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1 人回報1 年前
Lisa-Chase Wolf
@Chase_WolfBTG
No, not AIDS, Long COVID.
Believe what you want, but yes, this is
reality
不是疫苗惹的祸,不是
70 J.Z, 12:04

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  • CNN 對台積電董事長劉德音的專訪翻譯逐字稿 On GPS: Can China afford to attack Taiwan? Fareed Zakaria, GPS In a rare interview with Mark Liu, chairman of Taiwan's TSMC — Asia's most valuable company — Fareed asks about the ongoing tension between the self-governing island and Beijing. Source: CNN Fareed Zakaria: 如果中國攻打台灣,那會如何影響台灣,以及台灣的經濟? What would happen to Taiwan, and to the Taiwanese economy, if China were to invade? 劉德音: 噢,當然,戰場上沒有贏家;所有人都是輸家。台灣人已在台灣建立起自己的民主系統,然後他們想過自己的生活。雖然半導體產業對台灣整體經濟來說十分重要,但如果真的發生戰爭的話,那或許半導體業不是最需要我們擔心的事。我們真正需要擔心的是這場戰爭將會摧毀以具有穩定秩序的世界經貿活動(the destruction of the world rule-based order);整個地理政治將會有劇烈的變化。 Oh, of course, the war brings no winners. Everybody is losers. And people in Taiwan has earned their democratic system in Taiwan, and they want to choose their way of life. And we think that indeed the chip supply is a critical business and economy in Taiwan, but had it -- had it been a War in Taiwan, probably the chip is not the most important thing we should worry about because this invasion, if it comes after, is the destruction of the world rule-based order. There is no -- the geopolitical landscape would totally change. Fareed Zakaria: 你會擔心台灣目前在中國半導體供應鏈上所扮演的核心角色嗎? 這會對台灣造成甚麼危險嗎? 還是說其實有戰略上的嚇阻效果? 畢竟有時大家會說台積電是台灣的護國神山。不過即便如此,我們還是知道中國一直都強調「我們對台灣有絕對的主權,而且這是我們不可退讓的中國資產」。 Do you worry that Taiwan is now so integral to the Chinese supply chain at the high end?.. Does that create a danger for Taiwan? Or is it a deterrent? People sometimes talk about the TSMC shield, but you could equally see Beijing saying we need to have total control of this. This is the most valuable asset and it's outside our borders. 劉德音: 嗯,沒有國家能夠用武力控制台積電的,因為如果中國解放軍真的入侵台積電,台積電就完全不能運作了,因為這是一個十分複雜的龐大組織。台積電從原料、化學物質、設備零件、工程軟體與檢測等各面向都隨時都需要跟外面的世界,歐洲、日本、美國相互溝通合作。是在世界上的所有人的努力才能讓這間公司,台積電,能夠正常運作。所以假如你用武力侵占了台積電,那台積電就不可能正常運作了,也就沒有所謂的台積電了。至於我們與中國的生意,目前中國大概占了我們 10% 的生意吧,但我們只會跟一般企業與消費者做生意,我們不會將晶片賣給軍事組織。我們覺得說,消費市場是很重要的,而且是生生不息的。如果消費者有需求,那我想,跟他們做生意並不是甚麼壞事。 Ok. Nobody can control TSMC by force. If you take a military force or invasion, you will render TSMC factory not operable because this is such a sophisticated manufacturing facility. It depends on the real-time connection with the outside world, with Europe, with Japan, with the US, from materials, to chemicals, to spare parts, to engineering software, diagnosis. It's everybody's effort to make this factory operable. So if you take it over by force, you can no longer make it operable. In terms of the China business, its today composed about 10% of our business. We only work with consumer. We don't work with militaries entity. We think that is, the consumer pool, is important, and it is vibrant. And if they need us, it's not a bad thing. Fareed Zakaria: 解釋一下,為什麼這(台積電跟中國做生意)不是壞事? Expand on that. Why is it not a bad thing? 劉德音: 噢,這是因為我們停止運作後將會為中國帶來巨大的經濟損失,因為他們最先進的半導體晶片突然就這樣消失了,所以他們在做這種"武力犯台"之前,我想必定會三思而後行的。 你看烏克蘭戰爭,我想我們都得從中好好反省與汲取些經驗。人們認為烏克蘭跟台灣非常像,但我得說台灣跟烏克蘭非常不一樣。想想烏俄戰爭對各國帶來的種種負面影響,對任何國家來說都不是好事。從西方世界、俄羅斯與烏克蘭的角度來看,都是輸家,沒有人從中獲得好處。我真的認為大家都應該要好好反省這場戰爭究竟為我們人類帶來了甚麼,想想我們應該要如何避免戰爭,想想我們該如何確保全球經濟的穩定,如何讓全球經濟能持續生生不息,而且也讓我們以公平的方式相互競爭,這是我的想法。 Oh, because our interruption will create great economic turmoil in either side in China because suddenly their most advanced components supply disappeared. And -- and it is an interruption, I must say. So people will think twice on this. I think the Ukraine war, I think we should draw lessons from it. People think Ukraine will make connected with the Taiwan Strait. They are very different. But in case you think about imperil, Ukraine war is not good for any of the sides. From the Western world, from Russia, from Ukraine, it's lose, lose, lose scenarios. All three sides ought to draw lessons. I think they do. And we should use that lessons to look at the lens on Taiwan. How can we avoid a war? How can we ensure no -- the world economy -- the engine of the world economy continue humming and let's have a fair competition. That's what I think. Fareed Zakaria: 就你看來,你會怎麼解釋台灣的經濟奇蹟? 在過去五十年裡,台灣經濟成功達到每年有 5% 的經濟成長。世上很少能夠有著像台灣經濟成長幅度這樣的國家,你怎麼看呢? From your perspective, what explains the Taiwan miracle? This is now a place that has grown at 5% a year for five decades. There are very few places in the world that have managed that. What explains the Taiwan miracle? 劉德音: 從外人的角度來看,會覺得這是一個奇蹟。但對認真工作的台灣人來說,這只是奮鬥的過程。老實說我覺得,相較於其他國家,尤其是在亞洲,我覺得台灣其中一個特點在於它那和平的社會。從 1949 年到現在,台灣一直都是相當和平的。這是個和平的地方。而在這期間,台灣從威權主義社會轉型成民主國家,變成一個民主社會。而如果你從整個世界的角度來看這點,如此這般和平的社會轉型是相當神奇的事情,我們是非常幸運的。而如果真要說奇蹟,我想台灣的確還有一點是相當與眾不同的,那就是我們的教育制度。 在我還小的時候,只有 10% 的人上大學。如今有 80% 的年輕人擁有大學文憑。我們政府設立了非常多間大學,所以對於所有年輕人來說,如果你想讀大學,那一定可以讀,只要你願意花時間,所以這建立了一個相對高品質的社會環境,以面對未來可能的種種挑戰,這是我覺得非常非常特別的一點。 Looking from outside, it appears to be a miracle. For the people working hard on the island, it is just a history of fighting. I think, to be honest, compared with other nations, particularly in Asia, I think one of the key components in Taiwan is a peaceful society. It maintained peace since 1949 till today, 70 years. It's a peaceful island. And during that period of time, Taiwan has transformed from authoritarian state into a democratic state, became a democratic society. This is marvelous because if you look at the nations around the world, having such a smooth transition, peaceful transition, we are fortunate, to be honest. But if you talk about the miracles, I also think there's one thing that is very distinctly different, is the education system. When I was young, only 10% of the young people entered college or universities. Today, 80% of the young people have college or university degrees. The government set up many colleges, universities. And every kid, if you want to go to university, you can go, and just so long as you spend time. So that has created a relatively good quality of population in Taiwan, posing for any change ahead. That's why I think that's very, very special. Fareed Zakaria: 為什麼其他人都很難做出你做的晶片呢? 我現在在想的是你們的七奈米,美國有非常多擁有輝煌歷史的偉大公司,像是 Intel。而中國則是撒了數十億的資金去開設晶圓廠,但都沒有人能做出你們的晶片。 Why is it so difficult for anyone to make the chips that you make? And I'm thinking now about the 7 nanometer. The Americans have these great companies that have huge history, like Intel. The Chinese pour tens of billions of dollars into new companies. But no one can make the chips you make. 劉德音: 嗯,可以啊,只是晚幾年而已,就...哈哈哈哈... Well, they can, just a few years later. It's ... hahaha ... Fareed Zakaria: 但這就是重點啊... But that's all the difference in this business. 