How long does it take for a COVID-19 infected person to develop from mild to severe? -Maybe just 5 days.
On January 30, 2020, 62-year-old Tong Moumou went to the hospital for a fever symptom. When the doctor obtained Tong Moumou's lung CT, he thought it was a COVID-19 mild patient. However, by February 4, Tong Moumou's lung disease had significantly increased when he was examined again. Then on February 5, also on the 10th day of the infection, he began to receive high-flow oxygen inhalation therapy, 2 days after tracheal intubation, and finally used EMCO (artificial heart and lung).
In just 5 days, Tong Moumou developed from a mild patient to a critically ill patient in the Shanghai Public Health Clinical Center. On March 13, 2020, Hu Bijie, director of the infection department at Zhongshan Hospital affiliated to Fudan University, analyzed the severe case during a webcast for medical professionals.
According to the "New Coronavirus Pneumonia Diagnosis and Treatment Program" issued by the National Health and Medical Commission, the clinical classification of COVID-19 includes four categories: mild, general, severe, and critically ill. Severe patients will have shortness of breath symptoms with a respiratory rate of more than 30 breaths per minute and an oxygen saturation of less than or equal to 93%. Critical patients are more severe and require mechanical ventilation to assist breathing or other organ failure.
Respiratory failure is a sign that a patient is developing into a severe condition. Therefore, early detection of hypoxemia and avoiding critically ill patients becoming critically ill are the key to treatment.
In this webcast co-sponsored by Shanghai International Hospital Infection Control Forum (SIFIC) and China Medical Tribune, Ning Qin, director of the infection department at Wuhan Tongji Hospital, divided the recent clinical treatment of COVID-19 patients in Hubei Province into three stages. : Mid to late December last year to mid to late January this year, mid to late January to mid February, and mid to February to date. She said that at different stages of the epidemic, there are also some differences in the success rate of treatment, among which the mortality rate of the first batch of patients is relatively high.
Qiu Haibo, a member of the expert group of the National Health and Medical Commission and deputy dean of Zhongda Hospital affiliated to Southeast University, said at a press conference in Hubei Province on February 4 that COVID-19 deaths were mainly elderly patients, and their hypoxemia was not very Severe, but because of the combination of coronary heart disease and cerebrovascular disease, it is more likely to cause death.
Professionals believe that in the early stage of the COVID-19 epidemic, due to insufficient medical knowledge of the disease and the provision of medical resources, many patients could not be treated in time, and eventually developed into critically ill patients, or even died.
According to data released earlier by the Health and Health Commission, the highest proportion of severe cases in Wuhan among confirmed cases has climbed to 32.4% on January 28.
Tong Zhaohui is the vice president of Beijing Chaoyang Hospital and an expert in the medical treatment team of the Central Steering Group. On January 18, this respiratory critical expert with more than 30 years of experience was ordered to come to Wuhan. Speaking of the sights he saw when he first arrived in Wuhan, Tong Zhaohui said that he was a critically ill patient at that time. "With a look around, I feel like I can't save my life."
At the time, the 5, 6, and 7 floors of Wuhan Jinyintan Hospital were already full of critically ill patients. Most of the patients were over 60 years old with underlying diseases and were receiving non-invasive ventilation and high-flow oxygen therapy.
"In fact, these non-invasive and high-flow treatment methods are ineffective. The patient's blood oxygen saturation is only 70-80%, which must be intubated in normal times." Said Tong Zhaohui, but as an ICU doctor, he It is also clear that the standard operating guidelines are difficult to implement in special times.
In later days, Tong Zhaohui went to several hospitals to discuss the deaths, and found that many patients had not been intubated until death, which made him regret.
Clinical treatment proved the need for intubation. The National Health and Medical Commission released the "New Coronavirus Pneumonia Diagnosis and Treatment Plan (Trial Version 6)" on February 18, which has clearly stated that when patients have respiratory distress or hypoxemia that cannot be alleviated after oxygen therapy, a high-flow nose can be considered. Catheter oxygen therapy or non-invasive ventilation. If the condition does not improve or worsens within a short time (1-2 hours), tracheal intubation and invasive mechanical ventilation should be performed in time.
The initial clutter was related to the shortage of medical staff. Instead, an ICU ward nurse only needs to take care of one patient to ensure that the patient's vital signs are carefully and closely observed. At the time, at the then Jinyintan Hospital, a nurse had to manage three rooms.
