This article comes from WeChat public account: the power of machines (ID: almosthuman2017) , author: the machine can be, from the title figure: Figure worm

On January 15, a middle-aged American man returned to the United States after his family visit in Wuhan.

Five days later, on January 20, the man was diagnosed with the first 2019-nCoV infection in the United States. He reported that he had not traveled to the South China Seafood Market and had no contact with known patients.

11 days later, January 31, US Epidemic Intelligence Agency (MLH) , National Center for Immunity and Respiratory Diseases (AC, LF, AP) , the United States Department of Viral Diseases and other units jointly released the epidemiological and clinical characteristics report of the case.

The report shows that the man’s clinical symptoms have improved immediately after receiving intravenous treatment with the new American drug redeciver. He no longer needed oxygen, and his oxygen saturation returned to 94% to 96%. Apart from dry cough and runny nose, there are no other symptoms.

At the same time, according to the China News Agency, Berlin, January 29, reported that Germany used nebulization to treat neo-crown pneumonia, 4 confirmed patients were asymptomatic; according to the news time, from diagnosis to treatment, German medical experts It took less than 72 hours.

The first case of confirmed New Coronavirus in the United States after 12 days of treatment has significantly improved symptoms was published in the authoritative medical journal “New England Medical Journal” (NEJM) .

The report name is “First Case of 2019 Novel Coronavirus in the United States” (US 2019 New Coronavirus Cases) The epidemiological and clinical characteristics of the cases are described in detail, which is of great significance for domestic medical staff to better understand the characteristics of the disease and guide the diagnosis and treatment of patients.

1 I went to the emergency department with fever and no lung abnormalities were found

The patient is a 35-year-old male. On January 15, 2020, he ended his family visit in Wuhan and returned to the United States.

On the first day after returning to the United States, he started coughing.

The next day, after coughing, he felt some fever.

On the third day, he chose to rest at home and still felt feverish.

After learning about the health alert of the CDC in the United States, combining his symptoms and travel history in Wuhan, he decided to see a doctor.

On January 19th, the fourth day after returning to the United States, he went to (Snohomish) in Snohomish County, Washington. An emergency room span>. When the patient comes to the clinic for examination, wear a mask in the waiting room. After waiting for about 20 minutes, he was taken to the examination room for evaluation by the provider.

Except for a history of hypertriglyceridemia, this patient has no history of smoking.

At the clinic, the body temperature was 37.2 ° C, blood pressure was 134/87 mm Hg, pulse was 110 beats per minute, respiratory rate was 16 beats per minute, and oxygen saturation was 96%.

Hinary anterior chest and lateral chest radiographs on January 19, 2020 (day 4 of illness)

Auscultation of the lungs showed bronchitis and a chest radiograph was performed. No abnormalities were found.

Rapid nucleic acid amplification tests for influenza A and B (NAAT) were negative. Negative for all tested pathogens within 48 hours, including influenza A and B, parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus and four common coronavirus strains known to cause human disease class = “text-remarks” label = “Remarks”> (HKU1, NL63, 229E, and OC43) .

Although the patient reported that he did not spend time in the South China Seafood Market and reported no contact with the sick during his trip to China, the staff of the CDC agreed that it is necessary to Patients undergo a 2019-nCoV test.

On January 20th, the Centers for Disease Control and Prevention (CDC) confirmed that patients’ nasopharyngeal and oropharyngeal swabs passed real-time reverse transcriptase- Polymerase chain reaction (rRT-PCR) tested positive for 2019-nCoV.

The patient was treated in an isolation ward at a hospital near Seattle.

2 After 12 days, the clinical situation has improved significantly

At admission, the patient reported a persistent cough with two days of nausea and vomiting. He reportsSay he has no shortness of breath or chest pain. Vital signs are within normal limits. Physical examination revealed dry mucous membranes. The remaining tests are usually not obvious.

Patient’s highest temperature record

(January 16, 2020 to January 30, 2020)

On the 2nd to 5th days of hospitalization, (Days 6-9 of the illness) , the patient’s vital signs remained basically stable, except that Intermittent fever with tachycardia.

Post-anterior and lateral chest radiographs on January 22, 2020 (day 7 of illness, day 3 of hospitalization)

On the 3rd day of hospitalization, (Day 7 of illness) , the chest X-ray film showed no signs of infiltration or abnormality.