劉德音: 沒錯,這是唯一的關鍵。我想我們是把半導體技術本身看做是一門科學,但也是一門生意。這不是組裝零件那樣而已。當然,這一切都得歸功於我們與其他夥伴的合作。我們的工程師甚至因為 COVID 而戴上 AR (擴充虛擬實境) 跟遠在荷蘭以及加州的工程師合作,我們就是這麼密切的合作,共同推進最先進的半導體技術。我只能說這麼多了,沒辦法跟你透漏與解釋所有細節。 You're right. That's all the difference. I think we treat the semiconductor technology itself as a business, as a science. It's not assembly workers. And, of course, I credit this to be working with our partners. Even the COVID time, our engineer used the AR, augmented reality, lenses to work with engineer in Netherland, work with engineer in California. And that's how close we work together. And together, we push the frontier of the semiconductor technologies. I cannot tell you everything why. Fareed Zakaria: 哦當然你不可能跟我說可口可樂的配方的...哈哈...。好,最後一個問題,在技術與經濟層面上,你會怎麼看待未來? 你的願景是甚麼? You're not going to tell me the secret formula of coca cola. Finally, tell me what you think will look like in the future, technologically, economically. What are your hopes? 劉德音: 我希望我們不會因為很接近中國而被歧視(discriminated)。不論我們跟中國的關係是甚麼,台灣就是台灣。你得把台灣視為一個整體,視為一個充滿活力與衝勁的社會。我們希望能為世界帶來創新,並持續不斷地推進未來,而不會因為我們跟中國有些紛爭而害怕我們。這實在是不值得。 I hope that we don't get discriminated because we are close to China. No matter your relationship with China, Taiwan is Taiwan. You have to look at Taiwan as, by itself, a vibrant society. We want to unleash the innovation for the world, into the future, continuously, and not to be scared because we have some dispute with our neighbors. And that is not worth it. Fareed Zakaria: 這你這樣好像是在跟世界說 ── 如果我理解錯誤請糾正我 ── 不要害怕中國說的那些話。因為中國永遠不可能接手台灣。台灣經濟是建立於全球合作,建立於信任與公開透明之上。如果他們侵入台灣,他們會發現實際上他們甚麼也沒拿到。 But it seems to me you're saying to the world -- correct me if I'm wrong -- you're saying to the world, don't be scared by what China is saying because the Chinese will never be able to take. The Taiwanese economy is built on this global collaboration, -- on trust, on openness, on -- they'll find they've taken over nothing, if they come in. 劉德音: 正確,沒錯,我的確是這麼想的,所以我們大家只會為彼此帶來災難,每一方都是如此。雖然我們得做最壞打壞,但還是盡量往最好的方向看齊。 Correct, yes, I do believe so. So the world can only create problem on three sides, all three sides. And that is -- we need to prepare the worst, but we should hope for the best. Fareed Zakaria: 你剛有提到烏克蘭戰爭是 lose-lose-lose,所以你希望可以 win-win-win。 So you said about the Ukraine war, it's lose-lose-lose. Your hope is for a win-win-win. 劉德音: 對,如果真的開戰了,那就會變成這樣。如果一切和平,那麼就只跟我們三方的競爭策略有關,我想在商場上沒有人會想要發生戰爭,所以我們又為什麼要再跳進這個陷阱(戰爭)裡呢? Yes, if you have a war, then it will be that. If this is peaceful, well, it's upon the competition strategies on all three sides. And I think that nobody in the business world want to see a war happen. And why do we jump again into another trap? Fareed Zakaria: 感謝你寶貴的時間。 Thank you for taking so much time 劉德音: 很高興能參與訪談。 We enjoy talking to you. (zero game 2)(sun over mountain)(praying)
    7 人回報1 則回應2 年前
  • 關心你, 我關心你, 我很關心你! 轉傳 (這是一個英國護士給大家的忠告,請仔細閱讀。不用謝。) BE PREPARED 準備妥善 Everyone is telling you how to NOT catch #coronavirus, but NO ONE is saying what to do if you get it. 每個人都在討論如何避免新冠病毒,但是沒有人告訴你:萬一不幸染上新冠病毒,應該如何自處。 Thanks to this nurse in the UK for putting this guide together: 感謝這位英國護士整理下列指引: Finally, some sensible advice. From a GP Nurse in the UK. 終於有一些明確的建議了。來自一個英國執業護士。 What I have seen a lot of are recommendations for how to try to avoid getting coronavirus in the first place: 我已經看過很多關於如何免感染新冠病毒的建議: • good hand washing 勤洗手 • personal hygiene 個人衛生 • social distancing 社交距離 but what I have NOT seen a lot of is advice for what happens if you actually get it, which many of us will. 但是我沒看到太多關於感染新冠病毒後要如何自處的建議,而我們很多人會染疫的。 So as your friendly neighborhood Nurse let me make some suggestions: 所以作爲你家隔壁友善的護士,讓我給些建議: If you get Covid-19 如果你感染了新冠肺炎 You basically just want to prepare as though you know you’re going to get a nasty respiratory bug, like bronchitis or pneumonia. You just have the foresight to know it might come your way! 基本上,只要做好心理準備,就好像知道自己將會患上令人討厭的呼吸道疾病一樣,例如支氣管炎或肺炎。只要想像你有可能會感染新冠肺炎。 Things to start doing now: 從現在開始要做的事情: 1. Get 20 minutes sun on your entire body (or as much as possible) every day. This will dramatically increase your Vitamin D levels, which improves your immune system. 每天花 20 分鐘曬太陽(或盡可能多曬曬身體各個部位)。這將會大大提高體内維他命 D 的含量, 藉以增強免疫系統。 2. If affordable take a good general supplement, plus 2000mg Vit C a day. Include ZINC, SELENIUM & GLUTATHIONE. 如果負擔得起,要多吃營養均衡的食物,外加每天攝取2000mg 維他命C,再配合鋅、硒和谷胱甘肽(註:一種強效的抗氧化劑)。 3. Scott’s Emulsion is a great general tonic (cod liver oi) 司考特乳白是一種很好的補品(魚肝油) Things you should actually buy ahead of time: 一些應該事先準備好的物品: 4. Kleenex 面紙(或衛生紙) Paracetamol 撲熱息痛藥片(德國市面稱為Paracetamol 500) 5. Cough medicine of choice (check the label and make sure you're not doubling up on Paracetamol) 止咳藥(檢查標籤確保沒有撲熱息痛的成份,以免重複) Zinc lozenges 鋅錠 6. Throat spray like Andolex or TCP 喉嚨噴劑,如Andolex或TCP( Trichlorophenylmethyliodosalicyl) 7. Honey and lemon can work just as well! 蜂蜜和檸檬也有相同效果! 8. Vicks vaporub for your chest is also a great suggestion. Vicks vaporub 維克斯薄荷藥膏對舒緩胸部不適,是一種很好的藥物。 9. A humidifier would be a good thing to buy and use in your room when you go to bed overnight. (You can also just turn the shower on hot and sit in the bathroom breathing in the steam) 夜裡睡覺時,在房間裡使用加濕器,是一個不錯的法子。 (也可以打開淋浴的蓮蓬頭,然後坐在浴室裡呼吸熱蒸汽) 10. If you have a history of asthma and you have a prescription inhaler, make sure the one you have isn’t expired and refill it/get a new one if necessary. 如患哮喘毛病,而有哮喘噴劑,請確保所用的哮喘噴劑尚未過期,並重新加滿/如有必要,買個新的。 11. Meals This is also a good time to meal prep: make a big batch of your favorite soup to freeze and have on hand. 餐點部份 這也是準備餐點的好時機:將一大鍋你喜歡的湯冷凍起來備用。 12. Hydrate Hydrate, hydrate! Stock up on whatever your favorite clear fluids are to drink, though tap water is fine you may appreciate some variety! 水份 水份,水份!多準備一些你喜歡的清澈食用水,儘管自來水也可以,但多樣化的食用水或許是個不錯的主意! 13. For symptom management and a fever over 38°c take Paracetamol rather than Ibuprofen. 如有病徵同時發燒超過 38°c,那就服用撲熱息痛藥片(Paracetamol),而不是布洛芬(Ibuprofen)。 14. Rest lots You should not be leaving your house! Even if you are feeling better you may will still be infectious for fourteen days and older people and those with existing health conditions should be avoided! 多休息 不應外出!即使病情好轉,14 天內仍具有傳染性;也要避免與老人家和健康狀況欠佳的人接觸! 15. Wear gloves and a mask to avoid contaminating others in your house. 戴手套和戴口罩,以免傳染給家中的其他成員。 16. Isolate in your bedroom if not living alone, ask friends and family to leave supplies outside to avoid contact. 若非獨居,請在臥室中自我隔離,讓親朋好友將物品留在外面,避免和他們接觸。 17. Sanitize your bed linen and clothes frequently by washing and clean your bathroom with recommended sanitizers. 經常以優良的消毒劑清洗床單和衣物。 