Deputy director doctor: How did I become a critical patient from an epidemic prevention expert

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 Deputy director doctor: How did I become a critical patient from an epidemic prevention expert


Yu Changping, deputy chief physician of respiratory department, peoples Hospital of Wuhan University

From first-line doctor to critical patient

I am Yu Changping, a first-line respiratory physician, a member of the expert group for the prevention and control of this epidemic. At the same time, I am also a severe patient with coronavirus infection. I just came back to earth after walking in the ghost gate.

How can I get infected? When did it get infected? Who infected me? This is a difficult question to answer. Since the beginning of the pneumonia epidemic, I have contacted many patients every day. Sometimes a day (pneumonia) patients to see a few, but also a few. Once there was an emergency department consultation, three of them were all in one day. Another time, I attended a consultation in the fever clinic. The patient worked on the second floor of South China seafood market in Hankou. As a clinician, he was coronavirus pneumonia. Of course, there was no definite diagnosis at that time. It was very difficult to make a definite diagnosis in the early stage. Only when several experts and leaders signed, can we check the coronavirus.

As a clinician, he will contact many patients, rush to the front, the probability of infection is very high.

On January 14, I began to have a fever. I had a fever in the daytime and at night. The fever was not high. It was 38 degrees and 5 degrees. Everything else was normal. At that time, there was a phenomenon of burping and farting when eating. I was confused. Was it gastroenteritis? No, no tripe. What is the problem?

I had a rest for the next two days, thinking it might be better to have a rest. Now I want to come, why dont I have a fever to check it? Because the early diagnosis of the symptoms of coronary pneumonia is not comprehensive, I have only one symptom of fever, which is not consistent with the diagnosis of the symptoms of coronavirus pneumonia at that time.

On the 17th, our department was going to have a new years meal. At that time, I realized, would it be this (pneumonia) problem? Although Im worried about it, its not like it, but what if it is? There are dozens of people in that department, which has a great influence. I have to check it. At that time, I immediately checked it out and found that there was something wrong with my lungs. At that time, we had a colleague who was a little weak. Once we checked, it was the same problem. We were both hospitalized at the same time.

It was not heavy when I just lived in. It was OK the next day and the third day. I could walk down to do CT Reexamination myself, but people were more and more uncomfortable. According to the reexamination results, bilateral lung lesions are increasing, which I can expect. Viral pneumonia is definitely getting worse day by day, that is to say, the degree. I hope it will be slower.

But I didnt expect that on the third day after the reexamination, the condition worsened rapidly. I didnt get up for five days, and I had no chance to sit up. I had chest tightness, suffocation, and dyspnea. Only breathing oxygen can make me feel better.

When the 4th and 5th day is very heavy, I think of a question, will I die?

I thought about it at the time, theres a 30% chance of death. I didnt get better in five days. In another two or three days, I may not survive. But if it is stable after 5 days, there will be hope and even improvement, so I always have 60% - 70% expectation to survive.

But I turned to think again, what is death? People are always going to die. In case of that step, no one can solve the problem of how many years earlier and how many years later. Theres only one regret. I dont have much money and it doesnt pay. After I died, my family didnt take care of me very well. Thats all.

But death is not the most important thing now. The most important thing is to want to live. What is my belief that I can survive? One is that I am in good health and in good physical condition, so I can fight against this virus. There is also a belief that although I have difficulty breathing, I can eat, drink and sleep. When the fever subsides, I can eat. If I cant breathe well, I will eat slowly.

It is very important for me to reexamine CT on the 5th day to see if it can be stabilized. I took the oxygen bag and asked the master wheelchair to push me down. I went downstairs to do it myself. I know how to make this CT. The most difficult time for me is last night. Its over. Then theres the tug of war. If I get through it, Ill get better.

Thats what happened. Things began to improve day by day. There was also a little interlude in the middle. Because I didnt have a good rest, I had a little relapse. Why dont you have a good rest? Too much information. High school group, university group, master group, doctor group, doctor group, friend group, inpatient group, questioner group, questioner group There is too much information all over the country. Seeing this situation has no control. As a doctor, Im in a hurry. So I always think that I can do something.

My wife was not allowed to come to accompany me in the middle of the trip. But at that time, I was almost at the end of my life, and the staff deployment of the hospital was extremely tense. If no one cared, I might die, so I agreed.

