新冠肺炎研究进展，传播和预防 （新冠肺炎讲座10）

Welcome to another MedCram update. So first things first, we have 427 deaths and 20,600 confirmed cases. And again, we look at this ratio here not saying that this is a death rate or a fatality rate; it’s just a ratio of confirmed deaths divided by confirmed cases.

欢迎参加MedCram讲座。首先，我们有427例死亡和20,600例确诊病例。再一次，我们在这里查看此比率并不是说这是死亡率或死亡率。这只是确诊死亡人数除以确诊病例的比率。

But as we predicted, the total recovered has gone up, and I refer you once again to the dashboard at the Johns Hopkins University site for the coronavirus. So there are a lot of things to go over today. First of all, there was a paper that was trying to calculate the RO, (R Naught) or the basic reproduction number. This is basically: if the virus is in somebody, how many people does that virus get passed on to? And I will put a link to this paper. The description shows about 2.24 – 3.58 is the number, which is a respectable number. Measles is, of course, one of the worst; it’s about 14 or 15.

但是，正如我们所预测，回收的总量有所增加，我再次将您转至约翰霍普金斯大学网站上的冠状病毒仪表板。因此，今天有很多事情要做。首先，有一篇论文试图计算RO（R Naught）或基本复制数。这基本上是：如果该病毒存在于某人中，该病毒会传染给多少人？我将链接到本文。描述显示约2.24-3.58是数字，这是一个可观的数字。麻疹当然是最坏的情况之一；大约是14或15。

Next big thing: three new cases in California, and currently California has about six out of the 11 cases in the United States, and that’s not surprising given that California is probably the biggest destination from Asia to the United States.

下一件大事：加利福尼亚有3例新病例，目前美国11例中有6例在加利福尼亚，鉴于加利福尼亚可能是亚洲到美国最大的目的地，这也就不足为奇了。

Second death outside of China was in a relatively young gentleman although apparently this guy had underlying illness. Other big thing in the news: patient in Washington state was released to home isolation, and the key here is home isolation. So they don’t say much about him. However, the thing that I would like to know is whether or not he’s virus-free. Why did he go home on home isolation, and in fact he was still infectious and he’s just not sick enough to be in the hospital; that’s an interesting question to note, but we’ll have to see.

在中国以外的第二次死亡是在一个相对年轻的绅士中，尽管这个人显然患有潜在疾病。该新闻中的另一件大事：华盛顿州的患者被释放到家庭隔离中，这里的关键是家庭隔离。所以他们对他不多说。但是，我想知道的是他是否没有病毒。他为什么要在家隔离时回家，而实际上他仍然具有传染性，而且他还没有病入医院。这是一个有趣的问题，但我们必须要看到。

I’ve got a lot of comments asking about stuff from China, like mail or packages. We just talked about yesterday how on a door handle they were able to pick up the RNA of the coronavirus and PCR, and I’ve seen at least two or three articles now with experts, virologists looking at the coronavirus and saying that mail from China is fine.

关于中国的东西，例如邮件或包裹，我有很多评论。昨天我们刚刚谈到了他们如何在门把手上拾取冠状病毒的RNA和PCR，我现在已经看到至少两到三篇关于专家的文章，病毒学家正在研究冠状病毒并说来自中国的邮件很好

Now we bring up bats. So there seems to be some disagreement among scientists. When this originally came out, there was a study that showed that the coronavirus was very similar and probably most similar to that found in snakes. There seems to be some additional data that it could be from bats, and the news there are more evacuations coming, and the US government is going to be taking those to Air Force bases since that seemed to work out well for March Air Reserve Base in southern California.

现在我们拿起蝙蝠。因此，科学家之间似乎存在一些分歧。当这最初出现时，有一项研究表明冠状病毒非常相似，可能与蛇中的相似。似乎还有一些可能来自蝙蝠的数据，而且有更多的撤离消息，美国政府将把这些撤离到空军基地，因为对于3月份的空军后备基地来说，这似乎很不错南加利佛尼亚州。

A Travis Air Force Base seems to be one of the ones that’s targeted. They need to have big enough places where they can have single rooms to isolate, and as we mentioned yesterday in our video there were two people on a German flight to Germany with German Nationals that tested positive for the coronavirus.

特拉维斯空军基地似乎是针对的基地之一。他们需要有足够大的地方可以隔离单个房间，正如我们昨天在视频中提到的那样，有两个人乘坐德国人飞往德国的航班，德国国民的冠状病毒检测呈阳性。

Finally in weird news. Pakistan is bucking the trend. They’re going to resume flights with XXX, which leave a lot of people scratching their heads because they believe that Pakistan is in no way able to deal with a coronavirus outbreak there. They do note in some of the articles that I read that there is a pretty strong relationship between xxx and Pakistan. Of recent note, xxx has loaned them billions of dollars for infrastructure. Right now, there are no cases in Pakistan.