18. You DO NOT NEED TO GO TO THE HOSPITAL unless you are having trouble breathing or your fever is very high (over 39°C) and unmanaged with meds. 除非呼吸困難或發高燒(超過 39°C)並且沒有其他醫療藥物,否則,不要去醫院! 19. 90% of healthy adult cases thus far have been managed at home with basic rest/hydration/over-the-counter meds. 迄今為止,已有 90%的成人病例成功地在家中接受基本的療養/補充水份/非處方藥物治療。 20. If you are worried or in distress or feel your symptoms are getting worse: 假如你擔心、緊張、或感覺自己的症狀越來越嚴重: 21. Pre-existing risks If you have a pre-existing lung condition (COPD, emphysema, lung cancer) or are on immunosuppressants, now is a great time to talk to your Doctor or specialist about what they would like you to do if you get sick. 預存風險 如果已經患有肺部疾病(慢性阻塞性肺病,肺氣腫,肺癌)或正在接受免疫抑製劑的治療,現在正是與家庭醫生或專科醫生討論的絕佳時機,要預先了解染病時的可能治療方案。 22. Children One major relief to you parents is that kids do VERY well with coronavirus, they usually bounce back in a few days (but they will still be infectious). Just use pediatric dosing. 兒童 對父母而言,最大的安慰是:治療新冠病毒的方法對於兒童非常有效,他們通常會在幾天內復原(但仍具有感染風險)。同時只需使用兒童劑量即可。 23. Be calm and prepare rationally and everything will be fine. This is to inform us all that the pH for corona virus varies from 5.5 to 8.5. 保持鎮靜,合理應對,一切都會好轉。要告訴所有人,新冠病毒的pH值在 5.5 到 8.5 之間。 24. All we need to do, to beat corona virus, we need to take more of an alkaline foods that are above the above pH level of the Virus. 為了戰勝新冠病毒,我們一切所需要做的,就是大量攝取高於上述pH值的鹼性食品。 Some of which are: 其中包括: 25. Lime萊姆 - 8.2pH Tangerine柑橘 - 8.5pH Mango芒果 - 8.7pH Orange 柳橙 - 9.2pH Lemon檸檬 - 9.9pH Pineapple 鳳梨 - 12.7pH Garlic 蒜頭 - 13.2pH Avocado 牛油果 - 15.6pH Dandelion 蒲公英 - 22.7pH 26. How do you know you have coronavirus? 如何知道染上新冠病毒? 1. Itching in the throat 喉嚨很癢 2. Dry throat 喉嚨乾渴 3. Dry couch 乾咳 4. High temperature 發高燒 5. Shortness of breath 呼吸急促 6. Loss of sense of taste & smell 失去味覺和嗅覺 7. Covid toes - toes turning blue/black 有新冠病毒腳趾 - 腳趾變成藍色或黑色 27. So where you notice these things quickly take warm water with lemon and drink. 因此,如果自己有這些症狀,就要立刻飲用溫熱的檸檬水。 28. Do not keep this information to yourself only. Pass it to all your family and friends. 不要保留這個信息。轉傳給所有家人和朋友。 諸君健康
    3 人回報1 則回應3 年前
  • 爆炸性研究:新冠疫苗的已接種者攜帶着高於正常251倍的病毒載量威脅到未接種者 #冠狀病毒 #疫苗 牛津大學 (University of Oxford) 臨床研究小組最近進行了一項研究,發現武漢冠狀病毒 (Covid-19) 疫苗的「已接種者」的鼻孔攜帶病毒載量是「未接種者」的251倍。 • https://www.ox.ac.uk/ • https://childrenshealthdefense.org/defender/vaccinated-healthcare-workers-threat-unvaccinated-patients-co-workers/ 這篇將在著名的醫學期刊《刺針》(The Lancet) 上發表的預印本論文具有開創性意義,因為它證實了疫苗已接種者的威脅,當他們冒險出門走到公共場所時,這些人正在「散發」病毒,他們對其他人的身體進行傳播。 即使打了針的人沒有出現症狀,研究人員發現,他們攜帶極高的病毒載量,將其轉化為彼得A.麥卡洛醫學博士 (Dr. Peter A. McCullough, M.D., Ph.D.) 稱之為「前驅型超級傳播者」(“presymptomatic superspreaders”)。 麥卡洛在兒童健康防禦 (CHD) 通訊《捍衛者》(the Defender) 的一篇文章中寫道:「這種現象可能是全球大量接種疫苗人群在接種疫苗後出現病例驚人激增的根源。 這篇論文的作者周等人 (Chau et al) 證明,在越南胡志明市一家醫院被封鎖的嚴格控制環境下,疫苗普遍失效及傳播病毒。」 印證:新冠疫苗正在傳播「Delta」變種 科學家仔細觀察了醫院的醫護人員,他們注射了福奇流感 (Fauci Flu) 疫苗,並在醫院裏臥床了兩週。 幾個月後,所有這些人都被確定獲得、攜帶並將可怕的「Delta」變種傳染給其他人,包括他們的已接種疫苗的同事。 換句話説,所謂的疫苗對預防感染或傳播毫無作用,甚至對福奇認為本應受到保護的其他接種者也沒有作用。 這些已接種疫苗的醫護人員也可能將這種Delta病毒傳染給他們的病人,導致了最近這種疾病新「病例」的激增,世界各國政府及他們的主流媒體都將其歸咎於未接種疫苗的人。 麥卡洛説:「這與法林霍爾特 (Farinholt) 及其同事在美國的觀察結果一致,也與美國疾控中心主任承認新冠疫苗未能阻止沙士病毒2型 (SARS-CoV-2) 的傳播的意見一致。 2月11日,世界衛生組織 (WHO) 指出,牛津/阿斯利康疫苗 (AZD1222) 對出現症狀的新冠病毒感染的有效性為63.09%。周在論文的結論支持了領先醫學專家的警告,即三種眾所周知的新冠疫苗的部分非滅菌的免疫力 (non-sterilizing immunity),與2020年疫苗接種前時代的樣本相比,可以攜帶251倍的沙士病毒2型病毒載量。」 如果你錯過了,我們還報道了「有漏洞」疫苗的現象,揭示了新冠病毒的注射很可能是最新「一波」疾病的主要原因。 如果不是因為整個社會都有已接種疫苗的人,我們可能根本就不會有Delta病毒或任何其他變種病毒。這場「大流行」早就結束了,一切都將恢復常態,只要「曲速行動」(“Operation Warp Speed”) 從未出現。 https://humansarefree.com/2020/07/trumps-warp-speed-funding-hiv-vaccines-for-bill-gates-and-dr-fauci.html 麥卡洛説:「因此,我們有了解釋為什麼Delta疫情如此可怕的謎題的關鍵部分——已全面接種疫苗的人作為新冠肺炎患者進行參與,並充當強大的傷寒瑪麗式 (Typhoid Mary-style) 感染的超級傳播者。 https://en.m.wikipedia.org/wiki/Mary_Mallon 已接種疫苗的人正在他們的社區中爆發密集的病毒傳播,推動新的新冠病例激增。接種疫苗的醫護人員幾乎肯定會把病毒傳染給他們的同事及病人,造成可怕的間接傷害。」 雖然潘多拉的盒子 (Pandora’s box) 已經打開了,但如果疫苗接種運動,包括所有旨在給每個人注射致命毒藥的「強制令」立即停止,我們也許能夠解決這個問題。 作者:伊桑·哈夫 資料來源:https://humansarefree.com/2021/08/vaccinated-covid-251-times-viral-load-threatening-danger-unvaccinated.html 翻譯:Dick Wong ——————————————————————————————— Explosive Study: People Vaccinated For Covid Carry 251 Times The Normal Viral Load, Threatening The Unvaccinated #Coronavirus #Vaccines The University of Oxford‘s Clinical Research Group conducted a study recently which found that people who get “vaccinated” for the Wuhan coronavirus (Covid-19) carry in their nostrils 251 times the viral load of the Chinese Virus compared to “unvaccinated” people. • https://www.ox.ac.uk/ • https://childrenshealthdefense.org/defender/vaccinated-healthcare-workers-threat-unvaccinated-patients-co-workers/ The preprint paper, which is set to be published in the prestigious medical journal The Lancet, is groundbreaking in that it confirms the threat of vaccinated people who are “shedding” the virus and who even knows what else on others when they venture out in public. Even if the jabbed are not showing symptoms, researchers found that they carry with them extremely high viral loads that transform them into what Dr. Peter A. McCullough, M.D., Ph.D., calls “presymptomatic superspreaders.” “This phenomenon may be the source of the shocking post-vaccination surges in heavily vaccinated populations globally,” McCullough wrote in a piece for The Defender, a newsletter of Children’s Health Defense (CHD). “The paper’s authors, Chau et al, demonstrated widespread vaccine failure and transmission under tightly controlled circumstances in a hospital lockdown in Ho Chi Minh City, Viet Nam.” Confirmed: Covid Vaccines Are Spreading The “Delta” Variant Scientists took a closer look at healthcare workers at the hospital who were injected for the Fauci Flu and had to remain confined there for two weeks. Several months later, all of these individuals were determined to have acquired, carried and transmitted the dreaded “delta” variant to others, including their vaccinated colleagues. In other words, the so-called vaccines did absolutely nothing to prevent either infection or spread, even to other vaccinated people who, according to Fauci, should have been protected. These same vaccinated healthcare workers also presumably transmitted the delta variant to their patients, contributing to the latest surge in new “cases” of the disease that governments around the world and their mainstream media lapdogs are blaming on the unvaccinated. “This is consistent with the observations in the U.S. from Farinholt and colleagues, and congruent with comments by the director of the Centers for Disease Control and Prevention conceding COVID-19 vaccines have failed to stop transmission of SARS-CoV-2,” McCullough says. “On Feb. 11, the World Health Organization