Fully guarantee the treatment of critically ill and critically ill patients

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Currently, the number of new coronavirus infections is increasing everywhere. Is there a high incidence of severe illness? What is the status of rescue and treatment? How to prevent serious illness? This reporter interviewed relevant experts.

Is the probability of serious illness caused by the new coronavirus high?

“At this stage, the infected people are mainly mild, partly common type, and a few elderly people and those suffering from serious underlying diseases develop into serious and critical illnesses.” Li Lanjuan, an academician of the Chinese Academy of Engineering, analyzed that currently, the prevalent strain in China is the Omicron variant, and the number of infections is relatively high due to the highly infectious strain superimposed on the huge population base. The virulence of the Omicron variant is significantly lower than that of the original strain and the Delta strain, and the majority of infected patients are mild and asymptomatic. In mild cases, lung images are normal and there are no signs of pneumonia. Symptoms are mainly fever, malaise, generalized aches and pains, and upper respiratory symptoms such as sore throat and cough, and some patients have gastrointestinal symptoms such as diarrhea. Most people can return to normal temperature in 3 to 5 days, and other symptoms gradually improve.

“The current percentage of infected people admitted to the designated hospitals in Beijing is 3% to 4% for serious and critical illnesses.” Tong Zhaohui, vice president of Beijing Chaoyang Hospital affiliated with Capital Medical University, which is responsible for the treatment of seriously and critically ill patients in the two designated hospitals in Beijing, introduced that most of the patients coming to the hospital are of the common type.

Kang Yan, president of West China Tianfu Hospital of Sichuan University, introduced that in the past three weeks, the ICU of Tianfu Hospital has admitted a total of 46 critically ill patients, occupying about 1% of those with symptomatic infections. In terms of visits, the fever clinic has recently seen about 450 patients per day, of which those requiring admission to hospital occupy roughly 10% of those with symptomatic infections.

“Although the pathogenicity of the Omicron mutant strain has decreased, the absolute number of severe cases cannot be ignored because of the large base of infected patients.” Zhang Wenhong, director of the Department of Infection at Huashan Hospital of Fudan University, said that in cities like Shanghai, the absolute number of elderly people and vulnerable people with underlying diseases is not small, and even if the proportion of infections that become serious illnesses is low, it can put a lot of pressure on hospital resources for serious illnesses.

The so-called “white lung” is one of the manifestations of severe pneumonia. Ma Xiaochun, director of the Department of Critical Care Medicine at the First Hospital of China Medical University, said that severe pneumonia caused by a new coronavirus infection is mainly manifested as acute respiratory failure. From CT images, white lung is only manifested when there is a high percentage of lung loss, and not whenever pneumonia is present. Patients who present with white lung are often critically ill, and this is a very low percentage of all newly crowned patients.

The factors that lead to severe pneumonia and the presence of white lung are not just infection with the New Coronavirus. Yingli He, chief of the infection department at the First Affiliated Hospital of Xi’an Jiaotong University, said that in the past, the hospital would also admit some patients with white lung. Infection with influenza virus, bacteria, mycoplasma and other pathogens in winter can lead to severe pneumonia. Elderly people, patients with underlying diseases, and heavy smokers infected with the new coronavirus are more likely to develop severe or even critical illnesses.

Yu Kaijiang, vice president of Harbin Medical University and president of the First Hospital of Harbin Medical University, said that elderly people over 65 years old, those with underlying diseases such as cardiovascular and cerebrovascular diseases, chronic lung diseases, diabetes, chronic liver and kidney diseases, patients with immune deficiencies and heavy smokers are at high risk for severe pneumonia.

Can critically ill patients be treated effectively?

Over the past three years, in the process of treating patients with new coronary and critical illnesses, China has accumulated a lot of experience and resources for treatment, and has also trained a large number of combat-ready critical care medical teams.

In the past three years, the doctors in the intensive care, respiratory and infection departments of various hospitals have accumulated a lot of experience in the actual clinical treatment. In the past three years, doctors in the critical care, respiratory and infection departments of each hospital have accumulated good experience in clinical treatment.

Zhong Ming, director of the Department of Critical Care Medicine at Zhongshan Hospital of Fudan University, said that for patients with new coronary heart disease and critical illness, early antiviral treatment, such as the use of small-molecule antiviral drugs, as well as the reasonable use of glucocorticoids according to the needs of the condition, is the first step. For patients with respiratory failure, respiratory support devices such as ventilators, high-flow oxygen therapy and ECMO are used to provide respiratory support to patients. Enhance symptomatic treatment, such as rehydration of patients in shock, the use of vasoactive drugs, as well as nutritional support therapy.

