COVID-19 infection epidemic: the medical management strategies in Heilongjiang Province, China
Identifieur interne : 000100 ( Pmc/Corpus ); précédent : 000099; suivant : 000101COVID-19 infection epidemic: the medical management strategies in Heilongjiang Province, China
Auteurs : Hongliang Wang ; Sicong Wang ; Kaijiang YuSource :
- Critical Care [ 1364-8535 ] ; 2020.
Url:
DOI: 10.1186/s13054-020-2832-8
PubMed: 32188482
PubMed Central: 7081588
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">COVID-19 infection epidemic: the medical management strategies in Heilongjiang Province, China</title><author><name sortKey="Wang, Hongliang" sort="Wang, Hongliang" uniqKey="Wang H" first="Hongliang" last="Wang">Hongliang Wang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1762 6325</institution-id><institution-id institution-id-type="GRID">grid.412463.6</institution-id><institution>Department of Critical Care Medicine,</institution><institution>The Second Affiliated Hospital of Harbin Medical University,</institution></institution-wrap>Harbin, Heilongjiang China</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2">Heilongjiang Province Intensive Care Medical Aid Group for CVOID-19, Wuhan, Hubei China</nlm:aff></affiliation></author><author><name sortKey="Wang, Sicong" sort="Wang, Sicong" uniqKey="Wang S" first="Sicong" last="Wang">Sicong 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when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Huang, C" uniqKey="Huang C">C Huang</name></author><author><name sortKey="Wang, Y" uniqKey="Wang Y">Y Wang</name></author><author><name sortKey="Li, X" uniqKey="Li X">X Li</name></author><author><name sortKey="Ren, L" uniqKey="Ren L">L Ren</name></author><author><name sortKey="Zhao, J" uniqKey="Zhao J">J Zhao</name></author><author><name sortKey="Hu, Y" uniqKey="Hu Y">Y Hu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, N" uniqKey="Chen N">N Chen</name></author><author><name sortKey="Zhou, M" uniqKey="Zhou M">M Zhou</name></author><author><name sortKey="Dong, X" uniqKey="Dong X">X Dong</name></author><author><name sortKey="Qu, J" uniqKey="Qu J">J Qu</name></author><author><name sortKey="Gong, F" uniqKey="Gong F">F Gong</name></author><author><name sortKey="Han, Y" uniqKey="Han Y">Y Han</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wang, Dawei" uniqKey="Wang D">Dawei Wang</name></author><author><name sortKey="Hu, Bo" uniqKey="Hu B">Bo Hu</name></author><author><name sortKey="Hu, Chang" uniqKey="Hu C">Chang Hu</name></author><author><name sortKey="Zhu, Fangfang" uniqKey="Zhu F">Fangfang Zhu</name></author><author><name sortKey="Liu, Xing" uniqKey="Liu X">Xing Liu</name></author><author><name sortKey="Zhang, Jing" uniqKey="Zhang J">Jing Zhang</name></author><author><name sortKey="Wang, Binbin" uniqKey="Wang B">Binbin Wang</name></author><author><name sortKey="Xiang, Hui" uniqKey="Xiang H">Hui Xiang</name></author><author><name sortKey="Cheng, Zhenshun" uniqKey="Cheng Z">Zhenshun Cheng</name></author><author><name sortKey="Xiong, Yong" uniqKey="Xiong Y">Yong Xiong</name></author><author><name sortKey="Zhao, Yan" uniqKey="Zhao Y">Yan Zhao</name></author><author><name sortKey="Li, Yirong" uniqKey="Li Y">Yirong Li</name></author><author><name sortKey="Wang, Xinghuan" uniqKey="Wang X">Xinghuan Wang</name></author><author><name sortKey="Peng, Zhiyong" uniqKey="Peng Z">Zhiyong Peng</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="editorial"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Crit Care</journal-id><journal-title-group><journal-title>Critical Care</journal-title></journal-title-group><issn pub-type="ppub">1364-8535</issn><issn pub-type="epub">1466-609X</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32188482</article-id><article-id pub-id-type="pmc">7081588</article-id><article-id pub-id-type="publisher-id">2832</article-id><article-id pub-id-type="doi">10.1186/s13054-020-2832-8</article-id><article-categories><subj-group subj-group-type="heading"><subject>Editorial</subject></subj-group></article-categories><title-group><article-title>COVID-19 infection epidemic: the medical management strategies in Heilongjiang Province, China</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Hongliang</given-names></name><xref ref-type="aff" rid="Aff1">1</xref><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Sicong</given-names></name><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-4930-414X</contrib-id><name><surname>Yu</surname><given-names>Kaijiang</given-names></name><address><email>yukaijiang12@163.com</email></address><xref