最后是怪异的消息。巴基斯坦逆势而上。他们将恢复使用XXX的航班，这使很多人挠头，因为他们相信巴基斯坦根本无法应对那里的冠状病毒爆发。他们确实在我读过的一些文章中指出，xxx与巴基斯坦之间有很强的关系。值得一提的是，xxx已向他们提供了数十亿美元的基础设施贷款。目前，巴基斯坦还没有病例。

And what about the fact that this is a year that the Olympics are occurring, the Summer Olympics in Tokyo? So the question is where are we going to be when the summer comes around, and I will put some links in the description of epidemiologists, hoping that the summer is a slow-down because generally these viruses don’t do very well in the summertime.

那么，今年是奥运会在东京举行的夏季奥运会，又该如何呢？所以问题是夏天来临时我们要去哪里，我将在流行病学家的描述中加入一些链接，希望夏天放慢脚步，因为通常这些病毒在夏天效果不佳。

But, remember this is a completely novel virus to the human body, and the Diamond Princess cruise ship is in complete quarantine just off the coast of Japan, and that’s because there was one person in late January that tested positive for the coronavirus, and currently there are seven people on board that are ill. Of course, that’s not too surprising if you’ve been on a cruise ship, you’ll know that you’re bound to get somebody that’s ill. The testing is not going to be completed on these people until Tuesday night.

但是，请记住，这是一种对人体完全新颖的病毒，“钻石公主”号游轮在日本海岸附近已完全隔离，这是因为1月下旬有一个人的冠状病毒检测呈阳性，目前船上有七个人病了。当然，如果您去过邮轮，也就不足为奇了，您将知道自己一定会生病的。直到星期二晚上，这些人的测试才能完成。

Okay. The next thing I want to talk about is they check this patient out in Washington state and found that he definitely tested positive in his stool for the RNA for this coronavirus. Well, this reminded people of what happened back in 2002 with SARS. And as you make recall, and you will also link to a paper that describes this that there was a whole outbreak, I mean hundreds of people were exposed to one man having the SARS virus.

好的。我想谈的第二件事是，他们在华盛顿州检查了该患者，发现他的粪便中的冠状病毒RNA确实呈阳性。好吧，这使人们想起了2002年SARS时发生的事情。回忆起来，您还将链接到描述整个疫情的论文，我的意思是数百人暴露于一个患有SARS病毒的人。

And where’s this going to happen? And that’s the next thing we got to talk about is public restrooms, public bathrooms. There’s some good evidence even the Chinese are agreeing that this is a potential issue as to how this thing can be spread. Just the flushing of the toilet itself that can also aerosolize things, just by flushing. So the question is, what do you do? Well, I’ve got no studies, can’t tell you for a fact that this works, but here are some steps I think you may want to consider.

这将在哪里发生？这是我们接下来要谈的是公共厕所，公共浴室。即使中国人也同意，有很好的证据表明这是一个如何传播这件事的潜在问题。只是冲水，马桶本身也可以使物体雾化。所以问题是，你怎么办？好吧，我还没有研究，无法告诉您这种方法有效的事实，但是我认为您可能需要考虑一些步骤。

Number one is avoid public bathrooms if possible. Number two, wash hands, and what I would say here is, use paper towels if possible to touch anything in public bathrooms. So walking into the bathroom, usually, it’s a push you can use your foot. Obviously. You want to have a barrier between you and the toilet seat. When you’re done, if you can, you probably want to close the toilet cover. So if you flush, it doesn’t aerosolize, of course, that’s going to be for you not to spread it to someone else. But of course, you can’t prevent people from doing that.

第一是尽可能避免使用公共浴室。第二，洗手，在这里我要说的是，如果可能的话，用纸巾触摸公共浴室中的任何东西。因此，通常走进卫生间，这是您可以用脚踩的推杆。明显。您想在您和马桶座之间设置障碍。完成后，如果可以的话，您可能想要关闭马桶盖。因此，如果冲洗，它不会雾化，这将是您不要将其传播给其他人的原因。但是，当然，您不能阻止人们这样做。

Washing your hands for at least 20 seconds. Okay, some people say sing Happy Birthday in your mine twice to get the 20 seconds. I would also carry hand sanitizer. You would not believe how many times you touch your face, you scratch your nose, you put your finger in your mouth. These are all entryways.

洗手至少20秒钟。好的，有人说要在您的地雷里唱两次生日快乐，以获得20秒。我还要携带洗手液。您将不敢相信您摸过脸多少次，scratch鼻子，将手指放在嘴里。这些都是入口。

Another big thing. If you have children, teach them all of these things. So the second thing I wanted to get to really quickly was this Lancet article where they include a now 99, which is the most to date, people with pneumonia, with the coronavirus, and the average age here was 55 years old, 67% men, 50% chronic disease, 83% had fever, 82% had cough, 31 percent had shortness of breath. Interestingly, only 2% had diarrhea, 17% had ARDS, and 11% died as opposed to the original paper, which said 15%.