indicated the AZD1222 vaccine efficacy of 63.09% against the development of symptomatic SARS-CoV-2 infection. The conclusions of the Chau paper support the warnings by leading medical experts that the partial, non-sterilizing immunity from the three notoriously ‘leaky’ COVID-19 vaccines allow carriage of 251 times the viral load of SARS-CoV-2 as compared to samples from the pre-vaccination era in 2020.” In case you missed it, we also covered the phenomenon of “leaky” vaccines, revealing how Chinese Virus injections are more than likely the primary contributor to the latest “wave” of disease. Were it not for the presence of vaccinated people throughout society, we probably would not even have delta or any other variant at all. The “pandemic” would have long been over by now and everything would have been back to normal, if only “Operation Warp Speed” had never been brought into existence. https://humansarefree.com/2020/07/trumps-warp-speed-funding-hiv-vaccines-for-bill-gates-and-dr-fauci.html “Thus, we have a key piece to the puzzle explaining why the Delta outbreak is so formidable – fully vaccinated are participating as COVID-19 patients and acting as powerful Typhoid Mary-style super-spreaders of the infection,” McCullough says. https://en.m.wikipedia.org/wiki/Mary_Mallon “Vaccinated individuals are blasting out concentrated viral explosions into their communities and fueling new COVID surges. Vaccinated healthcare workers are almost certainly infecting their coworkers and patients, causing horrendous collateral damage.” Though the Pandora’s box has already been opened, we might be able to get a handle on this thing if the vaccination campaign is immediately stopped, including all “mandates” that aim to inject everyone with these deadly poisons. by Ethan Huff Source: https://humansarefree.com/2021/08/vaccinated-covid-251-times-viral-load-threatening-danger-unvaccinated.html
    9 人回報1 則回應3 年前
  • 以色列卫生部|辉瑞疫苗杀死的老年人比疾病本身杀死的老年人多40倍 2021年3月5日 摘要 以色列卫生部的最新分析得出结论,在最近5周的疫苗接种期间,辉瑞公司的新冠病毒疫苗导致的死亡人数”大约是该病毒本身导致死亡人数的40倍”,而年轻人的死亡人数则是病毒导致死亡人数的260倍。 以色列卫生部|辉瑞疫苗杀死的老年人比疾病本身杀死的老年人多40倍 New analysis from the Israeli Health Ministry concluded Pfizer's COVID vaccine killed"about 40 times more(elderly)people than the disease itself would have killed"during a recent five-week vaccination period,and 260 times more younger people than would have died from the virus. 以色列卫生部的最新分析得出结论,在最近5周的疫苗接种期间,辉瑞公司的新冠病毒疫苗导致的死亡人数"大约是该病毒本身导致死亡人数的40倍",而年轻人的死亡人数则是病毒导致死亡人数的260倍。 While in January a group of independent doctors concluded that experimental COVID-19 vaccines are"not safer"than the virus itself,a new analysis of vaccine-related death rates in Israel demonstrates that this may indeed be the case to dramatic levels. 今年1月,一组独立医生得出结论,实验性的2019冠状病毒疾病疫苗并不比病毒本身更安全,但对以色列与疫苗相关的死亡率进行的一项新分析表明,情况可能确实如此,达到了惊人的水平。 A re-analysis of published data from the Israeli Health Ministry by Dr.Hervé Seligmann,a member of the faculty of Medicine Emerging Infectious and Tropical Diseases at Aix-Marseille University,and engineer Haim Yativ reveal,in short,that the mRNA experimental vaccine from Pfizer killed"about 40 times more(elderly)people than the disease itself would have killed"during a recent five-week vaccination period.Among the younger class,these numbers are compounded to death rates at 260 times what the COVID-19 virus would have claimed in the given time frame. 艾克斯-马赛大学医学新兴传染病和热带疾病学院的 hervé Seligmann 博士和工程师 Haim Yativ 对以色列卫生部公布的数据进行了重新分析,简而言之,辉瑞公司的 mRNA 实验疫苗在最近五周的疫苗接种期间造成的死亡人数比疾病本身造成的死亡人数多40倍。在年轻一代中,这些数字加起来的死亡率是2019冠状病毒疾病病毒在给定时间范围内的死亡率的260倍。 While the full mathematical analysis may be found in the article itself,the authors demonstrate how among"those vaccinated and above 65,0.2%…died during the three-week period between doses,hence about 200 among 100,000 vaccinated.This is to be compared to the 4.91 dead among 100,000 dying from COVID-19 without vaccination." 虽然完整的数学分析可以在文章本身中找到,但是作者证明了"那些接种疫苗和超过65,0.2%的人......是如何在三周期间死亡的,因此在100,000接种疫苗的人中大约有200人。"。这个数字可以和没有接种疫苗的100,000名死于2019冠状病毒疾病中的4.91人相提并论 "This scary picture also extends to those below 65,"the researchers continued.During the five-week vaccination process"0.05%,meaning 50 among 100,000,died.This is to be compared to the 0.19 per 100,000 dying from COVID-19(who)are not vaccinated…Hence the death rate of this age group increased by 260(times)during this five-week period of the vaccination process,as compared to their natural COVID-19 death rate." 研究人员继续说:"这种可怕的情况也延伸到了65岁以下的人群。"在为期五周的疫苗接种过程中,"0.05%,即10万人中有50人死亡。因此,在这五周的疫苗接种过程中,这个年龄组的死亡率比他们的自然死亡率增加了260倍,而他们的自然死亡率为每100,000人中有0.19人,没有接种2019冠状病毒疾病......因此,这个年龄组的死亡率比他们的自然2019冠状病毒疾病死亡率增加了260倍 As reported by IsraelNationalNews(INN),Seligmann is of Israeli-Luxembourg nationality,has a biology degree from Hebrew University of Jerusalem,and has written more than 100 scientific publications.INN reports the researchers"have no conflicts or interests other than having children in Israel." 据以色列国家新闻报道,塞利格曼是以色列-卢森堡国籍,拥有希伯来大学的生物学学位,并发表过100多篇科学论文。国家旅游局报告说,研究人员"除了在以色列生孩子之外,没有其他利益冲突。" Yativ and Seligmann stipulate that even these"estimated numbers of deaths from the vaccine are probably much lower than actual numbers as it accounts only for those defined as COVID-19 deaths for that short time period and does not include AVC and cardiac(and other)events resulting from the inflammatory reactions." Yativ 和 Seligmann 规定,即使这些"估计的疫苗死亡人数也可能远远低于实际数字,因为它只包括那些在短时间内被定义为2019冠状病毒疾病死亡的人,而不包括由炎症反应导致的动静脉畸形和心脏(以及其他)事件。" Nor do these numbers"account for long-term complications,"they write. 他们写道,这些数字也不能"解释长期并发症"。 In addition,within several months they expect"mid-and long-term adverse effects of the vaccination as ADE(Antibody-dependent Enhancement)"begins to become manifest in those who have received the experimental Pfizer vaccine. 此外,在几个月内,他们预计"中期和长期的不良反应疫苗接种作为 ADE(抗体依赖性增强作用)"开始成为明显的那些已经接受实验辉瑞疫苗。 As explained by America's Frontline Doctors(AFLDS),ADE"is when anti-COVID antibodies,created by a vaccine,instead of protecting the person,cause a more severe or lethal disease when the person is later exposed to SARS-CoV-2 in the wild.The vaccine amplifies the infection rather than preventing damage." 正如美国前线医生(AFLDS)解释的那样,ADE"是指当人后来在野外暴露于 SARS-CoV-2时,由疫苗产生的抗Covid 抗体,而不是保护人体,导致更严重或致命的疾病。这种疫苗加重了感染,而不是防止了损害。" AFLDS provides an example of a vaccine produced to fight the Dengue fever,which resulted in deaths of 600 children in the Philippines due to ADE,and the filing of criminal charges against the decision-makers in 2019. 菲律宾儿童和青少年司提供了一个为防治登革热而生产疫苗的例子,登革热在菲律宾造成600名儿童死亡,2019年对决策者提出了刑事指控。 