The epidemic in Xi'an is superimposed on the sealing and control of multiple communities of hemorrhagic fever, and many kidney dialysis patients are trapped in their homes

Reporter/Hossie

Every Thursday and Sunday, it is the time for Zhang Xiaolu to go to the First Affiliated Hospital of Xi'an Jiaotong University for dialysis. December 19, 2021 is a Sunday, this morning at 9:30, Zhang Xiaolu went out as usual to prepare for dialysis, but was blocked at the door of the community. "I found that there were more than 20 people around the entrance of the community, including more than a dozen uniformed policemen, and many disease control personnel wearing white protective clothing." Zhang Xiaolu recalled. Previously, he had not received any notice, and when he found that the community was sealed, he panicked.

The National Health Commission pointed out on December 20 that the current national epidemic situation is generally stable. However, the epidemic situation in Xi'an and Dongguan continues to develop, and the risk of continued transmission between the two places is relatively high. From 0:00 to 24:00 on December 20, Xi'an city added 42 new local confirmed cases, twice as many as the previous day, and at present, Xi'an has reported a total of 91 local confirmed cases.

After the outbreak of the epidemic, Xi'an immediately began to carry out nucleic acid testing for all employees, demarcated medium- and high-risk areas, sealed the community, and stipulated that indoor entertainment venues such as bars, dance halls, sports and fitness venues, movie theaters, mahjong halls, script killing, and bathing were suspended. Since December 20, kindergartens and off-campus training institutions in primary and secondary schools in Xi'an have completely suspended classes and begun home observation. In order to extinguish the epidemic as soon as possible, most of the daily activities of Xi'an people have been pressed the pause button. What matters is that patients like Zhang Xiaolu, who need to do dialysis regularly, are also trapped at home.

Trapped dialysis patients

Zhang Xiaolu's community is not among the medium- and high-risk areas in Xi'an, but it is relatively close to the Chang'an Road residential area of Chang'an University, the "eye of the storm" of this round of xi'an epidemic, and the distance is only about four kilometers. Zhang Xiaolu inquired why the community was sealed, and only heard that Building 6 had been closed, "but whether it is suspected or confirmed, no one knows." The reporter combed the situation of the newly confirmed cases announced in Xi'an on the afternoon of the 20th and found that the trajectory of confirmed case 18 involved his community.

Zhang Xiaolu suffers from uremia. For these patients, interruption of dialysis can mean death, and the longer the interruption, the greater the risk. This process is accompanied by excessive water in the body, cardiac effusion, heart failure, and induces sudden death, and the high potassium in the body is also very easy to cause cardiac arrest.

Zhang Xiaolu quickly found the disease control personnel at the scene to react to the situation, and proposed that he was a dialysis patient and had urgent medical needs. Subsequently, his situation was reflected to the Yanta District CDC, where he was located, and the reply was that he had learned about and registered his situation, and asked him to wait patiently for the notification.

But Zhang Xiaolu's kidneys could not afford to wait. As of December 20, he had not had dialysis for four days, and the last dialysis was on Thursday, December 16. Now, he has symptoms such as edema and heart failure, and he has not dripped water for two consecutive days.

These symptoms of Zhang Xiaolu are the result of a series of chain reactions under the epidemic.

First of all, the First Affiliated Hospital of Jiaotong University, where Zhang Xiaolu was originally going to do dialysis, has officially entered a "lockdown" state on December 16 because of the epidemic, suspending outpatient reception work, and the ward has also been blocked. A medical staff familiar with the situation of the First Affiliated Hospital of Jiaotong University told China News Weekly that at present, only patients who regularly go to the hospital for dialysis are "exceptions" and can "walk the outpatient building" every day, but require 24-hour nucleic acid test results to enter the dialysis room, and other buildings have all been sealed and cannot enter and exit. In the dialysis room of the outpatient building, ordinary dialysis can only be done, that is, many dialysis machines are in the same room, and there is no isolation ward.

The nurse of the First Affiliated Hospital of Jiaotong University, who was previously responsible for doing dialysis for Zhang Xiaolu, told him that in the case of the community being controlled, he could contact the community for dialysis. But Zhang Xiaolu called the property many times, first "can't contact", after the connection, the other party let "contact themselves" and "call 120", although 120 said "can't come", but the nurse still insisted on "letting the community contact the hospital".

