The number of severe COVID-19 positive patients reached a peak of 128,000 long-term COVID-19 positive patients

At the press conference of the Joint Prevention and Control Mechanism of the State Council on January 14, Jiao Yahui, Director of the Department of Medical Affairs of the National Health Commission, introduced that the number of diagnoses and treatments in fever clinics across the country will reach its peak on December 23, 2022. It was 2.867 million passengers, and then continued to decline. By January 12, it fell back to 477,000 passengers, a decrease of 83.3% from the peak number. The number of emergency diagnosis and treatment visits nationwide peaked at 1.526 million on January 2, 2023, and has continued to decline since then.

Jiao Yahui also said that according to monitoring data, the number of hospitalized COVID-19 patients is showing a continuous downward trend. On January 5, the number of hospitalized patients with COVID-19 reached a peak of 1.625 million, and then continued to decline. On January 12, it fell back to 1.27 million, and the proportion of hospitalized patients with COVID-19 infection showed a continuous downward trend.

Jiao Yahui

Monitoring data shows that two weeks after the peak of fever clinics, the number of severe COVID-19 patients in the hospital also reached its peak, and then showed a slow downward trend. The number of critically ill patients currently in hospital remains high. On January 5, 2023, the number of severe COVID-19 positive patients in the hospital peaked at 128,000, and then continued to fluctuate and decline. By January 12, the number of positive severe COVID-19 patients in the hospital had dropped to 105,000, and the critical care bed utilization rate was 75.3%. , the critical illness beds can meet the needs of treatment.

On the morning of January 12, Wang Renyuan, director of the Zhejiang Provincial Health Commission, said after the opening of a meeting of the Provincial People's Congress that at present, the number of visits to fever clinics in Zhejiang has dropped significantly, and 120 emergency and emergency services are also currently in the process of gradual improvement. In the declining stage, the overall epidemic situation in the province has passed the peak period of infection and is expected to drop to a lower epidemic level by the end of January. However, hospitalization and severe and critical illness are still at their peak plateau, with people over 60 accounting for about 90%. He said: "The province's medical resources are generally in a balanced state and can basically meet the current medical treatment needs for epidemic prevention and control. However, they are still at the most critical stage, and the task of treating severe and critical illnesses is still very arduous."

On the evening of January 8, a reporter from China News Weekly interviewed Cai Hongliu, director of the Department of Critical Care Medicine at the First Affiliated Hospital of Zhejiang University School of Medicine. He is an expert on the medical treatment team of the Joint Prevention and Control Mechanism of the State Council, and has participated in the fight against the epidemic in Shijiazhuang, Hebei in 2021, Changchun, Jilin, Shanghai, and Sanya, Hainan in 2022. In the past three weeks, as the director of the comprehensive ICU, Cai Hongliu's work intensity has continued to increase. On the Sunday of the interview, his day was full, with cases discussed during the day and training on the tenth edition of the diagnosis and treatment plan at night. It was not until 10:30 in the evening that he ended his day's work and talked to reporters about Zhejiang's preparations before the peak of severe illness, why it takes time to transform ICU, how to train a critical illness team that can go to the battlefield in a short period of time, and the new coronavirus What are the major misunderstandings in treatment? He said frankly: "After the 'Twenty Points' measures were launched, I speculated that the rise in the number of infections in China might take three months to complete the journey that other countries took three years. In fact, it took us less than 20 days." This is what Cai Hongliu said:

Zhejiang has gradually entered the peak of severe cases since mid-December 2022. It is still in a plateau period with no obvious turning point. The biggest pressure at the First Affiliated Hospital of Zhejiang University School of Medicine, where I work, is that in the early days when the number of infections began to surge, a large number of medical staff fell down and the peak of infection partially overlapped. The staff was so tight at the time that a doctor from one of our hospitals even rented a house next to his unit as a dormitory. The doctors and nurses who became infected lived there. After working for seven or eight hours, they would lie down for three or four hours when they couldn't hold on any longer, and then return to the hospital to continue fighting.

