CDC: “Person to person” has long been inferred, conservative conclusions have reasons

Beijing News (Reporter Xu Wen) Yesterday, a paper published in the New England Journal of Medicine by more than ten institutions including the China Centers for Disease Control and Disclosure revealed that the new type of coronavirus has appeared in humans in mid-December, and some netizens questioned it accordingly. The China CDC concealed this information early in the epidemic, leading to misjudgement by the public.

On January 31, Feng Zijian, one of the corresponding authors of the paper and deputy director of the China Centers for Disease Control and Prevention, said in an interview with the Beijing News reporter that the above inference was made after obtaining case data on January 23 and was not concealed.

When did the Chinese Centers for Disease Control and Prevention find that the virus showed signs of being transmitted from person to person? Feng Zijian responded that in the early days, there had already been a “person-to-person” view, but subject to the conditions at that time, he carefully made conclusions such as “no obvious human-to-human phenomenon” “cannot rule out the possibility of limited human-to-human transmission”.

“Conclusions are conservative and of course cautious”

Beijing News: The paper mentions that in mid-December the new coronavirus has “interpersonal transmission among close contacts”. When was this inference made?

Feng Zijian: I got the data on January 23 and saw some cases without a history of exposure to the South China seafood market. I made this inference.

Beijing News: When did you realize that the virus could be passed from person to person?

Feng Zijian: In fact, the inference of “people pass from person to person”, we already have such a view relatively long ago. However, this process requires investigation and verification, including detailed inquiry and verification of each patient’s exposure history.

Of the 27 cases we initially obtained, 26 cases had a history of South China seafood market exposure, and only one did not. Therefore, the presumption that the patient was “infected by the South China seafood market exposure” prevailed.

In addition, a new coronavirus detection method was gradually used after January 11. Prior to this, cases could not be classified because there were many flu and adenovirus infections this season.

If the history of exposure is not a priority criterion in the beginning, it will cause a lot of misclassification, which is the “misclassification” in epidemiology.

Therefore, the first time we do not confirm the source of the exposure, but to determine whether this is an independent, new disease, or whether other diseases suddenly increased in a certain hospital during this season. In the first few days, this was the top priority. We should try to find “consistent”, such as common exposure, more consistent clinical characteristics.

After we confirm that this is an independent and new disease, we need to expand the test to search whether there are cases with similar pneumonia characteristics but no history of exposure to the South China seafood market, that is, the cases other than the exposure factors that were initially determined are A gradual expansion process.

The difficulty in this process is that there is no diagnostic reagent and it is not known whether it is the same disease, so the following conclusions are more cautious. After the detection reagents were available, early indications also showed that the initial detection rate of the reagents on the upper and lower respiratory tract specimens was relatively low at the beginning, and we dare not rule them out easily. With this early limitation, we are very cautious in drawing conclusions.

However, we have treated it as a highly contagious disease from the earliest time, and adopted measures such as close contact management as soon as possible.

There is a process of understanding the disease, it will not reveal the whole picture from the beginning. It is always prudent to publish information, so from the initial “no obvious human-to-human transmission phenomenon” to “the possibility of limited human-to-human transmission cannot be ruled out”, this is all related to the case diagnosis and laboratory test results used for patient screening. a process.

Beijing News: Now it seems that the judgment of “no obvious human-to-human transmission phenomenon” and “cannot rule out the possibility of limited human-to-human transmission” was not conservative.

Feng Zijian: It is conservative and of course cautious. We can only see what we say and what we have always observed carefully.

“No data concealed”

Beijing News: When did the medical staff know about the infection?

Feng Zijian: About January 19th and 20th, when Academician Zhong Nanshan arrived at the front line, local and national experts informed him of the results. After returning to Beijing on the evening of the 20th, he was interviewed by the media to disclose the infection of medical staff. The health committee made a disclosure, which is such a process.

Beijing News: One of the first infected doctors in Wuhan Union Medical College Hospital was admitted to hospital on January 16. Did the Chinese Centers for Disease Control and Prevention receive no news of suspected infection from medical staff on January 16th?

Feng Zijian: I’m not particularly clear about this. There are many levels of data reporting, including national, provincial, municipal, and district levels. Starting from the district-level department responsible for epidemic investigation tasks, data reporting has a process. I did not understand this process in detail.

Beijing News: Is n’t the infectious disease network direct reporting system able to send infectious disease information to the national level for 2 hours?

Feng Zijian: The launch of network direct reporting is not so early. The new coronavirus-infected pneumonia is a new-onset disease that does not exist in the list of infectious disease reports. Adjusting the network direct reporting system settings and staff training requires a process.

Beijing News: Some netizens questioned the China CDC’s concealment of the data. What do you think about this question?

Feng Zijian: This is not the case. There are corresponding rules for the release of epidemic data in our country, such as the Infectious Diseases Law, and each agency carries out its own functions.

China CDC publishes papers mainly for reference to international colleagues. This is also necessary. Foreign counterparts in the public health, scientific, and medical communities all want to know the information. Publishing data and research results in internationally renowned medical journals can improve The credibility and trust of the data. This is also the responsibility of China CDC as a professional institution.

“Whether right or wrong is good, then reflect on it, and now we must fully respond to the epidemic”

The Beijing News: Some people have also questioned that the Chinese disease control experts did nothing to prevent and control the epidemic after arriving in Wuhan on December 31.

Feng Zijian: Actually has been doing . Now is not the time to turn our attention to this aspect. We must now do our best to respond to the current epidemic. As for the right, wrong, good or bad, you may have to reflect and review afterwards. Don’t distract too much energy now.

Beijing News: What is the focus of the next epidemic prevention and control?

Feng Zijian: The focus is on implementing current prevention and control measures. The overall goal of prevention and control is to block the transmission route and block the transmission from person to person. Probably the first to achieve this goal is in areas outside Hubei and Wuhan. The epidemic spread in these areas is still very early. At this stage, the epidemic spread is suppressed, and then greater efforts are made to solve the transmission problems in key areas such as Hubei and Wuhan. , The prevention and control pressure will be much smaller.

Beijing News: Will the end of the Spring Festival holiday put a lot of pressure on epidemic prevention and control?

Feng Zijian: Of course it will, so it needs to be understood by all departments and everyone. It is now at a very critical stage. Everyone is working together and actively cooperating. The measures now taken may have an impact on your work and life. I hope the public Be able to understand and support. We will work together to fight the epidemic.

Beijing News: Some experts predict that an inflection point will occur on the fifteenth day of the first month. How do you judge?

Feng Zijian: It is difficult for anyone to make such a judgment without making such an expectation now. We just calmly and carefully observe the implementation of various prevention and control measures.

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