Goldbank Englisch 1

Links to the other parts:《金銀潭》Goldbank_Englisch Part 1&2&3, Goldbank_Englisch_1 Part 4&5&6, Goldbank_Englisch_2 Full

Part 4

快半拍的重要性

此次疫情中，金银潭医院全院感染21个人，其中有8个是行政人员，9个是护士。8个行政人员是在武汉华南海鲜批发市场感染的，之后又感染了另外三位同事。真正在病房里面被感 染的，只有一个医生。另外一个医生是在检验科，因为要给患者做血常规、生化常规，开盖的时候可能会有小的气溶胶“啜”一下悬浮在外面，由此被感染了。目前，所有的被感染的医务人员都出院了，有的已经开始工作了。 从最早收治被新冠病毒感染的患者，及时做好医护人员的防护，到提前做好病区扩充，大批量购买医疗设备，金银潭医院每一步都快了半拍。正是这半拍，让金银潭虽处于疫情的“风暴眼”，却紧张而有序，忙而不乱，最大限度地挽救了患者的生命，同时实现了医护零死亡。 “我说每次都要快半拍，是因为我自己首先心理上做好了准备，我们同事也做好了心理准备，而不是等到局势倒逼，要我们做这个决断。”张定宇认为，此次疫情会给国家的卫生管理部门以及医疗行业带来一些启示，比如灾难医学的扩充，医患矛盾的处理等等，进而会对医疗制度的改革起到一定的良性促进。

第二章救治与研究同步开展

历史罕见的新冠肺炎疫情暴发后，国家紧急启动一系列关于新冠肺炎的应急科研攻关项目。金银潭医院攻坚克难、不辱使命，主动承担了涵盖优化临床治疗方案、抗病毒药物筛选、康复期血浆使用等多个在临床治疗中急需解决的问题攻关。 众多临床专家云集金银潭医院，在救治患者的同时，也开展了一个又一个科研项目，并在中西医结合治疗方面取得成效，为医院救死扶伤这一阵地上的阻击战找到了突破口。

克力芝用于临床研究

2月2日，湖北省召开新型冠状病毒感染的肺炎疫情防控工作新闻发布会，通报湖北省疫情防控情况。张定宇详细介绍了患者转入金银潭医院后的治疗情况——每位患者均由国家、省、市专家组指导，按照《新型冠状病毒感染的肺炎诊疗方案（试行第四版）》诊疗规范开展诊疗。根据病情给予鼻导管氧疗、高流量湿化氧疗、无创通气治疗、气管插管呼吸机辅助通气， 其中部分患者还可使用ECMO和人工肝、人工肾等高级生命支持，并酌情给予抗病毒、抗感染、抗炎、抗休克，纠正内环境紊乱、纠正酸碱平衡失调等治疗。 在1月5、6号时，第一批国家卫健委医疗队专家、中日友好医院副院长曹彬教授就跟张定宇他们提到了克力芝（一种抗艾滋病药物），并把相关文献拿了出来。根据研究文献，在2003年SARS末期的时候，香港的袁国勇院士用克力芝治疗了一部分SARS患者，通过和历史数据对比，可以看到这个药能够抑制SARS冠状病毒。在曹彬教授的指导下，金银潭医院率先开展了克力芝用于新型冠状病毒肺炎患者的临床研究。 张定宇认为，既然两个病毒比较靠近，在没有好的对症药物之前完全可以进行尝试，并且金银潭医院作为传染病专科医院有一个先天的优势——克力芝是抗艾滋药，而金银潭医院有 着全省的抗艾滋药物。 克力芝的临床研究很快展开了，用了大概五六天的时候，有科室主任反馈说药确实有效，通过对吃了药的几个患者的片子进行对比可以发现，肺的吸收要快一些，患者的病灶区全部在往吸收方面好转。 2月2号，克力芝的整个临床试验入组完成，临床试验效果是比较好的，“不能说是特效药，但是是有效药”。 经过前期198例患者对比研究，克力芝能够降低危重患者的死亡率，也能减少危重病例发生率。尤其是对早期重症患者疗效较为显著。 张定宇结合自己的亲身经历认为，克力芝在临床上确实有一定的抑制病毒复制的作用：“因为我有渐冻症，在服用这类药，没有被感染，而我的妻子被感染了，我跟她有非常密切的接触。” 针对网络上炒作克力芝治疗效果，张定宇说：“切忌病急乱投医，切勿导致药物滥用。克力芝本身会产生胃肠道不适、过敏、肝损害、心率减慢等不良反应，建议患者在医生指导下进行治疗。”

瑞德西韦临床试验启动

2月5日下午，科技部应急攻关“瑞德西韦治疗2019新型冠状病毒感染研究”项目在金银潭医院启动。 瑞德西韦(Remdesivir)是美国吉利德公司的在研药物，在前期的细胞和动物实验中，均显示出对SARS冠状病毒、MERS冠状病毒有较好的抗病毒活性，国外已开展瑞德西韦针对埃博拉冠状病毒感染的临床试验。

