The Mid-Autumn Festival, Zhao Yong (a pseudonym) was spent at his mother-in-law’s house in the countryside of Hainan.
At the reunion dinner, he sat at one table with his wife and daughter, with chopsticks that he brought from home. His father-in-law and mother-in-law sat at another table with their families.
In the past, Zhao Yong would bring a lot of gifts for the Mid-Autumn Festival. This year, he only bought his father-in-law’s favorite five-cent moon cakes. He was ashamed, because of illness, this half year income is very little, buy too many gifts, afraid of the old man is not happy.
The reunion dinner is very sumptuous, white chicken, steamed fish …… full of two tables of food, but the family ate no atmosphere. The first thing you need to know is that you can’t be sure that you’re going to be able to do anything.
On the day of the Mid-Autumn Festival, Zhao Yong still felt tightness in his chest, chest pain, back pain, and occasional difficulty breathing. In fact, he had concerns about going home for the holiday, always thinking that the “virus” was still there, and that it might be contagious if there was intimate contact. But he also felt that if he kept his distance during meals, he might not be contagious, and that his mother-in-law’s family had experienced symptoms that seemed to have cleared up.
For the past eight months, Zhao Yong has been trying to prove that he is infected with the 2019 coronavirus.
At the end of January he had symptoms and was diagnosed with the flu, although there was inflammation in his lungs, but because there was no history of Wuhan exposure within 14 days, he could not get a nucleic acid test. Later, he repeatedly tried to get tested, but the nucleic acid and antibody tests were negative, and the symptoms did not disappear: dry cough, high fever, diarrhea, inflammation of both lungs, joint pain, low fever, difficulty breathing ……
On Mid-Autumn Day, he didn’t show up at the patient group as usual. The patient group was also stuffy, with people mostly talking about symptoms, “Betalactic (a common drug used in cardiovascular medicine for arrhythmias and angina) can’t be stopped, and when you stop, your heart rate starts to be bad”; “sneezing from time to time, is it a drop in immunity, or is the virus still there” …… Only three people in the group of more than 70 people mentioned the holiday.
They came from all over the country, most of them became ill in January or February of the outbreak, or outside of Hubei, with no history of exposure to Wuhan, or in Wuhan, where they could not do nucleic acid tests in the early stages of the disease because of the mild symptoms. Later on, they were able to do nucleic acid and antibody tests, and the results were negative.
Their symptoms, similar to some light patients: atypical symptoms in the lungs, chest tightness, rapid heart rate, fatigue, low fever, wandering pain in the body, muscle atrophy, abdominal distension …… And these symptoms are repeated, on and off, and still do not go away.
Most of them were diagnosed with anxiety disorders and neuroses by the hospital, but some symptoms, such as low oxygen saturation and pulmonary nodules, could not be explained by anxiety. They pay for their own tests and medications, suffer from family financial pressure, and are even more fearful and depressed because the cause of their illness is unknown and they cannot get systematic treatment.
They want to return to society, but are worried that they are contagious; some cannot return to work because of their illness, and some are afraid to go out for months. There is also a lack of understanding in the community and family, and they are seen as having psychological problems.
They suffer day to day, always hoping for attention from the government and society and for systematic and effective treatment.
They are not alone in their chronic illnesses, and on October 15, the National Institute for Health Research (NIHR) released a study, Living with COVID-19 2019, which stated that a proportion of people with mild illnesses have experienced persistent Long-term symptoms for more than three months. The report also mentions that many patients tested negative, but blood and chest x-rays showed 2019 coronavirus symptoms.
Weird symptoms.
Zhao Yong more than 30 years old, working in Haikou. 21 January, the first day of the company’s annual holiday, he suddenly got cold, sore throat, muscle aches, thought it was a cold, ate cephalosporin and Tylenol, no effect.
He didn’t know how he got hit. Maybe it was when he went to the supermarket, or maybe it was when he went to visit his father-in-law in the hospital. At the end of last year, his father-in-law was hospitalized due to diabetes, he went to visit three times, the ward and the respiratory department in the same building upstairs, up the stairs a lot of people, and no one wears a mask.
And, at the end of December last year, when he returned to Haikou on a business trip, had a transfer in Wuhan, when up a group of Wuhan people. At that time, Wuhan has appeared unexplained pneumonia.
Zhao Yong went to the clinic for an injection, a measure of body temperature 38.5 ℃, a two-day drip, no improvement. He didn’t think much of it, even though he saw on the news that an epidemic had already appeared in Wuhan, more than 1,500 kilometers away.
On January 23, Zhao Yong and his wife and daughter returned to their home in the Hainan countryside. The next day was New Year’s Eve, he woke up in the morning, feeling dizzy, as if something was covering him, his whole body was weak, high fever 39.5 ℃. In the afternoon, he had recurring diarrhea, “pulling things out like water”; and a dry cough, “from the bottom of his lungs upwards, feeling like his whole lung was buzzing”. He felt something was wrong and asked his wife to send him back to Haikou immediately for a check-up.
At the hospital, Zhao Yong underwent a CT scan, which revealed that the texture of both lungs was thickened and blurred, and a small amount of streaky blur was seen in the lower lobe of the right lung. He has always been in good health, playing football every week, and his respiratory system has no underlying disease, and his lungs are clean for his company’s annual physical examination. The company’s annual physical examination, and his lungs are clean. Zhao Yong then read online that a doctor said that low lymphocytes are one of the characteristics of 2019 coronavirus pneumonia. He showed the doctor this article, asked for a nucleic acid test, and explained that he was transferred through Wuhan last December, but the doctor disagreed, saying he did not have white lung and the history of Wuhan exposure was more than 14 days.
The doctor gave Zhao Yong cold medicine. In the evening, he came back, he went to bed early and slept until four or five in the morning, felt difficulty in breathing, ran to the window and breathed hard to feel better. Only after half an hour did he slowly get better.
The next day, Zhao Yong slept all day, and for the next half month, he didn’t sleep enough every day. He sweated badly at night, and on cold days, sometimes he had to change his clothes 2 times a day. Insomnia that lasted for more than a month. In addition, he found himself particularly able to eat, usually a bowl of food each meal is more than a bowl, and now to eat three or four bowls; the demand for protein is particularly strong, a meal without milk, the whole person will shake up, more than 10 days after that.
