援鄂医疗队专家介绍新冠肺炎重症科学救治记者见面会
发布时间: 2020-03-16 | 来源: 国新网

  国务院新闻办公室于2020年3月16日(星期一)下午4时在北京和湖北武汉同时举行国务院新闻办记者见面会,请北京协和医院援鄂医疗队的专家在武汉的新闻发布厅介绍新冠肺炎重症的科学救治,请记者在北京的中宣部(国新办)新闻发布厅远程视频连线提问。见面会全程英文。

  • 国新办新闻局副局长、新闻发言人袭艳春(湖北日报 蔡俊 摄)

  • 北京协和医院内科重症医学科主任、主任医师,中国医师协会重症医学医师分会会长杜斌(湖北日报 蔡俊 摄)

  • 北京协和医院内科学系副主任、心内科主任医师严晓伟(湖北日报 蔡俊 摄)

  • 北京协和医院感染内科副主任、副主任医师曹玮(湖北日报 蔡俊 摄)

  • 北京协和医院消化内科副主任医师吴东(湖北日报 蔡俊 摄)

  • 记者见面会主席台(湖北日报 蔡俊 摄)

  • 记者见面会现场(焦非 摄)

  • 国新办新闻发言人袭艳春邀请记者提问(焦非 摄)

  • 路透社记者提问(焦非 摄)

  • CGTN记者提问(焦非 摄)

  • 印度报业托拉斯记者提问(焦非 摄)

  • 荷兰广播电视协会记者提问(焦非 摄)

  • 人民日报记者提问(焦非 摄)

  • 韩国京乡新闻记者提问(焦非 摄)

  • 彭博新闻社记者提问(焦非 摄)

  • 香港中评社记者提问(焦非 摄)

  • 日本电视网记者提问(焦非 摄)

  • 华尔街日报记者提问(焦非 摄)

  • 中国日报记者提问(焦非 摄)

    SCIO briefing on the science-based treatment of severe COVID-19 cases

      Speakers:
      Du Bin, director of Medical ICU, Peking Union Medical College Hospital; chairman of the Intensive Care Medicine Branch, Chinese Medical Doctor Association

      Yan Xiaowei, deputy chief of the Department of Internal Medicine, Peking Union Medical College Hospital

      Cao Wei, associate chief physician, deputy head of the Department of Infectious Disease, Peking Union Medical College Hospital

      Wu Dong, associate chief physician at the Department of Digestive Disease, Peking Union Medical College Hospital

      Chairperson:
      Xi Yanchun, spokesperson of the State Council Information Office

      Date:
      March 16, 2020

      Xi Yanchun:
      Ladies and gentlemen, friends from the media, good afternoon. Welcome to today's briefing. Now, the COVID-19 epidemic has become a common challenge facing the whole world. In order to save people's lives, the Chinese government has acted decisively and launched a large-scale rescue mission. In a very short time, China has dispatched over 330 medical teams and sent more than 40,000 medics to the virus-hit Hubei province. Today, it is a great honor for us to invite four experts from among those 40,000 medics. All of them are from the Peking Union Medical College Special Aid Medical Team. They will share their experiences in the treatment of COVID-19, especially in severe cases in Wuhan. Before I introduce the distinguished experts, let's watch a short video about them.

      Welcome back. Please allow me to introduce to you the four experts from Peking Union Medical College Hospital: Professor and Dr. Du Bin, director of Medical ICU. He is also the chairman of the Intensive Care Medicine Branch, Chinese Medical Doctor Association. Professor and Dr. Yan Xiaowei, professor of cardiology and deputy head of the Department of Internal Medicine. Dr. Cao Wei, associate chief physician and deputy head of the Department of Infectious Disease. Dr. Wu Dong, associate chief physician at the Department of Digestive Disease. Now, I would like to let them say a few words about their team and also about themselves. Dr. Du, please.

      Du Bin:
      Good afternoon, ladies and gentlemen. This is Dr. Du Bin, again. I'm one member of the national expert team as well as a member of our team. I spent the last two and half days visiting five different hospitals in five cities to review the most critically ill patients with COVID-19 there, and I just rushed back to Wuhan a few hours ago. I would like to say a few more words about our team.

      As you may know, Peking Union Medical College Hospital has been the number one hospital according to the "national best hospital rankings" for about 10 years. It's the responsibility of my colleagues and I to participate in the medical rescue team, when the local health care resources have been overwhelmed by the COVID-19 outbreak. We spent the first couple of days remodeling one of the general wards into an intensive care unit and started admitting the most critically ill patients with COVID-19 on Feb. 4.

      It is not just ourselves fighting alone against COVID-19. We have strong support from the teams of Tongji Hospital, as well as other medical rescue teams. In addition, we also have very strong support from our colleagues in our hospital back in Beijing, through weekly teleconferences to communicate with them about the most difficult cases. This can maximize our efforts in order to rescue the lives of patients. Thank you.

      Xi Yanchun:
      Thank you very much Dr. Du. Professor Yan, please go ahead.

      Yan Xiaowei:
      Hi, good afternoon, ladies and gentlemen. I'm Dr. Yan from the Internal Medicine of PUMC Hospital. My duty in Wuhan is to coordinate the different departments of internal medicine for successful performance. I also propose and organize the MDTs with PUMC Hospital. As a cardiologist, I'm also responsible for the management of COVID-19 patients complicated by cardiac events and those with previously established cardiovascular diseases. Thank you.

      Xi Yanchun:
      Thank you very much Dr. Yan. Dr. Cao, please.

      Cao Wei:
      Good afternoon, ladies and gentlemen. I'm Dr. Cao Wei from the same hospital. I'm a physician of infectious diseases, and I treat patients with different infections. I arrived in Wuhan on Feb. 7 and have been here ever since as a member of the national medical team of PUMC Hospital. As a team, we worked together, as Dr. Du said, to set up an emergency intensive care unit, and have been taking care of critically ill patients with COVID-19 in Wuhan. Personally, I participate in the clinical care of these patients and I'm also involved in the coordination of the clinical collaboration with local hospitals here in Wuhan. Thank you.

      Xi Yanchun:
      Thank you very much, Dr. Cao. Lastly, Dr. Wu, please.

      Wu Dong:
      Thank you, good afternoon. I'm Dr. Wu Dong, an associate professor in gastroenterology in PUMC Hospital. I've been working there since 2003, the year when SARS epidemic took place. I came to Wuhan about five weeks ago and I took the service here as a calling to myself, because last time I wasn't offered the opportunity to fight coronavirus, and I didn't want to miss it this time. So, currently I'm an attending physician working in the ICU, taking care of patients who are very sick. I'm very glad to share my experiences with you. Thank you.

      Xi Yanchun:
      Thank you very much to all the experts. You're doing a great job because you're saving people's lives, competing against death. The floor is now open for questions. Please identify your news outlet before asking your question. Please raise your hands. OK, in the left area, the first line, the gentleman in the blue shirt, please.

      Reuters:
      Hi, I'm from Reuters and I have three questions. First, what is the current risk of reinfection amongst recovered patients in China? Second, how does the weather affect infection rates, and should we expect higher or lower rates of infection as it gets warmer? Last, when can we expect to find patient zero in China? And what clues do you have so far? Thank you.

      Du Bin:
      Dr. Yan, would you please answer the first question and Dr. Cao the second.

      Yan Xiaowei:
      Thanks. The first question is about re-infection. Actually, reinfection is a problem after patient discharge from hospital. In China, a patient discharged from hospital in recovery from COVID-19 will be followed regularly at in two weeks and four weeks after discharge. The patient will also be monitored by local inspectors.

      They will be asked to isolate themselves at home for at least two weeks. Also, they will be asked to take their temperature twice a day. If the temperature relapses, the patient will be sent to hospital for a chest CT scan and nucleic acid detection. One point I would like to address is that a positive nucleic acid test on its own doesn't mean that the patient has the intact virus particle in his body. Also, it doesn't mean the patient is infectious. So, a positive nucleic acid test alone which can be seen after virus infection is not a sign of reinfection.

      So, if we think a patient is re-infected, we should check for fever and the progression of the chest x-ray. Thank you for your question.

      Xi Yanchun:
      And Dr. Cao, please.

