The small county where she lives is located in the northwest border of Hunan Province, with a total population of about 6 1 10,000. At present, there are 53 health care institutions in the county, with the highest level being County People's Hospital and County Chinese Medicine Hospital.
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After lifting the quarantine zone, it was the first night shift that Li Sisi transferred back to the headquarters. From five o'clock in the afternoon to eight o'clock the next morning, 15 hours, Li Sisi roughly estimated that there were about 100 patients in the middle of the night, and someone came at four or five in the morning after midnight, and there were more people at six o'clock. On that day, she always treated nearly 200 patients. In the past, a night shift may have only a few people.
After two consecutive night shifts, Li Sisi felt weak and weak. At first, she thought it was overwork, but typical symptoms such as cough in the following days convinced her that she was infected.
But Li Sisi didn't do nucleic acid, because the hospital sent a notice "don't take nucleic acid", "anyway, even Yang, you have to go to work, everyone is almost Yang".
In the best hospital in this county, all 35 medical staff in cardiovascular department have been infected. "In addition to the high fever, the symptoms are very serious, and the whole body is too sore to get out of bed. As long as they can walk, they basically work in the hospital. " The nurse Shen Hui said.
In other hospitals in the county, the situation is similar: the number of patients has increased sharply, the medical staff are basically infected, and the beds are basically full.
After enduring the first wave of infection, there are medical concerns. In the next period of time, there will be more and more critically ill patients and the pressure will be greater.
Lack of people, "gather together" to go to work
Li Sisi judged that she was infected by 13 and didn't do nucleic acid. On the one hand, because the hospital doesn't recommend it, she also feels that the diagnosis results have increased psychological pressure: worrying about when it will get better and worrying about infecting her family and colleagues. In the next few days, Li Sisi worked two day shifts and two night shifts, and everything was no different.
She is also used to this pace of work. In 2020, after being transferred from pediatrics to infectious diseases, she encountered an epidemic. At that time, she was always on standby and worked overtime all the year round. She often receives calls at midnight 1 1 asking to enter the quarantine area. "Infected people will be sent to the quarantine area. Just make a phone call, things will be packed and the patient will be waiting for you. "
On February 26th, 65438, Tian Li, a nurse in obstetrics and gynecology of County Hospital of Traditional Chinese Medicine, clearly remembered that this was the tenth day of infection.
Her husband and two children have also been infected, because "a headache cures the head, a foot hurts the foot", and every day seems like a year to her. Seven doctors, eight nurses and four interns in obstetrics and gynecology 19 were all infected, and some colleagues had a high fever in the hospital. The same is true of the medical situation in other departments she knows.
Zhang Jun, a nurse in County Maternal and Child Health Hospital, has been infected for 10 days. In the past, when there were enough people, the scheduling could be divided into day shift, middle shift and night shift. Now there are not enough people, so we can only divide them into day shift and night shift. The night shift is from 6 pm to 8 am the next day, and the last shift takes more than ten hours. Most of Zhang Jun's colleagues are infected, but as long as they don't have a fever, they will return to their posts if they are a little better. She said they were "working together".
After the release of the "Ten Articles of New China", the question of whether medical staff should be treated at home or continue to work after infection has also been hotly debated. At the press conference on February 8th, 65438, Guo Yanhong, director of National Health Commission Medical Emergency Department, responded, "We have repeatedly asked for the implementation of various measures to care for medical staff, and to do a good job in vaccination and health monitoring of medical staff, especially to dynamically optimize and adjust the grouping of medical staff according to the situation of epidemic prevention and control and clinical treatment, so as to ensure that the strength of medical staff can meet the needs of clinical work and avoid infection due to a large number of occupational exposures of medical staff.
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However, in this county with limited medical resources, we should try our best to "dynamically optimize and adjust" and "ensure that medical staff can meet the needs of clinical work", and the ultimate solution is to "stick to work".
For small counties, the shortage of medical staff seems to be the most prominent problem, but Li Sisi can understand the difficulties of hospitals. This hospital has no spare capacity to recruit more people. "In recent years, the medical supplies consumed under the epidemic situation are all stored in hospitals, and the finances are not rich."
It's not that you can't rest. If you are really uncomfortable, you can report it to Cory. The situation is true. After being supervised by the department, you can rest at home, but no one chooses to rest. Li Sisi thinks, "If you have a rest, it means someone will take your place. Now everyone is infected and more or less uncomfortable. You must be embarrassed to borrow someone else's rest every day to cover your shift. "
Tian Li is still struggling. During the interview, her cough never stopped. Adults and children are "one after another", and the baby mixed with babbling is called "mother". "I can't help but go to work. There are many patients. I don't go to the patients and no one cares." Tian Li hopes to get better soon.
The beds are full.
65438+February 65438+February, there were only/kloc-0 nurses and/kloc-0 doctors in Li Sisi fever clinic. After the number of patients increased, it was urgently increased to 2 nurses and 2 doctors. "Most of them have a fever, some don't have a fever, just nervous and a little uncomfortable. They may also prescribe some medicine. I went back without a big problem, and the situation of the old man was more serious. They may recommend hospitalization. "
There are more and more patients, and the relevant policies of the county people's hospital are constantly being adjusted.