At that time, I had my own assessment that if I could pass this weeks dangerous period, I would survive and die if I could not pass it. She can take care of me for a few days, but she is also at risk, with a 70-80% chance of infection. But I also know in my heart that in case of infection, she should also be mild and controllable. This is judged by the characteristics of disease development.

Later, she was infected. I said you do a CT, she doesnt do it. She said she was light and I was heavy. She would do it when I was a little better. I said yes. After I was obviously better, she went to do it: double lung infection, but mild disease, obviously better with some medicine, no big problem.

Am I right in this matter? Theres no right or wrong. For the person Im going to die, she may be infected with mild illness. I know in my heart that such a small price can be paid. Of course, there is something wrong. After all, it puts her in danger.

From the CT results, we can complete the preliminary screening of the epidemic situation

First of all, if the patient has a fever, the doctor will take a CT scan. Usually, the general pathological changes are the changes of single lung, but the changes of double lung are very few. Our clinicians have experience. Once the patients with fever see the change of their lungs, they will see viral pneumonia. When the epidemic breaks out, it can be diagnosed. Its not 100%, its not necessary to wait for the detection of nucleic acid. This is very accurate for the doctors below us, city, county and district doctors, and we can make a preliminary screening.

From the CT manifestations, it starts from the edge of the lung, next to the chest wall, which is often referred to as the subpleural onset. Its pathogenesis is characterized by the change of floccule and cotton floccule under the pleura, as well as the more common flake and spot; some patients show the change of strip and branch, and it is bilateral, or it is not typical. According to these characteristics, clinicians can judge symptoms.

At the beginning of the disease, most of the patients have a characteristic that they dont cough. The incidence of the disease is mainly around the pleura, the periphery, in the stroma, not in the alveoli and airway, so no cough. Another feature is that the lesion is gradually wetted, gradually on both sides, and gradually increased. This is the manifestation of the lung, which can be seen from CT.

From the current case situation, one of the characteristics of this epidemic is that there are many confirmed cases. Many patients, the majority of patients are mild, not serious, can be isolated at home, take a small amount of drugs, which is also a good thing.

The second characteristic is that most of the patients are older. The patients with severe diseases are often older and have poor physique. The patients with critical diseases are often people with basic diseases, which is troublesome. But most people are mild to moderate patients, often over 30 years old, many teenagers and twenties are not easy to get sick. For example, in our department, doctors and nurses over the age of 30 take care of our four or five young people. They dont have the disease, and they have almost the same working environment. Some time ago, I heard that 13 of our classmates, the surgeons (doctors) of Central South Hospital, fell down, all of them were middle-aged and old people, but the young people did not. This is a good phenomenon.

But its an infectious disease. Anyone can infect it. Less does not mean no infection. I read the news before. A young man who went back from Wuhan in Hefei was infected by the Party of three people. Its not uninfected, but its relatively better, so we should also be alert and protective. Because universities and middle schools are all places where young people gather. In case of mutation and infection, it will be a large number of infections. We should pay attention to it.

And the battle may not be short. Many of our patients have been found early in clinical practice, such as our medical staff. They have many contacts, no lung symptoms, no cough and no fever. They do a CT directly, and find that there are changes under the pleura, changes in both lungs, but the scope is very small, indicating that they have this disease, and it is very early, they think they are normal people without symptoms. This situation will lead to that many patients in the early stage dont know they have the disease, but this early stage or incubation period is infectious, which is a bit troublesome, leading to its strong infectivity, we can deduce that the total number of patients will be more in the end.

It is worth noting that there is a new problem. The throat of our medical staff is not comfortable. The throat swab is positive. Its also the disease. Will this happen often in the future? Can common upper respiratory tract infection also appear it? Infectious, too? Although the treatment is when the upper respiratory tract infection treatment, pay attention to wearing masks, prevention and control of infection, isolation at home is not a big problem, this is a place of concern.

We should pay attention to tactics, guard against them and prevent them from dying. But we are not afraid of strategy. Most of us are OK. Although attention is paid to it, dont panic. Excessive panic is even more unnecessary. It makes sense to strengthen prevention, wear masks, stay at home and make more contributions, as Professor Zhong Nanshan said.

Be careful of pathological changes from mild to moderate severe

After mastering the disease, what should each of us do about this situation?

