Today, let’s discuss whether patients with COVID-19 will be cured or heal by themselves. 

To distinguish between "being cured" and "self-healing", we must start with the pathogenesis of COVID-19.

In fact, the pathogenesis of the disease is still unclear.

After studying medicine, you will know that most diseases have not been understood by human beings. COVID-19 is no exception. First, the virus spreads into the human body through droplets or contact, recognizes ACE2 protein in alveolar epithelial cells, binds to the protein and then enters the cells for replication, and finally causes lung inflammation. At the same time, the body's immune system recognizes foreign viruses and begins to fight against them. Macrophages phagocytize virus-infected cells and lymphocytes produce antibodies, thus preventing the viruses from replication and finally eliminating them.

In fact, the virus and the immune system are the main players in this battle.

People differ from one another in their constitution and reaction to the virus.

Some young people have strong immunity and good physical quality, so their immune system can eliminate viruses quickly and they only show mild symptoms such as fever, fatigue, dry cough, and mild cold symptoms.

Such patients can be cured without receiving too much medical treatment. Some of them can heal by themselves and do not need to go to the hospital. This is what we call “self-healing”.

Some elderlies have poor immunity or suffer hypertension, heart disease, renal insufficiency, and other basic diseases, so their immune system cannot fight against the virus effectively and may even hurt their body in the process.

If the immune system is too weak, it cannot curb the replication of the virus and the disease will get worse and worse. Or, if the resistance against the virus lasts too long, the immune system will hurt the human body and people will fall severely sick before the immune system wins the victory in the fight against the virus.

Such patients show serious symptoms such as high fever, expiratory dyspnea, acute respiratory distress syndrome, or even failure of body systems. But some others may show symptoms like low fever or no fever at all.

Patients with moderate or severe illness need medical intervention and active support so that the immune system will have enough time and ability to defeat the virus. We call this “being cured”.

So, how do doctors and nurses cure a COVID-19 patient?

If we compare the fight against the virus to the fight against enemies, these medical measures are like the strategic support to the human body.

• Support treatment. Illness is very energy-consuming. When people are ill, they often have a poor appetite and insufficient energy supply. Therefore, it is very important to let patients rest in bed and receive more nutrition. Patients with a good appetite should eat more nutritious food, and patients with a poor appetite should be given enteral nutrition support. Besides, the stability of the internal environment is also very important. Water and electrolyte are necessary and should be balanced, which requires timely infusion to maintain acid-base electrolyte balance.

• Oxygen therapy. Patients with mild disease and common patients, due to lung inflammation, may suffer chest tightness or mild dyspnea, as a result, they need oxygen therapy, commonly known as oxygen inhalation. By inhaling oxygen with relatively high concentration, patients’ oxygen saturation can be increased and oxygen deficiency can be relieved.

• Respiratory support. Patients with severe symptoms suffer serious lung injury. Oxygen therapy alone cannot relieve their dyspnea. So respiratory support is needed at this time such as using a ventilator.

• Antiviral therapy. So far there have been no specific drugs for COVID-19. The drugs available right now include anti-influenza and anti-AIDS drugs, such as Oseltamivir, Abidor, Lopinavir/Ritonavir, all of which have limited effect. Recently, it has been found that Remdesivir has a good curative effect. If anti-viral drugs have a good effect and the immune system works well, the therapeutic effect can be greatly improved.

• Antibiotic therapy. When viral pneumonia occurs, pathogenic bacteria will enter the human body and infect the lungs, known as co-infection. At this time, antibiotic therapy is required.

• Other treatments. When the immune system overreacts, it will injure lung tissue and aggravate lung injury. Theoretically, the proper administration of drugs to suppress the immune system at this time may reduce lung injury and inflammatory storm. However, at present, there is no evidence that any immunosuppressive agent has more advantages than disadvantages in treating COVID-19, so the administration of such an agent should be cautious.

Besides these treatments, doctors and nurses can do much more for patients suffering from COVID-19. But all these should be done according to patients’ own situation.

Finally, we hope that all patients will be cured or heal themselves as soon as possible.

