氯喹治疗新冠在法国的进展 （新冠讲座39）
Rapid COVID-19 Spread with Mild or No Symptoms, More on Hydroxychloroquine (lecture 39)
Welcome to another MedCram covid-19 update. We are looking at a total of almost 200,000 cases that are confirmed worldwide. Total deaths 7948; total recovered 81,000. If we look at Italy, we have 31,506 cases and 2,500 deaths. If we compare that to, for instance, South Korea, which has done extensive testing, and has despite that only about 1/4 of the cases, and only eighty-four deaths. Interesting numbers. The United States has 6362 confirmed, with 180 deaths and 17 total that have recovered.
欢迎来到MedCram covid-19的另一个更新。我们正在看到全球已确认的近20万例病例。死亡总数7948；康复81,000。如果看意大利，我们有31,506例病例和2,500例死亡。如果将其与例如韩国进行比较，韩国已经进行了广泛的测试，尽管如此，只有大约意大利1/4的病例，只有84例死亡。有趣的数字！美国已确诊6362例，其中180例死亡，17例已恢复。
There was an interesting paper that was published in Science that I will show you later, and I also put a link in the description below. Basically what it shows is that at a single point where this virus started, and we expanded out, there was a point where the travel ban went into effect in China. That was on January 23rd.
在《科学》杂志上发表了一篇有趣的论文，稍后我将向您展示，并且在下面的说明中也添加了链接。从根本上讲，这表明该病毒始于我们扩展的某个地方，在这一点上，旅行禁令在中国生效。那是1月23日。
What they did is they use Bayesian statistics to try to figure out how many people went undiagnosed, and which people were diagnosed in terms of before and after the travel ban. Using Bayesian statistics, they found that 86% of covid-19 patients prior to January 23rd went undiagnosed.
他们所做的是，他们使用贝叶斯统计数据来尝试找出有多少人未得到诊断，以及根据旅行禁令前后对哪些人进行了诊断。使用贝叶斯统计，他们发现1月23日之前的covid-19患者中有86％未被诊断。
In other words, here is the proportion of patients here at 86%, by the time we get to January 23rd in our timeline going across the bottom. These people here did not get tested for covid-19, so they didn’t know that they had it. The authors note that those who don’t get diagnosed often had mild, limited or no symptoms at all. So in other words, if these people had severe symptoms they probably would have gone to the hospital, and they probably would have gotten tested, but they didn’t get tested, so many of them were walking around with mild or no symptoms, going to work, going to school, going to restaurant.,etc.
换句话说，到1月23日到达时间表的最低点时，这里的患者比例为86％。这些人没有经过covid-19的测试，因此他们不知道自己是否有过。作者指出，那些没有被诊断出的人经常有轻度，有限或根本没有症状。因此，换句话说，如果这些人有严重的症状，他们很可能会去医院就诊，可能会接受检查，但是他们没有得到检查，所以他们中许多人轻度或无症状地走动，上班，上学，去餐厅等。
Furthermore, the author’s mathematical model predicts that these undocumented cases, where the source of approximately 79 percent of all reported cases in China. Had these people known that they had covid-19 and not spread it, let’s say that they were in isolation, because they knew they had the virus according to the model, the number of cases in China would have dropped by 79 percent, and the number of cases in Wuhan would have dropped by 66%.
此外，作者的数学模型预测这些未记录的病例，其中约有79％的病例来自中国。如果这些人知道他们拥有covid-19病毒并且没有传播，则说他们是孤立的，因为他们知道按照该模型携带该病毒，中国的病例数将减少79％，并且武汉的病例数将下降66％。
So this is the article that was published in Science, which is about as good as you get in terms of peer-reviewed journals. So you can go ahead and look at the graphs in the link in the description below. But I wanted to point out some things in their conclusion. “Our findings also indicate that a radical increase in the identification and isolation of currently undocumented infections would be needed to fully control SARS-cov2.
这是《科学》杂志上发表的文章，这是最好的同行评审期刊。因此，您可以继续阅读下面说明中链接中的图表。但是我想在他们的结论中指出一些事情。 “我们的研究结果还表明，要完全控制SARS-cov2，就需要从根本上增加对目前未记录的感染的识别和分离。
Just think about that. The two things here that they’re looking at, identification – that can only come from increased testing, and isolation – that’s what we have to do as citizens.
他们正在研究的两件事是确定病例-只有通过增加测试和隔离才能实现-这是我们作为公民必须要做的。
The key is understanding that a very large majority of the patients who had been infected at the time of the travel ban didn’t know that they had been infected with the coronavirus. Because of the fact that they didn’t isolate themselves, they were unfortunately, unwittingly able to infect far more people.
