Source: Finance Magazine
Author: Wang Bo, Xin Xiaotong, Zheng Ke Shu, Liu Xin, Gu Yiyu, Liu Shuqi, Wu Junyu, Liu Jianzhong, Liu Ding
In the past three weeks, the speed of the spread of Chinese coronal virus has surprised almost everyone.Some experts said that according to the development of the virus, the peak of severe illnesses usually appears two to three weeks after the peak infection.
Based on this, the first wave of severe peaks will appear in various places at the beginning of the year.At this time, the protection and treatment of elderly people became the focus of hospitals at all levels.
Compared with urban residents, most rural elderly people are separated from groups, and it is more difficult to buy medicines for medical purchase.In the past week, financial reporters have interviewed rural residents in Hebei, Jilin, Zhejiang, Yunnan, Guangdong, Jiangxi, Shandong and other places, focusing on understanding the situation of the elderly under the epidemic.
The level of treatment of township hospitals is limited
"Many elderly people have not been able to survive this winter." Wang Yan said to Financial reporters that since December, the activities of setting off firecrackers in surrounding villages have continued every day.I haven't seen such a scene.
Half a year ago, Wang Yan came to the White House School of Meijiang District, Meizhou City, Meizhou City, Meizhou City, Meizhou City, Meizhou City, which is about 400 kilometers from Guangzhou.There are also rare cases of coronary disease until mid -December.
Starting two weeks ago, the infected person quietly increased.Wang Yan's school put the winter vacation in advance before Christmas. Most teachers and students were calm. There were also a few people very anxious. They were not worried about their infection, but worried that they were old and who had no vaccine at home and had no vaccine.
Most of the students come from the surrounding villages and towns. As the students return home, more and more villages and surrounding villages are infected.Wang Yan estimates that the proportion of infection in surrounding villages should now exceed 70%.
A village cadre in a village in a village in the southwest of Ningbo City, Zhejiang Province said that there was an old man in the village had a fever and could not eat it for four days. The family drove to the hospital in the county., I arrived at home at more than three in the morning.The two interviewed villagers mentioned that the hospital in the nearby town has also been out of stock.
Even if there are antipyretics, most of the town hospitals are difficult to be able to admit to the infected elderly.A town of Ningbo, Zhejiang, is currently sufficient. When prescribing the medicine, the hospital can also be distributed by the hospital. Each patient gives two days of dosage, but the medical staff is infected and causes insufficient manpower.
The town where the hospital is located has a permanent population of 30,000.Li Fang, a staff member of the health center, said that they ushered in the peak of infection around December 15th, and a large number of patients were poured into a large number of patients.Li Fang told financial reporters that the original 10 clinicians of the hospital can only be on the job now.Because of the lack of manpower, the popular nesting clinic only opened during the day; at night, patients with fever and non -fever gathered in ordinary emergency, which caused cross -infection.
The hospital has not received hospitalized patients for a year.In the past three years, in addition to working in the unit, the hospital's medical staff must also undertake the prevention and control of the epidemic, and perform nucleic acid samples at the isolation point, high -speed rail station, and the mouth of the road.
Data from the National Health and Health Commission show that as of the end of 2021, 29,600 towns and villages in China have 35,000 townships and towns and villages, with 1.492 million health personnel; 490,000 administrative villages in China have 599,000 villages., 1.363 million in the village clinics.
Although the scale of village health medical staff is growing, villagers generally lack trust in grass -roots institutions such as township and township hospitals, and believe that there can only be a "minor illness" here.Sun Ming, a village doctor in a village in a village in western Ningbo, Zhejiang, said that the township health hospital 10 minutes away from the village is a general hospital, but there is no condition to take CT. In the case of severe patients, the township health hospital will also propose to transfer the patients to more advanced levels.Hospitals; the town health hospital for half an hour can take CT, but the villagers need to check the physical or severe condition. They will choose to drive for more than an hour and go to the county or urban hospital.
Qiu Yunqing, Executive Deputy Dean of the First Affiliated Hospital of Zhejiang University Medical College, said: The peaks of infections in various places are different, and the peaks of severe illnesses will be different.According to the development law of the virus, the peak of severe illnesses generally occurs after two to three weeks of the peak infection, and hospitals at all levels need to be prepared to treat patients with severe illnesses.
