2020年4月29日星期三

The Impact of the COVID-19 Epidemic on China's Tourism Industry and the ...







The Impact of the COVID-19 Epidemic on
China's Tourism Industry and the Countermeasures



The tourism industry is a highly
environmentally sensitive industry. This sensitivity manifests itself in being
very susceptible to shocks and impacts from domestic and foreign emergencies,
which can lead to severe recessions and landslides, and a tourism crisis.
According to the academic classification of crisis events, the national COVID-19
pneumonia incident belongs to "epidemic infectious diseases", and the first-level classification is "natural and man-made disasters".
Almost all segments in the tourism industry involve crowd gathering and
socialization. Unlike other crisis events that only affect a specific segment,
for example, international relations only affect the flow of entry and exit
passengers. Constitute a comprehensive shock.



1. The status of China's tourism industry
in the national economy


China's tourism industry plays an important
role in the national economy. According to statistics from the National Bureau
of Statistics, from 2014 to 2018, the overall contribution of tourism to GDP
accounted for 10.39%, 10.2%, 11.0%, and 11.04% of GDP, respectively. In 2018,
the comprehensive contribution of China's tourism industry to China's GDP was
9.94 trillion yuan, the comprehensive contribution to global GDP ranked second
in the world, and the number of jobs contributed by tourism industry was 79.91
million, ranking first in the world.

It can be seen that China's tourism
industry plays an important role in the national economy and even the world
economy. The more important tourism is to the national economy, the more the
national economy is affected by it

Impact of the epidemic on China's tourism
industry


The outbreak has had the most severe impact
on the tourism industry, far exceeding the impact of the 2003 SARS outbreak.
Not only because of the continuing uncertainty of this epidemic but also
because of the changes in China's economic structure over the past 17 years,
consumption, especially tourism consumption, has occupied a higher proportion,
and the economic cycle is also in a different position, so the impact on
tourism is not SARS The impact of the period is comparable. And the epidemic
happened just during the Spring Festival, and the resumed work of the tourism
companies involved was postponed. The direct and indirect impact on tourism the industry was reflected in the Golden Week, the first quarter, and even the whole
year.

1.Short-term direct impact
1) Impact on the Spring Festival Tourism
Golden Week: Major organizations predict that the number of tourists during the
Spring Festival in 2020 will exceed 450 million, an increase of 8% compared to
the Spring Festival in 2019, and market size of approximately 550 billion
yuan. Due to the sudden outbreak of the epidemic, the predicted value instantly
disappeared. Although there are no comprehensive statistics on the tourism
industry during the Golden Week, its impact can be seen from the following
data:
(1) Traffic data: The number of passengers
trips in the transportation channel dropped sharply: According to data from the
Ministry of Transport, from January 10 to 31, the country's railways, roads,
waterways and civil aviation sent a total of 1.258 billion passengers, a
decrease of 20.6 over the same period last year. %. Among them, the number of
passengers sent by railway decreased by 10.7%; the number of passengers sent by
road decreased by 22.1%; the number of passengers sent by water decreased by
34.0%; and the number of passengers sent by civil aviation decreased by 14.4%.
(2) Number of people traveling during
Golden Week (New Year's Eve-New Year's Day New Year): If you look at the data
during this year's Spring Festival Golden Week, the decline will be even
greater. The seven days from New Year's Eve to the sixth day of the Chinese New The year were originally the week with the largest number of travelers during the
Spring Festival. The 2019 Chinese New Year Golden Week (February 4 to February
10) had a total of 421 million seven-day travelers. From January 24 to January
30, the total number of trips across the country was only 152 million, a drop
of 63.9% year-on-year.


Subsequent impact

From the perspective of tourism supply, the
tourism industry as a whole has been affected. At present, all people in the
travel agency industry are unemployed, travel agencies are losing money, small
and medium travel agencies are facing closures and closures; hotels have been
suspended.
In the short term, the leasing rate has
fallen sharply, and business income has been hit hard. Many companies are even
in a basically closed state; flights have been canceled or grounded, and
inbound tourism has been severely damaged. Scenic areas have also been required
to be completely closed, unable to generate revenue, and they may We cannot
immediately welcome a rebound in passenger flow; the market value of stocks in
the tourism sector has fallen sharply, stocks in sub-sectors such as scenic
spots, travel agencies, and restaurants have fallen sharply; wages for
employees in the tourism industry have shrunk sharply.
From the demand side, due to the severe situation of the epidemic, the willingness of tourists to travel has decreased
sharply. Actually in culture and tourism
Before the notice of the General Office of
the Ministry of Tourism was issued, many consumers had taken the initiative to
cancel their travel plans during and after the Spring Festival to avoid the crowd
gathering and outing activities.
Therefore, at a critical juncture of the
people's fight against the epidemic, the domestic tourism industry is facing an
empty window period, or even an unprecedented industry crisis, and the entire
industry chain will suffer huge losses.

