The novel coronavirus pneumonia is positive after discharge. How can it be cured?

Wen Jing Wang Chen Wu yeting Novel coronavirus pneumonia novel coronavirus pneumonia control headquarters was announced in February 22nd From the day of the new crown pneumonia, the patients discharged from the new crown pneumonia were required to implement a 14 day free rehabilitation isolation and medical observation in the designated place The reason for novel coronavirus pneumonia is the recent detection of new crown pneumonia patients who have been discharged from hospital and the nucleic acid test has been positive from negative at discharge As early as the middle of January this year, the nucleic acid conversion of discharged patients has occurred in the medical staff who have been cured and discharged in Wuhan Each hospital has adopted strict discharge standards for its own medical staff or centralized isolation for 14 days This part of patients, not only their own disease in the hospital after repeated, and may have infectious In addition to Hubei, other cities have relatively sufficient medical resources Some patients can do multiple nucleic acid tests before leaving hospital after turning negative In other cities, such as Yuyao City, Zhejiang Province, the management requirement for patients in the recovery period is 14 days of centralized isolation However, in Wuhan, where more than 46000 patients have been diagnosed, the centralized management of discharged patients will face great challenges From February 16 to February 22, in a week, more than 4500 patients were cured and discharged from hospital in Wuhan According to people familiar with the matter, Wuhan is currently expropriating a large number of hotels for centralized isolation of discharged patients After discharge, the patients will be sent to the designated hotel by the street for isolation observation Xu Haibo, director of novel coronavirus of Wuhan Zhongnan Hospital, was impressed by the infection of a new coronavirus in a hospital in late December The worker began to have fever on December 23, 2019 He thought it was a common cold, and he also did lung CT by the way However, the imaging colleagues found that the image was very strange Unlike general viral pneumonia, they asked Xu Haibo for consultation At that time, the hospital had spread the unexplained pneumonia in Wuhan After discovering the situation of the employee, the hospital isolated him in the way of treating SARS in that year After two to three days in the isolation ward, the temperature of the employee returned to normal He stayed in the isolation ward for more than a week before and after, and the clinical symptoms had disappeared, so he was arranged to leave the hospital Before discharge, both viral nucleic acid tests were negative Xu Haibo also asked him to check the CT again At this time, many lesions in the lung had been absorbed, and the shadow was very thin Back to the early symptoms of the first CT examination, Xu Haibo thought that the absorption was obviously improved After leaving the hospital, the employee was isolated at home for nearly a month and continued to take some oseltamivir and other drugs At the beginning of February, the worker said that he would go back to the hospital for work There was no problem with the results of lung CT, but the results of nucleic acid test were unexpected The first result was weak positive After a day's examination, it was still positive Later, Xu Haibo found a second such case At present, although not all the discharged medical staff have been screened, four of them have been reexamined as positive after discharge In late January, a doctor of respiratory medicine in Wuhan Central Hospital, after discharge from hospital, not only did the nucleic acid test return to positive again, but also the lung shadow was aggravated More and more According to people familiar with the matter, in mid February, two doctors in Hubei people's Hospital, who had been discharged for more than half a month, had to go back to the hospital because of the same situation of nucleic acid positive during the reexamination After discharge, nucleic acid was positive, not only in medical staff A novel coronavirus pneumonia in Wuhan, February 20th, said that "2 new cases were confirmed, 1 suspected cases were all cured by the early stage of cure" The same situation happened in Wangjiang garden in Chengdu A new crown pneumonia patient who had been cured after going home to quarantine was rechecked positive after 10 days Those who still carry the new coronavirus after discharge are likely to be the source of infection To solve this problem, one way is to change the discharge standard, and the other way is to strengthen the management of discharged personnel from discharge to reexamination Many hospitals first adjusted the discharge standard of the medical staff on nucleic acid test The discharge standard of the medical staff in Central South Hospital and Hubei Provincial People's hospital increased from twice negative to five times negative Yuan Haitao, director of ICU of Wuhan Xiehe East and West Lake Hospital, thinks that if five nucleic acid tests are carried out every other day, the hospitalization period of each patient will be extended for one week, which is a challenge for the designated hospital beds that are always tense, and is not suitable for promotion to all patients Wuhan Xiehe East and West Lake hospital has opened a centralized isolation area for the medical staff of the hospital, including the medical staff who meet the discharge standard and continue to be isolated in the centralized isolation area of the hospital for 14 days In the sixth edition of the diagnosis and treatment plan issued by the national health and Health Commission on February 18, the suggestions for discharged patients are: "continue to carry out 14 days of self-health monitoring, wear masks, live in a well ventilated single room, reduce close contact with family members, eat separately, do hand hygiene, and avoid going out." Xu Haibo admitted that although there are no big data yet, some doctors who have been discharged have found repeated cases This means that the same will happen to other discharged patients Many doctors believe that the reason for this result is the discharge standard In the novel coronavirus pneumonia diagnosis plan, the fifth edition and the sixth edition, the two versions of the discharge standard were similar, with the following items: 1, the body temperature returned to normal for