At 4 p.m. of China time on Mar 25th, a video conference on the diagnosis and treatment protocol of COVID-19 attended by the University Hospital of Munich, a medical panel from Guangdong Provincial Hospital of Traditional Chinese Medicine and the medical team sent to Wuhan by Guangdong Provincial Hospital of TCM at the race against the clock to assist Wuhan which returned home in triumph, was held right in this hospital of dedication.
Bavaria is one of the hardest-hit areas in Germany, as the second-largest hospital, the University Hospital of Munich plays a significant role in this public health emergency. During this critical stage, Guangdong Provincial Hospital of TCM is willing to offer assistance at its best. The medical team sorted out valuable anti-epidemic suggestions of 12 pages on Mar 24th overnight.
As of March 6th, Guangdong Provincial Hospital of TCM has already sent 88 medical personnel of 9 teams to the race against the clock to assist Wuhan. Absorbed with the combination of Chinese traditional and western medicine, the medical personnel made full rational use of their characteristic advantages to the medical treatment that highly appreciated by the patients for the curative effect. Thereinto, the particular therapies, for instance, Scraping, Auricular point pressing beans, Huolong cupping, Acupoint application, Acupoint massage and Baduanjin have been extremely favored by the patients.
The attendees of this Experience Sharing Online include the Directors of eight key Departments of the University Hospital of Munich, Guangdong Provincial Hospital of TCM and the medical team mentioned above.
The attendee experts of the University Hospital of Munich: Chair of Virology, Prof. Dr. Oliver T. Keppler; Chair of Anesthesiology, Prof. Dr. Bernhard Zwißler; Chair of Internal Medicine, Gastroenterology and Hepatology Julia Mayerle; Chair of General, Visceral and Transplantation Surgery, Prof. Dr. Jens Werner; Chair of Oncology and Hematology, Prof. Dr. Michael von Bergwelt; Chair of Clinical Hygiene, Dr. med. Béatrice Grabein; Chair of Internal Medicine - Cardiology, Prof. Dr. Steffen Massberg and Chair of Emergency Department Prof. Klein.
The attendee experts of Guangdong Provincial Hospital of TCM: Assistant Medical Director Li jun, Director Chen Quanfu of the Medical Department, Vice Director Tian Biwen of the Medical Department, Director Guo Lihen of the ICU, Director Tang Guanghua of the Emergency Department, Director Huang Donghui of the Respirology Department and Director Xi Xiaotu of the Emergency Department, etc.
Outline of the Video Conference
Q1. What is the key to protect the medical personnel? What is the weakest link in terms of spread?
The COVID-19 is mainly transmitted by droplets and contact. It may also be transmitted under relatively closed high concentration aerosols. At present, there is no evidence of fecal-oral and digestive tract transmission.
Focus of personal protection:
(1) Standardized prevention and respiratory prevention. Medical personnel whoever enters the hospital must wear medical, changing once each time they enter the hospital, usually 4-6 hours. It should be noted that when in contact with infected patients or carriers of COVID-19, there is possibility of getting infected even with surgical masks.
(2) Medical personnel should be managed collectively. During the epidemic, medical personnel should live in a single room when treating suspected or confirmed patients, and it is not recommended to go home.
(3) Reduce group gathering and maintain a one-meter social distance.
(4) Measure body temperature every day.
Weak links:
(1) Personal protection awareness of medical staff needs to be strengthened, and protection knowledge needs to be updated.
(2) Lack of personal protective equipment.
(3) The incubation period of asymptomatic infected persons is also highly contagious.
Q2: Will the infected medical personnel continue treating patients after their recovery?
Among the designated medical team, there is no infected medical personnel. But there were some local medical personnel in Wuhan who were infected before the lockdown. They can not get back to work until 14-day quarantine after their recovery and get a negative PCR test.
Q3. How to disinfect the wards receiving COVID-19 patients for reuse?
The wards cannot be reused until the epidemic is over and have thorough disinfection.
