Another wave of respiratory diseases is coming, and we have walked through the autumn and winter of the virus together.
Author: Dong Rui.
*: Phoenix.com.
There are also more than 20 patients here, how can you get off work? ”
At 11 o'clock in the winter night, in the Jiangbei branch of Zhongda Hospital affiliated to Southeast University, emergency doctor Fan Zhiwei was blocked on the way to get off work. He was stopped by an elderly patient. The old man didn't know that Fan Zhiwei was on the day shift that day, and he had worked overtime from 8 o'clock in the morning to 11 o'clock at night. At this time, Fan Zhiwei had to eat and sleep as soon as possible, because there was a day shift waiting for him the next day.
After some explanation, the old man "let Fan Zhiwei go". But such anxiety and incomprehension have frequently appeared in Fan Zhiwei's clinic in the past six months. Since September 2023, respiratory diseases such as mycoplasma pneumonia, influenza A and B, syncytial virus, and new crown pneumonia have struck, and hospitals around the country have passed one peak after another with patients. Looking back on this "over-the-peak" experience, there are not only the coping methods that medical staff have explored and accumulated, but also the details that need more attention. Phoenix Health interviewed front-line experts in emergency, pediatrics, respiratory, and infection departments in many places to bring interpretation.
Source: Oriental IC
Around September 2023, a colleague around me contracted pneumonia. Soon we reacted to it, and it was mycoplasma pneumonia. The wave of infections peaked around late October to mid-November, followed by a decline in the incidence of infections, followed by the flu. In the past few months, our workload has skyrocketed by 3-5 times. ”
Fan Zhiwei told Phoenix Health that during the "peak" period, he had to see about 150 people a day at most, and he saw one person in an average of 5 minutes. "If you work the day shift, you usually have to work overtime until night. When we sit there, we feel like the patient will never finish seeing more and more. ”
The number of patients is not small, but the pressure to deal with is not great. Because compared with the new crown virus prevention and control in 2020-2022, the workload has been reduced a lot. In addition, there are fewer severe cases of mycoplasma pneumonia infection and influenza, and they are not too tricky to deal with. For Fan Zhiwei, the pressure to cope with the flu peak in 2023 is even less than that of 2018. "There was a very popular article that year called "Beijing Middle-aged under the Flu". At that time, oseltamivir was out of stock everywhere, and a friend from Yangzhou drove to Nanjing overnight to buy it from me. But I also have to queue up here, and I haven't been in line for a long time. ”
But this time, Fan Zhiwei's psychological feeling is worse than in 2018, because there are patients in the emergency department where he is in almost every day. "It's not with the doctors, it's with the patients. Some people now seem to be particularly anxious about the infection, and the level of panic is higher than before. I always feel that I am the most serious, and I must get the fastest **, which is easy to cause conflicts and disputes. In 2018, there were many patients with the flu, but everyone treated it as a cold and fever, and their emotions were much calmer. ”
Fan Zhiwei analyzed to Phoenix Health, on the one hand, this reflects the anxiety of patients; On the other hand, it also reflects the fact that the number of emergency personnel is indeed insufficient. It has been reported that the shortage of emergency doctors in Shanghai is as high as 1 3. In underdeveloped regions, there is a shortage of emergency doctors. Fan Zhiwei added that in order to improve the experience of medical treatment, hospitals should optimize the process within their capabilities, and also make good use of Internet tools to help patients reduce waiting time.
Of course, there are still many people who do not understand the role of emergency medicine. Is the urgency of the emergency department a critical condition and a life-threatening situation, or a mood and a time urgency? A lot of people don't think about it. ”
Pediatrics for lack of people
If the key word in the emergency department is "anxiety", then pediatrics may be "**In the epidemic stage of mycoplasma pneumonia and influenza in 2023, there are many children**, parents are anxious**, and medical staff are busy**."
Source: Oriental IC
Taking the pediatric flagship in central China and the pediatric department of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology as an example, the daily outpatient volume of the department is normally about 2,500, but in March 2023, the number of outpatient visits in the influenza epidemic stage and the second half of the year Mycoplasma pneumoniae epidemic stage suddenly rose to more than 3,600 people, a surge of nearly 50%.
