This article was written by John Chong and
Since March, the epidemic has occurred frequently in many parts of the country.
On March 27, Shanghai, which has always been a model for epidemic prevention, announced that it would implement a policy of implementing nucleic acid screening in zones and batches with the Huangpu River as the boundary. From 0 to 24:00 on March 29, Shanghai reported 326 local confirmed cases and 5,656 local asymptomatic cases.
Why do we continue to insist on dynamic clearing at this stage? What exactly are the challenges we face? Today, we will talk about this topic from the perspective of medical resources.
Medical care in China: large regional differences, lack of doctors
First, we need to understand the fact that coronavirus cannot be eradicated in the short term, it will coexist on the same planet as humans in the long term.
Looking back at the history of human response to viruses, the most successful campaign was the eradication of smallpox. But from the current point of view, the possibility of human eradication of the new crown is almost zero.
The complete eradication of smallpox depends not only on the effective intervention of the smallpox vaccine, but also on people’s ability to detect the signs of infection and epidemics in time, and the fact that smallpox virus only infects people, and in nature There are no natural hosts and animal vectors. However, it is difficult to successfully replicate the new coronavirus with such favorable conditions.
In the new crown epidemic, there are a large number of asymptomatic infections and mild infections, which makes it difficult to detect the signs of the epidemic at the first time.
At the same time, the new coronavirus does not only infect humans. Other countries have successively reported cases of white-tailed deer, tigers, snow leopards, Asian lions and other animals infected with the new crown. Although there is currently no evidence that the new coronavirus can be infected from animals to humans, even if the virus is eliminated in human society, it may still exist in other animals in nature, and it is difficult to completely eradicate it.
So, in the face of this reality, why should we choose dynamic clearing at this stage?
Lancet has published HAQ (Healthcare Access and Quality, HAQ) rankings for 195 countries and territories. The higher the score, the higher the score, the higher the access and quality of medical services to the common people in this country.
According to 2016 data, China ranks 48th in the world.
The picture shows the change and distribution of HAQ in several countries selected in 1990 (blue line), 2000 (red line) and 2016 (green line). The longer the line, the different the country. Regional differences in medical level are greater
From this picture, we can see two things:
1. In the past three decades, China’s HAQ has made very rapid progress, faster than any of the above developed and developing countries;
2. The regional differences in HAQ in China are very large.
In our country’s 9.6 million square kilometers of land, the most basic medical units are county-level hospitals; among China’s 2.6 million practicing physicians, 42% have college degrees or below. These county-level hospitals and their medical staff are the real main body of China’s medical care, and they are the real medical resources faced by the general public.
Not only that, but there is a shortage of doctors in China.
Generally speaking, the more developed the economy, the more emphasis on medical care, and the greater the number of doctors per thousand people. In China, there are only 2.59 doctors per 1,000 people (2019 data), “excessively concentrated in the top three hospitals in big cities, and the number of doctors at the grassroots level in urban and rural areas, especially in rural and remote mountainous areas is very limited” — this is The original words of Ma Xiaowei, director of the National Health Commission.
If we look at critical care resources again, the gap may further widen.
The number of ICU beds per capita in the United Kingdom and Japan is twice that of China, and the number of ICU beds in the United States is 10 times that of China. However, these countries have also experienced a run on medical resources in the face of the epidemic.
Returning to my country, in the past month, we have also observed that once an outbreak occurs in some cities, the medical treatment of patients with chronic diseases, acutely ill patients and pregnant women will suffer greatly. difficulty.
The most important medical resource in a pandemic is people
In February of this year, Hong Kong, China ushered in the most severe wave of the epidemic, and the mainstream strain has become the highly contagious Omicron BA.2, which is vaccinated in the elderly Under the circumstance that the rate is not high, Hong Kong’s daily new crown deaths per million people jumped to the highest in the world.
Prior to this, Hong Kong has had the highest life expectancy in the world for two consecutive years since 2018. The important reasons behind this are its developed economy and medical conditions.
But we still see that Hong Kong has paid a huge price in this wave of the epidemic. This is also the reason why we cannot let go and insist on dynamic clearing at this stage.
