What is an asymptomatic pneumonia carrier?

A number of cases of asymptomatic infections did occur across the country, that is, patients who did not show clinical symptoms such as fever, cough, or malaise, but who tested positive for the nucleic acid of the new coronavirus. Zhang Wenhong, head of Shanghai's medical treatment expert group, believes that this may be due to the fact that this part of the infection did not show a strong immune stress response, but also due to the heterogeneity of the body and the virus coexisted peacefully, so that they did not show any symptoms or symptoms are mild and do not know.

But it doesn't mean that the absence of symptoms doesn't make it contagious

在fifth editionThe Diagnostic and Treatment Program for Pneumonia with Novel Coronavirus Infections considers that asymptomatic infected persons may also be a source of infection, so they need to be quarantined as long as they test positive for the nucleic acid of the virus. Some people are concerned that this may make the current prevention and control difficult. This concern is normal, but there is no need to panic. This is because the proportion of asymptomatic infections is in fact very low, and the number of viruses they carry is also very small, and the harm of transmission is also relatively small. At present, the spread of asymptomatic infected people is mainly a phenomenon of family aggregation, and now many places have implemented a "closed" management (for example, in many places, no matter where they come back even if they do not have any symptoms, but also to isolate themselves at home for 14 days), which is really very effective in the discovery of potentially infected people to cut off the pathway of transmission of the virus. This is very effective in identifying potential infected persons and cutting off the transmission of the virus.Based on the available data, we know that the incubation period of the new coronavirus is up to 14 days, i.e., "asymptomatic infected persons".", beyond 14 days if there are no symptoms yet this is not a problem.

From this, we see that there are two measures to prevent viral transmission from occurring in asymptomatic infections, the most important being isolation, followed by nucleic acid testing of the virus.

So the question again is, who needs a nucleic acid test even if they don't have symptoms, and how can they be considered cured?

It is impossible for us to conduct nucleic acid tests on all people, and nucleic acid tests must be conducted in a targeted manner. Academician Zhong Nanshan has also said that there are certain reasons for us to do virus tests on some people, and the vast majority of them are because they have had contact with the patients, or they have been to Wuhan, or they have been in contact with people from Wuhan.

If the test is nucleic acid positive, isolation is needed. A portion of asymptomatic infections are self-resolving, and prompt treatment is needed if symptoms develop. According to the latest version of the treatment protocol for pneumonia with novel coronavirus infection, if two consecutive respiratory pathogen nucleic acid tests are negative (with at least 1 day between samples), and if the body temperature is normal for more than 3 consecutive days, and if the respiratory symptoms improve significantly, the patient can be released from isolation and discharged from the hospital. Then it is also considered cured.

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The number of infections continues to grow as the NCRP epidemic progresses to the present day, with a cumulative total of 74,282 confirmed cases, 5,248 suspected cases, 2009 deaths, and 14,814 cured cases as of 21:00 on February 19, 2020.

From these data, we can see how cunning and crazy the new coronavirus is, the number of infected people has reached more than 70,000 in about a month, which can be said to be more dangerous than the SARS outbreak in 2003, the whole SARS period of almost 8 months in mainland China infected only 5,327 people, and now only a month less than the number of infected people has reached more than 70,000 people and the number is still changing, it can be said that this epidemic has come very fierce. It can be said that this epidemic has come very fiercely.

This time the virus seems to become smart, if infected some people will appear clinical symptoms, and some people even if infected, will not appear clinical symptoms, which brings a lot of difficulties in the prevention of the epidemic, just like the side of the infected you can not know, because he is not not a fever, two do not cough, he is just like a normal person.

1. What exactly is an asymptomatic infected person?

Asymptomatic patients with novel coronavirus pneumonia are those who do not have major symptoms such as fever, dry cough, malaise, or symptoms such as nasal congestion, runny nose, sore throat, myalgia and diarrhea, but who have a positive nucleic acid test for the virus. To put it simply, there are people who carry the novel coronavirus, but they do not develop the disease themselves, have no obvious symptoms, and do not know they are sick. Such asymptomatic infected people actually account for a lot of clinically confirmed cases. The CDC analyzed 72,314 confirmed cases, of which asymptomatic infected people accounted for 1.2%.

Although asymptomatic infected patients are asymptomatic or have relatively mild clinical symptoms, in terms of pathogenesis, since such patients carry the virus, they may cause transmission. From a practical point of view, since these patients are asymptomatically infected and their condition is relatively mild, they may be weaker in terms of transmissibility than heavier patients, but they are still contagious. On the Internet, there was a case in which an asymptomatic infected person infected the whole family but did not develop the disease himself, of course, there are many other similar things. Therefore, asymptomatic infected people also need to receive treatment.

