实际预防策略,患者年龄与病死率

Practical Prevention Strategies, Patient Age vs. Case Fatality Rate (Lecture 28)

Welcome to another MedCram covid-19 update. We’re going to talk today again about the numbers, about the epidemiology. We’re actually going to talk about the case fatality rate and the age specifically. A lot of you have asked about how age effects that.

欢迎来到MedCram covid-19的另一个更新。今天,我们将再次讨论有关流行病学的数字。实际上,我们将具体讨论病死率和年龄。你们中的很多人都问过年龄是如何影响的。

We’re also going to talk about testing. There has been some interest in how we test for SARS COV-2, and in light of what we talked about last update, which is what the sensitivity and specificity were, we talked about how the sensitivity of the kits that have been made public and available in certain situations is not the best. We will also go to talk about healthcare workers, and this all sort of ties in together.

我们还将讨论测试。我们对SARS COV-2的测试方式引起了一定的兴趣,并且根据我们最近一次讨论的内容,即敏感性和特异性,我们谈到了已公开发布的试剂盒的敏感性以及在某些情况下可用不是最好的。我们还将去谈论医护人员,以及各种联系。

Here is the Johns Hopkins dashboard. Total confirmed 80, 389; total deaths 2858; total recovered is 36, 563. These are the numbers that are being put out by the various organizations.

这是Johns Hopkins仪表板。确认总数80,389;总死亡2858;回收的总数是36、563。这些是各个组织发布的数字。

Moving over to the Worldometer coronavirus cases. And if we exclude the Chinese numbers, we can see here that we are definitely in an epidemic phase outside of China. And if we look at the pie chart, we can see here that that slice of the pie is definitely growing, and I think you can expect that that is going to grow even more here in the next number of weeks.

移至Worldometer冠状病毒病例。如果我们排除中国数字,我们可以在这里看到我们肯定处于中国以外的流行阶段. 而且,如果我们查看饼图,我们可以在这里看到那部分饼肯定在增长,我想您可以预期,在接下来的几周内,这部分饼的数量将进一步增长。

If we look at the number of cases outside of mainland China, a huge swath of that is from the Diamond Princess. In terms of new cases, the fastest-growing one is South Korea. In fact, for the first time, there are more cases coming out of South Korea than there is coming out of China.

如果我们看一下中国大陆以外的案件数量,其中很大一部分来自钻石公主。在新案件方面,增长最快的是韩国。实际上,来自韩国的案件首次超过来自中国的案件。

Also here we have our outcome of cases, and you can see that the death rates. As more and more of these undetermined cases go to the side of recovery, that death rate is falling. That is not a case fatality rate. We’re going to talk about that here in just the bits. Again, looking at the latest updates, one new case in Canada. This used to be a very small section here where you could look at multiple dates, and now things have just taken off in different places.

同样在这里,我们有案件的结局,您可以看到死亡率。随着越来越多的这些未定病例进入康复期,死亡率正在下降。那不是病死率。我们将在这里仅谈一点。再次,查看最新的更新,加拿大的一个新案例。这曾经是一个很小的部分,您可以在其中查看多个日期,现在事情已经在不同的地方发生了。

North America here on February 27th. A new case in Ontario. The husband of the previously confirmed case in Toronto. We’ve got Europe and the Middle East, and you can see here all of the different cases. 20 new cases in France. For instance, five new cases in Sweden. 40 new cases in Germany. Italy has now actually relaxed its testing criteria. Recent travelers to outbreak areas will not be tested anymore unless they show symptoms, and that may be because they may be low on testing; that’s just speculation. Not exactly sure if that is the case. We’ve got two new cases in the UK; 4 new cases in Switzerland. And Asia, the number of new cases in South Korea has actually top to China for the first time.

