Media: how can Wuhan hold the trend of the epidemic? Currently, it faces three challenges

category:Global
 Media: how can Wuhan hold the trend of the epidemic? Currently, it faces three challenges


From 0:00 to 24:00 on February 4, there were 1967 new cases in Wuhan, while seven days ago (January 29), there were 356 new cases in Wuhan. In a week, the number of new cases per day increased 5.5 times. The cumulative number of cases as of 24:00 on February 4 was 8351, 3.69 times that of 2261 on January 29.

According to the research of Gao Fu, director of China Center for Disease Control and prevention and other experts, the case size of new pneumonia doubles every 7.4 days, the average interval between one person and another is 7.5 days, and the basic regeneration number (R0) is estimated to be 2.2.

Obviously, Wuhan has been speeding heavily. At present, how can Wuhan hold on to the severe epidemic situation? How to solve the shortage of hospital beds, medical staff and improve the speed of diagnosis are the three biggest challenges facing Wuhan.

Id like to get some

I want to go to the hospital for a drip. Now I have to lie down and feel comfortable. I feel very depressed when I move. In this room, I dare not go out. They send me food every day. No matter what it is, I eat it. Im thinking that if I eat more, my bodys resistance will be better. On February 5, Ms. Zhang, 50, who was isolated at the City Express Hotel on the second road of Optical Valley, told the first financial reporter.

This is the isolation point for community resettlement. On the evening of February 4, Ms. Zhang was informed by the community to go to isolation.

In recent days, Ms. Zhangs life has changed dramatically: on February 4, her mother stopped breathing while waiting in line for the hospital bed. The day before her mother died (February 3), Ms. Zhangs father left first.

My parents, my brother and I all cough. On January 31, my brother and I had a CT test. It was suspected that we were isolated at home. After my father died, my mother was no longer able. I called 120, and the community car took my mother to the hospital and left. Then my mother waited in line for the bed in the hospital, but it didnt wait at last. Zhang said.

After her parents left, Ms. Zhang fell into fear.

I just want to go to the hospital and get some professional treatment. But before because there was no nucleic acid test results, the hospital could not treat. I went to the branch of Tongji Hospital for nucleic acid test, but the result hasnt come out yet, so Im still waiting. My daughter said it would take 48 hours to get out today. Ms. Zhang is expecting the result of her nucleic acid test. Once she gets the result, she is expected to go to the hospital for treatment.

Ms. Zhang said that now she is buying medicine for herself. Some people say that baifule is very good, so they find someone to help prescribe the medicine. Its powerful and I feel light after eating it. She saw a bit of hope.

Like Ms. Zhang, there are many patients with family cluster infection in Wuhan. The hospital has no bed, cant do nucleic acid test in time, go home and isolate by itself, which is the inducement of this kind of family clustering infection, and also makes the number of confirmed cases in Wuhan completely slide out of the orbit of the basic regeneration number (R0) of the new coronavirus.

Wang Chen, vice president of the Chinese Academy of engineering and expert in respiratory and critical care medicine, said in the news 1 + 1 program on February 5 that the situation in Wuhan is severe and a large number of patients have not been admitted to the hospital in time, which is a great pressure. The flow of these patients in the society and living in the family will cause further family and community infection, which is aggravating the epidemic The most important factor.

Now we need to keep up with the prevention and control measures and press the disease down. An epidemiologist said.

Relax the standard of suspected cases

Hu Lishan, director and Deputy Secretary of the Standing Committee of Wuhan Municipal Peoples Congress, used the word barrier lake to describe this situation in Wuhan.

At a press conference in Hubei Province on the evening of February 5, Hu Lishan said, its true that we feel very painful. We feel very anxious and painful. Its also true that we have confirmed the diagnosis and many suspected patients have not been well treated. They have not been admitted to our designated hospital. In fact, after a contradiction between supply and demand, a barrier lake has been formed, which exists.

Wang Chen said that it is not clear how many patients there are in Wuhan at present. We expect the number of cases to be no more than the number of beds of the 12000 square cabin hospitals designed now. However, if the cross infection in the community does not stop, it is still an uncertain number. Therefore, the most important thing now is to be able to receive as many patients as possible as the source of infection to the hospital, so as to reduce the number of patients The spread of family and community, so that the overall epidemic tends to decline.

Therefore, in order to solve the problem of barrier lake, Wuhan needs to control the source of infection as soon as possible and comprehensively.

