On April 25, the Shanghai Municipal Government Information Office held a press conference on epidemic prevention and control to introduce the latest situation of epidemic prevention and control.
As of 24:00 on April 24, at There were 196 severe patients and 23 critically ill patients who received treatment in designated medical institutions.
April 24, 51 new local deaths. The average age is 84.2 years old, there are 37 elderly people over 80 years old, and the maximum age is 100 years old. 51 patients had serious underlying diseases, involving multiple organs, including acute coronary syndrome, heart failure, severe arrhythmia, hypertension grade 3 (very high risk), sequelae of cerebral infarction, diabetes, Parkinson’s disease, Alzheimer’s disease Symptoms, uremia, malignant tumors, severe malnutrition, electrolyte disturbances, etc. 4 cases have been vaccinated against the new crown pneumonia virus, and the rest have not been vaccinated against the new crown pneumonia virus. After admission, the patient died due to aggravation of the primary disease. The immediate cause of death is the underlying disease.
As of 9:00 on April 25: A total of 467,296 close contacts in Shanghai have been investigated for this outbreak in Shanghai, all of which have been put under control, of which 385,618 were tested for nucleic acid The results were negative and the rest are being tested.
Yesterday (April 24), 2,449 confirmed cases in Shanghai were discharged from hospital, and 19,523 cases of asymptomatic infections were released from centralized isolation and medical observation, and they will return to their place of residence for acceptance Health monitoring, the community is requested to properly do the pick-up work.
Since April 22, Shanghai has carried out nine major actions to clear the society. Tomorrow (April 26th), nucleic acid screening will be conducted for all personnel in the containment, control and prevention areas. We will further do a good job in on-site organization and environmental disinfection, and arrange for door-to-door sampling for those who are positive for antigen testing and awaiting review, those who have mixed positive for review and their co-residents. For people who can go downstairs for sampling, we will organize everyone to go downstairs by building, floor, and time period to reduce crowd gathering.
Shanghai death cases increase, Zhang Wenhong clears doubts
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Recently, Zhang Wenhong, head of the Shanghai New Coronary Pneumonia Treatment Expert Team and director of the Department of Infectious Diseases at Huashan Hospital Affiliated to Fudan University, was interviewed by People’s Daily “Dajiangdong”.
Dajiangdong: Since April, Shanghai Strict global static measures have been implemented, and the general policy of “dynamic clearing” has been resolutely implemented. How has the effect been during this period?
Zhang Wenhong: Shanghai has seen a daily peak of 27,000 infections since the beginning of April, but has gradually declined since the beginning of April. To about 20,000 cases per day, the basic reproduction number of virus transmission has also decreased from R0=9.5 to the current effective reproduction number Rt=1.0. In particular, Pudong, where the epidemic was the most severe, took the lead in reducing the effective reproduction number Rt to below 1.
Although the epidemic still has a high risk of rebound, the good news is that the number of social cases outside the control area is gradually decreasing, and some administrative areas have achieved all negative social screening.
The follow-up social-level clearing work is still very arduous and needs to be given full attention. Especially as the number of cases increases, the challenge of treating vulnerable populations begins to emerge.
Dajiangdong: In the early stage of this wave of epidemics in Shanghai, there were basically no deaths from the new crown, but in recent days, severe cases and deaths have increased significantly. Is this what you mean? challenges in the care of vulnerable populations? Can you tell me what the challenges are?
Wenhong Zhang: Yes. On April 23, 39 new local deaths were reported in Shanghai, with an average age of 78.7 years and the oldest being 98 years old. All of them suffered from severe chronic diseases of multiple organs. Almost all of the patients with severe cases that we face in clinical treatment have serious underlying diseases of multiple organs and are in critical condition, including advanced malignant tumors, severe cardiovascular diseases (coronary heart disease, heart failure, hypertension, etc.), nervous system Diseases (cerebral hemorrhage, cerebral infarction, etc.), end-stage liver cirrhosis, diabetes, uremia, etc. The direct cause of death is mostly caused by underlying diseases.
These patients with serious underlying diseases are also infected with the new crown. Although the pneumonia caused by the new crown is not necessarily serious, the treatment of the underlying diseases is still a serious challenge.
Dajiangdong: Most of the recent deaths from the new crown announced in Jilin and Shanghai were caused by underlying diseases, which is similar to the deaths reported in Wuhan two years ago, which were often accompanied by “severe breathing difficulties.” “Different, does this mean that the standard for new crown deaths has been adjusted?
