COVID-19更新5月26日th, 2020 by Dr. Andrew Morris

安东赫尔曼编辑

流行病学和预防COVID-19

我们不知道如何防止COVID-19与非药物干预(非营利机构),但很显然,已经有效地奉行一个测试,跟踪辖区,分离方法有物理疏远和组合,戴面具式可以得到COVID-19下控制。那些不能没有得到COVID-19受到控制。因为它的立场,也有COVID-19没有有效的药物干预。也许最紧追不舍是羟氯喹预防。我们期待着临床试验。我将在稍后讨论治疗。

如果我们谈论收购的疾病,流行病学已经相当一致:最高的风险来自于长期,密切的联系,在室内,东窗事发,最好有共同的面或食物。所以家庭接触是重要的,但也出现了一些高调的爆发,包括很好的描述合唱团的做法,其中61人参加,其中有一个人的症状,具有53-87%的攻击速度,导致3次住院,死亡2一2.5小时合唱团的做法。

什么变得不太清楚的是在疾病的采集和传输儿童的作用。与此有点流行病学斗争,因为孩子们长期认为是呼吸道病毒罪恶的来源:找伶俐可爱,但其实是相当致命的与各种病菌。我们知道,有过在加拿大没有儿童死亡。事实上,尽管在5M感染,343人死亡513,孩子们大量代表性不足。已经有一些先前尝试这个量化,一种nd much of it is very reassuring. In Europe, only about 2% of all lab-confirmed cases were under age 15. However, this one recent report from a tertiary centre in New York City, posted online May 11, describes a somewhat uneasy picture: 46 admitted patients, of which 13 were admitted to the PICU—8 were discharged home, 4 remained on a ventilator at Day 14, and 1 (with metastatic cancer) died.

而且有孩子的,我们开始更多地了解PIMS-TS(dyslexically标记Pædiatric中号ultisystem一世nflamatory小号yndromeŤemporally关联小号ARS-COV-2)或中号ultisystem一世nflammatory小号yndrome在儿童(MIS-C),这是川崎那样出现与COVID-19相关的疾病。它的特点是发烧,炎症,器官衰竭,和SARS-CoV的-2感染,但可有头痛;喉咙痛,咳嗽或其他呼吸道症状;结膜炎;淋巴结肿大;皮疹;腹痛,呕吐和/或腹泻;和特性肿胀和/或手和脚的发红(被称为冻疮). The fascinating thing is that it appears to be disappearing. Regardless, it is incredibly rare, with theEuropean CDC reporting最近,我国目前仅有230涉嫌PIMS-TS的情况下,欧盟和英国,那里有超过80万儿童。

Whether or not we need N95 masks for prevention—and where we need them—continues to remain a controversy for reasons unclear to me (https://www.cidrap.umn.edu/practice/facemask-and-n95-respirator-recommendations). Perhaps a more fascinating story is the position of the安大略省的牙科皇家外科医学院,谁决定,典型的牙科诊所需要清洗牙科操作之前要等待病人预约之间207分钟(烨,207)。


COVID-19的诊断

诊断并没有实质性的进展。我们通过鼻咽拭子仍听命于RT-PCR。就在几个星期前,FDA批准了家里收集的罗格斯临床基因组学实验室测试(LDT)使用频谱Solutions LLC的SDNA-1000唾液收集装置。美国食品药物管理局并没有对调控最吉祥道最近的记录,因此,该装置是否是真正的成交与否还有待观察。

我们似乎仍然依托,在急性期,对各种PCR测试。

Whether or not someone具有been infected (i.e. using serology) has been a story of 1 step forward and 2 steps back. There are a variety of different tests: rapid diagnostic test (uses a lateral flow assay as a point-of-care rest), ELISA, neutralization assays, and chemiluminescent immunoassay. Eleven such tests have been approved in the US, whereas there is only 2 approved in Canada: the LIAISON test, developed by DiaSorin (an Italian biotech) and the SARS-CoV-2 IgG assay by Abbott; an另外22次血清学试验是在加拿大卫生部批准的各个阶段


