Jiangsu Medical Team Drum Tower Hospital Vice President Wu Chao: How To Reduce The New Crown Pneumonia Severe Ratio? The Key Is Early Isolation And Early Treatment.

On the morning of February 13, 2020, the third batch of aid teams for the Wuhan anti epidemic medical team was held at Nanjing Gulou Hospital. The Nanjing Gulou Hospital selected 162 people, including 1 leaders, 1 liaison officers, 40 doctors and 120 nurses. They were led by Professor Wu Chao, vice director of Drum Tower Hospital and professor of infectious diseases.

The 40 doctors came from the Department of infectious diseases of the hospital, respiratory and critical care medicine, critical care medicine, emergency department, anesthetic surgery, digestive and oncology, and more than 20 departments. 120 nurses came from all departments of the hospital, and the construction system took over a severe disease area in Wuhan No.1 Hospital.

Wu Chao, vice director of Drum Tower Hospital and chief physician of infectious disease department, received an exclusive interview with the economic report in twenty-first Century as a leader. He talked about the treatment and infectious disease research and dissemination rules of the front line.

Wu Chao. Data map

Rush to the front line and take over quickly.

Our support medical teams were notified at 10 pm on February 12th, and the support list was confirmed in more than an hour. Since our hospital had mobilized in the early days, about more than 3000 people have been named. This time we came to 40 doctors and 120 nurses, plus a total of 162 leaders and liaison officers. We took over two patients in the first hospital of Wuhan, 22 districts and 23 districts, with 71 patients. At the same time, it brings some materials, including protective clothing and mask, about a week's dosage.

But after that, we felt that the first hospital in Wuhan was well arranged. Because it is a designated hospital, so the material is equipped with adequate, currently protective clothing and respirators can be guaranteed.

In the early days, the first hospital of Wuhan has also completed a very good preparatory work. In just three or four days, a new crown virus pneumonia was successfully treated by a 1000 bed surgical building. Protection has also made a relatively good process design, though not particularly perfect, because it is the old ward reform, not the infectious disease treatment process, there is only one access to the clean area and the contaminated area, of course, the medical staff and patients are separated. At the same time, the hospital is equipped with sufficient manpower to supervise the workers in and out of the isolation ward: including how to wear the shoes, whether the protective clothing meets the requirements, whether the goggles are standardized or not. Especially in the quarantine area, every step has been fully stipulated, such as hand disinfection, skin mucous membrane and shoes disinfection. Their doctors are not specialist doctors, but also other departments transferred to designated hospitals, including its electronic medical record system is relatively perfect, so that the work of convergence is very smooth.

Although they are not designated hospitals for infectious diseases, they really cost a lot of thought and are very admirable in this respect.

In February 15th, we entered and took over the ward. Most of them were critically ill patients. There were four or five critically ill patients who needed oxygen and ventilator maintenance. (previous team) left a nurse and a doctor to cooperate with us.

The most difficult thing to do when we take over is that we do not know enough about the patient's early condition. Because many of these patients are transferred from the community or other hospitals, we need to understand and track the progress of the disease in advance and the progress of the disease. We will probably take two or three days to find out the underlying diseases, the time of onset, the diagnosis and imaging examination of all the patients. Over the past few days, the work of spreading treatment has been carried out in a comprehensive manner, and great efforts have been made to make adjustments.

Another problem is hypoxia. Because of the oxygen supply in the surgical department, when our 10 wards are using oxygen, the respirator is not moving and the concentration of oxygen is not enough, so we are very difficult and can not be solved in a short time.

"Ensure the safety and rest of the players"

In terms of the protection of medical personnel, we renovated one day, and set up 8 teams, from medical, nursing and materials, publicity and so on to have special personnel management. At the same time, there were special sensory control teams, and personal infection control training was done for everyone. This is the most important thing: only if we protect ourselves, can we serve the patients better.

When scheduling, the players usually have 24 hours' rest, and they are arranged at different levels. They are divided into one line, two lines and three lines. At the same time, equipped with some walkie talkies to allow effective and full communication within and outside the quarantine area.

In the training of new crown pneumonia, it includes diagnosis and treatment, such as diagnostic criteria, discharge standards, and the principles of severe treatment. The 40 doctors we brought were temporary transfers from different specialties. Doctors in severe, respiratory and infectious diseases know more about the new crown disease and know more about the virus. It may be more difficult to train doctors in gastroenterology, internal medicine, surgery and other specialties.

Fortunately, our doctors have undergone very standardized residency training, most of them have many years of work experience and have taken over very quickly. I quickly admire and adapt to these situations. I admire these young doctors. They are very good at mastering the knowledge system, judging the state of illness, and dealing with the daily problems of patients. Of course, it is not perfect, there are many defects and omissions. There is no way to do this, not in our own hospital.

Most of the patients, who had not been hospitalized for a long time, were isolated at home and in the community. They obviously expected our medical treatment. When we introduced from Nanjing Gulou Hospital, many people were very happy, and also trusted and thanked, which in itself is also an encouragement for us.

The proportion of critically ill patients is too high.

All acute infectious diseases have their developmental characteristics, from incubation period, onset stage, extreme period to recovery stage. Therefore, our more task is to prevent the progress of patients, the most important thing is how to maintain the physiological functions of patients, such as normal diet, electrolyte balance, antiviral treatment and psychological counseling, such as some patients after exercise oxygen partial pressure drop. We should try to understand patients and grasp the stage of disease progression, which is a very important means in treatment.

