(Combat new crown pneumonia) how to deal with the "yin and yang change" of discharged patients?
China News Agency, Beijing, February 26, by question: How to deal with the "change in yin and yang" of the discharged patients?
Guo Chaokai
Recently, in Guangdong, Sichuan and other places, patients who have been cured and discharged from hospital have been tested positive for nucleic acid. The reporter interviewed relevant experts and explored ways to cure discharged patients from "yin" to "yang".
14%: "Fuyang" rate of Guangdong cured people is high
According to the news on the 25th of Guangdong Province, 14% of patients discharged from the province at this stage have been tested positive for nucleic acid. In response, Song Tie, deputy director of the Guangdong Provincial Center for Disease Control and Prevention explained that the official is still conducting scientific evidence-based research and has not yet reached a systematic scientific conclusion. But from the current point of view, most of the patients' lung inflammation is in the process of absorption, has not yet reached clinical cure, so it is determined that there may be intermittent detoxification.
In fact, this is not the first time that patients with new coronary pneumonia cured and discharged from hospital have a “rejuvenation” phenomenon. On February 21, Sichuan notified a cured patient in Chengdu that he had been discharged for 10 days but had a positive nucleic acid.
Why does the cured patient change from "yin" to "yang"? Lu Hongzhou, secretary of the party committee of Shanghai Public Health Clinical Center affiliated to Fudan University, said that patients who have recovered are unlikely to relapse because antibodies have been produced, and as long as the virus has not changed, there is no possibility of reinfection. There are two possibilities for "Fuyang" in Chengdu patients. One is that a positive specimen was not taken when the nucleic acid test was discharged and was mistakenly considered negative. The other is that the patient produced viral antibodies in the body after recovery, and the virus was discharged with cell metabolism. The nucleic acid test was positive, but it was not a live virus, it was just a metabolite.
A Beijing respiratory specialist said in an interview with the China News Agency that "14% of patients discharged from Guangdong's" Fuyang "may be due to inaccurate nucleic acid detection, which reminds us to further standardize virus detection." He believes that in addition to nucleic acid testing, methods such as gene sequencing can also be tried. Patients can be discharged after being cured by multiple testing methods.
Worry: Will "Fuyang" patients spread the virus?
The phenomenon of "Fuyang" has aroused attention from all walks of life, and it has also caused the public to worry about whether these patients are contagious and whether they will be transmitted from person to person.
Fortunately, more than 100 people in close contact with 13 "Fuyang" patients in Guangzhou were not infected. Guangdong Province also has preliminary data. When 14% of "Fuyang" patients were discharged from centralized medical observation, there were no close contacts of the second-generation cases.
"From the point of view of the characteristics of microorganisms, humans will produce antibodies after being infected with the virus, which is not transmissible." Song Tie believes that "Fuyang" is caused by the patient's condition and personal constitution. Without full recovery and absorption, Clinically, very rare cases have been found to be infected.
Song Tie said that through laboratory observations, young people will produce antibodies within two weeks. This antibody is a protective antibody. Even if a positive nucleic acid test occurs, the risk of transmission will become lower and lower. In addition, some elderly people have developed antibodies for a long time, and may continue to detoxify and become the source of infection. Officials will strengthen the management of the source of infection in the strictest way.
Regarding the infectiousness of "Fuyang" patients, Huang Bo, deputy director of the Institute of Basic Medical Sciences of the Chinese Academy of Medical Sciences, told a reporter from China News Agency that in the case of inaccurate nucleic acid testing, even if the discharged patients did appear "Fuyang", "The pathogenicity and infectivity of the new crown virus in their bodies are also very weak and should not be considered."
Day 14: Is unified isolation necessary?
The sixth edition of the "New Coronavirus Pneumonia Diagnosis and Treatment Plan" (trial version) proposed that the new isolation and discharge standards for new coronary pneumonia are that the body temperature has returned to normal for more than 3 days, the respiratory symptoms have improved significantly, and pulmonary imaging has shown that the inflammation is significantly absorbed, two consecutive times Respiratory pathogen nucleic acid test is negative (sampling interval at least 1 day), can be released from hospital. The plan also recommends that cured patients continue to monitor their self-health status for 14 days, and follow-up and follow-up visits to the hospital at 2 and 4 weeks after discharge.
In Hubei, where the epidemic is most severe, in order to avoid further spread of immunity, from February 23, those who have been discharged from the hospital should go to a designated place for uniform rehabilitation and medical observation for 14 days. Wuhan has recently acquired a group of student apartments from Hubei University, which has been transformed into a centralized isolation point for cured patients after discharge.
The emergence of "Fuyang" in 14% of patients in Guangdong has also led to new discussions on whether or not to cure and discharge patients should be uniformly isolated. In this regard, a Beijing respiratory medicine expert said that if 14% of Guangdong ’s cured people “Fuyang” did exist, then Hubei ’s practice of uniformly isolating and curing discharged patients for 14 days was worthy of Guangdong ’s follow-up and promotion.
Song Tie said that “the national diagnosis and treatment plan has clear regulations on 'Fuyang' and discharge standards, and requires patients to focus on medical observation for 14 days after discharge.” This requirement has been implemented at the grassroots level and monitoring will be carried out later. Patients to be discharged are found to have antibodies, and the nucleic acid test is negative before they can move to society in a healthy way. (Finish)