On January 30, Zhao Yong’s fever subsided, went to the hospital, CT scan showed that the upper lobe of the left lung, the right lobe of the right lung, see a little rope-like blurred shadow, both lungs a little chronic inflammation. Zhao Yong found it strange, January 24 just right lung infection, a week later, the left lung also has inflammation, except the lung image is not typical 2019 coronavirus images, the other symptoms are very similar. He again asked for a nucleic acid test, the doctor still did not agree.
On January 26, my wife also had symptoms, sore throat, body aches, temperature 38°C more than seven days, sustained fever, medication ineffective. On the eighth day, took two psyllium antitoxin pills, night turned to low temperature 35 ℃ more, the whole person in the shiver, after two or three days, the body temperature only rose.
After that, she also had daily fatigue and lethargy. Counting from the fever, the dry cough began on the tenth day; around half a month, the eyes became red, painful and afraid of light; around a month, diarrhea and bloating. She got up several times in the middle of the night, said her stomach was particularly upset, and walked around the room alone. She was also extremely afraid of the cold and had to wear a lot of clothes at night and wrap her head tightly.
Difficult to seek medical attention
Like Zhao Yong, Zhang Ling (a pseudonym), a northerner, doesn’t know how the symptoms appeared.
If you detail the physical abnormality, she thinks of December 2019, her hands trembled and she had sudden chills at night, but it passed quickly and she once suspected Parkinson’s disease. At the time, her 8-year-old son was also dizzy, losing his hair, and books often fell out of his hair.
One day in early February, Zhang Ling felt tightness in her chest and lay down to hold her breath, “the kind of tightness I’ve never felt before”. Muscles trembled, hands shook, and when disinfecting in the bathroom, I couldn’t smell the 84 disinfectant. When cooking, I couldn’t taste the salty smell …… Zhang Ling suspected that it was related to the virus. Later, domestic and international news reported one after another, 2019 coronavirus patients have lost the sense of smell and taste.
At 12:00 this night, it was snowing in the city, and Zhang Ling called an ambulance to go to the hospital. The doctor took her temperature, no fever. The first thing you need to do is to take a look at your skin, and then ask if you have any history of exposure to Wuhan, and she said that she didn’t subjectively have any, but there were symptoms. She said the doctor wouldn’t look at it or register her and told her to go home.
The next day, Zhang Ling went to another hospital for an emergency visit. The doctor took a chest X-ray and found a thick lung texture. Zhang Ling’s heart rate was very fast, 120 beats per minute when she was not moving, and she was having a hard time, but the doctor just told her to go to the outpatient clinic.
After a few days, Zhang Ling was really uncomfortable and went to a third hospital. The doctor took a CT scan of her chest and did blood tests, but still found no problem. By this time Zhang Ling had a fever of 37.8 ℃, the doctor said, this is certainly not 2019 coronavirus pneumonia. After going home, Zhang Ling fatigue, paralyzed in bed to move, the strength to lift the hand are not, but breathing is still normal.
After more than a week, nearly the end of February, my son could not inhale in the end, and was suffocating. Before he has asthma, but the daily state is quite normal.
Zhang Ling took her son to the hospital. The doctor listened to his lungs with a stethoscope, tested his blood, and said it was fine, go home. He was given two boxes of azithromycin. Zhang Ling begged for half a day before the doctor took a chest X-ray of her son and saw that both of his lungs were suffering from interstitial pneumonia. I’m not sure if this is the case, but I think it is.
Afterwards, Zhang Ling searched all the hospitals in the city, but her son couldn’t get nucleic acid, couldn’t get treatment, and couldn’t be hospitalized. The child began to suffer from stomach pains and chest tightness. Zhang Ling felt like she was about to collapse and could only save herself by purchasing equipment to nebulize and suction sputum for her son. Later, a ventilator and oxygen generator were prepared, just in case.
Zhang Ling knows many doctors, they help to go to some hospitals to treat 2019 coronavirus pneumonia Coleridge, Abidor, a variety of drugs, Zhang Ling to take large doses, to test the drug for her son.
In the patient group
In February, Zhang Ling added a low-heat group on the knowledgable Internet. She discovered that many people have similar symptoms.
There are many Wuhan people in the low fever group. In Zhang Ling’s impression, people looked at so many Wuhan people at that time, felt something wrong, so they exchanged ideas with each other, each saying symptoms. Some suspected that they were suffering from coronavirus, while others thought they were suffering from lung cancer because they had low fever and lung nodules.
Zhang Ling also saw, a Wuhan netizen posting on Zhihu, describing their January 26 suspected infection 2019 coronavirus light pneumonia status: at 4 a.m. suddenly more than 100 beats per minute, the fastest when more than 120, lasting 2 minutes, was shaken awake, and then a night shivering chills, body as sore as beaten, numb hands and feet …… post later can not be updated, there are still 176 people agree, 1195 comments.
The newest member of the family is a man who has been a member of the family for over 20 years. The group of friends from all over the country, to Hubei people most, all kinds of dark news flying around, some people can’t carry it, and privately pulled a small group, we discuss the condition, sometimes inevitably rhetorical excess, the group was closed.
At the end of February, a patient forwarded to Zhang Ling an article about 2019 coronavirus syndrome by Ding Hong, a professor at Wuhan University School of Pharmacy.
The first thing that you need to do is to make sure that you have a good idea of what you need to do to get the most out of your money. (diammonium glycyrrhizate + vitamin C + rutin)” for patients who could not be hospitalized in time. The program was later recorded by the State Drug Administration and was in clinical trials at Wuhan University’s Central South Hospital, the Health Times reported. She and her students constructed four 2019 coronavirus pneumonia patient groups in succession, volunteering to provide psychological comfort and medical and pharmacological consultation services, tracking the occurrence, development and recovery process of more than 2,000 patients throughout the course of the disease.
