How to protect the lives of home recuperators became a major issue in the fifth wave of the new Corona.
Toward the sixth wave, Ota Ward, Tokyo, treats home recuperators in cooperation with hospitals where local family doctors directly perform "antibody cocktail therapy" without going through a health center where work is delayed due to the spread of infection. We are in the process of creating a system to continue.
"Antibody cocktail therapy" The family doctor who consulted directly asks the hospital
In the fifth wave, when the infection spread rapidly, the work of the health center was concentrated in Ota Ward, Tokyo, and it took several days to contact the positive person for the first time.
Based on this lesson, the Ota Ward Health Center and the Ward Medical Association are preparing to promptly carry out "antibody cocktail therapy" in which two types of antibodies are simultaneously administered to mildly ill patients.
Specifically, we have designated eight hospitals in the ward as hospitals that provide antibody cocktail therapy, and have made it possible to administer them efficiently, such as by collecting therapeutic drugs.
Until now, many of the health centers asked patients about their condition and connected them to the hospital as to whether or not to use antibody cocktail therapy. The family doctor who examined the patient directly asks the hospital to have a home caregiver receive antibody cocktail therapy at the outpatient department of the hospital.
If the infection spreads and eight hospitals are under pressure, local family doctors are considering whether antibody cocktail therapy can be given directly.
In addition, we are working to create a system that does not leave home caregivers, such as having a family doctor perform health observations for patients on behalf of the health center.
Dr. Hirofumi Ishida, a director of the Omori Medical Association and who runs a clinic in the area, said, "I want to avoid leaving patients at home next time. I don't want to repeat that fifth wave. I realized that it is not enough to just have the patient sleep at home, and that it is a very risky illness that gets worse, so I think it is important to guide the patient to the best treatment such as antibody cocktail therapy. I'm talking.
Designated 8 hospitals for efficient administration of "antibody cocktail therapy"
Eight hospitals such as "Toho University Medical Center Omori Hospital", "Ebara Hospital", "Tokyo Labor Disaster Hospital", and "Omori Red Cross Hospital" have been designated as hospitals that promptly perform "antibody cocktail therapy" in Ota Ward, Tokyo. Therefore, therapeutic drugs are collected in these hospitals so that they can be administered efficiently.
Of these, the Omori Red Cross Hospital's vault stored the therapeutic agents for 10 people used for antibody cocktail therapy.
In order to connect to treatment more quickly, the hospital distributes a form for local family doctors to write information such as the patient's underlying illness, and almost everything in the hospital to secure a caretaker. The doctors are on duty to respond.
Dr. Hiroshi Nakase said, "Antibody cocktail therapy is more effective if it is given as soon as possible, so I would like to use this mechanism for smooth treatment. I want to prepare now. "
Family doctor is responsible for observing the health of home care recipients
東京 大田区は第6波への備えとして、患者を最初に診察する地域のかかりつけ医に協力してもらい、自宅療養者を取り残さない態勢作りを進めています。
その1つが、地域のかかりつけ医が診察した患者に対し「抗体カクテル療法」を行うかどうか診断し、直接、患者を病院につなぎ、治療を依頼してもらうことです。
これまで抗体カクテル療法を行うかどうかは、多くを保健所が患者に状態を聞き取って病院につないでいましたが、第5波では保健所の業務が滞ってしまい投与のタイミングが遅れるなど課題となっていました。
もう1つが、感染拡大で業務がひっ迫する保健所に代わって、かかりつけ医が自宅療養者の健康観察を担うことです。
自宅療養者にパルスオキシメーターを使ってもらい、血液中の酸素の数値が低下していないか、かかりつけ医が定期的にチェックするなど、見守ることにしています。
大森医師会の理事で、地域で診療所を営む石田博文医師は、ぜんそくの持病がある80代の女性の診察を行い、大田区の第6波への備えについて説明していました。
医師が「もしコロナに感染したら、僕が主治医として病院に抗体カクテル療法を依頼し、必ず治療が受けられるようにします。自宅で療養している間も酸素の数値が下がっていないか聞くなど、つながっていられるようにするから安心してくださいね」と話していました。
80代の女性は「私のように疾患がある場合、コロナに感染すると重くなると聞くから、安心感があります。ありがたいです」と話していました。
Dr. Ishida said, "Even though I reported positive when there were many patients in the 5th wave, there was a time when it took 3 to 4 days for the local government to call the person. The patient stayed at home for several days. I think many of us were very anxious and painful because we were just in the middle of the day. We triage how we should make a diagnosis and give antibody cocktail therapy. That role is important and we I think it's the job that practitioners are looking for. "
University hospital cooperates Ward staff learns infectious disease expertise
In preparation for the 6th wave, Ota Ward, Tokyo is working to develop human resources who can take effective infection prevention measures for facilities where clusters have occurred and home care workers.
This initiative is being carried out by Ota Ward in Tokyo with the cooperation of the Toho University School of Medicine in the ward, and five staff members of the ward are taking infectious disease classes.
Classes are divided into 10 classes from August to March next year to learn about infectious diseases such as the new coronavirus and specialized knowledge of therapeutic drugs through lectures and practical training.
Of these, Misato Sato, the chief of the Welfare Management Division, has specialized knowledge on how to reduce infections at facilities for the 6th wave because infections occurred at facilities for the disabled and the elderly in the 5th wave. I am taking a course to learn.
In the online class, when Mr. Sato asked how to get him to wear a mask thoroughly, he advised how much virus spreads in the air if he coughed, and if he could show it with photos and illustrations. Was receiving.
Mr. Sato said, "When deploying masks to facilities, I didn't know which masks should be distributed to which facilities. By studying this time, surgical masks have the effect of preventing airborne infections, so I went to admission facilities and hospitals. I came to know whether to deploy it or if it was a normal facility, a non-woven mask would be fine. I would like to understand the mechanism of how the virus causes infectious diseases and use it for future measures. " ..