Wuhan major hospitals fever outpatient tension has been a week, seven designated hospitals started only two days have been pressed to the limit.
Wuhan is not short of top-level hospitals, top-level experts, top-level medical capacity, lack of public health prevention and control capacity, administrative efficiency and epidemic treatment process.
Between patients and major medical institutions, there is no diversion, screening and grooming of primary medical institutions and primary community organizations, which leads to the spontaneous and direct impact of patients on major medical institutions.
The invaluable experience of the SARS campaign 17 years ago could have been applied to the epidemic, which, with a faster response, more orderly social mobilization, and lower economic costs, would have been less severely contained. But it backfired.
On the afternoon of january 23, the emergency room of wuhan fifth hospital was filled with fever patients. Ordinary febrile patients are huddled together with patients with suspected new coronavirus pneumonia, who are waiting to be admitted as soon as possible, regardless of whether they meet the admission criteria.
The crowd became more and more impatient. Within an hour, the distraught patients had been in hospital twice with the medical staff.One febrile patient, who was in the middle of an infusion, suddenly became agitated and spilled a hundred-dollar bill into the air.
Wuhan Fifth Hospital has just been announced as one of the seven designated hospitals in Wuhan to treat fever patients. The seven hospitals were notified until January 21, two days ago, that the ward should be converted into an isolated ward. Since 6 p.m. on January 23rd, they have received a new type of confirmed coronavirus pneumonia from the junior hospital and admitted a new fever patient with a temperature above 37.3 degrees. Meanwhile, the local junior hospital, which was hit by a large number of patients a week ago, has suspended treatment for fever patients.
This initiative is aimed at preventing cross-infections in the Junior Three Hospitals (where cases of infection among health-care workers have been continuously identified) and is managed in a "7 7" twinning manner, i.e. each designated hospital is exported and managed by a triple-A hospital. Wuhan City Fifth Hospital, is the only one of the seven designated hospitals, the remaining six hospitals are lower grade three B or two hospitals.
After the full opening of the fever clinic at 6 p.m. on January 23, seven designated hospitals were immediately overwhelmed by the influx of fever patients. Among all kinds of patients, there are a large number of patients with fever, respiratory tract infection, or suspected pneumonia. On the one hand, seven designated hospitals were quickly overwhelmed, and the medical staff were highly nervous and exhausted. On the other hand, a large number of callers and residents were agitated because they were not waiting for long queues or refused admission.
A hospital in Wuhan is overcrowded
Wuhan major hospitals fever outpatient tension situation, has continued for a week. Originally, the central China metropolitan medical resources are super strong, second only to the north to Guangzhou first-tier cities, with Wuhan Concorde, Central South, Provincial people`s Hospital, Wuhan Tongji and other four top 20 super hospitals in the country. At this time, but ushered in unprecedented pressure moment.
"Technically-class medical resources, such as the Junior A Hospital, are only the last link in the prevention and control of the epidemic. Wuhan is not short of top-level hospitals, top-level experts, top-level medical capacity, lack of public health prevention and control capacity, administrative efficiency and epidemic treatment process. "An expert who has worked in the health system for many years said.
Take this week`s influx of patients: the panicked crowd rushed spontaneously to a junior hospital and then to seven designated hospitals. However, in any case, there is no diversion, screening and diversion between patients and major medical institutions.
In the view of the above-mentioned experts, the measures taken by the city of Wuhan government, from the epidemic to close the source of infection, from the last resort to the city, to open designated hospitals to treat patients, every step is right, but every step is late.
The SARS campaign in 2003 made China accumulate valuable experience in the disaster and formed the world-class capability of epidemiological research, emergency response and social mobilization. Originally, these valuable lessons from practice should have been fully applied to the outbreak of the new coronavirus epidemic 17 years later, allowing governance and people to control the epidemic with faster response, more orderly social mobilization, and lower economic costs. At the moment, however, going up and down is in an awkward situation of "one step late."
Why is it a little late?
The SARS epidemic 17 years ago gave China valuable experience in dealing with the unknown. In some respects, china has made great progress over 17 years since the outbreak of pneumonia.
First, the first time the epidemic was announced and reported was significantly accelerated.
From the first case on December 12,2019, to the first epidemic announcement by the Wuhan Municipal Health and Health Commission on December 31,2019, it caused social concern, with less than 20 days between the middle.