In March, Zhang Ling joined Ding Hong’s patient group. In Zhang Ling’s impression, in the group, Ding Hong first explained everyone’s symptoms from a professional point of view, which effectively calmed everyone’s emotions in the chaotic situation at the time. At one point, she was available 24 hours a day to provide medical and pharmacy consultation services to everyone. When people had symptoms, they called her in the group @ her, and she basically answered all their questions.
With the help of Ding Hong and her patients, Zhang Ling felt a little more at ease. At the beginning of March, Zhang Ling took her son to the hospital for a CT scan, which showed improvement in his lungs, but at night, he was still holding his breath badly and needed oxygen. Zhang Ling also often woke up with suffocation just after falling asleep.
On March 19, when the peak of the epidemic in the city passed, Zhang Ling took her son to the designated hospital and tried to get a nucleic acid test, but the doctor wouldn’t do it. Zhang Ling cried in front of the infection department and met a doctor, with whose help they were able to do the nucleic acid test, but the results were negative.
At the end of March, according to Ding Hong’s therapy, Zhang Ling bought diammonium glycyrrhizate, vitamin C and rutin from the pharmacy and gave them to her son, and his lungs gradually improved. After another period of time, he still had chest tightness and breathlessness. Zhang Ling continued to nebulize and aspirate him.
In March, Li Feng (a pseudonym) from Wuhan also developed symptoms. For a week, every day she slept until midnight, she felt her mouth was extremely dry, and she couldn’t solve it with water. Then, for three days in a row, she was awakened in the middle of the night by the sound of her heart beating like a drum, with a heart rate of more than 180 beats per minute. ……
Li Feng’s heart showed symptoms, not an isolated case in the Wuhan epidemic. Later, a patient came across a report, compiled by CYN in April, that a study published in JAMA-Cardiology showed that more than a fifth of patients in Wuhan had heart damage, and some of them had no history of heart disease.
Ding Hong also found during her consultation that many patients have chest tightness, breathing difficulty and rapid heartbeat even if their fever is not obvious and their oxygen saturation is normal. She believes that some patients with 2019 coronavirus infection can develop not only pneumonia but also myocarditis at the same time.
According to the aforementioned article compiled by CYN, cardiologists believe that the following conditions may cause damage to a patient’s heart: lack of oxygen makes it difficult for the heart to pump blood; the virus invades heart cells; and the body causes an immune storm as it tries to destroy the virus, causing damage to the heart muscle.
Trying to get tested.
Zhao Yong has been seeking medical treatment, going to the hospital every three or four days. He has taken all kinds of medicines: cephalosporin, roxithromycin, silver granules, even flower clearing plague, guanhuang granules, forsythia antitoxin pill, moxifloxacin, and so on. The drip has been metronidazole, cephalosporin, and various cough waters.
The cough has not improved, and after half a month of dry coughing, it started to bring some phlegm, and it felt like something was gripping my lungs, like a stone pressing down on them, so I couldn’t cough it up.
The diarrhea was intermittent for seven days, after about a month, there were five or six times diarrhea. Zhao Yong found that after each bowel movement, there was something sticky on the toilet paper. He later heard that when the forensic pathologist dissected the bodies of the 2019 coronavirus victims, he found sticky stuff in the lungs, like paste.
A month after the fever broke out, Zhao Yong’s entire body became blotchy, like a blood clot symptom, and lasted for a week. Frostbite appeared on one of his fingers, which was itchy and swollen, and his arms were bruised, with the capillaries on his body being particularly visible. Zhao Yong is from Hainan, never had frostbite, he later saw the U.S. study said that 2019 coronavirus infection will appear after frostbite like skin lesions.
From January to April, Zhao Yong has been weak. In April and May, his joints were swollen and painful, and he couldn’t go up the stairs. Later, he found that his tonsils became smaller, and he developed a weakness and double chin. Tonsils can produce lymphocytes and antibodies, with anti-bacterial antiviral defense.
Zhao Yong always suspected that he was infected with 2019 coronavirus. He repeatedly called the Hainan Provincial Health Commission to report the situation, and they sent him to the hospital for examination.
The National Health Commission diagnosis and treatment plan from the second edition, the clinical characteristics of 2019 coronavirus patients have this statement: “early onset of the total number of peripheral blood leukocytes normal or reduced, lymphocyte count decreased ……” Zhao Yong once found out the plan with the doctor said, his white blood cells normal, low lymphocytes, both lungs have inflammation, couples have symptoms With these few things, it’s a suspected case. The doctor said, you’re still talking to me nicely, if it’s a new coronary, the lungs would have been white and laid down long ago.
White lung is a characteristic of heavy and critical patients, in the Wuhan epidemic is widely known due to media coverage, just become 2019 coronavirus pneumonia synonymous. In the National Health Commission’s treatment protocol, patients are classified as light, ordinary, heavy and critical, with light and some ordinary patients having no or mild inflammation in the lungs, often overlooked by some doctors and the public.
On February 7, Zhao Yong finally made the nucleic acid. By then Hainan had already found local cases, and the kit was relatively adequate. The test results were negative. After that, he did seven or eight more nucleic acid tests, all of which were negative.
In March, Zhao Yong found out that the hospital had a serum antibody test and asked for it, arguing with the head nurse. The head nurse said that the test is for patients with confirmed nucleic acid diagnoses to facilitate treatment, not for ordinary people like you.
In the end of March, Zhao Yong saw reports that 2019 coronavirus will attack the immune system, CD4 cells will be lowered.March 31, he went to the hospital to do the cellular immunity (CD4/CD8/CD3) chip test, found that his CD4, CD3 lymphocytes also lowered.
In May, he went to a dock in Haikou, pretending to have just returned from a boat trip to Wuhan, and fooled the security guards by rushing into the place where the antibody test was done, but in the end he was found out.
The Same Pity
In April, Zhao Yong saw a post on Zhihu. The author is a Henan girl, January 17 back from a trip to Wuhan, has been dry cough, low fever, back pain, arm lift …… she posted from mid-February, every day record symptoms. Zhao Yong saw that the symptoms were very similar to her own, and the post was later endorsed by more than 230 people, with more than 1,300 comments, many of whom said they also had the symptoms.