ref-type="aff" rid="Aff4">4</xref><xref ref-type="aff" rid="Aff5">5</xref></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1762 6325</institution-id><institution-id institution-id-type="GRID">grid.412463.6</institution-id><institution>Department of Critical Care Medicine,</institution><institution>The Second Affiliated Hospital of Harbin Medical University,</institution></institution-wrap>Harbin, Heilongjiang China</aff><aff id="Aff2"><label>2</label>Heilongjiang Province Intensive Care Medical Aid Group for CVOID-19, Wuhan, Hubei China</aff><aff id="Aff3"><label>3</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2204 9268</institution-id><institution-id institution-id-type="GRID">grid.410736.7</institution-id><institution>Department of Critical Care Medicine,</institution><institution>The Cancer Hospital of Harbin Medical University,</institution></institution-wrap>Harbin, Heilongjiang China</aff><aff id="Aff4"><label>4</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1797 9737</institution-id><institution-id institution-id-type="GRID">grid.412596.d</institution-id><institution>Department of Critical Care Medicine,</institution><institution>The First Affiliated Hospital of Harbin Medical University,</institution></institution-wrap>No. 23, Youzheng Road, Nangang District, Harbin, Heilongjiang China</aff><aff id="Aff5"><label>5</label>Expert Panel of Heilongjiang COVID-19, Harbin, Heilongjiang China</aff></contrib-group><pub-date pub-type="epub"><day>18</day><month>3</month><year>2020</year></pub-date><pub-date pub-type="pmc-release"><day>18</day><month>3</month><year>2020</year></pub-date><pub-date pub-type="collection"><year>2020</year></pub-date><volume>24</volume><elocation-id>107</elocation-id><history><date date-type="received"><day>6</day><month>3</month><year>2020</year></date><date date-type="accepted"><day>12</day><month>3</month><year>2020</year></date></history><permissions><copyright-statement>© The Author(s). 2020</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated in a credit line to the data.</license-p></license></permissions><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2020</meta-value></custom-meta></custom-meta-group></article-meta></front><body><p id="Par1">In late December 2019, an outbreak of the 2019-novel coronavirus (COVID-19) caused a substantial public health crisis in Wuhan, China, and then expeditiously spread all over China [<xref ref-type="bibr" rid="CR1">1</xref>–<xref ref-type="bibr" rid="CR3">3</xref>]. As of March 4, 2020, 80,409 cases of COVID-19 had been confirmed in mainland China [<xref ref-type="bibr" rid="CR4">4</xref>]. While in Heilongjiang province, which locates in northeastern China with 38.24 million residents and an area of 473,000 km<sup>2</sup>, all of its 13 cities were affected, making it one of the most serious areas for the outbreak of COVID-19 in China. Up to February 23, 2020, there were 480 confirmed cases of COVID-19; however, no newly diagnosed cases since then. Most of the infected patients were male and there were 13 deaths (2.7%). A series of protocols had been established since the first confirmed case emerged, and we herein summarize our experience from Heilongjiang province in dealing with COVID-19.</p><sec id="Sec1"><title>Protection of medical staffs</title><sec id="Sec2"><title>Education and training of staffs</title><p id="Par2">As soon as the outbreak of COVID-19 began in Wuhan, the Heilongjiang provincial health administration department started to launch training protocols for all the medical staffs. The content of training included personal protection such as hand hygiene, wearing personal protective equipment (PPE), safe waste disposal, and emergency handling protocols. The means of training included presentations, videos, and WeChat. First, the infection control experts from various hospitals trained their own staffs both theoretically and practically. The training emphasized the importance of standardized protection. Second, the infection control experts conducted standardized pre-job training. The infection control experts supervised the whole process to ensure that all the staffs had followed the correct procedures. Third, the infection control experts monitored the entire process before and after the medical staff entering the isolation wards. They also supervised the procedures of medical staffs in the isolation wards by wireless communication equipment.