First of all, when you have this disease, or doubt that you have this disease, first of all, self judgment, what stage and state are you in? Is it a mild illness? Its easy to be light: isolated at home, wearing masks, not going out, staying at home, listening to Professor Zhong.

There are also a small number of light patients isolated at home who should be prevented from becoming moderate or heavy at home. If you have fever, wheezing, chest tightness and dyspnea, you may become heavier. You should go to the hospital and be hospitalized. If you dont have this situation, you can be isolated at home. The isolation of most light patients at home can reduce a lot of burden and panic for our government and society. No matter how our government (strengthens prevention and control), it cant turn around. This is what we should do and guard against.

What is the focus of government prevention and control? In two aspects, the propaganda about diseases is very important. No one else knows whats going on. The village has a road closed immediately, and the county has a road closed immediately. I dont know whether there will be dead people or how the disease can be transmitted. Ignorance causes panic. We should propagandize and tell others how the disease is going on and how it is. Most people will have nothing to do. But nothing cant be ignored. Its important to strengthen prevention and publicity. Now, as we all know, all people are concerned about the automatic isolation of light illness. Isnt this a great burden to reduce?

In addition to publicity, the key point is to manage the light illness that may become severe, or the severe and moderate illness that may become severe, to receive them and to treat them, and to remove the panic that many light illnesses may become severe. If there is no worries, things will go smoothly. However, there are still many serious cases. The government should increase efforts to increase hospitals and reduce this major contradiction, otherwise it will become more and more difficult. This is my expectation for the government and the key point to be solved.

A few more questions

1. About disinfection

There are many answers about disinfection on the Internet. Respiratory tract infection, mainly a good mask less contact, less through respiratory tract infection. In addition, there are many contact infections, such as touching mobile phones and objects, touching face, nose and mouth, especially eyes. Bulbar conjunctiva is a weak place and easy to infect. It can be disinfected with alcohol, hands, mobile phones, articles, etc. bacteria (viruses) will not be free in the air for a long time and can be killed by high temperature.

2. Relationship with common cold and influenza

Now there are more questions about influenza. My disease is dominated by fever, with few coughs. What is influenza? It is dominated by high fever, cough, runny nose and sneezing. The treatment of runny nose and sneezing has little to do with it. Its usually a common cold or flu, which is a good thing. Its a season with high incidence of influenza and cold. You cant count everything in (viral pneumonia).

3. How will the epidemic follow up.

I dont necessarily have an accurate view of the follow-up. Its an outbreak period, a period of high symptoms. Do you know how about the follow-up? How many people will get sick and when will it stop? But I have a judgment. First, people all over the country pay attention to this disease and are trying to control it.

(function() {(window. Slotbydup = window. Slotbydup| []). Push ({ID: u5811557, container: ssp_, async: true});)) (); besides, from the development of this disease, most of them are mild and have recovery ability. Finally, as the weather warms, the virus will be affected and its diffusion ability will be reduced, which is generally the case; in the medium and long term, it will be eliminated by us. Finally, the epidemic is too severe now, so we must pay close attention to and protect it. But my general view is that there is no need to panic. We will always press it down. What are you afraid of? In Wuhans words, afraid of a ball, panic what? There was a panic. The sky fell down and a long man was standing on top. When the disease came, our medical staff rushed ahead. There is nothing terrible. It will get better and win! (Dr. Yu is recovering now, but it still needs a long time to take oxygen, hoping to help the public fight against the epidemic through the release of this website.) source: economic observation network Author: Qu Yixian editor in charge: Han jiapeng_nn9841

In addition, from the development of this disease, most of them are mild and have recovery ability. Finally, with the warming of the weather, the virus will be affected and its diffusion ability will be reduced, as is generally the case; in the medium and long term, it will be eliminated by us.

Finally, the epidemic is too severe now, so we must pay close attention to and protect it. But my general view is that there is no need to panic. We will always press it down. What are you afraid of? In Wuhans words, afraid of a ball, panic what? There was a panic. The sky fell down and a long man was standing on top. When the disease came, our medical staff rushed ahead. There is nothing terrible. It will get better and win!

(Dr. Yu is recovering now, but it still needs a long time to take oxygen. I hope the release of this website will help the public fight against the epidemic.)