Zhao Yong joined a WeChat group formed by netizens and met Zhang Ling in the group. The group spread negative comments from time to time, such as this disease is not cured, we quickly go to the cemetery and so on, sometimes quarrels. Later, Zhang Ling rebuilt a small group of people. There are more than seventy people in the group, from all over the country, at least half of them from Hubei, and both Zhao Yong and Li Feng are in the group. In the group, Zhao Yong found that the patients were really pitiful. Many of them were whole families showing symptoms, there were three families that had been hit, and there were also five or six that had been hit.
About half of the people in the group have a low fever in the evening. When Zhao Yong first got sick, he had a high fever for five days, 38.3°C-39.5°C, and then went to the hospital and found himself with a low fever again. After that, he tracked the measurements for several months and found that from 5 or 6 p.m. to 8 p.m., he started to have a low fever, 37°C-37.5°C.
Zhang Ling had a fever in February, the fever subsided in March, and the fever again in April. At first, the temperature was high during the day, then dropped to about 36.4℃ in the evening, and then later, the whole day was about 37.1℃. When the fever broke, I couldn’t go anywhere, not even the hospital or the mall. The fever is not a major symptom, so I don’t take it seriously and don’t bother to measure it. The women in the group have a lot of chest tightness and breathlessness, and can’t breathe well. There is a girl from Shaanxi, has been unable to breathe, chest tightness breathlessness weakness, are quite obvious, persistent phlegm, sometimes can not breathe.
Some people have palpitations as soon as they lie down and feel like they have a stone on their chest. Someone has a sudden increase in heart rate in the middle of the night and a heart rate of 110 beats per minute during the day.
Someone is short of breath and speaks with a crying voice, like a shy person speaking on stage, shaking every word.
There were more than 10 patients who coughed all the time and couldn’t finish spitting. This was the case with Mr. and Mrs. Zhao Yong.
Many patients have bloating, and some say that after eating, their stomachs are bloated as if they were pregnant.
There are also patients with symptoms of blood clots. Zhao Yong has frostbite fingers, arm capillary bruising, a few months did not go away, but to check D-dimer, and not high.
Many patients said their muscles were atrophied, “I have two different fingers. The muscles were sore and soft, and in severe cases you could see that the muscles were noticeably thinner.
Someone reported that they had wandering pains all over their body, “either this tendon hurts a little, or that tendon hurts a little, it hurts in a different place”.
Someone has numb hands and numb feet and says the soles of their feet feel like pins and needles. Some people’s hands shake and say they shake even when they don’t hold things.
There were a few women, who had gynecomastia, and the doctor said it was a candida infection, saying that it only happens when the body has very little resistance. Just a group of people said it means the immune system is under attack by a virus.
Many have severe hair loss. When you wash your hair, a cloud of hair is pinched in your hand. Some people lamented the loss of a piece of their forehead, while others said, “It’s already balding”.
Some people sweat at every turn, sweating profusely after a short walk.
Some people’s sense of smell disappears, some people’s vision is blurred, dry, or have a sense of foreign objects, always feel something falling out of the eyes, a few months bad ……
The weird thing was that their symptoms came and went, endlessly, like a long-term chronic illness that goes on for a while and then goes on for a few days. “Lungs, heart, muscles, over and over again. Their lungs, heart, and muscles keep coming back and forth. Sometimes I feel like the virus is dormant, and then a few days later I have symptoms again, always over and over again, sometimes my head, sometimes my heart, sometimes my abdomen, sometimes my legs,” someone said. Sometimes head, sometimes heart, sometimes abdomen, sometimes legs.” Some people say this.
These seemingly unimaginable symptoms are very similar to the subsequent symptoms that some patients with mild 2019 coronavirus experience as they recover, and they are all very long-lasting.
Tinghong claims to have found the aforementioned symptoms in her patient population as well. Some patients differed from the typical 2019 coronavirus pneumonia patient with no or mild lung infection, low fever, normal blood and oxygen saturation, static heart rate of 90-130 beats per minute, chest pain, chest tightness, rapid heart rate, muscle atrophy, free skin beating pain, male genital beating pain, body numbness, fatigue, dry mouth, and headache, and a prolonged course of illness.
The symptoms of this group of patients do not fit the official definition of typical features of 2019 coronavirus pneumonia, which Ding Hong defines as “neo-coronavirus syndrome” and “suspected neo-coronavirus syndrome”.
She believes that other viruses can also cause patients to be sick for a long period of time, but the symptoms usually do not last so long, 2019 coronavirus has the possibility of such a long attack, the reason is that after the virus enters the body of some physique, because of the mild symptoms, the immune system does not respond, can not recognize the virus as an invader, can not be suppressed and cleared as soon as possible.
The long-term effects of the virus on patients, there is no adequate research at home and abroad.On September 15, the British Medical Journal published a joint letter of 39 doctors, hoping that the public and the government to pay attention to the long-term effects of 2019 coronavirus. All 39 doctors mentioned above were infected with the virus and initially almost all of them were asymptomatic, but most of them have since deteriorated in conditions such as muscle weakness, difficulty in breathing when walking 200 meters, memory loss, and even life-threatening allergic reactions and chronic dizziness.
In this letter, the doctors urge that people with 2019 coronavirus symptoms should be treated even if they test negative, and suggest that one-stop clinics be set up to centralize medical specialists who can treat long-term symptoms.
Test results always come back negative.
In the group, Zhao Yong also found that the patients, like him, were almost all negative for nucleic acids and antibodies and were never diagnosed. In the early stages of the disease, many of the patients outside of Hubei could not get nucleic acids done because they had no history of Wuhan exposure or had no lung symptoms; the patients in Wuhan could not get nucleic acids done in the early stages because their symptoms were mild. Later, when they were able to do nucleic acid tests, the results were all negative.
This is the first time I’ve ever been to a school. The first thing that you need to do is to do the nucleic acid and antibody tests. Some people think that even if they do eight nucleic acid tests themselves, it will be too long after the initial illness. Some people say that even if the nucleic acid test is positive, what can you do? There is no cure. Might as well find a good herbalist and prescribe medication according to the symptoms.