北美2月27日在这里。安大略省的一个新案例。先前在多伦多确诊的丈夫。我们有欧洲和中东地区,您可以在这里看到所有不同的情况。法国有20例新病例。例如,瑞典有五个新病例。德国有40个新病例。意大利实际上已经放宽了其测试标准。除非出现症状,否则最近前往暴发地区的旅行者将不再进行测试,这可能是因为他们的测试水平较低;那只是猜测。不能完全确定是否是这种情况。英国有两个新案件;瑞士有4个新案件。在亚洲,韩国的新病例数实际上已首次超过中国。

This is the article entitled Coronavirus Fatality Rates Vary Widely Depending on Age, Gender and Medical History – Some Patients Fare much Worse than Others. This is in a JAMA review article, where they actually looked at 72,000 covid-19 cases, and there was a dramatic shift. I will put the link to this article in the description. Let’s go right to the actual article: characteristics of an important lesson from the coronavirus disease 2019 outbreak in China.

这是标题为冠状病毒死亡率严重取决于年龄,性别和病史的文章-一些患者的病情比其他患者差得多。这是在JAMA的一篇评论文章中,他们实际研究了72,000个covid-19病例,并且发生了巨大变化。我将在说明中放入指向本文的链接。让我们直接看一下实际文章:2019年中国冠状病毒病暴发的重要教训的特征。

This is 72,314 cases; pretty big numbers. Realizing of course, this doesn’t capture the entire picture, but it’s a good peek at what it is that’s going on. Let’s just jump to the Box findings. I like JAMA that they box these findings for you very concisely so out of 72,314 cases confirmed cases were 44,000; suspect the case is 16,000; diagnosed cases, 10,000; asymptomatic less than 1000.

这是72,314例;相当大的数字。当然,这并不能捕获全部图片,但是可以很好地了解发生了什么。让我们跳到Box的发现。我喜欢JAMA,他们非常简洁地为您列出了这些发现,因此在72,314例病例中,确诊病例为44,000例;怀疑案件是16,000;诊断病例10,000无症状的少于1000。

Here’s the age distribution of actual infections in this study. And you can see the vast majority of infections occurred in people 30 to 79 years of age; that maybe because most of these people were out and about. But you can see here that as you get younger 10 to 19, less than 10, there was a reduced population. What about the spectrum of disease? Overall, 81% of these cases were mild, 14% were severe, and 5% were critical.

这是本研究中实际感染的年龄分布。您会看到绝大多数感染发生在30至79岁的人群中;那也许是因为这些人中的大多数人都在外面。但是,您可以在这里看到,随着您的年龄在10到19岁之间,并且不到10岁,人口减少了。疾病谱如何?总体而言,这些病例中有81%为轻度,14%为严重,5%为严重。

The thing that everyone’s looking for is the case fatality rate. So, overall, all of those cases had a case fatality rate of 2.3 percent. But how did that get distributed? You can see that one of the highest age-related case fatality rates was in people aged 80 years and over, and that was 14.8%. Well, if you’re in the decade before that, 70 -79, 8%. You can see that it came down dramatically.

每个人都在寻找的是病死率。因此,总的来说,所有这些病例的病死率均为2.3%。但是,如何分配?您可以看到,与年龄相关的最高病死率之一是80岁及以上的人群,即14.8%。好吧,如果您在那之前的十年中,是70 -79,8%。您可以看到它急剧下降。

What about those who were less than 9? If you were to go down into the body of the paper, there were no deaths of anybody 9 years of age or younger. And if you did have a critical case, your chances of making it were about 50%. So what about all those people that are 30 to 80 years of age? Well, if you actually calculate the numbers, you get approximately 1.2 percent case-fatality rates.

那些少于9岁的人呢?如果您要深入研究本文的正文,那么9岁以下的人都不会死亡。而且,如果您确实有严重的案例,那么成功的机会约为50%。那么,那些30至80岁的人呢?好吧,如果您实际计算这些数字,您将获得大约1.2%的病死率。

Let’s look at healthcare personnel that were infected. The 44,000 that were confirmed, 3.8% of them were healthcare personnel, and 63% of those were in Wuhan. In total, there are only five deaths in this group.

让我们看看被感染的医护人员。确认的4.4万人中,有3.8%是医护人员,其中63%在武汉。该组总共只有五人死亡。

And they also tell you about how they determine which ones were mild, and which ones were severe., etc. Mild was determined as non-pneumonia or mild pneumonia. However, 14% were severe. What is severe? These are people that had shortness of breath; a respiratory frequency rate greater than 30 per minute; a blood oxygen saturation that was less than 93%, or partial pressure of oxygen fraction to the oxygen ratio of less than 300.

