{"id":7822,"date":"2020-04-15T10:17:37","date_gmt":"2020-04-15T02:17:37","guid":{"rendered":"http:\/\/www.whatchina.cn\/?p=7822"},"modified":"2020-04-15T10:17:37","modified_gmt":"2020-04-15T02:17:37","slug":"the-covid-19-virus-is-much-more-complex-than-the-sars-virus","status":"publish","type":"post","link":"https:\/\/www.whatchina.cn\/the-covid-19-virus-is-much-more-complex-than-the-sars-virus.html","title":{"rendered":"The Covid-19 Virus Is Much More Complex Than The SARS Virus"},"content":{"rendered":"<div class=\"37c28470d9d6d3cb9ff74e663adb766a\" data-index=\"2\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-3594734025006597\"\r\n     crossorigin=\"anonymous\"><\/script>\n<\/div>\n<p>On April 14th, the doctors of our hospital held a farewell ceremony for the Hubei Medical Team in Beijing Tongji Hospital, Wuhan Tongji Hospital. The medical team will return to Beijing on April 15. During the COVID-19 epidemic in Wuhan, a total of 42,000 medical personnel assisted Hubei. This was the last team left to support the Hubei medical team. Li Taisheng (a male from the left in the front row) will continue to stay in Wuhan, responsible for the treatment and related research of COVID-19 patients.<br \/>\nOn April 9, Li Taisheng prepared to enter the contaminated area to examine the patient. He and his colleagues formed the system to take over the 9th floor ward of Building C of Sino-French New City Hospital of Wuhan Tongji Hospital, responsible for the treatment of critically ill patients. On the afternoon of April 12, the ward was emptied. During 69 days of operation, they admitted 109 critical patients.<br \/>\n57-year-old Li Taisheng is the Director of Infectious Medicine at Peking Union Medical College Hospital. In 2003, he was an important expert in the fight against SARS. After 17 years, he once again dealt with the COVID-19 virus.<br \/>\nLi Taisheng has been paying attention to the progress since the early stage of the outbreak. On January 25, he wrote the &#8220;Beijing Union Medical College Hospital&#8217;s&#8221; New Coronavirus Infected Pneumonia &#8220;Diagnosis and Treatment Proposal Plan&#8221; released. On February 7, he served as the second batch of supporters of the Beijing Union Medical College Hospital to support the Hubei National Medical Team in Wuhan and took over the ICU ward of the Sino-French New City Campus of Wuhan Tongji Hospital. In more than two months, they admitted 109 extremely critically ill patients.<br \/>\nIn Wuhan, Li Taisheng went to the hospital for rounds every morning to analyze various indicators and clinical conditions of patients. After checking the room, Li Taisheng always had to stare at the book for a while, &#8220;This is a brand-new disease, we must use all the knowledge, think about the countermeasures repeatedly, and adjust according to the daily situation.&#8221;<br \/>\n&#8220;The COVID-19 virus is much more complicated than the SARS virus.&#8221; Li Taisheng said. Combined with clinical diagnosis and more than 30 years of experience in the treatment of infectious diseases, Li Taisheng proposed a series of original strategies and measures, which played an important role in the treatment of COVID-19 critically ill patients. He also shared these plans with domestic and international counterparts in time and gave his own suggestions.<br \/>\nOn April 9th, he was interviewed by reporters from China Youth Daily and China Youth Daily at the Sino-French New City Campus of Tongji Hospital.<br \/>\nReporter: What do you know about the COVID-19 virus?<br \/>\nLi Taisheng: For doctors, COVID-19 is a new disease. Most of us have encountered such a frustrating situation: many patients look good in the morning, and their condition is also improving. As a result, they died suddenly in the afternoon or the next day. To reduce mortality, several issues are crucial. How do we judge patients are at risk of becoming severe and critical? What clinical indicators can help us predict? Is there a way to intervene in advance? What is the mechanism of the patient&#8217;s aggravation?<br \/>\nUnfortunately, so far, we do not know its pathogenesis. We do not know whether these symptoms are caused by the direct attack of the virus, or the virus induces an excessive immune response in the body, or some other reason.<br \/>\nMany people mentioned the inflammatory storm and the acute respiratory distress syndrome caused by it. This makes sense, but it is not exactly the same as my clinical observation. The inflammatory storm may also be caused by subsequent bacterial infections, rather than the COVID-19 virus. In addition, if some patients are treated in a way to deal with the inflammatory storm, and a large number of hormones suppress the immune system, it may help the virus. This is a scientific issue, and more evidence is needed. Maybe we are all wrong.