Patients may make different progress at different stages, so we should try not to turn patients into critical and critical diseases. There are a number of risk factors, such as age, diabetes, hypertension and other underlying diseases. This part of the population is more likely to have severe and critical illness, which is our focus group.

At present, we have 71 patients, 5 critically ill, and more than half of them are critically ill.

In clinical treatment, according to the national diagnosis and treatment plan. The plan is relatively fixed. At the same time, we will take different treatment methods according to the patient's condition and stage. The emphasis is different. For example, early antiviral is more important. Late stage may prevent fibrosis and improve oxygenation.

In severe and critical diseases, the new crown virus is more difficult and complex. The severe proportion of a disease is relatively fixed. In our usual cognition, the proportion of severe cases of "new crown" should be around 10%, but the proportion of severe cases in Wuhan is far more than 10%.

The reason is that there are too many people and our medical resources are limited, and specialist doctors are also limited. Many patients may be delayed in the process of diagnosis and treatment. For example, the hospital can not be treated in time, there is no oxygen maintenance at home, and more importantly, the mentality of the patient will change. It is not heavy, anxiety, fear, and no one is very good at persuasion and care, it may also lead to an increase in the proportion of severe cases.

We conducted a study which concentrated on more than 200 cases of more than ten hospitals in Jiangsu and more than 10 cities. The severe cases in Jiangsu were about 10%, much smaller than that in Wuhan, but the average age of the patients was relatively low, mostly from Wuhan. Also because the number of patients in Jiangsu is small, medical resources can be found early, early treatment and fast recovery, and the proportion of severe cases is relatively small.

This is also why "early treatment and early isolation" is more important for infectious diseases. Early stabilization and effective intervention of acute infectious diseases must be the best way to prevent the occurrence of severe diseases.

Will the two or three generation weaken uncertainty?

The most unexpected thing is that the new crown is highly contagious. Our research team recently published a paper in the Lancet Infectious disease, analyzing a family case: a person who came back from Wuhan caused 11 people to be infected. From this case, the disease is highly contagious, similar to influenza, more than SARS and H7N9. From the point of view of transmission, besides respiratory tract, including droplets, mucus and hand pollution, all of them may be contagious. At the early stage of disease, the rate of spread of the new crown virus may be very high.

Will the virulence of the new crown virus diminished gradually? I don't think we can say that now because there are too many influencing factors.

Some viral infections are characterized by gradual attenuation. For example, the spread of bunyavirus by ticks is very serious in a generation, and the mortality rate is high. There is indeed infection through contact, mucous membrane and familial aggregation. However, these two generation patients are basically mild, with very few deaths.

So whether the new coronavirus and other viruses have these similar characteristics is not yet certain unless there are a large number of cases of two and three generations to be analyzed. Especially the two generation of Wuhan is particularly important. It is more valuable in the same environment, treatment condition and psychological state.

Will the new crown virus survive as a flu virus? The new crown virus is the seventh coronavirus that can infect humans. Besides SARS and MERS, the influence is relatively small. We do not have much epidemiological evidence to analyze the role of coronavirus in the occurrence of seasonal influenza. We are not sure.

Coronavirus is a member of the upper respiratory tract infection. Many viruses, such as H1N1 and B, can cause symptoms of influenza. Therefore, epidemiological investigation is particularly important. But from the perspective of new crown virus infection, it is impossible to become a chronic carrier like hepatitis B. It is not very similar to many hepatitis viruses, cytomegalovirus or EB viruses. It is unlikely to form chronic. It will be removed at a certain time.

Viruses that cause seasonal influenza, including many respiratory transmitted viruses, are rarely chronic. The virus must have a suitable place to grow into the human body. They mainly grow in some cells of the respiratory tract mucosa, and our human respiratory tract has a very strong ability to clear up, as well as human immunity. In terms of viral cognition, the new crown will not become chronic. Of course, we do not exclude exceptions, which will not be proved until later.

But I believe that the new crown virus will not become an unending disaster, because we have the experience of SARS and avian flu. But what exactly is the middle host of this virus is not yet conclusive. This is terrible.

Infection departments lack resources, grading treatment is very important.

In contrast, I participated in the 2003 SARS and N7N9 prevention work in 2013. Now, I think SARS is even more frightening, because the mortality rate was too high.

But many measures taken by the new crown will be reconsidered later. Once there is a fever crowd, when the epidemic comes, no matter what kind of virus infection, everyone goes to the fever clinic, this is a fatal matter. The infection rate in Wuhan is so high, so fast and concentrated that a large number of people are neglected, that is, many patients with influenza in winter are caught in it, resulting in cross infection.

This is caused by inadequate specialized resources and inadequate resources of infectious diseases. The construction of infectious diseases, how to dock the disease control system and hospital doctors is a big problem. For example, the early diagnosis of the new crown requires the city's disease control sampling. Early disease control in the province can not be done. This greatly delayed the process of treatment.

Second there is no good graded medical treatment. Early patients should be solved at the level of family doctors. For example, in Italy, if there is a suspicious infection, the government calls for symptoms, first call the hospital or family doctor, do not go to the hospital. The perfection of grading diagnosis and treatment can make people not panic and let patients feel dependent. This will greatly reduce the pressure of large hospitals. I saw a report that Wuhan Concord, at that time, had more than 2000 febrile patients at the most day, and how could a small fever clinic endure? How can it be? How did the doctor not get infected? How to better establish a hierarchical diagnosis and treatment system, especially the family doctor group, truly ensure that every citizen has family doctors. When these infectious diseases come, they will not panic.

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