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China's Zhanjiang Fight Against Coronavirus Epidemic — Intensive with Medicine Doctor of Affiliated Hospital of Guangdong Medical University Zhang Yuanli

Date:2020/3/25 17:03:52 Hits:

For those who have not experienced war or disaster, the 2019 coronavirus epidemic has allowed them to experience an emergency situation comparable to war and disaster. At present, this crisis is still spreading at an alarming rate and scale in other countries and regions of the world outside China. However, with the exception of Hubei, large-scale epidemics have not occurred in most parts of China, and Zhanjiang in Guangdong is one of the successful examples. So what played a role in effectively curbing the epidemic? UN News interviewed a doctor who worked in the critical care department of Zhanjiang, Guangdong Province, who had cured a new severely ill patient via an overseas call, and asked her to describe the thrilling story of Zhanjiang in the urban defense battle that prevented the invasion of the new crown.  Please listen to the report from the United Nations News Huang Liling.

Zhanjiang is the southernmost harbour city in mainland China. Like many provinces outside Hubei, Zhanjiang has not been severely affected by the 2019 coronavirus epidemic. In this 7.2 million city, only 25 cases have occurred.

Zhang Yuanli, a doctor in the Department of Critical Care Medicine of the Affiliated Hospital of Guangdong Medical University in Zhanjiang, told us in an interview that if there is no timely and strict control measures, the epidemic situation in any place may become a community infection and cause a catastrophe.

Zhang Yuanli: "Our first case should have been diagnosed in our hospital on January 14. The first patient in Zhanjiang came back from Wuhan, and everyone is very vigilant. The Health and Health Bureau has already taken action and established one. Specialized groups, then each hospital also has a team, and CDC to monitor, the government has set up tests in various departments and various locations, so we have been relatively strict in the early stages, and did not cause proliferation. In reviewing all our cases, none Secondary virus transmission, all cases have a clear history of epidemiological contact (contact with infected people returning from Hubei), which places have been to the patient or who have been in contact with the patient, can be tracked immediately for disinfection Or observe in isolation, the Internet also has big data to announce the places where patients have been active to remind the public. Once the pathogen has spread, you don't know where it is safe. "

Of the 25 cases in Zhanjiang, 3 were asymptomatic infections, there were some mild cases, and 3 severe cases were treated in isolation in the intensive care unit of the affiliated hospital of Guangdong Medical College.

Zhang Yuanli: "Our Zhanjiang is a city with a relatively early case in Guangdong Province, because we have a direct flight from Wuhan to Zhanjiang. But we are very lucky because the patient is more conscious, she is wearing a mask, she got sick in Wuhan, and watched In both hospitals, she could not go to the hospital, so she returned to Zhanjiang for treatment. We immediately isolated her, and she did not touch other people. The other patient was an elderly man. He came back from Wuhan to Zhanjiang for the Spring Festival. He returned 9 He was seen and hospitalized only after he was hospitalized, but fortunately he just passed it on to his wife. There were also transmissions within the family that did not cause widespread transmission. We found that they had isolated their entire homes. Outside the hospital, they also There is network monitoring or big data to help us analyze, you can track his activity track through his mobile phone, see where he has been, big data will come in handy, it is difficult to hide the contact history. The whole society is united Get up to jointly cope with this epidemic, and attach great importance to it from top to bottom, so prevention and control is more effective. "

Zhanjiang is the only way to go to Hainan for vacation by land. During the Spring Festival, Zhanjiang also received many people from Hubei. In a tense epidemic, this group may be a high-risk group carrying the virus.

Zhang Yuanli: "Xuwen City in Zhanjiang faces Hainan across the Qiongzhou Strait across the sea. At that time, some people in Hubei wanted to go to Hainan for the Spring Festival, but they arrived in Hainan, and Hainan did not let them go to the island. We opened it in Xuwen. I separated the hotel and provided them with food and accommodation. Zhanjiang is a very warm city at this point, receiving a lot of Wuhan people, and there are also open hotels in the city of Zhanjiang to receive them, which means that they are isolated and observed. This will prevent contact with other citizens. "

In the face of the growing epidemic, Chinese medical institutions have issued and updated clinical guidelines for treating patients six times at a rapid pace, and they have been fully implemented from top to bottom. International experts from the World Health Organization-China Joint Coronavirus Outbreak Study Group 2019 praised this speed and efficiency.

Zhang Yuanli: "For the classification of infected people, one is an asymptomatic carrier, and he is also contagious. In addition, the mild type is a common cold, without pneumonia, the patient has a fever and fatigue. There is also a common type, which behaves like ordinary pneumonia. Then comes heavy and critical. We didn't make a clear distinction in the early days, and now our country divides it like this. The country has very clear requirements for which type this case belongs to. It requires filling in statistical data and reporting every day. Do After a lot of homework, we received three cases of severe illness. We felt that the difficulty of treatment was not particularly difficult, but we must make a lot of records in the documents and report to the city every day, then to the province, and preferably to the country. Mayor, director Like government officials such as the CDC, like our doctors, there is no rest throughout the Spring Festival, and everyone rotates. "

Zhang Yuanli (third from left), deputy chief physician of the Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University in Zhanjiang at work

Entering the quarantine area, especially in the intensive care unit, will cause huge psychological pressure on the patients. Dr. Zhang Yuanli and other medical staff must give them careful psychological counseling. More importantly, at the same time, they must be cautious according to the specific conditions of the patients. Develop a treatment plan. After all, there is no specific medicine for coronavirus.

