Economic Observation Network reporter Zhang Ying On January 2, Zhang Wenhong, director of the National Center for Infectious Diseases and director of the Department of Infectious Diseases of Huashan Hospital affiliated to Fudan University, emphasized at the grass-roots treatment training meeting for key physicians in Minhang District, Shanghai, that a community doctor should quickly launch a new coronavirus infection treatment training session in the next two weeks. The important “battle” led by the community hospital should play an important role in reducing the severe and mortality rate of the new crown among high-risk groups such as the elderly.
Zhang Wenhong said that many community hospitals did not use the correct treatment plan before, which to a certain extent caused patients to aggravate their condition and flock to secondary and tertiary hospitals. At present, the number of beds in secondary and tertiary hospitals is very tight. The surgical and dermatology wards of some hospitals have been used to treat patients with new crowns, but the bed turnover rate is low, which is already at a critical point.
He suggested that community hospitals should make full use of the “golden 72 hours” and use the “4-step method” of oxygen therapy, antiviral drugs, glucocorticoids, and nutritional therapy to control the condition of high-risk groups.
Regarding antiviral drugs, Zhang Wenhong said that regardless of domestic imports, as long as they can save lives, they should be used. It is understood that since January 3, the domestically produced new crown oral drug Azvudine has covered 115 secondary and tertiary hospitals in Shanghai, and has been admitted to 113 community hospitals. In Minhang District, all 14 community health service centers in the district have been equipped with Pfizer’s new crown oral drug Paxlovid.
The following content is organized according to the training recordings, some are abridged, and have not been reviewed by myself:
Community hospitals should keep the “golden 72 hours”
It is estimated that these two days will be very difficult, because patients will flock to tertiary and secondary hospitals. The beds in higher-level hospitals are already very tight. For example, Huashan West Hospital, which has a relationship with Minhang, Huashan Hospital, has 100 beds. All of the 100 beds are managed by our department’s attending doctor. They are divided into three groups, and the lower ones are all neurologists who are usually very good. , they are working as residents below.
The number of patients has increased sharply in the past two weeks. Some hospitals have been unable to admit patients, and when they cannot be admitted, everyone is waiting to die. The current number of beds in the secondary hospital is as of this afternoon, and it may reach the position of the head and neck. If the number of patients increases, it will reach the position of the nose. It is difficult for our hospital to ventilate. In the end, it is difficult for patients to ventilate.
Why is it difficult to breathe? Because if our previous treatment plan is not the optimal treatment plan, the probability of remission of the patient is very low, and the process of treatment is also a process of continuous aggravation, and the turnover of inpatient beds must be slow. For example, patients in their 80s who have difficulty breathing, most of their pneumonia worsens during treatment in the community, and eventually they have to go to the emergency room of a second- and third-level hospital to hang water for five or six hours. Asking someone to find an inpatient bed may not guarantee a good cure. Basically, it is such a process.
Now the possibility of turnover in the ward is that the patient will die, because no effective treatment plan can be given before, and the bed will be vacated until the final result is death, and the patient will be sent in to continue to die.
I feel that everyone did not use the correct treatment plan, and the patients who deserved to live did not survive. So my request now is that within these two weeks, we must quickly and decisively launch an important battle led by community doctors. Today, the deans and technical backbones of many community hospitals are here. This year is also the most critical battle for the community health service centers. Through this battle, we will alleviate the attack of Omicron on a large number of elderly people and reduce the death rate.
The next peak of death has come, and everyone wants to come to you to issue a death certificate. Comrades, can you not issue a death certificate? Can we not die? As long as this step is achieved, we will establish the status of the community health center. The status in the world is achieved by oneself, not by seeking.
Antibiotics alone are ineffective treatment options
Most of the current treatment plans, whether it is a district-level central hospital or a community hospital, everyone likes to give water to critically ill patients. I’ll ask you right away, what did you put in the water? Many people will tell me that it is antibiotics. I would like to ask you a very heart-wrenching question. There is no bacterial infection in the early stage of treatment for a viral disease, but we are adopting a regimen that focuses on antibacterial treatment. What do you want to do? You want his disease to miraculously improve and the virus to become a bacterium? That name has to be changed, it is called a bacterial infection caused by the new coronavirus. Do you think such a treatment will work?
Why is such treatment enabled? It’s because we didn’t have effective medicine in our hands before.
The patient in the community hospital is mild at first, what medicine will you prescribe for him? I know very well that you are also treating with a 4-step method: the first antipyretic, the second antibiotic, the third cough medicine, and the fourth traditional Chinese medicine. You yourself think that the four-step method is given to the patient, but I tell you, there is a high probability that you are wasting the most precious golden 72 hours of the patient.
There are a lot of people looking for me recently. There are two groups of people. The first group is already serious and cannot find a bed in the hospital. The other group is people who happen to know me. Their parents are in their 80s and 90s, and they are infected with the new crown and need treatment. I will tell you the solution to the problem.
The first group of people are in critical condition. Last night a person called me and asked if he could provide a bed for me. His father’s oxygen saturation was less than 90 at home, which is very dangerous. If effective treatment is not given, he will die. When I went to the emergency room of a tertiary hospital, the doctor said that I should be hospitalized, but there were no beds. There were two options. The first option was to find a hospital with beds. Sound reliable.
