Tang Qizhu: Reviewing the prevention and control of the new crown epidemic and chronic disease prevention and control from Wuhan anti-epidemic
Title:On September 19, 2021, the opening ceremony of the new campus of NUIST and South-South College Chengze Park was held. The & quot;Healthcare Reform and Healthy China" forum and alumni fund lecture was successfully held with the support of PKU-Industry Alumni Fund, co-organized by PKU-Industry Institute of Global Health Development and PKU-Industry BiMBA Business School, and co-organized by PKU-Industry Alumni Association. This article is based on the speech given by Tang Qizhu, an alumnus of BNU-Industrial Development Institute EMBA class of 2005 and Vice President of Wuhan University, Head of Department of Medicine.
I am a cardiologist and have been engaged in hospital management for nearly 23 years. Only one month after I stepped down as president of the People's Hospital of Wuhan University (Hubei Provincial People's Hospital) in November 2019, the new crown epidemic hit with ferocity. Relying on the strong leadership of General Secretary Xi Jinping and the Party Central Committee, Wuhan took more than one month to control the spread of the epidemic, about two months to control the number of local cases to single digits, and about three months to achieve Wuhan and Hubei in about three months.
Sudden outbreak of the epidemic
Although the epidemic has not been completely eliminated nationwide and there are scattered cases, the Wuhan interdiction was a decisive victory. I still remember that the night Wuhan was closed, the secretary and president asked me to quickly organize a good fight against the epidemic in Wuhan University, fully supporting the affiliated hospitals for clinical treatment on the one hand, and organizing the whole university to carry out scientific and technological research on the other. At that time, in the building where I lived, there were many who had already been infected with the new coronavirus, and there were also fatal cases. I personally experienced the days when it was hard to get a bed, and I was approached to help arrange beds by ordinary people, as well as my student and his relatives. At the same time, I was notified by the provincial leadership and participated in some of the work of the scientific and technical attack group of the provincial prevention and control command. I also participated in several symposiums convened by the central steering group.
The fight against the epidemic in Wuhan began on December 27, 2019. There was a Dr. Jixian Zhang at the Hubei Provincial Hospital of Integrative Medicine, an alumnus of our Wuhan University. When she discovered several similar cases that could herald an epidemic, she immediately followed the procedures to report them truthfully in accordance with the Infectious Disease Control Law. Although the situation was not made public, from the day Zhang Jixian reported the situation, the Wuhan Health Bureau began repeatedly organizing discussions and internally informing hospitals to strengthen surveillance and report immediately, and in my opinion, the fight against the epidemic had already begun from that time. We should also remember the contribution of Dr. Zhang Jixian.
At the beginning of the anti-epidemic period, we did experience a busy period. However, it soon came into order under the strong leadership of the Party and the government, and on February 5, 2020, the Wuchang Square Cabin Hospital began its official operation, the first officially operating square cabin hospital, which was managed by the People's Hospital of Wuhan University. In my opinion, it is necessary to standardize the criteria for building a square cabin hospital, so I organized a group of management and legal experts from Wuhan University, who, although they did not know medicine, could guide the construction of the square cabin hospital from the perspective of law and standardized management, and the report written by them and the professional team, including Vice President Wan Jun of the People's Hospital of Wuhan University, became the basis for setting the standards for square cabin hospitals in China.
Later the Thornsan Hospital was also established. After its completion, it was taken over by Wuhan University Central and South Hospital as a whole.
The East Hospital of Wuhan University People's Hospital was contracted to start construction in 2008 when I was the Secretary of the Party Committee of the hospital and the then Director of the Management Committee of Wuhan East Lake High-tech Zone, Comrade Tang Liangzhi, negotiated with us. The East Campus of Wuhan University People's Hospital covers an area of more than 200 acres and has opened nearly 2000 beds by 2017. In the morning of April 26, 2020, with the last eight patients in the East Campus of Wuhan University People's Hospital having negative nucleic acid test results, all new cases of pneumonia in Hubei Province and Wuhan City were cleared.
