Newsweek 丨 In-hospital infections, inter-provincial transmission doctors concealed "positive" ... 1 transmission 80+ transmission chain extended
In the past week, in the process of preventing and controlling the epidemic, there was no big news, I am afraid it was the best news.
But there is no big news, it does not mean that there are no waves and risks. If you don't pay attention, Harbin has become a keyword in recent times. The important reason is that one person has infected more than 80 people.
This is the case with infectious diseases. In a short period of time, it does not add, but multiplies. If there is a loophole in any link, it will be passed ten or ten. This is exactly the case with this infection chain in Harbin. Dinners, especially in hospitals, have loopholes in the sense of hospitality, and eventually large-scale cross-infection occurs. This is an unfortunate result, but it is also a super-strong reminder that normalization in prevention and control Under normal circumstances, how can normal operation be prevented?
· One pass 80+? The scale of clustered infections in the hospital is still expanding
This week, the scale of contagious infections in the two largest top three hospitals in Harbin is still expanding. As of 0:00 on Saturday (25th), there were more than 80 confirmed cases and asymptomatic infections. At present, the first hospital of Harbin Medical University has closed the entire building where the infection occurred, strengthened outpatient screening, and controlled the flow of visits; the second hospital in Harbin, which has a large number of infections, has been completely closed, and inpatients in the infected hospital area They were all transferred.
Ke Yunnan, deputy director of the Harbin Health and Health Commission: These patients are divided into two parts, and some of them have basic diseases. They are transferred from the outpatient surgery comprehensive building of the hospital to the internal medicine building. The personnel in this isolation ward are relatively closed, so they are not contaminated. . For 128 people, we have found two isolation hotels for centralized isolation. The vast majority of them are in compliance with discharge standards and the condition is relatively stable. In the hotel, we will also provide some oral (medicine), as well as some simple medical equipment.
Looking back at this clustered infection, the 87-year-old Chen Moujun, who was hospitalized in two hospitals, was considered to be the key. The confirmed cases and asymptomatic infections found so far are almost all the patients of Chen Moujun's hospitalization, and his family members and accompanying staff. In addition, there were 2 doctors and 6 nurses diagnosed with infection in Harbin Second Hospital, and 405 medical personnel were isolated for observation.
· Infectious disease protection awareness is insufficient 18 party cadres and public officials were held accountable
Wu Zunyou, chief expert in epidemiology of the Chinese Center for Disease Control and Prevention: There are so many related cases in two hospitals on such a large scale. Even in our provinces other than Hubei, such a large scale did not occur during the high epidemic period. We also did some analysis on the infection status of medical institutions and medical staff during the epidemic in Wuhan, Hubei, especially the medical staff who performed tracheotomy and sputum suction were significantly lower than the medical staff in other departments. What does this suggest? You usually have the awareness of infectious disease protection, and the formation of such a habit, then it is very important for protection. Well, many of our patients did not come to see a doctor because of fever or pneumonia, but when other diseases came to see a doctor, so that our medical staff did not have the awareness to prevent infection and spread.
According to reports, from April 2nd to 6th, Chen Moujun was hospitalized in Harbin Second Hospital due to stroke. During this period, he developed fever symptoms, but the hospital did not perform nucleic acid testing according to regulations. Subsequently, Chen Moujun was transferred to the First Hospital of Harbin Medical University. According to the 120 doctors who did not wear protective clothing, the receiving doctor judged that Chen Moujun should not be a confirmed case of new coronary pneumonia, and he did not review the nucleic acid. The doctor on duty in the respiratory department where Chen Moujun finally stayed was lucky enough to say, "I have gone through several passes before, so I don't have to worry about it." I did not ask for a review of the nucleic acid, and I arranged it directly in an ordinary 8-person ward. At the same time, Chen Moujun's escort staff up to 3 people, far exceeding the "one-patient-one-care" regulations.