2. Long-term indirect effects

The indirect impact of the epidemic on the tourism industry has been reflected for a long time, and the lowest performance
of the tourism industry appeared in the two quarters after the outbreak.
Concentrated performance is that the epidemic has a long-lasting impact on the
performance of the tourism industry and has a certain lag, which shows that
consumers' willingness to travel is difficult to recover in the short term.
Outbound and inbound tourism may experience a downturn for a period of time,
and the degree of impact depends on the speed of epidemic control and the
implementation of overseas control measures and tourism revitalization plans.
The long-term indirect impact is specifically manifested in the following two
aspects:
1) The tourism market has started to
shrink, and conferences and exhibitions have been postponed or canceled.
2) Changes in tourism psychology, public
fear and anxiety have shaken consumer confidence and willingness to travel to a
certain extent.

Challenges facing the industry

On the whole, the epidemic will bring
challenges to China's tourism industry, participants in all links of the industry
chain, and international tourism cooperation. It can be summarized as income
loss, tackling cash flow difficulties, handling aftercare, and close
international cooperation.

1.      收入损失

1.Loss of income

The domestic tourism market mainly relies
on three periods to make money: the Spring Festival holiday, the summer holiday
and the National Day holiday. Due to the epidemic situation, tourism revenue
during the Spring Festival holiday has been greatly reduced, which is
equivalent to a direct loss of 1/3 of the national tourism industry. According
to the analysis of the 21st Century Business Herald by Wu Bihu, director of the
Tourism Research and Planning Center of Peking University, "If you
estimate based on optimism that the three-month closing period will be reduced
by 60% and the three-month recovery period will be reduced by 30%, the national
tourism industry is expected to lose close to 3 this year. Trillion yuan.
"

2.Difficult cash flow
For tourism companies, in addition to the
loss of business income, the cash flow gap is also a major challenge caused by
the epidemic. The cancellation of orders within a short period of time has made
the cash flow of upstream suppliers, such as airlines, travel product
suppliers, midstream distributors, such as travel agencies, online travel
platforms, agents, etc., and the entire industry very tight. If the strength is
not enough to cope with the difficulties, it may choose to lay off staff or
reduce wages in the early stage. However, if the domestic tourism market
continues to be depressed for more than 3 months, it means the risk of capital
chain breakage. Facing a broken capital chain and bankruptcy.

Aftercare work
After the epidemic, massive cancellations
made all links face huge processing pressures. For example, online travel
platforms and airlines need to rebuild the free refund system in a short period
of time, it is difficult to carry huge orders in the midstream, the upstream
and downstream conflicts, and travel contracts. Disputes, international cooperation,
etc.
The epidemic situation constitutes force
majeure. Due to the adjustment of tourist itineraries, especially for tour
companies that have refunded groups and fees, multiple industries, multiple
fields, and even multiple countries or regions are involved. There will
certainly be discrepancies in the understanding of related laws and
negotiations to resolve subsequent issues. Therefore, the contradictions and
contract disputes that may be caused in the future are potential derivative
problems.
In addition, tourism is naturally
international, and affected by the epidemic, a great deal of bilateral and
multilateral cooperation is required. For security reasons, many countries or
regions around the world have adopted immigration management measures for
Chinese tourists and information such as international flights is also subject
to change. How to ensure the safety and health of millions of inbound and
outbound tourists, and to prevent the spread of the epidemic, requires close
interaction in various fields of the visa, aviation, immigration, customs,
public security and tourism sectors, and a great deal of bilateral and
multilateral cooperation.

Coping strategies
   In response to the impact
and the challenge of the epidemic on the tourism industry, China's tourism industry
should take measures from the following aspects: 1. Government and tourism
industry
1) Do a good job of prevention and
treatment in the tourism industry
Continue to strengthen the command and
dispatch of the entire industry, tourism administrative departments at all
levels should set up special leading groups to respond to the epidemic, adjust
their work deployment in a timely manner, and do a good job of prevention and
control in the tourism industry. For example, each tourism business unit is
required to strictly perform cleaning and disinfection, do scientific
prevention and control, and ensure that domestic and foreign tourists and
tourism industry staff are not infected at all aspects of the tourism reception.
And specially formed a supervision and inspection team, sent to various places
to check the implementation. We attach great importance to the health and
safety of inbound tourists, and work with civil aviation, customs and other
relevant departments to prevent and control them.
2) Special subsidies and support for
tourism companies
Under the influence of the epidemic, the tourism industry has suffered heavy losses, coupled with some free refund
policies and many enterprises have caused huge losses and difficulties in cash
turnover. The government should help the tourism industry recover as soon as
possible to avoid the collapse and stability of a large number of small and
medium-sized tourism enterprises. Tourism employment, special grants for
tourism, increased tourism development funds, and even loan programs.
3) Develop a tourism revitalization plan
The government should actively formulate a
plan for the promotion of the tourism industry. The prevention and marketing of
the tourism industry and marketing and promotion should be two-pronged so
that people's lives can return to normal conditions as soon as possible. Once
the epidemic is over, a tourism revitalization plan will be implemented
quickly, from restoring domestic tourism confidence to global publicity and
attracting inbound tourists to revive China's tourism economy.

