曾錚的世界

(Jennifer’s note: This is an internal document circulating on the Internet, which I personally believe to be credible. There are many contents in it that are worthy of attention and reference, so I am publishing it now. The English translation is done by software to save time. )

（曾錚注：此爲網上流傳的一份內部文件，我個人認爲可信度較高。內有很多內容值得關注和參考，故此發表。）

【 Experts’ exchange on epidemic prevention】Theme: Review on COVID Outbreaks in Shanghai and China

Time: 20:00-22:15 , 4/8/2022

【防疫专家交流】主题:上海及全国疫情看法 时间:4 月 8 日晚 20:00-22:15

【Summary of key points】【要点总结】

1. The epidemic situation in Shanghai: experts predict that the peak will be reached in the next two days (around 4.10), and after reaching the peak there will be a slow downward trend, and the full clearance may last until early May. Late April to early May is a relatively broad node to declare the success of the epidemic prevention and control.
   1. 上海疫情形势:专家预测应该这两天就会达到高峰(4.10 左右)，达到高峰后 会有一个缓慢下降趋势，全员清零可能要持续到 5 月上旬。4 月下旬到 5 月上 旬，都是一个比较宽泛的宣布疫情防控成功的节点。

2. Nationwide prevention and control measures: precise prevention and control are no longer applicable, in the future, any case of more than 3 cases across the country will require urban closure measures. Although it may seem excessive, it will be much less costly.
   2. 全国防控措施:精准防控已经不适用了，未来全国各地只要出现 3 例以上都 需要采取城区封锁措施。虽然看上去有些过度，但代价会小很多。

3. Vaccines and drugs: The vaccine is extremely effective in preventing serious illness and death, and the third booster vaccination will continue to be promoted in the future, especially in the elderly population; the Pfizer-BioNTech/Comirnaty（Pfizer–BioNTech COVID-19） vaccine has not been approved yet. Drugs are mainly used as a supplement.

   3. 疫苗和药物:疫苗防重症和死亡的效果是极好的，未来继续推进第三针加强 针接种，特别是老年人群体;复必泰疫苗暂时未被批准。药物主要作为补充手段。

4. Conditions of reopening in the future: 1) the clinical and public health standards to be changed; 2) be supported by vaccine booster shots and drugs; 3) the medical system should be changed in response, patients are to be received and treated as severe pneumonia cases. There has been much discussion at the policy level about reopening. The current insistence on zeroing out is mainly a matter of concern about excess deaths.

   4. 未来放开条件:1) 改临床和公共卫生标准;2) 要有疫苗加强针和药物的支持; 3)医疗体系应对要有变化，按照重症肺炎来收治。政策层面对放开已经有很多 讨论，目前对于清零的坚持主要是担心超额死亡的问题。

   5. Recommendations for personal protection : 1) wear N95 masks during nucleic acid testing; 2) try not to touch any public facilities when going up and downstairs; 3) wear gloves and disinfect when unpacking the courier parcels; 4) handwashing regularly. Hhand hygiene is more important than wearing a mask.
   5. 个人防护建议:1)做核酸要戴 N95 口罩;2)上下楼尽量不要接触任何公共 设施;3)拆快递要戴手套，做好消毒;4)勤洗手，手卫生比戴口罩更重要。

   【 Minutes of Meeting】【会议纪要】

   Today we will introduce the current epidemic prevention policy in Shanghai and nationwide.

  今天介绍一下目前上海以及全国疫情防疫政策。

As we have all seen so far this year, Shanghai is now the most affected place overall. The epidemics are still in a rising stage. In addition to Shanghai, there is also an outbreak in Jilin in the northeast, and I noticed today that city Jilin was the original source of the outbreak because of a cluster of cases in a university. The next major concern is Changchun, the provincial capital, where the outbreak is not very optimistic at the moment, as it has been going on for almost a month and cases are still emerging.

今年以来大家都看到了，现在总体来说，上海是最拉垮的一个地方，目前疫 情还处在一个上升阶段。除上海以外，东北吉林也有相关疫情，今天我注意到宣 布吉林市是最初的源头，因为一所高校发生聚集性病例，吉林市现在控制比较好。 接下来主要看省会长春，长春疫情目前是不太乐观的，疫情已经持续了快一个月， 还是不断出现病例。

A. The epidemic situation in Shanghai and the future trend

  一、上海疫情情况及未来走势

Frankly speaking, the Omicron epidemics should be more serious than that of Wuhans in 2020. Up to now, we still announce at the public level that Shanghai is not closed, though in fact we have divided the city into Pudong and Puxi (to close – translator). Because the city is not officially closed, the exit route from Shanghai is always open, which, according to many inquiries, is tacitly approved by Beijing. Since people with special needs in the city can move around and people with permits outside the city can flow out, the epidemic has been spilling out of Shanghai for a month since the beginning of March and has spread to more than 20 provinces. This is not a scientific consideration anymore, but a political one.

坦率来讲，这一波奥密克戎疫情应该是比 2020 年武汉疫情更严重的。到目 前为止，我们在公开的层面上海仍然是没有封城，虽然我们事实上是分了浦东和 浦西这两块地方。因为没有正式封城，离沪通道一直开放，多方打听下来，这是 北京默许的。由于市内有特殊需求的人可以流动、市外有通行证的人可以流出， 从三月初至今整整一个月，上海不断外溢出相关疫情，已经波及 20 多个省。这 一点其实不是一个科学的考量了，而是一个从政治层面出发的考量。

The epidemic is still climbing in Shanghai and we predict that it will peak in the next two days, that is, on the 8th, 9th and 10th, with a slow downward trend after the peak. According to scientific forecasts, if the epidemic is to be fully cleared, it will probably last until early May, because together with the cases reported today, there should be 130,000 infected people, and if we take into account those infected people who are not transferred and not well controlled at the community level, there are basically more than 150,000 infected people. I personally think it is very likely to reach 200,000.

目前上海疫情仍然处于爬升阶段，我们预测应该这两天就会达到高峰，也就 是 8 号、9 号、10 号这三天，达到高峰后会有一个缓慢下降趋势。科学预测来 看，这一波疫情如果要做到全员清零话可能要持续到 5月上旬，因为加上今天报告的病例，应该已经有 13 万人感染，如果再算上社区层面没有进行转运、没有很好管控的感染者，基本上已经超过 15 万，我个人觉得冲上 20 万也很有可能。

These patients will appear slowly and may not be fully cleared until early May. If we implement stricter controls than the current measures before then, we expect to reach full clearance around April 20.  On 10th April we’ll conduct a new round of full nucleic acid testing on all the people. If the results of this round of full nucleic acid testing meet our expectations,  there shall be no more tens of thousands of positive tubes, and if there are no such cases, then we may start to unblock some communities next week, that is, we may consider unblocking those communities that have never had any positive patients for a long time. [After that] we will gradually move it to the streets and towns, and then to the whole region. The reason to do so is,  if this continues, it will be overwhelmed on the community level, and the supply of materials and logistics will barely be able to meet the regular needs of more than 20 million people.

