While LOW IQ FatRump tweets an ad for a Mexican Restaurant and mocks Mike's appearance, here's how China is handling the TrumpVirus:
China has a principle of early identification, early isolation, early diagnosis and early treatment. Early identification of suspect cases is critical to containment efforts and occurs via a process of temperature screening and questioning at entrances to many institutions, communities, travel venues (airports, train stations) and hospitals. Many hospitals have fever clinics that were established and maintained since the SARS outbreak. In China, laboratory tests were originally requested according to the case definitions, which included an epidemiological link to Hubei or other confirmed cases. However, more recently, a more liberal clinical testing regimen allows clinicians to test with a low index of suspicion.
Suspect cases are isolated in normal pressure single rooms, wear a surgical mask (for source control). Staff in China wear a cap, eye protection, n95 masks, gown and gloves (single use only). In Wuhan it is necessary for most suspects to be cohorted in a normal pressure isolation ward. Staff wear PPE continuously, changing it only when they leave the ward.
PCR test results are returned the same day. If positive, patients are transported to designated hospitals (including negative pressure ambulances in some cities). All patients, including the mild and asymptomatic, with a positive test are admitted. The designated hospitals are known and are strategically placed with at least one per district/county. Positive cases are cohorted by gender. Negative tested patients are managed based on clinical needs. All patients are evaluated with a respiratory multiplex to look for other diagnoses. This can add to the reassurance that a negative COVID-19 test reflects a lack of infection with COVID-19.
In Wuhan, there are 45 designated hospitals, 6 of which are designated for critical patients, and 39 for severe patients and/or any patients >65 years old. There are an additional 10 temporary hospitals reconstructed from gymnasium and exhibition centers, which are for mild patients. Other surge measures undertaken in Wuhan include two new temporary hospitals with 2600 beds, plus many makeshift hospitals to increase bed capacity. Bed capacity within Wuhan has increased to >50,000.
Patients are treated according to the National Clinical guidelines (edition 6) released by the China National Health Commission (NHC). There are no specific antiviral or immune modulating agents proven (or recommended) to improve outcomes. All patients are monitored by regular pulse oximetry. The guidelines include supportive care by clinical category (mild, moderate, severe and critical), as well as the role of investigational treatments such as chloroquine, phosphate, lopinavir/ritonavir, alpha interferon, ribavirin, arbidol. The application of intubation/invasive ventilation and ECMO in critically ill patients can improve survival. The Joint Mission Team was told of ECMO use in four patients at one hospital with one death and three who appeared to be improving. Clearly, though ECMO is very resource consumptive, any health system would need to carefully weigh the benefits. There is widespread use of Traditional Chinese Medicines (TCM), for which the affects must be fully evaluated.
Patients with COVID-19 are not permitted visitors. Staff use coveralls, masks, eye cover, and gloves, removing PPE only when they leave the ward. |
