On December 12, Tong Zhaohui, vice president of Chaoyang Hospital and director of Beijing Institute of Respiratory Diseases, was learning about the outpatient situation of pediatrics that day from nurses at the headquarters of Beijing Chaoyang Hospital affiliated to Capital Medical University.
On December 12, the National Health Commission held another press conference to introduce the prevention and treatment of respiratory diseases in winter. According to the press conference, according to the surveillance, the current epidemic of acute respiratory diseases are all caused by known pathogens, and there are corresponding mature treatment methods, and no new infectious diseases caused by new viruses or bacteria have been found.
Reporter: Why did you suddenly get so many people's attention this year? And there is such a concentration of queues in the hospital?
Tong Zhaohui, Director of the Beijing Institute of Respiratory Diseases: I think it may be the case, our prevention and control in the past three years is still relatively strict, everyone's habit of wearing masks is also relatively good, and in terms of prevention and control requirements, everyone has reduced going out, so we are facing a very clean environment. The human body has less contact with the respiratory microorganisms in the outside world, and the resistance to various microorganisms in the outside world is poor, and the immune tolerance is poor. After normalization, if you come into contact with these again, when the virus comes in winter, it is easy to have some respiratory symptoms.
In fact, since the beginning of winter, most parts of China have entered the flu season. On the front line of clinical practice, Tong Zhaohui believes that people still need to attach great importance to prevention, and vaccines are still the most effective means of prevention.
Tong Zhaohui: Because it has a high incidence in autumn and winter, and I think my protection is the most important. For example, in autumn and winter, it is better to reduce the opportunity to go out, for example, children have to go to school, or wear masks, wash hands, it not only protects against mycoplasma, but also other viruses like the flu and others. Especially when children go to school, there are dozens of people in a class, and they still have to wear masks and hand hygiene. If you have a fever, you can stay at home and don't go to school, so you should still have good habits of respiratory protection. The flu vaccine should be said to be very mature, and it is also recommended that especially the old and the young, be vaccinated in advance from September to November every year, including the pneumonia vaccine.
Every autumn and winter enter the high incidence period of respiratory diseases, and the elderly and children are the most vulnerable groups to viruses and bacteria. But in terms of how to deal with it, Tong Zhaohui believes that many parents' handling is not appropriate.
Tong Zhaohui: When it comes to children, people may just run to children's specialized hospitals, such as Beijing Children's Hospital and the First Children's Institute. Parents' feelings can be understood, children are the most important and precious, if there is a disease, you must go to a children's hospital for treatment, in fact, I think some large tertiary hospitals are not bad for pediatrics. In addition, there are some secondary hospitals and community hospitals near my home.
Tong Zhaohui: Today's community doctors are all general practitioners with standardized training, and children's respiratory tract infections, including upper respiratory tract infections and pneumonia, are common and frequent diseases, not incurable diseases. So I think that if the child has a fever, in fact, the first diagnosis can be directly to the nearest community hospital, which can be completely solved, and the medicine is also consistent, and the community is also equipped. Therefore, seek medical treatment in time, make a good judgment and diagnosis in time, and use the medicine in time, so as to avoid running to these large specialized hospitals and then arrange. You're waiting here for hours, even if you're a child with a fever, waiting here, it's easy to cross over with each other.
Reporter: But for parents, how to tell under what circumstances their children should be graded, at home, or go to the hospital?
Tong Zhaohui: At the beginning of the fever, you can go to the community hospital, because at that time, the condition has just gotten up, and the fever has just begun, and it is impossible to be seriously ill. In addition, community hospitals are now able to do antigen tests in a timely manner, and antigens are available immediately, including many families that also have antigens. So if you are a virus or mycoplasma, in fact, whether you go to the nearest secondary hospital or community hospital, it can identify it for you immediately. It's just an upper respiratory tract infection, then treat it symptomatically, or take some antiviral drugs and corresponding drugs to eat, and that's fine. Of course, if some children, for example, have a fever for several days, or have a high fever for several days, more than three days, and then the child also has some breathlessness and shortness of breath, then they should still go to a specialized hospital.