这些病人会慢慢释放出来，可能要到 5 月上旬才能清零。如果在这之前我们实施 比现行措施更加严格的管控措施，我们预计大概在 4 月 20 号左右可以达到全员 清零。刚刚我们接到消息，4 月 10 号我们会再进行一轮新的全员核酸检测，如果此轮全员核酸检测结果比较能够达到预期，不会再有几万管的混管阳性出现， 如果没有这种情况的话，那我们下周开始可能会有部分小区先行解封，就是说长期以来从来没有出现过阳性病人的小区我们可以考虑先行解封，逐步到街道、镇， 再上升到整个区域。因为继续这样下去，社区层面吃不消了，物资保障和物流供 应几乎没法满足两千多万人的常规需求。

B. More stringent control measure may be implemented in Shanghai and even entire China

  二、接下来上海乃至全国层面可能都会实施更为严格的管控措施

Main considerations: First, at the political level, in October there will be the 20th National Congress, which is an important point in time. We don’t want to have another epidemic like Shanghai, a mega-city, that needs to be closed down before this time, because this would lead to a worse impact on international public opinion. Secondly, on the scientific level, if we do not adopt “coexistence”, then we must implement stricter control measures, because Omicron is very strong in spreading no matter what subtype it is, and slight negligence may start a prairie fire. In fact, we can see from many other places, such as Hangzhou, Chengdu, Shaanxi and other places, the chain of successive transmission has reached a lot of people, the next will be more trouble. So, from a scientific point of view, if we really want to prevent it, then we must do it in a more stringent way, not like that of the so-called precise prevention and control in Shanghai in the past two years. In fact, most cities have not been particularly strict in the past. In 2020 and the first half of 2021, as we have found, the proportion of people wearing masks in many cities was not particularly high, and people did not wear them normally. Gatherings such as recreational activities, cultural and sports activities, conferences and exchanges were very frequent. In the past, the mutated strains were not known to be infected upon contact, but nowadays, it is possible to get infected by rubbing shoulders with Omicron. If there is no proper hygiene and protection in close contact, it can cause big problems

主要考量:一是政治层面上的，十月份会有 20 大，这是一个重要时间节点， 我们不希望在这个时间节点之前再出现一次像上海这样如此特大型城市需要出 现封城的疫情，因为这样会导致整个国际舆论影响比较糟糕。二是科学层面上的， 如果不采取“共存”，那我们必须要实施更严格的管控措施，因为奥密克戎无论是 何种亚型的传播能力都非常强，一旦稍有疏忽可能就是星星之火可以燎原的局势。 其实我们从很多其他地方可以看到，如杭州、成都、陕西等地，陆续传播链已经 传了不少人，接下来会比较麻烦。所以，从科学角度上来说，如果我们真的要防， 那我们必须要更严格，不能像过去两年当中上海所谓的精准防控。其实过去绝大 多数城市防范得并不是特别严格，我们在 2020 年和 2021 年上半年这段时间会发 现很多城市里面佩戴口罩比例并不是特别高，而且大家佩戴也不规范，并且聚集 性活动如娱乐活动、文体活动、会议交流等等非常频繁。以前的变异株在我们认 知范围内不是接触一下就感染了，但现在的奥密克戎很可能擦肩就会感染。如果 更近距离的接触，卫生没有做好、防护措施没有做好，那么都会造成大问题。

So, what steps can we take?

那么，我们能采取哪些措施?

1. Nucleic acid screening, which is a bottom-line tool. We must screen to find out who is positive or suspected to be positive, so that we can go on.

Isolation control. In the nucleic acid testing strategy, antigen detection reagents may be used. Now it seems that antigen detection reagents have many shortcomings, such as their window period is obvious, and many early and late stages are not very detectable. But this time, we have used a lot of antigen detection reagents in relevant medical institutions and closed control units in Shanghai to assist in epidemic prevention because of its fast speed. If we return to the status of 2020 and 2021 after this time, we may adopt more frequent screening methods of nucleic acid testing for people in high-risk industries such as medical personnel and logistics personnel, but for the general population in society, we may consider adopting antigen testing methods, which are convenient to use and conducive to rapid detection of infected people. This is especially true for the elderly in the community, who are not covered by any unit or do not have a regular job, and for whom nucleic acid testing is a hassle and antigen testing is relatively simple.
1. 核酸筛查，这是一个最底线的手段 我们必须要筛了之后才能发现说哪些人是阳线或者疑似阳性，从而能够进行

隔离管控。在核酸检测策略上，抗原检测试剂可能会被应用。现在看来抗原检测 试剂有很多缺陷，比如它的窗口期比较明显，早期、晚期很多不太能检测出来， 但我们这次在上海相关医疗机构和封闭管控单位当中协助防疫使用了大量的抗 原检测试剂，因为它速度快。如果我们这次结束之后，重新恢复到 2020、2021 的 状态，那么可能针对高风险行业人群比如医疗人员、物流人员会采取更频繁的核 酸检测筛查手段，但对社会上一般人群，可能会考虑采用抗原检测手段，毕竟它 使用方便，有利于快速发现感染者。尤其是像社区中老年人群，他们没有单位、 没有固定工作，这些人做核酸很麻烦，抗原会相对简单。

2. We may implement large-scale controls, but the thresholds value in responding to the control  may be reduced

2. 我们可能会实施大规模管控措施，但管控响应阈值可能会下降

If we want to detect outbreaks quickly, we may really adopt a very strict strategy as soon as there are imported cases, as many cities do, because Shanghai has given a good example of the opposite. From a scientific point of view, I personally don’t think this can be called an overreaction, because I have seen in medical institutions with my own eyes how omicron could spread to a dozen people in a very short period of two or three days, and even if we start isolation the next day, there is still absolutely no way to create a blockage. But in the future, we may need to set some thresholds, for example, if there is one case, start regional full nucleic acid; if there are two cases, start sealing off the whole street, not only the neighborhood; if there are three cases, seal off all the areas in the main urban areas through which the cases pass, which may still seem excessive, but in fact, in Shanghai, for example, the cost will be much less, because other urban areas continue to flow and can provide logistical assurance, unlike our current situation, in which it is very difficult to secure the whole area after sealing and control, and we have to rely on many sister provinces and cities. However, the long-distance truck drivers from sister provinces and cities are all positive when they arrive in Shanghai and unload their goods, which means that the protection is definitely not done properly. This situation is very awful. The next force to support Shanghai will be weaker and weaker, because they also need to be controlled, need to transfer the close contacts, disinfection of vehicles and a series of troublesome issues. By the way, the quarantine time has been changed from 14+7 to 10+7, which means that the clinical bed turnover rate can be improved a lot, because there could be probably almost 400,000 people who need to be quarantined, and if they were all quarantined for 14 days, there would be really no source of beds. Personally, I think it is good that the quarantine time is not so long. After that, the control of some neighborhoods also does not need 14 days, negative cases can be unsealed after 10 days of observation, which can facilitate the life of the residents, because it is almost impossible to protect more than 20 million people, it can be said that the majority of people in Shanghai now， though not to starve to death, have no much food left at home.

