Surfing News 1 from Shanghai Minhang District was informed that on the morning of January 1, the National Center for Infectious Diseases, director of the National Center for Infectious Diseases, Fudan University Huashan Hospital, Director of Infectious Diseases Zhang Wenhong came to Xinzhuang Community Health Service Center in Shanghai's Minhang District, to research and guide the community of the new Coronavirus infections medical treatment work.
In Xinzhuang Community Health Center, Zhang Wenhong visited the fever clinic, light clinic, general clinic, pharmacy and other areas to understand the process of receiving fever patients, the number of patients, and the allocation of resources for treatment, and provided on-the-spot guidance to solve the difficult problems in the work.
On the morning of January 1, Zhang Wenhong, director of the National Center for Infectious Disease Medicine and director of the Division of Infection at Huashan Hospital affiliated with Fudan University, came to Xinzhuang Community Health Service Center in Minhang District, Shanghai, to research and guide the medical treatment of new coronavirus infections in the community. All images are from Minhang District
Ensure that patients with minor illnesses receive timely treatment at the grassroots level
How should community health service centers play a role in the protection of medical services and treatment work in the near future? Zhang Wenhong pointed out in the field research, the current focus on "prevention of serious illnesses, strong treatment", community health centers should play a good hierarchical diagnosis and treatment of the advantages of the front line, and continue to expand medical resources, with adequate medical power, treatment equipment and drug reserves supply, optimize diagnosis and treatment service process, and comprehensively enhance the ability to provide medical treatment and service protection!
Zhang Wenhong also mentioned that the disease infection period should be "early detection, early intervention, early treatment" as the focus of diagnosis and treatment, to play the role of primary health care institutions "bottom of the net" and family doctors health "gatekeeper". To play the role of primary medical institutions "net bottom" and family doctor health "gatekeeper", to do a good job of key groups of people graded and classified diagnosis and treatment, relying on family doctor contracting services, focusing on the elderly, children, patients with basic diseases, pregnant and pregnant women and other vulnerable groups of health monitoring and service protection, effective guidance for reasonable medical care, smooth referral channels for patients with serious illnesses, and make every effort to reduce the incidence of serious illnesses caused by infection of the new coronavirus, and the death rate, and to protect the life safety and physical health of the population to the greatest extent possible. The people's life safety and physical health.
Small molecule therapeutic drugs have been put into use in the community of Xinzhuang
The surging news reporter learned from Minhang District, with the number of infected people in the community continues to rise, Xinzhuang Community Health Service Center to take multiple measures to save patients. On the basis of the introduction of the "midday even a company" "evening delay a" convenient medical services, additional daytime "light clinic", equipped with finger-clip oximeter, oxygen concentrator, non-invasive ventilator and other instruments and equipment, to provide patients with light illnesses. Instruments and equipment, for patients with minor illnesses to provide a full range of personalized diagnostic and treatment services.
In the expansion of the overall treatment capacity, the center will be the original fever sentinel clinic to expand into a fever clinic, increase the infusion area and oxygen therapy area seats, to better meet the needs of patients.
Xinzhuang Community Health Center
In terms of expanding the overall treatment capacity, Xinzhuang Community Health Center has expanded the original fever sentinel clinic into a fever outpatient clinic, and increased the number of seats in the infusion area and the oxygen therapy area, so as to better meet the needs of patients.
Based on the symptomatic characteristics of this new crown infection, the center is also equipped with antipyretic, antipyretic, antitussive, analgesic and expectorant medicines for the past 2 weeks, through the packaging of the split, proprietary Chinese medicines instead of other ways to ensure that multiple channels to protect the use of medication for patients with fever to visit the clinic. Recently, the center also introduced small molecules of new coronavirus treatment drugs, now put into clinical use.
According to statistics, since December 2022, the average daily attendance of Xinzhuang Community Health Center has reached 3,200, and the average daily attendance of fever clinic has increased to 300. Through the 24-hour health consultation hotline and Internet clinics, the center provides more convenient and efficient health management services for key populations as well as positive homebound people.
Xinzhuang Community Health Center
Since December 2022, the average number of daily visits to the Xinzhuang Community Health Center has reached 3,200, and the average number of daily visits to the fever clinic has increased to 300 visits.
Extended reading
Zhang Wenhong: I have been infected with omikron the first day of home the next day to check the room
Rushed to the hospital early in the morning to participate in the hospitalized critically ill patients of the shift, checking the room; in the morning, to participate in the municipal leaders convened by the new crown of the critical patients rescue and treatment of the thematic meeting; at noon to return to the hospital, to discuss the rescue and treatment program of a few newly admitted into the hospital of the critically ill patients; 13:30, to participate in the training activities for medical staff on the standardization of treatment for elderly patients; at 14:30, together with Chen Erzhen, vice president of Ruijin Hospital, as a treatment expert, discussing with the relevant leaders of Shanghai districts*** on how to continue to expand and expand the grass-roots treatment capacity; at 16:30, rushing to another tertiary hospital to consult with more than 10 elderly people infected with the new coronavirus
December 2022 29, Shanghai new crown epidemic prevention and control of treatment expert group leader, Fudan University Affiliated Huashan Hospital, director of the Department of Infectious Diseases Zhang Wenhong's work schedule, but also a microcosm of the busy state of the recent Shanghai treatment experts. In the evening, during a break from work, Dr. Zhang Wenhong accepted an exclusive interview with Dajiangdong Studio.