The nucleic acid test is used to detect 2019 coronavirus nucleic acid in a patient’s respiratory specimen, blood or stool, and is considered the gold standard for final diagnosis in mainland China’s medical community, but several media outlets have reported that its accuracy is not high. During the Wuhan epidemic, some patients who had white lungs but still tested negative for nucleic acid could not be diagnosed and hospitalized, and some even died at home as a result.
A woman in Ziyang, Sichuan, who had eight negative nucleic acid tests in February, was later diagnosed with 2019 coronavirus pneumonia based on clinical symptoms and laboratory test results. A patient in Beijing, who returned to Beijing from Hubei in January, had 10 negative nucleic acid tests and an antibody test in April that showed IgG positivity before being amended to a confirmed patient.
Zhang Xiaochun, former deputy director of the imaging department at Wuhan Zhongnan Hospital, is one of the experts who used CT images to identify and analyze 2019 coronavirus pneumonia during the Wuhan epidemic. She had analyzed more than 2,400 cases of pneumonia imaging data from January 14 to February 2 at Zhongnan Hospital and found that the positive rate of CT showing lung damage was 51.25%-80.98%, while the positive rate of nucleic acid testing was only 11.7%-38.1%. Later, the nucleic acid test kit was improved and the positive rate of nucleic acid test only reached 50%.
At the critical moment of the epidemic, Zhang Xiaochun contacted and contacted some white lung patients who could not be diagnosed and hospitalized, and was deeply shocked, taking the risk to call on CT images as the basis for the diagnosis of 2019 coronavirus pneumonia in Hubei Province during the special period, which was later adopted by the National Health Commission for a short period of time, helping more than 20,000 suspected patients to be hospitalized and effectively stopping the spread of the epidemic.
Zhang Xiaochun later said in an interview with Health News that the reason for these problems with nucleic acid testing lies in the existence of several limitations: nucleic acid reagent kits have been developed for a short period of time, and product quality is unstable; the accuracy of sampling depends on the operator; each patient has a different alveolar viral load at different stages of the disease, resulting in different viral loads of upper respiratory pharyngeal secretions; traditional nucleic acid testing reagents take a long time; and there may be organ-specific differences in virus attack on the human body.
Among the ways to confirm the diagnosis, there is also a specific serum antibody test that focuses on detecting the specific antibodies produced by the body in response to 2019 coronavirus. Usually after the 2019 coronavirus invades the body, the immune system produces immunoglobulins, the earliest of which are IgM antibodies, most often appearing 3-5 days after the onset of the disease; IgG antibodies are produced later and last longer. IgG antibodies are produced later and last longer. A positive IgM antibody indicates a recent infection, while a positive IgG antibody indicates a long-standing infection or a previous infection.
Antibody testing can compensate for the risk of missed nucleic acid tests, but there are limitations. According to the eighth edition of the National Health Commission’s protocol, an antibody test may be false positive due to the positive value of the reagent itself, the presence of interfering substances in the body, or the specimen.
During the Wuhan outbreak, there were also media reports that even when patients were diagnosed, some did not develop antibodies. In a paper published online Aug. 18 by Fudan University in the international medical journal JAMA Internal Medicine, 175 recovering patients discharged from the Shanghai Public Health Center were studied, and 10 of them had antibody levels that did not reach the lowest detectable level. The China Daily also reported that a British study found that the patients’ antibodies would disappear within months. These can cause problems in confirming the diagnosis through antibody testing.
Why do nucleic acid and antibody tests always come back negative in some patients? According to Li Hua (a pseudonym), a doctor at one of the top three hospitals in Wuhan, our nucleic acid test always uses a throat swab test, which can also lead to bias in the test. In fact, patients who do not have pneumonia as their main feature can have other samples tested, and if their abdominal symptoms are severe, they can have a stool swab test. In addition, if the patient’s condition is prolonged, after a month or two, some of the immune system has been destroyed and does not produce antibodies itself. Thus, some suspected cases, if they miss the sampling period for sensitive samples and do not produce antibodies, the nucleic acid and antibody tests become double-negative and they are in a dilemma.
“How can we prove that we are a neo-crown patient? There is no way to prove it”. Zhang Ling said, “You can see we are negative for nucleic acids and antibodies, it’s hard to produce evidence from a scientific point of view that the symptoms are caused by the new coronavirus”.
Groupmate Wang Xiu (pseudonym), a doctor in Shandong province, felt it was hard to say whether the patients were suffering from 2019 coronavirus, “Maybe some of them aren’t, because they had symptoms before the new coronavirus epidemic, anyway I think I am.
Wang Xiu’s nucleic acid and antibody tests were also negative, and she developed symptoms earlier. On January 24, Wang Xiu began to suffer from low fever, dizziness, coughing, muscle throbbing, chest and back pain, palpitations that made her unable to sleep, and a static heart rate of 120 beats per minute. When she was examined at the hospital, her blood pressure was found to be 170 systolic and 110 diastolic, which was already in a high-risk state, and she had never had high blood pressure before.
“I wonder how many people there are in this particular group who have not been diagnosed, but have been experiencing symptoms? Zhao Yong feels that the group of patients is only the tip of the iceberg, and that most of the patients in the group were met in Zhihu.
During her illness, she saw many people with similar symptoms on Weibo. Zhao Yong recalled that when he went to the hospital repeatedly, he had met two or three people who had been visiting the hospital for many times with diarrhea, low fever, and negative nucleic acids, and no problem with CT scan, but they were very sick. He felt that they were the same people.
We have been neglected and have not been treated systematically,” he said. Zhao Yong has always hoped that someone would speak up for them as a special group, so that they would be taken seriously by the government and society, and receive systematic and effective treatment. He once suggested that people in the group share their concerns, but some were reluctant to participate because they were worried about the risks.
Anxiety Disorder
In Zhao Yong’s impression, in April and May, people were particularly active in the group, asking each other to compare symptoms, desperately going to test for nucleic acids, doing routine tests, running to many hospitals, sending test results to the group, encouraging each other and diagnosing each other.
The thing that broke everyone’s hearts was that even though they felt very sick and had all kinds of symptoms, the doctors always diagnosed them as anxiety disorders when they couldn’t find anything obvious in the hospital.
