＂Class B and B Management＂： Are medical resources sufficient？ How to reduce the occurrence of severe diseases？ -authoritative experts explain Covid-19 infection in detail and implement the second seri
Xinhua News Agency, Beijing, December 26th Title: "Class B and B Management": Are medical resources sufficient? How to reduce the occurrence of severe diseases? — — Authoritative experts explain Covid-19 infection in detail and implement the second series of "Class B and B management"
Xinhua News Agency reporter Chen Fang and Dong Ruifeng
The infection in Covid-19 will be changed from "Class A tube" to "Class B tube" from January 8th, 2023. After the policy adjustment, how to effectively prevent the run on medical resources? How to reduce the occurrence of severe illness and death? The State Council’s joint prevention and control mechanism invites relevant experts — — Jiao Yahui, director of the Medical Administration Department of the National Health and Wellness Commission, and Guo Yanhong, director of the Medical Emergency Department of the National Health and Wellness Commission, made an interpretation.
Q: How to effectively prevent the run on medical resources after the "Class B Management"? How to reduce the occurrence of severe illness and death?
Jiao Yahui: Recently, the demand for diagnosis and treatment in fever clinics has increased rapidly, and the contradiction between supply and demand is more prominent. We have taken a series of measures to meet the needs of patients for diagnosis and treatment. Generally speaking, the growth rate of demand for general outpatient and inpatient medical services is relatively stable, and the utilization rate of the whole medical resources is in a safe and controllable range.
First, further expand medical resources and increase the supply of medical services. We require hospitals at or above the second level and qualified primary medical and health institutions to set up fever clinics or consultation rooms, equipped with sufficient medical strength. As of December 15th, more than 15,000 fever clinics have been set up in hospitals above the second level in China, and more than 35,000 fever clinics or consultation rooms have been set up in primary medical and health institutions. The consultation process of fever clinic is further simplified, which provides convenience for patients to prescribe drugs and further improves service efficiency. Beijing, Shanghai, Anhui, Jiangsu, Shandong and other places have opened temporary fever clinics by using facilities such as shelter hospitals and gymnasiums, which has greatly alleviated the problem of fever patients. All localities are upgrading and transforming designated hospitals and sub-designated hospitals as required, expanding and transforming the critical care resources of hospitals above the second level, and doing a good job in the preparation, equipment and medical personnel training of critical care beds and convertible ICU in tertiary hospitals. We have established a daily scheduling system to make overall arrangements for the preparation and use of medical resources throughout the country every day.
The second is to promote graded diagnosis and treatment. In cities, medical associations are used as carriers, and in rural areas, county medical associations are used as carriers to promote the implementation of Covid-19 infection and other medical service grading diagnosis and treatment. Give full play to the positive role of the three-level medical and health service network in urban and rural areas, and medical institutions perform their duties and responsibilities. Primary medical institutions mainly implement health monitoring of residents, especially health monitoring and health management of key populations; Secondary hospitals provide technical and human support for the grassroots to meet the needs of general diagnosis and treatment; Tertiary hospitals focus on meeting the needs of diagnosis and treatment of critically ill patients.
The third is to vigorously promote Internet medical services. Through Internet medical treatment, according to the diagnosis and treatment plan and the guide of home treatment, the patients with COVID-19’s symptoms will be given corresponding prescriptions, and the corresponding drugs will be provided through offline third-party distribution. We require medical institutions to provide 24-hour online consultation, medication guidance, and appointment services by time. In this way, the instantaneous peak of medical institutions can be reduced, the gathering of people can be reduced, and the risk of cross-infection in offline visits can be reduced.
Fourth, strengthen drug supply security through multiple channels. Relevant departments are strengthening the production, distribution and supply of related therapeutic drugs in COVID-19, so that more patients can obtain drugs through retail pharmacies, Internet purchases and other channels, thus reducing the pressure on medical institutions for diagnosis and treatment.
Fifth, grass-roots medical and health institutions manage and monitor the health of high-risk groups such as the elderly, and manage them at different levels according to different health conditions. Once changes in health conditions are found, they will be referred to medical institutions with corresponding diagnosis and treatment capabilities in time to prevent serious diseases to the maximum extent.
Sixth, strengthen vaccination, especially for the elderly, to reduce the risk of serious illness and death after infection in the elderly.
Q: What responsibilities will medical institutions assume after the policy adjustment?
