As of December 9, Fan Ye still needs to do nucleic acid every day.
He is a neurosurgery doctor at a tertiary hospital in Shijiazhuang City, Hebei Province. He works in the isolation ward for patients infected with the new crown. He wears three-level protection for several hours a day, wearing N95 masks, rubber gloves, isolation gowns, goggles or protective clothing. The face screen is quite stuffy inside.
Even so, there are still some colleagues around him who have become "positive" one after another. Fan Ye believes that this is inevitable, because the doctor will "inevitably shake the protective clothing" when leaving the isolation ward-although he himself has never been "positive".
While the virulence is obviously weakened, the infectivity of Omicron is enhanced.
Therefore, once medical staff are infected inside and outside the hospital, the hospital will encounter "non-combat attrition".
Under the new epidemic prevention situation, how to control the scale of nosocomial infection is related to the health of medical staff and various vulnerable groups who need to enter the hospital.
Among them, some details are involved, for example, how to monitor the doctor's physical condition?
How to achieve a relative balance between preventing and controlling nosocomial infection and maintaining the efficient operation of the hospital?
On the afternoon of the 8th, the Joint Prevention and Control Mechanism of the State Council held a press conference. Guo Yanhong, director of the Medical Emergency Department of the National Health and Health Commission, said that the vaccination and health monitoring of medical personnel should also be done according to the situation of epidemic prevention and control and clinical treatment. Dynamically optimize and adjust the organization of medical staff as needed.
Recently, some experts have also suggested that the new crown should be gradually returned to Category B management, which can release a large amount of medical resources and return to normal diagnosis and treatment, but such adjustments should be cautious.
"The return of the new crown to Category B must be timely and orderly"
In mid-November, the policy level just canceled the "secondary close contact" determination, and both positive and close contacts need to be isolated in a centralized manner.
Fan Ye said that at the time when nucleic acid testing was required when entering the hospital, "new positive cases appeared" in the outpatient clinic from time to time, and the hospital set up a floor to house patients with positive nucleic acid results and doctors and nurses who had been in contact with them, waiting for transfer.
During this period of time, some "positive" doctors and nurses continued to take care of patients who were isolated with them.
Some of them turned "yin" before the arrival of the vehicles to be transported to the shelter.
In January 2020, based on the characteristics of the virus at the time, the State Council approved the inclusion of COVID-19 in Class B management of statutory infectious diseases and the adoption of preventive and control measures for Class A infectious diseases.
According to my country's "Law on the Prevention and Control of Infectious Diseases", when a Class A infectious disease is found in a hospital, "for patients in medical institutions, pathogen carriers, and close contacts of suspected patients, medical observation and other necessary preventive measures shall be carried out in designated places." ; If Class B or Class C is found, "necessary treatment and transmission control measures should be taken according to the condition."
On December 7, Zhang Boli, an academician of the Chinese Academy of Engineering, mentioned in an interview with Science and Technology Daily that the decision at that time prevented hundreds of millions of people from being infected, and bought time for vaccine, drug development, and accumulation of treatment experience.
With the gradual weakening of the mutation and pathogenicity of the virus, Zhang Boli said that the necessary conditions for the continuation of Class A management are gradually decreasing, and the conditions for returning to Class B management are becoming more and more mature.
"Returning COVID-19 to Class B management can release a large amount of medical resources from shelter hospitals and return to normal diagnosis and treatment; in rescuing patients with COVID-19, we can focus on key populations; In the future, further optimization of prevention and control measures will provide a certain legal basis, so that there are laws to follow." Zhang Boli explained in the aforementioned interview.
Jin Dongyan, a virologist and professor of the School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, University of Hong Kong, also agrees that the new crown should be gradually managed as an ordinary infectious disease, and "relative isolation should be adopted, so that it is not necessary to put it in a negative pressure ward", and then the doctor wears N95 Masks are enough for proper protection.
However, he told The Paper that "these have to be done step by step."
