Freezing Point Feature Issue 1259
Shanghai Hospital: The Front Line Against Omikron
Editor's note
On May 17, the Shanghai epidemic prevention and control press conference introduced that all 16 districts in Shanghai have fully realized social zero.
This day did not come easily.
Over the past month or so, medical workers in hospitals at all levels in Shanghai have been exhausted to adapt to changes.
We summed up their experience and thinking, looked for the laws and methods to fight against Omikron, and followed the medical spirit of seeking truth and science, so that other cities that are or may face challenges can achieve the greatest prevention and control at the least cost. Effect.
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The line is from small single digits.
It sticks tightly to the bottom line of 0 infections.
On March 1, Shanghai reported 1 new confirmed case of local new coronary pneumonia and 1 asymptomatic infection.
Two days later, we still don't feel its slight fluctuations, it's still in the single digits: 2 supermarket employees have been diagnosed with new coronary pneumonia cases, and 3 people have been diagnosed with asymptomatic infections.
But these 5 people involved 195 close contacts and 342 second-close contacts.
Then, sporadic infected people appeared, this line was still close to the bottom line of 0, it just looked a little thicker to the naked eye.
On March 29, the number of newly confirmed local cases in Shanghai expanded from 96 on the 28th to 326, with 5,656 new cases of asymptomatic infections.
This infection line jumped out of the horizon of 0.
Over the next 12 days, the curve climbed nearly 90 degrees, sometimes breaking 20,000 a day.
Today, Omicron, an intractable invisible opponent, has infected more than 600,000 people in Shanghai, a mega-city with a population of more than 25 million.
During the fight with Omicron, various emergency medical help information emerged in Shanghai.
We contacted 11 units, including community health service centers, secondary hospitals, tertiary hospitals, Internet hospitals, and teams from other provinces, and interviewed more than 30 respondents.
They said that Shanghai is improving, and the most anxious and difficult time has passed, but it is far from the time to breathe a sigh of relief and rest.
A medical worker said that he hoped that we would record the process of medical treatment in Shanghai, and put forward constructive suggestions, so that the next city that faces Omicron can "draw inferences from one case" and stop taking too many detours.
Since May 1, the city's medical institutions have gradually resumed their daily medical services, but they have not fully returned to their pre-epidemic state. The Municipal Health Commission will accelerate the resumption of work and medical treatment in medical institutions.
Sink more people, money and things into the community
In April, 251 community health service centers in Shanghai were held back by nucleic acid sampling.
Urgent sampling tasks always appear at night. Fu Ying, a general practitioner at the Taopu Town Community Health Service Center in Putuo District, sleeps at most 3-4 hours a day. Nucleic acid screening and epidemiological transfer.
According to the "Regional Implementation Guidelines for Novel Coronavirus Nucleic Acid Detection Organizations (Third Edition)" issued in March 2022, the number of nucleic acid samples required is approximately the total population divided by 360.
In other words, Taopu Town needs about 583 medical workers to complete the nucleic acid sampling work, but the Taopu Town Community Health Service Center only has more than 100 medical staff.
On March 19, during the nucleic acid screening in Putuo District, this community health service center threw almost everyone on it.
The same situation appeared in Beicai Community Health Service Center.
There are 300,000 permanent residents here, but there is only one public hospital in Beicai Community Health Service Center.
Before the epidemic, there were about 2,000 outpatient visits per day here.
For a community health service center, this is a considerable workload.
There are 9 urban villages in Beicai. In order to avoid cross-infection, the medical staff did not set up sampling points in the urban villages, but took a tricycle to the door of the group house to do nucleic acid for the residents.
Every time I go to the village to test nucleic acid, the medical staff will do it late - the road is too hard to find.
On March 24, the community health service center was tasked with conducting nucleic acid screening for 57,000 residents.
However, there was a steady stream of people who came to do nucleic acid that day, and the nucleic acid was done until 4:00 in the morning, and a total of 154,063 people were finally sampled.
That day, Song Huijiang, director of the Beicai Community Health Service Center, kept asking his superiors for support, and more than a dozen community health service centers sent people over.
Later, there were not enough protective clothing and sampling tubes, so Song Huijiang went around to borrow them.
No one expected that more and more positive patients would be screened.
On March 26, the cumulative number of new crown infections in Shanghai has exceeded 10,000, with more than 2,600 new infections in a single day.
At the beginning of the lockdown, Liu Chen, director of the Taopu Town Community Health Service Center, predicted that the nucleic acid screening would end around April 5, leaving only one outpatient clinic in the hospital.
But 5 days later, he received round after round of nucleic acid tasks, and medical staff had to keep working.
Due to the shortage of personnel, the district mobilized resources to mobilize school doctors and volunteers with medical backgrounds.
