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The new coronavirus infection will be adjusted from "Class B tube" to "Class B tube"
from January 8, 2023.
After the policy adjustment, how to effectively prevent the run on medical resources? How can severe disease and death be reduced? The joint prevention and control mechanism of the State Council invited relevant experts - Jiao Yahui, Director of the Department of Medical Administration of the National Health Commission, and Guo Yanhong, Director of the Department of Medical Emergency of the National Health Commission, to interpret
it.
Q: After "Class B and B pipe", how to effectively prevent the run on medical resources? How can severe disease and death be reduced?
Jiao Yahui: Recently, the demand for diagnosis and treatment in fever clinics has increased rapidly, and the contradiction between supply and demand has become more prominent
.
We have taken a number of measures to meet the needs
of our patients.
In general, the growth rate of demand for general outpatient and inpatient medical services is relatively stable, and the utilization rate of the entire medical resources is in a safe and controllable range
.
First of all, further expand medical resources and increase the supply of
medical services.
We require hospitals above the second level and primary medical and health institutions with the conditions to set up fever clinics or fever consultation rooms, equipped with sufficient medical forces
.
As of December 15, more than 15,000 fever clinics had been opened in hospitals above grade II nationwide, and more than 35,000
fever clinics or fever clinics had been set up in primary medical and health institutions.
The process of fever outpatient visits has been further simplified, providing convenience for patients to prescribe drugs and further improving service efficiency
.
Beijing, Shanghai, Anhui, Jiangsu, Shandong and other places have used Fangcang hospitals, gymnasiums and other facilities to open temporary fever clinics, which has greatly alleviated the problem of
fever patients.
All localities are upgrading and transforming designated hospitals and sub-designated hospitals as required, expanding and transforming the critical care resources of hospitals above the second level, and doing a good job in the preparation, equipment and training of intensive care beds and convertible ICUs in tertiary hospitals.
We have established a daily scheduling system to coordinate the preparation and use of medical resources across the country every day
.
The second is to promote graded diagnosis and treatment
.
In urban areas, medical alliances are used as the carrier, and county medical communities are used as the carrier to promote the implementation of new coronavirus infection and other medical services graded diagnosis and treatment
.
Give full play to the positive role of the three-level medical and health service network in urban and rural areas, and medical institutions should perform their own duties and responsibilities
.
Primary medical institutions mainly implement residents' health monitoring, especially health monitoring and health management of key populations; Secondary hospitals provide technical, manpower and other support for the grassroots to meet the needs of general diagnosis and treatment; Tertiary hospitals focus on meeting the diagnosis and treatment needs of
critically ill patients.
The third is to vigorously promote Internet medical services
.
Through Internet medical treatment, according to the diagnosis and treatment plan and home treatment guidelines, patients with new crown symptoms are prescribed accordingly, and corresponding drugs
are provided through offline third-party delivery.
We require medical institutions to provide 24-hour online consultation, medication guidance, and time-based appointment services
.
In this way, the instantaneous peak of medical visits in medical institutions is reduced, the gathering of people is reduced, and the risk of
cross-infection during offline visits is reduced.
The fourth is to strengthen the guarantee
of drug supply through multiple channels.
Relevant departments are strengthening the production, distribution and supply of new crown-related therapeutic drugs, so that more patients can obtain drugs through multiple channels such as retail pharmacies and Internet drug purchases, reducing the pressure of
diagnosis and treatment in medical institutions.
Fifth, primary medical and health institutions manage and monitor the health of high-risk groups such as the elderly, carry out hierarchical management according to different health conditions, and promptly refer them to medical institutions with corresponding diagnosis and treatment capabilities once changes in health conditions are found to prevent the occurrence
of severe diseases to the greatest extent.
Sixth, strengthen vaccination, especially vaccination of the elderly, to reduce the risk of
severe disease and death after infection in the elderly.
Q: What responsibilities will medical institutions assume after the policy adjustment?
Jiao Yahui: After "Class B and B tube", all types of medical institutions at all levels must admit nucleic acid positive patients, and adopt graded and classified treatment according to the patient's diagnosis and treatment
needs.
Medical institutions no longer triage patients based on negative or positive nucleic acid, but seek medical treatment according to the patient's diagnosis and treatment
needs.
We have placed greater emphasis on the positive role of urban and rural three-level medical and health service networks, and required medical institutions to implement their own functional positioning
.
Simple asymptomatic infection of the new crown and mild cases, take home isolation or home self-care
.
