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 | 是 | 是 | 是 |
院內感染 | 是 | 是 | 是 |
醫護人員風險 | 是 | 是 | 是 |
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 | 是 | 是 | 是 |
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。
(財團法人國家衛生研究院 莊淑鈞博士摘要整理)
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 [1, 4]. 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 [1, 4, 5].
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 [6, 7]. Among the 79 394 confirmed cases in China, there were 2838 deaths [6, 7] 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 [9, 10]. 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 [11, 12].
Author:Yaseen M Arabi, Srinivas Murthy, Steve Webb, et al.
原文連結:https://reurl.cc/yZ19na