The doctor is not looking at the disease, but the patient
Interview with Academician Zhong Nanshan
On April 4, Zhong Nanshan was interviewed by the China Discipline Inspection and Supervision News and the National Discipline Inspection Commission website of the Central Discipline Inspection Commission at the Yuexiu Campus of Guangzhou Medical University. Reporter Zhang Ruishe
On the three-day holiday of the Ching Ming Festival, 84-year-old Zhong Nanshan has been working in the office at the Yuexiu Campus of Guangzhou Medical University.
Zhong Nanshan, academician of the Chinese Academy of Engineering, was born in Nanjing in 1936. He graduated from the Beijing Medical College (now Peking University School of Medicine) in 1960. After the reform and opening up, he was among the first public students. Seventeen years ago, during SARS, 67-year-old Zhong Nanshan firmly stood here; 17 years later, the new crown pneumonia epidemic struck. At the age of 84, he was still standing like a steel soldier at the forefront of the struggle.
"The doctor is not looking at the disease, but the patient." In an interview with reporters on April 4, Zhong Nanshan told the heart of the doctor with a straight line, and he also told an 84-year-old man's understanding of life.
Running to: "I have a more urgent mood when I go to Wuhan"
Q: You rushed to Wuhan on January 18th. What did you learn about when you arrived in Wuhan? How was your mood at the time?
Zhong Nanshan: On the afternoon of January 18th, when I was attending the meeting to discuss the deployment of the Guangdong Province to fight against the epidemic, I was suddenly notified that I had to rush to Wuhan that night to participate in the high-level expert group of the National Health and Health Commission, and arranged me to be the team leader. Discussion will be held the next day. At that time, I realized that this problem should be more serious, and I had a more urgent mood when I went to Wuhan.
I went to Wuhan with a series of questions, because once an acute infectious disease is passed on from person to person, it will affect the whole society and the whole economy. I have been thinking about this problem in the car.
Before the meeting the next morning, many of my students who were working in the frontline of the clinical clinic in Wuhan, as well as the experts who had been sent from Beijing before, gave me some information. Combining the investigation and understanding of the situation, I have a very certain conclusion.
On the morning of January 20, I reported on behalf of the expert group that the situation we have seen is relatively serious. It definitely has two phenomena, one is person-to-person and the other is the infection of medical staff. These are two very important signs that this disease will spread quickly.
Faced with a new infectious disease, we must first consider how to prevent it. For all public health incidents, we must first block it upstream, and we must prevent it from spreading outward in large quantities. At that time, I thought most about how to solve the patient's situation upstream. This is the key to the first wave of our minimization of transmission.
Fight: "Avoid more infections and reduce deaths, nothing is more important than this"
Q: How can I summarize the days of prevention and control on the front line for more than two months?
Zhong Nanshan: Under the leadership of the Party Central Committee, our epidemic prevention and control strategy is very correct. In the early stage, upstream interception was implemented to cut off the source of infection in Wuhan, and mass prevention and management were carried out throughout the country. Later, it became a joint prevention and joint control. What is joint defense and joint control? My own understanding is "four early": early discovery, early report, early isolation, early treatment, which is successful in China. While attaching importance to medical treatment, we should also pay attention to the summary rules, such as what clinical features it has and which drugs may be effective, which have a good guiding role for the world.
After arduous efforts, the prevention and control of the epidemic situation in our country has achieved important and periodic results, which is very difficult. However, the overseas epidemic situation is accelerating and spreading, and the pressure of China's epidemic situation input continues to increase. As of April 3, there have been more than 700 imported cases, and it continues to increase. Therefore, we must adjust and improve the epidemic prevention and control strategy in a timely manner, focusing on external defense input and internal defense rebound. Incoming personnel must all be tested, and they must be isolated as long as they are positive.
Q: During this period, what is the biggest pressure you personally feel?
Zhong Nanshan: Since I was a doctor, I feel that the biggest pressure is whether the patient was finally saved or died. After the patient was rescued and recovered, it was easy to say anything; if the patient was not rescued, then I was under the greatest pressure. Now it is the same to fight the new coronary pneumonia epidemic, to avoid more infections and reduce deaths. For doctors, what is more important than this?
Q: During the epidemic, you have repeatedly connected with the treatment team for consultation. What role did this special method play?
Zhong Nanshan: Remote video consultation played an important role in fighting the epidemic. Through the video connection, my team and medical staff in the Department of Intensive Medicine and Radiology regularly connect to the intensive care units of Shenzhen, Zhongshan, Dongguan and other places in Guangdong and Hubei Wuhan and other epidemic epidemic hospitals to consult and discuss the serious and critically ill patients Treatment, under special circumstances and special conditions, this way played a unique role.
