The speculation that Dorjee said was the result of unanimous discussions among the members of the previous investigation team.

Now, infectious disease experts from the national disease control and control have come to the scene, and all the results are focused on Nan Zhiqiao and Zhen Zhen.

Nan Zhiqiao put down the information handed over by Dorjee, looked at Zhen Zhen, and said, "Before you came, you have read the epidemic data of L County, what analysis do you have?"

"As early as 1917, there was an outbreak of plague in L County, which was caused by the infection of monastic monks, and affected nearly 300 people and killed about 200 people.

So far this year, it has been ascertained that there are 7 townships in L County as plague foci, with 65 epidemic sites and an area of more than 1,000 square kilometers.

In 1973, Y. pestis was isolated from Himalayan marmots for the first time in the region.

Yersinia pestis is the main reservoir host, followed by Tibetan sheep. Plague among animals in the region continues almost all year round, and the peak of human plague is from June to October.

There were 10 cases of plague in humans, with 35 cases of illness and 12 deaths, of which 3 cases were due to the feeding of marmots, 2 cases of Tibetan sheep and 5 cases of rat-flea bites.

Cutaneous anthrax epidemic occurs in this region, the onset season is from January to June, mainly among herdsmen, the cause of the disease is mainly to skin the dead cattle and sheep, and the skin infected by Bacillus anthracis causes local ulcers. ”

After Zhen Zhen finished talking about the background and incidence information of L County, the members of the investigation team present were taken aback, they did not expect that a young girl could tell the historical epidemic information of L County so completely, and she deserved to be an expert from the national disease control and control.

Nan Zhiqiao: "According to the symptoms of this patient and the historical epidemic data of L County, the pathogen that caused this outbreak is likely to be Yersinia pestis, and the isolation circle should be determined according to the plague epidemic first. ”

"How to determine the isolation circle?" asked Lao Zhao.

"Do you have a map of the area?"

"Yes. ”

Dorjee took out a map of the local area and spread it out on a makeshift conference table.

Nan Zhiqiao held a pencil in his hand and drew a circle on the map, "This is the large isolation circle, with the tent where the patient lives, and the station where people often come and go nearby, within two kilometers, it is a large isolation circle, and the people in the large isolation circle can carry out organized production activities, and collective activities such as gatherings are prohibited, and they are not allowed to go to other places." ”

Dorjee: "Since there is a large isolation circle, then there should be a small isolation circle?"

Nan Zhiqiao: "A small isolation circle is centered on the patient's residence, and the tents around it that may be contaminated are designated as a small isolation circle. According to the specific situation, the original residents in the small isolation circle are to be isolated and observed, preventive treatment is carried out, and non-relevant personnel are prohibited from entering and leaving. ”

Dorjee: "It's easy, we'll go and draw the big and small isolation circles in a while." ”

Nan Zhiqiao also instructed: "In the isolation circle, there should be a designated medical treatment team for the patient, and the medical staff should set up a temporary tent near the patient. ”

Dorjee: "Well, there are already two temporary tents, if it's not enough, I can still transfer a batch from the county." ”

Nan Zhiqiao: "For close contacts of the patient, they should live in a separate tent with the patient, isolate at home for nine days, and cannot come into contact with other people. For other healthy people, they were quarantined in place, restricted their activities, and placed under medical observation for nine days. ”

"Good. ”

"There is also the environment, spraying the ward with peracetic acid disinfectant, fully disinfecting in the small isolation circle, steam disinfection of general cotton clothes and bedding, and wiping the surface with alcohol for valuable instruments. The patient's excrement is soaked in bleach powder for two hours and buried, and the garbage is incinerated for burial. In addition, it is also necessary to exterminate rodents and fleas, do a good job in environmental sanitation, and do a good job in propaganda and education. ”

"Well, that's all done before. ”

Dorjee was happy, and Lao Zhao casually looked at the information that the investigation team had sorted out.

Flipping through one of them, Lao Zhao's eyes lit up, and he hurriedly pulled out the information page from it and put it in front of Nan Zhiqiao, "You see, this is the first case of the patient in this incident, Tenzin's family is investigating the disease. ”

Nan Zhiqiao took the information and looked at it carefully, and this flow survey data was described on a household basis.

The first household, the head of the household, Tenzin Quzha, the neighbors all called him Tenzin, male, 52 years old, Tibetan, herdsman and village doctor, 8 people in the family, 1 became ill, 1 died.

Tenzin, the first patient in this case, became ill on 10 March, died three days later, on 13 March, and was buried on 1 April.

Tenzin had not been exposed to a similar patient before the onset of the disease, and in the nine days before the onset of the disease, a healthy goat had been slaughtered during grazing for the whole family of 8 people, and the rest of the family was currently asymptomatic.

After Tenzin's illness, he was taken care of by his family, and after his death, because there was no celestial burial master at that time, he was mortuary at home for 21 days, and on April 1, he was buried by three celestial burial masters in the mountain behind his house, and only 7 family members who lived together attended the funeral.

After reading the information of the first household, Nan Zhiqiao asked, "Is Tenzin's corpse specimen preserved?"

"Nope. Dorjee shook his head and continued to explain: "Tenzin practiced a sky burial, and when our investigation team went to the mountain behind his house to look for it, only the bones of the vultures were left. ”

Dorjee knew in his heart that in order to make a clear diagnosis, an autopsy and sampling tests must be performed.

Nan Zhiqiao: "What about the other six deaths?

"No, only the village doctor Tenzin is a celestial burial, and the other six dead are all burials. Duo Ji took out another stack of materials and put them in front of Nan Zhiqiao, "This is the flow information of the other four households. ”

The second household: Zhuoma's family, there are six people in the family, 4 people are sick and 2 people die.

Dolma's patients include Dolma, Dolma's father, mother and eldest brother, and his uncle and second brother are not ill.

Dolma, a 25-year-old female, Tibetan and herdsman, was the first patient in the household, who became ill on April 13 and died three days later, on April 16, and was buried.

In the 9 days prior to the onset of illness, Dolma had not been in contact with similar patients.

At the beginning of April, Dolma, his father, mother, and brother had just moved back from the winter pasture to the summer pasture, and the family had repeatedly found their shepherd dog eating marmots from the wild, and one of the sheepdogs had brought back a dead marmot and ate it in the tent where Dolma lived alone.

After Dolma fell ill, she has been living at home and being cared for by her family.

The funeral was held on April 16, attended by five family members and two neighbors in charge of the burial, as well as a neighbor, Tashi, and Tashi's daughter, grandson, and third son.

Dolma's father, who became ill on April 18 and died on April 21, was buried the day after his death.

Dolma's mother and eldest brother are now showing symptoms and are being treated in isolation at home.

The third household: Tashi's family, 11 people in the family, 4 people became ill, and 3 people died.

Tashi's family had four patients, including Tashi, his grandson, daughter and third son.

All four of them had attended Dolma's funeral and visited Dolma's mother and eldest brother who were sick.

Tashi's grandson, daughter and third son are currently dead.