Since April, in addition to ward care, services for patients with mental disorders, and issuance of death certificates, other medical services at Beicai Community Health Service Center have been cut off, and only two simple outpatient prescriptions have been opened.
There are still a lot of "attenuations". At most, 47 of more than 130 medical staff had nucleic acid abnormalities.
Community health service centers, which were originally responsible for geriatric care and chronic disease management, had difficulty taking into account the medical needs of residents in closed-off areas.
Taopu Town Community Health Service Center has tried to send one doctor and one nurse in the closed community to meet the needs of the last mile for medical treatment.
But as more and more communities were blocked and they didn't have enough manpower, the plan was forced to stop.
Primary medical institutions became the weak link first.
Lin Feng, vice chairman of the Theory and Policy Committee of the Chinese Society of Health Economics, said that most of the grassroots health organizations in Shanghai have been very tired in the past two years, and "it has come to a point where they can't stand it" -- there are many imported cases in Shanghai, and the isolation point , Observation points are mainly managed by these first-level medical institutions.
In a paper by Jiang Rongmeng, a member of the National New Coronary Pneumonia Medical Treatment Expert Group, primary medical and health institutions are called the first line of defense against the epidemic and are "gatekeepers".
He suggested that primary medical and health institutions should give full play to the role of family doctors, and do a good job in the management and guidance of patients with mild symptoms in home isolation and recovery, so as to prevent patients from flocking to general hospitals and affecting the normal medical order of general hospitals.
But in Shanghai, most of the strength of the community health service center is devoted to nucleic acid screening and transfer.
A family doctor was very busy during the epidemic prevention work. The patient she contracted encountered medical problems, and when she sent a message to ask her for help, she comforted her, "You are busy, come back to me when you are free."
After the community health service center was almost evacuated, there was still a shortage of staff for nucleic acid sampling.
As a result, secondary hospitals also took out some medical staff to participate in nucleic acid sampling.
Tian Yuan, vice president of Nanxiang Hospital in Jiading District, introduced that the hospital is a second-class hospital with more than 500 medical staff, and at most 300 people are dispatched to take over 4 isolation hotels, 1 isolation point for close contacts, 1 There are only about 200 people left in the hospital for treatment.
Every day, the hospital has to draw more people from the remaining 200 people for nucleic acid sampling.
Tian Yuan explained that due to the large number of critically ill patients, the hospital will give priority to ensuring medical care in the emergency department and ICU, and draw people from other departments to complete the nucleic acid sampling work.
The shortage of nucleic acid sampling personnel is too large.
When Chang Jiang Liang, the medical team of Hubei Cancer Hospital in Shanghai, first arrived in Shanghai, there were more than 20,000 medical staff in shortage in Shanghai.
They often work in cabins at night and take nucleic acid samples during the day.
Zhejiang first came to 3,000 people to support sampling, and a month later, another 2,800 people came to the top.
Lin Feng believes that under the concept of hierarchical diagnosis and treatment, the primary task of hospitals at all levels under the epidemic is to take care of their original "own patients".
When there are no staff at the grassroots level to guard the patients, it is difficult for secondary and tertiary hospitals to operate on the original track, and it is necessary to make up for the shortage of grassroots manpower.
What is even more difficult is that even with the input of human resources from the first- and second-level hospitals and the addition of foreign aid, multiple rounds of nucleic acid screening have never found all the infected.
Luo Li, a professor at the School of Public Health at Fudan University, believes that if Shanghai's nucleic acid screening starts earlier, it can more effectively curb the spread of the virus.
He believes that when there are few cases, the risk of crowd spread caused by nucleic acid screening of all staff can be controlled at a low level, and even if it happens, there are enough resources to control it in the short term.
"But when there are thousands or even tens of thousands of new cases every day, this group of people has a higher risk of clustering and transmission, and the requirements for the standardization of nucleic acid testing increase sharply. In the context of lockdown, antigen testing for all staff is more appropriate."
Within the community, positive patients are snowballing.
When the first positive patient was hospitalized in the Beicai Community Health Service Center, Song Huijiang wanted to refer the positive patient to a designated hospital. The Beicai Community Health Service Center was rebuilt on the basis of the town government office building. Building requirements for infectious diseases are not considered, and there are only basic ECG monitors, no ventilators.
However, there are more and more positive patients, most of them are elderly people who cannot take care of themselves and need family accompaniment. If the family does not agree to transfer, the hospital cannot transfer.
Few patients are eventually transferred away.
Beicai Community Health Service Center is the fifth community health service center Song Huijiang has worked for.
He found that in Shanghai, which is rich in medical resources, community health service centers are relatively resource-poor.
If the community health service center is to function well, Shanghai will need to increase its investment in the future to bring more people, money and materials to the community, including talents, technology, and inspection equipment.
