The hidden spread of the coronavirus in Hebei exposed the weakest link in China’s epidemic prevention efforts

From Wuhan at the beginning of the year to the new birthplace of Beijing in the middle of the year, the city has always been the center of the epidemic. Rural areas were once spared because of relatively sparse population density and infrequent contact with the outside world. But the outbreak of the Hebei epidemic broke the previous illusion. Rural areas have become a possible breakthrough for the new coronavirus and a weak link in epidemic prevention.
Rural areas in China will become the weakest link in epidemic prevention and control. During the upcoming Spring Festival holiday, it will also face the most severe test since the Wuhan epidemic.

On January 2, Hebei, a new confirmed case;

On January 3, Hebei, 4 newly confirmed cases and 13 asymptomatic infections;

On January 4, Hebei, 14 newly confirmed cases and 30 asymptomatic infections;

On January 5, Hebei, 20 newly confirmed cases and 43 asymptomatic infections;

On January 6, Hebei, 51 newly diagnosed local cases and 69 asymptomatic infections were added.

On the first day of the new year, everything is business as usual in Hebei Province.

The next day, the epidemic took a sharp turn. In just 5 days, 234 new coronavirus infections were added (excluding some asymptomatic confirmed cases).

You know, when the epidemic spread across China on a large scale last year, Hebei Province had only 339 local confirmed cases a year.

Hebei is in a hurry

The geographical extent outlined by the 234 cases of infected people was alarming for a while.

The official trajectory of the cases can be glimpsed. The trajectory of confirmed cases has expanded from Shijiazhuang to Xingtai. Shijiazhuang is on the main railway line of China, connecting Beijing, Tianjin, Hebei, Henan, Shandong, and Shaanxi. The confirmed cases are located in large places: hospitals, shopping malls, markets, hotels, etc.

The long distance between the gathering time of the cases and the time of onset is enough to explain the long hidden and spreading time of the epidemic and the increasing difficulty in tracing the source. Some experts, including Feng Zijian, deputy director of the Chinese Center for Disease Control and Prevention, could not sit still. This is not a multi-point spread, this is a multi-point outbreak.”

On January 5, Xiaoguozhuang Village, Zengcun Town, Gaocheng District, Shijiazhuang, where a cluster of epidemics occurred, was adjusted to a high-risk area and became the only high-risk area in the country.

It is worth noting that Xiaoguozhuang Village, where the 18 confirmed cases live, is only about 5 kilometers away from Shijiazhuang Zhengding International Airport, which is usually the main source of overseas imports.

Some experts raised their concerns in an interview with Ba Jianwen. The small and medium-sized cases spreading before the winter can find a clear and single source of infection, all from imported cases or imported refrigerated chains and containers. “But the situation has become more recent. It is complicated. In addition to the cold chain, other environmental items such as car accessories and even garbage have virus detections.”

“This village is so close to the airport. I think the biggest possibility is that there are loopholes in the management of people and things entering the airport.” Another expert raised new doubts. He analyzed that there may be missed inspections in the entry inspection, and the infected persons have It may have contaminated the environment near the airport. “We don’t know if environmental testing is done near the airport. According to my estimation, the sewer wastewater around the airport terminal has not been tested.”

The loopholes in Hebei’s epidemic prevention and control have also been exposed in this epidemic. For example, for one of the confirmed cases, he set off from Xiaoguozhuang Village on January 2 and accompanied his spouse who had symptoms to the emergency department of the Second Hospital of Hebei Province in Shijiazhuang. The spouse was diagnosed on the same day. It stands to reason that he should be isolated in time as a close contact. Nucleic acid was tested in the hospital, but after his lover’s treatment, he took a bus from the hospital to Xiaoguozhuang Village. He was tested positive for nucleic acid the next day.

It may also be because of the scary moments experienced in many cities, which had nothing to do with Hebei before: there were neither too many sporadic cases in the middle and late stages of the epidemic, nor was it upgraded to high-risk areas, let alone large-scale nucleic acid testing for all employees. Judging from the memories and self-reports of some infected people, the locals relaxed their vigilance early.