Jiao Yahui: After the "B-type B-tube", all kinds of medical institutions at all levels should treat patients with nucleic acid positive, and classify them according to the needs of patients for diagnosis and treatment. Medical institutions no longer triage patients with negative or positive nucleic acids, but seek medical treatment according to the needs of patients. We put more emphasis on the positive role of the three-level medical and health service network in urban and rural areas, and require medical institutions to implement their own functional orientation. Simple asymptomatic infected persons and mild cases in COVID-19 should be isolated at home or take care of themselves at home. Ordinary cases and other infected people with stable conditions are referred to sub-designated hospitals for treatment. Severe and critical cases with COVID-19 as the main manifestation were referred to designated hospitals for treatment. Severe and critical cases with other diseases as the mainstay, and other patients who need to go to the hospital for treatment, regardless of whether the nucleic acid is positive or not, can go to the corresponding general hospital or specialized hospital for treatment.
We have deployed medical institutions to further adjust and optimize service processes. In the outpatient area, it is necessary to divide the nucleic acid positive diagnosis and treatment area and the nucleic acid negative diagnosis and treatment area to receive the corresponding patients respectively. The emergency area is required to be divided into normal diagnosis and treatment area and buffer area. Set up a relatively independent area (hospital, building, ward or ward) in the inpatient department to treat nucleic acid positive patients.
We require medical institutions to strictly implement the responsibility system for the first consultation and the emergency rescue system, and must not shirk or refuse the treatment of Covid-19-infected people for any reason, so as to meet patients’ medical needs.
Q: What is the preparation of inpatient beds, intensive care beds and intensive care equipment in China?
Jiao Yahui: In terms of bed resources, the total number of beds in hospitals above the second level in China is 5.616 million, and the bed utilization rate has fluctuated around 60% recently. The total number of beds in critical care medicine (including general ICU and specialized ICU) in China has reached 150,000, about 10.6 beds per 100,000 people, including 112,000 beds in tertiary medical institutions. Judging from the usage, the overall utilization rate of critically ill beds has fluctuated between 55% and 60% recently. In addition, the country reserves 70,000 beds in "convertible ICU".
In terms of treatment equipment, there are 151,100 hemodialysis units, 19,700 bedside hemofiltration machines (CRRT), more than 2,300 extracorporeal membrane oxygenation machines (ECMO), 116,000 invasive ventilators, 76,600 non-invasive ventilators, 971,200 monitors and 38,200 high-flow oxygen inhalers in medical institutions above the second level in China.
According to the development of the epidemic situation, we will continue to strengthen monitoring, transform and expand corresponding resources according to local conditions, and ensure the people’s medical needs.
Q: What kind of adjustment will be made to the nucleic acid detection after "Class B tube"? Under what circumstances is it necessary to do nucleic acid testing?
Jiao Yahui: After the "Class B tube", regional nucleic acid detection will no longer be carried out. First of all, nucleic acid detection is a means used by medical institutions for diagnosis, and it can be used when patients need to be diagnosed clearly. Secondly, for places where vulnerable people gather, such as nursing homes and welfare homes, nucleic acid detection is a means of health monitoring for staff and clients. Third, for large enterprises and other key places, nucleic acid detection can be used as a monitoring means. Other personnel completely adopt the way of willing to do all the tests, and can choose nucleic acid testing or carry out antigen testing by themselves. The comprehensive team of the State Council Joint Prevention and Control Mechanism has repeatedly stressed that all localities should keep the number and scale of nucleic acid sampling points unchanged for a period of time to meet the needs of nucleic acid testing in key places, key institutions and key populations. At the same time, in the process of nucleic acid detection, it is necessary to gradually reduce mixed sampling and mixed detection, and adopt the method of single sampling and single detection to ensure timely feedback of nucleic acid detection results.
Q: How to treat patients by classification? What kind of patients are going to what kind of hospital?
Jiao Yahui: We rely on grid-based medical associations, including urban medical groups and county medical associations, to build a graded diagnosis and treatment service network for Covid-19 infection with graded management and classified treatment, and provide systematic and continuous graded diagnosis and treatment services for Covid-19 infected people. All kinds of medical institutions at all levels in the medical association have their own functional orientation to meet the needs of patients for medical treatment: primary medical and health institutions mainly do a good job in crowd health monitoring and health management, especially for the elderly with basic diseases and other serious and high-risk groups to implement graded health management; The secondary hospitals in the medical association mainly provide technical support to improve the ability of grassroots doctors to identify, diagnose and dispose of high-risk groups, and at the same time do a good job in the diagnosis and treatment of common and frequently-occurring diseases among residents; The leading tertiary hospitals in the medical association are responsible for the treatment of critically ill patients, and provide a green channel for the elderly in primary health management when their condition changes and they need to see a doctor.