In the past three weeks, the intensity of our critical care work has continued to increase. Among the critically ill patients admitted, the proportion of elderly patients and those with aggravated underlying conditions after being infected with COVID-19 has been increasing, and the hospitalization period has also increased. Elongating. At the same time, the number of ICU beds we are responsible for has doubled. For example, the critical care medicine department where I work originally had 184 beds. Later, four new wards were opened, adding more than 100 beds. The entire hospital previously had more than 250 ICU beds, but now the number of prepared ICU beds has increased to nearly 600.

The National Health Commission has continuously emphasized since the beginning of December last year that comprehensive ICUs in tertiary hospitals should account for 4% of the total number of hospital beds. Each specialized ICU has also transformed convertible beds according to a proportion of 4% of the total number of beds. It is to ensure that the total number of comprehensive ICU and convertible ICU can reach 8% of the total number of hospital beds, and the transformation must be completed before the end of December last year. According to previous requirements, the proportion of ICU beds in secondary hospitals and above was 2% to 8%. In other words, 8% is already the ceiling.

Normally, the renovation of ICU beds usually takes at least several months, but now it only takes less than a month.

On the evening of January 11, 2023, in Huzhou, Zhejiang, medical staff were caring for patients in the respiratory ward of Huzhou Central Hospital. Picture/Visual China

Why does it take time to transform ICU? Because this is not as simple as adding a bed. For example, a ventilator does not just need to be moved over. There is a gas equipment belt attached to it. Modifying the ICU will also affect the oxygen, air, negative pressure suction interfaces, power sockets, etc. in the ward. They all have very strict requirements. We require one air switch for each bed. The ICU is full of life monitoring and support equipment. Once a problem occurs, it may endanger lives in an instant. Therefore, when transforming the ICU, we must pursue speed while ensuring quality.

The Zhejiang Provincial Health Commission recently organized critical care medical and nursing experts to conduct inspections for the treatment of severe cases in 22 medical units in 11 prefecture-level cities across the province. During my just-concluded inspection tour, I discovered that because all hospitals are racing against time to renovate their ICUs, the current supply of critical medical equipment is tight. Some county-level hospitals have ventilators, high-flow oxygen therapy equipment, CRRT machines, etc. in a tight balance.

Hardware modification and equipment purchase are not the biggest challenges. The most difficult thing is that the number of ICU medical care cannot be increased in the short term. Training a qualified ICU doctor requires at least three years of specialized training, because ICUs treat patients with severe conditions and rapid changes, so they rely on a lot of monitoring and treatment equipment, such as monitors, ventilators, CRRT machines, ECMO, etc. Therefore, our industry describes critical care as "special forces". They have to face a large number of patients with critical and complex conditions every day, and they also have to use various "weapons", which requires very high capabilities.

In fact, in the past three years, not too many medical staff across the country have actually participated in the treatment of COVID-19, especially in severe cases. After the adjustment of the epidemic prevention policy this time, this is the first time that almost all medical staff have truly participated in the treatment of COVID-19. In the actual combat mode of treatment, this battle must be fought and must be won. In this situation, one of the most realistic options is to adopt a mixed grouping working mode.

For example, there is an anesthesiologist working with us. His characteristic is his strong operational ability, because the anesthesia machine and the ventilator are very close, and he can perform rescue operations such as tracheal intubation, deep vein penetration, and even circular breathing. They were all relatively professional, but they lacked experience in anti-infection and nutritional support, so they asked an infectious disease doctor to join them. In other words, when resources are limited, the advantages of other supporting doctors must be fully utilized to form the most efficient combination. In our hospital, a mixed team basically consists of an intensivist, an anesthesiologist, plus a physician and a surgeon.

Moreover, try not to change this combination after it is finalized. Now in the newly expanded ICU ward, there are many brands of ventilators that even "old patients with severe illness" like me have never seen before. We all need to get used to the equipment. , doctors and nurses also need to get in touch with each other. It took us two weeks to really get in touch with each other. If we wait until we go to the battlefield, it will be too late.