另一件大事。如果您有孩子，请教他们所有这些东西。因此，我想很快讲的第二件事是《柳叶刀》上的这篇文章，其中包括迄今为止最流行的99种肺炎患者，冠状病毒患者，平均年龄为55岁，男性为67％ ，50％的慢性病，​​83％的发烧，82％的咳嗽，31％的呼吸急促。有趣的是，腹泻只有2％，ARDS有17％，死亡是11％，而原始论文则为15％。

Now we’re going little bit more granular because we have more. Now, this brings us to another interesting thing, which was the prediction score for those that were going to die followed something called an MuLBSTA score for viral pneumonia. I’ll include that in the description below. It’s a very nice article. And what did it look for? Well, there are actually a number of things that you could look for in these patients.

现在，我们将更加细化，因为我们还有更多。现在，这给我们带来了另一件有趣的事情，那就是对于即将死亡的人的预测评分，然后是针对病毒性肺炎的MuLBSTA评分。我将在下面的描述中包括它。这是一篇非常好的文章。它寻找什么？好吧，实际上，您可以在这些患者中找到很多东西。

To help tell you is this one that’s going to die, or just someone that’s not going to die. Number one was multilobar infiltrates. Number two was lymphocytes less than 0.8; number three was bacterial co-infection; number four acute smoker, number five quite smoker, number six was someone who had hypertension which I’ll abbreviate HTN. Number seven was age greater than 60 years of age.

为了帮助您告诉您，这将是死亡，还是只是一个不会死的人。第一是多叶浸润。第二是淋巴细胞少于0.8；第三是细菌共感染；第四位是急性吸烟者，第五位是非常吸烟者，第六位是患有高血压的人，我将其缩写为HTN。第七名的年龄大于60岁。

So from multilobar infiltrates, they got five points, and you want to have the least amount of points possible. For low lymphocytes, they got four points. For bacterial co-infection, four points; acute smoker, three points. If you a quit smoker, two points; hypertension was two points, in age greater than 60 was two points.

因此，从多叶浸润中，他们得到了5分，而您希望拥有尽可能少的分。对于低淋巴细胞，他们得到了4分。对于细菌共感染，四分；急性吸烟者，三分。如果您是戒烟者，则要加两分；高血压为两分，年龄大于60岁为两分。

So, I’ll give you some examples here. If you had zero points, your chances of dying from viral pneumonia was 0.47%. If you had six points, it was 2.9% if you had 12 points, it was 15% and if it was 20 points. And, of course, this can go up to as high as 20 points, but it was basically greater than 69%. And this was a very nice prediction method to determine in a viral pneumonia if someone would die, and it followed it pretty closely even for other viruses.

所以，我在这里给你一些例子。如果您的得分为零，那么您死于病毒性肺炎的机率是0.47％。如果您有6分，那么如果您有12分，则为2.9％，如果有12分，则为15％，如果为20分。而且，当然可以提高到20点，但基本上高于69％。这是确定病毒性肺炎是否会死亡的一种非常好的预测方法，即使对于其他病毒，它也非常接近该方法。

So the one that I see a lot of in the comments is this coronavirus and HIV. This probably started out because of a paper that was uploaded to bioRxiv not too long ago that found, by looking at the RNA, that there were four regions in the novel coronavirus that look like they had come from HIV. And this was a paper that was not peer-reviewed. It was uploaded to a particular part of the site where those papers can go before they get reviewed by other scientists. There was a disclaimer in that area that specifically said that, but the conspiracy theories abound. And I have to admit I saw it as well, and I was concerned about it because of what the implications could mean.

因此，我在评论中经常看到的是这种冠状病毒和艾滋病毒。这可能是由于不久前上传到bioRxiv的一篇论文发现，通过查看RNA，发现新型冠状病毒中有四个区域看起来像是来自艾滋病毒。这是一篇未经同行评审的论文。它已上传到网站的特定部分，这些论文可以在其他科学家进行审查之前进行保存。在该区域中有一个免责声明专门说明了这一点，但是阴谋论比比皆是。我必须承认我也看到了它，并且我担心它，因为这可能意味着什么。

These HIV stretches were coding for gp120, which is involved potentially in the binding site of CD4 cells. So what they actually found out? Two of those areas are actually found in bat coronavirus. Okay, so that’s normally there. And of the other two one is found in HIV, but it’s only six amino acids long, and I don’t think that based on the number of matches that they have to go through the fact that you would find something that matches 6 amino acids would be awash, statistically speaking. Nevertheless, this paper was removed Sunday by the authors, saying that he was going to re-look at this.

