-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
After Beijing, Shanghai's peak of infections
followed.
As in Beijing, the number of critically ill patients has increased sharply under the huge infection base; Unlike Beijing, or even more serious, the situation is that Shanghai is the most aging city in the country, and the elderly are the main group
of people who are critically ill with the new crown.
of people who are critically ill with the new crown.
Zhang Wenhong, director of the Department of Infection at Huashan Hospital affiliated to Fudan University, a trusted Internet celebrity doctor during the epidemic, said that Shanghai has reached a peak state of infection since December 22, and according to estimates, the number of infected people is currently tens of millions
.
The peak has not yet passed
.
In early January, at Huashan Hospital, where Zhang Wenhong worked, the emergency hall was filled with steaming heat every day because it was crowded and scorched
.
.
The two men stepped forward one after the other, almost clamping an old man with their bodies, and while carefully moving through the crowd, they shouted "Let one, let one!" Thank you! The old man in the middle was like a stump that had lost its roots, his eyes swaying
back and forth between the chests of the two men with his eyes closed.
It is clear that the old man can no longer stand independently and is confused
.
On the other side, a 65-year-old daughter is fighting for her father's "right to oxygen" — a typical pure old family, not uncommon
in Shanghai.
The father lay on the hospital bed, huffing and exhaling heavily
.
While comforting her father, the daughter urged her husband to pay attention to the vacant oxygen inhalation position
.
It happened that a hospital staff member passed by and was pulled by her: "Master, please
.
" My dad said he had chest tightness and couldn't breathe, can you help us find a place for oxygen? ”
in Shanghai.
"We don't have any extra space
here.
You see where the people just left, you have to grab
it yourself.
The staff member replied
.
However, the woman did not stop pleading
.
Probably considering that the family members are also elderly people with reduced mobility, the staff promised to help ask
.
After some time, he led the woman from the hall to the infusion room
.
In a corner with an oxygen interface, the staff adjusted the position of another patient's bed, and the two worked together to squeeze the old man in
.
The emergency department of Huashan Hospital uses wall-mounted oxygen inhalation equipment
.
A hose connects the oxygen system in the wall to the patient's nasal passage
through an interface on the wall.
The device is fixed and cannot be moved
.
"Some severely ill elderly people are frail and need to lie on makeshift beds, which sometimes block the access
to the wall.
There is not enough space, so we can only prioritize
according to the patient's criticality.
The above staff member said
.
In the emergency area of the Huashan crowd, the dense crowd is like the annual rings of a tree, and each circle marks people with different levels of health
.
The innermost circle is the consultation room, where the doctors are working at full capacity; Outside each clinic, there is a group of family members of patients who have nowhere to sit; Further out is the waiting seat, on which are sitting patients undergoing infusions, mostly young people and elderly
people with milder symptoms.
The outermost circle is a sea of elderly patients: in the hall, in the corridor, in the infusion room, in the rescue room, there are old people
lying flat on the hospital bed everywhere.
And the rescue room may be the last place
to pull them along.
Shanghai has always been the most aging city
in China.
According to the seventh population census, the population aged 60 and above in Shanghai accounts for 23.
4%
of the total population.
At the same time, it is the first city in the country to enter the elderly population structure, and it is also the first city
to practice the elderly medical service network.
As early as 2003, Shanghai introduced a community general practitioner system, aiming to alleviate the problem
of chronic diseases that gradually increase with the increase of the aging population.
At the same time, the elderly have become the bullseye of critical illness, which is a great test of the upper limit of the local medical level, of which the third-class hospital is an important dimension
.
In fact, Shanghai has 32 third-class hospitals, ranking among the highest in the country
.
in China.
。
So can Shanghai's medical resources and experience in solving the aging problem save the elderly in the vortex of the epidemic more?
-01-
-01-The helplessness of a tertiary hospital
The helplessness of a tertiary hospitalIn the bustling emergency hall of Huashan Hospital, family members watched the elderly people who were gradually falling asleep on the hospital beds and began to talk to strangers in similar situations next to them to dispel the fatigue
of standing for a long night.
