WHO宣布全球卫生紧急情况，病毒传播和德国案例 （新冠肺炎讲座7）

WHO宣布全球卫生紧急情况，病毒传播和德国案例 （新冠肺炎讲座7）

Global Health Emergency Declared, Viral Shedding, & Germany Case

Welcome to another MedCram update on the coronavirus. As of yesterday, it was 170 deaths and 7,783 confirmed infectious cases. This update is for January 31st, 2020.  So overnight, we’ve gone to unfortunately 213 deaths and 9,776 confirmed infections. Most of those in mainland China. This data is coming from the WHO and other healthcare agencies coming together. It’s about a 26 percent increase in the number of confirmed infections and a 26% increase in the number of deaths.

欢迎来到有关冠状病毒的另一个MedCram讲座。截至昨日，已有170例死亡和7,783例确诊感染病例。此更新于2020年1月31日发布。不幸的是，在一夜之间，我们去世了213例死亡和9,776例确诊感染。大多数在中国大陆。此数据来自WHO和其他医疗机构。确诊感染人数增加了26％，死亡人数增加了26％。

Now, I noticed I’ve got a lot of comments about the potential fallacy of dividing the numerator here, which is the number of deaths, which is current divided by the number of infections, which may have not matured to the effect that they may have caused mortality because it may be too early in the course, and I understand that, and a lot of people do understand that.

现在，我注意到我对分子除法的潜在谬误有很多评论，分子除法是死亡数，目前是死亡​​数除以感染数​​，这可能尚未成熟到可能之所以造成死亡，是因为它可能还为时过早，我了解这一点，很多人的确知道这一点。

The problem is though is the incubation period can vary quite long. And so, you know, do you go back one week to see what the case infection rate is? Do you go back three days? And so, if you really want to figure out what this is, of course you wait to the very end until the epidemic is over, which will hopefully be very soon, and then you take that numerator and divide it by that denominator, and you will get yet what the case fatality rate is.

问题是潜伏期可能会相当长。因此，您知道吗，您是否会回去一周查看病例感染率是多少？你回去三天了吗？因此，如果您真的想弄清楚这是什么，那么您当然要等到流行结束之后，才有望很快到来，然后您将分子乘以该分母，就可以了。将会得到病死率是多少。

Unfortunately, we can’t do that in the middle of it. And as we’ll talk about very shortly, the incubation may not be as long as we think, which is fortunately a good thing. However, there’s a trade-off in this situation as we’ll talk about in the Germany case very shortly, where there may be asymptomatic shedding of the virus.

不幸的是，我们无法做到这一点。而且，正如我们将很快讨论的那样，孵化可能不会像我们想象的那样长，这是一件好事。但是，在这种情况下需要权衡取舍，我们将在不久的德国案例中谈到，这种情况下可能会无症状地释放出该病毒。

And that brings us to the other point is: Yes, well, there may be an underestimation of the mortality rate by looking at the current numerator and divided by the current denominator, there’s also the possibility of way overestimating the mortality rate if there’s a bunch of asymptomatic infections, where people get it and they get better, then this denominator down here is actually way bigger than we think it is. If that’s the case, well, then this mortality rate is much less than 2%.

这又使我们得出另一点：是的，通过查看当前分子并将其除以当前分母可能会低估死亡率，如果有很多的话，还有可能高估死亡率在无症状感染的情况下，人们可以得到并得到改善，那么这里的分母实际上比我们认为的要大。如果是这样，那么这个死亡率就远远低于2％。

It’s hard to say exactly what it is at this point. Suffice to say, that if you want to look at an easy way of comparing how the mortality rate is changing over time, simply take the current fatality rate and divided by the current estimated infection rate.

现在很难确切地说出它是什么。可以说，如果您想研究一种比较死亡率随时间变化的简单方法，只需将当前的死亡率和当前的估计感染率相除即可。

We’re probably underestimating both the numerator and the denominator here because there’s just not enough kits to go around to test everybody. If you think about it in China, they’re not going to be testing people who might have a little bit of malaise if they’ve got a hospital full of people who had pneumonia. Those are the ones that are going to get tested. So what you may be seeing here in China is people who are very ill getting tested for the coronavirus, and that may make the mortality rate go higher because you’re selectively testing people that are sicker whereas here in the United States, we’re testing anybody who sneezes wrong that’s come from China.

