What's the latest policy for patients' rehabilitation?

Novel coronavirus Prevention and Control Plan (Ninth Edition) (hereinafter referred to as "the new version of prevention and control plan") was officially released, which refined the management standard of "relapse" patients, that is, whether there are respiratory symptoms or not, there is no need to manage and designate close contacts when the Ct value of nucleic acid detection is ≥35.

"Fuyang" refers to the phenomenon that COVID-19 infected people appear nucleic acid positive again after discharge. Because the emission standards of different countries and even regions are different, the definition of "Fuyang" is not uniform, and no institution has made a clear definition of it.

During the war with COVID-19 for a period of time, "Fuyang" aroused everyone's vigilance because it was not clear whether the patients in Fuyang were contagious and how infectious they were.

The new version of the prevention and control plan clearly takes the Ct value of nucleic acid detection as the judgment basis: after the previous infected person was discharged from the hospital (cabin), the respiratory tract sample was positive for nucleic acid detection. If there are no symptoms and signs and the Ct value of nucleic acid detection is ≥35, the close contacts will not be managed and judged; When the Ct value of nucleic acid detection is less than 35, the risk of transmission should be quickly evaluated by combining the course of disease and the dynamic change of Ct value. There is a risk of transmission, according to the management of infected people, to judge and control their close contacts who live or work together, not to judge close contacts.

"There are many studies that show that people with Ct value > 35 are not contagious," Cai Weiping, chief expert of the Department of Infectious Diseases, Guangzhou Eighth People's Hospital, said in an interview.

Zhou Qiang, director of the Laboratory Department of the Second Affiliated Hospital of Guangzhou Medical University, said that the Ct value of nucleic acid detection refers to the number of cycles that reach the set threshold for detecting virus fragments. Simply understood, the size of Ct value is related to the viral load in human body. The smaller the Ct value, the more the virus content in the sample, and the stronger the infectivity. The greater the Ct value, the less the virus content in the sample and the weaker the infectivity.

Lu Hongzhou, head of the public health expert group on epidemic prevention and control in Shenzhen and president of the Third People's Hospital of Shenzhen, said that most of the COVID-19-positive patients who were initially screened or diagnosed with COVID-19 infection had a Ct value of less than 25, but the current evidence seems to be that the Ct value of relapsed patients is not contagious if it is greater than 35. "Patients with recurrent Yang Can participate in work and life normally, without any respiratory symptoms, without entering designated medical institutions or receiving hospitals, without controlling key personnel and related places, and without organizing regional nucleic acid testing."

The new version of the prevention and control plan takes into account some special circumstances. Once the "back-to-yang" patients have clinical manifestations such as fever and cough, or CT images show that lung lesions are aggravated, they should be immediately transported to designated medical institutions for classified management and treatment according to the condition. At this time, if the Ct value of nucleic acid detection is ≥35, there is no need to track and control its close contacts; If the Ct value of nucleic acid detection is less than 35, close contacts who live and work with them, etc. It should be judged and controlled, and close contacts do not have to judge.

Are the prevention and control changes in the new version of the plan applicable to the entry personnel who have been infected with COVID-19? Lu Hongzhou explained that people who had been infected with novel coronavirus abroad should be managed as COVID-19 infected patients if they tested positive for COVID-19 nucleic acid at the time of entry, not as people who tested positive for nucleic acid after discharge.

In March this year, National Health Commission issued the "Notice on Printing and Distributing the Diagnosis and Treatment Plan of novel coronavirus (Trial Ninth Edition)", which adjusted the Ct value standard of nucleic acid detection from > 40 to ≥35, and the infected person was released from isolation management or home monitoring for 7 days after discharge. This practice won the unanimous praise of clinical experts at that time, which will shorten the hospitalization time of infected people and let limited medical resources serve more people in need.