On Thursday, the National Health Commission reported that this wave of domestic epidemics, which is stabilizing, began at Nanjing Lukou Airport on July 20. It was an epidemic caused by the import of a delta mutant strain into the country, following Wuhan. After the epidemic, it spread to the country with the widest scope and the number of infected people was relatively large.
Although the epidemic has stabilized, it is obviously not a time to relax. In this wave of epidemics, many weak links and shortcomings are also very obvious. Even the last line of defense for epidemic prevention and control-hospital infections are all in. The epidemics in Zhengzhou and Yangzhou occurred, so what shortcomings should we make up for?
The Mid-Autumn Festival and November holidays are not far away. Can we go out in a relaxed manner?
At least 200 beds are equipped with a sensory controller, which is not small
Tan Li, deputy director of the Hospital Infection Management Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology:
Our department is called the Hospital Infection Management Department, which is responsible for preventing the infection of medical staff and patients in the hospital. Air.
The prevention and control of hospital-influence is a myriad of things. In recent times, fever clinics have become the focus of Tan Li and her colleagues' recent work.
In Tongji Hospital, doctors from various departments have to take turns at the fever clinic. This Friday, Tan Li will train the doctors who are about to rotate.
Tan Li, deputy director of the Hospital Infection Management Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology:
Every time he enters a fever clinic for a pre-job training, we are all necessary. For the prevention and control of hospital infection, this is also very important. important.
In early August, three doctors in the west area of the Affiliated Hospital of Yangzhou University were diagnosed with the new crown, and they were the fever clinic doctors.
In the Liwan District Central Hospital, the source of the Guangzhou epidemic in May, the cause of the infection in the first confirmed case also pointed to the fever clinic.
In a paper in the latest issue of China CDC Weekly, experts from China CDC and other institutions have demonstrated through experiments that the distance between the hospital’s fever clinic window and the opposite TCM clinic is only 77 cm, and the distance between the two buildings is only 77 cm. There is a ceiling, which forms a relatively closed space, which may cause aerosol transmission.
Gao Xiaodong, deputy director of the Department of Infection Management, Zhongshan Hospital Affiliated to Fudan University, member of the National Health Commission’s Medical Institution Infection Prevention and Control Expert Committee:
The "handshake building" in Guangzhou is actually because the distance between the two buildings is too close. The upper and lower parts of the building were sealed by various things, so the upper and lower parts of the building were not ventilated. In the end, such a part was somewhat similar. A duct was used to connect the windows of the two buildings.
At this time, it will cause the airflow to go directly from a contaminated place (fever clinic) to our other clinic area.
Therefore, we basically hope that the newly-built fever clinic requires a 20-meter green space with the surrounding buildings.
But in fact, in first-tier cities, where there are many tall buildings, it may be more difficult in many cases.
In the "Technical Guidelines for Fever Clinics Building Equipment" issued by the National Health Commission in August last year, fever clinics should be set up in relatively independent areas of medical institutions, relatively isolated from ordinary outpatient (emergency) clinics, and it is clear that patients go to fever clinics. Try to avoid crossing other buildings.
Since the outbreak of the new crown epidemic last year, various places have begun to build or renovate fever clinics.
In the new district of Xingxian People's Hospital in Luliang, Shanxi, the passage for fever patients and the fever clinic are relatively independent.
Kang Yancheng, Director of the Infectious Diseases Department of Xingxian People's Hospital in Luliang City:
All patients pass through this gate and go to the pre-diagnosis and triage for triage. All patients with fever go to the fever clinic through the fever clinic channel.
Our hospital’s fever clinic is separated from the inpatient department by more than 30 meters to avoid cross-infection.
In Shanghai, the requirements for standardization of fever clinics are even higher.
In the fever clinic complex building of Shanghai Ruijin Hospital that has just been completed and will be put into use in September, the reporter saw that the fever clinic has become a comprehensive building independently, and the registration, inspection, inspection, medicine collection, treatment, and observation of fever patients are all available. Realized in the building.
Zhao Ren, deputy dean of Ruijin Hospital Affiliated to Shanghai Jiaotong University:
We do CT, including treatment, and even some first aid, so it is a completely enclosed area. We can not only serve as a sentinel. The hospital can also be used as a hospital for preliminary treatment.