It is the norm for one doctor to see 120 children in one work unit. Many colleagues continue to work at high intensity from 8 a.m. to 6 p.m., and have to work overtime at a.m. to 9 p.m. in the amateur outpatient clinic. Luo Xiaoping, director of the Department of Pediatrics of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology and president of Tongji Children's Hospital, told Phoenix Health that during the period of high incidence of respiratory diseases, the department will increase the number of general outpatient clinics, amateur outpatient clinics, night and weekend expert outpatient clinics, and pediatric respiratory specialist outpatient clinics. With these multi-measure triage methods, the emergency department of Tongji Pediatrics in 2023 has improved significantly compared with previous years, and there is no previous situation of "queuing for more than 12 hours", even during the peak hours of the night emergency, the average waiting time is only 1-2 hours. However, there is a shortage of pediatricians during the whole "peak" period, which has also become the most important factor restricting the rapid "peak" of the department.
Luo Xiaoping introduced that the overall treatment of pediatricians is low, and children can not express themselves correctly, the reception process and physical examination process are cumbersome and complicated, coupled with the emotional anxiety and communication difficulties of some parents, resulting in great mental and physical pressure on doctors during working hours, so pediatrics has poor attraction to talents, and it is difficult to retain talents.
In the medical industry, the "shortage of pediatricians" is not new. According to the National Bureau of Statistics, the number of pediatricians in China in 2022 will be 2260,000 people, with 2 children aged 0-14 in the same period3.9 billion, which equates to only one pediatrician per 1,000 children. At the same time, more and more medical students are hesitant about pediatrics. "The 2022 survey shows that in the ranking of the popularity of the college entrance examination for medical majors, clinical medicine ranks 64870,000 is at the top of the list, while pediatrics is at the top of the list with 2690,000 popularity is at the bottom. ”
Luo Xiaoping said that the concentration of respiratory diseases in 2023 has made many people pay attention to the hard work of pediatrics again. But for well-trained pediatricians, this is actually the norm of work, there will be a peak of various diseases every year, including adenovirus, influenza, rotavirus, RSV, etc., to meet the peak of disease is the norm for pediatricians, "over the peak" is not a difficult thing, a few extra shifts will pass. "We hope that parents and society can give more understanding and patience to pediatricians. We don't feel that working overtime is tiring, but we will be moved to tears by a word of hard work and a little care from our parents. ”
Luo Xiaoping suggested that the seasonal epidemic will come, and the management agency should increase policy tilt, implement the salary of pediatric medical staff, and attract more outstanding talents to join pediatrics and engage in pediatrics; At the same time, we will increase the training of pediatric ability of grassroots doctors and share the pressure of general hospitals.
Source: Oriental IC
and the respiratory department of the critical "hard-hitting".
Just completed a case of tracheoscopy. The mother of the child we treated tonight is also treating other children in the pediatric care unit. "At around 9 p.m. on November 14, 2023, Mu Xiangdong, director of the Department of Respiratory and Critical Care of Beijing Tsinghua Changgung Hospital, posted a circle of friends. Since the outbreak of mycoplasma pneumonia in October, it has become the norm for him and his team to have another bronchoalveolar lavage operation at 9 or even 10 o'clock every night. From time to time, Mu Xiangdong couldn't help but sigh in the circle of friends: "There are so many bronchopneumonias!" ”
The incidence of respiratory diseases is high, and emergency and pediatric departments bear the brunt, followed by respiratory departments and infectious disease departments, which have become the backbone of supporting the frontline and intensive treatment. "In July 2023, our outpatient volume was still 4,900, in October it reached 5,600, and then in November and December, it was running at a high level of around 6,500. With the increase in the number of patients, our working hours have also been extended, basically finishing the morning clinic at half past one in the afternoon, and then we have to do 6-7 alveolar lavage, plus deal with the things in the ward, and walk out of the hospital after 10 pm. ”
Mu Xiangdong is doing a tracheoscopy under general anesthesia for the child (the person holding the lens in the middle).