<br \/>\nI have been calling for this disease not just pneumonia. Many patients have no symptoms of pneumonia, and the virus not only causes inflammation of the lungs. Our research on critically ill and critically ill patients, including post-mortem autopsy, shows that the problem is not only the lungs, but also the blood system, immune system, heart, kidneys, and even the central nervous system. accurate.<br \/>\nReporter: Most of the people you contact are critically ill patients. What are your treatment experiences?<br \/>\nLi Taisheng: I roughly divided the course of the disease into three stages. The first stage is the viremia period, which is colloquially referred to as the virus reproduction period, usually 7-10 days. The second stage is the pneumonia period, which lasts 7-14 days, and the third stage is the rehabilitation or severe stage.<br \/>\nFor people with normal immunity, it is likely that there are no symptoms, or even if the typical symptoms appear during the pneumonia period, it is very mild. Unfortunately, quite a number of people have problems with their immune function. For example, they have high blood pressure and diabetes. They just had a fever for a day or two, but in fact they did not control the virus. In the second stage, the condition suddenly became worse.<br \/>\nFor these people, the diagnosis and treatment of pneumonia is quite critical. Properly handled, the probability of developing into a severe stage will be reduced, and the prognosis is better. If you are waiting for intubation and ECMO, the price is too high.<br \/>\nReporter: What key indicators did you find in the clinic?<br \/>\nLi Taisheng: There are some basic diseases, such as CT lesions, patient age, hypertension, diabetes and other basic diseases. There are also some key biological indicators, such as inflammation indicators (C-reactive protein, interleukin-6, etc.), lymphocytes continue to be low, leukocytes increase, platelets decrease, and blood has a hypercoagulable state. Once these conditions occur, we must intervene quickly.<br \/>\nAlthough anti-viral treatment is written in the diagnosis and treatment guidelines, there are some drugs that are useful for some patients, but no anti-viral drugs are particularly effective. Since there is no way to get the virus, nor understand the pathogenesis, we can only start from the actual disease and intervene in the abnormal state of the patient as soon as possible.<br \/>\nReporter: What specific interventions are there and how effective are they?<br \/>\nLi Taisheng: I mainly proposed two interventions. The first is to give the patient intravenous immunoglobulin as soon as possible. On the one hand, improve the body&#8217;s immunity, but more important is to interrupt his inflammatory process. If this stage is missed, a large dose of hormones may be given later, which may cause a decline in the patient&#8217;s immune system and sequelae.<br \/>\nThought this was based on years of understanding of infectious diseases, including SARS, MERS, hand, foot and mouth disease. 17 years ago, I participated in the fight against the SARS epidemic, and I discovered that SARS affected the body&#8217;s immune function. The COVID-19 virus is also a coronavirus. I checked the diagnosis and treatment records in Beijing and wrote this view in the &#8220;Beijing Union Hospital&#8217;s&#8221; Recommended Treatment Plan for &#8220;New Coronavirus Infected Pneumonia&#8221; &#8220;. It has also been included in the &#8220;New Coronavirus Pneumonia Severe and Critical Severe Case Diagnosis and Treatment Program (Trial Version 2)&#8221; issued by the National Health Construction Commission on February 14.<br \/>\nIn fact, none of my patients admitted to Beijing at that time had obvious symptoms of inflammatory storms. I made a judgment based on my experience and would like to remind everyone. When I came to Wuhan on February 7th, the severity of the inflammation indicators of the patients here was more than expected.<br \/>\nJudging from the results of clinical treatment, if the immunoglobulin is given about 7 days after the onset of the patient&#8217;s onset and the index is just getting worse, the patient&#8217;s condition can often be prevented from worsening.<br \/>\nThe second intervention is anticoagulant therapy. This was only discovered when I arrived in Wuhan. When I was warding, I found that many people who were not seriously ill and had no invasive ventilator had symptoms of purple and black feet. In general, this only occurs in patients with shock or dying, and this problem has rarely occurred in SARS patients before. So I quickly contacted the experts in the hematology department to check various coagulation indicators.<br \/>\nWe analyzed that this was caused by COVID-19 virus attacking vascular endothelial cells. It keeps the blood in a hypercoagulable state. Hypercoagulation will promote inflammation, and inflammation will promote hypercoagulation, and eventually form microthrombi. When you see black feet, the patient&#8217;s lungs and internal organs are already covered with microthrombi, resulting in multiple organ damage. After consumption of clotting factors, there is a tendency to systemic bleeding, and the mortality rate is extremely high. Later autopsy results also confirmed this judgment.