(2020/03/03)COVID-19: a novel coronavirus and a novel challenge for critical care(+中文摘要轉譯)

SARS-CoV-2之基因與SARS-CoV有75%~80%相似,MERS-Cov有50%相似,與蝙蝠冠狀病毒有96%相似,並且與SARS-CoV相同使用ACE2。下表整理SAES、MERS、及武漢肺炎三種冠狀病毒感染之臨床特徵。

  武漢肺炎 MERS SARS
起源地 中國武漢 阿拉伯半島 中國廣東
動物宿主 不清楚,可能是蝙蝠 駱駝 可能是狸貓及蝙蝠
人傳人
院內感染
醫護人員風險
受影響國家數 54 27 26
確診個案數 85,403,至2020/3/1 2494 8437
重症患者臨床特徵      
  年齡 60 58 57
  共病 40% 80% ++
  呼吸窘迫/肺炎 主要症狀 主要症狀 主要症狀
休克及多重器官衰竭
  呼吸器使用 42% 85% 76%
  血管加壓藥 35% 79% 44%
  腎臟移植 17% 49% 11%
  死亡率 最高62% 67% 34%

目前對重症醫師最大的挑戰,是什麼時候該懷疑武漢肺炎?目前臨床多依賴旅遊史,但隨著疾病擴散,定義隨時在變。目前的檢測方法其敏感度未被驗證,PCR檢測陰性仍須依臨床症狀小心解釋。

其次,要有大量病患的準備,必要時須將一般病房改成加護病房。

第三,感染的預防與控制。加護病房須嚴格遵守隔離政策,以保護人員、病患、及訪客,並加強環境消毒。此外,確保供應鏈給前線醫護人員已降低院內感染。

第四,保護員工。SARS、MERS、及武漢肺炎期間嚴重感染及死亡個案,大幅增加員工心理壓力。

WHO與Global Research Collaboration for Infectious Disease Preparedness (GLOPID-R)在2020二月11~12舉辦Global Research and Innovation Forum,討論目前最需要的研究,包括臨床特性、治療、診斷等。REMA-CAP (Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia)是一個專為嚴重社區感染肺炎重症患者事先規畫及核准的研究平台。平台用常用的分析方法,分析不同介入措施的單獨效果及其交互作用,一旦達到統計效益,及時報告介入措施的成功與否。(國衛院莊淑鈞博士整理)

In December 2019, several cases of pneumonia of unknown etiology were reported in Wuhan, Hubei Province, China, and were linked to Huanan Seafood Wholesale Market [1,2,3]. The disease which is now called COVID-19 is caused by a novel coronavirus, labeled as SARS-CoV-2, which was discovered through whole-genome sequencing, polymerase chain reaction (PCR) and culture of bronchoalveolar lavage fluid obtained from affected patients [14]. This virus, which is the seventh coronavirus that has been proven to infect humans, has 75–80% genomic similarity to the severe acute respiratory syndrome coronavirus (SARS-CoV), 50% to the Middle East Respiratory syndrome coronavirus (MERS-CoV) and 96% to a bat coronavirus and uses the same cell receptor, angiotensin-converting enzyme II (ACE2), that is used by SARS-CoV [145].

As of March 1, 2020, 87 137 confirmed COVID-19 cases were reported to the World Health Organization (WHO) from China and 53 other countries [67]. Among the 79 394 confirmed cases in China, there were 2838 deaths [67] With the expectation that these numbers are likely to increase, there are increasing global concerns about the outbreak, particularly for the intensive care community [8].

This is the third coronavirus that has emerged in the past 2 decades, causing multinational outbreaks and carrying substantial morbidity and mortality [910]. While there are distinct features for each of these outbreaks (Table 1), the ongoing COVID-19 outbreak brings to intensivists and the critical care community similar challenges to what was faced with SARS and MERS outbreaks, and there are multiple lessons that can be learned [1112].

Author:Yaseen M Arabi, Srinivas Murthy, Steve Webb, et al.
Link:https://reurl.cc/yZ19na