我们这里可能低估了分子和分母，因为没有足够的工具包来测试每个人。如果您考虑一下在中国的情况，他们将不会测试如果他们的医院里充满了肺炎患者，他们可能会感到不适。这些是将要测试的。因此，您在中国这里可能会看到正在接受冠状病毒检测的病情严重的人，这可能使死亡率更高，因为您正在选择性地检测那些较病的人，而在美国，我们正在测试来自中国的任何打喷嚏错误的人。

And so we maybe picking up a lot of asymptomatic cases, and that may be the reason why all of the deaths that we are seeing are almost exclusively from China, and nobody outside of China, and in the United States, nobody has really come down with a serious illness.

因此，我们可能接手了许多无症状的病例，这可能就是为什么我们看到的所有死亡几乎都来自中国，而没有人在中国以外，在美国，没有人真正死亡病重。

So these are observations. These are not facts. We don’t know yet. These are hypotheses. So to keep it simple. We’re going to go ahead with the current mortality rate divided by the current infection rate. Not saying that that is the mortality rate, but it’s certainly a way to track it. And so you’re comparing apples to apples.

这些是观察结果。这些不是事实。我们还不知道。这些是假设。因此，保持简单。我们将继续使用当前的死亡率除以当前的感染率。并不是说那是死亡率，但这当然是一种追踪死亡率的方法。因此，您正在将苹果与苹果进行比较。

But the total infection rate is way past SARS. Now, we are treading on new territory when it comes to viral epidemics, and that brings us to the other news which of course the WHO has now said that this is a serious global emergency in terms of a virus.

但是总的感染率已经超过了SARS。现在，在涉及病毒流行方面，我们正在迈入新的领域，这使我们想到了另一个新闻，当然，世卫组织现在已经说，就病毒而言，这是严重的全球紧急情况。

Now the other big news today is in Riverside, which is close to home for me because that’s the county that I work in, in Southern California, and I actually worked with the public health officer for Riverside County – Dr. Kaiser, who today had to forcibly quarantine a patient who was on the March Air Reserve Base who wanted to leave, and of course that caused him to be in isolation until deemed unnecessary, or two weeks.

现在，今天的另一个大新闻是在里弗赛德市（Riverside），它对我来说就在我家附近，因为那是我在南加州工作的县，而我实际上与里弗赛德县的公共卫生官员凯瑟博士（Kaiser博士）一起工作。要强行隔离要离开的3月空中储备基地上的患者，这当然使他处于孤立状态，直到被认为是不必要的，或者是两个星期。

So what they’re currently doing right now at March Air Reserve Base is this plane, which has about a 195 passengers are now voluntarily, (except for one because he tried to leave) staying on the base for 72 hours, and during that time they’re doing a lot of screening; they are checking for temperature; they’re doing nasal swabs. At the end of those 72 hours, if everything is an Okay, then they are free to go.

因此，他们目前在3月的空军后备队基地现在正在做的是这架飞机，目前有约195名乘客是自愿的，（因为他试图离开，所以除外）在基地停留了72个小时，在此期间他们正在做很多检查；他们正在检查温度；他们在做鼻拭子。在这72个小时结束时，如果一切正常，那么他们可以自由行动。

Of course, you may say Ha, they are in Southern California, let them stay in Southern California. Well, these people are from all over the United States, and I’m sure as soon as they are let go, they will be coming to your area of the woods.

当然，您可能会说哈，他们在南加州，让他们留在南加州。好吧，这些人来自美国各地，我敢肯定，一旦他们放开手，他们就会来您所在的社区。

So let’s explore a little bit about what’s happened in terms of our knowledge over the last couple of days over this virus, and how it behaves in terms of incubation period and in terms of the type of illnesses that it causes, and also the ability for it to shed, because there’s a lot of interesting information that we’re about to get into here that has been published recently in the New England Journal of Medicine, and it’s hot off the press.

因此，让我们从过去几天对这种病毒的了解，它在潜伏期，其引起的疾病类型，以及针对病毒的能力等方面的表现来看一点点它之所以消失，是因为最近我们在新英格兰医学杂志上发表了许多有趣的信息，这些信息已经广受欢迎。

We will give you a link in the description below, but let’s get into that. Okay, so this is a drawing that is based on a figure in that New England Journal of Medicine article, and what we’ve got is five people here. We got the index patient, and we’ve got Patient One, Two, Three, Four.

