On February 23, CCTV news said, “Will there be sequelae after the new coronary pneumonia is cured? On Feb. 22, CCTV news “War on Epidemic” exclusively connected with Tong Zhaohui, a nationally renowned respiratory critical care expert and vice president of Beijing Chaoyang Hospital, who is an expert of the central steering group, to bring you authoritative answers.
On January 18, Mr. Tong arrived in Wuhan as the first group of experts to guide and be responsible for the clinical treatment of critically ill patients. During the interview, Tong also shared his first-line treatment handbook.
Moderator: On the 21st Wuhan completed the delivery of all stock nucleic acid samples, and in the future it will be possible to clear the four types of nucleic acid testers on a daily basis. What does this mean? What help can it bring to the prevention and control of the epidemic?
Child Zhaohui: This means that compared to the past, the detection capacity is improving. As a clinical diagnosis of pneumonia, especially novel coronavirus pneumonia, timely completion of nucleic acid testing will allow these patients to receive an accurate diagnosis. Timely diagnosis will lead to timely hospital admission, treatment and exclusion, and will also relieve some of the burden of thought on the patient.
Moderator: The Health Care Commission released the fifth edition of the new coronavirus pneumonia prevention and control program, mentioned that negative nucleic acid test results can not exclude the new coronavirus infection, what is the significance of this, and what is the impact on the entire outbreak prevention and control process?
Child Zhaohui: Any test, including nucleic acid, although it is considered very important, it cannot be said that a negative result will definitely rule out infection. For example, in the clinical diagnosis of tuberculosis, the patient has a low fever, does not want to eat, is thin, and has changes in the CT image, so the doctor can diagnose from these characteristics. In fact, the percentage of positive TB tests is only 20 to 30 percent, and 70 to 80 percent of the tests show negative results, but these do not rule out TB. A negative nucleic acid test is not the only definitive criterion; a comprehensive judgment is required.
Moderator: What are the criteria for discharge?
Tong Zhaohui: The sixth edition of the guidelines mentions that clinically, the patient has a normal temperature for three days, no respiratory symptoms, or significant absorption on imaging; from the nucleic acid test, two negative test results, with one day in between, are the criteria for discharge.
Moderator: Wuhan’s latest regulations, patients should be discharged to a designated site to implement a 14-day rehabilitation isolation observation, for patients, what are the things to pay attention to after discharge?
Tong Zhaohui: The sixth edition of the guidelines requires patients to be isolated at home after discharge, do not contact other people, pay attention to rest and diet, and also requires the designated hospital to contact the discharged patients in the near future for follow-up, understanding, communication, follow-up visits, and so on. Patients are weaker after discharge and their immune function has not fully recovered, so contact with others or the outside world at this time can easily trigger other diseases.
Wuhan’s new initiative is a very good management of patients, if you can achieve centralized isolation, can be very good monitoring of the close changes in the patient’s condition, professional guidance and centralized management, certainly much better than their own home.
Moderator: A positive nucleic acid test was found in a patient discharged from the hospital in Chengdu, which caused some concern.
Tong Zhaohui: In fact, this situation is not only found in Chengdu, but also in other places, and Wuhan also has this case. We have to look at this matter correctly, firstly, this case is a minority; secondly, when this happens, it is not that the patient has relapsed. On the one hand, it has a relationship with the reagent assay, including the stability of reagents, sampling, laboratory quality control, we need to consider these issues from the objective side.
There are also some cases that need to be analyzed specifically, some patients with severe disease have been treated for a long time, especially some patients have been treated with hormones for a long time, the use of hormones for a long time, there is a delay in the clearance of the virus, the virus clearance is slower than the general population, so the nucleic acid test has some instability, this few cases should be specially handled.
Moderator: The preliminary test result was negative, and then it showed positive again, is this a concept of retention?
Child Zhaohui: No. Under normal circumstances, two negative test results, if the patient’s viral clearance is normal, it is possible that the test will not be positive again later, which is the majority of cases. However, some severe cases may be repeated, for example, the first two tests are negative, but they may not be true negatives, which may be due to various technical reasons. The third time the test is positive, on the one hand, because of the stability of the reagents, sampling problems caused by some special patients, including some special patients in the treatment process used hormones or hormone dose is relatively large, resulting in the virus from the body clearance time than others, so that in the test may also be positive.