      Cao Wei:
      I'll take the second question. I bet that's a question many people are interested in. Currently, there has been no data regarding COVID-19 and its relation with the weather. But if we take a look from the past experience of SARS, which was another coronavirus, we can see that there are multiple factors that influence the rates of infection. For example, the gradual loss of virulence with the progression of time or regaining of virulence, because of mutation and other joint measures of prevention and control, etc. among them. Unfortunately, the impact of the weather hasn't been confirmed yet. Thank you.

      Xi Yanchun:
      Next question, please. In the middle area, the first line, the gentleman in the dark suit. Thank you very much.

      CGTN:
      Thank you very much, I'm from China Global Television Network. Could you please introduce the latest situation of the combined method of treating COVID-19 patients with traditional Chinese medicine (TCM) and modern medicine? Also, what kinds of patients are generally being treated with TCM methods? And how effective have they been? Thank you.

      Du Bin:
      I'll take the question. I think some of my colleagues might add some comments after my words. It's my belief that traditional Chinese medicine (TCM) is both familiar and unfamiliar to our practitioners of Western medicine. Every day in Wuhan, we're working together with our colleagues from the traditional Chinese medicine department. It seems to me, at least in my mind, that traditional Chinese medicine works quite well in patients with mild disease and in those who have been recovering from critical illness. However, I do notice that people are suspicious of the efficacy of traditional Chinese medicine. I would say that TCM and Western medicine do not share the same philosophy. They have quite different philosophies. They have quite different evaluation systems for efficacy.

      For example, whenever we have the chance to test the efficacy of a specific medication in Western medicine, we will try to separate patients into different groups, and give those who are assigned randomly to the experimental group or the study group a specific drug at a fixed dose and fixed duration. Then we try to interpret any difference between the experimental group and the control group with regards to clinical outcomes as a manifestation or an evidence of the efficacy or safety of the specific drug. However, this is not the case for traditional Chinese medicine. From my own observation, when working with the TCM practitioners, I noticed that even for patients with quite similar appearances from my personal point of view, they would prescribe quite different medications with different doses every day. This makes the evaluation system futile or invalid.

      So it's very hard for us to assess the efficacy and safety of TCM from the Western medicine point of view. But my belief is that we should respect each other. We should know that both Western medicine and traditional Chinese medicine have their own strengths and weaknesses, and we should learn from each other. We also encourage our colleagues in the TCM sector to adopt our system of evaluation or assessment in order to let not only us but also the international community understand what they're doing. Thanks.

      Xi Yanchun:
      Does anyone want to add some words?

      Wu Dong:
      I do have some comments. First of all, I agree with Professor Du that we don't have panacea here. We don't have any specific anti-virus drug or medication that has been proved effective. But from a perspective of gastroenterology, which is my specialty, I would like to say that at least in some cases, traditional Chinese medicine seems work well. Because we know that for some patients in ICU, their bowel movements just stop, and their abdomens are quite distended. In several cases, the condition is severe enough to force us to stop enteral nutrition, which we all know is essential for the patient to recover. So we use TCM to treat this type of patients. I would say that they have a very good laxative effect, which enables us to continue to feed them. Thank you.

      Xi Yanchun:
      Ok. Next question, please. The gentleman in the first row in the middle area, who, I guess, is from India.

      Press Trust of India:
      Thank you. First of all, let me compliment the doctors, not simply those who are here, but hundreds of their colleagues who went to this epicenter and tried to confront this virus or the vicious virus head-on. Definitely, today as the virus winds down as well as the figures in Wuhan and probably in Hubei and the rest of China, the question being asked is, will there be a relapse? Will there be a second wave that can come up at a later stage or anytime soon here, because it's happening all over the world now. Secondly, there is not much data that has come out about the virus' impact on children. Now that there is debate about when the schools should be reopened, not simply here, but as well in places where this virus is popping up perhaps. What exactly is or are you rather reading about this virus' impact on children of different ages? Thank you.

      Du Bin:
      I'll ask my colleague, Dr. Cao Wei, to answer the question about the relapse. And I'll take the question about the children.

      Cao Wei:
      Thank you. I will take the first question. We all know that the status of pandemic has been declared by the WHO a few days ago, which means that the situation of the epidemic globally will not be solely dependent on the situations in China or any other single area or country in the world. Currently, after three months of fights, the outbreak in China, which started in December of last year, has almost come to an end.

      I think we will still wait for another month to see and make a final judgment. But for me, a second domestic outbreak in China wouldn't be a great concern under such measures of prevention and control. But we all know that another important source of newly onset cases now comes from the imported patients from outside China. So it is most probable that the newly reported cases, including the imported ones, may be kept at a relatively low level, but may last for a certain period of time. Thank you.

      Du Bin:
      Okay. The second question is concerning COVID-19 in children. Actually, from my observation and discussion with the pediatricians, we know that there are some children that contracted COVID-19. However, the majority of them are doing quite well. There are actually three recent publications, one in JAMA describing nine infants, all under the age of one year old. The other one is about six children, with ages ranging from two to seven years old. Among all these 15 children, only one was admitted to the intensive care unit requiring some sort of supportive therapy, including oxygen therapy; however, all children survived.

      Another paper just published earlier today in Nature Medicine described that, among all the close contacts, the adults have a higher likelihood -- about 2.7 times -- of contracting COVID-19 than children. We currently don't know what the rationale is behind this phenomenon, but we do understand that -- despite the fact they got infected -- the majority of children exhibited a mild disease course, and all of them recovered. According to my understanding, this is what is happening in Wuhan, Hubei, and other provinces. Thank you.

      Xi Yanchun:
      Ok, next question, please. The gentleman in the right area in the 3rd row in the suit.

      Dutch Public Broadcaster:
      Thank you very much. With NOS the Dutch public broadcaster. Doctors, could you give us a bit of an insight into how the situation is now in the hospitals in Wuhan? We've seen that several temporary hospitals have been closed down. Also, what I would like to know, since we're talking to the best doctors of this country, what advice or lessons would you like to share with people on the frontline in other countries that are facing the start of the epidemic, for instance the Netherlands? Thank you very much.

      Du Bin:
      Is there anyone who wants to answer the question? I'll answer first. Yes, you are right. I believe that all mobile cabin hospitals have been closed. Some of the designated hospitals for COVID-19 have also been closed, either discharging their patients or transferring their patients to other designated hospitals. It seems to us that, like Doctor Cao just said a minute ago, the outbreak of COVID-19 in Wuhan and Hubei has come to an end.

      We should be alert, though, to any abnormal signals or sporadic cases that rise from communities, what is happening during these days, and the imported cases from other countries out there and anywhere else. The second question: what kind of lessons or cleanup experience we can share. There are so many things. However, I should say the most important thing when combatting infectious diseases, such as COVID-19, is to prevent and control the disease rather than treatment. Thus, treatment is only secondary. Prevention and control are the primary goals. Previously, I remember talking about planning. You must have a plan. Failure to prepare is preparedness for failure. So even now, in Wuhan and Hubei, we have fewer newly diagnosed cases, but we should remain alert and prepare for future sporadic cases and imported cases, as well as learn from our own experiences of success and failure. Thanks.

      Xi Yanchun:
      Yes, Dr. Yan, please.

      Yan Xiaowei:
      To my overseas colleagues, I would like to address two points. The first is to the doctors: you should take good care of yourself from the coronavirus infection. This is the precondition for you to take care of patients. Also, it's a precondition to protect your colleagues and your family. My second point is the public should be educated widespreadly for the protection of themselves.

      It is not complicated. Just wash your hands, wear a mask, and avoid gathering, etc. Otherwise, health care facilities and systems will be overwhelmed by the outbreak of COVID-19. Thank you.

      Xi Yanchun:
      Okay, Dr. Wu, please.

      Wu Dong:
      I want to share a few words with the general public of other countries. I want to say that we totally respect that every nation, every person, has their own condition that could be very different from others.

      We are not saying that this is the Chinese example and you should follow. We're not saying this. We totally respect that you should take your own actions. But every one of us should take this very seriously, take necessary actions, change your behavior, and be responsible. As for the medical community, I would like to say that we have to protect them because, in the last few days, we know that our European colleagues have also contracted the disease during daily practice. And the proportion is quite similar to that in the early stages in Wuhan.

