Guangdong Aid Medical Team Captain Wang Hua: "The Most Reasonable Strategy Is To Move Forward, And Turn The Disease To Severe".

At 2:30 on the morning of January 25th, at the Wuhan Tianhe Airport, a group of aid medical teams from Guangdong province arrived at the center of the outbreak of the new crown pneumonia outbreak in Wuhan. As the first batch of aid medical teams, the task of Guangdong medical team is to build up a system to take over the ward of Hankou hospital in Wuhan.

The Hankou hospital was overloaded at that time. In February 24th, Wang Hua, leader of the Hubei epidemic prevention and control medical team of Zhujiang Hospital of Southern Medical University, recalled that in twenty-first Century, after a month's efforts, the phased treatment results of the Guangdong medical team were obvious. "Up to February 23rd, 159 cases were treated in the ward, 65% cases were severe and critical illness, 85 cases were cured or improved, and the cure rate was 53.5%, the remaining patients' condition was 53.5%. They are all getting better. The cure rate of Guangdong medical team is higher than that of the same type of severe patients. In the past month, the number of sick people in our ward was 20, and the average daily mortality was several times a day from the time when we first arrived in Wuhan.

Since taking over the Hankou hospital, as part of the Guangdong medical team, the Wang Hua team has worked with the medical team to collect oxygen cylinders and oxygen generating machines through the formulation of the medical process, ward management, nursing process and flow control process, aiming at the problem of insufficient oxygen supply in the center, and proposed the use of "oxygen making machine + oxygen mask", "oxygen bottle + non-invasive ventilator", "non-invasive ventilator + head hood" and so on. The method relieved oxygen supply and fought on the front line of epidemic prevention. In this process, what kind of process has Wang Hua team gone through?

Zhujiang Hospital, Guangdong medical team, Wang Hua. Data map

Solve the problem of oxygen supply

Twenty-first Century: what kind of situation is faced with when taking over the Hankou hospital?

Wang Hua: we first took over a ward in Hankou hospital. The number of fever clinics in hospitals has increased sharply, and 10 fever clinics have been set up, with more than 1500 patients receiving patients every day. At that time, there were more than 100 doctors in Hankou hospital. Even in three shifts, there were insufficient medical care, overloading and nearly 1/3 reduction. The hospital's logistics, security and other personnel are basically off the job, the hospital's dirt, ward cleaning, medical materials cleaning and disinfection and other untreated, most of the need for medical staff to deal with their own. At that time, the patients and their families could walk freely in the fever clinic, inside and outside the hospital, which was far from the requirement of infectious disease management. The hospital looked like an epidemic area.

In this situation, sense control is the top priority. Our sense control experts first rebuilt inside the wards, dividing the clean areas, non clean areas and polluted areas clearly, and reconstructing or replacing them when they are not required. Doctors themselves cleaned up a large number of medical waste, and decontamination of protective products; secondly, closed management of patients, set up an access control system, distributed family members' accompanying cards to patients' families, and asked patients to only perform activities in observation areas and out-patient clinics, so that they could not walk randomly. In addition, hospitals restore their logistical support by reflecting management problems to their superiors.

Twenty-first Century: what difficulties did the hospital have in terms of medical equipment? How to solve it?

Wang Hua: not only in Hankou hospital, but also in other hospitals. Most patients need oxygen inhalation. For patients, only primary respiratory support can be performed and no advanced treatment can be performed.

We quickly focused on improving oxygen supply, but it is difficult to rebuild the oxygen supply system on hardware, and the patient can not wait for a long time. In this case, we collect oxygen bottles everywhere and collect oxygen generators. At this time, the rear area of Guangdong province was very powerful, supporting us through various channels. Zhong Nanshan medical fund donated 100 oxygen making machines, and the medical team quickly collected more than 70 oxygen bottles and purchased more than 30 oxygen generating machines. For some patients who need higher oxygen concentration, our team has raised and raised oxygen mask, which is used in conjunction with oxygen generator, and oxygen bottles with non-invasive ventilation and high flow ventilation. Later, it was found that these methods significantly improved the effect of oxygen inhalation. One patient's oxygen saturation increased from 30% to 80%-90%.

After solving the hardware problem, the Guangdong expert group will continue to optimize and improve the treatment plan for patients, and conduct targeted treatment for patients. For example, in the use of hormones, we also subdivided, according to imaging and severity of illness to individualized treatment.

The new pressure of "epidemic prevention"

Twenty-first Century: with the continuous improvement of all aspects, the number of new cases continues to decline. Is there any change in your pressure on the front line?

Wang Hua: according to the classification, the average daily number of fever clinics dropped to only 6 patients. Only 10 or so patients in the observation room remained on the scene. The pressure dropped. We will invest more in the treatment of critical illness.

About 65% of the patients in our ward are critically ill and critically ill, but the number of abnormal deaths is greatly reduced. The number of deaths in the past two days has increased slightly, which is related to the patients who are mainly treated in the shelter hospital and the isolated patients. New crown pneumonia is progressing to the critical stage, and the effect of existing treatment methods will be worse. Especially for critically ill patients, there are very limited measures to be taken. In addition, in the face of some critically ill patients, there is a lack of referral to better environment in hospitals. The mortality rate of these patients will be slightly changed. But we are still thinking of ways to find better treatments to prevent the disease from developing to severe diseases, so as to reduce the mortality.

" Twenty-first Century: what is the effect of artificial heart lung replacement (ECMO) or other treatments for critically ill patients?

Wang Hua: there is a way to improve the rate of endotracheal intubation, but this method also needs to be used according to the actual situation. It is not applicable to all patients. For example, our hospital's sensory control condition and air disinfection condition are insufficient. If we intubate the patient, it may not only bring infection to the medical staff, but also create a new sense of hospital pressure. Early Hankou hospitals also treated patients through airway intubation. The result was that 5 patients were infected at that time.

In order to control the situation well, first, a negative pressure ward is needed for the situation of Hankou hospital. There are at least 6 large power sterilizing machines. Secondly, there are still some sewage treatment processes, equipment and equipment cleaning processes must meet the standards, and the treatment of breathing can be further optimized, but these involve hardware transformation, which takes at least one month, and in the current situation, there is no need to improve the disinfection system. Implementation of the transformation project.

But ECMO is not a life-saving device. It is a salvage treatment. Judging from the effect of other hospitals, the success rate is very low and the cost is high.

Twenty-first Century: at present, what is your team's treatment emphasis or therapeutic goal? What treatment plan is more effective?

Wang Hua: at present, a key point of treatment is to carry out targeted treatment under the existing ability. Our chloroquine from Guangzhou has been used. In addition, we are trying our best to improve the way, method and effect of oxygen therapy, and strive to early treatment and early treatment. Chloroquine has been clinically tested in Guangzhou. About more than 120 patients have been enrolled. The effect of negative rate has been good. The patient's condition has improved within the first 3 days, and most of the patients have gone negative within 9 days. At present, we are using the drugs in clinical practice.

Another key point of treatment is to move the treatment forward. It is to intervene in the patient's condition as early as possible so as to prevent the patient from being transferred from mild to severe. This is the most reasonable treatment strategy. Because the success rate of severe treatment is very low, once the patient intubated on the ventilator or ECMO treatment, it will not only consume a lot of manpower and material resources, increase the risk of infection, and increase the pressure of emotional control, but the key is the effect of treatment is too poor. Some colleagues once concluded that for the patients treated by ECMO, only 3 patients in 20 cases were successfully rescued, 6 died, others were still in critical condition, and the patients who were rescued were severely damaged, which was equivalent to losing half their lives. This is the current situation of severe rescue.

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