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周五发表的冠状病毒研究报告和疫情如何传播足以让人瞠目!这一发现意味着什么?




(大中报/096.ca讯)CNN报道说,周五/2020年2月7日发表在医学杂志《 JAMA》上的一项研究报告发现,中国武汉一家医院诊断出的首批138例患者中,有41%假定是在该医院被传染的。

这项研究报告的作者是汤姆·弗里登(Tom Frieden)。弗里登博士是美国疾病控制与预防中心的前任主任,也是纽约市卫生局的前任专员。他目前是Resolve to Save Lives的总裁兼首席执行官,Resolve to Save Lives是由彭博慈善基金会,Chan Zuckerberg Initiative和Bill and Melinda Gates Foundation资助的全球非营利性组织,也是全球非营利性Vital Strategies的一部分。

这是一个大新闻。用英语来说,这意味着这家医院最初被传染的人几乎有一半在医院内部发生的。医学上称之为医院传播(Nosocomial)。 (医生用Nosocomial这个词是怕吓着别人:此词的意思是病是在医院里得的。)

而且,大多数被传染的人似乎并非是所谓的“超级传染事件”,即单个患者将病毒传染给多人。在这些情况下,诸如支气管镜检查(医生将管子插入病人的肺部)之类的程序可能会导致许多人被病毒传染。



这将是一个令人头疼的问题,因为许多医疗保健工作者和许多患者在医院的各个角落被病毒传染。更重要的是,由于只有生病的患者才被检查,因此在医院里被传染比例可能远超过41%。

因此,像SARS和MERS(其他冠状病毒)一样,武汉冠状病毒正在医院传播。

这一发现意味着什么?

该病毒似乎具有很强的传染性,医护人员的风险尤其高。因此我们迫切需要有关该病毒的传染性的更多信息。该病毒很可能无法控制-正如无法预防普通感冒和流行性感冒一样,但这对健康和社会的影响却可能很大。

中国为制止该病毒的传播正在付出的巨大努力,即使未成功,却有可能减慢其传播速度,并减低该病毒对中国乃至世界造成的危害。



我们现在需要做什么?

我们必须保护医护人员和其他照顾病人的人。这需要层层设防:包括病源,控制的方法,监管和个人的自我保护。

病源控制包括鼓励病情较轻的患者不要与别人接触。要求所有生病的人都戴口罩;限制可能得病的人到医院就诊;确保生病的卫生保健工作者下岗,尽可能地减少那些与怀疑有病的人的医护人员人数;确保仅在隔离室中进行是否得病和得病程度的检查,例如支气管镜和痰液检查。

控制措施包括将病人隔离在预诊的区域中,确保他们不会污染室内的空气,并仔细清洁接触物表面,并对可疑情况采取其他预防措施。

监管措施包括问患者是否有症状并进行体温检查;要求咳嗽或发烧的人戴上口罩,并将它们与他人保持至少一米距离,直到对其进行更彻底的评估。快速鉴别所有可能感染的患者,并在所有医疗保健机构的各个角落及早实施严格的控制传染程序,这一点尤其重要。



个人自我保护措施包括洗手和防止空气传染。但是,没有症状,不需照顾病人的人不用戴口罩,这样反而会让那些需要口罩的人无法获得口罩,造成不必要的危害。口罩是医护人员和照顾病人照顾病人的人必备的东西。在卫生保健机构中,对那些可重复使用的安全呼吸设备的消毒至关重要。保持空气清洁的设备包括个人空气净化设备和弹性呼吸器(elastomeric respirators)。患者还必须戴口罩以减少通过呼吸传播病毒。

我们还需要知道什么?

我们正在不断地研究这一新病毒,但不幸的是,有太多的问题需要中国回答。

中国正在加强对此病毒的测试,护理和减少其对社会的影响。很高兴看到中国开始公布流行病学研究需要的那些信息和数据。



但是,我们仍然不知道许多基本的信息,包括中国都对那些人进行了检查,检查结果为阳性的比例是多少,病情是如何随着时间的推移而变化的,那些阳性患者都住在哪里,病人每周的测试结果和患者的年龄。举一个例子:有多少儿童接受了测试?儿童被传染的很少是因为没有对他们检测,还是他们被传染的可能性小?

对测试结果为阳性的人按年龄,性别和基本医疗状况分析,发展成严重疾病的比例是多少?通过对比分析,各个组死亡的比例是多少?

在武汉和其他地区通过聚合酶链反应(PCR)检测的鼻咽液体取样,有咳嗽的患者中有多少比例受到感染?通过PCR测试确认没有咳嗽的人中有新冠状病毒的比例是多少?

这些问题的答案将有助于确定该病毒是否已经广泛传播(即已成为地方病并且无法制止),占总感染比例的重病以及此病是否达到高峰。



新冠状病毒下一步将影响那些地方?

只有时间会给出答案。接下来的几天和几周将确定:

-    其他国家是否开始不断有人得病,这种情况似乎不可避免。
-    如果这一情况发生,这些国家能否防止疫情扩大?不幸的是,这似乎不太可能。
-    其他国家被传染的病人会病到何种程度,我们目前还不清楚。

在我们掌握这些关键信息之前,我们将无法评估这种新型冠状病毒的危害程度,以及哪些控制措施最有可能减缓传播速度。

编注:本评论中表达的观点仅是作者的观点。




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