Ke Yunnan, deputy director of the Harbin Health and Health Commission: The main reason is that there is often a leisure area in the corridor during the escort process. The leisure area is very close to the nurses station, and they chat together in the leisure area; The patient needs to leave the ward; the third is the public service facilities of the hospital, such as the water room, elevator, and confined space. These factors lead to nosocomial infections.
On April 17, the Heilongjiang Provincial Commission for Discipline Inspection held accountability for 18 party cadres and public officials, including the deputy mayor of Harbin and the deputy mayor of Harbin Medical University. The principal and president of Harbin Second Hospital etc. To prevent the epidemic from spreading further, the two hospitals have conducted nucleic acid tests on all medical staff, patients in the hospital, and patients discharged within 14 days before and after.
· Does doctors conceal "positive" work after cross-provincial transmission?
But what is worrying is that some of the staff who attended the two hospitals at the same time as Chen Mou have already left for other provinces. Currently, one each is found in Fushun, Liaoning and Hulunbeier, Inner Mongolia. Their nucleic acid test results were positive. The latest discovery was that a doctor in Shenyang who was positive for the IgM virus antibody and still concealed his report to work out of the clinic was also confirmed to accompany his family to the First Hospital of Harbin Medical University during this period.
· The source of the chain of spreading cocoons I still need to answer these questions
Xie Yunlong, second-level inspector of the Heilongjiang Health and Welfare Committee: Heilongjiang has made some achievements in the prevention and control of epidemics in the previous stage. This is the main reason for the rebound, because after our epidemic analysis, two cases of aggregation occurred in two families in Heilongjiang Province, and all nine people were infected because of the accumulation of people.
The staff of the Harbin Center for Disease Control and Investigation concluded that the reason why Chen Moujun was sick was because on March 29, he had dinner with 7 people including his son and his friend Guo Mou. This Guo was the first person to be diagnosed in the new local cases in Harbin on April 9.
Investigators found out about Guo's interpersonal relationships and found that Ms. Cao, a member of her family, was an asymptomatic infected person. She returned to the country from the United States on March 19 and lives in the same unit, Ms. Han, living upstairs and downstairs. Although the investigators did not find evidence of direct contact between the two, they analyzed and believed that the two may have shared an elevator or caused the virus to spread due to the structure of the two adjacent floors.
So far, the general chain of transmission has been described as that Han, who was isolated at home, passed on to Cao, and then passed it to Guo, and finally through dinner, causing the Chen Moujun family to get sick. In order to understand the isolation of Han's home, our reporter visited the community where Han lives.
Xu Li, Director of Zhengyanghe Sub-district Office, Daoli District, Harbin City: At about 20 o'clock on the evening of March 19th, Hanmou passed the hand of the Public Security Branch and returned to the checkpoint of the community after returning from the airport. After the transfer, we sent her to her unit, and then the community director put a seal on his home. At present, from March 19 to April 3, Han has not come out except that we need to ask her to come out for nucleic acid testing and serum testing.
According to the 14-day quarantine date, Han should expire on April 1. However, the results of nucleic acid detection did not come out on the 1st, and the isolation was not lifted. Until the morning of April 3, after the detection of nucleic acid and serum, it met the requirements, and the street handled the procedures for lifting the isolation.
On April 3, Han's nucleic acid and serum antibodies were negative, suggesting no infection. After that, she flew to Shanghai for cosmetic surgery from April 5 to April 8. During this period, except for the beauty salon and hotel, Han had never been to other places.
On April 10th, when investigators discovered that Han and Cao were neighbors, they again tested Han. However, this time the results were negative for nucleic acid and serum IgM antibodies, and positive for IgG antibodies. Han was identified as a former patient with new coronary pneumonia. But in the past 7 days, no matter whether Han contacted someone in Shanghai or a family member living together, there was no infection.
Why are there completely different test conclusions within 7 days?
Is Han really contagious?
Is she really the source of the infection chain?
How did Cao Mou infected upstairs?
Many questions are still under investigation.