The Shanghai Municipal Health Commission's "Shanghai Community Health Service Capability Standard (2019 Edition)" requires that the number of general practitioners per 10,000 population in urban areas should reach 4 or more, and the number of general practitioners per 10,000 population in suburban areas should reach 3.3, and 1.5-2.5 per 10,000 residents. public health physician.
In Taopu Town, the number of general practitioners just reached the standard last year, and it is difficult to recruit public health doctors. Liu Chen said, "People in public health basically do not come to our community, and most of them prefer to go to the city-level disease control department."
make the bed wait
In Luo Li's view, the construction of the shelter requires advance planning and early decision-making.
When the newly infected people in a city are scattered in various districts and more than 100 people are added every day, the government must consider emergency construction of Fangcang shelters.
He believes that if Shanghai can build shelters earlier, positive patients can be "received as much as they should" at an early stage, which can reduce community transmission.
On March 24, Jiahe Xinyuan, the first municipal makeshift hospital in Shanghai, opened with 1,900 beds.
On March 24, 25, and 26, more than 1,000 new local new coronary pneumonia infections were added every day in Shanghai.
For example, Luo Li, assuming that there are 1,000 positive infected people at the beginning, only 500 beds, and the remaining 500 people stay in the community to continue to spread the virus. According to the transmission ratio of one to four, there will be 2,000 more positive infected people every other day, then Building another 500 beds the next day would not be enough.
He believes that even if the shelters built in the early days are useless in the end, they are valuable. "The early redundancy is for future savings."
Lu Yiming, director of the emergency department of Ruijin North Hospital and director of the trauma center, also made similar observations: there were not enough shelters in the early days, and positive patients were waiting for beds.
He believes that the ideal situation is to take measures to deal with the possible outbreak of the epidemic in advance, and let the bed wait for people.
The Ruijin Hospital (North Branch) affiliated to Shanghai Jiaotong University School of Medicine is the largest tertiary general hospital in Jiading District.
On March 19, the hospital was notified that it was required to be converted into a designated hospital for the treatment of new crown patients in the shortest possible time. It is the earliest one in Shanghai.
That night, Ruijin Hospital transferred nearly 800 non-COVID-19 inpatients in the northern campus overnight to other hospitals, and began to treat COVID-19 patients the next day.
On April 8, the number of people infected with the new crown in Shanghai approached 100,000.
At that time, Shanghai was stepping up the construction of square cabins. There were already 38,000 beds in 4 city-level square cabins. At that time, the largest square cabin in the National Convention and Exhibition Center (Shanghai) in Shanghai had 50,000 beds to be delivered in batches on the 9th. , there are still positive patients waiting for beds.
Luo Li believes that in the past two years, Shanghai's precise prevention and control has played a role, but most residents have not really experienced a large-scale epidemic.
When there are too many people, various problems gradually emerge.
Due to the shortage of square cabin beds, a large number of positive patients had to stay in non-designated hospitals, affecting the speed at which non-designated hospitals receive patients.
Especially from the beginning of April to mid-April, the difficulty of seeking medical treatment for non-COVID-19 patients became prominent.
Emergency emergencies began to rush: Compared with the beginning of April, the number of emergency services in 36 municipal hospitals increased by 65%.
In the emergency department of Renji East Hospital, at most, 30 to 40 positive patients can be detected in one day.
This is a non-designated hospital. At the beginning of April, the emergency department received two or three hundred patients every day. At most 114 ambulances came a day. The fixed beds were already full, and the emergency hall was full of patients.
Deputy director Liu Li hopes to transfer positive patients as soon as possible to avoid spreading to non-COVID-19 patients.
But at the time, many designated hospitals were full of beds, and some were being renovated.
Liu Li recalled that from April 6th to 18th, the number of new positive cases in Shanghai was 20,000, 20,000, and 20,000 every day, which made many medical staff in the department feel depressed, "We are not afraid of being tired and busy at work, but we are afraid of There is no end in sight".
On April 13, the day with the largest number of new cases, Shanghai had 27,719 new crown infections.
When non-designated hospitals receive positive patients, they will begin to disinfect them. Some hospitals require patients to have a 48-hour nucleic acid test before entering.
In response, on April 15, the Shanghai Municipal Health and Health Commission responded that if emergency patients need immediate emergency treatment, medical institutions should activate emergency plans.
Shao Yun, deputy director of the Communications Department of the Shanghai Medical Emergency Center, is also very anxious: the turnover rate of 120 ambulances has dropped significantly, there are too many patients in the emergency department, and the capacity for admission has declined. Make a bed, or the ambulance leaves the stretcher in the emergency department.