Therefore, mixing cannot be done on paper. Before the peak of severe illness arrives, these supporting doctors must go to work in the ICU in advance and work for 1 to 2 weeks. Optimization and adjustment can be made in the meantime. This is also the most important part of emergency training for non-critical care doctors: it must be based on In the form of a team, in the form of actual combat.

Zhejiang has relatively sufficient training for critical care teams. The Provincial Health Commission issued a document in early December last year requiring all cities and towns to submit a specific list of medical staff participating in the training. Each hospital must have one doctor per ICU bed. , 2.5~3 nurses, and on this basis, an additional 20%~30% of personnel will be added as backup force.

On December 8 last year, all prefectures and cities in the province sent a backbone team of doctors, nurses, and respiratory therapists to treat severe COVID-19 to Hangzhou for five days of intensive training. Our hospital’s most experienced medical nurses and respiratory therapists in severe COVID-19 treatment came to Hangzhou. Teaching, introducing experience.

However, although Zhejiang has made various plans including ICU renovation, personnel training, etc., after the "New Ten Measures", the number of infections increased faster than we expected. After the "Twenty Points" measures were launched, I speculated that the increase in the number of infections in China might take three months to complete the process that took other countries three years. In fact, it took us less than 20 days.

On the evening of January 11, 2023, in Huzhou, Zhejiang, medical staff were caring for patients in the Respiratory Intensive Care Unit of Huzhou Central Hospital.

The mission of the ICU is to guard the last line of defense. As early as 2020, when we summarized our anti-epidemic experience, the most important thing was to move the border forward, which is still applicable today. The key to moving forward is to identify high-risk groups as early as possible. The tenth edition of the diagnosis and treatment plan mentions severe/critical high-risk groups. There are six points in one sentence. Every community doctor must memorize them and not miss any. A high-risk patient. One change in the 10th edition compared to the 9th edition is that the age threshold for high-risk groups has been raised from 60 to 65, and special emphasis has been placed on those who have not been fully vaccinated. When we participated in the Shanghai Defense War in 2022, a small number of patients who died were characterized by advanced age, multiple underlying diseases, and no vaccinations. Therefore, we must pay special attention to this "critical minority" vulnerable population.

Community doctors should tell high-risk groups what they need to pay attention to, who should be contacted immediately if there are several situations, and guide them to the community instead of waiting until they can no longer bear it. level hospitals to build trust in community hospitals. The training on the initial treatment of COVID-19 can actually be completed in a few hours. Community doctors are fully capable of handling it. If they feel that they cannot solve the problem themselves, they must immediately refer it to the next level. Therefore, there must be an efficient referral process to allow large hospitals to Limited medical resources are used to treat severe and critical patients. This is the lowest cost and best treatment effect.

The treatment of COVID-19 must focus on two main lines. One is to treat antiviral treatment as early as possible, and the second is to treat various basic diseases and complications caused by COVID-19 infection. The treatment of basic diseases, community Doctors have an advantage over large hospitals because their daily responsibilities include chronic disease management. There are two other points that we should pay special attention to: first, we should pay attention to prone position treatment, and we should lie down as much as possible, and put it in the same important position as antiviral treatment; second, we must not blindly use antibacterial drugs, especially when combined with broad-spectrum antibiotics. Spectrum antibacterial drugs. A few doctors overuse antibacterial drugs, which is a major misunderstanding. If the possibility of bacterial infection is considered, doctors should actively look for evidence. Blind use of antibacterial drugs is harmful. It is important to strictly grasp the indications for the use of antibacterial drugs. It is important to use antibacterial drugs rationally.

Published in the 1077th issue of "China News Weekly" magazine on January 16, 2023

Magazine title: Doctors on the front lines of severe COVID-19 treatment: What have you experienced in the past three weeks?

Reporter: Huo Siyi Li Jinjin

Editor: Du Wei