[Text/Observer Network Columnist Deng Bosheng]
On November 10, the release of the "Twenty Measures for Optimization" (hereinafter referred to as "Twenty Measures") based on the ninth edition of the prevention and control plan caused an uproar in public opinion. Many people said that it "subverted my understanding of epidemic prevention and control." In addition, in the past few days, various places have also shown some chaos in the implementation of prevention and control policies, which has aroused dissatisfaction among the masses.
The principle of "Twenty Articles" is to control the epidemic by "fast and quick battles and quick decisions". On the one hand, the people hope to resume normal life as soon as possible, and on the other hand, the epidemic prevention work in some regions has entered the "struggle to climb" stage again, and it is difficult to explain the contradictions clearly in one sentence. Faced with the "struggle" against the epidemic in the past three years, a complex feeling of "neither don't want it" has also emerged in the medical team. Neither "lying down" or "fighting tiredly", a few people also felt shaken. So, can the "Twenty Articles" solve the mental internal friction of medical workers, the backbone of the fight against the epidemic?
neither "lying flat"
Because the number of infected people with new crown in the world remains high, and the new coronavirus mutations are emerging one after another, and the vaccine products in various countries have experienced varying degrees of immune escape, and their efforts to build an immune barrier through vaccines have been set. Currently, various vaccine products mainly reduce the severity and mortality rate of vaccinated people, and cannot achieve the infection protection rate at the beginning of approval.
The new crown epidemic has become the main cause of death in the United States. (Picture source: Social Media)
With the mutation of the new coronavirus and the application of new drugs and vaccines, our ability to diagnose and treat this infectious disease has improved, and the current harm of the new coronavirus has dropped significantly compared with two years ago. However, due to the increase in infectivity of the mutant strain, the scale of infection has been expanded, and the number of deaths caused by the new crown epidemic has increased instead of decreasing, continuing to impact the medical service system in areas endemic to the epidemic.
From 2020 to 2021, no matter which strain is epidemic, the new coronavirus is the top three causes of death in areas with superior medical conditions such as Europe and the United States, second only to cancer and heart disease , and the death toll is higher than diabetes and other respiratory diseases. my country's medical resources are tight and the workload of medical staff is large. Adding a difficult "new crown science" to deal with is even more arduous for the medical industry.
Examples of the COVID-19 snatching the whole society's medical resources are not uncommon. Take the UK as an example. The number of appointments made by the country's public universal medical service system, NHS, has increased from 4 million before the epidemic to 6 million, equivalent to one-tenth of the country's population waiting for doctors. The NHS has an assessment indicator called "the proportion of cancer patients from diagnosis to treatment for more than 62 days." The indicator has risen from about 20% before the epidemic to 33% today. The UK requires that the average response time of ambulances for Class I accidents is less than 7 minutes, and the average response time of ambulances for Class II accidents is less than 18 minutes. This number has been going for two hours since the COVID-19 pandemic.
The COVID-19 pandemic has intensified the shortage of medical resources around the world. (Picture source: social media)
At the medical site, medical runs and medical resources are highly tight, the dilemma of "save A or B" will appear again and again, causing medical staff to suffer mental torture.
Another question is, how do we view the consequences of the sharp turnover of epidemic prevention and control measures? Taiwan is a lesson learned from the past. Since the abandonment of "zero" epidemic prevention measures in April 2022, Taiwan has reported a total of 12,586 deaths, and the mortality rate of infected people with the new crown is 0.54‰. In addition to the directly reported deaths from COVID-19, the cumulative death toll in Taiwan from May to October this year increased by 17,990 compared with the same period last year. According to a study by the Department of Public Health of National Taiwan University, local "excess deaths" increased by 15% to 43% compared with 2021, with an average of 23.4%.
The causes of excess death include rescuing patients with COVID-19, squeezing treatment resources for other patients, causing the death of patients, as well as the destruction of the immune system caused by COVID-19 and the sequelae of "long-term COVID-19". The mortality rate of new coronavirus patients after recovery is still far higher than that of ordinary people. Each round of COVID-19 peak eliminates a group of elderly, weak, sick and disabled, and creates a new group of elderly, weak, sick and disabled through sequelae.Unfortunately, due to the nature of work, medical staff will inevitably be repeatedly harmed by hospital infections when the new crown epidemic is prevalent for a long time. According to a survey by the UK, the highest proportion of reported sequelae of COVID-19 among all occupations in the country are medical staff and health care workers, which has exceeded 5%.
So what about other "old epidemic areas"? Has the so-called " herd immunity " been achieved? The new coronavirus is not chickenpox . The "herd immunity" that can obtain lifelong immunity with one infection is a fool. The antibodies obtained from infection with the new coronavirus will soon decline, or be damaged by the new mutant strain.