It is recommended that tourism
administrations, such as the National Tourism Administration, formulate the following
overall revitalization plan for the tourism industry:
(1) "Safe China" plan
Once the epidemic is under control, the
National Tourism Administration will work with other related industries such as
civil aviation, restaurants, travel agencies, etc. to quickly launch this
tourism promotion plan to eliminate the psychological impact of the epidemic on
domestic and foreign tourists and reshape China's safe tourist destination
image of. Infectious virus is a safety hazard, which will have a long-term impact
on people's psychology. After the crisis, people will also have long-term
sequelae in their hearts. On the one hand, the government should urge tourism
enterprises to implement all precautionary measures to provide a safe tourism
environment. On the other hand, the government should restore public confidence
and stimulate tourism consumption through transparent information distribution
channels and communication methods. For inbound tourism, it is also possible to
improve the tourism security protection scheme. For example, in the Chinese
tourism stage, if tourists are infected with local infectious diseases locally,
they can get corresponding medical compensation. It is hoped that the
protection scheme will build the confidence of tourists in China.


(2) "Enjoy going out" plan
Introduce and implement the plan to encourage
citizens to go outdoors and go nationwide, thereby restoring domestic tourism.
After the epidemic, we must increase media propaganda, strengthen the
construction of high-quality tourism products, and restore and stimulate
domestic tourism consumption. After the epidemic, the government can implement
measures such as free or half-price attractions, or cooperate with travel
agencies, online travel platforms, and hotels to provide consumer subsidies.
While stimulating tourism consumption, it will also promote travel agencies,
transportation, catering, and other industries Revenue.

(3) "Beautiful China" plan
Compared to reviving the domestic tourism
industry, stimulating inbound tourism is more difficult. The panic caused by
the epidemic worldwide can be highlighted by restrictions on flights to and
from China from various countries, charter flights to Wuhan for the
repatriation of citizens of their own country, and even the beatings of Chinese
students in Germany. In the short term, residents' impressions of the epidemic
in China will not disappear so easily. After the revival of tourism in China,
inbound tourists can be targeted to stimulate inbound tourism.

First of all, international tourism
promotion must tell the story of China and link a number of Chinese tourism
features and events in the global tourism promotion plan to promote the
recovery of inbound tourism. Secondly, tourism companies can provide: more
customized itinerary arrangements to increase their itinerary satisfaction;
more convenient services, including air tickets, restaurants, attractions,
restaurants, visas, tax refund procedures, etc .; more attractive prices, etc.
Attract tourists from inbound tourism. The National Tourism Administration may
draw up a set of incentives to encourage tourism companies to promote the
"Beautiful China" tourism plan. Relevant companies in the tourism
industry chain can cooperate and jointly launch promotional and incentive
travel programs for major source countries, such as preferential flight and
travel package itineraries, and various hotel, restaurant, and ticket price
discounts. It can also target non-tourist travelers to attract more tourists
to China to promote themed tourism, exhibitions, medical treatments, study
tours, education and other themed tourism, and package promotions according to
the characteristics of each market to meet the needs of tourists in different
market segments.

(4) Strengthening tourism regional
cooperation
Each tourist area in the country opens its
own market removes obstacles to tourism development and creates barrier-free
tourist areas without policy barriers, market barriers, traffic barriers, and
service barriers, providing tourists with a loose policy, smooth traffic, and
mutual benefit A mutually beneficial and satisfying tourism environment.
Further expansion in the intensity, depth, and breadth of regional tourism
cooperation has made the cooperation subjects more active, the cooperation
levels have been more abundant, the cooperation content has been more
comprehensive, and a win-win situation has been reached.

 For tourism companies
In addition to actively controlling the
epidemic situation in accordance with national and industry requirements,
tourism enterprises should also actively carry out the following self-rescue
activities:
1) Adjust the focus of work in the short
term and strengthen self-construction
The epidemic situation cannot be recovered
in a short period of time. During this period, tourism companies are bound to
bear losses on their own. Tourism enterprises should take emergency measures to
reduce expenditures, strengthen their own construction, strengthen internally
management, do a good job of training tourism professionals, enhance
competitiveness, and build brands to self-improve while resting, to lay the
foundation for the next stage of development To "turn disadvantages into
advantages". For travel agencies, management and personnel training can be
strengthened, costs can be reduced, and new routes and new product development
can be discussed. For the hotel and hotel industry, due to the large scale of
the industry, it is possible to arrange employee vacations and conduct business
training for employees when it is difficult at present to Reduce costs. At the
same time, you can also develop catering and takeaway businesses to increase
income. You can also reduce house prices to attract customers at low prices.
For scenic spots, you can strengthen scenic spot construction, new product
development, and scenic area management.