<br \/>\nThrough these two methods, we can try to avoid the development of critically ill patients to critical illness. But these two interventions must be used early. If you wait until the inflammatory storm appears, or your feet are &#8220;black,&#8221; it will be too late. After we gave anticoagulant treatment, the black on the feet of some patients faded, but they were still not saved, because the internal organs were already all kinds of microthrombi.<br \/>\nI remember very clearly that the blood clotting problem was analyzed on February 17, after which the results of the treatment were obviously better, and the whole team was more confident. I exchange research results with my peers and they are generally recognized internationally.<br \/>\nIn addition, as an infectious physician, you must predict in advance the bacterial infection that may occur after intubation. According to experience and various tests, antibiotic anti-infection treatment should be targeted.<br \/>\nReporter: Now people are more worried about asymptomatic infected people and re-yang patients. What do you think of this problem?<br \/>\nLi Taisheng: The emergence of asymptomatic infections is actually an expected thing. From the early stage of the epidemic, asymptomatic infections should be a focus of prevention and control. But we do n\u2019t need to be afraid, just be vigilant, because asymptomatic infected people will not appear out of thin air. If there are no new patients in an area for a period of time, there will be no asymptomatic infected people in this area.<br \/>\nFor patients with asymptomatic infection, we conduct medical isolation observation, and wait for the patient to heal just fine, this person is not contagious. There is no need to panic if there are asymptomatic people around. The virus is spread through certain channels. As long as you wear a mask to protect your nose and nose, pay attention to the hygiene of your hands, wash your hands frequently, and do n\u2019t touch them everywhere.<br \/>\nThe situation of Fuyang occurs in many countries. Except for the false negative test when we are discharged, we may have just found the virus fragments from the body of Fuyang, which does not necessarily mean that it is infectious. In fact, at present, we have not found any cases where Fuyang people infect others.<br \/>\nReporter: COVID-19 is raging all over the world, why is it so serious? Looking back, is there any way to avoid such a situation?<br \/>\nLi Taisheng: Objectively speaking, in addition to the smallpox, measles and other viruses that have been controlled, respiratory viruses are the most threatening to humans. It is not as strict as HIV, hepatitis B and other viruses through the digestive tract or blood, and sexual transmission. Very fast. Earlier, we experienced SARS and it suddenly disappeared; we encounter influenza every year, but its lethal rate is low.<br \/>\nProper prevention and control measures are to protect the unreached people to the greatest extent, and to carry out timely and reasonable treatment to reduce mortality. Health education for healthy people, monitoring and handling of suspected and mild people are the most important tasks in public health emergencies, and even determine the final outcome of the whole event.<br \/>\nI believe that the control of infectious diseases must require a strong government organization.<br \/>\nReporter: Do you have any specific suggestions for responding to public health emergencies?<br \/>\nLi Taisheng: First of all, it is to strengthen the construction of clinical front-line medical teams, especially the investment in the construction of infectious diseases. It is necessary to strengthen personnel training, give preferential policies, improve infrastructure, and include the number of beds and staffing in the infectious department in the hospital assessment index. At the national level, the policy of infectious diseases in general hospitals should be given preference, and special funds should be allocated for the training of personnel and infrastructure construction. The general hospitals should have relatively independent wards for infectious departments, and set up corresponding beds according to the urban population. number.<br \/>\nAt the hospital level, in addition to ensuring the completion of basic medical tasks, general hospitals should establish a public health emergency response medical team that is dominated by the infectious disease discipline and participates in multiple disciplines. Interactive process of departments and specialized hospitals. We must also continue to ensure the construction of specialized infectious disease hospitals, focusing on ensuring the isolation and treatment of necessary places and the construction of the corresponding medical team to reduce the pressure of non-communicable disease treatment, or may be combined with other specialized hospitals to save resources.