Photo: Zhuang Huimin (left) and Zhong Jianli (right) both said that the government has set up designated hospitals, which can concentrate resources, experts and patients to make the entire medical process of the hospital smooth.
The fifth wave of COVID-19 in Hong Kong was overburdened by the public healthcare system, and the pressure on public hospitals was alleviated by the construction of a number of square cabin hospitals to assist in receiving patients with the support of the central government, and the conversion of a number of public hospitals into designated hospitals. Dr Chung Kin Lee, Director of Quality and Safety of the HA, and Dr Chuang Wai Man, Chief Administrative Manager (Infection and Emergency Matters), were interviewed by Tai Kung Man Wai Media about the situation of patients admitted in strata.
Reporter: How to operate the specific procedure for triage of COVID-19 patients? How are the procedures and guidelines different for different facilities?
Zhuang Huimin: The fifth wave of the epidemic has a large number of confirmed patients, the previous four waves of the epidemic under the confirmed patients will usually be admitted to the halitary public hospital for isolation and treatment, basically regardless of whether there are symptoms or severe illness will also be admitted to the hospital, but because the fifth wave has too many patients, it is difficult to admit treatment as in the past, so with the SAR government to establish this hierarchical diversion mechanism to treat patients, the first and second floors belong to the hospital beds, admitted to serious diseases or patients who need to be admitted to the hospital, mainly for treatment purposes; the third layer is the community treatment center, Including the Asia-Expo Museum and the Hong Kong Infection Control Centre on North Lantau Island, it is mainly for the treatment of patients with mild illness or recovery but still not fully recovered; the fourth floor is the community isolation center, which is mainly for the purpose of isolation, such as the current temporary care center for the elderly and the cabin hospital, etc., mainly need to be isolated as a criterion, the SAR government is also requiring confirmed patients to try to isolate at the isolation facilities, if they have the ability to take care of themselves, they will go to the cabin hospital and other facilities, such as those who do not have the ability to take care of themselves, they will be arranged to the temporary care center. The center usually receives the elderly. The entire stratified shunting (mechanism) is mainly the use of limited resources, allocated in different places, to provide treatment and isolation to patients.
The first and second layers of the distinction lie in the clinical situation of the patient, if the patient needs some ventilators or needs high concentrations of oxygen, and to see if there are other organ failure problems, that is, in addition to the lungs, whether there will be kidney function or liver function problems, such as liver function and other failures to enter the first layer, mainly in the intensive treatment department to receive care; the second layer is mainly the new crown bed, isolation bed, care need to absorb oxygen but not to the point of organ failure, these patients need drug treatment, including antiviral drug treatment. As for these critically ill patients, they are centrally handled in the Intensive Care Department, while Queen Elizabeth Hospital is also responsible for the treatment of severely ill patients, concentrating experts and instruments to treat seriously ill patients, hoping to reduce the number of severe illnesses and even deaths.
Reporter: What needs to be improved in the "stratified diversion" mechanism? What problems are encountered in execution? How to solve it?
Chung Kin Lee: The whole diversion mechanism can always be perfected, in fact, at the beginning of the entire structure of several layers, the biggest pressure was on the second floor, the epidemic came very urgently, there were many elderly people who needed to be admitted to the hospital in the middle section, so that the second floor could not arrange for all the elderly to be admitted, at that time, the second floor should be expanded immediately, half of the BEDS of the HA should be converted into beds that can treat new crown patients, and each networked hospital will be converted into a designated hospital, especially the largest Queen Elizabeth Hospital in Hong Kong to a designated hospital, hoping to achieve "beds and others". Instead of people waiting for the bed, basically it has been able to do it so far.
In addition, the fourth floor, the community isolation center, has also been continuously improved, which is for younger and no patients aged 16 to 70 years old, and then the temporary care center hopes to take care of the elderly over 70 years old, and some more facilities will be added in Penny Bay in the future, hoping to help some elderly people at home and including children in the family, hoping to give them better equipment.
