I can see the status bar

Chapter 1044 D+6 day (2)

After eating lunch in the car at noon, Sun Lien finally arrived at He'an Hospital.

As an old tertiary hospital, the appearance of He'an Hospital is indeed incomparable to Ningyuan's Fourth Central Hospital and Yunhe City Infectious Diseases Hospital. "Old and young" is Sun Lien's first impression of this hospital.

Sitting in the car, Sun Lien first asked the volunteer who came to serve as his driver to go around the He'an Hospital. After he had a little idea of ​​the whole hospital, Sun Lien and the Yunhe City Health Committee who were in charge of the joint work Personnel met.After following the staff member into the interior of He'an Hospital, Sun Li'en fell into distress.

He'an Hospital is really not suitable as a designated hospital for infectious diseases.Among other things, there is a problem with the location of the fever clinic.

The fever clinic of He'an Hospital is their entire outpatient building.And this three-story outpatient building itself is a product of more than 30 years ago-the space layout is unreasonable, the passage is narrow and the ventilation is not smooth.

All patients need to gather in the not very spacious consultation hall, and then queue up through three stairs to the consultation room where they can be treated.The queue has been discharged from the hall, and a large number of patients even need to line up in the driveway at the door.

Fortunately, after Liu Pingchuan and others took over the Department of Critical Care Medicine, the situation in He'an Hospital has improved a lot.At least now the clinic is not completely in a state of mixed flow of people.All patients who have watched the disease will be guided to a separate exit if they do not need to be observed, and then leave the hospital through the disinfection channel.

This is already the best that He'an Hospital can do.But for patients with fever... it is still far from enough.

"The first priority is to separate all the patients for consultation. We can no longer accept them to seek medical treatment on their own, and they are queuing up here endlessly." Sun Lien immediately told the staff of Yunhe City Health and Health Committee after walking around for a while. Put forward his own request, "Among the fever patients here, I don't know how many of them are infected. Although they all wear masks, this kind of masks is difficult to protect - such close contact must let them Just wear an N95-level mask."

The staff member of the Yunhe City Health Commission said in a difficult way, "But...we can't find so many masks at all now." His idea is to send one to every patient who comes to He'an Hospital N95 masks to block possible nosocomial transmission.

"Even if there are tens of thousands of N95 masks for us to 'spend' at any time, breakthrough infection is very likely to occur at this density. After all, the filtration efficiency of N95 is more than 95% instead of 100%." ​​Sun Lien said very calmly, " Instead of allowing them to gather passively in this environment, it is better to simply move the gate forward like our clinical treatment.”

"How to move?" The staff member of the Health and Medical Commission took out the notebook in his pocket with difficulty and asked, "Dr. Sun, I have to remind you. Now resources are tight everywhere, and we need too many people. It might not work."

"Suspend the actions of patients coming to He'an Hospital by themselves." Sun Li'en said firmly, "First of all, we must develop a grading system. Can our community hospitals operate now?"

"Community hospitals lack sufficient protective equipment." The staff of the Health and Medical Commission replied with bad news, "If they are to be triaged, they must first provide community hospitals with protective clothing, N95 masks, disinfectant and face shields. The current supplies are very tight, and it is difficult to supply designated hospitals, so it is unrealistic for community hospitals to undertake the triage work."

"Then let the community take on this task." Sun Li'en said, "The community must control the first level - patients with fever without respiratory symptoms or gastrointestinal symptoms, and don't let them come to the hospital."

Fever is a symptom with very complex causes.But in general, this is due to the work of the body's own immune system.

Infection is the main factor that causes fever, but it is not the only factor.There are many reasons for infection including microorganisms such as bacteria, fungi, viruses, Rickettsia, and parasites.Among these reasons, the new coronavirus is a latecomer, but also a new product.

Starting from common sense, doctors can also make a very simple inference-not all fever patients in Yunhe are infected with the new coronavirus.In fact, the proportion of new coronavirus infections in the total number of fever patients should be extremely low.

But this "extremely low" does not mean that there is no risk of transmission between fever patients.On the contrary, the crowds queuing up in cold weather are simply the favorite breeding grounds for pathogens of various respiratory infectious diseases.

The cold constricts the blood vessels on the mucous membranes of the body.Constricted blood vessels prevent immune cells from reaching the mucosa.This directly leads to a decrease in the number of immune cells such as lymphocytes in the mucosa.However, patients with fever due to other factors have their own immune systems activated, and a large number of T cells are actively working against the original pathogens.At this time, if the antigen-presenting cells find a new type of pathogen to invade the body and deliver antigens to immune cells including T cells according to the original rules, there will be a problem of insufficient T cells.

Dendritic cells can stimulate T cell regeneration, while antigen-presenting cells can uncoat and integrate the virus after transcription, and then translate and produce synthetic viral proteins—endogenous antigens.This workflow differs from that of exogenous antigen production by antigen-presenting cells in response to bacterial infection.

However, antigen-presenting cells cannot process and present these two antigens simultaneously.In other words, once a patient is first infected with bacteria, his body's resistance to the virus will be weakened.

Mixed infection is a common clinical problem. After multiple pathogens infect patients at the same time, the situation will start to become very difficult.

"For fever patients without respiratory symptoms and diarrhea, centralized isolation or observation should be considered first, and they should be sampled and sent for nucleic acid testing." Sun Lien suggested to the staff of the Health and Medical Commission, "They must be separated from those with high-risk symptoms. Patients with high-risk symptoms should be separated first to protect the susceptible population. Then start to triage patients with high-risk symptoms."

"I will report this to my superiors, but it may not be possible in terms of manpower and execution." The staff of the Health and Medical Commission know better than anyone how serious Yunhe's situation is now.However, because there are various "interfering factors", it may not be implemented in the most ideal state in terms of actual implementation.

"Do as much as you can." Sun Li'en sighed and continued, "Fever outpatients should also be diverted. It is definitely unacceptable for everyone to gather together."

The most suitable diversion plan that Sun Lien can think of now is to take the community as the unit and send patients in the community who need consultation to He'an Hospital in batches.The community first filters out patients with non-high-risk symptoms, and then separates these high-risk patients to the hospital by means of batch transportation.

"Fever clinics should also be moved forward. All patients who need to enter the hospital must first undergo a review of body temperature, blood routine and CT images." The most ideal situation is of course to conduct nucleic acid tests on all patients who come to the hospital.However, this condition is not yet available, and the related IgM and IgG in vitro reaction test strips are still in the process of research and development, so we will not be able to count on it for a while.Therefore, moving this threshold forward must focus on some of the symptoms that have been mastered and are more likely to occur with the new coronavirus.

"Those who have close contact with confirmed patients, especially the family members of confirmed patients, need to be checked first." Sun Lien continued to talk about his thoughts. As the doctor who has seen the most Class A and Class B infectious diseases among non-infectious doctors, he does have some "Experience". "There is also the problem of masks. This must be solved by the relevant departments - the CT examination room is a relatively closed environment, and it is impossible for us to thoroughly disinfect the examination room after each examination. This will seriously reduce the Check efficiency..."

After thinking for a while, the staff member of the Health and Medical Commission asked, "Then... can it be done with mobile CT?"

(End of this chapter)