I can see the status bar

Chapter 1011 D+2 day (3)

Tocilizumab is an expensive biologic used to treat moderately to severely active rheumatoid arthritis in adults or active systemic juvenile idiopathic arthritis in children.

The price of a bottle of tocilizumab is 1280 yuan, the dose of a single bottle is 4 ml, and there is a total of 80 mg of tocilizumab in a bottle.

The price of gold is 364.83 yuan per gram, with an average of 0.364 yuan per milligram.The price of tocilizumab is 44 times that of gold.In treatment, the recommended dose of tocilizumab for adult patients is 8 mg/kg body weight.An adult weighing 60 kg needs at least six bottles of tocilizumab, and the price of one treatment is 7680 yuan - all at their own expense.

Few patients are willing to bear such a high cost of treatment. Many patients cannot afford a bottle of gamma globulin worth 600 yuan, not to mention monoclonal antibodies costing more than 7000 yuan in one breath.

Of course, Dr. Pascal knows that this kind of drug is unlikely to be considered by ordinary patients, but he dared to make this suggestion with his own considerations. Have the courage to propose the main reason for using monoclonal antibodies.

In fact, if you don’t consider the fact that the patient’s condition is deteriorating or even dying very quickly, being a doctor in Yunhe is simply a paradise for everyone in the medical industry.Don't worry about the cost of treatment, the patient's family members and relevant departments fully cooperate, and even things like off-site practice and nurse operation qualifications are fully liberalized-everyone has only one goal, to keep more patients alive.

It would be even better if there were not so many patients, and there were not so many critically ill patients who were always hovering between life and death.

"Use tocilizumab, right?" Sun Li'en and Dr. Pascal confirmed the recommended medication again, then he charged his mobile phone, turned his head and opened the laptop to start writing the report.

In order to alleviate the lung trauma caused by the new coronavirus infection, the overuse of tocilizumab is a very serious problem.Sun Lien only speculated on the clue that "the absolute value of lymphocytes in the patient's peripheral blood decreased", and then came to the conclusion that "the lung injury may be due to the decline of the phagocytic function of the immune system".From a medical point of view, this speculation is very far-fetched and lacks evidence.

Human life is a very precious thing, and of course such a far-fetched speculation alone cannot convince the relevant departments to agree to the use of tocilizumab.But Sun Lien still decided to write a proposal and submit it for a try.

If there were pathological examination reports or autopsy reports, perhaps Sun Lien's suggestion would be more confident.But... Now he really doesn't have this evidence.

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"I see." Professor Zhang Zhifu hung up the phone slowly, then buried his face in his hands, and sighed deeply.

Professor Zhang Zhifu has been in Yunhe City Infectious Disease Hospital for three days.Since returning to Yunhe, he hasn't even stepped into his own house.After getting off the plane, Professor Zhang has been shuttling back and forth between the Infectious Disease Hospital and the Provincial Health Commission.Support, materials, and policies are needed; reporting, scientific research, and communication... these three things have almost become the core of Professor Zhang Zhifu's daily work.

But such hard work has not brought any good results.So far, a total of four patients have been clinically cured in the entire Yunhe City Infectious Diseases Hospital.

680 four beds, began to receive patients from early January.As a result, it has been almost a month now, and only four patients have been cured.Professor Zhang felt that his body was full of heavy burdens, and he was almost out of breath under the pressure.

If daily work mainly brings pressure, then the phone call just now brought Zhang Zhifu a heavy blow.

Mrs. Zhang, who is the director of the Endocrinology Department of Yunhe Central Hospital and also a professor at Tongde Medical College of Yunhe University, was diagnosed with the new coronavirus today.

The person who called Zhang Zhifu just now was his wife's colleague.Because of close contact with Mrs. Zhang, all [-] doctors in the Endocrinology Department of the Central Hospital are now required to be isolated at home.

"Her condition is relatively stable now, and her blood oxygen saturation is okay." The only "good news" from colleagues is that Mrs. Zhang's current condition is still mild. "Although there are changes in lung imaging, except Other than the fever, she hasn't had any other changes."

