Onion Peeling
2020-02-26
Public health expert Lu Hongzhou said that the Shanghai Public Health Center submitted a formal report on January 5th. The process can only be described as "heart-stopping". We made the right choices, made the right decisions, and did what we needed to do. But unfortunately, things that shouldn't have happened still happened. "I think history will eventually have an objective and fair judgment."
Doctors from the Shanghai Public Health Center are in the clinical center.
Byline: Du Wenwen, New Beijing News reporter, intern Jin Qianyi
Editor: Chen Xiaoshu, Proofreader: Li Xiangling
►This article is about 3361 words long, and it takes about 6 minutes to read the full text.
On January 20th, when the first confirmed case of COVID-19 was admitted to Shanghai, Professor Lu Hongzhou checked into the hospital with his luggage. In the past month, he has only been home twice, taking the opportunity of going to the city for meetings to grab clean clothes.
Lu Hongzhou is a member of the national COVID-19 medical treatment expert group and the Party Secretary of the Shanghai Public Health Clinical Center affiliated with Fudan University (hereinafter referred to as the Shanghai Public Health Center). The center is a designated hospital in Shanghai for the treatment of adult COVID-19 patients. As of 12:00 on February 25th, Shanghai has had a total of 336 confirmed cases, with 268 discharged and 3 deaths.
Lu Hongzhou introduced that Shanghai is an aging society, and many of the infected patients are elderly people who were infected at home. The Shanghai Public Health Center also participated in the early prevention and control of the Wuhan epidemic and urgently reported relevant reports. Regarding whether the turning point of the epidemic has arrived, he said, "From a clinical perspective, we don't talk about turning points, we take the end of the epidemic as the criterion."
Hospital infection control is most critical in management
Onion Peeling: Are there any differences in the clinical manifestations of patients at the Shanghai Public Health Center compared to those early patients? Are there any special cases?
Lu Hongzhou: There are no significant differences in clinical manifestations, and no evidence of virus mutation has been found. Currently, there is a critically ill patient who is on a ventilator and has a tracheal tube. Serum therapy was started on the evening of February 20th. The serum was donated by a recovered patient. The treatment effect is not immediate, but it should be effective in theory.
Onion Peeling: In Chengdu, there was a patient who tested positive again for the nucleic acid test 10 days after being discharged. Are there any patients like this in Shanghai? What are the criteria for discharge?
Lu Hongzhou: There are currently no such patients in Shanghai. The discharge criteria are based on the standards in the national diagnosis and treatment plan, such as two consecutive negative nucleic acid tests with a 24-hour interval, no fever, obvious absorption of lung lesions shown in imaging, and no other symptoms. It needs to be considered comprehensively.
Patients who have recovered cannot relapse because they have developed antibodies and cannot be infected again. As long as the virus does not mutate, there is no possibility of reinfection.
I believe that the patient in Chengdu was also discharged based on the standard of two consecutive negative nucleic acid tests. However, the time it takes for each person to metabolize the virus varies. Sometimes, a positive standard sample can be obtained, and sometimes it cannot, which may be because the positive sample was not obtained.
Another possibility is that after the patient recovers, the body produces antibodies against the virus. The virus dies and is excreted through cell metabolism. At this time, a positive result may be obtained in the nucleic acid test, but it is not an active virus, but a metabolite.
Lu Hongzhou, member of the national COVID-19 medical treatment expert group and Party Secretary of the Shanghai Public Health Clinical Center affiliated with Fudan University.
Onion Peeling: Some information mentions that hospitals are under pressure to discharge patients. How do you view this issue?
Lu Hongzhou: Talking about the discharge rate has no value at all. The earlier the patients are admitted, the earlier they will recover. We now only have a few severe patients left. In the early stages of the epidemic, patients were not discharged, so the discharge rate was low. In the middle and late stages of the epidemic, patients were gradually discharged, so the discharge rate was high.
Onion Peeling: In Shanghai, have chronic disease patients been affected by the epidemic?
Lu Hongzhou: Shanghai is an aging society, and many of the infected patients are elderly people who were infected at home. Some of them are children working in Wuhan, and their parents went to Wuhan to visit them. Some are elderly people who came from Wuhan to Shanghai to visit their relatives. There are cases of cerebral infarction, myocardial infarction, diabetes, hypertension, and coronary heart disease among the elderly, so treatment is more difficult. Severe elderly patients may need to be put on a ventilator or ECMO, which poses many challenges.
The success rate of ECMO is higher for teenagers and younger children with better organ function. The success rate is lower for the elderly with more complications. In the past, during the SARS epidemic, there was no ECMO, so if these patients were put on ECMO at that time, they might not have survived.
Onion Peeling: According to the joint investigation team of China and the World Health Organization, there have been 3,387 cases of medical staff infected with COVID-19 in 476 medical institutions nationwide. How is the situation of hospital infection control at the Shanghai Public Health Center? How do you prevent and control it?
Lu Hongzhou: Currently, no medical staff have been infected.
We have very strict infection control measures. First of all, from a hardware perspective, we have negative pressure wards to minimize the presence of the virus in isolation wards. Medical staff wear personal protective equipment, including positive pressure respiratory hoods, goggles, and masks, fully armed.
