Wake up（291）

 

291

 

Nan Yangsheng and Wan Ru sat on the train back to the mainland from Hong Kong, and the two continued to talk about the past when the epidemic broke out in Wuhan.

Nan Yangsheng told Wanru what he saw and heard when he was a volunteer in Wuhan Fangcang Hospital:

After the outbreak in Wuhan, I wore heavy, tight, and stuffy protective clothing every day in the shelter hospital, and guarded the sick bed day and night. I remember very clearly that during the two sessions of Hubei Province from January 11 to January 17, 2020, although the Wuhan Municipal Health and Health Commission resumed the daily reporting system, the daily core content was basically the same: no new coronavirus cases A confirmed case of pneumonia with viral infection; no related cases were found among close contacts. Afterwards, in the face of social questioning about why there were no new confirmed cases between the 11th and the 16th, the Wuhan Municipal Health Commission responded that the main reason was that before January 16, there was no rapid detection of new coronaviruses in the entire Hubei Province. For the "kit" of coronavirus, the virus detection has to go through the district, city, province, and national four-level CDC. The result takes about 3-5 days from sending to returning.

What is a "kit"? Nanyangsheng explained to Wanru:

In order to solve the difficulties in the detection process, in late January, many capable medical institutions have begun to develop kits for the new coronavirus, but people in the disease control industry have said that the diagnosis is not the only means of kits. The media quoted an article by an American expert saying that the detection of the virus can be done through kits or gene sequencing, but the sequencing method requires high equipment requirements and is slower, so it is not suitable for mass screening. From epidemiological investigation and treatment to consultation, investigation, and case management—the complexity of the process is one of the key reasons for the "difficult diagnosis" of the novel coronavirus pneumonia in Wuhan, Hubei, and even many places across the country.

Nan Yangsheng said to Wanru: This is an explanation to shirk responsibility. In the days when there were no new confirmed cases, the Wuhan Municipal Health Commission also received a field visit from an expert group from Hong Kong, Macao and Taiwan from January 13 to 14. But the exact content of the proposal was never disclosed.

On January 17, the number of confirmed cases of pneumonia caused by a new type of coronavirus in Wuhan began to soar in notifications, with an increase of 17 cases within one day. On January 20, the number of confirmed cases in Wuhan nearly quadrupled to 198. On January 18, the high-level expert group of the National Health and Medical Commission led by the team leader Professor Zhong Nanshan arrived in Wuhan again. Since then, as Zhong Nanshan told the media that the new crown virus has been transmitted from person to person and that medical staff have been infected, the National Health and Medical Commission began to report the national new crown pneumonia data on January 21, and the Hubei Health and Medical Commission began to report on January 22 including Wuhan The Wuhan Health Commission will no longer report the relevant data separately.

The staff of Shizhen Hospital led by Nan Yangsheng and President Li Nana have all become volunteers of the shelter hospital. Su Meilan is also one of them.

Li Nana told Nan Yangsheng: Previously, the National Health and Medical Commission had decided to include the new type of coronavirus-infected pneumonia in the management of "Class B legal infectious diseases" similar to SARS and H7N9 bird flu, and to adopt Class A infectious diseases (plague, cholera) level of prevention and control measures. On January 22, a series of special plans such as the "Pneumonia Prevention and Control Plan for Novel Coronavirus Infection (Second Edition)" were also issued by the National Health and Medical Commission. For the link of "case discovery and reporting", the relevant content that medical institutions need to send specimens to the CDC for pathogen detection has been deleted. This means that hospitals and disease control departments can finally cooperate in rapid reporting, disposal and investigation in accordance with regulations.

Li Nana also told Nan Yangsheng: The first batch of PCR kits produced for the new coronavirus was first distributed to the provincial CDCs on January 16. In one kit, experimenters can perform parallel testing on 50 or more suspected samples, and the results can be seen within 2 to 3 hours, and "rapid diagnosis" has finally become possible.

However, the staff of Shizhen Hospital also told Nanyang Sheng that only 3 institutions were selected in the first batch of enterprises approved by the Chinese Center for Disease Control and Prevention to produce test kits. In interviews with the media, the three agencies all said that they are already running at full capacity. Taking the case of the selected Shanghai Jienuo Biotechnology Co., Ltd. as an example, the company had produced a kit for 75,000 copies on January 16 and delivered it to the outside world. But when the test kits are shipped to various places, the first places they arrive are still the CDCs of the provinces and cities, not the front-line hospitals. This is done because of "compliance" - until January 27, the new coronavirus detection kits produced by various companies have not been approved by the State Food and Drug Administration, and can only be provided to disease control in the name of scientific research. system used. Considering the pressure of a large number of suspected cases, Wuhan City also followed this system change and began to designate designated hospitals for treatment, counterpart hospitals for designated fever diagnosis and treatment hospitals, and "biosafety hospitals with corresponding protection levels" in Wuhan CDC. Laboratory” to carry out the detection of pathogenic nucleic acid of samples. Fangcai hospitals did not use this kit on a large scale.