However, over the past two years, we’ve also discovered a number of issues.
As I mentioned before, the most important resource in epidemic prevention is not masks, alcohol gowns, but people.
Dynamic clearing has very high requirements for people. As we said above, China’s per capita medical resources are insufficient compared to developed countries, such as the number of doctors per capita. Since the hierarchical diagnosis and treatment system still needs to be improved, before the epidemic, almost all tertiary hospitals in big cities were overcrowded. As long as you have the experience of seeing a doctor by yourself or accompanying your family to see a doctor, I believe this should not be difficult to understand.
The picture shows the data in 2019. The bed occupancy rate of first-, second-, and third-level hospitals across the country has increased step by step. The bed occupancy rate of tertiary hospitals is 97%, which means that some Community hospitals/clinics are crowded, but tertiary hospitals are often full
The medical staff in large hospitals in these first-tier cities are overworked all the year round; the large hospitals are also responsible for the treatment of chronic diseases, acute and severe diseases, and pregnancy and childbirth. Therefore, once the closure control management, there will be several problems immediately:
1. Many medical staff need to support large-scale nucleic acid testing;
2. Many critically ill patients cannot receive timely treatment due to the absence of medical staff in major hospitals.
Take Guangzhou as an example. The population of Guangzhou is about 18 million, and the city’s health technicians are over 170,000 (including more than 60,000 doctors and more than 80,000 nurses). This is the entire family in Guangzhou.
When the epidemic broke out in Guangzhou in June last year, more than 2,000 temporary monitoring points were set up in Guangzhou, and 18 million nucleic acids were sampled in three days (roughly equivalent to the city’s population, Guangzhou was a district at that time) In batches), Guangzhou also dispatched medical staff across districts and across the province to provide support.
In other words, when the epidemic broke out, behind the large-scale nucleic acid testing, the medical resources of the whole city were basically poured out.
In this case, in order to maintain basic medical services, some doctors and nurses must stick to the hospital, but 10 people were already enough to carry water, and now there are only 7 people left. The pressure can be imagined.
So in the event of an outbreak,even though we’ve worked so hard to keep the ER and ICU operating, there will still be a lot of people with unmet medical needs.
Taking the pregnant women in Guangzhou as an example, the number of newborns in Guangzhou is about 150,000 a year, which means that more than 400 babies come to the city every day, and these mothers and their expectant mothers come to the city every day. The mother will have at least 12 prenatal visits throughout the pregnancy (only for normal mothers, some high-risk mothers will have much more). Once the medical system is stagnant, expectant mothers will encounter more or less difficulties in their obstetrics.
Even in Shanghai, which has the most abundant medical resources in the country, the various help posts we see online today may be just the tip of the iceberg.
Why insist on dynamic clearing?
Based on the current state of medical resources in our country, it is impossible for us to let go at this stage, but at the same time, we will also face the difficulty of seeking medical treatment in the event of an outbreak.
And the current main variant, Omicron BA.2, is highly contagious than the original strain and all variants in the past, even 60% higher than Omicron BA.1. But the only good news is that in the case of mass vaccination and the reduction of endogenous toxicity, the severe rate of infection after BA.2 infection is also reduced.
In the latest version of the diagnosis and treatment plan, one of the important changes is that patients with mild symptoms are changed to centralized isolation, and they do not need to be admitted to designated hospitals. At the same time, the new version of the nucleic acid testing guidelines has also released rapid antigen testing. A few days after its release, some cities have quickly distributed tens of millions of antigen testing kits to citizens.
These changes also serve a purpose:
Make every effort to maintain medical resources for the treatment of patients with severe COVID-19 and other diseases, and reduce the occurrence of secondary disasters.
Of course, for ordinary people, personal protection, timely vaccination and booster injections are the most important; and for society, we must know that our medical resources are limited Yes, hospitals cannot be shut down, and medical resources should be allocated reasonably to protect those who should be protected the most.
There are games where we don’t have particularly good hands, but we have to work hard to win. (planner: z_popeye, producer: gyouza)
Image source: Visual China