如果我们想要快速发现疫情，可能真的会像很多城市一样，一旦有输入病例， 马上就采取很严格的策略，因为上海已经给了一个很好的反面典型。从科学角度上来说，我个人觉得这可能不能称为反应过度，因为我亲眼在医疗机构当中看过 奥密克戎如何在很短两三天内一传十几个人，即使我们在第二天就开始隔离，仍然完全没有办法来形成阻断。但是未来可能需要设定一些阈值，例如，未来如果 有一例，开始区域性全员核酸;如果有两例，开始封控整个街道，不仅是小区; 如果有三例，把主要城区病例经过的所有区域封控，这看上去可能还是比较过度， 但其实以上海为例，代价会小很多，因为其他城区继续流动，能够提供物资后勤 保证。不像我们现在，全域封控之后保障很难做到，必须要靠很多兄弟省市。但是，兄弟省市的长途货车司机到了上海卸货回去全都阳性，这说明防护肯定没做 好，这种情况很糟糕。接下来支援上海的力量会越来越薄弱，因为他们也需要管 控，需要转运密接、对车辆进行消毒等等系列麻烦问题。顺便提供一下信息，现 在已经把密接隔离时间从 14+7 改到 10+7，减少 4 天意味着临床上的床位周转率 可以提高很多，因为大概累计下来可能有快四十万人需要被隔离，如果都隔离 14 天的话真找不到床源了。我个人认为挺好，隔离时间不需要那么长。之后一些小 区的管控也不需要 14 天，阴性只要观察 10 天就可以解封，这可以方便居民生 活，因为保障两千多万人几乎是不可能的事情，可以说，现在上海绝大多数人家 里，饿死不至于，但没有太多余粮。

3. Vaccination issues

3. 疫苗接种问题

In the case of Hong Kong, the large number of deaths in Hong Kong at the beginning of the epidemic was clearly related to the low vaccination rate in their population in general and in the adult population in particular. The vaccination rate in the Hong Kong population is probably only about 60% because Hong Kong people generally do not like our inactivated vaccine and think that the quality is very questionable. Of course, we do recognize that the results are mediocre, but a 60% vaccination rate is easily broken. Not to mention the fact that most vaccines don’t protect against infection at all, but the vaccine is extremely effective in preventing serious illness and death, and I still believe the data. The overall vaccination rate in Shanghai is higher than that in Hong Kong, about 96-97% for adults, 90% for high school students, and 88% for junior high school students, but less than 20% for 3-5-year-old preschoolers and less than 70% for 50-60-year-olds. If we lie completely flat like Hong Kong, vaccines would be more effective. But there are far fewer ICU resources to treat serious illnesses, which can cause a serious run on ICU resources. Therefore, our vaccination strategy, especially the third booster dose, will continue to be promoted, and the target of promotion is very clear, not for the general population, but for the elderly, or the middle-aged and elderly with underlying diseases. Whether we have two or three doses will have a significant impact on our follow-up results. As for the type of vaccine, given the current situation, it is unlikely that the country will approve the launch of the Pfizer–BioNTech COVID-19 vaccine on the mainland market for the time being in April. In March last year, Pfizer started talking to the Shanghai municipal government, but the central government did not approve it. If the third booster dose can be given to Pfizer, then the overall protection efficacy or antibody level can reach a more desirable level, or is sufficient for China. However, if it is not approved, even if the vaccine of remodeling protein or inactivation is continued, the effect is still there, but it may just reach a lower peak level.

以香港案例来看，香港之所以一开始疫情出现大量死亡，与他们整体人群尤 其是成年人群疫苗接种率偏低有明确关系。香港人群当中的疫苗接种率可能是只 有 60%左右，因为香港人普遍不太喜欢我们的灭活疫苗，认为质量有很大问题。 当然，我们也承认效果确实很一般，但是 60%接种率很容易就会被攻破。更别说 绝大多数疫苗其实是没有办法来防感染，但是疫苗防重症和防死亡效果是极好的， 这个我还是非常相信相关数据的。上海总体接种率比香港高，成年人群大概 96- 97%，高中生大 90%，初中生 88%，但 3-5 岁学龄前儿童不到 20%、50-60 岁老 人不到 70%。如果我们像香港一样完全躺平，疫苗会发挥比较大的作用。但治疗 重症的 ICU 资源远不够，这会造成 ICU 资源严重挤兑。所以我们的疫苗接种策 略尤其是第三针加强针会继续推进，而且推进目标很明确，不再是一般人群，而 是针对老年人，或者说有基础性疾病中老年人群体。打了两针还是三针就会对我 们的后续结果有比较大的影响。关于疫苗种类，以目前情况，可能四月份国家暂 时还不太会批准复必泰疫苗在大陆市场上市。去年 3 月份，辉瑞已经开始跟上海 市政府谈，后来国家没批。如果第三针加强可以接种辉瑞，那么整体保护效能或 者说抗体水平是可以达到一个比较理想的水平，或者说对中国来说已经足够了。 但如果它确实不批，哪怕打重塑蛋白或者继续还是打灭活，效果其实还是有的， 只不过它达峰水平可能会偏低一些。

4. The drug issues

4. 新冠药物问题

In the history of infectious diseases and epidemiology, no disease, including influenza and smallpox, has ever been eliminated by drug control or interruption. The first effective measure is isolation and control, so that there is no contact between people and no way of transmission. The second effective measure is the vaccine, which should be used on a large scale in order to stop sporadic transmission at a later stage. The Pfizer drug is currently in use at the Shanghai Public Health Clinical Center, mainly for general patients, while other mild or asymptomatic infections usually do not require any treatment.

在传染病、流行病学的历史上，从来没有一种疾病包括流感、天花在内是因 为药物控制或者阻断消灭掉的。第一有效的措施还是隔离管控，人和人之间没有 办法接触，就没有办法传染。第二有效措施还是靠疫苗，疫苗大规模使用这样才能阻断后期零星传播。目前辉瑞药物已经在上海公益临床中心开始使用了，主要 针对对象包括普通型患者，其他轻症或者无症状感染者通常是不需要任何处置。

5. Diagnostic criteria questions

5. 诊断标准问题

Regarding the diagnosis of mild and asymptomatic disease, the criteria have been changed to the ninth edition, but Shanghai has just recently started to decide to diagnose according to CT values and to discharge if the patient reaches 35 or 40 or more. The reason is that we need to empty the square cabin as much as possible, there are still tens of thousands of patients waiting to be admitted to the Fangcang hospitals;    the plan for prevention and control also needs revising. At present, we treat it as a category B infectious disease,     the management level is very high,      every patient has to be reported, but if we do an epidemiological investigation for every case, write several pages of epidemiological investigation report for everyone, a lot of energy for the CDC and community health service centers has to be involved, because the patients are already more than 100,000, it’s too much work. We hope that in the future, the prevention and control program can be modified so that there is no need to conduct a mass epidemiological investigation, but only to report the numbers, the same way we do in the cases with most infectious diseases. Currently, we are suggesting whether we can stop doing the epidemiological survey, or only investigate some aggregated cases, such as school and hospital infections. Mass spread in the community would be ignored because most people have no symptoms,     those who do have symptoms have only flu symptoms or pneumonia symptoms additionally.