On December 28 last year, the city of Beijing, more than 200 kilometers away, was being raided in a small area by the new crown virus. Some blocks were temporarily upgraded to medium-risk areas. In the three streets of Wangjing, Donghu, and the airport with infected persons, 160,000 people completed nucleic acid testing within two days. At this time, the people in Beijing were panicked, and this did not seem to have had any impact on people outside Beijing.

On this day, Huang Yu (a pseudonym), a native of Hebei, went to a hotel near the North Road of Zhengding International Airport in Shijiazhuang as usual to attend the wedding. He is the groom’s distant relative. Some people who attended the wedding were wearing masks and some were not wearing masks. However, no one mentioned wearing masks, and the wedding was still going on lively. Within a few days, Huang Yu and four other people who attended the wedding were all recruited.

“The epidemic is still in the development stage,” said Ma Xiaowei, director of the National Health Commission. On January 5, he led a team to Hebei to guide the prevention and control of the epidemic.

From the first wave of Wuhan, the second wave of Jilin and Heilongjiang, the third wave of Beijing’s new place, the fourth wave of Urumqi, Xinjiang, the fifth wave of Dalian, the sixth wave of Shanwei, the seventh wave of Qingdao, and the Eight waves of Kashgar, Xinjiang, a new wave of multiple outbreaks seems to have come back.

The wartime state was quickly sounded in Shijiazhuang. Following Shijiazhuang, Zhuolu County, Dingzhou City, and Xingtai City in Zhangjiakou, Hebei Province, have also announced their entry into wartime status.

Shijiazhuang, which entered a wartime state, soon became an “empty city”. Schools are closed, factories are closed, shopping malls are closed, and communities are closed. The city is gradually shutting down. On January 6, Shijiazhuang Zhengding Airport cancelled 31 inbound flights and 33 outbound flights on the same day. The number of cancellations was four times the previous day. Some foreigners who were planning to leave the local area without undergoing nucleic acid testing were also temporarily intercepted and persuaded to return at passenger terminals and high-speed railway stations.

A local media used a drone to take a bird’s-eye view of the city. Under the camera, the city center, which used to be constantly flowing, was empty. This situation is familiar with the beginning of Wuhan’s lockdown last year.

Under the empty city, nucleic acid testing for all employees started overnight. On January 6th, the Hebei Provincial Health Commission urgently transferred 1,000 medical personnel from other places to Shijiazhuang City. These medical personnel had to complete the nucleic acid test for everyone in 3-4 days in the weather of minus ten degrees. As of 5 pm on the 6th, medical staff had collected a total of 2 million samples, sent 593757 people for inspection, and found 7 positive samples.

△ Shijiazhuang citizens waiting in line for nucleic acid testing. Image source: Visual China
In some cities in Hebei Province that have been concealed for some time, nucleic acid testing and large-scale epidemiological investigations are still continuing. How many more infected people will be discovered in the next few days or ten days is still unknown. However, in view of the current situation, even some interviewed experts believe that “the possibility of large-scale transmission still exists, and I estimate that there are at least several hundred.”

A hidden spread of the new coronavirus

At 4 a.m. on January 2, 2021, a 61-year-old female villager from Xiaoguozhuang Village, Zengcun Town, Gaocheng District, Shijiazhuang, “consciously chills, chest tightness, accompanied by cough and sputum, self-tested body temperature 38.7 ℃”, 5 a.m. Accompanied by his family, take a rented vehicle to the Second Affiliated Hospital of Hebei Medical University for treatment. On this day, after two quick tests, the nucleic acid results were all positive, and the villager was diagnosed that day.

And this early morning medical visit finally revealed the hidden spread of the virus in the village and sounded the alarm of the epidemic in Hebei. Since then, as the screening progressed, one after another virus-infected patients “surfaced”.

Feng Zijian, deputy director of the Chinese Center for Disease Control and Prevention, stated in CCTV’s “News 1+1” program on January 5 that it has been discovered that the virus is not a local virus, but is still imported from abroad, and it is likely to be imported from Europe. At present, the spread of the virus in Shijiazhuang is highly homologous to Nangong in Xingtai. The case in Nangong City is epidemiologically linked to Shijiazhuang, which may be caused by a virus transmission. At present, the number of patients is still increasing, indicating that the virus has spread in secret for some time.

