Interview with the first-line doctors of the United States against epidemic s: quarantine 2 weeks of re-work in the event of a storm, the outbreak platform period of hidden worries

TextsWang ChenProfessor of Respiratory and Critical Care at the University of Southern California Medical Center, and has been leading the new crown treatment at Nanga Hospital since MarchMeanwhile, he was quarantined for two weeks after the patient was found to be positive for the new coronavirusAfter returning to work in mid-April, Qiao was in charge of the intensive care unit of two hospitals, and had more than 50 new coronary critical lying cases, with only two deathsMay 26, a month and a half after Joe Renli, a professor of respiratory and critical conditionate at the University of Southern California Medical Center, returned to work after being quarantined for two weeks for failing to adequately protect patients with the new coronavirusAfterreturned to work, Joe was in charge of the intensive care unit of two hospitals, witnessing the entire process from the peak of the outbreak in Los Angeles, California, the second-largest area in the early years of the U.Soutbreak, from the peak of the outbreak to the "platform period."Over the past month, los Angeles has had a few hundred to one thousand new diagnoses a day, with fewer than 100 new deaths and fewer than 2,000 hospitalizationsComparing previous data, the outbreak has reached a "platform period"At the peak of the outbreak in late April, there were more than 20 critically ill patients on a ventilator at a hospital where Qiao was standingToday, there are only six seriously ill hospital patientsOf the more than 50 cases of new coronary critical illness managed by, the death toll was only two;medical staff from the beginning of the outbreak, every time to work like the battlefield, to now return to the pre-epidemic work stateAlthough the new corona epidemic in Los Angeles and throughout the United States today can be considered to have passed the peak, but let Joe's first-line doctors wonder that there are still thousands of new nucleic acid test positive cases in Los Angeles every day, no reduction;where the new infections come from in California, where strict home segregation, assembly cancellations, and the need to wear masks when they go out? Is nucleic acid testing expanded after screening out the stock of patients? Or is the virus still spreading?this reality, the next u.Sstates to resume work after the new crown outbreak will usher in another outbreak of the most uncertain factorOn March 18, Qiao renli participated in the rescue of a nasopharyngeal cancer patient, only to do general protection of him, for the patient after the end of intubation, only to get the patient's second new coronavirus test results: positiveAfter 14 days of isolation, in mid-April, he returned to the front line to manage the intensive care unit at Nanga Medical CenterJust returned to work was informed to go to a public hospital with a serious outbreak to take over the ICU ward, A doctor friend of MrQiao's in China, sent him some protective clothing used by Chinese doctors, which is like space suits, anti-virus, splash-proof, and can be used in the intensive care unitBut the public hospital managers refused to allow Joe to carry his own protective equipment, on the grounds that strict protective equipment would cause panic among other medical staff and patientsunsuccessful argument with the hospital, and finally obeyed the hospital's rules and went there in the intensive care unit to "fight the fire."a week after he had been supported, a new coronary patient suddenly suffered a haemorrhage in his digestive tractThree paramedics from the Qiao Manli treatment team went to the rescueThe patient was in critical condition and the pillow on the floor was covered with splattered bloodWith no shoe covers, the medical staff involved in the rescue had blood on their shoes with the virusDuring the rescue, one of the nurses was also sprayed with blood on her face - her mask could not protect her neck at all patient rescue is very successful, medical staff regardless of the risk of infection, the attitude of trying to rescue patients so that Joe li very moved, he will be the process written in English Just then, the local nurses' union was protesting against the lack of protective material sand at another hospital, which led to infection among the medical staff The story written by Joe's, to some extent, confirms that the hospital's inadequate consideration of the protection of medical staff is inadequate Joe's support for the hospital's management was so nervous that he was asked to talk to him and ask him not to go public with the incident, and the episode couldn't be stopped the article had a big impact Subsequently, a doctor launched a campaign to protect health care workers across the United States, in a very short period of time, the collection of 1 million signatures of health care workers the event also invited Joe, and the Los Angeles Times later asked him for an appointment, but he was not involved in the subsequent He didn't expect to get into trouble for talking about inadequate protection, but in order to stay on the front line, he chose to "make it all." He recalls: "There was a feeling of being humiliated, but I just wanted to save a few more patients and pull out a few more tubes." Of the more than 50 patients managed by Mr Qiao, two died One of the patients was infected with the new coronavirus, but the immediate cause of death was a haemorrhage caused by cirrhosis of the liver "This is not strictly a new crown death, but in statistics, it needs to be included." Joe li explained another death, which he thought could have been avoided The patient weighed about 500 pounds (226.8 kilograms) The care of obese patients is a great problem The patient has been oxygen-deprived, with a blood oxygen saturation of about 80% (at least 97% of the normal value), and half of these patients need to lie down in a special lying bed But the patient because of his weight, can not afford to put the rotating bed, ordinary bed is difficult to give him a tilt management, so his condition has not improved after admission to hospital, until death according to Joe's first-line clinical experience, the mortality rate for new coronary patients he received was less than 5% This figure is very different from the data he came into contact with in the early days of the outbreak at the beginning, like most American doctors, Mr