关于轻症和无症状的诊断，标准已经改到了第九版，但上海最近才开始决定 按照 CT 值诊断，达到 35 或 40 以上则可出院。因为我们要把方舱尽可能空出来， 还有好几万的病人等着进方舱，另外，防控方案也要修改。现在我们将其作为乙 类报告传染病，管理级别很高，每个病人都要报告，但我们对每一个案例都要做 流行病学调查，这其实牵扯了防疫机构疾控中心和社区卫生服务中心很大的精力， 因为病人已经十几万了，每个人都要写几页纸的流调报告，工作量过大。希望将 来防控方案可以修改，不需要进行大规模流调，只报数字，就像绝大多数传染病 一样。目前我们在建议是否可以不做流调了，或者说只调查一些聚集性案例，比 如说学校、医院感染。社会面的大规模传播不予理会，因为绝大多数人没有症状， 有症状的人也只是感冒症状或者加上肺炎症状。

The change will have a direct impact on whether to segregate mild and asymptomatic cases at home or not? During the Vice Premier’s visit to Shanghai, she requested that those who should be transferred must be transferred and those who should be isolated must be isolated. However, at present, there is a serious lag in isolating the close contacts because there are no more isolation hotels. Those who just tested positive are mainly isolated in Fangcang hospitals. According to public data the square cabin can accommodate up to 100.000 people. If there are still 50,000 or even 100,000 infected people left, we can only rely on the method of removing those who were in the compartments before and replacing them with new ones. Neutrally speaking, home isolation is not a good choice, because the environmental conditions during home isolation in most families can not afford the complete separation, so it is only a matter of time before the people living with them become positive, and the number of new cases will continue to increase. In addition, there are many ways of transmission in the building, such as poor protection, poor ventilation, and unregulated mask protection. I am not sure how home isolation will change because home isolation is not the best solution for new cases but it may be an optimal solution to reduce medical stress. At this point I don’t think the state is going to come out with a home isolation policy anytime soon, we do it now in an unofficial private way, for example, over 65, foreigners, small children, pregnant women, and mentally ill patients will basically not be pulled away. The next step is to discuss home isolation extensively, based on the big data of the epidemic of how many people become positively infected because they were not transferred in time and therefore led to an outbreak.

更改之后会有一个直接影响，到底轻症和无症状要不要居家隔离?副总理 来过上海之后是要求应转尽转、应隔尽隔。不过目前密接隔离已经严重滞后，因 为没有隔离酒店了。对于阳性来说，主要靠方舱，按照公开数据方舱最多容纳十 来万，接下来如果还有 5 万甚至 10 万感染者，只能依靠把此前方舱里的人清走 换新人的办法。中立来说，居家隔离不是一个好选择，因为居家隔离之后，势必 绝大多数家庭的环境条件没办法做到完全分割开，所以他的同住人阳性是迟早的 事情，新发统计病例也会不断增加。另外楼内传播有很多途径，防护不好、通风 差、口罩防护又不规范。我不确定居家隔离会如何更改，因为针对新冠居家不是 一个最好的办法但可能是一个最优解，可以减缓医疗压力。目前我认为国家不会 很快出台居家隔离政策，我们现在是私下操作，比如说 65 岁以上、外籍、小朋 友、孕产妇、精神病患者基本上不会拉走。接下来居家隔离会被广泛讨论，讨论 基础是此次疫情大数据到底有多少人是因为居家阳性没有及时转运导致激发感染。

C. Risk of the next outbreak

三、下一次疫情爆发的风险

 I have always been of the opinion that as long as the overseas flights don’t stop, there will always be loopholes in Shanghai, Tianjin, and small second-, third-, and fourth-tier cities, because it’s too strong to spread. Most of our quarantine hotels have been re-evaluated or rebuilt after the hotel incident to ensure good ventilation systems. Soon to enter the summer, the quarantine hotel will certainly turn on the air conditioning. It is a serious question that, once the air conditioning is turned on, whether exhaust ducts will spread the virus particles, aerosols everywhere. Even if the relevant renovation is carried out, I believe that the majority of isolation hotels are still not up to standard, because isolation hotels are for living, not for isolation. The staff of the isolation hotels are not well regulated, not hygienically qualified, do not have any medical background, and maybe ordinary workers, etc. Since the opening of the new international square cabin last week, there have been some doctors and nurses tested positive.

The main reasons are that the facilities are not up to standard, there are too many people, and the operation of the workers is not standardized. We have already experienced many dangerous situations, we need to be vigilant, otherwise, the Fangcang hospitals will be more embarrassing throughout the year. The next one will definitely come, between May and September, the only question is which city it will come to? How big a wave of epidemics can it really kick-off? Under this kind of situation, we need to continue studying and adjusting the policies in several areas that I mentioned earlier to control the epidemic through actionable measures.

我们已经有一批人启动预测和研判下一次疫情风险，我一直是这样一个观点， 只要境外航班不停，上海也好，天津也好，二三四线小城市也好，总是会有漏洞钻进来的，因为它的传播能力太强了。我们绝大多数隔离酒店在经历了此次宾馆事件后都重新进行评估或改造，保证通风系统良好。马上要进入夏天，隔离酒店肯定是要开空调的，一开空调排风管是不是会把病毒颗粒、气溶胶到处传播，这是个很严重的问题。就算是进行相关改造，我相信绝大多数隔离酒店还是不达标， 因为隔离酒店是居住用的，不是隔离用的。隔离酒店的工作人员操作规范、卫生素养不足、没有任何医学专业背景的，可能就是普通工勤人员等等。新国际方舱上周开了以后已经有医生和护士感染阳性，主要问题就是设施不达标、人多、工 勤人员操作不规范。我们已经发生了多起险情，需要警惕，否则方舱全年更尴尬。 下一次肯定会来，就在五月到九月之间，区别在于说它到底来哪个城市? 到底能掀起多大的一波疫情? 在此情况下，我们还需要继续研判，在我前面提到的几个方面政策进行调整，通过可操作性的措施控制住疫情。

【 Q & A】【问答环节】

Q1: The situation in Shanghai this time is so serious that exceeded most peoples’ expectations. What is the main reason?

Q1:上海这次这么严重超出了大部分人的预期，主要原因是什么?

A1:First of all, the initial research and judgment is not in place; many political factors  interfered; too many important conferences in Jan and Feb.

A1:首先初期研判不到位，很多政治因素的干扰。1、2 月份很多重要会议，

At that time, the epidemic was already spreading, but Shanghai, as a benchmark city, was not suitable to take measures during the meeting, therefore a critical time was missed. At the same time, we initially hoped to adopt precise control, but precise control is only suitable for situations where the number of infections at the community level is small. When the positive rate is high, accurate prevention and control are easy to misjudge the situation, and by the time the area is defined, Omicron would have already spread, and it will be impossible to keep them together with epidemiological surveys. Second, at the level of nucleic acid detection, there is hesitation, and the nucleic acid detection strategies are inconsistent. When there were hundreds of cases, no large-scale full-scale nucleic acid testing was performed. From February and March, regional full nucleic acid testing was done on an ongoing basis, which looked good and many positives were screened, however the constant activity of these individuals led to increased mobility of the residents. The nucleic acid testing strategy is not uniform, and only nucleic acid is done without control of the area or unit of residence. Third, there is too much mobility. This leads to the result that the problem stays unsolved, despite the division of Pudong and Puxi in the way of the “mandarin duck pot”. Lack of the decline of personnel mobility the significance of nucleic acid testing will be much reduced. The most important thing is to get to the basis of the numbers. Lots of missing people in the communities every time will cause a lot of interference in the later results and research, and the significance of guidance is just limited. Besides at the leadership level, one has to weigh the pros and cons politically.

