文章轉載自 世紀君 21世紀英文報 昨天
“峰值”不等於“拐點”
2月17日下午，廣州醫科大學附屬第一醫院副院長張挪富帶領廣東醫療隊，在武漢協和醫院西院區通過網絡平臺與中國工程院院士鍾南山進行視頻會診。
期間，鍾南山介紹，其團隊建立的數學模型將國家強有力干預措施和春節後務工人員返程高峰兩個變量納入考量，這兩個變量將改變疾病的自然發展規律。根據該模型預計，2月中下旬全國病例數將達到峰值，但並不意味著達到峰值後馬上下降。
“目前是否已經達到峰值還不確定，還需要再觀察幾天。” 鍾南山說，峰值不等於“拐點”，疫情還有可能隨著務工人員返程再次出現新的高峰。
不過他補充，主要大中城市都採取了強有力的措施做好出入人員的檢查，因此返程帶來新的疫情高峰的可能性不大。
The possibility of a spike in new coronavirus cases caused by people returning to big cities after the extended Spring Festival holiday is unlikely, said Chinese respiratory expert Zhong Nanshan on Monday.
Zhong said that strong measures taken in major large and medium-sized cities are effective in epidemic prevention and control.
According to a mathematical model built by Zhong’s team, the outbreak is expected to reach its peak in mid-late February, but that doesn't mean an immediate fall afterwards. "It is uncertain if the outbreak has reached its peak, we need a few more days of observation," said Zhong.
18日，廣東省人民政府新聞辦公室召開疫情防控新聞發佈會，鍾南山院士出席，針對新冠肺炎的治療、疫情防控等問題進行了回答。
保持下水道通暢極為重要
鍾南山在會上兩次提醒，防範新冠肺炎，保持下水道通暢極為重要！
Zhong warned the public to keep their waste pipes unobstructed as the novel coronavirus may spread through drainage systems.
此前，包括鍾南山的團隊在內的兩個團隊已經在糞便裡發現新冠病毒，引發人們對於糞口傳播的擔憂。
Two separate research groups, one of which was led by Zhong, announced last week they had isolated novel coronavirus strains from samples of infected patients' feces, triggering suspicion of fecal-oral transmission.
但鍾南山表示，新冠病毒並不一定通過消化道傳播感染，而是因為下水道中汙染物幹了，又通過空氣、氣溶膠傳播，人們吸入造成感染。這是最合理的解釋。
"If a waste pipe is blocked, the contaminated air, or the aerosol carrying the novel coronavirus, may cause infection," Zhong said. "I don't think the virus was ingested but inhaled by people," he said, adding that hospitals should also pay attention to drainage pipes.
前不久，香港有一棟樓宇，上下樓層住戶相繼確診新冠肺炎，引發關注。鍾南山說，要吸取2003年SARS期間香港淘大花園的教訓，當時一個小區就有300多人感染。
He said a similar case happened in 2003, when over 300 people were infected with SARS in a Hong Kong residential community due to the defective design of its sewage system that caused the spread of the virus.
武漢還沒有停止人傳人
鍾南山表示，全國確診病例已出現下降趨勢，但武漢仍是關鍵，現在全國80%新冠肺炎患者在武漢，95%以上死亡患者也在武漢或周圍，因為武漢還沒有停止人傳人。
Eighty percent of COVID-19 patients and 95 percent of the deaths are in Wuhan, Zhong said, noting that Wuhan is still the key to the battle against the epidemic, as the confirmed cases outside Hubei province have been declining.
Zhong also said person-to-person transmission of the novel coronavirus is still happening in Wuhan, the epicenter of the epidemic.
現在迫切需要解決兩個問題，一是正常人和患者分開，二是新冠肺炎病人和流感病人分開。如果混在一起，用了很大的人力財力，這個問題仍然不能解決。
He stressed the importance for Wuhan to distinguish health people from infected patients, and also to distinguish COVID-19 infection from common flu. "Virus transmission between people is unlikely to be halted if these different groups remain together," Zhong said.
