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"Fuyang" patients frequently occur everywhere. Have we encountered new problems?
2021-01-25 20:36 Source: The Paper, The Paper , Mediantion
The specific cause of "rejuvenation" in patients cured with new coronary pneumonia is still a mystery, but research shows that it is basically no longer infectious.
On the evening of January 24, Xicheng District, Beijing, notified the district's new coronavirus nucleic acid detection situation. In the nucleic acid test of 1,130,680 people. Except for one person who was collected on January 22 and tested positive, the results of the others were all negative. Subsequently, Xicheng District immediately activated an emergency response mechanism to review the person and found that he was a confirmed case diagnosed after entering Shanghai in August 2020 and cured. After complying with relevant regulations, he entered Beijing in October. It is not ruled out that more than four months after the cure The possibility of "rejuvenating Yang" again is currently being organized for expert consultation.
Also on the evening of January 24, Shanxi Fushan also notified a "Fuyang" patient. According to official reports, the patient returned from the Philippines to Zhengzhou on December 16, 2020. The nucleic acid test result was positive on December 17, and the patient was diagnosed as asymptomatic infection by the First Affiliated Hospital of Zhengzhou University, and was hospitalized for isolation treatment. On January 2, January 3, and January 4, 2021, the three nucleic acid tests were all negative. On January 5, 2021, he was discharged from the hospital and returned to Fushan, Shanxi. The nucleic acid test was negative. The "14+2" test was completed on January 22 Nucleic acid test was performed after home isolation, and the result was negative, but on January 23rd, Wei's nucleic acid test result was positive during the county's key population nucleic acid test in Fushan, Shanxi.
And at the 94th press conference on Shanghai epidemic prevention and control held on the afternoon of January 25.According to Wu Jinglei, director of the Shanghai Municipal Health Commission, more than 30 cases of "Fuyang" have been found in Shanghai during the 14-day quarantine period after healing. Shanghai-level designated hospitals will begin the fourth week of follow-up visits for discharged patients who have been released from quarantine for 14 days. Those discharged from other provinces and cities will be followed up by telephone, and they will be required to go to the local area for nucleic acid testing.
Earlier, Beijing Xinfadi had a case of "Fuyang" 28 days after being discharged from the hospital. In Hangzhou, Guangzhou, Zhuhai, and Chongqing, there have also been cases of “recovery” of immigrants after their isolation. The frequent occurrence of "rejuvenation" in various places seems to be a very difficult situation in epidemic prevention and control.
Regarding the phenomenon of "rejuvenation" one after another, Li Taisheng, the director-designate of the Infectious Diseases Branch of the Chinese Medical Association and the director of the Department of Infectious Medicine at Peking Union Medical College Hospital, said in an interview with a Global Times reporter that according to the existing "rejuvenation" of patients with new coronary pneumonia cured Research shows that many of the so-called “fuyang” are not necessarily the “endless” existence of the new coronavirus in the patient's body. The reasons that cause the new crown-cured patient's nucleic acid test to be positive again are more diverse and require specific analysis.
In April 2020, as the captain of the second batch of medical aid team of Peking Union Medical College Hospital, Li Taisheng, after the team members returned to Beijing triumphantly, was ordered to continue to stay in Wuhan, and went to Wuhan Jinyintan Hospital and Wuhan Pulmonary Hospital to treat the new crown. Designated hospitals for patients with pneumonia to carry out research on the phenomenon of "rejuvenation" in patients cured with new coronary pneumonia.
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According to Li Taisheng, at that time, Wuhan City collected more than 100 cases of "Fuyang" patients, but only 37 of them had relatively complete case data, suitable for comprehensive observation. All 37 patients were infected with new coronary pneumonia at the beginning of January. They were cured and returned home after multiple nucleic acid tests were negative. However, by the end of March and early April, these cured patients showed symptoms when they returned to the hospital for routine review. The nucleic acid test was positive again.
Through the clinical observation of these 37 "fuyang" patients, it was not found that they had various symptoms again. Analysis of their viral gene sequence did not find that there were new coronavirus-specific gene fragments in their bodies. Subsequently, they investigated their contact history, and carried out nucleic acid tests and IgG and IgM antibody tests among their relatives and friends and other long-term close contacts. The results were all negative. This confirms that their "rejuvenation" is not caused by a second time. The second proved that although they had a "rejuvenation" condition, they were no longer infectious.
Regarding the specific causes of the "fuyang" problem, Li Taisheng believes that existing research tends to believe that the "false negative" and "false positive" conditions in the testing process may be the main reason for the patient's "fuyang".
Because the new coronavirus is hidden deep in the human body, the virus content of the respiratory secretions in different parts of the nasopharynx, oropharynx, and respiratory lavage fluid is different. Therefore, in the process of nucleic acid testing to verify whether the patient is cured, there may be clear signs in the patient's body. There are still viral nucleic acid fragments, but the sample collection is not in place, and the nucleic acid test of the collected saliva samples is negative. Such "false-negative" patients generally may be found to be positive when they undergo a nucleic acid test again within two to three weeks after discharge, so it will give people the illusion of "rejuvenation". However, studies have shown that the viral load in such patients is small and basically non-infectious.
The polymerase chain (PCR) technology used in nucleic acid detection determines the equipment, reagents, temperature, air pollutants and other environmental factors that may affect the accuracy of nucleic acid detection. Problems in any of the above links may lead to errors in the test results, resulting in the possibility of "false positives". However, there is the possibility of errors in any laboratory inspection, and laboratory errors that meet the quality control standards are also allowed.
In addition, Li Taisheng also believes that as the global new crown pneumonia epidemic continues to worsen and the virus continues to evolve, when "fuyang" patients appear, they need to be checked for "secondary infection". Since the outbreak of the new crown pneumonia epidemic at the end of 2019, most countries in the world have now seen epidemics. From the perspective of virogenesis, the currently known virus strains in the world are divided into three types: A, B, and C. The strains of new coronaviruses circulating in different countries and regions are different. On August 24, 2020, the world’s first “second-infection” patient was found in Hong Kong. After sequencing and analyzing the whole genome of the virus, it was found that the patient’s two infections had different gene pedigrees.
Analysis of the patient’s two infections with different strains . This case shows that humans may not be able to achieve autoimmunity after being infected with the new coronavirus, and there may be repeated infections with different strains of the new coronavirus. This situation may also be understood as the so-called "rejuvenation" of nucleic acid, but This does not belong to the "rejuvenation" in the true sense, but a secondary infection.
"The're-yang' situation we really need to worry about is that the patient has a detoxification period after treatment for six months after being infected with the new crown, and it is still contagious. If this happens, it means that the virus is still in the human body. Chronic carrier state, it will be very troublesome. But the current observation and research on the new coronavirus has not found such a situation." Li Taisheng said.
As an infectious disease expert who has been dealing with the new crown virus for more than a year, Li Taisheng frankly admitted that the new crown pneumonia, as a new infectious disease, is a new challenge faced by all mankind. All aspects have broken through our previous cognition. Many issues including'Fuyang' still need us to continue to explore and understand. Nowadays, in some places, cured patients are regularly tested by throat swabs, and patients' detoxification conditions are tracked. I think research is necessary."
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