Many anxious calls for help poured into the 120 hotline, and patients had to wait in line for an ambulance, and the maximum number was more than 500.
Shao Yun said that on April 6 alone, 91,000 people in Shanghai made 120 calls, of which 21,000 were successfully answered.
These two figures have increased by 12.3 times and 3.3 times respectively compared with the number of calls and received calls of 120 on weekdays, which both exceeded the historical peak of the 120 business.
Shao Yun recalled that sometimes the ambulance arrived at the door of the hospital and was told that a positive patient had just appeared and was being killed, and had to be sent to the next hospital.
One ambulance driver said it was often not clear which hospitals were opening.
Some ambulances were "pressed" by the full emergency department, and the longest was pressed for 7 hours.
Some citizens were told by 120 that they had to contact the hospital themselves before sending an ambulance to pick them up. However, after many patients called the hospital's hotline, there was often no answer, and they didn't know which hospital to go to.
On April 17, a Shanghai citizen conducted an experiment and called 15 tertiary hospitals to ask if their emergency department was open. 11 of them were "temporarily unanswered" or were automatically hung up, which took an hour and a half.
Among non-COVID-19 patients, hemodialysis patients are the most urgent group.
During the lockdown period, transportation was a big problem for hemodialysis patients. "With the quota for hemodialysis, there is no car, and if there is a car, there is no quota." In addition, more and more hemodialysis departments are closed due to hospital feeling.
On April 5, Pudong Hospital set up a temporary hemodialysis center within 24 hours at a community health service center in Caolu Town that "has just opened for half a year, only has empty shells, and the oxygen meter on the wall does not match". The dialysis machine was running all the time. "Some dialysis machines have been alarming because the temperature is too high, 'The temperature is too high, the temperature is too high'." The nurse wiped it with disinfectant wipes to cool the machine.
Nurses working in the haemodialysis room wearing protective clothing fainted several times, and when they got off work, water could be wringed out of their clothes.
Zhong Qi, a nurse at the Blood Purification Center of Zhejiang Provincial People's Hospital, remembered that on the first day of supporting Zhongshan Hospital Affiliated to Fudan University, an old man was brought to the hospital by community staff.
This old man, who has not had hemodialysis for 3 days, dare not eat more and drink more water.
The old man cherished the opportunity of this hemodialysis, and kept begging Zhong Qi repeatedly to help her adjust the value, "pull a little more water", because "I don't know when the next hemodialysis will be" - the old man does not want to always trouble the community Shuttle back and forth.
On May 16, Ma Xiaowei, director of the National Health and Medical Commission, published an article in the magazine Qiushi, saying that the early prevention and control capabilities should be upgraded and strengthened, the admission and isolation capabilities should be further strengthened, and designated hospitals and sub-designated hospitals and permanent shelters should be planned and prepared in advance. Hospitals, centralized isolation points.
Play the role of Internet diagnosis and treatment
A large part of the reason for the emergency emergency and the "big traffic jam" of 120 is that after the extended period of lockdown, the patient "is out of medicine" and "can't carry it at home until it can no longer be delayed", so they come to the hospital as a last resort.
In the emergency department, a heart patient suffered from angina pectoris and chest tightness at first, but was unable to visit the hospital due to the lockdown management.
There are two extremes of diabetes patients who come to the emergency department.
"One's blood sugar is very high, and the other is very low." The former is that after the closure and control, the patient could not get the medicine for a while after the drug was discontinued, and the blood sugar increased after several days of withdrawal; the latter was that the drug was not stopped, but there was a shortage of food, less, lower blood sugar.
Another female patient ate two meals of meat in a row because she couldn't buy vegetables. "Eating greasy, pancreatitis attacked."
Difficulty in buying medicines and seeing a doctor became prominent problems in early April.
For example, there are more than 6,300 registered mental patients in Jing'an District. During the lockdown period, the demand for drugs for mental patients in the community surged.
Liu Han, deputy director of the Jing'an District Mental Health Center, recalled that in order to let community mental patients "have medicine to eat" and "someone to take care of", the hospital opened a drug maintenance hotline. From April 5th to 12th alone, nearly 200 patients were called for help. .
In the past, these patients were directly contacted by the community health service center, but people in the community rushed to epidemic prevention, and compared with the community health service center, Jing'an Jingwei has a more complete variety of psychiatric drugs.
In special times, the pressure of medicine falls on them.
Many hospital medical staff recalled that the hospital's pharmacy was always in sufficient stock, but due to logistics problems, the hospital was unable to deliver medicines to patients.
Dispensing volunteers have sprung up in many communities, with patients' medical insurance cards, they go to several hospitals to dispense medicines on their behalf. Sometimes it takes three or four hours to queue at a hospital. Finally, they ride shared bicycles and carry the medicines of seventy or eighty patients on their shoulders. Back it up.
