武漢肺炎自2019年底發展至今,仍需12~18月時間研發疫苗,即使開發出來,仍未必有效。治療發展較快,且已開始臨床試驗,但現在仍無法預測有效的治療方式何時問世。此外,現階段仍有許多問題待解,包括無症狀及輕症感染者的數目,整體侵襲率(overall attack rate, diseased/exposed)及致死率(case-fatality rate, death/diseased)在世界各國的差異。

目前美國武漢肺炎的準備多依照2009年H1N1流感爆發時的指引。簡單說,這些計畫包括醫院應如何保護醫護人員、如何處理資源短缺、病人暴增、病患分流、及資源不足的分配等。相關措施應擴大至診所、透析中心、護理之家、及長照中心等易感族群出現的場所,確保武漢肺炎不會影響一般的醫療照護體系,並直接影響致病率及死亡率。衛生主管機關須與廠商及政府密切合作以確保個人防護用品的製造與取得。有部分病人會發展為重症,因此有必要準備急重症病房,這些準備包括評估急重症病床容量及增加急重症病床及設備的能力,醫院還需準備當醫療資源不足時,集中醫療資源及需要者照顧者的標準。

為了解到底有多少武漢肺炎患者,檢測應擴大至任何有不明原因之呼吸窘迫及嚴重肺炎之患者,及有武漢肺炎症狀相符之輕微症狀者。增加檢測能力有賴醫材公司大幅提升其診斷製劑之產能。此外,血清學試劑對監測及計算正確之及病致死率也很重要。總而言之,正確檢出武漢肺炎感染者對各項準備非常重要。

目前各項公衛措施最重要的是減緩傳播速度,減緩一個城市的傳播速度有助於減少整體及病負擔。在流行初期,當個案數少時,公衛人員可在資源許可下,盡力找出感染源病進行隔離,但超過一定負荷,將無法找出所有接觸者;屆時,公衛人員須考慮採取其他加大「社會距離」的措施,如取消大型集會、遠距工作、及停課等措施。但此等措施必將增加其他社會成本,需要政治與公衛人員仔細思考及權衡。

(財團法人國家衛生研究院 莊淑鈞博士摘要整理)

In late December 2019, a cluster of unexplained cases of viral pneumonia occurred in Wuhan, China.1 This initial cluster of patients with what soon became known as coronavirus disease 2019 (COVID-19) heralded the arrival of a new pandemic caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date, close to 90 000 cases have occurred in more than 60 countries with approximately 3000 deaths. The World Health Organization (WHO) has declared these events a Public Health Emergency of International Concern.

It is expected that a COVID-19 vaccine will take 12 to 18 months to develop and manufacture, and even then it may not be effective. Therapeutics might be developed much more quickly, with clinical trials already under way, but it is too soon to know when such therapies might be available. There are still many uncertainties regarding COVID-19, including the number of asymptomatic or mildly symptomatic cases in China and other countries, the overall attack rate in the population, and the ultimate case-fatality rate in different countries around the world.

Despite these uncertainties, it is clear that COVID-19 is a dangerous new epidemic. Given this, important actions need to be taken to prepare the US health care sector for COVID-19 and to aim to slow the spread of disease through public health interventions.

Author:Amesh A. Adalja, Eric Toner, Thomas V. Inglesby, et al.
原文連結:https://jamanetwork.com/journals/jama/fullarticle/2762690