Every runnallist Cheng Xiaoling Each editor Liu Yanmei
"On the afternoon of February 19, a new type of coronavirus pneumonia patient was isolated after treatment in Wangjiang Jinyuan, Chengdu. "On February 21, the news was verified by the Chengdu Public Health Clinical Medical Center.
"On February 10, according to the National Coronary Pneumonia Diagnosis and Treatment Program (Trial Edition 5), the patient met the requirements for discharge indications and was allowed to leave the hospital. After 19 re-examination positive, the patient has been admitted to our hospital for further review. "
Does retesting positive mean recurrence? Is there a risk of infection for the contact? And how?
In response, Lei Xuezhong, a member of the Sichuan Provincial Group of Medical Specialists on New Crown Pneumonia and deputy director of the West China Hospital Infectious Diseases Center at Sichuan University, said in an interview that such conditions were not a recurrence and were more likely to be a persistent residue of a few viruses.
Virus residues are more likely No recurrence
"Even if there is a little virus residue in the later stage of this type of patient, as long as the appropriate isolation is given, the basic treatment after the situation is relatively stable, people need not be particularly nervous. "
Lei xuezhong said that the chengdu patients re-examined found nucleic acid positive cases are very few, the domestic has had a similar situation," this shows that the virus is far from enough understanding, need to strengthen research to deepen understanding."
"In previous editions of the national guidelines for diagnosis and treatment, specimens of nasopharyngeal swabs from the upper respiratory tract are mainly mentioned. Two times in a row,24 hours interval of nasopharyngeal swab nucleic acid detection negative, combined with clinical symptoms obviously alleviated, improved, can reach the standard of release isolation, count as recovery, can be discharged from home isolation observation. "In his view, the most important aspect of the current standard for patients to be discharged from isolation is the results of a nucleic acid test for the new coronavirus.
As awareness of the disease continues to deepen, the National Health and Health Commission is also constantly updating the diagnosis and treatment program.
"The New Pneumonia Treatment Scheme for Coronary Virus Infection (Trial Edition 6) has been further tested for lower respiratory tract, mainly sputum, and even alveolar lavage fluid, which is likely to be more accurate. "Lei Xuezhong analysis said.
Concerning the follow-up management of discharged patients, he suggested that home isolation should be carried out for 14 days to avoid going out. Follow up regularly according to doctor`s advice, do well health monitoring. During the home, for the health of the family, minimize close contact. and cooperate with the hospital to do later follow-up, testing, etc.
Strategies for "False Negative"
In fact, in addition to Chengdu, such cases have been reported elsewhere.
Earlier, Beijing-China-Japan Friendship Hospital issued a notice: a Wuhan patient with fever and pneumonia was diagnosed with a new coronary pneumonia on February 5. In this case, the three times before admission, the test of the new pharyngeal swab virus nucleic acid was negative, and the test of methyl-flu nucleic acid was positive. After admission, a ventilator was intubated and tested by alveolar lavage.
On february 5th academician wang chen, a critical medical expert and president of the chinese academy of medical sciences, told cctv:" not all patients can test positive for nuclear acid, but only 30% to 50% positive for patients with a new type of coronavirus. There are still many false negatives through the collection of throat swabs in suspected cases. "
"I had a patient who got better and left the hospital with two negative tests, but a little fever a few days later, and a nucleic acid test was positive. This is also the case, so discharge cases are kept at home for 14 days. On February 18, Professor Zhao Jianping, Head of the Department of Respiratory and Critical Care, Tongji Hospital, Huazhong University of Science and Technology, said.
Zhao said the nucleic acid test was negative and could be influenced by many factors. First of all, the detection is based on nasopharynx and oropharynx, but in fact, the virus quantity of the upper respiratory tract is not as large as that of the lower respiratory tract, and the positive rate of the lower respiratory tract is a little higher, but it is not realistic to need the patient to have sputum and carry out invasive sampling. Secondly," false negatives "are also linked to the level of material taken by medical personnel and the problems of the test reagents themselves.
"We think the patient should be positive, but the test is negative, how much is that? About 30% to 40% positive at a time, that is to say, it was sick, only 30% to 40% positive and 60% to 70% untested. Therefore, we need to combine the experience of doctors, comprehensive judgment. "Zhao Jianping said.
Gao Zhancheng, director of respiratory department at the People`s Hospital of Peking University, also said at a press conference on February 9 of the State Council`s joint defense control mechanism:" The results of nucleic acid testing of any virus cannot be 100 percent positive, and the detection of nucleic acid of new coronavirus pneumonia is no exception. The detection rate is also related to the severity of the patient`s condition, the different stages of disease development, the sampling method and the laboratory`s own detection conditions. "
Journallist, the daily economic news, notes that the new "treatment plan for coronary pneumonia (trial sixth edition)", released by the national health commission on february 19th, specifically supplemented matters needing attention after discharge.
Article 8 of the requirements of "Release of isolation and matters needing attention after discharge from hospital ", the standard of release of isolation shall meet the following four conditions:1. body temperature returned to normal for more than 3 days;2. respiratory symptoms obviously improved;3. pulmonary imaging revealed a significant uptake improvement in acute exudation of veneal disease;4. Two consecutive respiratory tract samples were negative for nucleic acid detection (sampling time was at least 1 day).
The new "Post Discharge Notes" are:
1. Designated hospitals should make good contact with the primary medical institutions in the place where the patients live, share medical records and materials, and timely send the information of discharged patients to the neighborhood committee of the patient`s jurisdiction or place of residence and primary medical and health institutions.
2. After discharge from hospital, due to low immune function and risk of infection with other pathogens during convalescence, it is recommended to continue to monitor self-health for 14 days, wear masks, live in a well-ventilated single room with conditions, reduce close contact with family members, eat meals, do good hand hygiene and avoid going out.
3. It is recommended that the second week after discharge, the fourth week after hospital follow-up, follow-up.
In addition, to reduce the risk of recurrence and potential transmission of the disease, the experts recommend that the following precautions should be taken after discharge:
1. Continue to stay at home for 14 days, avoid going out as far as possible, avoid going to crowded places and avoid taking public transportation.
2. Follow up regularly according to doctor`s advice, do well health monitoring. Take daily body temperature during home, pay attention to cough, dyspnea, chest pain and other respiratory symptoms. For respiratory symptoms such as fever (above 37.3°C) and cough, wear a mask, visit the nearest fever clinic in time, and inform the doctor of the new history of coronavirus infection.
3. Pay attention to hygiene, no spitting, cough with a tissue to cover mouth and nose, wash hands frequently. For the sake of family health, it is recommended to wear a mask until symptoms of respiratory tract completely disappear.
4. Pay attention to strengthen the ventilation of the bedroom and keep it clean. Home cleaning takes wet cleaning.
5. Care workers wear masks and long-sleeved rubber gloves when exposed to body fluid, sputum, vomit, excreta, and wash hands immediately after treatment.
6. Cooperate with relevant departments to collect samples after discharge and carry out virus nucleic acid detection. If the test results are positive,120 sent to the designated hospital isolation treatment.
7. No fixed accommodation, after discharge from the temporary stay in the city guests, according to the relevant guidelines to the city designated reception hotel accommodation, during the regular follow-up, wearing masks, avoid going out, reduce contact with personnel.