Progress: "From the historical situation, it still depends on the vaccine to prevent and control the epidemic."
Q: In this race of science and virus, what progress has your team made in the scientific treatment and drug verification of new coronary pneumonia?
Zhong Nanshan: We have carried out clinical trials of chloroquine and Lianhua Qingwen capsules. From the results of the current analysis, both of them have relatively positive effects. Chloroquine can shorten the course of the disease and reduce the viral load. Lianhua Qingwen Capsule can significantly shorten the time for symptom relief.
Compared with SARS, New Coronary Pneumonia not only has common features such as pulmonary fibrosis, but also has a prominent feature that there is a lot of mucus in the small airway, which obstructs the airway patency and easily leads to secondary infection. We have previously observed the use of hydrogen-oxygen mixed gas therapy in some patients, and initially found that hydrogen-oxygen mixed gas can significantly improve the shortness of breath, and may be more suitable for patients with dyspnea.
Question: In addition to treatment, the public is also generally concerned about the development of new coronary pneumonia vaccines. Why is the vaccine so concerned this time?
Zhong Nanshan: It is necessary to develop a vaccine. The new coronavirus is much more infectious than SARS, and the infectivity coefficient can reach 3.5, that is to say, one transmission is three and a half, and at most SARS is one transmission of two, so now some countries increase tens of thousands of confirmed cases every day. From the historical situation, the prevention and control of epidemics still depend on vaccines.
We know typical examples, one is smallpox and the other is polio. Both smallpox and polio are highly contagious, with a mortality rate of 20-30%, and many sequelae. I remember when I was young, there were many people with pockmarks on their faces. This is a sequelae of smallpox. It is now invisible, relying on the vaccine. In my opinion, it is very urgent to develop a new vaccine against coronary pneumonia, and it must be pushed forward.
Scientific research: "Basic scientific research should escort clinical practice"
Q: You are a doctor and an academician leading the team. What research has your team carried out in this new coronary pneumonia research?
Zhong Nanshan: Clinical treatment must always be placed in an extremely important position to fight against the epidemic, and basic scientific research should escort clinical practice. For example, after the outbreak, we quickly summarized the clinical characteristics of 1099 cases and published them in the "New England Journal of Medicine". This is the first time that more than a thousand cases of data have been collected nationwide, and it is by far the most cited paper in the world in this epidemic. The study found that half of the cases did not have a fever when admitted to hospital, so it is not appropriate to treat fever as the only symptom; in addition, some patients have particularly high laboratory indicators and will soon become severe. These basic scientific researches have played a very good guiding role in the global treatment, which is also the common concern of everyone when connecting with foreign counterparts.
Q: When connecting with foreign experts, what basic scientific research results did we share?
Zhong Nanshan: When connecting with the video of foreign counterparts, we mainly shared the main points of critical case management, new laboratory testing technology, new treatment methods, etc. based on the concepts of "four early days" and joint prevention and joint control. We have initially reached a consensus on cooperation with Harvard University in the United States. Both parties will cooperate extensively in the epidemiological investigation, laboratory testing, and clinical treatment of the new crown.
Family style: "My father seldom speaks, he said that there must be evidence of speech"
Q: Many people want to know, is your family environment related to becoming a doctor?
Zhong Nanshan: I think it still matters. My father is a pediatrician. In the 1940s and 1950s, a lot of neighbors often brought their children to my house to see a doctor from night to night. After the children took the medicine, the neighbors were very happy. The neighbors were very happy, and his father was very fulfilled. My mother was a senior nurse graduated from Union Medical University, and later served as the deputy director of South China Cancer Hospital and now the Cancer Hospital of Sun Yat-sen University, and participated in the establishment of this hospital. At home, most of my parents talked about medical content, which still had a great influence on me and cultivated interest.
Q: What do your parents and family style affect you the most?
Zhong Nanshan: The biggest influence on me is probably to seek truth from facts. My father seldom speaks. He said that there must be evidence for his speech. In 1969, I went to the countryside to attend a medical team to see some patients. Once I met a child with severe urinary blood. Everyone said that this was a tuberculosis patient and needed treatment. I went home and talked about this situation, and for a long time, my father suddenly asked me, how do you know he is tuberculosis? Suddenly asked me. Urine blood is a very common symptom, it may be inflammation of the bladder, it may be stones, and of course it may be tuberculosis, but you need to have evidence to treat it.