当时疫情已经在传播，但上海作为标杆城市，会议期间不适合采取措施，错失了 关键时机。同时一开始希望采取精准防控，但精准防控只适应社会面感染数量少的情况。当阳性率高的时候精准防控容易误判，当划定自以为精准的区域的时候， 奥米克隆已经传播开来，流调已经无法将他们聚合在一起了。第二，核酸检测层面上，犹豫不决，核酸检测策略不统一。当上百例的时候未进行大规模全员核酸。 从 2、3 月份不断进行区域性全员核酸，看上去很好，筛出了很多阳性，但由于这些人不断活动，导致人员流动性不断增加。核酸检测策略不统一，同时只是做核酸，未进行居住地区或单位的管控。第三，人员流动性太多。包括本次浦东浦 西“鸳鸯锅”的划分，还是无法解决流动性问题。人员流动性不下降，核酸检测的意义就会降低很多。最重要的就是摸清底数。若社区每次遗漏很多人，就会对后期的结果和研判造成了很大的干扰，指导意义有限。同时也包括领导层面上政治上的一些考量。

Q2:If the effectiveness of precise prevention and control is not as strong in the case of high infectivity, does that mean that in the future, if more cases happen, for example, three or few more cases, there will be a regional blockade?

Q2:若在高感染性的情况下，精准防控的有效性就没有那么强了，那是否意味着以后在更多数的情况下，三例以上或者有几例就会出现区域性的封锁?

A2:That should be the case, at least till the decision of reopening is made. Otherwise, it will be very difficult to control according to Omicron’s ability to spread. So all that is required of us is to act promptly, rather make a mistake than let it go.

A2:应该是这样的，起码在决定重新放开前，必须这么做。否则按照奥米克隆的传播能力，很难控制。那对我们的要求就是要更快，宁可错杀，不能放过。

Q3:How is it going with the conditions for gradual re-open afterward? Is that possible?

Q3:之后是否有可能逐渐具备逐步放开的条件?

A3: Actually, it should be done. This issue was discussed in an internal seminar last year, Many are thinking of a gradual re-opening. Because it is impossible to keep the country closed like this, the impact on the economic, political, and diplomatic situation is not good. However, we still have a major shortcoming mainly for the sake that,  since we fight against the epidemics in the past two years, we all relied on the controls sealing off the cities instead of on vaccines, drugs and clinical treatments, even we had fast no more patients with serious symptom  for the time after the first half of 2020 when the level of medical relief increased significantly, and since October 2020 we got to have the asymptomatic infected people.  But after entering into this year we found that such a sealing-off strategy was too costly.

A3: 其实应该是要这么做的。去年内部研讨会讨论到了这个问题，很多人是想着要逐步放开的。因为不可能老是这样闭关锁国，对经济、政治、外交形势 的影响都不乐观。但现在我们还有很大的短板，主要在于抗疫两年以来，除了 2020 年上半年，医疗救济水平有很大提升，但往后一段时间几乎没有重症病人。 从 2020 年十月份开始爆发无症状感染者疫情，最终控制都是通过封掉，而不是通过疫苗、药物、临床救治。但到了今年以后就发现这样的策略代价太大了。

After the Vice Premier’s arrival, she mainly said that we  “must inspect all those who should be inspected”, but the problem we encountered was the lack of personnel, and the reporting time was getting more and more delayed. The ambulances are also very strained, the square cabins are so full that we can not afford to “take all those in who should be taken in”;  what we can do is only “ to treat all those who should be treated”, because out of 130,000 people, about 120,000 are asymptomatic and do not need treatment. Therefore, the entire medical system for dealing with the Covid19 epidemic is not well integrated. In the future, if the system is liberalized, there will be no treatment for mild cases or general asymptomatic cases, and it will be gradually liberalized or liberalized at once, so that if there is a fever again in the future, one still goes to the fever clinic, and if there are no clinical symptoms, let him go home.  Only if the symptoms are serious, we will admit them to the hospital. It is necessary to reach such a level in order to talk about  how the future medical system is ready to respond. The main focus of medical resources now is, firstly, to support the square cabins, secondly, to sample the nucleic acid test in the communities, and thirdly, to ensure the functioning of the hospital， in opposition to the previous squeezing on medical care. In general, first, the national program is strictly enforced and cannot be overloaded； second, patients below the general type do not need to be treated. The only supplement is the critical care ICU, for which we are more worried  about re-opening because the country has a large base of population. The current estimated rate of serious symptoms is one in 10,000 people. Once it is liberalized, the need for an ICU will increase rapidly. Up to now, I haven’t yet found that our country is storing a large quantity of ICU resources. The ICU cells are easy to build, but the doctors for it have to be trained slowly.

副总理来了之后主要说“应检尽检”，但是遇到的问题就是缺人，报告时间越来越向后拖。“应转尽转”，救护车也很紧张;“应收尽收”，方舱完全满员，只有“应治尽治”我们能做到，因为 13 万里大概 12 万是无症状感染者，不需要治疗。所以整个应对新冠疫情的救治医疗体系没有很好整合。若将来放开，轻症和普通无症状将不收治，逐步放开或者一次性放开，将来若再有发烧还是去发热门诊，确诊新冠若没有临床症状还是回家，若症状比较严重，才收治入院。必须要达到这样的程度，才能说未来的医疗体系做好应对。现在医疗资源的主要集中在， 第一是方舱支援，第二是去小区核酸检测采样，第三才是保证医院运作。相较于以前医疗水平受到挤兑。总体来说，第一，严格执行国家方案，不能层层加码， 第二，普通型以下的病人不用就医。唯一补充的就是重症 ICU，是我们对于放开比较担心的，国家人口基数大，现在测算万分之一的重症，一旦放开对 ICU 需求就会快速增加，现在我还未发现国家在大量储备 ICU 资源。ICU 房间容易建，但重症科的医生还要慢慢培养。

Q4:When will the Shanghai epidemic top out and what kind of conditions are needed to meet the unblocking?

Q4:上海疫情什么时候会见顶，需要满足什么条件才能解封?