For these reasons and more,AFLDS and many other doctors strongly discourage the use of these experimental vaccines for most people while only acknowledging that it may be plausible for those over 70 years of age,yet acknowledging that such injections are"a higher risk than early or prophylactic treatment with established medications"(sources here, here, here, and here). 由于这些原因以及更多的原因,AFLDS 和许多其他医生强烈反对大多数人使用这些实验性疫苗,同时只承认这对70岁以上的人来说可能是合理的,但也承认这种注射"比早期或使用现有药物进行预防性治疗的风险更高"(来源是这里、这里、这里和这里)。 Given these death rates,Yativ and Seligmann also have harsh criticism for the severe pressure being imposed upon the population by Israeli authorities to receive these shots.According to INN,the researchers call these draconian efforts"a new Holocaust." 鉴于这些死亡率,Yativ 和 Seligmann 也受到严厉批评,因为以色列当局对居民施加了接受这些射击的严厉压力。国际犹太人学院称,研究人员将这些严酷的努力称为"新的大屠杀" In the past weeks,Israel's government made headlines when they adopted a"green pass"system,allowing people who have been injected to receive a green code,which then grants them entry into places such as entertainment and leisure facilities. 过去几周,以色列政府采用了"绿色通行证"制度,允许被注射者获得绿色代码,然后允许他们进入娱乐和休闲设施等场所。 As the country reopens after a two-month lockdown,the green pass would be given only to those who had been injected,not to people who tested negative for the virus.The proposed benefits include access to"non-essential"businesses as well as not being required to self-isolate if identified as a close contact of a confirmed case of COVID-19,and not having to self-isolate after a return from what the government calls a"red location." 随着这个国家在两个月的封锁后重新开放,绿色通行证将只发给那些被注射的人,而不是那些病毒检测呈阴性的人。拟议的好处包括可以进入"非必要"的企业,如果被确认为确诊的2019冠状病毒疾病病例的密切接触者,不必自我隔离,也不必在从政府所谓的"红色地点"返回后自我隔离 Despite there being no proof that these experimental vaccines actually prevent transmission of the virus,Israel's minister for health,Yuli Edelstein,said upon the release of the vaccine"passport"that"(g)etting vaccinated is a moral duty.It is part of our mutual responsibility."He went further,declaring,"Whoever does not get vaccinated will be left behind." 尽管没有证据表明这些实验性疫苗实际上能够阻止病毒的传播,但以色列卫生部长 Yuli Edelstein 在疫苗"护照"发放时表示,"(g)接种疫苗是一种道德义务。这是我们共同责任的一部分。"他更进一步,宣称:"不接种疫苗的人将被留下。" The green pass needs renewing every six months,and despite holding one,an individual must still abide by masking and physical distancing rules.The Jerusalem Post also reported that legislation is being considered to grant employers the right to refuse unvaccinated people entry into the workplace. 绿色通行证需要每六个月更新一次,尽管持有绿色通行证,个人仍然必须遵守伪装和物理距离规则。《耶路撒冷邮报》还报告说,正在考虑通过立法给予雇主拒绝未接种疫苗的人进入工作场所的权利。 Such measures prompted Business Insider to describe the country as"waging a war on the unvaccinated."Meanwhile,Dr.Anthony Fauci,chief medical adviser to President Joe Biden,has styled Israel's vaccination response as"extraordinarily good." 这些措施促使商业内幕组织将这个国家描述为"向未接种疫苗的人发动战争"与此同时,总统乔·拜登的首席医疗顾问安东尼·福奇博士将以色列的疫苗接种反应形容为"非常好" 来源: https://www.lifesitenews.com/news/experimental-vaccine-death-rate-for-israels-elderly-40-times-higher-than-covid-19-deaths-researchers
    5 人回報1 則回應3 年前
  • 分享這篇文章很受用💪👏😉💐💒 比爾蓋茲分享對疫情的反思,非常中肯。 ----摘自網路文章 中文版: 英國《太陽報》 刊登了比爾蓋茨的公開信,這封信得到極大關注,得到很多人轉發,人們稱讚比爾蓋茨是真正的智者,並有人第一時間就把他的公開信翻譯成中文。編者讀了這封信和譯文,感到蓋茨的話語直至心靈,非常受教育。希望大家都能讀一讀他的信,看看新冠病毒給我們上了一堂什麼樣的課、又教會了我們什麼。下面是比爾蓋茨的信。 ********************** 我堅信發生的每一件事後面都有一個精神層面的目的,無論我們認為是好還是壞。 當我沉思時,我想與大家分享我的心得,新冠病毒究竟對我們做了些什麼。 1) 病毒提醒我們,人都是平等的,無論我們的文化、宗教、職業、經濟狀況,或是一個人有多麼出名。在病毒眼中我們都是平等的,也許我們也應該平等對待他人。如果你不相信我的話,那就去問湯姆•漢克斯。 2) 病毒提醒我們,我們的命運都是聯在一起的,影響一個人的事情同時也會影響另一個人。病毒也提醒我們,我們建立的虛假國境線毫無價值,因為病毒並不需要護照。病毒還提醒我們,雖然我們暫時受到壓迫,世界上還有人一生都受到壓迫。 3) 病毒提醒我們,健康多麼珍貴。而我們卻忽視健康,吃垃圾食品,喝被各種化學品污染的水,如果我們不照顧自己,我們當然就會生病。 4) 病毒提醒我們,生命苦短,什麼是我們應該做的最重要的事情,特別是那些已經生病的老年人。人生在世的目的不是買一卷卷的廁紙。 5) 病毒提醒我們,我們的社會已經變得物質至上,當我們遇到困難時,我們才想起我們的基本需求是食物、飲水和藥品,而不是並沒有什麼價值的奢侈品。 6) 病毒提醒我們,家庭是何等重要,但我們卻忽視了這一點。病毒強迫我們回到我們的房子裡,所以我們可以把房子建成家庭,並建立牢固的家庭紐帶。 7) 病毒提醒我們,我們真正的工作並不是我們打的那份工,我們固然需要打工,然而上帝創造我們的目的並不是讓我們打工。我們真正的工作是互相照顧、互相保護、互助互利。 8) 病毒提醒我們,我們不能妄自尊大。病毒還提醒我們,無論你覺得自己多偉大,也無論別人覺得你多麼偉大,一個小小的病毒就能讓整個世界停擺。 9) 病毒提醒我們,自由掌握在我們自己手中。我們可以選擇合作互助、分享、付出、互相支持,或者我們也可以選擇自私、囤積和自顧自。只有在困難的時候才能看出一個人的真面目。 10) 病毒提醒我們,我們既可以耐心,也可以恐慌。我們既可以理解這種情況在歷史上已經發生過多次,但最後都過去了,我們也可以恐慌,以為世界末日到了,結果傷害了我們自己。 11) 病毒提醒我們,疫情既是結束也是開始。我們現在可以反省和理解,從錯誤裡吸取教訓。疫情也可以是一個輪回的開始,而且還會繼續下去,直至我們吸取教訓為止。 12) 病毒提醒我們,我們的地球病了。病毒還提醒我們,我們必須看到森林消失的速度,也必須看到一卷卷廁紙從貨架上消失的速度。我們都病了,因為我們的家庭病了。 13) 病毒提醒我們,困難總會過去,然後就容易了。生活是週期性的,現在只是週期裡的一個階段。我們不必恐慌,疫情一定會過去。 14) 許多人認為新冠病毒的疫情是一場災難,但我覺得這是一次“偉大的糾錯”。 👍👍Read this very enlightening *Bill Gate's* views on the Covid19: What is the Corona/ Covid-19 Virus Really Teaching us? I’m a strong believer that there is a spiritual purpose behind everything that happens, whether that is what we perceive as being good or being bad. As I meditate upon this, I want to share with you what I feel the Corona/ Covid-19 virus is really doing to us: - It is reminding us that we are all equal, regardless of our culture, religion, occupation, financial situation or how famous we are. This disease treats us all equally, perhaps we should to. If you don’t believe me, just ask Tom Hanks. - It is reminding us that we are all connected and something that affects one person has an effect on another. It is reminding us that the false borders that we have put up have little value as this virus does not need a passport. It is reminding us, by oppressing us for a short time, of those in this world whose whole life is spent in oppression. - It is reminding us of how precious our health is and how we have moved to neglect it through eating nutrient poor manufactured food and drinking water that is contaminated with chemicals upon chemicals. If we don’t look after our health, we will, of course, get sick. - It is reminding us of the shortness of life and of what is most important for us to do, which is to help each other, especially those who are old or sick. Our purpose is not to buy toilet roll. - It is reminding us of how materialistic our society has become and how, when in times of difficulty, we remember that it’s the essentials that we need (food, water, medicine) as opposed to the luxuries that we sometimes unnecessarily give value to. - It is reminding us of how important our family and home life is and how much we have neglected this. It is forcing us back into our houses so we can rebuild them into our home and to strengthen our family unit. - It is reminding us that our true work is not our job, that is what we do, not what we were created to do. Our true work is to look after each other, to protect each other and to be of benefit to one another. - It is reminding us to keep our egos in check. It is reminding us that no matter how great we think we are or how great others think we are, a virus can bring our world to a standstill. - It