Scientific Basis for Prevention and Treatment of Novel Coronavirus Pneumonia

CHEN Sheng

(The People's Hospital of Tianhe District, Guangzhou, Guangdong, China)

ABSTRACT: Objective To establish a theoretical system for the onset, prevention and treatment of new coronavirus pneumonia,and to provide a scientific theoretical basis for better prevention and treatment of new coronavirus pneumonia.Methods Novel coronavirus pneumonia was systematically expounded, including its clinical characteristics, pathogenesis, epidemiological characteristics, and the principle of prevention and treatment.Results The novel coronavirus pneumonia has clinical manifestations of fever, cough,and shortness of breath.The pathogenesis of the disease is caused by the immune response induced by the coronavirus infection of the lung,and it can dissipate itself after the onset.The novel coronavirus is transmitted from person to person through respiratory droplets and body contact with body fluids.Establishing a high temperature and flowing air environment can prevent the spread of new coronaviruses.Traditional and effective methods of prevention and treatment,such as the use of intensive care units, ventilator, mask breathing,wearing masks, etc., will aggravate coronavirus pneumonia.The anti-inflammatory drugs such as aspirin and 654-2 and drugs that support human metabolism are used in the treatment to help patients through the dangerous period.Conclusion The novel coronavirus pneumonia has the characteristics of self-healing.Establishing a high-temperature and flowing airflow environment can effectively inhibit the infection of new coronavirus.Try not to use the ICU, ventilator and mask to breathe and wear masks during treatment.

KEY WORDS: Novel coronavirus pneumonia; Prevention and cure; Scientific basis

Clinical characteristics of novel coronavirus pneumonia

Viral pneumonia is currently the most common form of pneumonia.At present, the common primary clinical pneumonia is mainly viral pneumonia, mycoplasma and chlamydia pneumonia, and bacterial pneumonia.Most viral pneumonias are not obviously infectious and are self-limited.The pneumonia that occurred in Guangdong Province in 2003 and outbroke in Wuhan this year is infectious and is caused by coronavirus.Coronavirus is an RNA virus.The coronavirusinduced pneumonia has the clinical characteristics of general infectious RNA viral diseases such as epidemic hemorrhagic fever, Japanese encephalitis, dengue fever, and measles.The onset of the disease are caused by the immune response of the human body, which have the characteristics of acute onset,rapid exacerbation, short course of disease, and self-healing.Therefore, when the coronavirus infects healthy humans,fever will occur after the incubation period, and lasts for 3～7 days.During the period of fever, the human body will produce interferon to inhibit the virus, produces antibodies to neutralize the virus, and activated immune cells phagocytose the virus.The immune response causes an inflammatory response in the lung tissue, and the pathological manifestations appear in the alveolar cavity to varying degrees with serum, fibrin exudation,transparent membrane formation and exuding cells of mainly monocytes and macrophages.In the alveolar septal with blood vessels congesting, edema, infiltration of monocytes and lymphocytes, and formation of transparent thrombus in blood vessels[1].The lungs have different degrees of consolidation with symptoms of cough, chest pain, shortness of breath, etc[2],which appear as pneumonia on x-rays.The pneumonia reaches its peak on the seventh day of fever, and lasts for 1～3 days, at which time the virus is purged; subsequently,the inflammatory secretions of the alveoli are gradually coughed out and lung will return to a normal state in about 14～21 days.Therefore,coronavirus pneumonia is a self-limiting disease, and it treats itself well like measles and hemorrhagic fever.Typical and mild coronavirus pneumonia can be treated without special treatment, closely observed, properly isolated in a space of the temperature being 30～33 ℃ and ventilation, and cooled with an electric fan.Pay attention to rest and diet.Severe pneumonia requires treatment.

Epidemiological characteristics of novel coronavirus pneumonia

1.Patients with novel coronavirus infection or coronavirus asymptomatic carriers have the characteristics of transmission by respiratory droplets and human-to-human.The population is generally susceptible[3].The most infectious time for patients is 1～2 days before and 1～2 days after the onset of the disease.

2.The infectious environment: people are easy to be infected in the relatively closed airflow environment with low temperature.The more closed environment is, the more infectious it is, such as patients are easily transmitted to the medical staff in the intensive care unit and ambulance.The hospital's consultation hall, ward and waiting room are also the main places of infection.The people are also easy to be infected from person to person in other relatively closed airflow environments such as homes, small conference rooms,and bus compartments.

Key points for prevention of novel coronavirus pneumonia

1.High-temperature flowing air environment is the main prophylactic measure The key measure to prevent the patient being contagious is to keep the patients in a high-temperature flowing air environment.The high-temperature flowing air environment is also the best way to prevent people from being infected.The indoor temperature must reach 30～33 ℃.If people feel hot, they can use the electric fan to cool their body surface.

