中國正在放鬆其清零 COVID 政策——這是科學家的看法
研究人員表示,規則的改變將導致感染率上升,從而使醫院不堪重負。
資料來源:自然 612, 383-384 (2022)/ 財團法人台灣紅絲帶基金會編譯
中國花了三年時間旨在完全阻止 COVID-19 的傳播。圖片來源:Kevin Frayer/Getty
中國政府週三發布了新的指導方針,放寬了一些嚴格的清零 COVID 政策。 放寬了檢測要求和旅行限制,首次允許症狀輕微或無症狀的 SARS-CoV-2 感染者在家中隔離,而不是在集中管理的設施中隔離。 但研究人員擔心,這些變化將導致感染率上升,有可能使醫院不堪重負。
研究人員表示,這些指導方針與中國過去三年一直維持的嚴格政策相比發生了重大轉變,中國過去三年過透過大規模檢測、嚴格封鎖和關閉邊境來平息疫情。「這是一個明顯的跡象,表明中國正在遠離清零 COVID」,紐約市外交關係委員會中國衛生政策專家 Yanzhong Huang 說。
該公告是在許多城市抗議嚴格封鎖之後發布的。 這些導致一些城市放寬了對測試和移動的一些限制,但新指引更進一步。
雅典喬治亞大學公共衛生研究員 Adam Chen 說,這些變化讓中國「朝著正確的方向前進」。 他說,他們試圖平衡保護最脆弱人群免受感染的需求,同時減少封鎖對經濟和社會造成的危害。
但黃說,政府尚未說明其新政策的目標,這可能會造成混亂。「這些措施很可能會導致混亂和倉促的過渡過程,地方政府在沒有認真投資準備過渡的情況下放棄所有清零 COVID 措施」,黃說,他希望看到分階段重新開放。
居家隔離
最新的國家指引指出,不再需要在整個城市進行大規模測試。 他們還採取了更慎重的封鎖措施:政府表示,行動限制應該適用於高風險社區、建築物和家庭,而不是關閉城市。 除了療養院等高風險環境外,人們不再需要出示陰性測試的證據即可在地區之間旅行或使用公共交通工具和其他場所。 該指引優先考慮提高老年人的低疫苗接種率。
但研究人員表示,新規定的某些方面含糊不清,地方政府可以自由解釋,包括在爆發期間何時何地對人們進行檢測、高風險區域的定義以及如何管理這些區域。
此外,該指引並未取消對國際旅行者的檢測和檢疫要求,「如果目標不再是 COVID 為清零,這就沒有理由」,香港大學的流行病學家本·考林 (Ben Cowling) 說。
倉促重開
中國許多人居住在人口密集的高層建築中,那裡很難限制傳播。 澳大利亞墨爾本拉籌伯大學公共衛生研究員 George Liu 表示,允許人們在家隔離會助長病毒傳播。這可能會使醫院不堪重負。
研究人員表示,重新開放的時機並不理想。 冬季是流感高峰期,因此醫院的患者人數已經有所增加。 康乃狄克州紐黑文市耶魯大學研究中國公共衛生系統的經濟學家陳曦說,許多人還將在下個月的農曆新年和春節期間在全國各地旅行,這進一步加劇了病毒傳播。
Adam Chen 說,政府需要就如何應對感染激增提供更明確的指導。「這將考驗中國衛生系統的應變能力」。
Xi Chen 說,中國沒有強大的初級醫療保健系統,例如全科醫生網絡,所以人們去醫院看輕症。他希望未來幾天能出現更多關於政府計畫如何對照護進行檢傷分類的細節。
英國坎特伯雷肯特大學社會學家 Joy Zhang 表示,如果沒有額外的支持,放鬆的限制可能無法幫助企業從長期封鎖中恢復過來,也無法消除 COVID-19 帶來的社會污名。「我擔心健康和社會經濟風險會轉嫁給個人」。
考林說,需要就如何在激增期間遏制傳播提供緊急指導,例如透過強制佩戴口罩、在家工作政策和臨時關閉學校。 他說,鑑於檢測減少,目前尚不清楚官員們將如何追踪城市是否正在接近或已經過了感染浪潮的高峰期。
疫苗驅動
研究人員擔心倉促的改變不會留下足夠的時間來加強老年人的疫苗接種。 目前,大約 70% 的 60 歲或以上的人和 40% 的 80 歲或以上的人已經接種了第三劑 COVID-19 疫苗。
劉說,在老年人中存在「嚴重的疫苗猶豫」,並且普遍缺乏對醫療專業人員的信任。 Xi Chen 說,許多老年人住在農村和偏遠地區,因此給他們接種疫苗需要時間。
該指引建議建立流動診所,並培訓醫務人員解決人們的安全問題,以加強疫苗接種。 但黃說,他們沒有發布疫苗接種指令或為地方政府提供強有力的激勵措施來提高疫苗接種率。 不可避免的感染增加是否會導致死亡人數激增還有待觀察。 「全面影響仍有待展開」,他說。
自然 612, 383-384 (2022)
doi: https://doi.org/10.1038/d41586-022-04382-0
China is relaxing its zero-COVID policy — here’s what scientists think
Researchers say the rule changes will lead to a rise in infections that could overwhelm hospitals.
