Rural ICUs prepare for surge in cases

Lower-level hospitals, clinics told to ready equipment, personnel for potential wave

China is shoring up intensive care facilities in rural areas and strengthening the training of grassroots medical staff to improve capacity before possible surges in cases of COVID-19, the top health authority said.

The National Health Commission said in a notice released on Sunday that major county-level hospitals should upgrade their intensive care units and increase the number of ICU beds to no less than 4 percent of total beds by the end of this month.

In addition, other departments should expand their critical care capacity by overhauling electricity and oxygen supply systems, and adding respirators, monitors and other ICU equipment.

Each ICU bed should be equipped with one doctor and 2.5 to 3 nurses on an 8-hour to 12-hour shift. Another 20 to 30 percent of full capacity medical staff should also be on standby as backup, the notice said.

"Paired assistance hospitals in urban areas should also send ICU specialists to county-level institutions to provide training for ICU and internal medicine medical staff, as well as pediatricians and emergency care workers," it said, adding that buffer wards in relatively isolated areas should be prepared.

Fever departments in rural clinics should also be strengthened by the end of this month to guarantee that they can be put into operation within 24 hours. By the end of March, about 90 percent of rural clinics should have a fever department, it said.

Rural clinics should also stock up on traditional Chinese medicine, fever and cough medications, and antigen tests to cover about 15 to 20 percent of the local population, it said.

Severe and critical patients whose conditions are beyond the local hospital's treatment capability should be promptly transferred to larger hospitals in urban areas.

Transfer protocols and expedited channels among different levels of hospitals should be clarified beforehand and hospitals must not reject COVID-19 patients for any reason.

The notice was released as China ramps up its medical systems to brace for a potential wave of COVID-19 infections following the relaxing of restrictions announced last week.

Jiao Yahui, director of the commission's bureau of medical administration, said during a news conference on Friday that reinforcing medical systems is the first and foremost task and a crucial part of the work to prepare for future outbreaks.

"Given a shortage of personnel at the grassroots level and their relatively scarce resources, we have required high-level hospitals to provide technical guidance, staff support and virtual consultations for them," she said.

Chen Xi, an associate professor of public health and economics at Yale University, said during an interview with China Newsweek that there are a number of left-behind elderly people in small counties and the countryside, and coupled with lagging healthcare systems, rural areas could face great challenges amid a nationwide outbreak.