How is an asymptomatic infected person considered cured?

For the cure criteria for asymptomatic infected patients, we can refer to the criteria for release from quarantine and discharge from hospital in the "Diagnostic and treatment program for pneumonia of novel coronavirus (trial implementation of the sixth edition)":

① Body temperature returns to normal for more than 3 days;

② Respiratory symptoms improved significantly;

(iii) Lung imaging showed significant improvement in acute exudative lesions;

④ Two consecutive respiratory specimens were negative for nucleic acid (sampling at least 1 day apart).

Those who meet the above criteria may be released from isolation and discharged from the hospital. Therefore, for asymptomatic infected persons, since there are no obvious clinical symptoms, the criterion for curative discharge is to meet the criterion of two consecutive respiratory specimens with negative nucleic acid tests (sampling time at least 1 day apart).

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The so-called asymptomatic infected people, i.e. those who do not have any clinical symptoms but have a positive nucleic acid test for the virus, are also the source of infection for the new coronavirus, but are difficult to find out in real life, and are also the weak link in the prevention and control of this epidemic.

The novel coronavirus infects the human body and causes a series of tissue and organ complications. Most patients have a good prognosis, while some elderly people or those with pre-existing chronic illnesses have a greater probability of developing severe or critical illnesses and a relatively poor prognosis.

At present, there is no specific drug for the new coronavirus, but through active symptomatic supportive therapy and antiviral therapy, we can control the disease well and achieve cure. Currently, the criteria for contact isolation and discharge from the hospital for new coronavirus pneumonia are defined as: (1) temperature return to normal for more than 3 days; (2) respiratory symptoms significantly improved; (3) lung imaging showed significant improvement in acute exudative lesions; (4) two consecutive negative respiratory nucleic acid tests (two times with an interval of more than 24 hours).

Approximately 1.2% of patients with new crown pneumonia can be asymptomatic. Although asymptomatic patients do less damage themselves, they can have a profound impact on the current and future epidemiology of neocoronavirus pneumonia. How can an asymptomatic patient be considered cured? Medical Xindanwei will help you to find out.

The impact of asymptomatic patients on themselves and others can be very different: for themselves, infection with the new coronavirus does not cause significant damage to lung tissue and may not manifest as pneumonia, so their condition is usually mild; for others, asymptomatic patients are an important source of infection and can transmit the virus to others, increasing the risk of infection and contributing to the epidemiology and outbreaks of new coronavirus pneumonia. Therefore, timely detection, isolation, and cure of asymptomatic patients with pneumonia is an important step in interrupting the spread of the new coronavirus. Asymptomatic patients can produce their own immunity and rely on antibodies to clear the virus and heal themselves; however, some asymptomatic patients cannot produce immunity and can coexist with the new crown virus for a long period of time and become carriers. Asymptomatic carriers are not easily detected, which can lead to the chronicity of the disease, and once chronic, the virus can cause outbreaks and epidemics like the influenza virus, which lasts for a long time.

So how are asymptomatic patients considered cured? Due to the current lack of specific drugs against the new coronavirus, asymptomatic patients mainly rely on their own immunity to destroy the virus. The standard of cure is to rely on the viral nucleic acid test to determine, if two consecutive tests are negative (at least one day interval), that has been cured, can be discharged from the hospital for observation. However, at present, there is a situation in many places that cured patients can still have a positive performance in retesting the nucleic acid test, and since the specific reason is still unclear, all cured and discharged patients should be quarantined for 14 days. The viral nucleic acid test is periodically reviewed to rule out laboratory errors. Of course, cured asymptomatic patients with positive viral nucleic acid tests need to be hospitalized to determine the cause of the disease.

In summary, asymptomatic patients, although their own damage is mild, are an important source of infection for others, so they also need to be isolated and treated; after treatment, if two retests of viral nucleic acid tests are negative, they can be discharged from the hospital for observation, but they should be observed for at least 14 days and retested regularly for viral nucleic acid tests.

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Note: The content of this article is intended as health science only, and is not intended as medical advice or opinion, and does not qualify as medical guidance.

How can an asymptomatic pneumonia carrier be considered cured?

Typical symptoms of neococcal pneumonia are fever, dry cough, and malaise. A small percentage of patients may have atypical symptoms such as nasal congestion, sore throat, runny nose, and diarrhea. In severe cases, patients may even develop respiratory distress, hypoxemia, coagulation disorders, and multiple organ failure.

