A respiratory doctor's Spring Festival clinic: About 80% of patients visit for cough after "Yang Kang

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On January 25, the holiday clinic of China-Japan Friendship Hospital started to receive patients. After 10 a.m., reporters walked into the hospital and found that there were more patients waiting in line at the respiratory clinic compared to other departments.

Comfort was the doctor on duty at the respiratory clinic, and she didn’t see all the patients until 12:00 noon. Comfort told the reporter that about 80% of the 21 patients in the morning came for coughing after recovering from a new coronavirus infection. In addition, there were some elderly people who visited the clinic for chronic lung diseases. The overall symptoms of the outpatients were relatively mild and none required hospitalization.

Comfort explained that viral infections can damage the airway mucosa, making the submucosal smooth muscle more reactive and causing problems such as coughing and dry throat, which may persist until the mucosa is fully repaired. Cough may be induced by cold air irritation due to the low temperature in the north, in addition to cooking fume particles and more unpleasant smells. This type of cough is mainly a dry cough, or with only a small amount of white sputum.

In some patients, the cough is accompanied by white mucous sputum or even yellow pus sputum. This is because viral infections destroy the epithelial cells of the airways, and the necrotic cells, as well as the “corpses” of viruses and bacteria killed by the immune response in the lungs, are excreted in the form of sputum. After sputum is formed in the body, it is expelled mainly through the tracheal and bronchial cough reflexes.

“Therefore, we do not strongly recommend the use of powerful cough suppressants, especially for this type of cough after infection with a new crown, if a few coughs occasionally, they will be fine after a while. If the cough is serious and affects normal life such as sleeping, you can add a little cough medicine appropriately. Patients with very sticky phlegm can use some phlegm-transforming medicine appropriately, so that the phlegm can be discharged outward more easily. In addition, when the color of sputum turns from white to yellow or the volume of sputum increases significantly, you need to be alert to the combination of bacterial infection, which needs to be treated with some antibiotics.” Comfort says.

Comfort hinted that if severe coughing time exceeds one month, or accompanied by breathing difficulties, blood oxygen drop, usually climbing 5 floors without wheezing, now climbing 3 floors are wheezing, suggesting that lung function is affected, you can go to the hospital to investigate whether there are other diseases.

Comfort said that after the Spring Festival holiday, because of the widespread movement of people, be alert to the emergence of a new wave of infection peak. Her department, which has already made preparations for this.

The day before her clinic visit, Comfort had just returned to Beijing from her hometown in Heilongjiang. It was the first time she had been home for New Year’s Eve in four years. For the past four years, Comfort had been working the first or second shift of the Chinese New Year. After the epidemic, the hospital has strengthened the management of medical staff entering and leaving Beijing. This year, on the fourth day of the year, Comfort was able to have time to go back home for two days, and she was already very satisfied.

As a national respiratory medicine center, CJH had just experienced a wave of new coronary infections in mid-to-late December 2022, with a peak in visits and treatment. In late December, Comfort, who was on duty in the respiratory ward, saw a critically ill patient who had been transferred from the emergency room and entered the ward on oxygen via a high-flow transnasal machine. But within a day, the patient’s condition worsened, with shortness of breath, indifference, and a drop in blood oxygen, to the point where tracheal intubation was necessary. Because of the urgency of the situation, this patient was extubated in the respiratory ward and later transferred to the intensive care unit for further treatment. The next day, Comfort was “struck” and was sore.

From the Wuhan epidemic in early 2020, to the more stringent epidemic prevention and control phase in the following three years, and now to the new phase where medical treatment is the center of work, medical staff has been in the forefront, and respiratory doctors have taken on more responsibility. As a respiratory physician, Comfort instead looks at it more prosaically, “Since the epidemic, it does feel harder, the workload has become more, and the clinical work has become heavier, but I think it’s okay, probably because the long-term high-intensity work pattern has been practiced.” After the infection, Comfort rested for five days and then went back to work.

Still, the three-year epidemic has brought changes to Comfort’s work. She feels that her colleagues are more united, that the doctor-patient relationship seems to have changed for the better, and that she has grown in her struggle with the virus.

After the “new ten rules”, the string that comfortably broke down psychologically could be loosened. In the past, respiratory inpatients needed to be tested for nucleic acid several times and go through cumbersome procedures such as CT to check whether the patient was a newly infected person, but now a hospitalization order can be admitted. Moreover, many patients with difficult medical conditions who had been admitted to China-Japan Friendship Hospital were unable to come to Beijing because of the epidemic. Now, these patients can be seen on an as-needed basis. Doctors can resume their clinical and scientific work of old.