On December 1, at the headquarters of Beijing Chaoyang Hospital affiliated to Capital Medical University, Tong Zhaohui, deputy director of Chaoyang Hospital and director of the Beijing Institute of Respiratory Diseases, asked the nurse about the pediatric outpatient situation that day.
Just the following December 2, the National Health Commission held another press conference to introduce the prevention and control of respiratory diseases in winter. According to the press conference, according to monitoring, the currently prevalent acute respiratory diseases are all caused by known pathogens and have corresponding mature treatments. No new infectious diseases caused by new viruses or bacteria have been found.
reporter: Why did it suddenly attract so much attention this year? And there are so many queues for treatment in hospitals?
Tong Zhaohui, Director of the Beijing Institute of Respiratory Diseases: I think this may be the case. Our prevention and control in the past three years has been relatively strict, and everyone's habit of wearing masks is also relatively good, and in terms of prevention and control requirements, people have gone out less. , so we are facing a very clean environment. The human body has less contact with external respiratory microorganisms, and its resistance to various external microorganisms will be poor, and its immune tolerance will be poor. After normalization, if you come into contact with these again, when the virus comes in winter, you will easily develop some respiratory symptoms.
In fact, since the beginning of winter, most areas in China have entered the influenza epidemic season. On the clinical frontline, Tong Zhaohui believes that people still need to attach great importance to prevention, and vaccines are still the most effective means of prevention.
Tong Zhaohui: Because it is more common in autumn and winter, and I think my own protection is the most important. For example, in autumn and winter, it is better to reduce the chance of going out. For example, if children have to go to school, they still wear masks and wash hands. This not only protects against mycoplasma, but also viruses like influenza and other viruses. Especially when children go to school, where there are dozens of people in a class, they still need to wear masks and clean their hands. If you have a fever, you can stay at home and not go to school. Therefore, you should still have good respiratory protection habits. The influenza vaccine should be said to be very mature, and it is also recommended that especially the elderly and children, be vaccinated in advance from September to November every year, including pneumonia vaccine.
Every autumn and winter enter a period of high incidence of respiratory diseases. The elderly and children are the most vulnerable groups to attacks by viruses and bacteria. But in terms of how to deal with it, Tong Zhaohui believes that many parents do not handle it appropriately.
Tong Zhaohui: When it comes to children, people probably go to children’s hospitals, such as Beijing Children’s Hospital and Beijing Children’s Hospital, which are all concentrated there. Parents' feelings are understandable. Children are the most important and precious. If you are sick, you must go to a children's hospital for treatment. In fact, I think the pediatricians in some large tertiary hospitals are also good. In addition, there are some secondary hospitals and community hospitals near my home.
Tong Zhaohui: Today’s community doctors are all general practitioners who have undergone standardized training. Children’s respiratory infections, including upper respiratory tract infections and pneumonia, are common and frequently occurring diseases, not difficult and complicated diseases. So I think if a child has a fever, he can actually go directly to the nearest community hospital for the first diagnosis. It can be completely solved, and the medicines are the same and the community is equipped with them. Therefore, go to the nearest hospital promptly, make a good judgment and diagnosis in time, and use the medicine in time, so as to avoid having to go to these large specialized hospitals and wait in line. You wait here for several hours, and even children with fever are waiting here. In fact, it is easy to cross each other. Reporter
: But for parents, how can we tell when their children should be graded, treated at home, or go to the hospital?
Tong Zhaohui: You can go to the community hospital as soon as the fever starts, because at that time the condition has just started and the fever has just started, so it cannot be serious. Furthermore, community hospitals are now able to conduct antigen tests in a timely manner, and the results of the antigens are available immediately, including many homes that also have antigens. So whether you have a virus or mycoplasma, you can actually identify it immediately at the nearest secondary hospital or community hospital. If it's just an upper respiratory tract infection, then treat it symptomatically, or take some antiviral drugs and corresponding drugs, that's fine.Of course, if there are some children who have had a fever for several days, that is, high fever for several days or more than three days, and then the child also develops shortness of breath or shortness of breath, then they should still go to a specialized hospital.
