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China - Reports of long lines at fever clinics in hospitals - December 10, 2022

sharon sanders

Editor-in-Chief & President
How do hospitals cope with the long queues for fever clinics?
December 10, 2022 10:00 China News Weekly
1,428
  On the afternoon of December 8, in the Houhu District of Wuhan Central Hospital, more than 50 people had lined up outside the fever clinic. Some elderly people were waiting in wheelchairs, and some fever patients were resting on benches. It is reported that many local medical institutions, including Wuhan Union Medical College Hospital, have patients queuing up for medical treatment in fever clinics.

  The day before, the joint prevention and control mechanism of the State Council issued the "Notice on Further Optimizing the Medical Treatment Process and Doing a Good Job in Current Medical Services" (hereinafter referred to as the "Notice"), which emphasized that patients with 48-hour nucleic acid test results should directly enter the emergency treatment area , 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.

  At the press conference of the Joint Prevention and Control Mechanism of the State Council held yesterday afternoon, Jiao Yahui, director of the Department of Medical Administration of the National Health and Medical Commission, said that all medical institutions will receive nucleic acid positive patients in the future. At present, many places such as Guangzhou and Shanghai require that fever clinics should be opened as much as possible, and that fever clinics and emergency departments should not be closed at will on the grounds of admitting patients with positive infections of the new crown.

  In fact, hospitals are more likely to become "amplifiers" for the spread of the epidemic. As the inspection of nucleic acid certificates is relaxed on many occasions, the prevention and control of nosocomial infections is facing challenges. According to previous regulations, if a medical institution finds a person who is positive for the new crown, it must report to the disease control department in a timely manner, determine the close contact in the hospital, and conduct sealing and disinfection within a clear range to effectively block the spread of infection.

  Recently, a doctor from a tertiary hospital in Guangzhou revealed that starting from December 5, positive medical staff in the hospital will no longer be counted as nosocomial infection, and medical staff who receive positive patients will no longer be counted as close contacts.

  "(Hospital Infection Standards) must be changed. Before that, we required medical staff to have zero infection, but it is difficult to achieve it now, and it cannot be a mandatory requirement." Director of Infectious Diseases Department, Zhongshan Hospital Affiliated to Fudan University, National Medical Treatment of New Coronavirus Pneumonia Hu Bijie, a member of the expert team, told China News Weekly, "The presence of infection does not mean that the (epidemic prevention and control) work has not been done well, but because the risk of the epidemic in medical institutions is greater, we hope that medical staff will be infected as little as possible and late." It will be able to top when the peak of the future outbreak comes.

On December 9, 2022, Beijing, outside the fever clinic of the Infectious Diseases Department of Tongzhou Luhe Hospital, citizens waited for treatment. Figure/Visual ChinaOn December 9, 2022, Beijing, outside the fever clinic of the Infectious Diseases Department of Tongzhou Luhe Hospital, citizens waited for treatment. Figure/Visual China
  Both patients and medical staff tested positive for new crown

  On December 1, the Wuhan Municipal Health and Health Commission announced the list of 42 general fever clinics, and reminded the public that each fever clinic may be temporarily closed for receiving positive cases. Take precautions.

  An emergency doctor at a tertiary hospital in Wuhan, who did not want to be named, told China News Weekly that on December 5, the emergency department of the hospital reopened after being temporarily closed for several days. According to the "Notice", the hospital only needs to check the patient's 48-hour nucleic acid test results. The emergency doctor said that his department first triages the emergency patients. Patients with fever and other symptoms in the past three days go to the fever clinic, and patients without fever symptoms go to the emergency department. In the past week, "the number of patients in both places has increased." On December 7, there was a long queue outside the fever clinic of the hospital, "and patients with positive nucleic acid have been detected in the fever clinic and emergency department in the past few days."

  On December 7, the doctor's hospital mentioned in an internal meeting that among the 101 patients admitted to the fever clinic the day before, 52 had positive nucleic acid results. The doctor also mentioned that more than 10 of the emergency patients have been found to be positive for nucleic acid. "Some patients had a normal body temperature when they arrived at the hospital, but suddenly developed a fever while waiting for the doctor, and the nucleic acid test was positive."

  According to the above-mentioned doctor, according to the previous hospital regulations, the emergency department had to stop the clinic if positive patients were found, but now there is no need to stop the clinic, just kill them quickly on the spot, conduct environmental sampling, and strengthen the protection of medical staff to avoid gathering.