Infected patients with stable conditions, such as common cases, are referred to sub-designated hospitals for treatment
.
Severe and critical cases with new coronary pneumonia as the main manifestation are referred to designated hospitals for treatment
.
Severe and critical cases with other diseases, as well as other patients who need to go to the hospital, regardless of whether the nucleic acid is positive or not
, can go to the corresponding general hospital or specialized hospital.
We have deployed healthcare organizations to further adapt and optimize service processes
.
In the outpatient area, the nucleic acid positive diagnosis and treatment area and the nucleic acid negative diagnosis and treatment area should be divided into the corresponding patients
.
The emergency area is required to be divided into normal care areas and buffer zones
.
Set up relatively independent areas (campuses, buildings, wards or wards) in the inpatient department to admit nucleic acid-positive patients
.
We require medical institutions to strictly implement the first diagnosis responsibility system and the emergency and critical illness rescue system, and must not shirk or refuse treatment to people infected with the new coronavirus for any reason, so as to meet the medical needs
of patients.
Q: How is the readiness of inpatient beds, intensive care beds and intensive care equipment in China?
Jiao Yahui: In terms of bed resources, the total number of beds in hospitals above grade II in China is 5.
616 million, and the bed utilization rate has fluctuated
around 60% recently.
The total number of intensive care medicine (including comprehensive ICU and various specialty ICU) beds in China has reached 150,000, about 10.
6 beds per 100,000 people, including 112,000 intensive care beds in tertiary medical institutions
.
In terms of usage, the overall utilization rate of intensive care beds has fluctuated
between 55% and 60% recently.
In addition, the national reserve of "convertible ICU" beds is 70,000.
In terms of treatment equipment, there are 151,100 hemodialysis units, 19,700 bedside hemofiltration machines (CRRTs), more than 2,300 extracorporeal membrane oxygenation devices (ECMO), 116,000 invasive ventilators, 76,600 non-invasive ventilators, 971,200 monitors and 38,200 high-flow oxygen inhalation meters
.
According to the development of the epidemic, we will continue to strengthen surveillance, adapt measures to local conditions and expand corresponding resources, and ensure the people's medical needs
.
Q: After "Class B tube", what adjustments will be made to nucleic acid testing? When is it necessary to do nucleic acid testing?
Jiao Yahui: After "Class B tube", regional nucleic acid testing
will no longer be carried out.
First of all, nucleic acid testing is a means used by medical institutions for diagnosis, and nucleic acid testing
can be used when patients need to be clearly diagnosed.
Secondly, for places where vulnerable people gather such as nursing homes and welfare homes, nucleic acid testing is a means of
health monitoring for staff and service recipients.
Third, for key places such as large enterprises, nucleic acid testing can be used as a monitoring method
.
Other personnel can choose nucleic acid testing or antigen testing
by themselves.
The comprehensive group of the joint prevention and control mechanism of the State Council has also stressed many times that all localities should keep the number and scale of nucleic acid sampling points unchanged for a period of time to meet the needs
of nucleic acid testing such as willing inspections and key places, key institutions, and key populations.
At the same time, in the process of nucleic acid detection, it is necessary to gradually reduce mixed sampling and testing, and adopt the method of single apheresis and single detection to ensure timely feedback of nucleic acid test results
.
Q: How to achieve graded and classified admission of patients? What kind of patients go to what kind of hospital?
Jiao Yahui: Relying on the grid-based medical consortium, including urban medical groups and county medical communities, we have built a hierarchical diagnosis and treatment service network for new coronavirus infection with hierarchical management and categorical admission, and provided systematic and continuous graded diagnosis and treatment services
for people infected with new coronavirus infection 。 All types of medical institutions at all levels in the medical alliance have their own functional positioning to meet the needs of patients: primary medical and health institutions mainly do a good job in population health monitoring and health management, especially for the elderly who are at high risk of severe disease such as underlying diseases; The secondary hospitals in the medical alliance mainly provide technical support to improve the ability of grassroots doctors to identify, diagnose and deal with high-risk groups, and at the same time do a good job in the diagnosis and treatment of common and frequent diseases of residents.
The leading tertiary hospital within the medical alliance is responsible for the treatment of acute and critical patients, and provides a green channel
for the elderly under primary health management when their condition changes and need to be treated.
For patients infected with the new crown virus, if it is a simple new crown infection, asymptomatic or mild infection without serious underlying diseases, home isolation treatment
is adopted.