This week, the fever clinic of the Liwan District Central Hospital was still closed, and the Chinese medicine outpatient office strengthened the sealing of the windows.
In the opinion of Gao Xiaodong, who has participated in the sense of hospital inspection many times, some old hospitals’ fever clinics cannot be renovated for the time being, but if conditions permit, windows should be opened for ventilation as much as possible to increase the frequency of ventilation.
Gao Xiaodong, deputy director of the Department of Infection Management, Zhongshan Hospital Affiliated to Fudan University, member of the National Health Commission's Medical Institution Infection Prevention and Control Expert Committee:
Once the windows are opened for ventilation, it can reduce the concentration of aerosols in our entire environment.
Through the dilution of the atmosphere, its overall viral load will be significantly reduced, which is not enough to cause infection in our population. If the window cannot be opened, add some mechanical ventilation and increase the number of air changes. Generally speaking, it is not recommended that you take the entire The windows are tightly sealed.
To strengthen the prevention and control of hospital sense, the improvement of hardware conditions is important, and the deployment of sense control personnel is even more important.
For a long time, the infection management department has a low status in hospitals. Many people cannot distinguish between the infection management department and the infection department. The number of infection control personnel is insufficient, promotion is difficult, and the treatment is generally not high.
And because there are no corresponding disciplines in universities, most of the sensory control personnel are transformed from other positions.
At Tongji Hospital, Tan Li’s original major was public health, while at Xingxian People’s Hospital, Guan Junhui, the director of the Department of Intensive Medicine, was a nurse.
Gao Xiaodong, deputy director of the Department of Infection Management, Zhongshan Hospital Affiliated to Fudan University, member of the National Health Commission's Medical Institution Infection Prevention and Control Expert Committee: As
it is not a discipline, we have no special way for promotion. We come from the nurse line. Yes, then you are promoted from the nursing level, and the doctor line comes in. Then you are promoted from the clinician line, which is very different from other clinicians or clinical nursing staff. .
On the other hand, the salary is relatively low, and now I feel that the pressure is increasing, so relatively speaking, many people are unwilling to come.
This week, a notice from the State Council’s Joint Prevention and Control Mechanism Comprehensive Group requested that the medical institutions’ infection control departments should be fully supported in staffing, and the number of infection control personnel should not be reduced for any reason.
In principle, non-designated hospitals are equipped with one full-time sensory control staff for every 150-200 beds actually used.
For many hospitals, it is not easy to complete such a requirement in a short time.
Gao Xiaodong, deputy director of the Department of Infection Management, Zhongshan Hospital Affiliated to Fudan University, member of the National Health Commission’s Medical Institution Infection Prevention and Control Expert Committee: The
number of people is one aspect, in fact, the quality is quite critical. The personnel, their own ability level is not enough, and many wrong practices have been mentioned, but they will have some counterproductive effects.
How to attract our good talents is indeed a big problem we face.
Bai Yansong:
When it comes to foreign defense imports, many people think of border guards, airports where international flights stop, and even ports with busy import and export goods. But in such a chain, few people think of seafarers.
Working on a ship, once the new crown virus is infected in a closed space, a chain reaction will occur. At this time, how can the ship dock at sea?
Which shore?
How to rescue them safely?
Seafarers encountered an epidemic:
difficult to land, difficult to change shifts, difficult to treat, difficult to return home
This is a coal mine freighter that was originally scheduled to dock at a power plant terminal in Guangzhou on the 30th to unload. 17 seafarers have reached the contract period, and the other 4 have exceeded the contract period by more than 3 months.
However, the terminal replied that the cargo could be unloaded, but the shift could not be changed.
Gu Jianwen, who is the ship manager, has trouble eating and sleeping these days.
Gu Jianwen, managing director of an international ship management company in China:
The voyage of ships around the world is uninterrupted, so there are ships changing at any time. If one is a crew member, the psychological pressure is very great, and the body is very exhausted, just like we are driving. , If you don’t take a break, continuous driving will cause problems, and you must take a vacation on time by the (contract) period.