For example, if someone has a bad heart and can’t find anything wrong with it, but his heart rate is extremely fast, the doctor will say it’s a neurological disorder; if someone has a generalized wandering pain or chest tightness, the doctor thinks it’s a somatization disorder caused by anxiety. Zhang Ling said.
That’s what happened to Li Feng. After waking up in the middle of the night in March or April to the sound of her own heartbeat, she rushed to the emergency room, where the doctor gave her Valium and put her on oxygen, saying she was too anxious and told her to go home to adjust. When she returned, Li Feng found that her heart was temporarily better, and then she did a CT scan, ECG and color ultrasound, but no problems were found. At one point, she thought she was really anxious.
When Dr. Wang Xiu treated her at the hospital, she was also diagnosed with psychological problems. Of course I didn’t believe it, I’ve been practicing medicine for more than ten years,” she said. She felt that her symptoms were there, and to this day, she still has a cough, an unstable heart rate, high blood pressure, bleeding spots on her skin, and all the tests are barely normal, but her physical symptoms are more prominent, “overturning all kinds of medical diagnoses. At one point, she thought she was suffering from a plant nerve disorder, but “it’s a bit far-fetched to have a family of three like this”.
Since March, when Zhao Yong went to the hospital for a check-up, doctors felt that he had too many of the symptoms he was talking about, with pains here and there, but they couldn’t find anything wrong, CT images of his lungs didn’t support that it was a new crown, and many doctors also said that he was suffering from anxiety, as well as anti-depressants that he had been prescribed for some time, which didn’t work.
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Zhao Yong did not believe that he had anxiety disorder and once asked the doctor, “Does anxiety disorder cause coughing? The patients in the group didn’t recognize it either, “Some people have nodules on their lungs, some people have low oxygen levels, and anxiety disorders are still like this? Zhang Ling said.
Zhao Yong had suggested that patients in the same city should go to the hospital together to register with the same doctor and tell almost the same symptoms and duration of their illnesses. Unfortunately, we had too many worries and couldn’t unify our opinions.
The patients felt that they were not welcome in the hospital because they had been to the hospital many times for check-ups and no obvious problems could be found. Every department doctor said they would not register me with a department next time, as if I was taking up medical resources for nothing,” one patient said. It’s like I’m taking up medical resources for nothing,” one patient said. They envied the patients who were diagnosed, “Those who were diagnosed were lucky, at least they could be treated thoroughly. What do you call this? All departments don’t take it seriously.
The doctors’ diagnosis of anxiety disorders was not unfounded, as some of the patients’ symptoms were not.
The National Health Commission’s “Rehabilitation Treatment Plan for Major Functional Impairments in Patients Discharged with New Coronary Pneumonia” argues that psychological dysfunction in recovering patients can lead to physiological reactions: panic attacks, headaches, muscle aches, indigestion, stomach bloating, nausea, and decreased appetite caused by emotions may occur.
In an interview with the media, Dr. Mei Junhua, deputy director of the Sleep Medicine Center at Wuhan First Hospital, said that the sleep disorders of some patients are closely related to the anxiety and depression caused by the epidemic, and that these emotional problems or psychological disorders do not manifest themselves in psychological symptoms, but are transformed into a variety of physical symptoms, which we call “somatization reactions”.
Anxiety disorder, also known as anxiety neurosis, is the most common type of neurological disorder. It is mainly characterized by anxious emotional experiences and can be divided into chronic anxiety (generalized anxiety) and acute anxiety (panic attacks). Numerous acute anxiety episodes occurred during the epidemic, highly overlapping with symptoms of 2019 coronavirus pneumonia. Anxiety can lead to decreased immune function, particularly affecting the lymphatic system; it can cause concurrent vegetative nervous system symptoms, such as chest tightness, panic attacks, dyspnea, sweating, shivering, and may cause a mild increase in body temperature, which can produce a severe sense of near death or loss of control.
In her patient group, Ding Hong found some patients who were different from typical pneumonia patients: low fever, static heart rate of 90-130 beats per minute, chest tightness, chest pain, muscle pain, free skin pain, and fatigue …… They had normal blood work, most of the lung CTs were normal, some had few features of viral infection, and most of the nucleic acid tests were negative.
Most of these patients were emotionally disturbed, and initially, Dinghong also thought they were anxiety disorders, but later felt that they were different from anxiety patients. Anxiety disorders have signs of vegetative nerve dysfunction, usually manifesting as dizziness, headache, panic attacks, chest tightness, abdominal pain, bloating, diarrhea, frequent urination and sweating with shaking hands, but rarely with symptoms such as hypothermia, muscle aches and pains, and peripheral neuralgia.
In the hospital, such symptoms are usually diagnosed as anxiety and depression, according to Ting Hong. However, she suspects that these patients may have been infected with 2019 coronavirus, but were not recognized as patients due to mild symptoms or atypical lung infection or multiple negative nucleic acid tests, and for a long time, they were very fearful and homeless because the cause was unknown, and they did have associated symptoms of depression. Some patients later tested positive for IgG antibodies, confirming her judgment.
She felt that the group members were talking too much every day, and that they did have some anxiety beyond the symptoms.
They loved me very much and were convinced that I was depressed,” she said.
For a long time, Chang Ling felt unsure of herself. Her symptoms and those of her sick friends were not recognized in the society, and they were not understood at home.
Zhang Ling’s family had some local social connections, but when mother and son got sick, they were running around in many directions, even almost on their knees to the doctor, and their son could not get treatment against 2019 coronavirus.
Zhang Ling’s encounter is not alone. A Wuhan patient said, she posted on Weibo for help, the neighbors did not believe her that a variety of symptoms, “from head to toe are sick, where it hurts”, said she was making up stories, rumors, “really new crowns have long been hung up. Li Wenliang has been in the hospital every day to save her life, but she hasn’t been able to carry it for as long as she has”.
Some neighbors thought she was faking pity to gain sympathy in order to trick netizens into donating money or free treatment from the state, and even thought she was mentally ill, with people once running to her door and saying they would drag her to a mental hospital.
At home, many patients are also not understood, and family members think they are mentally ill, which triggers family conflicts. Whenever I talk about the virus, my father-in-law blows up,” and “the smell of gunpowder is so strong that they fight at every turn. Patients said.
