On June 5438+0, the paper learned from Minhang District, Shanghai that on the morning of June 5438+0, Zhang Wenhong, director of the National Infectious Diseases Center and director of the Infectious Diseases Department of Huashan Hospital affiliated to Fudan University, came to Xinzhuang Community Health Service Center in Minhang District, Shanghai to investigate and guide the medical treatment of COVID-19 infection in the community.
In Xinzhuang Community Health Service Center, Zhang Wenhong inspected the fever clinic, light clinic, general clinic, pharmacy and other areas on the spot, learned about the process of receiving fever patients, the number of patients and the allocation of treatment resources, and gave on-site guidance to solve difficult problems in the work.
On the morning of June 65438+ 10/KLOC-0, Zhang Wenhong, director of the National Center for Infectious Diseases and director of the Infectious Diseases Department of Huashan Hospital affiliated to Fudan University, came to Xinzhuang Community Health Service Center in Minhang District to investigate and guide the medical treatment of COVID-19 infection in the community. All the pictures in this article are Minhang District.
Ensure that mild patients get timely treatment at the grassroots level.
How should community health service centers play a role in medical service guarantee and treatment in the near future? Zhang Wenhong pointed out during the field investigation that at present, it is necessary to focus on "preventing serious illness and strengthening treatment", and community health service centers should give full play to the advantages of the forefront of graded diagnosis and treatment, continuously expand medical resources, fully equip medical forces, treatment equipment and drug reserves, optimize the diagnosis and treatment service process, comprehensively improve the medical treatment and service guarantee capabilities, ensure that mild patients can be treated in primary medical institutions in time, meet the people's normal medical needs, and effectively alleviate the peak pressure of medical treatment in secondary and tertiary medical institutions.
Zhang Wenhong also mentioned that "early detection, early intervention and early treatment" should be regarded as the focus of diagnosis and treatment during the infection period, and grass-roots medical institutions should play the role of "net bottom" and family doctors as "gatekeepers", classify and treat key groups, rely on family doctors to sign contracts, focus on health monitoring and service guarantee for vulnerable groups such as the elderly, children, patients with basic diseases and pregnant women, effectively guide reasonable medical treatment, and smooth the referral of severe patients.
Small molecule therapeutic drugs have been put into use in Xinzhuang community.
Our reporter learned from Minhang District that with the increasing number of people infected in society, Xinzhuang Community Health Service Center has taken various measures to treat patients with all its strength. On the basis of "connecting at noon" and "delaying at night", a daytime "light consultation room" is added, equipped with finger-clip oximeter, oxygen generator, noninvasive ventilator and other instruments and equipment to provide comprehensive and personalized diagnosis and treatment services for mild patients.
In terms of expanding the overall treatment capacity, the center transformed the original fever clinic into a fever clinic, and added seats in the infusion area and oxygen therapy area to better meet the needs of patients.
Xinzhuang community health service center
In terms of expanding the overall treatment capacity, Xinzhuang Community Health Service Center transformed and expanded the original fever sentinel clinic into a fever clinic, and added seats in the infusion area and oxygen therapy area to better meet the needs of patients.
According to the symptoms and characteristics of the infection in COVID-19, the center has also equipped drugs for relieving fever and pain, clearing away heat and toxic materials, relieving cough and resolving phlegm in the past two weeks, and ensured that patients with fever can use drugs through multiple channels by unpacking and replacing Chinese patent medicines. Recently, the center also introduced a small molecule COVID-19 treatment drug, which has been put into clinical use.
According to statistics, since June 5438+February, 2022, the average daily number of patients in Xinzhuang Community Health Service Center has reached 3200, and the average daily number of patients in fever clinics has increased to 300. The center provides more convenient and efficient health management services for key populations and positive family members through 24-hour health consultation hotline and Internet diagnosis and treatment.
Xinzhuang community health service center
Since June 5438+February, 2022, the average daily number of patients in Xinzhuang Community Health Service Center has reached 3200, and the average daily number of patients in fever clinics has increased to 300.
Extended reading
Zhang Wenhong: I was infected by Omicron. The first day I stayed at home, I went on a tour the next day.
Rushed to the hospital early in the morning to attend the handover and rounds of critically ill inpatients; In the morning, I attended a special meeting on the treatment of critically ill patients in COVID-19 held by city leaders. Go back to the hospital at noon to discuss the treatment plan of several newly admitted critically ill patients; 13:30 to participate in the training activities of medical staff on treatment standards for elderly patients; 14:30, together with Chen erzhen, vice president of Ruijin Hospital, as a treatment expert, we discussed with relevant leaders of various districts in Shanghai how to continue to expand and expand the primary treatment capacity. /kloc-0 rushed to another 3A hospital at 6: 30, and consulted 10 many elderly people infected with COVID-19.
