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At the beginning of 2020, we who are experiencing new coronary pneumonia, sitting at home, will think of the atypical pneumonia 17 years ago-the same as the coronavirus, also before and after the Spring Festival, and it is also unmanned on the street and popular. Alas.

I don’t know if you ever asked in your heart: When will the epidemic end? When you go out again, New Crown Pneumonia subsides, is the epidemic over?

In contrast, on June 20, 2003, the discharge of the last 20 patients from Xiaotangshan Hospital announced the disappearance of the epidemic, but did not declare the end of SARS. There are still many problems left behind-various sequelae.

Taking this opportunity today, let’s take a look at the aftermath of SARS and its inspiration to us today.

Those words from Camus in “Plague” are thought-provoking (source: SARS Decade)

How terrible are the sequelae of SARS?

I can’t answer this question directly. Like most young people now, I don’t have a deep impression on the epidemic.

Cite here Phoenix.com Special Atlas Report , I hope to give you an intuitive feeling:

Fang Bo, 61, is in the third department of bone and joint of Wangjing Hospital. That year, the wife and sister who were infected with SARS came to Beijing to visit Fang Bo’s family from Harbin. As a result, the Fang Bo couple and their daughter-in-law were infected. Fang Bo’s wife and sister died unfortunately in this disaster. Due to the sequelae, the two daughters also divorced separately. After divorce, her young daughter marries northeast and never returns to Beijing. Six months after the SARS cure, Fang Bo was diagnosed with osteonecrosis, a sequelae caused by the overdose of hormones used in the treatment of SARS. In 2005 and 2006, he underwent two hip replacement femoral head surgery, and now he has osteonecrosis on his shoulders and knees. Fang Bo said: “My bones are as fragile as plaster, and my bones will irreversibly collapse until they become paralyzed or die.” Fang Bo suddenly burst into tears when chatting with others. (Photo source: Phoenix Network)

Nurses infected with SARS, although cured, became disabled due to sequelae (source: SARS 10th Anniversary)

We always hear that the sequelae of SARS are caused by the misuse of hormone therapy. What are the sequelae of SARS? How exactly are these sequelae caused? Back to the new crown pneumonia of 2020, what kind of “knowledge and memory” can these bring us?

I hope my answer will give you the answer.

What can hormone therapy cause?

Often referred to hormonal therapy with side effects, the full name is glucocorticoid therapy. Before understanding its side effects and sequelae, you may want to push the timeline forward to see what glucocorticoids are.

Glucocorticoids are a type of adrenal cortex hormones that are also present in the body. But glucocorticoids are not the kind of epinephrine you are relatively familiar with. (some high school biology, can promote excitement) , it plays another Role-Controls metabolic rate, anti-inflammatory, anti-immune response.

Glucocorticoids actually refer to a large class of hormone compounds, such as cortisone, hydrocortisone, dexamethasone, etc. (Figure sourcetps: //img.huxiucdn.com/article/content/202002/15/174722948892.jpg? imageView2 / 2 / w / 1000 / format / jpg / interlace / 1 / q / 85 “data-w =” 220 “data -h = “231”>

Academician Zhong Nanshan, 83 years old (source: Wikipedia)

From the retrospective literature on treatment methods published after the SARS epidemic, we can see that at that time, many hospitals directly used high-dose glucocorticoids without considering the specific conditions of the patients, and there had already been significant complications. Buried.

Screenshot of literature content (source: Zheng Zeguang, Zhong Nanshan)

After a brief review of history, we return to hormone therapy itself-how does glucocorticoids work? Why does it cause sequelae?

Some effects of glucocorticoids have just been mentioned. In fact, this is a bit like a body stabilizer, or brake: avoid excessive immune response, inhibit the metabolism of sugar, lipids, and proteins, and drive other hormones to work.

Symptoms such as SARS can cause a strong immune response. At this time, many functions of the body can be overreacted, forming a so-called “inflammatory storm” or “immunity storm”. This “brake” of glucocorticoids can slow down this type of immune action, which in turn reduces symptoms.