In addition, international conventions and the International Maritime Organization have requirements for seafarers’ leave, which cannot be overdue. If it reaches 12 months, sailing is not allowed and the ship will be arrested.
Then the captain’s pressure is also great, so if there is no shift, the safety of the ship will not be guaranteed.
Gu Jianwen revealed that, except for the Guangzhou, Shandong, and Jiangsu terminals, the other two ships managed by it this week have all responded similarly.
This Friday night, he sent a media report that the crew of a certain ship had psychological and behavioral problems due to the inability to change shifts.
According to his observations, some places advocate that if a seafarer's nucleic acid is positive, the terminal should be closed. In order to ensure the operation of the terminal, it is more common not to change shifts. Gu Jianwen described this phenomenon as "very severe".
And just this Wednesday, Liang Jianwei, the former director of the Guangdong Maritime Safety Administration, published an article that compared to the smooth handling of aviation prevention and control, Chinese seafarers are currently facing the four difficulties of disembarking and landing, difficult to change shifts, difficult to treat, and difficult to return home.
Gu Jianwen, managing director of an international ship management company in China:
Because of (epidemic) prevention and control, the policies of each place are different. Since everyone puts epidemic prevention very important, many ports in many places use the excuse of not having a place to isolate hotels. Refusal to change shifts of seafarers.
For example, the (aviation) crew has a relatively short journey, and our (sea) journey is relatively long. I returned from the U.S. after driving for 20 days. In those 20 days, it has long been known whether there was a virus (infection).
In Gu Jianwen's eyes, seafarers are retrogrades in the epidemic. 850,000 Chinese seafarers continue to transport commodities, energy, etc. from all over the world, and escort export trade. Their work is closely related to everyone's life.
He found that these "key personnel" in social operations often have to spend high costs to travel to foreign terminals, go through cumbersome procedures, and then take a pitiful flight back home.
On Thursday, the Ministry of Transport stated that, in order to ensure the safety of seafarers’ navigation, my country has issued seven editions of the “Guidelines for the Prevention and Control of Epidemics for Seafarers”. In view of the differences in epidemic prevention in various places, shifts in individual ports are not smooth.
Gu Jianwen and Liang Jianwei believe that compared with the complete items of aviation epidemic prevention, the terminal does not have clear and compulsory guidelines, and the locality has a lot of discretion between shift changes and epidemic prevention.
Lao Wu is about to become the third seaman to be discharged from the hospital, and his "Hongjin" ship has left Zhoushan to start operations.
Just a month ago, the "Hongjin" ship from the Philippines embarked on a dangerous journey.
Immediately after setting off, someone developed a fever and the illness spread rapidly.
On August 3, the ship broke down in Zhoushan and asked for help. The next day, Mr. Wu sent a video for help, but it was not until August 8 that Zhoushan started the transfer and treatment procedure, during which there seemed to be a five-sky schedule.
Suo Xudong, Deputy Director of the Zhoushan Port, Shipping and Port Administration:
We have two aspects of work. One is still communicating the situation and reporting the situation upward, and we are also urgently studying the disposal plan for this ship during this period of time. Because it is a heavy-duty ship that is not our destination port, it is more difficult to find a place to dispose of it.
Xu Fangming, deputy director of the Zhoushan Municipal Health Commission:
As the
deputy director of the Health Commission,
I am in charge of epidemic prevention and control. We have concerns in this regard.
Because Zhoushan is a maritime transportation hub, and of the 7 international routes, 6 of them pass through Zhoushan. There may be many similar patients coming to us in the Zhoushan waters, which will put a lot of pressure on our epidemic prevention and control. .
In fact, in April this year, Zhoushan had dealt with an epidemic in a non-destination port.
Facing the call for help on the "Hongjin" ship, the relevant departments formulated the "Hongjin" Ship Sick Crew Transfer Plan, but the actual work is more complicated than that of the airport.
Xu Fangming, deputy director of the Zhoushan Municipal Health Commission:
Why did you choose to transfer it after 11 o'clock in the
middle of
the night?