In this series of chain reactions, the most core link is disease control. After repeated communication, for dialysis patients such as Zhang Xiaolu who cannot enter and exit by themselves in the sealed control community, the solution given by the CDC is that the patients themselves contact the receiving hospital, and after setting a time, the disease control will send a car to pick up and drop off, and the whole process will be closed-loop management. But at present, dialysis beds throughout Xi'an are extremely tight. In a resource coordination group, Zhang Xiaolu got multiple replies that "the beds are full, continue to wait for the notification."

Therefore, he could only take the "last resort" and find the hospital himself. But he soon found that it was even more difficult. Due to the shortage of dialysis resources, other hospitals cannot even arrange their own patients, let alone accept patients from outside the hospital. When Zhang Xiaolu finally contacted a private medical institution that agreed to accept it, the disease control did not agree to let him go on the grounds that the institution was a non-designated hospital.

The medical institution willing to accept Zhang Xiaolu is called Xi'an Xinkangle Hemodialysis Center (hereinafter referred to as "Xinkangle"), which is located directly opposite the First Affiliated Hospital of Jiaotong University, because it has just been established this year, the approval of the designated hospital has not yet come down, and it has not developed a group of fixed patients, but unlike the designated hospitals that have been saturated, Xinkangle currently has a lot of surplus beds, at least for "temporary emergency". In fact, when Zhang Xiaolu did his last dialysis, that is, on the afternoon of Thursday, December 16, just in time for the First Affiliated Hospital of Jiaotong University to be suddenly "sealed", the hospital urgently coordinated another medical institution for dialysis patients who had been waiting for several hours.

A nurse in Xinkangle told China News Weekly that more than 30 people in Zhang Xiaolu's community are currently "looking for dialysis", so the center suggested that disease control can "pull" these patients together to the center and concentrate on dialysis. "However, the final statement of the disease control is not recommended, and for patients in the sealed community, if the disease control does not agree, we dare not take it privately." A disease control officer replied to Zhang Xiaolu on the 19th: "Now the epidemic situation is severe, the hospital infection prevention and control does not dare to have any slack, Xinkang le is not a designated hospital, for everyone's safety, please be patient and wait for coordination." ”

How to implement the normalization of epidemic prevention and control?

Zhang Xiaolu is not a confirmed patient of the new crown, but because there are suspected or confirmed cases in the community, he is also a high-risk group. For such groups, how to better achieve accurate management, it is necessary to introduce further refined classification control policies. In fact, after three days of sealing the community, Zhang Xiaolu's health code was still green.

In Xi'an, there are many patients like Zhang Xiaolu who have not had dialysis for several consecutive days, either because the community is sealed off, or because the dialysis hospital is sealed and cannot enter. One patient is trapped in an isolation hotel, unable to go out, and has not been on dialysis for three days. Another patient, due to hepatitis, had to be dialyzed in a special area and could not be dialyzed with ordinary patients, and after the Xi'an Aerospace General Hospital where he was located was sealed, it was even more difficult to find such a hospital with a special area.

Zhi'an, the founder of the uremia patient platform "Kidney-like People", said that his help platform began receiving help from patients and families from Xi'an on Friday, December 17. On Saturday, there were about 19 patients who could not dialysis because they could not go out, but after a weekend, the call for help suddenly "broke out", as of December 20, there were hundreds of requests for help, "the number is still rising." ”

The reporter found that the last dialysis of many patients was on December 16, that is, last Thursday, and then four or five days, a number of hospitals with a large number of dialysis beds in Xi'an "should be required for epidemic prevention and control" have been suspended, in addition to the First Affiliated Hospital of Jiaotong University, there are also the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Aerospace General Hospital, etc., the Air Force 986 Hospital is also partially sealed, and the Xi'an Chest Hospital was also suspended on December 19 due to "will undertake the task of epidemic prevention and control".

Many patients said that if there was no epidemic, Xi'an's original dialysis beds and equipment were relatively sufficient. According to the official data of the Xi'an Municipal Health Commission, in 2018, There were 53 hemodialysis rooms, 1352 dialysis equipment, and 4485 dialysis patients set up by Medical Institutions in Xi'an, and it is planned that by 2020, 14 new blood purification institutions (rooms) will be added in the city.