Zhang Zhifu's son is currently working in the Shanghai stock market, and the end of the year is approaching, which is the time to go home for the holiday.But when the Yunhe epidemic happened, Zhang Zhifu and his wife took turns calling their son, and repeatedly ordered him to celebrate the New Year on the spot and not to come back.

Repeated orders are somewhat useful. At first, the son didn't quite understand why his parents were so nervous, but at least he refunded the ticket under the insistence of his parents.

The child is in the Shanghai stock market, and he is currently quite safe.This made Zhang Zhifu feel a little better.But other than that... Zhang Zhifu couldn't do anything by himself.

Although his wife has been diagnosed, she is a mild patient.Can only receive treatment in the central hospital.These beds in infectious disease hospitals are for severe and critically ill patients -- that's the bottom line.

What worries Zhang Zhifu even more is the issue of home isolation.Housing prices in Yunhe City are not cheap, and every doctor has a family with seniors and young children—it is impossible for them to have a separate house for personal isolation.In daily life, eating, drinking and drinking will increase the probability of their contact with their family members. Some families even have housing shortages. It is not uncommon for eight people of three generations to live in a house.

If one of these doctors is diagnosed, there is a high probability that the entire family will be infected.The demand for medical resources is greater and more urgent.

Zhang Zhifu was silent for a few seconds, then picked up the phone and started communicating with other departments.He has only one request, at least to provide separate isolation rooms for medical staff and family members who need to be isolated at home.Now the Yunhe epidemic situation is extremely tense, and these doctors who have to deal with a large number of fever patients every day are more likely to be infected.Their families are also at greater risk, and separate isolation rooms are necessary to minimize the risk of transmission within the family.

Zhang Zhifu has a feeling that the precarious situation seems to be far from reaching the dawn.If the treatment capacity cannot be increased as soon as possible, outside the hospital and in the community, the water level of the barrier lake will only get higher and higher.

And when this barrier lake completely collapses... many designated hospitals will only be reduced to a lone boat in the violent tide, and will be quickly swallowed by the flood peak.

Zhang Zhifu was very anxious, he anxiously asked various organizations that might be able to help.I asked the Civil Affairs Bureau all the way from the Health and Health Commission, and then called the Sports Commission and the Education Commission from the Civil Affairs Bureau.But the answers given by various departments are still frustrating-no department has the ability to provide independent isolation rooms without the coordination of the superior department and other departments.

A standard isolation room is not something that can be conjured up like magic.It needs to have conditions without central air conditioning to prevent the spread of the virus through air conditioning ducts, it needs to have the reception capacity to accommodate hundreds of people, it needs a large number of medical staff equipped with red zone level personal protective equipment, it needs to have sufficient power supply capacity, and it needs to be strong enough The sewage treatment capacity, the need for a large supply of disinfection materials, the need for sufficient food and drinking water security capacity...

Zhang Zhifu only wanted a place to isolate high-risk medical staff and their family members. In order to meet this requirement, other departments needed to provide Zhang Zhifu with a temporary hospital for treating mild patients.

This contradiction is irreconcilable, even unsatisfactory.There are still a large number of confirmed patients in Yunhe City who cannot be treated in time.The beds in Vertex Hospital that have been put into use are basically exhausted, and the transformation of other hospitals is still going on.The Leihuo Shenshan Hospital is currently working hard, and the emergency construction forces of Yunhe and even Xiangbei Province have almost been exhausted.The current Yunhe doesn't even have the strength to renovate an idle student dormitory that Yunhe University said it could provide.

Zhang Zhifu, who had been on the phone for an hour, stopped what he was doing, and then buried his face in his hands again.

This time, the middle-aged man deliberately lowered his voice and howled, filling the dean's office.

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After writing the proposal letter, Sun Lien took a deep breath, re-examined his words from the bottom of his heart, and then corrected several typos.

It is better to be more rigorous about the content that needs to be handed over to the higher authorities for consideration and approval—at least it appears to have a correct attitude and has been well thought out.

Throughout the discussion, Sun Lien tried his best to use a relatively easy-to-understand description method, and described the phagocytosis of lymphocytes and these immune cells.Then, based on the existing data, he explained the possible benefits and disadvantages of using tocilizumab, and finally provided a table.

