Chapter 181 - 136: The Very Lucky Genius (Part 2)
And so, the situation had grown dire.
Jiang He took a deep breath, pulling out a paper towel to dry his hands.
’Since I’m the one who flapped my wings to start this storm, I have to be the one to end it.’
He gathered his thoughts.
’What can I do now?’
Lockdowns and contact tracing were matters for the authorities.
From a clinical perspective, the best course of action was to get all frontline critical care doctors in Yangcheng to immediately change their treatment approach.
Traditional treatment protocols for seasonal flu were completely useless against this mutated monster.
’How do I get the word out?’
After a moment’s thought, Jiang He switched to his burner QQ account. He logged on as Zhiyu.
He opened the chat group: [Clinical Applications of Gut Microbiome Research].
Zhiyu: [Colleagues, I’ve compiled a set of recommendations for the early clinical treatment of severe cases of a novel recombinant influenza A variant (suspected high pathogenicity). Please review.]
[1. This strain has an extremely short incubation period (24-48 hours) and a rapid onset. It tests positive on standard rapid antigen tests, but can easily be mistaken for the common seasonal flu.
2. Within 48 hours of onset, patients are highly likely to develop diffuse ground-glass opacities and patchy consolidation in both lungs, progressing to severe ARDS (Acute Respiratory Distress Syndrome).
3. Drug Resistance: The standard recommended dose of oseltamivir is ineffective against this variant during the severe stage. It is recommended to double the dose immediately, or switch to intravenous administration as early as possible.
If a patient’s SpO2 remains below 90% while on a high-flow oxygen mask, forgo non-invasive ventilation. Proceed with immediate tracheal intubation using a lung-protective strategy with low tidal volume (6ml/kg). Prepare for ECMO if necessary.
WARNING: This strain is highly transmissible from person to person with a very high aerosol load. When treating patients presenting with fever and lower respiratory symptoms, strict droplet and contact precautions are mandatory. Making rounds with standard surgical masks is strictly forbidden.]
For the first minute after the message was posted, the group was silent.
Then, in the second minute, the replies started flooding in.
Li Jianping: [Elder Zhi, where is this data from? Has a new strain broken out in the country?]
Ma Weiguo: [Standard-dose oseltamivir is ineffective? Immediate intubation? Elder Zhi, are there any definitive clinical cases to back this up?]
Zhiyu: [Cases have already appeared in Yangcheng. Two severe cases admitted to the Provincial People’s Hospital and City Eighth Hospital last night have confirmed these clinical manifestations. The National Disease Control Center will soon release an announcement with the full genome sequence. Everyone, especially you, Professor Xiaoqing, please forward these treatment recommendations immediately to the emergency, respiratory, and critical care departments of every hospital in Yangcheng.]
Wang Xiaoqing: [Understood, Elder Zhi.]
After sending that message, Jiang He immediately went offline, offering no further explanation.
On the other end, Wang Xiaoqing immediately compiled the recommendations into a document and began distributing it to the department directors of the major hospitals.
However, medicine is a precise science.
Frontline clinicians wouldn’t dare follow a treatment guide that appeared out of nowhere.
Within the public hospital system, unilaterally doubling the oseltamivir dosage and performing an invasive intubation without first following the standard escalation of care would be a serious procedural violation.
If the patient developed complications or died, the Attending Physician would face having their license revoked, or even a serious malpractice lawsuit.
Wang Xiaoqing was keenly aware of this. So, as she circulated the guide, she used some clever phrasing of her own:
"Directors, the standard treatment guidelines for seasonal flu remain the first choice. However, if your department sees a patient who is completely unresponsive to the standard dose of oseltamivir and whose lungs show rapid whitening within 48 hours, you might consider implementing these recommendations."
The key word here was "recommendations."
According to medical regulations, when standard treatments have failed and a patient’s life is at risk...
an Attending Physician is permitted to cite a [Consensus of Domestic Experts] to justify off-label treatments, in accordance with medical ethics and life-saving principles.
And as it turned out, this backup plan had arrived just in the nick of time.
...
「City Eighth Hospital.」
"Director Kang! That high-fever patient just transferred from the ER, his blood oxygen has dropped to 85%! A high-flow mask isn’t bringing it up!"
"He’s been on a standard dose of oseltamivir for a day, and it’s not working at all! The lung consolidation is still spreading!"
Director Kang hurried to the glass wall of the patient’s room and glanced at the data on the monitor.
’The standard protocol has hit a dead end.’
The message from Wang Xiaoqing flashed through his mind.
*Standard-dose oseltamivir is ineffective... If it drops below 90%, forgo non-invasive ventilation... immediate tracheal intubation.*
Director Kang made his decision and gave the order. "Conventional treatment is ineffective. Per the latest expert recommendations, we’re initiating the emergency protocol! Prepare for immediate tracheal intubation! Double the oseltamivir dose!"
"Yes, sir!"
The same scene began to play out in hospitals all across Yangcheng.
...
「Capital City. National Center for Disease Control and Prevention.」
Shu Yuelong strode down the hallway, clutching a stack of freshly printed verification reports.
"Director, the verification results are in. The sequence data from Xu Wenpei is a perfect match."
The director behind the desk shot to his feet and rapidly scanned the report.
"A quadruple reassortant... classical North American swine flu, Eurasian swine flu, and human seasonal flu..."
"Yes. Its genetic profile indicates that it has all the necessary components for efficient human-to-human transmission. The clinical feedback from Yangcheng is abysmal—the severe case rate is absurdly high. Xu Wenpei and Academician Zheng Liyan have already jointly vouched for the data’s authenticity to the Ministry."
The director listened, nodded, and hesitated no longer.
He immediately picked up the red hotline on his desk.
"Sir, the National Center for Disease Control’s virology institute has completed data verification. We’ve confirmed the sample from Yangcheng is a novel, quadruple-reassortant Influenza A H1N1 variant. The situation is extremely critical. We recommend an immediate, large-scale epidemiological investigation of the entire Yangcheng region!"