 Cost control
For an enterprise, the security of funds is basic to ensure its survival in the market. Even with government support
and assistance, the enterprise itself must digest the cost losses caused by the
epidemic. Tourism companies of all sizes must evaluate and Decisions, including
layoffs, business integration, corporate integration, and other decisions.

 Pre-order / low price promotion
Develop a pre-order / low-price promotion
strategy in advance. After the epidemic situation recovers, tourism companies
can better control costs through pre-purchase or low-price promotions and other
programs, and attract consumer spending, including booking and promotion of
hotels, transportation, and scenic spots.

we hope my article has some help for you.




2020年4月28日星期二

How do we allocate our assets

Cnmoulding believes that the economy is in a downturn and there is no way to avoid a big boom. Intuitively:" This will be an interesting event because we have a wealth of infrastructure. We have reached the peak of the rich world, and it is falling rapidly, and I am using the metaphor of $8000 SUV to get food from the government's food center. We will be in life without good things, which will become the norm. We're bound to get into trouble.

 A few years ago, we predicted that interest rates would fall. The ten-year national record is now close to record lows. Do you think interest rates are lower? Yes. I think we need to lower interest rates until people start to smell hyperinflation. You know I've been a generalist for years. I think in the face of vicious expansion, we must cross the chain. This doesn't require high-interest rates, because wherever we are, we all carry heavy debt, even 2%. Akerman says ten years of national market yields have reached ". 0.25%
 Is real estate safe? Or:" What do you do when the property sinks? Would you like to send the mortgage check to the landlord on behalf of the landlord? When you think real estate is open, it will be traded at the February price. we will get a 25% reduction. Because we have to deal with a lot of termination contracts. lowest, real estate will fall by 25%, which will bring us close to 2007-2008, and the national real estate lost its value by about 33%. I have said for a long time that real estate will fall by 70%, while the second house may fall by 90%. But I think next time we'll reduce the value of the whole house by 70%.

 It is a common phenomenon that governments around the world are now over-spending their currencies and that "governments are now paying for a lot of debt ". So he likes short-term cash and long-term gold. We think:" What do we use to buy things now? We almost use credit cards or cash. I don't think the financial system will survive the collapse of the derivatives market. You don't know when - like no one knows coronavirus is coming.
 It's better to invest in gold because "gold will remain valuable even in trading, trading and breaking contracts ".
 Finally, I still think that inflation is a bad thing after the deep penetration of the goods. I have to admit that the dollar was printed indefinitely and may have to. Unless the state collapses are declared, the result is bad inflation. financial market solutions.

2020年4月27日星期一

I'm ready to live with this country

From "protect six" to "six guarantees", it is to ensure the employment of the residents, the basic livelihood of the people, the main body of the people, the food and energy security, the stability of the supply chain of the industrial chain and the operation of the basic layer. This shows that this year is really bad, the original guaranteed growth has become stable. Real-world
 Now into who is worse than who. True relief is self-help, enterprises must first find ways to save themselves.

 A sudden outbreak of the new crown is making many small and medium-sized enterprises experience the experience and test of survival. The survival and development of small and medium-sized enterprises have also added new challenges, especially catering, hotels, tourism, physical retail industry, its business situation has caused a wide range of society。

 General attention.


 General Secretary Xi Jinping presided over a meeting of the Standing Committee of the Political Bureau of the CPC Central Committee, explicitly demanding that normal economic and social order be maintained. While strengthening the prevention and control of the epidemic situation, we should strive to keep production and life stable and orderly. How can our business find its own way to save itself.

 The survival of small and medium-sized enterprises has reached a critical moment!


 Recently, with the new coronavirus infection pneumonia epidemic this "black swan" economic effect gradually appeared, enterprises, especially small and medium-sized
enterprises production and operation situation has aroused concern. How much is affected by the epidemic? Large and medium-sized enterprises and premises in services
 Industrial enterprises are seriously affected by the epidemic situation, and small and micro enterprises are relatively less affected. Our mold making and injection molding manufacturing should belong to small and micro-processing enterprises, as long as their own control is good, should support more than 1 year is no problem. Now the whole
global supply chain has a big problem
 The next wave of unemployment is inevitable.
 How to rescue affected enterprises? We suggest that the state in a certain period of time to exempt enterprises from five risks a gold fee and taxes and so on. At the
same time, it is imperative to concentrate on eliminating the epidemic first and wait until it is over
 To explore solutions. "The real relief is self-help, enterprises must first find ways to save themselves."  We must first define clearly what is small and micro-enterprise, what is a medium-sized enterprise, what is a large enterprise? In my opinion, enterprises with more than 5 people and less than 50 people are small and micro enterprises, and enterprises with more than 50 employees are medium-sized enterprises. Meanwhile, coastal cities are affected.
 The smallest noise, the most hit must be the inland city and the three northeastern provinces. A large number of returning entrepreneurs and unemployed returnees have had an impact on social stability.
   Small and micro enterprises are mainly self-employed, the workplace, food, and accommodation are at home, the cost and profit are not high. In contrast to large and medium-sized service enterprises, small and micro enterprises are generally not seriously affected by the epidemic (not to say that small and micro enterprises are not affected) small and micro enterprises are exempted from tax Fish farming is really helpful. It is more important to help small and micro enterprises cut taxes and taxes. Even without the outbreak, small and micro enterprises should have been tax-free, small and micro-enterprises have no tax to pay. Internationally, small and micro enterprises in other countries do not have to pay VAT.