This form is based on the existing information and the summary data of the patient examinations in the entire Yunhe City Infectious Disease Hospital.So far, among the patients who died of ineffective treatment in the Yunhe City Infectious Diseases Hospital, there were severe peripheral blood lymphopenia.

By checking the patient's peripheral blood lymphocyte count, it may be possible to provide a reference for the severity of the patient's condition.At the same time, this data also proves that the patient's lymphocyte count may be related to the patient's rapid deterioration and death.

It is a very difficult job to explain the complex working mechanism of immune cells and the effect of tocilizumab, as well as the possible serious consequences of using tocilizumab, in the simplest language .Sun Li'en wrote for three full hours, and this is considered to have initially completed the proposed theme.

The paperwork is done, the next job...is to find strong enough evidence for this paperwork.

At the end of the document, Sun Lien left his position, name and contact information.And emphasized that the laboratory has begun to look for stronger evidence.At the same time, Sun Lien expressed the hope that Yunhe, the Xiangbei Health Commission, and even the National Health Commission will start organizing autopsies on the remains of patients who died after being infected with the new coronavirus as soon as possible.

"We cannot sample and inspect critically ill patients whose lungs have been severely damaged. This medical behavior may endanger patients whose lung function is close to failure. However, biopsies on mild or severe patients may lead to wrong conclusions ——Their lung damage is different from that of patients who are dying or even dying." Sun Lien added, "To improve the understanding of the new coronavirus and improve the cure rate of patients, it is necessary to conduct systematic research on the damage caused by the new coronavirus For the sake of more lives and the lives and health of 14 billion people, histopathology experts should dissect and identify the remains of dead patients as soon as possible."

After finishing the epilogue, Sun Lien picked up the phone and called Shen Xi who was far away in Ningyuan.Then he issued a new order to his laboratory director.

"Cooperate with the laboratory of Professor Pascal, who studies immunity, and the laboratory of Professor Huang Wenhui, Department of Respiratory Medicine, and start research on the damage mechanism of the new coronavirus as soon as possible while ensuring the progress of the development of test strip detection accuracy."

"You kill me." Shen Xi, who was hardworking and hardworking, gave up after hearing this request, "Director Sun, the main research direction of our laboratory has nothing to do with lymphocyte phagocytosis and alveolar tissue! "

"This is the most urgent research project right now." Sun Lien didn't care how embarrassing Shen Xi was, he was much more anxious than Shen Xi now, "Even if it's to help sweep the floor and water in Professor Pascal's laboratory, this cooperation must be done. Do it! In the entire academy, you have the earliest research on the new coronavirus, the most knowledge and the deepest understanding, who do you not like?!"

Sun Lien forced his laboratory to join this kind of research, and there is another reason that is not convenient to say.

The research directions of each laboratory in the college have specific goals.Only when the project is completed within a certain time limit or the progress of a specific topic is obtained, it is possible to obtain new financial support in the subsequent approval.

At present, the country has begun to organize a group of colleges and research institutions to start emergency scientific research on the new coronavirus.But... there is no name of Ningyuan Medical College in this group of colleges.

Sun Lien's laboratory has a separate subsidy from the school, and at the same time, Sun Lien serves as a "background".They can devote themselves to new research projects without any burden, which is not the case in other laboratories.

Letting one's own laboratory "mix" in can at least force other laboratories to invest more energy and resources in research.

"Our resources are open to other laboratories without restriction. You will give them whatever they want." In order to emphasize his determination, Sun Li'en said seriously to Shen Xi, "As long as you can produce results, you can give the laboratory to others and I will give it to you." I have no opinion—as long as I get the result, I must find out the mechanism of alveolar damage and the influence of the absolute count of peripheral blood lymphocytes on the damage as soon as possible.”

"Then..." Shen Xi asked after a few seconds of silence, "Is it okay to use the mice that study AQP4 aquaporin as experimental animals?"

"I have no problem with you using the cynomolgus monkey in the MRI research project." Sun Lien emphasized again, "At all costs, we must get the data out. I am waiting for help here!"

　May the compatriots in Henan be safe, and let the damn rain stop quickly...

　　
　
(End of this chapter)