Tong Zhaohui: The second question, fever, parents can't see that their child has a fever, so they go to the hospital as soon as they have a fever. In fact, the temperature does not represent the severity of the disease, not that the higher the body temperature, the more serious the disease. So in fact, if you are still in the upper respiratory tract and there is no pneumonia, it is only 39 degrees, 39.5 degrees, 40 degrees, but the body temperature is high. Sometimes the opposite, for example, for example, those who are in good health react strongly and have a higher body temperature, and if they are in the upper respiratory tract, they are given some fever reducers. In the case that some antipyretics are not effective, you can use physical cooling, such as a few cold towels on ice in the refrigerator, put them on the brain, and apply them on the body, this physical cooling effect is sometimes better than the medicine, in fact, as long as it is not burned, the child's mental state is very good.
According to the monitoring of the National Health Commission, influenza is still the main respiratory tract infectious disease in China recently. In addition, there are rhinovirus, Mycoplasma pneumoniae, respiratory syncytial virus, adenovirus, etc. The analysis concluded that the continuous increase of acute respiratory diseases since the beginning of winter was related to the superposition of multiple respiratory pathogens. As a result, superimposed infection has also become a concern for many people.
Tong Zhaohui: In winter, these viruses are all present, but infecting a person does not mean that I am infected with the flu and syncytia. It is impossible to superimpose on one person. Second, if I have a fever and go for some antigen or nucleic acid tests, I may test positive for both or three. But if there is phlegm in the upper respiratory tract, or the throat swab is positive, it means that they are all infected. In our daily work, whether it is an outpatient or an inpatient, we will do pathogen testing, and it is often not one kind of pathogen testing, especially for long-term hospitalization, we can detect two, or even three or four. But the doctor wants to judge, not that I test positive must be pathogenic bacteria, many of them are colonized in the upper respiratory tract, because the respiratory tract itself has a defensive function, if it is a nucleic acid, it will show some viral load, some have a high viral load, some low, the doctor will help you judge, for example, he through your antigen, nucleic acid, chest X-ray CT, blood routine, including some other laboratory tests, the doctor will comprehensively analyze which is the main treatment. Therefore, if only these etiologies are in the upper respiratory tract, symptomatic treatment is sufficient, or corresponding antiviral drugs can be used. There are corresponding drugs for influenza and mycoplasma, and there are no obvious anti-drugs for viruses such as syncytial virus and adenovirus, so they often rely on symptomatic treatment, dealing with fever and cough, and symptomatic treatment, and they recover in a week or two.
Reporter: This time, many patients have a continuous cough after the fever has subsided, may this cause pneumonia?
Tong Zhaohui: Actually, there are many causes of cough, we usually see a doctor with acute cough, chronic cough, and there are hundreds of causes of chronic cough, so we need a doctor to help you identify. Some people have a cold, he will cough for half a month, a month, three months, or even half a year, because he has tracheitis and pneumonia before, and the bronchial mucosa is damaged, and he will cough if he is slightly irritated, and it will form an airway hyperreflex.
Reporter: So what should be done?
Tong Zhaohui: Symptomatic treatment, cough suppression, there is a way to do this clinically. We have some cough suppressants, some drugs that reduce airway response, and sometimes we need to take this cough medicine and airway hyperresponsiveness medicine at the same time, and the effect is still very good.
Reporter: Because we have noticed that in the society nowadays, from the fever at the beginning to the cough in the later stage, the whole stage is repeated and repeated, such as the fever is cured, and then the cough has to go to the doctor again.
Tong Zhaohui: The infection period has been controlled, and only some symptoms remain in the later stage, so as long as you no longer have a fever after treatment, no longer have a body temperature that comes up again, no longer appear these yellow sputums, and no longer have some respiratory changes like the previous acute stage, you can treat the symptoms with some cough medicines. And especially the dry cough, there is no phlegm, there is no yellow phlegm, it does not mean that it is infected again, I have aggravated it again.
Reporter: However, during the high incidence of respiratory diseases, many people will also worry that after the child is so young, even if it is treated, will there be similar sequelae or other injuries in the future?
Tong Zhaohui: Actually, I don't think you should worry about this, because it is very common for adults and children to have colds, coughs, pneumonia, and bronchitis in winter. But as mentioned earlier, many diseases and viruses, including upper respiratory tract infections, are self-limited, so it's fine. Even if pneumonia is present, pneumonia is the best treatment for doctors. Moreover, pneumonia is a curable disease, and it is not at all said that it is due to the sequelae of upper or lower respiratory tract infections. Okay, it's fine, there won't be any problems.
