What about the new coronary critically ill recovery patients? A follow-up note from 100 patients in 90 days by a front-line doctor.

Wen . . . Wang Chen Wujing in the first phase of follow-up, Wuhan University Central South Hospital ICU Director Peng Zhiyong found: 90% of critically ill patients are still impaired lung function;
the end of the new crown outbreak in Wuhan, a landmark sign is the June 15 clean-up.
, new confirmed, hospitalized, dead, asymptomatic infection, suspected and other indicators were all cleared.
doctors in Wuhan, China, experienced a panic in January in the face of unfamiliar infectious diseases, and in February the health care system was nearly paralysed by a run, and finally returned to normal medical order.
but the doctors' battle for the new crown is far from over, and their battleground has shifted from treating new crown patients to tracking follow-up studies of new crown rehabilitation patients.
Zhiyong, director of the ICU at Wuhan University's Central South Hospital, is one of them.
From January, central and southern hospital ICU ushered in the first case of new coronary critical patients, to February and March, central and southern hospital new coronary critical patients reached 50 or 60 cases, he has been fighting in the front line, under his leadership, central south hospital critical patients treatment results are significant: by early March, Peng Zhiyong estimated that the ICU mortality rate in Central South Hospital in about 20%, lower than the average mortality rate of new critical patients in the same period.
April 2020, the new coronary critically ill patients in the ICU ward of The Central South Hospital were nearly zero, and Peng Zhiyong began to study the health status of the new coronary critically ill patients after their recovery.
he and his team followed 100 critically ill patients, with an average age of 59, who had experienced life and death on ICU ventilators, including intestation and non-invasive ventilators.
the entire follow-up period is tentatively set at one stage every three months.
, Peng Zhiyong selected some important indicators for follow-up: including lung function, immune system, antibody status, psychological scale testing, etc.
July, the first phase of the follow-up was completed, and Peng Zhiyong found that of the 100 recovered new coronary critically ill patients: 90% of critically ill patients still had impaired lung function; In 0% of patients, abnormalities occurred in antibody testing, another 20% - 50% of patients developed depression, and almost all follow-up patients experienced more or less sense of illness, making it difficult to fully return to normal life as before.
90 per cent of critically ill patients have not yet fully recovered their lungs, especially those on ventilators.
During the treatment of the new crown, Dr. Yi E, Beijing University of Traditional Chinese Medicine, Dongdingmen Hospital, deputy director of the emergency department, Dr. Liang Tengxuan, is also doing 65 years of age and older new coronary critical illness rehabilitation patients return visit: some patients are still in the hospital's general ward, one of them, take off the ventilator, non-exercise state can only last ten minutes;
follow-up to 100 new coronary critically ill patients, Peng Zhiyong's team first tested lung function.
lung function test consists of two main indicators: one is the lung's breathing function, that is, oxygen can enter the lungs, and the other is the lung's breathing function, that is, the lung gas can enter the capillaries.
these two functions, can ensure that the body breathes enough oxygen, and oxygen to the body's organs.
Lung function test results are not optimistic: about 90% of patients, lung function is still impaired, not fully recovered, not up to normal human values;
Peng Zhiyong's team conducted a six-minute walking experiment and found that their athletic ability was equivalent to 80 per cent of normal people of the same age - i.e. the distance between a normal person walking six minutes was 500 metres, while rehabilitation patients could only walk about 400 metres.
that the immune system is still in a "war-ready" state to Peng Zhiyong's surprise, the recovering patient's immune system is still not restored to the state before being infected by the new crown virus.
the immune system of recovering patients is not measured by subjective perception, but by counting lymphocytes in their bodies and in immune-related cells.
Immunity is divided into two types, one is natural immunity, that is, the human immune system's innate "xenophobic instinct" to remove cells before the virus infects them, and the other is obtained immunity, which is the body's precise identification of introbes and the formation of markers of introviral immune behavior.
Obtained immunity is done by B-cells and T-lymphocytes, where B-cells produce antibodies that destroy out-of-cell pathogens, and T-cells, one that kills infected cells and the other that help activates other immune cells.
In these recovered patients, the B-cell count of the antibodies they produce is low, but the "main force" T cells used to kill the virus are still very strong, even if the new coronary virus nucleic acid test in the recovered patients is negative, but the T-cells are still in a state of readability.
means that the patient's immune system has not yet returned to normal, perhaps their immune system is still recovering, after all, this is only the first stage of follow-up.
," explains Peng Zhiyong.
Very few people should have antibodies disappeared, should not have appeared in the 100 rehabilitation patients in the discharge, did two tests, one is the new crown virus nucleic acid test, all negative, meaning that there is no new corona virus in the body, this is the first discharge condition.
is the nucleic acid testing of antibodies, which are divided into two indicators, immunoglobulin IgM and IgG.
IgM and IgG mainly judge when the virus enters the human body, IgM-positive, meaning that the virus has just infected the human body, IgG-positive means that the virus has been infected in the human body for some time, for the virus nucleic acid test negative rehabilitation, IgG-positive means that the virus has been infected before, and has produced antibodies - after injection of effective vaccine will produce the same test results.
antibody testing is also an important means of judging asymptomatic infections.
if IgM is positive, IgG is negative, and the virus nucleic acid is tested negative, it means that the person has just been infected with the virus and needs to be quarantined.
the opposite criteria for rehabilitation and discharge - IgM-negative, IgG-positive, and viral nucleic acid testing negative.
that most of the 100 rehabilitation patients had met the three discharge criteria.
In Peng Zhiyong's follow-up results, the virus tested negative for all recovered patients, but surprisingly, 10% of the recovered patients were negative for immunoglobulin IgG, which prevents the re-invasion of the new coronary virus; In 5% of patients, he was even more puzzled by the fact that even if their nucleic acid test was negative (indicating that there was no new coronary virus in the body), antibody testing indicated that the immunoglobulin IgM, which indicates entry into the early stages of infection, was positive and needed to be isolated again for 14 days until IgM turned negative.
this indicate a recurrence of the virus in these recovering patients? Will their viral nucleic acid tests turn yang? Because this part of the patient is still in isolation, it is difficult to make a judgment.
Depression and illness In these 100 rehabilitation patients, most of them were office workers with stable social relations before they became ill, but three months after discharge, less than half returned to work, and others still faced physical rehabilitation and psychological adjustment.
the 100 patients, Peng Zhiyong's team also conducted a psychological scale of depression assessment.
used two internationally recognized authoritative depression test scales, one of which is the sci-90 scale.
", each has its own variety and can complement each other.
" test results showed that 50 percent of people met the symptoms of depression, and another showed that 20 percent were depressed.
Peng Zhiyong team in the follow-up of patients with new coronary critical illness, try to be based on objective indicators, including in the psychological state of this higher degree of subjective testing, the same is true.
but the team was able to clearly feel most of them depressed during their contact with recovering patients, with a greater or less "sick sense of shame."
some of these rehabilitation patients, heard that the doctor may do follow-up, family members and patients immediately refused, want to cut off all and "new crown" contact.
almost all of the rehabilitation patients who were followed by doctors mentioned the same scenario, even at home, the family did not want to eat with them at a table, outsiders to avoid them.
recovery of patients with new crowns is not only the disappearance of viruses in the body, but also the recovery of individual mental state and the process of reconnecting with the outside social system.
this is a more complex proposition and a longer process than the new crown confirmed cases.
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