Tong Zhaohui: The second question is about fever. Parents don’t want their children to have a fever. They go to the hospital as soon as they have a fever. In fact, the temperature does not indicate the severity of the illness. The higher the body temperature, the more serious the illness. So in fact, if it is still in the upper respiratory tract and there is no pneumonia, it is only 39 degrees, 39.5 degrees, or 40 degrees, which is just a high body temperature. Sometimes on the contrary, for example, those who are in good health react strongly and have a higher body temperature. If it is in the upper respiratory tract, some antipyretics are used. When some antipyretics are ineffective, you can use physical cooling. For example, put a few cold towels on ice in the refrigerator and apply them on your forehead and body. This physical cooling effect is sometimes better than drugs. In fact, as long as you don’t have a fever , the child's mental state is very good.
According to monitoring by the National Health Commission, influenza is still the main respiratory infectious disease in China recently. In addition, there are rhinovirus, Mycoplasma pneumoniae, respiratory syncytial virus, adenovirus, etc. Analysts believe that the continued rise in acute respiratory diseases since the beginning of winter is related to the superposition of multiple respiratory pathogens. Therefore, superinfection has become a hidden worry for many people.
Tong Zhaohui: In winter, these viruses still exist, but infecting a person does not mean that I am infected with influenza and syncytial infection. It is impossible to superimpose them on one person. Second, for example, if I have a fever and go for some antigen or nucleic acid tests, two or three types of tests may be positive. But if there is sputum in the upper respiratory tract, or if the throat swab is positive, it means that you are infected. In our daily work, whether we are outpatients or inpatients, we will do pathogen testing. When we do pathogen testing, we often don’t just say one type. Especially for people who have been hospitalized for a long time, we can detect two or even two types. Three or four kinds. But the doctor has to make a judgment. It does not mean that if I test positive, it must be a pathogenic bacteria. Many of them are colonized in the upper respiratory tract, because the respiratory tract itself has a defensive function. If nucleic acid is used, it will show some viral load, and there is Some viral loads are high and some are low. The doctor will help you judge. For example, he will use your antigens, nucleic acids, chest X-ray CT, blood routine, and other tests to comprehensively analyze which type of treatment is the main one. Therefore, if the etiology is only in the upper respiratory tract, symptomatic treatment is enough, or corresponding antiviral drugs can be used. There are corresponding drugs for influenza and mycoplasma. There are currently no obvious drugs against viruses such as syncytial virus and adenovirus. Therefore, we often rely on symptomatic treatment, such as treating fever and cough. Symptomatic treatment can recover in a week or two. .
Reporter: This time, many patients continued to cough after their fever subsided. Could this cause pneumonia?
Tong Zhaohui: In fact, there are many causes of cough. In our daily medical treatment, there are acute cough and chronic cough. There are hundreds of causes of chronic cough, so you need a doctor to help you identify them. Some people just have a cold, and they will cough for half a month, a month, three months, or even half a year. This is because after they had bronchitis or pneumonia before, the bronchial mucosa was damaged, and they would cough if they were slightly irritated. Airway hyperresponsiveness will occur.
reporter: What should we do?
Tong Zhaohui: There are clinical methods for treating symptoms and relieving cough. We have some cough medicines and some medicines that reduce airway hyperresponsiveness. Sometimes you need to take these cough medicines and the medicines that reduce airway hyperresponsiveness at the same time, and the effect is still very good. Reporter
: Because we have noticed that in today's society, from the initial fever to the later stage of cough, you have to go to the doctor again and again during the entire stage. For example, when the fever is gone, you have to go to the doctor again when you cough.
Tong Zhaohui: The infection period has been controlled, and only some symptoms will remain in the later stage. So as long as you no longer have a fever after treatment, the temperature will no longer rise again, these yellow sputum will no longer appear, and the acute symptoms will no longer appear like before. Some respiratory changes in the early stages can be treated symptomatically with some cough suppressants.And especially for dry cough, if there is no excessive phlegm or yellow phlegm, it does not mean that I have another infection and it has gotten worse again. Reporter
: However, during this period of high incidence of respiratory diseases, many people are worried that if their children are so young, even if they are cured of such a disease, will they have similar sequelae or other harm in the future?