Some commonalities slowly emerged in the conversation, first of all, many seriously ill elderly people had not been vaccinated
against the new crown because of underlying diseases.
These common underlying diseases include: diabetes, coronary heart disease, tumors, etc.
, and most of the elderly have 2-3 underlying diseases
.
against the new crown because of underlying diseases.
"Before we let go, we went to the hospital to consult a doctor
.
The doctor believes that there are too many underlying diseases in our elderly, although they are not too serious, but vaccination may have a serious immune reaction
.
Coupled with the fact that the elderly usually go out less, they are not vaccinated
in the end.
A family member of the patient mentioned
.
This immediately aroused the echo of the people around us, "We didn't even ask the doctor, because our elderly people have been doing chemotherapy for prostate cancer, and their bodies are particularly weak
.
" We instinctively feel that we should not vaccinate
him when his immunity is so weak.
Another family member sighed reproachfully
.
According to the Shanghai Municipal Health Commission, there are 490,000 cancer patients in the city, with a prevalence rate of 3%.
The aging population of Shanghai is the leading cause of the increase in cancer rates, with the average age of patients being about 65 years old
.
The prevalence of underlying diseases has raised concerns among families about adverse reactions to vaccination in the elderly
.
Coupled with the fact that most elderly people have limited mobility or even bed rest, families believe that they are less at risk of contracting the new coronavirus
.
A series of reasons make the elderly lack vaccine protection, and even the phenomenon of "the lower the vaccination rate among the poorer the elderly", thereby increasing the risk of
developing critical disease.
developing critical disease.
In the Shanghai epidemic last spring, nearly half of the severely ill patients were over 80 years old, but the vaccination rate for the severely ill was only 3.
6%.
Older people over 80 account for 67% of deaths, but the vaccination rate is only 1.
3%.
In addition to the low vaccination rate of the new crown, there is also a common point that the elderly are not cured
for a long time after being infected with the new crown.
In many cases, the critical symptoms of the elderly do not erupt immediately, but gradually worsen.
After going to multiple hospitals and trying a variety of ways to send to the hospital, some people finally chose the emergency department
of the top three like Huashan Hospital.
Patients and their families generally believe that compared with some first-level and second-level hospitals, tertiary hospitals are more effective
in treating the seriously ill elderly.
"We started out at a community hospital, but all we could do was hang water and prescribe fever-reducing medicine
.
The old man's condition has been deteriorating and he was sent to the emergency room in the early hours of this morning
.
After coming, the doctor prescribed us antiviral, globulin, and hormone drugs, and after using it for a day today, the old man had the strength to sit up
.
A family member said
.
At this time, ten days
had passed since his mother tested positive for the antigen.
It cannot be denied that some timely rescue time
has indeed been delayed before.
Some doctors believe that it is best to choose emergency treatment for severely ill elderly patients when referring to the way of medical delivery
.
"Rather than sending themselves to the hospital, it's better for families to call an ambulance
.
" Because the hospital stipulates that ambulances and emergency departments need to hand over patients within fifteen minutes, the process is faster
than the patients they send themselves.
”
But whether it is to send themselves to the hospital or call an ambulance, for most families of the seriously ill elderly, as long as they go to the third-class hospital, they will face a run on resources
.
Families of patients generally report that the current queue for an ambulance is 200-300 people, and the waiting time is about
4-6 hours.
Because of the difficulty of breathing caused by the new crown, and most families do not have their own oxygen equipment, the elderly cannot take a car to the hospital
for a long time.
Even if their bodies can afford to drive to the third-class hospitals in the district, after arriving at these crowded hospitals, the long queues in registration, triage, and waiting for treatment often "dissuade" these already very weak elderly people and their families
.
Crowded emergency room of Huashan Hospital
"Originally, we had already hung up the outpatient number of a hospital, but the old man sat outside the clinic for ten minutes, and he felt very uncomfortable and could not support it
.