      So we need to protect our medical staff working in the ICU. The environment is quite stressful. The mortality is relatively high. As a physician, you will lose some of your patients from time to time, no matter how hard you have been trying to save their lives. This could easily damage the morale of the ICU staff. So I suggest them to rest and relax. You need to take very good care of yourself. Thank you.

      Xi Yanchun:
      Ok. Next question, please. The gentleman in the right area in the second row, please.

      People's Daily:
      Thank you very much. I am from the People's Daily English language app. As we all know, some countries are short of medical resources, so, the majority of patients with mild symptoms have to stay at home in isolation. My question is: which alarming signals should they heed to prevent dangerous escalation? Thank you.

      Xi Yanchun:
      Dr. Cao, please.

      Cao Wei:
      Thank you. First, if you have to stay at home in isolation because of other reasons, the first important thing is to identify or ensure that you are the right person who can accomplish this. This means you are not associated with identified risk factors of deterioration, such as elderly people, people with multiple comorbidities, including hypertension, diabetes, chronic lung diseases, or other chronic diseases. Secondly, if you are young and generally healthy, and you have decided to stay at home in isolation by yourself, then it is very important for you or one of your family members to keep a close eye on your symptoms or feelings.

      Once you begin to have a persistent high fever or when you begin to feel short of breath, or maybe you feel altered mental status, it is time for you to go to the doctor and seek help. The last and most important thing during your home isolation period is to make sure not to let your family members get the virus from you. There are multiple measures of prevention and protection for the family members, and you can get the full version from the WHO website. I'm sure. Thank you.

      Xi Yanchun:
      Okay, next question. The lady in the middle area in the third row from South Korea.

      The Kyunghyang Shinmun:
      Thank you. I'm a journalist from South Korean newspaper. The problem of COVID-19 infection by medical staff in Wuhan is a little bit serious. What protective measures are the medical staff taking? Please explain the local situation as a medical team. Thank you.

      Du Bin:
      Thanks for your question. I do believe that my colleague Dr. Yan has already answered the question. But any way, I may add a few words that as Dr. Yan said that there are multiple reasons, multiple factors, contributing to the infection of COVID-19 in the health care workers, especially during the initial stage.

      One is the lack of knowledge that this is a human-to-human transmission disease. So you may know that a lot of health care workers have been infected in a couple of local hospitals in Wuhan, such as the Wuhan Central Hospital. This is the hospital that is located very close to the Huanan Seafood Market, that at the initial phase that many patients went there to see doctors, and the doctors didn't know.

      They didn't know that this is a human-to-human transmission disease. And the second important factor is the lack of personal protection equipment (PPEs), especially during the initial phase. And you can see that, as many external assistances came to Wuhan, as the supply of the PPEs became adequate, that as just mentioned by my colleague Dr. Yan, that no healthcare workers has been infected anymore. I mean during the second phase—if we can call it that. And another important lesson we learned is that, even within the same hospitals, some of the specialists—let's say, ENT doctors, and eye doctors—became easily infected, than their pulmonary colleagues, than their emergency colleagues, or their ICU colleagues.

      My personal interpretation is that, whenever you see an eye doctor or ENT doctor, he or she will have a very close contact with their patients, right? So that's the major reason for the phenomena that they got easily infected, in addition to the lack of knowledge of infectious diseases among these specialties. So, my belief is that it is important to let your colleagues—no matter what specialty they are—that they got educated, that they got trained about these infectious diseases, in order to prevent the nosocomial transmission of COVID-19. Thanks.

      Xi Yanchun:
      Ok, next question, please. Middle area, second line. The gentleman.

      Bloomberg:
      I'm from Bloomberg News. Thank you for taking your time to speak to us today. I'm sure you're all very busy. I have three questions. My first question is: What are the underlying conditions that really influence whether a patient survives or doesn't survive this disease? Dr. Cao mentioned various comorbidities, but are these the main factors you look for when you look at some patients who do and don't survive? My second question is: Now that you're saying that the outbreak in Wuhan and Hubei more generally are sort of petering out towards an end, what do you expect the case fatality rate to be across the whole province? I think in Wuhan, initially it was it was much higher than the rest of China. Do you expect the case fatality rate and Hubei to come down towards the rate in the rest of China? My third question goes back to the first question from Reuters: Do you expect to be able to trace the patient zero, where this disease cross from animals into humans? And is your expectation that will be linked to the seafood market that Dr. Du just mentioned? Thank you.

      Cao Wei:
      I'll take the first question. As I just mentioned, there are some risk factors already identified for COVID-19 patients, including the elderly people, comorbidities, etc. And these are the risk factors you could identify before you go to the hospital, once you have been diagnosed.

      And there are also very important signals showing that you are transferring or you are processing from a mild type of case, or common type of case, to the severely or critically ill patients, which include the change or continuous decreasing of lymphocytes, which is the indication that your immune system is gradually being broken down. And also the elevation, or robust elevation of inflammatory markers, which is also another sign that the immune systems are activating. And also if there is progressing changes of the lung radiology, including the infiltrations of bilateral lungs. This is another important sign you should pay attention to, which indicates you might be going to the critically ill patients.

      Du Bin:
      For the risk factors for mortality in patients with COVID-19, I do believe we are still waiting for more evidence coming from the investigations. Because previously during discussion with my colleagues, all of us believe that the hypertension is a risk factor for either the severe cases or the mortality rates. However, we also know that hypertension is associated with older age.

      So currently we have no idea, which is the confounding factor. Because these two risk factors—older age and the hypertension, diabetes as well—are closely correlated with each other. So we're still waiting for more evidence. However, according to current data, I agree with Dr. Cao that the lymphocytopenia is one of the signals, and probably the cardiac injury biomarkers is another signal for mortality.

      And the second question concerns the case fatality rate. I am sorry that I don't think this is the right time to calculate or estimate the case fatality rate. Even though, right now, the majority of the patients have been discharged back home, but we are still having more than 3,000 or 4,000 patients in the hospital. We still have no idea how many of them will survive, and how many of them will die. A certain number of them will die. Absolutely. So it's not the right time to estimate the case fatality rate at present. In my mind, the case fatality rate is a retrospective term rather than the terminology we can discuss right now. And we also know that the supportive, life-sustaining treatment employed in the intensive care unit may prolong the patient's life, which will make some early deaths into late deaths. That's one of the reasons for the later increase in the case fatality rate, as you can see.

      And the reason for a higher case fatality rate in Wuhan than in other provinces—that I just can't remember if I have already answered the same question in the last press conference or not, but anyway—in my mind that the reason number one is that there is always a learning curve. Our colleagues—the healthcare workers in other provinces—they learn from our experience, and they learn from our failures, so they can treat their patients better than us. And the second reason: They have much fewer cases than what we have here in Wuhan, in Hubei, which means that patient there had a better chance for better medical care. They have enough resources; they have enough human beings, enough health care workers around them; they have enough ventilators, monitors, and all the other devices. I don't think the difference can be explained by any genome mutation at the present time. But if this is the case, I'm not surprised.

      The last question concerns the number zero patient. I'm sorry, I'm not the right one to answer the question, because I think this is the task for the CDC staff. They should look for who is the index case for this whole outbreak. But currently, I have no idea what is going on there. Sorry for that. Thanks.

      Xi Yanchun:
      OK. Next question, please. The middle area, the lady in the fourth line with long hair.

      Hong Kong China Review News Agency:
      Thank you. Hong Kong China Review News Agency. My question is about ECMO. We know that ECMO is recommended for rescue treatment for severe cases. How do you assess the role that ECMO had played so far? Are there enough ECMO equipment for severe patients in Wuhan? Thank you.

      Du Bin:
      Thank you very much, for that is a specific question for ICU doctors like me, but not for my colleagues. I don't believe ECMO plays an important role in the whole outbreak. For example, according to data, a couple of days ago, there were 260 patients still on the ventilator, and there are fewer than 30 cases treated with ECMO. Apart from this, we still have more than 4,000 patients hospitalized. I think that you can have your own judgment based on this number, that ECMO—although a technical innovation, and to some of my colleagues working here and working in other provinces, is a life sustaining treatment—but I don't believe, based on these numbers, it plays a significant role in decreasing the case fatality rate. Of course, it is a device to buy the time for the patient in order for the definitive therapy to have some effect. So, my personal impression is that, no.

      Xi Yanchun:
      OK, next question. Right area, third line. The gentleman.