But how hard does this brake go? Many hospitals did not know at the time.

Specific effects of glucocorticoids on skeletal cells (source: Weinstein RS)

Osteoporosis and bone necrosis are of most concern because bone problems directly lead to the disability of cured patients.

In addition, according to a recent Lancet review, the sequelae of glucocorticoid therapy also include concurrent mental illness, diabetes, difficulty in removing viruses from the body, or vascular necrosis.

These correspond to reports about patients with SARS sequelae, and they all feel relevant.

However, in the case of new coronary pneumonia in 2020, the dosage of glucocorticoids has been clearly marked in the treatment plan provided by the National Health and Health Commission, and it is only used for severe and critically ill patients.

Screenshot of a new type of coronavirus pneumonia diagnosis and treatment (trial version 5)

The World Health Organization ’s January 28 clinical care guidelines strictly prohibit the use of drugs such as glucocorticoids in routine treatment.

Screenshot of the WHO’s Clinical Nursing Guide

So, at least after this fight with coronavirus, we will not easily see patients with sequelae of glucocorticoids.

Why is pulmonary fibrosis a sequela?

In addition to bone necrosis, a common sequela is pulmonary fibrosis.

The process of SARS virus infection will promote the immune system response and release a large number of cytokines. An excessively strong immune response will trigger the “immunity storm” we just mentioned, which will lead to alveolar damage.

The alveolar is broken and it is necessary to “repair” it. However, under the induction of cytokines, fibroblasts responsible for repairing divide and differentiate in large numbers, and the collagen and other components produced are gathered in large quantities, blocking the alveoli and blood vessels, causing patients to breathe. Poor ventilation.

Or to put it another way, it’s “overkill.”

A series of reactions caused by specific SARS infection. The detailed mechanism can be read in related materials (source: Zuo W, et.al.)

Description of state subsidies for patients with SARS sequelae, but I found in the news that there are mental subsidies, so I still say no to this OK (source: Screenshots of the SARS Ten Years Festival)

What have we changed in 2020?

In 2020, there are now more than 50,000 confirmed cases and more than 10,000 critically ill patients. The number of people infected this time is much stronger than SARS seventeen years ago.

Reviewing the sequelae of SARS seventeen years ago is definitely helpful for medical, scientific research, public health, and psychologists: in this critical period of epidemic change, what kind of prevention should the serious patients take? How should patients follow up after a cure? These should be prepared in advance, especially the number of people far exceeds SARS, and how to better manage it is also a big challenge.

But as mentioned earlier, the use of glucocorticoids has been greatly reduced, and sequelae such as femoral head necrosis should not occur. However, pulmonary fibrosis still occurs in severe patients, and mental illness is also prone to occur. How to deal with this type of problem? Hope the experts and doctors are ready.

Guidelines on psychological intervention issued by the National Health Commission on January 26

For generalHuman, do those sequelae make sense?

Now that the Internet is developed, information is obtained more quickly. Ordinary people also suffer from panic, anxiety and other psychological problems due to empathy. We should regulate our own psychological problems and not let this become one of the new sequelae.

We should take care and care of patients, especially those who have been discharged. Although there are reports of the risk of re-infection after healing, this does not isolate caring from person to person.

We also need to improve our ability to identify public opinion information. Every drug is effective or a special effect. The effect of glucocorticoids at that time cannot be grasped by even many hospital doctors. Now that new drugs are coming out, how should we treat them? Do these drugs also have side effects? Recognize objectively and reasonably, understand how the double-blind random experiment is, and understand a little more relevant knowledge, your ability to identify public opinion will be better.

The article is very long, thank you very much for seeing it, don’t know how to answer your questions? My original intention was to think that we should have a better sense of foresight to realize what might happen later. Searching for information while writing was shocked and sentimental by these sequelae incidents.

Back to the question at the beginning: When will the epidemic end?

Perhaps when you can take off your mask, the epidemic is still going on, just out of your sight.

Reference:

1. SARS Decade-Phoenix TV

2. Atypical pneumonia has elapsed for ten years. Phoenix Special Issue. < / a>