Dajiandong: Please tell us about the main features of this new wave of coronavirus infections in Shanghai and the recent treatment of patients.
Zhang Wenhong:
Shanghai has reached the peak state of infection since December 22, and according to estimates, the number of infected people is now at the level of 10 million. Assuming that 0.5 percent of the 10 million infected people in Shanghai need to be hospitalized, that means 50,000 people will need to be hospitalized in the near future in the next few weeks, and major hospitals will have to admit thousands of people without exception, with those who are particularly critically ill needing respiratory support. So while the proportion of severe cases in the infected population is low, the base is large and the absolute numbers are still high, and that's what characterizes this wave of omicron infection --
We face the kind of daunting challenge that all countries have experienced at the beginning of the opening of an epidemic.
Shanghai is now making every effort to improve its ability to treat critically ill patients, with all doctors and nurses, from primary health care organizations to tertiary hospitals, engaged in an all-out battle against omicron.
The first is to enhance the grass-roots community's treatment capacity, including increasing the number of treatment points, training medical staff, providing oxygen therapy, antiviral drugs, the development of standardized diagnostic and treatment manuals,
To allow more patients to get effective treatment in the onset of the "golden 72 hours", so that the serious patients as soon as possible through the hierarchical system of diagnosis and treatment The first is to allow more patients to receive effective treatment within the "golden 72 hours" of the onset of illness, so that seriously ill patients can be referred to higher-level hospitals as soon as possible through the hierarchical treatment system.
The second is that the second and third tier hospitals to expand the number of beds, optimize the admission process, so that emergency seriously ill patients as far as possible within 24 hours can be admitted to complete all the new crown resuscitation process. My Huashan Hospital, in addition to the hundreds of beds in the infectious diseases department in various hospital districts, today took out a number of other departments two floors of beds, as the hospital centralized admission of public **** platform.
DJT: What are the characteristics of the response and treatment of this wave of the epidemic compared to the previous one? Do doctors have newer drugs or treatments?
Zhang Wenhong: After these three years, we have developed a lot of standardized processes for treatment. Through research and analysis of previous deaths and severe cases, we found that vaccination can effectively reduce the rate of severe disease and mortality. Vigorously promoted through multiple campaigns, many people have completed the full vaccination. We have also made certain preparations in terms of antiviral drugs, respiratory support, ICU wards and equipment. In the treatment process, according to the characteristics of severe new crowns, early use of oxygen therapy to correct hypoxia, use of hormones to improve inflammation as well as early anticoagulation are used. Generally speaking, the peak of critical care will follow the peak of infection, and the weapon to cope with this is to make the greatest effort and work tirelessly to lay out medical resources, from primary hospitals to tertiary hospitals, to seize the 72-hour "golden hour" of treatment as quickly as possible, whether it is early primary care in the community or emergency care for critically ill patients.
Striving to be faster and earlier in order to grab time and life with the God of Death and strive to reduce the rate of serious illnesses and deaths, we must
Strive to be more efficient in the treatment of serious illnesses.
Zhang Wenhong video interview
Da Jiangdong: The elderly and vulnerable people with underlying diseases are the most concerned groups in this wave of infection. What preparations have been made for the protection and treatment of vulnerable people in Shanghai, which is highly aging?
Zhang Wenhong: Shanghai's nursing homes are home to 88,000 elderly people, nursing homes are home to 22,000 people, and there are 700,000 to 800,000 elderly people with a variety of basic diseases, and more than 5 million people over the age of 60. Shanghai has done a comprehensive mapping of the situation. In addition to promoting vaccination, our earlier thinking was to try to protect the elderly and vulnerable groups from being infected in this wave of the epidemic, so nursing homes were closed, and the elderly were advised to stay at home, go out less, and not to come out to square dance or play mahjong, so as to lower the peak of infection in the key populations, and to slow down the time of their infection. However, in the rapid tsunami-like spread of omicron, the infection rate of the elderly is still relatively high, and the number of seriously ill patients is also increasing.
Shanghai is now entering a critical period of Armageddon, when it is trying to bring medical resources to the elderly so that vulnerable people can receive timely treatment within the "golden 72 hours. All districts in Shanghai are organizing to bring medical power down to nursing homes and homes for the elderly, and municipal expert groups are also docking with the grassroots in different regions to strengthen consultation, checkups and training.
