Delta strain "The conventional treatment does not work" -Adhesion / Severely ill ward August 23, 16:22

The threat of Delta stocks is now hitting the medical field.

People in their twenties, who have no underlying illness, are rapidly becoming more severe, and conventional treatments are no longer valid.

It has been a year and a half since I continued to cover the critically ill ward of the new Corona.

I have never been more aware of the term “medical collapse” than this time.

Report what is happening at the forefront of treatment.

(Chief Director, Social Program Department, Dai Matsui)

Rapidly aggravated even in the 20s without underlying disease

On the 15th of this month, the new Corona Severe Acute Respiratory Ward at St. Marianna University School of Medicine Hospital.

The man in his twenties who had no underlying illness was transported by emergency.

I was unconscious when it was brought in.

Already, the oxygen saturation of blood had dropped to the 60% level.

Shortness of breath and respiratory failure occur below 90%.

This number of 60 is an extremely dangerous situation that requires an immediate ventilator.

Immediately, I decided to install an artificial heart-lung machine, ECMO.

Since April last year, the hospital has accepted more than 400 critically ill patients with the new corona, but this was the first time they used ECMO in their 20s.

Now, in this hospital, highly infectious Delta strains have been detected in many patients.

As the number of Delta strains increases, the number of cases in which the "younger generation becomes more severe" is increasing rapidly.

"Speed ​​of increasing severity" Unprecedented speed

And, "the speed at which the disease progresses" is said to be something that has never been experienced before.

An image of the lungs of a man in his thirties four days after the onset.

You will see a frosted white shadow that indicates inflammation.

In just four days, it became difficult to breathe on its own, so I introduced a respirator and ECMO.

After 7 days, a white shadow spread throughout the lungs, losing most of the lung's function.

It was becoming more severe than ever before.

This is Dr. Shigeki Fujitani, who is in charge of the ward for the severely ill.

It is said that the situation has changed completely since the opening of the Tokyo Olympics.

Dr. Fujitani

"Until a few weeks ago, the majority of patients with the Alpha strain were the" 5th wave ". However, almost all of the severely ill patients are now replaced by infected patients with the Delta strain. Almost all patients are under 65 years old. Approximately 90% of patients are in their 20s to 50s. How highly infectious the Delta strain is, and the misconception that "young people are less likely to get infected" is wrong. I will be

Delta strain "Traditional treatments do not work"

Furthermore, what is worrisome to Dr. Fujitani is that conventional treatments do not easily lead to recovery.

Prone position therapy in which 7 to 8 nurses and medical staff take the patient's body on his back to the prone position and then back on his back a few hours later.

By turning the body, blood is distributed to the cells of the lungs and promotes recovery.

In addition, medications such as remdesivir and steroids.

It is said that these treatments are less effective.

Dr. Fujitani

"I think there is no doubt that the conventional treatments are no longer valid. I feel that they are showing a completely different pathology from the corona infection up to the third wave. not"

"It's tough, or it's collapsed."

"Medical collapse" is also becoming a reality.

In early August, the 17 beds in the critically ill ward were finally full.

However, even when the floor was full, requests for new patients continued.

For the first time, Dr. Fujitani and his colleagues, who have always believed in "medical care without refusal," have had to give up accepting critically ill patients.

In a hurry, we decided to reconstruct the intensive care unit that accepts patients with traffic accidents and strokes for the severely ill with the new corona, and increase the number of beds by seven.

However, just after the addition of 3 beds, it was soon filled with new patients.

Doctor

"It takes about 30 minutes to get the information that (the bed) is vacant. It's very strict, or it has collapsed."

Suspended support for cherished patients and their families

The rapid increase in patients is also affecting the efforts that we have cherished so far.

One of them is "online visitation".

To prevent infection, families who could not enter the hospital room were allowed to talk using tablets.

In addition, we thoroughly implemented infection control measures so that the family could make the final farewell in the same room as the patient.

These efforts have continued to protect human dignity as much as possible, even in the case of Corona.

However, due to the rapid increase in patients, we were forced to stop.

A painful choice “Patients with low chance of recovery go to another hospital”

On the 17th of this month, the hospital reduced the general ward to make more beds for critically ill corona patients, bringing the total to 32 beds.

The staff was secured by collecting from other departments and alumni.

Therefore, we have no choice but to limit emergency general medical care such as traffic accidents and strokes.

However, further expansion is said to be difficult.

Corona's intensive care unit requires at least two nurses 24 hours a day for each patient.

Furthermore, if an artificial heart-lung machine / ECMO is installed, staff such as clinical laboratory technicians will also be required.

