Curve Flattening in California, PPE in the ICU, Medication Trials (Lecture 48)
加利福尼亚的曲线变平，ICU中的PPE，药物治疗（48讲）
Welcome to another MedCram Covid-19 update. And we are well on our way to a million plus cases confirmed and almost 50,000 deaths worldwide and the large majority of those cases are in the United States at 215,000.
欢迎收听MedCram Covid-19的另一个更新课程。全球确诊病例即将超过一百万，死亡病例有将近50,000，其中大部分病例在美国，达到215,000例。
And a large proportion of those are in New York, followed by New Jersey and then California. I wanted to apologize for no video yesterday. It’s been a busy week. I’m back in the Intensive Care Unit. And for the first time this week, I have seen the eyes of the enemy. I am working in the Intensive Care Unit where I’m taking care of Covid-19 patients and it’s completely changed how we do work.
其中很大一部分在纽约，其次是新泽西州，然后是加利福尼亚州。很抱歉我昨天没有做视频课程。这一周很忙。我回到了重症监护室。这是我本周第一次见证死亡。我在加护病房工作，负责照顾Covid-19患者，这完全改变了我们的工作方式。
We are very conscious about personal protective equipment. There are negative pressure rooms. We’ve expanded negative pressure rooms. Going into one of these negative pressure rooms is literally like getting ready to go out on a spacewalk.
我们对个人防护设备非常了解。有负压室。我们扩大了负压室。进入这些负压房间之一就像在太空行走一样。
You have to have an n95 mask, of course, covered up with a surgical mask, and you also have to wear eyewear protection, which is not your typical eyewear protection. It’s goggles so that the virus, if it is in the air, doesn’t get into your eyes. You also have to have a hair cover like a cap or a hat, not to mention that you have to have gloves on and a gown. Usually, you have to have shoe covers as well.
当然，您必须戴n95口罩，并用外科口罩遮盖住，并且还必须佩戴护目镜，这不是一般的护目眼镜。戴这种护目镜，即使病毒在空中，也不会进入你的眼睛。你还必须有一个像帽子这样的发套，更不用说你还必须戴上手套和防护服。通常，你还必须要穿鞋套。
Of course, putting all that stuff on is not so difficult. If you’re clean and you’re outside the room, that’s not the hard part. The hard part is after you’ve gone in the room and done what you’re supposed to do and now you’re about to come out because you’ve got to assume that the virus has landed on every part of your exterior surface.
当然，穿戴上所有这些东西并不是那么困难。如果你很干净而且在房间外面，那不是难事。难的是在你进入房间并做完了你应该做的事情之后，现在你要出来了，因为你必须假定该病毒已降落在你外表的每个部分。
And so what you have to do is take off all of these things in the right order without contaminating yourself. And putting on the materials called Donning and taking it off is called Doffing and it’s the Doffing part that you can kind of mess up and you have to be careful.
因此，你要做的就是以正确的顺序卸下所有这些东西，而不会污染自己。穿上防护的过程被称为Donning，脱下防护的过程被称为Doffing，正是Doffing的这一步，你可能会弄糟，你必须要小心。
And at each step of the process of taking one thing off first and then the other, you have to make sure that you’re using hand sanitizer on your hands, your gloves at first and then finally down to your hands. And as soon as you are finally done and you’re out of the room, you’ve got to go and wash your hands very carefully and make sure you don’t contaminate yourself.
在先脱下一件防护然后再脱下另一件防护的过程的每个步骤中，你都必须确保先使用洗手液，先是手套上，然后才是手上。一旦你完成工作并离开房间，就必须非常小心地洗手，并确保自己不会污染自己。
We now walk around the units with a mask on to make sure that we don’t touch our face. This significantly slows things down, but it’s a necessity and it’s something that we have to live with. And our hospital is resilient and it’s making it work in terms of what we talked about last time and those huge collections of patients that are coming to the hospital but don’t meet the criteria to be admitted.
现在，我们戴着口罩在监护室周围走动，以确保不要碰到脸。这大大降低了速度，但这是必须的，这是我们必须忍受的。我们的医院政策灵活，并且正在按照我们上次说的观点拒绝接受不符合入院标准的大量患者。
We talked about the role of hydrotherapy and especially since we looked at those accounts in non peer-reviewed journals back in 1918 and 1919 and some of the things that we could do. I’m actually in touch with an experts in hydrotherapy. And in terms of what the protocols would be based on their experience, I plan on revisiting this in the future, but there’s a lot of other topics that we want to talk about.
