Zhou Xin is the discipline leader of the Department of Respiratory and Critical Care Medicine at Shanghai First People’s Hospital, and has treated such patients in Shanghai. In January this year, he was the first to sign up and also the first to arrive in Wuhan, Shanghai respiratory experts, but also the first batch of Shanghai medical aid team medical team leader. Since the aid to E, Zhou Xin is responsible for the treatment of two critical wards in Wuhan Jinyintan Hospital. The following is an interview with Zhou Xin from Southerners Weekly. Southerners Weekly: You have been in charge of the treatment of critically ill patients in the ICU ward of Jinyintan Hospital, what is your experience in the treatment of critically ill patients now? Zhou Xin: Generally speaking, the treatment effect of critically ill patients is not very good. Once neocoronavirus pneumonia becomes severe, the disease can progress very quickly and the death rate is still quite high. We are now seeing data that the national mortality rate for NCCP is 1.0 percent, but the rate in Wuhan is 4.0 percent. There are many patients with mild cases of neoconiosis, and 80-90% of them can be cured. However, about 10-20% of patients will develop into severe disease, and a small number of patients in severe disease will develop into critical disease, and once they develop into critical, the death rate is even higher, and the death rate of tracheal intubation ventilator treatment reaches more than 80%. The patients we admit here are mainly critically and critically ill and are treated with high-flow oxygen, non-invasive ventilators, invasive ventilators, and ECMO. Different treatments are chosen depending on the patient’s oxygenation status. Regarding the treatment of critically ill neocoronary pneumonia with non-invasive ventilators also with invasive ventilators, in general, non-invasive ventilators are given first according to the patient’s oxygenation status, and if the patient’s oxygenation status does not improve significantly after several hours of treatment, tracheal intubation is performed for invasive ventilator therapy. However, since critically ill patients tend to have multiple organ failure, even after tracheal intubation and invasive ventilator treatment, the patient’s morbidity and mortality rate is still very high. Southerners Weekly: What is the difference between this new coronavirus pneumonia and SARS in terms of treatment? Zhou Xin: Like SARS and bird flu, the main lesions involve the lungs, the mortality rate is high, and bleeding secretions can be aspirated from the airways, like flesh washing water. In contrast, the airways of patients with new coronavirus pneumonia are drier, no bloody secretions are seen, and severe patients have more severe symptoms of coughing and breathing difficulties. In the rescue and treatment are currently in accordance with the diagnosis and treatment guidelines issued by the state. When a patient develops into a critical illness, it is not possible to solve the problem with a single drug. There are some antiviral drugs in clinical use now, and these drugs are mainly used in the early stage. The earlier the antiviral drugs are used, the better it will stop the development of the disease and shorten the course of the disease. The earlier the antiviral is used, the better, it will stop the progression of the disease and shorten the course of the disease. When it comes to severe and critical patients, the efficacy of antiviral treatment will not be good anymore and may increase the side effects of the drug. Southern People Weekly: What are the requirements for the hospital’s treatment force to treat critically ill patients? Zhou Xin: Our medical team has doctors and nurses in respiratory medicine, critical care medicine, emergency medicine, etc. They have good clinical experience in treating critically ill patients. Saving critically ill patients is a system project, not relying on one medicine or one equipment, medical care is also very important. Southerners Weekly: Is it easy to confuse the early onset of neoconiosis with influenza? Zhou Xin: Winter is also a high season for influenza, which can be accompanied by fever and pneumonia, and some patients have runny nose, sneezing and other khat symptoms, while almost all patients with NCCP have no khat symptoms, mainly fever, malaise, cough and dyspnea. (The word catarrh comes from the English word “catarrh”, which means “mucositis”. It is usually used clinically for mucosal inflammation of the upper respiratory tract. Upper respiratory catarrh symptoms include cough, runny nose, sneezing, nasal congestion and other upper respiratory symptoms, which are common in clinical practice.) Southerners Weekly: People are worried about the spread of aerosols and feel that it is impossible to prevent it. Zhou Xin: Aerosol transmission is relative, depending on the virus load and the size of the space. If it is a square cabin hospital, the space is so large, it would have been blown away long ago. There should be no problem with exposure to air outdoors. In general, respiratory droplets spread the most. Wearing a mask, washing your hands, and not going to places where there are many people are the safest. Southerners Weekly: What is the most difficult patient you have treated so far? Zhou Xin: The most difficult one is the critically ill patient who was not successfully treated in the end. We thought of a lot of ways, but the result is still not saved, on ECMO useless, can not pull back. One of the characteristics of a critically ill patient with neoconiosis is that it develops rapidly, causing multiple organ function damage, and another characteristic is sudden death. It may be the effect of the virus on the heart …… it is not just a lung lesion. Southerners Weekly: What kind of difficulties and challenges have you encountered in your work here? Zhou Xin: At the beginning there was not enough protective equipment, not enough masks, which led us all to restrict doctors from entering the wards. Originally, we all had to go in together for room visits, but then we restricted each medical team to one doctor. First of all, we had to make sure that nurses could go in because there was a lot of nurse care. Now the supply of protective equipment and masks and so on is much better. Southern People Weekly: The Shanghai medical team requires zero infection among the medical staff, can it be achieved? Zhou Xin: There must be zero infection. All medical teams must have zero infection and must protect themselves in order to be able to save patients. We attach great importance to nosocomial infections, and personal protection is right no matter how strict. In the early stages of the disease, many local hospital staff in Wuhan were infected by contact with patients. In the early days, they had no protection and wore a thin mask. Now there are more than 30,000 medical team members, because the protection work is done, no more infected. Southerners Weekly: It seems that there are fewer young people among the deaths reported in the past? Zhou Xin: Young patients also die. There are not a lot of new coronary pneumonia patients who die in their thirties or forties, all without underlying diseases, but also with systemic organ failure. Why do young people have this condition even without underlying disease? When a virus invades the organism, the immune function of the organism creates a fight, and a large number of cells go against the virus, causing a significant decrease in lymphocytes, indicating that you have a low immune function, which then produces an inflammatory response. However, if you can’t resist the virus, when the inflammatory response is intense, the lung damage is severe. Who can cause this severe response? It is not known yet. It is only clinically found that the more obese people are, the stronger the “inflammatory storm” will be. In a few young people, there is an excessive immune response, and the body reacts strongly, eventually causing damage to multiple organs. In pregnant women, too, the inflammatory response is more intense, and once infected, multi-organ failure can easily occur. The number of children in the infected population is low this time, although we claim that all people can get the disease, there are a few children in the tens of thousands of reported cases?less than 100. It may be that children are less exposed, or it may be that the virus is less likely to infect children. Source: Southerners Weekly