is reminding us that the power of freewill is in our hands. We can choose to cooperate and help each other, to share, to give, to help and to support each other or we can choose to be selfish, to hoard, to look after only our self. Indeed, it is difficulties that bring out our true colors. - It is reminding us that we can be patient, or we can panic. We can either understand that this type of situation has happened many times before in history and will pass, or we can panic and see it as the end of the world and, consequently, cause ourselves more harm than good. - It is reminding us that this can either be an end or a new beginning. This can be a time of reflection and understanding, where we learn from our mistakes, or it can be the start of a cycle which will continue until we finally learn the lesson we are meant to. - It is reminding us that this Earth is sick. It is reminding us that we need to look at the rate of deforestation just as urgently as we look at the speed at which toilet rolls are disappearing off of shelves. We are sick because our home is sick. - It is reminding us that after every difficulty, there is always ease. Life is cyclical, and this is just a phase in this great cycle. We do not need to panic; this too shall pass. Whereas many see the Corona/ Covid-19 virus as a great disaster, I prefer to see it as a great corrector. It is sent to remind us of the important lessons that we seem to have forgotten and it is up to us if we will learn them or not. Bill Gates.
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  • 張凱銘醫師(美國紐約市立醫院感染科醫師)   5月14日下午1:21   發表於【COVID-19 醫療人員防疫戰術戰技交流中心】     **文章最後面補充以下章節:兒童,孕婦,COVID後遺症,COVID傳染途徑,疫苗副作用處置**   *再補充DVT prophylasix, ivermectin, 非嚴重COVID病人*   現在已經不是2020年3月了,對於COVID知識,我們了解更多了,很多過去錯誤的做法,都可以調整,有新的東西,也應該嘗試使用,這就是與時俱進。不要害怕病毒,我們可以克服。一年後再發一篇review。(註:本文特別是治療方法寫的很粗淺,以綱要提醒重點為主,裡面講的東西你如果搜尋多半有論文佐證,細節東西還是以有公信力的來源為主,此文非醫療建議)   #傳染力:   為什麼COVID-19傳染力驚人?因為無症狀也可以開始傳染,這跟2003年的SARS不一樣,SARS原則上要病人有發燒或咳嗽症狀才會傳染,所以當年很快就可以擋下來,現在的COVID可以沒有症狀也傳染給別人,所以各大出入口體溫篩檢其實不一定很有用。因為可以無症狀感染,所以疫情才會這麼難以控制。COVID原則上出現症狀前兩天到發病後一天內傳染力最強,發病後七天內逐漸減弱傳染力。病人多久還有傳染力確切時間很難告訴你一個數字,但是大致上7-10天後就沒有什麼傳染力了,這也是美國CDC的隔離時間是訂在10天的原因,當然不是說十天後就一定不會傳染,這邊是說傳染力越來越弱,機率越來越低,一個概率的問題,醫學到最後都是統計的問題,極端值先不討論。   #什麼叫確診?   在此次疫情爆發之前,時常看到境外確診者,常常沒有症狀,也許在國外一陣子前染過病,到台灣篩檢陽性,或甚至是隔離14天後期滿然後自主申請檢驗然後被確診,那些人的通性都是CT值很高(>30),抗體早就已經產生陽性,這代表,他們早就被感染了,他們某種程度已經免疫了,PCR測出來的只是死掉的病毒片段被檢驗出來,其實沒有什麼傳染力不用太擔心。CT值代表要複製病毒片段多少次才能被檢驗出來,所以CT值如果很高,代表病毒片段實在是太少了,要一直複製到30次以上才有辦法被檢驗出來,有個小篇的NEJM韓國研究指出CT值在28.4以上病毒培養都培養不出來,所以CT>30其實根本不用擔心。這種沒有什麼臨床意義的病例,是否有需要每個人都送去負壓病房隔離,我認為是很需要商榷的,我很難想像這些人既沒有症狀,也沒有傳染力,到底是要住院做什麼治療?如果疫情不嚴重就算了,但國內疫情持續升溫,這可能占用醫療資源讓有需要的人無法住進醫院,那問題就大了。現在已經是2021年五月了,早已不是2019年12月或2020年一月,COVID已經不是神秘的病毒了,我認為需要用科學方法對待隔離這件事。然而此次境內社區感染,很多都是有症狀且CT值低(10-20幾),這些人就是剛被感染,這些才是真正有意義的確診者,這些是最要小心的族群。   #檢驗:   PCR是1980年代就發展出來的一種檢驗技術,這不是什麼酷炫的科技也不是昂貴的檢查,任何一個檢驗,結果是死的,判斷是活的,如果有偽陽性或偽陰性問題,都可以再重複檢查。臨床判斷不能忽略。如果覺得重複檢驗費太貴,那問題應該是為什麼此項檢查會這麼貴,而不是懷疑其檢驗的必要。COVID都可以無症狀,如果懷疑COVID,不要用猜的,要用驗的。   #Variant (變異病毒):   COVID病毒跟其他常見流感病毒一樣,越多人被感染,病毒一直複製,外膜就容易產生片段的變異,所以本質還是同一個病毒,因此我不喜歡用變種病毒這個名稱,我比較喜歡講變異。不管是英國或南非病毒,他們並不會使感染後的病人變嚴重,但是變異病毒的傳染力確實比較強,也可能讓疫苗效果比較不好,但是目前看來疫苗對英國變異病毒還是有效的。我認為未來的世界可能會需要每年都打COVID疫苗,就像流感每年都會變,每年都該打流感疫苗,任何人終究都需要打COVID疫苗,在這地球村就是不可能不打,除非你永遠關起來不要跟外界的人接觸。阻止病毒繼續傳播的最好方式就是疫苗。如果可以,我希望全世界70億人現在都注射好疫苗,一兩個月後COVID大流行就會終結。為什麼COVID一直流行,就是因為全世界疫苗施打太緩慢,太多人猶豫不決。越慢打疫苗,病毒一直在複製,一直複製的結果就是又產生變異,到時候疫苗又漸漸失去效果,大流行又要重來一輪。   #疫苗:   現在全世界有四家有效的疫苗:Pfizer和Moderna是mRNA疫苗,AZ和JNJ是腺病毒載體疫苗。這四種都非常有效,重症死亡率保護都非常的好。疫苗最重要的是防止死亡,不是打了就一定不會被感染。實際上COVID大部分的人被感染了只有輕度或無症狀,但是有些有危險因子的人(COVID特別喜歡攻擊老年人,肥胖,糖尿病者)可能產生嚴重肺部纖維化而至死亡。如果今天全世界的人都打滿疫苗,有些人也許還是會有感染或輕微症狀,但是到時候就不會有人擔心,因為跟感冒一樣,沒什麼大不了的!今天還在擔心那些輕微副作用(發燒、疲憊、肌肉痠痛這些真的是無關緊要1-3天就會消失的副作用),那你就失去了大局觀。99.99%的人都沒有出現嚴重副作用,甚至在國外都有過敏案例用漸加劑量還是把第二劑疫苗打齊的記載。打疫苗很多人當然會有不舒服反應,但是這些是可以接受的,因為打疫苗本來就不是要打舒服的,打了針會不會舒服一直都不是打疫苗的考量點,就跟你終究要買歐洲車,你這輩子終究是要打COVID疫苗的,早打就早有保護力,就不會一直擔心會不會被感染。我認為能早點打疫苗就是好事,任何上述四種疫苗都非常的好,真的不需要挑,沒有打就是沒有防護力,與其思考70-95%的差距,不如想0-70%的差距,沒有打疫苗病毒可以長驅直入,有疫苗你平常沒有太多病史或免疫問題,你要死於COVID的機率會非常非常的低。打疫苗不是大學聯考,去計較一兩分的差距,每個疫苗臨床試驗的基準點都不一樣,沒辦法拿純數字去比較。美國人做事慢,非常沒有效率,有在美國生活過一定知道這點,然而美國疫苗是在FDA星期五通過,星期一就開打,這點就非常有效率。看到很多人因為疫情爆發終於願意趕快打疫苗了,這也算好事,雖然在過去兩三個月早就可以做的事,真的是有點可惜。我真的很希望疫苗覆蓋率可以再高一點。   #疫苗副作用:   常見副作用就不說了,發燒疲憊肌肉痠痛等,這些不應該是你不打疫苗的理由。有些人可能淋巴腫大但是不嚴重且看運氣。立即過敏反應極度罕見。現在要談談血栓。AZ或JNJ腺病毒載體疫苗有一個非常罕見(約十萬到百萬分之一)但可以是嚴重的副作用就是血栓問題。這邊的血栓並非腿部因久不動而產生的靜脈栓塞(DVT)或肺栓塞(PE),而是會產生類似Heparin-induced thrombocytopenia (HIT)的原理,身體產生platelet factor 4 (PF4)抗體跟heparin結合消耗血小板導致的血栓問題,然而這些人都沒有接觸過heparin類藥物,所以因為疫苗導致的血栓病有一個新的病名叫做Vaccine-induced immune thrombotic thrombocytopenia (VITT),這比較類似自體免疫反應,常發生在年輕女性,過去可能沒有什麼明顯病史或血栓問題,在打了AZ或JNJ疫苗,一般在兩個禮拜左右發作(時間相對短,長一點可能一個月),血栓產生部位有可能是在splenic vein or cavernous venous sinus,所以病人也許會有肚子痛、頭部腦神經異常,動眼神經異常,視力異常,等問題。如果是腦內血栓影像診斷甚至要靠Magnetic Resonance Venography (MRV),血液檢查要驗HIT panel (PF4 or serotonin release assay)。相信很多台灣醫師可能根本沒有驗過HIT,因為東方人血栓問題不大,這對我們來說也是好事所以更加肯定疫苗風險是很低的。臨床醫師警覺性要很高。疫苗副作用通報系統要很完善才行。治療方式不可以用傳統heparin類的抗凝血劑,enoxaparin這些常見的都不行。可以使用argatroban,fondaparinux,或DOAC (apixaban, rivoraxaban)這類。還可以用IVIG治療。所幸國外的案例多半治療後無大礙。   #COVID的治療,現在有什麼?   - 剛確診沒多久,最好前48小時內,如果屬於高危險族群(病人本身身體比較差者),打單株抗體(monoclonal antibody)效果最好,可以預防病情的進展,在美國有很多infusion center,或有些急診也可以打,抗體趕快中和病毒。美國現在有Regeneron藥廠的Casirivimab/imdevimab跟Bamlanivimab/etesevimab。   - Hydroxycholoroquine奎寧在2020年三月美國疫情剛爆發甚至世界各地都很常用,多個研究出來結果就是沒有用,希望以後不會有人再提這個了   - 慎用抗生素:在2020年三月幾乎每個人因為COVID住院都會給azithromycin等抗生素,因為臨床上病毒性肺炎跟細菌性肺炎都很類似。但是發現COVID剛發病很少有細菌感染,如果病人只是乾咳,沒有痰,CXR或CT很典型就是bilateral GGO沒有局部consolidation(局部細菌肺炎感染),其實可以不用上抗生素。一般細菌性感染多半發生在ICU病患、插管者、住院住兩三個禮拜以上者,這些再好好考慮。不應該每個人得到COVID就給抗生素。   - Remdesivir IV for 5 days(200mg*1 day, then 100mg*4 days)在美國算最常用的抗病毒藥物,如果有氧氣需求患者一般都會給,注意肝指數可能升高需要檢測,攜帶remdesivir的cyclodextrin需要靠腎臟清除所以如果eGFR<30可能不能使用,但是洗腎可以清除所以洗腎患者又可以使用   - Dexamethsone 6mg IV or PO for 10 days: nejm上大名鼎鼎的recovery trial顯示,對於重症患者(需氧或插管者)有助於降低死亡率,特別是插管者幫助最大,因為可以避免免疫風暴過度激化導致急性呼吸窘迫症(ARDS),如果病人不需要氧氣輕症患者,給dexamethasone是無用的,請勿濫用類固醇。   - 氧氣目標不一定要100%,如果病人沒有特別覺得喘,SpO2維持在92-96%左右其實也可以。跟2021年3月做法不一樣的事,避免早期插管!插管可以避免最好,一旦插管就很難拔管,俯臥(肚子貼地臉朝下)prone position對於血氧維持還是非常有效,high flow nasal cannula (HFNC)高速鼻氧氣管對於維持血氧也很有效,這些都可以避免走入插管這一途。   - Tocilizumab: 2020年3月很多人用,後來研究說沒有用,最近又捲土重來越來越多研究看似有用。Toci(這樣簡稱才不會念太長)是IL-6 inhibitor,可以抑制免疫反應也是想避免走入cytokine storm,先前研究結果會失敗可能跟使用時機最有關,因為不是每個病人都可以給,而是建議在氧氣需求量一直增加,已經到只用HFNC或BiPAP這種階段隨時要被插管這種階段可能會比較有用,而且至少給過類固醇(上述的dexamethasone)24小時還是一直惡化再給。   - 小心菌血症甚至黴菌感染:這些是指ICU重症患者,他們可能產生MRSA or MSSA bacteremia, Candidemia等,如果住院有發燒,該做的blood culture還是不能少。甚至有些病人肺部產生mucormycosis or Aspergillosis的關聯性世界各國有越來越多的paper報導 (我也有一篇相關論文)。     後記:算是一年後的一篇心得文章,在美國紐約2020年3月我們走過最可怕的多次融斷潮,紐約當時宛如空城,時代廣場空無一人,空氣中彷彿都有高濃度的病毒,ICU要擴張三倍,整間醫院只有COVID病人相比,現在怎麼樣台灣情況都好得多,而且現在有疫苗,有更多對病毒的認識,少了很多未知,我們現在更多知道什麼藥物有用,什麼沒有用,可以少走很多冤枉路。