Wu Jun, Calm the Covid Panic

Wu Jun, “Being Infected Does Not Mean Getting Sick; We Need to Calm the Covid Panic”[1]

Introduction and Translation by David Ownby
 
Introduction
 
Wu Jun is a medical doctor, presumably originally from China, who now works at the City of Hope Medical Center in Duarte, California.  The text translated here is Wu Jun’s contribution to a debate about how to manage the pandemic in China, published online by the journal The Intellectual.  The debate began with a contribution from Zhang Zuofeng 张作风, another Chinese medical doctor working in Los Angeles, who, on March 29, argued essentially that the nature of the Omicron variant means that China needs to dial back its strategy of eliminating the virus and move toward a strategy of coexistence.  Wang Liming 王立铭, a Professor at Zhejiang University’s Institute of Life Sciences, replied on March 30 that Zhang might be right eventually, but that his suggestions were not appropriate in the current situation.  A third text, published on April 1, put Zhang and Wang in dialogue, so that they could discuss their points of agreement and disagreement.   Wu Jun’s contribution to the debate, published on April 3, takes Zhang Zuofeng’s side.
 
All of these arguments are cast in purely scientific, medical terms, and seek to avoid anything political or polemical.  Zhang Zuofeng and Wu Jun essentially argue that with the emergence of the Omicron variant, the coronavirus will cease to become a pandemic disease and enter the endemic stage, which can be managed in less draconian and expensive measures than those China is currently employing (China is apparently testing less demanding models than that used in Shanghai in other cities).  These are the same arguments that have basically prevailed outside of China, so they are familiar to us and do not require much explanation from me (although I personally find some of Wu Jun’s claims concerning self-reporting, vaccination, and the wonders of new drugs to be naively optimistic).  The point here is to illustrate that public, scientific debate over these issues does indeed occur in China, even as the Party-State doubles down on “dynamic zero.”
 
Translation
 
Professor Zhang Zuofeng, Chair of the Department of Epidemiology at the UCLA School of Public Health, recently made four recommendations for the prevention and control of the coronavirus epidemic in Shanghai, which have received the attention of professionals and the general public.
 
Omicron, a mutant strain of the coronavirus, is highly infectious and can cause rapid infection and widespread transmission in large metropolitan areas with concentrated populations. This phenomenon has emerged not only in Europe and the United States, but also in Hong Kong. As reported by Reuters on March 29, the World Health Organization (WHO) estimates that the new mutation BA2 of the coronavirus variant Omicron accounts for more than 86% of the samples so far analyzed by sequencing. The Shanghai Health Commission announced on April 1, 2022, that there were 260 new confirmed cases of indigenous coronavirus pneumonia infection and 6051 new indigenous asymptomatic infections. The epidemic is developing so quickly that it has forced Shanghai to adopt a territory-wide static management strategy to stop the development and spread of the virus.

In order to help Shanghai defeat the epidemic and restore normal life to the general population as soon as possible, Professor Zhang Zuofeng proposed:

1. To replace testing in a group setting with self-testing;  2.  To replace centralized isolation with home isolation for close contacts and mild cases;  3.  To protect elderly high-risk groups and children with effective vaccines;  4.  To strengthen the treatment of patients with effective drugs (Paxlovid, Pfizer's new coronavirus treatment drug, is recommended for timely treatment of early infections) with the goal of effectively protecting the health of the population by reducing the morbidity and mortality rate of the coronavirus and successfully transforming the coronavirus pandemic into an endemic disease.

Professor Zhang is a senior epidemiologist, and his recommendations are based on scientific data and experience in the prevention, control, and treatment of epidemics worldwide, and are highly actionable and timely. However, there are also many scholars who expressed different views, including Professor Wang Liming from the Institute of Life Sciences at Zhejiang University, who wrote an essay especially for The Intellectual to express his views.  After reading the debate between Prof. Wang Liming and Prof. Zhang Zuofeng, I feel it is necessary to write an article echoing Prof. Zhang Zuofeng's suggestions and clarifying some issues.

First, the relationship between viral infection and disease should be correctly understood and the fear of coronavirus infection should be alleviated. Since the onset of the epidemic, the virus has caused several million deaths worldwide. Many people are afraid to talk about the epidemic, and there are cases of suicide by people who have caught the virus. Although the coronavirus is rampant, being infected and becoming ill are two different things. People will be infected by many bacterial or fungal viruses over the course of their lives. Most viral infections, due to the immune system in our bodies working to protect our health, do not lead to disease.