Because the next day's weather is rainy, windy, and waved, it is not conducive to transportation, and it is also not conducive to disinfection. After the disinfectant is sprayed on, it will either be diluted or washed away.
And whether it is fully loaded, unloaded and so on.
So there must be someone on the ship to watch, are the people on watch healthy, and so on.
There are also different maritime regulations and customs requirements.
The original three-day nucleic acid check and test was reduced to 15 hours by using the customs and health personnel for double sampling and double inspection, and the medical expert team was quickly assembled, and local, provincial and even Tianjin killing teams were selected, while seafarers were based on the severity of symptoms. Transfer in batches.
Xu Fangming said frankly that only Zhoushan's strength could not complete the treatment of the epidemic.
Xu Fangming, deputy director of the Zhoushan Municipal Health Commission:
We have made a special medical waste transfer plan. You can imagine that some living materials of more than 20 crew members, including food, must be thoroughly disinfected, and all of them must be lifted from the "Hongjin" ship. Come down.
Second, the dedicated medical waste removal terminal is followed by a special team to supervise it, so who will supervise it?
Then I feel very impressed that our own director of the Health and Medical Commission, he himself went to the dedicated medical waste terminal, wore protective clothing and stared at the scene for three hours. The garbage transfer ship is controlled by closed-loop control when it arrives at the dock and loaded on the truck.
Zhang Guoqiang, leader of the Zhoushan New Coronary Pneumonia Medical Treatment Expert Team:
The crew of the "Hongjin" ship this time all suffered from Delta (variant strain infection).
It is especially worth recommending that all the work contents that patients need to be treated and checked are placed in that building.
Medical treatment, nursing, life, and nursing care, including nucleic acid testing, blood testing and CT examination, are under absolute closed-loop control.
Currently, Zhoushan continues to treat the remaining seafarers in an orderly manner.
In the face of the big test of handling the maritime epidemic, Xu Fangming is still reflecting on the areas in Zhoushan that need to be reinforced.
Since April last year, the country has completed more than 270,000 crew changes on international voyages, of which more than 1,600 were rescued for crew injuries.
But how many tired seafarers still need to change shifts, and how many seafarers may need to be treated in the future. Obviously, after Zhoushan, each territorial terminal must have precise anticipation policies and smart humanity.
Bai Yansong:
In a blink of an eye, it was the end of August, not far from the planned Mid-Autumn Festival and National Day trips, but in the context of this wave of epidemics just stabilizing, many people would think that Mid-Autumn Festival, especially National Day, can travel smoothly?
In fact, for the tourism industry, I am afraid that it will also rely on the upcoming Mid-Autumn Festival and National Day to restore its vitality!
But wishes are beautiful. How does reality meet wishes?
Zhangjiajie was adjusted to a global low-risk area this Wednesday, and the tourist city that had been pressed for 23 days was unblocked. How will it open its doors to welcome guests next?
The tourism industry accounts for 57% of GDP. How will Zhangjiajie recover after the unblocking?
This Friday, Zhangjiajie, a tourist city that has been stagnant for a long time due to the current round of the epidemic, finally opened its doors to welcome guests. The current main scenic spots have been restarted, and a half-price discount on tickets will be implemented at the beginning of the restart.
Zhangjiajie tour guide Liu Yang:
If it weren't for the epidemic, under normal circumstances, at least 20,000 people would come here a day. Now we are the only team here.
The tour guide Liu Yang is one of more than 16,000 local tourism practitioners. On the first day of restart, he received a small tour group.
Although there are not many tourists, practitioners like Liu Yang still see hope.
Zhangjiajie tour guide Liu Yang: The
tourism industry is a very sensitive industry, so when this kind of epidemic occurs, its impact is very huge. It can be said that so far these tour guide groups in Zhangjiajie are in a state of temporary unemployment.
The profession of a tour guide is an industry that deals with and contacts with people, so he will come into contact with tourists from various places.
After the epidemic is over, the management and control of the epidemic prevention and control of tourism practitioners must be stricter than before.
During this epidemic in Zhangjiajie, the spread of the epidemic caused by the infection of tour guides occurred. Due to the special nature of the work, they need to frequently contact tourists from all over the country.
