JAMA: COVID-19 Can recovering patients be contagious?
Original Riaubian'yi SIFIC Infection Evidence-Based Information 3/1
On February 27, the wuhan Zhongnan Hospital team published a letter in JAMA, four patients who had been discharged according to the discharge criteria, and after discharge, RT-PCR tested positive, and the paper pointed out that the recovered patients may be contagious.
From January 1, 2020 to February 15, 2020, Wuhan University Zhongnan Hospital treated one patient in hospital, COVID-19 and three COVID-19 patients (all of whom were medical staff) who were isolated at home, and tested them for RT-PCR to determine whether they had recovered.
According to current standards, discharge and discharge must meet the following four requirements:
(1) The temperature continues to be normal for more than 3 days;
(2) Respiratory symptoms are alleviated;
(3) CT showed a significant improvement in acute oozing lesions;
(4) RT-PCR negative for 2 consecutive pharynx swab tests, and 2 samples are at least 1 day apart.
After the patient's recovery, medical staff contact the patient directly with the patient and his or her family and ask the patient to go to the hospital to collect a pharynx swab for RT-PCR testing.
All four patients were exposed to COVID-19 for work reasons. Age 30-36 years old, 2 men. Three had symptoms and 1 had no obvious symptoms (ct tests were available for close contact). All four were RT-PCR-positive, and CT had glass-like lesions and partial lung lesions.
Four patients were then treated with antiviral therapy (75 mg of oseltamivir taken orally every 12 hours), after which the abnormal performance of CT imaging in three patients improved significantly. The CT of the 4th patient showed subtle glass-like turbidity. Four patients tested negative twice in a row for their pharynx swabs, RT-PCR. Four people ranged from 12 to 32 days from onset to rehabilitation.
After recovery, four patients continued to be isolated for 5 days. After 5-13 days of re-examination of the specimen test found that all four people RT-PCR retest positive. All patients performed RT-PCR three times over the next 4 to 5 days, and all four were still positive. Using other different brands of RT-PCR kits, they are still positive.
However, there were no clinical symptoms in patients, and there was no significant difference between CT detection and ct testing during rehabilitation. During this time, they did not come into contact with any patients with respiratory symptoms and did not transmit them to their families.
Discuss
Although previous studies have shown false negative RT-PCR test results, continuous negative RT-PCR test results and clinical and imaging evidence indicate that the four patients have met the discharge criteria.
In accordance with the requirements of the New Coronary Virus Pneumonia Treatment Program (Trial Sixth Edition), 14 days of self-health monitoring is recommended after discharge from hospital to avoid out-of-office activities. After discharge from the hospital in the 2nd and 4th weeks to return to the hospital for re-treatment.
According to the results of this study, the importance of post-hospital monitoring is re-emphasized. After the patient recovers, it may still be carriers of the virus. Patients discharged or released from isolation should receive further observation and follow-up, and patients should be aware of protection.
Although the families of these patients were not infected, they were medical staff and were therefore strictly isolated at home and cared for differently from the general patient.
The study showed that the study was limited to a small number of patients with mild or moderate infections. The next step in the study, which should include non-medical personnel, as well as patients with more serious infections, a longitudinal study of larger populations will help to understand the prognosis of the disease.
JAMA：COVID-19 康复病人可能有传染性？
Original 廖丹bian'yi SIFIC感染循证资讯 3/1
2月27日，武汉中南医院团队，在JAMA发表了一篇letter，4名按出院标准康复出院的患者，出院后RT-PCR出现阳性，文章指出康复的患者，可能会存在传染性。
2020年1月1日至2020年2月15日，武汉大学中南医院对1例住院COVID-19患者和3例在家中隔离的COVID-19患者（4人均为医务人员）进行了治疗，并对他们进行RT-PCR检测，以判断他们是否康复。
根据现行标准，出院和解除隔离必须满足以下4个要求：
（1）温度持续正常超过3天；
（2）呼吸系统症状得到缓解；
（3）CT显示急性渗出性病变明显改善；
（4）2次连续咽拭子检测的RT-PCR阴性，且2次取样至少间隔1天以上。
患者康复后，医务人员均直接与患者及其家人联系，并要求患者去医院收集咽拭子以进行RT-PCR测试。
这4名患者，均因为工作原因暴露于COVID-19。年龄在30-36岁，2人为男性。3人有症状，1人无明显症状（因密切接触而接受了CT检查）。所有4人均为RT-PCR阳性，且CT出现磨玻璃样病变和部分肺实变。
而后对4名患者进行了抗病毒治疗（每12小时口服75mg奥司他韦 ），之后3名患者CT影像学的异常表现明显改善。第4例患者的CT显示有细微的磨玻璃样混浊。4名患者咽拭子经RT-PCR检测连续两次阴性。4人从发病到康复从12至32天不等。
康复后，4名患者继续隔离5天。之后的5-13天重新取标本检测发现，4人RT-PCR复检均为阳性。所有患者在之后的4至5天均进行了3次RT-PCR，4人仍均为阳性。使用其他不同品牌RT-PCR试剂盒，仍为阳性。
但患者无临床症状，CT显示与康复时CT检测无明显差异。在此期间，他们没有与任何有呼吸道症状的患者接触，也没有传染给家人。
讨论
尽管先前的研究可能会出现假阴性的RT-PCR 检测结果，但连续阴性的RT-PCR检测结果以及临床和影像学的证据表明，这4例患者已达到出院标准。
根据《新型冠状病毒肺炎诊疗方案（试行第六版）》的要求，患者出院后建议进行14天自我健康状况监测，避免外出活动。出院后第2周和第4周回院复诊。
根据本研究结果，再次强调了出院后监测的重要性。在患者康复后，依然可能是病毒携带者。出院或解除隔离患者应该接受进一步观察和随访，且患者应该均有防护意识。
虽然这些患者家人没有被感染，但这些患者是医务人员，因此在家中进行了严格的隔离和与普通患者不同的照护。
这项研究则表明出该研究仅限于少数轻度或中度感染患者。下一步的研究，应纳入非医务人员，以及感染更严重的患者，对较大人群的纵向研究将有助于了解该疾病的预后。
原文：https://jamanetwork.com/journals/jama/fullarticle/2762452
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