Lu Hongzhou, secretary of the Party Committee of the Shanghai Public Health Clinical Center, explained to Badian Jianwen that the so-called covert transmission does not mean that the virus itself has changed. Its transmission and pathogenicity are the same as before, but that the virus has appeared in small areas in the community. When it spread, it was not caught early.

Judging from the regional distribution and flow trajectory of these 39 confirmed cases in Hebei Province, the virus has indeed been spread secretly for a long time.

First of all, from the results, there have been multiple clusters of cases in the epidemic in Hebei. 39 cases are distributed in Shijiazhuang (33 cases) and Xingtai Nangong (Nangong City is a county-level city under the jurisdiction of Hebei Province and is managed by Xingtai City) (6 cases) Two cities. Xiaoguozhuang Village, where patient No. 1 is located, has the largest number of confirmed cases, with a total of 18 cases found. Liujiazuo Village, Dongqiaozhai Village, Beiqiaozhai Village, and Nanqiaozhai Village are all located near Xiaoguozhuang Village and belong to Zengcun Town, Gaocheng District, Shijiazhuang. . These villages are less than 5 kilometers from Shijiazhuang Zhengding International Airport.

Several villages in Zengcun Town, Gaocheng District, Shijiazhuang, are 120 kilometers away from Nangong City, Xingtai. It was the Hebei Children’s Hospital on the morning of December 25 that linked the two groups of epidemics. Early that morning, a family from Liujiazuo Village in Shijiazhuang and a family from Nangong Village in Xingtai visited the Provincial Children’s Hospital, and both were diagnosed.

The number of cases in Xingtai Nangong is relatively small. Among the 6 confirmed cases, 4 are related to the Children’s Hospital, and they are in the relationship of husband and wife, brothers, and colleagues. It is a cluster of cases. It can be said that compared with the epidemic in Shijiazhuang, Nangong in Xingtai is still at an earlier stage of virus transmission.

This intersection at the Children’s Hospital allowed the spread of the virus to go back at least to December 25. The virus has an incubation period from infection to onset. In these confirmed cases, when did the symptoms first appear?

Judging from all the published information, the earliest symptom appeared on December 23, when a 66-year-old villager in Xiaoguozhuang Village had sore throat symptoms.

Most of the confirmed cases developed fever, headache, chest tightness, and cough on January 1 and 2, and earlier symptoms appeared on December 28 (sore throat) and December 26 (fever).

Since this epidemic first broke out in rural areas, not everyone is like Case 1. They go to the hospital for treatment at the beginning of symptoms or on the day of onset. This is also the reason the virus escaped the nucleic acid test in the hospital and continued to spread in secret. important reason.

“Take your own medicine” and “clinic” are the high-frequency words that appeared in this tune. Many confirmed cases had been infused in the clinic for 3 or 4 days instead of going to the hospital in time. Among them, the severe case confirmed on January 4 was seen in the Xiaoguozhuang Village Medical Office on December 26 and received an infusion for four days. It was not until January 3 that the nucleic acid test was found to be positive at Gaocheng District People’s Hospital.

In addition to the natural weaknesses of prevention and control in rural areas, climatic factors and the characteristics of the virus itself are also contributing to the hidden spread of the virus.

Including Hebei, most of the recently identified risk areas for the epidemic are concentrated in the north. In winter, these high-latitude regions are even colder, with outdoor temperatures below minus ten degrees Celsius.

In November last year, when Wu Zunyou talked about tracing the source of the Kashgar epidemic in Xinjiang, he said that he originally thought that the cold chain could serve as a virus carrier, but in winter, when the temperature is below 0 degrees Celsius, everything is cold chain. When there are more substances as virus carriers, the difficulty of preventing epidemics will increase. Therefore, to prevent the arrival of winter epidemics, it is necessary to prevent people outside from bringing the virus in, but also to prevent outside objects from bringing the virus in. .

Another feature of the new coronavirus is that asymptomatic infections are also extremely contagious, which enhances the privacy of the virus during its transmission. More extreme cases are cases where, for example, 11 nucleic acid tests were finally confirmed positive.