Lu Min, a gastroenterologist at Nanxiang Hospital, also said that from early to mid-April, she went to the hospital's simple outpatient clinic every day to dispense medicines for those patients who were about to stop taking medicines. From morning to night, she had to issue two or three hundred prescriptions.
Sun Huajun, director of the Department of Pharmacy of Shanghai Children's Hospital, saw a video circulating on the Internet in which a cadre of the neighborhood committee said to an elderly man in the community who asked for medicine, "I am also helpless, and I have no choice." He followed and cried.
He didn't even dare to look at the specific numbers of the daily prescriptions, "it's all in the computer, I just didn't dare to pull them out to see."
He recalled that the unbalanced state of "inflow is greater than outflow" of this medicine started in late March because the logistics transfer station was closed.
He thought that the socialized logistics could be resumed after April 5, and he comforted the patient's family, "the logistics will be issued as soon as possible after the recovery."
But after the 5th, there was still no movement, and the hospital accumulated a backlog of 3,000 orders.
Niu Jun, director of the Office of the Internet Hospital of Children's Hospital, launched a "drop-in" campaign to let some doctors and nurses go to the community or nearby to deliver medicine after get off work every day.
A pharmaceutical company in Shanghai organized more than 50 employees who were originally engaged in financial and administrative work to become drug delivery volunteers, and drove private cars to deliver drugs.
But once they have positive or close contact in their place of residence, they will not be able to get out.
Around April 10, a drug delivery volunteer from a food delivery platform came to the Children's Hospital, doubling the efficiency of drug delivery. Some doctors felt that they still need professional people to do professional things.
Seeing a doctor is difficult, and many patients returning to the Internet hospital flooded in for a while.
Niu Jun introduced that since the outbreak of the epidemic in March, the number of online consultations at the Children's Hospital has increased by 53% year-on-year in 2021, and the number of online follow-up consultations has increased by 216%.
From March 15th to May 3rd, more than 35,000 people visited Renji Hospital Internet Hospital for online follow-up and consultation, an increase of more than 10 times compared with the same period last year. Nearly 900 doctors registered online. Among the doctors every day, nearly 40% are experts with senior professional titles.
Jiang Rongmeng once mentioned in the paper "Improving the First Line of Defense of Primary Medical Institutions" that Internet diagnosis and treatment services can promote hierarchical diagnosis and treatment, divert patients, and avoid "running" on the advantageous medical resources of large hospitals.
But at present, Internet hospitals also have many problems.
For example, insulin and other drugs cannot be delivered by cold chain; many patients are not proficient in the operation of Internet hospitals.
Zheng Jiaoyang, an endocrinologist at the Changzheng Hospital, consulted on the Internet Hospital and found that it took longer than ever to see a patient.
Many elderly patients are not proficient in operating the Internet. They do not see the reminder of the number calling by text messages. They often call for a long time, and no one enters the online consultation room.
She analyzed that before the epidemic, many hospitals did not invest much in the Internet.
If we want to solve these problems, we also need the hospital to coordinate the cooperation of finance department, software department, pharmacy, information department and other departments, "equivalent to building a second hospital".
Early identification of patients prone to severe illness
In mid-to-late April, Shanghai began to focus on treating elderly and critically ill patients.
"It wasn't for this epidemic. I didn't even know there were so many elderly people in Shanghai." A doctor at the Shanghai Public Health Center was busy writing medical histories and prescribing medical orders for the elderly every day.
Some elderly people have many underlying diseases and need to take more than 20 kinds of medicines.
She couldn't sleep every night, thinking about how to give the old man medicine.
A doctor described these old people as a candle with a weak flame. "Under normal conditions, it can be extinguished little by little, but you blow a light breath to speed up the extinguishing of the candle. For the elderly, the new crown is that breath."
Zhang Xiaolin, deputy director of the Department of Respiratory and Critical Care Medicine of the Shanghai Public Health Center, told reporters that after many elderly people were infected with the new crown, their lungs did not respond significantly, but the infection "really damages a system", "one is the coagulation system, and the other is the alveoli. Epithelial system, after these problems appear, it affects the whole body. The elderly are in a very fragile state of balance. A little burden will break this balance. Once the balance is broken, the human body will lose its ability to correct itself, and it will become more and more Heavy."
Luo Li analyzed that in any city, the first batch of infected people are mostly young people with a wide range of activities, and it is the elderly who have a small range of activities or even in the hospital later.
If the city collects the pre-infected people into the square cabin in time, it can reduce the subsequent infection of the elderly, and the occurrence of infected people in nursing homes and rehabilitation hospitals.
On April 13, the day with the largest number of new cases, Shanghai had 27,719 more confirmed cases of the new crown.