The mapping of rescue and treatment methods
On December 30, 2019, medical staff performed fibrinoscopy under strict protection to obtain alveolar lavage fluid for some patients concentrated at Wuhan Jinyintan Hospital, through which the disease was finally confirmed to originate from a coronavirus infection.
At the beginning of the outbreak, the diagnosis was not very clear at that time because the cause of the disease was unknown. In addition, the sensitivity of the method to detect the presence of a new coronavirus infection was not high. For this reason, I organized a discussion among clinicians in one ward of the Wuhan University People's Hospital and one ward of the Wuhan University East Hospital, and suggested that & quot;clinicians should not rely solely on the test results for diagnosis and treatment. Even if the cause of the disease is unknown, clinicians have their own medical expertise and rules of treatment, so they should intubate when necessary.
At the same time, we have selected a number of drugs with certain efficacy, promoted plasma therapy, stem cell therapy and other technologies to achieve breakthroughs, and continuously improved the treatment plan, which has increased the cure rate from 14% at the beginning to 93%.
In addition, we have also developed several testing products that have been approved and applied in the clinical setting, and the overall level of testing has improved significantly to meet the domestic demand for diagnostic testing. The reagents for both antibody and nucleic acid tests complement each other and further improve the detection rate.
Overall, the above treatments were very effective in the early stage of the outbreak when the cause of the disease was not clear. Subsequently, many hospitals have also adopted similar clinical treatment strategies.
Although there is no specific drug for neocrown pneumonia until now, we have found many effective drugs and effective treatment methods in the course of rescue and treatment. Through experimental studies, we have identified eight drugs or compounds that significantly inhibit the replication of COVID-19. One of the effective drugs is & quot;Leflunomide", a drug used to treat rheumatoid arthritis, which I found in my experimental study in 2018 to have an inhibitory effect on myocardial remodeling and myocardial fibrosis, and published a paper. In a study conducted by Lan Ke of the State Key Laboratory of Virology, Wuhan University, we found that leflunomide inhibited COVID-19 at the cellular level. We have used it for COVID-19 treatment, and the time to negative viral nucleic acid is 40% shorter than the control group. In addition, the & quot;three drugs and three parties" of Chinese medicine also played a very important role.
Establishment of treatment principles
Most importantly, in the face of such a rampant epidemic, we always put patients' lives in the first place, as instructed by General Secretary Xi Jinping.
I was impressed by a 65-year-old patient. Almost every means of resuscitation was tried to treat this patient, who was later maintained for 62 days using ECMO, an artificial heart-lung machine, and the country paid a huge price for his successful lung transplant, and this patient recovered and was discharged from the hospital.
However, this case sparked a lot of suspicion in the overseas media that the patient must have a great background, either a high-ranking official or a wealthy businessman. Since the patient's treatment was done in the East Hospital of Wuhan University People's Hospital, I know very well that the patient is an ordinary welder, his partner is retired and his daughter is an ordinary worker, living in an ordinary two-room apartment in Wuhan. Following the principle of patient-centeredness and life first, this patient was transferred to Wuhan People's Hospital East Hospital three times and was finally discharged here.
There was a photo on the Internet of a doctor accompanying an elderly patient to watch the sunset, and the photo received 128 million hits that night. The patient, who was 87 years old at the time, was diagnosed with a serious illness and was kept completely on a ventilator for a long time. Later, when his condition was in remission, the patient suggested that he wanted to see the sunlight, so our doctors and volunteers pushed the patient outside just as the sun was setting, and the picture was very touching. Now, the elderly man has recovered.
At the National Commendation Conference for the Fight against the New Coronary Pneumonia Epidemic, General Secretary Xi made an important speech summarizing the important experience and profound insights we have accumulated in the fight against the epidemic. This anti-epidemic process also made the people deeply feel the incomparable superiority of the socialist system with Chinese characteristics.
Optimization of the anti-epidemic model
In retrospect, Wuhan University has developed a unique model for fighting the epidemic: medical treatment in affiliated hospitals on the one hand and scientific and technological research on the other hand.