In general, from the current epidemic prevention and control situation and the characteristics of new crown virus mutations, the vast majority of people infected with new crown virus do not need to go to the hospitalPurchase medicines through Internet medical treatment, retail pharmacies or online pharmacies, etc.
, and do a good job of home treatment
in accordance with the home isolation treatment guidelines.
Community health service centers and township health centers may provide guidance
if necessary.
For ordinary cases, elderly people with serious underlying diseases but stable conditions can go to sub-designated hospitals; Severe and critical cases with new coronary pneumonia as the main manifestation are concentrated in designated hospitals; Severe and critical cases with underlying diseases, as well as patients with other disease needs, even if they are positive for nucleic acid or antigen, can go to the corresponding general hospital or specialized hospital for normal treatment according to the corresponding diagnosis and treatment
needs 。
Q: After "Class B and B pipe", how does the three-level urban and rural treatment network play a role?
Jiao Yahui: The comprehensive group of the joint prevention and control mechanism of the State Council has successively issued relevant work plans, guiding local governments to use medical alliances as the carrier to build a systematic continuous, hierarchical management, classified admission of new coronavirus infection graded diagnosis and treatment service network, make every effort to ensure the timely treatment of infected people with high serious risk such as elderly combined with underlying diseases, reduce the rate of severe disease and mortality to the greatest extent, ensure the smooth progress of the treatment of new crown virus infection, ensure the development of normal medical services, and meet the needs of the people for medical treatment
。
The first is to plan several grids horizontally in prefecture-level cities and counties, and form one medical consortium within each grid to include all key groups such as the elderly into the scope of
services.
Establish a referral mechanism between the medical consortium and sub-designated hospitals, designated hospitals and tertiary hospitals, and realize the primary first diagnosis and orderly referral of patients with symptoms related to new coronavirus infection such as fever
.
The second is to give full play to the role of urban high-quality medical resources, in accordance with the principle of zoning and based on the counterpart assistance relationship between urban and rural hospitals in the province, establish and improve the counterpart assistance mechanism between urban secondary and above general hospitals and county-level hospitals, and at the same time smooth the referral mechanism at the city and county levels to improve the ability
of severe treatment in rural areas.
The third is to give full play to the positive role of grassroots medical and health institutions, strengthen health monitoring for special personnel such as the elderly with underlying diseases in their jurisdictions, especially in rural areas, and implement health management
according to the level of health risks.
It is necessary to give full play to the supporting role of hospitals above the second level in the medical alliance, and improve the ability
of grassroots doctors to identify, diagnose and deal with high-risk groups.
The fourth is to clarify the hierarchical diagnosis and treatment process and strengthen the hierarchical and categorical admission
.
If the situation is urgent, you can go directly to a medical institution with the corresponding diagnosis and treatment capacity
.
If the patient does not have the conditions for referral, the counterpart hospital will guide the treatment
through remote or dispatch an expert group.
Q: Are the medical institutions' reserves and supplies of relevant drugs adequate? Can it meet the patient's medication needs?
Guo Yanhong: Whether people infected with the new coronavirus are treated at home or hospitalized, drugs are indispensable
.
Therefore, the preparation of medicines is crucial
.
On the one hand, it is necessary to ensure that the supply of medicines is sufficient, and on the other hand, it is necessary to ensure fair access, so that the people can obtain medicines
in a timely and convenient manner.
In order to ensure the use of drugs by medical institutions, we have made arrangements for the preparation of drugs in medical institutions, requiring medical institutions at or above the county level to dynamically prepare symptomatic treatment drugs such as traditional Chinese medicines, anti-new coronavirus small molecule drugs, antipyretic and cough drugs for the treatment of new coronavirus infection according to the daily usage of 3 months; Primary medical and health institutions dynamically prepare relevant traditional Chinese medicines and symptomatic treatment drugs according to 15% to 20% of the population served, and increase
them in densely populated areas as appropriate.
With the recent increase in the number of patients, the demand for drugs has surged, and there has been a shortage in some places and some varieties
.
Relevant departments are doing everything possible to promote the rapid expansion of production capacity and production of enterprises, increase the market supply of key drugs such as related traditional Chinese medicines, symptomatic treatment drugs, and anti-new coronavirus small molecule drugs, and give priority to ensuring the demand of medical institutions, so as to alleviate the shortage of
drugs in medical institutions in some areas as soon as possible.
Rational and safe drug use is also very important
.
We require medical institutions and medical personnel to vigorously strengthen the popularization of drug knowledge, adopt various forms to strengthen guidance for the use of drugs by the masses, and ensure the safety of
the masses' medication.
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