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      長期新冠不能忽視,防疫措施不能放松

      長期新冠不能忽視,防疫措施不能放松

      CAROLYN BARBER 2022-04-24
      長期新冠在美國已經廣泛存在。

      圖片來源:SCOTT OLSON—蓋蒂圖片社

      長期新冠患者的故事在社交媒體上傳播,幾乎從每個人的故事中都能看出他們的擔憂和痛苦,比如呼吸問題、慢性痛疼、不明原因的挫傷、幻覺、腦霧等。一個人寫道:“我只能說我的后背好像插了六把匕首?!币幻t生在2020年因為工作感染了病毒,她表示:“與以前相比,我現在只是一個軀殼?!?/p>

      新冠疫情許多方面的問題令研究人員困惑不已,政府部門迫切希望找到合理的政策,但最令人印象深刻的當屬長期新冠。長期新冠的發展過程是個謎,它所引發的并發癥各不相同,目前它可能比我們實際了解到的情況更值得擔憂。

      但可以明確的一點是,長期新冠及其虛弱效應最終會影響數以千萬計的美國人,這也是與新冠有關的國家健康政策和預防措施依舊至關重要的原因之一?,F在還不是叫停防疫措施的時候。

      數字非常驚人。解決長期新冠倡議(Solve Long COVID Initiative)最近的報告估計,有2,200萬美國人在最初感染新冠后的幾個月依舊受到病毒的影響,約占美國總人口的6.7%。(這與美國政府問責署(U.S. Government Accountability Office)預測的數據接近。)美國約有700萬人可能存在令人失去行動能力的長期新冠癥狀。換個角度來說,英國的數據顯示,其約2.7%的人口受到長期新冠影響。

      但我們對于長期新冠甚至還沒有一個確切的定義。一般來說,長期新冠是指患者初次感染新冠病毒后幾周或幾個月內癥狀出現、復發或持續存在。這些癥狀可能會持續幾個月甚至幾年,可能造成可怕的后果。

      這并不是一個之前從未有過的醫療術語。政府問責辦公室的報告稱,一項研究顯示,上一次冠狀病毒疫情(即2003年在亞洲首次發現的嚴重急性呼吸道綜合征病毒)的幸存者中,有27%在首次感染4年后依舊存在慢性疲勞綜合征。

      但新冠疫情比SARS疫情更加嚴重,而且長期新冠(又被稱為“后新冠”)的影響,對于數百萬人而言極其嚴重并且改變了他們的生活。長期新冠的癥狀包括心臟異常、凝血問題、腎臟損傷、肺損傷甚至糖尿病等。超過四分之三長期新冠患者出現了認知障礙,而且專家表示抑郁和創傷后應激障礙等也是常見癥狀。

      退伍軍人管理局(Veterans Administration )對超過15萬新冠患者所做的大規模研究發現,患者在確診至少一年后,患心臟病或約20種心血管疾病的風險大幅提高。與對照組相比,新冠康復患者中風的概率提高了52%,患心臟病的概率提高了72%。

      為什么要在現在談論這個問題?因為任何年齡的患者都可能出現長期新冠癥狀,即使是最初的輕癥或無癥狀患者也難以幸免。簡而言之,更多新冠患者意味著長期新冠患者增加。目前,美國不僅對病例數量的統計嚴重失真,還放松了疫情防控措施,盡管已經被削弱的統計系統顯示隨著東北部地區奧密克戎BA.2亞變異株的傳播,病例數再次增加。

      家用檢測試劑盒無疑非常重要,但它的出現卻影響了監管機構確定到底有多少人檢測呈陽性,因為實驗室看不到這些檢測結果。前美國食品藥品管理局(FDA)專員斯科特·戈特利布最近表示:“如果我們只能確定七分之一或八分之一病例,我不會感到意外?!备晏乩颊J為:“我們說每天新增30,000例感染者,但實際上可能更接近每天增加了25萬例?!边@讓人覺得可怕,而且如果這些數據被真正記錄在案,而不是猜測的結果,那么肯定會促使政府采取截然不同的防疫措施。

      本月早些時候,人們更清楚地理解了持續病毒威脅的觀點。當時,在華盛頓特區召開的年度烤架俱樂部晚宴實際上變成了一場超級傳播事件,事后有超過70人被感染。這起高知名度的事件提醒我們,病毒依舊在美國肆虐,但許多州正在關閉檢測點,取消口罩限制令,并停止每天公布感染病例、住院病例和死亡病例情況。

