I can see the status bar

Chapter 1152 Recommendations
In Professor Liu's office, Sun Lien met three "visitors" who were busy with travel.They were wearing black jackets with white shirt collars peeking through the slits of the jackets.

These visitors first greeted Professor Liu, then glanced at Sun Lien, and then looked at Professor Liu again with a questioning look.

"This is Director Sun Lien." Professor Liu quickly introduced Sun Lien, "He is the first member of the National Medical Team of Song'an Province, and is currently in charge of the North Fifth District of Yunhe Infectious Disease Hospital."

"Director Sun is very young." The leading "visitor" smiled, and then said, "When I received a call from Director Sun, I thought you were older."

Sun Lien was a little confused, and then suddenly remembered the staff member who answered the phone when he called the Health and Medical Commission for support from a psychiatrist, "Are you from the Planning Department?"

"Yes." The visitor said with a smile, "Hello, Director Sun, my surname is Qian, and I am the deputy director of the Planning Department of the Health and Medical Commission—this time I came to Yunhe to be in charge of our guidelines for the diagnosis and treatment of patients with pneumonia caused by the new coronavirus infection." Team leader for the seventh edition of the draft for public comments."

According to Deputy Director Qian, he led the team to Yunhe this time to collect feedback from as many members of the medical team as possible on the current trial implementation of the sixth edition.At the same time, he also needs to summarize Professor Liu's autopsy results, and experts from the National Health Commission will conduct a second appraisal.Ensure that the results of the anatomy are credible, so that they can be written into the upcoming seventh edition, which will be used to guide the treatment of all patients with new coronavirus-infected pneumonia in the future.

"The result of this autopsy is very important. Only by understanding the extent and type of damage of the virus and how the virus harms the human body can we have a correct understanding." Deputy Director Qian said with emotion, "Mr. A top expert in the field of anatomy, the relevant identification and research have been done very well."

Deputy Director Qian first affirmed the significance of Professor Liu's work, and then said to Sun Lien, "According to Mr. Liu's autopsy results, as well as your assumptions and the experimental treatment plan currently underway, Mr. Liu formally informed us the day before yesterday A suggestion was made. It is suggested that the tocilizumab you are currently presiding over should be included in the recommended treatment plan of the seventh edition."

In the past few days, Professor Liu, his colleagues and students have done one thing together - sorting out and summarizing all the general cases that have been dissected, and using the statistical data to draw an important conclusion.

Sun Lien's assumption is very likely to be correct.

Although there is a lack of larger-scale data for comparison, Professor Liu observed pathological changes such as a large number of multinucleated giant cells and macrophage infiltration in the alveolar cavities of 9 gross bodies that had been dissected.Diffuse alveolar damage in both lungs was accompanied by fibromyxoid exudates, and interstitial inflammatory cell infiltration, mainly lymphocytes, was observed in lung sections.

Interleukin-6 is the main cytokine that mediates the activation of lymphocytes, and its large production is caused by the activities of macrophages, T lymphocytes and B lymphocytes.

Infection leads to macrophage activity, which leads to a rapid rise in interleukin-6 levels, which in turn leads to a systemic inflammatory storm.The inflammatory storm dominated by lymphocytes damages the vascular endothelium, triggers the activity of macrophages again, and forms a vicious circle.

In other words, if the condition of severe and critically ill patients begins to deteriorate and the level of interleukin-6 in their bodies begins to increase, corresponding precise immune blockade can be carried out.The systemic vascular inner wall damage of many patients can be contained.

At the same time, in the puncture test, Professor Liu and his doctoral students also found capillary transparent thrombus and intravascular mixed thrombus in some lung puncture samples.This can also explain from another perspective why the hypoxemia in patients with severe infection of the new coronavirus pneumonia is so severe and stubborn-when the blood vessel is blocked, all the oxygen exchange pathways through this blood vessel are completely blocked, it can Causes widespread damage that is more severe than death from single alveolar damage.

"From the current anatomical conclusions and data, there is no problem with the immune storm and the injury mechanism of the new coronavirus infection proposed by Director Sun." Professor Liu said to Deputy Director Qian, "Moreover, this hypothetical mechanism even led us to discover Clear thrombus and mixed thrombus were found. It can be said that this hypothesis is not only correct, but also has prospective and important guiding significance.”