針對康復病人血漿治療方法(plasma therapy)，鍾南山表示，現在數據太少，還顯示不出統計學的意義 。在武漢現在做了10例，6例經過用藥以後，兩三天病毒血症消失了，病人臨床情況有些改善。
鍾南山表示，到目前為止，血漿治療是比較老的辦法，我認為是一個很有效的方法，特別是對重症病人。垂危的病人就差一些，因為他不單純是病毒感染。
The renowned Chinese respiratory scientist also added that plasma therapy is a stable and safe method that has so far been found effective in treating the novel coronavirus patients, especially for those in severe condition.
Ten coronavirus patients in Wuhan have received the treatment so far, six of whom have shown signs of their symptoms easing.
肯定中藥作用
鍾南山表示，就西藥來說，在實驗室發現的細胞水平對新型冠狀病毒有效，真正進入人體有個過程，有相當多的西藥體外有效，進到人體沒效。
但中藥不太一樣，一些藥在臨床已經很常用。如果這些中藥真的顯示了減少病毒進入細胞或減少炎症，這樣就能夠給中藥使用提供依據和線索。一旦有證據，中藥是可以放心用的。特別是針對一些早中期患者。
"For Western medicine, there is a process before it works in human body even with proven effectiveness in lab," said Zhong. "Quite a few Western drugs are found to be effective in vitro, but not in the human body."
The case is different with TCM (Traditional Chinese medicine). Some TCMs have already been commonly used in clinic. Further tests in lab and animals can provide evidence and clues for their use.
"Once there is evidence, TCM can be used securely, especially for those early and mid-term patients," said Zhong.
磷酸氯喹還夠不上特效藥，但值得探討
鍾南山介紹，磷酸氯喹(Chloroquine phosphate)還夠不上特效藥，但是它是非常值得探討的藥。面對新的東西，往往實踐先於科研，摸著石頭過河。已有的比利時、美國的研究表明，磷酸氯喹對冠狀病毒是有效的，這次是真正用在人體。磷酸氯喹是老藥。
短期使用來看，沒有太大的副作用。相當一部分患者，能夠在一段時間內使得病毒轉為陰性。和其他藥物對比，發熱症狀消失，副作用不是很大。個別會出現腹瀉，很個別會出現耳鳴，停藥後就會停止。目前正在開展較大（範圍）的臨床觀察，要進行用藥和不用藥的比較。Zhong told reporters work and research are speeding up on medicines to treat this new virus and a drug called Chloroquine phosphate has shown good clinical efficacy.
"Chloroquine is not really a kind of medicine with a special effect, but it is worthy of study," Zhong said.
屍體解剖目前非常重要
鍾南山表示，17年前的SARS，也是通過屍體解剖（post-mortem examinations）瞭解除了肺部之外，全身臟器受損的影響情況。通過屍體解剖，這次新冠肺炎患者肺部的表現，和SARS有點不一樣，沒有嚴重纖維化，肺泡還存在，但是炎症很厲害，還有大量的粘液，非常黏，這將導致病人的通氣不通順。解剖可以幫助我們認識病人的特點，在幫助他們通氣上改變一些方式。
據報道，2月16日凌晨3時許，在國家法律政策允許下，並在徵得患者家屬同意後，全國第1例新冠肺炎逝世患者的遺體解剖工作在武漢金銀潭醫院完成，併成功拿到新冠肺炎病理。在同一日18點45分，全國第2例新冠肺炎逝世患者的遺體解剖工作也在金銀潭醫院順利完成，這兩具解剖病理目前已被送檢。
由解剖獲得的新冠肺炎病理，對於探索新冠肺炎患者臨床的病理改變、疾病機制等有重大幫助，並能從根本上尋找新冠肺炎的致病性、致死性，給未來臨床治療危重症患者提供依據。
The dissections of the bodies of the first and second patients who died of the novel coronavirus in China were completed at Wuhan Jinyintan Hospital last Sunday. The move was made subject to the national laws and policies and came after their families granted permission. By obtaining their pathological organs, further studies can be made and aid clinical treatment.
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