</p></sec><sec id="Sec3"><title>Mental health care</title><p id="Par3">The mental stress of the medical staffs increased significantly since they had to work in a relatively confined space, wearing thick isolation clothes, and care for a large number of anxious patients. The high-intensity work further deteriorated the mental health of the medical staffs, especially for those who came from all over the country to support Wuhan. It is crucial to ensure the stable psychological state of the medical staffs. Therefore, early professional intervention is necessary. At the same time, active communication with family members and initiative support from a local hospital can also be very helpful.</p></sec><sec id="Sec4"><title>Monitoring of physical condition</title><p id="Par4">It is particularly important to ensure the physical health of the medical staffs. All of them should undergo medical examinations, including blood routine tests and chest CT before managing COVID-19 patients. Daily self-examinations of respiratory symptoms and body temperature were also conducted. Once the medical staff had any uncomfortable symptoms, they should report to the team leader immediately. A specialized screening for COVID-19 would be performed. The medical staffs who treated COVID-19 patients lived in special and isolated areas.</p></sec><sec id="Sec5"><title>Management of protective equipment</title><p id="Par5">Adequate protective equipment was prepared for all the medical staffs who participated in the management of COVID-19. The protective equipment included medical masks, goggles, face shields, and waterproof isolation clothes. The protective equipment was supplied by the government and hospitals, as well as donated by the public. The equipment such as goggles and face shields that was reused would be disinfected strictly.</p></sec></sec><sec id="Sec6"><title>Reassignment of medical resources</title><p id="Par6">Heilongjiang province set up a multidisciplinary team (MDT) soon after the outbreak of COVID-19, including intensive care unit (ICU), emergency department, infectious disease department, respiratory department, psychological department, infection control department, administrative department, and nursing department. Meanwhile, the medical resources of the whole province were redistributed to meet medical needs. Medical staffs in Heilongjiang province were divided into 4 groups (Fig. <xref rid="Fig1" ref-type="fig">1</xref>).
<fig id="Fig1"><label>Fig. 1</label><caption><p>Reassignment of medical resources in Heilongjiang province. *COVID-19: Coronavirus Disease 2019</p></caption><graphic xlink:href="13054_2020_2832_Fig1_HTML" id="MO1"></graphic></fig></p><sec id="Sec7"><title>Group 1: Supporting Wuhan</title><p id="Par7">Wuhan, as the most serious epidemic area, needs a national support. The first set of medical teams arrived in Wuhan on January 27, 2020, and soon started medical work. As of February 23, Heilongjiang province had dispatched eight medical teams consisting of 1533 medical staffs to Hubei Province.</p></sec><sec id="Sec8"><title>Group 2: Establishing fever clinics</title><p id="Par8">The majority of the medical staffs worked in the fever clinics, which involved the largest number of patients to be screened. Fever clinics were essential for the proper triage of fever patients: diagnosis of COVID-19 patients, isolation of suspected cases, and exclusion of non-COVID-19 patients.</p></sec><sec id="Sec9"><title>Group 3: Centralized management</title><p id="Par9">Heilongjiang province appointed four designated hospitals in Harbin to treat all the COVID-19 patients. Medical staffs of the whole province, especially intensivist, respiratory physician, emergency physician, and infectious disease physician, were assigned to work in the designated hospitals.</p></sec><sec id="Sec10"><title>Group 4: Quality control and inspection group</title><p id="Par10">The group members included provincial health authorities, medical experts, and infection control experts. During inspection, the team summarized, discussed, and handled any problems timely, thus ensuring that the infection rate of the medical staffs was zero.</p></sec></sec><sec id="Sec11"><title>Plans for hierarchical treatment</title><sec id="Sec12"><title>Procedures of hierarchical treatment</title><p id="Par11">During the outbreak of COVID-19, all the patients with fever in our province were screened according to the procedure, as detailed in Fig. <xref rid="Fig2" ref-type="fig">2</xref>.