China has spent three years aiming to halt the spread of COVID-19 completely.Credit: Kevin Frayer/Getty
The Chinese government issued new guidelines easing some of its strict zero-COVID policies on Wednesday. Testing requirements and travel restrictions have been relaxed, and people infected with SARS-CoV-2 who have mild or no symptoms are for the first time allowed to isolate at home instead of in centrally managed facilities. But researchers worry the changes will lead to a rise in infections that risks overwhelming hospitals.
The guidelines represent a significant shift from the strict policy that China has maintained for the past three years, which involved quashing outbreaks through mass testing, stringent lockdowns and border closures, say researchers. “It is a clear sign that China is moving away from zero COVID,” says Yanzhong Huang, a specialist in Chinese health policy at the Council on Foreign Relations in New York City.
The announcement follows protests in a number of cities against the strict lockdowns. Those led some cities to loosen some restrictions on testing and movement, but the new guidelines go further.
The changes move China “in the right direction”, says Adam Chen, a public-health researcher at the University of Georgia in Athens. They try to balance the need to protect the most vulnerable people from infection, while also reducing the economic and social harms of lockdowns, he says.
But the government hasn’t stated the goal of its new policy, which could create confusion, says Huang. “These measures will very likely lead to a messy and hasty transition process where local governments ditch all the zero-COVID measures without investing seriously in preparing for the transition,” says Huang, who would have liked to have seen the reopening happen in phases.
Home isolation
The latest national guidelines state that mass testing across entire cities is no longer required. They also take a more measured approach to lockdowns: instead of shutting down cities, the government says movement restrictions should apply to high-risk communities, buildings and households. People no longer have to show evidence of a negative test to travel between regions or access public transport and other venues, except for high-risk settings such as nursing homes. And the guidelines prioritize boosting the low rates of vaccination among older people.
But researchers say some aspects of the new rules are ambiguous and open to interpretation by local governments, including when and where to test people during an outbreak, what defines high-risk areas and how to manage them.
Furthermore, the guidelines do not lift testing and quarantine requirements for international travellers, which “doesn’t have a rationale if the objective is no longer zero COVID”, says Ben Cowling, an epidemiologist at the University of Hong Kong.
Hasty reopening
Many people in China live in densely populated high-rise buildings, where it will be difficult to limit transmission. Allowing people to quarantine at home will contribute to viral spread, says George Liu, a public-health researcher at La Trobe University in Melbourne, Australia. This could overwhelm hospitals.
The timing of the reopening is not ideal, say researchers. Winter is peak influenza season so hospitals will already be experiencing a rise in the number of patients. And many people will also be travelling across the country for next month’s Lunar New Year and spring festival, further increasing viral spread, says Xi Chen, an economist at Yale University in New Haven, Connecticut, who studies China’s public-health system.
The government needs to provide clearer guidance on how to handle a surge in infections, says Adam Chen. “It will test the resilience of the Chinese health system.”
China doesn’t have a strong system for primary medical care system, such as a network of general practitioners, so people go to hospital for mild conditions, says Xi Chen, who hopes more details on how the government plans to triage care will emerge in the coming days.
Without additional support, the eased restrictions might not help businesses to recover from protracted lockdowns or remove the social stigma attached to COVID-19, says Joy Zhang, a sociologist at the University of Kent in Canterbury, UK. “I’m afraid that the health and socio-economic risk will be passed on to individuals.”
Urgent guidance is needed on how to curb transmission during a surge, such as through mask mandates, work-from-home policies and temporary school closures, says Cowling. And given the reduction in testing, it is not clear how officials will track whether cities are approaching, or have passed, the peak of an infection wave, he says.
Vaccine drive
Researchers are concerned that hasty changes will not leave enough time to ramp up vaccination among older people. Currently, some 70% of people aged 60 or older, and 40% of those aged 80 or more, have received a third dose of a COVID-19 vaccine.
There is “serious vaccine hesitancy”, among older people, and a general lack of trust in medical professionals, says Liu. Many older people live in rural and remote areas so it will take time to vaccinate them, says Xi Chen.
The guidelines propose setting up mobile clinics, and training medical staff to address people’s safety concerns to boost vaccination. But they stop short of issuing vaccine mandates or introducing strong incentives for local governments to increase their vaccination rates, says Huang. Whether the inevitable rise in infections will lead to a spike in deaths remains to be seen. “The full impact remains to be unfolded,” he says.
Nature 612, 383-384 (2022)
doi: https://doi.org/10.1038/d41586-022-04382-0