他们还告诉您如何确定哪些是轻度的,哪些是重度的,等等。轻度被确定为非肺炎或轻度肺炎。但是,严重的占14%。什么是严重的?这些是呼吸急促的人。呼吸频率大于每分钟30次;血氧饱和度小于93%,或氧分压与氧比的分压小于300。

What is this less than 300 mean? It’s a determinant of how much oxygen they have to give you to keep your oxygen levels up. The more oxygen that they have to give you to keep your oxygen levels up, the lower this number goes, so you want to have a high number. This is called a p/f ratio. A lung infiltrates; that is more than 50 percent within 24 to 48 hours, and 5% were critical: respiratory failure; they are on ventilators; they are in septic shock; or they have multiple organ failure.

小于300是什么意思?这是决定他们必须给您多少氧气以保持体内氧气水平的决定因素。他们需要给您更多的氧气以保持体内的氧气水平,这个数字越低,因此您希望拥有一个更高的数字。这称为p / f比。肺部浸润;在24至48小时内超过50%,而5%则很严重:呼吸衰竭;他们在呼吸机上;他们正在败血性休克中;或他们有多个器官衰竭。

No deaths were reported among mild and severe cases. However, among critical cases, the case fatality rate was the flip of a coin. Those with pre-existing comorbid conditions, 10.5% for cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6% for hypertension, 5.6 percent for cancer, and among the 44,000 cases, a total of 1,716 were healthcare workers, or about 3.8 percent. A lot of whom were in Wuhan.

在轻度和重度病例中没有死亡报告。但是,在关键案例中,案例死亡率是一掷硬币。患有合并症的人,心血管疾病的10.5%,糖尿病的7.3%,慢性呼吸道疾病的6.3%,高血压的6%,癌症的5.6%,在这44,000例病例中,共有1,716名卫生保健工作者,约3.8%。很多人在武汉。

Here is a key point: covid-19 rapidly spread from a single city to the entire country in just 30 days. The sheer speed of both the geographical expansion and the sudden increase in numbers of cases surprised and quickly overwhelmed health and public health services in China, particularly in Wuhan city and Hubei province.

这是一个关键点:covid-19在短短30天内迅速从一个城市传播到整个国家。地域扩张的巨大速度和病例数的突然增加都使中国,特别是武汉市和湖北省的卫生和公共卫生服务感到惊讶,并迅速使他们不堪重负。

Epidemic curves reflect what may be a mixed outbreak pattern, with early cases suggestive of a continuous common source, potentially zoonotic spillover at the Hunan Seafood Wholesale Market, and later cases suggestive of a propagated source as the virus began to be transmitted from person to person.

流行曲线反映出可能是混合的暴发模式,早期病例提示持续的共同来源,潜在的人畜共患病在湖南海鲜批发市场的溢出,而后期病例提示传播的来源,因为病毒开始在人与人之间传播。

And here we have this graph. This is a great graph. We see going along here rather undetected, and then all of a sudden, we see this huge increase, depending on whether or not you’re looking at the date of onset of the cases or the date of diagnosis of the cases. In either situation, if we look at the date of onset, we can see here that things start to spread very, very quickly and overwhelm the health care delivery system.

这里有这张图。这是一个很棒的图。我们在这里发现的情况相当未被发现,然后突然之间,我们看到这种巨大的增长,这取决于您是在查看病例的发病日期还是病例的诊断日期。无论哪种情况,如果我们看一下发病的日期,我们都可以在这里看到事情开始非常非常非常迅速地传播,并淹没了医疗保健提供系统。

No deaths were reported among mild and severe cases. I think that’s a pretty extraordinary statement, whether you believe the numbers or not, especially seeing based on this study. The majority of the cases were mild and severe, and 5% are critical, and half of those are dying.