Qiao's perception of the death rate for new coronary pneumonia came from data from Wuhan and New York, China, where, at the height of the outbreak, the mortality rate for critically ill patients on ventilators was as high as 70 percent and the lowest mortality rate was about 30 percent March 19, experts at the University of Washington reported in a study published online in the Journal of the American Medical Association (JAMA) that as of March 17, 2020, the mortality rate for patients with new coronary pneumonia in the study was 67 percent In late , a retrospective study published in The Lancet by several hospitals in Wuhan showed that 32 of the 52 critically ill patients in the sample (61.5%) died within 28 days of admission to the ICU high mortality data, at one point, joe was hesitant to decide whether to plug the patient why the mortality rate varies so much at different times when no new drugs and treatments are available? Qiao believes that the mortality rate of new crown patients and the shortage of medical resources is related "A significant proportion of patients die because of delays in treatment or poor care due to inadequate medical resources " "fortunately , los Angeles has not yet experienced a shortage of medical resources, even at the peak of new crown hospital admissions in mid-to-late April The hospital's intensive care unit, where Mr Qiao is based, has always had empty beds, and even at peak times, a quarter of the beds are empty bought the Los Angeles Times in February, the los Angeles Times of a bankrupt hospital, the hospital reopened after the outbreak began, dedicated to the treatment of new crown patients I thought it would be very soon to fill up, but the hospital was never full one of the longest-standing patients spent 49 days on a ventilator according to the general experience, no matter what causes of respiratory failure, as long as relying on a ventilator for two to three weeks, to give the strongest breathing support, if the patient can not withdraw, this to the limit of the disease, there is little hope of survival 14 days is a gateway for ventilator support, either to remove the narrowed tracheotomy fistula or to consider removing the treatment at the beginning of the , some of the new coronary pneumonia patients who were in critical condition were in critical condition when he first took over, and the patient had been suffering from respiratory failure for two to three weeks His decision was not to remove the ventilator as long as the heartbeat did not stop He recalls that there was only a vague feeling that if you gave up a patient, the death rate would be a little higher and the human battle with new coronary pneumonia would be lost Fortunately, the patients who decided to continue treatment at the time of the crisis survived patient, who had been on the ventilator for 49 days, was in his 50s with kidney failure At that time, the highest level of respiratory support was given, and after more than 20 days of inhaling 100 percent of pure oxygen, the oxygen saturation of the blood was only about 90 percent, and the condition had not improved at all The hospital ethics committee has spoken to his family about "abandoning treatment." But in the end, Joe decided to insist on treatment as long as the patient's condition did not continue to deteriorate with the support of a high-strength ventilator, doctors are most worried about the patient's lungs being broken The treatment team used a muscle loose agent to keep the patient's muscles loose to withstand the highest level of lung pressure Gradually, the patient began to improve, the oxygen concentration of the ventilator decreased, the oxygen saturation of the blood did not drop, the patient's kidney function also gradually restored, began to produce urine the day the patient pulled out the tube, Joe stood impressed On that day, a total of three patients pulled out the tube, the treatment team could not resist the excitement, in the ICU door holding milk tea photo of a relaxed strange photo, looked like on vacation The inpatients in the intensive care unit, from more than 20 at the height of the outbreak to only six now, did not make Qiao feel relaxed the new crown outbreak in Los Angeles, which first broke out in March in Hollywood's affluent neighborhoods, they usually travel to Europe, get a new crown when the outbreak breaks out in Europe and bring it back to the United States when the new corona outbreak in Los Angeles spread to the community, the largest number of infections were among the poor in the Mexican community More than 90 percent of the new crown patients in the local hospital are now Mexican One of the reasons for their high infection rate is that one person lives together, and more importantly, without attention to protection, even at the height of the outbreak, few people wear masks to Joe's bewilderment, the State of California has adopted the strictest quarantine measures in nearly a month, with Los Angeles still adding more than a thousand new corona-positive patients a day Although most of the positive patients tested during this time are mild or asymptomatic, this is still a cause for concern optimistic that L.A nucleic acid testing is much more efficient than before, and it's likely that the recent screening of patients who haven't been tested before in the early stages of the outbreak, testing reagents and the extraction of swallow swabs cotton rod shortage, testing methods backward, directly limit the number of tests, doctors rarely give patients to prescribe nucleic acid testing, patients need to meet a range of epidemiological conditions, such as whether to travel, whether from the outbreak of the hard-hit areas, testing is possible Even medical staff who need to do testing, nucleic acid test results often take about a week to come out But in the last month, people can do it as long as they have the need to do nucleic acid testing, and the results are often available the next day If this is the case, it is reasonable for the state government to consider the resumption of work But if the most stringent isolation measures, the positive patients are still newly infected patients, then the road to return to work will be full of the risk of re-emergence has entered the "platform period" of epidemic development in the United States, whether people can return to normal life, the final decision of the government is still a scientific, political, economic, social stability and other factors of the game of uncertainty.