But the media said: According to the normal process, it usually takes 3-5 years for a nucleic acid detection kit to be developed and obtained a registration certificate from the State Food and Drug Administration. However, due to the emergency of the epidemic this time, the State Food and Drug Administration decided to implement emergency approval for all medical devices needed for epidemic prevention and control, which is already a "special matter".

Zhijiang Bio is also one of the companies that obtained the registration certificate for the kit. Ni Weiqin, deputy general manager of the company, said in an interview with the "Economic Observer" that approval including design and development, verification, cross-reaction, and clinical data review The standard is "the same as the original requirements, not lowered at all", but the approval process has been optimized. Previously, multiple registration processes that were generally carried out in sequence can be carried out simultaneously, which shortens the registration time.

Li Nana told Nan Yangsheng: There are currently only 10 institutions in the first batch of institutions in Wuhan that have obtained this license, and it is estimated that they can test nearly 2,000 samples per day when they are all in operation. The requirement for the biosafety level of the testing laboratory is mainly because the blood or other body fluids used to detect the new coronavirus may be highly infectious, and the aerosols generated during the detection and centrifugation process may infect the testing personnel. For example, the detection of SARS virus requires the laboratory to meet the level 3 biosafety level, and the Ebola virus requires the level 4 biosafety level. In the biosafety rating process of the laboratory, aspects such as ventilation, air pressure, and sample flow must also be considered, and testing personnel must also undergo special training. In terms of instruments, at least there must be centrifuges, nucleic acid extraction instruments, real-time polymerase chain reaction instruments, etc. Therefore, not every hospital has the conditions to test for the new coronavirus. If laboratories are screened according to the requirements of the SARS virus, most of the first-level and second-level hospitals nationwide will be rejected, and only most of the third-level hospitals, disease control systems and some inspection and quarantine units meet the requirements, and this also leads to In Huanggang, Ezhou, Xiaogan and other cities in Hubei Province, patients still face the problem of difficult diagnosis.

Nanyangsheng understood: For hospitals with insufficient laboratory levels, even if they get the kit, they still cannot complete the diagnosis by themselves, and can only be used for informal initial screening of patients.

According to a newsletter issued by China Business News on January 28, Nanyangsheng saw that the World Health Organization (WHO) changed the global risk of the new coronavirus epidemic to high risk in the new coronavirus report on January 26 and 27. . The WHO stated that in the previous report, the global risk of the new coronavirus epidemic was wrongly summarized as medium, but in fact it was high risk.

Nan Yangsheng said to Wanru: Soon, Dean Li Nana and some of the staff of Shizhen Hospital led by her, as well as the volunteers of the shelter hospital including Su Meilan, all passed out.

At that time, Xiang Weiqun, a friend who accompanied Nan Yangsheng from his hometown to Wuhan and let him find a job in Shizhen Hospital, was also involved in the Fangcai Hospital because he became positive.

Nan Yangsheng visited Xiang Weiqun. Xiang Weiqun secretly said to Nan Yangsheng: I don't have a yang, and I came here pretending to be a volunteer.

Xiang Weiqun said to Nan Yangsheng in pain: After Wuhan was closed, my home was also closed. My mother Luganke was dragged into the crematorium two days ago due to illness. My father and I were dissatisfied with not being allowed to go to the crematorium to say goodbye to the remains. My father cried and cursed the government all day long. I tried to persuade him to no effect, he must be suffering from severe depression. So I thought of you. I hope you can help diagnose my father. If the illness is not too serious, I will take him to escape to Hong Kong. I have already completed the procedures for the underpass to Hong Kong.

Nanyangsheng agreed. He got a shelter volunteer pass and handed it to Xiang Weiqun.

Xiang Weiqun and Nanyang Sheng left the shelter hospital smoothly with the shelter volunteer pass.

When Xiang Weiqun accompanied Nan Yangsheng to his home, he learned that his father, Xiang Wan, had committed suicide by jumping off the building. Before his death, his father yelled: "The one who kills me is a devil!"

Xiang's body has long been dragged away by the police, and his whereabouts are unknown.

Xiang Weiqun said sadly to Nanyang Sheng: I contacted the two people who smuggled into Hong Kong through underground channels. Now that my father has gone away with hatred, you might as well go to Hong Kong with me. I have many acquaintances in Hong Kong. Living in the mainland is worse than dying. at Hong Kong.

Nan Yangsheng hesitated, and finally left Wuhan with Xiang Weiqun. With the help of underground pipelines, they broke through various checkpoints and arrived in Hong Kong safely.

After listening to Nan Yangsheng's narration, Wanru understood his experience in Wuhan and the process of going to Hong Kong. It was only then that Wanru realized that when the government does evil, it is no weaker than the plague.