From February 3, when the epidemic in Wuhan was at its worst, the Chinse government decided to quickly coordinate the opening of a large-scale medical facility that concentratedly treats patients diagnosed with mild cases and will transform the exhibition centers and stadiums into Fangcang shelter hospitals.
In retrospect, this measure is considered to be the key move for China's epidemic prevention and control.
On April 2, local time, the top medical journal "The Lancet" published an article focusing on the construction and opening of Fangcang shelter hospitals (Fangcang shelter hospitals) online in China.
This article was jointly completed by the team of Academician Wang Chen, the Deputy Dean of the Chinese Academy of Engineering, the Dean of the Chinese Academy of Medical Sciences, and the Institute of Global Public Health, University of Heidelberg, Germany.
Wang Chen is the corresponding author of this article and the main promoter of Wuhan's construction of Fangcang shelter hospitals.
The article states that, in response to the new crown epidemic (COVID-19), China adopted Fangcang shelter hospitals for the first time.
The word Fangcang sounds reminiscent of "Noah's Ark" in Chinese. It is similar to a field mobile hospital, but it refers to a new concept.
It is a large, temporary hospital. It is generally converted from public buildings (such as stadiums and exhibition centers). It is used to isolate patients with mild to moderate symptoms from families and communities and provide medical care. Care, disease testing, food, shelter and social activities.
Fangcang shelter hospitals can be quickly established to provide a large number of beds and appropriate care for patients who do not have a serious or critical illness.
If the condition worsens, medical staff at Fangcang shelter hospitals can transfer patients to higher-level hospitals for more complex treatments. Fangcang shelter hospitals can also provide emotional and social support to help patients recover from the difficult stages of life.
Wuhan opened the first three Fangcang shelter hospitals on February 5, and in the following three weeks, 13 Fangcang shelter hospitals were successively established.
The 16 Fangcang shelter hospitals can accommodate a total of 13,000 beds. As of March 10, the 16 Fangcang shelter hospitals have provided care to approximately 12,000 new crown patients.
As the epidemic gradually subsided in Wuhan, the occupancy rate approached zero, and Fangcang shelter hospitals successively closed their cabins.
The first was closed on March 1, 2020. As of March 10, all Fangcang shelter hospitals have been closed.
The authors believe that China's experience in enabling Fangcang shelter hospitals in response to the COVID-19 epidemic shows that Fangcang shelter hospitals can be strongly adopted in the future in the event of a public health emergency.
Especially suitable for other epidemics but can also be used for other large-scale or fast-growing events involving diseases or injuries, such as large-scale poisoning or natural disasters.
In this article, the authors explain the concept and development of Fangcang shelter hospitals that China opened during the New Crown epidemic, describe their main features and basic functions, discuss key issues for the success of Fangcang shelter hospitals, and consider that other countries should consider Fangcang shelter hospitals as part of the response to COVID-19.
Why did Wuhan establish Fangcang shelter hospitals?
During the development of the Wuhan epidemic, the local medical system was once under high pressure.
The authors mentioned that at the beginning of February this year, the hospital designated to treat COVID-19 patients in Wuhan did not have enough beds, and thousands of patients with mild to moderate COVID-19 had to be sent home for isolation and observation.
Because of the shortage of hospital beds, Wuhan needs a fast and large-scale method to isolate and treat mild to moderate patients. When the epidemic reached its worst level in Wuhan, thousands of people were infected every day.
In view of this actual situation, Wuhan opened three Fangcang shelter hospitals on February 5 by rebuilding the exhibition center and the stadium. In the next few weeks, 13 new Fangcang shelter hospitals were opened in Wuhan.
During the epidemic in Wuhan, patients in Fangcang shelter hospitals moved.
As the epidemic gradually subsided in Wuhan, the bed utilization rate approached zero, and Fangcang shelter hospitals were shut down one after another. The first was closed on March 1, 2020. As of March 10, all Fangcang shelter hospitals have been closed.
Before starting Fangcang shelter hospitals, patients with new crowns or suspected patients who could not be hospitalized could only be isolated at home.
Home isolation is also one of the countermeasures in the epidemic of infectious diseases. It is an important alternative to hospital isolation. Isolators need to change their behavior during home isolation but do not need additional infrastructure investment.
However, the authors mention that China has decided not to isolate patients with mild to moderate COVID-19 at home for a number of reasons.
First, family isolation puts the patient's family members at risk.
Early epidemiological evidence in China shows that more than half of the patients with COVID-19 have at least one family member with the disease, and 75% -80% of all cluster infections occur within the family, suggesting a high intra-family transmission rate.
Second, patients can have significant psychological stress if they are isolated at home because they know that they put the person they care about most at risk of contracting the disease.
Third, home isolation is unlikely to be completely effective because it cannot be strictly enforced. Patients may break the rules of quarantine at home and go out for work, entertainment or exercise.
