Will the anatomical conclusion subvert the treatment plan of the new coronavirus?

As of February 25, the autopsy of 11 patients with new coronary pneumonia has been completed nationwide. Why should an autopsy be performed, which will help us better understand new coronary pneumonia, and what will it mean for prevention and treatment?

On February 16th, Liu Liang’s team from the Department of Forensic Medicine of Tongji Medical College of Huazhong University of Science and Technology completed the first autopsy of the new crown pneumonia. So far, Liu Liang’s team has completed 9 cases. At the same time, Xu Xiuwu, an academician of the Chinese Academy of Sciences and director of the Institute of Pathology, Army Military Medical University, and a team from Shanghai Ruijin Hospital, have also completed pathological anatomy of two cases of neocoronary pneumonia.

Autopsy and biopsy are called the “gold standard and final diagnosis of disease diagnosis”, and are the most basic and important means for the diagnosis and research of difficult and emerging diseases. In SARS prevention and control, autopsy results have made important contributions to determining the cause of the virus, clarifying the virus’ distribution and pathological changes in patients, and adjusting treatment and prevention and control strategies.

Of the 11 cases of neocoronary pneumonia deaths that have been completed, Liu Liang’s team has been responsible for 9 cases. Currently, 3 cases have completed the preliminary pathological diagnosis. Liu Liang said that from the current pathological results, some deceased patients can see mucus secretions on the lung section. He believes that this is a need for vigilance in clinical treatment. At the press conference of the Guangdong Provincial Government’s Information Office on February 18, Academician Zhong Nanshan also said that according to the information he has, the lung performance of patients with new coronary pneumonia is not the same as that of SARS patients. It is not severe fibrosis, and some alveoli are present. The inflammation is severe and there is a lot of mucus.

The publication of anatomy and pathology will help improve the clinical treatment plan, such as whether adjustments in ventilation are needed, because some patients have less sputum, but are sticky, which will hinder ventilation, so special attention needs to be paid to airway patency. Professor Liu Liang also said that if the mucus components are not resolved in the treatment, the use of oxygen alone may not achieve the purpose of treatment, and sometimes even counter-productive, pushing the mucus deeper and wider, aggravating the patient’s hypoxia.

Ding Yanqing said that autopsy can also help analyze the dissemination route. By detecting the distribution of the virus in the tissues and cells in the body, you can understand the exact site of infection, the main target organs, tissues, and cells, which is an important basis for understanding the dissemination pathway and target organs. For example, previously discussed more fecal-oral transmission may also be more clearly confirmed.

Based on this, Professor Ding Yanqing said that the clinical diagnosis of patients with new coronary pneumonia cannot rely on throat swabs alone. Comprehensive consideration should be given to the use of throat swabs, urine, feces or anal swabs, with particular emphasis on urine tests. The academician Zhong Nanshan’s team recently detected the virus from urine, to a certain extent, the feasibility of a urine test.

Han Ding, deputy director of Peking Union Medical College Hospital, said in an interview with a special reporter from Wuhan from the Global Times that if the autopsy results can be certified by experts and quickly shared into the clinic, it is of great significance. Clinical is an empirical thing. Only through pathological anatomy can we truly see the results and changes of the disease progression. What organs of the human body have been harmed by the virus? To what extent is organ failure? What causes the failure? Both are very intuitive. In addition, the treatment method for the patient can be more clearly understood. It can not be treated like this, and it should be treated like this: if the anatomy of the lungs is a sputum plug, it must be sucked out. At this time, the ventilator cannot be used.

Translated by ChinaNudge.

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