Jiao also said the number of hospitalized new crown infections now shows a continuous downward trend, according to surveillance data. It reached a peak of 1.625 million hospitalized new crown infections on Jan. 5, and then declined continuously, falling back to 1.27 million on Jan. 12, with the percentage of hospitalized new crown infections showing a continuous downward trend.
Jiao Yahui
The surveillance data showed that 2 weeks after the fever clinic peaked, the number of hospitalized new crown-positive critically ill patients also peaked, and then showed a slow downward trend. At present, the number of hospitalized patients with severe illnesses is still at a high level. on January 5, 2023, the number of hospitalized patients with new crown-positive severe illnesses reached a peak of 128,000, and then fluctuated downward continuously, and the number of hospitalized patients with positive severe illnesses dropped back to 105,000 on January 12, and the utilization rate of intensive care beds was 75.3%, which was able to satisfy the need for intensive care beds.
January 12 morning, zhejiang province health commission director WangRenYuan in the provincial people's congress after the opening of the first meeting, said, at present, zhejiang fever outpatient clinic visits fell significantly, 120 emergency and emergency is also currently in the stage of gradual decline, the province's overall epidemic has been over the peak of the infection, is expected to fall to a lower level of prevalence at the end of January. However, hospitalization and serious and critical cases are currently still at a peak plateau, with about 90 percent of those over 60 years of age. He said, "The province's medical resources are generally in balance and can basically meet the medical treatment needs of the current epidemic prevention and control, but it is still in the most critical stage, and the task of treating severe and critical illnesses is still very difficult."
On the evening of January 8, the China News Weekly reporter interviewed Cai Hongliu, director of the Department of Critical Care Medicine at the First Hospital Affiliated to Zhejiang University School of Medicine. He is an expert of the State Council's Joint Prevention and Control Mechanism medical treatment group, and has participated in the fight against the epidemic in Shijiazhuang, Hebei in 2021, Changchun, Jilin in 2022, Shanghai and Sanya, Hainan. For nearly three weeks, as the director of the comprehensive ICU, Cai Hongliu's work intensity has been continuously increasing. On the very Sunday of the interview, his day was packed, discussing cases during the day and training on the 10th edition of the diagnosis and treatment program at night. It was not until 10:30 p.m. that he finished his day's work and talked to the reporter about Zhejiang's preparations before the peak of critical care, why ICU remodeling takes time, how to train a critical care team that can go to war in a short period of time, and what are the major misconceptions about the treatment of new crowns. He said frankly, "After the '20 measures' were introduced, I speculated that the rise in infections in China might take three months to go the way other countries have gone in three years, and it actually took us less than 20 days." Here is Cai Hongliu's account:
Zhejiang has been gradually entering the peak of severe cases since mid-December 2022, and is still in the plateau period, with no obvious inflection point. My hospital, the First Affiliated Hospital of Zhejiang University School of Medicine, the biggest pressure was in the early days when the number of infections began to surge, a large number of health care collapsed and the peak of infections partially overlapped into one. Staffing was so tight that doctors in one of our hospital districts even rented a house next to their unit to use as a group home. The doctors and nurses who were positive lived there, and when they couldn't hold out after seven or eight hours of work, they went to lie down for three or four hours before returning to the hospital to continue the fight.
In the past three weeks, the intensity of our intensive care medical care has been continuously increasing, the proportion of admitted critically ill patients who are of advanced age and whose original bases have been aggravated by infection with a new crown is increasing, and the hospitalization cycle is also lengthening. At the same time, the ICU beds we are responsible for have increased exponentially. For example, the Department of Critical Care Medicine, where I work, originally had 184 beds, and then four new wards were opened, adding more than 100 beds. And the entire hospital before the ICU beds a **** is more than 250, now ready ICU beds increased to nearly 600.
The National Health Commission from the beginning of December last year has constantly emphasized that the three hospitals comprehensive ICU to reach 4% of the total number of hospital beds, the various specialized ICUs are also in accordance with the proportion of 4% of the total number of beds converted convertible beds, that is, to ensure that the comprehensive ICUs and convertible ICUs total **** can reach the total number of beds in the hospital of 8 percent, the transformation must be completed by the end of December last year. And according to previous requirements, the number of ICU beds in hospitals above the second level accounted for 2% to 8%, that is to say, 8% is already the ceiling.
Usually, the transformation of ICU beds usually takes at least a few months, but now there is less than a month.
Medical staff are caring for a patient in the respiratory ward of Huzhou City Central Hospital on the evening of Jan. 11, 2023, in Huzhou, Zhejiang province. Photo/Visual China
Why does it take time to remodel an ICU? Because it's not as simple as adding a bed, for example, respiratory machine, not to move it over on the line, it's immediately after the gas equipment belt, remodeling the ICU on the ward oxygen, air, negative pressure suction interface, power outlets and so on have very strict requirements, we require a bed an air switch. ICU are life monitoring, support equipment, once the problem occurs, it may be a split second of life, so the ICU must be a good place to start, and the ICU is a good place to start. So remodeling the ICU must ensure quality while pursuing speed.
The Zhejiang Provincial Health Commission recently organized a tour of critical care medical and nursing experts to 22 medical units in 11 prefecture-level cities across the province to treat critical cases. I found during the just-concluded tour that because hospitals are scrambling to remodel their ICUs, the current supply of critical care medical equipment is tighter, and some county hospitals are in a tight balance of ventilators, high-flow oxygen therapy equipment, and CRRT machines.
