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The death toll from the new crown epidemic in Shanghai exceeded 200! How to reduce mortality? Where is the difficulty in the treatment of severe cases in the elderly?
April 27, 2022 17:31 First Financial
Introduction : With the sharp drop in the number of new local new crown infections in Shanghai, controlling the fatality rate will become the top priority of the recent epidemic prevention work.
As of April 26, 271 severe and critically ill patients have been treated in this round of epidemic in Shanghai, with a total of 238 deaths. According to what was revealed at the Shanghai Epidemic Prevention and Control Conference on April 27, the case fatality rate rose to 0.045% based on the total number of infected people in this round of the epidemic so far 533,000.
How to reduce mortality? Where is the difficulty in treating the elderly and critically ill patients? These issues have received much attention.
Controlling the fatality rate will be
The top priority of the recent epidemic prevention work
Experts said that with the sharp drop in the number of new local new crown infections in Shanghai, the case fatality rate will rise to a certain extent, and controlling the case fatality rate will become the top priority of the recent epidemic prevention work.
"The important thing now is to move the border forward to prevent patients from becoming severe." An expert in critical care medicine at a designated hospital told Yicai.com, "As long as the urban linkage mechanism is established, severe patients can be identified and transported as soon as possible, and the fatality rate will be reduced. going down soon."
A reporter from China Business News learned from some city-level designated hospitals that the death toll from the new crown is only below single digits (referring to less than 5). "A large part of the deaths now occur in district-level hospitals. From today onwards, we must start to focus on the quality of district-level treatment." An internal expert told Yicai.com reporters.
Expert advice: to achieve "two-way diversion",
Efficient allocation of medical resources
The above- mentioned experts analyzed to the First Financial Reporter that the treatment conditions of district-level hospitals are relatively limited, especially in some sub-designated hospitals. "As long as it can be transported to a higher-level designated hospital in time, many lives can be saved." He told a reporter from China Business News.
The expert also said that although the beds in municipal hospitals are tight, there are still a large number of patients of various types transferred to municipal hospitals every day. "It can be seen from the reported number of severe and critically ill patients that not all the city-level designated hospitals are actually critically ill patients, and not all elderly people with underlying diseases will be transformed into severe cases." He told Yicai.com reporter .
He said that the ideal next step should be to achieve "two-way shunting", that is, some severe patients in district hospitals should be transferred to municipal hospitals; mild patients in municipal hospitals should be transferred to district hospitals, so as to be more effective allocation of medical resources.
Zhang Wenhong, director of the National Medical Center for Infectious Diseases, leader of the Shanghai New Crown Medical Treatment Expert Team, and director of the Department of Infectious Diseases of Huashan Hospital Affiliated to Fudan University, also told Yicai: "The resources of municipal hospitals will also connect with these district-level designated hospitals. "
On the evening of April 24, Zhang Wenhong emphasized in an interview with "Dajiangdong": "We have noticed that at present, the district-level designated hospitals need stronger medical support. The treatment resources need to gradually sink to the grassroots level to improve the grassroots' awareness of the new crown epidemic. The strength of the patient's treatment, to achieve full coverage of medical resources."
According to Zhang Wenhong, Academician Ning Guang of Ruijin Hospital led the team to connect with hospitals at all levels in Huangpu District, and the critical care medical team of Zhongshan Hospital went to the community for first-line treatment, all of which fully improved the capacity of primary medical treatment, implemented full coverage of medical resources, and improved the treatment of the elderly. A new exploration of the treatment effect of vulnerable people.
Recently, some square cabins are being converted into sub-designated hospitals. Li Zhiqiang, vice president of Zhongnan Hospital of Wuhan University and leader of the medical team of Zhongnan Hospital in Shanghai, is currently supporting the new National Expo. He told the First Financial Reporter that the new National Expo has transformed two halls into sub-designated hospitals, and related medical equipment is being stationed in succession, including monitors, ultrasound, bedside testing equipment, etc.