Zhang Yuanli: "We are very concerned about cases where the common type is converted to severe. Once transferred to the severe type, the patient's lung disease is progressing. Many times he will be hypoxic, mainly referring to the decrease in the oxygenation index of the lung, which is manifested as dyspnea. , The patient will feel weak, walking will drag, he is short of breath after the activity, chest tightness. Many times the patient will have a fever, and some patients do not. Of course, patients with new crowns have blood routine performance, blood routine lymphocytes Relatively low, decreased immunity. In severe cases, patients have difficulty breathing, and oxygen is the most important. In our ICU, we give high-flow humidifying oxygen therapy and non-invasive mask to give oxygen. In our hospital, because the patient has not reached critically ill, So instead of invasive mechanical ventilation, invasive is to insert the gas pipe as soon as possible to give oxygen.If the patient's immunity declines, we will take immune support treatment. We will give him some immune boosters. We also had the intervention of traditional Chinese medicine and Chinese medicine for a long time. Several of our patients had fever. Traditional Chinese medicine usually reduced fever as soon as it took 24 hours. After he had reduced the fever, we had to change prescriptions. The professor of traditional Chinese medicine consulted and supported the whole process. None of us use glucocorticoids. In addition, we also need to prevent bacterial infection, because there is a patient who is quite old and has chronic obstructive pulmonary disease. It is easy to be combined with bacterial infection. We also need to prevent bacterial infection, but we cannot use too broad-spectrum and too powerful We are using antibacterials carefully with close monitoring. "

After careful treatment, Zhanjiang Guangdong Medical University Affiliated Hospital successfully cured three severe patients, and none of the medical staff were infected.

Zhang Yuanli: "The general general protection is to wear surgical masks, gloves, hats, and general gowns. It is enough to wear N95 masks for secondary protection. If some outpatient clinics are high-risk outpatient clinics, they are generally required to be secondary You may be exposed to the air exhaled by the patient, and then you need goggles. The third level is mainly used for high-risk operations. I want to intubate the patient's trachea, or I need to make a fiberoptic bronchoscope, which produces aerosol, or He will spray a lot of gas with high virus content. Just like this high-risk operation, he needs third-level protection, he needs a helmet, or this fully enclosed mask. In our ward, it is second-level, If there is a special operation, we do three levels of protection, and we need to keep the whole closed without touching any such droplets or aerosols containing viruses. "

Dr. Zhang Yuanli told us that since Level 2 and Level 3 protection is rarely used in hospitals, not every medical staff member fully understands the wearing of Level 2 and Level 3 protective equipment. The hospital also conducted a special drill for this purpose, and set up a special person to supervise and strengthen the correct wearing of protective clothing.

Zhang Yuanli: "When we wore protective clothing, we felt like we should understand it once. In fact, we found that we must wear it again. All protection is not possible without drills. Although we went through the whole department in turns Everyone will wear it after training. Later, we also found that this is not safe enough. We set up a supervisor, that is, before you enter the quarantine zone, that is, the pollution zone, you wear it yourself, and there is a person to supervise it. Look at you. Because the protective clothing is layer by layer, which one should you wear, which one to wear, and which one to take off, you must pay attention to it inside and outside. Don't pollute it. It may not be demanding because it is clean and off. Be careful not to contaminate it inside. "

Zhang Yuanli expressed sympathy for medical institutions in other countries in the world who were caught off guard by the outbreak of a menacing epidemic. She emphasized the importance of quickly isolating nucleic acid-positive patients. If conditions do not permit, patients can be placed together because there is no problem of cross-infection between them. People who test positive for the virus cannot stay home, because they can cause family-based cluster infections.

Zhang Yuanli: "As a medical staff, I do not support contacting patients without protection. Whether it is a foreigner or a Chinese, I personally cannot accept it emotionally, as if this is my comrade in arms. To go shirtless like this, because training a doctor takes a long period, so there is no protection, and you would rather reduce contact. If you only have so many protective clothing, you do n’t want so many doctors to see the patients. The patients I was treating at the time, I Just look at it alone. If they are both diagnosed, it doesn't matter. You can see two confirmed patients at the same time. They don't have any cross infection, but they must get protective clothing. "

When asked whether she was worried about her safety during the treatment of the patient, Dr. Zhang Yuanli's answer was simple and frank, which fully reflected the humane spirit and dedication of a medical worker.

Zhang Yuanli: "I don't know what others think. I didn't think too much myself. Anyway, I think it's a job need, we all have to go."

Liling Huang, reporting from the UN headquarters in New York.

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