The most critical aspect of hospital infection control is management. We strictly implement the regulations for personal protection. In each ward, we have a dual leadership system for infection control, with the head nurse and the infection control department staff responsible for management. We rely on front-line command, process management, and detailed supervision.
In particular, for operations in the ward, such as intubation, tracheotomy, and sputum suction, strict infection control standards must be followed. We have dedicated personnel to supervise the process of removing isolation suits, and hand disinfection must be performed for 20 seconds at each step.
In addition, when leaving work in the morning and evening, all staff members use the spray we developed ourselves, inhaling interferon in the digestive tract as a preventive measure. If a small amount of the virus is inhaled, interferon can suppress the virus. We use it as a pre-exposure prevention.
We also have a P3 biosafety laboratory for nucleic acid amplification. Environmental sampling is conducted every three days, including sampling of contaminated areas in the ward, such as the floor, bedside, and handles, as well as semi-contaminated and clean areas. All medical staff are also sampled for throat swabs every three days.
Even in the clean area, personal protective measures must be taken when eating, having meetings, and discussing. Eating together and not wearing masks are not allowed. Medical staff work in shifts, with single rooms and fixed schedules, to minimize the possibility of cross-infection in rest areas.
For medical staff who come to assist from other hospitals, some of them come from comprehensive hospitals and may not have a concept of infection control. We provide training and strict supervision of dressing and undressing.
"From a clinical perspective, we don't talk about turning points, we take the end of the epidemic as the criterion"
Onion Peeling: In recent days, there have been outbreaks of infections in prisons in various parts of the country. Are there any other places that we may have overlooked where such situations may occur?
Lu Hongzhou: Some construction sites, especially construction sites, are easily overlooked. The workers themselves may not have received sufficient training and may not have adequate personal protective equipment, especially those who are reluctant to use such protective equipment.
Onion Peeling: For mega-cities like Beijing and Shanghai, what level of prevention and control should be achieved in the future?
Lu Hongzhou: At this stage, occasional outbreaks may occur in some places, so we should be more strict and "overdo" it. Otherwise, if outbreaks occur from time to time in different places, and we keep sounding the alarm and repeating the process, it will take too long and affect the national economy.
Onion Peeling: Everyone is discussing the turning point. How do you define the turning point, and when do you think it will occur?
Lu Hongzhou: From a clinical perspective, we don't talk about turning points, we take the end of the epidemic as the criterion.
The World Health Organization has a standard: if a country or region has no new cases for two consecutive longest incubation periods, it can be completely lifted. For example, in the Shanghai area, if there are no new cases for two consecutive longest incubation periods, restrictions can be lifted, and isolation and masks will no longer be necessary.
Onion Peeling: Some experts have talked about the need to be prepared for long-term coexistence with the novel coronavirus, as it may become a virus similar to the flu. Do you agree with this?
Lu Hongzhou: I don't think so. The host range of the flu is very wide, including humans, birds, and some wild animals. For example, even if we control the transmission among humans, other animals can still transmit the virus to humans, so the flu will coexist with humans in the long term and will continue to exist in the future.
However, the novel coronavirus is not as widespread globally as the flu. The known hosts of the novel coronavirus are humans and possibly a few animals such as pangolins, although the source has not been clarified yet. It has been confirmed that poultry and livestock will not be infected.
This time, we have made a concerted effort to contain the virus and cut off the source of transmission, so it will disappear. Of course, if the source is not found, it may reappear in the future. But for now, it is unlikely to spread like the flu, which accompanies humans on a long-term and widespread basis. This is my personal opinion.
Patient with COVID-19 discharged from the Shanghai Public Health Center.
There is room for improvement in the infectious disease reporting system
Onion Peeling: The Shanghai Public Health Center participated in the early prevention and control of the Wuhan epidemic. Can you talk about the process?
Lu Hongzhou: On January 5th, the Shanghai Public Health Center submitted a formal report. From the perspective of public health, our scientists and managers did what we needed to do.
Our sample sources were legal and reasonable, and we did the work. After the discovery, we promptly and urgently reported according to the relevant regulations because it was a major issue. We did what we needed to do.
I can only describe the process as "heart-stopping". But we made the right choices, made the right decisions, and did what we needed to do. The report was stamped with the official seal of our unit, not just a casual report. This shows our level of importance, including the subsequent reports. But unfortunately, things that shouldn't have happened still happened. I believe that history will eventually have an objective and fair judgment.
Onion Peeling: Through this epidemic, what suggestions do you have regarding the monitoring and reporting of newly emerging infectious diseases?
Lu Hongzhou: There is room for improvement in the infectious disease reporting system. The country will definitely increase efforts to improve the public health field, including legal and management aspects. After SARS, this is a bigger price to pay, and it should not happen again.
My personal suggestion is to be scientific and transparent. Chairman Xi Jinping said it very well, the lives and health of the people are the most important. Infectious diseases are collective events, and we cannot always use the excuse of avoiding social panic to delay timely and transparent communication. If the people don't know, they won't take measures, which will increase transmission. Only with open and transparent information, letting the people know, can we avoid transmission.
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