      波士頓兒童醫院(Boston Children’s Hospital)流行病學家、ABC News撰稿人約翰·布朗斯坦表示:“有效的公共健康響應取決于高質量的實時數據。檢測行為的變化、公眾缺乏興趣和地方公共健康部門的資金嚴重不足等問題所導致的漏報,導致病例數和住院人數造成了誤導,引發一場完美風暴?!?/p>

      我們需要以充分的數據為基礎制定合理的決策。首先應該在全美擴大廢水監測規模,因為病毒可能通過有癥狀或無癥狀感染者的糞便傳播,而污水監測可以提前預警新傳播事件。

      我們應該免費大規模提供快速檢測,跟蹤檢測結果,并完善醫院和各州收集和分享信息的方式。在感染人數增加之后,等到與新冠相關的住院人數增加時就會為時已晚。

      公共健康的目標當然是為了預防。在疫情期間要求室內大型公共活動、餐廳等場合配戴口罩的規定,應該作為常態,而不是取消規定??谡?、疫苗、更先進的通風系統、便利的抗病毒藥物獲取途徑、新療法開發等,都可以幫助防御病毒,反過來可以減少長期新冠病例。

      關于長期新冠,依舊有許多信息無法確定。在4月初,拜登政府公布了加快國立健康研究院(NIH)大型研究項目的患者招募和協調多個聯邦政府就的計劃。國立健康研究院的項目患者招募進展緩慢,令人意外。在此之前,聯邦政府行動遲緩并且對潛在治療藥物的研發不夠重視,引發多個團體不滿,遭到公眾的嚴厲批評。目前沒有一款治療藥物面世。

      毋庸置疑,人們正在承受痛苦,就連兒童也出現了可怕的癥狀。對Paxlovid等抗病毒藥物以及抗凝血劑和抗血小板藥物的大規模臨床試驗進行投資,可以幫助我們加快找到潛在治療藥物?,F在應該加快研發進展。

      與此同時,長期新冠患者的痛苦經歷仍在繼續,長期新冠對美國的影響不容低估。

      退伍軍人事務部圣路易斯醫療保健系統(Veterans Affairs St. Louis Health Care System)臨床流行病學中心(Clinical Epidemiology Center)主任齊亞德·阿爾-阿里表示:“我們認為[病例數據]將演變成數以百萬計需要護理的長期新冠患者,總之,我們的醫療系統需要做好準備。醫療系統或診所經營者需要做好準備,迎接大量有心臟病或其他長期新冠癥狀的患者蜂擁而至?!比澜缂s有1億人正承受著長期新冠的影響或之前曾經出現過長期新冠癥狀。

      我們要面對長期新冠的事實,盡管我們仍在努力了解長期新冠綜合征最有可能以哪種方式在哪些情況下出現。整個國家有責任對新冠的傳播保持警惕,因為在傳播過程中會誕生長期新冠。(財富中文網)

      本文作者醫學博士卡羅琳·巴伯擔任急診科醫生已有25年。她著有《失控的藥物:你不知道的事情可能會害死你》(Runaway Medicine: What You Don’t Know May Kill You)一書。她曾為《財富》和《美國科學》(Scientific American)等美國期刊撰文,詳細介紹新冠疫情。巴伯是加州無家可歸者工作計劃“改變之輪”(Wheels of Change)的聯合創始人。

      譯者:劉進龍

      審校:汪皓

      長期新冠患者的故事在社交媒體上傳播,幾乎從每個人的故事中都能看出他們的擔憂和痛苦,比如呼吸問題、慢性痛疼、不明原因的挫傷、幻覺、腦霧等。一個人寫道:“我只能說我的后背好像插了六把匕首?!币幻t生在2020年因為工作感染了病毒,她表示:“與以前相比,我現在只是一個軀殼?!?/p>

      新冠疫情許多方面的問題令研究人員困惑不已,政府部門迫切希望找到合理的政策,但最令人印象深刻的當屬長期新冠。長期新冠的發展過程是個謎,它所引發的并發癥各不相同,目前它可能比我們實際了解到的情況更值得擔憂。

      但可以明確的一點是,長期新冠及其虛弱效應最終會影響數以千萬計的美國人,這也是與新冠有關的國家健康政策和預防措施依舊至關重要的原因之一?,F在還不是叫停防疫措施的時候。