      NTV:
      Thank you very much. I'm from Japanese TV. It's called NTV. My question is: In China, various new technologies, including 5G network or robots are used to fight against coronavirus. How do technologies help doctors? What do you think about the most dramatic change by these technologies? Thank you.

      Wu Dong:
      Thank you. I will take this question. You raised the issue of new technology in this campaign. But first of all, please allow me to make clear that, I don't think it's new technology that we rely on to bring the situation under control. I think we have brought the situation under control because we are still following the classic theory of epidemiology, which is to control the source of infection, cut down the spread route, and protect those susceptible population.

      But on the other hand, in terms of new technology, I'm glad to share with you that by utilizing the 5G network, we have established a virtual online consultation system. We routinely have those online meetings with experts in PUMC hospital back in Beijing, so we can discuss some difficult and complicated cases with them almost face-to-face. I think this enables us to provide high-quality care to all of our patients. And also in our daily practice, we routinely use mechanical ventilation, bedside ultrasonography, continuous renal replacement therapy. I think these new technologies will give us more weapons or opportunities to fight the coronavirus and protect people. Thank you.

      Du Bin:
      I only have a few words apart from what Dr. Wu said. As far as I know, the teleconference with doctors and experts back in their mother hospital, thousands of miles away, is a common practice within each national medical team here in Wuhan or in other cities in Hubei. So this is number one.

      And number two, the so-called virtual hospital, or virtual medical care system, is not only for us the doctors, but also for the patients. Whenever the patients are advised to stay at home, as patients with other diseases, other than COVID-19—especially in epicenters as like Wuhan or other cities in Hubei, that they are advised to stay at home—however, whenever they think there's any need to seek for medical advice, medical care, they can get access to the doctors through the virtual hospital or medical care apps.

      And third, as far as I know, some of the investigators are now trying to do some research that, with the use of the wearable devices, for those patients who are asked to do the home isolation or home quarantine, that some kind of artificial intelligence will tell what is the probability that they have the COVID-19 or the disease progression, and when is the right time to go to see the doctor, or you should be okay to continue staying at home. Thanks.

      Xi Yanchun:
      Okay, the very last two questions: one for a foreign journalist and one for a Chinese reporter. The gentleman in the middle area, 3rd line.

      Wall Street Journal:
      Thank you very much. I'm from the Wall Street Journal. Thank you doctors for sparing the time to do this. Dr. Du, you mentioned the importance of preventing and controlling the disease rather than treating it. I was wondering if you could go into a bit more detail about what you think were the most effective steps that were taken in Wuhan to prevent and control the spread of the epidemic, and at what point those came into effect. I was also wondering, you spoke a little about the fatality rate and I take the point that it's a little early to calculate that. But, given the evidence that the fatality rate does seem to have been higher in Wuhan, I was wondering if you could go into some more detail about why you think that was, particularly amongst medical workers. You spoke a little in the last briefing about treatment with steroids and invasive ventilation and I wonder if you could elaborate on that a little? With hindsight, is there anything that could have been done to avoid that or was it simply inevitable? Is there anything that you could advise other countries facing similar problems now? Thank you.

      Du Bin:
      Okay, thank you very much for the questions. The first question was concerning the specific measures to control the epidemic. I'm not an expert for this, but anyway: test, test and test. Whenever you fail to do the nucleic acid test for COVID-19, you don't know who is the carrier, who is the patient, who should be quarantined and who are close contacts.

      I know there are different approaches than here in China, like what you're doing in the States. I'm not the one who make the judgment about which is right and which is wrong. But, apart from testing, I just have no idea how you can identify suspected cases and quarantine close contacts. I mean, there was just a question to Dr. Cao about what is the turning point. In my opinion, the major reason or decision that led to a turning point was when we had the opportunity to isolate all suspected patients and close contacts. That was the turning point of the outbreak here in Wuhan, and in Hubei.

      Now for the second question about what specific factors contributing to the higher case fatality rates in Wuhan. I would say that a strong belief of mine is that delayed mechanical ventilation, delayed endotracheal intubation and long-term cortical steroids make a difference. I mean, they are major risk factors for mortality rates. I have seen dozens of cases who tried inappropriately or failed, an NIV trial – NIV meaning noninvasive ventilation.

      They failed the NIV trial, but doctors maintained the noninvasive ventilator. They doctors did not intubate them. But eventually, even after endotracheal intubation, after the initiation of mechanical ventilation, the patients still died. So, we can actually make a huge difference, at the later stage, by encouraging every physician to intubate their patients as soon as possible – as soon as they see their patients fail an NIV trial. There's one study, although not a large one, from my colleagues in Tongji hospital. They found that an aggressive approach for endotracheal intubation will significantly improve the patient outcome.

      I believe the paper has been submitted, but I have no idea whether it's accepted or not. Thanks.

      Xi Yanchun:
      Ok, the last question, please. Okay. Right area second line, the lady, please.

      China Daily:
      Thank you. Question from China Daily. It has been more than a month since medical workers from across China raced to Wuhan to help fight the virus – and we know that you are all part of that effort. So, my question is, what have those medical teams contributed in terms of treating COVID-19 patients in Hubei, and in Wuhan. Second, after weeks of intense work, what is on the top of your mind right now? What would you like to share with us the most? Thank you.

      Xi Yanchun:
      May I suggest each of you say a few words for this question please?

      Du Bin:
      Thanks. I'm not quite sure if I'm the right person to answer the first question, because I think the question is to the healthcare authorities rather than us. But anyway, I'll come directly to the second question. Although this is a chance for us, my colleagues and I, to share our experiences to the international community, I would say that the Chinese approach for the control of the epidemics may not be the only approach.

      We can see what has happened in Singapore and what has happened in Japan. I would say that my colleagues and I can learn from their experiences. Whenever you have a quite different situation, in terms of the number of cases and the community support system, you can adopt a quite different approach that achieves a similar success in controlling epidemics.

      So, it's also an opportunity for us to learn from each other – just like we said for the Chinese medicine and western medicine. So, the last sentence from me is that the beauty of the world lies in its diversity, but not identity. Thanks.

      Xi Yanchun:
      Okay, Professor Yan, please.

      Yan Xiaowei:
      I think it's my great pleasure to come to Wuhan as a doctor in the intensive care unit to save my patients. Yes, in the intensive care unit, I have had so many casualties – this kind of experience I will never forget in my life.

      And also, I'm very glad to be here to share my experience with overseas friends and colleagues. Thank you very much.

      Xi Yanchun:
      Ok. Cao Wei, please.

      Cao Wei:
      I want to share some personal feelings. 17 years ago, when SARS came, I was still a medical student in college. At that time, I was the one to be protected. And this time, I was able to come here with my teachers and seniors to fight together for my people and my country. I'm very proud of that and I'm sure that's a common feeling of all the medical workers here in Wuhan – despite sacrificing a lot, personally, and being apart from our families for such a long time. But it deserves.

      Lastly, I want to express my deep thanks and show respect for all the nurses that have been working with us. They have taken the same responsibilities as us and, not like me, many of the nurses who have come to Wuhan are actually very young. Most of them were born in the 1990s with only remote memories of the SARS season. But when it came, they all stood up and came here. Without them we wouldn't have achieved so much, especially for these critically ill patients. So, thank you very much.

      Xi Yanchun:
      Okay, Dr. Wu, please.

      Wu Dong:
      Thanks for the question. Also, some personal feelings. During the last five weeks, I was totally devoted to caring for patients in the ICU. The only thing I feel sorry for is that I couldn't take care of my own family, as a father and as a husband. Five weeks ago when I left Beijing for here, my eight-year-old daughter asked me, "dad, why are you going to Wuhan?" To be honest, it was a question that I couldn't quite answer at that time. But last week I had a patient in the ICU. She was a 57-year-old woman and she was very sick. So, our plan was to intubate her and put her on mechanical ventilation. That seemed the only way to save her life.

      Before incubation, she whispered several words to me in Wuhan dialect, so it was difficult for me to understand what she was talking about. But finally, I figured out what she said and it was, "Doc, I don't want to die. The end of this month is my daughter's wedding day." At that very moment, and deep in my heart, I saw that many of our patients are parents too. They love their own kids, the same as I do. It also reminds me of the novel by Gabriel García Márquez, "Love in the Time of Cholera." What I learned from the novel is that human beings are mortal, but love is not.