A4:The inflection point was previously predicted to be these two days, and it looks like 4.9-10 will continue to rise, and the numbers will gradually drop from next week. If we go wider, we could get to 5.10 to full clearing. If the control is stricter, at all costs, the zero-covid can be done till 4.20. But what we are talking about now is not zero-covid for all residents, but more about zero-covid for the social side, say, centrally controlling the people at risk, and managing buildings/communities with a high positive rate. The advantage is that there will be no more positive cases on the social side of the city, and the social side can be declared zero-covid, so theoretically there will be no transmission to others. However, this measure is extreme, there is a lot of international public pressure, and the number of people is too large, requiring a lot of capacity and management. With some precision, it is possible to turn out the worst of the worst, but subject to no backlash from public opinion and the public. If not, the time to clear the social side will be closer to the time to clear the whole residents and will continue to be delayed. In summary, late April through early May is a relatively broad point at which the epidemic is finally declared successful. If we look at the scope of specific streets and neighborhoods, it is estimated that certain exemplary neighborhoods will be gradually unsealed from next week. However, the scope and intensity of the outbreak are not known for the time being, and the second round of citywide nucleic acid testing will be conducted after 4.5 on April 10. After this test, we will see the results, and if there are still 10,000 positive mixed tests, then we will not be able to unseal any neighborhoods next week.

A4:拐点之前预测是这两天，看上去 4.9-10 会继续上升，从下周开始数字会逐步下降。如果宽泛一点的话，可能到 5.10 全员清零。如果控制更严格一些， 不惜一切代价，后续可以做到 4.20 清零。但是我们其实现在提的不是全员清零， 提的更多的是社会面清零。将有风险的人集中管控，将阳性率较高的楼宇/小区进行管理，好处就是城市社会面上不会再有阳性病例出现了，可以宣布社会面清零，理论上不会传染给其他人。但这个措施比较极端，有很多国际舆论的压力， 而且人数太多，需要使用很多运力、管理人员。如果精准一些，转出最严重的是可以实现的，但前提是舆情和民众不反弹。如果不这样做，社会面清零的时间就会和全员清零的时间比较接近，会继续往后拖。总结来说，从 4 月下旬到 5月上旬，都是一个比较宽泛的宣布终于成功的疫情的节点。如果从具体的街道小区范围来看，估计有可能从下周开始某些模范的小区逐步采取先行解封。但范围和力度暂时不好说，4.10 还要进行 4.5 之后第二轮全市全员核酸检测。在这次检测之后再看结果，若还是上万管阳性混检，那么下周还是不能够有任何小区解封。

Q5:How do you see the spillover effect, other places don’t seem to be as serious as Shanghai?

Q5:怎么看外溢影响，其他地方好像没有上海这么严重?

A5: The spillover is seen in two ways: first, after all, the proportion is still relatively small, the vast majority of people are not positive after all. Second, surrounding cities such as Jiangsu and Zhejiang have taken strict control measures on the inflow of people from Shanghai, as long as one comes from Shanghai one has to be quarantined for 14 days, followed by 7 days of home health observation. The seriousness of the outbreak in Shanghai is due to the mobility problem mentioned earlier, the frequent movement of people, and the high population density. Especially in an outbreak such as in Shanghai, it is most effective to adopt simple and rude epidemic prevention methods. We could have explored a better path, but we misjudged the transmission capacity of Omicron and the risk of an epidemic, so the precise measure of prevention and control was rejected.

A5:外溢分两方面看:第一，毕竟现在的比例还是比较小的，绝大多数人毕竟还不是阳性。第二，周围城市比如江浙就对上海流入人口采取了严格的管控措施，只要从上海出来隔离 14 天起，后面 7 天居家健康观察。上海这么严重还是之前说的流动性问题，人员流动的太频繁，人口密度高。尤其上海这次爆发成这样，如果采用简单粗暴的防疫方法是最有效的，而我们本来可以探索一个比较好的路径，结果因为错误的判断了奥米克隆的传播能力，和带来的疫情风险，导致精准防控整个被否决。

Q6:What conditions need to be met so that the policy of dynamic zeroing may be adjusted accordingly?

Q6: 需要满足什么样的条件，有可能动态清零的政策会进行相应的调整?

A6: First of all, the clinical and public health standards should be changed so that if a test is determined to be below the lower threshold, it is considered negative. This way brings great convenience to us. Since April 7th a large-scale nucleic acid test has been conducted in Shanghai, and those with values below 35 can go home. Second, the epidemiological criteria for prevention and control must also be changed. If asymptomatic cases are found in the future, they should be under home control, or mass nucleic acid testing should be discontinued. It may be feasible to judge influenza viruses according to their common pathogens, but this is a big step, scientifically sound, but still depends on political determination.
Thirdly,  we still need to have the support of a vaccine. I personally suggest that we should have a booster shot, but we still need a reliable vaccine, such as the Pfizer vaccine. Or do not rule out the development of better ones in the future. First of all the effect  of vaccines has to be good;  the next is the high vaccination rate, and the third concerns the vaccine protection time. It is difficult to say that there is a particularly long-lasting protective effect of both domestic and western vaccines.
Consider the introduction of a tiered policy like that in some European countries, with 2-3 shots for the general population and a fourth shot for the elderly and medical personnel. It is not ruled out that we will also introduce a tiered policy in the future.
The next matter is drugs. Although drugs cannot really stop or quell an outbreak, they are still important. It will give hope to patients, families, and the whole society. Then there is the response of the entire health care system.

 On the one hand, the determination of clinical criteria will affect the crowding out of medical resources. On the other hand, there must be a hierarchy of graded diagnosis and treatment measures. People still want to go to big hospitals when they are infected, then there must be policies, such as asymptomatic patients are not allowed to be admitted; even ordinary patients with unclear indications of pneumonia can be treated with drugs. We do not admit patients according to the Covid itself, but according to the severe pneumonia, as long as no more serious symptoms appear to him, then there is no problem.

A6:首先改临床和公共卫生标准，只要判定为检测阈值的下限，就認为是阴性的，这会带来很大的方便。从 4.7 开始上海已有的方舱进行了大规模的核酸检测，值低于 35 的就可以回家，这样的好处在于可以腾出很多空间给新的人。
第二，流行病学防控的标准也一定要改。如果以后再发现无症状，就居家管控，或者不再进行大规模核酸检测。如果按照普通的流感病毒病原体来判，或许是可行 的。但这个步子迈的比较大，科学上没问题，但还是要看政治上的决心。
第三， 还是要有疫苗的支持，个人建议还是要进行加强针，但还是要有靠谱的疫苗，比如辉瑞疫苗。或者不排除未来研发更好的。第一要求疫苗效果好，第二接种率高， 第三疫苗保护时间问题。现在国产疫苗也好，西方疫苗也好，很难说有一个特别持久的保护作用，考虑像欧洲一些国家出台分层政策，普通人 2-3 针，老年及医 护人员第四针，不排除未来我们也出台封层政策。再次是药物的问题。虽然药物不能真正阻断或者平息疫情的爆发，但还是很重要的。这会让患者、家庭、全社 会看到希望。然后是整个医疗体系的应对。一方面是临床标准的判定会影响医疗 资源的挤兑。另一方面要有分级诊疗措施。大家感染了还是想去大医院，之后必 须有相关政策，比如无症状坚决不允许收治，甚至普通型病人肺炎指证不明确， 也可以通过药物。我们不是按新冠来收支，是按照重症肺炎来收治，只要他不出现更重的症状，那就没问题。

Q7:Is liberalization of prevention and control only discussed in academia, or is it already being done at the policy level?