      數字非常驚人。解決長期新冠倡議(Solve Long COVID Initiative)最近的報告估計,有2,200萬美國人在最初感染新冠后的幾個月依舊受到病毒的影響,約占美國總人口的6.7%。(這與美國政府問責署(U.S. Government Accountability Office)預測的數據接近。)美國約有700萬人可能存在令人失去行動能力的長期新冠癥狀。換個角度來說,英國的數據顯示,其約2.7%的人口受到長期新冠影響。

      但我們對于長期新冠甚至還沒有一個確切的定義。一般來說,長期新冠是指患者初次感染新冠病毒后幾周或幾個月內癥狀出現、復發或持續存在。這些癥狀可能會持續幾個月甚至幾年,可能造成可怕的后果。

      這并不是一個之前從未有過的醫療術語。政府問責辦公室的報告稱,一項研究顯示,上一次冠狀病毒疫情(即2003年在亞洲首次發現的嚴重急性呼吸道綜合征病毒)的幸存者中,有27%在首次感染4年后依舊存在慢性疲勞綜合征。

      但新冠疫情比SARS疫情更加嚴重,而且長期新冠(又被稱為“后新冠”)的影響,對于數百萬人而言極其嚴重并且改變了他們的生活。長期新冠的癥狀包括心臟異常、凝血問題、腎臟損傷、肺損傷甚至糖尿病等。超過四分之三長期新冠患者出現了認知障礙,而且專家表示抑郁和創傷后應激障礙等也是常見癥狀。

      退伍軍人管理局(Veterans Administration )對超過15萬新冠患者所做的大規模研究發現,患者在確診至少一年后,患心臟病或約20種心血管疾病的風險大幅提高。與對照組相比,新冠康復患者中風的概率提高了52%,患心臟病的概率提高了72%。

      為什么要在現在談論這個問題?因為任何年齡的患者都可能出現長期新冠癥狀,即使是最初的輕癥或無癥狀患者也難以幸免。簡而言之,更多新冠患者意味著長期新冠患者增加。目前,美國不僅對病例數量的統計嚴重失真,還放松了疫情防控措施,盡管已經被削弱的統計系統顯示隨著東北部地區奧密克戎BA.2亞變異株的傳播,病例數再次增加。

      家用檢測試劑盒無疑非常重要,但它的出現卻影響了監管機構確定到底有多少人檢測呈陽性,因為實驗室看不到這些檢測結果。前美國食品藥品管理局(FDA)專員斯科特·戈特利布最近表示:“如果我們只能確定七分之一或八分之一病例,我不會感到意外?!备晏乩颊J為:“我們說每天新增30,000例感染者,但實際上可能更接近每天增加了25萬例?!边@讓人覺得可怕,而且如果這些數據被真正記錄在案,而不是猜測的結果,那么肯定會促使政府采取截然不同的防疫措施。

      本月早些時候,人們更清楚地理解了持續病毒威脅的觀點。當時,在華盛頓特區召開的年度烤架俱樂部晚宴實際上變成了一場超級傳播事件,事后有超過70人被感染。這起高知名度的事件提醒我們,病毒依舊在美國肆虐,但許多州正在關閉檢測點,取消口罩限制令,并停止每天公布感染病例、住院病例和死亡病例情況。

      波士頓兒童醫院(Boston Children’s Hospital)流行病學家、ABC News撰稿人約翰·布朗斯坦表示:“有效的公共健康響應取決于高質量的實時數據。檢測行為的變化、公眾缺乏興趣和地方公共健康部門的資金嚴重不足等問題所導致的漏報,導致病例數和住院人數造成了誤導,引發一場完美風暴?!?/p>

      我們需要以充分的數據為基礎制定合理的決策。首先應該在全美擴大廢水監測規模,因為病毒可能通過有癥狀或無癥狀感染者的糞便傳播,而污水監測可以提前預警新傳播事件。

      我們應該免費大規模提供快速檢測,跟蹤檢測結果,并完善醫院和各州收集和分享信息的方式。在感染人數增加之后,等到與新冠相關的住院人數增加時就會為時已晚。

      公共健康的目標當然是為了預防。在疫情期間要求室內大型公共活動、餐廳等場合配戴口罩的規定,應該作為常態,而不是取消規定??谡?、疫苗、更先進的通風系統、便利的抗病毒藥物獲取途徑、新療法開發等,都可以幫助防御病毒,反過來可以減少長期新冠病例。