      So why did I come to Wuhan? It's not only about professionalism or responsibility; it is also about love. I love my daughter, I love my patients, I love my country and I love humankind. As humankind, we are all in this together and we will get through this together. Thanks.

      Xi Yanchun:
      Thank you. I'm quite touched by what all these experts have just shared with us. I'd like to say that the COVID-19 outbreak is neither the first nor the last challenge confronting all mankind.

      The pandemic knows no borders. The only right thing for the world to do is to make concerted efforts. While combating the disease at home, China will work hand in hand with other countries and contribute our strength and wisdom to securing a final victory.

      Today, the four experts from the PUMC hospital shared a lot of valuable experiences. When they came to Wuhan, they didn't know how long this would take and how many difficulties and challenges would be faced. But from what they just said, we know how important it is to have them with us when combating the virus.

      I'm sure people in Wuhan and in Hubei will remember all of them forever. And the Chinese people will be very proud of them – all the Chinese doctors and nurses. So lastly, I suggest we take a group photo together and give a thumbs-up to all the Chinese doctors and nurses. Well done.

      Thank you very much. That's the end of the briefing. Thank you. Bye bye.

    国新办新闻局副局长、新闻发言人袭艳春(湖北日报 蔡俊 摄)

      袭艳春:
      女士们、先生们,媒体朋友们,下午好。欢迎出席国务院新闻办今天举办的新闻发布会。目前,流行性新型冠状病毒肺炎已成为全世界面临的共同挑战。为了挽救人民的生命,中国政府采取果断行动,展开了一场驰援大行动。在极短时间内,中国向遭受病毒袭击的湖北省派出330多支医疗队、4万多名医护人员。今天,我们非常荣幸地从这4万多名医护人员中请来四名专家。他们都来自北京协和医院的特殊救助医疗队。他们将分享新冠肺炎的治疗经验,特别是治疗武汉重症病例的经验。在介绍这些杰出的专家之前,让我们先看一段关于他们的短片。

      欢迎回来。请允许我向大家介绍来自北京协和医院的四位专家:杜斌教授,北京协和医院内科重症医学科主任。他也是中国医师协会重症医学医师分会会长。严晓伟医生,心脏病学教授、北京协和医院内科学系副主任。曹玮医生,副主任医师、北京协和医院感染内科副主任。吴东医生,北京协和医院消化内科副主任医师。现在,我想请他们谈一谈他们的救助医疗队以及他们自己的情况。有请杜医生。

      2020-03-16 16:00:29

    北京协和医院内科重症医学科主任、主任医师,中国医师协会重症医学医师分会会长杜斌(湖北日报 蔡俊 摄)

      杜斌:
      女士们、先生们,下午好。我再次来到媒体见面会。我是国家卫健委高级别专家组成员,同时也是协和医疗队的成员。在过去两天半的时间里,我分别走访了五个城市的五家医院,考察新冠肺炎危重患者的情况,几个小时前才匆匆赶回武汉。

      关于我们医疗队的情况,我想再多说几句。大家知道,北京协和医院在全国最佳医院排名中位列第一大约有10年时间了。当武汉当地的医疗资源因新冠肺炎爆发而瘫痪时,加入医疗救援队就是我和我的同事们的责任所在。在头几天的时间里,我们将一间普通病房改造成重症监护病房,并于2月4日开始接收新冠肺炎危重患者。

      对抗新冠肺炎,我们不是在单打独斗。我们得到了同济医院和其他医疗救援队的大力支持。此外,我们还得到了我们医院北京同事的大力支持,通过每周的电话会议与他们交流最棘手的病例。这可以让我们的努力发挥最大作用,挽救患者的生命。谢谢大家!

      2020-03-16 16:02:53

      袭艳春:
      谢谢杜医生。接下来有请严教授。

      2020-03-16 16:06:29

    北京协和医院内科学系副主任、心内科主任医师严晓伟(湖北日报 蔡俊 摄)

      严晓伟:
      女士们、先生们,大家下午好。我是来自北京协和医院内科学系的严医生。我在武汉的职责是协调内科各部门的工作,确保工作顺利进行;向北京协和医院提出并组织多学科会诊。作为一名心内科医生,我还负责管理新冠肺炎合并心脏疾病的患者以及有基础心血管疾病的患者。谢谢大家!

      2020-03-16 16:10:16

      袭艳春:
      非常感谢严医生。请曹医生给大家自我介绍一下。

      2020-03-16 16:17:16

    北京协和医院感染内科副主任、副主任医师曹玮(湖北日报 蔡俊 摄)

      曹玮:
      先生们女士们,下午好。我是来自同一家医院的曹玮医生。我是一名感染内科的医师,治疗患有不同感染性疾病的病人。我是2月7日抵达武汉的,并从那以后,作为北京协和医院的国家援鄂医疗队的一员,一直在这里工作。正如杜主任说的那样,作为一个团队,我们共同协作,在武汉建立了一个紧急重症监护区,并一直在那里救治新冠肺炎危重患者。个人来讲,我参与了对这些病人的临床救治以及与武汉当地医院的临床合作。谢谢。

      2020-03-16 16:23:16

      袭艳春:
      非常感谢,曹医生。最后,有请吴医生。

      2020-03-16 16:27:16

    北京协和医院消化内科副主任医师吴东(湖北日报 蔡俊 摄)

      吴东:
      谢谢,下午好。我是吴东,北京协和医院消化内科副主任医师。我从2003年起就在协和工作,那一年发生了非典。我五周前来到武汉,我是志愿到这里来的,因为上一次,我没有得到机会去抗击冠状病毒,这次我不能错过。现在,我在重症监护区担任主治医师,照顾那些危重病人。我非常高兴能与你们分享我的经验。谢谢。

      2020-03-16 16:29:16

      袭艳春:
      非常感谢所有的专家。你们在从事着一份伟大的工作,因为你们在拯救人们的生命,与死神赛跑。现在记者可以提问了。在提问之前请报一下你们的新闻单位。请举手。好的,左边第一排,那位穿蓝色衬衣的男士,请提问。

      2020-03-16 16:31:16

    路透社记者提问(焦非 摄)

      路透社记者:
      你好,我是路透社记者,我有三个问题。第一个问题,那些痊愈的患者目前存在什么样的二次感染风险?第二个问题,天气因素是如何影响感染率的,天气越来越暖后,我们应该预期更高还是更低的感染率呢?最后,什么时候我们有望找到中国的零号病人?你们目前有什么样的线索吗?谢谢。

      2020-03-16 16:37:16

      杜斌:
      严医生,请你回答第一个问题。曹医生,请你回答第二个问题。

      2020-03-16 16:39:16

      严晓伟:
      谢谢你的提问。第一个问题是关于二次感染。事实上,二次感染是在病人出院后发生的问题。在中国,新冠肺炎痊愈患者出院后,一般将在两到四周时间内被紧密跟踪。当地的公共卫生监督员也会监控病人的情况。

      他们会被要求居家隔离至少两周。同时,他们会被要求每天测两次体温。如果体温回升,病人会被送到医院进行胸部CT扫描和核酸检测。我想提到的一点是,单纯的阳性核酸检测结果并不意味着病人身体内有完整的病毒颗粒。并且,也不意味着病人具有传染性。所以,被病毒感染后再次进行核酸检测得到的阳性结果,并不是二次感染的标志。

      所以如果我们认为一个病人被二次感染了,我们将会检查体温并随之进行胸部X光检查。谢谢你的提问。

      2020-03-16 16:44:16

      曹玮:
      我来回答第二个问题。我相信这个问题有很多人感兴趣。目前来说,还没有关于新冠病毒和天气关系的数据。但如果我们从过去非典时期另一种冠状病毒SARS的经验来看,我们可以看到有多重因素影响感染率。比如,由于时间推移病毒的致病性可能会逐渐降低,由于变异致病性可能会增强,其他联防联控措施也会影响感染率。遗憾的是,目前为止天气对此的影响并没有确切证据。谢谢。

      2020-03-16 16:47:16

    CGTN记者提问(焦非 摄)

      CGTN记者:
      非常感谢,我是中国国际电视台的记者。请你们介绍一下中西医结合治疗新冠患者的最新情况。此外,那种类型的患者会主要用中医的方式治疗?疗效怎么样?谢谢。

