On the evening of February 19th, Tong Zhaohui, vice president of Beijing Chaoyang Hospital, Jiang Rongmeng, chief physician of the Second Department of Infectious Diseases of beijing ditan hospital, and Wu Anhua, director of the Department of Sensory Control of Xiangya Hospital of Central South University, and other three experts from the Central Steering Group held a press conference on the severe treatment in COVID-19, introducing the characteristics and treatment of severe and critical patients in COVID-19.
It has been more than a month since Tong Zhaohui arrived in Wuhan on January 18th. At the press conference, he introduced that through this period of clinical observation, it was found that the age groups of severe and critically ill patients in COVID-19 were mainly over 50 years old and 60 years old, and they often had more basic diseases, such as hypertension, diabetes, coronary heart disease, and some had kidney and cerebrovascular diseases.
What is the difference compared with SARS?
"You may know that SARS patients in 2003 were young and middle-aged. In fact, this time they were all older and had basic diseases." Tong Zhaohui said that compared with SARS, the age and foundation of patients are different.
Tong Zhaohui introduced that most of these patients are suffering from severe hypoxia and their condition is progressing rapidly.
"I have also experienced SARS, which mainly involves the organs in the lungs. If we can take some measures, whether non-invasive or invasive, to reverse the lungs during SARS, the disease will basically be fine. " Tong Zhaohui said that now they found that novel coronavirus not only attacked the lungs of patients, but also the heart and kidneys.
The expert group found that patients with severe and critical illness had higher troponin. Tong Zhaohui said that if these patients eventually develop into respiratory failure, the heart, kidneys and other organs will have problems, leading to multiple organ failure.
Jiang Rongmeng introduced that SARS in 2003 had a characteristic, basically (patients) had a fever above 38℃. Therefore, after 2003, fever clinics were set up in China to screen out the disease, so it could be screened out at a relatively early stage.
"But this disease (COVID-19) is different. There are still many (patients) with low fever, 37 degrees, and some without fever, so it has certain concealment." Jiang Rongmeng said.
"After infection, the progress of this disease is relatively slow." Jiang Rongmeng said that compared with the familiar diseases, severe pneumonia can be found in three or four days after the onset of influenza or bird flu. In COVID-19, some patients are not too serious in the first five or six days, and patients may not come to see a doctor. However, patients are still contagious and will spread through family, community or friends’ dinners.
"Another feature is that the early stage is not typical." Jiang Rongmeng said that the elderly with this disease are much more infected, and the disease is more serious. Now many patients are found to go to the general department for medical treatment because of other diseases (early). "For example, go to the respiratory department, or go to neurosurgery, or go to other departments. He may have pneumonia when he sees a doctor, but pneumonia is not serious. This disease is not the main one. He may go to see some diseases in neurosurgery. Of course, it is contagious. "
Critical care began to get on the right track.
Tong Zhaohui introduced that through this period of time, under the leadership of National Health Commission, the current critical care work has gradually begun to get on the right track.
First of all, Wuhan Jinyintan Hospital, Zhongnan Hospital of Wuhan University, and Wuhan pulmonary hospital are regarded as three key hospitals that specially treat severe and critically ill patients. With the shortage of beds, it continues to expand. Wuhan union hospital West Hospital, Tongji Sino-French (tongji hospital Sino-French New Town Campus affiliated to Tongji Medical College of Huazhong University of Science and Technology) and East Hospital of Hubei Provincial People’s Hospital are also included. At present, there are six relatively large hospitals as hospitals for treating severe and critical diseases. With the arrival of medical teams from all over the country, some key and important medical teams have been placed in these six hospitals.
Secondly, from the strategy, through the early exploration, it is concluded that we should move the threshold of rescue and treatment forward and actively treat critically ill patients. And there are national experts and provincial experts who go to various hospitals to patrol and consult and guide the work. These patients are all suffering from multiple organ failure, and there are also multidisciplinary experts for consultation. In addition, it is necessary to analyze and discuss the death cases in time and sum up some experiences.
Third, pay close attention to and monitor the changes of patients’ condition. Some mild and ordinary patients will suddenly get worse and become severe. During this period, it is necessary for doctors to closely monitor patients’ indicators. This close observation can prevent the development of serious illness.
Tong Zhaohui introduced that medical staff also took some intervention measures, such as trying to give patients a good environment to rest, and then antiviral treatment, as well as the treatment of combining Chinese and Western medicine, so that these light and ordinary patients can develop into severe diseases as little as possible.
"Sometimes it is inevitable that some patients will develop into critical illness, and the transfer and referral mechanism has also been established and there are processes." Tong Zhaohui said that according to these measures, hospitals, especially several hospitals that focus on treating critically ill patients, have been running smoothly and orderly during this period. At present, some critically ill and critically ill patients are discharged from these hospitals every day.