Moderator: Will there be any sequelae in the treatment process that need to be prevented or solved in the healed patients?
Child Zhaohui: It should be said that there are no obvious sequelae from the patients who have been discharged from the hospital so far. Many patients may be concerned about the recovery of pulmonary fibrosis and myocardial damage.
We have followed up with many SARS patients, and generally speaking, lung CT fibrosis and changes in lung function can eventually be recovered, but it may take a little longer in severe cases.
Then there is the heart problem, because coronavirus also has damage to the heart muscle, so it is also necessary to regularly check the heart and review the corresponding cardiac enzymes, troponin and cardiac ultrasound.
In particular, we remind patients with new coronary pneumonia to focus on monitoring their heart and lungs for a longer period of time after they are discharged from the hospital. This kind of patients, especially the severe patients with heart and lung damage is more obvious, do not rush to do rehabilitation, or rest is the main focus.
Moderator: How to grasp the progress of patients with mild disease?
Tong Zhaohui: For patients with mild disease, if there is sudden breath-holding, dyspnea, or significant progression of CT imaging within 24 to 48 hours, or sudden drop in oxygen saturation, sudden acceleration of respiratory rate, sudden drop in lymphocytes and other changes, it means aggravation of the disease, we should actively intervene.
Moderator: Speaking of treatment, we are very concerned about drugs, you said before that after SARS, human beings have experienced many viruses, but 17 years have passed, domestic and foreign have not found a real antiviral drugs for these viruses, how about the situation of our drugs now?
Child Zhaohui: As you know, when SARS was introduced, no good antiviral drugs were found for it. From SARS to now 17 years, during this period of time, human beings have been ravaged by many viruses, such as avian flu, influenza A, Ebola, Middle East respiratory syndrome, H1N1, etc.. Scientists and clinical experts are trying to find an effective drug, and the people (69.260, -1.95, -2.74%) also hope that there is an effective drug can be eaten as soon as they get well.
In fact, clinically speaking, there is no special drug to cure a certain disease, only that we found that a certain antiviral drug, the effect of a certain virus than other drugs, but only a relative antiviral effect, but certainly not a special drug.
In addition, we found in vitro tests, some drugs have a very good effect, but these drugs used in clinical, and in vitro tests are not the same thing, so we must look at this issue correctly. Don’t be superstitious about a certain drug, superstitious about a certain in vitro test is very good, in fact, it only has its merits in a certain aspect.
Moderator: The latest news is that Zhong Nanshan’s team has isolated the new coronavirus from urine. We know that the nucleic acid was previously detected positive from feces, what tips are there for the public to detect the new coronavirus from urine, and can something be done in protection?
Zhaohui Tong: In the past, the focus was on wearing a mask to prevent respiratory infections. With the detection of live virus in feces or urine, it is important to pay attention to the protection of the excretory system.
Moderator: Is it necessary to cover the toilet with a lid when flushing the toilet?
Tong Zhaohui: I think further research is needed to see how big the sample is in this case, how large.
Moderator: Some experts have a consensus on the new coronavirus, saying that it is extremely infectious and more difficult to treat than SARS, but the death rate is lower than SARS, this conclusion seems a bit contradictory, how to interpret?
Child Zhaohui: This is actually not contradictory, there is a saying that the lighter is more, the heavier is heavier.
The virulence of the new coronavirus is stronger than that of SARS because SARS only attacks the lungs of patients. The new coronavirus not only attacks the lungs, but also the heart and kidneys, so it is more aggressive and destructive than the SARS virus.
The reason for saying that the disease and death rate is lighter than SARS is that the calculation of the disease and death rate is based on the number of patients divided by the total number of cases, and it depends on the denominator. In the world SARS patients less than 10,000, only 9,600, if more than 9,600 as the denominator, the number of deaths as the numerator, its rate of death is about 10%. Now there are more than 70,000 patients with New Guan Pneumonia, and its sickness and death rate is about 4% in Wuhan, 3% in Hubei, and even lower in non-Hubei, so its sickness and death rate is lower than that of SARS.
Content source: Pengbai News