  On December 5, the Guangzhou Municipal Health and Health Commission also stated that the treatment plan for people who test positive for the new crown nucleic acid or antigen is to quickly guide them to wear N95 masks, transfer them to a relatively independent area for isolation and treatment, and accurately determine the area where positive people are treated. Expand the closed area, and continue to receive medical services in non-closed areas.

  According to media reports, a few days ago, there were long queues in front of fever clinics in many hospitals in Beijing. On December 7, at the 430th press conference on Beijing’s epidemic prevention and control work, Zhong Dongbo, Secretary of the Party Committee of the Beijing Municipal Health and Health Commission, explained that recently, with the development of the epidemic situation, patients’ demand for fever clinics has increased, and some medical institutions After a positive infection occurs, it needs to be eliminated. Therefore, when citizens go to fever clinics and emergency departments for medical treatment, there is a phenomenon that the clinics are suspended due to the epidemic.

  In order to better protect the normal medical needs of citizens, Zhong Dongbo emphasized that fever clinics and emergency departments should be set up and opened as much as possible, and fever clinics should be set up in secondary hospitals and above if conditions permit. Fever outpatients, emergency departments, or outpatients who come into contact with positive infections will be transferred to the isolation ward within 1 hour; after positive infections are transferred out, the related clinics will be immediately disinfected and resume use as soon as possible to reduce the impact of the epidemic on medical institutions.

  In the "New Ten Articles" released on December 7, the latest change is that asymptomatic and mildly positive patients can be isolated at home. According to the doctor mentioned above, generally speaking, positive patients who come to see a doctor will be sent to the designated hospitals for the treatment of the new crown, but currently the designated hospitals in Wuhan are already saturated. For some patients with mild symptoms, "we will notify the community to pick them up." However, the doctor added that the community is too busy at the moment, "We usually put N95 masks on each other, disinfect them well, and suggest that they go home and isolate themselves."

  Infections among medical staff have also occurred in some hospitals. Many interviewed doctors emphasized to China News Weekly that at present, in order to reduce the risk of nosocomial infection, the first thing to do is to advise most patients with mild symptoms of the new crown not to flood into the hospital, which may easily cause cross infection.

  "We must deal with people infected with the new crown in a stratified manner. According to current research, 99% of infected people are asymptomatic or mild, and these people do not need to go to medical institutions." Hu Bijie, director of the Department of Infectious Diseases, Zhongshan Hospital Affiliated to Fudan University, told China News The Weekly said that the most important thing now is to tell everyone that 99% of the population must not run out of medical resources for 0.1% (severely ill patients).

  Guo Wei, deputy chief physician of the Department of Infectious Diseases, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, observed that currently, most of the infected patients who go to the hospital are mild, and the pressure on the fever clinic is increasing. Tongji Hospital has converted the square at the entrance of the hospital into a temporary fever clinic. He suggested that patients with a body temperature below 38°C, non-sustained high fever, and no severe respiratory symptoms should be isolated at home, and their health should be monitored in a timely manner. Those who have high blood pressure and uncontrollable elevated blood pressure, or children with lethargy and persistent diarrhea should go to the hospital immediately."

  In addition, the above-mentioned emergency doctor also reminded that the new coronavirus infection does not necessarily manifest as fever symptoms, "it may also manifest as general fatigue, loss of appetite, nausea and vomiting, or sore waist and legs, etc. At this time, everyone should be vigilant and do not go out. Pay attention to rest and monitor your body temperature."

  Try to let medical staff "infect less and get infected later"

  In Hu Bijie's view, after the release of the "New Ten Measures", it must first be clarified that the current optimization and adjustment of the epidemic prevention policy has two main goals. As the pathogenicity of Omicron has been greatly reduced, "Under the new situation, everyone should be mentally prepared and stop thinking about how many cases of infection have increased, but accept the fact that the new crown virus may not be able to hide from anyone." .”

  On December 8, the joint prevention and control mechanism of the State Council held a press conference, mentioning that the occupational exposure risk of medical staff should be minimized, and management should be strengthened in areas with relatively high occupational exposure risks such as fever clinics, emergency departments, and wards.

  On December 3, Hu Bijie gave special training on infection prevention and control for medical staff in Shanghai. In his sharing, he mentioned that medical staff engaged in emergency department, fever clinic, ICU, tumor radiotherapy and chemotherapy, diagnosis and treatment of geriatric diseases, etc., it is best to To do a nucleic acid test, especially for key positions, you must complete the vaccination and monitor the antibody level. If the antibody level is not enough, you should consider supplementary vaccination. In addition, it is also recommended that medical staff reduce the risk of infection and protect key departments by wearing N95 masks and conducting nucleic acid and antigen tests every day.

