免疫力和结核病疫苗（BCG）是否有助于预防COVID-19（新冠讲座43）

免疫力和结核病疫苗（BCG）是否有助于预防COVID-19（新冠讲座43）

Shortages, Immunity, & Can a TB Vaccine (BCG) Help Prevent COVID-19 (Lecture 43)

短缺，免疫力和结核病疫苗（BCG）是否有助于预防COVID-19（第43讲）

Welcome to another MedCram COVID-19 update. We can see that we’re almost at 400,000 total confirmed worldwide. If we look here at the new daily deaths in the United States, we can see that that is increasing. There’s been some interesting quotes in the news here from March 24th, and they anticipate that the peak number of cases is still two to three weeks away in New York. The governor of New York has said that they need 37,000 ventilators at that point, and they need to get another 30,000 because they’ve got about 7,000 now at this point.

欢迎来到MedCram COVID-19的另一个更新。我们可以看到，全球已确认的总数约为40万。如果我们看一下美国每天新增的死亡人数，我们可以看到这种情况正在增加。从3月24日开始，新闻中有一些有趣的报价，他们预计纽约的案件高峰期仍需2至3周。纽约州州长表示，当时他们需要37,000台呼吸机，并且他们还需要再购买30,000台呼吸机，因为目前他们已经有7,000台呼吸机。

There’s an ominous warning coming from New York saying that because they’re first, what is happening there could be what’s happening in your community in about four to six weeks. They are also saying that hundreds of thousands of people probably have already had COVID-19. They didn’t know that they had it and have recovered, and they’re echoing what we’ve said here earlier, which is that antibodies should be checked for because if they’re positive for the antibodies, then they don’t need to stay home, they could go to work.

纽约有一个不祥的警告，说因为它们是第一位的，所以正在发生的事情可能在您的社区中大约四到六周内发生。他们还说，成千上万的人可能已经有了COVID-19。他们不知道自己已经有了并且已经康复了，他们在回应我们之前在这里所说的，那就是应该检查抗体，因为如果它们对抗体呈阳性，则不需要待在家里，他们可以上班。

Which brings me to this news that was on Yahoo! Fever map could show just how crucial it is to stay home to stop COVID-19 spread. This is a smart thermometer made by Kinsa which is able to upload the data from people who are taking their temperatures and put it on a map. What they’ve shown here through this article, we’ll put a link to it, is that in Florida, there are a number of people who have had elevated temperatures more than they would have guessed for this time of year.

这使我了解到有关Yahoo!的新闻。发烧图可能显示出在家中阻止COVID-19传播至关重要。这是Kinsa生产的一款智能温度计，它可以上传正在测量温度的人的数据并将其放在地图上。他们通过本文在此处显示的内容，我们将与之链接，即在佛罗里达州，许多人的气温升高幅度超过了一年中这个时候的预期。

If you look at the data, the blue is what would be expected. You can see here as you go from February 14 to May 14, the percent of illness should be dropping as we get out of the flu season. That’s the typical range that we see, and we can see here the observed in yellow. Then, when we hit a certain amount outside of that range, that shows an atypical disease pattern, and of course, this doesn’t require any testing no serological data. As soon as the temperatures taken, this is uploaded to the database. During this point, there were isolation measures that were put in place, and we can see an immediate drop. It is an interesting way of checking to see if there is a response to public policy.

如果您查看数据，那将是蓝色。从2月14日到5月14日，您可以在这里看到，随着我们摆脱流感季节，疾病的百分比应该会下降。这是我们看到的典型范围，我们可以在此处看到黄色的观察值。然后，当我们达到该范围之外的某个量时，表明存在非典型的疾病模式，当然，这不需要任何测试就不需要血清学数据。一旦温度升高，就将其上传到数据库。在这一点上，已经采取了隔离措施，我们可以看到立即下降。这是检查是否对公共政策有回应的一种有趣方式。

The article goes on to quote Mr. Singh the CEO of Kinsa, in the example above, Singh says that the spike in the fever coincides with reports of Miami residents and tourists ignoring guidance around recommended distancing. The steep drop-off, however, follows after more extreme measures, including beach closure and other isolation tactics, were adopted in the area. Singh says that they’re regularly seeing that areas, where residents are ignoring social distancing, are seeing spikes. As soon as those are implemented, the lockdowns and other measures, within five days of those aggressive actions, you begin to see downward dips in the curve’’.

