隨著新冠肺炎疫情在全球加速蔓延,各國(guó)專家開始求助其爆發(fā)地中國(guó),希望以中國(guó)的研究結(jié)果加深對(duì)這種疾病的認(rèn)知。自1月以來,在疫情爆發(fā)中心武漢,許多醫(yī)生一直在潛心從事臨床研究。據(jù)悉,感染者大多為輕癥,但也有一些致死病例。
上周三,參與一線救治工作的中國(guó)醫(yī)學(xué)專家在武漢與北京的中外記者舉行遠(yuǎn)程視頻連線發(fā)布會(huì),分享中國(guó)治療經(jīng)驗(yàn)。以下是這些醫(yī)生的三個(gè)觀察結(jié)果:
潛伏與傳播
坊間傳聞新冠病毒可能有很長(zhǎng)的潛伏期。這不由得讓人們擔(dān)心,病毒攜帶者可能會(huì)在未被察覺的情況下,不知不覺地感染其他人。
2月22日,湖北神農(nóng)架一名70歲男子感染了病毒,但在27天后才出現(xiàn)癥狀。
“從目前報(bào)告的大多數(shù)病例看,潛伏期的中位數(shù)是5至7天,最長(zhǎng)的潛伏期為14天。”國(guó)家衛(wèi)健委高級(jí)別專家組成員杜斌說。“沒有數(shù)據(jù)顯示潛伏期超過14天?!?/p>
北京大學(xué)第一醫(yī)院呼吸內(nèi)科副主任李海潮表示,一些患者在發(fā)病初期,只是輕微的發(fā)燒,但10天后病情卻迅速惡化。
杜斌指出,迄今并沒有證據(jù)表明,康復(fù)后病毒檢測(cè)轉(zhuǎn)陽的患者還會(huì)傳染其他人。他還是北京協(xié)和醫(yī)院重癥醫(yī)學(xué)科的主任醫(yī)師。
澎湃新聞?dòng)谏现芩膱?bào)道稱,武漢一名新冠肺炎患者經(jīng)過治療,病毒檢測(cè)呈陰性,準(zhǔn)予出院,但不到一周后,這名男子再次發(fā)病,送醫(yī)后不治身亡。
年輕患者死亡
這種冠狀病毒的致死率相對(duì)較低,大多數(shù)死亡病例都是免疫系統(tǒng)較弱,或者患有基礎(chǔ)病的老年人。然而,一些相對(duì)年輕的死亡病例則很難解釋。
杜斌表示,諸如高血壓和糖尿病這類基礎(chǔ)疾病、長(zhǎng)期使用無創(chuàng)通氣,以及服用高劑量皮質(zhì)類固醇,是導(dǎo)致這些患者死亡的主要因素。不過,他沒有具體說明他提到的年輕患者的年齡范圍。
世界衛(wèi)生組織指出,中國(guó)重癥患者普遍服用甲潑尼龍,而根據(jù)早前對(duì)中東呼吸綜合征(MERS)、非典(SARS)和流感的研究,這種抑制免疫的皮質(zhì)類固醇藥物跟“長(zhǎng)期的病毒泄出”有關(guān)。
經(jīng)驗(yàn)教訓(xùn)
杜斌說,如果上天讓他重來一次,他會(huì)更加努力地敦促衛(wèi)健委安排指定醫(yī)院的所有ICU醫(yī)護(hù)人員攜手工作,盡早確立最好的重癥監(jiān)護(hù)方式。
此外,對(duì)于所有呼吸衰竭或低血氧水平(即低氧血癥)出現(xiàn)“臨床惡化”的患者,他將更積極地使用有創(chuàng)機(jī)械通氣。
杜斌表示,做好規(guī)劃是應(yīng)對(duì)這場(chǎng)疫情最重要的一環(huán)。各國(guó)需要提前知道如何處理每一位進(jìn)入發(fā)熱門診的病患,需要及時(shí)發(fā)現(xiàn)疑似病例,確定他們是否檢測(cè)出病毒,并做好可能病例的隔離工作。
“各國(guó)必須未雨綢繆,不僅要提供足夠的床位,還要做好所有醫(yī)護(hù)人員的后勤物資保障工作,尤其是個(gè)人防護(hù)設(shè)備?!彼f。
杜斌還表示,湖北省的確診病例確實(shí)在減少,醫(yī)院的空置床位也越來越多。但目前還不能完全排除確診病例數(shù)再次上升的可能性。
譯者:任文科
隨著新冠肺炎疫情在全球加速蔓延,各國(guó)專家開始求助其爆發(fā)地中國(guó),希望以中國(guó)的研究結(jié)果加深對(duì)這種疾病的認(rèn)知。自1月以來,在疫情爆發(fā)中心武漢,許多醫(yī)生一直在潛心從事臨床研究。據(jù)悉,感染者大多為輕癥,但也有一些致死病例。
上周三,參與一線救治工作的中國(guó)醫(yī)學(xué)專家在武漢與北京的中外記者舉行遠(yuǎn)程視頻連線發(fā)布會(huì),分享中國(guó)治療經(jīng)驗(yàn)。以下是這些醫(yī)生的三個(gè)觀察結(jié)果:
潛伏與傳播
坊間傳聞新冠病毒可能有很長(zhǎng)的潛伏期。這不由得讓人們擔(dān)心,病毒攜帶者可能會(huì)在未被察覺的情況下,不知不覺地感染其他人。
2月22日,湖北神農(nóng)架一名70歲男子感染了病毒,但在27天后才出現(xiàn)癥狀。
“從目前報(bào)告的大多數(shù)病例看,潛伏期的中位數(shù)是5至7天,最長(zhǎng)的潛伏期為14天。”國(guó)家衛(wèi)健委高級(jí)別專家組成員杜斌說?!皼]有數(shù)據(jù)顯示潛伏期超過14天?!?/p>
北京大學(xué)第一醫(yī)院呼吸內(nèi)科副主任李海潮表示,一些患者在發(fā)病初期,只是輕微的發(fā)燒,但10天后病情卻迅速惡化。
杜斌指出,迄今并沒有證據(jù)表明,康復(fù)后病毒檢測(cè)轉(zhuǎn)陽的患者還會(huì)傳染其他人。他還是北京協(xié)和醫(yī)院重癥醫(yī)學(xué)科的主任醫(yī)師。