Liu Chen, director of the Taopu Town Community Health Service Center, suddenly received a notice on the evening of April 17 that Putuo District People's Hospital would cooperate with them to build a designated hospital to treat elderly positive patients.
But in front of them is a six-story building that has just been renovated. The construction enclosure has not yet been removed. The 144 rooms are empty, not even curtains.
They want to complete the renovation of this under-construction aged care home within 24 hours.
Liu Chen recruited more than a dozen workers, but as soon as the other party heard that they were going to a designated hospital, only two were willing to work. Due to the lockdown, it was difficult for suppliers to send supplies.
He stayed up all night and asked his superiors for help, and finally transferred 200 formal hospital beds, a large number of wooden beds and camp beds, basic first aid equipment, and medicines.
From the afternoon to the early morning the next day, more than 500 elderly people were transported here.
The symptoms of the new crown of these elderly people are mild, but many people suffer from serious hemiplegia, hypertension, diabetes and other basic diseases.
There were so many people that for a time, beds were placed on the aisle and opposite the nurse's station.
Later, all the rooms were filled.
This temporary designated hospital has been supported for nearly a week without adequate nursing staff, security guards, and cleaning.
At the beginning, the hospital was in a state of "only entering but not entering". According to regulations, some high-risk patients should be promptly transferred to a higher-level hospital and admitted to the intensive care unit.
However, at that time, the higher-level hospitals were also short of resources, and it was difficult to transfer them out in time.
After a week, the referral channel slowly became smooth.
As of April 24, the cumulative number of infected people in Shanghai has exceeded 500,000, and 87 people have died. The maximum age is 101 years old and the average age is 81.1 years old.
On the 24th, 51 new deaths were reported in Shanghai.
Due to the increase in the number of people discharged from the Fangcang cabins and freeing up some beds and manpower, Shanghai began to transform the Fangcang cabins into designated hospitals to serve critically ill patients.
Jiang Liang, a Shanghai-aided doctor from Hubei Cancer Hospital, recalled that some of the cabins in the Shanghai New International Expo Center Fangcang Cabin Hospital were subsequently transformed to the standards of designated hospitals to treat confirmed and critically ill patients.
