展平COVID-19曲线,新冠病毒在空气及物体表面存活时间(新冠肺炎讲座36)

Flatten the COVID-19 Curve, Social Distancing, Hospital Capacities (Lecture 36)

Welcome to another MedCram covid-19 update. As you can see, this is now becoming a pandemic. This is validated with the numbers that are coming outside of China. If we go to the Worldometer site, you can see clearly we are in the acceleration phase here.

欢迎来到MedCram covid-19的另一个更新。如您所见,这正成为大流行病。来自中国境外的数字对此进行了验证。如果我们去Worldometer网站,您可以在这里清楚地看到我们处于加速阶段。

As a result of this, we are seeing some things that are very unusual, notwithstanding, of course, the stock market, which is taking a tumble at this point, but we’re also starting to see things that we’ve never really seen before.

因此,我们看到了一些非常不寻常的事情,尽管股市在这一点上虽然正在暴跌,但我们也开始看到我们从未真正见过的事情。

We’re starting to see official statements made because of the fact that there are groups, there are fans, there are stadiums, where when you have people congregate together, it can spread disease. We’re seeing that from the NHL; we’re seeing that on the NBA website; we’re even seeing spring training Major League Baseball being postponed.

我们开始看到正式的声明,是因为有一群人,有粉丝,有体育馆,当人们聚集在一起时,就会传播疾病。我们从NHL看到了这一点;我们在NBA网站上看到了这一点;我们甚至看到春季训练美国职业棒球大联盟被推迟。

Governor Newsom of California is now able, through an executive order, to commandeer hotels and motels to house coronavirus patients. Patients in the state have already been moved to hotels. The Desert Sun reported that a 120-room hotel in San Carlos, which is near San Francisco, has already been tapped to house passengers from the Grand Princess cruise ship.

加利福尼亚州的州长Newsom现在可以通过一项行政命令来征用旅馆和汽车旅馆,以容纳冠状病毒患者。该州的患者已经被转移到旅馆。 《沙漠太阳报》报道说,位于旧金山附近的圣卡洛斯有120间客房的酒店已经被用来接待来自大公主号游轮的乘客。

There was an executive order released on Thursday that includes the authority for Sacramento to take over hotels and motels for medical use for coronavirus patients in a move, he said, will help the state of 40 million to prepare for any widespread outbreak.

周四发布了一项行政命令,其中包括萨克拉曼多有权接管冠状病毒患者医疗用旅馆和汽车旅馆的举动,这将帮助该州4000万为任何大规模爆发做好准备。

We’re also starting to see here at the municipal government level, Garcetti, who’s the mayor of Los Angeles, urging residents to take steps to protect themselves. But they also banned all events or conferences with more than 50 people. They called these common-sense measures. In San Bernardino County, which is the largest county in the United States, there’s not even a single confirmed case of covid-19.

我们也开始在市政府层面看到洛杉矶市长加塞蒂(Garcetti),他敦促居民采取措施保护自己。但是他们也禁止所有活动或会议禁止超过50人参加。他们称这些常识性措施。在美国最大的县圣贝纳迪诺县,甚至没有一例确诊的covid-19病例。

This website here is very instructive, which I’ll put a link to in the description below. It has to do with this notion of “flattening the curve,” and that’s what I want to talk about today。

因这个网站很有启发性,在下面的说明中将链接至该网站。这与“展平曲线”的概念有关,这就是我今天要谈的。

So here’s the curve. If you have everybody congregating together, of course, the virus is going to move fairly quickly it is thought. If you don’t have protective measures, that transmission is going to be very rapid. But then just as quickly because you have burned a large swath in the population of people, there’s going to be immunity that is built very quickly in the survivors, and then the curve is going to flatten out quickly as well. But there’s going to be so many patients so fast coming into the hospital that we’re not going to be able to take care of them. As it shows here, this is the healthcare system capacity way down here in terms of the daily number of cases.

这就是曲线。当然,如果大家聚集在一起,则病毒会迅速传播。如果您没有防护措施,那么这种传播将会非常迅速。但是很快,因为您已经消耗了一大批人,幸存者会很快建立起免疫力,然后曲线也会很快趋于平坦。但是会有这么多的病人这么快地进入医院,以至于我们无法照顾他们。如此处所示,就每日病例数而言,这是医疗系统容量下降的地方

If, however, we are able to distance ourselves and to shut down the transmission of the virus by spreading us out, so we’re not in close contact with each other, if we’re not congregating together in large masses, then the daily cases, it is thought, is going to come up slowly. Even if it’s the same number of people, we can spread those out so that the amount of cases that we’re seeing on a daily basis doesn’t exceed our ability to take care of those people.

