I can see the status bar

Chapter 1117
The blue status bar does not have much value for the time being, and the treatment of other patients seems to have no place to adjust.On the whole, we are gradually gaining an advantage over the disease, but if we focus on the North Fifth District of the Yunhe City Infectious Disease Hospital, the battle situation is still very stalemate.

From the current point of view, the most hopeful people in the whole battle situation are Guan Guxue and her children.Among the family of three, Zhao Jian has turned negative, but out of humanitarian considerations, Qian Hongjun agreed to Zhao Jian's request to stay in the room after discussing with other doctors.And Guan Guxue finally turned negative for the first time in today's routine PCR test.

Sun Li'en went upstairs to check on Guan Guxue's situation. After confirming that there was no "new coronavirus infection" reminder on her status bar, he proposed his own suggestion to Qian Hongjun, "Let her start giving children Breastfeeding."

"Okay." Qian Hongjun nodded, and he had already had this idea, "I have stored a batch of breast milk in cold storage before, and let her breastfeed the child to see the effect. If the effect is good, the remaining breast milk Maybe send it to a lab to see if you can make antibodies."

The "antibody" Qian Hongjun refers to does not refer to the monoclonal antibody often referred to in the field of biopharmaceuticals.To be more precise, the antibody he is talking about is the IgA immunoglobulin contained in breast milk.

If Zhao Hean's condition improves after breast-feeding, the doctors can be sure that the breast milk of the recovered person contains IgA immunoglobulin that can work against the new coronavirus.

The effect of this kind of immunoglobulin is slightly weaker than that of the most specific IgG immunoglobulin, but compared with the route of administration of IgG that must be injected intramuscularly or intravenously, IgA immune globulin has a great advantage-it belongs to mucosal antibody , while also being able to tolerate the gastric juices and enzymes of the digestive system - it may be the only immunoglobulin that can enter the body through the oral route.

There are still many uncertainties and fogs in the study of oral absorption of IgA. Researchers cannot even determine the shape of IgA protein, and we are not 100% sure that this particular immunoglobulin can pass through adults. digestive tract and is absorbed.

But this is at least a direction. It is the same as the specific IgG immunoglobulin against the new coronavirus and the monoclonal antibody against some targets on the S spike protein of the new coronavirus. It is possible for us to obtain anti-virus The direction of specific drugs.

常规的研究渠道对于新冠来说还是太慢了些。孙立恩个人对于抗体研究并不抱太大希望。当年针对SARS的特效药是SARS马血清制剂，而这种特效药是在当年的7月20日才宣布提取成功的。而SARS疫情在当年的7月13日就基本结束了——在13日之后，全球范围内都再未出现过新增的SRAS确诊病例。

Although it is not known why the SARS virus suddenly disappeared back then, there is one thing Sun Lien can be sure of—even horse serum preparations, which have a high risk of allergies, require at least four months to develop. It is safer, and there are more unknown factors in the development process of specific immunoglobulins, and the time required for monoclonal antibodies is bound to be longer.

The number of confirmed cases in Yunhe has begun to decline day by day.Under the circumstances that no one person was missed, and the national medical forces concentrated on supporting Yunhe, a large number of square cabin hospitals and designated hospitals realized the transfer of severe and critical cases, and the transfer of mild and asymptomatic cases, the spread of the epidemic was controlled or even completely cut off. The spread of the epidemic is already a certainty.

The only question is when victory will come.And, how much will the research and development of related specific drugs lag behind.

It is very likely that Yunhe will not need special medicine.Any new type of special drug that wants to be used as it is, must at least pass the first, second and third phases of clinical trials before it can be officially put into use.Phase I and Phase II clinical trials take a relatively short period of time and can usually be completed within a few months to two years.But it is the largest, and it is also the Phase III clinical trial that mainly evaluates the safe dose and drug effectiveness before clinical use... It is very normal to do it for three to five years.

It is impossible for Yunhe's epidemic to last for three to five years. Given the current situation, it may not even last for three to five months.With the will of the country and the efforts of the whole people, it is simply impossible for the new coronavirus to continue to spread on this scale in the country.