文章继续引用了金莎（Kinsa）首席执行官辛格（Singh）先生，在上面的示例中，辛格（Singh）说，发烧高峰与迈阿密居民和游客无视建议的距离指导的报道相吻合。然而，在该地区采取了包括海滩封闭和其他隔离策略在内的更极端措施之后，陡峭的下降。辛格说，他们经常看到居民忽视社交距离的地区出现高峰。一旦采取了这些措施，锁定措施和其他措施，在采取这些积极行动后的五天内，您就会开始看到曲线的下降。

It’s interesting to note that we know from other data that five days is about the median incubation period for SARS-CoV-2. They’re not actually testing for COVID-19 with temperature, but as is pointed out, fever is a key and early symptom of COVID-19, so bear that in mind.

有趣的是，我们从其他数据中得知，SARS-CoV-2的中位潜伏期约为5天。他们实际上并没有在温度下测试COVID-19，但要指出的是，发烧是COVID-19的关键和早期症状，因此请记住这一点。

I wanted to take this to a bird’s eye view. If this represents the total population, then obviously not the whole population is going to be infected. There is some debate on exactly what percent of the population is going to be infected with COVID-19, but let’s say it represents it by this, we’ll call this infection, and there are a number of issues that could make this proportion go up or go down.

我想将其鸟瞰。如果这代表了总人口，那么显然并非所有人口都将受到感染。关于到底有多少人口将感染COVID-19尚有争议，但可以说它代表了这一点，我们称这种感染为例，并且有许多问题可能会使这一比例下降上升或下降。

We know that some of the things that they’re employing right now to allow it to go down, social distancing, or isolation, or even some medications that would be called prophylaxis. Prophylaxis is a medication that would prevent the infection. We don’t have anything that’s FDA approved, but that’s where it would go at this point. So what are things that could make the number of people with infection go up? That would be apathy or just carelessness. We’re trying to do social distancing and isolation to reduce the number of people in the population that might get the infection.

我们知道他们现在正在使用的某些东西可以使它掉下来，与社会保持距离或孤立，甚至可以使用某些被称为预防的药物。预防是可以预防感染的药物。我们没有FDA批准的任何产品，但这就是目前的情况。那么，哪些因素会使感染人数上升呢？那将是冷漠或只是粗心。我们正在尝试进行社会隔离和隔离，以减少人口中可能感染的人数。

That’s important because what we have over here, if you can imagine that these bars are on wheels, is we’re trying to get these car trains, if you will, through a tunnel that has a capacity for the healthcare system. And there are certain things that will increase the capacity of the healthcare system, and there are certain things that will decrease the capacity. We’ll get to that. But there’s one other intermediate step that really has not been looked at that seriously.

这很重要，因为如果您能想象这些杠铃在车轮上，我们在这里拥有的一切就是，如果您愿意，我们是否正在尝试通过一条可容纳医疗保健系统的隧道来运送这些汽车。某些事情会增加医疗保健系统的容量，而某些事情会降低医疗系统的容量。我们将解决这个问题。但是，还没有认真考虑过另一个中间步骤。

That is this car right here. We don’t know exactly how tall these are; they’re not drawn to scale. But these are the people here from the infection that will be going to the hospital. They will be going in through the tunnel. Hopefully, they are shorter than the tunnel. Otherwise, there’s going to be a problem.

那就是这辆车。我们不知道这些有多高。他们没有按比例绘制。但是这些都是来自医院的感染者。他们将穿过隧道。希望它们比隧道短。否则，将会有问题。

So what are the things that are going to increase the height of the tunnel that will allow it to go inside? Personal protective equipment on healthcare workers that allows the capacity to be higher because they’re able to do more; having ventilators that would increase the capacity of the healthcare system; medications, not only clinical trials to see what medications are appropriate but also the manufacture and the delivering of those medications, are going to be key as well.

那么，增加隧道高度使其进入内部的原因是什么？对医护人员的个人防护设备，由于他们能够做更多的事，因此可以提高工作能力；配备能增加医疗保健系统容量的通风机；药物，不仅是临床试验，以了解哪种药物合适，而且这些药物的生产和交付也将是关键。

Well, what would decrease this? Well, if healthcare workers have to be quarantined because they didn’t have personal protective equipment, or if there is no PPE either because people are taking the masks or they’re just not enough masks for healthcare workers to use. So where we are seeing a lot of resources spent right now is for the development at the making of personal protective equipment.

好吧，什么会减少呢？好吧，如果医护人员因为没有个人防护设备而必须隔离，或者如果没有PPE，或者是因为人们拿着口罩，或者因为他们没有足够的口罩供医护人员使用，那么就好了。因此，我们现在看到大量资源用于个人防护装备的开发。

We are getting the government involved in trying to convince manufacturers to make more ventilators. The FDA is waiting for these clinical trials to be completed so that it can decide whether or not it’s going to indicate those medications for use in COVID-19.

