I can see the status bar

Chapter 981 - 4 D-day
Zeng Xia's condition has improved significantly.

Under the action of hormones and gamma balls, after a day of treatment, her body temperature has returned to the normal 36 degrees Celsius.

Under the effect of critical ultrasound, doctors first discovered an important feature of pneumonia caused by a new type of coronavirus - regional pulmonary edema in the patient's lung lesion area.This pulmonary edema is not cardiogenic but results from another, as-yet-unidentified, injury.

After clarifying this feature, a conservative fluid management strategy for Zeng Xia and monitoring indicators through bedside ultrasound at any time became a very critical diagnosis and treatment plan.The results of Zeng Xia's various examinations showed that she did not have the problem of insufficient volume. Therefore, it was a very important decision to try diuretic negative balance to reduce pulmonary edema and increase blood oxygen saturation.

On the other hand, continuous immune support for patients is also very important.The gamma globulin and methylprednisolone are actively anti-inflammatory. Such measures have at least significantly relieved Zeng Xia's cough, sputum, and persistent high fever.

"This may explain the damage mechanism of the new coronavirus." Director Huang Wenhui concluded.For this case, the four hospitals took it very seriously.Various disciplines actively participate in consultations, not just for the simple purpose of "getting a patient back".

This is an example, a training session.It is an excellent opportunity for many doctors to safely get close contact with patients with pneumonia caused by the new coronavirus infection.

Even just one "experience" is better than nothing.Participating in the treatment of such patients can greatly improve doctors' understanding of this new disease.In times of ignorance, any knowledge is precious.

"We know that the previous SARS virus entered cells through the ACE2 receptor. This means that the high blood pressure that the patient had yesterday was probably also a symptom caused by infection." During today's remote consultation, Director Huang Wenhui She shared with you the content of her "research investigation" yesterday. "At the same time, we should also look at these sites of local pulmonary edema. The edema occurs in scattered locations, and most of them are close to the lower lung."

Several pictures appeared on the screen of the remote consultation, which were the results of Zeng Xia's CT examination yesterday and today.

"I have a hypothesis about this. Of course, it's just a hypothesis at the moment." Obviously, Director Huang doesn't think it's a hypothesis, at least she's very confident about it—otherwise, she wouldn't be so excited. "The higher the level of ACE2 receptor, the lower the patient's blood pressure. On the contrary, the higher the level of ACE receptor, the higher the blood pressure. The spike protein of the new coronavirus enters the cell through the ACE2 receptor, and the virus is inside the cell after entering the cell. Rapid multiplication, and finally the cell dies and the virus is released."

"In other words, the new coronavirus may cause a decrease in the level of ACE2 in the lungs - any cell containing the ACE2 protein will be the target of their attack. The decrease in the number of cells containing the ACE2 receptor in the lung will directly lead to the protective effect of the alveoli. At the same time, the osmotic pressure of other alveolar cells will increase, resulting in severe local pulmonary edema.” Director Huang Wenhui said firmly, “That is to say, one of the main symptoms of 2019-nCoV is to damage the alveoli, causing pulmonary edema and reducing Oxygen saturation."

"ACE2 is not only found in the alveoli." The director of nephrology who participated in the consultation asked, "Heart, kidney, testicle, absorptive intestinal epithelium, and bile duct cells are all highly expressed. Does this mean that 2019-nCoV is still possible? Cause damage to these places?"

"The mechanism of the injury may be similar." Director Huang said after a moment of pondering, "But we have not yet been able to confirm that the injury will definitely occur in other organs..."

"This...not sure." Sun Li'en, who was wearing a protective suit on the computer side, suddenly interjected, "Two patients on my side showed symptoms of diarrhea. And the use of probiotics and montmorillonite powder can't stop it." Could Zhuxie be caused by damage to the absorptive intestinal epithelium?"

"It's possible." The director of the Department of Gastroenterology said after pondering for a moment, "If possible, I suggest taking a sample for a biopsy."

"Let me give it a try..." Sun Li'en said with some uncertainty, "Although they have diarrhea, the current situation is acceptable. And their weight loss is not too serious-they have lost about two days since they were admitted to the hospital. kg. Considering that they may be in a state of stress now, this weight loss is completely acceptable."

"It's better to do a biopsy." The director of the Department of Gastroenterology said seriously, "If it is confirmed that the absorptive intestinal epithelial tissue is damaged, it means that we may need to supplement them with more nutrients, and may even require Consider infusion of nutrient solution. Nutritional status has a huge impact on the immune system, and the effect of simply giving gamma globulin is definitely not as good as adding the patient's immune system."

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The follow-up treatment of Zeng Xia was taken over by the doctors in the second group.A group of doctors had been in protective clothing for seven hours and had to come out to rest.

It was a very painful torture to have no water or rice for seven hours.But Sun Lien couldn't go to a nearby restaurant with his colleagues to have a good meal to soothe his tired soul and stomach.

The Yunhe City Health Commission sent a request for help to Yuhua Biotech.They urgently ordered [-] PCR test kits, and also asked Yuhua Bio to start expanding production as soon as possible to meet "possible demand."

The help letter was sent at 09:30 in the evening, and around ten o'clock, the latest notification had already been sent to Sun Lien's mailbox.

截止1月19日22时，云鹤市认定新增确诊病例136例，发病日期均在1月18日以前。根据最新修订的诊疗方案，新发患者中轻症100例、重症33例、危重症3例（其中死亡1例）。

As of 1:19 on January 22, Yunhe City has reported a total of 198 cases of pneumonia caused by new coronavirus infection, 25 cases have been cured and discharged, and 3 cases have died.At present, 170 cases are still being treated in the hospital, including 126 cases of mild cases, 35 cases of severe cases, and 9 cases of critical cases. All of them are receiving isolation treatment in designated medical institutions in Yunhe City.A total of 817 close contacts have been tracked, 727 have been released from medical observation, and 90 are still under medical observation. Among the close contacts, no related cases have been found.

The situation in Yunhe City was even more serious than the worst scenario Sun Lien imagined.This made him really panic.

Although it has been detected in advance, although the deployment has begun in advance.All these countermeasures that seem to have the ability to predict are still not enough in Sun Lien's view.

The addition of 136 confirmed patients within two days does not mean that all the patients have been controlled locally.All patients in this group had symptoms, and at least they had two classic symptoms of respiratory infection, fever and cough.

In other words, this group of patients should have been receiving treatment in the hospital before, but due to insufficient testing capabilities, they could not be diagnosed.The sudden increase in statistics is not necessarily due to sufficient detection capabilities-it may just be that the original detection capabilities have completed inspections today.

From the 12th to the present, the number of patients has increased by 136 in a week.In other words, the virus is weakly transmissible -- but that's clearly impossible.In Zhou Yuze's home alone, there have been at least three generations of transmission.It can't just be that the virus mutated when it was only spreading in Zhou Yuze's home, which led to a sharp increase in transmissibility.

As the test kits with an accuracy rate of about 85% are shipped to Yunhe in large quantities, this test data will probably only get higher and higher.

(End of this chapter)