One of the measures is to make an important adjustment in the new pneumonia diagnosis and treatment plan (trial version 5) issued by the national health and Health Commission on February 5: relax the standard of suspected cases in Hubei Province:

One is to adjust from the original fever symptoms to fever and / or respiratory symptoms. Second, clinical diagnosis classification has been added between suspected cases and confirmed cases. In addition to meeting the requirements of fever and / or respiratory symptoms, the reduction of clinical manifestations to normal or reduced total white blood cells or lymphocyte count in the early stage of the disease can be considered as suspected cases. The suspected case, if it has another clinical manifestation that has been removed - the one with the imaging characteristics of pneumonia, is a clinical diagnosis case.

This also means that the number of suspected cases in Hubei Province will rise to a certain extent.

(change of suspected case standard in Hubei Province)

The source of infection will be fully exposed in the flood discharge of the barrier lake

Li Xingwang, a member of the national medical expert group and chief expert of the infectious diseases diagnosis and research center of Ditan hospital in Beijing, responded to the change of the suspected standard at a press conference on the afternoon of May 5, saying that fever or respiratory symptoms have been added to the standard of suspected cases, which means that patients with mild clinical manifestations but also epidemiological history cannot be ignored It is also for early detection of patients, early diagnosis and early isolation treatment.

As for whether it will increase the number of suspected cases, I think it may increase, but if we can search out these less typical cases early, it will also be very beneficial to control the epidemic situation and the source of infection. Li believes.

At the same time, in the clinical classification, the fifth edition of the diagnosis and treatment plan also added a light. From the original ordinary type, heavy type and dangerous heavy type, it is adjusted to light type, ordinary type, heavy type and dangerous heavy type. Mild refers to mild clinical symptoms and no manifestation of pneumonia in imaging.

Li Xingwang said that with the improvement of detection ability, it was found that pneumonia caused by the new coronavirus not only has the manifestation of pneumonia, but also some patients are relatively light without pneumonia. Specifically, this part of patients have fever, moderate and low fever, slight asthenia, occasional dry cough and no pneumonia in the history of the disease. Although these patients are in light condition, they are still infectious.

In the diagnosis and classification, we add this type. The first is to isolate these patients for treatment, so as to better control the source of infection.

Lack of hospital beds and medical staff after flood discharge

On the one hand, it is necessary to expose all possible sources of infection. On the other hand, Wuhan must speed up the classified and centralized treatment.

At present, Wuhan is in the process of classified and centralized treatment of four types of personnel (confirmed patients, suspected patients, patients with fever that can not be ruled out and close contacts of confirmed patients).

Among them, for the confirmed patients who are admitted in a centralized way, the severe ones are sent to designated hospitals, and the minor ones are sent to designated hospitals and other medical institutions; for the suspected patients who are staying in the fever clinic, they will continue to stay in the clinic; for the patients who are unable to stay in the clinic due to the lack of beds, they will be transferred from the area where they are located to the designated centralized isolation point; for the fever patients who are diagnosed by CT in the fever clinic and have pneumonia symptoms but can not be excluded for the time being, they will be sent from the area where they are Institutions with fixed medical conditions shall be isolated for centralized treatment, separated from suspected patients to prevent cross infection; close contacts of confirmed patients shall be screened, and they shall be isolated at home after centralized observation with reference to patients with fever.

In order to solve the barrier lake caused by unavailability, Wuhan needs to solve the problem of hospital bed. However, there is no doubt that the contradiction between the supply and demand of hospital beds in Wuhan is quite prominent.

Hu Lishan said that currently, there are 8254 beds in 28 designated hospitals in Wuhan, and there are 8182 people living in hospitals. More than 2000 cases and 780 suspected cases were confirmed in Wuhan on February 4, adding up to more than 2700 cases. But with the discharge, the number of empty beds was 421 yesterday.

In order to reduce the harm of barrier lake, Wuhan is doing four things: first, it requires 28 designated hospitals to tap the potential internally, accelerate the turnover of beds, and improve the discharge rate as soon as possible. In addition, more beds are needed in the light illness ward. Second, we should focus on solving the problem of critical patients, adopt the 5 + 2 approach, and determine five designated hospitals to treat critical patients, and accelerate the construction of huoshenshan and leishenshan.

The third thing, Hu Lishan said, is the construction of the shelter hospital. At present, there are three shelter hospitals, i.e. Wuhan International Convention and Exhibition Center, Hongshan gymnasium and Wuhan living room, which add up to 4400 beds. As far as I know, around 10 p.m., our Wuhan International Convention and Exhibition Center will begin to receive patients, which is to reduce the number of patients with mild illness we have confirmed. At the same time, we also ask each district to find a way to make good use of its own gymnasium or school to build a shelter hospital like this, to treat patients with mild illness and reduce the problem of mild illness.

The fourth thing, Hu Lishan said, is to tap social resources and separate and observe suspected patients, fever patients and close contacts.