In the end, we called 120 to the emergency room and sent to the nearest hospital to get oxygen
.
A family member said that before receiving treatment, the blood oxygen saturation of the elderly in his family was as low as about
85%.
The respiratory department and infectious disease department of Huashan Hospital have a good reputation
in Shanghai and even the whole country.
Like other tertiary hospitals, the problems of medical infection and insufficient medical resources will become more and more apparent, which may lead to patients not being able to seek medical treatment
in time.
in time.
"Doctors in Huashan Hospital fall every day, and the hospital does not know if the doctors will not be able to go to work
the next day because of a sudden fever.
When the condition of the elderly was not so serious, we made an appointment for the respiratory clinic, but on the day of the visit, we were notified that the registration was canceled
.
Seeing that the old man's illness could not be delayed, he came to the emergency room
.
The patient's family believes that this uncertainty will affect the course and condition
of the elderly.
A doctor at Huashan Hospital said that the situation described by the family members of the patients basically occurred in
the registration of specialist clinics.
Although the infection rate of medical care in general outpatient clinics is very high, it can still ensure a certain proportion of doctors on the job and the number of
patients received.
"Doctors have just turned negative and returned to work
.
Now everyone is seeing three or four patients, and they need to come out to sit and breathe, and their bodies are really unbearable
.
The above-mentioned doctor introduced, "Usually when we encounter unreasonable patients, we still have the strength to argue two sentences
.
Now I really feel like I don't
even have the strength to speak.
”
.
Now everyone is seeing three or four patients, and they need to come out to sit and breathe, and their bodies are really unbearable
.
”
The dermatology department where this doctor works is the ace department of Huashan Hospital, with many doctors and patients, so it is also one of
the earliest departments for medical infection.
According to the dermatologist's recollection, it was first on December 10 that there were two positive
cases among the department doctors.
After that, 80-90% of doctors have developed symptoms
of the new crown.
In the past week, doctors have begun to gradually return to work, and the current attendance rate can reach about
30-40%.
Admission of new crown patients has become the focus
of all departments of Huashan Hospital.
"Every department will send doctors to support the emergency department
.
At present, the dermatology department has 5 support staff
, which belongs to the first echelon.
By the end of December, the inpatient department of the dermatology department also began to admit patients with severe new crown disease, and the admission
of patients in the department was suspended.
The doctor said
.
According to another emergency department doctor at Huashan Hospital, the number of daily emergency consultations has increased by 3-4 times compared to the past, and nearly eighty percent of them are elderly
.
Tertiary hospitals in Shanghai are struggling to cope with the spike in infections and severe disease – a geriatric center that is ready to open has been temporarily used as a designated hospital for the new crown, and all the internists working there are treating new crown patients
.
-02-
-02-In crowded district hospitals, infusion patients all flock to the emergency department
In crowded district hospitals, infusion patients all flock to the emergency departmentThe plight of Huashan Hospital, a well-known tertiary hospital, also exists in other secondary and tertiary hospitals in Shanghai, especially in the district central hospital
with the highest degree of aging.
with the highest degree of aging.
The night before New Year's Day, Putuo District Central Hospital could see crowding and chaos
from outside the emergency room.
A delivery guy was crouching in front of the emergency room, stacking fruit and food on the ground, and he couldn't get through to the person who ordered the delivery
.
People with anxious faces stood outside the door, they were no longer sensitive to "positive" and ripped off their masks to breathe
.
Push open the emergency door, and the crowding inside is beyond imagination, with a makeshift hospital bed
parked in any place that does not block the road.
The security guard sat at the door so tired that he couldn't make a sound, and the nurse at the pre-screening table no longer asked if the patient was positive, and when he heard the patient cough, he handed a pink medical pre-test slip
.
With this pink note, people who came to see the emergency department lined up
in the internal medicine.
On the corridor leading to the emergency internal medicine department, the crowd is divided into four groups, and on both sides of the corridor are hospital beds, most of the people lying on the beds are 120 patients, mostly elderly
people.