Hardware remodeling and equipment purchases are not the biggest challenge, the most difficult is that there is no way to increase ICU medical care in the short term. The training of a qualified ICU doctor requires at least three years of specialized training, because the ICU is admitted and treated by patients with serious and rapidly changing conditions, and therefore relies on a lot of monitoring and therapeutic equipment, such as monitors, ventilators, CRRT machines, ECMO, etc., and therefore we in the industry describe critical care doctors and nurses as "Special Forces" who have to face a large number of patients with critical conditions, and who have to deal with a large number of patients with critical conditions every day, and who have to deal with a large number of patients with critical conditions. They have to face a large number of critically ill and complex patients every day, and they also have to be able to use a variety of "weapons", which requires a very high level of competence.
In fact, the previous three years, the country really involved in the treatment of new crowns, especially in the treatment of serious illnesses is not too many health care workers, after the adjustment of the epidemic prevention policy, is the first time that almost all the health care really into the new crowns of the treatment of the actual combat mode, the battle must be fought, and must be won. This situation, one of the most realistic choice is to take a mixed grouping work mode.
For example, there is an anesthesiologist working with us, he is characterized by strong operating ability, because the anesthesia machine and the ventilator is very close to each other, on the tracheal tube intubation, through the deep vein, and even circulatory respiratory resuscitation and so on are relatively professional, but in how to fight infection, nutritional support and other aspects of the experience will be relatively inexperienced, and so then look for infectious diseases doctors to join in. In other words, with limited resources, when mixing and matching, the strengths of these doctors from other departments who come to support must be fully utilized to form a most efficient combination. At our hospital, a mixed team basically consists of an intensivist, an anesthesiologist, plus an internist and surgeon.
And, after this combination is set, try not to change, now the new expansion of the ICU ward, many of the brand of the ventilator, even I such as the "old critical care" have not seen, we need to be and the equipment to break in, medical and nursing each other also need to break in, it took two weeks to really break in, if you wait to go to the battlefield and then break in, it will be too late. It's too late to wait until you're in the field.
So mixing can't be done on paper. Before the peak of critical care, to let these doctors to support the ICU to work in advance, the first 1 to 2 weeks, and in the middle can be optimized and adjusted, which is the most important part of the emergency training for non-critical care doctors: must be in the form of a team, in the form of real combat.
Zhejiang in the critical care team training is more adequate, the provincial health commission last year in early December, issued a letter requesting, cities and towns to participate in the training of the specific list of medical and nursing, the hospitals should be according to an ICU beds with a doctor, 2.5 ~ 3 nurses, and based on this additional 20% ~ 30% of the personnel as a reserve force. On December 8 last year, all cities in the province sent a backbone team of doctors, nurses and respiratory therapists to Hangzhou for five days of intensive training, with the most experienced doctors and nurses and respiratory therapists in our hospitals to teach and introduce their experiences in the treatment of new crowns and serious illnesses.
But although Zhejiang has made various plans, including ICU renovation and staff training, the number of infections rose faster than we expected after the "new ten".
When the "20" measures were introduced, I speculated that the rise in the number of infections in China might take three months to complete the three-year path of other countries, but in fact it took us less than 20 days.
Medical staff care for a patient in the respiratory intensive care unit of Huzhou City Central Hospital on the evening of Jan. 11, 2023, in Huzhou, Zhejiang province.
ICU's mission is to guard the last line of defense. As early as 2020 we summarize the experience of anti-epidemic, the most important is to move the gate forward, which is still applicable today. The key to moving the gate forward is to identify high-risk groups as early as possible, the tenth edition of the diagnosis and treatment program refers to heavy/critical high-risk groups, a **** there are six points, each community doctor should memorize, can not miss any high-risk patients. A change in the 10th edition compared to the 9th edition is that the age threshold for high-risk groups was raised from 60 to 65 years old, with special emphasis on those who have not been fully vaccinated. 2022, when we participated in the defense of Shanghai, a small number of deaths were characterized by a combination of advanced age and a variety of underlying diseases, and did not take the vaccine, so this kind of "critical minority" vulnerable people must be focused on. The people must be focused on.
Community doctors need to tell high-risk people what they need to be aware of, who to contact first if they develop any of these conditions, and direct them to the community rather than to a tertiary hospital when they can't cope, so that they can build trust in the community hospital. The training for the initial treatment of the new crown can actually take a few hours to complete, community doctors are fully capable of coping, if they feel they can not solve the problem, they must be immediately referred to the next level, so there must be a set of efficient referral process, so that the limited medical resources of large hospitals are used to save the treatment of heavy, critical type of patients, which is the lowest cost, the best treatment results.
There are two main threads to be grasped in the treatment of neoguana: one is the need for early antiviral treatment, and the second is the treatment of various underlying diseases and complications caused by neoguana virus infection. For the treatment of underlying diseases, community doctors have an advantage over large hospitals, because they have the responsibility of chronic disease management in their daily duties. There are also two other points to pay extra attention to: first, we should emphasize the prone position to save the patient's life, and we should lie down as much as possible, and mention it as important as antiviral treatment; second, we must not blindly use antimicrobial drugs, especially the combined use of broad-spectrum antimicrobial drugs. A few doctors have overused antimicrobials, which is a major misconception. If you consider the possibility of combined bacterial infections, doctors should actively seek evidence that the blind use of antimicrobial drugs is harmful, to strictly grasp the indications for the use of antimicrobial drugs, the rational use of antimicrobial drugs is very important.
Posted on 2023.1.16 total issue 1077 of China Newsweek magazine
Magazine title: the new crown critical care front-line doctors oral: what has been experienced in the past three weeks?
Reporter: Huo Siyi Li Jinjin
Editor: Du Wei
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