Zhang Wenhong: Omicron "can bite"! Make good use of the "golden 72 hours" to protect vulnerable groups

　　Da Jiangdong｜Interview with Zhang Wenhong: Omicron "can bite"!

Make good use of the "golden 72 hours" to protect vulnerable groups

　　Arrived at the hospital early in the morning to participate in the shift and ward rounds of inpatient critically ill patients; in the morning, participated in a special meeting on the treatment of severe patients with new crown convened by the city leaders; returned to the hospital at noon to discuss the treatment plan for several newly admitted critically ill patients; 13: 30. Participate in the training activities for medical staff on the standard treatment of elderly patients; at 14:30, together with Chen Erzhen, vice president of Ruijin Hospital, as a treatment expert, discuss with relevant leaders of various districts in Shanghai how to continue to expand and expand grassroots treatment capabilities.

At 16:30, I rushed to another tertiary hospital and consulted more than 10 elderly people infected with the new crown virus...

　　On December 29, 2022, the work schedule of Zhang Wenhong, leader of the Shanghai New Crown Epidemic Prevention and Treatment Expert Group and director of the Infectious Diseases Department of Huashan Hospital Affiliated to Fudan University, is also a microcosm of the recent busy state of Shanghai treatment experts.

In the evening, during work breaks, Dr. Zhang Wenhong accepted an exclusive interview with Dajiangdong Studio.

　　Da Jiangdong: Please introduce the main characteristics of the new coronavirus infection in Shanghai and the recent treatment of patients.

Zhang Wenhong: Shanghai has reached the peak of infection since December 22. According to estimates, the current number of infections is in the tens of millions.

Assuming that 0.5% of the 10 million infected people in Shanghai need to be hospitalized, it means that 50,000 people will need to be hospitalized in the next few weeks. All major hospitals will admit thousands of people without exception, and those who are particularly critical will need respiratory support.

Therefore, although the proportion of severe cases among the infected population is low, the base number is large, and the absolute number of people is still large. This is the characteristic of this wave of Omicron infection—

　　At present, Shanghai is making every effort to improve the ability to treat critically ill patients. From grassroots health institutions to tertiary hospitals, all doctors and nurses are engaged in an all-out battle against Omicron.

, including increasing the number of treatment sites, training medical personnel, providing oxygen therapy and antiviral drugs, and formulating standardized diagnosis and treatment manuals, so that

In the Huashan Hospital where I work, in addition to the hundreds of beds in various districts of the Infectious Diseases Department, some beds on two floors of other departments have been provided today as a public platform for centralized treatment in the hospital.

　　Da Jiangdong: Compared with the previous ones, what are the characteristics of the response and treatment of this wave of epidemics?

Do doctors have newer drugs or treatments?

Zhang Wenhong:

After these three years, we have formed many standardized procedures for treatment.

Through the research and analysis of previous deaths and severe cases, we found that vaccination can effectively reduce the rate of severe cases and mortality.

Through multi-party publicity and vigorous promotion, many people have completed the full vaccination.

We have also made certain preparations in terms of antiviral drugs, respiratory support, ICU wards and equipment.

In the treatment process, according to the characteristics of severe new coronary pneumonia, early use of oxygen therapy to correct hypoxia, use of hormones to improve inflammation and early anticoagulant treatment, etc.

Generally speaking, the peak of severe disease treatment will follow the peak of infection soon. The weapon to deal with it is to deploy medical resources with the greatest efforts and the spirit of restless, from primary hospitals to tertiary hospitals, with the fastest speed Seize the 72-hour "golden time" treatment, whether it is early primary medical treatment in the community or emergency treatment of critically ill patients, we must

　　Da Jiangdong: The elderly and vulnerable groups with underlying diseases are the most concerned groups in this wave of infections.

With a high degree of aging in Shanghai, what preparations have been made for the protection and treatment of vulnerable groups?

Zhang Wenhong:

There are 88,000 elderly people living in nursing homes in Shanghai, 22,000 people living in nursing homes, there are 700,000 to 800,000 elderly people with various underlying diseases living at home, and more than 5 million elderly people over the age of 60.

Shanghai has made a comprehensive investigation on this.

In addition to promoting vaccination, our idea earlier was to try our best to protect the elderly and vulnerable groups from being infected in this wave of epidemics, so we implemented closed management of nursing homes, and advised the elderly to stay at home, avoid going out, and avoid square dancing and mahjong. Crowd infection peak line, delaying their infection time.

However, in the rapid tsunami-like spread of Omicron, the infection rate of the elderly is still relatively high, and the number of critically ill patients is also increasing.