Mu Xiangdong told Phoenix Health that whether it is mycoplasma pneumonia or influenza A and B, it is not a new thing for the industry. Healthcare teams that have weathered the pandemic are not under much pressure to cope with these diseases. It's just that as an important force in severe cases, the respiratory department needs to do a good job of medical support with more professional cognition and skills. "For example, mycoplasma pneumonia, which has recently become the focus, is characterized by the susceptibility of young children and relatively severe symptoms, coupled with the limited effect of drugs caused by drug resistance, severe children will develop complications such as plastic bronchitis, bronchiectasis, atelectasis, large-scale lung consolidation and necrosis, which will be life-threatening in severe cases. For these children, bronchoalveolar lavage**, commonly known as 'lung lavage', works well. Tsinghua Chang Gung Respiratory Department has developed general anesthesia lavage on the popular "bronchoalveolar lavage under semi-anesthesia" method, which has a good irrigation effect and a high degree of cooperation with children, and the first effect is very good. The disease is ferocious, and we are more willing to use technology and disease to help patients win the battle than to pay attention to the hard work of medical care. ”
As early as the end of October 2023, Mu Xiangdong put forward the "Concise Clinical Recommendations for Bronchoalveolar Lavage** Children with Severe Mycoplasma Pneumonia", and the "bronchoalveolar lavage" method developed by him has also become an important support for severe cases of mycoplasma pneumonia in children in Beijing.
The infectious disease department that dares to be "unhurried".
At the beginning of December 2023, Shenzhen CDC announced that Shenzhen is in an influenza epidemic period, and the risk level of influenza in Shenzhen is "medium". Li Xiaohe, deputy chief physician of the infectious disease department who works at the Third People's Hospital of Shenzhen, did not feel obvious pressure to receive treatment. In addition to the increase in the number of patients to see every day, Li Xiaohe's working hours have not been extended. Colleagues from the hospital's emergency, pediatric, and respiratory departments have also maintained their previous work rhythm, and the only national clinical research center for infectious diseases in Shenzhen has passed the peak of the disease in a smooth and orderly manner. It is understood that during the previous high incidence of influenza in May and mycoplasma pneumonia in October 2023, the three hospitals also spent it "unhurriedly".
Li Xiaohe told Phoenix Health that many years ago, the hospital formed a set of training and preparation systems to deal with the occurrence of infectious diseases. This system runs all year round, and in November every year, the hospital will start training on the prevention and control of respiratory infectious diseases in winter and spring, and protective materials are also stored for many years. "In the event of a sudden infectious disease or even a peak of the disease, we will quickly increase the number of personnel, open additional clinics, and successively replenish the standby doctors, second-line doctors, and third-line doctors, and the infection, pediatric respiratory, and emergency departments will support each other, and the inspection and imaging colleagues will also be quickly in place to .........Even at the peak of the disease, everyone was able to leave work on time. Because there will be other trained and qualified colleagues**.
The stable and orderly reserve system has given the Shenzhen Third Hospital the "confidence" to deal with the peak of various diseases. According to the data, when the new crown epidemic broke out, the dynamics of pneumonia of unknown cause in Wuhan were observed in December 2019, and the three hospitals started full-staff training on January 2, 2020, and conducted actual combat drills on the 8th. By the time the first positive patient arrived on January 11, the hospital was fully ready.
The hospital also provides free flu vaccinations to employees every year. In the past, the emphasis was on vaccination in key departments, such as infectious disease wards, intensive care units, fever clinics and other units. Now the entire hospital, including medical staff, support staff, nurses, etc., are vaccinated. Li Xiaohe added to Phoenix Health that he had also communicated with some medical units, and knew that everyone had difficulties and hardships at the peak of the disease. From a practical point of view, it is particularly important for hospitals to successfully "pass the peak" by focusing on equipping rapid testing equipment and actively training reserve professional echelons, especially the team of fever clinics and emergency personnel who can complete the identification and disposal of infectious diseases.
It should be said that coping with the peak incidence of infectious diseases has become part of our daily work, and there will not be too many new feelings. However, some changes can still be seen in recent consultations. Nowadays, many patients will take the initiative to describe the symptoms, details and contact history when they come to the outpatient clinic, and will remind the doctor to consider whether it is mycoplasma pneumonia or influenza ......The public's awareness of respiratory infectious diseases has really improved a lot. It is valuable that we have walked through the days of disease shock together. ”