在轻度和重度病例中没有死亡报告。无论您是否相信数字,我认为这都是一个非常特别的陈述,尤其是根据本研究得出的结论。大多数病例为轻度和严重病例,其中5%为重症病例,其中一半死亡。

So we can see by looking at this that the key is going to be early detection, and this brings up another interesting article here: Co-Diagnostic Stock Soars 57% on High Hopes for its Coronavirus Test. So if you looked at our last update, you would have seen that the current CDC kits are not performing like they should be. You may remember the case in San Diego; that was released early after they determined initially that the patient was negative; only to retest and find that the patient was in fact positive, and that could be because of a somewhat lower sensitivity of the test. Instead of it being 97%, it’s as low as is 70%.

因此,我们可以通过查看此内容来了解​​关键在于早期发现,这在这里提出了另一篇有趣的文章:Co-Diagnostic股票的冠状病毒测试对高希望的股票飙升了57%。因此,如果您查看了我们的最新更新,您会发现当前的CDC套件的性能不如预期。您可能还记得圣地亚哥的情况;在他们最初确定患者为阴性后,便将其释放;只是为了重新测试并发现患者实际上是阳性,这可能是因为测试的敏感性较低。而不是97%,它低至70%。

Well, here is possibly a new test. That is developed by Co-Diagnostics. Its month-to-date gains to 333% after the company said it received CE Mark for its test, and this indicates that the test is compliant with health and safety standards, and now it is going to be allowed to be sold in the European economic area. There is an analyst that says that this test is easier to use than the test in use by the Centers for Disease Control and Prevention. Well, we’ll see what happens with this and hopefully, if it does work, it’ll be more available and faster than the current testing that we have.

好吧,这可能是一个新的测试。由Co-Diagnostics开发。该公司表示已通过CE标志测试,其月度迄今的涨幅达到了333%,这表明该测试符合健康和安全标准,现在将被允许在欧洲销售。经济领域。一位分析师说,此测试比疾病控制和预防中心所使用的测试更容易使用。好吧,我们将看到这种情况会发生什么,并希望,如果它能够正常工作,它将比我们目前进行的测试更加可用且速度更快。

Because of this article about the California issue that we have in Sacramento with the patient that was diagnosed as we talked about in our last update, some California health workers held in isolation, quarantine after exposure to coronavirus patient.

由于这篇文章是关于萨克拉曼多在加利福尼亚州发生的与我们在上次更新中被诊断为患者的患者有关的文章,因此一些加利福尼亚卫生工作者在暴露于冠状病毒患者后被隔离隔离。

This is what we’ve been talking about, and that is if somebody comes into the hospital and has coronavirus, but we don’t know that, and we can’t detect that until they’re on the ventilator, and then we’re worried because they have a viral pneumonia, and none of our tests are positive then we get it tested and it’s positive.

这就是我们一直在谈论的,也就是说,如果有人进入医院并感染了冠状病毒,但我们不知道,只有在他们进入呼吸机后我们才能检测到,然后因为他们患有病毒性肺炎而感到担忧,而我们的检测均未呈阳性,然后我们对其进行了检测,结果呈阳性。

We’re going to look back and see which health care workers were in contact with that patient. And then we’re going to have to quarantine them – dozens of health care workers in Solano County, California are under isolation, and some will be quarantined after being exposed to a patient who recently tested positive for the coronavirus.

我们将回头看看哪些医护人员正在与该患者联系。然后,我们将不得不对其进行隔离-加利福尼亚州索拉诺县的数十名医护人员正在隔离中,并且其中有一些在暴露于最近测试为冠状病毒呈阳性的患者后将被隔离。

Now we talked about this as it turns out this patient visited centers at two hospitals: North Bay, Vaca Valley Hospital in Vacaville, and the UC Davis Medical Center in Sacramento after the patient was transferred there.

现在,我们讨论了这个问题,结果证明该患者被转移到两家医院的中心:北湾,瓦卡维尔的Vaca Valley医院和萨克拉曼多的UC Davis医疗中心。

Now, we don’t know how many people have to be put on isolation and taken out of service basically, but they say it was under a hundred people. Now for them to say that high of a number, I’m thinking here that it’s not far under a hundred people, and it kind of goes to show that adjust the point where you need to have as many healthcare workers as possible to deal with this epidemic, you’re going to be knocking out a lot of healthcare workers if you can’t get the diagnosis right and quickly.