Even with oxygen, many patients still breathe hard with their mouths open, "We waited for a few hours two days to call (120), and you can't live in these days
.
" A family member of the patient said
.
In the middle of the corridor is the people in the emergency room, and the other is reserved for the medical staff and those
coming out of the emergency room.
There are only 3 doctors in the emergency internal department, but there are hundreds of people in the queue, and the queue is endless
.
Most of the people in the queue are middle-aged and elderly, and they have to stand and queue for nearly four hours to see the doctor
.
When you see a doctor and then open a check-up and then re-queue
.
If a person wants to go to the emergency department late at night on December 28 to be treated, he or she needs to wait as little as five hours and as much as eight hours
.
Emergency corridor of Putuo District Central Hospital
Recently, Putuo District Central Hospital was one of
the 2 district-level hospitals with the most pick-ups in the 120 pick-up areas of downtown Shanghai.
Since December 26, the hospital's emergency department has been scheduled to 1600, which is nearly four times
higher than the previous number of visits.
Previously, for most Shanghainese, Putuo District Central Hospital was not the first choice for sick consideration, they would go to the community hospital to get medicine for minor and chronic diseases, and they had to go to Zhongshan Hospital and Ruijin Hospital for major problems
.
The reason for this crowding is that Putuo District, where the hospital is located, has an aging degree of 41.
7%, ranking third among all districts in Shanghai, but the hospital resources are not as rich
as Huangpu District and Hongkou District.
In contrast, Putuo District Central Hospital, as one of the few large hospitals in the district, has to carry greater emergency peak pressure - critically ill elderly people lying in 120 ambulances, like a tidal wave
.
7%
The emergency department of Putuo District Central Hospital is doing its best to support
it.
There are almost all 40 nurses on the first floor of the emergency room, almost all of whom have been infected, but they cannot rest because the emergency patients are very anxious, and the queue of people breaks out into quarrels from time to time
.
Most of the hundreds of people in line were elderly, most of them had underlying medical conditions, many of whom had been diagnosed with pneumonia
.
Pneumonia patients also include some young people
.
Wu Qian (pseudonym), who is in her 30s, brings her own small bench
.
Three days after the onset of symptoms, she noticed that her cough was getting worse
.
She was diagnosed with pneumonia in the outpatient clinic, but because the outpatient clinic could not receive fluids, she had to come to the emergency room again to queue up
.
Another family member of a brain tumor patient said that because the outpatient clinic could not receive infusions, and the emergency department could only prescribe medicine for three days, they had to come to the clinic and queue up again every three days
.
She said that the current infusion has to wait for an hour or two, and it is estimated that the position of the infusion will be more tense
in a few days.
Opposite the emergency internal medicine department, the atmosphere in the emergency room is more tense and depressing, and many patients who are constantly being pushed in seem to be in critical condition
.
Relatively speaking, the proportion of critically ill patients in the emergency department is much smaller than that of general patients
.
But a week or two after the first wave of new crown infection, severe diseases will follow, the proportion will gradually increase, medical resources, including oxygen, will become very tight, and triage will become very necessary
.
If the pre-screening unit can be triaged in the front link, the maximum pressure will not all flow to the doctor, and the doctor will have more time to deal with critically ill patients
.
-03-
-03-Lack of triage, desertion of community hospitals
Lack of triage, desertion of community hospitalsAccording to public data in the past two years, in Shanghai, the number of elderly people aged 80 and over and the number of tertiary medical institutions are 838,800 and 55, respectively – that is, an average of 15,000 elderly people aged 80 and over share the resources
of one tertiary hospital.
When the elderly became the main medical population in the epidemic, the crowding of their hospitals can be seen
.
So, what is the situation and role of community hospitals, which should be tertiary hospitals to triage patients?
What is the situation and role of community hospitals, which are supposed to be tertiary hospitals to triage patients?The scene of the Kangjian Street Health Service Center in Xuhui District is in stark contrast
to the crowded Huashan Hospital.
