·Pneumonia caused by new coronavirus (COVID-19) infection
·At first fever, fatigue, dry cough, dyspnea gradually appear, etc.
·Have the ability to infect people, wear masks properly to strengthen protection
·Most have a good prognosis, a few are critically ill and can even cause death
Definition of disease
The new coronavirus-infected pneumonia is an acute infectious pneumonia, the pathogen of which is a new coronavirus previously not found in humans, namely the Corona Virus Disease 2019(COVID-19).
The initial symptoms of the patient were mostly fever, fatigue and dry cough, and gradually developed severe symptoms such as dyspnea. Most patients have a good prognosis, and some severe cases may develop acute respiratory distress syndrome or septic shock, or even die. At present, there is no specific treatment for this disease.
Based on the current epidemiological investigation, the incubation period of the disease is generally 3-7 days, the shortest incubation period is one day, and the longest incubation period is 14 days. The incubation period is contagious. The disease is mainly transmitted through droplets and contact. There may be aerosol transmission risks in closed and unventilated places, and prevention and isolation measures need to be strengthened. The population is generally susceptible, the elderly and those with underlying diseases are more severely infected, and children, infants and young children are also affected.
The first patient with pneumonitis infected by a new coronavirus was found in Wuhan, Hubei Province on December 12, 2019. The subsequent patients mostly had a history of exposure to the South China seafood market or family clustering. There is droplet transmission and contact transmission.
·At 21:00 on January 7, 2020, researchers detected a new type of coronavirus in patient specimens;
·At 24 o’clock on January 10, the detection of pathogenic nucleic acid was completed;
·On January 12, the World Health Organization (WHO) named the new coronavirus that caused the pneumonia epidemic in Wuhan as 2019 new coronavirus (2019-nCoV);
·As of 24:00 on January 29, the National Health and Health Commission has received a cumulative report of 7711 confirmed cases, 31 cases of severe cases, 170 death cases, and cumulative cures and discharges from 31 provinces (autonomous regions, municipalities) and the Xinjiang Production and Construction Corps. There were 124 cases with 12,167 suspected cases. A total of 25 confirmed cases were reported in Hong Kong, Macao and Taiwan: 10 in Hong Kong Special Administrative Region, 7 in Macao Special Administrative Region, and 8 in Taiwan
New coronavirus-infected pneumonia is an acute infectious disease;
Mainly caused by Corona Virus Disease 2019 (COVID-19) infection;
The elderly and those with underlying diseases are likely to become critically ill after infection.
Coronaviruses are single-stranded positive-strand RNA viruses. There are six known coronaviruses that have previously infected humans, namely HCoV-229E, HCoV-OC43, SARSr-CoV, HCoV-NL63, HCoV-HKU1, and MERSr-CoV.
The coronavirus isolated from the lower respiratory tract of patients with unexplained pneumonia in Wuhan this time is a new type of coronavirus belonging to the genus β, which is the 2019 new coronavirus (2019-nCoV), which belongs to the seventh species. Current research shows that it has more than 85% homology with bat SARS-like coronavirus (bat-SL-CoVZC45).
The elderly and those with underlying diseases are more ill after infection.
According to the National Health and Health Commission’s “Pneumonitis Diagnosis and Treatment Program for New Coronavirus Infection (Trial Version 4)”, some patients have mild onset symptoms and no fever. Severe and critically ill patients may have moderate to low fever during the course of the disease, or even no obvious fever.
·Main symptoms are fever, fatigue, and dry cough;
·Nasal congestion, runny nose and other upper respiratory symptoms are rare;
·About one-half of the patients develop dyspnea after one week. In severe cases, they progress rapidly to acute respiratory distress syndrome, septic shock, difficult to correct metabolic acidosis, and coagulation dysfunction.
It is worth noting that in the course of severe and critically ill patients, there can be moderate to low fever, even without obvious fever. Some patients have mild onset symptoms and no fever. They usually recover after 1 week. Most patients have a good prognosis, and a few patients are critically ill and even die.
Seek medical treatment
The disease is an acute infection, which usually worsens gradually during the first week. If you have any of the following conditions, please seek medical treatment in time:
·Recent fever, fatigue, and cough of unknown cause;
·Wuhan residence or travel history within two weeks before the onset of illness;
·A history of close contact with confirmed patients two weeks before the onset of illness;
·Aggregative onset (2 and over).
During the consultation, the doctor may ask the following questions to get a preliminary understanding of the medical history, and patients can prepare corresponding answers in advance:
·When do you experience fever and cough?
·Where did you go before and who did you contact?