我對台灣人高水準的國民素質很有信心,多半人都很願意戴口罩也配合,疫情肯定不會太差。冷靜準備,有疫苗趕快打。看著歐美在疫苗施打後疫情逐漸散去,台灣也不可能永遠用高壓圍籬,非常”old school”的”2020年”防疫方式一直下去,最有效控制疫情還是要靠疫苗,希望全球大流行可以趕快結束。     *************************   補充   #兒童:   小孩子也會得到COVID,他們症狀多半比較輕微,但是說小孩子得到都不會有事也不是正確的。有部分小孩得到病毒急性感染也可能會嚴重到插管,因此不能因為多半無症狀或症狀輕微就掉以輕心。小孩子常常造成家長或成人的感染來源,就算小孩子沒什麼事但是如果傳染給家裡長輩可能導致長輩嚴重生病,因此這部分公衛預防也很重要。另外小孩比較可能因為COVID的併發嚴重疾病叫做Multisystem inflammatory syndrome in children (MIS-C),在美國我們讀MIS-C為”Miss C”,MIS-C並非病毒急性感染導致的疾病,實際上多好發兒童感染後一個月後,其症狀表現如川崎病(Kawasaki disease),這些病人說不定COVID PCR都已經陰性,因此不需要給remdesivir等抗病毒藥物,這比較像免疫發應引起的全身發炎反應,處置方法類似Kawasaki disease,給IVIG、Aspirin,要做心臟超音波Echo。成人也可能會有MIS-A (A=adult),但是成人科醫生對川崎病經驗不足也許比較容易漏掉。目前僅有美國Pfzier疫苗降低施打年齡到12歲以上,其他疫苗還沒有開放讓兒童施打。   #孕婦:   孕婦如果感染到COVID多半還是輕症為主,但是部分病人會有比較糟的預後。所以如果能盡早接種疫苗,還是多一點保護。目前沒有證據疫苗會對流產或胎兒有不良影響,實際上很多新生兒的血液可以測得對抗COVID的抗體,意思是說如果媽媽有打疫苗,新生兒也會間接打到疫苗,其實對兩方都是好事。如同之前所說AZ有可能導致某些罕見血栓,而這個又比較好發較年輕的女性,是一個要衡量的點,但各大婦產科醫學會偏向鼓勵孕婦施打疫苗,病人需要知道潛在風險,孕婦打了疫苗也不用太恐慌,如果疫情嚴重施打可能還是Z>B。   #COVID後遺症:   有部分人得到COVID後,儘管已經康復沒有病毒感染的跡象,但還是有持續的症狀特別是疲憊、思慮不清、運動一下就很累需要停止、焦慮、嗅味覺異常等甚至到六個月以上之久,此為“Post-acute sequelae of SARS-CoV-2 infection” (PASC)。PASC是一個真實的疾病國外很多人都有類似的問題,多半好發年輕女性30-40歲左右,可能跟免疫反應有關,一系列的血液或抽血檢查多半都正常,卻有持續的症狀且都得過COVID,他們一般都沒有嚴重COVID疾病,多半輕症且不需要氧氣。目前沒有特別好的治療方式,症狀治療為主,時間久了多半慢慢改善緩解,可能需要多方專科(包含精神科)一起幫助病人。   #COVID傳染途徑:   還是以空氣、飛沫傳染為主。接觸傳染似乎沒有想像中常見。勤洗手、環境清潔當然很重要,但是不用過度恐慌而反覆一直消毒等,接觸傳染沒有那麼容易傳染。   #疫苗副作用處置:   不需要預防性吃退燒藥,如果有發生發燒或疼痛等再吃止痛退燒藥就好(acetaminophen or NSAIDs)。免疫力不全者或老人、安養院居民,其實是最需要施打疫苗的對象,因為他們一旦得到COVID死亡率最高,這些人施打疫苗反而最不會有任何症狀因為他們免疫反應力弱,就算是施打了mRNA疫苗還是可能無法產生足夠的抗體,因此他們還是要戴口罩等特別小心,他們是所謂”breakthrough infection”(突破感染)最常見的族群。這也是為什麼我建議一般人有什麼疫苗就先打什麼,因為對一般人來說現有疫苗保護力其實就很夠了,根本不用區分保護力高低基本上打滿了都可以非常有效預防重症,至於高危險族群他們更不能承擔沒有疫苗去保護的風險下,總之就是建議趕快施打。   #深部靜脈栓塞預防(DVT prophylasix):   在美國不管什麼原因住院,沒有明顯禁忌症基本上都會每天皮下注射抗凝血劑enoxaparin SQ 40 mg daily預防DVT,這個是在COVID疫情之前就一直這樣。COVID的其中一個致病機轉是因為他容易形成微血栓microthrombi堵塞肺部導致缺氧甚至是到處形成DVT或肺栓塞PE。然而研究顯示,給治療DVT/PET的劑量enoxaparin 1 mg/kg BID一天兩次的高劑量用於COVID住院病人,對於預後並沒有顯著差異,意思是說你不需要每個COVID病人都給抗凝血劑的治療劑量,建議一般住院病人給預防劑量就可以。然而我知道台灣或者說東方人的血栓機率本來就低於西方人,因此本來在台灣住院病人就沒有用enoxaparin DVT ppx的習慣,但我還是會建議要定期檢查病人有沒有什麼症狀,驗d-dimer,如果有升高可能要小心DVT or PE,如果真的有還是要給治療劑量。另外有研究指出,COVID病人可以給aspirin,算是輕度的抗凝血劑,對預後也許有幫助,這可能需要更多證據。   #Ivermectin:   Ivermectin是用來治療寄生蟲的藥,有些人腦筋動到ivermectin做研究有小部份說對COVID有幫助,但是美國感染科(IDSA)的建議是不要例行性的使用ivermectin治療COVID,只建議用在臨床試驗的情況。個人覺得用治療寄生蟲的藥來對抗病毒學理好像沒什麼道理應該不會有用。   #非嚴重COVID病人:   我不知道之後疫情會怎麼變化,但如果疫情非常嚴重在社區散開,那輕重症分流就會很重要, 多半人感染了實際上只有輕症而已,COVID不是黑死症!!希望台灣可以不要有獵巫的行為對患者指指點點。台灣醫療器材法規似乎很嚴格?在美國藥局或網路上隨便很容易可以買到手指的血氧機(pulse oximetry)一台很便20-30美金而已,因為COVID本身是病毒,意思是大部分還是症狀治療為主,如果沒有缺氧hypoxia,那其實就沒什麼醫療治療可以做了,所以發燒等症狀還是吃退燒藥為,那在家用血氧機監測自己氧氣濃度,沒有缺氧其實就可以不用擔心。不過高危險族群還是會建議給單株抗體看能不能趕快中和病毒導致不會演變嚴重。如果嚴重病人在ICU插管住院甚至一個月以上,其實也跟COVID無關了,因為肺部已經嚴重受損, 高品質的ICU照護就會是關鍵(回歸到一般內科的基本治療).   Thank you for this most interesting consultation, allowing me to participate in the most difficult and challenging case. I shall continue to follow up with you.     #感謝張凱銘醫師無私分享 #必讀好文
    5 人回報1 則回應3 年前
  • James Robb, MD UC San Diego. 詹姆斯.萝卜,加州大学圣地亚哥分校医学博士 Subject: What I am doing for the upcoming COVID-19 (coronavirus) pandemic 新冠疫情扩散下我的防备攻略 Dear Colleagues, as some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources. 众所周知,我是冠状病毒的分子病毒专家,从70年代到现在一直在研究这些病毒。所以我是有发言权的。 The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April. 现在大规模在美国爆发还只是一个可能,现在还是数据不足。但是广泛传播要到三月底四月。 Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves.: 我预防冠状病毒的方法和防止流感一样,只是增加口罩和手套。 1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc. 不要和别人握手。用碰拳头,小鞠躬,碰胳膊肘等代替。 2) Use ONLY your knuckle to touch light switches. elevator buttons, etc.. Lift the gasoline dispenser with a paper towel or use a disposable glove. 只用手指关节去开灯的开关和电梯按钮。用纸或者戴手套加汽油。 3) Open doors with your closed fist or hip - do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors. 不要用手抓门把,特别是公共厕所,邮局,商业中心的门。用拳头和屁股把门撞开。 4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts. 如果店里有抗菌湿巾提供,用它来擦所有碰到的把柄和儿童座。 5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been. 每次从外面回家,至少用肥皂洗手20秒。 6) Keep a bottle of sanitizer available at each of your home's entrances. AND in your car for use after getting gas or touching other contaminated objects when you can't immediately wash your hands. 在家里的门口和车里放一瓶消毒液。 7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more! 如果来得及,尽量打喷嚏擤鼻涕到纸巾上。如果来不及用胳膊肘捂了,要及时换衣服。 What I have stocked in preparation for the pandemic spread to the US: 在美国家里,我囤积了一下物资: 1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas. 一次性橡皮手套,外出时备用。 Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average - everything that is associated with infected people will be contaminated and potentially infectious. 注意,病毒靠咳嗽和打喷嚏产生的较大的水雾珠传播的,不是因为空气本身。所有的水雾珠会落在各种各样的表面,在那里呆一个星期之久。所有感染的人碰过的东西都有病毒。 The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth. 这个病毒只会感染你的肺,而进入的途径就是你的口鼻。所以唯一被感染的机会是你的手带到你的口鼻除非有人直接对着你的脸打喷嚏咳嗽。 2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you - it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth - it is only to keep you from touching your nose or mouth. 在家里储存一些一次性医用口罩。其实口罩并不是用来防止别人对你打喷嚏,而是阻止你的手老是去碰你的口鼻。你可能不知道,我们每天不知不觉会碰自己的口鼻90次以上。 3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective. 储存一些洗手消毒液,最好是含有有60%以上酒精那种。买一些手套。 4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY "cold-like" symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available. 储备大量的锌锭剂。一般的药店应该有很多选择。其中一种叫Cold-Eeze lozenges。锌锭剂被证实对冠状病毒和其他病毒有一定防治作用。当你开始感到有感冒的感觉到时候,按照说明书每天服用数次。最好安静的躺下来,让锌锭剂慢慢融化在喉咙和鼻腔里。 I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available. 和大家一样,我希望冠状病毒的疫情能够得到控制。科学界已经学到很多关于这个病毒的东西。可是毕竟人类没有见过这个病毒,也没有建立对它的免疫力。我不认为一年内会有真正有效药物和疫苗开发出来拯救人类或者控制病毒。目前只能减缓病状。 I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share this email. Good luck to all of us! Jim 我希望我这样个人的想法对你有所帮助。欢迎你和大家分享这份文章的内容。祝我们好运!詹姆斯 James Robb, MD FCAP
    2 人回報1 則回應5 年前