      2020-03-16 16:51:16

      杜斌:
      我来回答这个问题。我想我的同事会在我发言后进行补充说明。一直以来我都认为中医对西医从业人员而言是即熟悉又陌生的领域。在武汉,我们每天都在与我们的中医同行并肩作战。中医,至少就我的理念而言,对轻症患者和脱离重症正在恢复的患者都有效果。但我也注意到有些人对中医持有怀疑态度。就我而言,中医与西医理念不同。他们有不同的治疗理念和功效评估体系。

      例如,西医在验证任何一种具体药物功效的时候,都会把病人分组,然后将固定剂量的药物在固定的期限内用于接受随机分组后的实验组患者。

      然后,我们会根据实验组和对照组的不同结果对药物的疗效和安全性进行判断。但是中医却与此不同。就我观察来看,在与中医同行共同工作的时候,我注意到,对于那些我认为症状极为相似的病人,中医同行每日所开的处方乃至于药量也是大不相同的。这使得上述评估体系无法有效运行。

      所以,从西医的角度而言,评估中医的有效性和安全性是非常困难的。但是即便如此,我仍坚信我们应该彼此尊重。我们应该知道西医和中医各有千秋,因此我们应该相互学习。我们也鼓励中医同行应当采用我们的评估系统,不仅让我们,也让整个国际社会了解中医是如何行医的。谢谢。

      2020-03-16 16:57:16

      吴东:
      我想就此再做些评论。首先,我同意杜教授的观点。此时此刻我们没有灵丹妙药。我们现在没有针对新型冠状病毒的特效药。但是就我专长的肠胃学而言,我想说的是中医至少在其中一些领域应该是行之有效的。因为,在重症室的一些病人,他们的肠道停止运动,而腹部也是胀气的。

      在一些情况下,病人的情况过于危急以至于我们无法给他们输入营养液。要知道营养液对于病人恢复是至关重要的。因此我们对这样的病人采取了中医治疗。可以说通便效果很好,这样我们可以继续向他们输送营养。谢谢。

      2020-03-16 16:59:16

    印度报业托拉斯记者提问(焦非 摄)

      印度报业托拉斯记者:
      谢谢。首先,请让我对在座的,以及那些奔赴疫区,或是直面此次病毒乃至任何恶性病毒的医生们致以敬意。今天,就武汉、湖北及中国其他地区的数字来看,病毒的势头毫无疑义地减弱了。我想问的是,会不会有反弹?因为现在全世界正在遭遇疫情,那么病毒会不会很快,或是在未来某个时间卷土重来?其次,现在没有数据表明病毒对儿童产生的影响。现在不仅仅是在这里,在很多疫情开始出现的地方,有关学校开学的争论不断。各位对不同年龄段的儿童受病毒影响的解读究竟是怎样的?谢谢。

      2020-03-16 17:07:16

      曹玮:
      谢谢。我来回答第一个问题。我们知道世卫组织几天前已宣布新冠疫情为全球性流行病,这意味着全球的疫情发展态势将不单独由中国或世界上任何一个地区、一个国家的情况而决定。经过三个月的努力,中国自去年十二月以来的疫情已经基本得到控制。我认为我们还需要再观察一个月,再来做最终的判断。但是,我认为在目前这些措施的防控下,国内出现二次疫情爆发的可能性不大。同时,我们都知道,新增确诊病例的另一个主要来源是境外输入。因此未来将很有可能是这样的情况,新增病例,包括输入病例的数量会处在相对低的水平,但有可能要持续一段时间。谢谢。

      2020-03-16 17:10:16

      杜斌:
      第二个是关于儿童感染新冠病毒的问题。确实,根据我的观察,以及和一些儿科医生的探讨,我们知道有些孩子感染了新冠病毒。但是,大部分情况良好。近期有三篇论文,一篇来自《美国医学会杂志》,讨论了九个一岁以下婴儿的患病情况。另一篇论文讨论了六个年龄在二到七岁之间的孩子的情况。这十五个孩子当中,只有一个进了重症监护病房,需要包括氧疗在内的支持性治疗。这些孩子中没有出现死亡病例。

      还有一篇是今天早些时候刚刚发表在《自然-医学》期刊的论文。论文称在所有新冠肺炎患者的密切接触者中,成人比儿童感染的机率更大,大概是2.7倍。我们目前还不知道这种现象背后的原因,但是我们知道即使儿童被感染了,绝大多数也都是轻症,都能治愈。以我的理解,武汉、湖北、其他省份都是这种情况。谢谢。

      2020-03-16 17:17:16

    荷兰广播电视协会记者提问(焦非 摄)

      荷兰广播电视协会记者:
      非常感谢。我来自荷兰公共广播。各位医生可否深入介绍一下武汉当地医院的情况?我们看到一些临时医院已经关闭了。此外,因为我们正在和中国最好的医生对话,我还想了解一下,你们想和其他处于疫情初期的国家及其抗疫一线的人们分享哪些建议和经验?比如荷兰。非常感谢。

      2020-03-16 17:20:16

      杜斌:
      有哪位想回答这个问题吗?我先来回答。确实,你说的对。所有的方舱医院已经关闭。一些新冠肺炎定点医院也已经关闭,部分患者治愈出院,其他患者转移到了其他的定点医院。就像曹医生刚才说的,武汉和湖北的疫情已经接近尾声。

      尽管如此,我们还是应该对社区里出现的异常信号或偶发病例保持警惕。这些天还有从其他国家或地区入境输入的病例。

      第二个问题是我们可以分享哪些教训和经验。确实有很多可以分享的。但是,我想说对于像新冠肺炎这样的疫情而言,最重要的是防控,而不是治疗。因此,治疗是第二位,防控才是最主要的目标。我记得之前谈过计划。必须要有计划。没有做好准备就意味着要为失败做准备。因此,即使现在武汉和湖北的新增确诊病例极少,我们仍要保持警惕,并为应对未来偶发病例和输入病例做好准备。我们也要从成功和失败的经验中得到启示。谢谢。

      2020-03-16 17:25:16

      严晓伟:
      我想和海外同仁谈两点。第一,请医生们照顾好自己,避免被新冠病毒感染。这是医生救治患者的前提,也是保护同事和家人的前提。第二,广泛开展健康科普,指导公众做好自我防护。

      这并不复杂,做到勤洗手、戴口罩、不聚集就可以。如果不这样做,疫情将会让医疗设施和医疗体系不堪重负。谢谢。

      2020-03-16 17:27:16

      吴东:
      我想和其他国家的公众说几句。每个国家、每个人,都有不同于其他国家和个人的自身情况,我们完全尊重这一点。

      我们并没有说大家应该效仿中国的模式。大家应该采取自己的方式,我们完全尊重这一点。但是,我们每个人都应该非常认真地对待疫情,采取必要的行动,改变自己的行为,并负起责任。至于医学界,我想说,我们必须保护好医护人员,因为在过去几天里,我们得知一些欧洲同行也在日常工作中感染了病毒,而且感染比例与武汉疫情爆发早期的情况非常接近。

      所以我们应该保护好在重症监护室工作的医护人员。那里的环境压力很大,死亡率相对较高。作为一名医生,不论你多么努力地去挽救生命,都会有患者死亡的情况出现。这很容易打击重症监护室医护人员的士气。所以我建议医护人员要做好休息和放松,照顾好自己。谢谢。

      2020-03-16 17:30:16

    人民日报记者提问(焦非 摄)

      人民日报记者:
      非常感谢。我是人民日报英文客户端的记者。我们知道一些国家缺乏医疗资源,因此,大多数症状轻微的病人只能居家自我隔离。请问,他们应该注意哪些警示信号,以防止病情恶化?谢谢。

      2020-03-16 17:33:16

      曹玮:
      谢谢。首先,如果因为某些原因必须居家隔离,那么首要一点是,你得确认自己的身体状况适合进行自我隔离。这意味着你不应属于高危人群,比如老年人,以及患有高血压、糖尿病、慢性肺病或其他慢性病等合并症的人群。第二,如果你很年轻、身体状况良好,而且决定居家自我隔离,那么你或你的家人需要密切关注你的症状或感觉,这一点非常重要。

      一旦你开始持续高烧,或是感到呼吸急促,又或是感到精神状态不对,那么你应该马上看医生寻求帮助。最后,也是最重要的一点,居家隔离期间要确保不把病毒传染给家人。有很多预防和保护措施可以防止家人感染病毒,大家可以从世卫组织网站找到相关防护措施全文。谢谢。

