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Open Access 01-12-2020 | SARS-CoV-2 | Editorial
Covid-19 in China: ten critical issues for intensive care medicine
Published in: Critical Care | Issue 1/2020
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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).
Table 1
Ten critical issues for intensive care medicine
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Current situations or problems
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Suggestions or solutions
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1
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Severe shortage of critical medical resources including physicians, nurses, and ICU beds in China.
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Increase financial and staff investment, value the training of intensive care physicians and intensivists, and increase the ratio of ICU beds to hospital beds nationwide.
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2
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The levels of intensive care medicine in different provinces are uneven.
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Strengthen training to achieve the homogeneity of clinical cognition and management capabilities of intensive care physicians in different provinces.
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3
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To focus medical resources on rescuing large numbers of Covid-19 patients, many non-Covid-19 patients are unable to receive effective treatment.
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Establish a professional agency for the integration and optimization of the allocation of critical medical resources.
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4
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Medical staffs in Wuhan City from other provinces or cities were unfamiliar with the local conditions and the early phage of rescuing was in unordered states.
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Set up standardized operating procedures for ensuring the refined risk stratification and subsequent refined management of critically ill patients.
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5
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Lack protection awareness and equipment early, many physicians or nurses were infected by SARS-CoV-2.
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Strengthen occupational protection training and develop special standardized protection procedures during epidemics.
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6
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The continuous recognition of Covid-19 by Chinese intensive care physicians is a long and deepening process.
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Develop the ability of intensive care physicians to quickly analyze and respond to a new disease.
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7
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Covid-19 patients usually are complicated with multiple organ failure.
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More cooperation between intensive care medicine and other disciplines to deal with the rapid development of Covid-19.
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8
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The timing, dose, and duration of many therapies or life support for Covid-19 still remain controversial.
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More training to improve the research ability of intensive care physicians.
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9
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The published studies mostly are single-centered and retrospective. It is difficult to integrate clinical, basic and public health data.
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Establish a national special disease database, specimen bank and share research data from different medical centers.
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10
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Critical patients obtain multi-disciplinary expert team consultations through a national video remote consultation platform during Covid-19.
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Promote ICU informatization construction. The successful experience should be extensively extended to the cure of other critical patients.
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