However, according to a reporter from China Business News, the medical conditions of these sub-designated sites are uneven, which is related to the region, but the overall situation is improving; and most of the cabins are relatively lacking in complete medical facilities, and are only equipped with basic medicines. Medical staff The observation of the patients and the treatment of traditional Chinese medicine are the main ones. For the treatment of the patients with acute diseases, they still need to be transferred to the designated hospitals in time for relevant treatment.
Chen Erzhen, head of the medical treatment team at the Shanghai centralized isolation point and vice president of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, said in an interview with "Dajiangdong" on April 26 that 0.03% of the new crown infected patients in the Fangcang shelter hospital will be seriously ill Transformation, for some elderly infected people who are unable to take care of themselves, they are trying to send them to relevant designated hospitals.
In response to the challenges faced in the treatment of new crown patients during the transfer process, an expert from a designated hospital expert group told Yicai.com: "More attention should be paid to the sudden illness of the transferred patients. For example, a patient with acute myocardial infarction is transferred and admitted for treatment. Whether we can carry out PCI coronary intervention immediately will test the sub-specialty emergency ability of designated hospitals.”
Treatment of severe and critically ill patients
will be the main contradiction
As the focus of the new crown treatment task shifts to the treatment of severe and critically ill patients, the turnover of hospital beds in designated hospitals has attracted much attention.
Professor Gao Yuan, director of the intensive care department of Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine and executive deputy head of the expert group of the designated hospital of Renjinan Hospital, revealed to the First Financial Reporter on April 26 that the average length of hospitalization for adult patients in the designated hospital of Renjinan Hospital is about 8.9 days, and the average length of hospital stay for children was about 9.2 days.
At present, Renjin South Hospital's patients mainly come from several large square cabins in Pudong, as well as those who are transported from Pudong, Xuhui and other hospitals with serious illness, and also accept children, pregnant women and hemodialysis patients.
Dr. Wu Yizhe, the attending physician of the Department of Cardiology, Zhongshan Hospital Affiliated to Fudan University, told Yicai.com that it will take longer for the elderly to turn negative from the virus. Wu Yizhe was dispatched to the ICU (intensive care) ward of the designated hospital of the geriatric medical center during the epidemic. He said that in his hospital, an elderly patient with the longest hospital stay has not turned negative since April 5.
"This is because the immunity of the elderly is poor and the ability to clear the virus is also poor, so the Ct value will always be very low." He told the first financial reporter, "If the Ct value does not meet the standard, you cannot be discharged from the hospital."
Wu Yizhe has been supporting the Geriatrics Center for three weeks. He told Yicai.com that in the past two weeks, the number of critically ill patients has increased significantly. Some patients have unstable vital signs and need to be admitted to the ICU. Poor patients need to be put on a ventilator.
In the treatment of the new crown, the ICU ward of the designated hospital is the top priority of the treatment position. Gao Yuan told China Business News that currently Renjin Nanyuan has 892 beds and nearly 40 ICU beds. The ratio of the number of ICU bed units to the adult patients admitted is close to 10%, which has exceeded the general standard set by the country's ICU bed units.
According to Gao Yuan, the proportion of patients over 60 years old in the ICU of Renjinan Hospital currently accounts for more than 80%, of which patients over 80 years old account for more than 30%, the oldest is 97 years old, and the proportion of patients with more than one underlying disease exceeds 96% , the proportion of patients with three or more underlying diseases exceeds 50%.
The geriatric medical center, which is fully taken over by the medical team of Zhongshan Hospital, has about 1,000 beds and more than 20 approved ICU beds. Wu Yizhe told Yicai.com that in order to cope with the increase in critically ill patients, some general wards were converted into sub-intensive wards, and critically ill patients with stable vital signs were also admitted.