      2020-03-16 17:37:16

    韩国京乡新闻记者提问(焦非 摄)

      韩国京乡新闻社记者:
      谢谢。我是韩国京乡新闻社的记者。武汉医护人员感染新冠病毒的情况较为严重。医护人员采取了哪些防护措施?请从医疗队的角度谈下当地情况。谢谢。

      2020-03-16 17:40:16

      杜斌:
      谢谢你的问题。我想,我的同事——严晓伟医生刚才已经回答过这个问题,但我还想再补充几句,因为严医生刚提到了,诸多原因和因素导致了医护人员感染新冠肺炎,特别是在疫情发生的早期。

      其中的一个原因是对这种疾病可在人际间传播缺乏认识。大家应该已经知道,武汉的一些医院,例如武汉市中心医院,出现了很多医护人员被感染的情况。这家医院距离华南海鲜市场非常近,在疫情初期,很多病人去那里就诊,但医生当时并不了解这种病。医生们当时并不知道这是种会人传人的疾病。

      还有一个重要原因是缺乏个人防护装备,特别是在疫情早期。大家应该已经看到,在大量的外界援助陆续到达武汉、防护物资供应充足之后,正如严医生刚才提到的那样,医护人员被感染的情况再没有发生过。我指的是在第二阶段,如果我们可以那样划分的话。

      同时,我们还得到了一个重要教训——在同一家医院,一些科室的医生,如耳鼻喉科和眼科,被感染的比例高于呼吸内科、急诊科和ICU等科室。我个人对此的理解是,眼科和耳鼻喉科的医生要同患者进行非常近距离的接触,对吧。因此,除了对病毒本身的了解不够,这也是这些科室的医务人员更容易被感染的主要原因。我认为,让所有的医务人员,无论他们是哪个专科的,接受与新冠肺炎有关的防护教育和培训是非常重要的,这些措施将有助于阻断病毒院内传播。谢谢。

      2020-03-16 17:45:16

    彭博新闻社记者提问(焦非 摄)

      彭博新闻社记者:
      我是彭博新闻社的记者。谢谢你们抽出时间来参加今天的记者见面会。我相信你们都非常忙碌。我有三个问题。第一个问题:哪些基础疾病会增加新冠肺炎患者的死亡风险?曹医生刚才提到了很多种合并症,但这些合并症是你们判断患者能否存活时考虑的主要因素吗?第二个问题:你们提到武汉和湖北的疫情总体上持续消退,那么,你们认为湖北省的新冠肺炎患者病死率会出现什么变化?我认为,最开始的时候,武汉的病死率远远高于中国其他地区。你们认为湖北的新冠肺炎患者病死率是否会降至与中国其他地区接近的水平?我的第三个问题和路透社记者提的第一个问题相似:你们是否希望能够追溯到零号病人,也就是第一个被动物身上携带的病毒感染的人?你们是否认为这跟杜医生刚才提到的海鲜市场有关联?谢谢。

      2020-03-16 17:47:16

      曹玮:
      我来回答第一个问题。我刚才已经提到,目前已经确认了新冠肺炎患者所面临的一些风险因素,其中包括高龄和合并症等。而且,这些风险因素是在患者确诊收治时就可以明确的。

      还有一些非常重要的临床指标可以提示患者的病情正在从轻症或普通症状向重症或危重症方向发展,例如,淋巴细胞计数进行性下降表明患者的免疫系统正在逐渐被破坏;炎症标志物水平升高或急剧上升说明患者免疫系统正在被激活;肺部影像学改变,包括出现双肺浸润性病灶,是必须引起重视的另一个重要症状,这种情况说明医生面对的很可能是向危重症进展的患者。

      2020-03-16 17:51:16

      杜斌:
      对于导致新冠肺炎患者死亡的危险因素,我认为我们还需等待更多的研究证据。因为此前,我与同事讨论时,我们所有人都认为高血压是重症病例或致死率的危险因素。但是,我们也知道,高血压与年龄相关,多发于老年人。

      因此,目前我们尚不清楚哪个是混杂因素。因为这两个危险因素:高龄和高血压,以及糖尿病,彼此密切相关。因此,我们仍在等待更多证据。但是,就目前的数据来看,我同意曹医生的观点,淋巴细胞减少是一个信号,而心肌损伤生物指标或是与死亡率相关的另一个信号。

      第二个问题与病死率相关。很抱歉,我认为现在还不到计算或估计病死率的时候。即使目前大多数患者已出院回家,但我们医院仍有超过三四千例患者。我们仍然不知道其中有多少人能活下来,有多少人会病亡。其中有些病患一定会进入死亡名单的。因此,现在不是估算病死率的适当时机。在我看来,病死率是一个回顾性术语,而不是我们现在就可以讨论的词。此外,我们知道,重症监护室采用的生命维持治疗可能会延长患者的生命,使某些患者的死亡时间延后了。但您可以看到,病死率后来上升了,这就是原因之一。

      至于武汉市病死率高于其他省份的原因,我不记得是否在上次的新闻发布会上已经回答过相同的问题。但我再重复一遍,我认为首要原因是始终有一条学习曲线。我们的同事——其他省份的医护人员——可以从我们的经验中学习,从我们的失败中学习,因此他们可以比我们更好地治疗患者。第二个原因是他们的病例数比湖北武汉的少得多,这意味着那里的病人有更大的机会获得更好的医疗资源。他们有足够的资源;有足够的人手,足够的医护人员负责医疗照护;有足够的呼吸机,监控器和所有其他设备。我认为目前无法用任何基因组突变来解释这个差异。不过如果真是这种情况,我也并不感到惊讶。

      最后一个问题关于零号病人。不好意思,这个问题不应由我来回答,因为我认为这是疾控中心工作人员的任务。他们应该在寻找谁是造成整个疫情的原发病例。但是目前,我还不知道具体情况。不好意思。谢谢。

      2020-03-16 17:57:16

    香港中评社记者提问(焦非 摄)

      香港中评社记者:
      谢谢,我是香港中评社记者。我的问题关于人工肺(ECMO)。我们知道,ECMO被推荐用于重症病例的抢救治疗。您如何评估ECMO到目前为止发挥的作用?武汉是否有足够的ECMO设备可用于重症患者?谢谢。

      2020-03-16 18:07:16

      杜斌:
      非常感谢您的问题,这是像我这样的重症监护室医生可以回答的具体问题,但不是我这几位同事从事的领域。我认为ECMO在这场疫情中拯救病患时,并没有扮演了重要角色。例如,根据数据,几天前,有260名患者仍在使用呼吸机,用ECMO治疗的患者少于30例。除此之外,我们仍然有4000多名患者在住院。我认为,您可以根据这个数字做出自己的判断。尽管ECMO是一项技术创新,并且对在湖北或是其他省份工作的一些同事来说,它是一种维持生命的治疗方法,但从这些数字判断,我不认为它在降低病死率方面起到了重要作用。当然,它的确能为患者争取时间,使最终治疗方案产生一些效果。综上,我个人的看法是,没有太大的作用。

      2020-03-16 18:10:16

    日本电视网记者提问(焦非 摄)

      日本电视网:
      非常感谢。我来自日本电视台。我的问题是:中国将5G网络、机器人等新技术应用到疫情防控中,这些技术是如何帮助医生的?您认为这些技术带来的最大变化是什么?谢谢。

      2020-03-16 18:17:16

      吴东:
      谢谢。我来回答这个问题。您的问题是关于新技术在抗击疫情中的作用,但是首先,我想说明的是,我认为我们控制住疫情所依靠的并不是新技术。我们使疫情得到控制,是因为我们遵循了流行病学的经典理论,即控制传染源、切断传播途径、保护易感人群。

      另一方面,从新技术的角度,我很高兴和您分享的是,通过运用5G网络,我们建立起了线上虚拟咨询系统。我们经常与在北京的协和医院专家一起召开线上会议,几乎是面对面地讨论一些困难和复杂病例。这种方法帮助我们为患者提供高质量的医疗服务。此外,在日常工作中,我们也经常运用机械通气、床旁超声检查、连续性肾脏替代治疗等技术。有了这些新技术,我们就有更多武器和机会去抗击病毒,保护患者。谢谢。