我们将在下面的描述中为您提供一个链接，但让我们开始讨论。好的，这是一张基于《新英格兰医学杂志》文章中的图形的绘图，我们在这里只有五个人。我们有零号病人，我们有病人一，二，三，四。

This is all happening in Germany, and these are all dates in January here below. Okay. So the first thing that happened here is that there was a business meeting that was occurring, and this index patient here was actually from China, and they flew over to Germany to attend a business meeting, and this meeting occurred over the period of the 19th to the 22nd. So who was that that business meeting? Well, these two people here who are German natives attended at the business meeting with index patient.

这一切都发生在德国，这些都是下面1月份的日期。好的。因此，这里发生的第一件事是正在召开一次商务会议，而这里的零号患者实际上是中国人，他们飞赴德国参加了商务会议，而这次会议是在19世纪到22日那次商务会议是谁？好吧，这两个德国本地人参加了与零号患者的业务会议。

Everything was fine. Nobody was having symptoms, and the index patient, while she hopped on a flight on the 22nd and goes back to China and starts developing symptoms almost immediately after she gets on the flight. Okay. She goes back to China and of course, there’s the big rage of what’s going on, and she has the symptoms. So what does she do? She goes and gets tested and she goes and gets tested over here on the 26th.

一切都很好。没有人出现症状，而零号患者在22号跳上飞机返回中国后，几乎在乘飞机后就开始出现症状。好的。她回到了中国，当然，发生的事情非常猖rage，而且她有症状。那她怎么办？她去了接受测试，然后在26号去了这里接受测试。

Meanwhile, what happens is Patient Number One who was at the meeting; he starts developing symptoms on the 24th, mild symptoms. So cough, fever, malaise, all the sorts of things that you would assume would go along with the flu, and his symptoms get worse, and then they get better.

同时，正在开会的是一号患者。他于24日开始出现症状，出现轻度症状。因此，咳嗽，发烧，全身乏力，您会想到的所有各种症状都会与流感一起发生，他的症状会变得更糟，然后情况会好转。

Now, the index patient. She gets tested here on the 26th, PCR, and it’s positive. Soon as it gets positive, she goes back, and she calls her company, and they do it a trace-back to try to figure out all the people that she may have come in contact with, so they can figure out where to test. And of course by this point, Patient Number One: well, yeah, I had a little bit of flu symptoms, but I’m fine now, so they check him the next day on the 27th. PCR positive! Boom! But he’s asymptomatic. He’s gotten better for it’s mild symptoms; they’re really not that bad anymore.

现在，零号病人。她在26日在这里接受了PCR检测，结果是肯定的。事情变得积极起来之后，她很快就回去了，并打电话给她的公司，他们进行了回溯，试图找出所有可能与她联系过的人，以便他们找出在哪里进行测试。当然，这是第一位患者：好吧，是的，我有点流感症状，但是我现在很好，所以他们第二天在27日检查了他。 PCR阳性！繁荣！但是他没有症状。他的症状较轻，病情有所好转。他们真的不再那么糟糕了。

Nevertheless, they go ahead and they test him, they check for viral loads. They see if there’s virus in his saliva, virus in his sputum. And guess what? He has a high viral load, even though he is not symptomatic. In other words, he is contagious, and they find up to ten to the eighth viral particles per milliliter. That’s pretty high.

但是，他们继续进行测试，检查病毒载量。他们看唾液中是否有病毒，痰中是否有病毒。你猜怎么着？即使他没有症状，他的病毒载量也很高。换句话说，他具有传染性，他们每毫升最多发现十到八分的病毒颗粒。太高了。

Well, guess what? Patient Two, Three and Four? They all start developing symptoms as well during the same time. Patient Two symptoms last a little bit longer, and they test on the 28th, of course when he turns out positive all hell breaks loose, and they’re like, wow what’s going on here? And so, a whole bunch of other people get tested, and so sure enough Patient Two has a positive PCR. But remember this Patient Number Two attended the same meetings, and so it’s very possible that this is how it worked.