关键是要了解，在旅行禁令实施时被感染的绝大多数患者并不知道自己已被冠状病毒感染。由于他们没有孤立自己的事实，因此他们不幸地，不知不觉地能够感染更多的人。
This is interesting. Their model predicts that the undocumented infections were less contagious, 55% as contagious as documented infections. But since there were a lot more of this undocumented infection group, this group of people contributed most to the spread of covid-19 in China.
这是有趣的。他们的模型预测，未记录的传染病的传染性较小，与记录的传染病一样，其传染性为55％。但是，由于这个未记录在案的感染人群更多，因此这一人群对covid-19在中国的传播贡献最大。
The 2009 H1N1 pandemic influenza virus also caused many mild cases quickly spread globally and eventually became endemic.
2009年的H1N1大流行性流感病毒还导致许多轻度病例迅速在全球传播，并最终成为地方性流行病。
Presently, there are four endemic coronavirus strains currently circulating in human populations, and they’re listed there. If the novel coronavirus follows a pattern of 2009 H1N1 pandemic influenza, it will also spread globally and become a fifth endemic coronavirus within the human population.
目前，有四种流行的冠状病毒菌株在人群中传播，并在此处列出。如果新型冠状病毒遵循2009年H1N1大流行性流感的模式，它还将在全球传播，并成为人类中的第五种地方性冠状病毒。
These findings explain the rapid geographic spread of SARS-cov-2 and indicate containment of the virus will be particularly challenging, and that’s what we’re finding out at this point. What I get out of this article is basically the best way to flatten the curve is to isolate. Otherwise, you might be having a similar situation to what is going on in Italy at this time.
这些发现解释了SARS-cov-2在地理上的迅速传播，并表明遏制该病毒将特别具有挑战性，这就是我们目前要寻找的。从本文中得出的结论基本上是使曲线变平的最佳方法是隔离曲线。否则，您可能会遇到与意大利目前类似的情况。
I want to revisit the entire zinc and chloroquine, hydroxychloroquine issue because that seems to be picking up rapid speed here in the last couple of days. So the first thing is, of course, here’s this very busy picture enough to say that when the coronavirus infects the cell, it’s going to dump in to your cell a messenger RNA that’s going to be translated using ribosomes. Those ribosomes, the first thing they’re going to do is translate that RNA molecule into a protein called RNA-dependent-RNA polymerase, or replicase, and it is this enzyme that it’s been shown that is inhibited by high intracellular concentrations of zinc.
我想重新审视整个锌和氯喹，羟基氯喹的问题，因为在过去的几天里，这似乎正在迅速发展。因此，第一件事当然是这张非常繁忙的图片，足以说明当冠状病毒感染细胞时，它将把信使RNA倾倒到您的细胞中，该信使RNA将通过核糖体进行翻译。这些核糖体要做的第一件事是将RNA分子翻译成一种蛋白质，称为RNA依赖性RNA聚合酶或复制酶，并且已证明正是这种酶被高细胞内锌浓度抑制。
As it turns out, chloroquine is a zinc ionophore as is hydroxychloroquine. Zinc ionophore is just basically a protein or a gate that allows zinc to come into the cells. We don’t know if that is the actual way that it is working in this case, but it does seem to lead credence to the mechanism of action that zinc does inhibit replicase, and that hydroxychloroquine and chloroquine increase intracellular concentrations of zinc. For more on hydroxychloroquine and chloroquine and dosing and mechanism and recent articles, please go to Update 35, which will give you a lot of the background information.
事实证明，氯喹和羟基氯喹一样都是锌离子载体。锌离子载体基本上只是一种蛋白质或使锌进入细胞的门。我们不知道这是否是在这种情况下起作用的实际方式，但是它似乎确实证明了锌确实抑制复制酶，以及羟氯喹和氯喹增加细胞内锌浓度的作用机理。有关羟基氯喹和氯喹，剂量和机理以及最新文章的更多信息，请转到Update 35，它将为您提供许多背景信息。
What I wanted to show you today was some recent reports, but not actual publications as yet. There was an article that was published in today’s edition of a French publication called The Connection. French researcher posted a successful covid-19 drug trial. I don’t know if this has been peer-reviewed or even published in a journal, but it is a newspaper article that talks about a renowned research professor in Marseille, France by the name of Professor Raoult, and there is a video in French on YouTube, which I will put the link to, and this is what is reported.