The epidemic has made the locals realize that it is necessary to strengthen the management of tourism practitioners.
In the future, carrying out regular weekly nucleic acid testing has become a new epidemic prevention method in Zhangjiajie.
Xia Jianbo, deputy director of the Center for Disease Control and Prevention of Wulingyuan District, Zhangjiajie:
People are also prone to crowding during the tourist season, and it is difficult to find out in time after gathering the epidemic area.
We will increase the number of nucleic acid tests for tour guides and front-line service personnel in scenic spots once a week. Through these, we hope to achieve the purpose of early detection and early reporting.
At the beginning of the opening of the scenic spot, the local area still focused on implementing conventional epidemic prevention measures. Since there are currently not many tourists and most of the first open attractions are outdoor attractions, such measures can still be strictly implemented.
However, for indoor performance venues such as the charming Xiangxi Theater, which has attracted much attention due to the outbreak, the future opening plan is still being studied and judged.
Xia Jianbo, deputy director of the Center for Disease Control and Prevention of Wulingyuan District, Zhangjiajie:
Indoor performance venues are the focus of our new crown epidemic prevention and control because of the high crowds and poor indoor ventilation.
In the face of the more transmissible mutant strains, local disease control personnel believe that the stricter the prevention and control measures such as "shifting peaks and current limiting" are implemented, the easier the epidemic will be controlled.
But for a long time, "visiting scenic spots during the day and watching performances at night" has become a mode of tourism for many tourists visiting Zhangjiajie. Under this mode, the level of local tourism income depends largely on the number of tourists. The reduction in the number of tourists due to epidemic prevention will have an impact on the market.
Zhang Gong, Secretary of Wulingyuan District Committee, Zhangjiajie:
Confined places are indeed very difficult to prevent and control for new coronary pneumonia.
Our tourism industry accounts for 57.1% of our GDP in Wulingyuan, which should be more than half.
Secondly, our district has 16,000 working in various industries in our scenic spot. Therefore, all scenic spots have been closed since the epidemic, which has had a great impact on our entire scenic spot.
In March of this year, the Ministry of Culture and Tourism issued a notice to theaters and other performance venues, proposing to prevent the “one size fits all” phenomenon, and no longer impose uniform restrictions on the proportion of consumers in theaters and other venues in low-risk areas. Discretion.
But at the same time, how to solve the contradiction between "increasing passenger flow and expanding revenue" and "limiting passenger flow to prevent and control the epidemic" has become a must-answer question for various scenic spots after the recovery.
Zhou Weihong, deputy general manager of Spring and Autumn Tourism:
If the attendance rate is not high, you think its comprehensive performance cost is indeed there.
But from the perspective of the epidemic, it is necessary to reduce the crowd density, especially for such large-scale performances.
Do we have to pass a particularly huge performance? Small ones are not necessarily bad.
The small theater, including this immersive, life-style performance is also very vivid.
In this passive situation, we are still taking the initiative. In fact, we may need to pay attention to the surrounding areas of performing arts, including its development in the tourism industry chain. The comprehensive development needs to be extended.
Including cultural and creative, I also think that it should be included in the comprehensive performance of such a source of income, even a very important source of income.
In addition, there is a good brand output, which in itself is also a source of economic benefits.
Looking at the whole country, Nanjing scenic spots have been opened this week. Guangdong, Sichuan and other places have recently resumed inter-provincial team tours that were suspended due to the epidemic. Disease control experts also said that the Mid-Autumn Festival can still travel normally under the implementation of prevention and control.
The restart of tourism indicates that the distance between the public and normalized life is one step closer.
It is also necessary for the main body of the tourism industry to find a way to break the situation in response to the epidemic caused by the mutant strain.
Bai Yansong:
The virus has been mutating and has brought more and more challenges to our epidemic prevention, but as time goes by, the magic is one foot higher, and we are also one foot higher, accumulating more and more rich experience, but also Many ways of responding to the epidemic should be adjusted.
I hope we are more calm, not more nervous, more open, not more closed, and closer to the turn of light, rather than a dark tunnel with no end in sight. I hope we can all continue to work with confidence and work together to get out of the tunnel of the epidemic.