Professor Liu is a forensic doctor, but he is also a university professor.He is very aware of the correctness and importance of Sun Lien's theory, but he is even more worried that the deputy director of the Health Commission will not understand.

He would rather push part of the findings and credits in the autopsy to Sun Lien, and let tocilizumab enter the seventh edition of the diagnosis and treatment plan.

As long as more critically ill patients can be saved, it doesn't matter if this kind of credit goes out.

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Professor Liu's explanation has already made Deputy Director Qian attach great importance to it, and what surprised him even more is the PPT that Sun Lien has produced so far.

On the PPT, Sun Lien summarized the situation and treatment results of all patients who have received triple therapy so far in as simple and straightforward language as possible.

Since taking over the North Fifth District, the entire fifth floor has become the jurisdiction of the Song'an Provincial Emergency Medical Team. Sun Lien and the members of the Song'an Provincial Emergency Medical Team have received more than 700 patients.Among them, 19 people died of ineffective treatment.

Of more than 700 patients, 62 received supportive care with triple therapy.Two of the patients receiving treatment died, and all the remaining 60 patients have improved, of which 44 have been converted to mild or recovered, and 16 are still severe patients.

From this data point of view, the therapy of tocilizumab effectively reduces the mortality of patients, and has positive significance in supporting the recovery of patients.

There is a theoretical basis, autopsy evidence, and statistics on the actual treatment results - even the comparison of the recovery speed of patients who use tocilizumab and those who do not use tocilizumab is also charted, even for people who are completely ignorant , can also quickly understand the role of tocilizumab.

The other two "experts" who appeared in the office with Deputy Director Qian looked a little unusual.One of the female experts said with emotion, "This research report is really good - I never thought that our company's products are still so useful."

Sun Li'en narrowed his eyes slightly. His thesis had been pre-published in New England for more than two weeks.The National Health and Medical Commission did not immediately include tocilizumab in the recommended medication due to safety considerations.But... How could Roche's experts not know the role of tocilizumab?They are the ones who produce all the tocilizumab around the world—an old drug with annual sales of billions of dollars has miraculous effects in treating severe patients with the new coronavirus. Any pharmaceutical company will be happy to wake up in the middle of the night with a smile That's right.

totally no idea?Believe you are a ghost.

Another expert asked, "Then can your donation amount be larger?"

"This is Ms. Ding Ning, CEO of Roche Pharmaceuticals in China." Deputy Director Qian introduced to Sun Li'en and Professor Liu, "This is Director Cheng of our Medical Insurance Bureau."

Both Ding Ning and Director Cheng nodded to Sun Lien, and then continued the discussion.

Ms. Ding's attitude was very frank, "To be honest, neither our company's senior managers in China nor the management in Switzerland thought that tocilizumab could play a role in the epidemic. After Director Cheng's invitation, the Japanese headquarters did not give me relevant authorization in advance."

This is the beginning of a ready rejection.But because of Ms. Ding's frank attitude, neither Deputy Director Qian nor Director Cheng spoke in a hurry.They just looked at Ms. Ding quietly, planning to at least wait until she finished speaking before making a statement.

"However, the Swiss headquarters still gave me a lot of discretionary power when I came this time." Sure enough, Ms. Ding changed the subject and said, "Now I can directly make the decision and donate 400 tubes of [-]mg to Yunhe for free. Tocilizumab, as a treatment drug."

Five thousand tubes of tocilizumab can treat at least 2500 critically ill patients.Based on the current price of a 1925 dose of tocilizumab, this is a large donation close to 1000 million RMB.

"Tocilizumab is a good medicine." Director Cheng did not rush to agree or disagree, he said in a very gentle voice, "When tocilizumab was included in the medical insurance of Jiangsu and Zhejiang, Roche's sincerity was quite sufficient. "

Deputy Director Qian nodded and agreed, "The price has been reduced from 1925 to 830. This price reduction is still very good."

