areas is low, close contacts have been promptly controlled, and it is judged that there is no risk of community transmission, then risk areas may not be delineated.

It is worth noting that on June 24, the Joint Prevention and Control Mechanism of the State Council reiterated that "it is not allowed to arbitrarily expand the scope of travel restrictions from medium- and high-risk areas to other areas" and "it is not allowed to take restrictive measures such as forced persuasion and isolation against people from low-risk areas." Subsequently, Sichuan, Guangdong, Jiangsu, Zhejiang, and Hubei adjusted their adjustments to low-risk areas.

For example, according to the news released by the "Sichuan CDC" WeChat official account, from 0:00 on June 27, the entire Shanghai area Class B screening management will no longer be implemented.

However, some regions still adopt a "one-size-fits-all" policy for the entire Shanghai area. For example, according to Zhengzhou's "Summary of the Latest Travel Policies as of the 27th", Zhengzhou currently continues the "7-day centralized quarantine + 7-day home health monitoring" policy for people entering Zhengzhou from Shanghai (except college students) since the adjustment on the 19th.

On June 24, the Joint Prevention and Control Mechanism of the State Council held a press conference, at which the country issued the latest "Nine Prohibitions" for epidemic prevention and control, requiring all localities to implement them. At the same time, the press conference also criticized the excessive epidemic prevention behaviors that have recently appeared in Hebei, Qinghai, Liaoning and other places.

Afterwards, the special task force for rectifying the problem of “adding layers of restrictions” of the comprehensive group of the joint prevention and control mechanism of the State Council and all member units will seriously accept and verify the problems of “adding layers of restrictions” reported by the masses.

On June 28, Mi Feng introduced that in response to the strong public complaints about excessive epidemic prevention, especially violations of the "Nine Prohibitions", the Comprehensive Group of the State Council's Joint Prevention and Control Mechanism opened a public message board on the homepage of the National Health Commission's official website.

He said that after the policy adjustment, all localities should firmly control what should be controlled, firmly implement what should be implemented, firmly cancel what should be canceled, and clear inconsistent measures within a time limit. The State Council's joint prevention and control mechanism will send a working group to supervise.

In addition, the definition of a cluster outbreak has changed:

The eighth edition of the plan stipulates that an epidemic cluster refers to the discovery of five or more cases and asymptomatic infections in schools, residential communities, factories, natural villages, medical institutions, etc. within 14 days.

The ninth edition of the plan stipulates that if two or more cases occur within a week, it is considered a cluster infection.

Optimize the nucleic acid testing strategy for all employees, ideally only 4 rounds are needed

The ninth edition of the plan optimizes the regional nucleic acid testing strategy. For provincial capitals and cities with a population of more than 10 million, after an epidemic occurs, it is determined through flow investigation that the transmission chain is unclear, there are many risk places and risk personnel, and the mobility of risk personnel is high, and there is a risk of the epidemic spreading. In the area where the epidemic is located, a full nucleic acid test will be conducted once a day. After three consecutive nucleic acid tests have no social infections, another full nucleic acid test will be conducted at an interval of three days. If there are no social infections, the full nucleic acid test can be stopped.
This means that under ideal circumstances, areas where the epidemic occurs only need to conduct four rounds of nucleic acid testing for all residents to stop the epidemic.

Virology expert Chang Rongshan analyzed that according to the new version of the prevention and control plan, the routine nucleic acid testing currently being implemented in many regions should be dynamically adjusted. First, in non-provincial capitals and cities with a population of 10 million, there is no need to conduct high-density nucleic acid testing; second, in provincial capitals and cities with a population of 10 million, adjustments should be made based on the prevention and control needs of each district, and the whole city cannot be treated the same way.

In fact, many places across the country have recently made dynamic adjustments to routine nucleic acid testing. For example, Hubei Province, Hangzhou, Zhejiang, Ningbo and other places have recently reduced the frequency requirements for routine nucleic acid testing. Hefei, Huainan, Anhui, Zhoushan, Zhejiang, Hai'an, Jiangsu and other places have suspended routine nucleic acid testing. Dezhou, Shandong, Suzhou and other places have made it clear that nucleic acid negative certificates will no longer be checked for entry and exit of public places.

What is the current epidemic situation?

It is worth noting that there are still sporadic social infections in some areas of my country, and the risk of community transmission still exists. In addition, the infected people had a wide range of activities before they were controlled, so some places have formed a relatively long tail period of zero clearance.

Wang Wenling, a researcher at the Institute of Viral Diseases of the Chinese Center for Disease Control and Prevention, said that since February this year, the main virus strain prevalent in my country is the Omicron BA.2 subclade series. In May, BA.4 and BA.5 were first detected in imported cases in China. Recently, the number of BA.4 and BA.5 infections found in imported cases from abroad has shown a gradual increase.

More than 400 cases have been reported in this round of epidemic in Macau. She said that the epidemic in Macau was caused by the BA.5 variant, and the prevalent strains in various parts of the country are still the Omicron BA.2 sub-branch series. According to the existing preliminary research results, the transmission and immune escape abilities of the new coronavirus Omicron variants BA.4 and BA.5 have slightly increased, and the difficulty of prevention and control will increase, and the pressure on China to prevent imported cases will increase.

Source: Comprehensive China Business Network, Shangguan News, Caixin Big Health, etc.