Now entering the critical period of the decisive battle,

All districts in Shanghai are organizing the distribution of medical resources to nursing homes and nursing homes, and the municipal expert group is also connecting with the grassroots by region to strengthen consultation, ward rounds, and training.

This time, it's an all-out power showdown between us and Omicron.

There is no opportunity to make things happen. It is not that the tertiary hospitals can open a few more intensive care units to solve the problem of treatment. It is necessary to mobilize effectively from the grassroots to the center. Every family must also know how to protect the vulnerable population and under what circumstances to go to the hospital for treatment; Every community health center can also expand the treatment force as much as possible...

　　Struggling to hold on to the threshold of infection of vulnerable groups, this pandemic, we can grit our teeth and pass.

　　Da Jiangdong: Some people say that BA.5 or BF.7, the main strain of this wave of infection, is more "poisonous". Is it reasonable?

Zhang Wenhong:

The current main strains are all widely circulated abroad, and some scholars have done virulence comparisons. The severe disease rate and mortality rate of BA.5 and BF.7 are very close to those of the first generation Omicron.

After infection, many people feel severe symptoms such as fever and muscle aches, and they have given fancy names, such as "blade strain" and "dry rice strain", but such people are still mild.

Severe cases are clearly defined in medicine: dyspnea, oxygen saturation below 93%; CT scans show extensive infiltration of the lungs, large shadows or even white lungs.

If oxygen inhalation is useless, and tracheotomy and mechanical ventilation are required, it is a critical illness.

　　Da Jiangdong: Have you ever been infected with Omicron?

Are the symptoms severe?

Zhang Wenhong: I have been infected, and my symptoms are very mild.

On the first day, I rested at home and held six or seven online meetings; on the second day, I went to the positive ward for rounds.

No one around thought I was infected, because I was in the ward and working every day.

I've had my fourth shot, and my own experience has made me even more pro-vaccination.

　　Da Jiangdong: Since the beginning of the epidemic, you have always emphasized the importance of strengthening nutrition, especially protein intake.

Why should so much attention be paid to nutritional issues in the treatment of respiratory diseases?

Zhang Wenhong:

When participating in the epidemic treatment and ward rounds, I have seen many cases.

In 2020, many imported cases from abroad are often due to frequent transfers on the road, no three meals, lack of nutrition, and the condition quickly worsens after infection.

During the Shanghai epidemic from April to June this year, many elderly people suddenly left nursing homes and other familiar environments and went to shelters or isolation hotels. Coupled with lung infections and changes in underlying diseases, their nutritional intake was affected and their resistance dropped significantly. Symptoms suddenly worsen.

This time, we also found that due to the shortage of emergency medical resources, it is difficult for patients stranded in the emergency department to ensure sufficient nutritional supply. Remedial measures may not be effective.

However, if the nutritional quality is good and the immunity level is good, the patient may carry it through.

Nutrition is the basis for treating COVID-19 infection.

Nourishment leads to resistance. The importance of nutrition cannot be overemphasized.

I hope that during this period of time, all infected people or elderly people who are observing at home must pay special attention to increasing nutrition, including a diverse and balanced intake of vegetables, carbohydrates, etc., and the intake of high-quality protein is the most important thing.

　　Da Jiangdong: At the beginning of 2022, you said that you studied the medical images of Omicron-infected people, not the "big flu", and thought that this mutant strain "will bite people".

What did you see on the image?

Now look, where does it mainly "bite"?

Zhang Wenhong:

At that time, many people believed that Omicron only invaded the upper respiratory tract, and its virulence decreased.

Compared with the Delta strain, the virulence of Omicron was indeed significantly reduced.

At the beginning of 2022, Shanghai will assume the function of the main entry point for international flights, and imported cases will continue.

I watched the film and saw that the overall incidence of severe cases of Omicron is decreasing, but there are still pneumonia manifestations in vulnerable groups.

　　Influenza has been prevalent in the world for more than 100 years, and we have also established a certain degree of cross immunity.

The new crown is a new virus. If the infection spreads widely, the risk will be magnified rapidly.

More recently, we have seen more clearly that Omicron does "bite," with vulnerable populations developing pneumonia symptoms and some even requiring intubation.

The rate of severe cases of Omicron is not high, but it is also wrong to say that it is all upper respiratory tract symptoms and "does not bite".

The base of infected people in China is so huge, even if it only "bites" a few bites, it will bite all the elderly and vulnerable people, and it will make us feel very painful and anxious.

　　We are now in the stage of the first wave of impact of Omicron, which is particularly rapid after the opening, and it is particularly difficult.

It is necessary to gather the strength of the whole society, expand medical resources, protect vulnerable groups, and strive to withstand the impact of Omicron, get out of this wave of epidemics, and win the final victory.

(People's Daily Central Kitchen - Dajiangdong Studio)