(1)To cut off the infectivity of the patient in family

To establish a high-temperature and ventilating air environment in the home, the first choice is to use a bath heater or an electric heater to heat the air temperature to 30～33 ℃ ; the second choice is the airconditioning to heat the air temperature to 30～33 ℃.The ideal patient micro-environment is a heater on the left and right of the patient, and an electric fan is blowing gently.Remember that the patient cannot wear a face mask at home,and use the breeze to blow the patient's face, so that the virus exhaled by the patient can spread without being inhaled into the lung to form a repeated infection.Other family members of the patient should wear face masks and be not in a room with patient as much as possible.The elimination of viruses in the family room mainly depends on high temperature, dry air, and possible chemical disinfection.Because coronavirus pneumonia is a self-limiting disease, it is can be treated in isolation at home for light patients.When the patient has fever and cough, take aspirin 0.5, 3 times a day or acetaminophen 0.5, 2 times a day.If the fever is relieved, the patient/s spirit is good, the appetite is good, and there is no fatigue, it means that the condition is mild; otherwise, the patient is poor spirit,fatigue, and poor appetite after fever (need to exclude mental factors such as fear), further medical assistance is needed.Other common cold medicines such as proprietary Chinese medicines and antibiotics of cephalosporins and clindamycin to prevent bacterial infections can be used during home.Antibiotics cannot treat viral pneumonia, but can prevent bacterial infection associated with viral pneumonia.

(2) To cut off the patient's infection in hospital

a.Establish a high-temperature and air-flowing environment for medical treatment: The medical environment must be high temperature and air flow whether it is by a heater or an air conditioner.The source of infection must be cut off at the hospital.The general spaces such as the consultation hall,consultation room, and ward must meet the temperature and ventilation standards.Where the patients and medical staff are required to wear masks.

b.Establish isolation ward with high temperature and air flow Isolation ward is a temperature of 30～33 ℃ and ventilation, air inters from the ceiling and exhausts from the ground.It is best to sterilize the exhausted air by a high temperature device such as a heater-like equipment.The patient should not wear a mask in the isolation ward, blowing his face with an electric fan breeze.The patient in the isolation ward is isolated separately until the fever n a t u r a l l y s u b s i d e d (without hormones) for 3 days.The process of fever and pneumonia in the patient is the process of virus elimination.The naturally subsided fever indicates that most of the virus has been eliminated.Of course, the exception is the use of glucocorticoids.After the fever stops for 3～4 days,patient can go home for isolation and observation or transfer to a general high temperature ward for observation and treatment.

2.The patients with fever cannot be treated in ICU: The intensive care unit (ICU) is a relatively closed space, and the patient breath and share with other patients and medical staff in a common confined space.It is generally believed that the ICU is negative pressure, the air is laminar, and it is safe.However, the negative pressure makes the tiny particles in the air easier to float.Especially when the air outlet of the intensive care unit is on the roof, the airflow flows from low position to high position, the particles fly from the patient in the low position to the doctor who are looking down on them,and the medical stuff to be infected is inevitable.The same scenario also occurs in a negative pressure ambulance.

3.The general masks do not have the effect of preventing infection, so it is not recommended to wear masks indiscriminately and extensively.However, you still need to wear a mask when you go to the hospital for treatment and in public places and buildings with many people.Masks may not be worn outside buildings, in parks or in private car.

Essential treatment of novel coronavirus pneumonia

The patient's treatment in the hospital should follow the following points.

1.Disable ICU: When people suffer from viral pneumonia,the inflammation in the lungs is not caused by the replication and accumulation of the virus, but by the inflammatory response caused by the virus, that is by the inflammatory exudation caused by the body's immune response.When the novel coronavirus invades the alveoli for the first time, it stimulates the body to produce antibodies and activate immune cells.When the novel coronavirus invades the alveoli again or continues to replicate in the alveoli, the antibodies from the blood through the capillaries to the alveoli bind to the coronavirus, vascular permeability increases, and inflammatory factors, plasma, and inflammatory cells enter the alveoli or the location of virus to form pneumonia.The more viruses repeatedly enter the lung, the larger the area of pneumonia is.In the ICU with the state of negative pressure air, the virus exhaled by the patient is not easy to spread, and aerosol particles are formed and repeatedly inhaled into the alveoli by the patient.The area of the patient's alveoli infected virus further expands, the pneumonia further worsens.When the patient is admitted into the intensive care unit, if 5% of the alveoli are infected by the virus on the first day, maybe 10%the next day and 30% by the third day, the pneumonia are getting worse day by day.The treatment in ICU is one of main causes of exacerbation of coronavirus pneumonia.

