JAMA: Multiple inflammations and sequelaes of COVID-19 infection
JAMA: Multiple inflammations and sequelaes of COVID-19 infection. the treatment of COVID-19 infection is mainly focused on COVID-19 pneumonia. The Journal of the American Medical Association (JAMA) recently released a study from the Centers for Disease Control and Prevention in the United States that emphasized that the burden of other diseases such as inflammatory diseases and sequelae caused by viral infection may have exceeded that of pneumonia caused by acute infection. Therefore, we need to do a more comprehensive and comprehensive analysis of viral infections and do a good job of long-term management of the disease.
According to researcher S. Deblina Datta of the US Centers for Disease Control and Prevention, the new coronavirus infection can be divided into three stages: the earliest acute infection, inflammatory diseases after the acute stage, advanced inflammatory diseases and virological sequelae. This is not only the time course of virus infection, but also the different stages of the interaction between the human body and the virus.
Acute infection period
Acute infection of the new coronavirus may cause symptoms such as cough, fever, and dyspnea. They are related to virus replication and initial human immune response. It is also the most studied disease, that is, COVID-19 pneumonia. Statistics show that 3% to 67% of people may not have symptoms after infection, but they will still have symptoms in the next two periods. Therefore, the presence or absence of symptoms is not a precursor to other later inflammatory diseases.
The duration of acute infection is usually a few days or weeks. Most patients test positive for the new coronavirus nucleic acid after infection. Serological conversion occurs within 2 weeks, and IgM and IgG become positive.
Disease after acute inflammation
After acute infection, children and adults may develop a rare multi-system inflammatory disease. Different from the early inflammation caused by virus replication, these multi-system inflammations may appear in some other organ systems that are not directly attacked. Symptoms may appear even after the human body is cleared of the new coronavirus. Patients usually develop such symptoms 2 to 5 weeks after infection. Multiple system inflammatory syndrome response.
In clinical work, many cases of such inflammation have been reported, such as heart disease or gastrointestinal disease in patients, and skin and mucosal diseases similar to Kawasaki disease. Laboratory tests of such patients found elevated levels of inflammation markers such as C-reactive protein and ferritin, and elevated levels of D-dimer and troponin.
Patients with multi-system inflammation generally test positive for the COVID-19 antibody, but most of the nucleic acid tests are negative. Compared with children, adults have more and more complicated diseases, and the course of the disease is longer. It is difficult to distinguish this inflammatory response from acute infection in adults.
Late inflammation and virological sequelae
Lyme disease, syphilis, and Ebola infection can cause late sequelae. The etiology is unclear. It may be organ involvement during acute infection, long-term excessive inflammation, long-term physical weakness and psychological sequelae, or other human body. The effect of virus interaction. At present, we have very limited understanding of the late sequelae of the new coronavirus infection, especially the lack of case-related control reports.
Reports on late sequelae are not limited to severely ill hospitalized patients. At present, a long-term report of 143 hospitalized patients shows that 87% of patients have one or more persistent symptoms 60 days after the first onset of symptoms, including fatigue, dyspnea, joint pain, chest pain, etc. In addition, there are reports that patients may have cardiovascular, pulmonary, neurological and psychological symptoms.
The current pathological causes, disease duration, and long-term prognosis of late sequelae are limited. It may manifest as a variety of syndromes, which are caused by pathophysiological processes at different stages. Generally speaking, patients may experience inflammation or viral sequelae 4 weeks after the onset of symptoms, but the duration of symptoms is not known. As more and more detailed reports of long-term infections appear, researchers are paying more and more attention to the sequelae, and I believe they will have more understanding of these symptoms and their treatment methods.
The public health significance of prevention and control of multiple diseases
The current “pneumonia” of the new coronavirus is just one of the diseases caused by the new coronavirus infection. The author pointed out that with the accumulation of more and more evidence, the scientific community will further improve the process of disease onset, especially the understanding of the late stage and late sequelae of acute inflammation. Affected by this, we can provide more meaningful prevention and control methods for reducing disease morbidity and mortality, and have an important impact on future public health surveillance, clinical research, treatment and health service planning.
Currently, most of the resources are focused on the acute infection period, that is, the prevention and treatment of COVID-19 pneumonia. Future medical and social service measures need to take into account all diseases caused by the new coronavirus, otherwise, the cost of treatment will inevitably far exceed early diagnosis and early treatment.