What will happen to the Phase III clinical trials at that time...?Sun Li'en sighed, the third phase of clinical trials must at least have thousands of patients enrolled.Now no matter how fast the specific medicine is produced, there are no patients who cannot complete the Phase III clinical trial, and this medicine is still useless.

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Yunhe's doctors have been fighting this sudden disease for at least a month without any specific medicine.And this situation will continue.

Judging from current experience, after the spread of the epidemic has been fully controlled, doctors are still far from being able to stop and rest their feet.Patients with pneumonia caused by the new coronavirus have an average hospitalization time of about 20 days.From the onset of admission to the gradual recovery and discharge, it takes at least 20 days on average.

Of course, there are patients who start to improve and leave the hospital within three to five days after being hospitalized.These patients are mainly young people, and most of the symptoms are not too severe.

Many more patients require hospitalization for 20 to 2 days.Most of them are middle-aged, and a large proportion of them have underlying diseases.The new coronavirus that attacks human cells through the ACE[-] receptor will cause damage to their systemic organs through secondary hypertension, hypoxemia and interstitial pneumonia.Part of the reason for the long hospital stays is that doctors still need to contain and work to repair the damage caused by the virus.

The vast majority of critically ill patients are hospitalized for 30 days or longer.The systemic organs of this group of patients suffered greater damage, and inflammatory storms and more severe pulmonary fibrosis and other lesions appeared.When the patient progresses to this stage, the case fatality rate will be higher than that of severe disease.The damage caused by the new coronavirus is mainly concentrated in the lungs, and the mechanism of the impact on systemic organs is closely related to respiratory distress syndrome (ARDS).Therefore, the current medical team speculates that the mortality rate of critically ill patients with pneumonia infected by the new coronavirus may be close to the 50% mortality rate of respiratory distress syndrome.

At present, the average mortality rate of severe and critically ill patients received in the North Fifth District is about 13%, of which the mortality rate of critically ill patients is 25%.This value is much lower than everyone estimated, and it is also much lower than the statistical data of the ICU of Yunhe City Infectious Disease Hospital.

No matter what kind of magic was used in the North Fifth District, at least so far, the medical staff in the entire Yunhe City Infectious Disease Hospital are eager to know how this magic is done.

As long as they can achieve the same effect as the North Fifth District, let alone learning magic—even if they can make them dance to the Great God, it's not impossible.

Sun Lien, who had just entered the red zone for four hours, received a call from Zhang Zhifu. Comrade Zhang called Director Sun with one purpose—to invite him to tell everyone about his work experience in the North Fifth District.

"Isn't this matter already talked about before?" Sun Li'en asked a little confused, "It's about moving the gate forward and thousands of people and thousands of strategies."

"Stop talking about what you've already said." Zhang Zhifu coughed lightly and said, "Share your experience with tocilizumab."

Medical teams in several other wards also found abnormalities in interleukin-6 (IL-6) in patients with pneumonia infected by the new coronavirus.Almost all critically ill and critically ill patients with rapidly deteriorating conditions have a rapid increase in interleukin-6.In the terminal stage, the level of interleukin-6 in the patient's body can even exceed the normal value by several hundred times.

The level of interleukin-6 has risen rapidly, which has basically been equated with the inflammatory storm in the patient.In this case, tocilizumab targeting the interleukin-6 receptor has become the most effective inflammatory storm blocking drug.It works even a bit better than steroids and seems to have fewer after effects.

However, the specific usage of tocilizumab, and how to use gamma globulin for humoral immunity after using tocilizumab, if these need to be explored from scratch, it will take a long time and a very...very serious price.

Trial and error requires cost, and after the North Fifth District has basically completed the trial and error, it is the least costly solution to ask them to promote the experience as soon as possible.

"Promotion experience?" Sun Lien asked with some uncertainty, "But we have just handed in the materials for this therapy, and the higher authorities haven't approved it yet."

"Special period, special plan." Zhang Zhifu coughed and said, "We don't plan to completely push away your treatment plan. The most urgent task now is to find a specific immunosuppressive plan that is effective against interleukin-6. Since you Yes, you can also tell us about this content first.”