2020年2月5日，瑞德西韦临床试验项目负责人、中日友好医院副院长曹彬教授讲解项目内容。（新华社记者 程敏 摄）（图）

2020年2月5日，中国工程院副院长、中国医学科学院院长王辰院士（右一）介绍项目情况。（新华社记者 程敏 摄）（图）

新冠肺炎疫情发生后，我国学者报道瑞德西韦在细胞水平上对2019新型冠状病毒也有较好的活性，但在人体应用前仍需严谨的临床试验评价。 这一临床试验项目负责人、中日友好医院副院长曹彬教授介绍说，针对目前新冠病毒感染患者缺乏有效的抗病毒药物，期待瑞德西韦在临床中的表现。 中国工程院副院长、中国医学科学院院长王辰院士说：“各界对这一试验有期望，但有无效果，还需要等待严格的科学试验结果。” 王辰介绍说，目前药品运输、分组编盲等前期准备工作已完成。瑞德西韦临床试验由中日友好医院、中国医学科学院药物研究所牵头，研究将在金银潭医院等多家临床一线接诊新型冠状病毒感染肺炎患者的医院中进行，拟入组761例患者，采用随机、双盲、安慰剂对照方法展开。

金银潭医院医护人员坚守在一线。（武汉市金银潭医院供图）（图）

在科技部、国家卫健委、国家药监局等多部门支持下，抗病毒药物瑞德西韦很快完成临床试验的注册审批工作，第一批病例入组工作也已就位。 2月6日，首批新冠病毒感染的肺炎重症患者接受用药，首位用药者是金银潭医院收治的一位68岁的男性重症患者。

探索利用康复期血浆“免疫性治疗”

2月13日，张定宇在湖北省新冠肺炎疫情防控指挥部召开的第23次新闻发布会上发出呼吁：“康复期患者，请伸出您的胳膊，捐献宝贵的血浆，共同拯救还在与病魔作斗争的患者。” “康复后的患者体内有大量中和抗体，可以抵抗新型冠状病毒。”张定宇介绍说，在缺乏疫苗和特效治疗药物的前提下，采用这种特免血浆制品治疗新冠病毒感染是较为有效的方法。“康复者捐献的血浆，会经过一系列处理，得到一个相对纯化的对抗新冠病毒中和抗体，用于新冠肺炎危重患者的治疗。” 专家认为，从临床病理发生过程看，大部分新冠肺炎患者经过治疗康复后，身体内会产生针对新冠病毒的特异性抗体，可杀灭和清除病毒。 金银潭医院配合相关研究团队立即开展了康复期患者血浆的釆集工作。 捐献血浆必须符合三项条件：一、年龄在18—60周岁之间；二、确诊感染过新型冠状病毒（核酸检测阳性）；三、 病愈出院一周以上。

2020年2月18日，张定宇的夫人程琳来到金银潭医院，捐献了400毫升血浆。（新华社发 武汉市金银潭医院供图）（图）

金银潭医院在门诊部二楼设立采血机构。捐献者经过电话预约到医院后，先进行身份登记并填写健康征询表及知情同意书，再进行健康状况问诊、血液检查，经最后确认后，每人采集血量在200—400毫升之间，采血完成后，向献血者发放一定数额的经济补偿。 张定宇在发布会上发出呼吁后，社会广泛关注。 2月13日晚，中国生物技术股份有限公司、武汉市血液中心也联合向新冠肺炎康复者发出献血倡议书，并在湖北省人民医院开放爱心献血屋。 从第二天开始，就有不少康复者来电咨询，表示支持金银潭医院的这项研究。 金银潭医院将这一方法很快用于4个重症患者的治疗。 4个患者的病情都有好转。从整体来看，患者自我感觉喘气等症状减缓了，精神状态、食欲都有提升；从指标上看，血氧饱和度比以前稳定些，淋巴细胞的绝对值也得到了提升。 “这类指标对患者康复是很重要的参考。”但张定宇提醒说，采用特免血浆制品治疗的方式并不是“灵丹妙药”，最终战胜病魔更多的还是要靠患者自身的免疫力。这种治疗主要是给患者一个喘息的机会，使病情往好的方向发展，同时也给医生抢救危重患者赢得更多的时间。 已于1月29日康复出院的张定宇的夫人程琳，也来到金银潭医院捐献了400毫升血浆。

