SARS-CoV-2不可溯源感染者在防止疫情再爆发中的价值、确认与中医药治疗

SARS-CoV-2 Infected Cases with Untraceable Epidemic Origin: Its Values, Identification and TCM Treatment in Preventing Recurrence

  • 摘要: COVID-19爆发过程中,不可朔源感染病例具有三方面意义:首先,表明该地区存在社区蔓延;其次,显示该社区已有一定数量人群获得了自然免疫和更多个体正在获得自然免疫;再次,提示对于没有出现不可朔源感染病例的地区,未来存在随时爆发局部流行的未知风险。认请局部微环境是导致聚集感染的关键因素,而不是仅仅注重超级传染源,有利于减少和避免聚集感染的发生。因为感染病例不一定由基因检测阳性确定,因此正确应用基因检测对无症状病例的确认至关重要。在疫情暴发的早期阶段,基因检测可用于识别无症状病例,但不应用于排除具有典型临床症状和体征的病例。在疫情暴发的中后期,基因检测除了用于传播者的识别和隔离外,还可应用于评价一个地区的人口感染率。关于无症状感染者,虽然显示其自身对病原体反应具有很强抑制力,但仍是传染源。中医认为,无症状感染者属于气虚毒恋型,临床治疗以益气补肺、清热解毒、扶正固本为主,防治建议采用清肺排毒汤、益气祛毒汤、宣肺败毒颗粒或莲花清温胶囊、金花清感胶囊等。

     

    Abstract: During the outbreak of coronavirus disease 2019 (COVID-19), the identification of a SARS-CoV-2 infected case with untraceable epidemic origin has three values: (1) the region has community transmission of the virus; (2) a certain portion of population in the community is getting immunized and more individuals have already been immunized; (3) an unpredictable future risk exists for regions where there are no infected cases with untraceable epidemic origin. Minimizing or avoiding the aggregation infection through individuals with no clinical symptoms is crucial and possible as its occurrence is mainly attributed to the local environment as opposed to the super spreader with or without clinical symptoms. As infected cases are not necessarily positive with gene test by definition, proper application of gene test is crucial in the identification of asymptomatic cases. In the early stage of an outbreak of infectious disease, gene test can be used to identify asymptomatic cases but it should not be used to exclude cases with typical clinical symptoms and signs. In the middle or late stages of an outbreak gene test should be applied in evaluation of infection rate of the population of a region, in addition to be used in spreader identification and isolation. Although asymptomatic cases are attributed to the overwhelming effect of personalized defense against pathogens, they are still a source of infection. Asymptomatic cases are considered to be Qi deficiency and with lingering toxicity in traditional Chinese medicine (TCM). Treatment in such cases, typically, involves therapy focused on replenishing the Qi, tonifying the lung, clearing the fever, and detoxification in order to return to a normal health condition. The recommended Chinese medicines include Qing Fei Pai Du Decoction, Yi Qi Qu Du Decoction, Xuan Fei Bai Du Granule, Lian Hua Qing Wen Capsule (Granule), and Jin Hua Qing Gan Granule, etc.

     

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