Wuhan expropriates and expropriates private hospitals, hotels, Party schools, schools and other places as centralized isolation points for pneumonia patients and close contacts. As of 24:00 on February 4, there were 132 centralized isolation points with 12571 beds and 5425 people of all kinds.

Hu Lishan said that a special class has also been set up in the districts centralized isolation points to separate and observe suspected patients, fever patients and close contacts. At this point, we want to think ahead of time, and now we ask each district to raise more schools, hotels and sports centers as our next centralized isolation place.

We use these methods to try to reduce our barrier lake. Hu Lishan said.

The gap of medical staff is closely behind the expansion of admission and the increase of beds.

At present, Wuhan is not only building hospitals, but also transforming hospitals. At the same time, it is also increasing the opening of beds in the top three hospitals, all of which need medical staff.

On February 4, Wuhan decided to build another fangcang hospital in China Optics Valley Science and Technology Exhibition Center, Wuhan Sports Center, Wuhan International Expo Center and other places to treat patients with mild pneumonia infected with new coronavirus.

According to local media, in addition to the above-mentioned six shelter hospitals, Wuhan City Jiangan, Qiaokou, Hongshan, Jiangxia District, Qingshan and other urban areas will build another shelter hospital. It is expected that 11 shelter hospitals will be set up to specially treat patients with light illness infected by new coronavirus pneumonia.

Relevant people said that with the completion of these shelter hospitals, the treatment capacity will be greatly improved, to some extent, to alleviate the situation that patients in Wuhan cannot be centralized and isolated for treatment.

The ability of treatment is great, but where do people come from? Every 20 patients need one doctor, two nurses, three shifts, a 1000 bed shelter hospital, and 450 medical staff. But here, the community doctors are all on the front line. Some doctors go back before the Spring Festival, and they dont come in again. We can only call some retired medical staff back, but the prevention and control of infectious diseases need professional training, not everyone can do it. So there is a big gap in the future. Wuhan local area administrative staff told reporters.

In the future, with the construction of more shelter hospitals and the increase of centralized isolation points, they will form a line of defense to block the epidemic in Wuhan, so that suspected and mild patients can be isolated and treated in the first time, but the shortage of medical staff will become increasingly prominent.

Diagnosis speed cant be delayed any more

Expanding treatment and isolation not only puts pressure on beds and medical staff, but also challenges Wuhans diagnostic ability.

Tian Yulong, chief engineer of the Ministry of industry and information technology of the peoples Republic of China, said at the press conference of the State Council on February 3 that the daily output of the kits had reached 773000, which could meet the demand.

It has been suspected that the diagnostic reagent is insufficient, which is confirmed by the figures of Ministry of industry and information technology. But why cant so many people get tested in time?

At present, only 19 large hospitals and several third-party testing institutions can do nucleic acid diagnosis, not all fever clinics of medical institutions can do the test. And it will take two days for the test results to come out. A doctor in Wuhan said.

Patients who can only go home and wait for two days create a chance for the virus to spread.

(function() {(window. Slotbydup = window. Slotbydup| []). Push ({ID: u5811557, container: ssp_, async: true}););); in many outpatient clinics, because there is no way to detect, after doing CT, they will be asked to go to a large hospital for nucleic acid detection, and need to run two hospitals. Said the doctor. The uneven distribution of nucleic acid diagnostic reagents makes it difficult to detect patients in time. At the beginning, the diagnosis needs to be carried out in the P3 level laboratory, so the patient samples need to be sent to the conditional testing institutions for testing, but now the diagnostic reagents have been improved, which can be done in the P2 level hospital testing room. It takes three hours for a sample to be tested. A virologist said. However, in Wuhan, at present, not every fever clinic can be tested in the first time, and the results still need to wait for 2 days. There may be changes in the future. Some diagnostic reagent products that are being urgently submitted for approval will make it possible to quickly screen suspected patients on a large scale. Source: First Financial Editor: Han Jiapeng Peng Peng nn9841

In many outpatient clinics, because there is no way to test, after doing CT, they will be asked to go to a large hospital for nucleic acid test again, and need to run two times to the hospital. Said the doctor.

The uneven distribution of nucleic acid diagnostic reagents makes it difficult to detect patients in time. At the beginning, the diagnosis needs to be carried out in the P3 level laboratory, so the patient samples need to be sent to the conditional testing institutions for testing, but now the diagnostic reagents have been improved, which can be done in the P2 level hospital testing room. It takes three hours for a sample to be tested. A virologist said.

However, in Wuhan, at present, not every fever clinic can be tested in the first time, and the results still need to wait for 2 days.

There may be changes in the future. Some diagnostic reagent products that are being urgently submitted for approval will make it possible to quickly screen suspected patients on a large scale.