我们正在促使政府参与，试图说服制造商制造更多的氧气机。 FDA正在等待这些临床试验完成，以便可以决定是否要指明那些用于COVID-19的药物。

But of course, we have other medications that haven’t been labeled for use in COVID-19, and we’re using those as off-label at this point because there are no medications that are FDA approved for COVID-19. We are starting to get manufacturers to make a lot more medication.

当然，我们还有其他未标记为可用于COVID-19的药物，并且由于目前尚无FDA批准的COVID-19药物，因此我们现在将其标记为不适用。我们开始让制造商制造更多的药物。

So we have focused a lot of energy in trying to get this tunnel increased in size because we know that there’s a lot of people coming down the pike. There’s going to be quite a number of people going through, and as it turns out, we know that about 20% of the people that become infected will end up needing to go to the hospital to get hospitalization; about 80% of those will simply have a mild case. So 80% no hospitalization.

因此，我们投入了很多精力来尝试增加此隧道的大小，因为我们知道有很多人从长矛中摔下来。将会有大量的人在经历，事实证明，我们知道大约20％的被感染者最终将需要去医院住院；大约80％的人只会患有轻微的情况。因此80％没有住院。

What’s happening over here? Well, we’re having a lot of time and effort being put into social distancing, isolation, and things of that nature. So up to this point, this is where we’ve seen most of the effort being made to handle this situation with COVID-19. The question remains: what else can we do?  May I suggest to you that where we need to be focusing as well is on this center section because the question really boils down to: why is it that 80% with an infection will not need to go to the hospital? And the answer is very simple. The answer is your immune system.

这是怎么回事好吧，我们花了大量的时间和精力在社会隔离，孤立以及类似的事情上。因此，到目前为止，这是我们看到为使用COVID-19处理这种情况所做的大部分努力。问题仍然存在：我们还能做什么？我是否可以向您建议，我们也需要重点关注这个中心部分，因为问题的实质可以归结为：为什么80％的感染者不需要去医院？答案很简单。答案是您的免疫系统。

The reason why we know that’s the case is that people who are older, have more comorbidities typically have weaker immune systems. Those that are younger typically have stronger immune systems. That’s exactly what we’re seeing in this situation. Older folks tend to be the ones that need to go to the hospital; that’s not a big surprise. There are exceptions, of course, all the way up and down. There are young people that end up going to the hospital and there are elderly people who become sick but then recover on their own, but by and large, the 20% that end up at the hospital have a lower immune system generally.

我们之所以如此，是因为年龄较大，合并症更多的人的免疫系统通常较弱。那些年轻的人通常具有更强的免疫系统。这就是我们在这种情况下看到的。老年人往往是需要去医院的人。这并不奇怪。当然，上下都有例外。有年轻人最终去医院就诊，有老年人生病后又自行康复，但总的来说，最终进入医院的20％患者的免疫系统通常较低。

So, in fact, the way that this box gets increased is if you have a bad immune system, and the way that this comes down is if you have a good immune system. And not much resources as of yet has been put into making sure that we have a good immune system. And I think this is a good area to look at because if you had a good immune system here to prevent you from going to the hospital, it also can work that a good immune system here might have prevented you from getting the illness in the first place. So I think having a good immune system is of paramount importance.

因此，实际上，如果您的免疫系统较差，则增加此框的方式是如果您的免疫系统较差，则降低此框的方式。到目前为止，尚未投入太多资源来确保我们拥有良好的免疫系统。我认为这是一个很好的研究领域，因为如果您的免疫系统良好，可以防止您去医院就诊，那么良好的免疫系统可能也可以阻止您从一开始就染病。地点。因此，我认为拥有良好的免疫系统至关重要。

There are two reasons why that’s the case. Because for you personally, if you’re able to improve your immune system, then you’re not going to the hospital. But even more important, if you’re not going to the hospital, that means the hospital doesn’t need to deal with you and can concentrate their efforts on somebody else.

出现这种情况有两个原因。因为对您个人来说，如果您能够改善自己的免疫系统，那么您就不用去医院了。但是更重要的是，如果您不去医院，那意味着医院不需要与您打交道，而是可以将精力集中在其他人身上。

Now notice that we’re dealing with about an 80% and 20% differential there. That means if we can just improve the immune system by a short amount, in other words, if we can improve the immune system instead of 80% go to 85%, so that 85% don’t need to go to the hospital. That means this 20% drops to 15%; that’s actually a 25% drop in hospital admissions, which would be a massive impact at the hospital level. Of course, we’re all hoping that if we can reduce this, then we can finally slip this car right into the tunnel without a problem.