Fourth, it is difficult to isolate medical care at home, frequently monitor the progress of the disease, and promptly transfer patients who are isolated at home to the hospital for treatment. COVID-19 can progress from mild or moderate to severe disease and requires prompt transfer to the hospital for treatment.
Before enabling Fangcang shelter hospitals in Wuhan, it took up to 10 days for severely symptomatic patients to enter tertiary hospitals for intensive care. Fangcang shelter hospitals have significantly reduced these delays.
The authors point out that hospital isolation for the growing number of patients with COVID-19 in Wuhan is not feasible, and home isolation is not desirable.
Therefore, China needs a new method to control the epidemic in Wuhan.
In view of this, the Chinese government and related experts have proposed Fangcang shelter hospitals: large-scale health care facilities that can be built overnight, providing isolation, triage, medical care, monitoring and referral, housing and social activities.
Fangcang shelter hospitals "three districts and two channels".
Fangcang shelter hospitals are built in existing public places. These hospitals also usually set up "three zones and two channels" to avoid cross-infection, that is, clean areas, potentially polluted areas, contaminated areas, as well as medical staff channels and patient channels.
Three characteristics: rapid construction, large scale, and low cost
Although there are some historical precedents for Fangcang shelter hospitals, such as temporary hospitals, emergency field hospitals, emergency shelters, hospital isolation wards, etc., compared with the facilities used to control public health emergencies in the past, the authors believe that this time Fangcang Shelter hospitals have three different characteristics.
The main features and basic functions of Fangcang shelter hospitals.
They concluded in their article that the three characteristics of Fangcang shelter hospitals make them particularly suitable for responding to public health emergencies, such as the outbreak of COVID-19 in Wuhan.
The first feature is rapid construction. Fangcang shelter hospitals can be built quickly because they are built into existing physical infrastructure.
Wuhan's first three Fangcang shelter hospitals completed the renovation in 29 hours and provided 4,000 beds.
During the renovation process, buildings originally used for other purposes (such as stadiums or exhibition centers) were transformed into hospitals.
The process involves the redesign of some interior spaces and the purchase and installation of beds, medical equipment and supplies to support care, monitoring and living.
Location and capacity of Fangcang shelter hospitals during the Wuhan epidemic.
The second characteristic is the large scale. Fangcang shelter hospitals, once converted to hospital service functions, will greatly increase medical capabilities.
The 16 Fangcang shelter hospitals established by China in 3 weeks can provide a total of 13,000 hospital beds.
As of March 10, these 16 Fangcang shelter hospitals have provided care to approximately 12,000 patients.
These Fangcang shelter hospitals have effectively supported China's “receivable and exhausted” policy in response to the new crown epidemic.
The third characteristic is the low cost of building and operating Fangcang shelter hospitals. The investment cost is low because transforming public places into health care facilities can avoid expensive new physical infrastructure.
Similarly, once the epidemic subsides, these buildings can be restored to their original use, avoiding long-term inefficient use of space, which is a particularly important consideration in densely populated cities.
The lower operating cost is that Fangcang shelter hospitals require fewer doctors and nurses than traditional hospitals.
The ratio between medical workers and patients is relatively low for two reasons: first, all patients have the same primary admission diagnosis, reducing the complexity of care; second, all patients are only mild to moderate Disease.
By isolating and treating mild to moderate cases, Wuhan Fangcang shelter hospitals have reduced the burden on higher-level hospitals that can provide respiratory support and intensive care units for COVID-19 critically ill patients and other patients who require severe or complex care.
The article mentioned that more than 90% of severe cases in Hubei Province are in Wuhan, and the empty bed rate of designated traditional hospitals for COVID-19 patients rose from 4% on February 4 (before the opening of the first Fangcang shelter hospitals) to February 22. Day (16 Fangcang shelter hospitals opened) 16%.
Fangcang shelter hospitals improve the distribution of patients based on the severity of symptoms and improve overall care efficiency.
Five basic functions: Improved the efficiency and effectiveness of China's response to COVID-19
In addition to the three major features mentioned above, the authors also summarize the five basic functions of Fangcang shelter hospitals.
The first basic function is isolation. Before the construction of Fangcang shelter hospitals, thousands of patients with mild to moderate COVID-19 in Wuhan were sent home for isolation.
Patients with mild to moderate symptoms are usually more active than severe patients, so they have more contact with others, increasing the possibility of transmission and putting family and community members at risk.
Fangcang shelter hospitals are better at isolating patients than at home.
Fangcang shelter hospitals admission criteria.
The second basic function is triage. Fangcang shelter hospitals add an additional level of care to China's health system, thus providing a strategic triage function for COVID-19 patients.
