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At around 6 pm on December 8, An Lei, who developed a fever, came to the fever clinic of the Civil Aviation General Hospital for treatment. The fever clinic is located inside the parking lot. At this time, there is already a long queue in front of the fever clinic. The queue spread from the entrance of the fever clinic to most of the parking lot. After more than 20 minutes, only 3 parking spaces have been moved. Because the waiting time was too long, some patients in front of An Lei left one after another.
“It’s too slow. It takes at least 1 to 2 hours to enter the fever clinic. Visually, it’s full of people. I underestimated it.” An Lei told Times Finance.
A few days ago, Zhang Yu, who lives in a certain district of Beijing, went to 4 designated hospitals with fever clinics, but couldn’t see the doctor. He told Times Finance that because he could not determine whether he was positive, he was rejected by the fever clinic of the first hospital, and the second hospital directly told him, “The fever clinic is closed, you can go.” No one answered the calls of the four hospitals, leaving only voice prompts that the hospitals have opened online fever clinics, and it is recommended to seek medical treatment online. After a day of tossing around, he finally decided, “Go home, New Contac works.”
The scene of a massive crowd influx did not just happen in a hospital in Beijing. Times Finance made calls to Civil Aviation General Hospital, Anzhen Hospital, Chuiyangliu Hospital, China-Japan Friendship Hospital, etc., or transferred extension numbers, or displayed that the user was busy or was in the middle of a call. In addition, Times Finance called the Balizhuang No. 2 Community Health Service Center in Chaoyang District to inquire whether patients with fever could go there. Relevant staff at the community hospital responded that the fever sentinel in Balizhuang was the Balizhuang Health Service Center. However, Apple Maps currently shows that the Balizhuang Community Health Service Center is temporarily closed, and the phone cannot be connected.
On the evening of December 8, in Beijing, a long queue formed in front of the fever clinic of the Civil Aviation General Hospital. Image source: provided by the interviewee
The scenes presented by many hospitals in Beijing are by no means isolated cases. Times Finance searched social media platforms such as Weibo and WeChat groups and found that there were long queues for fever clinics in many hospitals in many places in China.
Fever clinics are the outposts for epidemic prevention and control. After the release of the “Twenty Articles” and “New Ten Articles”, along with the gradual liberalization of social control, the first wave of new crown infection hits, and the prevention and control of hospital infections is facing huge challenges.
“As a designated hospital, although our emergency treatment center has opened up multiple wards, it is already full.” Han Bing, a medical worker at a tertiary hospital in central China, told Times Finance that ordinary wards also receive positive patients. At present, doctors, Nurses were also infected. “There are only two nurses in our department who are not infected.”
On December 9, Jiao Yahui, director of the Department of Medical Affairs of the National Health and Health Commission, said at a press conference held by the Joint Prevention and Control Mechanism of the State Council that before the positive results of the new crown were sent to designated hospitals, all medical institutions will receive positive patients in the future. Nucleic acid results are used to distinguish whether to receive a diagnosis, and patients do not have to worry about the hospital not accepting a diagnosis.
In addition, at present, Guangzhou, Shanghai and many other places also require that fever clinics should be open as much as possible, and that fever clinics and emergency departments should not be closed at will on the grounds of admitting patients with new crown positive infections.
The pressure of the epidemic has shifted to the hospital. In the face of the menacing peak of admissions, Liu Ran, a nosocomial infection expert at a tertiary hospital in Shanghai, pointed out to Times Finance that although there has not been a surge in patients in the outpatient clinics, emergency departments, and inpatient wards of his hospital area, but As the incidence of positive patients becomes higher, the infection peak may enter in the next month, and for medical staff, the pressure may increase in the next two weeks.
“Guide close contacts, asymptomatic infections, and patients with mild symptoms to do home isolation, educate the public about science, and reduce public panic. Only in this way can we effectively slow down the flock of people to medical institutions in a short period of time and in large numbers.” Liu Ran told Times Finance. Say.