Q4. How to organized the COVID-19 patients after their symptoms get mild? Should they go home or stay at a hotel?
The discharge standards of COVID-19 patients are: negative results from at least 2 consecutive throat swabs collected at an interval of 24 hours; symptoms significantly improved; obvious absorption of inflammation on lung images.
Q5: How to organize the wards for suspected and infected patients of COVID-19?
The suspected patients should be isolated in single room and the infected patients can be treated in a same room collectively. The critically ill patients should be sent to the ICU as soon as possible.
Q6: How to protect patients who are particularly vulnerable patients, such as organ transplant recipients and cancer patients? Is it recommended that cancer treatments be paused until the situation has stabilized?
Early diagnosis, treatment and isolation should be carried out whenever possible. For patients with chronic diseases such as hypertension, diabetes, and coronary heart disease, it is recommended to continue to use previous medications with COVID-19 treatment protocols. However, the medical team has not treated COVID-19 patients who have undergone an organ transplant or have cancer, so they cannot give further answer.
Q7: How to give further evaluation to suspected patients?
It is necessary to assess whether the patient has an epidemiological history and symptoms of infection such as cough, sore throat, fever, etc., nucleic acid testing and lung CT scans are required. It is recommended that all suspected patient whoever has been to the epidemic area be quarantined for 14 days.
Q8: Which is the preferential testing sample for PCR? Nasopharyngeal swab or lower respiratory tract sample?
Generally we use throat swab but the lower respiratory tract sample is more reliable.
Q9: Is it recommended to treat patients with serum from a cured patient?
Some hospitals in Wuhan use serum therapy.
Q10. How to solve the problem of insufficient PCR test strips?
At the beginning of the epidemic, this situation did exist in Wuhan, but the test strips were soon replenished. At present, the test strips in Chinese hospitals are abundant.
Q11. How many PCR test will be run by the hospital per day?
About 400 tests will be done by the Guangdong provincial hospital of TCM every day. The average daily detection volume in Wuhan is 14,000.
Q12. What determines whether a patient needs CT scan or not? What’s its place in diagnosis?
Here in Guangdong Provincial Hospital of TCM, any patients with fever or respiratory symptoms and those who are hospitalized need to do CT scan.
Q13. Is there a certain antiviral drug that’s most effective in clinical trial?
At present, no effective antiviral therapy has been confirmed and there is no clear evidence for which drug works better.
Q14. At what stage does antiviral drugs need to be involved? Is it better to intervene earlier?
Yes, the sooner the better.
Q15. What is the proportion of the asymptomatic infected of COVID-19 and how many of them had pneumonia?
Among the patients with positive test result, 5% had no obvious clinical symptoms, 75% were general cases, 20% were severe and critical cases.
Q16. What is the standard to admit a patient to ICU?
Patients with respiratory failure, mechanical ventilation, shock and other organ failure have to be admitted to ICU to receive monitor and treatment.
Q17. Is surgical approach taken into consideration?
Conservative treatment will be the first option. However, when surgical approach does come into needs, it has to be carried out in an OR with negative pressure and all the medical staffs have to wear protective equipment.
The government have issued directors that every citizen needs to stay at home for quarantine and report their body temperature. Suspected patients need to be tested thoroughly, including those who have close contact with confirmed patients.
There were 3387 medical staffs were diagnosed with COVID-19 and 90% (3062) of them are from Hubei.
There isn’t much clinical data shows that ibuprofen can’t be put into use yet.
The professionalism of Guangdong Provincial Hospital of TCM benefited and inspired the German experts a lot.
After the conference, the medical team of Guangdong Provincial Hospital of TCM sent the SOP of collecting PCR testing samples of both video and text version to the University Hospital of Munich, which would be a great help for their confrontation with COVID-19. Meanwhile, Guangdong Provincial Hospital of TCM are well known for the assistance around many hospitals in Germany.
During this critical stage, the cooperation of hospitals in China and Germany would be strongly enhanced and the two will confront the epidemic together.