Wang Qi is the dean of a township hospital in Lichun City, Jilin Province. He mentioned that the business level of primary medical care in the past three years has declined."In the past three years, we could hardly contact patients with fever. Policies required to transfer patients to higher -level hospitals and designated medical institutions.P>
The outbreak of the epidemic in December suddenly broke out, the heating patients began to pour, and the antipyretic medicine was used up quickly. Some of the township hospitals were helpless.Wang Qi said: "There is a significant gap in the needs of doctors and patients. Patients may have high expectations for us, but our business level and service capabilities are relatively lagging behind."
"The role of the grass -roots card point has not been played," Wang Qi analyzed. "At the beginning, there were no patients, which caused the medicine to have no reserves, and then caused the business level to be deserted.It's gone, just run to the big hospital, even if you need to spend more money. "
Elderly people buy medicine difficult
Villagers from Hebei, Yunnan, Jilin, Anhui, Zhejiang and other places said that the elderly in the village will not go to the hospital as long as they have medicine.But for some special elderly people, it is not easy to buy medicine.
There is only one staff member of the acter of Ningbo Village Doctor Sun Ming, serving about 600 permanent population in the village.
On December 5, Zhejiang Province optimized the epidemic prevention and control measures, no longer conducting normalized nucleic acid testing, and canceling the control measures for the purchase of "four types of" drugs (fever, cough, antiviral, antibiotics).
After seeing the notice, Sun Ming immediately contacted the Township Health Center and wanted to configure 30 boxes of antipyretics; but the health center told her that there were not so many medicines.On December 14, she brought back 10 boxes of Tailuo and 20 bottles of cough syrup from the hospital.At that time, no one was diagnosed in the village, but some old people in the village listened to the reminders of children in the city and came to buy medicines in advance.10 boxes of Tyno were able to be sold out of 10 people and sold out in three days. Sun Ming did not save the consciousness of prescribing medicine at the time. She did not expect that since then, the antipyretic medicine became so tight.
Some village doctors in their surrounding villages have a slow response. When they want to go to the hospital to take medicine, they have no antipyretic medicine at all; some colleagues told her that they went to the pharmaceutical company to buy the goods and could not get the medicine.
Around December 17, a positive case began to appear in the village where Sun Ming was located. Six or seven people came to buy antipyretics a day, but Tono had already sold out.The township health center has no medicine anymore.
On December 21, Sun Ming went to get medicine again.She saw that the antipyretic medicine of the township toilet was saved by two, three -piece land, and only provided to the heater; more than 20 medical staff in the hospital, more than 10 infections, and some asymptomatic infected people were still onStick to work.Sun Ming stayed in the hospital for two or three hours, and only brought back some hypertension and beef detoxification tablets.The next day, she also started to have a fever.
There are more than 5,300 residents in a village community in Puding County, Anshun City, Guizhou Province, of which more than a quarter of the elderly over 60 years old and children under 12.Liu Wei, secretary of the village neighborhood committee, is linked to the supply of antipyretics through various ways.Liu Wei told the financial reporter that since a foreign -returned personnel have had high fever symptoms on December 16, nearly 600 people in the community have similar symptoms.
Liu Wei said that the price of ibuprofen in township hospitals and the price of acetaminol is 10 yuan (RMB, the same below, S $ 1.94) to 28 yuan, and the price is reasonable.There are a certain number of antipyretic medicines in the town health home, village clinics, and pharmacies. Now the township pharmacies can't buy antipyretics. They can only go to the county seat to buy it. It takes more than four hours to go back and forth.The information in the village was blocked, and most of the villagers had no medicine at home.
Liu Wei is most worried about the empty nest elderly and left -behind children in the village. It is difficult for them to go to the county seat to buy medicines, and at the same time, they are susceptible people.
The neighborhood committee previously organized village cadres to visit and take care of the elderly in the empty nest, convey some knowledge of epidemic prevention, and find other methods without antipyretics.Nowadays, village cadres are also obvious symptoms. Only Liu Wei's symptoms are relatively mild, and they are still on duty.
Yin Bing and his mother are both doctors.MotherIn the sanitary service station in a suburbs of a city in Qujing City, Yunnan Province, she told financial reporters that about 80%of families in the village have positive patients.At present, the needle water supply of the health service station is sufficient, but it is missing antipyeing drugs such as ibuprofen and acetaminol.The service station cannot purchase medicine by itself. It may be collected by the local medical system and distributed to the health service station, but now the medical system can not purchase antipyretics.Therefore, doctors at the service station generally give patients a sensitivity, antiviral particles, cold heat -clearing particles, urgent syrup and other medicines.quantity.
