Not long ago, Zhang Wenhong was interviewed by Dajiangdong Studio, the Shanghai channel of People's Daily's mobile client. Dajiangdong: Since April, Shanghai has implemented strict static data countermeasures for industrial ecosystems, and implemented the guiding principle of "dynamic clearing" from beginning to end. What have you achieved during this period?

Zhang Wenhong: From the beginning of April to the present, the highest daily infection rate in Shanghai is 27,000 cases, which has gradually dropped to about 20,000 cases at this stage. The basic number of virus regeneration has also dropped from R0=9.5 to the current reasonable number of virus regeneration Rt= 1.0. Especially in Pudong, where the epidemic situation in COVID-19 is obvious, the reasonable regeneration number Rt will first drop below 1. Although the epidemic situation in COVID-19 is still more risky than that in Big bounce, the good news is that the number of medical cases outside the province is gradually decreasing, and some administrative regions have completed social development screening, all of which are negative. The work in the future era of Qing dynasty is still very serious, so we must pay full attention to it. Especially due to the increase in the total number of medical records, the treatment challenges of sensitive people are gradually emerging.

Dajiangdong: In the early days of this wave of COVID-19 epidemic, there were basically no deaths in COVID-19, but recently, the number of seriously ill patients and deaths increased significantly. Is this what you call the challenge of treating sensitive groups? Can you tell me what the challenge is?

Zhang Wenhong: Yes. On April 23rd, there were 39 new local deaths in Shanghai, with an average age of 78.7 years and an advanced age of 98 years, all of which suffered from severe chronic diseases of multiple organs. Almost all the patients with critical medical records we meet in clinical medicine have obvious multi-organ basic diseases, including advanced tumors and serious cardiovascular diseases (myocardial infarction, chronic heart failure, hypertension, etc.). ), nervous system diseases (cerebral hemorrhage, cerebral infarction, etc. ), end-stage cirrhosis ascites, diabetic patients, diabetes, etc. The root cause of most deaths is caused by basic diseases.

This patient with a serious underlying disease is also infected with COVID-19 virus. Although COVID-19 caused by COVID-19 is not necessarily serious, the treatment of basic diseases is still a challenge that is not optimistic.

Dajiangdong: Most of the deaths in COVID-19 released recently in Jilin and Shanghai were caused by basic diseases, which is different from the deaths released in Wuhan two years ago. The deaths in Wuhan are usually accompanied by "severe shortness of breath". Does this indicate that the death standard in COVID-19 has been adjusted?

Zhang Wenhong: Before the epidemic in COVID-19, patients with this severe multi-organ complication who needed long-term treatment were usually treated in the original treatment institutions or medical institutions. During the COVID-19 epidemic, such patients will be admitted to designated hospitals in COVID-19. They suffer from obvious multiple organ dysfunction. When combined with COVID-19's feelings, even if COVID-19's own pneumonia symptoms are not serious, when we calculate the death cases in COVID-19, COVID-19, we will still calculate the medical records of this part who died of basic diseases.

Dajiangdong: From the perspective of treatment, what is the difference between this wave of COVID-19 epidemic in Shanghai and the previous situation in Wuhan? What are the methods for treating critical illness in Shanghai?

Zhang Wenhong: Omicron Rongxinguan gene mutant has been popular so far, and it is found to be very different from that when COVID-19 epidemic appeared in Wuhan in the early stage, when the mortality rate in COVID-19, COVID-19 was higher than 5%. Today, even if the death records of basic diseases are calculated, the total death rate in Shanghai remains at 0.01.78% (87/488,000), and the death rate of severe pneumonia in COVID-19 is very low. At present, the death of elderly patients and patients with basic diseases is the most harmful to the mortality rate, which is also the biggest challenge encountered by Shanghai at this stage.

When the COVID-19 gene variant of Omicron is prevalent, the treatment of patients with COVID-19-positive basic diseases or other subacute diseases will lead to the work pressure of medical resources. Obviously, positive patients must go to the designated hospital in COVID-19 for consultation, which obviously puts high demands on the designated hospital-not only to treat COVID-19's disease, but also to treat all basic diseases in a single way.

Accordingly, there are many and serious basic diseases in elderly patients, and the treatment regulations for severe patients with multiple courses are very high. Shanghai has gathered more than 360 authoritative experts in critical care medicine who have rich experience in clinical medical diagnosis and treatment in our city, and combined with authoritative experts from other places, nine elite teams in critical care medicine have been established, and they have settled in eight designated hospitals at the prefecture and city levels, and standardized management and comprehensive treatment have been carried out for severe patients with COVID-19's ultra-severe, critical and COVID-19-positive basic diseases. In order to better improve the three-level treatment capacity of designated hospitals in COVID-19, the mother hospitals of municipal-level designated hospitals also set up a multi-disciplinary three-level treatment team for outpatients, and established a team of 53 prefecture-level experts with rich experience in diagnosis and treatment in 15 College. Using the consultation service platform system software developed and designed by emergency department, we conducted multi-course collaborative nursing rounds for critically ill patients in municipal designated hospitals, with one person and one policy for treatment, and adjusted the treatment plan immediately to try our best to save the lives of critically ill patients.

We have noticed that at this stage, it is more necessary to apply strong diagnosis and treatment in designated hospitals at provincial and municipal levels. Medical resources must be slowly moved down to the lowest level, so as to improve the energy for treating COVID-19 patients at the bottom level and complete the full coverage of medical resources. Academician Ning Guang of Shanghai Zhongshan Hospital led the elite team to dock the outpatient departments of hospitals at all levels in Huangpu District. The intensive care team of Zhongshan Hospital provides in-depth community first-line treatment, which is the latest exploration to fully improve the ability of primary medical treatment, implement full coverage of medical resources, and improve the actual effect of treatment for sensitive elderly groups. In a word, resisting Omicron in the future will be a long and lasting people's war. Everyone's overall goal has always been to let the elderly and sensitive groups solve the major risks brought by the COVID-19 epidemic.

Dajiangdong: In the long run, what suggestions do you have for the treatment of critical illness in COVID-19? Zhang Wenhong: In the future, we will create a more reasonable rescue management system and strive to minimize the impact of Omicron.

In the next stage, in order to solve the infection of Omicron virus with very high transmission rate, on the one hand, the designated hospitals in COVID-19 should be turned into general hospitals, and not only patients in COVID-19, COVID-19, but also patients with serious basic diseases who are positive in COVID-19 should be treated, so as to vigorously promote the capital investment of colleges and universities and provide single-hospital treatment for sensitive people with Dna positive before the outbreak in COVID-19.

On the other hand, it is necessary to greatly increase the vaccination rate for this part of the population who did not inject because of the fear of vaccine side effects in the previous stage. There has been a lot of direct evidence that the side effects of vaccination in this group of people are not high, but the risk of critical illness and death caused by non-injection is extremely high.

In Shanghai, the patients with severe pneumonia in COVID-19 are mostly elderly people who have not been vaccinated or patients with basic diseases. Therefore, vaccination should be further promoted. For the elderly and patients with long-term basic diseases who have difficulty in vaccination, they can actively send vaccines to their homes. These sensitive people must be well protected to avoid the risks brought by the fashion in COVID-19. Only by maintaining them well can we have the courage to say that we have standards to solve the impact of the COVID-19 epidemic on us.