For weeks, amid a surge in positive cases of new crowns, officials have been advocating that people with mild illnesses monitor their own health at home and "not go to the hospital unless it's necessary". People's daily chatter has changed from "Are you positive?" to "Did you get the medicine?" After ibuprofen, Tylenol, Lianhua Qingdian and other antipyretic painkillers, vitamin C and effervescent tablets are also at the top of people's drug hoarding lists.
Zhang Wenhong, director of the Department of Infection at Huashan Hospital affiliated with Fudan University in Shanghai, pointed out that in the face of the new coronavirus, human immunity is the best weapon. A few days ago, in the Huashan infection public number of the latest release of the article "to protect the family, out of the epidemic", Zhang Wenhong team bluntly said, "as far as the normal immune function of the people, who has a cold and fever will be looking for nucleic acid kiosks all over the world? It's just a matter of finding some fever-reducing medicine to eat, sleeping, drinking more water, and taking some vitamin C to carry through."
Academician Zhong Nanshan of the Chinese Academy of Engineering and Tong Zhaohui, vice president of Beijing Chaoyang Hospital affiliated with Capital Medical University, and other well-known experts have also advised the public that more vitamin C can be supplemented after the infection of the new crown in order to increase the body's ability to defend itself against the virus.
But whether vitamin C can prevent and treat New Crown has been controversial. Several experts suggest that the public can take a moderate amount of vitamin C during infection, no more than 200 milligrams per day, and must not overdo it. "To supplement vitamin C, it is best to get it from fruits and vegetables rich in vitamin C. For medicines or nutrients, take as little as you can." A respiratory and critical care medicine doctor at China-Japan Friendship Hospital explained to China News Weekly.
Vitamin C can't prevent new crowns
Vitamin C is an essential nutrient that is essentially an antioxidant. Scientific studies have shown that Vitamin C is involved in the synthesis of immune proteins in the body and regulates the body's immune response by promoting the activity of white blood cells and phagocytes. For people's daily intake of Vitamin C, the European Union recommends an average of 90 mg/day for men and 80 mg/day for women to maintain normal plasma levels and prevent scurvy in adults. A Swiss panel of experts in 2020 recommended a daily supplement of 200 milligrams of Vitamin C for people over the age of 65 who suffer from colds or whose bodies have been invaded by viruses.
Guo Wei, deputy chief physician of the Department of Infection at Tongji Hospital affiliated with the Tongji Medical College of Huazhong University of Science and Technology, pointed out to China News Weekly that Vitamin C is more like a placebo for newly crowned infected people, and that while it can to some degree boost the Although it can enhance the body's immunity to some extent, it can't "boost immunity to a level sufficient to ward off new crown infections" in a short period of time, which means that Vitamin C can neither prevent new crowns nor kill the virus, and therefore can't be used as a substitute for symptomatic medication.
He reminded the public that they must not blindly take large quantities of Vitamin C after an infection because it is an acidic ingredient, and large quantities of it may disrupt the acid-base balance in the body. In addition, it is necessary to supplement Vitamin C through fresh fruits and vegetables as much as possible."
An infectious disease doctor from a tertiary hospital in Anhui province also told China Newsweek that it is not recommended to take Vitamin C every day in order to prevent new crowns, and that many studies have shown that Vitamin C has a "very limited effect" on the prevention of new crowns. Many studies have shown that Vitamin C has a "very limited" effect on preventing new crowns. After the human body is infected by the virus, moderate supplementation of Vitamin C after producing symptoms may shorten the course of the disease, ease the severity of symptoms, and facilitate recovery from the infection as soon as possible. "There is some medication-assisting function."
As early as the beginning of the new crown pandemic, many governments have listed vitamin C as a preventive medicine. on January 22, 2020, the Shanghai Municipal Health Commission was the first to explicitly issue a notice to Shanghai's various medical institutions, recommending that the clinical application of Vitamin C as a preventive medicine against the new crown pneumonia; January 26, Hangzhou Epidemic Prevention and Control Command issued the "10 Recommendations to All Citizens", calling on people to "to supplement Vitamin C appropriately". Since then, health departments in Shandong and other places have also listed vitamin C as a nutritional supplement to prevent new crown pneumonia.
But there has been considerable controversy in the scientific community over whether vitamin C can combat colds or respiratory infections. Several Italian academics counted all the studies published between January 2020 and February 2021 on the topic of "Vitamin C for the prevention or treatment of neocoronitis" and found that there was no evidence that supplementation with Vitamin C prevented neocoronitis, although some clinical observations reported improved outcomes in patients with neocoronitis who were treated with Vitamin C, such as shorter duration of symptoms, available data from controlled studies are scarce and highly uncertain, and trials have not produced consistent results. Taken together, the evidence is currently insufficient to conclude that Vitamin C supplementation is beneficial for the prevention and treatment of new crowns, and larger, high-quality studies are needed.