Multi-hospital optimized hierarchical diagnosis and treatment
In order to deal with the medical run-off problem that may be brought about by the liberalization of epidemic prevention, all parties request to point to medical institutions, and propose that medical institutions should protect and treat patients in accordance with the principle of grading, zoning, classification and triage.
On December 7, the “New Ten Measures” for epidemic prevention came into effect. The “Work Plan for Hierarchical Diagnosis and Treatment of New Coronary Pneumonia Using Medical Alliances as a Carrier” issued by the Comprehensive Group of the Joint Prevention and Control Mechanism of the State Council proposes to strengthen the classification and referral of patients infected with the new coronavirus. The emergency rescue system for critically ill patients shall not shirk or refuse medical treatment for patients infected with the new coronavirus for any reason.
On December 9, the Joint Prevention and Control Mechanism of the State Council held a press conference. Jiao Yahui, director of the Department of Medical Administration of the National Health and Health Commission, said that hospitals above the second level must open fever clinics, and qualified grassroots medical and health institutions should also open fever clinics. Consulting rooms must be equipped with sufficient strength to meet the medical needs of the people as much as possible. In addition, “Designated hospitals strengthen the reserve of medical resources; take prefectures and cities as units, upgrade and transform square cabin hospitals into sub-designated hospitals according to the population size of the city; An important supplement to critical care resources of tertiary hospitals.”
Medical institutions in Zhejiang, Henan, Beijing and other places have also announced relevant hierarchical diagnosis and treatment plans.
Taking the “Recent Epidemic Prevention and Control Work Practices of Peking Union Medical College Hospital” as an example, in addition to “one department, one policy” to do a good job of emergency response to the sun in wards and work areas, Peking Union Medical College Hospital also proposed to do everything possible to expand medical resources, including accelerating Promote the expansion, transformation and capacity improvement of emergency and fever clinics, improve the working environment and conditions of emergency and fever clinics, and further expand the isolation wards for positive patients. In order to make full and effective use of medical resources, the hospital also dynamically and accurately adjusts the nucleic acid testing plan according to the principles of zoning, classification, and time-sharing.
Sheng Jifang, director of the Department of Infectious Diseases at the First Affiliated Hospital of Zhejiang University School of Medicine, said in an interview with the media that Zhejiang has formulated a hierarchical diagnosis and treatment plan. Those infected with the new crown will be diagnosed and treated in designated hospitals, and critically ill patients will have corresponding intensive care units.
An Lei told Times Finance that a notice was posted on the way from the gate of the Civil Aviation General Hospital, the emergency department to the fever clinic. Field dedicated channel”.
According to the notice posted at the door of the fever clinic of the Civil Aviation General Hospital, under normal circumstances, patients still have to wait for the nucleic acid results before they can be triaged or go home. This process still needs to wait for 4 to 6 hours.
“I went after six o’clock in the evening. If I continue to line up like this, I will have to stay up until midnight.” An Lei told Times Finance.
The hospital where Han Bing works requires a 48-hour nucleic acid result. If it is an emergency and severe case, you can be hospitalized immediately without waiting for the nucleic acid result; At present, Han Bing’s department is divided into positive wards, negative wards, and transitional wards. Patients who do not have 48 hours are treated in the transitional wards. After the nucleic acid results come out, they are transferred to positive or negative wards.
In addition, its hospital requires each department to arrange shifts according to their own actual situation. In the process of going to work, medical staff need to wear isolation gowns, N95 masks and protective face shields, but in fact, isolation gowns cannot meet the protection needs of nursing positive patients, and medical staff have no way to have more rest after infection time.
Han Bing’s department used to be divided into two wards. Due to lack of manpower, the merger of the two wards is currently being promoted.
Facing the peak of the epidemic that may occur in the future, various medical institutions are trying their best to optimize hierarchical diagnosis and treatment to delay the occurrence of medical runs.
