Today, Dr. Bo Shining, an ICU doctor at Peking University Third Hospital, talks to you about why viral pneumonia is so difficult to treat, what ICU doctors do, and importantly, how ordinary people should better protect themselves.
I. From SARS to new pneumonia, viral pneumonia is never far away
In 1997, two of my closest classmates were assigned to Beijing together and worked as doctors in the same large hospital. They were lovers and later got married. When they got together, the classmates huddled in their cramped house and looked at their pictures, some of them playing together in the forest, some of them sitting together on the green to study, and some of them attending hospital events together. Life was just so happy and everyone envied them.
In 2003, SARS (Severe Acute Respiratory Syndrome) came.
The girl was infected at work, the most contagious and virulent kind of virus, and many of the infected people were not saved.
She was getting heavier and heavier. In order to keep her, during the resuscitation, her lover, this male classmate of mine, took off his mask and gave her mouth-to-mouth artificial respiration and external cardiac compressions. Big big tears just flowed down his face to the girl's face, and then dripped on the white hospital bed ......
Unfortunately, in the end, the girls are still gone.
The history of mankind is a tragic and viral game of history, a variety of viruses caused by virulent plague are brought to mankind a tragic memory. Far away are smallpox, polio (polio), and more recently SARS, Ebola, MERS (Middle East Respiratory Syndrome) ......
Worldwide, 291,000 to 646,000 people die each year from influenza virus-related respiratory illnesses. If you think these numbers are still far away, then you must remember an article - "Middle Age Beijing Under the Flu" - that made everyone aware of the fact that a flu not taken for granted can require resuscitation, can be costly, and can even be fatal.
And all of this has actually been very close to us.
Second, why is viral pneumonia so difficult to treat?
Although the pathogens of SARS, influenza pneumonia, and today's neocoronavirus pneumonia are different, they are all viral pneumonia, and all three have similar pathophysiological mechanisms and clinical manifestations, as well as similar treatments.
It can be said without doubt that most patients with infections caused by these three viruses are relatively mild, have no problems, and will improve and recover after rest and symptomatic treatment. Only those with serious complications, such as respiratory failure or even multi-organ failure, that result in critical condition, require ICU admission for resuscitation treatment.
ICU doctors: How difficult is the new coronary pneumonia to treat? What should ordinary people do?
So, why do some viral pneumonias lead to such serious consequences?
Two key reasons.
First, there is no specific drug.
Second, the body's self-defense is reduced.
Why are there no specific drugs? We need to understand the difference between viruses and bacteria.
Virologists may tell you that the two are different in size and structure, and talk to you about cell walls, cell membranes, protein shells, genetic material, DNA, RNA, reverse transcription, enzyme systems, and so on, all of which are important.
But I just want to tell you one thing: the difference between bacteria and viruses boils down to the ability to survive independently.
Most bacteria have an independent nutrient metabolism system and can survive independently, so it enters the body and just seeks "nutrition", it does not have to invade the cells.
ICU doctors: How difficult is the new coronary pneumonia to treat? What should ordinary people do?
But viruses are different, they don't just want "nutrition". All viruses do not have a cellular structure, so they can only invade the cells of other species and use the cells of other species to process genetic material, process proteins, and keep reproducing the next generation of viruses.
If you understand this, it is easy to understand why severe viral pneumonia is difficult to treat.
If it is a bacterial infection, there can be antibiotics. Many antibiotics can effectively "kill" sensitive bacteria. For common bacterial infections, we have drugs.
But it is too difficult to develop antiviral drugs.
The first reason, as I said earlier, is that unlike bacteria, viruses enter the body, burrow into the cells and insert their genetic material into the chromosomes inside the cells, so drugs that interfere with virus replication will inevitably cause abnormalities in human cell function.
The second reason is that viruses multiply rapidly and mutate constantly, and you have just developed a drug and the virus has changed again.
The third reason is that many bacteria have some structural or metabolic similarities, and antibiotics that act on a certain part of a bacteria or metabolic link can be effective against other bacteria. However, there are so many different viruses with few commonalities that it is difficult to find broad-spectrum antiviral drugs.
This dictates that for the vast majority of viral infections, we have no specific drugs. Even if there are drugs with some effect, the effect on the virus is only "inhibition", and the more early the application of the effect, the later the application of the effect is not satisfactory.
How do many viral infections, such as mild influenza, get better?
Yes, by our body's self-defense ability. With or without drugs, the body's self-defense mechanism is very important.
In response to bacterial pneumonia, the body naturally has two basic defenses.
● Coughing and coughing up sputum.
● An increase in white blood cells, especially the neutrophils among them.
Coughing and sputum are used to expel sputum, necrotic material, and even pathogenic microorganisms. In our ICU, one of the key indicators to evaluate a patient's prognosis is whether the patient has a "strong" cough, sometimes more important than the use of antibiotics.
Leukocytosis, especially neutrophilia, is also an important defense mechanism of the body during bacterial infections, to increase the bactericidal power.
However, have you noticed that the main symptoms in patients with neocoronavirus pneumonia are fever, malaise, and dry cough? Laboratory tests: normal or reduced total white blood cell count and reduced lymphocyte count.
A dry cough means that although the body initiates a coughing reflex, trying to expel the virus or necrotic material from the body. However, the cunning virus hides in the cells. There is little secretion and little sputum in the airways, and although some of the virus can be eliminated from the body with droplets by coughing, this also satisfies the very nature of the virus to reproduce itself and speed up its spread, and does not effectively remove the pathogen. So the alveolar cells are constantly under attack, but the body has a hard time getting them out effectively by coughing up sputum.
