Editor's Note
More than two years after the global outbreak of covid-19, it is still raging. Qiao Renli, a professor of CLINICAL medicine at PCCM at the University of Southern California School of Medicine, lives in the United States for a long time and fights the frontline of the fight against the epidemic as a front-line respiratory doctor, how does he view and summarize the new crown epidemic in the United States from a professional perspective? What kind of inspiration will his unique interpretation and thinking bring to us? Starting from today, "Breathing World" will continue to launch an exclusive interview with Dr. Qiao Renli " What I Saw in the United States in the Two Years of the New Crown".
In the United States, the epicenter of the new crown epidemic in the "epidemic base camp"... Uninsured, homeless, prison inmates, etc. who have received COVID-19 are all sent here
At 7:30 p.m. Beijing time on April 19, 2022, and 4:30 a.m. Los Angeles time on April 19, 2022, Dr. Qiao Renli sat in front of the computer wearing a suit jacket and began to participate in a transnational academic seminar. What he wants to share with his domestic respiratory colleagues is his observations and feelings about the new crown epidemic in the United States in the past two years...
Figure 1: Los Angeles General Hospital in the spring light, USC Teaching Hospital, march 2020 became the "epicenter" of the new crown epidemic, the base camp of the epidemic.
This is Los Angeles General Hospital, where I worked during the pandemic, which was once the epicenter of the new crown epidemic in the United States and was called the "base camp of the epidemic" by the American media. This is a very classic European-style high-rise building, which is a typical American public hospital. What is the concept of public hospitals in the United States? This is a government-funded institution that provides medical care for the uninsured, homeless, prison inmates, etc., and basically does not charge any fees. During the epidemic, this type of NEW CROWN patient has been packed here in large numbers, many of which are pulled from the street by police cars. This is a major teaching hospital in USC. Usually we only rotate twice a year. But after the outbreak of the new crown epidemic, from March 2020 to 2021, I was urgently transferred here and stayed in the ICU of the General Hospital for more than a year.
What was the situation in the General Hospital at that time? Simply indescribable, a simple English word, overwhelming (overwhelmed): 8 ICU, each with an average of 16 beds, all changed to a new crown ICU, and all medical affairs that can be scheduled are suspended. There are people dying every day in the ICU, even the morgue has reached the point where it is necessary to queue, and two huge freezer trucks have been parked behind the hospital for a long time to use as a temporary morgue plus. Because family members are not allowed to visit, the fences on the four sides of the hospital are full of balloons, flower baskets, banners that family members express their wishes... That period was the worst time of the epidemic in Los Angeles, and it is no exaggeration to describe it as a feeling of "hell on earth". It is conceivable that working in such an environmental atmosphere, people's mental pressure is very large.
The United States has also tried to learn from China's successful anti-epidemic methods, but in reality it has been difficult to fully realize
Figure 2: The "U.S.-China Joins Hands to Fight COVID-19" webinar held in March 2020.
In March 2020, the COVID-19 outbreak in the United States had just begun. At that time, the American Association of Chest Physicians and the Chinese Medical Doctor Association jointly carried out exchanges. Academician Wang Chen and President Qu Jieming both introduced China's anti-epidemic experience, such as the anti-epidemic experience of Wuhan and Shanghai, and achieved very good results, especially how Shanghai took measures to "flatten the curve". At that time, the impact of this meeting in the United States was very large, and the head of the US CDC and many government officials came to attend, and the Chinese consul general in Los Angeles also delivered a special speech.
The United States has also tried to learn from China's successful anti-epidemic measures, such as quarantine and lockdown, but in reality it has not been fully realized.
In March 2020, Los Angeles did declare a state of martial law. The government even sent a letter of attestation to each doctor, going out to work at night, and with this letter, they could be licensed to pass, but others would not let them go to the streets at night. How is it being implemented? In fact, the implementation is all self-conscious, and no one has checked at all. But, though not mandatory, Los Angeles did see a millennium spectacle, with almost all of the Los Angeles highways, known for its traffic jams, empty.
The Convention Center in Los Angeles was a fairly large building that could accommodate tens of thousands of people for meetings, and the U.S. government at the time also followed China's approach and transformed the convention center into a "square cabin hospital" and wanted to achieve "full collection". But in fact, the national conditions are different, and the "square cabin hospital" in the United States has not been used, that is, no one has ever lived in it.
At that time, you may have seen from the news that the first American medical warship sailed to New York, the second to Los Angeles, and then placed in St. Peter's Harbor for two or three months, it was much more difficult for patients to transfer in than to transfer to ordinary hospitals, and finally the warship was not used. St. Vincent's Hospital, the fourth largest hospital in Los Angeles, was closed and vacated for COVID-19. The result was the opposite of what was expected, and the hospital is now an abandoned building. So, in Los Angeles, the united states, the lockdown has never really been achieved, which is the situation of the epidemic at that time.
Doctors who have just finished intubation of their new coronavirus patients wear incredibly simple isolation suits... The pandemic has fostered a sense of responsibility for the Fellows that is close to fatherhood
Figure 3: Protective equipment of doctors in ICU wards in the United States during the COVID-19 outbreak in March 2020.