From June 5, 20438 to February 29, 2022, the work schedule of Zhang Wenhong, head of the expert group on epidemic prevention and control in COVID-19, Shanghai, and director of the infectious diseases department of Huashan Hospital affiliated to Fudan University, also epitomized the recent busy state of Shanghai rescue experts. In the evening, during the work break, Dr. Zhang Wenhong accepted an exclusive interview with Dajiangdong Studio.
Dajiangdong: Please introduce the main features of this wave of COVID-19 infection in Shanghai and the recent treatment of patients.
Zhang Wenhong:
Shanghai reached the peak of infection from February 22, 65438. It is estimated that the number of infected people is tens of millions. Assuming that 0.5% of Shanghai100000 infected people need to be hospitalized, it means that 50000 people will need to be hospitalized in the next few weeks, and all major hospitals will treat thousands of people without exception, among which the particularly critical ones need respiratory support. Therefore, although the proportion of severe cases in infected people is low, the base is large and the absolute number is still large. This is the characteristic of this wave of Omicron infection-
We are facing severe challenges that all countries have experienced at the beginning of the epidemic.
At present, Shanghai is making every effort to improve its ability to treat critically ill patients. From primary health institutions to tertiary hospitals, all doctors and nurses are engaged in an all-round Omicron campaign.
First, improve the treatment capacity of grass-roots communities, including increasing the number of treatment points, training medical staff, providing oxygen therapy and antiviral drugs, and formulating standardized diagnosis and treatment manuals.
More patients should be effectively treated within the "golden 72 hours" of onset, and critically ill patients should be referred to higher-level hospitals through the graded diagnosis and treatment system as soon as possible.
Second, secondary and tertiary hospitals should expand the number of beds, optimize the admission process, treat emergency patients with severe illness within 24 hours as much as possible, and complete all COVID-19 rescue processes. Huashan Hospital, where I am located, has hundreds of beds in infectious diseases departments of various campuses, and today it has taken out some two-story beds in other departments as a public platform for centralized treatment in the hospital.
Dajiangdong: Compared with before, what are the characteristics of this wave of epidemic response and handling? Does the doctor have any newer drugs or treatments?
Zhang Wenhong: After these three years, we have formed many standardized treatment procedures. Through the research and analysis of past deaths and severe cases, we found that vaccination can effectively reduce the severe and mortality rates. Through publicity and vigorous promotion, many people have completed the whole vaccination. Some preparations have also been made in antiviral drugs, respiratory support, ICU wards and equipment. In the course of treatment, according to the characteristics of severe COVID-19, oxygen therapy should be used as early as possible to correct hypoxia, hormone should be used to improve inflammation, and early anticoagulation therapy should be used. Generally speaking, the summit of intensive care comes shortly after the peak of infection. The weapon to deal with is to allocate medical resources with the greatest efforts and sleepless spirit, and seize the 72-hour "prime time" treatment from primary hospitals to tertiary hospitals as quickly as possible, whether it is early primary medical care in the community or emergency treatment for critically ill patients.
Strive to be quick and early, so as to compete with death for time and life, and strive to reduce the rate of severe illness and mortality.
Zhang Wenhong video interview.
Dajiangdong: The elderly and vulnerable people with basic diseases are the most worrying groups in this wave of infection. What preparations has Shanghai, which has a high degree of aging, made for the protection and treatment of vulnerable people?
Zhang Wenhong: There are 88,000 elderly people living in nursing homes and 22,000 people living in nursing homes. There are 700,000 to 800,000 elderly people with various basic diseases at home, and there are more than 5 million elderly people over 60 years old. Shanghai has made comprehensive arrangements for this. In addition to promoting vaccination, our early idea was to try our best to protect the elderly and vulnerable groups from being infected in this wave of epidemic. Therefore, the closed management of nursing homes should be implemented, and the elderly should be advised to go out less at home, not to go out to dance in square dance and play mahjong, so as to reduce the infection peak line of key people and delay their infection time. However, in the process of Omicron spreading like a tsunami, the infection rate of the elderly is still high, and the number of seriously ill patients is also increasing. At present, we are entering a critical period of Armageddon.
Shanghai is trying to send medical resources to the old people, so that the vulnerable people can get timely treatment in the "golden 72 hours". All districts in Shanghai are organizing hospitals to be sent to nursing homes and nursing homes, and municipal expert groups are also docking with grassroots units in different regions to strengthen consultation, rounds and training.