On the one hand, we mobilized all medical resources, including medical and nursing staff from all affiliated hospitals, and collaborated with multiple faculties to provide scientific and human support for the treatment. In addition to the headquarters and branches of the affiliated hospitals, we also temporarily took over two municipal hospitals, four square cabin hospitals, and took over the whole Lei Shen Shan Hospital. We also supported Jinyintan Hospital, to which we sent a medical team to take over one of the wards, providing a combined total of more than 13000 beds. Of course, we could not have accomplished such a difficult task by ourselves alone. At that time, about 42000 medical and nursing staffs from all over the country rushed to help Wuhan, and medical and nursing staffs from hospitals affiliated with Wuhan University worked together with the rushing medical and nursing staffs to fight together.
At the same time, we extensively mobilized donations from alumni of Wuhan University at home and abroad for global procurement. Wuhan received 4 billion yuan in donations during the epidemic, and the donations from Wuhan University alumni amounted to 1.2 billion yuan. At the beginning of the epidemic outbreak, alumni donated nearly 10 million masks, more than 600000 pieces of protective clothing, more than 200000 pairs of gloves, more than 100000 pairs of goggles and other shortage supplies.
While medical treatment was provided, we also firmly guarded the bottom line of campus epidemic prevention. We adopted classification, zoning and triage strategies in decision-making and mobilized all available forces to support materially.
We have also continued to strengthen scientific and technological research to provide strong scientific and technological support for the prevention and control of the epidemic. On January 2, our State Key Laboratory of Virus detected nucleic acids in alveolar lavage fluid specimens from a suspected case obtained from the Central South Hospital, and subsequently confirmed it as a novel coronavirus, and reported the nucleic acid sequence to the National Center for Disease Control as required, naming it WHU01 and WHU02, which was later cited in the joint study report of the Chinese government and the World Health Organization. After the pathogen was identified, the transmission route was not completely clear. In addition to direct contact and droplet transmission, the problem of aerosol transmission needs to be addressed. Our State Key Laboratory of Virology, Professor Lan Ke and others quickly initiated research to collect aerosols in different areas such as intensive care wards, hospital passages, medical staff working and living areas, square cabin hospitals, and communities to explain the aerosol in the transmission of the new coronavirus.
At that time, our researchers encountered difficulties in conducting environmental aerosol viral load monitoring and the hospital director had concerns about it. I was able to coordinate this from a professional and duty perspective and was able to complete it successfully. The results of the study proved that viruses can be transmitted through aerosols. It was also found that conventional disinfection methods such as alcohol or normal disinfection could block aerosol transmission. The results of this research were later published in the main issue of Nature and also adopted by the CDC, which was really influential.
In terms of nucleic acid testing, for example, the sensitivity and specificity of reagents for nucleic acid testing were not high at the beginning of the outbreak. In order to change this situation, we organized professionals from the School of Pharmacy, the State Key Laboratory of Virus, the Institute of Biotechnology, the Central South Hospital and the People's Hospital, and adopted relevant high technology to significantly improve the sensitivity and specificity of the reagents. Moreover, according to the traditional testing method, only 200 people could be tested in a day, but under the guidance of the new technology, the number of people tested was increased to 1900 at once. This also reflects the role of scientific and technological innovation in the fight against the epidemic. We didn't think about applying for patents for these new technologies, we just thought about how to contribute to the fight against the epidemic and clear the & quot;roadblocks" on the way. Later, when the epidemic broke out in Xinfa Di, Beijing, our People's Hospital and Zhongnan Hospital went to Beijing with advanced nucleic acid detection technology to support them.
The power of scientific innovation is also reflected in other aspects, such as patients infected with neoconiosis, whose lungs may be extensively infected, and there is a serious shortage of radiologists to diagnose CT images of lungs. System to assist image diagnosis with the power of artificial intelligence. After a period of practice, we found that the AI processing system of COVID-19 CT images has a detection sensitivity of 97.6% and an accuracy rate of 91.5% for initial screening of normal and severe patients. This is a surprising breakthrough. We still did not apply for a patent for this technology, and also published the result directly on the Internet. Subsequently, new crown outbreaks occurred in other countries around the world, and many countries offered to adopt this technology. In the spirit of the community of human destiny, we developed five language versions of this system in Chinese, English, French, Italian, and Spanish, which were shared with all countries in the world free of charge.
