This article examines how primary hospitals in Chengdu, China, responded to the relaxation of COVID-19 prevention and control measures in December 2022.
Due to the highly contagious nature of the Omicron variant of SARS-CoV-2 and its subvariants, a high rate of transmission was observed throughout Chengdu, China, within 2 weeks of the relaxation of COVID-19 measures on December 3, 2022, particularly in hospitals. Hospitals experienced different degrees of medical overcrowding during the first 2 weeks, with a high patient volume in the emergency departments and a significant lack of beds in the medical wards, particularly in the respiratory intensive care unit (ICU) and ICU. The authors’ place of employment, Chengdu Jinniu District People’s Hospital, is a tertiary B-level public hospital situated in the Jinniu District in northwest Chengdu. The hospital’s emergency coordination and response efforts emphasized addressing patients’ difficulties in obtaining medical care and hospitalization in the region and keeping the mortality rate of patients with pneumonia to a minimal level. It has been emulated by sister hospitals and was well received by the local populace and municipal government. The hospital made the following significant alterations and modifications to this emergency medical care: (1) immediate establishment of the General ICU (GICU), a temporary unit set up in emergency situations that had most of the functions of but was not as complete as the ICU and had a lower ratio of doctors to nurses; (2) dynamic adjustment of anesthesiologists and respiratory physicians jointly stationed in the GICU; (3) choice of nurses with extensive experience in internal medicine and allocation to the GICU according to a 2:3 ICU bed to nurse ratio; (4) emergency purchase or deployment of pneumonia-related treatment equipment; (5) implementation of the GICU resident rotation system; (6) “twinning” of internal medicine and other departments to add beds; and (7) implementation of uniform hospital bed allocation for inpatients.
Am J Manag Care. 2023;29(6):e159-e161. https://doi.org/10.37765/ajmc.2023.89373
Our institution is a tertiary B-level hospital in Chengdu, China. After the relaxation of COVID-19 measures in December 2022, the hospital’s early response emphasized addressing patients’ difficulties in obtaining medical care and hospitalization in the region and keeping the mortality rate of patients with pneumonia at a minimal level. In this letter, we share our COVID-19 experience with readers.
The COVID-19 pandemic spread quickly across the world and has been deemed a worldwide public health event by the World Health Organization since its outbreak in early 2020. The pandemic has been ongoing for more than 3 years and has caused tremendous damage internationally, with 632 million cumulative confirmed cases and 6.6 million cumulative deaths worldwide as of November 17, 2022.1 With the increased awareness of COVID-19 and the popularity of vaccination (the number of individuals who have received 1 dose of the COVID-19 vaccine is 5.44 billion as of November 17, 2022, and China has one of the highest vaccination rates globally), the burden of COVID-19 is progressively being relieved and the disease controlled.2
The dynamic zero COVID-19 strategy that China had been adhering to and that had produced positive outcomes had effectively stopped the epidemic’s progress in China and saved a significant number of lives. After the Omicron variant entered China in 2022, as of December 6, 2022, there had been a total of almost 250,000 confirmed cases nationwide, with almost 1.7 million infections and a fatality rate (deaths / confirmed cases) of 0.24%. (Infections are defined as patients who have COVID-19 and have positive nucleic acid amplification tests with no pneumonia manifestation seen on CT of the lungs; confirmed cases are defined as patients who have COVID-19 and have positive nucleic acid amplification tests with abnormal imaging examinations.) That value of 0.24%, which includes previous data, has recently approached 0.1%.3 According to some studies, Omicron is mutating and becoming more transmissible but far less pathogenic than the original COVID-19 virus.4 China has gradually loosened restrictions on COVID-19 prevention and control measures since December 3, 2022, in particular on the management requirements for the frequency of nucleic acid amplification (eg, polymerase chain reaction) tests and asymptomatic infections with positive nucleic acid amplification tests. The Comprehensive Group of Joint Prevention and Control Mechanism for Novel Coronavirus Infection by the State Council of China released the General Plan for the Implementation of the Downgrade of COVID-19 to a category B disease (from the top-level category A) on December 26. The phrase “novel coronavirus pneumonia,” which had been used in China to refer to COVID-19, has now been changed to “novel coronavirus infection,” and starting on January 8, 2023, novel coronavirus infection has been treated as a category B disease.