This time, it is a full-scale power confrontation between us and Omicron. There is no chance to cheat. It's not that more intensive care units can be opened in tertiary hospitals, but that effective mobilization should be carried out from the grassroots to the center. Every family should also know how to protect the vulnerable groups and when to go to the hospital for treatment. Each community health center can also expand the treatment power as much as possible.
Try to keep the vulnerable people from being infected. We can bite our teeth in this epidemic.
Dajiangdong: Some people say that the main strain of this wave of infection, BA.5 or BF.7, is more "toxic". Does this make sense?
Zhang Wenhong: At present, the main strains are widespread abroad, and some scholars have compared their virulence. The severity and mortality of BA.5 and BF.7 are very close to those of the first generation Omicron. Many people feel fever, muscle aches and other symptoms are more serious after infection, and they also have dazzling names, such as "blade strain" and "upland rice strain", but these people are still relatively mild. Severe disease is clearly defined in medicine: dyspnea, oxygen saturation below 93%; Do CT to check the extensive infiltration of the lung, and there is a large area of shadow or even white lung. If oxygen inhalation doesn't work, tracheotomy and mechanical ventilation are needed, which is very important.
We have continuously monitored the virus genome and found no new special strains. At present, BA.5 and BF.7 are the main strains in Shanghai, and the proportion of severe diseases caused by them is clear.
Dajiangdong: Have you ever been infected with Omicron? Are the symptoms serious?
Zhang Wenhong: Yes, my symptoms are mild. On the first day, I rested at home and held six or seven online meetings. Go to the positive ward for rounds the next day. No one around thinks I'm infected, because I'm in the ward every day and I'm working. I took the fourth injection, and my own experience made me more supportive of vaccination.
Dajiangdong: Since the outbreak, you have always stressed the importance of strengthening nutrition, especially the intake of protein. Why should we pay so much attention to nutrition when treating respiratory diseases?
Zhang Wenhong: I have seen many cases when I participated in epidemic treatment and rounds. In 2020, many imported cases are often caused by wandering around on the road, not giving three meals, malnutrition, and the condition is rapidly aggravated after infection. During the epidemic in Shanghai from April to June this year, many elderly people suddenly left the familiar environment such as nursing homes and went to cabins or isolation hotels. Coupled with lung infection and changes in basic diseases, their nutritional intake is affected, their resistance is greatly reduced, and their symptoms suddenly worsen. This time, we also found that because of the shortage of emergency medical resources, it is difficult for patients stranded in the emergency department to ensure adequate nutritional supply. After two or three days, nutrition can't keep up, and the progress of severe illness will accelerate. Treatment may not be effective at this time. The nutrition quality is good, the immunity level is good, and patients can carry it.
Nutrition is the basis of treating COVID-19 infection. Only with nutrition can we resist, and the importance of nutrition cannot be overemphasized. It is hoped that during this period, all infected people or the elderly who are observing at home must pay special attention to increasing nutrition, and take in vegetables, carbohydrates and other diverse and balanced intake, and the intake of high-quality protein is the most important.
Dajiangdong: At the beginning of 2022, you said that you studied the medical images of Omicron-infected people, but it was not an "epidemic flu" and thought that this variant would "bite people". What do you see in the image? Now, where does it mainly "bite"?
Zhang Wenhong: At that time, many people thought that Omicron only invaded the upper respiratory tract and its toxicity was reduced. Compared with Delta strain, the virulence of Omicron was obviously reduced. At the beginning of 2022, Shanghai assumed the function of the main port of entry for international flights, and imported cases continued. I saw from the film that the overall incidence of severe disease in Omicron was declining, but there were still pneumonia manifestations in the vulnerable population.
Clinical practice tells us that it can never be said that Omicron is not dangerous to everyone and will not invade the lungs.
Influenza has been prevalent all over the world for 100 years, and we have also established a certain degree of cross-immunity. COVID-19 is a new virus. If the infection is widespread, the risk will increase rapidly. Recently, we can see more clearly that Omicron can really "bite", vulnerable people will have pneumonia symptoms, and some people even need intubation. The severity rate in Omicron is not high, but it is wrong to say that it is all upper respiratory symptoms and "don't bite". China has such a huge number of infected people, even if we only "bite" a few bites, all we can bite are the elderly and the vulnerable, which will make our hearts very painful and anxious.
We are now in the first shock stage of Omicron, which is particularly rapid and difficult after opening up. We must gather the strength of the whole society, expand medical resources, protect the vulnerable groups, and strive to shoulder the impact of Omicron, get out of this epidemic and win the final victory.