我们讨论了水疗的作用，尤其是因为我们回顾了1918年和1919年未经同行评审的期刊中的这些报道以及我们可以做的一些事情。我实际上与水疗专家保持联系。关于基于他们的经验的基础采取什么治疗方案，我计划在将来重新讨论它，但是我们还有很多其他话题需要讨论。
So first to this interesting article published in the Washington Post showing some good news: social distancing works. The earlier the better, California and Washington data show. And it goes through very nicely about how the curve that we’re trying to flatten was flattened. This is per 100,000 cases and you can see here from March 13 to March 31 the United States on average in terms of the growth in Seattle can see how this kind of was flattened in comparison to what happened here in New York.
首先刊登在《华盛顿邮报》上的这篇有趣的文章发布了一些好消息：保持社交距离起作用。加利福尼亚和华盛顿的数据显示，越早实施越好。它很好地介绍了我们要展平的曲线是如何展平的。这是每100,000例病例，你可以在这里看到3月13日至3月31日，从西雅图的增长趋势来看，并与纽约发生的情况相比，美国可以看到曲线变得平坦了。
We can see here in Miami that there was a regional order to stay home and there was some flattening, but not as much in the Boston area, certainly not as much. Then San Francisco, there was a flattening of the curve here and you can see that there was two orders: there was restaurants and public events bans and then there was a county order to stay at home in the San Francisco Bay area, of course that spread to just about all of California.
我们在迈阿密可以看到，有一个地区命令要求待在家里，病例曲线有些趋于平缓，但在波士顿地区却没有那么大变化。然后是旧金山，这里的曲线趋于平缓，你可以看到有两个命令：有餐馆和公共活动禁令，然后有一个县命令，要求旧金山湾区的人呆在家中，当然，这些命令几乎遍及整个加利福尼亚。
Also some good news is that California Governor Gavin Newsom is feeling more confident that the state can handle what’s coming based on what he‘s seeing with this flattening of the curve.
还有一些好消息是，加利福尼亚州州长加文·纽瑟姆（Gavin Newsom）更加自信，该州可以根据他所看到的曲线平缓来处理即将发生的事情。
And as we’ve talked about before here on MedCram, it takes some time. Remember there’s about a five day incubation period median, another seven or eight days before about 20% will need to be hospitalized because of pneumonia shortness of breath, etc. So it’s almost about two weeks before you start to see the effect of that. And we’re sort of getting into that period now about two weeks since we’ve had this thing called social distancing and isolation here in California.
正如我们之前在MedCram上讨论的那样，这需要一些时间。请记住，潜伏期大约为5天，大约20％的患者因肺炎造成的呼吸急促而需要住院之前还有七，八天的时间。所以大约要两周的时间才能开始看到这种效果。由于我们在加利福尼亚州施行保持社交距离和隔离的政策，我们现在进入这一平缓阶段（大约两个星期）。
The other thing I wanted to talk to you about is this study post-exposure prophylaxis and treatment for SARS-CoV2. The type of enrollees that would fit the criteria are: number one exposed without symptoms and number two exposed with symptoms. In other words, if you were closely exposed to a person with a confirmed test within four days of enrolling and live in the same household as this person or are a healthcare worker or if you have symptoms and currently diagnosed with confirmed Covid-19 within four days of symptom onset.
我想与大家讨论的另一件事是这项SARS-CoV2接触后预防和治疗的研究。符合条件的参与者类型为：第一：无症状接触；第二：有症状接触。换一句话说，如果你在参与研究后四天内与经过确认测试的人紧密接触并与其住在同一家庭中或是医护人员，或者你有症状并且在症状发作后四天内被确诊为Covid-19。
This is a way of testing to see whether or not hydroxychloroquine might prevent you from coming down with the virus. And here’s the sheet that you get when you sign up. They can tell you here about what happens with the SARS-CoV1 virus. That was the initial SARS virus and what happens when you increase the chloroquine here. So this is an important trial that you might be able to be involved with, but remember that you’ve got to be involved within four days.
这是一种测试方法，以查看羟氯喹是否可以阻止你感染该病毒。这是你注册时得到的表。他们可以在这里告诉你SARS-CoV1病毒的情况。那是首次SARS病毒，当你在增加氯喹时会发生什么。这是你可以参与的重要试验，但请记住，你必须在四天内参与其中。
I’ll have a short video today just because it’s a busy week, but we do intend to get into a lot of questions and recommendations and requests that you’ve had.
我今天视频课程短，因为这一周忙，但我们确实想听大家提出问题、建议、请求。
We look over all of the comments and we try to answer as many of those comments as we can. We’ve had a lot of requests about Kirsten zinc, about hydroxychloroquine, about chloroquine about nutrition, about diets. We’re going to try to get to all of those things in due time.
我们查看所有评论，并尝试尽可能多地回应这些评论。我们有很多关于Kirsten锌、羟氯喹、氯喹，营养、饮食方面的请求。我们将尝试在适当的时候解决所有这些问题。
Until next time. Thanks for joining us.
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