首例遗体解剖完成并送检

对于一种致人死亡的新型疾病，遗体解剖对掌握其病理意义重大。解剖新冠肺炎死亡者遗体，对于探索新冠肺炎患者临床的病理改变、疾病机制等有重大帮助，能从根本上探究新冠肺炎的致病性、致死性，给临床抢救和治疗危重症患者提供依据。 实际上，新冠肺炎疫情暴发后的一个多月里，有关方面一直呼吁对死亡病例进行病理解剖。但由于新冠肺炎属烈性传染病，解剖风险过高，加上国内少有针对甲级传染病、达到P3级生物实验室标准的病理解剖实验室，使得相关工作迟迟难以落实。 国际上根据生物安全的防护等级将生物实验室分为四级：Pl、P2、P3和P4实验室。P是Protection的缩写，其中1级的防护级别最低，4级最高。 在国家法律政策允许下，并征得患者家属同意，2月15日深夜，华中科技大学同济医学院法医病理学专家来到金银潭医院，在金银潭的医护人员配合下，开始了全国第一例新冠肺炎 遗体解剖工作。 由于整个湖北都没有专门的负压解剖室，金银潭医院临时腾出一间负压手术室用来做解剖工作。 解剖从16日凌晨1点开始，4点结束，休息两个小时后展开讨论；上午11点，第二例病理解剖工作敲定，下午4点开始，6点半结束……不到18个小时，即完成两例病理解剖，并于当日送检。 首战告捷，随后的几例遗体解剖工作开展得也是格外顺利：2月17日下午5点，第三例病理解剖；紧接着，第四例……2月22日，是解剖团队最为忙碌的一天，“24小时之内做了五例解剖”。

中医武汉抗疫临床发挥重要作用

2月3日，武汉市金银潭医院首批以中医药或中西医结合方式治愈的新型冠状病毒感染的肺炎患者出院。 这批出院的患者共有8名，包括6名女性、2名男性，其中重症6例、轻症2例，最大年龄68岁，最小年龄26岁。中医中药参与治疗后，患者呼吸困难、乏力、口干口苦、胸闷、腹泻等症状明显改善，精神状态也明显好转。 1月28日，国家中医药管理局应对新型冠状病毒感染的肺炎联防联控工作专家组组长、中国工程院院士黄璐琦带领北京西苑医院和广安门医院医疗团队支援武汉市金银潭医院，对这 批患者采用中西医结合、辨证治疗。出院时，金银潭医院赠送了每位患者2周用量的中药调理药剂，并嘱咐他们适当增强运动、合理饮食，以加速身体恢复。 3月2日，新华社播发记者廖君、黎昌政在武汉抗击疫情第一线采写的报道，称中医经验方在减轻发热咳嗽症状、控制病情进展、提升人体免疫力方面有独特优势。 报道说，新冠肺炎疫情发生后，全国中医药系统医疗队员3350人、5支国家中医医疗队739名医务人员驰援武汉，进驻武汉市金银潭医院、湖北省中西医结合医院、雷神山医院救治患者，同时在武汉市江夏区整建制托管大花山方舱医院，收治患者416人，开展中医药特色救治。 “中医药早期介入干预，稳定人心，减少新发患者，从源头上防控疫情蔓延发挥了作用。”湖北省卫健委中医综合处负责人介绍说，仅武汉市面向集中隔离观察点隔离人员和有需求 的居家密切接触者，发放中药汤剂近32.1万人份，发放中成药 24.8万人份，隔离人员基本做到中药应服尽服。 湖北还以方舱医院为重点，推动中医药全面参与治疗。16个方舱医院累计收治病例11740人，同步配送中药汤剂和金花清感胶囊等4种中成药，中药使用率99.93%。在14家定点医疗机构的重症、危重症患者中，也强化中医药全程参与。

2020年2月25日，在江夏方舱医院，湖南中医药大学第一附属医院护士长涂丽准备为新冠肺炎患者实施中医耳穴压豆治疗。武汉江夏方舱是武汉首个以中医院运转模式来迸行临床治疗、管理的方舱医院。医疗团队由釆白多个省份中医院的数百名医护人员组成。（新华社记者 沈伯韩 摄）（图）

1月25日，61岁的钱先生因持续高热、呼吸困难被送到湖北省中医院光谷院区急诊科，随后确诊为新冠肺炎，由于基础疾病多，病情发展快，曾先后两次被宣告病危。 钱先生后经湖北省中医院急诊科主任李刚副教授团队进行十多天中西医结合治疗和调理，于2月17日康复出院。 李刚说：“中医药治疗贯穿钱先生治疗全病程。根据不同病程，开具‘肺炎2号’‘肺炎3号’‘肺炎4号’和‘肺炎5号’方。他能转危为安，中医药发挥了重要作用。” 68岁的重症患者霍先生与钱先生同一天出院。两人病程发展有所不同，治疗过程中，中药使用也略有差异。 霍先生入院后，是先采用抗感染的西药，控制炎症反应，再用中药对症调理的。 湖北省中医院肺病五科负责人冯毅说，中医药参与治疗，能促进肺部病灶吸收，减少甚至解决肺组织损伤、肺纤维化等并发症和后遗症。目前，随访出院患者，均反馈病情稳定且在逐步康复中。 相关统计数据显示，湖北确诊病例中医药使用率为88.93%o截至2月28日24时，全省43家定点中医医院累计收治确诊病例7246人，中医药使用率为97.71%，患者发烧、乏力、咳嗽等症状和影像学表现均明显改善。 张伯礼等3位院士领导的团队，在武汉临床研究初步结果也表明，中西医结合总体疗效，明显优于单纯西药治疗。