Q7:放开防控是仅在学术界讨论，还是政策层面已经开始着手做了?

A7:Liberalization is definitely a major trend, because the impact of closure on our economy is too hard. From the second half of last year, all kinds of health-related departments in the country were brought to consult and discuss. In February of this year, the state began to discuss the issue, and many of the views expressed at the Shanghai seminar were the same as those I mentioned above. From the academic point of view, everyone agrees to re-opening. The main concern of the current experts regarding the insistence on dynamic zeroing concentrates on the problem of excess deaths once it is unlocked. The lockdown in Shanghai this time is a complete mess. If the whole country is unlocked, these problems may also occur. If we deregulate it, the number of serious illnesses will increase dramatically, and not all of these people can be saved; except for these serious and critical illnesses, It is not ruled out whether some ordinary patients can receive routine treatment. Our current political system, social institutions, and cultural traditions do not allow this to happen.

Q7:Is liberalization of prevention and control only discussed in academia, or is it already being done at the policy level?

Q7:放开防控是仅在学术界讨论，还是政策层面已经开始着手做了?

A7: Easying up the control is definitely a major trend because the impact of the closure on our economy is too hard. From the second half of last year, all kinds of health-related departments in the country were brought to consult and discuss. In February of this year, the state began to discuss the issue, and many of the views expressed at the Shanghai seminar were the same as those I mentioned above. From the academic point of view, everyone agrees to re-opening. The main concern of the current experts regarding the insistence on dynamic zeroing concentrates on the problem of excess deaths once it is unlocked. The lockdown in Shanghai this time is a complete mess. If the whole country is unlocked, these problems may also occur. If we deregulate it, the number of serious illnesses will increase dramatically, and not all of these people can be saved; except for these serious and critical illnesses, It is not ruled out whether some ordinary patients can receive routine treatment. Our current political system, social institutions, and cultural traditions do not allow this to happen.

A7:放开肯定是大趋势，因为封闭对我们的经济影响打击太大。从去年下半年，全国各类卫生相关部门都开始咨询研讨。今年 2 月，国家层面开始研讨了， 其中在上海研讨会上很多观点与上面我提到的相同。从学术角度上来说，大家认可放开。目前专家对于动态清零的坚持，主要的担心是一旦放开导致的超额死亡问题，上海这次封控一塌糊涂，如果全国放开的话，这些问题可能也会发生。如果我们放开的话，重症的数量会大幅上升，这些人不是都能被救活;而且除了这些重症和危重症以外，也不排除有些普通型病人能否得到常规救治。我们目前的 政治制度、社会体制、文化传统是不允许这事情发生的。

***********

Q8:Who are the relevant risk groups published every day in Shanghai?

Q8:上海每天发布的相关风险人群指的是哪些人?

A8:In fact, it refers to those found among non-close contacts during the mass nucleic acid screening, we hope that the smaller the number the better.

A8:其实就指的是非密接里面发现的，在全员核酸筛查当中发现，我们希望这个数字越小越好。

Q9:There are 130,000 cases in Shanghai now, how do you determine who are the close contacts?

Q9:上海现在病例 13 万，怎么确定密接?

A9:It is very simple to determine the close contacts, family members, and people who live together.

A9:密接判定很简单，同住人、家属。

Q10:Is the premise of reopening the community that the basic social workers are not positive to be allowed?

Q10:小区放开的前提是不是社会基础工作人员都没有阳性才可以?

A10:This is not easy to say, still depends on the specific results of the second round of the city’s nucleic acid screening on April 10, if the results are good, certain communities will open to release some people first, of course, not particularly many. Theoretically, basic social workers, such as public security, logistics and delivery, and medical personnel, are now doing nucleic acid tests quite frequently, but there is still a possibility that they will turn positive. At the same time, the common people are under great pressure and there are voices of rebellion. The Shanghai government’s logistics and distribution capacity are insufficient because the population is too large.

A10:这一点不好说，还是要看 4 月 10 号的第二轮全市核酸筛查的具体结果，如果结果好的话，会开放某些社区先放一部分人出来，当然不会特别多。理论上社会基础工作人员，比如说公安、物流配送外卖、医务人员，他们现在核酸做得相当频繁，但是还是有可能会转阳的。同时老百姓压力特别大，出现了反抗呼声，上海市政府的物流配送能力不足，因为人口实在太多了。

Q11:The Shanghai Health Code has not been adjusted, why is the city not closed and public transportation is always open?

Q11:上海健康码一直没调，为什么没有封城，公共交通一直开着?

A11:This is a permitted behavior in Beijing, there are political considerations; Shanghai has not closed the city, and is still doing regional grid screening, so the channel away from Shanghai has not been closed, and there is a risk of export.

A11:这是北京允许行为，有政治考量; 上海没有封城，仍然是在做区域的网格化筛查，所以离沪通道一直没有关闭，有输出的风险。

Q12:The turnaround at Shanghai Modular (Square Cabin) Hospital is about five to eight days, right?

Q12:上海方舱医院的周转天数大概是五到八天对吗?

A12: Currently, the average length of in-and-out stay in the modular hospitals in Shanghai is 8-10 days. In Jilin it is 5~6 days, so we need to push down the length of stay.

A12:目前上海从进方舱和出方舱的平均住院时间是 8~10 天。吉林是 5~6 天，所以我们需要把住院时间往下压。

Q13:What are the isolated control areas in the published data?

Q13:公布数据里的隔离管控区包括哪些?

A13:The isolation control area mainly refers to the close contacts, not including the sub-close contact. Since the middle of March, Shanghai CDC has stopped judging sub-close contacts because there are too many to judge; and the epidemiological investigation has also stopped judging subclassification because theoretically everyone is controlled at home from the end of March to April, so the sub-close contacts should no more happen.

A13:隔离管控区主要指密接，不包含次密接。从 3 月中旬开始，上海疾控已经不判次密接了，因为判不过来了;而且流调也已经不判次密接了，因为理论 上来说 3 月底到 4 月所有人都管控在家了，不应该有次密接的。

Q14:What are the changes and implementation of prevention and control guidelines?

Q14:防控指南的更改和执行?

A14: Theoretically, the prevention and control guidelines have not yet been changed, but are only being piloted. Let me clarify, the prevention and control program has not yet been officially issued, the revision of the prevention and control guidelines that I said before, including the change from 14+7 to 10+7, is currently only in the pilot.

A14:防控指南理论上还没有改，只是在试点。我澄清一下，防控方案还没有正式文件发下来，我前面说的是防控指南的修改，包括密接的 14+7 改成 10+7， 目前都只是在试点。

Q15:Is the criteria for release from quarantine based on CT 40 or 35?

Q15:解除隔离的标准到底是按 CT 40 还是 35?

A15:That needs reconfirming. In my impression, it is 35.

A15:要再确认一下，印象里面是 35。

Q16: about the incubation period of Covid, what is the reason for finding positives after three or four weeks of control?

