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起疯了 20201124

(2020-11-26 19:54:16) 下一个

我这些天有好几个80岁以上的病人,除了low degree fever,没有其他typical covid symptoms, 基本都是supportive treatment,预防并发症,和缓解症状治疗,大部分几天能安全出院。

一个81岁的老奶奶,症状严重,发病早期给了Remdesivir x 5 days ; 另一个40多岁的墨兄,SOB 严重,血氧低,错过了Remdesivir最佳期,给了convalescent plasma 。

有症状的病人,如果Rapid test 是阴性,我们会做second test,因为如果 viral load 不够,会呈false negative。 如果病人present病程超过7天,我们会order PCR test。The duration of viral shedding varies significantly and may depend on severity (based on testing of oropharyngeal samples ranged from 8-37 days, with a median of 20 days),

即便Rapid 和 PCR 都呈阴性,CXR 显示有不正常发现(Patchy ground glass opacities), 我们会把病人做PUI 处理,一样隔离和治疗。 而且会重复CXR,因为Early in the course of the disease, there are many mildly symptomatic patients with clear chest x-rays that quickly progress over days to patchy ground glass opacities.

有的症状病人,Case-by-case,同时还会做respiratory viral panel, strep throat 和其他Labs;根据病情,有的也会做Antibody Test (IgM, IgG , but It is not necessarily confer immunity to COVID-19 and it is unknown how long antibodies last)

 

 

PS,

阎老在症状几天后,检测 covid test negative,based on cases and studies,采样的viral loading dose应该合适,采样的技术问题除外。

阎老,也许是flu造成的心肌炎导致直接死亡。 Acute myocarditis is a well-known complication of influenza infection。 Myocarditis can be life-threatening if not treated in time。(我不知道阎老病程的具体细节,无法判断)

 

 R.I.P,阎老!

 

 

补充一个Research information for PCR test 

Over the 4 days between infection (day 1) to the typical time of symptom onset (day 5), the probability of a false-negative result in an infected person decreased from 100% on day 1 (95% CI, 100%-100%) to 67% (CI, 27% - 94%) on day 4.

On the day of symptom onset (day 5), the median false-negative rate was 38% (CI, 18% to 65%).

On day 8 the median false-negative rate decreased to 20% (CI, 12%- 30%), and then began to increase again (21% [CI 13%-31%] on day 9). On day 21 the median false negative rate was 66% (CI, 54% -77%).

 

 

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