But some patients with neocoronavirus pneumonia can show mild symptoms or even no symptoms, which is not the subject of the new coronavirus carriers without symptoms, how to be counted as cured. In fact, this kind of new coronavirus pneumonia is a mild form. The gold standard for diagnosing this patient as cured is two consecutive negative respiratory pathogen nucleic acid tests, with a sampling interval of one day or more. In other words, when the respiratory tract is free of the new coronavirus, then it is considered cured.

First of all, this problem is still difficult to solve, now found in the population there are some addictive carriers, but these patients do not have some of the typical symptoms of the new coronavirus infection, and the same as the normal population, some people think that these people are isolated for 14 days after the test is not abnormal, and there are no symptoms counted as a cure, but in fact, it is not so simple.

First of all, why there will be this asymptomatic pneumonia carriers, may be the virus itself aggressiveness, in the human body cell binding, human immunity and so on, so that these people carry the virus is not strong aggressiveness, but does not guarantee that it will not be in the future, so these people are also a kind of invisible source of infection, and is also the most easy to ignore the crowd.

Now in front of the epidemic, whether it is patients or carriers early detection and early treatment this is the best way, so for some of the heavy infected areas back to the crowd, the need for timely isolation, and eating utensils and other common supplies should be independently disinfected, isolation can not be contacted during any healthy people.

Now for the new coronavirus cure standard is not very clear, for the requirements of the infected patient is after treatment of the patient does not have fever, dry cough and any other symptoms, and chest X-ray disappeared without abnormality, consecutive nucleic acid test negative is also counted as a cure, but these carriers quarantine period is over in time to check if there is no abnormality can only be said to be initially ruled out.

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For asymptomatic pneumonia carriers, although the number is small overall, it is where the difficulty lies in the prevention and control of this outbreak. The reason why there are asymptomatic carriers of the new coronavirus is partly due to the strong immunity of that patient, and partly because these patients may have been exposed to a small amount of virus, and the body's immunity has suppressed the virus so that they do not have any obvious symptoms.

People without symptoms may still be contagious, but I think this kind of patients will be a bit less contagious, and the symptoms of those who have been infected will also be milder, though this has obviously made it more difficult to prevent and control the disease. Therefore, even though there is now a trend of gradual improvement in the epidemic, we should not slacken off at all. In particular, people should put on their masks properly because you do not know whether the person who looks good in front of you is carrying the virus.

So how can a symptomless pneumonia carrier be considered cured? The criteria for cure are actually the same, two to three consecutive negative nucleic acid tests, no imaging signs of pneumonia, but most of these people will not go to the doctor, I guess we have to wait for the body's immune system to completely remove the virus, we do not know exactly how.

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An asymptomatic infected person is a patient who is infected with the virus but does not develop the disease, does not have symptoms such as fever, malaise, cough, etc., but the nucleic acid test is positive. It may be that the patient has good autoimmunity, where the autoimmune system can inhibit the growth of the virus, but if the immunity is lowered, it is possible that the disease may develop as well. The criteria for cure are at least two negative nucleic acid tests, no abnormalities on CT of the lungs or significant absorption of the infected lesions. After cure, the patient needs to be isolated for at least 14 days, during which time he or she should be rechecked, especially if there is fever or cough. Currently, there has been one case of cured patient in Chengdu who was positive when the nucleic acid was rechecked 10 days after discharge from the hospital. Therefore, it must be taken seriously.

In fact, according to the latest "New Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Sixth Edition)" issued by the National Health Commission, the criteria for lifting the isolation and discharging the infected (confirmed) patients with the current new coronavirus pneumonia have been stipulated in detail: for the return of the body temperature to normal to reach more than 3 days, the respiratory symptoms have been significantly improved, and the imaging of the lungs (CT) shows that there is an acute exudative lesion that has improved significantly, the Virologically, there are two consecutive negative nucleic acid tests on respiratory specimens, and the sampling time must be at least 1 day apart. If the diagnosed infected person is able to meet all the above conditions, he/she can be released from isolation and discharged for observation.

However, we need to note that the "Program" does not suggest what kind of criteria for diagnosed infected people to be considered completely "cured", because even after discharge, you still need to observe 14 days at home, wear a good mask, avoid contact with strangers, minimize close contact with family members, to avoid the possibility that there is still a residual virus caused by the transmission of infection.

It is also important to note that the current outbreak does not make extensive use of the medical term "carriers" in the official Program, but mainly uses the terms "suspected infected", "confirmed infected", etc. The terms "suspected infected" and "confirmed infected" were mainly used.