Tong Zhaohui: In fact, I think everyone should not worry about this, because it is very common for adults and children to have colds, coughs, pneumonia, and tracheitis in winter. But as mentioned above, many diseases and viruses, including upper respiratory tract infections, are self-limiting and will be cured once they are cured. Even if pneumonia occurs, pneumonia is the best treatment for doctors. Moreover, pneumonia is a curable disease, and it is not said that there are any sequelae caused by upper respiratory tract or lower respiratory tract infection. That's fine, there won't be any problem.
In many media reports, infusion has become a common scene. However, many people are accustomed to immediate infusion treatment as soon as they have a fever and cough. Tong Zhaohui emphasized that this is a misunderstanding.
Tong Zhaohui: In fact, when treating any disease, the doctor will judge whether infusion is needed based on the severity of your disease. Of course, if it reaches the lower respiratory tract, such as pneumonia, influenza, or other viruses, infusion is actually a supportive treatment. Furthermore, if the virus infects the lower respiratory tract, some children will develop secondary bacterial infection on the basis of viral infection, in which case infusion should be given. That is to say, when it comes to pneumonia or some bronchiolitis, both adults and children may need infusion.
The high incidence of respiratory diseases in China has also attracted the attention of the WHO. On November 23, the WHO posted on social media that since October, the WHO has been paying close attention to the health system reported by China. Condition. Based on the available information, WHO has not identified any unusual or novel pathogens or unusual clinical manifestations, except for a general increase in the above-mentioned respiratory diseases caused by a variety of known pathogens. Reporter
: Why are international health organizations so concerned about our respiratory disease this time?
Tong Zhaohui: They also said something that you may not have noticed. They said that pathogens are still common.
reporter: What does this sentence mean?
Tong Zhaohui: What they are saying is that there is not a new infection or a new pathogen. Although we will have more respiratory infections this winter, whether it is viruses or mycoplasma, they are still common pathogens. There are no new pathogens. I think this is also to dispel some of the suspicions of the people. Reporter
: For patients who have suffered from such respiratory diseases, will their bodies produce antibodies, so that they may not get it again after suffering from it once?
Tong Zhaohui: That’s right. For example, the flu virus will be like this, and the mycoplasma will be like this too. If he gets it at least in the near future, he won’t get it again. For example, after a recent infection, IGM antibodies are produced first, and then IGG antibodies are produced, so it will have a protective effect in a short period of time. Of course, the antibodies will disappear slowly and infection will occur again.
After respiratory diseases entered a period of high incidence this winter, based on the experience of the past three years, people are also paying attention to the activity of the new coronavirus and whether this round of respiratory diseases is related to the new coronavirus. Reporter
: There is also a voice that there is cross-infection in this concentration. Is it possible that it is a mutation of the new coronavirus, or an extension in other ways?
Tong Zhaohui: This should not be the case. Whether we have some fever patients or these respiratory diseases this winter, it is no different from the past, they are still the same pathogens. Second, mycoplasma is not a new pathogen. It is still common, and the treatment of mycoplasma is also part of daily work, not only in winter, but also in normal times. This is all scientifically proven, so don’t make assumptions.Reporter
: But many people also have a view. For example, some children who have had COVID-19 before have low immunity, so this time the respiratory disease will react so quickly and violently.
Tong Zhaohui: In fact, there should be no causal relationship between the two. Of course, it’s possible that I had COVID-19 before and I still have some symptoms that haven’t healed yet, so I got another flu, or I got mycoplasma recently. But I think this is still within the scope of treatment and control.
As a well-known expert in respiratory and critical care medicine in China, Tong Zhaohui, director of the Beijing Institute of Respiratory Diseases, and his colleagues monitor influenza-like cases from Beijing and even across the country every year, and adjust diagnosis and treatment methods based on changes in etiology. Make adjustments on. Tong Zhaohui has his own views on this wave of high incidence of respiratory diseases.
reporter: What suggestions do you have for society?
Tong Zhaohui: I think it may be that we are all professionals and look at this issue very rationally and calmly. So I think first of all, people should believe in science, and people should treat this issue correctly. First of all, respiratory diseases, including fever, are very common in winter, whether in adults or children. The second one is that no new pathogens have emerged, so no one should worry about this. Moreover, the characteristics of these pathogens, including our clinical diagnosis and treatment, hospitals at all levels are still very experienced in common respiratory infections.