The inability to cough them up, combined with a decrease in the number of lymphocytes, the force that fights the virus, decreases the ability of these two key defenses.
The virus continues to replicate and invade the cells, and in severe cases, within two or three days, most of the patient's alveolar cells are attacked, showing up as "white lung" under X-ray or under CT.
How do doctors treat it?
So, how do doctors treat this severe viral pneumonia?
First, antiviral drugs are given. Although they are not effective, they will be used if they are effective at this time, and anything that can help the patient will be considered.
Also, nebulized inhalation of interferon increases the ability to fight the virus. Antibiotics are also used when there is a combination of bacterial infection. When the lung lesions are progressing rapidly, hormones are used to reduce the local inflammatory response.
Then, in severe cases, it's time to address the various complications.
If the patient is in respiratory failure, we use a ventilator to pump oxygen into the lungs using positive pressure.
If the patient has renal failure, we can use CRRT, which is an artificial kidney, to help remove toxins and dehydrate the patient.
If the patient's blood clotting collapses, we can replenish fresh plasma and clotting substances.
If the patient's respiratory failure is further aggravated, when the ventilator can't give pure oxygen, we have ECMO, which is an extracorporeal "heart-lung" that can add oxygen to the patient's blood outside the body, expel carbon dioxide, and then pump fresh blood back to the body.
Some time ago, it was reported that ECMO was successfully used to save severe neocoronavirus pneumonia. Does this mean that ECMO is the ultimate weapon for curing viral pneumonia?
I must tell you, no.
Why? Because all of these cutting-edge, top-of-the-line life-saving devices play the role of support.
● Ventilator support for the lungs, allowing them to rest and wait for self-healing.
● CRRT supports the kidneys, replacing their function and waiting for self-healing.
● ECMO, which is for the heart and lungs, the highest level of support.
All of these treatments are aimed at running out of virus replication and giving the body's immune system back the upper hand. In other words, to save lives first, to buy time and create conditions for self-repair. This is not only the time for strong medical treatment, but also the time to fight the body's immunity!
Speaking of which, you must still be worried about the male student mentioned in the very first case, he must have been infected too, right? Because the virus was too contagious, so mouth-to-mouth artificial respiration, it is difficult to be spared.
Fortunately, it did not. Even fever and even coughing did not, the boys did not have any problems at all.
Of course, this is an extreme case in an extreme scenario, absolutely do not encourage anyone to try to do without protection in front of such a virulent virus. Remember! Remember!
Why he preserved himself in front of such a virulent virus doesn't really matter anymore. You just need to remember one thing, maintaining a good human immunity is the right way.
Fourth, the underlying logic of health: human immunity
In the virus rampant at the moment, rapid boosting of immunity is unlikely, there is no food, health products that can quickly boost immunity.
We ordinary people, what should we do? I send you three words: strengthen protection, sleep well, and peace of mind.
I will not say much more about the first point. I believe you have learned more about self-protection in the past few days than the sum of all the knowledge you have ever learned about self-protection.
I just want to emphasize that when you go to densely populated and poorly ventilated places, such as public transportation and hospitals, you should always wear a mask properly.
I'm talking about wearing a mask properly, not wearing a mask, which many people don't do. Wash your hands regularly, don't use dirty hands to touch your face, rub your eyes, wipe your mouth, pick your nose, it's easy to get the virus from your dirty hands into your body. There are also fewer parties. This time there is no party more important than health, home is the best protection.
The second point, sleep well. Staying up late has an "immediate" effect on the lowering of the human immune system. Staying up late affects the body's biological clock, the immune system's ability to respond and defend itself, and studies have shown that a week of continuous sleep deprivation affects more than 700 health-critical genes, with subsequent long-term effects on health.
ICU doctors: How difficult is new coronary pneumonia to treat? What should the average person do?
A good night's sleep increases our ability to fight infection. We have a common sense that sleepiness follows illness, which in the past we would have thought was a direct result of disease factors secreted by the disease, but recent research suggests that it is actually more of a self-repair of the body.
A gene called nemuri, which regulates sleep, was found in other species, and this gene can guide the brain to synthesize inhibitory peptides that increase resistance and survival, and also promote sleep. This may be the real driver of increased sleep, which is not only a physiological rule, but also a need for self-repair and fighting diseases such as infections.
Therefore, it is more important than anything else to ensure 7-8 hours of good sleep every day during special times.
Finally, calm your mind and learn to smile. Tension, anxiety, anxiety, these psychological changes will affect our immunity through the vegetative nervous system and the endocrine system, and the immune system will be less able to resist pathogens and more susceptible to infections.
At the same time, drastic psychological changes can also cause many psychosomatic diseases, such as insomnia, headache, blood pressure fluctuations, stomach discomfort, intestinal dysfunction, etc.. These diseases further weaken the body's resistance.
When facing the threat of viruses, all we can do as ordinary people is to protect our immune system by strengthening our self-protection, through good sleep and a calm mind, and leave the rest to public health administrators and doctors.
Finally, we have started to treat suspected critical cases and are always ready to replace our colleagues who are supporting Wuhan. I've been working on this article overnight, but I may not have much time to give more advice. The virus is raging, do a good job of protection, hope everyone is well.