"However, I remember that the drug tocilizumab has not applied for patent protection of antibody sequences in China. And the patent protection period you applied for in overseas regions has basically expired." Director Cheng changed the subject, "Domestic At least six companies are working on the same biosimilar, and three of them have entered phase III clinical trials."

"There are many companies competing in the field of tocilizumab." Ding Ning nodded, "However, we are confident in our products. For a period of time to come, our company's products will still be the best on the market. The safest medicine."

"Tocilizumab is still in category B now." Director Cheng said with a smile, "Now is an excellent opportunity to make tocilizumab famous. When the voice of the society becomes louder, we also have reasons and motivation to guide other provinces Let’s include Tocilizumab in the Class B medical insurance drugs.”

Ding Ning thought for a while and said, "That's it, let's donate [-] sticks first. If Yunhe still needs medicine in the future, then we can make at least one more donation—the total donation should not be less than [-] sticks."

Sun Lien blinked. Is this the legendary "four sentences, let a well-known multinational company spend an extra 4000 million" negotiation skills?
"Then, on behalf of the 1000 million residents of Yunhe, I would like to thank your company for your great assistance and free donation." Director Cheng was very satisfied with the result, and he even bowed to Ding Ning, "Director Sun and Professor Liu The experimental data and related materials here can also be handed over to your company after desensitization. If you plan to apply for emergency use in other regions, this data should be useful."

When Ding Ning heard "other regions", Ding Ning's expression froze for a moment, and then she sighed, "This is... recently, the headquarters is in a hurry to ask for data. Branches in South Korea and Europe are actively applying for emergency use authorization."

韩国地区目前累计确诊病例3706例、伊朗累计确诊978例、英国累计确诊35例、意大利累计确诊1128例、日本累计确诊947例。在全球范围内，新型冠状病毒的确诊报告都在不断增加。而且目前还看不到任何“疫情被就此扑灭”的迹象。

Therefore, the joint prevention and control mechanism of the domestic epidemic has also increased the direction of work. In addition to preventing the outbreak of the Yunhe epidemic and sporadic outbreaks in other provinces and cities, it is also necessary to prevent the import of epidemics from abroad to the country.

The pressure on the front line of Yunhe is gradually decreasing, but for the whole country, the risk of the spread of the epidemic continues to rise.From a short-term perspective, this is a good thing.But not in the long run.

Yunhe's resolute fight against the epidemic and the goal of completely clearing it have established a "standard template" for the global epidemic prevention and control work.Although this pathogen is very unfamiliar, although it requires a lot of medical resources and social control measures to prevent and control the disease, and although the disease is highly contagious... China and Yunhe have proved that scientific prevention and control methods are adopted and the prevention and control measures are resolutely implemented. The new coronavirus is just a relatively serious infectious disease.

As long as it is an infectious disease, it is preventable, controllable and curable.Through the ages, without exception.

"For the global fight against the epidemic, we have the responsibility and obligation to lend a helping hand." Deputy Director Qian said to Ding Ning, "We will also actively look for other solutions for the treatment of patients with pneumonia caused by the new coronavirus infection. I believe that Roche has a long history as a company. The multinational giant pharmaceutical companies can also play a greater role in this fight against the epidemic."

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In Professor Liu's office, Ding Ning directly used his phone to call experts from relevant departments in the company for an impromptu meeting.And as a manufacturer, Ding Ning made some minor adjustments to Sun Lien's medication recommendations.

The patient's medication interval was changed from 16 hours to 12 hours, and gamma globulin and CRRT treatment were not listed together as supporting treatment measures to be enforced.

"The role of gamma globulin is to increase the body's immune response, which may have a certain effect on antiviral treatment. But it is not necessary for immunosuppression." Ding Ning said to Sun Lien, "CRRT treatment is also a supportive treatment. After all The clearance of tocilizumab is not through the kidneys. It doesn't have to be a combined treatment either."

Sun Li'en thought about it, and then agreed to the suggestion.

Combining tocilizumab with gamma and CRRT is actually not very beneficial for the promotion of treatment.After all, not every hospital has the capability of CRRT.

A regimen that blocks interleukin-6 with tocilizumab alone...that's fine.Dilute it with saline and inject it intravenously. Even the village health center can do this kind of treatment.

(End of this chapter)