赋予团队合作新的意义——来自西班牙马德里
本文译自：ESC官网
华中科技大学同济医学院附属协和医院 程翔 翻译并供稿
关于COVID-19，有两件事令人震惊。首先是感染传播的速度。每两天左右，我们的病人数量就会增加一倍。现在我们并不真正在乎谁是阳性，因为我们假设所有患者都是阳性。今天，有2名梗死的患者被收治。他们两个都是COVID阳性。
第二件事是心脏病部门工作人员的团结。我们有120名医院工作人员（包括心脏病医生）被隔离，其中部分被感染。实际上，已经有一些心脏病专家被确诊患有肺炎和呼吸系统疾病。但是，您仍然可以看到团结以及医生们希望如何帮助他人。即使没有足够的资源，她们仍然可以继续工作。
我们医院的急诊室通常每天接待约800名患者。现在，它可以处理COVID患者，因此您需要重新调整急诊科的位置，并尽量不要接收额外的患者。周日，有100名新的COVID嫌疑人来到急诊室。星期一是150例COVID患者，而星期二是200。目前，大多数ICU患者都患有COVID-19。
这种感染可能突然出现，以至于您可能发现自己没有为所有在医院工作的人提供足够的保护措施。这不仅包括口罩，还包括手套，外套和眼镜。感染不是通过吸入而是通过飞沫传播，因此保护眼睛和面部的方法非常重要。但是，有些医院的库存可能不足，这可能会发生。在您生活中的这些时刻，您需要具有想象力的人。一位护士发明了一种使用塑料文件夹制作防护面罩的方法，医院工作人员戴着她的发明直到物资到达。
我们会尽力隔离COVID患者到达医院的那一刻，以免与未感染的患者混在一起。这意味着急诊科内有一个专用的COVID急诊区，心脏病科内有一个COVID心脏病科区域，依此类推。通常，心脏病患者会在急诊室待2至3个小时，以进行心电图，临床检查，分诊…肌钙蛋白等检查。但是现在我们想直接将他们带到心脏病部门，因为我们不希望他们被感染冠状病毒。我们对他们进行治疗，如果可行的话将他们出院，然后在家里通过电话会议跟踪他们。
我们的心脏病科每年进行51,000次门诊就诊。在过去的两个星期中，每次门诊都通过与心脏病专家的电话会议进行。在极端情况下，患者只有在电话会议后才能进入医院-大约每天两名患者。我们将其降至最低，因为我们需要减少感染的传播。但也值得注意的是，这些天大多数患者都不想去医院。
心脏病科的非COVID区域每天都在变得越来越小。该部门的每个人都自愿在COVID区域轮班。我们有32位高级员工，每周我都会思考轮换谁来分配COVID区域或电话会议工作，因为现在压力更大。您每天在病房中看不到超过6名COVID患者，而我们习惯于每天看12名心脏病患者。要看COVID患者，您需要以其他方式打扮自己，穿上外套，专用口罩，眼镜和手套。
在重症监护室，我们的麻醉师将COVID患者俯卧，因为他们无法呼吸。我们有需要通气帮助的患者。我告诉我的部门，我恐怕会感染我的妻子，孩子……但是您永远都不要基于恐惧做出决定。相反，恐惧会使您变得更好-尊重疾病，感染和病毒。我们都在与这种疾病作斗争。
由于COVID-19，我们的心脏病学试验也发生了变化。所有研究人员和研究护士都是在家而不是在医院工作。我们没有在任何一项试验中招募任何新患者，因为我们不知道他们是否会被感染并且需要接受重症监护。我不能向其他人推荐我们的方法，但这就是我们所做的。对于研究护士的面对面拜访，我们已要求两家公司允许将其更改为远程监护拜访。
我认为在COVID之后的世界将有所不同-医院，公司，ESC会议-因为我们都已经非常快地转向数字化了。这是每个人都打算做的事情，但是我们被迫立即实施它。没有别的办法了。在公司中，主要用于千禧一代的远程工作现在已经在老年人那里。在我们医院，我们进行了一项名为HAZLO的心脏康复试验计划，现在所有患者都在家中进行。如果考虑到这一点，为什么低危患者应该去医院康复呢？我认为在COVID之后，只有高危患者才能来医院康复。在COVID之前我们在考虑做这件事。但现在它只是简单地实现了。
我为能成为心脏病专家和医生而感到自豪。世界各地的ESC心脏病学同事正在联系：他们给您发送电子邮件，您最近好吗，这是我的经验。ESC帮助我们建立了这个网络，以共享问题并相互学习。我从意大利同事以及比利时，葡萄牙，法国和中国的同事那里学到了很多东西。这似乎是一件小事，但是来自意大利的Luigi Badano告诉我，他从医院回家后，就把鞋子和衣服留在外面，直接去洗个澡。我现在这样做了，并已通知我的部门去做。其他人告诉我，他们的亲戚，妻子或父母被感染。我们分享我们的关注和想法。
另一个有用的事情是与澳大利亚交流协议和待遇。我们对该病毒了解甚少。但似乎我们在全球范围内为患者提供的治疗方法几乎相同。大约有10种药物，包括白介素6抗体，氯喹和抗病毒药。这是一种呼吸系统疾病，主要是肺炎。他们可能有通常的心脏感染表现，意味着心动过速，血压问题，甚至心力衰竭。
在西班牙，我们已经参与了禽流感和埃博拉病毒的治疗，但是COVID-19的感染率与感染前的难易程度是前所未有的。当我从医院开车回家时，马德里是一个幽灵城市。这是一个奇怪的情况。我们在一起，没有疆界。我看到的团结真的非常出色。谨向所有人致以最良好的祝愿，知道其中一些人已经在他们的亲密家庭中受苦。如果需要帮助，请给我打电话或发电子邮件。
原文：
Giving Teamwork a New Meaning – Madrid, Spain
Prof. Jose Luis Zamorano , FESC
Head of Cardiology
University Hospital Ramon y Cajal
ESC Vice President
Two things are striking about COVID-19. First is how quickly the infection spreads. Every two days or so we double the number of patients. Now we are not really concerned about who is positive because we assume all patients are positive. Today two patients with infarction were admitted. Both of them were COVID positive.
