"Returning positive" has become a hot word in the recent epidemic of new coronavirus, referring to patients with new coronavirus pneumonia who "reexamined positive for nucleic acids" after discharge.

Why is there a "returning positive"? Is the patient's negative result a "false negative", or is there still virus in the body or intermittent detoxification?

According to thepaper.cn, a number of medical experts believe that "returning positive" involves a variety of factors, and the reasons need to be further observed.

Since late February, several clinicians in Wuhan, Hubei have suggested re-evaluating and raising the standards for lifting patients from isolation and discharge.

Cases of "returning positive"

On February 24, when Mr. Wang, the first patient with a new type of coronavirus pneumonia in Xuzhou, Jiangsu, was released from quarantine and returned home, he was welcomed by some residents and community members in Tianshan Oasis Community.

Two days later, Mr. Wang went to the hospital to review the nucleic acid, and the test result was positive.

Soon, he was admitted to the designated hospital for medical observation, and some of his close contacts were welcome to be observed in isolation at the gate of the community. The disease control department of Xuzhou City notified the situation.

In addition to Jiangsu, Hubei, Guangdong, Tianjin, Sichuan, Hainan and other places have also recently seen patients "returning positive".

On March 1, Mr./Mrs. Yi, Hainan's first patient with "new-positive" coronavirus pneumonia, was discharged from the People's Hospital of Hainan Province.

According to Xinhua.com, Mr./Mrs. Yi was discharged on February 19, and during the quarantine observation period, his throat swab test was positive and he was again admitted to hospital for treatment.

There are also "negative" soon after "recovering positive".

On March 2, the Tianjin Municipal Health and Health Commission reported that after the 43rd confirmed patient in the city was discharged on February 11, the nucleic acid test result was positive on the 27th and was re-admitted for observation. The nucleic acid test was negative twice in March. 2 Sunrise.

In addition, after the 20th and 121 confirmed patients were discharged from the city, the nucleic acid was retested during isolation and observation. The two patients were transferred to the hospital for observation again on March 2.

In Hubei, the country's most severe epidemic, Zhang Yi, secretary of the Party Branch of the Department of Respiratory and Critical Care Medicine, Wuhan University People's Hospital, wrote on February 24 that 18 patients with new-type coronavirus pneumonia (all medical staff at the hospital) were treated. Nucleic acid tests for two consecutive respiratory specimens were negative, and they could be discharged according to treatment standards.

The hospital performed a nucleic acid test on the throat swab after the delayed discharge of the 18 persons and found that 13 patients had positive results.

A similar situation occurred in Guangzhou. At a press conference held by the Guangzhou Municipal Government on February 25, Li Yueping, director of the ICU of the Infectious Diseases Center of the Eighth People's Hospital of Guangzhou, said: "In the follow-up of discharged patients, 13 patients were found to return positive."

"Today, Guangzhou has released a total of 13 cases returning positive, and 104 close contacts did not show any infection. At a press conference held by the Guangdong Provincial Government Information Office on the afternoon of February 25, the Guangdong Provincial Center for Disease Control and Prevention Deputy Director Song Tie said that the "returning positive" patients in the province did not appear to be transmitted to others. "Our province actually has preliminary data. Among the discharged patients, 14% also have a"returning positive"phenomenon."

Reasons to be studied

Although there are many cases of "returning positive" patients, fortunately, no cases of "returning positive" infection have been found.

"Some provinces reported that patients who were discharged from hospital were cured, and positive nucleic acid tests were found during the follow-up. We attach great importance to organizing experts to study this issue and also strengthen continuous monitoring of these cases." At a press conference held on February 28, Guo Yanhong, the inspector-general of the State Administration of Health and Medical Administration's Medical Administration and Hospital Authority, said that through monitoring, it was found that this group of patients did not infect others.

Why is there a "returning positive" situation? Guo Yanhong said that the new coronavirus pneumonia virus is a new virus, and further understanding is needed for its pathogenic mechanism, the full picture of the disease and the characteristics of the course of the disease.

On February 19, a patient with a new type of coronavirus pneumonia discharged from Wangjiang Jinyuan, Jinjiang District, Chengdu, underwent reexamination and showed a positive nucleic acid. Lei Xuezhong, a member of the Sichuan Province New Coronavirus Pneumonia Medical Treatment Expert Team and Deputy Director of the Center for Infectious Diseases, West China Hospital, Sichuan University, said in an interview with Red Star News that this patient in Chengdu is not a relapse. "The greater possibility is a little viral Persistence is a process that has not been cleaned up."

Regarding the 13 recovered positive cases admitted to the Eighth People's Hospital of Guangzhou City, Li Yueping, director of the ICU of the Infectious Diseases Center of the hospital, said at a press conference held in Guangdong on February 25 that these patients did not experience symptoms of re-emergence. There is a little poison in it, but it is technically difficult to distinguish whether the poison in the stool is a live virus or a dead virus. "

Song Tie, deputy director of the Guangdong Provincial Center for Disease Control and Analysis, analyzed at the above-mentioned press conference. From the current observations, the lung inflammation of many “returning positive” patients were previously in the absorption process and cannot be called clinical recovery. Because of this, we judge that it may intermittently detoxify. "

On March 2nd, the Chinese Journal of Tuberculosis and Respiratory published an article by Zhou Ling, Liu Ye, and Liu Huiguo of the Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology. Cause analysis.

Liu Huiguo and others believe that patients' "returning positive" is generally affected by factors such as viral biological characteristics, clinical status, underlying diseases, and use of glucocorticoids.

In addition, it may also be related to the sample sampling and detection process. "2019-nCoV's main infection site is in the lower respiratory tract and lungs, and a certain amount of virus is required to detect a nucleic acid positive. When taking a throat swab to take an upper respiratory tract sample, it may be Leading to false negatives. "

On February 27, Academician Zhong Nanshan, leader of the high-level expert group of the National Health Commission and director of the National Respiratory Diseases Clinical Medical Research Center, said that the discharged patients "returned positive" "It may involve a variety of factors such as its own condition and nucleic acid detection. It needs constant observation." One is the problem of the reagent itself, and the second is the method of detection. "

Guo Yanhong, Supervisor of the Health, Medical and Health Administration of the National Health and Medical Commission, said on February 28 that experts are being organized to study the situation of "returning positive" and "to further deepen the understanding of the occurrence, development and outcome of the disease."

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