In mid-December, when Wuhan realized that the unexplained pneumonia could be an outbreak, it quickly transmitted a sample of the virus to the CDC. On January 9, Chinese scientists successfully deciphered the new coronavirus genome found in Wuhan and shared information about the virus`s genome on international websites on January 10. Gao Li, the World Health Organization`s representative in China, said China was responding very quickly and quickly to research and identify new virus species. This virus proliferates slowly and the sample size is low, and identification is a great technical challenge, which indicates that China`s ability in this field has developed rapidly in recent years. The move has won international acclaim. Fred, USA. Trevor Bedlford, evolutionary geneticist at the Hutchinson Cancer Research Center, said:" It`s very difficult."
Compared with the SARS epidemic in 2003, the first case occurred on November 16,2002, and Xinhua first reported it on February 12,2003, almost three months apart.
Second, after the widespread outbreak on january 18th, the country`s medical experts quickly developed a scientific and effective diagnosis and treatment guidelines. On 20 January, the Beijing Ditan Hospital Infection Center led the formulation of the first "Diagnosis and Treatment of Pneumonia with New Coronary Virus Infection (Trial)". On 22 and 23 January, the programme was updated in two successive editions. A doctor who experienced SARS told the 8:00 news that it was unthinkable 17 years ago.
"At that time there was no uniform clinical guidelines, the hospital is popular with a variety of traditional Chinese medicine prescription. Especially in late 2003, there were no good restrictions on hormone use to save lives. Later looking back, using so many hormones, in fact, is ineffective, but also left a lot of sequelae. "
Although the technological advances are obvious, today`s epidemic control in Wuhan is clearly not quite right. So far, the vast majority of provinces in the country have seen imported diseases from wuhan, from the scope of the epidemic, more than the spread of sars.
In the control of the epidemic, wuhan disease control system still follows the traditional "internal and external loose" way, that is, the confirmation of virus-infected people must go through a series of processes, in the provincial, national disease control departments can be released after the dual determination, intended to prevent the public from producing panic sentiment. In addition, wuhan also needs to make a balance in the epidemic release and economic, social impact: wuhan as the central transportation hub of the spring transportation period, any release of information about the epidemic will have significant consequences. After many trade-offs, policymakers have chosen the more conservative one in political decision-making.
On January 1,2020, Wuhan only closed and disinfected the source of the South China Seafood Market. Doctors in major hospitals in Wuhan are still treating febrile patients with high flu rates as usual in winter. In their view, fever patients have increased since the end of december, but the proportion of severe patients has not increased compared with previous years, and some doctors are not even wearing masks. On december 31, when members of the national health and health commission`s high-level expert group came to wuhan for the first time, local clinicians were optimistic, telling him that the epidemic was not serious, it was still a generational case, and there was no human transmission.
For the next two weeks, the epidemic seemed to have been almost stable and controllable:
At 8 p.m. on january 5th, the official website of wuhan health and health commission revealed that as of the same day, the city reported a total of "59 patients with unexplained disease toxi city pneumonia ".
January 5- January 11, the official website of Wuhan Health and Health Commission did not have any cases of disease.
On January 9, domestic scientists identified the pneumonia as a new type of coronavirus. To this end, on the morning of january 11th, the official website of wuhan health and health commission restored circuitanotice: as of january 10 24:00, the city reported a new type of coronavirus pneumonia confirmed 41 cases. No new cases have been found since Jan.
At the same time, there has not been a single case in the city outside Wuhan. Prof Guan Yi, a professor at the University of Hong Kong, was optimistic at one point that the source of the infection had been eliminated and the epidemic had been controlled.
The reversal came after january 18th, when new cases began to increase in wuhan and new coronaviruses from wuhan emerged in other cities. Around January 18, the main hospitals in Wuhan fever outpatients increased sharply, some hospitals a number of doctors infected. Hospital pressure, public panic, was instantly amplified and spread throughout the country.
On jan.19, mr. zeng returned to wuhan, where clinicians changed his judgment:" more serious than expected. "
"The biggest problem is still out of concern, since it has long been recognized as an infectious disease, why not first in the city-wide prevention and control? A senior medical official told the news that the South China Seafood Market, which shut down the source of the virus, was at least a week late, not to mention the official acquiescence to the follow-up banquet of more than 40,000 residents.
"In general, it`s the government`s slow response to this, and if it closes the market earlier and controls the mass movement of people, it`s not as likely as it is today. "The person said," In special times, there must be an iron fist. Like this decision to seal the city, as a Wuhan citizen I hold both hands to support. The only regret is that such decisiveness came too late. "
However, the expert also admitted that if the government in the initial stage of the outbreak "big war ", will achieve better prevention and control, but also likely to be" unprovoked manufacturing panic "hat. The scale of this will test local officials and even national team experts on the epidemic.