"Under special circumstances, a nurse wearing protective clothing is responsible for three wards. In her ears, all the monitors are calling. She is inaudible. It is impossible to tell which room is the problem for the patient. Individual oxygen and index are very low. "Tong Zhaohui said.
Similarly, in the early days of the epidemic, experts in professional respiratory critical illness in Wuhan were also seriously inadequate. In mid-to-late January, only three hospitals in Wuhan (Jinyintan, Wuhan Pulmonology, and Wuhan University Zhongnan) treated critically ill patients. As the epidemic fermented, it was later increased to six hospitals (the new Eastern Hospital of Hubei Provincial People's Hospital, Tongji Zhongfa, and Xiehe). West Court). Tong Zhaohui said that in the beginning, emergency treatment could only be made by locally deploying some doctors and nurses engaged in respiratory critical illness. Until the medical team from across the country arrived in Wuhan, the situation gradually eased.
In response to the specific shortage of medical resources for the prevention and control of the outbreak in Hubei, in addition to the urgently needed personnel in the respiratory, infectious, and critical medical departments, medical teams sent from various places also cover multiple departments such as emergency department, cardiac medicine, neurology, and kidney medicine. In order to effectively prevent and control nosocomial infections, the medical teams dispatched in many places also include specialized hospital sense prevention and control personnel.
According to statistics, as of early March, the National Health and Medical Commission has sent a total of 346 medical teams and 42,600 medical staff to support medical treatment in Hubei Province. Among them, professionals in critical medicine, infection, respiratory and circulatory medicine have reached More than 16,000 people.
While some medical teams from other provinces and cities rushed to Hubei, they also carried a lot of medical supplies and equipment. For example, the third batch of medical teams in Zhejiang Province rushed to Hubei on February 9, and accompanied them with 40 ventilators, 4 defibrillators, 4 central monitors, 60 ECG monitors, 1 ECMO, and more than 40 facilities and equipment. Ton.
The support of personnel and equipment has effectively alleviated the treatment difficulties in Wuhan and the entire Hubei Province, and the treatment plan has been continuously optimized.
Officials from the National Health and Medical Commission previously introduced in an interview with CCTV that comprehensive treatment measures are still needed to improve the cure rate. For severe cases, it is not only the use of antiviral drugs, because there are many patients with severe illness who not only have lung damage, There are also multiple organ damages, including heart, kidney, liver, etc., so the treatment of other comprehensive factors is needed. In addition, the hospital has also used new therapies, such as the treatment of plasma for rehabilitation patients, as well as the use of traditional Chinese medicine and integrated Chinese and western medicine.
But Tong Zhaohui also pointed out that there are still thousands of severe patients in Wuhan, and there are many white lung patients. Experts said that the common characteristics of these severe cases are: elderly patients, with chronic diseases, rapid progress of lung disease, and persistent fever.
Therefore, the treatment plan for critically ill patients also needs to be continuously adjusted according to individual circumstances. Yang Qing, a professor at Wuhan Pulmonary Hospital, believes that although hormone use may be considered to cause secondary infection, delay virus clearance, and cause sequelae, a number of severe clinical cases of COVID-19 have shown that early low-dose hormone therapy can improve clinical symptoms and clinical The ending may be favorable.
Yang clarified and summarized that when the patient's inflammation index rose (need to exclude bacterial infection), the body temperature was above 38.5 ℃, the chest lungs had multiple lung exudations or large ground glass shadows or 48-72 hours of rapid progress, dyspnea progressed When the exacerbation and irritating cough are obvious, and common symptoms show severe symptoms, methylprednisolone (glucocorticoid drugs) can be used according to the prescribed dose. The course of treatment is generally 7-10 days, and it is gradually reduced if necessary, and implemented individually.
However, Wuhan is currently reducing the number of patients requiring hormones, ventilator and tracheal intubation.
From the beginning of March, Ning Qin found that the number of patients admitted to the hospital with severe criteria was significantly less. The big reason is that the state has adopted a series of measures to allow patients to be screened and treated early in the disease, even if it develops later. Severe and critical illness can also be well managed.
According to Hubei Provincial Health and Medical Committee data, as of 24:00 on March 15, there were 8703 confirmed cases of Hubei Province currently being treated in the hospital, including 2403 severe cases and 572 critical cases. It can be seen that compared with the highest point in mid-February (9,289 cases of severe cases, 1957 cases of critical cases) on February 18, the data of severe cases and critical cases has been reduced by more than half.
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