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Covid-19 in China: ten critical issues for intensive care medicine
Critical Care ( IF 15.1 ) Pub Date : 2020-03-31 , DOI: 10.1186/s13054-020-02848-z Li Li 1 , Shijin Gong 1 , Jing Yan 1
Critical Care ( IF 15.1 ) Pub Date : 2020-03-31 , DOI: 10.1186/s13054-020-02848-z Li Li 1 , Shijin Gong 1 , Jing Yan 1
Affiliation
In December 2019, a newly identified coronavirus (SARS-CoV-2) major outbreak appeared in Wuhan City, Hubei Province, and it is now termed the Covid-19. The SARS-CoV-2 infection moved rapidly through China [1, 2] and spread to more than 90 countries. As of February 26, 2020, 78,064 patients were cumulative diagnosed, 12,224 cases were accumulative severe status. On January 29, 2020, the Chinese Society of Critical Care Medicine combined with the Chinese Medical Doctor Association of Critical Care Medicine and the Chinese Association of Pathophysiology of Intensive Care Medicine jointly issued a proposal to all of the Chinese intensive care colleagues to fight against Covid-19. According to the data from the National Health Commission of the People’s Republic of China, as of February 26, 2020, 29 provinces have dispatched 32,395 medical staff to support Wuhan City, of which 11,638 are intensive care physicians and nurses. Subsequently, more patients with Covid-19 have been effectively treated and the deaths of patients and the proportion of critically ill patients have shown a relatively declining trend in Wuhan. In fighting against Covid-19, intensive care physicians and nurses are not only the main force in the frontline, but also summarized and published valuable clinical study results in the first time, which provides useful first-hand clinical data for deepening the understanding of Covid-19, which mostly benefited from the rapid development of Chinese intensive care medicine in the past 20 years. More importantly, from this epidemic, we should find problems and sum up experiences. The following critical issues need to be concerned (Table 1). First, the proportion of the critical care unit (ICU) beds is seriously insufficient in China. According to the survey data from the Chinese Society of Critical Care Medicine, the ratio of ICU beds to hospital beds nationwide is only 1.65%, which means that there are only 3.43 ICU beds per 100,000 people. Certainly, when epidemic outbreaks such a large number of critically ill patients are huge challenges for any province or city. Second, there is an urgent need to strengthen training to achieve the homogeneity of clinical cognition and management capabilities of intensive care physicians. From 2009 to 2019, 24,639 physicians were certified as intensive care physicians in the Chinese Critical Care Certified Course (5C) program in China, only accounting for about 30% of physicians engaged in intensive care medicine in China. The levels of intensive care medicine in different provinces are uneven. The top province in the number of participants is Jiangsu Province (1808, 9.55%), while Hubei Province only 610 participants (3.2%). Third, professional agency needs to be established for the integration and optimization of the allocation of critical medical resources. During epidemic, not only to ensure the therapy of patients with severe Covid-19, but also to ensure that other critically ill patients, nonCovid-19 patients can also be effectively treated. Fourth, standardized operating procedures should be set up for ensuring the refined risk stratification and subsequent refined management of critically ill patients. According to the severity of patients, not only the patients are allocated in a hierarchical manner, but also the allocation of critical medical resources from other provinces and cities. Fifth, it is necessary to strengthen occupational protection training and develop special standardized protection procedures for high-risk invasive operations during epidemics. In Hubei Province, more than 3000 physicians
更新日期：2020-03-31
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