However, on the evening of the 5th day of hospitalization, (Day 9 of the illness) The second chest X-ray examination at night showed Pneumonia in the lower lobe of the left lung. Changes in breathing at nightIt coincided with the time when the patient’s blood oxygen saturation value measured by pulse oximetry decreased to 90% while breathing the surrounding air.

January chest X-ray film on January 24, 2020 (day 9 of illness, day 5 of hospitalization)

On day 6 (day 10 of illness) , the patient begins to receive supplemental oxygen, which is 2 liters per minute from the nasal catheter Speed ​​delivery. Taking into account changes in clinical manifestations and concerns about hospital-acquired pneumonia, starting with vancomycin (1750 mg loading dose, then 1 g intravenously every 8 hours) and cefepime (intravenous injection every 8 hours) .

X-rays before and after January 25, 2020 (day 10 of the disease, day 6 of the hospital)

On the same day, the fourth chest X-ray photograph showed basal bar opacity in both lungs. This finding is consistent with atypical pneumonia, and a snoring sound appeared in both lungs at auscultation = “text-remarks” label = “Remarks “> (Lung rales) .

(啰 sound: when auscultating breath sounds, when air passes through the trachea, bronchus containing secretions, or through the bronchi that is narrowed by cramps or swelling, On the basis of breathing sounds, an additional breathing murmur is heard, that is, snoring sounds. The presence of snoring sounds indicates that there are lesions in the lungs, and treatment needs to be treated in a regular hospital for cause and symptom treatment. p>

From the evening of the 7th day, the doctor injected intravenously a new nucleotide analogue prodrug, which is being developed—redeciver (remdesivir ) , an antiviral drug developed by the United States Gilead (Gilead) , no adverse events related to infusion were observed .

(Reedivir, used for Ebola virus treatment, can inhibit RNA-dependent RNA synthetase (RdRp). Because the same is true in coronavirus There is RdRp, so this research therapy is also expected to inhibit coronavirus.)

(A mouse study led by Ralph Baric of the University of North Carolina (published in the journal Nature-Communications) tested interferon beta- 1b is used in combination with the experimental drug Remdesivir manufactured by Gilead. MERS infected with this combination performs better, reduces virus replication and improves lung function. This combination may also be used to treat 2019- nCoV.)

After continuous procalcitonin levels and nasal PCR testing of methicillin-resistant Staphylococcus aureus, vancomycin was discontinued on the evening of day 7 and cefepime was discontinued the following day.

On the 8th day after hospitalization, (12th day of illness) , the patient’s clinical condition was improved, and no need for oxygen and oxygen Saturation also returned to 94% to 96%. The previous bilateral lower lobe rales no longer exist. Appetite has improved, with the exception of dry cough and runny nose.

As of January 30, 2020, the patient is still hospitalized. All symptoms except fever and cough have been alleviated, and the degree of cough is decreasing.

3 High respiratory virus load and potential for transmission

The report shows that the case patient had been to Wuhan, China, but had not been to a seafood wholesale market or medical institution, and had not contacted a known patient.

Although the source of his 2019-nCoV infection is unknown, evidence of human-to-human transmission has been made public. As of January 30, 2020, no secondary cases of 2019-nCoV related to this case have been identified, but are still under close surveillance.

This patient detected 2019-nCoV RNA with a low Ct value from the upper respiratory tract samples on the 4th and 7th day of the disease, and also in the stool sample collected on the 7th day 2019-nCoV RNA was detected, indicating high viral load and potential for transmission.

The patient initially showed mild cough and low intermittent fever. On the fourth day of the disease, auscultation of the lungs showed bronchitis, and no abnormality was found on the chest radiograph. The condition did not occur until the ninth day of symptoms Progression to pneumonia.

Considering that the early symptoms are very mild and similar to other winter infectious diseases, this also makes the diagnosis difficult.

Despite the deterioration of the patient’s clinical condition, whether to use the United States’ “sympathy” (compassionate use) principle, but still need A randomized controlled trial was conducted to determine the safety and efficacy of remdesivir and any other study medications for the treatment of 2019-nCoV infection.

4 Four cases of nebulization treatment in Germany, but no drug name was published

Recently, there is good news from the Bavarian Ministry of Health in Germany regarding the treatment of new coronary pneumonia.

Germany used the nebulization treatment method proposed by the authoritative European experts on the four cases of new coronary pneumonia diagnosed on January 27 in Germany, and all of them have been cured. As of now, they do not have any clinical symptoms of new coronary pneumonia. For the next few days, if the virus test continues to be negative, these people can be formally recovered and discharged.