Chinese medicine actively participates in the treatment of severe and critical illnesses. Wu Wei, a famous Chinese medicine doctor in Guangdong Province and director of the Department of Internal Medicine at the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, said that Chinese medicine has shown conclusive clinical efficacy and characteristic advantages since the outbreak. China’s summary of the “three parties and three medicines” and the experience of combining Chinese medicine and traditional Chinese and Western medicine around the world shows that the light, ordinary type can be treated effectively with Chinese medicine alone and can stop the transformation to heavy. The synergistic treatment of severe and critical cases with Chinese and Western medicine has also achieved better results.

What is the effect of treatment for patients with severe and critical illnesses? Are there any sequelae?

According to Li Lanjuan, most of the patients have good prognosis from the current clinical cases, but very few patients with underlying diseases may have pulmonary fibrosis after recovery. To “early detection, early treatment”, the vast majority of patients will not leave sequelae.

Ma Xiaochun introduced, patients in the ICU can get standardized treatment, the vast majority of patients have a good prognosis, except for some particularly elderly patients, with serious underlying diseases. From three years of clinical observation, the prognosis of patients is good, both in terms of lung function and imaging, and there are very few cases of residual significant damage to the lungs.

“At present, the overall bed resources and equipment resources nationwide can meet the demand for the treatment of critically ill patients.” Jiao Yahui, director general of the Medical Department of the National Health Care Commission, said the total number of critical care medicine beds nationwide is 181,000, with an average of 12.8 beds for 100,000 people, of which 133,400 critical care medicine beds in tertiary care institutions and 104,800 beds in convertible ICUs are available, and the utilization rate of critical care beds in medical institutions above the second level fluctuates at around 50% on average.

How can individuals protect their health against serious illness?

At present, China’s epidemic prevention and control has entered a new stage, and the focus of work has shifted from “preventing infection” to “preserving health and preventing serious illness”. How can elderly people and patients with chronic diseases protect themselves and avoid serious illness once they are infected with the new coronavirus?

Prevention is the key to dealing with serious illnesses. Party Secretary of the First Hospital of Guangzhou Medical University, Li Yimin said, the elderly, patients with underlying diseases and other vulnerable people are the high incidence of serious illnesses. This group of people should strengthen prevention, treat and control the underlying diseases well, and do regular medication, reasonable diet, moderate exercise and maintain a good state of mind.

Zhang Wenhong said that nutrition is the basis for saving infected people, and cannot be overemphasized. Called on nursing homes, home elderly, must do everything possible to ensure that the elderly high-quality protein intake, to achieve nutritional diversity, to maintain a balance of vegetables, carbohydrates, to enhance the resistance of the elderly themselves.

Vulnerable people should do a good job of personal protection. Zhang Lina, director of the Department of Critical Care Medicine at Xiangya Hospital of Central South University, said to avoid going to crowded places, especially confined places. Wear a mask, preferably an N95 mask, when you go out, and improve hand hygiene. Maintain a safe social distance of “one meter line” when in contact with people. If someone living with you is infected, you should also take isolation measures, wear a good mask, live in a single room, do not share meals, and do not share bathrooms if possible.

Zhong Ming said that after the vaccination, the rate of serious illness and mortality of the elderly has been significantly reduced. In clinical treatment, it was found that people who were fully vaccinated had a higher probability of recovery than those who were not vaccinated at all and those who were not fully vaccinated.

What are the signs and symptoms of neocoronavirus infection in elderly people living at home that require medical attention? Cheng Zenshun, director of the Department of Respiratory and Critical Care Medicine at Wuhan University Central South Hospital, said that elderly people should seek medical attention if they have been infected for too long, have difficulty breathing, have chest tightness, and monitor a drop in oxygen saturation that is below 93. Early warning, early detection and early treatment can effectively control the development of the disease and reduce the occurrence of serious illness.

It is important for family members or companions to do a good job of monitoring the health of the elderly. Tong Zhaohui said that pneumonia in the elderly is relatively insidious in its onset and has no obvious symptoms, which means that the elderly cannot be observed according to the usual symptoms of pneumonia, fever, cough, coughing and other symptoms of young people. If an elderly person has a loss of appetite, sleepiness, or inability to fight after infection, the condition may worsen. At this time, family members or accompanying persons should carefully check whether the old person’s breathing rate is accelerated, whether he or she is wheezing, and whether there are symptoms such as chest tightness. If the answer is yes, send them to the hospital in time to prevent the condition from worsening.

“The cold season coupled with the new coronavirus infection, patients with chronic respiratory diseases such as chronic obstructive pulmonary and bronchial dilatation have more morbidity and their condition may worsen and pneumonia may appear.” Tong Zhaohui said such patients need oxygen if there is an acute exacerbation of their condition, and it is recommended to set up oxygen therapy equipment at home. It is important to adhere to the medication, and it is best not to go out in cold weather to help reduce the number of episodes. New coronavirus, cold, flu and bacterial infections can cause exacerbation of chronic obstructive pulmonary disease, and if symptoms of fever and pneumonia appear, hospitalization should be promptly treated to prevent severe pneumonia.