On February 8, 2020, the Mount Thor Hospital was officially opened. Mount Thor Hospital is somewhat larger than Vulcan Hospital, yet it took only 12 days from the start of construction to its opening, with the entirety taken over by Wuhan University Central South Hospital. But this was not done by ourselves. More than 3000 medical staff from 16 medical teams from Wuhan, Liaoning, Shanghai, Guangdong, and Jilin attended patients at Mount Thor Hospital, and in 67 days, 1,2011 patients were admitted to the hospital, half of whom were serious or critically ill. Ultimately, more than 1900 patients recovered and were discharged from Mount Raytheon Hospital. As the epidemic situation improved, all the remaining patients from the Leishenshan Hospital were concentrated in the East Campus of Wuhan University People's Hospital and Tongji Hospital.
It was also a remarkable achievement for the Fangcao Hospital to concentrate on the treatment of patients with mild cases of New Guan Pneumonia, which was very important to cut off the transmission route. As the first hospital in Wuchang, we have organized a multidisciplinary team of talents, including jurists and management scholars, to develop the operational mechanism and construction standards of the hospital. It can be said that the operating mechanism and standards of China's square cabin hospitals were born here, and these mechanisms and standards have become important references for the experience of Hong Kong and other places in preventing and controlling and supporting overseas fight against the epidemic.
The epidemic also brought psychological panic to some of the population, and a lot of psychological counseling was also needed to help overcome the fear and apprehension. One-to-one counseling was clearly not enough, so the Wuhan University Rescue Center took the lead in developing software that could be used by more than 300000 people. The work we have done has also had a big impact internationally. The US agency Digital Science has done a ranking of the papers published by institutions on the new coronary pneumonia epidemic in the first half of 2020, and the first place was ranked by the Massachusetts General Hospital of Harvard University, and the second and third places were ranked by Wuhan University Central South Hospital and People's Hospital.
In terms of vaccines, most of the vaccines that people are playing now are inactivated vaccines, which have high safety and are currently available in three main vaccine products from Sinopharm, Kexing and Wuhan Biological Institute. The second generation vaccines belong to genetic engineering vaccines, mainly recombinant subunit vaccines, virus-like particle vaccines, live virus vector vaccines, etc. The third generation vaccines are nucleic acid vaccines, mainly DNA vaccines and RNA vaccines. In April 2020, we started to organize the State Key Laboratory of Virology, Wuhan University, Lan Ke and Xu Ke to carry out the research and development of trimeric protein subunit new crown vaccine, and breakthrough progress has been made, and the results are very exciting, so we must believe in the power of science and technology. At this point, we are very proud to recall that we have implemented all the five major areas of research called for by General Secretary Xi Jinping during his visit to Tsinghua University and the Academy of Military Medical Sciences on March 2, 2020: & quot;virus tracing, transmission pathways, nucleic acid detection, drug screening, and vaccine development", and we have achieved remarkable results.
This spring, in the beautiful season of cherry blossoms at Wuhan University, we kindly invited medical personnel from all over China to enjoy the cherry blossoms at Wuhan University, as an expression of our gratitude to medical personnel from all over China for supporting Wuhan.
At present, the new crown epidemic is far from over, the epidemic is still spreading abroad, and there are also localized disseminated cases in China, in such a situation, we still need to pay attention to the regular epidemic prevention and control. For general non-health care workers, the main way is to wash hands properly and wear a good mask. As an example, some time ago a patient with neoconiosis from Shijiazhuang went to Wuhan for a few days without knowing that he had been infected with neoconiosis. After related flow investigation and screening, this patient had about 7000 to 8000 close and non-close contacts in Wuhan, but ultimately none of them were infected. Why is this? It turns out that this patient took into account that Wuhan had an epidemic, so everywhere he went, he wore his mask tightly, and the Wuhan people themselves had a strong sense of protection, and wore their masks in place. This case is enough to show that wearing a good mask is still a very effective protective measure.