Sun Ming said that in the past few years, the toilet has not reserved the drug -related drugs, and the village doctor will be fined if the patients are prescribed for patients.Therefore, Sun Ming's consultation is mostly chronic patients such as hypertension and diabetes.
Generally speaking, village and town health service stations are often the last stop for drug supply. Hospitals and pharmacies in large cities have completed their goods before it is the village.
Zhang Hongjuan, a villager in Lujiu Village, Zhuyi Town, Laizhou City, Shandong Province, said that the county seat has begun to be distributed, but this "welfare" has not yet penetrated into the village and towns.At present, there are four pharmacies in the county that can queue up and receive fever, but they will not go. "I can't get it." The villagers believe that drinking more water and sleeping, and the family group conveys various dietary prescriptions.There are also villagers to ask doctors to prescribe traditional Chinese medicine, but Chinese medicine clearly notices that Chinese medicine only has preventive effects, enhances immunity, and has no significant effect on fever.
In the remote areas of Zhangjiajie, Hunan, in a small village that is dominated by the elderly and more than 80 people, the Song Xuan family's way to resist the virus is to eat more fruits."There are orange trees at home. Eat two to three every day. Eat and drink well, and you don't have to prepare anything else." This is Song Xuan's mother. A doctor in the county town is prescribed by the family.
Song Xuan told financial reporters that there are already a lot of positive patients in the hospital where his mother is located, but there is no trace of epidemic in the village. "We have no health hospital here, and the recent township health centers are also 3 kilometers away.. My mother's hospital is farther. Usually someone gets serious illnesses. The ambulances in the hospital in the county town are pulled away, and they have to drive tens of kilometers. "He said that the occlusion of traffic allowed the villagers to have a villagers a one.Most of the self -confidence that is isolated from the world believes that the epidemic will not happen here at all. "Because we are almost self -sufficient, there will be a few people in a year. Nothing will be wearing a mask here, and I have not heard of who has stocks.Medicine. "
The phenomenon of antibiotics is common
In the absence of drugs, the villagers of the epidemic will choose more infusion, but there are a lot of antibiotics.
Zhou Yu is a doctor, and his hometown is located in a countryside in Maitreya City, Yunnan Province."I am aunt and aunty, and the four children have people in the house. One of the two uncle family is one, and the second uncle and four are all Yang." Zhou Yu all infected with relatives.Middle move.
According to Zhou Yu's observation, many people in the villages of Yunnan's hometown in Yunnan will not doubt that they have been infected with the new crowns even if they have fever and cough. They speculate that they are cold or exhausted.With the symptoms, the first reaction of most people is to go to the clinic to get an injection, which is already a deep -rooted idea of locals.In mid -December, the clinic in Zhou Yu's hometown village was full. Many people were in line to get an injection. From 7 am, there were still people.
Two health homes (a Chinese medicine hospital, a western hospital) in a village and towns in Anshun City, Guizhou Province have also become a place for the crowd.High -fever villagers came to the hospital to get a bit. The main component was virusazole (a antiviral injection drug, with certain side effects, and children under the age of three prohibited use).The sanitary home try to arrange the symptoms in the same room.Fortunately, the only three doctors in the village (one of them is Chinese medicine) has no symptoms such as fever.
At a suburbs of a city in Qujing City, Yunnan Province, there are more than a dozen people who have had injections at the Health Service Station every day in the past. More than one hundred patients who have had a fever recently have recently increased.Needle water given to patients includes antibiotics such as antivirus, anti -virus Yanhenin, plain asthma, asthma, and cephalosporin.
In order to cope with the impact of the crown disease, the local health department has conducted online course training for grassroots medical staff, but there are still irregular drugs."Many of them teachers inherit the primary medical staff of the elderly and lack systemic medical knowledge. When patients are fever and throat redness and swelling, they begin to use antibiotics. However, many patients do not need to use antibiotics. Only when bacterial infections are combined with bacterial infections.For example, there are color sputum such as yellow pus sputum, green pus sputum or iron rust sputum. The lung imaging science suggests pneumonia. When the infection indicators are rising, antibiotics need to be used. "Yin Bing said.
The crisis has not yet appeared, the most dangerous during the Spring Festival
Financial reporters learned that although rural medical barriers are limited, not all regions have medical extrusion, nor a large number of severe elderly people have occurred in all regions.