Upgrading the square cabin to the designated hospital standard means investing more manpower.
Jiang Liang said that in the past, a nurse could manage one or two hundred asymptomatic infected persons; after the transformation, six or seven hundred medical staff can take care of more than 1,100 critically ill patients. There are 300 people over the age of 70.
Oxygen cylinders, ventilators and other necessary rescue equipment and instruments have also been transferred one after another.
一些重症倾向的病人堆积在区级定点医院里，希望转运到市级定点医院，但市级定点医院的床位已满。“转运流程比较麻烦，上面的床位也很紧张，有时候一个星期也等不到。”一位院长说。
市级定点医院也有难处。有些患者转阴后，无法及时转运出去。比如，有的患者核酸转阴后基础疾病仍然很重，无法及时转到非定点医院，只能继续留在医院治疗。还有的患者转阴后生活不能自理，回到养老院没有护工照顾，也滞留在医院。
根据《新冠肺炎定点救治医院设置管理规范》，重症病区应达到医护比1:3，床护比1:6。多家定点医院的医生告诉记者，很难保证达到这个比例。
随着重症患者增多，医生们表示，将重症救治关口前移很重要。一位医生说，有的患者从区定点医院转运过来，到达医院时已经危重，只能上ECMO进行呼吸支持。还有的患者刚下救护车，血压“掉到极点”，刚被安置在床上心脏就停了。
还有医生注意到，有老人因为在方舱医院时没有及时吃药，导致病情恶化，转来的时候情况较差、已经陷入昏迷。“到我们这边来其实治疗也很简单，把药吃上，营养给他弄好了，四五天就出院了。”
“重症治疗是一个时效性的问题，你错过了代偿期，后续工作会越来越复杂，有可能这个病人就会丧失生命。好比他上坡的时候欠一点力，我推一把，他就上去了。但如果他已经滑到坡底，就会很麻烦。”一位医生说。
他们建议，区级定点医院、方舱医院要及早识别有重症倾向的患者。
专业的人干专业的事
当一些医务人员回望近两个月的抗疫经历时，总爱强调“专业的人干专业的事”，不能资源错配，尤其是在空间协调、人员协调上。
在有的方舱医院，每个舱准备了4个抢救室，配备了抢救设施、药品。但医护人员说，有许多抢救室从没用到过。而一家临时改造的定点医院里，早期没设抢救室，只能在地上抢救，多位高龄老人在抢救条件不足的情况下离世。
在有些社区卫生服务中心，床位没满，却因人力不足，不敢接收上级医院的康复病人；但一些二级、三级医院床位爆满，只能压下救护车的床，导致许多救护车，因为没床，不得不闲置。
外省援沪队里，一个性格内向的医生，擅长开刀做外科手术，支援上海后，在方舱负责接收防疫、生活物资，和不同的人联络。一位曾去过雷神山医院护理重症病人的护士，现在在方舱里不断做心理疏导。
物流人员大多被封控在家里，而有医生、护士下了夜班要顺路送药——孙华君还见到过一家三甲医院的院士去小区送药。他还看到，医院的年轻医生刚出了方舱，就去社区采样，回到医院又到发热门诊轮班。
桃浦社区一位负责职业慢性病管理的公共卫生医师，2022年只有1个月留在单位做常规工作，其余时候都驻扎在入境人员的隔离酒店、收治新冠感染者的临时方舱。据《中国经济周刊》报道，上海驻隔离酒店医护人员甚至要承担取快递、收垃圾、取外卖的工作，最长一天要工作16个小时，每天睡觉不超过4小时，基本24小时要“在线”。
还有的社区卫生服务中心，只留下八九个人守在医院。他们要撑起原先150多个医护人员的工作。
仁济东院急诊科一位护士回忆，每个医护都做好了充足的防护工作，但仍然有人感染，本质上是在长时间工作后，人的抵抗力下降。
医护人员“非战斗性减员”，也极大拖慢了医院的收治能力。浙江援沪护士钟琦回忆，4月3日，当她抵达中山医院时，正在血透室工作的本院护士只有个位数，原先的护士要么感染了病毒，要么被封控在家里。由于护士少，患者正常的透析从每周3次、每次4小时，减少至每周2次、每次3小时。
南翔医院消化科医生陆敏也发现，许多居委会干部、社区工作者、志愿者没有基本的院内感染培训，不知道如何保护自己，这会给社区感染带来隐患。
对很多人来说，这种“疲于奔命”的状态不是从4月才开始。中青报·中青网记者了解到，桃浦镇社区卫生服务中心从2020年9月投入第一针新冠疫苗接种工作开始，就没停过。每当接到接种任务，30多个诊室只留一半，其他人全去打疫苗，最忙的一天，一个接种点打了5000针。
长时间超负荷工作让一些医护人员身心俱疲。静安区精神卫生中心临床心理科主任胡海萍设计了一份心理自评测量表，在回收的近500份测量表中，三分之二的一线医疗人员、社区工作者存在抑郁、焦虑、睡眠问题的困扰。
刘晨开始思考，有没有方法能让社区医护人员从核酸采样里解脱出来、回到日常工作？他想，当核酸检测常态化，或许可以借助第三方人员，平时加强训练，需要时动员起来，这样既能保证平时不冗余，“战时”又能拉出来。
2021年10月，上海市卫健委印发《上海市医疗机构设置规划(2021-2025年)》：上海市医疗系统存在一些不足，例如“各级医疗机构功能定位和分工协作机制有待进一步落实，公共卫生体系医防协同不充分，平急结合不紧密。”该规划提出，要“建立健全防治融合、有序转诊、平急结合的传染病救治网络体系”。
实际上，上海的医院和床位总量，在全国城市中，一直是排头兵。截至2020年年末，上海有57家三级医院，14.1万张床位， 8.2万名执业医师，10.3万名护士。这个医疗实力发达的城市，有许多优势和进步：百强医院数量占全国近两成；全国诊疗人次最多的城市；疫情直推系统，直推上海传染病病例的速度为1-2分钟，数据即时上传国家平台。
但这些医疗资源平摊到上海2000多万人口上，人均医院、床位、医护拥有量，甚至排在中西部地区、长沙等城市之后。在60多万新冠感染者面前，上海人均有限的医疗资源，更显得紧巴巴。
织一张更密的网
4月24日以后，上海新增病例数再也没有突破两万。至今，那条确诊数量的曲线，以弯弯曲曲的趋势，下滑。