      關于長期新冠,依舊有許多信息無法確定。在4月初,拜登政府公布了加快國立健康研究院(NIH)大型研究項目的患者招募和協調多個聯邦政府就的計劃。國立健康研究院的項目患者招募進展緩慢,令人意外。在此之前,聯邦政府行動遲緩并且對潛在治療藥物的研發不夠重視,引發多個團體不滿,遭到公眾的嚴厲批評。目前沒有一款治療藥物面世。

      毋庸置疑,人們正在承受痛苦,就連兒童也出現了可怕的癥狀。對Paxlovid等抗病毒藥物以及抗凝血劑和抗血小板藥物的大規模臨床試驗進行投資,可以幫助我們加快找到潛在治療藥物?,F在應該加快研發進展。

      與此同時,長期新冠患者的痛苦經歷仍在繼續,長期新冠對美國的影響不容低估。

      退伍軍人事務部圣路易斯醫療保健系統(Veterans Affairs St. Louis Health Care System)臨床流行病學中心(Clinical Epidemiology Center)主任齊亞德·阿爾-阿里表示:“我們認為[病例數據]將演變成數以百萬計需要護理的長期新冠患者,總之,我們的醫療系統需要做好準備。醫療系統或診所經營者需要做好準備,迎接大量有心臟病或其他長期新冠癥狀的患者蜂擁而至?!比澜缂s有1億人正承受著長期新冠的影響或之前曾經出現過長期新冠癥狀。

      我們要面對長期新冠的事實,盡管我們仍在努力了解長期新冠綜合征最有可能以哪種方式在哪些情況下出現。整個國家有責任對新冠的傳播保持警惕,因為在傳播過程中會誕生長期新冠。(財富中文網)

      本文作者醫學博士卡羅琳·巴伯擔任急診科醫生已有25年。她著有《失控的藥物:你不知道的事情可能會害死你》(Runaway Medicine: What You Don’t Know May Kill You)一書。她曾為《財富》和《美國科學》(Scientific American)等美國期刊撰文,詳細介紹新冠疫情。巴伯是加州無家可歸者工作計劃“改變之輪”(Wheels of Change)的聯合創始人。

      譯者:劉進龍

      審校:汪皓

      Their stories are shared through social media, the fear and agony front and center in almost every conversation: breathing issues, chronic pain, unexplained bruising, hallucinations, brain fog. “No way to describe besides six daggers in my back,” wrote one. Added another, a doctor exposed on the job in 2020, “I am a shell of my former self.”

      Of the many facets of the COVID-19 pandemic that have baffled researchers and left governing bodies grasping for sensible policies, perhaps none will leave as deep a mark as long COVID. Its path a mystery, its complications wildly varied, it remains at this point the subject of more concern than actual knowledge.

      What is clear, though, is that long COVID and its debilitating effects will ultimately affect tens of millions of Americans—and that is one reason why national health policies and preventative measures related to the disease in general remain critically important. Now is not the time to take our foot off the gas pedal.

      The numbers are stark. A recent report by the Solve Long COVID Initiative estimates that some 22 million Americans, about 6.7% of our population, are already dealing with effects of the virus months after their initial infection. (The numbers are similar to those put forward by the U.S. Government Accountability Office.) Roughly 7 million in our country may be experiencing disabling long COVID symptoms. To put that in perspective, U.K. figures show that long COVID is affecting approximately 2.7% of its population.

      Still, we don’t even have a precise definition of long COVID. Broadly speaking, it is the appearance, recurrence, or persistence of symptoms in patients weeks or months after they initially contracted the virus. The symptoms may then continue for months or even years, with potentially dire consequences.

      This is not unprecedented, medically speaking. The GAO’s report notes a study indicating that 27% of survivors of a previous coronavirus, severe acute respiratory syndrome (SARS), which was first discovered in Asia in 2003, were still experiencing chronic fatigue syndrome four years after their initial infection.

      But COVID’s scale is vastly more significant than was SARS, and the effects of long COVID (sometimes also called post-COVID) are, for millions, severe and life-changing. These may include cardiac disorders, clotting issues, kidney injury, lung damage, even diabetes. More than three-quarters of those living with long COVID have reported cognitive impairment, and depression and post-traumatic stress disorder are common, experts say.

