➥在應付伊波拉、HIV、結核病、及其他零星傳染病後,非洲幾個國家已具有不錯的疾病反應能力。
非洲政府罕見地提供了COVID-19有效的國際合作。在沒有疫苗及有效的治療藥物之前,普篩是遏止傳染及死亡的重要方法,尤其無症狀感染占了二次感染的44%。雖然每千人僅檢測2.7人,小於德國及南韓,截至2020/4/25止,南非僅4000明確診個案,79人死亡,致死率與其他國家相似。
但每個國家應對方式不同,未來應會持續一段時間,政府將很難徹底執行各種非藥物預防措施,如,隔離、宵禁、關閉市場及學校、限制集會人數。
在許多人口稠密的大城市,社交距離並不可行;因非正式就業很常見,停工所帶來的社會及經濟衝擊將很嚴重。因此,檢測措施是緩解經濟及社會衝擊、集中社會衝擊、使介入更具針對性的關鍵。
但在整個非洲做檢測、追蹤、及照護,並非易事,急需各國政府及捐助者的資金贊助。檢測試劑及消耗品的供應有限,難以有效提升量能,PCR製造商亦無法快速提升產能。
歐洲國家仰賴國際捐助購買試紙、試劑、測試盒、及其他產品,在採購上亦遭遇瓶頸,尤其有些平台僅某些地區可購得。
分配稀少物資的倫理問題通常發生在國家內部,而非國家之間,WHO的國際衛生條例及Pandemic Influenza Framework通常不適用。政府有責任保護其公民,但,必須公平。
全球資源合理分配仰賴國際政治,可預期有些國家將被排除在市場之外,因此,政治上的號召是必要的,但目前大國之間仍無共識。就診斷、個人防護裝備、及疫苗與治療的投資,現在講克服地區產量及及減少對外國產品的依賴,為時已晚。
以往的經驗顯示,政府可激勵生產,但國際間的合作對確保融資及技術移轉非常重要,政府與廠商間的合作,更能發揮影響力。(「財團法人國家衛生研究院」莊淑鈞博士 摘要整理 ➥http://forum.nhri.org.tw/covid19/virus/j_translate/j930/)
📋 Access to lifesaving medical resources for African countries: COVID-19 testing and response, ethics, and politics (2020/05/07)+中文摘要轉譯
■ Author:
Matthew M Kavanagh, Ngozi A Erondu, Prof Oyewale Tomori, et al.
■ Link:
(The Lancet) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31093-X/fulltext
🔔豐富的學術文獻資料都在【論壇COVID-19學術專區】
■ http://forum.nhri.org.tw/covid19/
#2019COVID19Academic
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇
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medical ethics journals 在 國家衛生研究院-論壇 Facebook 的最讚貼文
「Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China(2020/02/07)+中文摘要轉譯」
➥中文摘要轉譯:
截至2/4日,北京報告13例,大多為年輕健康人。症狀輕微且無人死亡。與過去報導一致,健康人感染後預後較佳。
註:初期流行病學易有偏誤,不可推估大流行時狀況。(財團法人國家衛生研究院-郭書辰醫師整理)
➥In December 2019, cases of pneumonia appeared in Wuhan, China. The etiology of these infections was a novel coronavirus (2019-nCoV),1,2 possibly connected to zoonotic or environmental exposure from the seafood market in Wuhan. Human-to-human transmission has accounted for most of the infections, including among health care workers.3,4 The virus has spread to different parts of China and at least 26 other countries.1 A high number of men have been infected, and the reported mortality rate has been approximately 2%, which is lower than that reported from other coronavirus epidemics including severe acute respiratory syndrome (SARS; mortality rate, >40% in patients aged >60 years)5 and Middle East respiratory syndrome (MERS; mortality rate, 30%).6 However, little is known about the clinical manifestations of 2019-nCoV in healthy populations or cases outside Wuhan. We report early clinical features of 13 patients with confirmed 2019-nCoV infection admitted to hospitals in Beijing.
「Methods」
Data were obtained from 3 hospitals in Beijing, China (Beijing Tsinghua Changgung Hospital, School of Medicine, Tsinghua University [8 patients], Beijing Anzhen Hospital, Capital Medical University [4 patients], and College of Respiratory and Critical Care Medicine, Chinese PLA General Hospital [1 patient]). Patients were hospitalized from January 16, 2020, to January 29, 2020, with final follow-up for this report on February 4, 2020. Patients with possible 2019-nCoV were admitted and quarantined, and throat swab samples were collected and sent to the Chinese Center for Disease Control and Prevention for detection of 2019-nCoV using a quantitative polymerase chain reaction assay.3 Chest radiography or computed tomography was performed. Data were obtained as part of standard care. Patients were transferred to a specialized hospital after diagnosis. This study was approved by the ethics commissions of the 3 hospitals, with a waiver of informed consent.