Unable to keep up with preventive measures
This winter as usual, according to Wuhan people`s medical habits, meet fever, high fever and other diseases, will first go to the big hospital. A technician at a pulmonary hospital in wuhan, recalling doctors in the hospital`s intensive care unit in early january, felt they were calm, and some doctors were not wearing protective clothing, not even masks.
Another doctor working at a third-class hospital in wuhan said that in early january, although a new type of coronavirus pneumonia was known, some patients in other departments who did not have any fever symptoms during the incubation period became the biggest source of infection. His colleagues in the hospital`s urology department, who washed the bladder of a patient who was still in the incubation period for a new type of coronavirus pneumonia, had no protective measures and the patient`s body fluid spattered on his coat. When the patient diagnosed a new type of coronavirus pneumonia a week later, the doctor realized the problem and immediately isolated himself.
The same situation, appeared in Wuhan Concorde and other four junior A hospital. A week before January 20, a number of medical staff in the four hospitals were suspected of contracting a new type of coronavirus pneumonia. In the people`s hospital of hubei province, half of the respiratory staff were infected, and the oncology department found a patient and isolated four doctors, according to insider. The Provincial People`s Hospital has opened two wards, about 100 beds. Wuhan central hospital opened at least four wards to isolate the hospital`s medical staff.
These temporary wards are not strictly set up in accordance with isolation standards, the insider said. "Everyone in the bed was together, chatting and walking. There are no tips and personnel outside the ward guard, people outside if the wrong elevator floor, can also reach these wards. "
In the week leading up to january 18th, hospital doctors, unlike the outside world, were beginning to realize the magnitude of the problem. A doctor in the emergency department at a third-class hospital said it was true that winter was a high incidence of toxi city pneumonia, but this year it was especially common. Although it`s all about toxi city pneumonia, for some experienced doctors, looking at cts can roughly sense the possibility of a new type of coronavirus pneumonia. However, at that time, the major hospitals in Wuhan did not have the nucleic acid kit used to detect the virus itself, nor did the provincial CDC staff collect samples of suspected cases for testing. Therefore, a week before January 18, Wuhan did not have a new type of coronavirus pneumonia patients increased, in fact," unreal calm ".
The infection of medical personnel with the new type of coronavirus pneumonia is a very serious signal to experts, which means that the virus is beginning to pass on human beings, and the prevention and control measures should be substantially adjusted to close only one generation of cases of infection in the South China market, which is far from solving the crisis caused by "human descendants ". However, this has been a reality in the health care staff, government departments have not been active disclosure. It wasn`t until academician zhongnanshan went to wuhan on january 18th to learn of the situation that on january 20th he was the first to reveal that 14 medical staff had been infected. The next day, Wuhan City Health and Health Commission will release the news.
When the epidemic progresses to the "human-to-human" stage, prevention and control is far more important than treatment. The disinfection measures in public places and the popular science of self-isolation consciousness test a city`s ability to deal with the epidemic.
Spreading panic
On january 22, the expert group of tongji hospital affiliated to huazhong university of science and technology, based on the first batch of first-hand information of patients in wuhan major hospitals, formulated the rapid guidelines for the diagnosis and treatment of new coronavirus pneumonia: for all suspected cases, local medical isolation is required. For mild patients, can be in the outpatient isolation observation or home isolation observation. All home-visited patients are required to return to a designated hospital for intensive treatment as soon as any deterioration of the disease appears. Severe cases, critical cases, need hospital treatment.
But at this time, people are increasingly flustered, fever, increasing number of people infected, medical resources are increasingly tight, the implementation of this guide has been difficult.
As the number of cases continues to increase, people in Wuhan began to panic. Hospitals are overcrowded with popular diagnoses. On january 23rd government launched seven designated hospitals, focusing on patients with pneumonia who had been transferred from a junior hospital and treating new fever patients.
handover period, is the most chaotic moment. On the one hand, in seven designated hospitals, patients who have already been hospitalized refuse to leave. At the same time, these designated hospitals need to make ward changes in the course of a normal infectious disease hospital in just two days. Some designated hospitals lack both experience and practice, but also lack of specialized doctors, protective clothing, masks and so on. On the other hand, the original junior hospital has not received fever patients, let patients go directly to seven designated hospitals.
On the evening of january 22, li ding took his father to the 7th hospital in wuhan, spent the night in the emergency room, or failed to let his father get into hospital.