"In the (infection) tsunami period, medical care does not live in a vacuum, and there will definitely be infections." Jin Dongyan said that during the Hong Kong epidemic, the hospital implemented precise prevention and control, and did not close the hospital or close the entire building. "At most Closing the clinic or ward, if it goes to the most extreme step, it will be treated as a cold, and the medical staff will rest at home and come back to work, so the basic services can be maintained.”
Lu Dewen, a professor of sociology at Wuhan University, has long been concerned about rural governance in China and has conducted in-depth investigations into rural areas.
He believes that the return of the new crown to Category B management needs to be more prudent, "Speed is not a problem, the key is order."
Lu Dewen is concerned about whether the prerequisites for the current Category B management are mature, "For example, the vaccination rate of the elderly population must reach at least a certain proportion, medical resources, especially severe medical resources, must be prepared, and there are other related supporting measures, such as rural areas. The population, especially the elderly in rural areas, has a very different view of the epidemic from other groups, and it takes a certain amount of time to publicize and educate. These are a systematic project."
Zhang Boli also said that downgrading control is a major adjustment in epidemic prevention, and it is necessary to "seek progress in stability and make adjustments in a timely and orderly manner."
How to deal with "downsizing"?
On December 7, the State Council issued the "Notice on Further Optimizing the Medical Treatment Process and Doing a Good Job in Current Medical Services" by the State Council's Joint Prevention and Control Mechanism for the Novel Coronavirus Pneumonia Epidemic. , directly enter the emergency diagnosis and treatment area, and if there is no 48-hour nucleic acid test result, the patient will be treated in the emergency buffer area, and the antigen and nucleic acid will be checked at the same time.”
According to the current requirements, people who are "positive" for the new crown need to be isolated at home for seven days without special treatment, and those who are in close contact need to be isolated for five days.
The Paper has learned from many sources that in recent days, many places are tightening the scope of identification of "close contact" between medical staff and nurses for the detection of positive cases in hospitals.
For example, on December 6, Zhang Zhao, a doctor at a tertiary hospital in Wuhan, told reporters that a positive case was found in the department a few days ago and was transported away, while other doctors continued to work.
He was in the respiratory medicine ward, some doctors were transferred to the isolation point, and some were transferred to the fever clinic.
Zhang Zhao felt that if he was taken away again as a close contact, there would be no one in the ward.
A doctor from a tertiary hospital in Guangzhou also told reporters that after positive cases were found in the fever clinic, the hospital required the medical staff on duty to be quarantined.
This system has been adjusted to return to work normally after killing and disinfecting, and "it is not easy to reduce staff."
On December 6, Wuhan doctor Li Ping received an emergency patient with cerebral hemorrhage. The patient did not have a 48-hour nucleic acid result, but he was not sure whether he was "positive" for the new crown and urgently needed rescue.
According to Li Ping, some patients need to be intubated for rescue, and some patients vomit, which are easy to cause infection. Such patients are sent to negative pressure wards, and those who can be postponed are placed in the buffer zone.
He told reporters that recently some beds in the emergency room were covered with transparent materials to prevent cross-infection.
Until December 6th, in Li Ping's hospital, emergency medical staff still needed to wear protective clothing, and when entering and leaving the negative pressure ward, they were covered with isolation gowns.
Policies are being adjusted on a rolling basis.
It turned out that several Hubei hospitals required medical staff to nucleic acid every day.
On December 8, Zhang Zhao told reporters that the nucleic acid test was no longer performed, and inpatients were originally tested once a day, but they stopped doing it from this day on.
In the original situation of "one test a day", both Fan Ye and Zhang Zhao were worried about the prospect of "reducing staff" of medical staff.
Zhang Zhao saw that the hospital was vacating wards to build some emergency rooms: "The number of patients will definitely increase, there is no doubt about it."
Hospital workloads will also increase.
If doctors are quarantined as soon as they become positive, it may be difficult for hospitals to operate.