。但是,如果我们能够拉开自己的距离,并通过分散自己来阻止病毒的传播,那么我们就不会彼此密切接触;如果我们没有大量聚集在一起,那么病例将慢慢出现。即使人数相同,我们也可以将其散布出去,以使我们每天看到的病例数量不会超出我们照顾这些人的能力。

We can kind of see that happened in the early phases of this epidemic in China. In the epicenter of this outbreak in Wuhan, the mortality rate was calculated to be higher than the mortality rate outside. Of course, this is not a case fatality rate because we don’t know exactly the toll, and we don’t know exactly the denominator and the numerator involved in that, but if you were to compare those two, you would see that the number of deaths divided by the number of confirmed cases was lower outside of Wuhan than it was inside of Wuhan.

我们可以看到这是在中国这种流行病的早期阶段发生的。在武汉这次暴发的震中,据计算其死亡率高于武汉之外的死亡率。当然,这不是病死率,因为我们不知道确切的数字,也不知道其中涉及的分母和分子,但是如果您要比较两者,您会发现武汉以外地区的死亡人数除以确诊病例的数量低于武汉地区。

Of course the reason for that was that the hospital capacity was just not there, and that was part of the reason why the Chinese felt it was necessary to build thousand-bed hospitals. It was to take care of this swell of daily number of cases.

当然,另外的原因是医院的能力还不存在,这就是中国人认为有必要建造数千张床位的医院的部分原因。这是为了照顾每天增加的病例数。

Distancing is going to slow down the virus, but as it has turned out here from this not peer-reviewed paper that is ready for publication, they did extensive research to answer a question that I have been asked several times, and that is how long does this SARS-cov-2 last on surfaces and in the air?

隔离将减慢该病毒的速度,但是正如从准备发表的这份未经同行评审的论文所证明的那样,他们进行了广泛的研究,回答了我多次询问的问题,即多长时间 SARS-cov-2能在表面和空气中持续存在?

The results are disconcerting. It showed here that the H-covid-19, or the SARS-COV-2, was investigated, and they showed the overall stability is very similar with the original SARS-COV-1 that was found back in 2002. They found that the viable virus could be detected into aerosols up to three hours post aerosolization. So this is when somebody sneezes, or if there is an isolation event, like if the patient is being intubated, or if they’re on a positive pressure mask.

结果令人不安。结果表明,已对H-covid-19或SARS-COV-2进行了研究,结果表明总体稳定性与2002年发现的原始SARS-COV-1非常相似。气雾化后最多三个小时,可以检测到气雾中活病毒。因此,这是有人打喷嚏或有隔离事件的时候,例如患者正在插管或正压面罩。

This could be seen up to four hours on copper and up to 24 hours on cardboard and up to two to three days on plastics and stainless steel, which of course has real implications in hospitals and in operating rooms.

在铜上最多可以看到4个小时,在硬纸板上最多可以看到24个小时,而在塑料和不锈钢上最多可以看到2到3天,这当然对医院和手术室有实际影响。

These two viruses, SARS-COV-1 and SARS-COV-2, exhibited similar half-lives in aerosols with meeting estimates around 2.7 hours. Both viruses show relatively long viability on stainless steel and polypropylene. The median Half-Life was around 13 hours on steel, and around 16 hours on propylene.

SARS-COV-1和SARS-COV-2这两种病毒在气溶胶中的半衰期相似,估计达到2.7小时左右。两种病毒在不锈钢和聚丙烯上均显示出较长的生存能力。钢的半衰期中值约为13小时,丙烯约为16小时。

So basically they found that these viruses can remain viable and aerosols for multiple hours and on surfaces up two days, so you can see that the importance here of masks is there, but really the key is not touching things where this virus may exist, and making sure things get wiped down on a frequent basis, which may give you a question about exactly what could you use to make sure that SARS-COV-2 virus would be eliminated, and we’ll put a link in the description below to EPA website that lists that information.

基本上,他们发现这些病毒可以在多个小时内和在气溶胶中存活数小时,并且在表面上停留两天,因此您可以看到,口罩在这里很重要,但实际上关键是不要接触可能存在该病毒的东西,并且确保经常擦拭所有东西,这可能会给您带来一个问题,即您可以使用什么来确保消除SARS-COV-2病毒,我们将在下面的描述中链接到EPA列出该信息的网站。

Going back to this flattening of the curve. When we eliminate sporting events and meetings, things of that nature, we are able to drag this out. Even though the same number of people might become infected, we are able to better take care of them. I know exactly what it’s like being on the frontline and being in the Intensive Care Unit. How frustrating it is to have more cases than you can actually take care of.

回到曲线的扁平化。当我们取消体育赛事和会议之类的事情时,我们可以取消它们。即使可能感染相同数量的人,我们也可以更好地照顾他们。我确切地知道,身处一线并进入重症监护室是什么感觉。遇到比实际需要多得多的案件是多么令人沮丧。

It doesn’t happen often, and it might happen for just a short period of time. But imagine trying to take care of a very critically ill patient and have another patient becoming critically ill right at the same time, then as that’s happening, something else is happening downstairs in the emergency room that they need help with right away. You just can’t be in three places at once. Oftentimes, when this happens, I call in a backup physician who’s a colleague of mine who’s in clinic. He has to cancel clinic and come in and help me.