林枫认为，未来可以把更多医疗资源倾斜到预防老人、高危人群感染上，比如，把没接种疫苗的老人保护起来，就像太空舱一样。
除了老人，还有一些因特殊疾病而没有打疫苗的患者，需要专业的医护人员关注。
静安区精神卫生中心医生姜华说，医院近600名住院患者因病没有打疫苗，长期封闭管理，65岁以上占35%，部分患有基础疾病。3月中旬起，病区开始闭环管理。但4月13日，病区里有人转阳。至今，经过治疗，阳性患者基本转阴。
徐璐是静安区精神卫生中心科教科科长。徐璐所在的方舱，临时改建了两个房间，作为精神障碍患者的隔离点：窗户不能开大，要去除一切危险品，门也不能反锁。这个特殊的方舱最开始准备接收15个病人，但精神障碍患者的需求量大，就增加到25床，静安区精神卫生中心也抽调更多人手，支援这个特殊的方舱。
回顾上海医疗资源吃紧的情况，林枫说，病毒升级了，所以防疫措施要适当调整。“在奥密克戎时期，应该研究每个策略是不是可以优化，不要死板地抱住它。”
“方舱的作用是巨大的，但是功能要再定位。”林枫说，德尔塔时期传播率低，方舱储备量可以少，但奥密克戎传播力强，方舱的储备量要加大。方舱有灵活性，可以随时根据抗疫的需求，改造升级。
比如，方舱可以作为部分轻症老年人的保护性场所，安排医务人员巡查，就像慢性病医院一样监护和管理。而那些劳务工人、医院护工等外来务工人员，流动性强，住在集体宿舍，没有居家隔离条件，也是入住方舱的重点人群。
浙江省人民医院副院长涂建锋认为，病毒升级了，传播速度更高，但有些措施还停留在病毒未升级之前，遇到奥密克戎，防疫政策需要更系统、更完善。
病毒的变化还在继续。据上海疫情防控工作新闻发布会介绍，截止5月11日，导致本轮本土疫情的新冠病毒，绝大部分为奥密克戎 BA.2型和BA.2.2型。5月4日，世界卫生组织提醒密切监测亚型BA.2.12.1，与其他奥密克戎亚型毒株相比，BA.2.12.1亚型具有更强的免疫逃逸能力，一些研究表明其传播率比BA.2快23%至27%。《中国疾病预防控制中心周报(英文)》5月16日报告了我国首例确诊感染新冠病毒“奥密克戎”亚型毒株“BA.2.12.1”的境外输入病例的具体情况。
“奥密克戎来得太猛了，我们只是一时没跑过它，但是我们不曾停步，始终在跑啊！”南翔医院副院长田源在回顾职业生涯中这段最忙碌的日子时说。
5月10日的上海发布会，发言人总结，从地区分布上来看，上海阳性感染者中90%以上来自于中心城区和近郊区，这些地区往往是老旧小区、旧式里弄和城乡接合部，包括城中村比较集中的区域。这些地区人口密度高，厨卫共用或使用公共厕所等现象较为普遍，存在较多容易导致病毒传播的风险环节。
发言人说，上海下一阶段将以老旧小区、城中村等作为重点工作，强化定期筛查，努力消除可能存在的风险因素和环节。
进入5月，上海正在织一张更密的网。虹口区建设了200多个核酸采样点，每个采样点的间距，保证居民步行15分钟内能抵达。普陀区正加大疫苗接种，把流动疫苗接种点设立在小区门口、楼门口，方便老年人接种疫苗。
闵行区新上线了15家互联网医院，其中，13家是社区卫生服务中心。除需要冷链配送的胰岛素、精神类药物等，许多药物可以直接在互联网医院上配送，还可以在线上实时联系上家庭医生。
而积压在上海儿童医院互联网医院那3000多单药品，终于在4月30日见了底。进入5月，能来医院自取药品的家长也变多了。
随着疫情向好，人员流动逐步加快。5月16日，上海宣布将延长门诊时间，“中午连一连或下午延一延”，确保当日就诊者都能够得到接诊，有序增加周末手术安排，解决疫情期间积压的手术，也会增加社区卫生服务中心药品配备，不断拓展药品种类，加强对老年人、慢病患者、儿童、孕产妇等重点人群的主动健康管理。
5月15日，上海交通大学医学院附属医院的医学专家在线上开了一场研讨会，探讨疫情期间的医疗救治和应急管理。主讲的专家都参与了上海疫情医疗救治中，有人剖析了方舱医疗救治的问题和需求，总结上海方舱经验，有人建议部分区域转为定点医院功能时，应该有针对性调整人力、场所、设备，让重症患者早期、及时、有效转移到定点医院，提高救治成功率。
As of the 16th, there were 5 city-level shelters closed in Shanghai, accounting for half of the city-level shelters, and all 68 district-level temporary transit platforms were closed.
A shared document called "Shanghai Medical Emergency Relief" has been online since March 29, and it is filled with medical treatment channels related to hemodialysis, cancer, dispensing, hypertension, diabetes, and mental illness.
The daily number of requests for this shared document reached its peak on April 15, with more than 100 requests. In May, the number of new requests per day dropped to less than 10.
The data statistics on the homepage of the document stay on May 6th. On that day, only 3 help messages were added to the document.
(China Youth Daily and China Youth Daily reporters Li Qiang, Yin Haiyue and Jiao Jingxian also contributed to this article)
China Youth Daily and China Youth Daily trainee reporter Guo Yujie reporter Wei Xi trainee Jia Jinghan Source: China Youth Daily