Small microenterprises

 Does the industry still need to pay enterprise income tax? Ordinary small and micro enterprises to remove rent, wages, borrowing high interest and other costs have not much left. Large restaurants, hotel chains, tourism real estate, and other large and medium-sized enterprises in the service industry are seriously affected by the epidemic. In addition, the real estate industry was more affected by the epidemic. Because the first quarter was originally the peak season of real estate sales, now

no one to buy a house, at the same time the housing enterprise capital flow problem has been prominent, housing enterprises in the absence of income at the same time to pay back bank loans, I believe there will be a lot of real estate enterprises that will fall. And the biggest problem in our manufacturing industry is labor and rent costs, and the government can first reduce the rent to help the manufacturing industry. Of course, manufacturing is already overcapacity, do not worry too much about

the impact of the epidemic. From the auto industry,2019 auto sales and output are falling, no matter dealers, manufacturers have a lot of inventory. In this case, the car production line stops for twenty days a month, will not be in a mess. Enterprises must also truly reflect the situation, some enterprises ill-intentioned, with the help of disaster innovation, take advantage of the fire to rob, scare the government. Loan fraud and relief can happen.
  
 Many of the problems of China's economy and private enterprises have not been caused by the epidemic, many of which have always existed, but the epidemic has made some problems more prominent.
 Now the global economic situation is not good, China's economy a lot of problems have not been resolved, I am ready to live with this country.