现在,我们不知道必须隔离多少人并基本上使他们退出服务,但他们说,这个数字还不到一百人。现在让他们说出这么高的数字,我想在这里是不超过一百人,并且这似乎表明,调整点可以使您需要尽可能多的医护人员来应对在这种流行病中,如果您无法迅速正确地做出诊断,您将淘汰很多医护人员。

So the quote here by Dr. Matias, the county public health officer, said “at both hospitals, we are at present aggressively evaluating everyone who may have had contact with this patient. They are being identified, and their risk for exposure is being assessed.” “Efforts are made to identify all workers who may have been exposed.” a spokesman for North Bay Healthcare said, “and the number of healthcare workers impacted was a moving target.”

因此,县公共卫生官员Matias博士的话说:“在两家医院中,我们目前正在积极评估可能与该患者接触过的每个人。他们正在被识别,并且正在评估其暴露的风险。” “努力确定所有可能暴露的工人。”北湾医疗保健公司的一位发言人说:“受影响的医疗保健人员数量是一个不断变化的目标。”

The announcement comes hours after county health officials declared a local emergency and activated its Department Operations Center to identify and screen those potentially exposed to the coronavirus. Officials called the virus a public health threat but caution that the risk to the public in Solano County remains low.

在县卫生官员宣布当地紧急情况并启动其部门运营中心以识别和筛查可能暴露于冠状病毒的人员后数小时,就宣布了这一消息。官员称该病毒是对公共健康的威胁,但警告说,索拉诺县对公众的风险仍然很低。

So that leads me to give you some advice on what to do, and we have to stop thinking about what am I going to do to protect myself and myself only, because what we need to do is we need to start and think like a group to protect ourselves from this virus, and what I mean by that is we need to take steps not only concentrating on how to prevent ourselves from getting the virus. You really need to think about this hard. If you get the virus, what are you going to do to prevent somebody else from getting the virus? If we all think this way, and we all act this way together, we can prevent a lot of problems. So we need to think together as a group and cooperate.

因此,这使我为您提供了一些建议,而我们必须停止思考该怎么做才能保护自己和自己,因为我们需要做的是我们需要像一群人一样开始思考。为了保护自己免受这种病毒的侵害,我的意思是我们不仅应采取措施,不仅要集中精力防止自己感染该病毒。您真的需要认真考虑一下。如果您感染了病毒,您将如何防止他人感染该病毒?如果我们都这样认为,并且我们都一起行动,那么我们可以避免很多问题。因此,我们需要作为一个小组一起思考和合作。

And so the number one thing I’m going to tell you here is get a thermometer. And the reason why I’m telling you that is so you can know objectively if you have a fever. The definition of a fever, by the way, is a temperature greater than 100.4 degrees Fahrenheit or 38.0 degrees centigrade, and I know some people will say well I’m always very cold, and therefore this is a temperature for me. I understand that, but I’m just letting you know that when you come to the hospital, and we check your temperature, these are the criteria that we’re going to use: a temperature of 100.4 or 38.0.

因此,我要在这里告诉您的第一件事就是买一个温度计。我之所以告诉您,是为了让您客观地知道自己发烧的原因。顺便说一句,发烧的定义是温度高于华氏100.4度或摄氏38.0度,我知道有人会说我总是很冷,因此这对我来说是一个温度。我理解这一点,但我只是想告诉您,当您来医院检查温度时,我们将使用以下这些标准:温度100.4或38.0。

If you get a fever, I would say the second thing to do is don’t go to the hospital unless you need to, and what I mean by that is be reasonable, if it is only a cold, or if it is only mild flu symptoms, that you don’t need to go to the hospital for. If you have shortness of breath; if you have severe cough, things of that nature, those are the things that you need to go to the hospital for. Talk to your doctor, call into your nurse; do those sorts of things, because if you go, you’re going to inundate yourself into the hospital system, you’re going to be another patient that they have to see, and you’re going to expose yourself potentially to other people who might be infected.