In numerous media reports, infusion has become a common scene. However, for many people who are accustomed to infusion therapy as soon as they have a fever and cough, Tong Zhaohui emphasized that this is a misunderstanding.
Tong Zhaohui: In fact, for any disease, the doctor will judge whether you need an infusion based on the severity of your disease. Of course, if it reaches the lower respiratory tract, such as pneumonia, flu, or other viruses, in fact, infusion is still a supportive treatment. In addition, if the virus is infected to the lower respiratory tract, some children will have secondary infection, and the bacterial infection will be secondary on the basis of the viral infection, which should be infusion. That is to say, when it comes to pneumonia and some bronchiolitis, this is often an infusion for both adults and children.
The high incidence of respiratory illness in China has also attracted the attention of the WHO, which posted on social media on November 11 that the World Health Organization has been closely monitoring China's reported health system since October. Based on the available information, WHO has not identified any abnormal or novel pathogens, nor has it found any abnormal clinical manifestations, except for the general increase in respiratory illness caused by a number of known pathogens.
Reporter: Why do international health organizations pay so much attention to our entire respiratory disease?
Tong Zhaohui: They also have a sentence that you may not have noticed, they say that it is still a common pathogen.
Reporter: What does this mean?
Tong Zhaohui: What they mean is that there is not a new infection or a new pathogen, that is, although we say that we will have more respiratory infections this winter, whether it is a virus or mycoplasma, it is still a common etiology, and there is no new etiology, which I think is also to dispel some suspicions of the people.
Reporter: For patients who have suffered from such respiratory diseases, does the inner body produce antibodies, and may not get them again after getting them once at such a stage?
Tong Zhaohui: That's right, for example, the flu virus will be like this, and the mycoplasma will be like this, and he won't get it again at least in the near future. FOR EXAMPLE, AFTER A RECENT INFECTION, IGM ANTIBODIES ARE PRODUCED FIRST, AND THEN IGG ANTIBODIES ARE PRODUCED, SO IT WILL HAVE A PROTECTIVE EFFECT FOR A SHORT TIME, AND OF COURSE THE ANTIBODIES WILL DISAPPEAR SLOWLY, AND YOU WILL BE RE-INFECTED.
After the high incidence of respiratory diseases in the winter of this year, based on the experience of the past three years, people are also paying attention to the activity of the new crown virus and whether this round of respiratory diseases is related to the new crown virus.
Reporter: There is also a voice that believes that there is also cross-infection in this concentration, is it possible that it is a mutation of the new coronavirus, or an extension of other ways?
Tong Zhaohui: This shouldn't be. We have had some fever patients this winter, whether it is these respiratory diseases, it is no different from the past, it is still those pathogens. Second, mycoplasma is not a new pathogen, it is still common, and the treatment of mycoplasma is also in daily work, not only in winter, but also in peacetime. This is all scientifically proven, so don't speculate.
Reporter: But many people also have a point of view, for example, some children who have had the new crown before have low immunity, which is why this respiratory disease will respond so quickly and violently.
Tong Zhaohui: Actually, there should be no causal relationship between the two. Of course, if I had COVID before, I still have some symptoms that I haven't recovered, I have another flu, or I recently got mycoplasma, this is possible. But I think it's all within the scope of treatment and control.
As a well-known expert in respiratory and critical care medicine in China, Tong Zhaohui, director of the Beijing Institute of Respiratory Diseases, and his colleagues monitor influenza-like cases from Beijing and the whole country every year, and adjust the diagnosis and treatment methods according to changes in etiology. Regarding the high incidence of this wave of respiratory diseases, Tong Zhaohui has his own opinions.
Reporter: What kind of advice do you have for the society?
Tong Zhaohui: I think it may also be like we are all professionals, very rational and calm about this issue. So I think first of all, the common people should still believe in science, and the common people should treat this issue correctly. First of all, this respiratory illness is very common in winter, including fever, both in adults and children. The second is that we have not seen new pathogens, so don't worry about this. Moreover, the characteristics of these pathogens, including our clinical diagnosis and treatment, hospitals at all levels are still very experienced in common respiratory infections.
Producer丨Liu Bin Wang Huidong
Reporter丨Gu Bing
Planning丨Monk
Choreographer丨Yin Jianzhang
Editor丨Wang Feng
Camera丨Liu Hongbo, Yang Fan, Gao Zhong