In September this year, Japan was in a relatively "low trough" state of the epidemic, and it was clear that the number of deaths from the new crown was 7,295. However, Japan reported a total of 135,649 deaths in that month, surpassing the 17,845 in the same month of the previous year, an increase of 15.1%; it exceeded the average of 25,087 in the past five years, an increase of 22.7%. The situation in Japan also occurs in other "old epidemic areas". All the above excess death data exclude the increase in the number of natural deaths caused by the intensified social aging.
"I hope that people in the world will not be sick, so why not put on the medicine to produce dust" is the long-term moral ethics and responsibility of our medical community. Under the current characteristics and prevention and control of the new coronavirus, medical staff are unwilling to "lie down" whether it is for their duties or for their own protection.
"Don't" fatigue combat
There is a relative balance between the medical supply in a specific area and the population and social and economic development level of its jurisdiction. In a country like our country with a large population and a low per capita medical resources, the distribution of medical resources is even more "tightly balanced". When the epidemic breaks out, the medical team must take into account both epidemic prevention and control and routine diagnosis and treatment, and the supply and demand balance is easily broken. However, in addition to more difficult epidemic events such as the "Wuhan Defense War", the epidemics in various places are overcome and resolved by local medical teams, and at most they are supported by brother cities in the province, which is under great pressure.
The income source of medical institutions in my country mainly comes from the business income from providing medical services to the outside world. Even for public hospitals, fiscal revenue accounts for only about 10% of hospital revenue. The fiscal revenue of hospitals is used to pay employees' salaries, less than one-third of the total salary of medical staff. The main income of medical staff in public hospitals comes from performance, and the fiscal salary is only a small part.
Once the epidemic prevention and control affects the hospital's regular diagnosis and treatment services, the most urgent thing is the hospital director. If the non-acute surgery is suspended for one month, the dean will have to borrow money to pay for performance. Large hospitals are concentrated in big cities, and patients come from the province and even the whole country. The more top hospitals are, the more so. Shanghai Oriental Hepatobiliary Hospital , 85% of the inpatients are from outside Shanghai. If epidemic prevention and control measures affect the normal cross-regional movement of people, it will be a heavy blow to leading public hospitals and high-end private hospitals with a wide range of patients.
Secondary hospital services account for the first place among medical institutions at all levels in my country. According to the performance appraisal of public hospitals by the National Health Commission, in 2020, when the epidemic prevention and control tasks are the most difficult, the medical surplus rate of my country's second-level public hospitals was -0.66%, a decrease of 2.73 percentage points from 2019. About 40% of hospitals suffered losses, and the proportion of hospitals with losses increased by 16.75% compared with 2019. Among the loss-making hospitals, 7.51% of secondary public hospitals have an asset-liability ratio of more than 100%, and 49.53% of secondary public hospitals have an asset-liability ratio of more than 50%.
National Health Commission analyzed that the general decrease in medical surplus is related to factors such as hospitals in order to ensure the simultaneous development of epidemic prevention and control and daily diagnosis and treatment, increasing investment in prevention and control, and increasing operating costs of . Recently, the country has introduced preferential policies such as 1.7 trillion loan interest subsidies, encouraging public hospitals, especially county-level hospitals, to purchase medical equipment, to improve the ability to treat critical diseases and improve the level of treating new coronary pneumonia. However, hospitals are more afraid of "going forward with debt" in the current environment.
Affected by the 2.64 trillion yuan tax refund and tax reduction and the impact of the epidemic, many local fiscal revenue has rarely declined this year, while rigid expenditures have not decreased, and the contradiction between income and expenditure has increased. So this year, when many regions announced their local fiscal revenue, they emphasized that after excluding the tax refund and tax reduction factors, local fiscal growth has achieved positive growth, thereby stabilizing market entities' confidence and expectations for the local economy.Under this circumstance, some regions have begun to arrears nucleic acid fees from medical institutions and nucleic acid testing institutions, and will stop issuing or arrears of anti-epidemic allowances and subsidies from medical personnel. The author visited three doctors on the front line of the fight against the epidemic, and the information I got was intriguing.
A doctor worked in a hospital under a municipality directly under the central government. In the past three years of the epidemic, Dr. A has repeatedly left his post and is engaged in nucleic acid sampling and supporting disease control and epidemiological investigation. Dr. A participated in the nucleic acid tests of all local personnel in previous local areas and was often called to reconcile by the hospital accountant. According to him, the district owes hospitals more than 600,000 yuan in consumables for nucleic acid screens every quarter, and the total amount is about 2 million yuan per year. The nucleic acid fees for districts and other hospitals and independent testing institutions are more. Medical staff’s epidemic prevention allowances have always been a mess. Recently, medical staff who have closed-loop management of have to pay for their own meals, which is 45 yuan a day.