今天，我们就来探讨一下，新型冠状病毒肺炎究竟是自愈的还是治愈的。

要想分得清「治愈」和「自愈」，还要从病毒的致病机理开始讲起。

其实，新型冠状病毒肺炎的发病机理尚不明确。

学了医你就知道，世界上大部分疾病人类都没闹明白。这次也不例外。大概过程是，新型冠状病毒通过飞沫或者接触传播进入到人体内，识别肺泡上皮细胞的 ACE2 蛋白，结合蛋白后进入细胞开始复制，进一步引起肺部的炎症。与此同时，人体的免疫系统识别了外来的病毒，也开始工作起来。巨噬细胞吞噬病毒感染的细胞、淋巴细胞产生抗体，从而阻止病毒复制并清除病毒。

其实，病毒和免疫系统才是这场战役的主角。

每个人的体质不一样，对病毒的反应也有所不同。

有的人年纪轻，免疫力比较强，身体素质也比较好，很快就能把病毒消灭，因此只表现为轻度的症状，比如发热、乏力、干咳，甚至只有轻微的感冒症状。

对于这类患者，不需要给予过多的医疗措施，甚至不需要去医院，可能自己就能够痊愈，这种，我们称之为自愈。

有的人年龄比较大，或者免疫力比较差，又或者合并有高血压、心脏病、肾功能不全等等基础疾病。这时候，免疫系统和病毒的战斗非常胶着，免疫系统攻击病毒的过程也会伤害人体本身。

免疫系统太弱了无法控制病毒的复制，病情会越来越重。又或者，抵抗的时间太长了，伤害自身机体，还没胜利自己先撑不住了。

这种病人症状就比较严重，可以表现为高热，也可能为低热或不发热。通常有呼吸困难甚至急性呼吸窘迫综合征，还可以伴有各个系统的衰竭。

对于中度或重症的病人，就需要医疗干预，给与积极的支持，让免疫系统有足够的时间、足够的能力打败病毒。这种医疗干预下痊愈的病人，我们称之为治愈。

那么，医生护士们又是如何治愈一个新型冠状病毒肺炎患者的呢？

如果把人体本身和病毒的之间的对抗比喻成一场战争，那么这些医疗措施就是对人体的各种战略支援。

➊ 支持治疗。生病是一件非常非常消耗能量的事情，而人生病了往往食欲不好，能量供给更加不足。因此，让病人卧床休息、加强营养非常重要。能吃的病人多吃点高营养的食物，吃不下的病人就给肠内营养支持。内环境的稳定也非常重要，水、电解质不能缺乏，也不能失衡，这就需要及时输液、保持酸碱电解质的平衡。

➋ 氧疗。对于轻症和普通患者，由于肺部存在炎症，可能伴有胸闷或轻度的呼吸困难，这时候可以给予「氧疗」，俗称吸氧。通过直接给予比较高浓度的氧气，提高血氧饱和度，缓解机体缺氧。

➌ 呼吸支持。对于重症患者，肺部损伤十分严重，即使给予氧疗也无法缓解呼吸困难，这时候就需要进一步给予呼吸支持。首先，我们可以上呼吸机。

➍ 抗病毒治疗。所谓的「新型冠状病毒肺炎没有特效药」就是指目前为止还没有特别有效的抗病毒药物，人们只能用已有的抗流感、抗艾滋等药物，比如奥司他韦、阿比多尔、洛匹那韦 / 利托那韦，效果有限。最近，人们发现瑞德西韦初步表现出了较好的疗效，如果抗病毒药物效果较好，免疫系统就有了好帮手，那能大大提高治疗效果。

➎ 抗菌治疗。在病毒性肺炎发生的时候，致病菌也会趁虚而入，一起感染肺部，称为肺部继发感染（co-infection），这时候就要给予一些抗生素治疗。

➏ 其他治疗。在免疫系统过度应答的时候，还会误伤肺部组织，加重肺部损伤，理论上此时适当给药抑制免疫系统，或许能减轻肺部损伤和炎症风暴。但目前还没有哪种免疫抑制剂用后对新冠有利大于弊的证据，应用要慎之又慎。

对于一个新型冠状病毒肺炎患者而言，医生护士们能做的事有很多，但都需要根据患者本身的情况进行处理。

最后，无论自愈还是治愈，都希望感染的病人们早日痊愈。

(Executive Editor: Ye Ke, Shang Ruofei)