From the "Twenty Articles" to the "New Ten Articles", after the adjustment of the epidemic prevention and control measures, the epidemic is still spreading.
At the 431st press conference on the prevention and control of the new crown pneumonia epidemic in Beijing, Li Ang, the spokesperson of the Beijing Municipal Health and Health Commission, introduced that after the optimization and adjustment of the epidemic prevention and control policy, the number of visits to fever clinics and the number of influenza-like cases have increased significantly. The volume of calls has grown dramatically.
On December 11, there were 22,000 outpatient visits to fever clinics in the city, 16 times that of a week ago.
As the number of infected people increases, medical institutions are under considerable pressure.
Zhang Wenhong of Huashan Hospital Affiliated to Fudan University mentioned at the "Seventh China Telemedicine Conference" on December 11 that after the optimization of the epidemic prevention policy, my country's medical resources will usher in the first wave of the epidemic.
How can medical institutions withstand the impact of the epidemic and maintain normal order of diagnosis and treatment?
We interviewed Wang Guangfa, director of the Department of Respiratory and Critical Care Medicine at Peking University First Hospital and member of the National Expert Group on Novel Coronavirus Infection Pneumonia, Yang Fan, director of the Department of Infection at Huashan Hospital affiliated to Fudan University, and Yu Xuejie, professor at the School of Public Health of Wuhan University.
The following is the conversation between the Beijing News reporter and them.
The epidemic situation in the society is getting worse, and the risk of hospitals is increasing
Beijing News: What impact does the current epidemic have on hospitals?
Wang Guangfa: The fever clinic in the hospital has become very stressful, and many patients with fever come to see the doctor.
Secondly, due to the cold winter, there are relatively more emergency patients every winter, and there are still some people who have aggravated their underlying diseases due to infection with the new coronavirus.
In addition, some medical staff have also been infected with the new crown, and the hospital has experienced staff reduction.
Yang Fan: The risk of the hospital must have increased, because the social epidemic situation has intensified.
Now the country is optimizing the epidemic prevention and control measures. After the adjustment, there will be an impact on the society, and it will indeed put a lot of pressure on the hospital.
The clinic is still crowded.
At the current stage, it is still necessary to control the speed and number of simultaneous infections. It is best not to have too many infected people at once, otherwise the bearing capacity of the whole society will decline.
Hope this process is slower.
Beijing News: What is the difficulty of prevention and control in hospitals?
Wang Guangfa: At present, the detection of antigenic nucleic acids has actually been relaxed in the whole society. Now our whole society has shifted from the focus of epidemic prevention and control to medical care.
The hospital must first solve the patient's problem.
If there is a positive case in the hospital, it is still necessary to isolate it as much as possible, but it may not be possible now. For example, if a positive case comes to the emergency room, so many patients come and go, there is no way to completely isolate it.
Yu Xuejie: As the social epidemic situation continues to grow, even if the hospital takes nosocomial infection prevention and control measures, it may not necessarily reduce the number of infections.
The hospital certainly does not want everyone to mix together after entering, but it is unrealistic to have a single ward, and the hospital does not have this condition.
For hospitalized patients, nucleic acid or antigen screening can also be done in advance to prevent other people from being infected in the hospital.
However, the number of patients in the outpatient clinic is very large. In the current environment with a large number of infections, it is unrealistic for everyone to have an examination in advance.
If patients are asked to come to the hospital for nucleic acid testing 24 hours in advance, the nucleic acid testing places will also have to line up and gather.
Especially in the emergency department, no matter whether the patient is nucleic acid positive or not, the doctor has to treat the patient immediately.
For example, if you have a cerebral hemorrhage or trauma, you have to deal with it first.
The emergency room may be simpler, because there is no need to consider who is negative or positive, and the doctors and nurses will take appropriate protection by themselves.
At the same time, medical staff on the front line bear a lot of risks of infection.
Ensure the combat effectiveness of the hospital and do a good job in personal protection
Beijing News: At present, what is the focus of hospital infection prevention and control?
Yang Fan: The current strategy of Huashan Hospital is not to completely avoid infection, but to do its best to ensure the safety of patients and reduce losses.