Diseases are meant to have perceptible and measurable clinical symptoms. For infectious diseases, the presence or absence of clinical symptoms is the basis for determining whether or not you are sick and need to be hospitalized. This is common sense, just like we have all had the flu, but whether or not we need to go to the hospital for treatment should depend entirely on the severity of the symptoms.

According to the People's Daily Health Client, the information in which was reproduced in several media outlets on March 13, the coronavirus variant currently present throughout China is mainly the BA2 variant of Omicron. It is relatively contagious, but most infections are asymptomatic or mildly symptomatic, and it is mainly confined to the upper respiratory tract, rarely invading the lungs and causing death. According to an interview with Hu Bijie, Director of the Department of Infectious Diseases and Infection Management at Zhongshan Hospital, Fudan University, in early March, the current high proportion of asymptomatic infected patients in Shanghai are those who have tested positive for the coronavirus nucleic acid, but have no related symptoms, and none of the characteristic changes in lung imaging, which also supports the description of a virus that is mainly mild following infection. The main symptoms after BA2 infection are basically the same as those of the cold or flu , mainly runny nose, headache, fatigue, sneezing, and sore throat.

According to my own experience, the majority of patients with mild symptoms see these symptoms diminish after three days if they take proper care of themselves, and they return to normal after ten days. Based on clinical experiences in South Africa, even those hospitalized due to Omicron during the fourth wave had hospital stays of only three days, if they required hospitalization at all.  These individuals should not be treated and handled as patients requiring hospitalization, but should be encouraged to rest and convalesce at home in isolation. If symptoms worsen, they can contact the nearest hospital.

Grasping this is only way that the general public will not be frightened by talk of infection, fearing that if they get sick they will either give up completely or suffer discrimination. Nor do anti-epidemic resources have to target asymptomatic and mildly ill patients, which wears everyone out. Medical units should primarily serve those who are seriously ill and require hospitalization (e.g., respiratory distress, low blood oxygen levels).
 
Second, there needs to be a change in the practice of mass concentrated testing for viral nucleic acids. Testing is needed, but mass gatherings of people for testing have the potential to cause cross-infection and aggravate the spread of the outbreak. The current development of the epidemic in Shanghai has become an area with a relatively high prevalence of the coronavirus in China. With a population of nearly 25 million, requiring the entire population of Shanghai to line up several times a week for nucleic acid testing would not only be a severe challenge for the testing system, but also greatly increase the risk of an expanded outbreak due to mass aggregation. As we have seen in web videos, there are often large crowds of people trying to get a nucleic acid test. In some areas of Shanghai, people even had to wait in line for several blocks to get tested.

Large-scale centralized nucleic acid sampling is inefficient and more likely to cause the spread of infection. Although Shanghai is offering better service by increasing the number of testing sites to reduce waiting times, people repeatedly queuing several times for testing wind up physically and mentally exhausted, which increases the risk of minor illnesses developing into serious ones. And now with the Coronavirus Pathogen Rapid Test Kit, people can do their own tests at home, avoiding the risk of infection caused by collective nucleic acid testing as well as a great deal of stress. Therefore, Professor Zhang Zuofeng's suggestion of "self-testing to replace group testing" is a very important and timely recommendation. Self-testing, reporting of positives, and retesting will be more targeted and efficient. Self-testing can avoid cross-infection and inefficiency caused by mass testing, and this is the key benefit of allowing wide-scale self-testing.
 
Third, care for the mental health of those who catch the virus by encouraging home isolation. After being infected by the virus, whether a mild illness develops into a serious one depends largely on the immune system of the infected person. A person's immune system, in turn, is closely related to his or her mental state and care conditions. If they can isolate at home, the patient's mental stress will be greatly reduced, care will convenient, and there will be the warmth of the family, which will greatly help the infected person to recover as soon as possible. Professor Zhang Zuofeng's proposal of "replacing centralized isolation with home isolation for close contacts and those with light symptoms" will not only reduce the cost and burden of fighting the epidemic, but more importantly, it will help the infected people to reduce their mental stress and facilitate self-care.
 