However, he said that the situation of different positions is different, and it is not possible in the ward, and some outpatient clinics should be feasible under the condition of good protection.
But in Li Ping's view, doctors and nurses with fever are still working in protective clothing, "it's easy to collapse."
Wang Cheng, a doctor at a designated hospital in a central province who has participated in the "anti-epidemic" for many times, told reporters that under the current social mobility, it is normal for some people to be "yang".
He suggested that it is not mandatory for medical staff to do nucleic acid tests, and those with symptoms can voluntarily undergo nucleic acid testing, rest if necessary, and return to work after recovery.
"Manage public expectations well to avoid a run on"
Wang Cheng is a hospital sense expert.
He introduced that in order to deal with the risk of "attrition", his hospital has divided the medical staff into different echelons according to the different situations of different departments, and they go to work in turn to prevent a certain department from closing down.
However, "it is still manageable." On December 8, there was no obvious increase in the flow of people in the hospital.
He also worked in the Department of Respiratory Medicine before. Every year during the flu season, he sees one or two hundred numbers a day.
According to Wang Cheng's understanding of the new crown, when the current respiratory medicine department receives patients with cold symptoms, whether the patient is "yang" or not is not important for the diagnosis and treatment plan.
However, hospitalized patients should still be tested for infection with the new crown, and those who are positive can be hospitalized in a specific area of the department. He believes that some places where vulnerable groups are concentrated also need attention, such as nursing homes.
Even if the new crown is converted to "Class B and B management", it will be a long-term problem to prevent and control "hospital infection".
Liu Ming, another respiratory physician in Wuhan, recalled to reporters that in previous flu seasons, once patients in the emergency department were confirmed to be infected with H5N1 and other influenza viruses, they were also sent to special wards. The ability to spread is far inferior to that of Omicron.
Before the "new crown", every winter and spring flu season, Liu Ming consciously did not eat with his family.
In an interview with The Paper, Liang Haonan, a specialist in infectious diseases at Elizabeth Novena Hospital in Singapore, believes that it is not necessarily necessary for hospital staff to wear protective clothing for consultations.
But he reminded that all doctors should wear N95 masks as much as possible in the hospital and on the way to and from get off work. One is to prevent patients from passing the "new crown" to medical staff, and the other is to prevent medical staff from passing it to patients.
Visitors to these hospitals, whether hospitalized or not, are often immunocompromised.
A study conducted in the first half of 2021 showed that medical staff in Singapore are actually more likely to be infected with the new crown outside of working hours than "hospital flu".
Singapore, with a population of more than 5.5 million, is considered by the WHO as a "model for international response to the epidemic", and the local severe disease and fatality rates remain at a low level.
Paul Anatharajah, an epidemiologist in Singapore and president of the Asia-Pacific Society for Clinical Microbiology and Infectious Diseases (APSCMI), replied to reporters that at present, Singapore's "nosocomial infection" protection is relatively loose, and the emergency department only treats patients with respiratory symptoms. Patients should be used as antigens; medical staff only need to wear protective clothing instead of isolation gowns when treating positive or suspected positive related infected patients.
However, it needs to be pointed out that Singapore is no longer in the outbreak period of the new crown.
Hospitals are reserved for patients with higher risks. Liang Haonan concluded that first of all, family doctors who do not work in large hospitals should be encouraged to provide diagnosis for the elderly and explain how to recover at home; hospitals admit people with serious underlying diseases and those who have not been vaccinated.
At the same time, help should also be provided to those who are recovering at home but their condition has worsened, and those who really need diagnosis and treatment should be sent to the hospital; he also mentioned that some isolation points should be reserved and equipped with nurses so that infected persons who do not need diagnosis and treatment but are emotionally anxious can have place to go.
"For you, it is a shelter hospital." He wrote in an email reply to The Paper.
Jin Dongyan also told The Paper that, first of all, we should do a good job in policy advocacy, and explain clearly to everyone "what is going on with this disease now", and then if it returns to Category B management, "where is the basis and what is the goal?" , What should our hospitals and buses do?"