澎湃新聞?dòng)谏现芩膱?bào)道稱,武漢一名新冠肺炎患者經(jīng)過治療,病毒檢測(cè)呈陰性,準(zhǔn)予出院,但不到一周后,這名男子再次發(fā)病,送醫(yī)后不治身亡。
年輕患者死亡
這種冠狀病毒的致死率相對(duì)較低,大多數(shù)死亡病例都是免疫系統(tǒng)較弱,或者患有基礎(chǔ)病的老年人。然而,一些相對(duì)年輕的死亡病例則很難解釋。
杜斌表示,諸如高血壓和糖尿病這類基礎(chǔ)疾病、長(zhǎng)期使用無創(chuàng)通氣,以及服用高劑量皮質(zhì)類固醇,是導(dǎo)致這些患者死亡的主要因素。不過,他沒有具體說明他提到的年輕患者的年齡范圍。
世界衛(wèi)生組織指出,中國(guó)重癥患者普遍服用甲潑尼龍,而根據(jù)早前對(duì)中東呼吸綜合征(MERS)、非典(SARS)和流感的研究,這種抑制免疫的皮質(zhì)類固醇藥物跟“長(zhǎng)期的病毒泄出”有關(guān)。
經(jīng)驗(yàn)教訓(xùn)
杜斌說,如果上天讓他重來一次,他會(huì)更加努力地敦促衛(wèi)健委安排指定醫(yī)院的所有ICU醫(yī)護(hù)人員攜手工作,盡早確立最好的重癥監(jiān)護(hù)方式。
此外,對(duì)于所有呼吸衰竭或低血氧水平(即低氧血癥)出現(xiàn)“臨床惡化”的患者,他將更積極地使用有創(chuàng)機(jī)械通氣。
杜斌表示,做好規(guī)劃是應(yīng)對(duì)這場(chǎng)疫情最重要的一環(huán)。各國(guó)需要提前知道如何處理每一位進(jìn)入發(fā)熱門診的病患,需要及時(shí)發(fā)現(xiàn)疑似病例,確定他們是否檢測(cè)出病毒,并做好可能病例的隔離工作。
“各國(guó)必須未雨綢繆,不僅要提供足夠的床位,還要做好所有醫(yī)護(hù)人員的后勤物資保障工作,尤其是個(gè)人防護(hù)設(shè)備。”他說。
杜斌還表示,湖北省的確診病例確實(shí)在減少,醫(yī)院的空置床位也越來越多。但目前還不能完全排除確診病例數(shù)再次上升的可能性。
譯者:任文科
As the new coronavirus epidemic spreads across the globe, experts are turning to findings from China, where it originated, to better understand the disease. Since January, doctors at the outbreak’s epicenter in Wuhan have been studying the virus whose effects are mostly mild but can occasionally turn deadly.
Medical professionals who have been treating and studying Covid-19 patients in Wuhan shared their insights with reporters in Beijing on last Wednesday. Here are three observations from the doctors.
Incubation and Transmission
Anecdotal reports that the novel coronavirus may have a long incubation have stoked fears that carriers can go undetected and unknowingly infect others.
Local authorities in another city in Hubei -- the same province that Wuhan belongs to -- reported on Feb. 22 that a 70-year-old man was infected by the virus but only showed symptoms 27 days later.
“From most of the publications right now the median incubation period is five to seven days, with the longest incubation period as 14 days,” said Du Bin, a member of China’s team of experts overseeing coronavirus treatment. “There’s no data showing that an incubation period longer than 14 days ever existed.”
In some patients, the onset of the virus happened very slowly with only a mild fever before their conditions deteriorated rapidly 10 days later, according to Li Haichao, deputy director of the respiratory department at the First Hospital of Peking University.