Wu Yizhe said that as mild cases can be discharged soon, some Fangcang shelter hospitals have also been changed to designated hospitals, which highlights that the treatment of severe and critically ill patients will become the main contradiction for a long time in the future.
"The remaining patients who cannot be discharged from the hospital are actually severe and critically ill. In the future, the social spread will gradually stop, so that the proportion of severe cases will gradually increase. The treatment of these patients is still very difficult. Of course, our doctors also I will do my best." Wu Yizhe told the first financial reporter.
How difficult is the treatment of elderly critically ill patients?
At present, there are still some difficulties in the treatment of critically ill patients. The first is that the nutrition of the elderly with underlying diseases needs to keep up. "Some elderly people have electrolyte imbalances and blood sugar fluctuations because they can't eat. These are common problems. How to strengthen the nutritional treatment of elderly patients is particularly important." Gao Yuan told Yicai.com reporter.
In addition, not all city-level designated hospitals have very advanced medical facilities. Yicai reporter learned that although the medical conditions of the geriatrics medical center were not complete at the beginning of its opening as a designated hospital, and the facilities were still far behind other city-level designated hospitals, with the support of leaders from various parties recently, the medical conditions have been greatly improved. .
Another challenge is the shortage of nursing staff, especially nurses in the intensive care unit. "The doctors in the ICU ward now undertake a large part of the nurse's work, such as sucking phlegm, patting the back and turning over. The work intensity is very high." Wu Yizhe said.
Although the mission of critically ill treatment is difficult, there is still good news coming. The first financial reporter learned on the evening of April 26 that a 93-year-old critically ill patient with a variety of underlying diseases, who was led by the team leader of the remote consultation expert group of the Geriatrics Medical Center and Academician Ge Junbo of Zhongshan Hospital, has now been significantly Recovery, and can be discharged after the nucleic acid turns negative.
zhttps://news.sina.com.cn/c/2022-04-27/doc-imcwipii6790569.shtml?cre=tianyi&mod=pcpager_news&loc=23&r=0&rfunc=89&tj=cxvertical_pc_pager_news&tr=340#/
April 27, 2022 17:31 First Financial
Introduction : With the sharp drop in the number of new local new crown infections in Shanghai, controlling the fatality rate will become the top priority of the recent epidemic prevention work.
As of April 26, 271 severe and critically ill patients have been treated in this round of epidemic in Shanghai, with a total of 238 deaths. According to what was revealed at the Shanghai Epidemic Prevention and Control Conference on April 27, the case fatality rate rose to 0.045% based on the total number of infected people in this round of the epidemic so far 533,000.
How to reduce mortality? Where is the difficulty in treating the elderly and critically ill patients? These issues have received much attention.
Controlling the fatality rate will be
The top priority of the recent epidemic prevention work
Experts said that with the sharp drop in the number of new local new crown infections in Shanghai, the case fatality rate will rise to a certain extent, and controlling the case fatality rate will become the top priority of the recent epidemic prevention work.
"The important thing now is to move the border forward to prevent patients from becoming severe." An expert in critical care medicine at a designated hospital told Yicai.com, "As long as the urban linkage mechanism is established, severe patients can be identified and transported as soon as possible, and the fatality rate will be reduced. going down soon."
A reporter from China Business News learned from some city-level designated hospitals that the death toll from the new crown is only below single digits (referring to less than 5). "A large part of the deaths now occur in district-level hospitals. From today onwards, we must start to focus on the quality of district-level treatment." An internal expert told Yicai.com reporters.
Expert advice: to achieve "two-way diversion",
Efficient allocation of medical resources
The above- mentioned experts analyzed to the First Financial Reporter that the treatment conditions of district-level hospitals are relatively limited, especially in some sub-designated hospitals. "As long as it can be transported to a higher-level designated hospital in time, many lives can be saved." He told a reporter from China Business News.
