After the peak of the epidemic, Zitong County in Mianyang, Sichuan recently ushered in a sunny day. People in the county go out of their homes to eat, drink tea and chat in open-air teahouses, restaurants and farmhouses. There are more and more people on the pedestrian streets and squares.
At the same time, it was a different scene in the respiratory medicine outpatient department and ward of Zitong County People's Hospital.
From January 5th to 6th, The Paper conducted interviews with villages, towns and county-level medical institutions in Zitong County and found that after the peak of infection, life began to recover, but the pressure for treatment was concentrated on the county People’s Hospital, and doctors and nurses were still Respond with all your might.
After the launch of the "one bed for the whole hospital" model, the hospital strengthened business training for front-line support staff. The pictures in this article are all pictures by The Paper reporter Xu Hui
On January 5, when The Paper met Yang Lin, director of the Department of Respiratory Medicine at Zitong County People’s Hospital, she was participating in training medical staff and introducing the use of ventilators and special precautions. She paused, gasped, and coughed from time to time. She had been infected before, and due to the shortage of staff in the department, an oxygen mask was put on for treatment.
In order to alleviate the shortage of personnel and beds, Zitong County People's Hospital launched the "one bed for the whole hospital" management model: during the peak period of the new crown epidemic, all spare beds in all departments of the hospital can be used for treatment. Persons with "positive" sexually transmitted infections. At present, the hospital is strengthening the training of medical staff, focusing on the treatment and first aid capabilities of general medicine and critically ill patients.
Under the hierarchical and hierarchical treatment system, during the peak period of the first wave of new coronavirus infections, Zitong County Hospital shouldered the heaviest treatment pressure in the county, while each township health center and village clinic were positioned according to their respective positions. , undertook the tasks of receiving and treating patients in the region, as well as transporting and triaging severe patients to higher-level hospitals, and smoothly passed the first wave of infection peaks.
In the first ten days of this month, the Baoshi Township Health Center and Baoshi Township Health Clinic in Zitong County that The Paper interviewed only received sporadic COVID-19 infected patients. Township health centers and village clinics are mobilizing equipment or preparing medicines, and medical staff who have suffered from yang or are overworked are also recovering and adjusting. “I don’t know if there will be another rebound during the Spring Festival, so we have to prepare in all aspects.” Good," said a primary care doctor.
Village doctor of Qingqing Village: "Symptomatic treatment" according to the guidance
On the afternoon of January 6, Fan Jibin, the village doctor of Qingqing Village, Baoshi Township, Zitong County, once again came to the home of villager Yang Yongfang , to measure her blood pressure.
Fan Jibin told The Paper that the permanent population of Qingxi Village is 1,460, including 334 elderly people. 127 of these elderly people have high blood pressure and more than 40 people have diabetes.
As a village doctor, one of Fan Jibin’s main tasks during his rounds is to measure blood pressure for the elderly in the village. Whose blood pressure is high or low, remind them to seek medical advice and take medicine in time. This is an important service he can provide to the villagers with simple medical equipment. In the past two or three years, he has also had an important task, which is to conduct nucleic acid testing for villagers.
President Fan Jibin participated in 36 nucleic acid tests last year, including the previous two years, and he did not detect a single "positive" one. The coronavirus seems far away to them. Until a month ago, many people around me suddenly said that they were "yang".
On December 7, 2022, the "Ten New Measures" for epidemic prevention began to be released, which Fan Jibin and many grassroots medical workers called "relaxation."
Fan Jibin could not tell how many people were infected with the new coronavirus and how many just had a cold after the "relaxation". According to the guidance given by experts, scholars and superior medical institutions on general symptoms, "symptomatic treatment" is carried out.
In the past 10 years of his career as a village doctor, Fan Jibin has mostly dealt with illnesses such as "headache, brain fever". For villagers who come for consultation, he will judge the symptoms according to their symptoms. If the symptoms are more complicated, they will be sent to the township health center or county hospital. If the symptoms are not serious, they will be given symptomatic medication directly.
Because Murakami’s conditions are limited, Fan Jibin directly recommends adults and children with complicated COVID-19 infections to go to the hospital. Especially for children, he asked parents to take them directly to the county hospital, because children cannot express themselves and have to go to a professional and well-equipped hospital for treatment. Every village in Zitong County has a cement road and can go directly from Qingxi Village. The County People's Hospital is 20 kilometers away, and it only takes about half an hour by car.