According to the news time, from the diagnosis to the treatment, the German medical experts took less than 72 hours.

Berlin, Jan. 29, China News Agency, the Bavarian Ministry of Health said on the evening of the 29th that there were no new cases of new coronavirus infections in the state on the same day. At the same time, the four patients diagnosed previously were asymptomatic and in good condition. Authorities are continuing to screen close contacts, including colleagues of the four individuals.

The Bavarian Ministry of Health announced the same day. According to the information released so far, the first patient diagnosed in Germany on the 27th and the last three patients diagnosed on the 28th were both automotive sunroof system supplier Webasto (WEBASTO) company employees, located in the southern capital of Bavaria, Munich.

The information released on the same day showed that the first confirmed patient was a 33-year-old male, and the latter three were 27-year-old and 40-year-old males and 33-year-old females.

The Munich medical expert Wendtner, who is responsible for treatment and preventive isolation, (Clemens Wendtner) said that all four have been asymptomatic class = “text-remarks” label = “Remarks”> (symptomfrei) , which is currently in good condition. The hospital stated that the four people will continue to observe and isolate, because there is no risk of disease transmission in the hospital’s isolation conditions.

The cases were all taken to Schwabing’s Munich Clinic, which has a station dedicated to the isolation of patients with highly infectious diseases, the so-called HoKo-Unit. In addition, Germany has other infectious disease centers in Berlin, Frankfurt and Hamburg.

Clemens Wendner (Clemens Wendtner) was a professor of medicine and assistant medical director of the University of Cologne. According to information, he A 73-year-old man who had been admitted to a suspected novel coronavirus (nCoV) in March 2013 from Abu Dhabi, the capital of the United Arab Emirates .

At that time, the case aroused great interest from researchers, so Science and other related platforms reported that the patient might be infected by one of his racing camels. In the end, the patient became worse because of his condition. 11th death rate.

After aerosolization, Wentner claims that the patient’s condition has been asymptomatic. The person in charge of the authoritative research center in Germany pointed out that the method used in Germany for the treatment of new crown pneumonia is “atomization”. As the name implies, the treatment solution is atomized, and then enters the respiratory tract through the nose and nose to reach the lungs, thereby achieving treatment. effect. However, the name of the drug used in the atomization process was not disclosed.

Refer to the “Expert Consensus on the Application of Nebulizing Inhalation Therapy in Respiratory Diseases” formulated by the Respiratory Branch of the Chinese Medical Association in 2016. The so-called nebulization is a method of treatment. The instrument breaks down the drug into small diameters. (The diameter is preferably 3 ~ 5μm, which is the key point when selecting a nebulizer) , and enter the respiratory tract and lungs through breathing. To play a therapeutic role.

Aerosol therapy has the following advantages: simple and easy to operate, directly acting on the lesion, quick onset, good curative effect, and less systemic adverse reactions.

Atomizers are generally divided into three types:

  • Jet atomizer (Air compression pump or oxygen driven) : High drug utilization, the main treatment method for clinical application at present.


  • Vibrating screen atomizer: quiet and noiseless.


  • Ultrasonic atomization: due to its large particle size for drug decomposition and poor drug stability.



    New lung diseases can easily be mistaken for flu, with similar symptoms.

    Fentner said fever, dry cough, shortness of breath, shortness of breath, and fatigue are also the first signs of lung disease. Because the virus infects the lower respiratory tract, patients do not catch a cold.

    Wentner added that in addition to the symptoms of respiratory disease with pneumonia-another key criterion must be added: during the first two weeks of the onset of the disease, patients must be in direct or indirect contact with Chinese in Wuhan.

    On January 31, the Ministry of Health of Bavaria, Germany announced that two new patients with pneumonitis infected with new coronavirus were diagnosed that day, and a total of 7 cases have been confirmed.

    According to the introduction, the two newly diagnosed patients have close contact with the first 5 patients, of which the 6th patient confirmed in the afternoon on the 31st is the child of the 5th confirmed man on the 30th, which is the first case in Germany Children were diagnosed and the first case of an infection among family members in Germany.

    The current epidemic of coronaviruses has swept the global economy. Not only is China’s economy affected, but global companies are worried about losing billions of dollars due to supply chain disruptions and lack of Chinese customers.

    This article is from WeChat public account: the power of machines (ID: almosthuman2017) , author: the machine can