  Even protecting the "0.1%" of vulnerable groups will still put great pressure on medical institutions. Many medical staff said, "We can only slow down the spread of the virus as much as possible in our work, and completely prevent its spread, which is impossible."

  "China News Weekly" understands that in recent days, many tertiary hospitals in Wuhan have adjusted the requirements for nucleic acid testing of medical staff. Guo Wei introduced that at present, according to the regulations, Tongji Hospital no longer requires doctors to perform nucleic acid testing every day. For departments with high infection risks such as the Department of Infectious Diseases, Respiratory Medicine, and Emergency, medical staff are required to perform nucleic acid testing three times a week, and other departments once a week. Inside, all medical staff have to do antigen testing every day, and take pictures of the results and upload them.

  In order to cope with the peak of consultations, Wen Daxiang, director of the Shanghai Municipal Health and Health Commission, introduced at a press conference a few days ago that Shanghai has adopted a series of hierarchical and triage measures. Triage, the outpatient clinic checks the patient's 48-hour nucleic acid test results, and the outpatient department divides the nucleic acid negative and positive diagnosis and treatment areas, and receives corresponding patients respectively. In addition, through the expansion of consultation rooms and sufficient medical resources, the capacity of fever clinics and emergency consultations will be further improved, and the three-tier medical service system will be further consolidated.

  In addition, Hu Bijie mentioned that early and rapid identification of positive patients is the basis for the prevention and control of the new crown, so that effective and precise prevention and control can be achieved. In addition to outpatient and emergency screening, the "Notice" also emphasizes that for inpatients, the hospital should focus on patients over 65 years old, with serious underlying diseases such as tumors and respiratory diseases, and who have not completed the full course of vaccination. , We must pay attention to changes in the condition in a timely manner and strengthen medical treatment. Medical institutions should arrange relatively independent areas such as hospital areas, buildings, wards or wards to admit and treat nucleic acid positive patients.

  In Guo Wei's view, "Most of the patients who are currently hospitalized have underlying diseases and low immunity, and cluster infections must not occur." He introduced that setting up buffer wards in the hospital is a solution. At present, Tongji Hospital will treat all patients who are going to be hospitalized in the buffer ward after checking the nucleic acid certificate. Transfer to general ward. "We found that the patients who were positive for the new crown before were tested in the buffer ward. Almost 99% of the positive patients can be detected to ensure the greatest degree of safety."

  But Guo Wei mentioned that not all hospitals have the conditions like Tongji Hospital. In addition, there is a "dilemma" in the prevention and control of nosocomial infection, that is, how to balance the strengthening of nosocomial infection protection against the new crown and actively promote the treatment of other diseases in the hospital. He explained that some hospitals do not have the conditions to set up buffer wards, and positive patients cannot be found on the front line, and the risk of infection for patients and medical staff will increase. But on the other hand, if the hospital strictly manages the buffer ward, it will also reduce the efficiency of admission, "because the buffer ward has special requirements, such as independent single or double rooms, the occupancy rate of medical resources is higher."


  In the face of a possible peak of the epidemic in the future, Guo Wei introduced that Tongji Hospital has made relevant plans to expand the fever clinic. In addition, a branch hospital has been separated to treat COVID-19 positive patients.

  "After 2020, we feel that the situation at that time will never happen again, but if we don't handle it right now, there may be a medical run, so that critically ill patients cannot be admitted to the hospital. Everyone will always have a shadow. We still have to try our best to 'soft landing' ’, don’t cause a surge in the number of infections in the short term.” Guo Wei told China News Weekly that in his opinion, each medical institution can play a limited role, and he hopes to conduct more publicity and education in the whole society so that everyone can be infected at this stage. Strengthen protection.

  On December 8, at the annual meeting of the Chinese Medical Association Respiratory Diseases, Wang Chen, vice president of the Chinese Academy of Engineering and president of the Chinese Academy of Medical Sciences and Peking Union Medical College, said that the epidemic prevention and control policy is changing. In this way, the peak of the epidemic can be controlled, so that medical resources can be used in an orderly, appropriate, and scientific manner, so as to better promote economic and social development while maximizing protection good patient health.

zhttps://news.sina.com.cn/c/2022-12-10/doc-imxweckx1742915.shtml#/
 
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