Five days ago, Li Ding took his father to a hospital emergency department, and the doctor told Li Ding that your father had two shadows in his lungs, possibly a new type of pneumonia. In order to diagnose, Li Ding took his father to the fever clinic in Hankou Hospital first, and the doctor thought it was not serious, but also because there was no bed," let go home to isolate themselves, prescribed 5 days of medicine, and warned that high fever should not be returned to timely medical treatment. "
On january 22, father li fever, aggravated, li ding with his father rushed to hankou hospital, but found the entire fever clinic lined up hundreds of people. The doctor told her that the hospital really couldn`t make room for it. Li Ding father and daughter rushed to Wuchang Hospital fever clinic, also overcrowded.
That night, the father and daughter were advised that the seventh hospital will be a designated hospital to treat fever patients, and then rushed to the seventh hospital. At this time, the hospital`s fever clinic has been lined up hundreds of meters long line. There was no noise in the crowd.
Liding had been standing for two hours at 11:30. At this time in the streets of Wuhan, the temperature is close to below zero. She wrapped up and looked at the progress from time to time. After that, he finally entered the emergency room of the hospital. However, Li Ding was once again disappointed that the hospital did not have a nucleic acid kit, could not be confirmed on the spot, so he could not be admitted to hospital.
That night, perhaps, was Liding`s longest. On the one hand is the father`s increasingly serious illness, on the other hand is the endless long wait. In the aisles of the emergency room, mild and severe patients huddled together, wearing masks and a tired look to relieve their symptoms by taking a drip. Someone had waited nearly 12 hours to wait for a diagnosis.
Li ding seems to feel the virus in the hospital, the smell of death is getting closer and closer, the heart is mixed with helplessness, anxiety and fear.
Until 2 p.m. on january 23rd, all the patients in the emergency room of the seventh hospital of wuhan were staying, and none of the patients were placed in hospital.
Whether or not a patient is admitted to hospital depends on the severity of the clinical symptoms and is not necessarily waiting for a nucleic acid test, a top third-class hospital doctor in Wuhan said. Clinicians`guidelines for diagnosis and treatment are to combine the patient`s fever, blood test results, combined with CT analysis of severe pneumonia, to decide whether to be admitted to hospital. However, some new coronavirus carriers with minor clinical symptoms are of little significance, so it is more important to isolate and prevent infection. According to the treatment guidelines, whether diagnosed or not, the patient is treated with general disease, toxi city pneumonia, and self-segregated for three days.
"If all patients are admitted to hospital, the medical resources will not be able to meet those who are critically ill. "said the doctor. But people in panic, whose first choice is to stay in hospital, have to get calls one day from many of their leaders to admit their acquaintances to hospital, and he insists he isn`t eligible for a hospital certificate.
But he also admits that hospitals do miss a number of patients who should have been admitted. "This is the whole and the part. "Li Ding`s father, a patient with three days of self-isolation and worsening symptoms, should have been admitted to hospital, but it was too late to be admitted because of lack of medical resources.
To doctors, the worst-case scenario is that everyone is rushing to the hospital, and the less symptomatic carriers have a strong ability to become a moving source of infection, and they should have been self-segregated at home. As a result, hospitals are the most vulnerable to the virus.
A besieged city
On January 18, the National Health and Health Commission High-level Expert Group re-visited Wuhan and collectively formulated the four-character principle of "no entry ". After their proposal was reported to the relevant state departments, on the evening of the 22nd, governmentment finally made a decision to seal the city in Wuhan.
Academician Li Lanjuan is one of the members of the high-level expert group of the Health and Health Commission. She believes that the decision to seal the city on the eve of the Spring Festival is very decisive and correct. "The vast majority of confirmed cases are from Wuhan. Before the city was closed, a large number of people came out of Wuhan. Where these people ended up, they couldn`t master it. These people will also pass on, and other provinces and cities are likely to become the second, the third. And now after Fengcheng, only one epidemic area in Wuhan, to control the population movement of epidemic areas, is a very important step in the management of class A infectious diseases. "
According to mr zeng, the new type of coronavirus pneumonia is not as severe as the current death rate. According to clinical observation, the final use of hormones in critical cases is rare. During the SARS period, many patients needed ventilators and intubation later, but this time it didn`t.
Up to now, more than 90% of the country`s new coronary virus cases are still concentrated in older patients with basic diseases such as cerebral infarction, heart disease, tumor, high blood pressure and diabetes.
Other regions of the country have quickly launched a first-level response to major public health emergencies. On January 23, Guangdong, Hunan and Zhejiang provinces took the lead in initiating the first-level response, followed by more than a dozen provinces and municipalities in Hubei, Tianjin, Anhui, Beijing, Shanghai, Chongqing, Sichuan, Jiangxi, Fujian and Hunan.
And at this time Wuhan, like a besieged city, the people inside cannot get out, the people outside do not want to come in.
Wang Chen Tam Cheuk MAO Xiaoqiong | Writing
