Author of this article:yxtlavi
On April 17, Shanghai reported three deaths for the first time. In the following days, the number of deaths showed a fluctuating upward trend, and there have been more than 40 new deaths for 4 consecutive days. As of 24:00 on the 28th, Shanghai has reported a total of 337 deaths, 318 critically ill patients and 52 critically ill patients.
The reported death cases are generally of high age, and most of the patients are complicated with multiple organ underlying diseases, such as cardiac insufficiency, myocardial Infarction, coronary heart disease, cerebral hemorrhage, malignant tumor, etc.
Zhang Wenhong, director of the National Medical Center for Infectious Diseases, said in an interview with “Dajiangdong” on the 24th, ” If a patient with a serious underlying disease is also infected with the new crown, Although the pneumonia caused by the new crown is not necessarily serious, the treatment of the underlying disease is still a serious challenge. ”
In the face of the epidemic, Shanghai has gone through a month. Now that severe cases and deaths are increasing, how can Shanghai meet this challenge?
The primary problem of treatment: severe Identify
when critically ill patients appear,medical care The first challenge for personnel is to be able to identify critical illnesses in a timely manner.
Taking the Fangcang shelter hospital of the National Convention and Exhibition Center (Shanghai) as an example, among the 65,000 discharged people , 20 people became severe, accounting for about 0.03%. Including the medical staff, there are about 55,000 people in the cabin at the same time. The scale is like a small town, and there are many people. Chen Erzhen, vice president of Ruijin Hospital, who manages the shelter, said in an interview with “Dajiangdong”, In addition to managing the health of infected people, the medical staff also need to deal with thieves and fraud. He also needs their assistance to go to the toilet and get hot water. He himself has not rested for more than 20 consecutive days.
Under such continuous working conditions, how do medical staff pay attention to tens of thousands of infected people and treat critically ill patients? Timely response is a difficult problem. At the same time, infected people living in makeshift hospitals may themselves be high-risk groups of severe illness. Taking the Fangcang cabin hospital as an example, there are currently about 45,000 people in the cabin, and about 20% of them have underlying diseases such as hypertension and diabetes. There are more than 6,500 people over 70 years old, and the oldest is 93 years old. And more importantly, a significant number of them were not fully vaccinated.
As of the 27th, more than 3.6 million people aged 60 and over in Shanghai have been vaccinated against the new coronavirus. The overall vaccination rate is about 62%.
Photo source: Visual China
In a corner of the epidemic, there are more than 120 similar cabins and 50 transit platforms on the same ship. They carry a total of more than 300,000 beds and are located all over Shanghai. When a serious condition occurs in the cabin, medical staff need to transfer the patient to 9 designated hospitals (as of the 19th).
Once identified, the next key is to transport as soon as possible. For example, the southern branch of Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine is responsible for receiving critically ill patients transferred from the two Fangcang shelter hospitals of the World Expo and the New International Expo, as well as the designated hospitals in Pudong New Area and Xuhui District. , the southern campus of Renji Hospital is 24 kilometers away from the Xinguobo Fangcai Hospital. Even if the road is unobstructed, it still takes more than 30 minutes to reach it by car.
In this regard, the Shanghai release also stated, “It is necessary to further coordinate the city’s medical resources and increase the allocation of critical care medical teams. Unblock the referral channel.”
Nowadays, some makeshift hospitals have tried to come up with solutions. After upgrading about 2,000 beds, Lingang Fangcai Hospital is equipped with oxygen cylinders, monitors, suction machines and other equipment. The elderly infected patients have been successively treated, and they have initially met the conditions for emergency treatment. It seems that the speed of response is no longer a problem, and the patients can complete basic treatment in the cabin. But outside Lingang, more medical staff are still facing the problems of a large infection base, saturated work, and the need for coordination in transport.
How many beds are needed?
In 2021, three scholars from the School of Public Health of Fudan University published “my country In the article “Short-term allocation of hospital health resources”, it was estimated that the number of comprehensive ICU beds per 100,000 permanent residents in China is 4.37.
It is estimated based on the resident population of about 25 million in Shanghai, and the number of ICU beds is about 1,093; There are a total of 370 severe cases. If you only look at the numbers, the ICU beds are far from full, or even half full.
But the theoretical situation is far from reality. Under the circumstance that some hospitals have closed outpatient clinics and patients with severe new crown can only be treated in designated hospitals, designated hospitals are under unprecedented pressure. According to a report by Guangming.com on the 28th, Renji Hospital has approved 600 beds and has now expanded to 892 beds, and all of them are full of patients, so it is difficult to expand the beds. The hospital adopts the “one person, one policy” treatment method.Not full, energy has reached its limit.
However, medical experts are dealing with critically ill patients with different conditions, with acute coronary syndromes in previous cases. vascular syndrome, heart failure, sequelae of cerebral infarction, diabetes, Parkinson’s disease, Alzheimer’s disease, uremia, malignant tumor, severe malnutrition and other different diseases. Can these patients receive the same precise treatment as specialized hospitals in designated hospitals?
according to N Engl J Med Research: Taking acute myocardial infarction and heart failure as examples,If patients can visit a hospital that handles a large number of patients with the disease every year, the mortality rate will be reduced. On the contrary, there may still be difficulties in the treatment of different underlying diseases. Professor Chang Rongshan also said, “The mortality rate will indeed increase if the patient fails to seek treatment in a specialized hospital.”
< p>In order to solve the problem of specialized treatment for specialized diseases, the Shanghai Health and Health Commission stated at a press conference on the 24th that it has established 53 municipal-level expert teams with rich clinical experience in 15 specialties to give full play to the city-level designated hospitals. Taking advantage of the comprehensive disciplinary advantages of the parent hospital, the hospital has established a multi-disciplinary specialist treatment group to study and judge the patients admitted to the affiliated hospital one by one.