The importance of taking a proactive approach

In this outbreak, 21 people were infected in Jinyintan Hospital, including 8 administrative staff and 9 nurses. 8 administrative staff were infected in Wuhan South China Seafood Wholesale Market, and then 3 other colleagues were infected. Only one doctor was actually infected in the ward. Another doctor was in the laboratory department, because he had to do routine blood tests and biochemical tests on patients, and when he opened the lid, there might be small aerosols suspended outside, so he was infected. All of the infected medical staff have been released from the hospital and some have already worked. From the earliest treatment of COVID-19 patients and timely protection of medical staff, to the advance of ward expansion, large-scale purchase of medical equipment, Jinyintan Hospital always accelerated a bit at each step. Thanks to that, although Jinyintan was in the pandemic "storm eye," it was tensive, busy, but orderly, which to the maximum extent saved lives of patients, at the same time achieved zero death of medical care personnel. "I said that I should be half a beat faster every time, because instead of waiting for the situation to force us to make this decision, I was mentally prepared first. So did my colleagues." Zhang Dingyu believed that the pandemic would bring some enlightenments to the national health management department and medical industry, such as the expansion of disaster medicine, the handling of medical-patient contradictions, etc., and then it might bring a certain benign promotion to the reform of the medical system. Anti-pandemic Chronicle of Jinyintan Hospital

Chapter 2 Simultaneous development of treatment and research

After the outbreak of the rarely-seen COVID-19, our country launched a series of scientific research projects for emergencies. Jinyintan Hospital endeavored to accomplish its mission, taking the initiative to tackle many problems needed to be solved urgently in clinical treatment, including optimization of clinical treatment plan, screening of antiviral drugs, use of plasma during the convalescence, etc. Numerous clinical specialists gathered here. In addition to treating the sick, they also developed a great many scientific research projects, and achieved results in the integrated treatment of TCM and western medicine, which found a breakthrough for the hospital to work much more effectively.

Kaletra used in clinical research

On February 2, Hubei Province held a press conference on the prevention and control of COVID-19 to announce the situation of pandemic prevention and control in Hubei Province. Zhang Dingyu introduced in detail the treatment of patients transferred to Jinyintan Hospital. Each patient was guided by the national, provincial and municipal expert groups, and the diagnosis and treatment were carried out according to the diagnosis and treatment standards of Pneumonia Diagnosis and Treatment Scheme for COVID-19 (Trial Version 4). Nasal catheter oxygen therapy, high-flow humidified oxygen therapy, non-invasive ventilation therapy, tracheal incubation ventilator assisted ventilation were given according to the patient's condition. Some patients could also use ECMO, artificial liver, artificial kidney and other advanced life support, and antiviral, anti-infection, anti-inflammatory, anti-shock, correction of internal environment disorder, correction of acid-base balance imbalance and other treatments were given as appropriate. On January 5,6, the first batch of National Health Commission medical team experts, China-Japan Friendship Hospital vice president Professor Cao Bin and Zhang Dingyu they mentioned Kaletra (an anti-AIDS drug), and took out the relevant literature. According to the research literature, at the end of SARS in 2003, Academician Yuan Guoyong of Hong Kong treated some SARS patients with Kaletra. Compared with historical data, it can be seen that the drug can inhibit SARS coronavirus. Under the guidance of Professor Cao Bin, Jinyintan Hospital took the lead in carrying out clinical research on the use of Kaletra in patients with COVID-19. Zhang DingYu think, Since the two viruses are relatively close, In the absence of good symptomatic drugs before completely can try, And Jinyintan Hospital as infectious disease specialized hospital has an innate advantage-Kaletra is anti-AIDS drugs, And Jinyintan Hospital has the province's anti-AIDS drugs. The clinical study of Kaletra was carried out soon. After about 5 or 6 days of use, the department director reported that the medicine was really effective. Through the comparison of the films of several patients who took the medicine, it can be found that the absorption of the lung is faster, and all the focal areas of the patients are improved in terms of absorption. On February 2, the whole clinical trial enrollment of Kaletra was completed, and the clinical trial effect was relatively good."It is not a specific drug, but it is an effective drug." Through the comparative study of 198 patients in the early stage, Kaletra can reduce the mortality rate of critically ill patients and also reduce the incidence of critically ill cases. especially for early severe patient. Zhang Dingyu combined with his own personal experience that Kaletra does have a certain effect on inhibiting virus replication in clinical practice: "Because I have ALS, I'm taking these drugs and I'm not infected, but my wife is infected and I have very close contact with her." For the network hype gram force cheese treatment effect, Zhang Dingyu said: "Please don't see doctors casually and abuse medicines. Kaletra itself will produce gastrointestinal discomfort, allergy, liver damage, heart rate slowing and other adverse reactions, so it is suggested that the patient should be treated under the guidance of a doctor."