「Results」
The median age of the patients was 34 years (25th-75th percentile, 34-48 years); 2 patients were children (aged 2 years and 15 years), and 10 (77%) were male. Twelve patients either visited Wuhan, including a family (parents and son), or had family members (grandparents of the 2-year-old child) who visited Wuhan after the onset of the 2019-nCoV epidemic (mean stay, 2.5 days). One patient did not have any known contact with Wuhan.
Twelve patients reported fever (mean, 1.6 days) before hospitalization. Symptoms included cough (46.3%), upper airway congestion (61.5%), myalgia (23.1%), and headache (23.1%) (Table). No patient required respiratory support before being transferred to the specialty hospital after a mean of 2 days. The youngest patient (aged 2 years) had intermittent fever for 1 week and persistent cough for 13 days before 2019-nCoV diagnosis. Levels of inflammatory markers such as C-reactive protein were elevated, and numbers of lymphocytes were marginally elevated (Table).
Four patients had chest radiographs and 9 had computed tomography. Five images did not demonstrate any consolidation or scarring. One chest radiograph demonstrated scattered opacities in the left lower lung; in 6 patients, ground glass opacity was observed in the right or both lungs (Figure). As of February 4, 2020, all the patients recovered, but 12 were still being quarantined in the hospital.
➥Author: De Chang, Minggui Lin, Lai Wei, et al.
➥Link: (JAMA) https://jamanetwork.com/journals/jama/fullarticle/2761043
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇
#2019COVID19Academic
medical ethics journals 在 國家衛生研究院-論壇 Facebook 的精選貼文
「Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China(2020/02/07)+中文摘要轉譯」
➥中文摘要轉譯:
截至2/4日,北京報告13例,大多為年輕健康人。症狀輕微且無人死亡。與過去報導一致,健康人感染後預後較佳。
註:初期流行病學易有偏誤,不可推估大流行時狀況。(財團法人國家衛生研究院-郭書辰醫師整理)
➥In December 2019, cases of pneumonia appeared in Wuhan, China. The etiology of these infections was a novel coronavirus (2019-nCoV),1,2 possibly connected to zoonotic or environmental exposure from the seafood market in Wuhan. Human-to-human transmission has accounted for most of the infections, including among health care workers.3,4 The virus has spread to different parts of China and at least 26 other countries.1 A high number of men have been infected, and the reported mortality rate has been approximately 2%, which is lower than that reported from other coronavirus epidemics including severe acute respiratory syndrome (SARS; mortality rate, >40% in patients aged >60 years)5 and Middle East respiratory syndrome (MERS; mortality rate, 30%).6 However, little is known about the clinical manifestations of 2019-nCoV in healthy populations or cases outside Wuhan. We report early clinical features of 13 patients with confirmed 2019-nCoV infection admitted to hospitals in Beijing.
「Methods」
Data were obtained from 3 hospitals in Beijing, China (Beijing Tsinghua Changgung Hospital, School of Medicine, Tsinghua University [8 patients], Beijing Anzhen Hospital, Capital Medical University [4 patients], and College of Respiratory and Critical Care Medicine, Chinese PLA General Hospital [1 patient]). Patients were hospitalized from January 16, 2020, to January 29, 2020, with final follow-up for this report on February 4, 2020. Patients with possible 2019-nCoV were admitted and quarantined, and throat swab samples were collected and sent to the Chinese Center for Disease Control and Prevention for detection of 2019-nCoV using a quantitative polymerase chain reaction assay.3 Chest radiography or computed tomography was performed. Data were obtained as part of standard care. Patients were transferred to a specialized hospital after diagnosis. This study was approved by the ethics commissions of the 3 hospitals, with a waiver of informed consent.
「Results」
The median age of the patients was 34 years (25th-75th percentile, 34-48 years); 2 patients were children (aged 2 years and 15 years), and 10 (77%) were male. Twelve patients either visited Wuhan, including a family (parents and son), or had family members (grandparents of the 2-year-old child) who visited Wuhan after the onset of the 2019-nCoV epidemic (mean stay, 2.5 days). One patient did not have any known contact with Wuhan.
Twelve patients reported fever (mean, 1.6 days) before hospitalization. Symptoms included cough (46.3%), upper airway congestion (61.5%), myalgia (23.1%), and headache (23.1%) (Table). No patient required respiratory support before being transferred to the specialty hospital after a mean of 2 days. The youngest patient (aged 2 years) had intermittent fever for 1 week and persistent cough for 13 days before 2019-nCoV diagnosis. Levels of inflammatory markers such as C-reactive protein were elevated, and numbers of lymphocytes were marginally elevated (Table).
Four patients had chest radiographs and 9 had computed tomography. Five images did not demonstrate any consolidation or scarring. One chest radiograph demonstrated scattered opacities in the left lower lung; in 6 patients, ground glass opacity was observed in the right or both lungs (Figure). As of February 4, 2020, all the patients recovered, but 12 were still being quarantined in the hospital.
➥Author: De Chang, Minggui Lin, Lai Wei, et al.
➥Link: (JAMA) https://jamanetwork.com/journals/jama/fullarticle/2761043
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇
#2019COVID19Academic