However, under the influence of the epidemic, dialysis resources have become tight, especially when the epidemic is superimposed on the recent occurrence of multiple cases of hemorrhagic fever patients, now, it is a time to test xi'an's ability to coordinate the scheduling, emergency response and refined management of medical resources under the state of emergency. "Up to now, the problem of dialysis has reflected four or five days, and the government has not yet come up with a clear plan, and the responses given are ambiguous." Zhi An said.

A patient who had not been on dialysis for five days finally waited for the arrangement of disease control, "only said that the car would come as soon as possible, but did not say when to come or which hospital to go." Another patient, who had coordinated a hospital, was temporarily notified that "it was impossible to go". Zhang Xiaolu's disease control personnel originally said that they would come to pick him up early in the morning of December 20, but the night before, they suddenly said no, at this time, he knew that the non-designated hospital "can't go if you contact himself", and before that, the disease control has never stressed this restriction to him.

During the epidemic in Wuhan, after experiencing early chaos, the Wuhan Municipal Health Commission announced a list of hospitals for medical treatment of non-new crown pneumonia special patients in the city, including 16 designated hospitals for hemodialysis. Zhian pointed out that the advantage of this program is that it can separate new crown dialysis patients from other ordinary patients, and also allow dialysis patients from medium- and high-risk areas to not have to worry about no place to receive, and this process is "point-to-point transportation", which not only ensures the safety of epidemic prevention, but also facilitates the travel of patients.

Zhian also pointed out that if the hospital is sealed, it should generally be coordinated by the hospital to divert its own patients: help contact the dialysis room, and communicate with other hospitals or medical insurance departments about how to pay the cost. But among the Xi'an patients who asked him for help, "many of them could not enter the hospital, and the patients were left unattended." "In addition, during the epidemic period, the travel of dialysis patients is also a big problem, which needs to be guaranteed by supporting systems, and Xi'an has not yet introduced a specific plan."

At the beginning of November, the epidemic situation in Lanzhou was serious, and then an emergency plan specifically for dialysis patients was introduced, and there was a very humanized design in the travel, for patients who had to go out due to "dialysis" in the sealed control community, if there was a 48-hour nucleic acid negative certificate, they could manually modify the color of the health code, and then ask the hospital to issue a dialysis certificate for the patient, so that they could travel normally.

However, on the morning of December 21, "Xi'an advises citizens not to show the code brightly unless necessary" appeared on Weibo's hot search. A number of patients interviewed also found that on the morning of the 20th, their Xi'an health code could not be opened for a while, and later recovered, but it failed again near the evening.

Liu Jun, director of the Xi'an Big Data Bureau, explained at the epidemic prevention and control press conference held at 5 p.m. on the 20th that at about 7:40 on December 20, the number of user visits in Xi'an Yidiantong surged, and the number of visits per second reached more than 10 times the previous peak, resulting in network congestion, resulting in some application systems, including Yidiantong, being unable to use normally. In the special period of nucleic acid testing for all employees, in order to reduce the pressure on the system, it is recommended that the general public do not show the code and bright code unnecessarily.

As of the morning of December 21, most dialysis patients said that the health code had been restored, but some patients reported that the original vaccination records and nucleic acid test information on the page were no longer displayed, and some citizens reported that they could not open normally.

A public health expert suggested that for special groups such as hemodialysis patients, it is best to introduce a corresponding accurate prevention and control plan at the national level, and with the plan, all localities will allocate resources. Now it is said that the epidemic prevention and control should be normalized, but the key is to standardize under normalization, how to achieve standardization? It involves a series of detailed measures and standardized institutional schemes.

He also pointed out that in addition to dialysis patients, some other acute patients "may face a more tragic situation" under the epidemic, such as myocardial infarction patients and severe hepatitis patients, "if they are not rescued, they may die immediately." These are urgent medical needs, in the context of the normalization of epidemic prevention, how to balance the prevention and control of the epidemic and this part of the medical security, the next step will become the focus of testing a city's anti-epidemic ability.

On the evening of December 20, Zhang Xiaolu waited for good news, and the First Affiliated Hospital of Jiaotong University finally agreed to pull six "trapped" patients, including him, to dialysis. Xi'an Aerospace General Hospital also issued a notice to 8 to 10 patients who "can't afford to wait" on the evening of the 20th to resume normal dialysis. Another patient finally waited for the call of the disease control after five days of interrupting dialysis, and coordinated her to another hospital for temporary dialysis, but she said worriedly: "After dialysis is done this time, what if the back can't be found?" ”

(Zhang Xiaolu is a pseudonym in the text)

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