“For medical institutions, the previous environment was that the society helped to carry out the screening in the early stage, but now the screening of the society has decreased, and they can only rely on themselves. In the process of relying on themselves, the emergency department is the first emergency, and it is also the first line of care in the hospital. Checkpoints, outpatients may be able to do nucleic acid testing, but it is difficult to do in emergency departments.” Liu Ran told Times Finance that, from the current situation, nucleic acid results are also required within a certain period of time in outpatient clinics and emergency departments, but if patients In an emergency situation, we will wait for the results of antigen and nucleic acid tests while receiving treatment. If the nucleic acid is negative, it will be admitted to the general ward; if the nucleic acid is positive, it will be directly transferred to the treatment area for positive patients.
The fever clinic still serves as a sentinel in the hospital. According to the formal procedure, after the patients are still screened from the fever clinic, it is judged whether they are new crowns, and then they are classified and triaged in the later stage to ensure that the virus will not spread and flow on a large scale in the hospital area, and block the hospital to the greatest extent. The occurrence of infection.
“Protecting medical staff is protecting patients”
Nosocomial infections generally refer to hospital-acquired infections. Generally speaking, hospitals are places where patients are densely populated, and the hospital environment is most likely to be polluted by pathogenic microorganisms, thereby providing conditions for the spread of diseases and leading to nosocomial infections.
With the release of the “Twenty Articles” and “New Ten Articles”, many places across the country have successively adjusted and optimized epidemic prevention and control policies, and relaxed the inspection of nucleic acid certificates on many occasions. Medical institutions are facing more severe tests than ever before. More and more patients are pouring into the hospital, and the risk of nosocomial infection is increasing.
“Our hospital is emphasizing strengthening protection every day, but with the increase in patients, the chances of medical staff being infected are very high.” Li Hui, a physician at a tertiary hospital in Guangdong, told Times Finance.
On December 8, the joint prevention and control mechanism of the State Council held a press conference, mentioning that the occupational exposure risk of medical staff should be minimized, and management should be strengthened in areas with relatively high occupational exposure risks such as fever clinics, emergency departments, and wards.
Liu Ran told Times Finance and Economics that hospital staff cannot be infected on a large scale in a short period of time, otherwise the operation of the hospital will be affected. In the current state, although the outside world has let go, there are higher requirements for most medical institutions specializing in non-communicable diseases. How to ensure that medical staff and non-infected patients are not infected is a daunting task under the condition that both infected and non-infected patients are treated at the same time.
“Epidemic prevention requires precise prevention and control. Usually, there will be no closure of departments, because the hospital itself must maintain normal operation.” Liu Ran said.
On December 8, the Department of Infectious Diseases of Huashan Hospital Affiliated to Fudan University released the “New Coronary Home Rehabilitation Manual”, which pointed out that 99.5% of people may not need to go to the hospital. Internet or face-to-face consultation can be resolved. “However, our medical system must ensure that 0.5% of patients should be admitted to the hospital.”
Liu Ran pointed out that the most important purpose of medical institutions is to treat people who need treatment, especially critically ill patients. This is a major decision-making change in prevention and control since the epidemic. The hospital where Liu Ran works is actively cooperating with this work. The purpose of all the publicity and triage currently implemented is very simple, that is, when patients see a doctor, patients with mild symptoms will not run out of medical resources and cause severe patients to be delayed in treatment.
A large number of timely science popularization and education is one of the important measures for the triage of Liu Ran’s hospital, including suggesting that asymptomatic patients and patients with mild symptoms should be isolated at home.
“The treatment of infection caused by Omicron is not complicated and there is no need to panic. A good way is to take antiviral drugs in the early stage of infection, drink plenty of water, supplement vitamin C and take proper rest. The effect is actually very good Yes.” Liu Ran told Times Finance, “Next, no matter the country or region, or the medical staff should do a good job in this part of publicity, in order to achieve better triage, reduce medical run-off, and allow medical staff to concentrate on treating severe cases patient.”
(At the request of interviewees, An Lei, Zhang Yu, Han Bing, Liu Ran, and Li Hui are all pseudonyms in the article)
This article is from the WeChat public account “Times Finance APP” (ID: tf-app) , author: Zhang Yuqi, 36 Krypton is authorized to publish.
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