Yanghu Township's resident population in Yanghu Township under the jurisdiction of Zhangshu City, Jiangxi Province has exceeded 30,000. In the absence of antigen and nucleic acids, townships and rural residents use methods to deal with ordinary colds and fever to cope with coronary virus.
The resident of Yanghu Township said that after a cold and fever, everyone defaults to "Yang".According to his observations, around December 20, almost everyone around him had burned it.However, there is no phenomenon of large -scale medical crowding or medical difficulties. Only a few elderly people with basic diseases died of fever.
On December 27, after a short week of desertedness, the streets of Yanghu Township were restored to bustling, although the street was accompanied by a cough sound.
Four villagers from different rural areas in Zhejiang Province told financial reporters that crown diseases were originally infectious and terrible "plague" in the mouth of elderly villagers.Basically overcome the fear of crown disease.
They believe that today the villagers have a strong sense of protection and wearing masks; the temples of the village to read Buddha in the village, the elderly activity rooms such as the social entertainment, and other people's gathering places have been temporarily closed.
A cadre of a village in southwestern Ningbo said that the village would find the confirmation of crown disease, requiring conditions to be diagnosed with the villagers' home for seven days, and signed a commitment.Free concentration isolation.In response to the emergency, the village made a plan and sent a car to send severe patients to the county hospital for treatment.As of December 26, no one has used this service.
Aforementioned a town health center in Ningbo, Zhejiang also set up a public health department for high -risk groups such as elderly people with basic diseases. The responsibilities include the management of chronic diseases of the elderly.The quantity and situation are well understood.According to Li Fang, every year, the health centers need to accept the assessment of the human body inspection rate of the district.
Most of the rural areas of Jilin Province, the supply of medicines is also sufficient, the prefectures are rare, and the elderly basically stay at home and rarely go out.
Anti -fever medicine for the government has reached a belonging to the townships of Huichun City, Jilin Province, and the antigen has also been distributed, but some common medicines of cough, phlegm, and asthma are still scarce.
Wang Qi, dean of the township hospital, said that the antigen reagent of the township and township hospital was allocated by the Health and Health Commission, requiring the hospital to register in detail and use priority to ensure that the patients who were isolated from the kidnapper and home -to -home wereolation.However, the number of antigens is not large, and many patients cannot be sieved as soon as possible, and they are treated in a timely manner.
Wang Qi's townships where there is no signs of large -scale virus infections have not yet occurred.The detection crowd, especially the elderly."The habit of the elderly here is that if you are uncomfortable, you do n’t go to the hospital, go to the pharmacy to buy some medicines, and even find a recipe, so it is difficult to know that there are multiple patients."
The streets and township neighborhood committees of Huichun City are making accounts for the elderly these days, recording the data of the elderly with basic diseases and no vaccine.However, this part of the information has not been opened with the township health center.Grass -roots cadres are still mobilizing the elderly to take vaccines. Wang Qi believes that this is the most effective way and moves the epidemic mount forward, but he also believes that the grass -roots publicity is still not enough.
A number of village doctors said that young villagers have a sense of protection and wearing masks. Some people even wear two floors. There are positive cases in the family and will also be separated from the elderly.
But this is not a long time.You just go out to workIt may be infected, and then passed to the elderly at home, which is equivalent to passive infection.And the elderly's own awareness of epidemic prevention is also poor. They know to wear masks, but what masks, how to wear, how long to change the mask, and how to deal with the paper that wipes the nose and vomit phlegm.clear.
In response to the current status of prevention of the elderly in the countryside, Dr. Yin Bing in Qujing City, Yunnan gave three suggestions:
First of all, many rural traffic is inconvenient, and it is important to keep medicine at home.Rural elderly people are used to prescribing medicines in the village, but the variety of medicines in the clinic room lacks oral heat -relieving analgesic drugs. Therefore, it is urgent to increase the supply of such drugs such as the toilet.
Second, the elderly are inconvenient to use mobile phones, and it is difficult to obtain epidemic protection knowledge through the Internet.You can print leaflets or set up epidemic prevention publicity columns in the village, and science popularization in a simple and easy -to -understand picture.
Third, increase popular science to the family members of the elderly.Many elderly people are inconvenient to move and have no ability to grasp the common sense of protection. If children's awareness of protection is higher, and disinfection with disinfection is used for comprehensive disinfection at home.