The second striking thing is the solidarity of staff in the cardiology department. We have 120 hospital staff, including cardiologists, in quarantine, some with infections. In fact, some cardiologists have already been admitted with pneumonia and respiratory impairment. But still, you see the solidarity and how the doctors want to help others. Even with insufficient resources they continue to work.
Our hospital emergency room normally receives about 800 patients per day. Now it deals with COVID patients, so you need to readapt the emergency department and try not to receive extra ones. On Sunday, 100 new COVIDs suspicions came to the emergency room. On Monday it is 150 COVID patients and on Tuesday 200. Most ICU patients currently have COVID-19.
This infection can appear so suddenly that you may find yourself without adequate protective measures for all the people working at the hospital. This not only includes masks but also gloves, coats and glasses. The infection spreads not by inhalation, but via droplets, so the way you protect your eyes and face is very important. But it may happen that some hospitals don’t have a large enough stockpile. At these moments in your life you need people with imagination. A nurse invented a way to make a protective face covering using a plastic folder, and hospital staff were wearing her invention until supplies arrived.
We do our best to segregate COVID patients the moment they arrive at the hospital so that they don’t mix with uninfected patients. That means a dedicated COVID emergency area within the emergency department, a COVID cardiology area inside the cardiology department, and so on. Normally, cardiology patients stay in the emergency department for two to three hours for an ECG, clinical exam, triage…troponins, etc. But now we want to take them directly to the cardiology department straightaway because we don’t want them to be infected with the coronavirus. We treat them, discharge them if feasible, and follow them at home using teleconferencing.
Our cardiology department has been doing 51,000 outpatient visits per year. For the last two weeks, every single outpatient visit is done by teleconference with a cardiologist. Patients only come into the hospital after their teleconference in extreme situations – around two patients per day. We keep this to a minimum because we need to cut the spread of infection. But it’s also worth noting, most patients don’t want to come to the hospital these days.
The non-COVID area in the cardiology department gets smaller and smaller every day. Everyone in the department has volunteered to do shifts in the COVID area. We have 32 senior staff and every week I will alternate who is assigned to the COVID area or to the teleconferencing work because it’s much more stressful now. You cannot see more than six COVID patients on the ward per day, whereas we are used to seeing 12 cardiac patients in a day. To see COVID patients you need to dress yourself in a different way, with a coat, special mask, glasses, gloves.
At the intensive care unit, our anaesthesiologist puts COVID patients in a prone position because they cannot breathe. And we have patients that require ventilatory assistance. I told my department that I am afraid I will infect my wife, my kids... But you should never take decisions based on fear. Instead, fear is something that makes you better – to respect the disease, the infection, and the virus. We are all together fighting this disease
Our cardiology trials have also changed as a result of COVID-19. All of the research fellows and the research nurses work from home instead of at the hospital. We have not enrolled any new patients in any single trial because we don’t know if they will become infected and need to be in intensive care. I cannot recommend our approach to others, but this is what we did. For face-to-face visits by research nurses, we have asked the companies for permission to change these to telemonitoring visits.
I think that the world is going to be different post-COVID – hospitals, companies, ESC meetings – because we have all moved so quickly to digital. It was what everybody was planning to do, but we have been forced to implement it immediately. There is no other way. In companies, the remote work that was mainly for millennials is now there for older people. In our hospital, we did a pilot cardiac rehabilitation programme called HAZLO and now all patients do it at home. If you think about that, why should low risk patients come to the hospital for rehabilitation? I think that post-COVID, only high-risk patients will come to the hospital for rehabilitation. We were thinking pre- COVID of doing this. But now it is simply implemented
I’m so proud of being a cardiologist and a doctor. ESC cardiology colleagues around the world are in contact: they send you an email, how are you doing, this is my experience. The ESC has helped us to establish this network to share problems and learn from each other. I have learned a lot from Italian colleagues, and colleagues in Belgium, Portugal, France, and China. It seems like a minor thing, but Luigi Badano from Italy told me that when he gets home from the hospital, he leaves his shoes and clothes outside and goes straight to the shower. I do that now and have told my department to do it. Others told me their relatives are infected, wife or parents. We share our concerns and ideas.
Another helpful thing was to exchange protocols and treatments with Australia. We don’t know a lot about this virus. But it seems that the treatment we are giving patients is pretty much the same worldwide. Around 10 drugs including interleukin-6 antibodies, chloroquine, and antivirals. This is a respiratory disease, mainly pneumonia. And they may have the usual cardiac manifestations of an infection, meaning tachycardia, blood pressure problems or even heart failure.
In Spain, we have been involved treating Avian flu and Ebola, but the infection rate with COVID-19 is like nothing I’ve seen before related to how easy it is to be infected. When I drive home from the hospital, Madrid is a ghost city. It’s a strange situation. We are all in this together, no frontiers. The solidarity I am seeing is really outstanding. My best wishes to all of you, aware that some of you are already suffering in their close families. If I can be of help, just give me a call or email.