During the day, there were three or four elderly people sitting sparsely in the infusion room, the same number as the medical staff
.
At about seven o'clock in the evening, the hospital was empty, and only the registration window of the fever clinic was still lit
.
Next to the gate, two staff members in protective suits are guarding five cardboard boxes
containing medicines.
The distribution of medicines is the only medical service
available at nighttime community hospitals.
"At present, there are only five medicines, all of which are used to reduce fever, cough, and phlegm
.
" The staff next to him said
.
In addition to the tight supply of medication, the weakness of community hospitals in the face of the seriously ill elderly is also reflected in
the lack of testing methods.
Not long ago (December 26, 2022), Peking Union Medical College Hospital released a reference plan for the diagnosis and treatment of new coronary pneumonia in the Department of Respiratory and Critical Care Medicine, and the necessary examination items for patients infected with new coronavirus are: vital signs, electrocardiogram, blood gas analysis, blood routine, coagulation, D dimer, liver function, renal whole, LDH, CRP, ESR
.
The staff of the Health Service Center mentioned that at present, hospitals can only do blood routine examinations, which is not enough for people with a higher risk of
severe disease.
"If the elderly have obvious symptoms, we recommend that it is best not to send them to a community hospital
.
Although it is relatively close to home, we really do not have the ability to judge his specific symptoms, let alone symptomatic treatment
.
”
severe disease.
At the same time, the staff member also suggested that the elderly should contact their family doctor
as soon as possible after being infected with the new crown.
In some cases where emergency medical evacuation is required, a family doctor can contact the ambulance centre to obtain a certain priority
.
.
At the Jiuting Town Community Health Service Center in Songjiang District, the scene is similar: the hall of the fever clinic has been turned off, and only one doctor on duty is sitting in front of
the computer.
In addition, only an elderly couple supported each other and was staggering towards the exit
of the hospital.
They had just developed a fever and came to the hospital to get some fever-reducing medicine and were ready to go home
.
"Rural hospitals like ours (Songjiang District on the outskirts of Shanghai) have problems even with the supply of
medicines.
" The doctor on duty said, "
The amount of medicine during the day is quite sufficient
.
Although it is often not enough, it can be sent over temporarily; But at night, the types and quantities of drugs are generally few, and they cannot be replenished
.
”
At the same time, the doctors of the Kangjian Street Health Service Center also reported that at present, only simple infusion services
can be provided for new crown patients in the hospital.
"We can only hang antibiotics, and even antibiotics arrived urgently yesterday, and they were almost used up before
.
"
According to the Shanghai Municipal Health Commission, various community health service institutions in the city have used 2,594 fever clinics, and fever diagnosis and treatment drugs are tilted towards the community to ensure that residents' needs for fever diagnosis and treatment are met nearby
.
Judging from the above doctor's description, the pressure on drug supply in some community hospitals has not been completely solved
.
"At night, we just give medicine to patients, and during the day, at most
, we can get infusions.
Therefore, all the people who come to our hospital are young people, and the elderly still have to be sent to large hospitals above the second level for observation and treatment
.
The doctor advised
.
-04-
-04-The existential crisis of P drugs: seeking and mismatching resources
The existential crisis of P drugs: seeking and mismatching resourcesAfter getting Paxlovid (hereinafter referred to as P medicine), Luo Ru (pseudonym) immediately came to Shanghai Hongqiao Station
.
She boarded the high-speed train back to her hometown on the evening of January 3, hoping to deliver the medicine to her mother in the shortest possible time
.
She works in the pharmaceutical-related industry and has recently been keeping an eye on the information of
P drugs.
Not long ago, she opened a box
from an international hospital in Shanghai through a classmate.
The new crown vaccine and oral medicine have been regarded as two axes to provide protection for people at higher risk of severe disease
.
When the vaccination situation of the elderly is not optimistic, the new crown oral medicine has become an important line
of defense.
of defense.
