The number of infected people has surged by 400,000, how to "dynamically clear zero" to attack the "fortress" of severe disease?

Xinhua News Agency, Shanghai, April 22 title: The number of infected people surged by 400,000, how to "dynamically clear zero" to attack the "fortress" of severe disease?

Xinhua News Agency reporters Gong Wen and Zhou Lin

On April 21, at the Shanghai Public Health Clinical Center, nine elderly people over the age of 80 were cured of COVID-19, the oldest of whom was 92 years old. Since March, many of the new crown pneumonia patients admitted here have been elderly people over 90 years old, and even a few centenarians have achieved the cure of new crown pneumonia.

At the same time, as of April 21, 160 cases of severe patients and 24 cases of critically ill patients received treatment in designated medical institutions have sounded the alarm bell again, Omiljung is not a "big flu", especially for the aging degree of more than 36%, 80 years old and above the elderly are close to 830,000 people, the absolute number of basic disease patients in Shanghai, in order to achieve "dynamic clearance", go all out to treat seriously ill patients, and do everything possible to reduce the case fatality rate is the current top priority.

Severe treatment is a race against time and against the disease. What is the current pressure of treatment? How do I move the threshold forward? The reporter interviewed authoritative experts such as members of the Shanghai Working Group of the State Council's Joint Prevention and Control Mechanism Comprehensive Group, Ma Xudong, director of the Medical Administration Bureau of the National Health Commission.

The number of severe diseases has exceeded 100, and "aging" cities have fought a hard battle

The new coronavirus spread by the current round of Shanghai epidemic is the Aumi Kejung subtype variant BA.2, which spreads quickly and is highly hidden, and the number of infected people in a short period of time is relatively large, with more than 400,000 cases of infection as of April 20. For Shanghai, which has a high degree of aging, the harm of Omi kerong cannot be underestimated, and a set of data reflects the current pressure of treatment:

From 0 to 24:00 on the 21st, there were 11 new local deaths in Shanghai. The mean age was 84.2 years, and the maximum age was 94 years (2 cases). All 11 patients had severe multi-organ underlying disease and were critically ill, including coronary heart disease, cardiac insufficiency, end-stage cirrhosis, cerebral infarction, Parkinson's disease, Alzheimer's disease, uremia, etc. After the patient was admitted to the hospital, his condition progressed rapidly and he died after ineffective rescue. The direct causes of death are all based on disease. In the Shanghai Public Health Clinical Center alone, since March, a total of 93 elderly people aged 90 to 100 years old and 5 elderly people over 100 years old have been treated.

Ma Xudong: For Shanghai at this moment, severe treatment is a "hard bone" that must be gnawed down in the battle and a "fortress" that must be attacked.

At present, among the hospitalized patients, the elderly over 60 years old account for nearly 30%. More than 60% of patients with underlying diseases are combined, and more than 40% of the more than 1,000 patients with severe underlying diseases currently in the hospital have more than 3 underlying diseases. The main diseases are renal failure, cardiovascular and cerebrovascular diseases, COPD, diabetes, tumors, etc.

The treatment of severe cases of new crown pneumonia itself is difficult, and the workload and difficulty of this medical treatment and nursing mainly stem from two aspects: First, among the hospitalized new crown pneumonia patients in Shanghai, not only 35% of patients with severe underlying diseases are more than 80 years old, but also the vaccination rate of new crown over 80 years old is less than 5%, and treatment requires multidisciplinary diagnosis and treatment and high specialized treatment capabilities.

Second, the designated hospital in Shanghai is very different from the past, and its function is not simply to carry out the treatment of new crown pneumonia, but a general hospital that needs to have the ability to diagnose and treat patients with various specialty diseases infected with new crown virus. For example, it is necessary to meet the medical service needs of high-risk pregnant women, neonatal diseases, tumor radiotherapy and chemotherapy, cardiovascular and cerebrovascular diseases, emergency surgery, interventional surgery, long-term dialysis and so on. Taking the positive patients of new crown pneumonia who need hemodialysis as an example, 8% of the current hospitalized patients in designated hospitals.

Life is supreme, and "one person, one strategy" is fully protected

Don't give up every life. In this race against the clock, Shanghai is doing its best to protect the people's lives and health with the mentality of decisive victory.

Shanghai Public Health Clinical Center, one of the "main battlefields", fired the "first shot" of epidemic prevention and control more than 2 years ago, and the war against new crown pneumonia has never stopped here.

Fan Xiaohong, director of the center, led a team to Leishenshan Hospital to witness Wuhan pressing the "start button" and the last batch to evacuate Wuhan. Today, she has been fighting in the frontline of epidemic prevention in Shanghai. "The most memorable thing was on March 13, when our ward was full. After research and judgment, the emergency start door emergency building was vacated, and the whole hospital was able to put down the staff working in their hands, all went to the open space in front of the door emergency building, screwed the screws of each newly purchased bed within 2 hours, and hundreds of beds were assembled and urgently put into the outpatient emergency building. Fan Xiaohong said.

The city is coordinated, and the intensive care teams of six hospitals are stationed in an integrated system; the intensive care experts in many places are doing their best to fight and apply the experience of early treatment, and the goal is to do everything possible to reduce the case fatality rate. Multidisciplinary, multi-team collaboration like this is the norm in the admission of severe diseases.