我今天想向您展示的是一些最近的报告，但还没有实际的出版物。在今天的法国出版物“The Connection”中发表了一篇文章。法国研究人员发布了一项成功的covid-19药物试验。我不知道这是否经过同行评审，甚至还没有发表在杂志上，但这是一篇报纸上的文章，谈到了法国马赛的一位著名研究教授，名叫拉乌尔特教授，并且有一段法语录像带在YouTube上，我将其链接到该网站，这就是报道的内容。
There is a medication, of course, chloroquine and hydroxychloroquine, which is marketed as Plaquenil. What they say here is that they took 24 patients who are among the first patients to become infected in southeast France. The patients were given 600 micrograms per day for 10 days. They were closely monitored. What they found was that they were able to ascertain that patients who had not received Plaquenil, which is the drug, were still contagious after six days. But of those that had received Plaquenil after six days, only 25% were still contagious.
Plaquenil是一种氯喹和羟氯喹药物。他们在这里说的是，他们带走了24名患者，这是法国东南部首批被感染的患者。每天给患者600微克，持续10天。他们受到密切监测。他们发现，他们能够确定未接受药物Plaquenil的患者在六天后仍具有传染性。但是在六天后接受了Plaquenil的那些中，只有25％仍然具有传染性。
A caution here: because we don’t actually have the peer-reviewed data, this was only 24 patients. But this is an interesting finding as it may represent the first glimpse into some of the trials that will be coming out in the next few months. I’m sure the professor was very excited to get this word out.
请注意：由于我们实际上没有经过同行评审的数据，因此只有24例患者。但这是一个有趣的发现，因为它可能代表了即将在未来几个月进行的一些试验的第一眼。我相信教授会很高兴听到这个词。
Here is a similar news on another French news site, coronavirus, hydroxychloroquine would be effective according to Professor Raoult, and we don’t have the actual paper published as yet, but this is the highlights from the press conference that again I will link to in the description. It says here that the professor presented the first results of the clinical tests with hydroxychloroquine, and the results are even more promising with hydroxychloroquine and Azithromycin, an antibiotic effective against viruses.
根据拉乌尔特教授的说法，这是另一个法国新闻网站上的类似新闻，冠状病毒，羟氯喹将是有效的，我们没有看到发布的论文，但这是新闻发布会的重点，我将再次链接到在说明中。此处说的是，这位教授介绍了使用羟氯喹进行临床试验的第一批结果，而采用羟氯喹和阿奇霉素（一种对病毒有效的抗生素）的结果则更有希望。
Azithromycin, for those who don’t know, is an antibiotic; it’s the active ingredient in what you may know as Z-packs that you might get if you went to the urgent care, or your primary care doctor, or the emergency room, and had an infection. That’s interesting that azithromycin might have an effect against viruses. It’s an interesting point and one that has to be looked into to see why that was the case.
阿奇霉素是一种抗生素。它是Z-packs中的有效成分，如果您去急诊室，初级保健医生，急诊室并受到感染，可能会得到Z-packs。有趣的是，阿奇霉素可能具有抗病毒作用。这是一个有趣的观点，必须研究一下为什么会这样。
There are some indications that Azithromycin may have anti-inflammatory properties. One of the other concerns that I would have personally is the fact that hydroxychloroquine may have QT prolongation issues, and we know that those are issues also that are present with Azithromycin. QT prolongation is a consequence of a number of medications which can lead to fatal cardiac arrhythmias if not monitored correctly. Apparently, the government was impressed enough to extend this test to other hospitals to test its effectiveness on a much larger scale.
有迹象表明，阿奇霉素可能具有抗炎作用。我个人会担心的另一个问题是羟氯喹可能存在QT延长问题，我们知道这些也是阿奇霉素也存在的问题。 QT延长是许多药物的结果，如果监测不正确，可能会导致致命的心律不齐。显然，政府对这项检查印象深刻，足以将这项检查扩展到其他医院，以更大规模地测试其有效性。
And if we go back to the table of countries here, we know that South Korea has used this medication early with extensive testing. We can see here that the mortality, or the number of deaths divided by the number of confirmed cases, is quite small. In fact, it’s about 1%. This makes one wonder if chloroquine is part of that calculus.
如果我们回到这里的国家表，我们知道韩国已经在广泛的测试中使用了这种药物。我们在这里可以看到，死亡率或死亡人数除以确诊病例的数量非常少。实际上，大约是1％。这使人们想知道氯喹是否是该演算的一部分。
Well, that’s it for today. Further updates will talk about this idea of re-infection and immunity. Thanks for joining us.
好了，今天就这样。进一步的更新将讨论这种关于重新感染和免疫的想法。感谢您加入我们。
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