2020年4月13日星期一

Ventilator Classification

 We share a new article from TL medical about Ventilator Classification

In modern clinical medicine, the ventilator, as an effective means of energy artificial alternative autonomous ventilation function, has been widely used in respiratory failure caused by various reasons, anesthesia and respiratory management during major surgery, respiratory support therapy and emergency resuscitation It occupies a very important position in the field of modern medicine. The ventilator is a vital medical device that can prevent and treat respiratory failure, reduce complications, save and prolong the lives of patients.
1. Classified by type of use or application
(1) Controlled mechanical ventilation (CMV)
1. Definition: When the patient’s spontaneous breathing weakens or disappears, it is completely generated by the mechanical ventilator to control and regulate the patient’s breathing.
2. Reduction: The automatic breathing caused by the disease disappears or weakens; when the automatic breathing is irregular or the frequency is too fast, and the mechanical ventilation cannot coordinate with the patient, the artificial breathing is suppressed or weakened by artificial methods.
(2). Assisted mechanical ventilation (AMV)
1. Definition: In the presence of patient breathing, the ventilator assists or enhances the patient’s spontaneous breathing. Various types of mechanical ventilation are mainly triggered by the patient’s inspiratory negative pressure or inspiratory airflow.
2. Reasonable: Although spontaneous breathing exists and is more regular, it cannot be used in patients with weakened spontaneous breathing but insufficient ventilation.
2. According to the use of mechanical ventilation
(1) Intrathoracic or airway compression type
(2) Chest shape
3. According to the switching mode of inhalation and exhalation
(1) Constant pressure type: After the pressure in the respiratory tract reaches a predetermined value, the ventilator opens the exhalation valve, and the thoracic and lungs are passively atrophy or exhaled by negative pressure. When the pressure in the airway continues to fall, the ventilator is again generated by positive pressure Airflow and causing inhalation.
(2) Constant volume type: The positive tidal volume is used to send the estimated tidal volume into the lungs. After reaching the expected tidal volume, the air supply is stopped and the exhaled state is entered.
(3) Timing type: supply air according to the pre-designed inhalation and expiration time. (4) Mixed type (multifunctional type).
4. Supply air according to ventilation frequency
(1) High-frequency ventilation: ventilation frequency> 60 times / min.
1. Advantages: low airway pressure, low intrathoracic pressure, little interference to circulation, no need to close the airway.
2. Disadvantages: Not conducive to the removal of carbon dioxide.
3. Classification: high-frequency positive pressure ventilation, high-frequency jet ventilation, high-frequency oscillatory ventilation.
(2) Normal frequency ventilation: ventilation frequency <60 times / min.
5. According to whether there is a synchronization device or performance
(1) Synchronous ventilator: The inhalation of the patient’s spontaneous breathing can trigger the ventilator to supply air into the patient’s respiratory tract and produce inhalation action.
(2) Non-synchronized ventilator: The patient’s breathing or inspiratory negative pressure cannot trigger the ventilator to supply air, and is generally only used for patients with controlled mechanical ventilation.
6. Classification by applicable objects
(1) Baby ventilator
(2) Infant ventilator
(3) Adult ventilator
7. Classified by working principle
(1) Simple ventilator
(2) Membranous lung
Main mechanical ventilation function
(1) Holding the breath at the end of inhalation
1. After the end of inhalation and before the start of the exhalation, the ventilator does not supply air, and the exhalation valve continues to close and close to maintain the lung pressure at a certain level.
2. Clinical application:
(1) The inspiratory time is extended, which is beneficial to the distribution of gas.
(2) Conducive to the dispersion of gas
(3) The distribution and dispersion of the inhaled drugs in the lungs
3. It can increase the burden on the heart.
(2) Positive end-expiratory pressure ventilation
1. At the end of expiration, the airway pressure does not drop to zero, and still maintains a certain positive pressure level.
2. Clinical application: suitable for hypoxemia caused by shunt in the lung, such as ARDS PEEP breakthrough ARDS mechanism
(1) Reduce alveolar collapse, reduce lung shunt, and correct hypoxemia caused by lung shunt
(2) Reduce alveolar collapse and increase FRC, which is conducive to the full exchange of alveolar-capillary catheter gas.
(3) The increase in alveolar pressure makes the alveolar-arterial oxygen partial pressure increase, which is beneficial to the diffusion of oxygen to the capillaries.
(4) Increased inflation of the alveoli can increase the compliance of the lungs, and can also reduce breathing work.
4. The main symptoms of PEEP
(1) Influence on hemodynamics
(2) Barotrauma to lung tissue
(3) Capable of compressing pulmonary capillaries. Decreases lung blood flow and may increase ineffective ventilation
(4) It can reduce the alveolar surfactant.
5. Selection of the best PEEP: keeping preset of FiO2 <60%, the lowest PEEP level of PaO2> 60mmHg can be achieved.
6. Endogenous PEEP: due to the short expiratory time or high dyspnea, the gas in the alveoli is retained, which can maintain the positive pressure of the alveolar pressure throughout the exhalation cycle. Application of ventilator artificially caused.
(3) Prolonged expiratory breath and end-expiratory breath-hold: suitable for patients with COPD and cardiovascular retention.
(4) Sigh: 1-3 deep breaths equivalent to 1.5 times-2 times the tidal volume in every 50-100 breathing cycles, so that the alveoli at the bottom of the lungs that are prone to collapse can expand regularly, and improve the Gas exchange to prevent atelectasis.
(5) Inverse Ventilation (IRV)
1. Advantages: Prolonged inhalation time is conducive to the diffusion and distribution of gas, and is helpful to correct hypoxia.
2. Disadvantages: great interference to circulation, great pressure injury to lung tissue

2020年4月11日星期六

Medical protective clothing classification, grade, scope of application, and standards

 TL Medical retail companies with 15 years of history,0 complaints, real quality assurance.  I share a new article from their blog for Medical protective clothing by Cnmoulding


The number of COVID-19 diagnoses has been rising, and there is constant domestic news about the shortage of medical protective masks, medical protective clothing, and other materials. The shortage of medical protective clothing has become the heart disease of patients receiving new coronavirus infections in hospitals. This article will introduce the classification, grade, scope of application, standard and putting on and taking off of medical protective clothing.

Medical protective clothing
Medical protective clothing

Classification and scope of medical protective clothing
Medical protective clothing includes all kinds of clothing especially worn in the medical environment, so there are many classification methods.

  1. According to usage

According to the use and occasion, it can be divided into daily work clothes, surgical clothes, isolation clothes, and protective clothes.
Daily work clothes refer to white coats worn by medical staff in their daily work, also known as white coats.
Surgical gown refers to specially designed clothing worn in the operating room.
Isolation gown refers to the clothing worn by medical staff when they are in contact with patients or when family members visit patients.
Protective clothing refers to the clothing worn by people in special areas such as medical emergency, entering infectious disease areas, electromagnetic radiation areas, etc.

  1. According to the service life

According to the service life, medical protective clothing can be divided into disposable protective clothing and reusable protective clothing.
The standards for domestic medical disposable surgical gowns are the industry standards YY / T 0506-2016 “Surgical drapes, surgical gowns and cleans for patients, medical personnel and instruments implemented by the State Food and Drug Administration from January 1, 2017 clothes”. The standard that medical disposable protective clothing complies with is the technical requirements for medical disposable protective clothing that will be implemented from March 1, 2010, specified by the China National Standardization Administration: GB19082-2009.