好吧，你猜怎么着？患者二，三和四？他们都同时开始出现症状。患者2的症状会持续更长的时间，并且在28日进行测试，当然，当他证明阳性时，所有地狱都崩溃了，它们就像，哇，这是怎么回事？因此，一大堆其他人都受到了测试，因此可以肯定的是，两名患者的PCR阳性。但是请记住，第二位患者参加了相同的会议，因此很有可能就是这样。

Okay, but here’s the point that should blow you away. Patient Three and Four never attended the meetings; however, Patient Three and Four did have contact with Patient Number One, and they can actually map out when patient Three and Four had contact with Patient Number One, and all of these contacts were before the patient actually had symptoms. So, in other words, Three and Four started to develop symptoms, but they started to develop symptoms later, about a day later.

好的，但是这是应该让您震惊的地方。 3号和4号患者从未参加过会议。但是，三号和四号患者确实与一号患者接触过，并且他们可以在三号和四号患者与一号患者接触时实际绘制出地图，而所有这些接触都是在患者实际出现症状之前。因此，换句话说，三号和四号开始出现症状，但是大约一天后，它们开始出现症状。

So they develop symptoms on January 25th, January 26th. And of course, they got tested with everybody else because they were all freaking out of course, and sure enough PCR was positive. So here’s the take-home message. Number one: it looks as though the incubation period here is fairly short. So that’s a good thing. That means that you’re going to find out quickly whether or not the patient has a virus. What’s bad about this though is that you’re able to spread the virus both before and after it seems you have symptoms. The fact we know that Patient Three and Four got their virus from a patient who got it from the index patient here, and they got it before they had symptoms.

因此他们在1月25日，1月26日出现症状。当然，他们也和其他所有人一起接受了测试，因为他们全都失控了，并且确定有足够的PCR阳性。这是带回家的信息。第一：这里的潜伏期似乎很短。这是一件好事。这意味着您将迅速发现患者是否患有病毒。但是，这样做的坏处是您可以在出现症状之前和之后传播病毒。我们知道，三号和四号病人是从一个病人那里感染病毒的，而这个病人是从这里的索引病人那里得到的，并且他们在出现症状之前就已经感染了。

So this begs the question, and it’s a very interesting question about what are we doing at March Air Reserve Base? Yes, if we were to watch them for 72 hours, which of course is three days, we should be able to pick up if any of them have symptoms, fevers, anything of that nature. But the question is do we release them after 72 hours if they’re all clean? And I think the debate is still going on that. Should you hold them for two weeks? Yeah, that would be safer for everybody. But you have to weigh the practicalities of holding them for 72 hours versus two weeks. And do you really need to do that? If it looks as though the incubation period is pretty short.

这就引出了一个问题，这是一个非常有趣的问题，关于我们在3月的空军后备队基地正在做什么？是的，如果我们要观察它们72个小时（当然是三天），那么如果它们中有任何症状，发烧或任何类似性质的东西，我们应该能够恢复。但是问题是，如果它们都干净，我们会在72小时后释放它们吗？我认为辩论仍在继续。你应该把它们抱两个星期吗？是的，这对每个人来说都比较安全。但是您必须权衡将它们保持72小时而不是两个星期的实用性。而且您真的需要这样做吗？看起来潜伏期很短。

So what are the big take-home messages from this New England Journal of Medicine article? Number one: the incubation period seems to be relatively short, maybe three or four days, could be longer, could be shorter. But that seems to be what we’re seeing here. Number two: even though you’re asymptomatic, it seems pretty clear that you’re able to shed and infect somebody else with the virus. Number three: it seems as though at least here in this short cohort of four people that all of these people had very mild symptoms. Everyone here so far is not in the hospital. They’re not on a ventilator. They seem to be doing just fine. These were healthy people though in Germany. So it’s sometimes hard to actually generalize this to everyone. Alright, more updates as they come. Thank you for joining us!

那么，《新英格兰医学杂志》上的这篇文章的主要启示是什么？第一：潜伏期似乎相对较短，也许三四天，可能会更长，可能会更短。但这似乎就是我们在这里看到的。第二点：即使您没有症状，也很明显您能够感染并传染该病毒。第三：似乎至少在这四个人的短暂队列中，所有这些人都有非常轻微的症状。到目前为止，这里的每个人都不在医院。他们不在呼吸机上。他们似乎做得很好。这些人虽然在德国是健康的人。因此有时很难将其概括为每个人。好吧，随着更多更新的到来。感谢您加入我们！