现在请注意，我们正在处理大约80％和20％的差异。这意味着如果我们可以少量改善免疫系统，换句话说，如果我们可以改善免疫系统，而不是80％可以提高到85％，这样85％就不需要去医院了。这意味着这20％下降到15％；实际上，住院人数下降了25％，这将对医院产生巨大的影响。当然，我们都希望，如果能够减少排放量，那么我们最终可以将这辆车毫无问题地滑入隧道。

Hopefully, all of these things – working together, social distancing, isolation, a good immune system, medications, delivered when they need to be, personal protective equipment, ventilators, clinical trials yielding good medications – all of these things can work together so that when we have the peak hit, we’re able to take care of all the patients that we need to take care of.

希望所有这些事情-一起工作，社会隔离，孤立，良好的免疫系统，需要时提供的药物，个人防护用品，呼吸机，产生良好药物的临床试验-所有这些都可以一起工作，以便当达到高峰时，我们就能照顾到所有需要照顾的患者。

There are two components to your immune system. There is something called the innate and the specific. The innate portion of your immune system is made up of components of the white blood cells, which are the soldiers of your military immune system that basically indiscriminately take anything that’s foreign and destroy them. It doesn’t need to have specific knowledge of specific antigens. That’s why it’s known as innate; whereas the specific has to be taught and shown specifically what the foreign antigen is, so it can make antibodies against that specific and foreign antigen.

免疫系统有两个组成部分。有一种叫做先天的和特定的。免疫系统的先天部分是由白细胞组成的，这些白细胞是您的军事免疫系统的士兵，基本上不加选择地将任何外来物质杀死。它不需要具有特定抗原的特定知识。这就是为什么它被称为先天的原因。然而，必须教导并具体显示外源抗原是什么，因此它可以制备针对该特定外源抗原的抗体。

So if you have here a pathogen. When the pathogen comes, it must penetrate through the innate immune system first. Now, what are the components of the innate system? You have things called natural killer cells, you have macrophages. These are cells that eat up the foreign substance, munch it up and take little pieces of it and then present it to the specific portion of the immune system so that they can see what parts of it look like, and then make sure that they can identify it later. Also, neutrophils are part of that innate system.

因此，如果您有病原体。当病原体到来时，它必须首先穿透先天免疫系统。现在，先天系统的组成部分是什么？你拥有所谓的自然杀伤细胞，你拥有巨噬细胞。这些细胞会吞噬异物，将其吸收并吸收一小部分，然后将其呈现给免疫系统的特定部分，以便它们可以看到异物的外观，然后确保它们可以稍后再识别。而且，中性粒细胞是该先天系统的一部分。

So generally, what happens is you have a pathogen, it gets eaten up by either natural killer cells, macrophages, neutrophils. The macrophages generally speaking take pieces of it and present it to the specific arm that’s called an antigen-presenting cell, that’s a macrophage. And there are two types of cells here, there are T cells and there are B cells, and generally speaking, the T-cells are the things that are involved with cell-mediated immunity where there are cells that are problems. These T cells can kill them. There are T4 helper cells which can help communicate as well.

因此，通常情况是，您有一种病原体，被自然杀伤细胞，巨噬细胞和中性粒细胞吞噬。一般来说，巨噬细胞会将其碎片并呈递给称为抗原呈递细胞的特定臂，即巨噬细胞。这里有两种类型的细胞，即T细胞和B细胞，通常来说，T细胞是涉及细胞介导的免疫力的事物，其中存在有问题的细胞。这些T细胞可以杀死它们。 T4辅助细胞也可以帮助进行交流。

The B cells on the other hand secrete antibodies which neutralize antigens, be aware of that. What is going on around the world? There’s something called the BCG vaccine. Now, the BCG vaccine is given in various parts of the world; it’s an injection that’s given in young children to protect them from tuberculosis even though it’s not tuberculosis. There is a crossover between the vaccine and the innate immune system’s response to tuberculosis.