      2020-03-16 18:21:16

      杜斌:
      我只在吴医生回答的基础上补充几句。据我所知,在武汉及湖北其他城市的所有国家医疗队都会和几千里之外自己所在医院的医生和专家召开远程电话会议,这是第一点。

      第二点,虚拟医院,或者虚拟医疗系统,不只供我们医生使用,患者也可以用。对于患新冠肺炎以外疾病的病人,特别是在武汉或湖北其他城市等疫情严重地区的病人,我们建议他们待在家里。如果这些病人需要医疗建议和医疗服务,他们可以随时在虚拟医院或医疗应用程序上找到医生。

      第三点,据我所知,研究人员正在研究通过可穿戴设备,应用某种人工智能去判断居家隔离的患者感染新冠肺炎的可能性、疾病的发展阶段、就医的正确时间以及是否应该继续待在家里。谢谢。

      2020-03-16 18:27:16

    华尔街日报记者提问(焦非 摄)

      华尔街日报记者:
      非常感谢。我是《华尔街日报》的记者。感谢各位医生抽出时间出席发布会。杜医生,您谈到预防和控制疫情传播比治疗更重要。能否请您详细说明在武汉采取的预防和控制措施中,哪些是最有效的?这些措施见效需要多长时间?您提到死亡率的问题,我知道现在计算死亡率还为时尚早,但是有证据表明武汉的死亡率更高。您认为出现这种情况,特别是医务人员死亡率较高的原因是什么?您在上次发布会上谈到类固醇和有创通气疗法,能否请您再详细说明一下?事后看来,您认为有什么办法可以避免此类疫情发生,或者这是不可避免的?对于其他现在正遭受疫情影响的国家,您有什么建议?谢谢。

      2020-03-16 18:31:16

      杜斌:
      好的,非常感谢你的提问。第一个问题关于控制疫情的具体措施。我不是这方面的专家,但我认为控制的办法就是:检测、检测、还是检测。如果没有进行核酸检测,就不会知道谁是携带者,谁是患者,谁应该被隔离以及谁是密切接触者。

      我知道,在其他国家存在与中国不同的做法,比如美国就有自己的做法。我不能说谁对谁错。但是,除了检测之外,我不知道还有什么办法可以发现疑似病例并隔离密切接触者。刚刚曹医生回答了一个关于疫情拐点的问题。我认为,疫情出现拐点的主要原因或决定性的一点就是我们能够做到隔离所有疑似患者和密切接触者。这就是武汉和湖北疫情的转折点。

      第二个问题是,哪些具体因素导致了武汉的死亡率更高。我的看法是,未能及时采用机械通气、气管插管以及长期使用皮质类固醇导致了这一数字。我的意思是,这些都是导致死亡的主要风险因素。我见过数十个采用无创通气但尝试不当或失败的案例。

      医生起初尝试使用无创通气,但是效果不好,却又坚持用了一段时间,没有插管。但最终结果是,即便后来进行了气管插管,患者还是去世了。所以后来我们调整了策略,鼓励医师一旦发现患者的无创通气没有效果,就尽早为患者插管。同济医院的同事们进行了一项研究,虽然不算大型的研究,但他们发现积极的气管插管方法可以显著改善患者的治疗结果。

      就我所知论文已经提交,但是我不知道它是否已被录用了。谢谢。

      2020-03-16 18:37:16

      袭艳春:
      最后一个问题。

      2020-03-16 18:40:16

    中国日报记者提问(焦非 摄)

      中国日报记者:
      谢谢,我是中国日报记者。自中国各地的医务人员驰援武汉帮助抗疫以来,已经过去了一个多月的时间,我知道诸位都参与了这项工作。我的问题是,这些医疗团队在治疗湖北和武汉的新型冠状肺炎患者方面做出了哪些贡献。第二个问题,数周的紧张工作过后,诸位现在有什么感想?最想与我们分享什么?谢谢。

      2020-03-16 18:47:16

      袭艳春:
      我建议请大家轮流说几句吧。

      2020-03-16 18:52:16

      杜斌:
      谢谢。我不确定我是不是回答第一个问题的合适人选,因为我认为这个问题主要是对医疗卫生部门提的,而不是我们。我回答第二个问题。尽管这是我和我的同事们向国际社会分享经验的机会,但我要说,中国控制疫情的方法可能不是唯一的方法。

      我们可以看到新加坡的情况,日本的情况。我想说,我和我的同事们也可以从他们的经验中学到东西。如果情况不同,比如病例数量和社区支持体系不同,就可能采用完全不同的方法,但最终达到类似的成功控制疫情的效果。

      因此,这也是我们相互学习的机会,就像我们谈论用中药还是西药一样。因此,最后我想说,世界之美在其多样性,而非同一性。谢谢。

      2020-03-16 18:57:16

      严晓伟:
      能够来武汉在重症监护病房里治病救人,是我的荣幸。在重症监护室里,我看到太多的生死,这些都是我永生难忘的。

      此外,我很高兴能在这里与国外的朋友和同事分享我的经验。非常感谢。

      2020-03-16 18:59:16

      曹玮:
      我想谈谈我的个人感受。17年前,非典肆虐,那时候的我还是一名医学专业的大学生,有很多人保护着我(们)。现在,我能够和我的老师和前辈们并肩作战,保护我们的人民和祖国,我觉得非常自豪,我也相信这是所有身处武汉的医护工作者的共同感受。尽管我们个人付出了很多,也和家人分开了这么久,但是这一切都是值得的。

      最后,我要向和我们并肩作战的全体护士表示衷心的感谢和敬意。他们承担着和我们一样的责任,而且和我不同,许多来武汉的护士其实都很年轻。他们大部分都是90后,对非典只有一星半点的记忆。然而疫情发生后,他们都挺身而出驰援武汉。没有他们的付出,我们不会取得今天的进展,救治危重病人尤其如此。所以,非常感谢他们。

      2020-03-16 19:01:16

      吴东:
      谢谢你的提问。我也想分享一些个人感受。在过去的五周里,我全身心投入到重症监护病房病人的救治工作中。唯一让我遗憾的就是不能照顾到我的家人,没有尽到一个丈夫和父亲的职责。五周前,当我从北京出发来武汉的时候,我八岁的女儿问我说:“爸爸,你为什么要去武汉呀?”说实话,当时我没法回答这个问题。但是上周我在重症监护室收治了一位病患。她是一位57岁的女性,当时病情非常严重,所以我们计划插管治疗,进行机械辅助呼吸(使用呼吸机)救治。这似乎是挽救她生命的唯一办法。

      插管治疗之前,她小声对我说了几句话,因为是武汉方言,我也不太懂她说了些什么。不过,最后我还是弄明白了。她说:“医生,我不想死,我女儿这个月月底就结婚了。”在那一刻,我内心深处感同身受,我们的病人也一样为人父母。他们深爱着自己的子女,就像我一样。这也让我想起马尔克斯的小说《霍乱时期的爱情》。这部小说告诉我,人有生老病死,但爱永垂不朽。

      所以,我为什么来武汉呢?这不仅仅是由于我的专业素养和责任意识,更关乎爱。我爱我的女儿,也爱我的病人。我爱我的祖国,也爱全人类。我们所有人共同面对疫情,我们也将共同渡过难关。谢谢。

      2020-03-16 19:06:16

      袭艳春:
      谢谢。听了几位专家的分享,我深受感动。我想说新冠疫情的爆发既不是全人类面临的第一次挑战,也不会是最后一次。

      疫情无国界,而世界唯一要做的就是共同努力。在国内抗击疫情的同时,中国也将和各国携手,为取得抗击疫情的最后胜利贡献我们的力量和智慧。

      今天,来自北京协和医院的四位专家和我们分享了许多宝贵的经验。刚到武汉的时候,他们并不知道这场抗疫将会持续多久,也不知道他们将会面临多少困难和挑战。但是听了他们刚才的发言,我们都很清楚,在抗击疫情的过程中,有他们同在是多么的重要。

      我相信,武汉和湖北的人民不会忘记他们,所有中国人民也将为中国医护工作者感到骄傲。所以最后,我提议我们一起来张合影,为所有中国医护工作者点赞。你们是好样的。

      非常感谢。今天的发布会到此结束。谢谢,再见。

      2020-03-16 19:11:16