Remdesivir clinical trials started

On the afternoon of February 5, the emergency research project of Ministry of Science and Technology "Research on Remdesivir Treatment of COVID-19" was launched in Jinyintan Hospital. Remdesivir is a drug under development by Gilead Company of the United States. In the early cell and animal experiments, it has shown good antiviral activity against SARS coronavirus and MERS coronavirus. Clinical trials of Remdesivir against Ebola coronavirus infection have been carried out abroad.

On February 5,2020, Professor Cao Bin, Head of Clinical Trial Project of Remdesivir and Vice President of China-Japan Friendship Hospital, explained the project content. (Photo by Cheng Min, Xinhua News Agency)

On February 5, 2020, Academician Wang Chen (the first from the right), Vice President of Chinese Academy of Engineering and President of Chinese Academy of Medical Sciences, introduced the project. (Photo by Cheng Min, Xinhua News Agency)

After the outbreak of COVID-19, Chinese scholars reported that Remdesivir also had good activity against the COVID-19 at the cellular level, but rigorous clinical trial evaluation is still needed before application in human body. Professor Cao Bin, director of the clinical trial project and vice president of China-Japan Friendship Hospital, said that in view of the lack of effective antiviral drugs for patients infected with the COVID-19, he looked forward to the clinical performance of Remdesivir. Academician Wang Chen, vice president of the Chinese Academy of Engineering and president of the Chinese Academy of Medical Sciences, said: ""There are hopes for this experiment, but whether it will work or not will depend on the results of rigorous scientific experiments." Wang Chen said that at present, drug transportation, group coding and other preliminary preparations have been completed. The clinical trial of Remdesivir is led by China-Japan Friendship Hospital and Institute of Pharmacy, Chinese Academy of Medical Sciences. The study will be conducted in Jinyintan Hospital and other hospitals that receive patients with pneumonia infected with COVID-19.761 patients are planned to be enrolled in the study, which will be conducted in a randomized, double-blind and placebo-controlled manner.

Overall staff of Jinyintan Hospital were staying at the front line.(Photo by Jinyintan Hospital)

With the support of the Ministry of Science and Technology, National Health Commission, State Food and Drug Administration, and other departments, the registration and approval of the clinical trial of the antiviral drug Redoxivir were completed soon, and the enrollment of the first batch of cases had been put in place. On Feb.6, the first batch of severe pneumonia patients infected with COVID-19 received medication, the first of which was a 68-year-old male critically ill patient admitted to Jinyintan Hospital.

Exploring the use of convalescent plasma "immunity therapy"

On Feb.13, Zhang Dingyu issued an appeal at the 23rd press conference held by Hubei Province COVID-19 Prevention and Control Headquarters: "For convalescent patients, please extend your arm and donate precious plasma to save the patients who are still fighting against COVID-19." "After recovery from COVID, patients have a large number of neutralizing antibodies in their bodies, which can resist the coronavirus." Zhang Dingyu said that under the premise of a lack of vaccines and specific therapeutic drugs, the use of this special immune plasma product to treat the infection of COVID is a more effective method. "The plasma donated by the convalescent patients will undergo a series of treatments to obtain a relatively purified neutralizing antibody against the coronavirus, which will be used for the treatment of critically ill patients." Experts believe that from the clinical pathology process, in most patients with COVID after treatment and rehabilitation, the body will produce specific antibodies against the coronavirus, which can kill and remove the virus. Jinyintan Hospital cooperated with relevant research teams to immediately carry out plasma collection of convalescent patients. People who want to donate plasma must meet three conditions: I. The age is between 18 and 60 years old; II. Confirmed infection with COVID (positive nucleic acid test); III. Discharge from the hospital after recovery for more than one week.