Many people believe that centralized isolation seems to prevent family members from being infected. It sounds reasonable, but in reality it doesn't work that way because transmission of the virus is a very quick affair, a matter of minutes. When any member of a family tests positive, this means that they have already been infected for at least a few hours (the incubation period for Omicron is usually two to three days), and if they are to be contagious, then the family is already affected. With thousands of new infections every day, hauling them all away to centralized quarantine facilities will require huge social resources to fight the epidemic and exhaust health service personnel fighting the epidemic.
 
Conditions permitting, it would be best if those isolating at home were given thermometers and blood oxygen monitors to monitor their own health. Most of the finger oximeters sold in the U.S. market for home use are imported from China at low prices. The government can purchase these in large quantities and distribute them to the public. If the condition of someone isolating at home deteriorates, the patient can immediately use a management system similar to a health code, allowing the patient to go to the nearest hospital for oxygen and other life-saving treatments.

Fourth, it is necessary to eliminate the public's psychological concerns about the side effects of vaccines, and to increase efforts and improve strategies to accelerate vaccination in high-risk groups over 60 years of age. Vaccines are the most effective means of prevention against microbial infectious diseases, yet since the invention of the coronavirus vaccines, anti-vaccine advocates have continued to promote conspiracy theories about the vaccine and to incite people to resist getting the vaccine.

These vaccine conspiracy theories have been refuted by the world's mainstream media and the mainstream medical community, but they are still prevalent among some segments of the population. At the same time, concerns about the side-effects of vaccination are more harmful than the vaccine conspiracy theories. In fact, both Chinese inactivated vaccines and foreign mRNA vaccines have undergone extensive clinical trials worldwide and have proven to have relatively few side effects and to be safe and effective for the majority of the population.
 
Outbreaks around the world, as well as in Hong Kong, tell us that deaths from the coronavirus are mainly among people aged 60 years or older who have not had at least two vaccinations. According to a preliminary analysis by the Centre for Protection of the Hong Kong Department of Health, as of April 2, the cumulative number of deaths in the fifth wave of the epidemic in Hong Kong was 7732, with a median age of 86 years, and some 88% were unvaccinated or had received only one dose. The mortality rate of people aged 60 years or older who had received two or three doses of the vaccine was greatly reduced compared with those who had not received the vaccine.  For example, the mortality rate of people aged 60-69 years who were not fully vaccinated was 2.42%, and if they received two or more doses of the vaccine, the mortality rate was 0.09%; for people aged 80 years or older, the mortality rate of those who were not fully vaccinated reached 16.3%, while for those who had received two or more doses of the vaccine, the mortality rate was 2.97% .
 
Currently, there are more than 264 million elderly people aged 60 years and older in China, of which more than 212 million are fully vaccinated against the coronavirus, which means that about 52 million elderly people are either unvaccinated or not fully vaccinated. Therefore, there is a broad consensus that increasing vaccination of people over 60 years of age is the key to defeating the epidemic.
 
The question now is how to speed up the vaccination of people over 60 years old. Since Shanghai is experiencing some 10,000 covid cases a day, some people believe that Shanghai is running out of medical manpower to administer the vaccine. This is actually an easy problem to solve. The Chinese government has a great capacity for mobilization, and training people to administer vaccines is quite easy. With the power of full nucleic acid testing and the proper organization of health care workers, it is possible to get at least two doses of vaccine to people 60 and over by going into neighborhoods to administer and, in special cases, providing home vaccination services.

The second approach is to adopt a safer and more effective vaccine. Prolonging the epidemic for even one day means one more day of suffering.  Improving the efficiency of the vaccine can defeat the epidemic sooner. The Fubitai vaccine is a vaccine that has proven to be effective and safe in the practice of fighting epidemics in many countries around the world. According to a clinical study conducted in South Africa, out of 19,070 nucleic acid positive cases, only 114 (0.6%) were positive if they had received a second dose of the Fubitai vaccine for more than 14 days. The number of people who received other vaccines but still had positive results was 3296, or 17.3%. It is clear that the Fubitai vaccine is a more effective vaccine against the Omicron strain of infection than other vaccines.