A 107-year-old Alzheimer's patient impressed Fan Xiaohong. Her son and daughter-in-law are both in their 80s, and the family is sick at the same time. The elderly cannot take care of themselves and have difficulty communicating with medical staff; patients have many underlying diseases, and some drugs may interact with the treatment of new crown pneumonia; patients cannot take care of themselves, which is also a great challenge for nurses to take care of their lives. The hospital sent elite forces to carry out antiviral treatment, including interferon atomization inhalation, antiviral small molecule drugs, traditional Chinese medicine treatment, etc.

It's a reverence for life – on April 17, the 107-year-old was discharged from the hospital with his son and daughter-in-law and went home!

"Elderly patients have anxiety about their mental condition, frequent getting up is not conducive to recovery, we will discourage them from bed rest, and at the same time provide oxygen support." The treatment of the underlying disease is carried out simultaneously using an appropriate regimen. We must go all out to treat every patient, and 'one person, one policy' will fight a tough battle for severe treatment. Fan Xiaohong said.

Ma Xudong: At present, the intensive care medical teams in many places are going all out to adopt a comprehensive strategy to treat seriously ill patients.

The first is to speed up the admission and treatment of infected people, and expand beds by strengthening the construction of square cabin hospitals and designated hospitals, so that positive infected people can be admitted and treated in a timely manner as much as possible. Through the three-level medical treatment system of municipal designated hospitals, regional designated hospitals and square cabin hospitals, in accordance with the "four concentrations" principle of concentrating patients, concentrating experts, concentrating resources and concentrating treatment, all seriously ill patients are admitted to high-level municipal designated hospitals for treatment.

Second, experts with rich experience in treatment in China will set up a circuit expert group together with Shanghai experts to conduct roving guidance in square cabin hospitals and designated hospitals to identify seriously ill patients and high-risk groups at an early stage. The state has dispatched a severe medical team and a square cabin medical team to be stationed in the designated hospital and the square cabin hospital respectively to carry out medical treatment.

The third is early intervention to prevent mild diseases from turning into severe diseases. Apply the experience of medical treatment in Wuhan, establish a joint medical department, a joint nursing department, and a joint infection control office in designated hospitals, cabin hospitals, respectively, strengthen the implementation of systems such as three-level rounds, graded nursing, and discussion of difficult and critical cases, implement list management for seriously ill patients, and carry out treatment with "one person, one policy".

Fourth, the treatment of new crown pneumonia and underlying diseases is equally important. In accordance with the ninth edition of the national diagnosis and treatment plan, the homogenization and standardization of the treatment of new crown pneumonia, the combination of traditional Chinese and Western medicine, the strengthening of specialized medical and nursing forces, the strengthening of the treatment of basic diseases, and the reduction of the mortality rate.

Move the threshold forward and intervene early to put the protection of people's health in the first place

Many experts said that Shanghai has a high degree of aging, and if the epidemic spreads, it will pose a serious threat to the lives and health of the elderly and people with underlying diseases, and lead to a run on various resources such as medical treatment. To make every effort to treat seriously ill patients, it is even more necessary to move forward to prevent patients from mild illness from turning into severe diseases, so it is crucial to accelerate the promotion of "dynamic clearance" and strengthen vaccination.

Omikeron is not a "big flu", but a formidable adversary that humanity faces together.

As of now, the vaccination rate of the elderly aged 60 and over in Shanghai is 62%; the enhanced immunization rate is 38%, and the overall vaccination rate is still relatively low.

Sun Xiaodong, deputy director of the Shanghai Municipal Center for Disease Control and Prevention, said at the press conference recently that according to the study of the incidence of new crown pneumonia in the elderly at home and abroad, in the elderly who have been vaccinated throughout the whole process and vaccinated with the reinforced dose of the new crown vaccine, the effectiveness of the vaccine in preventing severe disease, critical illness and even death is very obvious, and the effectiveness of the whole vaccination is more than 70%, and the effectiveness of the whole vaccination is more than 90% after the strengthening dose.

Experts suggest that eligible elderly people should make an appointment for COVID-19 vaccination as soon as possible after the unsealing and opening of nearby vaccination points in the future, and if the elderly who have completed the full vaccination, they should receive boosters as soon as possible after 6 months.

Ma Xudong: This hard battle of severe treatment is fought in the present and also enlightens the future. In the future, there are a number of measures to prevent and treat severe diseases that must be paid attention to. One is vaccination. Available data suggest that vaccination can indeed be effective in reducing the conversion rate of severe illness into COVID-19. It is recommended that people who have no contraindications and who are eligible for vaccination be vaccinated as soon as possible.

The second is early detection and early intervention. Adhere to the combination of traditional Chinese and Western medicine to prevent mild diseases from turning into severe diseases; identify high-risk groups at an early stage, establish sub-ICU for treatment, and attach equal importance to the treatment of underlying diseases and new crown pneumonia, and block the course of entering the ICU.

The third is to prevent infection. Strengthen personal protection, wash hands frequently, wear masks scientifically, eat civilized, abide by the one-meter line, ventilate frequently, and do not gather.

The fourth is to increase the intensity of drug and vaccine scientific research, race against the virus every second, and save more patients' lives until the end of the new crown pneumonia pandemic through the development and use of more specific drugs.