He reminded that under this premise, the public's expectations should be well managed to avoid running out of medical resources.
For example, during the COVID-19 outbreak, sending children to the hospital is risky.
Pediatricians should tell everyone that if you have a fever, you can give the child antipyretics, unless he has special symptoms, such as screaming, shortness of breath, and then consider sending him to the doctor; try to solve the problem through consultation, telemedicine, and hotline.
According to Hong Kong's hierarchical diagnosis and treatment system, after the antigen test is positive, the government will give home isolation guidelines and send a large gift package consisting of thermometers, masks, antigens, and traditional Chinese medicines; as of March 15 this year, Hong Kong has set up 23 "designated medical institutions" It is estimated that it can receive 4,300 infected people every day. Jin Dongyan concluded in a related article that these are "serving people with mild symptoms and emotional anxiety."
In February and March of this year, the Hong Kong Hospital Authority once disclosed the number of new infections among medical staff every day, but it stopped publishing it in mid-March.
Jin Dongyan mentioned in the paper that more than 15,700 people, or about 20% of medical workers, had been infected with the new crown.
Jin Dongyan interpreted that the purpose of releasing these data at the beginning was to remind medical staff and draw everyone's attention, which is also an important part of the epidemic; "but then we felt that this was very common", and many people in the Hospital Authority were infected.
Recently, "Baoding Epidemic" was once on the hot search, and the local rumors were exaggerated, and there was no obvious medical run.
On the afternoon of December 6, the reporter contacted the emergency hotline of Baoding First Central Hospital, which treats patients who are "positive" for the new crown.
However, the reporter interviewed many Baoding citizens, and they all expressed that they were reluctant to go to the hospital recently, "worrying about cross-infection".
Most of the locals choose to isolate at home, and their mentality is relatively relaxed.
Ning Guang, academician of the Chinese Academy of Engineering and president of Ruijin Hospital, once introduced that the vast majority of patients with new crowns are asymptomatic and do not need to seek medical treatment, but possible symptoms include: dry throat, sore throat, cough, fatigue, fever, etc., basically 7 - It will turn negative in about 10 days. If you are infected, you can isolate yourself at home if you can.
He also added that if the fever persists for more than three days and does not cool down, if there is asthma, dyspnea, decreased oxygen saturation, and the underlying disease is aggravated, it is recommended to seek medical treatment in time.
If a baby under 3 months has fever, no matter what the child's condition is, he should go to the hospital for treatment.
When the body temperature is too high, it is recommended to take antipyretics before going to the hospital.
Sun Jia, a resident of a county under the jurisdiction of Baoding, told reporters that a few days ago, she saw many people with fever in the county, so she went back to live in the village, bought some antigens at the pharmacy in the village, and the whole family tested themselves.
First, the father became positive and turned negative within a few days; then the mother became positive again.
They were unwilling to go to the county hospital for diagnosis and treatment. As close fathers, they went out wearing masks and sold some traditional Chinese medicine to their wives.
Previously, Feng Zijian, executive vice president and secretary-general of the Chinese Preventive Medicine Association, mentioned in an interview with The Paper that the risk of public infection will increase greatly in the coming period. It is recommended that those who have not completed basic immunization and enhanced immunization be vaccinated as soon as possible. Especially key groups such as the elderly and patients with chronic diseases should be vaccinated as soon as possible.
Jin Dongyan believes that in the face of the inevitable peak of infection, in addition to vaccines and antigens, he also hopes to store enough oral medicines so that the elderly in rural areas can also use them.
The Paper reporter Ge Mingning Zhu Ying Liu Haonan intern Guo Sihang Xue Ke Huang Jiani (The Paper reporter He Kai also contributed to this article; at the request of the interviewees, Fan Ye, Zhang Zhao, Li Ping, Wang Cheng, Liu Ming, and Sun Jia are pseudonyms. )