In the early stage of implementation, such as the admission of new isolation facilities in the process involved many departments, including the Security Bureau, the Department of Health and the Hospital Authority cooperation, etc., in the early stage such as Penny Bay (patients) and other departures or waiting in, there were some problems, but after everyone's consultation and efforts, it has now been straightened out, the current isolation center and cabin hospital, etc., services have been improved, including drug treatment, Chinese medicine treatment, etc., and recently there are some children's projects, etc., hoping to make the isolated patients get appropriate treatment and care as much as possible. The bigger challenge ahead is the new respite centres, which will streamline the smooth delivery of elderly people to these isolation centres so that they can receive appropriate treatment.
Reporter: What role have designated hospitals played in the COVID-19 pandemic?
Zhuang Huimin: Seven designated hospitals, including Queen Elizabeth Hospital, and half of the emergency and nursing beds were converted to treat COVID-19 patients, with a total of about 11,500 beds, which played a role at the peak of the epidemic in mid-March, when the emergency wards were stranded and could not be arranged to attend the wards, through a large increase in beds and the concentration of patients in the designated hospitals, the backlog of patients in the emergency rooms has been reduced, the current situation has been greatly improved, and the recent epidemic situation has gradually eased, which can basically be said to be "beds and others".
There are also benefits to focusing on patients, including the ability to pool resources, specialists and patients to smooth the entire medical process in the hospital. In addition, in the past, the hospitals received new crown and non-new crown patients, the patient had the opportunity to enter the hospital when the first test was negative, was arranged to the general ward, but may test positive after two days, because he mixed with non-new crown patients, it is necessary to isolate the patients who have been in contact with the patient, which will also make the ward can no longer accept the disease, although there are beds but because of the isolation, affecting the effectiveness of receiving patients, so sometimes a ward has more than ten or twenty patients, some beds fail to accept patients, because to do infection control tracing, After changing to a designated hospital, the use of hospital beds is much more effective, and it can also reduce infections in the hospital.
Reporter: According to the distribution of the disease, what is the current proportion of moderately ill patients? How many people need treatment such as ventilators? How are critically ill elderly patients treated? Is the intensive care unit in public hospitals in high demand? Are there enough beds in the Intensive Care Unit?
Zhong Jianli: At its peak, more than 300 COVID-19 patients were using ventilators in the hospital, and today (April 6) there are about 100 people, and as for the patients who want oxygen, more than 3,000 of the more than 9,000 patients in the hospital at the peak also need oxygen, and today it has dropped to about 1,000 patients who want oxygen, and the situation has improved.
Zhuang Huimin: The proportion of severe illness has decreased, the calculation method in Hong Kong is slightly different from that in the mainland, if you want to inhale 3 liters of oxygen in the mainland, it has been classified as a serious disease, and in Hong Kong, if you want to inhale 6 degrees, that is, 6 liters of oxygen, it will be regarded as a serious disease, and the peak period of severe patients is close to 20%, which is about 13% in today's figures.
Zhong Jianli: Critically ill patients, especially those who want to use ventilators, in fact, even in the peak period can provide them with treatment, because the new crown patients who need to use ventilators are different from the critically ill patients who usually stay in the ICU (Intensive Care Department), (new crown patients) are often only single organ failure, mainly the respiratory tract, if the ICU bed is insufficient, we requisition other beds, add ventilators and have enough experts and nurses, in fact, can provide treatment, and this can be done better in designated hospitals. For example, there are some wards in Queen Elizabeth Hospital that are ready to provide respiratory support in addition to the ICU when the patient is critically ill.
In addition, to prevent patients from becoming critically ill and needing to use ventilators, we have also adopted the advice of mainland experts, who, based on the experience of the mainland, provide high flow Nasal Cannula (HFNC), which is the oxygen of high-flow oxygen nasal catheters, which can also reduce the chance of patients deteriorating. We originally had more than 200 (HFNC instruments) and another 1,000 specially purchased, which were used by patients in need in different designated hospitals.