I asked him what kind of water he was hanging on, and he sent it to take a look, a bottle of salt water with antibacterial drugs, and antipyretic (acetaminophen). I immediately sent the treatment method to the director of the infection department of their hospital, and I said, can you help me find out what is wrong with this treatment? He said that there is a problem with the treatment of respiratory failure. A viral pneumonia caused by the new coronavirus even gave him antibiotics. We can foresee that if the patient stays in the emergency room to inhale oxygen at night, he may not have problems immediately tomorrow, but if he goes back at night, his hypoxemia may not be corrected, because the treatment plan is not for the new coronavirus itself. Such treatments are ineffective.
The hospital continues such ineffective treatment time and time again. The patient will go from mild respiratory failure to severe respiratory failure, and when he arrives at the ward, if he can no longer give effective treatment, he will be intubated at last and asked whether he wants to intubate or not. Many patients are hesitant. If they are 90 years old or not, they will not do so. As you can imagine, if we do not provide effective treatment options, this is the end.
I used to see that some hospitals used antibiotics for treatment. They said that some patients were cured. These patients cured by you were killed by themselves, not by you, because the medicine you gave him was ineffective. of.
Antiviral drugs + hormones are “single-edged swords”
The second group of people who found me were elderly people who had just been infected with the new crown. They found me within 72 hours. These are the patients you see, because you are the front line. Yesterday, the children of two such patients sent me WeChat to ask what to do. I took what I taught you in the training. One is antiviral drugs. The best small-molecule new crown drug in the world, no matter whether it is domestic or imported, as long as it can save the Chinese people and keep the elderly alive, I want it. Antiviral drugs are only available in the community now.
If it gets worse the next day and the blood oxygen saturation drops, something is wrong with his lungs. The blood oxygen saturation used to be 95 or 96, but now it’s 93 or 94. There must be lesions in the lungs, and CT doesn’t even need to be taken. up. If this patient develops disease progression, the next treatment is very important. In addition to antiviral drugs, a very important drug is hormones.
Many people will have questions, how can hormones be used for viral infections? Immunity is weakened after using hormones, but how can bacterial viruses be controlled? I tell you today that most viral infections and most bacterial infections cannot use hormones. You are very right, because all textbooks tell you that hormones cannot be used. However, the new coronavirus has not yet come out when you study textbooks. The new coronavirus is the only viral infection that has shown that hormones have clearly worked for high-risk groups in the process of transforming from mild to severe. It has completed large-scale clinical trials all over the world. According to research, hormones are definitely effective drugs.
I didn’t want to come here to give you training before, because it was difficult to train. When I had no antiviral drugs in hand, I let the elderly start hormone therapy, and I started a double-edged sword. Hormone is always a double-edged sword, but today I When you have antiviral drugs in your hand, the double-edged sword becomes a single-edged sword, only killing the virus but not yourself. Antiviral therapy plus hormone therapy, most patients are in remission within 72 hours.
After taking antiviral drugs, if the elderly stop eating, hormones can be taken earlier. If the blood oxygen saturation is better, you can take 2 tablets, and if the saturation is poor, you can take 4 tablets, and if it is not good, you can take 6 tablets. What adverse reactions can 2 tablets and 4 tablets have? You all know that for rheumatic diseases, they take 20 tablets a day, and they take it for half a year. You haven’t seen people dying or living. If you take it for two or three days now, what are the side effects? You said blood sugar will be high, so what if the blood sugar rises in two or three days? If diabetics should use insulin, you should test your blood sugar and control it with insulin. If you used to take oral hypoglycemic drugs, just add another meal after a meal.
So please everyone, we must use antiviral drugs and add hormones during the 72-hour prime time in our community. It would be meaningless to throw all the patients with blood oxygen saturation above 93 to the emergency room of the District Central Hospital to get water. The most congested place in the world is his place, which is crowded with people and has the highest viral load in the entire Minhang District.
Mild patients do not need too much rehydration. They are prescribed 100 ml of 5 mg dexamethasone. They are hung up to inhale oxygen, and then sit for another hour. The body temperature begins to drop, the oxygen level begins to improve, and they start to have an appetite when they go back at night. up. You can eat vegetable porridge. There are vitamins in the vegetables. You need to add some salt to supplement the salt, and then boil eggs for him, and you will have protein. If the digestion is okay, it would be better to add some minced meat. The next day at the community hospital, I took small-molecule drugs, and changed the intravenous dexamethasone to oral dexamethasone. If the blood oxygen saturation is very good, 2-3 tablets of 0.75 mg are enough. If it is heavier, 4 tablets , It improved in 3 days, then changed to 2 tablets, and changed to 1 tablet after two or three days, and it was over in two or three days.
So what is the method of this war in our community hospitals? It is also a 4-step method: the rational application of oxygen therapy, antiviral drugs, and glucocorticoids, plus a nutritional therapy.
Focus on nursing homes
The next battle will be initiated by various community health service centers and nursing home nurses. Nurses for the elderly are in contact with everyone. We not only take care of patients in the community, but also cover nursing homes.
Today I was talking to Director Ma, can you tell me about the nursing homes with the highest death rate in Minhang District in the past two days? He said that the elderly living in some nursing homes are too old, and the mortality rate is high. I agree, the death rate is high at old age, everyone will die, and I will die too, but can we not let everyone die together? “.
What I mean is that nursing homes with higher death rates during this period can invite the community to send people to take charge. If you do a good job in the nursing home below, he will not go to your Fifth People’s Hospital or Minhang District Central Hospital. An expert from the community service center will go to the docking station, choose a nursing home with the highest death rate to visit first, hold an on-site meeting, implement a good treatment plan through your hands, and stabilize all patients within 72 hours .
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