63 Day treatment of non-English patients

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Receiving “Patient 91”, laboratory personnel of the Hospital of Tropical Diseases HO Chi Minh City warns “careful doctor” due to the virus load of patients who are many times more than other patients.

“This means a high-risk patient spreads to the medical team of doctors who treat him”, Dr. Nguyen Thanh Phong, dean of Infection D, hospital for Tropical Diseases in HCMC, recall discussions with colleagues. Early in the morning 18/3, the doctors first held the test result of the patient’s 43-year-old British pilots.

This is the first Covid-19 patient to relate to the Buddha Bar & Grill in HCMC. Several days later, there were many patients involved in this bar. At the same time, on 23/3, men of the 29-year-old doctors of central tropical Diseases in Hanoi determined nCoV positive, becoming the first medical staff to be infected in the process of working. This show shows that the high risk of doctors with cross-contamination from the patient’s Covid-19 is in treatment.

As head of the Department of direct treatment of nCoV patients, Phong doctors are not worried about the possibility of cross-contamination for the medical team in the faculty. Especially as they have just received “patient 91” with higher than normal virus load.

“We do not waver mentally, but can not be no more vigilant,” Dr. Phong said. Every day he reminds medical staff to be careful of personal protection, infection control, because “a person who does not follow the process is an influence on the rest of the collective.”

South Africa pilots weigh 100 kg, 1.81 m high, BMI of more than 30. “Young patients, no underlying disease but obesity is a risk of Covid-19, can not be subjective,” Doctor Phong analyzes the analysis when new patients hospitalized.

At the time, the Covid-19 was still very refreshing. There are many things about epidemiology, in terms of treatment related to the new disease, the researchers of the world are Loay-Hoay explained. However, the initial judgment of doctors Phong with 23 years of experience in the field of infectious, about the patient’s condition of the pilots, was not wrong.

When entering the institute, the patient remains awake, walking healthy, not eating Vietnamese food. The hospital has to contact his work-Vietnam Airlines-support to order food separately. A few days after patients with increased respiratory failure, assisted respiratory breathing with nasal oxygen. From 25/3 on, he must switch to oxygen breathing through a mask. By the day 5/4 must breathe invasive machines and from 6/4 to interfere with ECMO in the room negative pressure.

The collective doctor experienced a series of days of time to save the patient, “there is no longer definition of time”.

“Sometimes when I don’t notice what today is, the day has been, because almost everyone has to do overtime, take the hospital on a regular basis, no matter the weekend, the Night”, Dr. Phong shared. With doctors, it is the days of “very extreme, very overload, very tired”, even “to sleep also dreaming to see the treatment regimen for South pilots”.

Dr. Nguyen Van Vinh Chau, director of Hospital for Tropical Diseases HO Chi Minh City, said during the treatment, the immune system of patients responded excessively when attacked by nCoV. The body secreted many cytokines against the body itself, which influenced the organ cover. The patient’s lungs have just been traumatized by nCoV, both due to the body that secreted anti-inflammatory effects.

An online chat group is established, gathering the leading experts in resuscitation, infectious, hematologist, respiratory, clinical Microbiology, Clinical Pharmacy,… Focus on monitoring and diagnosis of “patient 91”. Experts from the Hospital of Tropical Diseases, Cho Ray such as associate Professor Pham Thi Ngoc Thao, Dr. Phan Thi Xuan, Dr. Nguyen Van Minh, Dr. Nguyen Thanh Truong… The patient’s situation is updated, discussed continuously in 24/7. Although not directly caring for patients, they are quiet people who make the decision to survive for the South pilot.

Dr. Nguyen Thanh Phong, head of infection D, hospital for Tropical Diseases HCMC prepares the protective outfit in the patient care room Covid-19. Photo: Huu Khoa.

Dr. Nguyen Thanh Phong, head of infection D, hospital for Tropical Diseases HO Chi Minh City, preparing the protective costume into the care Room “patient 91”. Photo: Huu Khoa.

Patients with ECMO treatment Heparin anticoagulants must be taken. However, he has had a coagulation disorder due to Covid-19, while adding a HIT-thrombocytopenia syndrome caused by an allergy to heparin, a high risk of bleeding, life threatening. The adjustment, the choice of drugs for him is difficult.

Doctors diagnosed, deciding to pass through intravenous anticoagulants. Medicines that have not been used in Vietnam, the Ministry of Health must make procedures for import from Germany. For more than 10 days of drug waiting from Germany, specialists must take temporary medicines Xarelto has never been in the regimens. This is the drug for treatment and prevention of thrombosis, with little effect on blood clotting disorders.

When switching from infection D to the negative pressure room of emergency resuscitation Department, the patient was Doctor Duong Thi Bich thuy, ha Thi Hai Duong, Nguyen Van Thanh was, Le Thanh Xuan and 16 nursing in charge of the day and night. Cho Ray Hospital also sent doctors NGO Viet Anh, Quoc Minh Quan, Tran Hoang An, Huynh Thi Thu Hien to the hospital for tropical treatment.

The patient’s lungs are severely dense. First CT scan yesterday 12/5 saw the condition of dense fibrosis of two lungs, only about 10% of active lung area, the patient will die if they leave the life support machine. The Ministry of Health specifies Lung transplantation.

By day 18/5, patients CT the second scan, identifying the lungs with signs of recovery 10-20%. On 20/5, the Ministry of Health confirmed the patient was treated out of nCoV. However, the patient still has a pleural infection, so it is not possible to transplant and continue medical treatment to limit the infection condition.

Mr. Luong Ngoc Khue, director of health care management, said the unified Board of medical expertise transferred patients to intensive treatment center in intensive resuscitation at Cho Ray Hospital to continue treatment.

Mr. Khue reviews the hospital for tropical Diseases in HCMC “has completed the mission to treat the patients pilots”. Total patients treated Covid-19 two months on, at a tropical hospital.

Behind the Mission It was the days of forgetting to sleep, the faces of a dedicated wound of the medical staff. “Every time you leave the hospital, take off the protective class outside of the new, see the clothes inside the drenched self, can squeeze the water,” Dr. Phong said.

Despite experiencing large transactions such as H1N1, SARS, MERS… But with physicians, the fight with Covid-19 delivers “too many first-time experiences in life”. Both the collective curious treatment, just wait for the monitoring, fears the incidents, complications in the disease of the course of unpredictable performance. Patients repeatedly opposite critical situations, such as pneumothorax, hemorrhage when open tracheal ventilation…

“Though many struggles but we have not always strenuous, discouraged, willing to be in the heart of the frontline who has the opportunity to contact special illness,” Dr. Phong said. This is also the first time in Vietnam to treat severely nCoV patients with unprecedented regimens in the world, leaving many lessons learned in “the war against very new enemies”.

Many friends call to ask the Doctor Phong, tell the story to buy fish market, also hear the little trade discussed “patient 91”, trust Vietnamese doctor to save South Africa.

The foreign press in the view of Vietnam is trying hard to save the patient’s pilots, praising the “strong hands” of the government.

Airline Reuters Insisting in efforts to save British citizen Network, Vietnam “does not regret anything to retain life for man 43 years old”. The government received widespread support by the people in the nCoV containment campaign. Reuters Leads people wishing to donate lung to the pilot patient, including a 70-year-old volunteer veteran for the lungs.

Inform New York Times In accordance with Vietnam’s efforts to treat pilots ‘ patients: “Physicians in Vietnam are hoping for a lung transplant that can save British pilots, so he does not become the first fatality in this Southeast Asian country”.

Le Phuong