它不经常发生,并且可能只在短时间内发生。但是,想象一下要照顾一个重病患者,并让另一个患者同时患上重病,然后这种情况发生了,在急诊室的楼下正在发生其他事情,他们需要立即提供帮助。您只是不能一次在三个地方。通常,发生这种情况时,我会找一位替补医生,他是我的一位同事,正在诊所工作。他必须取消诊所并进来帮助我。

Instead of being an exception to the rule, could be the rule itself. Obviously nobody wants to have a loved one or be that patient in that situation because you want the attention of the doctor to be on you when this is happening. Of course that’s assuming that everything gets done correctly. What you don’t want to have is what’s described here in this medical staff update, and that is Distracted Doctoring and Patient Safety.

规则本身可以代替规则的例外。显然,在这种情况下,没有人希望有一个亲人或成为那个病人,因为您希望在这种情况下,引起医生的注意。当然,这是假设一切正确完成的前提。您不希望拥有的是此医务人员更新中此处描述的内容,即分心医生和患者安全。

Imagine someone being interrupted. By their interruptions, it’s hard to put two thoughts together. You’re not dealing with computers when you go into the hospital even though there are many computers there. You’re dealing with physicians. Physicians who are human beings, who have to think and have to decide what needs to be done on a patient, and they need to take all those things into consideration. If they get interrupted because there’s such an influx of patients coming in, that’s when mistakes can also happen, and that’s what this article points out. I’ll put a link to this article as well.

想象有人被打扰了。由于他们的打扰,很难将两种想法融合在一起。即使那里有很多计算机,当您进入医院时也不需要处理计算机。您正在和医生打交道。作为人类的医师,必须思考并决定需要对患者进行哪些操作,并且他们需要考虑所有这些因素。如果他们因为有大量的病人涌入而被打扰,那是错误也可能发生的时候,这就是本文所指出的。我也将链接到本文。

An example of this point is a recent event. A physician was busy trying to complete progress and consult notes while waiting to get a call back on a page that he had placed. Realizing that there were orders that needed to be put on Patient A, the physician inadvertently placed a medication order into Patient B’s record, which was opened in EPIC. EPIC for those who don’t know is the medical record system.

这方面的一个例子是最近发生的事件。一位医生正忙于完成进度并查阅笔记,而他正等待回拨他放置的页面上的电话。由于意识到需要向患者A发出命令,医生无意中将药物命令记录在患者B的记录中,该记录已在EPIC中打开。对于那些不知道是病历系统的人来说,EPIC。

The staff complied immediately with the order with Patient B, getting the medication intended for Patient A. Fortunately, Patient B did not get injured by the event. But the root cause of this error was the physicians’ momentary distraction while trying to do several routine things at once. That is the key and that is generally going to happen more often if this is the situation that we have versus this being the situation that we have. We just don’t have enough hospital beds, physicians, nurses, ancillary staff, respiratory therapists, to be able to deal with this in a safe way.

工作人员立即遵照患者B的指示,为患者A服用了所需的药物。幸运的是,患者B并未因该事件而受伤。但是,导致此错误的根本原因是医生在试图一次执行多个常规操作时瞬间分散注意力。这是关键,如果这是我们所面临的情况,而不是我们所拥有的情况,那通常会更频繁地发生。我们只是没有足够的医院病床,医生,护士,辅助人员,呼吸治疗师来安全地进行处理。

Pothof says that if everyone practices social distancing and practices good hygiene, it will help slow the spread of the virus so that everyone who will eventually need medical care can be properly treated. If that, what is happening in Italy and China doesn’t happen here. Even though in many parts of the country, where there are no cases, because we really don’t know how widespread this virus is because really we’ve under-tested.

Pothof说,如果每个人都与社会隔离开来并保持良好的卫生习惯,将有助于减缓病毒的传播,从而使最终需要医疗的每个人都得到适当的治疗。如果那样的话,意大利和中国正在发生的事情就不会在这里发生。即使在该国的许多地方,也没有病例,因为我们真的不知道这种病毒的广泛传播,因为我们的确测试不足。

So on this update, we took a little bit of a break from the molecular biology, but next week we’re going to be getting into a lot of the details of this ACE2 receptor. This is the receptor that is targeted by the virus itself. There are a lot of interesting things about this receptor not only from a vaccination and from an entry point, but this ACE2 protein is not in isolation, it does have a function, and that function may be modified by the binding of this virus. It’s interesting to talk about the implications of that modification. We’re also going to talk about practical things that you can do. And what does it mean to have immunity. Thanks for joining us.

因此,在此更新中,我们在分子生物学上稍作休息,但是下周我们将深入研究该ACE2受体的许多细节。这是病毒本身靶向的受体。关于该受体的很多有趣的事情,不仅是从疫苗接种和从切入点开始,而且这种ACE2蛋白并不是孤立的,它确实具有功能,并且该功能可以通过与这种病毒的结合而被修饰。谈论这种修改的含义很有趣。我们还将讨论您可以做的实际事情。拥有免疫力是什么意思。感谢您加入我们。

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