I still remember his words until now. This makes me insist on telling the truth and seeking truth from facts no matter what I do in the future. You must believe in what you practice, not just hear.
Q: How do family members view your career?
Zhong Nanshan: Their support is silent and invisible. Because I rarely take weekends, even at home, my lover also said that your best rest is to be able to sit quietly at home reading. My family didn't ask me too much, and I didn't want the whole family to travel, but I owe it to my family. My work has achieved some results, and family support is extremely important.
I am now in a state of "meal comes to open my mouth and clothes come to reach my hand". When I get home, I can eat and have a good life care. Since there are no worries in life, he can also undertake the heavier tasks.
Being a man: "" How Steel Is Made "has a great influence on me, and the spirit of patriotism has affected a whole generation"
Q: You once said that your medical career only started when you were 35 years old. Why do you say that?
Zhong Nanshan: At that time, the children were still very young, and my spouse and I were separated for a long time. It was very difficult to take care of the family and the elderly. Why is it a big turning back? Because I was engaged in basic research at Beijing Medical College. When I was 35 years old, I started from scratch when I returned to Guangzhou. I was engaged in clinical work in the Fourth People ’s Hospital of Guangzhou, now the First Affiliated Hospital of Guangzhou Medical University It is unforgettable for me. At that time, clinical knowledge was almost "one poor, two white", because during my college I also trained for one year to participate in the first National Games, returned to Beijing Medical School for half a year of clinical courses, and then stayed as a teacher. So I haven't done clinical practice before, this is a big challenge.
Q: You went to study at the University of Edinburgh in the UK in 1979, and on April 2 a few days ago, you also won the Edinburgh Outstanding Alumni Award. What was impressive during your study abroad?
Zhong Nanshan: I am the first group of international students after the reform and opening up. I have to take the examination of the Ministry of Education. I took 52.5 points for the English test at that time, but I passed 45 points that year, and I went out.
At that time, all the foreign students were very difficult. It takes 9 days to take the train to the UK. In order to save money, I even bring straw paper and washing powder. We only have 6 pounds of living expenses per month, and it costs 12 pounds to cut a hair in the UK. We have to rely on ourselves. After arriving at the Royal Medical College of Edinburgh, the most difficult thing is the language barrier. I used to study Russian. After attending rounds every day, I went to the library to bring in recordings to listen to and write. If I didn't understand, I asked. It took almost half a year to improve English.
My tutor Professor Franri is very famous for studying chronic airway diseases. I have done some research work, and three of them have done a good job, and have been recognized by the whole department. Some research ideas in the UK are worth learning. We often make a little bit of results and rightly do it directly. They want to repeatedly verify that they do n’t take the second step before taking the first step. The second thing is to believe in your own experiments, not necessarily in authority. These two impressed me deeply, so I have always attached great importance to the training of the basic skills of the team, and then improve it after practicing it.
Question: I heard that the tutor tried to keep it before returning to China. Why did he decide to return to China?
Zhong Nanshan: Later, when I wanted to do research on asthma, I went to London to study and stayed for another six months. I want to stay with another professor in London. He mainly sees that my research on asthma has done a good job. But I feel that the country is so difficult and gives us the opportunity to go abroad to study. I never thought about not coming back. After studying, I had to come back to improve the scientific level of our country. At that time, it was such a simple idea.
Q: You often say that you are "just a doctor", how do you view the profession of doctors?
Zhong Nanshan: Medicine is a practical science. Many of my ideas and even inspiration, or some scientific research topics, come from clinical practice. I am not used to finding topics in the literature.
The doctor is not looking at the disease, but the patient. What we have to think often is that there are no problems that can be solved in medicine, how do you solve them? Like I was in the UK 40 years ago, I started to study chronic obstructive pulmonary disease with my instructor. At that time, the diagnosis was very clear, but the treatment was lagging behind. Later, the technology has been improved a lot, but the treatment of patients has not yet brought substantial changes.
I have been thinking, where is the key? Many chronic diseases, such as high blood pressure, will not develop into cerebral hemorrhage and cerebral infarction if you control it early. The same is true of diabetes. It is not necessary to wait for other symptoms to appear before diagnosis. Blood sugar is controlled to a certain degree. Some comorbidities can be avoided. This is the progress of strategy.
Many respiratory doctors are reluctant to study chronic obstructive pulmonary disease because there is no good way to treat it. When the patient came, he had difficulty breathing. At this time, the lung lesions were irreversible. So in early 2000, I had this idea, why not intervene early in the disease?
In the diagnosis and treatment of chronic obstructive pulmonary disease in the world, only when symptoms appear, we will intervene. Now our views have changed, because we did some research and found that when there were no symptoms earlier, or if there were only mild symptoms, the intervention was implemented, and the effect was very good. We have to continue this way.