There’s also no evidence so far that people who have recovered and later test positive again for the virus can pass it on to others, according to Du, who is also the director of intensive care unit for internal medicine at Peking Union Medical College Hospital.
On last Thursday, Chinese media The Paper reported that a man in Wuhan who had recovered from Covid-19 and tested negative for the virus died less than a week later from the infection. The report was later removed from the internet.
Younger Deaths
The coronavirus has a relatively low fatality rate and has largely claimed the lives of older patients with weaker immune systems, or those with pre-exisiting conditions. The deaths of some younger patients have been more difficult to explain.
Underlying diseases like hypertension and diabetes, the prolonged used of non-invasive ventilation and high doses of corticosteroids over a long period of time were major factors in those deaths, according to Du. He did not specify the age range he was referring to when speaking of younger patients.
Methylprednisolone, an immune-suppressing corticosteroid drug that’s in common use in China for severe cases, has been linked to “prolonged viral shedding” in earlier studies of MERS, SARS and influenza, according to the World Health Organization.
Lessons Learned
Du said if he could do it all over again, he would have pushed health care authorities harder to have all ICU staff work together in designated hospitals to better establish best practices for critical care.
He also would have been more aggressive in using invasive mechanical ventilation in all patients who showed “clinical deterioration” in their respiratory failure or low blood oxygen levels -- known as hypoxemia.
Planning is the most important aspect of the virus response, according to Du, and countries need to know ahead of time how they are going to handle each patient entering a fever clinic, detect suspected cases, confirm if they have the virus in labs and isolate possible cases.
“You must have a plan to provide not only space but also supplies such as personal protective equipment for all the healthcare workers involved,” he said.
Du said it’s true that there is a decreasing number of patients in Hubei and more empty hospital beds, although it’s impossible to rule out the possibility of another spike in cases.