"COVID-19's experience is almost zero". What about the epidemic situation in rural areas?

122, 65,438 (Spring Festival travel rush 16, the first day of the first lunar month), the national railw

"COVID-19's experience is almost zero". What about the epidemic situation in rural areas?

122, 65,438 (Spring Festival travel rush 16, the first day of the first lunar month), the national railways, highways, waterways and civil aviation * * * sent passengers170.52 million, an increase of 49.6% over 2022. It is estimated that the total population of Spring Festival travel rush will be about 2.095 billion in 2023. 19 among the first-tier and new first-tier cities, the number of people going to Guangdong, Henan, Hunan and Anhui provinces is the largest, and Guangdong, Henan, Hunan and Anhui are the provinces that "return to their mother's home" in the Spring Festival of 2023.

Such a large-scale population movement has also made everyone more worried about the rural epidemic. Before Spring Festival travel rush, small and medium-sized cities and rural areas have already ushered in the peak of infection, and these cities and regions are likely to usher in the peak of emergency and serious diseases during Spring Festival travel rush. In this regard, many places have begun to conduct offline family surveys on the incidence of COVID-19 infection in rural areas.

How does the rural medical system cope with the impact during the Spring Festival? What is the reserve and supply of medical resources in rural areas? What help do you need now? Dr Ming Huang Ping from Zhang Pu Village, Taizi Town, Tieshan District, Huangshi City, Hubei Province described the local situation to Observer.

Observer Network: Hello, Dr. Ming. First of all, please introduce the overall situation of Zhangpu Village, including population size, population structure, usual outpatient service and local medical habits.

Minghuangping: Our Zhangpu Village was formed by merging the original Zhangshu Village and Mingpu Village. There are two clinics in the village. I belong to the second clinic and am in charge of Mingpu Village. Zhang Pu Village is far away from Prince Town, about 7.5 kilometers. There are more than 4,600 people in the village, including more than 390 elderly people over 65. The first clinic is mainly responsible for 2,800 people in Zhangshu Village and has 4 doctors. The second clinic is in charge of Mingpu Village 1800 people, only my wife and I are two doctors.

I am in charge of public health in Mingpu Village. In Mingpu Village, there are 65-year-olds 1 14, hypertensive patients 102, 20 diabetics and 6 mental patients. Two elderly people suffer from diabetes and hypertension at the same time. One of the most serious patients in our village is the five-guarantee patient. Now more than ten days have passed, and the situation is relatively stable and has not developed into a serious illness.

Yangxin People's Hospital, the nearest to Zhang Pu Village, usually takes 40 minutes by car. People in the village seldom go out unless they are seriously ill, so I know the villagers very well.

Doctor Ming from Zhang Pu Village, Taizi Town, Tieshan District, Huangshi City, Hubei Province. Source: Jingchu positive energy

Observer Network: This wave of rural infections came faster than expected. Originally, the outside world predicted that it would be accompanied by the tide of returning home, but now it seems that the peak of infection appeared in the countryside almost at the same time as the city, which exceeded previous expectations. Is it the same as what you observed locally? What is the situation of medicine and equipment in the village? What medicine did you prescribe for the patient?

Bright yellow screen: At first, the equipment was only a thermometer, a sphygmomanometer and a stethoscope. I bought an oxygen machine myself, and Huangshi Health and Health Commission gave me an oxygen machine. I have two oxygen machines, but the other equipment is gone.

I studied the combination of traditional Chinese and western medicine, focusing on Chinese medicine treatment. The medicines prescribed for patients are Pueraria lobata Decoction, Jiuwei Notopterygium Decoction, Maxingshi Dry Decoction and Xiaochaihu Decoction. At the beginning of the epidemic, there was a shortage of drugs. I found a regular medicine intake channel, and the pharmaceutical factory sent the medicine, but I couldn't stop by because of the express card. I usually like to use lysine aspirin because it has a good analgesic effect and is not a hormone drug, but I can't take it out later.

The peak of treatment in our village started from 65438+February 14, with 63 people on the first day, 87 people on the second day, 0/02 people on the third day, 0/50 people on the fourth day and 0/73 people on the fifth day. Since then, the number of patients has gradually decreased.