B Doctor, a county-level hospital in the southeast coastal area of a county-level hospital. The hospital where Doctor B is located ranks among the top five in the city and is an inspiring role model for in county hospitals. The "Overseas Chinese Hometown" prevented many imported epidemics in 2021, and implemented months of isolation control in the county and overall isolation of high-risk township residents. The hospital sent a large number of personnel to support epidemic prevention, and the hospital laboratory tested 3,000 nucleic acid tests every day. The county owed nearly half a million nucleic acid fees owed to the hospital in the first three quarters of this year, accounting for about one-sixth of the hospital's total revenue, and the hospital is on the verge of technical bankruptcy. At the end of last year, the hospital went to the county health committee to ask for the account. The director said, "The money in the public account is not enough to buy a cigarette, and you can take it away if you have the ability." The Finance Bureau cried poorly and said that it took half a year of fiscal revenue from , and there was no money. This year, the county sold 200 mu of land and earned 800 million yuan. When the hospital heard about it, it immediately rushed to the Finance Bureau. The bureau leader came forward and said earnestly, "There are 26,000 financial support personnel in the county!"
C doctor, ", Three Districts, Three Prefectures, " contiguous poverty-stricken district hospital was in office. Since the beginning of this year, the local epidemic has been repeated, and the state hospitals have supported the temporary cabin for three months. The previous "one-size-fits-all" lockdown measures were ineffective, resulting in the decline of local industries and the risk of large-scale poverty relapse. The workers and the masses suffered from the epidemic and were inconveniently blocked, and their hearts were disintegrated. A long-term conflict broke out in a hospital in a county in the state, and a large number of medical staff resigned at the last minute. Fortunately, the local blockade was timely and the people did not run away, so they all persuaded them to come back. The regular diagnosis and treatment of state hospitals has stopped, business income has dropped sharply, and performance salary is paid according to the standards of 20 yuan per day in isolation ward work, 15 yuan per day in community sampling work, 10 yuan per day in nucleic acid testing laboratories and isolation ward logistics work, and 20 yuan per day in routine diagnosis and treatment work.
Obviously, if no changes are made, the medical team will find it difficult to complete the tasks assigned by society as always, "both both want, and still want".
"Twenty entries" can help medical staff get into battle lightly?
Once again, Doctor A, who supported the district CDC, may be the first to feel the "twenty" changes. Doctor A's city is in a tight stage of the epidemic recently. On the day of the promulgation of the "Twenty Articles", the close contacts and secondary close contacts in the district where Doctor A was located reached 1% of the population in the district, and some close contacts could not be transferred in time. The "Twenty Articles" are about to stop quarantine for close contacts. The workload of the CDC close contact group suddenly dropped by half. Although the whole city was worried about the epidemic, Dr. A felt that the office was calm, just like dawn was coming. Two days later, the close contacts in the district also reached 1% of the population in the district. In the past two days, it has gained valuable strategic depth for the construction of centralized isolation points in local cabins.
B The province where doctors are located took the lead in piloting the "Twenty Articles" before the promulgation of the "Twenty Articles" to stop publishing the activity trajectory of for asymptomatic infections in , and concentrate on key tasks of epidemic prevention and control. Dr. B was sweating in his heart at that time: Winter is the peak period of respiratory diseases. Is it reliable to implement seemingly looser measures when the epidemic is unstable? In addition to the new crown this winter, there is also a global pandemic of influenza A and respiratory syncytial viruses. Once our country fails to fight the epidemic this winter, the "three ghosts will knock on the door". my country has limited critical care capacity, with only 4.5 ICU beds per 100,000 population. The data in the United States is 29.4. If there is an American "pandemic", the situation will be worse than that in the United States.
0 The United States has shortage of medical resources due to the epidemic, and heart disease patients were rejected by 43 hospitals
What Dr. B did not expect was that the local social situation was quickly cleared, and Dr. B began to recall the previous epidemic prevention model that had been silent throughout the county. The previous epidemic prevention model has put a huge burden on local finances, resulting in some regions looking forward to the epidemic and missing out on opportunities and breaking through innovative methods.