Township health center at peak time: only 1 of 12 doctors and nurses was not infected
Qingbao Village, Baoshi Township, is located in a ravine, and a road built along the ravine connects the residents of the entire village. Up, there are more than 10 miles from the beginning of the village to the end of the village. Most of the villagers live in independent houses, with the distance between houses ranging from tens to hundreds of meters. In this environment, it is not difficult for residents to avoid mutual infection.
On January 6, villager Yang Yongfang said that many neighbors had "exposed the sun" at that time, but her family was an exception and no one was infected. Her family opened a canteen by the road, giving her more opportunities to meet outsiders. She believes that the lack of "yang" may be related to the fact that she has been careful to protect herself. She wears a mask when going out, always keeps an appropriate distance from outsiders, and disinfects her clothes when washing.
Last month, two young men who were driving stopped to shop on the roadside. They rolled down their windows and told her that everyone who came back from Chongqing was "yang". She quickly asked them not to get out of the car. Prepare the things, put them together with the payment QR code in one place, and then walk away. The young man will go over to pick up the things and pay.
Although most of her neighbors have been infected, she hasn’t heard of anyone who is particularly serious. She said that last month, an 86-year-old five-guarantee household in the village died. However, he had high blood pressure, diabetes, bronchitis and other diseases, and it was not sure whether the old man's death was related to the new coronavirus. Every winter, heart and lung diseases always take away the lives of some elderly people.
Except for this old man, Yang Yongfang has not heard any other bad news. After being infected, neighbors usually get better after a few days of rest, and they have not gone to the township health center, even though it is only two or three kilometers away. .
On the afternoon of January 6, when The Paper went to Baoshi Township Health Center, only the 73-year-old Cao Shuzhen was receiving infusion, and his wife was with him. The only ambulance in the health center was parked in the yard and had no mission.
Cao Shuzhen said that she developed infection symptoms around December 30. In the past few days, she had a severe cough and a slight pain in her chest. So, her husband took her to the health center on a motorcycle for medical treatment. She started infusion on January 5 and went home after the infusion every day. She did not need to be hospitalized.
Cao Shuzhen’s infusion medicine contains the antibiotic penicillin, which is usually the main method used by grassroots doctors to deal with diseases such as pneumonia. Antibiotics are generally used to treat bacterial infections, not viral infections.
While Cao Shuzhen was receiving infusion, her husband was sitting by the bed with the mask in his pocket but not wearing it. He is confident that he is in good health and will not be infected. Even if he is infected, he feels that he can just carry it away like other villagers.
On January 6, medical staff at the Baoshi Township Health Center said that during the peak period of infection, the health center had 20 to 30 people receiving infusions every day. A doctor at a health center in another nearby town said that the peak period of infection was from December 10 to 20, 2022, and only one of their 12 medical staff had not yet been infected. He believed that the infection rate in the town had exceeded 80%, but there was a medical shortage. Didn't appear at their level.
The current tight situation of drug supply has eased somewhat. A doctor at a township health center said that if he orders 50 boxes of medicine, only 20 boxes may be delivered, at least he will not run out of medicine. When it is time to prescribe medicine for three days or one week, the doctor can only prescribe it for two days first and let the patient come back two days later.
Zitong County Hospital: assumes the main treatment pressure of the county and towns
Under normal circumstances, it is only a half-hour drive from Baoshi Township Health Center to Zitong County People's Hospital. The main task of the local township health center is It is pre-hospital first aid, routine disease diagnosis and treatment, and public health and epidemic prevention. Complex cases will be transferred to county-level medical institutions or directly to Mianyang Central Hospital, the best hospital in the Mianyang region.
The fever clinic of Zitong County People’s Hospital after the peak of the epidemic.
A doctor from a township health center in Zitong County told The Paper that most township health centers do not have the conditions to take CT scans and put on ventilators, but referrals from township health centers to county hospitals and then to municipal hospitals are The passage is clear.
During the peak period of infection, Zitong County People’s Hospital took on the main treatment pressure from counties and towns.
On January 5, when The Paper met Yang Lin, director of the Department of Respiratory Medicine at Zitong County People’s Hospital, she was participating in ventilator training for medical staff in a conference room in the hospital.
When Yang Lin introduced the use of ventilators and special precautions, he paused, gasped, and coughed from time to time.
The staff of the hospital explained that during the peak period of infection, the number of admissions in the Department of Respiratory Medicine was too large. Yang Lin was a member of the second wave of infections in the hospital and developed symptoms of pneumonia. He had been receiving infusions last week and was wearing oxygen during the treatment. , has not fully recovered yet.