Many patients began to have a fever and ache all over, but in the later stage, they coughed. Two people have a bad cough. They went to the county hospital for filming and diagnosed pneumonia, but the hospital had no beds and had to go home to recuperate. I give them injections and prescribe Chinese medicine.

Just a few days ago, my son had a holiday, so I asked him to help. In the infirmary, my wife and son and I start work at five o'clock every morning, and the consultation is almost 12 o'clock. For half a month, I've been busy around, and my mother cooked dinner for me in those days. By the time I had dinner in between, it was already cold.

Observer Network: How was the reception in the clinic during this period? What are the patients' demands for treatment, symptoms and follow-up feedback?

Ming Huangping: During the treatment, neither the doctor nor the patient knows whether the patient turns negative, because we have no antigen to detect. I checked the patient's tongue coating, and 95% of the patients were cold syndrome. Old people and children need medication most. Young people generally don't take medicine and can survive by resting at home.

The most impressive case, a patient in his 50 s, just came back from Jiangxi, and his pulse was very slow, just in time for all the Chinese medicines to be out of stock, so I gave him an injection. The next day, he wanted to consolidate it again. The person next to him said that the doctor was taking hormones and told him to stop taking them. He didn't come later.

10 days later, the patient came again, complaining of sore throat and chest tightness. I felt the pulse of my hand and felt that pneumonia was more likely, so I quickly advised him to make a film. Up to now, he has basically recovered.

There is also a patient's case. He got a pituitary tumor some time ago, which is acromegaly. He didn't feel anything about it, but I saw signs of growth on his nose and hands. I suggest that he go to the hospital for examination. At first, he did not believe it. I told him three times and his father twice. Later, I went to Wuhan Hospital for examination, and the result was pituitary adenoma. It didn't take long for him to go to the hospital for surgery, and his symptoms became more serious because he was weak after surgery. I prescribed him Chinese medicine for 4 days, and he also gave him infusion to supplement nutrition. During this time, he made progress gradually.

Observer Network: According to media reports, villages in many places in COVID-19 treat patients with fever with a four-piece set of "antivirus+antibiotics+hormones+antipyretics". What do you think of this four-piece therapy set?

Ming: For prescriptions of anti-virus, antibiotics and hormones, for rural doctors, many antibiotics have no authority and hormones cannot be used casually. Others think that we are "three elements and one soup"-antibiotics, hormones, vitamins and glucose injection, but in the actual operation process, everyone's situation is different. Some patients require water suspension, and some patients are not suitable for taking medicine.

Observer Network: Everyone is concerned about the shortage of primary medical resources. In the past, antipyretic drugs, cough drugs, antibiotics and antiviral drugs were strictly controlled, and hospitals and pharmacies kept fewer drugs. What is the overall deployment and replenishment situation of county and town health bureaus?

Ming Huangping: Three years after the outbreak, there were almost no antipyretics, cough medicine and other drugs in township hospitals and ordinary people's homes. When the notice was issued, we didn't feel anything. After the rush hour, Prince Town Health Center sent me four bottles of ibuprofen, but at this time, visitors did not have much demand. /kloc-gave me two oximeters in the middle of October, and now the peak of infection has passed, and patients don't need these things.

Now another person asks about the medicine for diarrhea, because they have heard that people with diarrhea in Zhejiang are infected. In order to prevent people from robbing and hoarding drugs, I only sell three packs at most per person.

Observer Network: Can antiviral drugs such as Pfizer and acyclovir be supplied in county and township hospitals?

Ming Huangping: Everyone here doesn't know about Pfizer, and the economic conditions are not very good. Everyone likes to buy immunoglobulin. This drug used to cost more than 500 yuan, and the price rose to 1, 800-2 1, 000 yuan at the peak of infection. I didn't buy this medicine, and I told people around me not to rob it and leave it to critically ill patients who need it more.

Observer Network: I saw in the news that many grass-roots rural areas have some assistance policies for local elderly groups, such as giving medicines, seeing a doctor and volunteering. What is the specific situation? Any suggestions for this?