Disposable protective clothing is discarded after use without disinfection or washing. It is easy to use and can avoid cross-infection. However, the degradation of disposable materials is easy to cause environmental pollution. Generally, surgical protective clothing and isolation clothing with high protective requirements are used in this way. Types of. After repeated use, it needs to be washed and sterilized at high temperatures. The comfort of the material is usually better, but the protection performance is usually poor. The washing and disinfection process will also increase the cost of a lot of manpower and water resources. Most of the daily work clothes (white coats) use this type.
  1. According to the material
According to different processing techniques of materials, medical protective clothing is divided into woven and non-woven protective clothing.
Woven materials are mainly used for processing reusable medical protective clothing, including traditional woven fabrics, high-density fabrics, coated fabrics, and laminated fabrics. Traditional woven fabrics are mainly made of blended yarns of synthetic fibers such as cotton fiber or polyester and cotton. They have good comfort and are mainly used in daily work clothes (white coats). High-density fabrics are woven from high-count cotton yarn or other ultra-fine synthetic fiber filaments. The yarn gap is very small. Due to the capillary action of the fiber, it has moisture permeability and then is treated with a fluorocarbon, silicone, or another waterproofing agent. Liquid permeability, mainly used for surgical gown materials that need a better waterproof effect. Coated and laminated fabrics are used to enhance the material’s impermeability and are used in protective clothing materials that use harsh environments. The coated fabric is processed by coating, the surface is closed by the coating agent, and it has anti-permeability. The hydrophilic groups in the coating or a special method to form a microporous structure to ensure the moisture permeability of the fabric. Laminated fabric is a composite of fabric and a special film (such as microporous film, polyurethane vinegar permeable film, etc.) through a lamination process, such as Teflon super waterproof and breathable composite fabric. Because the micropore diameter of the main body membrane of the fabric is much smaller than the water droplet diameter, it can prevent the penetration of blood, body fluids, etc. The high porosity of the micropores is larger than the diameter of the water vapor molecules, and the water vapor molecules can pass freely, so the moisture permeability is good.
Non-woven fabric protective clothing materials are basically disposable, using more spun-bonded non-woven fabrics, spun lace non-woven fabrics, SMS (spunbond-meltblown-spunbond) composite nonwoven fabrics, flash method Non-woven fabrics and spun-bonded fabric laminated products, etc. Generally, non-woven protective clothing has better protection than mechanical materials.
In addition to these, there are special medical protective clothing, which can be divided into three categories, and its scope of application is as follows:
  1. Chemical protective clothing
Chemical protective clothing is protective clothing worn to protect itself from chemical hazards or corrosive substances when handling hazardous medical chemicals. In addition to chemical resistance, chemical protective clothing requires stricter requirements on the tightness and seam structure of the clothing.
  1. Electromagnetic radiation protective clothing
Electromagnetic radiation protective clothing is an item of protective clothing that implants very fine conductive fibers in the fabric material so that the protective clothing does not generate static electricity and can shield electromagnetic waves in the range of 100kHz to 300GHz. It is mainly used by the operating crowd of electronic medical equipment systems in hospitals.
  1. Nuclear and radiation protective clothing
Used in a nuclear radiation environment (small dose, large range of ionizing radiation, mainly with α and β rays) to prevent the aerosol and dust from invading the human body. It has the functions of protecting radioactive aerosols, protecting more than 150 kinds of toxic and corrosive gases, liquids and solids, protecting potential radioactive particles and liquids from invading the body, and 100% blocking dry particles above 0.2μm.
Medical protective clothing grade
China’s protective clothing classification standard is the People’s Republic of China pharmaceutical industry-standard YY / T 1499-2016 “liquid barrier performance and classification of medical protective clothing”, which divides medical protective clothing into 4 levels in total, the higher the level, the better the protective performance.
Barrier levelLiquid exposure riskReference surgeryPerformance requirements
AAMI Level 1Very little liquid splash or less pressure on the patientOphthalmology, simple ENT surgeryMust pass spray impact penetration test, seepage volume <4.5g
AAMI Level 2More fluid injection and pressureSimpler orthopedics include surgery to bind tourniquet, tonsillectomy, appendectomy, etc1, must pass the spray impact penetration test, the amount of water seepage <1g
2. A hydrostatic pressure test, hydrostatic pressure> 20cm.H2O
AAMI Level 3More body fluid splashes, more pressureMastectomy, some general surgical procedures
1, must pass the spray impact penetration test, the amount of water seepage <1g
2. A hydrostatic pressure test, hydrostatic pressure> 50cm.H2O
AAMI Level 4Need the most advanced protective surgical drapes and high protective surgical gownsMajor chest surgery, orthopedics without tourniquet surgery, implant surgery, cardiac surgery, cesarean1,Surgical gown: In addition to reaching the level 3 test requirements, you must pass the Bacillus virus penetration test
2. Surgical draping: In addition to reaching the level 3 test, it must pass the artificial synthetic blood penetration test