Shantou University’s virology expert Chang Rongshan analyzed the reason for this phenomenon to Badian Jianwen, which is that the new coronavirus mainly occurs in the lower respiratory tract, not the upper respiratory tract. There is only a 3 to 5 day window for the detection of the virus in the upper respiratory tract. If this window is missed, the virus may not be detected by nasopharyngeal swabs. According to existing literature studies, the incubation period of the new coronavirus can be as long as one month, and the virus can even enter the intestinal tract of the infected person.

The virus is spreading quietly in such an undetected way. Chang Rongshan also reminded that this is not an unsolvable problem. It can be supplemented by adequate circulation. In his opinion, northern cities are not as good as Shanghai and other southern cities in terms of circulation adjustment and prevention and control. “For some asymptomatic infections in the north, the test may have been missed.”

The virus was latent for a few days, and symptoms of the disease began to appear. Villagers in the outer suburbs thought that the epidemic was far away, and occasionally they would only visit densely populated cities. They did not realize that the crisis had come, and they might take their own medicine at that time, or Go to the clinic for an infusion. Villagers and rural doctors seemed to be isolated from the epidemic prevention and control system until they walked into the hospital and encountered a nucleic acid test.

Before that, people’s life went on as usual, with children going to school, old people participating in collective village activities twice a week, and visiting relatives and friends to participate in wedding banquets at the end of the year (6 people attended the wedding banquet, and 1 of them participated in 4 days) 3 wedding banquets), the virus is also spreading unscrupulously in secret.

Rural areas, the next breakthrough for the new coronavirus?

The biggest difference between this epidemic and the past is that rural areas with low population density began to become the outbreak site, and then spread to cities.

From Wuhan at the beginning of the year, the new place in Beijing in the middle of the year, and several local epidemics that have erupted since autumn and winter, the city has always been the center of the epidemic.

The countryside was once spared because of the relatively sparse population density and the infrequent contact with the outside world.

But the outbreak of the Hebei epidemic broke the previous illusion. Rural areas have become a possible breakthrough for the new coronavirus and a weak link in epidemic prevention.

Wu Zunyou, chief expert of epidemiology at the Chinese Center for Disease Control and Prevention, said at a meeting in December last year that the biggest challenge in epidemic prevention and control is how to detect cases as soon as possible. If early cases are asymptomatic or have mild symptoms, self-purchase drugs Or go to a private clinic and fail to find out in time, and the epidemic may spread quickly.

This is precisely the most unfavorable factor in the prevention and control of the rural epidemic:

First, for rural villagers, when they have headaches, the usual choice is not to go to the hospital, but to take their own medicines, or to go to the nearest rural health centers, clinics, and clinics for treatment by rural doctors.

Secondly, there are very few clinics and medical institutions in rural areas that have the ability to diagnose and recognize the new crown.

Image source: Visual China
Xu Yucai, deputy director of the Shanyang County Health Bureau of Shaanxi Province, told 8:00 Jianwen that villagers, especially elderly villagers, are not accustomed to seeing doctors in large hospitals. They think colds and coughs in winter are minor problems, and they are accustomed to visiting village clinics and clinics. . On the other hand, the natural conditions of these primary medical institutions are limited, and the prevention and control awareness of rural doctors is also uneven, which is prone to loopholes in prevention and control.

Xu Yucai also paid attention to the clinic infusion phenomenon that appeared in the Hebei epidemic. “Usually it doesn’t work for a day or two, so you should not continue the infusion.” He told 8:00 Jianwen that there is a habit in rural areas that doctors in rural clinics prefer infusion therapy (and (Income related), and personal protection is difficult to do when infusion in the clinic.

As a result, when the virus reaches the countryside, village clinics and clinics become a transit point for the virus. More cross-infections occur here, accelerating the spread of the epidemic.

Therefore, the epidemic that started in the rural areas is prone to “nothing but a blockbuster”-just like this Hebei epidemic, when it is discovered, it directly passed the early stage of the epidemic and entered the multi-point outbreak stage.

Now that the Spring Festival holiday is approaching, rural areas will usher in a

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