For those infected in Covid-19, if they are asymptomatic or mildly infected with COVID-19 infection without serious basic diseases, they should be treated in isolation at home. Generally speaking, from the current situation of epidemic prevention and control and the characteristics of Covid-19 variation, the vast majority of Covid-19-infected people do not need to go to the hospital for treatment, but can do a good job of home treatment through Internet medical treatment, retail pharmacies or online pharmacies, according to the guidelines for home isolation treatment. If necessary, community health service centers and township hospitals can provide guidance.
For ordinary cases, elderly people with serious basic diseases but stable conditions, they can go to sub-designated hospitals; Severe and critical cases with COVID-19 as the main performance are treated in designated hospitals; Severe and critical cases with basic diseases, as well as patients with other diseases, even if nucleic acid or antigen is positive, can go to the corresponding general hospital or specialized hospital for normal treatment according to the corresponding diagnosis and treatment needs.
Q: After the "Class B Management", how can the three-level rescue network in urban and rural areas play its role?
Jiao Yahui: The comprehensive group of joint prevention and control mechanism in the State Council has successively issued relevant work plans, guiding local governments to build a graded diagnosis and treatment service network for Covid-19 infection with systematic continuous, graded management and classified treatment, making every effort to ensure the timely treatment of the elderly patients with high risk of serious diseases such as basic diseases, so as to reduce the serious disease rate and death rate to the greatest extent, and ensure the normal medical service to meet the people’s medical needs while ensuring the smooth treatment of Covid-19 infection.
First, a number of grids are horizontally planned in prefecture-level cities and counties, and a medical association is formed in each grid to include all key groups such as the elderly in the service scope. Establish a referral mechanism between medical association and sub-designated hospitals, designated hospitals and tertiary hospitals, so as to realize the first diagnosis and orderly referral of patients with fever and other symptoms related to Covid-19 infection at the grass-roots level.
Second, give full play to the role of urban high-quality medical resources, establish and improve the counterpart assistance mechanism between urban secondary and above general hospitals and county-level hospitals based on the principle of regional package and the counterpart assistance relationship between urban and rural hospitals in the province, and at the same time unblock the referral mechanism at the city and county levels to enhance the ability of severe treatment in rural areas.
Third, give full play to the positive role of primary medical and health institutions, strengthen health monitoring for special personnel such as the elderly with basic diseases in the area under their jurisdiction, especially in rural areas, and implement health management according to health risk levels. It is necessary to give play to the supporting role of hospitals above the second level in the medical association and improve the ability of grassroots doctors to identify, diagnose and dispose of high-risk groups.
The fourth is to clarify the grading diagnosis and treatment process and strengthen grading and classification. In case of emergency, you can go directly to a medical institution with corresponding diagnosis and treatment ability. If the patient does not have the referral conditions, the counterpart will help the hospital to guide the treatment remotely or send an expert group.
Q: Are there sufficient reserves and supplies of related drugs in medical institutions? Can it meet the patient’s medication needs?
Guo Yanhong: Drugs are indispensable for home treatment or hospitalization of Covid-19 infected people. Therefore, the preparation of drugs is very important. On the one hand, it is necessary to ensure adequate supply of drugs, on the other hand, it is necessary to ensure fairness and accessibility, so that people can obtain drugs in a timely and convenient manner.
In order to ensure the use of drugs in medical institutions, we have made arrangements for the preparation of drugs in medical institutions, requiring medical institutions at or above the county level to dynamically prepare symptomatic treatment drugs such as traditional Chinese medicine for treating Covid-19 infection, anti-Covid-19 small molecule drugs, antipyretic and cough-relieving drugs according to their daily usage for three months; Grassroots medical and health institutions dynamically prepare relevant traditional Chinese medicines and symptomatic treatment drugs according to 15% to 20% of the population they serve, and increase them in densely populated areas as appropriate.
With the recent increase in the number of patients, the demand for drugs has surged, and some places and some varieties have been in short supply. Relevant departments are doing everything possible to promote enterprises to rapidly expand their capacity and production, increase the market supply of key drugs such as related traditional Chinese medicines, symptomatic treatment drugs and anti-Covid-19 small molecule drugs, give priority to ensuring the demand of medical institutions, and alleviate the drug shortage problem of medical institutions in some areas as soon as possible.
It is also very important to use drugs rationally and safely. We require medical institutions and medical personnel to vigorously strengthen the popularization of drug use knowledge, and take various forms to strengthen guidance for the people to use drugs to ensure the safety of drug use.