This time, it's a full-scale power showdown between us and Omicron.
There's no chance of getting any luck, and the problem can't be solved by opening a few more intensive care units in the tertiary hospitals, but rather, we need to mobilize effectively from the grassroots to the central level, and every family needs to know how to maintain the vulnerable people, and in what cases they need to go to the hospital; every community health center should be able to expand the treatment force as much as possible
The struggle to hold on to the vulnerable people infected with the disease is the only way we can grit our teeth and get through this pandemic. The pandemic will not be a pandemic, but a pandemic will be a pandemic.
Da Jiangdong: Some people have said that the main strains of this wave of infections, BA.5 or BF.7, are more "toxic".
Zhang Wenhong: the current main strains are widely prevalent in foreign countries, all scholars have done toxicity comparisons, BA.5, BF.7 of the rate of severe illness, mortality rate and the first generation of omikron is very close. Many people who are infected with Omicron feel more serious symptoms such as fever and muscle aches, and they even call themselves "razor blade strain" and "dry rice strain", but such people are still suffering from mild symptoms. Serious illnesses are clearly defined medically: respiratory distress, oxygen saturation less than 93%; CT tests show more extensive infiltration of the lungs, with large shadows or even white lungs. If oxygen doesn't help, and tracheotomy and mechanical ventilation are needed, it's critical care.
We carry out continuous monitoring of the viral genome, and now no new specific strains have been found, Shanghai is now mainly BA.5, BF.7, and the proportion of them that cause severe disease is clear.
Da Jiangdong: Have you ever been infected with Omicron? Were the symptoms severe?
Zhang Wenhong: Infected, my symptoms are very mild. The first day of home rest, six or seven network meetings; the next day to the positive ward check. No one in the neighborhood thought I had been infected, because every day in the ward, were working. I had my fourth dose, and my own experience has made me more supportive of vaccination
Daejangdong: From the beginning of the outbreak to the present day, you have emphasized a lot on the importance of strengthening nutrition, especially protein intake. Why do you emphasize nutrition so much in the treatment of respiratory diseases?
Zhang Wenhong: In participating in the epidemic treatment and checkups, I have seen a lot of cases. 2020, a lot of overseas imported cases are often because of the road to change planes, three meals are not given, nutritional deficiency, infection and quickly aggravated. During the outbreak in Shanghai from April to June this year, many elderly people went to square pods or isolated hotels because they suddenly left their familiar environment such as nursing homes, and coupled with lung infections and changes in underlying diseases, their nutritional intake was affected, and their resistance dropped drastically, and their symptoms suddenly worsened. This time, we also found that, because of the emergency medical resources constraints, it is difficult to ensure adequate nutritional supply of patients stranded in the emergency department, two or three days, nutrition can not keep up with the problem, there will also be a problem of accelerated progress of the serious illnesses, which may not necessarily play a role in the effectiveness of the means of salvage. The quality of nutrition is good, the immunity level is good, the patient may be able to carry through.
Nutrition is the foundation of the treatment of new crown infection. With nutrition comes resistance, and the importance of nutrition cannot be overemphasized. It is hoped that during this time, all infected people or elderly people under home observation must pay special attention to increasing nutrition, with a varied and balanced intake of vegetables and carbohydrates, and the intake of high-quality proteins is a top priority.
Dajangdong: In early 2022, you said you studied medical images of people infected with Omicron and that it was not a "major flu", and that you thought the mutant strain "would bite. What did you see on the images? Now, where does it mainly "bite"?
Zhang Wenhong: At the time, many people thought that Omicron only attacked the upper respiratory tract and that its virulence had decreased. Compared with the Delta strain, the virulence of Omicron is indeed significantly reduced. 2022 early, Shanghai has assumed the function of the main entry point of international flights, imported cases continue. I look at the film and see that the incidence of severe illness is declining overall with omicron, but there are still pneumonia manifestations in vulnerable populations.
The reality of the clinic tells us that by no means can it be said that omicron is not dangerous to everyone and does not invade the lungs.
Influenza has been endemic in the world for more than 100 years, and we have built up a degree of cross-immunity. The new crown is a new virus, and the risk is rapidly amplified when the infection is widespread. Recently, we can see more clearly that omicron does "bite", with vulnerable people showing symptoms of pneumonia and some even needing to be intubated. Omicron has a low rate of severe illness, but it would be wrong to say that it is all upper respiratory symptoms and "doesn't bite". China's infected population is so large, even if it only "bites" a few, but all the bites are the elderly, vulnerable people, will make our hearts very painful and anxious.
We are now in the phase of the first wave of the impact of the opening of the particularly rapid Omicron, particularly difficult. We must gather the strength of the whole society, expand medical resources, protect the vulnerable people, struggle to carry the impact of omicron, out of this wave of the epidemic, and achieve final victory.