The second is to ensure the combat effectiveness of the hospital and ensure that other patients can be treated. Not only the new crown, but also countless other diseases that may threaten life. live.
Illness is definitely not a good thing, even a cold is not a good thing, so we must press the peak, we must ensure combat effectiveness, survive the most difficult days, including the coldest climate, and then we can slowly recover normal life.
Yu Xuejie: In reality, doctors and nurses will also be infected.
If I were the director of the hospital, I would consider not allowing doctors and nurses to be infected at the same time in a very short period of time, because everyone is infected. After all, they may still have symptoms and feel very uncomfortable, so everyone will not be able to go to work.
Purely from the perspective of work, I hope that medical staff can protect themselves well, at least not within the same day, week or month. Their infections can occur over a relatively long period of time, and each person is different. Infection in time, so that the hospital will not be unavailable.
Beijing News: What are the specific measures to prevent infection in hospitals?
Yang Fan: The measure is to strengthen the protection level and make the turning as smooth as possible.
In the past, when the control was the most stringent, an employee became positive, and a hospital had to be closed for two weeks. Although this minimized the spread, closing a hospital, under the recent situation where the number of infected people continues to increase, will bring benefits to the society. The losses caused are far greater than the gains.
Now the positive colleague is isolated at home, and the environment where he is is disinfected to a certain extent. Other comrades strengthen protection, stay vigilant, and report in time if there is any situation.
Yu Xuejie: After all, medical staff have to face so many people. Even if the hospital is divided into shifts to reduce the gathering of medical staff, it is difficult to ensure that they will not be infected. It is still the best way to take personal protection.
At the same time, disinfection inside the hospital must be done more frequently.
Key departments such as dialysis and geriatrics focus on prevention and control
Beijing News: What are the different prevention and control measures for different departments?
Yang Fan: Some key departments will be a little stricter. We no longer require all employees to be tested for nucleic acid when entering the hospital, but some key departments are still testing, such as the dialysis department and the geriatric department.
This is because the patients in these departments have underlying diseases themselves, and after being infected with the new crown, they may have a greater impact on them.
Yu Xuejie: The hospital must carry out different prevention and control in each department.
For some patients with serious underlying diseases, or elderly patients, or patients undergoing surgery, they must be well protected, and people who are already infected must not be allowed to bring the virus into the ward.
Especially in the intensive care unit, you may consider whether you need to be isolated separately.
The doctors and nurses in these departments must also do a good job of nucleic acid testing, otherwise, if the medical staff is positive, it will be bad if they infect the patient.
If it is an outpatient clinic, doctors and nurses may be more in need of protection, because the prevention and control measures have just been released, and it is inevitable that many positive patients will come to the outpatient clinic and emergency department.
Beijing News: At present, is it still necessary to isolate and partition hospitals?
Wang Guangfa: Now that the number of patients is increasing, it is difficult to fully meet the isolation conditions, because the spread of the new coronavirus can be transmitted through close-range droplets, contact, and aerosols. Sometimes cross-infection cannot be completely avoided. .
It used to be three districts and two channels, but now it is not required. In fact, it is because there are too many patients. According to the three districts and two channels model, the hospital cannot handle so many patients.
If the scale of the epidemic is not large, we can still distinguish it.
Yang Fan: Because the number of cases in Shanghai is not particularly large, we can still divide them in this way.
Our hospital still retains the admission test for patients for the time being. Those who are positive must at least be dealt with separately. Now the outpatient clinic does not require nucleic acid reports, but they will still be asked to test for antigens.
But if we wait until the infection rate in the society increases to a certain level, it is actually a bit difficult.
Because we have no way to take out two buildings, one for positive and one for negative.
If this division is made in the same building, it may be more symbolic for respiratory infectious diseases.
Three zones and two channels like in the past will not be done. These things have high requirements on hardware and will take up a lot of resources.
Now is to simplify the process and allow doctors to deal with patients quickly.
Doctors do the screening. For example, this person can be treated symptomatically, and that person can go home. This reduces everyone's time and saves medical resources.