另一方面，请注意，B细胞分泌中和抗原的抗体。世界各地发生了什么事？有一种叫做卡介苗的疫苗。现在，卡介苗已在世界各地使用。这是给幼儿注射的药物，以保护他们免受结核病的侵害，即使它不是结核病。疫苗与先天免疫系统对结核病的反应之间存在交叉。

The reason why they’re doing this in different parts of the world is because they have noticed that when they give the BCG vaccine to young individuals, not only do these young individuals have a natural killer cell, macrophage, neutrophil response or the innate response, they also have a specific response against it, which is helpful in trying to kill tuberculosis. But they’ve also noticed something else, it seems as though the specific arm of the immune system is talking to the innate after it gets revved up with the vaccination, and it’s using a carrier called IL-1 beta.

他们之所以在世界各地进行此操作，是因为他们注意到，当他们向年轻人接种BCG疫苗时，这些年轻人不仅具有天然杀伤细胞，巨噬细胞，嗜中性白细胞反应或先天反应，他们也对此有特定的反应，这有助于尝试杀死结核病。但是他们也注意到了其他事情，似乎免疫系统的特定部分正在与先天性接触，因为先天性免疫接种后，它正在使用一种叫做IL-1 beta的载体。

Now when this happens, it not only revs up the specific but it revs up the innate as well to the point where when they give the BCG vaccine, they’re noticing a reduction of 30% in viral infections.

现在，当发生这种情况时，它不仅提高了特异性，而且还提高了先天性，以至于他们接种BCG疫苗时，他们注意到病毒感染减少了30％。

There were some criticisms of this study, but by 2016 a review was done that was published in the British Medical Journal that showed that there was an excess reduction in mortality after the BCG vaccine was given. That couldn’t be explained solely by the prevention of tuberculosis.

这项研究受到了一些批评，但是到2016年，发表在《英国医学杂志》上的一项评论表明，接种BCG疫苗后死亡率会大大降低。不能仅通过预防结核病来解释这一点。

So more studies since 2016 had confirmed that this is what it is that’s going on. In fact, it culminated in a study where they gave the BCG vaccine and they noticed that it protected against a completely different pathogen, the yellow fever virus in a weakened form which is also seen as a vaccination. Something that was new and interesting was that when you stimulated the specific arm of the immune system it also stimulated the innate arm.

自2016年以来的更多研究证实了这就是事实。实际上，它在一项研究中达到了顶峰，他们给他们提供了BCG疫苗，他们注意到它可以抵抗完全不同的病原体，一种弱化形式的黄热病病毒，也被视为疫苗。有趣的是，当您刺激免疫系统的特定臂时，它也会刺激先天臂。

Therefore, if you could rev up the immune system by giving a specific antigen that maybe not even related to the thing you’re trying to protect against, a boosted innate immune system could be protective against another virus, and that’s exactly what they’re hoping on doing here with COVID-19.

因此，如果您可以通过提供一种甚至与您要保护的东西不相关的特定抗原来增强免疫系统，那么增强的先天免疫系统就可以防御另一种病毒，而这正是它们的本质所在。希望在这里使用COVID-19。

So there’s a number of studies all across the world including Greece, the Netherlands, Australia and the UK that’s looking at giving the BCG vaccine to elderly population and high-risk people like physicians, nurses, healthcare workers., etc. If they can give them the BCG vaccine, they’re hoping that the innate immunity will go up enough that they might not get the infection. I’ll put a link in the description below to the article describing this technique: Can a century-old TB vaccine steell the immune system against the new Coronavirus?

因此，世界各地都有许多研究，包括希腊，荷兰，澳大利亚和英国，正在为老年人和医生，护士，医护人员等高风险人群提供BCG疫苗。他们是BCG疫苗，他们希望先天免疫力会提高到足以避免感染。我将在下面的描述中链接到描述该技术的文章：百年历史的TB疫苗能否增强针对新冠状病毒的免疫系统？

But you can see here on this graph. We’re looking at the areas in red as we’ve mentioned. The other area that we should look at is the areas in green even if it helps a little bit. A lot of the problems that we’re having over here in red is the system trying to get the PPE out to enough hospitals that they can use it, our medications we’re having shortages trying to get enough of these things out to the hospital.

但是您可以在此图上看到。如上所述，我们正在查看红色区域。我们应该注意的另一个区域是绿色区域，即使它有所帮助。我们在这里遇到的很多红色问题是系统试图将PPE送到足够的医院使用，而我们的药物短缺，试图将足够的这些东西送到医院。

So we’ll ask a different question, what are some things that we can do without having to worry about a healthcare delivery system that can improve our immune system? So for future updates, we are going to take a look at the data of things that can improve your immune system.

因此，我们将提出一个不同的问题，在不必担心可以改善免疫系统的医疗保健提供系统的情况下可以做些什么？因此，在以后的更新中，我们将研究可以改善您的免疫系统的事物的数据。