Multidisciplinary consultation in the hospital under the epidemic span>
Source: Public Account of Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine
Experts: The number of severe cases may drop after a week
The number of new deaths in Shanghai has exceeded 40 for 5 consecutive days, and the number has not yet dropped.
On April 28, 52 new local deaths were reported in Shanghai, with an average age of 84. 52 patients had multiple organ serious underlying diseases, including advanced malignant tumors such as esophageal cancer, pancreatic cancer, meningioma, and melanoma; neurological diseases such as postoperative cerebral hemorrhage and cerebral infarction sequelae; as well as coronary heart disease, severe cardiac function Insufficiency, uremia, etc. None of them have been vaccinated against the new crown. The immediate cause of death is the underlying disease.
Professor Lu Hongzhou, president of Shenzhen Third People’s Hospital and member of the National Health Commission’s Disease Prevention and Control Expert Committee, told Lilac Garden, For those with underlying diseases and the elderly who are prone to serious illness, the significance of “prevention” is more significant, “The first is vaccination vaccine”.
Today, 38% of people over 60 years old in Shanghai have not been vaccinated. Age structure calculation, this number is not small. The Shanghai Municipal Health Commission stated at a press conference on the 28th that it will use “elderly people”As the focus, we will actively promote the vaccination of the new crown and improve the coverage rate of the vaccine.
In addition, Professor Lu Hongzhou suggested that for those who may be severely ill, antiviral therapy can be used in the early stage of the disease course. Treatment, plan ahead. The Shanghai Health and Health Commission stated at a press conference on the 24th that currently, among the patients in designated hospitals at the Shanghai level, nearly 30% of the patients are over 70 years old, and more than 60% of patients have underlying diseases, of which the proportion of patients with three or more underlying diseases. 40%, “patients with advanced age and underlying diseases, and at the same time the vaccination rate is low, susceptible to critical illness” Professor Lu Hongzhou told Lilac Garden.
an old man walking on crutches at the Expo.
Source: Visual China
In addition to the changes in the condition, psychological factors also have certain reasons. Chen Erzhen said in an interview with “Dajiangdong”, “In the process of observing the transformation of cases into severe cases, we need to analyze the reasons. The patient’s condition is easy to fluctuate when he leaves his family. Therefore, we need to be prepared at any time.” p>
Professor Huang Senzhong’s team from the Institute of Public Health and Health of Nankai University said in an exclusive conversation with Lilac Garden earlier, “If we can By predicting the peak number of beds for critically ill and ordinary patients and the peak time point, it will help the management department “know”, make arrangements or expand inpatient beds in advance, or consider transferring to other places for treatment.” Huang Senzhong The professor’s team made a prediction on April 13: On April 18, the number of critically ill patients will peak, and it is estimated that 235 beds will be needed.
As of April 28, the number of deaths related to the current round of the epidemic in Shanghai reached 337. The team predicts that the final scale of deaths in this round of epidemics will likely be controlled within three digits.
About Shanghai Xinfa Institute of Public Health and Health, Nankai University Screenshot of the Research and Judgment Briefing (2022.4.13 update)”
29th, Shanghai Health Commission News According to the press conference, there are 318 critically ill patients and 52 critically ill patients. Together, 370 beds are required. In this regard, Professor Chang Rongshan also put forward his own views, “The peak of severe illness may be in the nearest week, and then the number begins to decline. However, the number of new infections per day has dropped below 100, and it is expected to be in late May at the earliest.”
Professor Chang told Lilac Garden that due to the large proportion of the elderly in severe cases, combined with serious underlying diseases, cure It takes longer. “Therefore, even if the number of diagnoses dropped significantly, the severe cases would be delayed by two weeks.Some older patients were hospitalized for more than a month, This puts pressure on the entire medical system, because there are only about 1,000 ICU beds in Shanghai.”
Planning: yxtlavi, carollero< span>Producer: gyouzaSource of title map: Visual ChinaReferences:1. Chen Yinzi, Li Jing, Wang Xiling. Hospital Health Resources in China Short-term allocation forecast[J]. China Health Resources, 2021, 24(4): 453-457,461.2. Rossman, Hagai et al. “Hospital load and increased COVID-19 related mortality in Israel .” Nature communications vol. 12,1 1904. 26 Mar. 2021, doi:10.1038/s41467-021-22214-z3. Kristoffer Strålin, Erik Wahlström, Sten Walther, Anna M. Bennet- Bark, Mona Heurgren, Thomas Lindén, Johanna Holm & Håkan Hanberger (2022) Mortality in hospitalized COVID-19 patients was associated with the COVID-19 admission rate during the first year of the pandemic in Sweden, Infectious Diseases, 54:2, 145 -151, DOI: 10.1080/23744235.2021.19836434. Ross, Joseph S et al. “Hospital volume and 30-day mortality for three common medical conditions.” The New England jour nal of medicine vol. 362,12 (2010): 1110-8. doi:10.1056/NEJMsa0907130Lilac Garden Recruitment1. New Media Operation Intern (Lilac Garden)Independent operation Lilac Garden Public Account Lilac Morning Reading ColumnAssist in the operation of the Lilac Garden official accountWork location: HangzhouClick here to send your resume directly< /strong>2. New media operation (Lilac Garden)Complete original content planning independently< span>Assist in the operation of Lilac Garden’s official account WeiboWork location: HangzhouClick here to send your resume directlyYou can also send your resume to the mailbox[email protected]Mail Title: Post Name-Name