Ming: Let's do a good job in the registration of critically ill patients and visit them more. Grassroots cadres will also visit them.

I personally suggest that rural cooperative medical insurance needs to actively support rural doctors. There are too few kinds of drugs on the rural cooperative medical platform, and the people have no benefits at all.

At present, the national rural medical insurance pays 350 yuan every year, and the annual increase is about 30 yuan. However, there are problems in the actual reimbursement ratio of patients and reimbursement of traditional Chinese medicine. The proportion of people who have paid insurance in the village is 85%. Difficulties in reimbursement and less reimbursement will also become a problem for villagers to seek medical treatment and buy medicines. There are 273 kinds of drugs on the medical platform I * *, and less than 100 kinds of drugs are available to primary doctors, almost all of which are antihypertensive drugs, cough drugs and antibiotics.

There are not enough doctors in 29 villages in Taizi Town who can integrate traditional Chinese and western medicine and traditional Chinese medicine 10. In the three years since the outbreak, rural clinics have been unable to treat patients with cough and fever, so our treatment experience is almost zero. I hope that county and city hospitals can organize training for township doctors in traditional Chinese medicine technology, because we lack first-hand information.

Tongren, Guizhou launched the anti-freezing level IV emergency response medical staff to provide on-site service for key rural people. Source: vision china.

Observer Network: Netizens discuss the recent increase in the number of elderly deaths in rural areas. What is the situation in your hometown?

Ming: Since the peak period in our village, only one lung cancer patient has passed away. There are two cases in the next village. One is that the old man fainted. I gave him acupuncture. A few days later, I heard that the old man went to the hospital for examination. The hospital made a serious judgment and refused to accept it. The old man died soon. The old man has been in good health, and this sudden death is quite unexpected and shocking. On another occasion, it was said that there was a big white lung. He suffered from diabetes and stroke, and died soon after being positive.

Observer Network: What is the difference between this infection tide and the previous winter flu season?

Ming Huangping: In the three years since the epidemic, there has never been a peak of consultation here, and the days of 10 multi-clinic have hardly passed. Before the outbreak, such as 20 19, there may be about 20 patients coming every day. These three years have been positive, so people who are suspected of being positive will go to the county hospital.

Observer Network: Did the villagers panic in this wave of infection? What is everyone's attitude towards this?

Ming Huang Ping: Everyone has some fears. For example, some people are very tired after infection and come to see a doctor by car. Everyone will deliberately stay away from it after seeing it, unwilling to say hello and worried about infection. I also go to comfort everyone, not everyone will get sick.

Observer Network: The tide of returning home is about to begin. The rush hour on your side appears earlier. How much impact do you think the rural medical system will face during the Spring Festival?

Ming Huangping: It's hard to say at present. Some people may still have symptoms and need some antipyretic drugs and equipment. At first, many people said it was "Yang Fuyuan". I judge that the last infection may not have fully recovered. COVID-19 needs a rest period of at least one month. In winter, there is a high incidence of influenza, so we should pay more attention to rest.

Observer Network: Although we have been fighting the epidemic for three years, many primary hospitals have not really treated COVID-19 on a large scale, lacking first-hand experience. Many times, when patients come, they are advised to go to higher-level hospitals, resulting in insufficient medical resources in secondary and tertiary hospitals. Any suggestions for graded diagnosis and treatment?

Ming Huangping: Graded diagnosis and treatment is difficult to implement on our side. When the peak of infection came, everyone gathered in the health care center. It was difficult to distinguish different patients and needs, and soon everyone was infected.

Three years after the epidemic, the basic medical conditions, equipment and medicines have not changed much, and they are still the same. However, the price of drugs has obviously gone up, and the cost has gone up by ten or twenty dollars, but the drugs I sold to patients have not gone up that much.

In addition, medical insurance drugs are expensive and have few varieties. Primary doctors use drugs in a narrow sense. For example, many cephalosporins are not allowed to be used because our level is not enough. If the patient has severe pneumonia, the effect of penicillin is definitely not good. If the patient is allergic to penicillin, we really have no medicine available.