<br \/>\nIn addition, we will also increase the personnel and hardware construction of the early warning department, establish and continuously optimize the communication process between the response departments and exercise regularly, and establish a top-level design and response team (including epidemiologists, majors in infection departments The medical care team, the disease control team with the responsibility of flow control, and the community prevention and control team with the responsibility of group prevention and group control). Once the patient is encountered, the routine examination can&#8217;t find it, and it should be immediately reacted. This is not a new disease. It must be checked by a more advanced department.<br \/>\nThe current CDC is an institution outside the medical system. In the future, it should be with hospitals and infectious physicians. Disease control cannot just be in your own office building, nor can it be just statistics and reports. We have written to the relevant departments to reflect these suggestions.<br \/>\nReporter: How does the Department of Infection exist?<br \/>\nLi Taisheng: Take this COVID-19 epidemic as an example. At the beginning of December 2019, the infection doctors of Union Hospital and Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, with professional vigilance, noticed the obvious aggregation of respiratory infection cases related to the seafood market in South China. The number of treatment cases has increased significantly. After many communications with relevant departments, the &#8220;COVID-19 virus pneumonia&#8221; incident was confirmed, and the multi-faceted epidemic control work including the National Disease Control Center and a number of domestic expert teams was initiated. In the subsequent medical treatment, the medical staff of the infection department undertake a lot of daily medical work. The medical staff in the infection department is the person closest to the patient, who can accurately grasp the characteristics of the disease, adjust the diagnosis and treatment plan at any time, and coordinate the different specialists involved in the treatment.<br \/>\nInfection Department&#8217;s role in responding to the COVID-19 incident is to epitomize all public health emergencies in China.<br \/>\nInfection is actually a very old discipline. When Peking Union Medical College Hospital was first established in 1921, the Department of Infection was the most important subject. At that time, the problem of infectious diseases in China was very serious. But with the founding of New China, there are fewer and fewer infectious diseases, leaving only diseases such as hepatitis. During the &#8220;SARS&#8221; in 2003, we were once valued, but then slowly relaxed again.<br \/>\nIn various hospitals, the infection department is generally the lowest paid and the most suffering, and no one wants to go. But it is also very important. Any hospital, including county-level hospitals, must have policy preference, capital investment, and talent reserves. Otherwise, if you encounter unexpected situations, you will not find them.<br \/>\nThis kind of training construction is what I call the combination of peace and war. As a doctor in the infectious department, you must have professional knowledge, including microbiological testing, epidemiological knowledge, let alone clinical. Departments in other departments of the hospital should also have basic knowledge of infectious diseases.<\/p>\n<div class=\"37c28470d9d6d3cb9ff74e663adb766a\" data-index=\"2\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-3594734025006597\"\r\n     crossorigin=\"anonymous\"><\/script>\n<\/div>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>On April 14th, the doctors of our hospital held a farewell ceremony for the Hubei&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"ngg_post_thumbnail":0,"footnotes":""},"categories":[272],"tags":[],"class_list":["post-7822","post","type-post","status-publish","format-standard","hentry","category-today"],"_links":{"self":[{"href":"https:\/\/www.whatchina.cn\/wp-json\/wp\/v2\/posts\/7822","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.whatchina.cn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.whatchina.cn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.whatchina.cn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.whatchina.cn\/wp-json\/wp\/v2\/comments?post=7822"}],"version-history":[{"count":0,"href":"https:\/\/www.whatchina.cn\/wp-json\/wp\/v2\/posts\/7822\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.whatchina.cn\/wp-json\/wp\/v2\/media?parent=7822"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.whatchina.cn\/wp-json\/wp\/v2\/categories?post=7822"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.whatchina.cn\/wp-json\/wp\/v2\/tags?post=7822"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}