Introduction
At the end of 2019, the ‘novel coronavirus pneumonia’ ravaged the land of China. This disease shows high rates of infection, incidence and mortality, to which the public population is susceptible.1 2 It spread rapidly across the country within a short time and brought a considerable negative impact on the lives and economy of the Chinese people. In order to prevent the epidemic from spreading, the Chinese government made a wise and decisive move to close the city of Wuhan, which played a vital role in the future victory over the ‘war epidemic’. Taking the epidemic very seriously, the government upgraded the epidemic to a wartime level emergency. Novel coronavirus pneumonia, an acute infectious pneumonia, was named COVID-19. The main clinical manifestations of COVID-19 in China were fever, fatigue dry cough, and a history of being in Wuhan 14 days before the onset of the disease. The outbreak of the disease in the beginning occurred in Wuhan, Hubei Province, and the surrounding cities of Wuhan.3 4 During that time, the high numbers of people reporting a fever attracted great attention. Under this situation, some people began to experience emotions of anxiety and depression.3 Here, we try to distinguish between reoccurrent fever from anxiety/depression induced by epidemic situations and the suspected novel coronavirus pneumonia through the example of this case.
Case history
The patient, male and 18 years old, showed reoccurrent sweating, fever, cough and fatigue for 1 month, having a history of being in Wuhan for an exam a month ago and then returning to Jingmen 2 days later. Community authorities checked his body temperature, showing 37.8°C, and realised that the patient had reoccurrent fever and cough for more than a month, and had been to Wuhan in the past month. This attracted much attention and he was sent to an infectious disease department of a general hospital in Jingmen to be hospitalised and was isolated for suspected COVID-19.5 The results of physical examination were as follows: isometrical pupils sensitive to light reflection, no rigidity in the neck, body temperature of 37.8°C, heart rate of 110 beats/min, respiratory rate of 20 breaths/min and blood pressure of 110/70 kPa. Chest CT showed a few fibrous foci in the right middle lobe. Nucleic acid test of novel coronavirus was negative on admission day and on the third day. Tests of nine respiratory virus, influenza A and B virus antigens showed negative. Mycobacterium tuberculosis antibodies were negative. Thirteen items of extractable nuclear antigen antibody were negative. Ten items of toxoplasma, others, Rubella virus, Cytomegalovirus, erpes virus were negative. No abnormalities were found in blood, urine routine, liver and kidney function, myocardial enzyme spectrum, thyroid function, C reactive protein, equivalent series resistance, hepatitis B, hepatitis C, HIV antibody and treponema pallidum antibody. The patient's temperature did not improve for 5 days after admission. All blood biochemical and auxiliary examinations were normal. Chief complaints from the patient were as follows: when going to Wuhan to take an important exam a month ago, he felt more stressed than before and was always worried about failing the exam; during that time, when COVID-19 was outbreaking, he developed symptoms such as nervousness, sweating, fever, insomnia and dizziness, which made him consider himself as suffering from COVID-19. The patient's mood was low, pessimistic and negative. He reported sleeping poorly at night, sleeping for only about 3 hours a night, being restless in the ward and being nervous during the day. He often sweated after having body tension, and then the body temperature dropped; after experiencing a cold irritation, his body temperature rose again, between 37.5°C and 38°C. His family members reported that he showed a depressed mood for more than a month and had a 6-year history of depression. After ruling out any physical illnesses causing the fever, psychiatrists carefully inquired interviewed the patient and his family members and considered that (1) although the patient had been to Wuhan a month ago, he did not have any close contact with people in Wuhan. He was driven back and forth to Wuhan by his father (2) there were no clinical indicators of ‘COVID-19’ in all auxiliary examinations in the patient (twice nucleic acid test was negative, and no ground-glass CT was seen in the lung), and the close contacts of the patient (his parents and grandpa) did not have fever, cough and other discomforts (and the father, who stayed with him during the hospitalisation, also underwent a novel coronary pneumonia nucleic acid test, which showed negative);6 given that the patient had a history of depression for 6 years and was hospitalised in our hospital three times due to the reoccurrence of depression, was particularly anxious during each episode, and then sweated followed by an increased body temperature; when the symptoms of depression and anxiety improved, his body temperature returned to normal. Considering these aforementioned facts, we thought that the fever symptom was caused by repeatedly catching cold, after a sweat due to anxiety. Hence, he was immediately transferred to the psychology department because of depression and, before the exclusion of COVID-19, underwent isolation treatment from medical staff who were under secondary protection. The patient was admitted to the hospital with complaining of ‘anxiety, depressed mood, slow thinking, self-blame, reoccurrent fever, cough, fatigue for 1 month, and a 6 year history of depression’. The results of psychological examination were as follows: clear consciousness; complete orientation; appropriate emotional response; passive contact; negative pessimism; slow thinking; self-blame and self-incrimination; repeated complaints of infection by ‘novel coronavirus’, which had encumbered his family members; depressed mood; anxiety; poverty of speech; and good insight. Laboratory examinations and blood biochemical examination showed no abnormalities. The Hamilton Depression Scale7 score was 26; the Emotional Self-rating Scale/Depression–Anxiety–Stress Scale 218 showed a depression score of 25, an anxiety score of 16 and a stress score of 30. After admission into the hospital, he was treated with venlafaxine sustained-release tablets (75 mg/tablet, oral administration, two times per day in the morning and midday), olanzapine tablets (2.5 mg/tablet, once a day in the midday, oral anxiolytic) and olanzapine tablets (5 mg/tablet, oral, once every night). After 3 days, the patient's night-time sleep improved significantly with 7 hours of deep sleep every night; anxiety during the day significantly improved; the symptom of sweating in the patient disappeared; and the body temperature dropped to between 36.5 °C and 37 °C. The patient's depressive mood significantly improved after 10 days of treatment. The patient smiled when talking and even said that he was in a good mood and was full of hope for his future life. Additionally, he displayed active thinking and showed no anxiety or low self-esteem and pessimistic mood. After being hospitalised for half a month, he was ruled out from having COVID-19 and was cured of depression and discharged from the hospital. After a week, the telephone feedback showed that the patient's mood was stable and that no discomfort such as fever and cough had occurred.
