On the premise of respecting science, home isolation needs to balance the epidemic curve, the carrying capacity of the medical system, the management ability at the grass-roots level and the will of the people.
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When the number of cases in a city is limited, all infected people will be isolated in designated hospitals and given corresponding treatment according to the severity of the disease. At the same time, the most effective way to avoid the spread of the epidemic is to isolate close contacts;
-When the number of cases increases and there are a large number of mild and asymptomatic infected people, the number of beds in designated hospitals will exceed the upper limit at a certain critical point. At this time, it is necessary to send the infected people with mild symptoms or below to the receiving hospital, otherwise it will directly penetrate the original medical system and affect the medical treatment of other patients. This is also an important reason why our country made this revision in the ninth edition of the guidelines for diagnosis and treatment in March this year;
—— When the number of cases continues to rise and exceeds the upper limit of the number of people isolated in hospitals in shelters, further adjustment is needed at this time, and home isolation of some newly infected people is considered, which is not as effective as centralized isolation in preventing the spread of the epidemic, but it is the only choice at this stage.
At the most difficult time in Wuhan, our country established central hospitals (such as Thunder God Mountain hospital and Huoshenshan Hospital) in a short time, and at the same time established large-scale reception hospitals to treat mild patients. The latter is also unprecedented in the history of human struggle against infectious diseases.
The establishment of shelter hospitals has truly achieved "everything" and "everything", effectively reducing the spread of the virus in families and communities.
But in 2022, we will also see the challenges faced by hospice hospitals under the new situation. The main difficulty lies not in the establishment of hospice hospitals, nor in the infrastructure capacity of our country, but in the medical staff of hospice hospitals.
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Someone asked what the upper limit of the hospice hospital was, and I mentioned it before. It is not difficult to establish a hospice hospital. What is difficult is the number of medical staff. According to the current requirements, 100 beds are equipped with 25 medical staff (5 doctors +20 nurses). Adding 1 10,000 infected people every day will reduce more than 2,000 medical staff in ordinary hospitals, and there is no rotation here (because medical treatment also needs rest, the current regulation is four shifts).
It is impossible to provide such a huge medical team by relying on the medical resources of one city, which is why large-scale support from different places or brother provinces and cities is needed. Another issue that needs to be considered when supporting shelters is the treatment of other non-COVID-19 patients, because some doctors usually need more beds than 10.
How to allocate medical staff reasonably is an important issue.
Nowadays, medical staff are actually in short supply. Some support asylum, some support nucleic acid detection, some are confined at home, and some are isolated in or out of the hospital. There is not much power available for daily diagnosis and treatment.
However, even when the proportion of doctors and nurses is insufficient, the shelter can still reduce the risk of community transmission through centralized isolation, screen risk factors at the same time, establish a list of risk factors and report the illness every day (these take up most of the time and energy of the doctors in the shelter's actual paperwork).
However, it should be noted that the medical transportation capacity is insufficient in the case of explosive growth of the epidemic. Many places can't meet the requirements of the ninth edition of the prevention and control guidelines, "After diagnosis, they should be transported to designated medical institutions or receiving hospitals within 2 hours", and some even test positive for two or three days before being transported, while the median incubation period in COVID-19 is only three days. Some infected people can excrete live virus after exposure to 1 ~ 2 days, which is contagious.
Therefore, the role that Fangcang Hospital can play in cities with outbreaks and many infected people should be further evaluated according to the current epidemic situation. In order to make good use of hospice hospitals, it is necessary to set them in strict accordance with the norms, including the allocation of medical staff and the time of transfer. And the reduction of control effect is avoided.
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Of course, for the medical department, home isolation can not only greatly reduce the work pressure, but also restore the focus of work to the original patient treatment; For asymptomatic infected people, many people may also prefer to be isolated at home.
But this is a great test for the grass-roots management.
For example, the simplest eating problem. Under the closed management of some communities, unified distribution replaces the original personal grocery shopping, but it is essentially equivalent to the original normal fresh food supply chain, express delivery and intelligent scheduling of the Internet. At this moment, this highly differentiated and diversified system has been replaced by a temporary volunteer system.
So before you search for #XX Shopping #, you will find many problems that citizens encounter every day. Centralized isolation can still solve the problem of eating to a certain extent through unified supply, but if it is isolated at home, infected people will encounter greater difficulties in eating and taking drugs than ordinary citizens. Of course, after the Shanghai epidemic, this issue has attracted more and more attention from all walks of life.
In addition, not all infected people are willing to be isolated at home. On the one hand, some citizens' houses do not have the conditions of home isolation. For example, some three people live in a house with one room and one living room without physical compartments, and there is no condition to isolate infected family members alone. In order to protect their families, infected people are usually more willing to go to the shelter hospital for isolation;
Moreover, for other residents in the community, not everyone is in favor of home isolation, especially when the vast majority of families are not infected, the vote is definitely one-sided. The design of sewage and ventilation pipes in some old communities is a contributing factor to the building explosion in COVID-19.