At the same time, it reassures the patient that he has been to the hospital, and the doctor prescribed the medicine to take it home.
Keep the people who are really at risk, and use this method to ensure the normal operation of the hospital and use resources where they are most needed.
This building receives Yang, and that building receives Yin, which will definitely disrupt a certain specialty, and will affect the quality of medical care. No cardiologist handles it well.
Every hospital will have its own wisdom to maximize the safety of patients.
There is not only a new crown disease in this world, our current principle is to minimize losses.
Yu Xuejie: If the conditions are good, the hospital can separate infected patients and non-infected patients.
For inpatients, it is best to divide the area, otherwise, if one person is infected and is not isolated in time, the entire ward may be infected.
But once partitioned, the workload in all aspects of the hospital will increase.
Now the main consideration is whether the patient's physical condition can withstand the infection of the new coronavirus, and it is necessary to make an assessment in advance.
Do a good job of cleaning your hands, it is best to wear N95 masks
Beijing News: How should medical staff be protected now?
Wang Guangfa: There are indeed some infections among medical staff.
This infection is actually like going to war on the battlefield, and it is inevitable that there will be some injuries.
But fortunately, the proportion of serious illnesses caused by this virus is relatively low. Most of the medical staff will recover in a short time after being infected, so the problem is not too big.
Medical personnel should do a good job of personal protection, wear masks, goggles or splash screens, isolation gowns and gloves when receiving patients with new crowns. When leaving the hospital, it is best to take a bath to minimize infection risks of.
Yang Fan: Medical staff need to improve their level of protection. In the past, they used to wear protective clothing at all times. These have actually decreased, but the level of masks has increased instead.
It is now required that all suspected places wear N95 masks or KN95 masks, because there are many positive people now, including some patients who were negative for nucleic acid at the beginning. Be vigilant.
Beijing News: How can ordinary people prevent themselves from being infected in hospitals?
Wang Guangfa: Take protective measures, wear a mask, and maintain social distance.
There are hand sanitizers in many places in the hospital, which can be used to clean them in time. Before leaving the hospital, they should also clean their hands.
Masks must be worn correctly. Many people do not wear them properly. When going to a hospital, it is best to wear a medical protective mask, which is what we call an N95 mask.
Yang Fan: Every patient or staff member, every individual must pay attention to protection.
In fact, it means wearing a mask and keeping your hands clean.
In the hospital, many patients took off their masks inadvertently. Sometimes when I went to the outpatient clinic, some patients entered the office and the first thing they did after sitting down was to take off their masks.
Now I hope that everyone can do these things well. This is something that can be done well at a small cost.
Try not to take off your mask.
If you pay attention to yourself, you can bring a small disinfectant with you, and spray it on your hands often.
If you can't wash your hands and disinfect them temporarily, don't touch your mouth and nose, and try not to touch other parts of your body.
Be more particular about the jacket you wear when you go out, and put it at the door when you get home, and change into your home clothes.
If everyone does these things well, the probability of being recruited can actually be reduced, but it cannot be completely reduced to zero.
It is also necessary to objectively accept that everyone has the possibility of being recruited, and don't panic if you are recruited.
In fact, at present, this is a respiratory infectious disease. The data shows that for most people, it will not pose a life-threatening threat. Of course, the body will have a painful process.
Of course, patients are also hoped to truthfully tell the hospital whether they are infected, so as to avoid nosocomial infection.
Those who seek medical treatment have to weigh it themselves. If the disease is not an urgent matter, such as for plastic surgery, and some chronic diseases such as benign tumors can be elective surgery, I think you can wait. After all, the hospital is a densely populated place. place.
Yu Xuejie: For ordinary people, try not to go to the hospital now, and only go to the hospital if you have to go to the hospital.
Leave resources to those who really need them
Beijing News: How to avoid the relative shortage of medical resources?
Wang Guangfa: There will be a large number of patients in a short period of time. In fact, any country will have relatively insufficient medical resources to deal with this situation. We can only do our best to minimize the impact, including emergency departments, outpatient clinics, and fever clinics. We must try our best to improve efficiency , Do some stratification and grading, deal with it quickly, identify some patients who really need treatment, admit them in time, and prepare as many beds as possible for treatment.