The expert also said that although the beds in municipal hospitals are tight, there are still a large number of patients of various types transferred to municipal hospitals every day. "It can be seen from the reported number of severe and critically ill patients that not all the city-level designated hospitals are actually critically ill patients, and not all elderly people with underlying diseases will be transformed into severe cases." He told Yicai.com reporter .
He said that the ideal next step should be to achieve "two-way shunting", that is, some severe patients in district hospitals should be transferred to municipal hospitals; mild patients in municipal hospitals should be transferred to district hospitals, so as to be more effective allocation of medical resources.
Zhang Wenhong, director of the National Medical Center for Infectious Diseases, leader of the Shanghai New Crown Medical Treatment Expert Team, and director of the Department of Infectious Diseases of Huashan Hospital Affiliated to Fudan University, also told Yicai: "The resources of municipal hospitals will also connect with these district-level designated hospitals. "
On the evening of April 24, Zhang Wenhong emphasized in an interview with "Dajiangdong": "We have noticed that at present, the district-level designated hospitals need stronger medical support. The treatment resources need to gradually sink to the grassroots level to improve the grassroots' awareness of the new crown epidemic. The strength of the patient's treatment, to achieve full coverage of medical resources."
According to Zhang Wenhong, Academician Ning Guang of Ruijin Hospital led the team to connect with hospitals at all levels in Huangpu District, and the critical care medical team of Zhongshan Hospital went to the community for first-line treatment, all of which fully improved the capacity of primary medical treatment, implemented full coverage of medical resources, and improved the treatment of the elderly. A new exploration of the treatment effect of vulnerable people.
Recently, some square cabins are being converted into sub-designated hospitals. Li Zhiqiang, vice president of Zhongnan Hospital of Wuhan University and leader of the medical team of Zhongnan Hospital in Shanghai, is currently supporting the new National Expo. He told the First Financial Reporter that the new National Expo has transformed two halls into sub-designated hospitals, and related medical equipment is being stationed in succession, including monitors, ultrasound, bedside testing equipment, etc.
However, according to a reporter from China Business News, the medical conditions of these sub-designated sites are uneven, which is related to the region, but the overall situation is improving; and most of the cabins are relatively lacking in complete medical facilities, and are only equipped with basic medicines. Medical staff The observation of the patients and the treatment of traditional Chinese medicine are the main ones. For the treatment of the patients with acute diseases, they still need to be transferred to the designated hospitals in time for relevant treatment.
Chen Erzhen, head of the medical treatment team at the Shanghai centralized isolation point and vice president of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, said in an interview with "Dajiangdong" on April 26 that 0.03% of the new crown infected patients in the Fangcang shelter hospital will be seriously ill Transformation, for some elderly infected people who are unable to take care of themselves, they are trying to send them to relevant designated hospitals.
In response to the challenges faced in the treatment of new crown patients during the transfer process, an expert from a designated hospital expert group told Yicai.com: "More attention should be paid to the sudden illness of the transferred patients. For example, a patient with acute myocardial infarction is transferred and admitted for treatment. Whether we can carry out PCI coronary intervention immediately will test the sub-specialty emergency ability of designated hospitals.”
Treatment of severe and critically ill patients
will be the main contradiction
As the focus of the new crown treatment task shifts to the treatment of severe and critically ill patients, the turnover of hospital beds in designated hospitals has attracted much attention.
Professor Gao Yuan, director of the intensive care department of Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine and executive deputy head of the expert group of the designated hospital of Renjinan Hospital, revealed to the First Financial Reporter on April 26 that the average length of hospitalization for adult patients in the designated hospital of Renjinan Hospital is about 8.9 days, and the average length of hospital stay for children was about 9.2 days.
At present, Renjin South Hospital's patients mainly come from several large square cabins in Pudong, as well as those who are transported from Pudong, Xuhui and other hospitals with serious illness, and also accept children, pregnant women and hemodialysis patients.