2.Careful use of ventilator: Under normal circumstances, the distance from the mouth and nose to the alveoli is 45～55 cm, and that means the distance that the virus particle exhale from the alveoli to the outside of the mouth and nose is 45～55 cm.At present, the standard length of the breathing tube of the ventilator is 180 cm, and the length of both the tracheal tube and the ventilator's own pipe is about 50 cm.The air needs to travel about 280 cm from the outside of ventilator through the ventilator piping system to the alveoli; otherwise, the virus particles are exhaled from the alveoli through the ventilator tube system and need to travel a distance of 280 cm.Can the alveolar coronavirus of patients be exhaled out of the human body through the ventilator's tube system? The answer is certain, no; maybe a few.The virus that cannot be excluded are Inhaled into the lungs again, causing a wider dissemination.If 1% of alveoli are infected when the ventilator is started use,2% of alveoli may be infected after 2 hours, and 20% of the alveoli may be infected after 1 day.As a result, the pneumonia is getting worse after treatment with ventilator.Improper application of the ventilator is one of the main causes of exacerbation of coronavirus pneumonia.Except in the state of sleep and normal temperature, respiratory rate is greater than 30 times/minute, blood oxygen saturation is less than 85%,respiratory muscle fatigue are obvious, the ventilator may consider to be used.

3.The patient is prohibited from mask breathing and wearing a mask: When patients breath with face mask and wear a mask, the virus particles exhaled by the patient cannot be completely diffused out from mouth and nose and staying there,and will be inhaled into the lungs again, causing more alveolar infections and aggravating the disease.Do not use a mask to provide oxygen and non-invasive ventilation to patients.The better a mask such as KN95, the easier the virus exhaled by the patient will stay in the mask and be inhaled into the alveoli again by the patient.Mask breathing and wearing a mask is one of the main causes of exacerbation of coronavirus pneumonia.

4.Prohibition of glucocorticoids: When the virus infects the human body, the human body will produce an immune response, with the rise of cytokines such as interferon and interleukin-2.Interferon inhibits virus replication on the one hand and causes fever on the other hand; on the one hand,interleukin-2 promotes the body to produce more antibodies to eliminate virus and on the other hand it also causes fever.So, higher fever indicates more interferon and antibody.Glucocorticoids suppresses the immune response to achieve the goal of fever reduction by inhibiting the levels of interferon and interleukin-2.The reduction of interferon, antibody and the weakening immune response are not conducive to the elimination of pneumonia virus.The application of large doses and prolonged hormones will produce many complex negative reactions.The incorrect medical cognition of the use of hormones in viral pneumonia is an important cause of exacerbation of pneumonia.

5.Coronavirus pneumonia is a self-limited disease Its fever and pneumonia are exactly the process of destroying the virus.After the virus is eliminated, it improves and heals itself.No medicine can replace the human immune response to destroy the virus.There is no specific drug, because no drug is better than the interferon to inhibit the virus, and no drug is better than the antibody to neutralize the virus.What we can do is to reduce hypoxia and other organ damage such as myocarditis, encephalitis, vasculitis, etc.caused by pneumonia during this process.

Patients wait for the patient to pass the dangerous period and improve smoothly.

(1) Aspirin application: Aspirin for the treatment of coronavirus pneumonia has the following characteristics: a.Antiviral action Elevated interferon causes prostaglandin E to increase.Prostaglandin E cause fever on the one hang, and inhibit further increase of interferon on the other hand.Aspirin inhibits prostaglandin E, interrupts the feedback inhibition of prostaglandin E on interferon, further increases interferon,and better inhibits the virus.b.Antipyretic effect.c.Aspirin inhibits the marginal Inflammatory reactions of immune response, alleviates pneumonia, reduce inflammatory reaction of trunk and gastrointestinal tract, reduces fatigue, enhances appetite, and improve mental state of patients.d.No obvious side effects such as gastrointestinal bleeding were found in intravenous aspirin, and we did not find Reye Syndrome.

(2)Application of 654-2: 654-2 is a synthetic drug of anisodamine.654-2 can stabilize lysosomal membrane, inhibits the migration of inflammatory cells, and inhibits the marginal inflammatory response of the immune response.654-2 dilates the capillaries, reduces the hydrostatic pressure of the capillaries,allows the tissue fluid and alveolar exudate to be absorbed back into the blood vessels, and reduces tissue inflammation.Among the complex anti-inflammatory drugs, 654-2 is the only and truly direct anti-inflammatory drugs.The sequential combination of aspirin and 654-2 can significantly reduce the inflammatory response.

(3) The drug used to reduce cell damage include highdose vitamin c, glutathione, phosphatidylcholine, etc.

(4) To increase the tolerance of cells to hypoxia Includes combined use of ATP, coenzyme, multivitamins, glucose and insulin, etc.Antibiotics are used to prevent secondary pulmonary bacterial infections.The treatment of other diseases such as diabetes and lung disease will help patient to pass through the dangerous period.