What is the critical illness treatment capacity and medical resource reserve in China at this stage? National Health Commission said on the 9th that the number of intensive care beds in China is close to 10/65438+ 10,000, with a total of 138 10000, including beds in tertiary medical institutions 106500. At the same time, the total number of intensive care physicians is 80,500, the number of reserve doctors in "convertible ICU" is106,000, the total number of intensive care nurses is 220,000, and the number of nurses in "convertible ICU" is177,700.
Zhong Ming, director of the Department of Critical Care Medicine of Zhongshan Hospital affiliated to Fudan University, told the First Financial Reporter that at this stage, the plan for severe illness has been very clear, and the problem to be solved is the "management" level, that is, once there are orders of magnitude of patients coming in, our resources can accommodate it; If the medical resources are overloaded, how to deal with it can maintain a stable order and let patients get timely treatment. This is the core and a big test at the moment.
CBN: Are medical institutions ready for critical care?
Zhong Ming: According to the existing national regulations, the comprehensive ICU of tertiary hospitals needs to reach 4% of the total number of beds; All specialized ICU beds are converted into convertible ICU beds according to the proportion of 4% of the total number of beds, and can be quickly converted into intensive ICU resources within 24 hours when needed; Ensure that comprehensive ICU and convertible ICU reach 8% of the total number of hospital beds. I believe that next, tertiary hospitals in various places will be deployed according to these standards.
As far as our team is concerned, we actually had some expectations for the adjustment of future epidemic prevention measures earlier. These expectations include: in a short time, the absolute number of critically ill patients who need treatment will increase, and the demand for critically ill medical resources will be great. Therefore, the allocation of related medical equipment and medical posts is also predicted in advance.
At present, the ICU of our hospital has made corresponding reserves, and we have also made corresponding plans according to the setting requirements of ICU wards and sub-ICU wards. But in fact, the present situation of a hospital cannot represent the overall situation of society, but should be treated as a whole.
CBN: How to dynamically adjust the intensive care strategy in the future?
Zhong Ming: Obviously, if there are many COVID-19 infected people in a period of time, and most of them have to go to the hospital, it will be a huge challenge to the allocation of medical resources. Therefore, we have always stressed that most people do not need to go to the hospital, but it will cause a run on medical resources.
At the same time, we also need to optimize related processes. The number of patients must not increase sharply, but there is a certain increasing trend, so we can pay attention to it in advance. Therefore, firstly, the work intensity of medical staff involved in severe cases will be greatly increased, and secondly, the work roles of some medical staff need to be changed to treat COVID-19 patients. Generally speaking, medical staff will work harder.
CBN: According to your epidemic situation in Wuhan in 2020 and your subsequent support experience in Jilin and Hainan, what are the differences between intensive care in COVID-19?
Zhong Ming: When the Wuhan epidemic occurred in 2020, we were still a little strange to COVID-19, but unlike then, at this stage, our plan for severe treatment was actually very clear, and what we lacked most was not the knowledge of how to treat it.
What needs to be solved at this stage is the problem of "management", that is, once an order of magnitude patient comes in, can our resources accommodate it? If the medical resources are overloaded, how to deal with it in order to maintain a stable order and let patients get timely treatment is the core and a big test at present.
Therefore, the ability to optimize the allocation of resources is particularly important. The overall medical staff is still the same, but under certain circumstances, if there are not enough medical staff in ICU, some medical staff with intensive care background will be temporarily transferred to join the ICU. We need to optimize the mechanism and space and increase the relevant equipment of intensive care under the condition that the number of existing personnel remains unchanged.
Zhong Ming rushed to Jilin for help. Source: Guan Wei, Zhongshan Hospital
CBN: How will the COVID-19 epidemic develop?
Zhong Ming: COVID-19 positive family isolation actually means that COVID-19 will spread in society, but it is also an important step to optimize epidemic prevention measures.
It is predicted that the epidemic situation in COVID-19 will reach the peak of infection within 1 month. But when will it end later, this model will be more complicated. The reason is that virus infection and recovery do not happen at the same time. From the perspective of medical institutions, simultaneous infection will lead to the concentration of personnel and the shortage of medical resources; Therefore, orderly and gradual medical care can make medical institutions have stronger coping ability, but it will be longer than this period.
At this stage, our department has not accepted COVID-19-positive patients, but our "Medical Association" organization is ready.
First Finance: How should the elderly and people with basic diseases manage themselves?
Zhong Ming: The elderly and people with basic diseases have always been regarded as special and key groups.
These people should strengthen self-health monitoring during their stay at home. If you find that the primary disease is aggravated, or the symptoms such as chest tightness and shortness of breath are aggravated, you should seek medical advice in time. At the same time, eligible elderly people and basic patients can also check the oxygen saturation value. Once the oxygen saturation value is low, they need to seek medical attention in time.
In addition, for a special institution like nursing home, it is suggested that the management should be positive, positive and relatively closed, so as not to let the momentum of COVID-19 infection spread to nursing homes, among which the people are vulnerable and susceptible.
CBN: How to prevent asymptomatic and mild infections from becoming severe?
Zhong Ming: First of all, vaccination is necessary for the general population. Secondly, if the general population is infected, it needs regular rest to maintain the normal operation of the immune system. Only the vulnerable special population need to do health monitoring, including measuring body temperature and monitoring blood oxygen saturation with fingertip oximeter. Thirdly, the perception of conscious symptoms, including the original basic diseases, chronic diseases, and whether the related symptoms are aggravated, will be familiar to you.