Question: We see that on your desk, in addition to computers and information, a small statue playing basketball when you were young, you can still take on very heavy work tasks when you are over 80s. Exercise related?
Zhong Nanshan: I have been fond of sports since I was a child. Later, I often participated in sports competitions in middle schools and universities. The advantages of competitive sports, on the one hand, mean that exercise is very good for the body, on the other hand, it is also very helpful to cultivate the quality of will, and everything wants to fight upstream and pursue high efficiency. I originally ran 400 meters, and it's amazing to improve my performance in a year or two or three seconds. In a normal job, why can't you cherish every minute and every hour? So this is a great inspiration for me to improve my learning efficiency. The other is collaboration. Like running a relay race, everyone has to work hard together. The basketball team has been organized in our institute since 1982. Every Saturday night, everyone gathers together for more than 30 years.
The body is the foundation, and health requires investment. I now work twelve or three hours a day, and this ability support is very much related to physical exercise. For me, this life has benefited greatly.
Question: Can you recall with us, what book has a greater impact on yourself?
Zhong Nanshan: After work, I did not have time to read books such as novels, but I read a lot in elementary and middle schools, such as "How Steel Is Made", which had a great impact on me at that time. The spirit of patriotism has influenced a whole generation of people for me and for everyone. As my father said, it is not a waste of life to leave something in this world.
The future: "Health should be implemented in all policies of the entire medical and health work, this is the key"
Question: In the future, where should we focus on improving the public health system?
Zhong Nanshan: After SARS, China has made tremendous efforts to be able to monitor the possible infectious diseases in time. These years have indeed done a good job, including effective response to H1N1 influenza A, MERS (Middle East Respiratory Syndrome), H5N1 and H7N9 avian influenza. But there are still areas for continued improvement, because prevention work should be placed at a higher status. The Party Central Committee put forward the implementation of a healthy China strategy, and "health" should be implemented in all policies of the entire medical and health work. From this perspective, we should pay more attention to upstream and do a good job of prevention. This is the most critical issue.
In general, the public health system, one needs to be strengthened in understanding, and the other is that the organizational structure needs to be improved. For sudden outbreaks, disease control agencies should be given greater power.
Just 20 years after this century, there have been three outbreaks of coronavirus infections-SARS in 2003, MERS in 2012, and this new coronary pneumonia. This is a game between nature and humans. It is important to maintain a harmonious ecological relationship between man and nature so that the natural ecological chain can operate relatively well.
Q: A few years ago, you said that you have two wishes to build a Guangzhou Respiratory Center and launch your own anti-cancer drug. Could you please introduce the latest progress of these two tasks?
Zhong Nanshan: With the support of Guangdong Province and Guangzhou City, the Guangzhou Respiratory Center is currently advancing smoothly. There are more and more pharmaceutical and medical device companies that cooperate with us. They see that we are doing real work and have real results. It took us ten years to advance, and now the platform is being accelerated and is expected to be completed in the second half of next year.
This center has four functions, one is scientific research, the other is personnel training, the third is diagnosis and treatment of difficult diseases, and the fourth is prevention and control of acute infectious diseases. Now we are very confident to build it into the world's largest respiratory disease research center.
A Chinese American scientist and I spent 26 years developing an anti-cancer drug. This medicine has certain universality. It is not just a specific tumor, but a variety of solid tumors, including lung cancer, gastric cancer, breast cancer, liver cancer, etc., and it is expected to be clinically approved this year. I have encountered various difficulties in the process of drug development, but I have never given up. Because this medicine can benefit many people, I must stick to it.
In addition to these two wishes, I also have a wish to change the treatment strategy for chronic obstructive pulmonary disease worldwide. This disease is divided into one to four stages, and the current treatment focus is on the three or four stages. A lot of energy is spent on treating dyspnea and respiratory failure. This is the next strategy. If you put the top priority on early prevention, you can do more with less. I particularly hope that the early diagnosis and treatment of chronic obstructive pulmonary disease can form a treatment idea for the whole country and even the whole world.
The interview ended at 10 am. The alarm sounded outside the window, Zhong Nanshan stood up, his waist was straight, and he stood silent in silence. "Chinese medical staff have always been worthy of the title of" white angel "", he said that this nationwide mourning event is also the recognition and respect for the medical staff who have been sacrificed by the new crown virus infection. It is from people's hearts that these white soldiers contribution. (Reporter Jiang Yongbin Zhang Rui Jing Peixuan)