Q16:新冠潜伏期的问题，已经管控了三四周后发现阳性，原因是什么?

A16: it’s considered to be an object-to-human transmission. Some districts there have been positive, although sealed controls for three weeks. The only point that can be explained now may be transmission from material to human, such as take-out delivery or canteen. In foreign countries have a negative attitude toward the transmission of object-to-human beings. But some of it should really be attributed to the surface of the object, theoretically, a spray of disinfectant is useless, you have to spray it and wipe the surface clean.

A16:考虑是物传人。有些封控三个礼拜，发现里面有阳性，现在唯一能够 解释的点可能就是物传人，例如外卖快递、食堂。但国外总体来说，对于物传人是持否定态度的。但是里面有一部分应该确实要归咎于物体表面，理论上来说消毒喷一喷是没有用的，必须要喷了之后去把它表面擦干净。

Q17:According to your prediction, we may reach the high point in mid-April, right? The number of people screened in the full nucleic acid is still 600+, considering the large population base in Shanghai, what is the trend of the epidemic after that?

Q17:据您预测 4 月中旬可能会到高点对吗，全员核酸中筛出的数字仍有 600+，考虑到上海人口基数大，之后疫情的走势如何?

A17:The current asymptomatic data in Shanghai is not reliable, because some of these asymptomatic people will still have symptoms after they arrive at Modular Hospital, but the numbers, later on, are not revised. In the data of extreme cases in Jilin, the proportion of symptomatic to asymptomatic is about 1:1, but Shanghai’s data shows that about 97% are asymptomatic, I personally think it is about 70% asymptomatic. I personally think the asymptomatic rate is about 70%. The model prediction is not very valuable because prevention and control are not in place at the grassroots level in Shanghai. If optimistic, the lockdown will be gradually lifted in mid-April

In late April, most of the places may probably be zeroed out, but it will be more troublesome if the community’s prevention and control policies are delayed in transit.

A17:目前上海的无症状数据不可靠，因为这些无症状到了方舱医院之后， 有一部分人还是会有症状的，但是后期的数字没有修订。吉林的数据中比较极端情况下，大概是 1:1 有症状无症状，但上海数据显示大约有 97%都是无症状，我个人觉得其实无症状大概是 70%左右。上海基层防控也不到位，模型预测价值不大，乐观的话，4 月中旬会逐步解封。到了下旬可能大部分地方会清零，但是如果社区的防控政策转运的时间都比较拖延的话，会比较麻烦。

Q18:What exactly are the criteria for confirming the diagnosis?

Q18:关于确诊的标准，到底是什么?

A18:At present, Shanghai does not use the same criteria to make judgments, which is one of the reasons why our medical response system is very confusing, and each district is not exactly the same. But their current practice is based probably on lung imaging and imaging diagnosis, but this cannot be done at the community level. Pulmonary imaging is heavily dependent on imaging examination and can only be done at a designated hospital. This is getting rougher and rougher as the overall number of infected people increases. Some of the modular clinics are not yet capable of diagnostic imaging, but this may be what we want to do in the future, that is, we will only diagnose those who have pneumonia on lung imaging as covid19-pneumonia, for the rest not even the asymptomatic shall be done.

A18:目前上海没有完全统一采用同一种标准在判断，这也是我们这次医疗应对体系很混乱的一个原因，各个区也不完全一样。但是他们目前的操作可能就是按照要有肺部影像和影像学诊断，但这个在社区层面做不了。肺部影像严重依 赖于影像学的检查，得去定点医院才能够做。随着整体的感染者越来越多，这件事情就越来越粗糙。有些方舱都还不具备影像诊断的能力，但这可能是我们未来想要去做到的，就是把有肺部影像的肺炎表现的这些人才判为新冠肺炎，其他的人我们连无症状都不要做。

Q19:The diagnostic criteria are not consistent in each district, why is it so confusing?

Q19:每个区的诊断标准都不一致，为什么这么混乱?

A19:The prevention and control process is very complicated, which results in a lot of loopholes: health is only a small part of it, civil affairs, etc. is also included.  From the district CDC via the city and finally reported to civil affairs, the district management is also in chaos. Many medical institutions are relatively high level, it’s difficult for them to direct (those of district CDC level). In fact, this is not new, in Xi’an, Shijiazhuang, Northeast, etc. one has met it, each pit Shanghai has stepped in precisely. These are not scientific problems, but the implementation of operational problems.

A19: 防控流程很复杂，导致漏洞百出:卫生只是其中的一小部分，还要包括民政等。由区疾控经过市里再报到民政，小区管理人员也比较混乱。很多医疗机构级别比较高，也难以指挥。其实这也不是新鲜事，之前西安、石家庄、东北 等等都遇见过，每个坑上海都精准踩了进去。这些都不是科学问题，是执行操作问题。

Q20: I think it is hopeless to achieve zero-COVID?

Q20:感觉清零无望?

A20: inside the CDC, we also feel that there is no hope to achieve zero-COVID because a large absolute number of confirmed cases came from the screening of full nucleic acid, so troublesome. Therefore,   I don’t think we should open up the community just because the long-term control phase is negative; if we can guarantee the supplies, at least until the end of April.

A20:在疾控内部来说，我们也觉得清零无望，因为绝对数很大的确诊是从全员核酸当中筛出来的，这就很麻烦。所以我个人觉得不能因为长期封控阶段都是阴性，就贸然开放小区;如果在保证物资的前提下，至少封到 4 月底。

Q21:Finally, can you give us some advice on personal protection?

Q21:最后您能不能给我们提供一些个人防护的建议?

A21:First of all, for Omicron, you should wear an N95 mask when possible. Because ordinary surgical masks are not very effective. Secondly, try not to touch any public facilities when going up or downstairs, because the surface of the object can sometimes be positive and it will last for a short period of time; Third, wear a glove if possible while unpacking the food purchased outside,  preferably rubber gloves or latex gloves, open the outer packaging, turn it inside out and throw them together away. The rest of the items are to be sprayed with alcohol, and then wiped clean with a rag. The rag should also be well disinfected and cleaned. If it is conditionally impossible to do that, then wipe repeatedly more than a few times, and then wash it clean and rub it clean, this is also effective after all. Finally, after doing these things, hands should be washed,  according to the seven-step washing method.  Hand hygiene has a better effect than the standard mask-wearing for protection to some degree.

A21:首先，针对奥米克隆希望有条件时候还是戴 n95 口罩。因为普通外科口罩效果不太好。第二，上下楼尽量不要接触任何的公共设施，因为物品表面有时候会呈阳性的，而且会持续一小段时间。第三，拆封外面购买的食品，有条件的话戴一层手套，最好是橡胶手套乳胶手套，把外包装打开之后，把它反过来脱掉，然后一起扔。剩下来的物品用酒精喷一喷，然后拿抹布擦干净，抹布也要很好的消毒洗干净。然后实在是没有条件，就反复的多擦拭几遍，然后洗洗干净搓搓干净，这个毕竟也是有效的。最后，做完这些事情之后，手还是要清洗，而且要规范的七步洗手法，手卫生会比规范佩戴口罩防护效果更好一些。

4/12/2022 *

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