In the notice issued by WeChat official account hospital in February16,65438, there are still isolation wards and general wards. The newly admitted patients and their caregivers need to be hospitalized, and the nucleic acid results are negative in 24 hours, while the positive patients are treated in the isolation ward set up in the old hospital area. On 19, the hospital issued a notice advising medical staff not to take nucleic acid, and the general ward began to accept positive patients. Around the 24th, the isolation ward for positive patients has been dismantled.
1Feb. 9 19, maternal and child health hospital stopped checking nucleic acid, and the number of patients increased. "Before the release, it was divided into negative areas and positive areas. Now, 9 of the hospitalized patients in 10 are positive. " Zhang Jun said.
Zhang Jun used to work in breast department. With the increase of social infection, the number of positive doctors and patients in hospitals has increased. Patients in breast department basically go home asymptomatic, and there are more and more patients in obstetric inpatient department. Zhang Jun was seconded to maternity duty. "After the maternal infection, she had fever, soreness and stomach upset, but she didn't dare to use drugs indiscriminately and went to the hospital more often."
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By February 26, 65438, more than 20 beds in this county maternal and child health hospital were full, and new patients could only suggest transferring.
In this county, the number of positive patients admitted to every hospital is increasing. In the county hospital of traditional Chinese medicine, the positive ward was reserved at first. When the patient is admitted to the hospital, he will be sent to the transitional ward first, and then diverted after examination. After that, there were also positive patients in the department, and the ward was divided into two. "The first half is negative and the second half is positive." Later, there were more and more positive patients, and they could not be separated.
12 On February 25th and 26th, the number of people attending the fever clinic in the county people's hospital was around 100, which was lower than before. Li Sisi said that it was because fever clinics were also set up in community clinics in the county, and antipyretics were also available in township hospitals.
On February 25th, 65438, the county epidemic prevention and control headquarters issued a notice to distribute the first batch of antipyretics free of charge in the Maternal and Child Health Hospital and 2 1 Township Health Center, and each person was limited to 4 tablets.
Because nucleic acid is no longer needed, the number of infected people is not accurate. Li Sisi, Shenhui, Tian Li and Zhang Jun can't judge whether the peak of infection has arrived or passed, and whether the decrease in the number of fever clinics is due to diversion or the decrease in the number of infected people. They can only think that "they are all going door to door, and they should all be infected." There is no one in the street. "
How to deal with severe peak?
"There are too many patients. Winter was originally a season with many patients, and now there are more people. " It was mentioned that 65 beds in Cardiovascular Department were full, and 10 beds were added in the corridor. "In the past, extra beds were not allowed."
Compared with Li Sisi in the fever clinic, Zhang Jun on duty in obstetrics and Tian Li in obstetrics and gynecology, the pressure of applying for the meeting is greater, because patients in cardiovascular medicine are at risk of cardiac arrest at any time.
Since the 24th, the number of patients in the application department has gradually increased, mainly due to the complications of infection in the elderly. On the 24th, Shen Hui received an 80-year-old man with a high fever of 40 degrees. After arriving at the hospital, it dropped to 38 degrees, and I was unconscious all day long. Now in ICU, the situation has not stabilized.
Li Sisi is worried that the number of critically ill patients will increase in the future. "Now everyone may still be in the process of infection. Some people are not in serious condition and have not come to the hospital yet. After a while, when they come to the hospital seriously ill, the risk of death will increase and the pressure on medical staff will increase. " In order to cope with the increase of critically ill patients,1February 25th, the county people's hospital newly established the second area of critical care medicine.
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Earlier, Jiao Yahui, director of the Department of Medical Administration of National Health Commission, said at the press conference that there are two key measures to prevent and control the epidemic in rural areas by implementing "B and B-like management" measures for COVID-19 infection. First, drugs should be sent to the terminal. In addition to counties and townships, village clinics can be equipped with sufficient and complete medicines. Second, critically ill patients can be transported out. Severe patients in rural areas should be transported out in time and sent to medical institutions with the ability to treat.
On February 29th, 65438, the reporter of National Business Daily consulted several township hospitals under the jurisdiction of the county, and they said that there was basically no shortage of adult antipyretics. "Yes, there are antipyretics." "I have got the medicine I sent before, but I will get it tomorrow." However, if the elderly and children are unwell, the health center will basically recommend going to the county hospital. "If you don't have children, go to the city hospital." "If the old man is panting, he should go to the city hospital, and there may be a lung infection." "We usually see fever and cough. If there are other problems, we suggest going to the city hospital if possible. "
This may be understandable. The medical conditions in township hospitals are limited. If the symptoms are slightly severe, the patient's first choice is usually to go to the county hospital, which will further increase the pressure on the county hospital. For county hospitals, will the medical staff who are already running at full capacity usher in the next wave of impact? Can you hold on in the next wave of impact?
There is no answer to this question.
Li Sisi hopes that spring will come. "The weather is fine, it's warm, and everyone is fine. Maybe there will be fewer respiratory diseases. "
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