The 32 beds are also full as of the 20th of this month.

How will we accept the ever-increasing number of critically ill patients in the future?

Dr. Fujitani was forced to make strict choices that he had never thought of before.

In order to save lives that can be saved, it may be necessary to consider transferring patients with a low chance of recovery to another hospital.

Dr. Fujitani

"I have to make a very difficult decision."

Director

"It's hard to say, but if you can't help, do you mean to see someone else?"

Dr. Fujitani

"We are beginning to become unbearable unless we completely divide the roles of helping critically ill patients who can be helped by intensive care."

The number of positive patients for pregnant women is increasing rapidly, and some hospitals have tight beds.

Even in a hospital that accepts patients with moderate illness in collaboration with St. Marianna University School of Medicine, we faced a tight bed.

This is Kawasaki Municipal Tama Hospital.

Although the general ward was closed and 30 beds were reserved for patients with the new corona, they remain full.

There are a series of positive pregnant women.

We have accepted two pregnant women since the beginning of this month.

It is feared that if a pregnant woman develops pneumonia, it may become more severe.

According to the Japan Obstetricians and Gynecologists Association, infections are common in the second trimester (14-27 weeks), and about 60% are domestic infections.

Dr. Motohashi

"I think it's related to the weakened immunity. Also, when pregnancy is late, the stomach grows bigger and it presses on the lungs, so that's also related. I may have to say that it is an abnormal situation because it has never happened before. "

What doctors want to tell you now

How can we get out of the crisis on the verge of medical collapse?

Dr. Fujitani of St. Marianna University School of Medicine says he wants to convey three points.

1. 1.

New measures need of people flow suppression

you think of ". Be the first person flow that it is how to suppress is important.

Also issued a emergency situation declared, in a prolonged self-restraint fatigue, has not come out the effect of pretty people flow suppression status quo I think you.

as a policy, is necessary measures with a more deterrent, when the country does not cause any action, I think that people flow can not be suppressed.

is no longer just an emergency declaration of the effort and up to now the medical field is I don't think the spread of infection can be stopped. "

2. 2. Adequate supply system and vaccination promotion of vaccines

"currently, in most of the patient to be transported to the critical care ward 50s from the 20s, is all unvaccinated person of the vaccine.

That you are surely severity is suppressed by vaccination is the obvious and are in clinical practice.

in particular, against the possibility of a mutant strain that severe in young people, vaccination of the vaccine, I think it necessary to promote with a sense of speed.

the government is enough of the vaccine established a supply system, we have a plan of should proceed with vaccination.

Furthermore, ensure. of hand strikes to inoculate

not only doctors and nurses, EMTs, so that you can ensure a more aggressive personnel such as pharmacists Therefore, I think that vaccination should be recommended as soon as possible.

Especially, some young people hesitate to vaccinate, but after seeing the actual clinical situation, those who can vaccinate should be vaccinated. I would like to have it. ”

3. Need for large-scale medical facilities The

reason why medical institutions are on the verge of “collapse” in the face of the threat of Delta strains is that home medical care and moderately ill patients receive appropriate medical care at the appropriate time. can not, and severe in the meantime, it would be filled beds for critical care are related.

First of all for the sake of the patient's home care and moderate, to prepare a large-scale care facilities such as gymnasiums and temporary tents, early as medical care can intervene, I think that we should establish a system that does not occur waffling and treatment of delay.

selection of resources and aggregation I think it is necessary in this disaster mode.

"fifth wave With the peak number of infected people still

unclear,

it is expected that the number of people in need of treatment will continue to increase rapidly.

Immediately, we will provide appropriate treatment to these mild and moderately ill people. If you do not, you will not be able to receive medical treatment even if it becomes severe.

A terrible scene like Europe and India facing "medical collapse" due to an infection explosion is imminent in Japan. I have a strong sense of crisis. ”

I think that how we can share Dr. Fujitani's strong sense of crisis with as many people as possible is one of the keys to the fight against Delta stock.

We will continue to cover the new Corona Severe Acute Respiratory Ward as long as it is permitted.

Dairin Matsui,

Chief Director of the Social Program Department

Joined the

station in

1993.

Since April of last year, I have been covering the Corona Severely Injured Ward of St. Marianna University School of Medicine Hospital.

Related program "Close-up Gendai Plus"

"Crisis caused by the new Corona Severe Acute Respiratory Ward" Negative Spiral "" is being delivered overlooked until August 24th.

Close-up Gendai Plus "Interview Note"

Many articles by Chief Director Matsui are also posted in this "Interview Note".