Dr. Wu Yizhe, the attending physician of the Department of Cardiology, Zhongshan Hospital Affiliated to Fudan University, told Yicai.com that it will take longer for the elderly to turn negative from the virus. Wu Yizhe was dispatched to the ICU (intensive care) ward of the designated hospital of the geriatric medical center during the epidemic. He said that in his hospital, an elderly patient with the longest hospital stay has not turned negative since April 5.
"This is because the immunity of the elderly is poor and the ability to clear the virus is also poor, so the Ct value will always be very low." He told the first financial reporter, "If the Ct value does not meet the standard, you cannot be discharged from the hospital."
Wu Yizhe has been supporting the Geriatrics Center for three weeks. He told Yicai.com that in the past two weeks, the number of critically ill patients has increased significantly. Some patients have unstable vital signs and need to be admitted to the ICU. Poor patients need to be put on a ventilator.
In the treatment of the new crown, the ICU ward of the designated hospital is the top priority of the treatment position. Gao Yuan told China Business News that currently Renjin Nanyuan has 892 beds and nearly 40 ICU beds. The ratio of the number of ICU bed units to the adult patients admitted is close to 10%, which has exceeded the general standard set by the country's ICU bed units.
According to Gao Yuan, the proportion of patients over 60 years old in the ICU of Renjinan Hospital currently accounts for more than 80%, of which patients over 80 years old account for more than 30%, the oldest is 97 years old, and the proportion of patients with more than one underlying disease exceeds 96% , the proportion of patients with three or more underlying diseases exceeds 50%.
The geriatric medical center, which is fully taken over by the medical team of Zhongshan Hospital, has about 1,000 beds and more than 20 approved ICU beds. Wu Yizhe told Yicai.com that in order to cope with the increase in critically ill patients, some general wards were converted into sub-intensive wards, and critically ill patients with stable vital signs were also admitted.
Wu Yizhe said that as mild cases can be discharged soon, some Fangcang shelter hospitals have also been changed to designated hospitals, which highlights that the treatment of severe and critically ill patients will become the main contradiction for a long time in the future.
"The remaining patients who cannot be discharged from the hospital are actually severe and critically ill. In the future, the social spread will gradually stop, so that the proportion of severe cases will gradually increase. The treatment of these patients is still very difficult. Of course, our doctors also I will do my best." Wu Yizhe told the first financial reporter.
How difficult is the treatment of elderly critically ill patients?
At present, there are still some difficulties in the treatment of critically ill patients. The first is that the nutrition of the elderly with underlying diseases needs to keep up. "Some elderly people have electrolyte imbalances and blood sugar fluctuations because they can't eat. These are common problems. How to strengthen the nutritional treatment of elderly patients is particularly important." Gao Yuan told Yicai.com reporter.
In addition, not all city-level designated hospitals have very advanced medical facilities. Yicai reporter learned that although the medical conditions of the geriatrics medical center were not complete at the beginning of its opening as a designated hospital, and the facilities were still far behind other city-level designated hospitals, with the support of leaders from various parties recently, the medical conditions have been greatly improved. .
Another challenge is the shortage of nursing staff, especially nurses in the intensive care unit. "The doctors in the ICU ward now undertake a large part of the nurse's work, such as sucking phlegm, patting the back and turning over. The work intensity is very high." Wu Yizhe said.
Although the mission of critically ill treatment is difficult, there is still good news coming. The first financial reporter learned on the evening of April 26 that a 93-year-old critically ill patient with a variety of underlying diseases, who was led by the team leader of the remote consultation expert group of the Geriatrics Medical Center and Academician Ge Junbo of Zhongshan Hospital, has now been significantly Recovery, and can be discharged after the nucleic acid turns negative.
zhttps://news.sina.com.cn/c/2022-04-27/doc-imcwipii6790569.shtml?cre=tianyi&mod=pcpager_news&loc=23&r=0&rfunc=89&tj=cxvertical_pc_pager_news&tr=340#/