Who is recovering from novel coronavirus pneumonia or still carrying a virus? Health Care Commission: no further infection

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 Who is recovering from novel coronavirus pneumonia or still carrying a virus? Health Care Commission: no further infection


The study found novel coronavirus pneumonia patients who met the criteria of discharge or quarantine. 4 patients were tested for COVID-19 nucleic acid by real-time reverse transcription polymerase chain reaction (RT-PCR) after 5 to 13 days. The results show that at least a part of the recovered patients may still be virus carriers, and the discharge criteria may need to be reevaluated. In response to the situation of positive nucleic acid test found in the process of further consultation, Guo Yanhong, the supervisor of the medical administration of the national health and Health Commission, said at the press conference of the joint prevention and control mechanism of the State Council on February 28, through the monitoring, it was found that this part of patients did not infect others again, and another part of patients turned negative when they tested the new coronavirus nucleic acid again. She pointed out that novel coronavirus pneumonia is a new virus, and its pathogenesis, the whole picture of disease and the characteristics of the disease need further understanding.

The corresponding authors of the above-mentioned papers are Xu Haibo, director of imaging department, medical doctor of Radiology, director of laboratory department and Li Yirong, medical doctor, Central South Hospital, Wuhan University.

Previous studies on coronavirus disease (covid-19) in 2019 were mainly focused on the epidemiological, clinical and radiologic characteristics of patients with confirmed infection. Few studies focused on the follow-up of rehabilitation patients.

In the study of Central South Hospital of Wuhan University, from January 1 to February 15, 2020, one inpatient and three isolated patients (all patients were medical staff) were treated in Central South Hospital of Wuhan University, and real-time reverse transcription polymerase chain reaction (RT-PCR) was conducted to test the nucleic acid of covid-19 to determine whether they can resume work. Discharge or quarantine must meet all the following conditions: (1) normal body temperature lasts for more than 3 days, (2) respiratory symptoms are relieved, (3) acute exudative lesions on chest CT images are significantly improved, (4) two consecutive RT-PCR test results are negative, and the test interval is at least 1 day.

At first, novel coronavirus was tested by swabs in 4 patients in 2019, according to the previously described method. The 4 patients were infected with the new coronavirus in 2019. Two of them were men, ranging in age from 30 to 36. All patients had fever, cough or both symptoms. One patient was initially asymptomatic and had a thin-layer CT examination due to contact with an infected patient. The RT-PCR results of all patients were positive. CT images showed ground glass opacity or mixed ground glass opacity and combination. The severity of the disease is mild to moderate.

The hospital provided antiviral treatment (75 mg oseltamivir orally every 12 hours) to 4 patients. All the clinical symptoms and CT images of 3 patients have returned to normal. CT images of the fourth patient showed fine ground glass opacity. RT-PCR was negative for 2 consecutive times in all 4 patients, and the time from symptom onset to recovery was 12 to 32 days.

After meeting the discharge conditions of RT-PCR negative, clinical features and normal chest CT manifestations, the above four patients were discharged from the hospital or suspended isolation, but were required to continue isolation at home for 5 days. They repeated RT-PCR tests five to 13 days later, all positive. Then, all patients were tested by RT-PCR three times in the next four to five days, all of them were positive. In addition, the hospital also used kits from other manufacturers to carry out RT-PCR tests on these patients, and the results showed that they were all positive. After clinical examination, these patients are still asymptomatic, and the results of chest CT examination have no change compared with the previous images. The patient reported no contact (after discharge) with anyone with respiratory symptoms and no family infection.

The study found that the 4 patients who met the discharge or isolation quarantine standard of covid-19 (no clinical symptoms and radiology abnormalities, and both RT-PCR test results were negative), and the RT-PCR test results were positive 5 to 13 days later. This suggests that at least some of the recovered patients may still be virus carriers.

The study suggests that although no family members have been infected, these reported patients are all medical professionals and receive special care during family isolation, which may require reassessment of current discharge or suspension of quarantine standards and ongoing patient management.

The study was limited to a small number of patients with mild or moderate infection, the paper noted. For non healthcare professionals, patients with more severe infection after discharge or suspension of isolation should be further studied. Longitudinal study of more patients will help to understand the prognosis of the disease.

How to deal with the phenomenon of recovery of Yang after discharge? Zhong Nanshan, head of the high level expert group of the national health and Health Commission and academician of the Chinese Academy of engineering, said that Fuyang may involve many factors such as its own situation and nucleic acid detection, and the detection reagents, detection methods and sampling methods may have an impact on the positive rate.

The novel coronavirus pneumonia is a new infectious disease, and we can not make any final conclusion. Generally, as long as rehabilitation patients produce enough antibodies, they will not be reinfected. It remains to be seen whether it will spread to others. If the patient is positive in isolation at home, he needs to be tested again 24 hours later. If he is positive twice, he needs to go to a doctor.

Through monitoring, it was found that this part of patients did not infect others again, and another part of patients turned negative when they tested the nucleic acid of new coronavirus again. Guo Yanhong said the novel coronavirus pneumonia virus is a new virus, and its pathogenesis, the whole picture of disease and the characteristics of the disease need further understanding.

Guo Yanhong said that to further strengthen the management of discharged patients, it is now required to conduct 14 days of medical observation, and strengthen follow-up, health monitoring and health guidance during the implementation of 14 days of medical observation. At the same time, experts are organized to conduct further research on this situation, so as to further understand the whole process of the occurrence, development and prognosis of the disease.

The interpretation of the novel coronavirus pneumonia diagnosis and treatment plan (trial version sixth) also mentioned that after discharge, it is recommended that 14 days of self health monitoring should be continued, wearing masks, conditional living in a well ventilated single room, and reducing close contact with family members. It is suggested that the patients should be followed up at the 2nd and 4th week after discharge.

Earlier, many places also issued a notice calling for re isolation observation of the cured patients. Novel coronavirus pneumonia novel coronavirus Pneumonia Control and control headquarters announced in February 22nd that the new crown pneumonia patients should be discharged from the hospital until the completion of hospital treatment. The 14 day free rehabilitation and medical observation should be carried out in the designated place. At the end of the observation period, if the physical condition meets the conditions, the isolation shall be removed. The next day, Huangshi City also announced the implementation of the above practices.

Paper link of positive rt-pcrtest results in patients recovered from covid-19

https://jamanetwork.com/journals/jama/fullarticle/2762452