Zhang Wenhong: Before the COVID-19 epidemic, these patients with severe complications of multiple organs required long-term treatment , generally in the original treatment facility or nursing facility. During the outbreak of the new crown epidemic, these patients will be centralized and treated in designated new crown hospitals. They suffer from severe multiple organ insufficiency. When co-infected with the new crown, some patients even if the pneumonia symptoms of the new crown itself are not severe, when we calculate the death cases of new coronary pneumonia, we still count these cases of deaths due to underlying diseases.
Da Jiangdong: From the perspective of treatment, what are the similarities and differences between this wave of epidemic in Shanghai and the previous situation in Wuhan? What measures does Shanghai have in terms of treating severe cases?
Zhang Wenhong: Since the epidemic of the new coronavirus variant of Omicron, we have found that it is closely related to the early Wuhan epidemic. There is a major difference, when the mortality rate of new coronary pneumonia was at its highest at more than 5%. Today, even if the deaths from underlying diseases are counted, the total fatality rate in Shanghai remains at 0.0178% (87/488,000), of which the proportion of deaths from severe pneumonia caused by the new coronary pneumonia is very low. At present, the death of elderly patients and patients with underlying diseases has the greatest impact on the fatality rate. This is the biggest challenge facing Shanghai’s current treatment.
During the epidemic period of the new crown variant of Omicron, the treatment of patients with new crown-positive underlying diseases or other acute diseases will cause pressure on medical resources. Obviously, positive patients must be admitted to designated hospitals for COVID-19, which puts high demands on designated hospitals – not only to treat symptoms of new crowns, but also to provide homogeneous treatment to various basic disease departments.
Based on this, in view of the multiple and severe underlying diseases of elderly patients, the treatment requirements for multidisciplinary critically ill patients are very high. Shanghai has brought together more than 360 critical care medical experts with rich clinical diagnosis and treatment experience in the city, together with experts supported by other provinces and cities, to form 9 critical care teams, stationed in 8 city-level designated hospitals, to treat the new crown severe, critical and new crown. For positive patients with severe underlying diseases, centralized management and comprehensive treatment are implemented. In order to improve the specialized treatment capacity of the designated hospitals for COVID-19, the parent hospital of the designated city-level hospital has also established a hospital multidisciplinary specialized treatment group, and established a team of 53 city-level experts with rich clinical experience in 15 specialties. Using the emergency developed consultation platform system, Implement multidisciplinary joint rounds and consultations for critically ill patients in designated municipal hospitals, carry out treatment by one person and one strategy, adjust treatment plans in a timely manner, and do our best to save the lives of critically ill patients.
We have noticed that the district-level designated hospitals need stronger medical support. Rescue resources need to gradually sink to the grassroots level, improve the grassroots’ ability to treat new crown patients, and achieve full coverage of medical resources. Academician Ning Guang of Ruijin Hospital led the team to connect with hospitals at all levels in Huangpu District. The critical care medical team of Zhongshan Hospital went to the front-line treatment of the community to fully improve the capacity of primary medical treatment, implement full coverage of medical resources, and improve the treatment effect for the elderly and vulnerable groups. New exploration. In short, the future against the Omicron epidemic is a long and protracted people’s war. Our goal has always been to free the elderly and vulnerable populations from the significant risks posed by the pandemic.
Da Jiangdong: From a long-term perspective, what are your suggestions for the treatment of severe COVID-19 patients?
Wenhong Zhang: In the future, We will establish a more scientific treatment system, and strive to minimize the harm of Omicron.
Next stage, dealing with propagation On the one hand, we must make the designated hospital for the new crown pneumonia not only a hospital for the treatment of new coronary pneumonia, but also a general hospital for the treatment of patients with new crown positive but more serious underlying diseases /span>, vigorously promote the investment of various specialties, and provide the nucleic acid-positive vulnerable groups with the same specialist treatment as before the epidemic.
On the other hand, It is necessary to greatly increase the vaccination of this group of people who were not vaccinated because of concerns about the side effects of the vaccine in the previous stage.. There is a lot of evidence to prove that the adverse reaction rate of this group of people vaccinated is not high, but they are not vaccinated. The risk of severe illness and death is extremely high.
In Shanghai, the vast majority of new crown patients with severe pneumonia symptoms are elderly people who have not been vaccinated or patients with underlying diseases. Therefore, the vaccine should be further promoted Vaccination, elderly people and patients with long-term underlying diseases who have difficulty in vaccination can actively deliver vaccines to their doorsteps. We must protect these vulnerable groups from the risks brought by the new crown epidemic.
Only by protecting them can we have the courage to say: we have the conditions to get rid of the impact of the epidemic on us.
Source: China News Network, CCTV News Client, People’s Daily Client
Editor: Li Xiaohang (internship)
Review: Julie
< span>Final review: Wang Yu