·Does anyone have similar symptoms?
·Are you having difficulty breathing?
·What are the underlying diseases?
According to the “Pneumonitis Diagnosis and Treatment Program for New Coronavirus Infection (Trial Implementation)” issued by the National Health Commission:
|| Suspected cases (formerly observed cases)
Combining the following comprehensive analysis of epidemiological history and clinical manifestations, there is any one of the epidemiological history and any two of the clinical manifestations.
Travel history or residence history in Wuhan within two weeks before the onset of illness;
Or patients who had fever from Wuhan with respiratory symptoms within 14 days before the onset of illness;
There is an epidemiological association in patients with clustered onset or new coronavirus infection.
Have the above-mentioned pneumonia imaging characteristics;
The total number of white blood cells is normal or decreased in early onset, or the lymphocyte count is decreased.
Suspected cases with one of the following pathogenic evidence:
·Real-time fluorescent RT-PCR of respiratory or blood samples for detection of novel coronavirus nucleic acids.
·Respiratory or blood specimens are genetically sequenced and highly homologous to known new coronaviruses.
With fever, respiratory tract and other symptoms, imaging shows pneumonia.
Meet any of the following:
·Respiratory distress, breathing frequency ≥ 30 times / minute;
·In the resting state, it means oxygen saturation ≤ 93%;
·Arterial blood oxygen partial pressure (PaO₂) / oxygen concentration (FiO₂) ≤ 300 mmHg (1 mmHg = 0.133kPa).
One of the following:
·Respiratory failure occurs and requires mechanical ventilation;
·Combining other organ failures requires ICU monitoring.
Fever diagnosis and infection department.
Mainly check the lungs, auscultation of breathing sounds, etc.
·Blood routine: The total number of white blood cells in the early stage is normal or decreased, and the lymphocyte count is reduced.
·Liver and kidney function: Transaminase, creatine kinase, etc. may be elevated.
·C-reactive protein (CRP) is elevated and procalcitonin can be normal.
·Coagulation function: D-dimer can be increased.
|Film Degree Exam
Multiple small patchy shadows and interstitial changes appeared early, and the extrapulmonary bands were obvious. Furthermore, it develops multiple ground glass infiltration and infiltrates in both lungs. In severe cases, pulmonary consolidation and pleural effusion are rare.
For pathogen detection, samples of throat swabs, sputum, or lower respiratory tract secretions were collected and subjected to real-time fluorescent RT-PCR. The results were positive for the new coronavirus nucleic acid test. Or sequencing of pathogen genes suggests a high degree of homology with the new coronavirus.
The disease needs to be distinguished from influenza virus, SARS coronavirus, MERS coronavirus and other known viral pneumonias, as well as from Mycoplasma pneumoniae, Chlamydia pneumonia and bacterial pneumonia. In addition, it should be distinguished from non-infectious diseases such as vasculitis, dermatomyositis, and organizing pneumonia.
Doctors will make detailed inspections from multiple aspects to determine. The main characteristics of this pneumonia are atypical onset, less high fever, most around 38 ° C, and some of them may not have fever, mainly dry cough. Compared with influenza, severe disease progresses slightly slowly The incubation period is generally 3 to 7 days, and the final diagnosis depends on the results of pathogenic testing.
At present, there is a lack of effective antiviral drugs for pathogens, mainly in isolation and symptomatic supportive treatment.
According to the “Pneumonitis Diagnosis and Treatment Program for New Coronavirus Infection (Trial Version 4)” issued by the ·National Health and Health Commission: For severe and critical cases, based on symptomatic treatment, actively prevent complications, treat basic diseases, and prevent secondary Infection, timely organ function support. Take the following measures:
·Respiratory Support: Non-invasive mechanical ventilation for 2 hours, no improvement in the condition, or the patient cannot tolerate non-invasive ventilation, increased airway secretions, severe cough, or hemodynamic instability, and should promptly transition to invasive mechanical ventilation. Invasive mechanical ventilation uses a small tidal volume “pulmonary protective ventilation strategy” to reduce ventilator-related lung injury. If necessary, take prone ventilation, lung retension or extracorporeal membrane oxygenation (ECMO), etc .;
·Circulation Support: based on adequate fluid resuscitation, improve microcirculation, use vasoactive drugs, and monitor hemodynamics if necessary;
·Other Treatment Measures: According to the patient’s dyspnea and chest imaging progress, glucocorticoids can be used for a short period of time (3 to 5 days) as appropriate. The recommended dose is not to exceed 1 to 2 mg / kg · d of methylprednisolone. Xuebijing can be administered intravenously 100mL / day, twice a day for treatment. Intestinal microecological regulators can be used to maintain intestinal microecological balance and prevent secondary bacterial infections. If possible, consider recovery plasma therapy;
·Patients often have anxiety and fear, and psychological counseling should be strengthened.