Sun Lien rolled his eyes, "Okay, then shall I go over now?"

"Come now." Zhang Zhifu affirmed, "This kind of knowledge is very precious, let other doctors master it earlier, we will have a little more weapons!"

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"First of all, I want to pour cold water on everyone." In the large conference room on the first floor, Sun Lien's opening remarks were straightforward, "The triple therapy of tocilizumab, gamma globules and CRRT is by no means a panacea. The application has strict indications and scope. Patients who do not meet the requirements should not use this therapy.”

Sun Lien's "opening remarks" quickly attracted the attention of the doctors present.Sun Lien continued, "I can understand everyone's feelings, but we still need to promote a treatment plan that is thousands of people. For those patients whose interleukin-6 level is not too high, tocilizumab should not be used."

After finishing the most important content, Sun Lien began to explain his treatment plan.In order to make the explanation more efficient, he simply took out the first draft of the thesis he wrote, as if he was telling the teachers of the defense committee about his research process, starting from scratch.

"Like everyone, when our team took over the North Fifth District and started sorting out the patient's condition, we found a positive correlation between the level of interleukin and the severity of the patient's condition. After communicating with the immunology experts of Ningyuan Fourth Hospital, we decided to start trying Tocilizumab treatment plan. Although tocilizumab is a high-efficiency biological monoclonal antibody targeting interleukin-6 receptors, this process will still inevitably lead to a decline in the patient's immunity. In order to make up for the impact of this decline on the virus At the same time, we used a large dose of gamma globulin pulse therapy to the patient. The purpose is to temporarily protect the patient through the passive immune function of gamma globulin, and continue to block the activity of the cytotoxic immune system.”

"Because of all the characteristics of gamma globulin itself, when used in patients with thrombosis or hypercoagulation tendency, the dose should be reduced, or anticoagulant drugs such as warfarin or heparin should be given appropriately according to the test data related to coagulation time. Moreover, in order to remove harmful substances in the patient's body as soon as possible and prevent possible kidney damage during high-dose IVIG (intravenous infusion of gamma globulin), the patient should be treated continuously with CRRT. During the treatment, the patient must be precisely controlled The blood volume in the body, if the blood volume is too high, it will burden the heart, and if it is too low, it will easily cause blood coagulation."

It is not too difficult to carry out such a treatment plan in the North Fifth District. After all, Sun Lien has a status bar as a comprehensive monitoring device.He can make relevant adjustments to patients in a very timely manner according to the prompts in the status bar.But how to carry out triple therapy in other wards, Sun Lien himself has no idea - can't let other departments conduct blood coagulation tests every hour for patients receiving triple therapy?

If we really want to do this, the doctors in the laboratory can go straight to the fifth floor, and then tear Sun Lien alive.

"Using triple therapy in patients with higher levels of interleukin-6, we have observed very good therapeutic effects so far." After talking about the ugly words and risks, Sun Lien began to explain the benefits of triple therapy to everyone, "this inflammatory storm mediated by interleukin-6. But I need to reiterate to everyone that the inflammatory storm is not only mediated by interleukin-6. In our current practice, we have found at least A case of an inflammatory storm induced by interleukin-2. Tocilizumab has very limited efficacy in this patient."

The special case that Sun Lien mentioned was Dean Liu Lianzhi.I don't know how he is doing now.

"So, when facing a patient who may be at risk of an inflammatory storm, it is first necessary to clarify what causes the inflammatory storm the patient is facing." Sun Lien explained to many doctors in the audience, "Moreover, after using the triple therapy, It is also necessary to monitor the changes in the patient's pulmonary edema frequently through chest B-ultrasound and other detection methods. Our ideal goal is to directly prevent possible inflammatory storms through tocilizumab and accelerate the body's response to the virus through gamma globulin. Immunization, and slow down the damage of cytotoxic immunity to lung tissue. Finally, through other support and anti-viral means, let patients complete immunity to the new coronavirus and turn negative as soon as possible.”

After talking back and forth for half an hour, Sun Lien finally stopped his hand of sliding the WPS document, and then said, "If you have any questions, you can ask them now."

(End of this chapter)