However, Guo Wei introduced, emergency room in the treatment of new crown critical patients, often will give the patient intravenous injection of vitamin C. Vitamin C at this time can play a two-fold role, one is to enhance the stability of the blood vessels, because the patient infection produced by the inflammation will lead to the body of a large number of capillary rupture, seepage; second is a certain liver protection effect, after the injection of Vitamin C can reduce the hepatocyte and other organisms cellular damage. "But how good the effect is after doing so, there is no very objective evidence-based medical evidence to support, only to say that everyone is so accustomed to use, and it is also quite safe, no side effects."
In February 2020, Peng Zhiyong, director of the Department of Critical Care Medicine at Wuhan University's Zhongnan Hospital, told the media that his team was conducting a clinical trial of "high-dose Vitamin C" for the treatment of new crowns. He said, whether it is the past SARS, Middle East Respiratory Syndrome, or now the new crown, the main cause of death of patients are acute respiratory distress syndrome, as well as other complications caused by multi-organ failure. When the virus leads to increased oxidative stress and patients develop acute respiratory distress syndrome and other multi-organ failure, antioxidants such as vitamin C can play a positive role.
Related research results from Peng Zhiyong's team were published in January 2021 in the journal Annals of Critical Care. The paper notes that "vitamin C deficiency" is common in critically ill patients, with about 40 percent of them severely deficient. The trial injected high-dose vitamin C, 24 grams per day, into patients with severe acute respiratory syndrome in New Crown and found a potential signal of improvement in critical illness. But because the early outbreak in Hubei province was quickly brought under control, the study had a small sample and ended up recruiting only 56 severely ill patients.
Guo Wei explained that this treatment is not designed to boost patients' immunity in the short term, and is mainly used to save new crowns of critically ill patients, usually in large doses, up to 12 to 24 grams in a single day, "a much larger amount than the amount needed for daily intake, while most mildly ill patients who want to supplement their Vitamin C at home, 100 to 200 milligrams a day would be enough, and overdose may have side effects. Excess instead may have side effects."
A number of experts warned that the effect of vitamin C can not be overstated, especially for people who are not infected with the new crown, there is no need to take a large amount of vitamin C in order to prevent, as long as you make sure to meet the recommended amount of daily diet.
Beijing people's home standing medicine.
No combination of antipyretics and cold medicines
Behind the "Vitamin C myth" is the anxiety and helplessness people feel after contracting a new crown. The same mentality will also lead people to find themselves in fever, pain, "plus code use" of a variety of drugs. Experts pointed out that this is a misconception, many drugs can not be combined, mixed, more, people must be vigilant, or may cause more serious consequences than the new crown.
How to rationalize the scientific use of drugs after the infection of the new crown?
Guo Wei pointed out that the main antipyretic and analgesic drugs have two categories, one is simple antipyretic drugs, such as ibuprofen, acetaminophen this kind of, the other is a cold medicine, such as the commonly used Tylenol, white plus black, most of them for the compounding, which is the main ingredient also includes acetaminophen. He warned that these two types of drugs must not be used in combination, otherwise it is equivalent to the "dose of acetaminophen increased", which may lead to liver damage, or even liver failure.
He suggested that the choice of drugs must be carefully reviewed before the ingredient list, if there are fever symptoms, antipyretic drugs, cold medicine, "must only be able to choose one", contraindicated the joint use of repeated use of drugs, "can not eat a kind of fever can not be down on the non-stop change of drugs! "
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December 8, the State Council held a joint prevention and control mechanism news conference, Peking University First Hospital Infectious Diseases, Wang Guiqiang, director of the Department of Infectious Diseases, also suggests that if infected with the new crown fever, cough and other symptoms, you can symptomatic medication, but do not have to hoard or buy large quantities of medication. In particular, it should be noted that many analgesics, although the name of the drug is different, but the composition is the same, can not be mixed to take, only one can be used. If you use too much and take too much, it may cause adverse reactions.
Wang Guiqiang also suggests not to abuse drugs, various drugs also have side effects, and interactions may increase the adverse effects of drugs. "In particular, antibacterial drugs can not be used casually, for example, antibiotics themselves are prone to secondary dysbiosis, secondary infections and other problems, so antibacterial drugs should be strictly controlled use."
Currently the two most "hot" antipyretics, we should choose ibuprofen or acetaminophen?
Guo Wei said, for most adults, both drugs have good results, but relatively speaking, acetaminophen is safer for pregnant women and children, because of its side effects are smaller, children can also be used with diclofenac sodium, a type of drug. But the point to note is that, whether it is ibuprofen or acetaminophen, a history of gastric problems, especially gastric ulcers, should be used with caution, because these drugs may damage the gastric mucosa, leading to gastrointestinal bleeding. "When we use antipyretic and analgesic drugs in the clinic, we pay attention to whether the patient has any comorbid gastric disease, and we will use them with great caution, because we have already seen some people who took a large amount of these drugs have black stools, which indicates gastrointestinal bleeding."
Also, what are the contraindications for patients with multiple co-morbidities such as cerebrovascular underlying disease, diabetes, heart disease, tumors, etc., when choosing these two drugs?
