[Wuhan Pneumonia] The symptoms of confirmed patients are not obvious Liang Zichao: It is not a missed diagnosis and it is difficult to test one by one

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Written by: Chen Qianting

2020-02-16 23:48

The latest patient diagnosed with new-type coronavirus pneumonia in Hong Kong is a 54-year-old man. When he first sought treatment in the emergency department of the Eastern Hospital, even if he had a fever, his lungs were clear and he had no travel history. The test was finally obtained after the second consultation.

Liang Zichao, chairman of the Infectious Diseases Advisory Committee of the Medical Association and a respiratory doctor, believes that the symptoms of the infected person and the virus transmission chain are not obvious, and that the new virus is highly transmissive, making it difficult to find the patient completely, which is a "congenital defect." Hong Kong can only do nearly a thousand virus tests per day, but the number of patients with cold symptoms and the limited diagnostic tools make it difficult to quickly test for many patients.

He pointed out that everyone should do a good job of personal hygiene at this stage. Enterprises can formulate flexible work policies. If a private doctor sees that the patient's condition has not improved for a long time, he should be referred to a public hospital as soon as possible.

At present, the Hospital Authority will perform virus tests on patients with suspected cases that meet the criteria for reporting new pneumonia, that is, they have fever and respiratory symptoms or pneumonia. They have visited Wuhan or Mainland hospitals 14 days before the onset of illness, or have been in contact with patients with confirmed new pneumonia. Are suspected cases. Since January 31, the HA's "Enhanced Laboratory Surveillance" program has also performed a new virus test for all hospitalized pneumonia patients.

The newly diagnosed 54-year-old male patient has had 6 visits within 9 days since the fever on February 7 and went to the private doctor's clinic 4 times and the Eastern Hospital Emergency Department twice. Although he had a fever when he arrived at the Eastern Hospital for the first time, he was discharged without a test because his lungs were clear and he had no travel history, which did not meet the hospital's testing guidelines.

Chairman of the Infectious Diseases Advisory Committee of the Medical Association Liang Zichao (profile picture)

If the testing standards are tightened or restrictions on laboratory testing volume, reagent supply, etc. are involved

Liang Zichao, chairman of the infectious disease advisory committee of the Medical Association and a respiratory doctor, pointed out that the symptoms and transmission chain of the confirmed virus are not obvious, but the virus transmission is high. These are "congenital defects", making it difficult for hospitals to find testing standards. All patients. However, he believes that there are several restrictions to further tighten the testing criteria, including restrictions on testing.

At present, public hospitals can perform about 700 to 800 virus tests per day. The results of preliminary diagnosis will be reviewed by the Public Health Laboratory Service of the Department of Health. Liang Zichao said that if all patients with respiratory symptoms, such as cold or mild pneumonia, need to be tested, the number of patients is quite large, and the laboratory may not be able to cope with it. In addition, the test also involves the supply of reagents and manpower, which is expected to bring some Load, so it is necessary for public hospitals to first screen for testing.

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Sampling restricted by diagnostic tools needs to be performed at the hospital

The results of the current rapid PCR test need to wait for several hours. Different local and overseas teams are studying how to speed up the test efficiency, including the development of the "Automated Rapid Diagnostic System" by the Hong Kong Polytechnic University, which will reduce the test to 1 hour; Expert Zhong Nanshan has developed a rapid test kit that only needs a drop of blood sample from the patient to detect the new virus's IgM antibody, and the results are expected to be known within 15 minutes.

Liang Zichao believes that before new technologies are available, current diagnostic tools are limited. He explained that if only patients with upper respiratory tract samples were taken, because of the chance of false negatives, or lung samples were needed to determine, but these sampling procedures are difficult to complete in the clinic, and suspected patients will eventually need to be hospitalized. In the future, if you "finger finger" you can take samples for testing, or you can expand the testing criteria to find more relevant patients.

Private doctors should avoid sampling patients in clinics

There have been many cases of local infection in Hong Kong of unknown origin. Liang Zichao reminded the public that they should do good personal hygiene at this stage to minimize the symptoms of going out, and enterprises can formulate flexible work policies to reduce office hours and crowds of people in the office.

In this case, a private doctor referred him to a public hospital twice because of a fever. Liang Zichao reminded doctors that if there is a suspected case, if the patient's condition does not improve, he should be referred as soon as possible. He should wear a mask during the consultation. He should also avoid high-risk procedures such as sputum extraction in the clinic to reduce the risk of infection.

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