On Feb.18, 2020, Cheng Lin -- Zhang Dingyu's wife -- came to Jinyintan Hospital and donated 400ml of plasma.(Photo by Jinyintan Hospital, issued by Xinhua News Agency)

Jinyintan Hospital has set up a blood collection institution on the second floor of the outpatient department. When the donor arrives at the hospital after a telephone appointment, he/she shall register his/her identity and fill in the health consultation form and informed consent form, and then conduct a health status inquiry and blood examination. After final confirmation, the blood volume collected by each donor shall be 200-400ml. After the blood collection is completed, a certain amount of economic compensation is issued to the blood donor. After Zhang Dingyu issued an appeal in the press conference, society widespreadly concerned. On the evening of Feb.13, China Biotechnology Co., Ltd. and Wuhan Blood Center also jointly issued a blood donation proposal to convalescent patients with COVID, and opened a charitable blood donation house in Hubei Provincial People's Hospital. From the next day, many rehabilitated people called for consultation and expressed support for the study by Jinyintan Hospital. Jinyintan Hospital quickly applied this method to the treatment of four critically ill patients. All four patients improved. On the whole, the patient felt that the symptoms such as wheezing were alleviated, and the mental state and appetite were improved; From the index point of view, blood oxygen saturation is more stable than before, the absolute value of lymphocytes has also been improved. "This kind of index is very important reference to the patient's rehabilitation." However, Zhang Dingyu warned that the use of special immune plasma products treatment is not a "panacea," the final victory over the disease more depends on the patient's own immunity. This kind of treatment is mainly to give the patient a chance to breathe, make the condition develop in a good direction, but also to the doctor to save critically ill patients to win more time. Zhang Dingyu's wife Cheng Lin, who recovered from hospital on January 29, also came to Jinyintan Hospital to donate 400 ml of plasma. The first autopsy was completed and submitted for inspection.

The first autopsy was completed and sent for inspection

For a new type of disease that causes death, the autopsy is of great significance to grasp its pathology. Anatomy of the dead body of new crown pneumonia is of great help to explore the clinical pathological changes and disease mechanism of patients with new crown pneumonia, and can fundamentally explore the pathogenicity and lethality of new crown pneumonia, and provide the basis for clinical rescue and treatment of critically ill patients. In fact, more than a month after the outbreak of new crown pneumonia, there have been calls for a pathological autopsy of deaths. However, because Xinguan pneumonia is a severe infectious disease, the anatomical risk is too high, and there are few pathological anatomy laboratories aiming at Class A infectious diseases and reaching the standard of P3 biological laboratories in China, it is difficult to implement the relevant work. Internationally, biological laboratories are divided into four levels according to the protection level of biological safety: Pl, P2, P3, and P4 laboratories. P is the abbreviation of Protection, where Level 1 is the lowest protection level and Level 4 is the highest. Permitted by national laws and policies and with the consent of the patients' families, late on the night of February 15, forensic pathology experts from Tongji Medical College of Huazhong University of Science and Technology came to Jinyintan Hospital. With the cooperation of medical staff of Jinyintan Hospital, they began the autopsy of the first human corpse dying of COVID-19 in China. As there is no special negative pressure dissection room in Hubei province, Jinyintan Hospital temporarily vacated a negative pressure operating room for dissection. The autopsy began at 1 a.m. and ended at 4 a.m. on February 16, and the discussion began after a two-hour break; at 11 a.m., the second pathological autopsy was finalized, starting at 4 p.m., and ending at 6:30 p.m.... In less than 18 hours, two cases of pathological autopsy were completed and submitted for examination that day. After a successful first battle, the subsequent autopsies was carried out exceptionally smoothly: at 5 p.m. on February 17, they did the third pathological autopsy; then, the fourth... February 22 was the team's busiest day, "five autopsies were done within 24 hours."

Traditional Chinese medicine in Wuhan played an important role in the anti-pandemic clinic