However, due to the highly contagious nature of Omicron and its subvariants, a high rate of transmission was observed throughout Chengdu within 2 weeks of the relaxation of COVID-19 measures, particularly in hospitals. The majority of infected patients displayed varying degrees of fever, muscle pain, cough, and sore throat. Additionally, it was discovered that patients 70 years and older and those with comorbidities such as diabetes, cardiovascular disease, chronic kidney disease, and tumors had a higher risk of becoming seriously ill. A life-threatening combination of hypoxemia and pneumonia struck down some of these patients. Hospitals experienced different degrees of medical overcrowding during the first 2 weeks, with a high patient volume in the emergency departments (EDs) and a significant lack of beds in the medical wards, particularly in the respiratory intensive care unit (ICU) and ICU. This led to certain delays and challenges when treating patients with COVID-19.
The authors’ place of employment, Chengdu Jinniu District People’s Hospital (also known as Sichuan Provincial People’s Hospital Jinniu Hospital), is a public hospital situated in the Jinniu District in northwest Chengdu. Chinese hospitals are classified by the level of medical technology and the number of beds, with the highest level being tertiary A-level, followed by tertiary B-level, secondary A-level, secondary B-level, and primary; this hospital is classified as a tertiary B-level hospital. It provides health care for more than 500,000 residents within a 35-acre campus with a building area of 110,000 square meters and 500 actual open beds. After the relaxation of COVID-19 measures, the hospital experienced a similar increase in sudden visits and hospitalization of patients. Through the hospital’s emergency coordination and response efforts, the hospital quickly opened up 800 inpatient beds in total within a week without increasing the number of medical or nursing staff; more than 80% of the beds were for patients with COVID-19, greatly easing patients’ difficulties in obtaining medical care and hospitalization in the region and keeping the mortality rate of patients with pneumonia at a minimal level. It has been emulated by sister hospitals and has been well received by the local populace and municipal government. The hospital made the following significant alterations and modifications to this emergency medical care:
As of mid-January, the majority of the hospitalized patients had been discharged, and the number of patients with SARS-CoV-2 infection in Chengdu has greatly decreased. The number of patients in the ED has decreased significantly. Due to the primary hospitals’ emergency measures, Chengdu’s health care system has gradually returned to normal provision of services. Because COVID-19 is still not completely under control, we recommend that each primary hospital set up an emergency response system, examine the capability of setting up a GICU on a temporary emergency basis, pay attention to the training and use of anesthesiologists, and enhance duration and intensity of nurse rotation training in the internal medicine department to deal with the challenges ofany future epidemic we may face.
Author Affiliations: Department of Nephrology, Affiliated Hospital of Southwest Medical University, Clinical Medical College of Southwest Medical University (YK, WY), Luzhou, Sichuan, China; Department of Nephrology (YK, JM, SX, FD), President’s Office (BL, PL), Department of Nursing Administration (YF), and Department of Anesthesiology (RW), Chengdu Jinniu District People’s Hospital, Sichuan Provincial People’s Hospital Jinniu Hospital, Chengdu, Sichuan, China; Department of Nephrology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology (YK, WY, WZ, SM, FD), Chengdu, Sichuan, China.
Source of Funding: This work was supported by Sichuan Medical Research Project Program (S20014&S21002), Sichuan Medical Association (Hengrui) Scientific Research Fund (2021HR16), Chengdu Medical Research Project Program (2020208&2022533), and Chengdu Jinniu District Medical Association Research Project (JNQN20-21).
Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Authorship Information: Concept and design (YK, JM, WY); acquisition of data (YK, WZ, SM); analysis and interpretation of data (YK, JM, WY, WZ, SM, FD); drafting of the manuscript (YK, JM); critical revision of the manuscript for important intellectual content (YK, JM, WY, WZ, SM, SX); statistical analysis (YK, JM, PL, WY, WZ, SM); provision of patients or study materials (JM, BL, PL, YF, SX, RW); obtaining funding (BL, YF, SX, FD, RW); administrative, technical, or logistic support (BL, PL, YF, SX, FD, RW); and supervision (BL, PL, YF, FD, RW).
Address Correspondence to: Fei Deng, MM, Department of Nephrology, Chengdu Jinniu District People’s Hospital, Sichuan Provincial People’s Hospital Jinniu Hospital, Chengdu, Sichuan, 610036, China. Email: email@example.com.
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