<fig id="Fig2"><label>Fig. 2</label><caption><p>Treatment procedures of patients with suspected COVID-19. *COVID-19, Coronavirus Disease 2019; ICU, intensive care unit; CDC, Centers for Disease Control and Prevention</p></caption><graphic xlink:href="13054_2020_2832_Fig2_HTML" id="MO2"></graphic></fig></p></sec><sec id="Sec13"><title>Strategies for management and reassignment of medical staffs</title><p id="Par12">In all isolation wards, a three-level round system was adopted, both in Heilongjiang and Hubei. The morning and evening medical care shifts were adopted to achieve the standardized management of COVID-19. The medical resources were reassigned accordingly: physicians from general wards who specialized in respiratory or infectious disease treated mild patients, while critical cases were handled by a team led by intensivists. Medical treatment and nursing were managed in the same way as mentioned above.</p></sec></sec><sec id="Sec14"><title>Utilization of network platform</title><p id="Par13">To prevent the spread of COVID-19, our province suspended outpatient services and non-emergency surgeries of all levels of hospitals. Health Commission of Heilongjiang Province launched online free consultations. More than 12,000 medical staffs provided free online consultation, initial screening, popularizing the knowledge, and summarizing the experiences of managing COVID-19.</p><p id="Par14">In conclusion, the COVID-19 outbreak is a significant threat to international health and a big challenge for all of us. We need to understand more and more about the disease to overcome it.</p></sec></body><back><fn-group><fn><p><bold>Publisher’s Note</bold></p><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p></fn></fn-group><ack><title>Acknowledgements</title><p>We would like to thank all the medical staffs and local authorities of Heilongjiang province for their efforts in combating the outbreak of COVID-19.</p></ack><notes notes-type="author-contribution"><title>Authors’ contributions</title><p>All authors were major contributors in writing the manuscript and approved the final manuscript.</p></notes><notes notes-type="funding-information"><title>Funding</title><p>Funding was provided by the China International Medical Foundation (Grant no. Z-2018-35-1902).</p></notes><notes notes-type="data-availability"><title>Availability of data and materials</title><p>All data generated or analyzed during this study are included in this published article.</p></notes><notes><title>Ethics approval and consent to participate</title><p id="Par15">Not applicable.</p></notes><notes><title>Consent for publication</title><p id="Par16">Not applicable.</p></notes><notes notes-type="COI-statement"><title>Competing interests</title><p id="Par17">The authors declare that they have no competing interests.</p></notes><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Huang</surname><given-names>C</given-names></name><name><surname>Wang</surname><given-names>Y</given-names></name><name><surname>Li</surname><given-names>X</given-names></name><name><surname>Ren</surname><given-names>L</given-names></name><name><surname>Zhao</surname><given-names>J</given-names></name><name><surname>Hu</surname><given-names>Y</given-names></name><etal></etal></person-group><article-title>Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China</article-title><source>Lancet</source><year>2020</year><volume>395</volume><issue>10223</issue><fpage>497</fpage><lpage>506</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(20)30183-5</pub-id><pub-id pub-id-type="pmid">31986264</pub-id></element-citation></ref><ref id="CR2"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chen</surname><given-names>N</given-names></name><name><surname>Zhou</surname><given-names>M</given-names></name><name><surname>Dong</surname><given-names>X</given-names></name><name><surname>Qu</surname><given-names>J</given-names></name><name><surname>Gong</surname><given-names>F</given-names></name><name><surname>Han</surname><given-names>Y</given-names></name><etal></etal></person-group><article-title>Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study</article-title><source>Lancet</source><year>2020</year><volume>395</volume><issue>10223</issue><fpage>507</fpage><lpage>513</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(20)30211-7</pub-id><pub-id pub-id-type="pmid">32007143</pub-id></element-citation></ref><ref id="CR3"><label>3.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>Dawei</given-names></name><name><surname>Hu</surname><given-names>Bo</given-names></name><name><surname>Hu</surname><given-names>Chang</given-names></name><name><surname>Zhu</surname><given-names>Fangfang</given-names></name><name><surname>Liu</surname><given-names>Xing</given-names></name><name><surname>Zhang</surname><given-names>Jing</given-names></name><name><surname>Wang</surname><given-names>Binbin</given-names></name><name><surname>Xiang</surname><given-names>Hui</given-names></name><name><surname>Cheng</surname><given-names>Zhenshun</given-names></name><name><surname>Xiong</surname><given-names>Yong</given-names></name><name><surname>Zhao</surname><given-names>Yan</given-names></name><name><surname>Li</surname><given-names>Yirong</given-names></name><name><surname>Wang</surname><given-names>Xinghuan</given-names></name><name><surname>Peng</surname><given-names>Zhiyong</given-names></name></person-group><article-title>Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China</article-title><source>JAMA</source><year>2020</year><volume>323</volume><issue>11</issue><fpage>1061</fpage><pub-id pub-id-type="doi">10.1001/jama.2020.1585</pub-id></element-citation></ref><ref id="CR4"><label>4.</label><mixed-citation publication-type="other">Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE. <ext-link ext-link-type="uri" xlink:href="https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6">https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6</ext-link>. 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