On February 3rd, the first batch of novel coronavirus infected pneumonia patients in the Jinyintan Hospital of Wuhan city were discharged,who were cured by traditional Chinese medicine or integrated traditional and western medicine. There were 8 patients discharged from the hospital, including 6 women and 2 men. Among them, 6 patients were with severe symptoms and 2 patients were with mild symptoms. The oldest patient was 68 years old，while the youngest patient was 26 years old. After the treatment with traditional Chinese medicine, the symptoms of the patients such as dyspnea, fatigue, dry mouth and bitter mouth, chest tightness and diarrhea were significantly improved, as well as their mental state. On January 28th, Huang Luqi, the leader of the expert group of the State Administration of Traditional Chinese Medicine on joint prevention and control of pneumonia caused by infection with novel coronavirus and an academician of the Chinese Academy of Engineering, led the medical teams of Beijing Xiyuan Hospital and Guang'anmen Hospital to support the Jinyintan Hospital of Wuhan city, and used integrated traditional and western medicine and syndrome differentiation treatment for these patients. When these patients were discharged, Jinyintan Hospital presented each patient with a 2-week dose of Chinese herbal medicine conditioning agent, and instructed them to properly enhance exercise and eat reasonable food to speed up their recovery. On March 2nd, Xinhua News Agency broadcast a report written by reporters Liao Jun and Li Changzheng on the front line of the fight against the epidemic in Wuhan, saying that traditional Chinese medicine has unique advantages in relieving fever and cough symptoms, controlling disease progress, and improving human immunity. It was reported that after the occurrence of the COVID-19, 3350 medical personnel from the national TCM（Traditional Chinese Medicine）system and 739 medical personnel from five national TCM medical teams came to support Wuhan. They were stationed in the Jinyintan Hospital of Wuhan city, Integrated Traditional Chinese and Western Medicine Hospital of Hubei province, and Leishen Mountain Hospital to treat patients. At the same time, they received and treated 416 patients and carried out characteristic cure with traditional Chinese medicine in Dahuashan mobile cabin hospital, which was restructured and entrusted in Jiangxia District of Wuhan city. "The early intervention of traditional Chinese medicine (TCM) has played a role in reassuring people, reducing new patients and preventing the spread of the epidemic from the source." According to the head of TCM general office of Hubei Provincial Health Commission, in Hubei, all infected people isolated in centralized isolation of observation points and close contacts in home quarantine have been distributed nearly 321,000 portions of TCM decoction, and 248,000 Chinese patent medicine, with all isolated people in need basically taking TCM. Hubei also focuses on shelter hospitals to promote the full participation of TCM in treatment. A total of 11,740 cases were admitted to 16 shelter hospitals, and 4 kinds of Chinese patent medicines including traditional Chinese medicine decoction and Jinhua Qinggan capsule were distributed simultaneously, with the utilization rate of traditional Chinese medicine reaching 99.93%. Among the severe and critically ill patients in 14 designated medical institutions, participation of traditional Chinese medicine in whole treatment process has been strengthened.

On February 25, 2020, in Jiangxia Square Cabin Hospital, the head nurse of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Tu Li, was prepared to carry out traditional Chinese medicine ear acupoint bean pressing treatment for patients with COVID-19 patients. Jiangxia shelter is the first shelter hospital in Wuhan to carry out clinical treatment and management in the operation mode of traditional Chinese medicine hospital. The medical team consists of hundreds of medical staff from traditional Chinese medicine hospitals in many provinces.(Photo by Shen Bohan, Xinhua News Agency)

On January 25, 61-year-old Mr. Qian was sent to the emergency department in the Guanggu district of Hubei Province Hospital of Traditional Chinese Medicine due to persistent high fever and dyspnea. Later, he was diagnosed with COVID-19. Due to many underlying diseases and rapid development of COVID-19, he was declared to be terminally ill twice. After he was treated and conditioned more than ten days by associate professor Li Gang and his team by integrating TCM and western medicine, Mr. Qian recovered and was discharged from the hospital on February 17. Li Gang, director of the emergency department of Hubei Province Hospital of TCM, said: "TCM treatment was applied into the whole course of Mr. Qian' treatment. Prescriptions of "pneumonia No.2,""pneumonia No.3,""pneumonia No.4" and "pneumonia No.5" were prescribed according to different courses of disease. TCM played an important role in curing him." Mr. Huo, a 68-year-old critically ill patient, was discharged from the hospital on the same day with Mr. Qian. The disease courses of these two people were different, so the uses of TCM were also slightly different correspondingly. After admission, Mr. Huo first adopted anti-infective Western medicine to control inflammation, then used traditional Chinese medicine to recuperate. Feng Yi, Head of the fifth Department of Pulmonary Diseases at Hubei Hospital of Traditional Chinese Medicine, implied that the participation of traditional Chinese medicine in treatment could promote the absorption of lung lesions, reduce or even solve the complications and sequelae of lung tissue damage and pulmonary fibrosis. At present, all discharged patients were reported to be in stable state and recovering during follow-up. Relevant statistics showed that the utilization rate of TCM of confirmed cases in Hubei was 88.93%. As of 24:00 on February 28, a total of 7246 confirmed cases had been treated in 43 designated TCM hospitals in Hubei, and the utilization rate of TCM was 97.71%, while significantly improved the symptoms of fever, fatigue, cough and imaging manifestations. The preliminary results of the clinical study in Wuhan led by Zhang Boli and three other academicians also showed that the overall effect of integrated Chinese and Western medicine was much better than that of only Western medicine application.