The hospital staff said that during the busiest time of the department, some patients found that the doctor was hung up on oxygen when they came in. They felt that the doctor was more serious than themselves, and advised "you are like this, go back and rest." In fact, hospitals are also required to ensure normal rest for infected medical staff.
Yang Lin said that at that time, doctors and nurses in the department were infected one after another, but the number of patients continued to increase. She only had five doctors in the entire department, and one person had to support several people. Therefore, at first, those who are not infected are treated first, and those who are infected go home to rest and become "yang", then those with mild symptoms are treated, and then those who recover faster and have fewer symptoms are treated, and those with severe symptoms are treated. people rest.
Some doctors and nurses "collapsed" while they were busy. Yang Lin said that two female doctors in the department had to work night shifts for three consecutive days after becoming infected. The fatigue and infection once caused them to collapse. As the head of the department, she could only take the lead and persevere, even if she needed oxygen.
Yang Lin said that she applied to the hospital to support a doctor at that time. Although the leader did not agree, he finally supported a doctor for her.
In order to alleviate the shortage of human resources during the peak period of infection, Zitong County People's Hospital has redeployed employees. All personnel who have been transferred to administrative, logistics, and medical qualifications have returned to front-line departments and returned to their professions. The barriers between hospitals have been completely broken, and patients will be admitted to any department as long as there are extra beds.
Now, the hospital is strengthening the training of medical staff, focusing on the treatment and first aid capabilities of general practitioners and critically ill patients.
"One bed for the whole hospital" model: mobilizing the beds and medical staff of the whole hospital
"Although the beds are tight, we still have the capacity to receive treatment." Director of the Administrative Office of Zitong County People's Hospital Liu Dan said that during this wave of infection peaks, the number of infected people requiring hospitalization continued to increase. As the largest and most authoritative public hospital in the county, it must maintain its treatment capacity in accordance with the requirements of the local party committee and government.
In order to mobilize medical resources, the hospital launched the "one bed for the whole hospital" management model. Now all departments treat infected patients, and the respiratory medicine department conducts ward rounds, consultations, and formulates treatment plans. However, Severely ill patients still need to be transferred to the Department of Respiratory Medicine for "specialized treatment." This means that through temporary reform measures, all departments of the hospital, regardless of specialty, have participated in the treatment of new coronavirus infections.
The emergency room of Zitong County People’s Hospital.
This has alleviated the stress of medical staff to a certain extent. Liu Dan told The Paper that there are now 700 people hospitalized in the hospital, which is a historical record for the hospital. Before the peak of infection, the highest number of hospitalizations was just over 500 people.
Liu Dan said that at the beginning of last month, the hospital had some predictions about the coming peak of infection, ordered 165 beds in advance, coordinated more than 100 oxygen tanks, and the security department repaired some and also Several idle ventilators have been repaired. Now there are 28 ventilators in the hospital. Three ventilators urgently coordinated by the Mianyang Municipal Health Commission will be in place on the evening of the 6th. There are currently 20 to 30 critically ill patients in the hospital, and the ventilators are The problem of deficiencies has been alleviated to a certain extent.
But acquiring new equipment and antiviral drugs remains a thorny issue. Liu Dan said that in early December last year, the hospital ordered 15 ventilators, but they have not arrived yet. Antiviral drugs against COVID-19 are also in short supply. Only recently did 2 boxes of nematvir/ritonavir combination and 20 bottles of Azivudine tablets arrive, which can only be used to treat critical illness.
On the one hand, the hospital is focusing on treatment. On the other hand, as the peak of infection has passed, the number of admissions to fever clinics has been significantly reduced.
After the rush hour, the information desk of Zitong County People’s Hospital.
On January 5, The Paper saw at the entrance of the Zitong County People’s Hospital that small groups of people entered and exited the hospital through the side entrance passage. There were fewer people in the square inside the hospital, and an ambulance drove out of the door. Sound the alarm. There was only one doctor on duty at the fever clinic and no patients were seen.
However, recently, some patients have developed cough, chest pain and other symptoms after being "positive", and more and more people go to the hospital for emergency treatment for CT scans.
A doctor from the Zitong County People’s Hospital told The Paper that during the peak period of infection, there were many people in the fever clinic. Now that we have reached the recovery stage, there are many people who suspect “sequelae” and go to the emergency department to take CT scans. But in reality, Only a small number of patients are diagnosed with pulmonary infection or convert into pneumonia. Once these patients are found, they will be admitted to the Department of Respiratory Medicine for "specialized treatment."
At present, whether the large-scale movement of people during the Spring Festival will bring about a new wave of infections is another issue that medical staff are focusing on.