Acute Phase Treatment
Patients with hypoxia and dyspnea should be given oxygen therapy (such as nasal catheter oxygen, mask oxygen) and non-invasive or invasive ventilator support if necessary.
·Rest in bed, strengthen supportive treatment to ensure sufficient heat; pay attention to water and electrolyte balance to maintain internal environment stability; closely monitor vital signs, oxygen saturation, etc.
·Monitor blood routine, urine routine, C-reactive protein (CRP), biochemical indicators (liver enzyme, myocardial enzyme, renal function, etc.), coagulation function according to the condition, and perform arterial blood gas analysis if necessary, and review chest imaging.
·According to the change of oxygen saturation, timely provide effective oxygen therapy measures, including nasal catheter, mask to give oxygen, nasal high-flow oxygen therapy if necessary, non-invasive or invasive mechanical ventilation.
·Antiviral therapy: There are currently no effective antiviral drugs. Try alpha-interferon inhalation (5 million U each time for adults, add 2 ml of sterile water for injection twice daily), 2 capsules of lopinavir / ritonavir, twice daily;
·Antimicrobial treatment: Avoid blind or inappropriate use of antimicrobials, especially in combination with broad-spectrum antimicrobials. Strengthen bacteriological surveillance and apply antibacterial drugs in time when there is evidence of secondary bacterial infections;
·Others: According to the patient’s dyspnea and chest imaging progress, glucocorticoids should be used within a short period (3 to 5 days) as appropriate. The recommended dose is not to exceed 1 to 2 mg / kg · d of methylprednisolone.
TCM treatment of the disease is currently lacking evidence-based medical evidence. On January 23, 2020, the National Health and Medical Commission issued the “Diagnosis and Treatment Scheme for New Coronavirus Infected Pneumonia (Trial Version)”, which covers 4 traditional Chinese medicine prescriptions and can be used as a treatment for pneumonia caused by new Coronavirus Important addition. It is recommended to go to a regular medical institution for treatment under the guidance of a physician.
Judging from the current cases, most patients have a good prognosis, children with relatively mild symptoms, a few patients are critically ill, and deaths are more common in the elderly and those with underlying diseases.
Individuals with severe illness may have pulmonary fibrosis and recovery may take longer.
Severe cases can be complicated by acute respiratory distress syndrome, septic shock, metabolic acidosis that is difficult to correct, and coagulopathy.
New coronavirus-infected pneumonia currently lacks effective treatments. The management of daily life focuses on the prevention of infection and the effective isolation of suspected and confirmed cases.
New coronavirus-infected pneumonia has a family gathering phenomenon, and if there are suspected symptoms, go to the infectious department for treatment in time. It needs to be isolated and treated in a hospital with effective isolation and protective conditions.
Daily Life Management
·Paying attention to wearing masks in public places and striving for personal protection is a practical approach;
·Pay attention to hand hygiene, wash your hands frequently, wash your hands with soap or water, or hand disinfectants containing alcohol;
·Pay attention to proper cough etiquette. Do not cover your hands with sneezing. Cover with elbows or paper towels.
·Pay attention to drink plenty of water, rest more, avoid staying up late, and improve individual immunity;
·Ventilation should be maintained in living and working environments;
·Eat properly and thoroughly cook meat and eggs during cooking to avoid contact with wild animals and poultry and livestock without protection;
·Do not go to crowds and avoid close contact with anyone with cold or flu-like symptoms.
Daily Condition Monitoring
Pay attention to monitoring body temperature. Seek timely consultation if you have fever, fatigue, or cough. If you have a history of living or travelling in the epidemic area (Wuhan) within two weeks before the onset of illness, have a history of contact with a confirmed or suspected patient, or have symptoms of collective illness, you need to seek medical treatment and take active isolation.
The incubation period of this disease can be 1 to 2 weeks. If a confirmed or suspected patient has a history of exposure, even if there are no symptoms such as fever, active isolation is required.
The release of isolation requires that the body temperature return to normal for more than 3 days, the respiratory symptoms improve significantly, and the pathogen detection is negative for 2 consecutive times (at least 1 day apart).
There is currently no effective vaccine prevention method for pneumonitis infected by the new coronavirus.
Personal protection is the most practical way. This includes not going to crowds, washing hands, drinking plenty of water, and taking rest.
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