无症状病毒传播，游轮隔离，无症状检测  （新冠病毒讲座22）

无症状病毒传播，游轮隔离，无症状检测

Viral Shedding Without Symptoms, Cruise Quarantine, Asymptomatic Testing (Lecture 22)

Welcome to another MedCram lecture. And we can see here the numbers are increasing, but slowly. Here on the WorldOmeter website, 75,730 total (confirmed cases); deaths 2128; recovered 16,000. If we look at the Active Cases and the Closed Cases, you can see that the number of recovered has gone up slightly, and seems to be doing that on a daily basis. If we look at the total worldwide cases, you can see here that they are dwindling overall, but in looking at the cases that are outside of China, we can see that they continue to increase. In terms of the number of deaths, unfortunately, those continue to be increasing pretty much at a linear rate.

欢迎参加另一个MedCram讲座。我们可以看到这里的数字在增加，但速度很慢。在WorldOmeter网站上的总数为75,730（确诊病例）；死亡2128;恢复了16,000。如果我们查看“活动案例”和“结案”，您会发现回收的数量略有增加，并且似乎每天都在这样做。如果我们看一下全球范围内的病例总数，您可以看到它们总体上正在减少，但是查看中国以外的病例，我们可以看到它们继续增加。不幸的是，就死亡人数而言，死亡人数继续以线性速度增长。

I want to update you on the situation with the Diamond Princess cruise ship that’s docked outside of Japan. There was a statement put out by the CDC commending the government of Japan for the fact that they quarantine patients, but there’s been a lot of international criticism of how Japan actually handled this. And there’s been an intervention, and basically the consensus, if you read between the lines, is that this did not work very well. This currently has more than a hundred US citizens either onboard the Diamond Princess or in hospitals in Japan.

我想向您介绍日本以外停靠的钻石公主号游轮的情况。疾病预防控制中心发表声明称赞日本政府隔离患者，但国际上对日本如何处理这一问题提出了很多国际批评。并且已经进行了干预，如果您仔细阅读这两句话，基本上达成的共识是，这种方法效果不佳。目前，在钻石公主号上或在日本的医院中，已有一百多名美国公民。

And they’ve been placed on restrictions, and they’re saying that they will be required to wait 14 days before coming home, before they’re permitted to go onboard flights. However, if an individual does make it to the United States before that 14-day period ends, they will be subject to a mandatory quarantine until they completed that 14-day period. So the CDC is coming out with that statement, and they want to make sure that everyone is aware that they are taking this seriously.

而且他们已经受到限制，他们说他们将被要求等14天才能回家，然后才被允许登机。但是，如果某人确实在14天期限内到达美国，则必须接受强制性隔离，直到他们完成14天期限。因此CDC提出了这一声明，他们希望确保每个人都知道他们正在认真对待这一点。

I also want to quickly highlight a letter that was submitted to the New England Journal of Medicine dated yesterday, February 19. It was an interesting look at about 18 patients; nine men and nine women, meeting 59 years of age. And what they did was they looked at viral loads in the upper respiratory tract to see what they were based on when the symptoms began, and now these people from Wuhan, and all of them, except for one, were symptomatic.

我也想快速强调一下昨天2月19日提交给《新英格兰医学杂志》的一封信。这是对18位患者的有趣观察。九男九女，年龄59岁。他们所做的是，他们观察了上呼吸道的病毒载量，以根据症状发作时的情况进行判断，现在这些来自武汉的人以及除一个人以外的所有人都是有症状的。

There was one person that was asymptomatic, and we’ll talk about that in just a second, but you can see here the graphs of the CT value, which is basically the viral load. And on the x-axis here is the number of days since the onset of symptoms is 0 being here on the far left, and what you can basically see is that the viral load was quite high in the very early days of the symptoms, and then tapers off almost all of them being undetectable here towards 14 days.

有一个人没有症状，我们将在稍后讨论，但是您可以在此处看到CT值图表，它基本上是病毒载量。在x轴上，最左端的位置是自症状发作为0以来的天数，您基本上可以看到的是，在症状出现的初期，病毒载量就很高，并且然后逐渐减少到14天都无法在此处检测到的所有对象。

Now, please don’t confuse these days as the incubation period. This is nothing to do with the incubation period. This has to do with how long the symptoms last once you get the symptoms. incubation period has to do with how long it is between infection and the onset of symptoms. The other thing to notice here at the bottom is may be difficult to see, but in terms of throat swabs versus nasal swabs, there was a higher viral count in the nasal swabs in general than there was in the throat swabs, meaning that this virus tends to potentially congregate in the upper airways.

现在，请不要混淆这些天作为潜伏期。这与潜伏期无关。一旦出现症状，这与症状持续多长时间有关。潜伏期与感染和症状发作之间的时间长短有关。在底部需要注意的另一件事可能很难看清，但是就咽拭子与鼻拭子而言，总体而言，鼻拭子的病毒计数高于咽喉拭子，这意味着该病毒倾向于潜在地聚集在上呼吸道。

There was one patient that was tested and was asymptomatic, and they say here that the viral load that was detected in the asymptomatic patient was similar to that in the symptomatic patients, which suggests that the transmission potential of asymptomatic, or minimally symptomatic patients, and this is confirming what we had discussed earlier at the beginning of this outbreak that potentially can be spread by asymptomatic individuals. And we will put a link in the description below to this article, as well as the CDC article.

有一名患者经过测试且无症状，他们在这里说，无症状患者中检测到的病毒载量与有症状患者相似，这表明无症状或极少症状患者的传播潜力，以及这证实了我们在爆发初期就已经讨论过的可能由无症状个体传播的内容。并且我们将在下面的描述中链接到本文以及CDC文章。

Another article that was submitted on the same day yesterday was a perspective that was written by a number of physicians and epidemiologists on their perspective of defining the epidemiology of covid-19, and how more studies are needed. One of the interesting aspects that they mention here is they may need to do testing in people that may not meet the current definitions, which is someone who has traveled from that particular area of China and has symptoms, and they say here key point of these recommendations is that viral testing should not be used only for clinical care.

昨天同一天提交的另一篇文章是许多医师和流行病学家就定义covid-19流行病学的观点以及需要进行更多研究的观点发表的观点。他们在这里提到的有趣的方面之一是，他们可能需要对可能不符合当前定义的人进行测试，这些人是从中国那个特定地区旅行并且有症状的人，他们在这里说这些要点建议病毒检测不应仅用于临床护理。

I think that’s an interesting point. If we really want to find out what the scope is of the infection, especially in China, there’s going to have to be a lot of people who are asymptomatic be tested to see whether or not they had the virus at some point. Anyway, I leave that perspective there for your consideration. In future updates, we will plan on tackling the molecular biology of coronavirus and contrast it and compare it to other viruses, and that might give us a little bit of information about what this virus likes to do. Thanks for joining us.

我认为这是一个有趣的观点。如果我们真的想找出感染的范围，尤其是在中国，则必须对很多无症状的人进行检测，以了解他们是否在某些时候感染了病毒。无论如何，我将这种观点留给您考虑。在未来的更新中，我们将计划解决冠状病毒的分子生物学问题并将其与其他病毒进行对比，并将其与其他病毒进行比较，这可能会为我们提供有关该病毒喜欢做什么的一些信息。感谢您加入我们。