Many patients in fever clinics go to prescribe medicines. In fact, some antipyretics and cold medicines are over-the-counter medicines, which can be bought at pharmacies, and they don’t necessarily have to go to the hospital.
Now you can also buy online, which is also a way.
Then there is Internet medical care, see a doctor online, and then prescribe medicine online. Now that everyone uses these modern tools, it may be better, it is convenient for themselves, and it also reduces the burden on some hospitals.
The hospital is actually very tired now, with few staff and many patients. We have always adhered to the attitude of being highly responsible for people's life and health, overcoming many difficulties and persevering.
If it is not particularly necessary to go to the hospital to see a doctor, use the above methods to solve it.
There are also some patients who really need medical help, so it depends on what should be seen. After arriving at the hospital, the doctor will conduct an examination and judgment, and then proceed to the next step of treatment.
Leave resources to those who really need them.
Yang Fan: For some people who have been infected with the new crown virus, if it is a non-emergency and unnecessary hospitalization, for example, some are originally elective surgery, or it is just a chronic problem. If they can choose a time to be hospitalized, they can wait until they are negative.
But if there are necessary medical needs, separate him from other patients and try to ensure everyone's safety.
For fever clinics, for example, if someone feels that he has been recruited, but the symptoms are not serious, he should rest at home.
If you go to the hospital to queue up, there is no special treatment in the end, or you simply dispense some medicine and go back, which will add a lot of burden to the hospital.
I still hope that everyone will have a correct understanding, keep calm, and reduce panic about this disease.
The biggest impact comes from the early strains, which are different from the current Omicron, and this message must be conveyed clearly.
There is one more thing that needs to be made clear. There are still many things that threaten our health in the world. In order to prevent the spread of the new crown, a lot of hospital resources are used to do this, which may delay the treatment of many other diseases. There must be balance considerations.
In our society, all resources are limited. If too many resources are invested in one thing, other resources will be crowded out.
There is also enough consultation and support. A 30-year-old person may be very calm when his fever reaches 40°C, but an 80-year-old person will be advised to come to the hospital as soon as possible. This requires the health administrative department to organize medical staff to provide unimpeded Consulting channels.
In addition, government departments can also do one thing, which is to dynamically publish the waiting information of fever clinics in hospitals to guide everyone to choose by themselves.
For example, how many people are queuing up for the fever clinic of Huashan Hospital, and the waiting time may be expected to be several hours, and another hospital can wait for 5 minutes.
It is convenient for patients to decide whether to go to the hospital and which hospital to go to.
Beijing News: Under what circumstances do you need to go to the hospital?
Wang Guangfa: Generally, if you get a new crown or a cold, solving the fever is not the main purpose of our medical treatment.
Of course, children are different. Infants and young children may have febrile convulsions, especially children under 3 years old with a history of febrile convulsions or a family history. They may have a fever and have to actively reduce the fever. Antipyretics should be actively purchased, or Go to the hospital to see a doctor.
Another special group is the elderly and those with underlying diseases.
After they have a fever, their reaction may be different from that of young people. Sometimes although the temperature of the fever is not necessarily high, but because of their own underlying diseases and poor organ function, these patients should go to the hospital in some cases.
There are also some people, although they are young and middle-aged, but they continue to have a high fever after getting the new crown. From what we can see, the fever usually subsides in about three days. If the fever does not subside after four or five days, you may need to see a doctor in time. It is said that there is suffocation, especially the suffocation is getting worse day by day, this must be seen by a doctor, and if there are palpitations, palpitations, or even loss of consciousness, you should also go to the hospital in time.
The extremities are very cold, and the skin may be a little purple in color at first glance, or the circulation is not very good, and there are some problems with other organs, so we must pay attention.
It is not necessarily caused by the new crown, and it may also be caused by some other conditions, including some adverse drug reactions. You may need to identify when to see a doctor and when not to see a doctor. You must have knowledge in this area.
Beijing News reporter Wang Chang