Part 5

中西医协同作战成效显著

金银潭医院是最早尝试中西医结合抢救重症患者和治疗轻症患者的医院。 1月25日，大年初一，国家中医药局组织中国中医科学院广安门医院、中国中医科学院西苑医院中医专家组成25人的医疗队，赶赴湖北省武汉市新型冠状病毒感染的肺炎防疫一线参与防治工作。 医疗队由国家中医药局副局长闫树江带队，中国中医科学院院长黄璐琦院士领队，广安门医院和西苑医院各派出呼吸科、急诊科、ICU等科室的6名医师和4名护士，携N95口罩、手术衣以及部分中药等物资，乘火车前往武汉，提供中医医疗援助。 此前，由中国科学院院士、中国中医科学院首席研究员仝小林，广东省中医院副院长张忠德，中国中医科学院西苑医院呼吸科主任苗青，首都医科大学附属北京中医医院呼吸科主任兼肺病研究室主任王玉光组成的高级别中医专家组已经抵达武汉。 出发前，黄璐琦就做了充足准备：研读疫情有关报道和科研文章，分析非典期间中医药发挥的优势和特色，梳理治疗方案；组建医疗队，培训呼吸科、急诊科、ICU等科室的医务人员； 协调沟通武汉医务人员，了解武汉情况，准备防护物资。 金银潭医院是抗疫的最前沿和主战场之一。在该院坚持中西医结合，推动中医药全面参与治疗，搭建一个中医药的保障平台，积极完善中西医结合诊疗方案，对于抗击疫情有着重要作用。 1月29日，经过连续几天病区布局、人员调配、药品保障等准备，国家中医医疗队接管金银潭南一区。这也是疫情发生后第一个接管重病区的中医医疗队。 针对医院中药药品不足的现状，医疗队迅速搭建中药供应保障平台，保证医院药品供应。 “接管病区奠定了中医药防控新型冠状病毒肺炎的基础”，黄璐琦说，当时医疗队主管的32张病床开辟了中医药防控新冠肺炎的战场，使中医药能够与西医同台合作。 病区第一批患者服用中药，第二天就有患者反映：睡眠好转，咳喘、乏力症状减轻。 “寻找中医药疗效的高级别循证证据，有利于优化临床方案并加以推广，提高临床救治率。”黄璐琦介绍说，在医疗队接管金银潭医院病区的同时，中国中医科学院后方科研攻关组也同步成立，配合武汉前方进行临床数据分析，优化治疗方案。科研攻关组紧急设计开发了供医护人员使用的症状信息和舌诊图像采集程序，以及针对方舱医院的患者自述症状采集系统，为全面开展临床研究提供了技术支撑。 金银潭8名患者经中西医结合治疗，2月3日病愈出院后不久，张定宇找到黄璐琦和苗青商量，希望在全院进行中西医结合治疗。 2月14日晚，湖北省新型冠状病毒肺炎疫情防控工作指挥部召开第24场新闻发布会，介绍中医药参与湖北省疫情防控有关情况。 黄璐琦在发布会上介绍说，截至2月14日，中国中医科学院医疗队在金银潭医院负责的床位42张，共收治患者86例，其中重症65例，危重21例，目前治愈的有33人。 他说：“我们把出院的患者进行统计对比，中西医结合在核酸转阴的时间上比纯西药效果显著，在降低发热、咳嗽、乏力、食欲减退、心慌等十个症状上比西医组的改善也更明显，对淋巴细胞中性粒细胞的改善也更明显，且中西医结合的平均住院时间小于西医治疗时间。”

2020年2月25日，在武汉江夏方舱医院，湖南中医药大学第一附属医院医护人员易琴（前）带领新冠肺炎患者习练八段锦。（新华社记者 沈伯韩 摄）（图）

2020年2月26日，在武汉江夏方舱医院院内的“流动应急智能中药房”里，工作人员吴志婷把盛有药方中包含的单味药的药瓶取下来后，逐一扫描确认，准备制药。（新华社记者 沈伯韩 摄）（图）

3月4日，在发布的最新版诊疗方案中，由黄璐琦及团队根据临床不断优化的“化湿败毒方”被列入新冠肺炎重型患者推荐用药处方。 “临床疗效才是评价中医药优势的金标准。”黄璐琦介绍说，截至3月4日，他们这一团队共收治新冠肺炎患者121例，其中中医辨证纯中药治疗出院41例、中西医结合治疗出院32例。所收治新冠肺炎重症患者的病情好转率达到83.61%。 截至3月上旬，中国中医科学院，北京中医药大学和天津、江苏、河南、湖南、陕西等地中医院抽调3300多名医务人员，组成多支国家医疗队驰援湖北和武汉，分别进驻金银潭医院、 湖北省中西医结合医院、雷神山医院等重点院区，接管部分方舱医院。

2020年2月25日，在武汉江夏方舱医院，湖南中医药大学第一附属医院副院长、江夏方舱医院副院长朱莹（左）和湖南中医药大学第一附属医院医生戴飞跃（中）为一名新冠肺炎患者号脉。（新华社记者 沈伯韩 摄）（图）

金银潭医院等几家重点医院中西医结合治疗的成功经验，很快在武汉推广开来。截至2月28日，武汉已开放的16家方舱医院收治的7600多位患者基本做到中医治疗全覆盖；湖北地区中医药参与救治确诊病例57910例，其中治愈出院 21193 例。

延伸阅读： 一位医生的确诊和治疗康复之路

从一名医生，到一名新冠肺炎患者