      A massive study by the Veterans Administration of more than 150,000 individuals with COVID-19, meanwhile, found them to be at a substantially higher risk of heart problems or cardiovascular disorders—some 20 types in all—for at least a year after diagnosis. Those who had recovered from COVID-19 were 52% more likely to have a stroke and 72% more likely to experience heart failure, compared to a control group.

      So why talk about all of this now? Because long COVID symptoms can develop in a person of any age, even after a mild or asymptomatic case of the virus. In short, more COVID means more long COVID. And not only might we be dramatically undercounting cases in our country right now, but we are relaxing the rules around the virus at a time when even our diminished counting system shows that caseloads are again on the rise, driven by the arrival in the Northeast of the BA.2 subvariant of Omicron.

      The advent of home test kits for COVID, while unquestionably important, has compromised agencies’ ability to know how many people are actually testing positive, because labs never see those results. “I wouldn’t be surprised if we were only capturing one in seven or one in eight cases,” former FDA Commissioner Scott Gottlieb said recently. Gottlieb suggested that “when we say there’s 30,000 infections a day, it’s probably closer to a quarter of a million infections a day.” That’s a chilling thought, and if it were actually documented rather than guessed at, it would almost certainly prompt different decisions about the precautions we should take.

      The notion of continued viral threat was driven home with some clarity earlier this month, when the annual Gridiron Dinner in Washington, D.C., effectively served as a super-spreader event, with more than 70 people subsequently infected. It was a high-profile reminder that the virus is still thriving in the U.S.—yet many states are shuttering test sites, dropping mask restrictions, and discontinuing the daily reporting of infections, hospitalizations, and deaths.

      “An effective public health response depends on high-quality, real-time data,” said John Brownstein, an epidemiologist at Boston Children’s Hospital and an ABC News contributor. “Underreporting, driven by changes in testing behavior, lack of public interest, and severely underfunded local public health departments, creates a perfect storm of misleading case counts and hospitalizations.”

      We need good data to make good decisions. One start would be to vastly scale up wastewater surveillance across the U.S., since virus can be shed by individuals with and without symptoms in feces, and sewage surveillance can provide an early warning of new spread.

      Let’s also make rapid tests more widely available and free, with a way to track results, and improve how we gather and share information from hospital systems and states. Waiting for COVID-related hospitalizations to rise simply puts us behind the curve, after infections already have taken off.

      The goal of public health, of course, is to be preventative. The idea of masking indoors at large public events, restaurants, and the like during COVID surges should be normalized, not shunned. Masks, vaccines, improved ventilation systems, easy access to antivirals, development of new therapeutics—all these things can help fend off the virus, which in turn could lower cases of long COVID.

      Much remains to be determined about long COVID. In early April, the Biden administration announced plans to accelerate the shockingly slow enrollment in a major NIH research project and to coordinate efforts across a number of federal agencies. This announcement arrived in the face of bitter public criticism by groups frustrated by the slow pace of federal activity and the lack of a focus on potential cures, none of which currently exist.

      Unquestionably, people are suffering; even children are contracting the dreadful condition. Investment in large-scale clinical trials of antivirals like Paxlovid, along with anticoagulants and antiplatelet therapy, among others, may get us more rapidly on the path to answers on possible treatments. It’s time to push the accelerator.

      In the meantime, the difficult journey for COVID “long haulers” goes on, and the impact on the nation cannot be discounted.

      “We think [the numbers] will translate into millions of people with long COVID in need of care, and broadly speaking, our health systems need to be prepared,” said Ziyad Al-Aly, director of the Clinical Epidemiology Center at the Veterans Affairs St. Louis Health Care System, in a recent podcast. “People running health systems or clinics need to start preparing for the tide of patients that are going to hit our doors with heart problems and other long COVID problems.” Worldwide estimates are that around 100 million people are suffering or have previously suffered from this.

      The reality of long COVID is upon us, even as we strain to learn more about how and under what circumstances the syndrome is most likely to appear. It’s on us as a country to remain vigilant against the spread of the disease that fosters it.

      Carolyn Barber, M.D., has been an emergency department physician for 25 years. Author of the book Runaway Medicine: What You Don’t Know May Kill You, she has written extensively about COVID-19 for national publications, including Fortune and Scientific American. Barber is cofounder of the California-based homeless work program Wheels of Change.

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