如果您发烧,我想说的第二件事是除非您需要,否则不要去医院。我的意思是合理的,如果只是感冒,或者只是轻微的话流感症状,您无需去医院就医。如果您呼吸急促;如果您咳嗽得很厉害,那是您需要去医院就诊的东西。与您的医生交谈,打电话给您的护士;要做这些事情,因为如果您去了,您将淹没自己进入医院系统,您将成为他们必须看到的另一位患者,并且可能会将自己暴露给其他人可能被感染了。

Number three: don’t hoard masks. There are two types of masks. There are the regular surgical masks which we all know, and then there’s something called n-95 masks. Let me just tell you right now. A regular surgical mask, other than preventing you from touching something and then touching your nose, isn’t going to prevent you from getting coronavirus. If you’re breathing in air, then you’re breathing in the viruses in the air, and those surgical masks are not designed to filter air that you breathe in. Only the n95 masks do that, so wearing a surgical mask if you’re perfectly healthy, other than the fact of just trying to remind yourself not to touch your nose, your mouth is going to do you no good. So don’t take those masks. Those masks are needed for people at the hospital to put on patients who are already sick.

第三:不要囤积口罩。口罩有两种。有众所周知的常规外科口罩,然后有一种叫做n-95的口罩。现在让我告诉你。常规的口罩,除了可以防止您接触到东西然后触碰鼻子外,还不能防止您感染冠状病毒。如果您呼吸的是空气,那么您正在呼吸的是空气中的病毒,并且这些手术口罩并非旨在过滤您吸入的空气。只有n95口罩可以做到这一点,因此,如果您要戴呼吸口罩,完全健康,除了试图提醒自己不要碰鼻子的事实外,嘴巴对你没有好处。所以不要戴这些口罩。医院的人们需要戴这些口罩戴上已经生病的病人。

Now as far as n95 masks, those masks are needed by physicians and nurses and respiratory therapists and other ancillary service people at the hospital so that they can continue to treat people there and still be healthy and not have to be quarantined. It’s important that they get that equipment, because if they don’t have that equipment, they’re going to get sick, and they’re not going to be there at the hospital when you need them to be there.

现在,就n95口罩而言,医生,护士和呼吸治疗师以及医院的其他辅助服务人员都需要这些口罩,以便他们可以继续在那里治疗人们,并且仍然健康,而不必隔离。他们必须拥有这些设备,这很重要,因为如果他们没有这些设备,他们将会生病,并且当您需要将它们放在医院时,他们也不会在那里。

Number four: if you are having severe symptoms, if you are having shortness of breath, you’re having dyspnea, chest pains, symptoms that are more severe, or you’re lethargic, that means sleepy, you’re not being responsive, these are all things that you should definitely go to the hospital for, and especially if you’re not getting better, but you should call ahead and find out where you should go because you don’t want to expose people at the hospital to your virus.

第四点:如果您有严重的症状,呼吸急促,呼吸困难,胸痛,症状更严重或昏昏欲睡,即表示昏昏欲睡,无反应,这些绝对是您应该去医院做的所有事情,尤其是当您病情没有好转时,但您应该提前打电话确定应该去哪里,因为您不想让医院里的人与您接触病毒。

What they will do is they will probably put a mask on you, like a surgical mask, so that you don’t spread the virus to other healthcare workers. If you or your kids have symptoms, don’t see grandma and grandpa. We just went over what the mortality rates were for people above 70 years and 80 years of age. These are some very basic things that you can do to help prevent the spread of disease and to keep our hospitals healthy so that they can take care of you if you get sick.

他们会做的是,他们可能会像手术口罩一样在您身上戴上口罩,以免将病毒传播给其他医护人员。如果您或您的孩子有症状,请不要去看奶奶和爷爷。我们只是回顾了70岁以上和80岁以上人群的死亡率。这些是您可以做的一些非常基本的事情,可以帮助您预防疾病的传播并保持我们医院的健康,以便在您生病时他们可以照顾您。

We’re going to take a break, and we will come back on Monday morning. Thanks for joining us.

我们要休息一下,我们将在星期一早上回来。感谢您加入我们。

MedCramChina

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