Chinese Virus

Chinese Virus www.infralive.com 48 Infra LIVE April 15, 2020 evidence of human-to-human transmission. None of the 99 patients we examined were medical staff, but 15 medical workers have been reported with 2019-nCoV infection, 14 of whom are assumed to have been infected by the same patient. When populations with low immune function, such as older people, diabetics, people with HIV infection, people with long- term use of immunosuppressive agents, and pregnant women, are infected with 2019-nCoV, prompt administration of antibiotics to prevent infection and strengthen- ing of immune support treatment might reduce complications & mortality. In terms of laboratory tests, the absolute value of lymphocytes in most patients was reduced. This result suggests that 2019-nCoV might mainly act on lymphocytes, especially T lymphocytes, as does SARS-CoV. Virus particles spread through the respiratory mucosa and infect other cells, induce a cytokine storm in the body, generate a series of immune responses, and cause changes in peripheral white blood cells and immune cells such as lympho- cytes. Some patients progressed rapidly with ARDS and septic shock, which was eventually followed by multiple organ failure. Therefore, early identifi- cation and timely treatment of critical cases is of crucial impor- tance. Use of intravenous immu- noglobulin is recommended to enhance the ability of anti- infection for severely ill patients and steroids (methylprednisolone 1–2 mg/kg per day) are recom- mended for patients with ARDS, for as short a duration of treat- ment as possible. Some studies s ugg e s t t ha t a s ub s t an t i a l decrease in the total number of l ymphocy t es indi cat es that coronavirus consumes many immune cells and inhibits the body's cellular immune function. Damage to T lymphocytes might be an important factor leading to exacerbations of patients. a 61-year-old man (patient 1) and a 69-year-old man (patient 2). They had no previous chronic underlying disease but had a long history of smoking. Patient 1 was transferred to JinyintanHospital and diagnosed with severe pneumonia and ARDS. He was immediately admitted to the intensive care unit (ICU) and given an intubated ventilator-assisted breathing therapy. Later, the patient, having developed severe respiratory failure, heart failure, and sepsis, experienced a sudden cardiac th arrest on the 11 day of admission andwas declared dead. Patient 2 had severe pneumo- nia and ARDS after admission. The patient was transferred to the ICU and given ventilator-assisted breathing, and received anti- infection and ECMO treatment after admission. The patient's hypoxaemia remained unre- solved. On the ninth day of admission, the patient died of severe pneumonia, septic shock, and respiratory failure. The intervals between the onset of symptoms and the use of ventilator-assisted breathing in the two patients were 3 days and 10 days, respectively. The course of the disease and lung lesions progressed rapidl y in both patients, with both developing multiple organ failure in a short time. Of the remaining nine patients who died, eight patients had lymphopenia, seven had bilateral pneumonia, five were older than 60 years, three had hypertension, and one was a heavy smoker. However, additional deaths might occur in those still hospita- lised. Discussion The sequence of 2019-nCoV is relatively different from the six other coronavirus subtypes. Club- shaped glycoprotein spikes in the envelope give the virus a crown- like or coronal appearance. Transmission rates are unknown for 2019-nCoV; however, there is also called bronchoinflation sign. Chest CT on Jan 15 showed improved status (3B). All patients were treated in isolation. 75 (76 pc) patients received antiviral treatment, including oseltamivir (75 mg every 12 h, orally), ganciclovir (0·25 g every 12 h, intravenously), and lopinavir and ritonavir tablets (500 mg twice daily, orally). The duration of antiviral treatment was 3-14 days. Most patients were given antibiotic treatment; 25 (25 pc) patients were treated with a single antibiotic and 45 (45 pc) patients were given combination therapy. The antibiotics used generally covered common pathogens and some atypical pathogens; when secondary bacterial infection o c c u r r e d , me d i c a t i on wa s administered according to the results of bacterial culture and drug sensitivity. The antibiotics us ed we r e c epha l ospor i ns , qu i no l one s , c a r bap enems , tigecycline against methicillin- resistant Staphylococcus aureus, linezolid, and antifungal drugs. The dur a t i on o f an t i b i o t i c treatment was 3-17 days. 19 (19 pc) patients were also treatedwith methylprednisolone sodium succinate, methylprednisolone, and dexamethasone for 3-15 days. 13 patients used non-invasive ventilator mechanical ventilation for 4-22 days. Four patients used an invasive ventilator to assist ventilation for 3-20 days. The ventilator adopted P-SIMVmode, the inhaled oxygen concentration was 35–100 pc, and the positive end-expiratory pressure was 6-12 cm H2O. All four patients were still using ventilators at data cutoff. Moreover, nine (9 pc) patients received continuous blood purification due to renal failure and three (3 pc) patients were treated with extracorporeal membrane oxygenation (ECMO). By the end of Jan 25, 31 (31 pc) patients had been discharged and 11 (11 pc) patients had died; all other patients were still in hospital. The first two deaths were