Patients with mild to moderate COVID-19 who meet the admission conditions are treated in isolation at Fangcang shelter hospitals, while patients with severe to critical COVID-19 are treated in traditional hospitals.
This strategic triage function has relieved the pressure of traditional hospitals, so Fangcang shelter hospitals are likely to improve the efficiency and effectiveness of China's COVID-19 response.
Fangcang shelter hospitals allow Wuhan's health system to give priority to providing medical services to patients with severe to critical illness in traditional hospitals (about 20% of patients with COVID-19), and to patients with mild to moderate illness (about 80% COVID-19 patients) to provide appropriate medical services.
The third basic function is to provide basic medical services, including antiviral, antipyretic and antibiotic treatments; oxygen support and intravenous fluids; and mental health counseling. In order to support medical services, a few days after the opening of the first Fangcang shelter hospitals, medical staff in Wuhan can use the electronic information system supported by the cloud platform and connect with higher-level hospitals for record-keeping and data transmission. And monitoring of medical quality and results.
The fourth basic function is frequent monitoring and rapid referrals. Through a simple referral, Fangcang shelter hospitals were integrated into the entire Wuhan health system.
Medical staff at Fangcang shelter hospitals monitor the progress of the condition several times a day by measuring respiratory rate, temperature, oxygen saturation and blood pressure. Patients will be referred promptly as soon as they respond.
Healthcare professionals also provide a series of specific tests, such as nucleic acid tests and CT scans, to ensure rapid confirmation of worsening in specific patients.
As of February 29, the day before the first Fangcang shelter hospitals were suspended, the total number of patients transferred from Fangcang shelter hospitals to higher-level hospitals accounted for 13% of all Fangcang shelter hospitals.
After February 29, this proportion increased because all patients who had not been discharged before Fangcang shelter hospitals were discharged were transferred to higher-level hospitals.
Overall, the authors point out that compared to choosing to quarantine at home, Fangcang shelter hospitals may significantly reduce the time from severe symptoms to being sent to a higher-level hospital.
The fifth basic function is to provide basic life and social interaction. Basic living functions, including accommodation, food, hygiene, etc. Of course this is necessary for a large number of patients.
In addition, social participation is designed to promote patient recovery and reduce the anxiety that COVID-19 diagnosis and isolation can cause.
Wang Chen and others wrote: China envisions Fangcang shelter hospitals as a community of patients. Patients are isolated from COVID-19 negative people, but patients support each other and participate in social activities. Medical staff provides emotional support in addition to medical care; community activities typically include eating together, watching TV, dancing, reading, and celebrating birthdays.
It is worth learning from other countries, China sends experts to help build Fangcang shelter hospitals
During the outbreak of the COVID-19 outbreak in Wuhan, Fangcang shelter hospitals isolated thousands of patients, provided high-quality medical care and care, and completed important shunting functions.
In the article, Wang Chen and others stated that early descriptive evidence showed that Fangcang shelter hospitals were the main reason for China's successful control of the epidemic.
The number of confirmed cases in Wuhan has steadily declined since February 18, 12 days after the first Fangcang shelter hospitals started receiving patients. As the number of new infections continues to decline, China has suspended all Fangcang shelter hospitals.
The authors suggest that future research could focus on the causal impact of establishing Fanggang shelter hospitals on the incidence of COVID-19 and the health outcomes of the population.
There are some key factors behind the successful operation of Fangcang shelter hospitals.
They pointed out in the article that as part of the epidemic prevention strategy, Fangcang shelter hospitals need a variety of supporting strategies and solutions, including human resources strategies, communication and public participation strategies, governance structures, and prevention of nosocomial infections and a degree of privacy for patients' protective measures.
In addition, although the epidemic is gradually subsiding in China, the COVID-19 pandemic is spreading globally, and countries other than China are facing a shortage of traditional hospital beds. These hospitals are providing care for the rapidly growing number of large patients with COVID-19.
They mentioned that China has begun to assist Italy, Iran, Serbia and other countries. As part of international cooperation, China has translated all Fangcang shelter hospitals' policies, management manuals and clinical guidelines into the languages of other countries with rapidly growing epidemics.
China has also sent experts with experience in assisting in the construction and operation of Fangcang shelter hospitals to other countries to provide consulting services to local governments.
They stressed that other countries facing the COVID-19 pandemic should consider using Fangcang shelter hospitals as part of their public health response.
They believe that by incorporating Fangcang shelter hospitals, many countries and communities around the world can strengthen their response to the current COVID-19 epidemic and future epidemics and disasters.
They pointed out that the design and construction of large-scale public places (such as stadiums, convention centers, exhibition centers, stadiums, factories and warehouses) in the future should integrate some functions to promote the possible transition to Fangcang shelter hospitals in the future.
For example, indoor equipment can be quickly removed, entrances are large enough to pass through hospital beds, and ventilation systems reduce the risk of mutual infection.