more than 3 days, and respiratory symptoms improved significantly 2 The lung imaging showed that the inflammation was obviously absorbed (the sixth edition showed that the lung imaging showed that the acute exudative lesions were significantly improved) 3 The nucleic acid test of respiratory pathogens was negative for two consecutive times (the sampling interval was at least one day) All of them have no objection to the first article, and the disputes mainly focus on CT imaging and nucleic acid detection For example, one of the two versions of discharge standards requires doctors to make judgments in combination with lung CT But the standard of lung imaging is subjective According to Xu Haibo, the "obvious absorption" and "obvious improvement" of inflammation in the discharge standard are fuzzy descriptions How much is the "obvious absorption"? There is no quantitative standard From CT, is the focus to be shrunk by one third, two thirds or completely absorbed? Still, there is only a little pulmonary fibrosis, and the guidelines are not detailed According to Xu Haibo, an important principle of discharge standard is that the patient should not be infectious after discharge Based on his own clinical experience, he hypothesized that if the lesion has shown fibrosis on CT images, the patient can be discharged from the hospital Because pulmonary fibrosis is a scar formed by abnormal repair of alveoli, which means that by the end of the disease, it is generally no longer infectious But he is worried that other infectious diseases, including SARS, have been confirmed to be non infectious in the stage of pulmonary fibrosis, and whether the pulmonary fibrosis of this disease also represents non infectious, which cannot be confirmed Moreover, how to make a judgment based on CT images is related to the level of interpretation of each imaging doctor Even if the CT standard is quantitative, there are different subjective judgments of each doctor As for nucleic acid detection, it has always been an important objective indicator for the diagnosis of new coronavirus pneumonia In terms of admission criteria and discharge criteria, nucleic acid detection plays a decisive role, directly affecting the final results of patients' admission and treatment Even if the test is negative twice before discharge, there is a possibility of false negative In the opinion of experts, the accuracy rate of nucleic acid detection is only 30% - 50%, which directly leads to the fact that some discharged patients have not detected the new coronavirus, which may still be infectious after discharge Zhang Xiaochun, deputy director of Medical Imaging Department of Central South Hospital of Wuhan University, explained that the improvement of the condition of the new crown patients lies in the change of virus load In one patient, the nucleic acid test was positive at first, and after a certain treatment, it improved The reason for the improvement is that the virus has eliminated part of it to some extent, not only in quantity, but also in aggression The decrease of virus results in the absence of virus at the sampling site of upper respiratory tract, or the virus content in the sample is less At this time, the nucleic acid detected is negative, but it does not mean that there is no virus in the alveolus If the results of the two nucleic acid tests are negative, the patient will be released from the hospital, and the disease may be repeated At the time of hospital treatment, various measures, including oxygen inhalation, are in place The lung has a strong self-resistance After leaving the hospital, the patient's environment changes, and the remaining virus in the body may become active again, which causes the process of recurrence rather than recurrence It is not because of the imprecise detection of nucleic acid, but because of the change of viral load, which affects the result of nucleic acid detection The most critical point is, if the patient's nucleic acid test results turn positive after 2 weeks of discharge, is he infectious? It is not clear clinically There is only one way to test whether they are infected when they are with their families and exclude the chance of family contact with the outside world, but such an experiment is against ethics At present, the laboratory of Central South Hospital is breaking through the "low degree of positive nucleic acid test" Looking for low degree is to find a reasonable range, to see which range the nucleic acid positive in, the least pathogenic or infectious Some of the patients recurred after discharge, showing obvious lesions in the lung and positive nucleic acid test But in another case, some people are positive for nucleic acid, but their lungs are normal Another employee in Zhongnan Hospital, who was infected by his parents, also underwent lung CT and throat swab tests As a result, the lung was abnormal and nucleic acid test was positive One month after being hospitalized and isolated in the hospital, the lung CT of the worker showed that the inflammation was almost completely absorbed, but the result of nucleic acid test was positive Xu Haibo thinks that the virus is very strange It seems that it can coexist with people The lung may not show strong pathological changes Therefore, in addition to nucleic acid detection and lung CT images, researchers are also looking for new detection methods Relevant experts are carrying out the research of new coronavirus "anal swab" Experts believe that the new coronavirus infection initially gathered in the upper respiratory tract, but the incidence is mainly in the lower respiratory tract With the treatment, the upper respiratory tract is likely to not detect the virus, so the nucleic acid test is negative Virus can only be detected by alveolar lavage, but it is impossible in reality Based on this theory, they are studying the feasibility of anal swab detection But when will the virus appear in the digestive tract after the symptoms of respiratory tract disappear? How long will the virus disappear in the digestive tract after cure? To solve these problems, a lot of experiments are needed If the basic time for the virus to appear and disappear in the digestive tract is determined, the discharge standard can be added to the anal test A doctor in Wuhan Zhuankou fangcang hospital said that several experts also combined some other factors, such as the length of the disease, in the clinical diagnosis of discharge standard The average incubation period of the disease is 7-10 days, the most