By January 9 this year, more community hospitals in Shanghai had P drugs, but the number was small
.
The doctor of the Kangjian Street Health Service Center said: "At present, there are many patients who are eligible for receiving medicine, and there are not many P drugs left, which may not be available in the next two days
.
" ”
The doctor also said that the current prescription conditions for P drugs in hospitals are: elderly people over 70 years old, need a positive nucleic acid test certificate, as well as liver function and kidney function test reports, and the glomerular filtration rate needs to be greater than 30
.
At the same time, patients must have signed a contract with the community, and preferably provide their own chronic disease certificate, and submit it to the medical office for approval before prescribing drugs
.
From the beginning of this wave of the epidemic, Luo Ru began to prepare
for the return of medicine to her hometown.
Regardless of the hospital's guidelines for the diagnosis and treatment of the new crown, her mother — a 70-year-old man with diabetes and several stents in her heart — was identified as a high-risk group after the new crown infection, that is, the target group
of existing antiviral drugs.
After many studies, Luo Ru determined that once the population in this situation progresses to critical illness, even if the medical resources are abundant, it is likely to return to the sky
.
After getting her mother vaccinated with the fourth dose, Luo Ru bought azvudine
again.
At the same time, while dismissing her family to let her mother live alone, she went around buying P medicine
.
She wants to race against time and do her best to give her mother the most comprehensive medical support
.
After almost a month of preparation, on New Year's Day 2023, three days after her mother was diagnosed with the new crown and developed symptoms, Luo Ru finally bought P medicine
.
This is thanks to her classmate's work in an international hospital in Shanghai, which had said that P medicine had arrived in the hospital a dozen days ago, but many people went to prescribe the medicine and returned home
.
"Maybe it's luck, there just happened to be medicine
at that time.
" Luo Ru said that just two days ago, another friend of hers went to inquire, and the hospital was still in a state
where there was no medicine.
Luo Ru decided to take leave to deliver the medicine
in person.
After getting on the high-speed train, she found that her neighbor was also calling around to buy P medicine
.
After talking, she found out that this was a doctor practicing in Shanghai, rushing home to see her father
, who contracted the new crown and had progressed to severe disease.
The doctor blamed himself very much - the 75-year-old father had been infected a week ago, but his symptoms were mild, there were no underlying diseases, his blood oxygen was normal, his lungs were in good condition on CT, and he was busy with work, so he felt that his father could get through
it.
But the day before, his father's blood oxygen suddenly dropped to more than 80%, and after an emergency CT scan, he found that both lungs had been infected
.
And even as a doctor, he had a hard time finding a bed for his father in his hometown
.
So he decided to leave for his hometown immediately and personally treat his father
.
What made him most uncomfortable was that he had Azvudine in his hand, but he didn't send it to his father
a few days ago.
It is emotional that Luo Ru and this doctor are already people with medical professional information and resource advantages, but when facing the new crown crisis of the elderly at home, they rely more on luck to find medicine
.
Before getting out of the car, the doctor finally asked for P medicine and a bed
.
But the most suitable time to take this medicine is within 5 days after the start of infection, apparently, the optimal period for taking it has been missed
.
"This box of medicine may be wasted
.
" Luo Ru said, but in the face of the survival opportunities of his loved ones, this doctor has no choice
.
The tsunami of infection must be accompanied by a peak of critical illness, and the stronger the tsunami, the higher the
peak.
For the elderly, even if fully vaccinated, a large proportion of them are not immune enough to cope
.
Therefore, when the epidemic tsunami hit, the children of the elderly had to do their best to seek medical treatment for their parents
.
There are more than one wave of infections, and although we were at a loss when the first wave came, some experience can provide cases and guidance for future public health decisions: increasing the proportion of elderly people vaccinated and allowing sufficient COVID-related drugs and examinations to sink into community and village health centers will remain the top priorities
for building for critically ill patients in China in the future.
for building dikes for critically ill patients in China in the future.