Xu Yucai, the former deputy director of the Shanyang County Health Bureau of Shaanxi Province, told financial reporters that entering the lunar month and the upcoming first month, the most risk risk of rural infection."Many rural areas have traded a lot in the market before the lunar month, and the elderly came out to collect the annual goods; the customs and habits in some areas were to do happy events in the first month, and relatives and friends giving gifts to the banquet.The important thing is that the three -year epidemic prevention and control, the state has always advocated that children of migrant workers can not go home without going home. This year, a large number of people will return to home to increase the risk of epidemic dissemination. "
Prevention, vaccine, establishment of key population monitoring files
As a response to the adjustment of the epidemic prevention policy, many villages and towns have begun to accelerate the fourth vaccination work of the crown vaccine.
Ludian County is located in the northeast of Yunnan Province. It is a national poor county and has 10 towns and two townships under its jurisdiction.Near the years, a large number of people who went out to work and studying returned home, and the spread of the epidemic spread to the countryside.Li Xiao works in a township government in Ludian County. In terms of protection of the elderly, a key task of her town government is that a certain number of vaccines are allocated every day, and vehicles organize vehicles to come to the elderly by the hospital."The elderly are very cooperative. The vaccination rate of the elderly in the town in the past has been close to 90%. At present, the elderly who allow the physical quality to support the vaccination can also be vaccinated."
Elderly people with basic diseases occupy a large proportion in rural areas, but their vaccination rate is not high, which also brings difficulty in preventing epidemic prevention in rural areas.
"When the country was initially implemented by vaccination, the specified age was 18 to 59 years old, which largely left the impression of" the elderly in vaccination "in the minds of ordinary people. Until now, the vaccination is also refused."Xu Yucai explained that in fact, the new crown vaccine has already limited age to over 3 years old, and the elderly are one of the best priorities for vaccination. However, because the propaganda work at all levels is not in place, people still have similar panic.
Various cases have led to a greater risk of infection in rural people."The virus depends on 'defense' that is basically unstoppable. It can only be used through a series of risk management measures to avoid sudden outbreaks of the epidemic." Regarding risk management, Xu Yucai believes that the community and village committees must first do a good job of doing a good job.Propaganda work allows everyone to understand the danger of excessive gathering, try not to make the door and not to catch up.
Secondly, improve the natural immunity of residents through effective ways, including calling for vaccines and providing dietary guidance.The most important thing is to establish a high -risk group management file, pay close attention to the elderly with basic diseases in the jurisdiction, give timely help to control the basic diseases."And this work should not end with the end of the epidemic, and long -term mechanism should be formed."
In addition to prevention, treatment and monitoring are the biggest difficulties in rural epidemic.Xu Yucai introduced that the state proposed a hierarchical treatment for medical treatment. The role of grass -roots medical institutions was that it was able to discover and refer it in time for high -risk people, and to effectively treat people with low -risk infections.However, the two role of the basic medical facilities in rural areas can not be fully played.
"First of all, it is scarcity of conventional drugs, insufficient reserves, and no antipyretic medicine in many areas; then the lack of experience in grass -roots medical staff and weak response to the emergencies. After a large number of cases appear, the medical staff is very tired.At the same time, it is also easy to be infected, and the situation of reduction is prominent. "Xu Yucai said.
In addition, many rural areas cannot identify high -risk patients in the first time."The lack of antigen reagents in the countryside -cannot determine whether it is infected as soon as possible; in addition, the ischemia instrument,‘ silence hypoxia ’is an important cause of death.”
Xu Yucai introduced that after many elderly people were infected, their bodies did not have obvious discomfort, and their symptoms were not obvious. The family may not care."But this situation may also be reduced by blood oxygen saturation. This is not seen by the naked eye. It must be detected by the oxygen meterometer.Dangerous. "
Cao Bin, deputy dean of the China -Japan Friendship Hospital, mentioned that some elderly people still do not have obvious chest tightness and breathing difficulties when severe hypoxia (even less blood oxygen saturation is less than 70%). "This is very dangerous.Need to absorb oxygen immediately. "
"If the hypoxia cannot be corrected in a short period of time, patients can easily advance to critical pneumonia." Zhang Wenhong, director of the National Infectious Disease Medical Center, said.
<<<(at the request of the interviewer, Wang Yan, Sun Ming, Liu Wei, Li Fang, Li Xiao, Zhou Yu, Wang Qi, Zhong Ran, Song Xuan as a pseudonym)
(The author is a reporter and researcher of Finance and Economics, Zheng Hui and Yin Lu also contributed to this article)