Professor Zhang Zuofeng is not alone in calling for the country to approve the use of imported vaccines as soon as possible, and many senior professionals and relevant authorities in Shanghai agree with him. The Fubitai vaccine remains in application status and has not been approved for use by the Chinese authorities. This is not a question of a lack of clinical trial data, but a matter of perception. The efficacy of the Fubitai vaccine is not an illusion, and its safety and efficacy are confirmed by extensive scientific clinical data from around the world. Which is more important?  To protect the Chinese mRNA vaccine industry?  Or to free the Chinese people from the travails of epidemic and allow life and the economy to return to normal as soon as possible? 

For people over 60 years old, the interval between the second and third dose need not be too long, and 30 days is enough. The CDC recently revised its guidelines to allow for the administration of a third dose of vaccine in adults with moderate and severe immunodeficiency only 28 days after receiving the second dose. The results of the previously mentioned South African study showed a significant boost in resistance to Omicron infection 14 days after the administration of the vaccine.  A study of the protective effect of the Fubitai vaccine (mRNA vaccine) after the third dose in Israel, published in the New England Journal of Medicine last October, showed a significant reduction in the chance of being infected 10 days after receiving the third dose, although 21 days were required for protection to reach its peak.
 
A study published by Dr. Xin Zhao of the Chinese Academy of Sciences in the New England Journal of Medicine on March 3 of this year showed that the level of antibodies against the Omicron strain produced in those who received the third dose of the inactivated vaccine ZF2001 at an interval of 30 days from the second dose did not differ significantly from those who received a booster dose at an interval of four months, although results were better after a four-month interval. As for the effectiveness of two doses of inactivated vaccine plus one dose of Fubitai, there has been a clinical study in Turkey using the Chinese inactivated vaccine plus a third dose of Fubitai that demonstrated that this combination was also able to significantly improve coronavirus immunity.

Fifth, vigorous introduction of the coronavirus treatment drug Paxlovid provides timely treatment of early infection. As mentioned earlier, the people’s fears about the virus are based on the belief that there is no medicine available in case they are infected. If we want to alleviate these fears, then we must scientifically ensure that those infected by the coronavirus can be prevented and treated. This is what Pfizer's drug does. Pfizer's Paxlovid, which has been proven in scientific studies and clinical trials, significantly reduces the chances of the disease developing into a serious illness if taken within the first 5 days of infection. No one in the industry doubts this clinical efficiency.Professor Zhang Zuofeng's fourth recommendation is "to enhance patient treatment with effective drugs (Pfizer's new coronavirus treatment drug Paxlovid is recommended for timely treatment of early infections).”

​Although dose availability is currently limited, based on current outbreak data in Shanghai, there have been about 300 new cases per day since the end of March. If these are the cases that require Paxlovid, 10,000 doses of Paxlovid might be able to sustain them for 20 days. During these 20 days, it is believed that the Chinese government will continue to increase the number of imports of the drug. Meanwhile, Pfizer has opened up the patent and authorized three Chinese pharmaceutical companies to manufacture it. It is believed that with the production capacity of Chinese pharmaceutical companies, which will rapidly ameliorate the supply situation.

In conclusion, because of limitations in medical resources, the coronavirus epidemic is a great threat not only to infectious diseases caused by the virus, but also to non-communicable diseases such as cancer, cardiovascular disease and diabetes. The annual global death toll from non-communicable diseases exceeds 40 million, several times the number of deaths from covid-19 (6.15 million worldwide to date). We should take very seriously the pressure on health care resources that should be deployed on non-communicable diseases due to the coronavirus epidemic.  According to WHO statistics, 28 million surgeries for cancer patients worldwide were cancelled in 2020 because of the epidemic. Judging from the previously mentioned deaths in Hong Kong, the high-risk groups are those over 60 years old with underlying pathologies. For this population, using the most effective and safest vaccine to complete at least two doses of vaccination will greatly reduce the risk of death due to covid-19.
 
We should allow the people to self-test at home and report positive cases, and to isolate at home, which will reduce mental stress and prevent the disease from developing into a serious illness. Those who test positive can receive effective medications as early as possible. In this way, the limited medical resources will be able to take care of not only patients who need to be hospitalized due to the coronavirus, but also patients with non-communicable diseases, allowing an early return to normal medical services, social life, and economic activities.
 
Notes

[1]吴军, “感染不等于发病，应减轻恐慌情绪,” published online on 知识分子/The Intellectual, on April 3, 2022.