Zhuang Huimin: There are about 115 isolation beds in the intensive care department of the HA, this time the new crown virus will mainly cause single organ failure, that is, lung failure, other organ function decline is rare, there is organ failure needs to go to the intensive treatment department, such as kidney failure to wash blood and stomach, etc., or liver failure needs liver support, but the new crown patients are mainly affected by the lungs, using ventilators as support, basically the demand for the intensive treatment department of this wave of the epidemic is not as high as before. That is, there are not so many patients who need intensive treatment, and the clinical situation of some patients is not so critical that they need intensive care services, but some patients enter the intensive care department, because we will also use the inner isolation bed for isolation, and now when dealing with severe or even critically ill patients, we also have enough beds, including the isolation ward of the internal medicine ward, to cope with it.
Reporter: What is the occupancy rate of public hospitals and community isolation facilities such as square cabin hospitals?
Zhong Jianli: In fact, there are still many new crown patients, not counting the patients who have recovered, today (6th) there are still more than 4,000 patients in the public hospital are still infectious, of course, the higher peak period is much better, basically if there are patients in need can also be admitted to the hospital for treatment. As for community treatment facilities, the Asia Expo Or North Lantau Infection Control Center, basically half the occupancy rate, because the above two facilities were originally to take care of mild and younger patients, but there were many elderly patients who needed to be cared for in the middle of the fifth wave, so it was necessary to concentrate on manpower, preferring to collect fewer people and concentrate on taking care of the elderly.
As for the community isolation facilities, whether it is a temporary care center or a cabin hospital, the relative occupancy rate is not very high, because the current epidemic situation is downward, the situation is good, but the relevant facilities still have their needs, because at the beginning of the fifth wave, it is precisely the isolation facilities that may have some deficiencies, so that many patients stay in the community and the number of confirmed cases rises, so it is hoped that the mainland experts say that it is "prepared and not used", leaving room, if there is really a sixth wave of the epidemic, it can be responded to.
Reporter: As the epidemic stabilizes, under what circumstances will stable patients be moved from the hospital to community treatment facilities, and the hospital beds will be vacated to treat non-COVID-19 patients, so as not to delay the condition of non-COVID-19 patients, especially long-term patients?
Zhong Jianli: Different isolation facilities have different (admission and treatment) guidelines, such as the square cabin and other facilities are mainly to take care of patients aged 16 to 70, mild symptoms or asymptomatic, temporary care centers are over 70 years old and their own stable condition, but there is still a need for isolation, it is necessary to transfer (from the public hospital) to the temporary care center, and most of the patients in the public hospital to this moment are the elderly, the median age of hospitalized new crown patients is about 80 years old, if one falls, most of them also go to the temporary care center, or some (patients) still need some treatment. Then go to the North Lantau Infection Control Center or the Abo pavilion community treatment center on the third floor, which are also carried out daily.
In fact, many beds themselves are to take care of other non-COVID-19 patients, and now the hospital has fallen from more than 9,000 (the number of infectious COVID-19 patients) to more than 4,000, so (some beds) have been transferred back to receive non-COVID-19 patients, otherwise the HA's services cannot continue, and these beds have been appropriately modified, in case the need for treating COVID-19 patients rises again, these wards can be used at any time.
Regardless of whether the SAR Government will conduct universal testing in the future, or whether there will be a sixth wave of the epidemic, the fifth wave of the epidemic has seen a considerable number of (patients), and now the relevant facilities have been deepened, including facilities for the care of the elderly and children, which is very important, so as to cope with the future rise of the epidemic situation, if the whole people test, it is estimated that there is a greater demand for the third and fourth floor facilities, because whether the patient with poor condition will also be found by the national test, because there are symptoms that need to be admitted to the hospital, and the national test can find invisible patients and reduce the infection of the community. Therefore, the demand for isolation facilities is larger, and the capacity of isolation facilities is relatively large.
![Analysis| Zhang Wenhong said that the most scientific new crown diagnosis and treatment plan so far, what is the basis behind it?[fig]](data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACwAAAAAAQABAAACAkQBADs=)