Wang Yang, chief physician of neurosurgery at Beijing Chaoyang Hospital, pointed out in an interview that cerebrovascular patients usually take aspirin or warfarin and other drugs, these two drugs and ibuprofen have a synergistic effect, which will increase the risk of bleeding, so these patients try to use acetaminophen to reduce the adverse effects. Acetaminophen is also preferred for diabetic patients. However, if you only have ibuprofen on hand, it is recommended to take it 2 hours apart from your usual medication. Patients with heart disease, especially those with severe cardiac insufficiency and heart failure, are not advised to take ibuprofen and are also advocated to choose acetaminophen.
Guo Wei also emphasized that the elderly must be careful when taking Pfizer Paxlovid, an oral antiviral drug that has an ingredient that interacts with many medications, so try not to take other drugs at the same time as you are taking the drug. Some elderly people with high blood pressure and heart disease are at greater risk when taking antiviral medications and must be under a doctor's supervision.
In addition, a number of experts suggest that fever-reducing drugs should not be taken too much, the interval between medication is usually 4 to 6 hours, no more than 4 times a day, otherwise it will also lead to organ damage. Moreover, the temperature should be stopped immediately after the drop, antipyretics should not be used more than 3 days, if the symptoms are still not relieved, it is recommended to go to the hospital in a timely manner. Overall, we should adhere to the principle of "no drugs unless necessary".
Guo Wei explained, the human body will be infected with a virus fever, because the body's immune response is mobilized to resist the killing of the virus, so if the fever temperature is not too high through the drug will be forced to lower the temperature, may be detrimental to the entire body's immune system to play a role in the body, "because the body always have to face the virus". The reason why medication is recommended for high fevers is because cell damage in the body can be caused when the temperature is too high, so medication is generally recommended when a fever exceeds 38.5 degrees Celsius.
"If the temperature is 38.5 ℃ or less, clinically do not recommend that people take medication to reduce fever, can be through the ice and other physical ways to cool down, such as in the carotid artery blood vessels near the towel wrapped in some ice to cool down, in addition to be sure to drink more water." Guo Wei said.
In addition to ibuprofen, acetaminophen and other commonly used Western medicines, another drug that has been out of stock in many hospitals is Lianhua Qingdian. Can Chinese and Western drugs be mixed after contracting the new crown?
Academician of the Chinese Academy of Engineering, Tianjin University of Traditional Chinese Medicine honorary president Zhang Boli gave advice, Western medicine fever-reducing drugs and Chinese medicine cold medicine do not try to take the same service, such as taking Lianhua Qingdian, Jinhua Qing sensation, Xuanlong sepulchral particles and other fever-reducing effect of proprietary Chinese medicines, no longer jointly take ibuprofen or acetaminophen. Other Chinese and Western medicines such as taking should also be spaced 1 hour to avoid each other. Guo Wei also pointed out that many proprietary Chinese medicines contain Western medicines, it is recommended not to mix with antipyretic and analgesic Western medicines.
Many experts emphasized that the new crown home treatment, the most important is symptomatic, high fever with antipyretic drugs, if the sore throat or cough, you can use some cough expectorant drugs, the use of the instructions must look good, according to the prescribed dose.
Guo Wei said, some patients reacted to the infection of the throat "like a knife cut", do not worry too much about the symptoms, you can take watermelon cream, golden throat throat treasure and other types of throat tablets to reduce local inflammation can be, try not to go back to the medicine. If coughing with phlegm, you can symptomatically eat some expectorant drugs, but should try to avoid central cough suppressants, such as dextromethorphan, etc., the mechanism of this type of drug is through the inhibition of the central nervous system, do not allow people to cough, but coughing is actually the body's own protective mechanism at work, through coughing up phlegm to the inflammatory substances out of the body. "It is recommended that you can take some non-central cough medication, such as eucalyptus-pinocampus enteric capsules, and you can also drink some Chuanbei loquat paste."
What are the symptoms that require prompt medical attention after they appear during home treatment?
Guo Wei pointed out that the first and most important a signal is three consecutive days with a high fever of 38.5 ℃ or more, or take fever-reducing drugs two or three children immediately rebound, which indicates that the infection of the viral load is large, and the drug can not play a role in the human body, "in general, three or four consecutive days with a fever of 38.5 ℃ or more is relatively rare. " Second, the patient feels shortness of breath and suffocation, and should seek immediate medical attention when respiratory distress occurs. Third, the elderly with underlying diseases in the infection of the new crown, the symptoms of the underlying disease is difficult to control, such as blood sugar to maintain a high level, hypertension can not be controlled, it is recommended to seek medical attention in a timely manner.
Fourth, pregnant women with abdominal pain and bleeding, reduced fetal movement and other symptoms, children continue to lose appetite for two or three days, appear irritable and noisy phenomena. "Theoretically, the symptoms of children infected with the new crown are very mild, and although they also have a fever, they usually recover quickly, so if children continue to experience uncomfortable symptoms, they should seek medical attention in a timely manner."
The aforementioned infectious disease doctor from a tertiary hospital in Anhui also warned that the younger the child, the more special attention should be paid to his emotional changes. "Clinical findings, many children infected with the beginning of just sore throat, and then tonsils enlarged, or even edema, this situation may eventually lead to breathing difficulties and even suffocation and death, especially can not yet speak the child, the symptoms of the change will be very fast, must be extra vigilant."
Written by Fossey