They believe that a negative nucleic acid test means nothing is wrong, that having 2019 coronavirus pneumonia is serious, and that there are no mild cases. “My dad says he only believes in doctors. Even if I died in front of him, he said he wouldn’t believe me. The first thing you need to do is to take a look at the results of the study. …… I didn’t die from the poison, I died from his anger.
Some patients said their family members were on guard, saying she was chatting online about mental problems and checking her phone from time to time like a spy. Some patients said they were forced to leave the group by family members.
There are also family members who have been euphemistically educated, “Don’t live in a fairy tale world every day, get out of your own little world and get back to real life”. A few days ago, I was so exhausted that I couldn’t walk, I couldn’t eat, and my chest felt like poison. They loved me so much that they took me to see a psychiatrist one after another, because they were convinced that I was depressed because they couldn’t find anything wrong with me.
They live with anxiety, like a bird in a panic, in the torment of the disease and the fear of the unknown, worrying about being cursed to death, worrying about “if they are diagnosed now, will they be arrested”; they feel far away from the world, there is nothing that can go to their heart; they get angry easily, as if they don’t want to be close to anyone, and they even doubt their life because of it, “all those years before, living too much for granted”.
They even feel guilty, afraid to go to work, afraid to have a normal social life, afraid of touching others and infecting them too.
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Some patients are even afraid to contact their families, and their children are about to start school, afraid to let her go to school. Some patients have resigned from their jobs, others are renting rooms out of their homes, and others want to go to the mountains to live their lives. When it was hardest, some people wrote a suicide note.
“In fact, groups like us should attract social attention, do those doctors and specialists know we exist? Someone asked this.
“All that’s left is to live well.
Unlike his sick friends, Zhao Yong is relieved that his friends and relatives have not abandoned him, and his family has always missed him, but they just don’t believe he is 2019 coronavirus infected.
He is the eldest son in the family, his two younger brothers are brought to the society, and he usually presides over the family affairs. On New Year’s Eve, he returned to Haikou for medical treatment without having a reunion dinner with his family, and didn’t return home for the next six months.
His family didn’t understand, and at first said he was crazy. They, like the local doctors, thought that Xin Guan was suffering from white lung and needed to be rescued immediately,” Zhao Yong said. Zhao Yong said.
In the evening of March, Sandi called, crying, “The doctor said there was no problem, why did you drive yourself into such a state? After hanging up the phone, Zhao Yong also cried for a long time, “Why did God choose me?
The second brother and sister-in-law also live in Haikou and often say he wants more. The old family killed chickens, they sent over from time to time, so that brother and sister-in-law tonify the body.
My father-in-law and mother-in-law miss them and often send meat, chicken and vegetables. The father-in-law asked when they had a fever, and privately invited people to practice magic, for them to get rid of demons and diseases, “to our family engaged in a lot of ‘superstitious’ activities, I’m the black-haired people let the white hair worry about ……” Zhao Yong heart felt bad.
Zhao Yong also stopped seeing his classmates and friends outside of his family. After the epidemic, friends and soccer teammates from school often asked him out, but he said he was busy with work. The neighborhood security guard often asked him why he wasn’t at work. He said that the company was shutting down.
The company knew that he and his wife together with the disease, symptoms like coronavirus infection, has not let him go to work, monthly basic salary, and then the basic salary stopped, social security stopped paying, “forced me to leave, I still work in this company for 10 years it, tired”.
He felt his illness cycled every day, the morning state poor, get up dizzy, sometimes breathing difficulty. In the afternoon, his condition improved only after three o’clock. In this condition, he could not return to work.
He was afraid that he would be marginalized, and he really wanted to get systematic treatment. He is only in his late thirties, and he has an old and a young son, so his burden is not easy to bear.
In June, he sold his wedding house, “After selling the house, my wife and I hugged our heads and cried.” ……
I told my wife that I would try to buy a house every five years and that my life would get better and better. Now all I have left is to live well and pray to God to spare us ……,” he said.
Still trying to save himself
After May, the sick people in the group slowly became a bit numb, didn’t want to go to the hospital, didn’t want to post test results in the group, and talked less about their illnesses. But their symptoms didn’t go away, some had difficulty breathing from time to time, some had sore joints ……
The Henan netizen who posted in Zhihu, stopped recording symptoms after May 20. Zhao Yong called her and asked her, she said she hadn’t been well, was tortured almost like that anyway, and didn’t bother to update.
Zhao Yong and Zhang Ling are still saving themselves.
In April, Zhang Ling hand numbness, foot numbness, fast heart rate, hair loss, sometimes dizziness, atrophy of palm and foot muscles, no warm feeling in the left hand, hot bubbles when cooking. My son lost hair, stomach pain, flatulence, static heart rate of 140 beats per minute, and thinning of palms and feet.
By May, my son still had no energy, tightness in his chest, breathlessness, sometimes eye pain, memory loss, and sometimes he would suddenly scream. According to Ding Hong’s prescription for nerve nutrition, she gave her son lecithin, zinc sulfate, and methylcobalamin.
At the end of May, Zhang Ling took her son to test his lung function and found that he had a small airway ventilation disorder. Afterwards, her son was hospitalized and found to have cerebral vasospasm by video EEG, cerebral blood flow diagram, combined with brain CT, before he had a severe headache in the evening; blood testing of terminal brain natriuretic peptide revealed his heart damage.
After his son was discharged from the hospital, Zhang Ling followed Ding Hong’s advice to improve his blood vessels, and his pain diminished and his panic improved slightly, but his heart rate was still fast.
Zhao Yong went to the hospital every few days for various tests: tuberculosis, AIDS, rheumatology, visceral ultrasound, MRI ……
At the end of June, he and his wife went to Guangzhou, found the First Affiliated Hospital of Guangzhou Medical University and registered with Zhong Nanshan’s apprentice, but the doctor also said they were anxious.
Back in Hainan, Zhao Yong went back to the hospital and strongly demanded a nucleic acid and antibody test, saying he had just returned from Guangzhou and there were cases there too. After arguing with the doctor for a long time, he finally did the antibody test, but the result was negative.