In hospitals in the United States, starting in March 2020, the outfit in the picture is the main equipment used by American doctors to protect themselves. Among them, it mainly relies on the hood worn on the head, which has a small hair dryer in it, puts it on the head, and after starting, the air only goes out, and does not pour in. We have never worn the kind of "big white" that Chinese medical workers wear. At the beginning of the epidemic, the Chinese in the United States were exhausted and bought out the inventory of Protective Equipment in the United States to support the motherland. Unexpectedly, the epidemic in the United States soon entered an outbreak state, and all hospitals in the United States even had a quota of masks. Domestic colleagues and friends have been far away from the ocean, a large number of sent to me "big white", there are also local people donations, which were sent to China when the "robe with the son" label is still there. However, U.S. protection policies have not adopted Chinese standards. At first there were nurses on strike and organized protests, but then no one mentioned it. Fortunately, the infection rate of health care workers in the United States has not reached the point where the relevant responsible persons have been forced to re-examine the PPE (personal protective equipment) policy.
The photo above is the isolation suit worn by the front-line medical personnel in the United States to fight the new crown, which is extremely simple and thin like a raincoat. This is in the new crown ICU ward, and behind them are the new crown patients who have just finished endotracheal intubation. This is the protective measures in the United States, medical staff wear this kind of simple isolation gown, if someone is more careful, they will put a pair of shoe covers on the shoes and then enter the ICU ward. In the middle of the photo is Dr. Joe himself. The two foliaws on either side, the left and right arms in the ICU, were all infected, but fortunately they were fully recovered.
As an attending physician, the pandemic has fostered a sense of responsibility for the fellows that is close to paternal love. None of these young doctors flinched at the time, they were the main force that really underpinned the operation of the ICU. The United States does not have the habit of issuing medals to praise promotions, relying on the professionalism of professionals. There are also no subsidies for overwork due to the pandemic, as they are not yet full employees of medical schools or hospitals. Colleagues in the department decided to donate grants to share with the fellows, and I took the lead.
The total number of cases has more than tripled, but the number of hospitalizations has decreased... Covid-19 vaccines do play a decisive role in preventing severe illness and death
Figure 4: Prof. Renli Qiao's team's research data analysis of COVID-19 cases, tests, hospitalizations, and deaths.
This is the state of the outbreak in California, USA, as of last week. Cases began to appear in February 2020, the first climax was in the summer of 2020, the second climax was late 2020, and the most recent "Omi kerong" variant strain, which lasted from late 2021 to early 2022, reached its peak.
The gray curves at the bottom of the figure show the situation of hospitalized patients during several peak outbreaks, and the last two roughly correspond to the prevalence of the Delta and Omikeron variants. It can be seen that in the earliest first peak period, as the total number of cases increased, the number of hospitalized patients increased to the same extent, but by the stage of the "Omi Kerong" mutation, there was a significant change. While the total number of people and the total number of cases increased more than threefold, the number of hospitalizations decreased. This divergent difference is even more pronounced if the number of deaths is made into a curve to observe the trend.
To emphasize, this contrast reflects that the first outbreak peaked in the summer of 2020 (July-August), and the number of deaths was also at a peak during the first small peak period. Since then, there has been a gradual divergence between the number of infections and the trends in hospitalizations and deaths.
In early 2022, when the "Omikeron" mutant strain first appeared, it caused a wave of tension. The ICU medical staff almost faced psychological pressure and collapsed, and they really couldn't stand it. As a result, the case data of the ICU in the United States has not been up. At that time, the 8 new crown ICU originally transformed by the public hospital had basically resumed normal operation and was no longer used as a new crown ICU, leaving only one new crown ICU. But even the 15 beds in this new crown ICU were never full. The number of COVID-19 cases in private hospitals has not exceeded 10. Therefore, this is the characteristic of the "Omikejong" mutant strain, which infects a particularly large number of people, but the severe illness and mortality rate have obviously changed, which is far from the curve of any previous mutant virus.
However, it is clear that a sober analysis shows that the trend reflects two situations. First, in the summer and autumn of 2020, the large-scale nationwide campaign caused by the Floyd incident, while completely destroying any quarantine measures, was far from the peak of the outbreak caused by the mutation of the virus. That is, the human factors that isolate or disrupt isolation drive or mitigate outbreaks much less than mutant strains or vaccines. In addition, changes in epidemic trends are closely related to the state of vaccine prevalence. Judging from the vaccination situation in the United States, the number of vaccinated people currently accounts for about 75% of the total population of the United States, basically people have been vaccinated with the third stage of the vaccine, and now the fourth vaccine is also open. Although data on phase IV vaccinations are not yet available, nearly 90 per cent of people have been vaccinated with phase III vaccines (boosters).
As can be seen from the reality of the three curves in the figure, although the several ups and downs of the epidemic are triggered by the emergence of virus variants, the more the separation of the next three curves is. While mutations can lead to weakening viral pathogenicity, the most important influencing factor should be the increased popularity of vaccines. It is very worth pointing out that the COVID-19 vaccine does play a decisive role in preventing severe illness and death. A common misconception is that vaccines do not reduce incidence and are therefore a failure. However, it is the responsibility of medically literate professionals to explain to the public that the antibodies produced by vaccines are IgG and IgM, both of which are serum antibodies. Existing vaccines do not produce IgA, which is a secretory antibody that may play a role in preventing infection. Theoretically, the existing vaccines cannot prevent the infection of the new crown, and its real role is to reduce the damage of the new crown virus after infecting the human body and prevent the occurrence of severe diseases. That's where vaccines really do.
What other data can help us analyze the situation at that time? How exactly are the drugs used to treat the coronavirus in the United States? What's different about the program? In the next issue, Dr. Qiao will continue to share with us "What we saw in the United States in the second year of covid-19 (2)"
Expert introduction
Joe stands
Quad-certified specialist of the American Council of Internal Medicine (internal medicine, lung disease, critical care, sleep medicine); professor of clinical medicine at the University of Southern California, consultant to the PCCM Special Training Committee.
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Author: Winter Snow Condensation; Editor-in-Charge: Jerry