这些HIV片段编码gp120，gp120可能与CD4细胞的结合位点有关。那么他们实际发现了什么？蝙蝠冠状病毒实际上发现了其中两个区域。好的，那通常在那里。另外两个是在艾滋病毒中发现的，但是它只有六个氨基酸长，我不认为基于它们必须匹配的数目，您会发现一个匹配六个氨基酸的事实从统计上讲，这将是充裕的。不过，作者于周日删除了该论文，并说他将对此进行重新审视。

But people will say, well, why are we using HIV meds then in this current outbreak? Why are they trying it? And why are people getting better on the HIV meds? Well, this is not a new theory back when SARS broke out in 2002. They also used HIV medications. Well, why? Well, because coronavirus is an RNA virus, and HIV is also an RNA virus, and so some of the machinery and getting RNA viruses into species that have DNA primarily. They are going to be very similar, and they may help, and of course, we already have it. We know that it’s relatively safe.

但是人们会说，那么，为什么我们要在这次疫情中使用HIV药物呢？他们为什么要尝试？为什么人们在艾滋病药物方面变得更好？好吧，这不是2002年SARS爆发时的新理论。他们还使用了HIV药物。好吧，为什么呢？好吧，因为冠状病毒是一种RNA病毒，而HIV也是一种RNA病毒，因此某些机制将RNA病毒带入主要具有DNA的物种中。它们将非常相似，并且可能会有所帮助，当然，我们已经有了。我们知道它相对安全。

And so there are these questions about people being readmitted to the hospital, people who have recovered, yet they get sick again, only to have to end up on this. Well, I haven’t seen any cases out there of this particularly. If you see any, I would love to hear from you, please put actual case reports in there.

因此，存在着一些问题，如人们被重新送往医院，已经康复但又再次生病的人们，最终不得不接受这一问题。好吧，我还没有看到任何特别的案例。如果您有任何意见，我希望收到您的来信，请在其中放置实际的病例报告。

There was the gentleman in the Philippines who did die, but you’ve got to realize that a lot of these people who have viral infections will get secondary bacterial infections. And in fact, I see this all the time personally in my practice is people will come into the hospital with severe bacterial pneumonia. But if you check their history, they’ve had a viral infection prior to that. They’ve got better from the virus, moves in; it denudes the respiratory epithelium, and then the bacteria moves in as an opportunistic infection. So these people being readmitted to the hospital could be opportunistic infections of bacteria.

菲律宾有一位先生死了，但是您必须意识到，其中许多人感染了病毒，会继发细菌感染。实际上，在我的实践中，我一直亲眼目睹这种情况，那就是人们将患有严重的细菌性肺炎进入医院。但是，如果您检查他们的病史，那么他们在此之前就已经感染了病毒。他们从病毒中康复了，进入了；它剥夺了呼吸道上皮，然后细菌作为机会性感染而进入。因此，这些人再次入院可能是细菌的机会性感染。

Well, you say, well, what about the fact that a lot of these people have decreased white blood cells? I mean, couldn’t this be the virus tearing up the CD4 cells, T-helper cells? Well, if you look back at that article that I was talking about with the viral pneumonia, you’ll see that part of the way they differentiate is that many times, regardless of the viral pneumonia, there’s going to be a lymphocyte count is low. In fact, that was one of the criteria that we used in figuring out whether or not the patient’s actually have higher risk of dying.

好吧，你说好吧，这些人中很多人白血球减少的事实又如何呢？我的意思是，这不是病毒会破坏CD4细胞，T辅助细胞吗？好吧，如果您回顾一下我在谈论病毒性肺炎的那篇文章时，您会发现它们区分的部分原因是很多次，无论病毒性肺炎如何，淋巴细胞计数都很低。实际上，这是我们用来确定患者是否实际有更高死亡风险的标准之一。

Remember that was the MuLBSTA score, and these people that are being discharged from the hospital as part of their criteria, at least in China, is that their viral loads are undetectable. They cannot detect the virus on PCR.

请记住，那是MuLBSTA评分，而至少在中国，作为标准的一部分从医院出院的这些人的病毒载量无法检测。他们无法在PCR上检测到病毒。

So the point of this is be careful. There’s a lot of theories out there that may be based on less than scientific data, and I guess I’ll take this opportunity to thank everyone for all of the nice comments. I’m glad that this is helpful. Thanks for joining us, and remember what we said about hand-washing. Pray for this to turn around and we will see you next time.

因此，这一点要小心。有很多理论可能是基于不到科学数据的，我想我将借此机会感谢大家的所有美好评论。我很高兴这很有帮助。感谢您加入我们，并记住我们所说的洗手。为这个问题祈祷，我们下次见。