COVID-19的治疗

羟氯喹(HCQ)继续挨打。这项研究in mild-moderate COVID-19 failed to show a benefit in 148 patients randomized to HCQ vs. standard of care. There was no apparent microbiological benefits, with 30% of HCQ patients getting side effects vs. 9% of those receiving standard care. (Tang W, Cao Z, Han M, Wang Z, Chen J, Sun W, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ. 2020;369:m1849.) Similarly, an observational study published in柳叶刀looked at 96,032 patients hospitalized with COVID-19, with 1,868 receiving chloroquine, 3,783 CQ + macrolide, 3,016 receiving HCQ, and 6,221 receiving HCQ + macrolide (Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet. 2020.) It really doesn’t matter how you dice this study up, it is an observational study that does not favour CQ or HCQ. We需要一种bigger and better RCT.

大部分的注意力在过去的一周歇remdesivir。超过3周后,NIH的福西博士公开表示,remdesivir应该是标准的护理,这是由新英格兰医学杂志在线发布什么是相当显着:在停止试验的初步结果。我们学到了什么?好了,这是1059个例,538分配给remdesivir和521安慰剂与在remdesivir杆11天,安慰剂组15天,平均恢复时间的RCT。选择14天死亡率的Kaplan-Meier估计,那些remdesivir的7.1%死亡与服用安慰剂的11.9%;不良事件的青睐remdesivir。也许更惊人的:益处不是在那些接收高流量氧,非侵入性的机械通气,机械通气,或ECMO看出。所以,如何处理这一切的?那么,它矗立在救济小得多中国审判发表在柳叶刀与237例是显示在时间临床症状改善无差异的整体,但确实显示出时间的临床改善这些早期治疗的减少。(王Y,张d,都G,都R,召Ĵ,金Y,等人Remdesivir重症COVID-19成人:。随机,双盲,安慰剂对照,多中心试验柳叶刀2020;395(10236):1569年至1578年)此外,看来,一旦你真的生病了,它是最小的利益。这是有问题的,因为它是静脉给药,以及它做的更好更快的得到你,但它可能不会对您的结果总体差异。我真的希望他们并没有停止这项试验呢。我希望世卫组织的团结审判(其加拿大CATCO手臂)为我们提供了更清晰。


References for COVID-19 update

  1. https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/covid-19/diagnostic-devices-authorized.html#wb-auto-5
  2. 哈姆纳L,杜贝尔P,卡普隆I,等人。高SARS-COV-2攻击率在合唱实践曝光之后 - 斯卡吉特县,华盛顿,2020年三月MMWR MORB致死Wkly众议员2020; 69(19):606-610。
  3. https://www.cps.ca/en/documents/position/update-on-covid-19-epidemiology-and-impact-on-medical-care-in-children-april-2020
  4. https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-risk-assessment-paediatric-inflammatory-multisystem-syndrome-15-May-2020.pdf
  5. https://www.cidrap.umn.edu/practice/facemask-and-n95-respirator-recommendations
  6. https://www.rcdso.org/en-ca/rcds​​o-members/2019-novel-coronavirus/covid-19-managing-infection-risks-during-in-person-care
  7. 唐W,曹Z,韩梅,王Z,陈军,孙W,等人。羟氯喹的患者主要为轻度至中度冠状病2019:开放标签,随机对照试验。BMJ。2020; 369:m1849。
  8. 梅赫拉MR,德赛SS,Ruschitzka楼帕特尔AN。羟氯喹或有或无治疗COVID-19的大环内酯类:跨国注册表分析。柳叶刀。2020年
  9. Beigel JH,Tomashek KM,杜德LE,等人。Remdesivir为Covid-19的治疗 - 初步报告。新英格兰医学杂志。2020;
  10. 王Y,张d,杜G,杜R,赵Ĵ,金Y,等人。Remdesivir重症COVID-19成人:一项随机,双盲,安慰剂对照,多中心试验。柳叶刀。2020; 395(10236):1569至1578年。