In early August, he felt the need to take oxygen at night to sleep, and on August 3, a CT scan of his lungs showed that he had emphysema changes and a small amount of chronic inflammation in the left lower lobe of his tongue. Few fibrotic foci in the posterior basal segment. Doctor’s diagnosis: “Cough variant asthma?
My wife’s cough was also getting worse, as if she was coughing dry every minute.On August 10, an examination revealed multiple nodules in both lungs.
Fear of contagion
What disturbs Zhao Yong and his wife even more is the fear that they are contagious.
For fear of contagion, they didn’t dare to go back to their hometown, and their second brother lived in Haikou and didn’t dare to visit. The first thing you need to do is to take a look at the newest products that are available.
The daughter is only 4 years old and I haven’t seen her for almost 7 months. When they returned to Haikou on the 30th day of the Lunar New Year, they left their daughter at home and then sent her to her mother-in-law’s house. I heard my mother-in-law say that at the end of the first month, my daughter did not like to talk for three or four days, and she sat up alone in the morning, “thinking of my parents. Then, she had a fever for two or three days and a cough. After that, laying down at all times, sweating a lot at night, with small spots on the body.
On August 11, my wife made up her mind to go back to see her daughter, no matter what, and resigned herself to her fate. They stayed in their hometown for two days, but a few days back, in a video with her daughter, Zhao Yong found that her daughter was coughing. Mother-in-law also said sore throat, there are 3 days of general weakness and lethargy.
On August 12, in and sister-in-law WeChat, they found that the daughter-in-law dry cough for ten days, in the clinic bottle, has not been well. On the other hand, it is also a good idea to have a good understanding of the situation.
On August 17, the daughter-in-law in the hospital, CT showed multiple grinding glass density shadow in both lungs, the lower lobes of both lungs significantly, exudate and alveolar insufficiency identification, interstitial changes in both lungs, a small amount of fluid in the right side of the chest, the doctor’s preliminary diagnosis of interstitial pneumonia (viral). The second brother was asymptomatic and also found a small amount of chronic pneumonia in the upper and lower lobe of the left lung and both lower lobes of the lung, the same as Zhao Yong’s earlier CT scan findings.
The second brother-in-law had just gotten married and was very healthy, so how could he suddenly become ill? Zhao Yong suspected that he and his wife had infected them. Since mid-July, he went to Erdi’s house for dinner six times, the last time on July 26, and his brother-in-law showed symptoms on August 2. Later, the second brother said that there was a female neighbor in their neighborhood who was also hospitalized with pneumonia and that her husband often ate at his house. The younger brother suspected that they infected the neighbor.
Zhao Yong remembered the group, the families of the patients more or less something. One patient from Tianjin, who had been quarantined for several months, relaxed in July and ate dinner with her parents, who were in various states of distress within a few days. A patient from the northeast of China stayed at a relative’s house for 50 days after the onset of symptoms before returning home.
I felt like my family was really wasted and I regretted contacting them,” he said. Zhao Yong called the Hainan Provincial Center for Disease Control to report the situation again. When my sister-in-law went to the hospital, Zhao Yong went with her. He alerted the doctor that his sister-in-law had been diagnosed with viral pneumonia, with the same symptoms as before, and that she was still coughing. The doctor said that you are well here, you are all better, you will not be contagious; adding that the ground glass shadow in the lungs is not necessarily a new crown, but many infections can be like that.
The first thing that you need to do is to make sure that you have a good idea of what you are looking for.
Zhao Yong read an online paper in the Chinese Journal of Tuberculosis and Respiration, “Status and Considerations of Post-Inflammatory Pulmonary Fibrosis in Novel Coronavirus Pneumonia,” which stated that many 2019 coronavirus pneumonia patients were discharged with post-inflammatory pulmonary fibrosis, some of which manifested as common interstitial pneumonia or non-specific interstitial pneumonia, and had varying degrees of post-activity dyspnea.
Zhao Yong or cough, feel hypoxia, oxygen saturation in the 90-94%, he believes that this is a manifestation of interstitial pneumonia, to a friend please Wuhan Sanjia Hospital’s imaging experts, look at the early August CT test text results. The doctor said, based only on CT scan text results, not interstitial pneumonia, lung lesions will not cause low blood oxygen, to look into other aspects, to see what causes low blood oxygen.
The first time I was in the hospital, I did two nucleic acid tests, an antibody test, the results were negative, the routine examination could not find the reason. 26 August, the doctor to her lungs to take sputum, sent to Wuhan virus Institute to do laboratory tests, but the hospital later said, did not find anything. 31 August, the examination found that her two lungs multiple grinding glass density shadow basic absorption, but the lower lobe of the right lung new patchy grinding glass density shadow, both lungs oblique cleft Tiny nodules.
Zhao Yong was about to despair. My sister-in-law had symptoms, but she couldn’t find the cause. At that point, his family stopped talking about his anxiety, “and they somewhat understood why we were away from everyone.
In September, when his daughter was about to start kindergarten, Zhao Yong decided to take her back to Haikou, “If anything happens to her, we’ll accept our fate.
When she returned, Zhao Yong noticed that her face, like his own, was swollen and tossing and turning at night, and there was a wheezing sound when she fell asleep. Zhao Yong measured her oxygen saturation level, only 95 percent.
On September 28, Mr. and Mrs. Zhao took their daughter to a checkup and found that she had signs of bronchitis and restrictive air retention in her left lower lung.On October 2, their daughter had a high fever and found signs of emphysema. Zhao Yong’s condition was also poor, feeling severely hypoxic at the end of September, sometimes requiring oxygen in the morning.
At this time, the sister-in-law appeared to turn around, said he was better. Sick friend Zhang Ling also temporarily not low fever, not weak, she withdrew from the group, try to live a normal life.
At the end of October, Zhao Yong saw the “Chinese Journal of Tuberculosis and Respiration” paper “new coronavirus infection caused by interstitial lung lesions diagnosis and treatment of expert advice”, three members of the expert group from Nanjing Gulou Hospital. He also took his wife and children, a family of three went to Nanjing to seek medical treatment.
At this time, the WeChat group, the patients are still simmering. One after another, some left, quietly; others came in, triggering a new round of symptom discussion, and then fell silent again.
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