Also looking forward to the changes is the liver disease doctor from an infectious disease hospital. Since the hospital he worked for was converted into designated hospitals, his income has been greatly affected. The "New Coronavirus Pneumonia Prevention and Control Plan (Ninth Edition)" proposes that people who are positive for the new coronavirus can be admitted to centralized isolation facilities. However, since the relevant graded diagnosis and treatment of measures have not been implemented, the vast majority of mild cases and a considerable number of -positive infections in my country have been admitted to designated hospitals. Most designated hospitals are infectious disease hospitals or leading hospitals with good conditions, with huge construction costs and high operating costs. The treatment of mild and positive infections is less, which brings less business income to the hospital, which directly leads to losses in the hospital for admission and affects the income of medical staff. In order to avoid cross-infection, some designated hospitals have stopped routine diagnosis and treatment services, resulting in rustration of related business of medical personnel and loss of patients. The "Twenty Articles" once again emphasize tiered diagnosis and treatment, and hope that this measure will be implemented as soon as possible.
C doctor proposed that the "Twenty Articles" of home isolation only adopts code management. For some areas with low social management levels, can it really ensure that they do not leave their homes? The western region is vast and sparsely populated, and centralized isolation can concentrate manpower, but home isolation is inconvenient for management. The "Twenty Articles" emphasize accuracy and have higher requirements for the county-level governance level in remote areas.
C doctor's problems are more representative. In some areas where the epidemic has recently occurred, especially those in remote areas where Doctor C is located, the source of the epidemic and the transmission and spreading paths are vaguely reminding the shadow of a huge pre-modern group. Regardless of whether the number of days of isolation is 14+7 or 5+3, this pre-modern group is out of control. They actively or passively resist modernization, including mature means of epidemic prevention and control such as nucleic acid testing and health code verification. These compatriots lack concepts about the epidemic and epidemic prevention and control measures and cannot cooperate well with epidemic prevention and control measures. Doctor C once stopped a fellow villager outside the isolation ward who didn't know what the new crown epidemic was and was carrying a big burden to go into the ward to sell goods. The spread of
mutant strain increases the difficulty of epidemic prevention and makes the shadow group surface. The old method of "should be sealed" cannot solve the problem and even intensify the contradictions. The impact of pre-modern on epidemic prevention is far greater than that of post-modern. The postmodern has the ability to mobilize but not do it, and the premodern has no ability to mobilize at all. The epidemic has once again made us realize that social development must take into account all regions and classes to solve all kinds of inadequate and unbalanced problems.
optimization is not "lying flat"
"Twenty Regulations" measures were introduced, a few voices tried to misinterpret "Twenty Regulations" as "lying flat". Shijiazhuang, Guangzhou and other places have been constantly being hyped up during the process of adjusting measures. This trend also has an impact on the medical industry.
On November 13, 2022, a patient with acute myocardial infarction of Huaqing University Taibai Hospital (pseudonym) tested positive for the new crown. The investigation of the cause of death of a patient requires a process. At this time, some people politicized the academic issue: "At present, I haven't decided whether to announce die of according to the zero-cutting thinking, or announce die with according to the lying flat thinking, or pretend that there is no such thing as a matter of stability maintenance." When some areas adjust their work, the old and new measures do not connect. For example, the normalized nucleic acid testing points have been cancelled but the nucleic acid certification requirements for working, studying, or riding in a bus have not been cancelled. This has led to residents flocking to hospitals to do nucleic acid, which has increased the work burden of medical staff and caused the risk of epidemic prevention and control. The goal of the "Twenty Measures" measures is that the prevention and control policy measures after optimization can effectively respond to some bottlenecks and difficulties in the epidemic response process in various places, such as tight isolation resources and insufficient sampling and detection capabilities. Limited resources should be invested as much as possible in people and areas with high risk of epidemic transmission.The new measures should minimize the normal impact of epidemic prevention and control on people, ensure social economic development, take into account people's living needs, which is conducive to the people's support for the fight against the epidemic, and to the good development of the medical industry, and jointly help epidemic prevention and control.
Currently, the evolution of the new coronavirus is becoming stable. If revolutionary vaccines, special drugs and testing methods are not developed, the domestic fight against the epidemic will still be a long-term and arduous process under the pressure of imported epidemics from abroad. The anti-epidemic model of countries around the world has its own rationality, but we do not have the capital to repeatedly shake between different models. Under objective conditions, in order to sustainability of epidemic prevention and control work, we must adjust epidemic prevention measures in a timely manner according to the characteristics of changes in the epidemic, and seek the most suitable balance point between coordinating epidemic prevention and control and economic and social development, and work hard for a long time.
This article is an exclusive article by Observer.com. The content of the article is purely the author's personal opinion and does not represent the platform's opinion. It may not be reproduced without authorization, otherwise legal responsibility will be pursued. Follow Observer.com WeChat guanchacn to read interesting articles every day.
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-