But wear a mask to pay attention to a problem, the mask do not save excessively, generally four to six hours to change out. Surgical masks can resist the principle of the virus, not by filtration but by charge, charge intact, the virus can not invade. If the mask is used for too long, our breath may wet the mask and lose the charge protection. This is the same reason why during an epidemic, health care workers have to change their protective clothing in four to six hours.
Integrating regular epidemic prevention and control with chronic disease prevention and control
Epidemic prevention and control is still the top priority, but at the same time, we must also pay great attention to the prevention and control of chronic diseases.
At present, the problem of chronic disease prevention and control is still relatively prominent, and major chronic diseases are still the main threat to people's health in China.Figures from the 2018 National Statistical Yearbook show that among the chronic diseases that cause death among Chinese urban and rural residents, the top four are malignant tumors, heart disease, cerebrovascular disease and respiratory disease.
Over the years, the incidence of diabetes and malignant tumors has also remained high. I am presiding over the National Key Research and Development Program project "Science and Technology Demonstration Research on Prevention and Control of Major Chronic Diseases in Central and South China". During the research, we made some comparisons and found that the prevalence of diabetes is still increasing nationwide; the incidence of malignant tumors is also high from a national perspective. Comparing the data in the past decade, we found that the incidence of malignant tumors in China has not increased, but the number of tumor patients has greatly increased. Why did this situation occur? It is mainly due to the concerted efforts of various sectors that the survival time of cancer patients is significantly longer, and the total number of cancer patients in the society is greatly increased than in the past, which is one of the reasons for the increasing cost of medical care in the country.
As a cardiologist, I urge everyone to be aware of the prevention and control of cardiovascular diseases, which now account for 43% of all deaths. Most of the people in our country live in high-risk areas for cardiovascular disease, such as Liaoning, Shandong, Henan, Hubei, Chongqing, Hunan, and Guangdong, where many cardiovascular and cerebrovascular patients develop or die suddenly "without a sound". More than 50% of cardiovascular deaths occur suddenly and without warning, and only 20% of patients have angina before their heart attack.
Since the founding of New China, we have made great strides in health care, and when New China was founded in 1949, the average life expectancy of the Chinese people was only 35 years. In the 35 years between 1949 and 1996, the average life expectancy in China increased by almost one year per year. During this time, neonatal and maternal mortality rates dropped dramatically and many deadly acute infectious diseases disappeared.
However, after everyone's standard of living improved, not enough attention was paid to the prevention and control of chronic diseases, so that between 1996 and 2006, chronic diseases had a significant impact on the health of many people. Our country has been implementing the Health China Initiative since 2016, and now China has fully achieved the set goal of 77.3 years of life expectancy by 2020, and is expected to reach 79 years of life expectancy by 2030.
It is important to note that with the outbreak of the new crown epidemic, the high public attention to major chronic diseases has shifted, the order of prevention and control of major chronic diseases has been somewhat disturbed, and the ability to prevent and control major chronic diseases has been weakened. The epidemic has led to recurring secondary disasters.
The more in such a situation, the more we should be soberly aware that major chronic diseases are still the main hazards for the people, and we must do a good job of coordinating the prevention and control of epidemics with the prevention and control of major chronic diseases.
In major chronic disease prevention and control programs, we should establish a personal follow-up system, which is how we operate in our research, only to be interrupted sometimes due to the epidemic. As the epidemic improves, we should re-implement this measure.
In addition, we should also actively learn from the advanced experience of some countries. From the 1970s, the United States had a high incidence of chronic diseases, and the incidence of cardiovascular diseases dropped significantly after effective prevention and control was adopted. Finland is the same situation, in the 1960s in Finland, the streets rarely see elderly men, because most of the elderly men died of cardiovascular disease. After a period of prevention and control of chronic diseases, the cardiovascular incidence in Finland is now declining and life expectancy is comparable to the level of other European countries.
The key to cardiovascular disease is good blood pressure control, and respiratory diseases can be intervened in advance. More difficult may be malignant tumors, where it is not yet known how to intervene effectively. However, we can still combine a healthy lifestyle with effective prevention and control measures, which can effectively reduce mortality and morbidity.
Collation | Wen Zhanchun
Editing | Xianqing Wang and Zhiqin Wang