“Our discharge standard is too wide!” Zhang Zhan, deputy chief physician and associate professor of respiratory and critical care medicine, people’s Hospital of Wuhan University, said recently.
Recently, many places such as Chengdu, Wuhan and Guangdong have seen positive re examination of discharged patients, among which 14% of discharged patients in Guangdong have positive re examination. On February 24, Zhang Zhan wrote on the wechat official account of “Department II of people’s respiratory and critical care medicine of Wuda”, saying, “with the cooperation of patients (the composition of medical staff in our hospital), we delayed the discharge of 18 patients who met the discharge standard of the national guidelines, continued to reexamine the pharyngeal swab nucleic acid for 5 times, and found that 13 patients showed positive results for the third time. The results of 5 consecutive nucleic acid tests were all negative, and they were discharged immediately. All the samples were collected by the patient himself to avoid false negative results caused by different personnel every day. Five consecutive negative patients have been positive in the past, so there is no false negative due to manual sampling and other reasons. “
Wuhan doctors suggest three times of negative nucleic acid before discharge
According to the novel coronavirus pneumonia diagnosis and treatment plan (trial version sixth) issued by the National Health Protection Committee, there are 4 criteria for lifting isolation and discharge, of which fourth are: two times of respiratory tract specimens are negative for nucleic acid detection (sampling time is at least 1 days).
However, at present, many patients are positive in nucleic acid reexamination two weeks after discharge. Zhang Zhan pointed out that the possibility of reinfection is small because these patients have produced high IgG of new coronavirus antibody. In order to solve this problem, Zhang Zhan believes that the fourth article of the treatment plan should be revised to “three consecutive negative nucleic acid tests of respiratory samples”
As early as January 31, Zhang Zhan published an article saying that in clinical practice, she found that patients who met the national treatment plan to lift the isolation standard fell ill about 8 days after discharge. During the isolation period, the family members did not contact other people.
At the same time, after the first confirmed medical staff of the people’s Hospital of Wuhan University returned to work, they were tested for viral nucleic acid again, and the result was still positive. Knowing this situation, Zhang Zhan immediately reported to the hospital headquarters. The hospital listened to the opinions of Zhang Zhan and other first-line doctors, and asked the infected medical staff in the hospital to continue isolation for 2 weeks after the throat swab nucleic acid was negative twice. Before returning to work, the virus nucleic acid must be rechecked, and the work can only be resumed if the result is negative.
For novel coronavirus pneumonia, the patient was tested for viral hepatitis DNA by a series of viral tests for 44 new two patients with negative results, including two of the above. Of these 44 people, about 26 had a third positive nucleic acid result, with a very high probability.
“At present, the data shows that there are 5 patients who have negative nucleic acid test for 3 times, and 5 consecutive tests are negative. That is, if the three tests are negative, it can be basically determined that there will be no more positive possibility. In terms of probability, after three times of negative test, the probability of positive test is greatly reduced. At present, it can be determined that the discharge standard in the current diagnosis and treatment plan is too loose, and there are many positive cases after two negative cases. ” According to this, Zhang Zhan suggested that the patients who had been discharged should go to the hospital for virus nucleic acid test two weeks after isolation at the isolation point, and reexamine four weeks after discharge.
Zhang Zhan explained that there may be two reasons for this situation. On the one hand, it may be the problem of the kit, that is, the test result before discharge is false negative. Another more likely cause is the cycle of virus replication. In the course of improvement, the viral load will decrease and intermittent detoxification will occur, so it may cause the results of intermittent negative and positive detoxification.
Anal swab to be tested in Shanghai
Zhang Zhan told reporters that at present, discharge standards in Jiangsu, Zhejiang, Shanghai and Guangdong are stricter than those in the current treatment plan.
Professor Lu Hongzhou, Secretary of the Party committee of Shanghai public health clinical center, introduced to China News Weekly that the patients in Shanghai should not only meet the standards of obvious absorption of pulmonary exudative lesions, improvement of clinical symptoms and negative detection of pharyngeal swab virus nucleic acid, but also require that the anal swab (fecal) nucleic acid test of discharged patients be negative. He said that since the discharge standard in Shanghai is more strict than that in the diagnosis and treatment plan, so far, there has been no case of nucleic acid conversion in patients discharged from Shanghai.
Lu Hongzhou also pointed out that at present, in the “diagnosis and treatment plan” in Shanghai, patients discharged from the hospital in the second and fourth weeks of follow-up and follow-up are recommended to be reexamined in the first and third weeks after discharge. “If the patient recovers after discharge, we can find out in time in the first week,” he explained. Although up to now, it is not clear whether there is infectivity in Fuyang patients after discharge, but if there is still infectivity in Fuyang patients, it may lead to more infections, then why should we wait until the second week for reexamination? We would rather be strict with a new infectious disease. It’s better to let the patient come back for reexamination in the first week than to let the patient reexamine in two weeks, which is more reassuring. “
As novel coronavirus pneumonia medical treatment expert group, member of the infectious disease group, Lu Hongzhou said, “I believe that the seventh edition of the” diagnostic plan “will take into account the anal swabs (feces) nucleic acid positive. With our continuous understanding of new diseases and the increase of evidence-based medicine basis, the diagnosis and treatment plan will be one version to one