According to the different requirements of the protection level, the non-woven fabric and film used are also different. Polyethylene breathable membrane / non-woven fabric composite material has an excellent effect on blocking bacterial particle penetration and liquid penetration, and the feel can be adjusted by changing the softness of the composite fabric, which has strong tensile strength, good breathability, and comfortable performance Greatly improved, can withstand disinfection treatment, does not contain toxic ingredients, weighs 60 ~ 100g / m2, has a good price-performance ratio, medical disposable protective clothing made with it can protect medical personnel from pollution by pollution sources, overcome cross-infection To effective protection.
The “Notice on Issues Related to the Production and Use of Protective Clothing during Epidemic Situations” states that when medical protective clothing is insufficient, emergency medical supplies protective clothing may be used.
Emergency medical supplies protective clothing shall comply with the European Union medical protective clothing EN14126 standard (where the liquid barrier level is above 2) and obtain the EU CE certification, or liquid compact protective clothing (type 3, comply with EN14605 standard), spray dense protective clothing (type 4, Comply with EN14605 standard), anti-solid particulate protective clothing (type5, comply with ISO13982-1 & 2 standards). Protective clothing for emergency medical supplies is only used to isolate wards (rooms) and quarantine wards (rooms). It cannot be used to isolate intensive care units (rooms) and other places with strict microbiological index control. All localities are invited to organize health departments to guide hospitals, disease control centers, and other units to regulate the rational use of emergency medical material protective clothing.
Medical protective clothing-related standards
In our country, the corresponding standard for medical protective clothing is the National Standard GB 19082-2009 “Technical Requirements for Medical Disposable Protective Clothing”, which not only specifies the appearance of protective clothing, but also the liquid barrier function, Filtration performance, microbiological index, residual amount of ethylene oxide, taking performance and comfort performance have been made strict regulations.
China’s protective clothing classification standard is the People’s Republic of China pharmaceutical industry-standard YY / T 1499-2016 “liquid barrier performance and classification of medical protective clothing”, which divides medical protective clothing into 4 levels in total, the higher the level, the better the protective performance.
Internationally, the European standard EN14126-2003 “Protective clothing-Performance requirements and test methods for protective clothing against infectious sources” divides protective clothing into 6 categories. The biomarker protective clothing marked with the letter “B” can be used for medical care Personal protection; American standard NFPA1999: 2018 “Protective clothing and equipment for emergency medical operations”, which specifies detailed protective clothing and equipment, and does not classify medical protective clothing.
Whether the medical protective clothing meets the standard needs to be checked by the testing agency. The medical protective clothing testing institutions with full project testing qualifications are Beijing Medical Device Inspection Institute, Anhui Food, and Drug Inspection Institute, Hubei Medical Device Quality Supervision and Inspection Institute, China Food and Drug Inspection Institute (China National Drug Inspection Institute) Institute) and the State Food and Drug Administration Jinan Medical Device Quality Supervision and Inspection Center.
At present, most of the national standard medical protective clothing production uses ethylene oxide sterilization, which takes 7-14 days. However, after verification, the sterilization time can be controlled within 1 day, but considering that radiation sterilization may have a certain impact on the structural strength of the protective clothing, the “Emergency Code” limits the use period of radiation sterilized medical disposable protective clothing Within 1 month.

2020年4月9日星期四

Studies have shown that COVID-19 can survive on the surface of the mask for 7 days

reprint sth. that has been published from TL medical website:

A recent study published in the medical journal “The Lancet” showed that COVID-19 can survive on the mask surface for 7 days.
According to a report on the “Business Insider” website on April 6, researchers such as Pan Liewen and Malik Peiris of the School of Public Health of the University of Hong Kong published a newsletter in the “Lancet” on the 2nd to explain the new coronavirus on different materials. Study of survival time.
The subjects of this experiment included paper towels, wood, and cloth. A week later, the researchers found COVID-19 on the surface of the mask. Researchers say this result shows that it is very important to wear and remove masks correctly.
Peiris told the South China Morning Post: “That ’s why it ’s very important not to touch the outside of the mask when wearing a surgical mask, because touching the mask will contaminate your hands, and if you touch the eyes with your hands, you may bring the virus to your eyes in.”
The research team also found that COVID-19 is more stable on smooth surfaces. Previous studies have found that the COVID-19 can survive on copper surfaces for 4 hours, on cardboard for 24 hours, and on plastic masks surfaces for 3 days, but the survival time of COVID-19 is also affected by various factors such as temperature and humidity. According to reports, all countries, therefore, recommend regular disinfection of household items that are infrequent contacts, such as door handles, countertops, and telephones.
Pan Liewen emphasized that washing hands with soap is one of the best ways to protect yourself. He told the South China Morning Post, “If you want to protect yourself, just maintain good hygiene, wash your hands frequently, and then clean your face, mouth, and nose.”
Now that COVID-19 is getting more serious, everyone should wear a disposable medical face mask , and at the same time wear a plastic maskto reduce the risk of infection