  • 轉~ 翻譯一篇在西雅圖感染新冠肺炎病毒的美國人所寫的個人經歷。 I had COVID-19 and here is my story. I made this post public out of several requests from my friends who asked me to share. I hope it gives you some good information and peace of mind! 我感染了新冠病毒(武漢肺炎),由於不少我身邊朋友的請托,希望我可以跟大家分享我的情況,所以我決定把我的染病的經驗公開,讓大家可以有更多的了解。 First how easily you can get it. I believe I caught it when attending a small house party at which no one was coughing, sneezing or otherwise displaying any symptoms of illness. It appears that 40% of the attendees of this party ended up sick. The media tells you to wash your hands and avoid anyone with symptoms. I did. There is no way to avoid catching this except avoiding all other humans. 40% of folks were all sick within 3 days of attending the party all with the same/similar symptoms including fever. 首先對於新冠病毒,它比你想像的更容易被感染. 我確信我是在參加一個小型家庭聚會時被感染的。當時參加的客人沒有人咳嗽、打噴嚏,或者顯現出任何生病的症狀。結果呢?約40%參加聚會的人都被感染了!媒體上所說的要勤洗手避免跟有症狀的人接觸,我都照做了. 我覺得沒有任何方式可以避免被感染,除非你完全避免跟人群接觸。40% 被感染者都是在參加聚會後三天之內就發病,他們都有著相同的症狀,包含發燒. Second, the symptoms appear to be different depending on your constitution and/or age. Most of my friends who got it were in their late 40s to early 50s. I’m in my mid 30s. For us it was headache, fever (for first 3 days consistently and then on and off after 3 days), severe body aches and joint pain, and severe fatigue. I had a fever that spiked the first night to 103 degrees and eventually came down to 100 and then low grade 99.5. Some folks had diarrhea. 其次,這些症狀因人而異,因每個人的身體狀況及年齡而有所不同。大部分受感染的朋友年齡層約在40到50歲左右,而我是30幾歲。對我們來說染病的初始症狀是頭痛,發燒(最初三天是持續高燒而後三天是間歇性高燒),身體的劇烈疼痛以及關節疼痛,而且有強烈的四肢無力與倦怠感。在我感染的第一個晚上高燒到103度,隨後下降到100度、99.5度.有些朋友則有腹瀉的症狀。 I felt nauseous one day. Once the fever is gone some were left with nasal congestion, sore throat. Only a very few of us had a mild itchy cough. Very few had chest tightness or other respiratory symptoms. Total duration of illness was 10-16 days. 有一天我覺得想嘔吐。當發燒症狀消退後,鼻塞、喉嚨痛的症狀則持續,僅僅極少數的人感到輕微的喉頭搔癢的乾咳。只有幾個人感到胸口鬱悶感及其他的呼吸道感染徵狀。整個發病期約持續10-16天。 The main issue is that without reporting a cough or trouble breathing many of us were refused testing. I got tested through the Seattle Flu Study. This is a RESEARCH study here in Seattle and they have been testing volunteers for strains of the flu to study transmission within the community. A few weeks ago, they started to test a random subset of samples for COVID-19 infection. They sent my sample to the King County Public Health Department for confirmation; however, I was told that all of the samples that have tested positive in the research study have been confirmed by Public Health. 問題的癥結點在於很多人在沒有咳嗽或呼吸困難的症狀時,都傾向於不需要(或不認為必須)接受武漢肺炎測試。我是透過一個叫做西雅圖流感研究的機構所做的測試。這是一個位於西雅圖的研究機構,它們透過對志願者的檢測,來研究流感病毒類型與社區傳播。幾週前這個機構開始對志願者提供新冠肺炎病毒做隨機抽樣檢測。它們把我的初測到的陽性樣本送到國王郡的公共衛生部門去做感染病毒的確認。隨後我被通知連同我在內所有陽性反應的檢測人,都被確認是感染了新冠肺炎的病毒。 As of Monday March 9th, it has been 13 days since my symptoms started and more than 72 hours since my fever subsided. The King County Public Health Department is recommending you stay isolated for 7 days after the start of symptoms or 72 hours after your fever subsides. I have surpassed both deadlines so I am no longer isolating myself however I am avoiding strenuous activity and large crowds and I obviously will not come near you if I see you in public. I was not hospitalized. Not every country is hospitalizing everyone with a COVID-19 infection and in my case, and in many other cases, I didn’t even go to the doctor because I was recovering on my own and felt it was just a nasty flu strain different from the ones I have been protected from with this season’s flu vaccine. 從最初感到症狀到昨天3/9為止,已經過了13天,發燒症狀消退已經過了72小時(3天)。國王郡的公衛部門建議感染者在有感染的症狀出現後,做至少7天的自我的居家隔離。在發燒症狀消退後的72小時內,也應居家隔離,避免接觸公眾。目前我已經度過了這兩個期限,所以我不再自我居家隔離,於此同時,我還是避免過度參與公眾活動與接觸大批人群。我並沒有住院,也不是所有感染新冠肺炎病毒的人都住進郡立醫院。很多跟我一樣的感染者,並沒有去看醫生,就自我痊癒了。對我們來說,這感覺就像一個比以往流行型感冒稍微嚴重一點的新型流感,與我所接種而受到保護的流感疫苗,略為不同。 I also truly believe the lack of testing is leading to folks believing that they just have a cold or something else going out into public and spreading it. And worse folks with no symptoms are also spreading it as in the case of a person attending a party or social gathering who has no symptoms. 我確信缺乏對新冠病毒檢測的機制是造成多數人相信他們只是感染風寒或一般正在傳播的季節性流感而已。最糟的情況是,很多人在沒有顯現任何症狀的情況下,仍舊正常參加集會活動或正常社交聚會,而將病毒傳播出去。 I know some folks are thinking that this can’t/won’t impact them. I hope it doesn’t but I believe that the overall lack of early and pervasive testing damaged the public’s ability to avoid the illness here in Seattle. All I know is that Seattle has been severely impacted and although I’m better now I would not wish this very uncomfortable illness on anyone. 我知道很多人認為這款病毒不會傳染給他們。我真心希望真的是如此,但是我仍舊相信整體上缺乏早期的發現與預防性檢測,將會嚴重影響到西雅圖地區公眾對新冠肺炎的抵抗能力。 目前已知的情況是西雅圖地區已經有嚴重的疫情,雖然我已經痊癒,但是我真的不希望這樣的病情發生在其他更多人身上。 One thing that I believe may have saved me from getting worse respiratory symptoms is the fact that I consistently took Sudafed, used Afrin nasal spray (3 sprays in each nostril, 3 days at a time and then 3 days off), and used a Neti pot (with purified water). This could have kept my sinuses clear and prevented the symptoms from spreading to my lungs. This is not medical advice: I’m simply sharing what I did and correlating it with the fact that I had no respiratory symptoms. The two could be entirely unrelated based on the viral strain and viral load that I received. 我想我做了一件正確的選擇,讓我呼吸系統感染的症狀不致於變得更嚴重,就是我按時服用 Sudafed (一種藥方販售,不需處方的感冒退燒藥),Afrin 鼻腔噴劑 以及使用清鼻腔咽喉分泌物的Neti Pot 。這些措施保持我的鼻腔咽喉乾淨,從而防堵病毒向下蔓延到我的肺部。我不是在這裡提供醫療建議,只是單純的分享我個人的經驗,因為我並沒有肺部的感染。也許我所做的跟肺部感染並無相關性。而是跟我所感染的病毒特性與病毒感染量有關。 I hope this information helps someone avoid getting sick and/or push to get tested sooner rather than later so you know to isolate before it gets worse or to get medical care if you have respiratory distress. Hand washing doesn’t guarantee you won’t get sick, especially when folks without symptoms are contagious and could be standing right next to you in any given social situation. You more likely than not will not die, but do you want to risk spreading it to a loved one over 60 or someone with an immunity issue? Stay healthy folks! 我希望我所分享的資訊,能幫助大家避免受到感染,或者推動整個公眾檢測系統能更快啟動讓感染者能早期自我隔離,而有呼吸道症候群感染疑慮者,能早期接受治療。洗手並無法完全避免受到感染。尤其那些沒有任何徵兆的帶原傳播者,可能正是你身邊普通社交場合出現的人們。感染病毒後不一定會致死。但是你也不會想不小心傳播病毒給你身邊所關心的年長者,或者有免疫系統功能失調的親友們。大家保重。
    10 人回報2 則回應5 年前
  • mRNA 疫苗的副作用 01、副作用對少數人頗為嚴重 今年夏天,麻省理工學院的盧克·哈奇森(Luke Hutchison)自願參加了默德納的 COVID-19 疫苗臨床試驗。 當他接受了在第二次注射後,他手臂打針的部位立即腫脹到 「鵝蛋」 大小。 他不能確定自己被注射的是疫苗還是安慰劑,但是在幾個小時內,身體健康、只有 43 歲的哈奇森感覺到骨骼和肌肉酸痛,發燒燒到 38.9°C,他感到難以忍受,身體發抖,時冷時熱。他整夜手捧電話,想著是不是要打 911 求助? 哈奇森的症狀在 12 小時後消失。 但他說,沒有人告訴他副作用會如此嚴重,也沒有人幫助他做任何準備。 02、準備好退燒藥 本週,在默德納和輝瑞雙雙發佈了他們的 mRNA 疫苗保護作用高達 95%! 儘管兩個公司都聲稱,他們的疫苗 「沒有嚴重的安全問題」,但像上述哈奇森所經歷的 「嚴重副作用」 還是有可能的。 公眾應該為疫苗可能產生的副作用做好心理準備,並採取必要的預防措施。 「嚴重的副作用」 將是少數,更多的人將會面臨其他 「短暫的副作用」 。 默德納疫苗第一次注射的副作用主要為注射部位反應(2.7%),第二次注射的副作用包括 9.7% 的參與者疲勞,8.9% 的肌肉疼痛,5.2% 的關節痛和 4.5% 的頭痛。 而輝瑞疫苗的副作用包括疲勞(3.8%)和頭痛(2%)。 美國如果安計劃在 12 月底之前為美國 3500 萬人接種疫苗的話,按預期會有2% 接種者出現 39°C 至 40°C 的嚴重發燒,那將是 70萬人。 那麼,打疫苗前,請先去藥店買好退燒藥! 03、mRNA疫苗的副作用比傳統疫苗可能會更大 默德納和輝瑞的疫苗都需要兩劑,中間間隔數周。通常在第二劑後副作用會更高,「副作用」 其實也是疫苗產生的免疫反應。 由於以前人類還沒有正式使用過 mRNA 疫苗,對這類疫苗的長期副作用仍需要時間的檢驗。 我們知道,mRNA 疫苗是將一段人工合成的 mRNA 裝在脂質納米顆粒——微小脂肪氣泡中。 疫苗被注射到肌肉組織後,mRNA 會通過脂質膜融合,進入肌肉組織的細胞,指導冠狀病毒刺突蛋白在人體細胞內的產生。 這種人體細胞產生的冠狀病毒刺突蛋白,與天然新冠病毒的刺突蛋白是一樣的,被人體的免疫細胞識別後,會產生特異性的抗體,能阻止新冠病毒入侵,或殺死病毒,起到保護作用。 mRNA分子通常是極不穩定的,但裝進脂質納米顆粒後,不僅穩定性提高,而且還具備了進人人體細胞的能力。 與大多數流感疫苗相比,mRNA 疫苗的分子特性決定了它的副作用可能會更大。 04、孰輕孰重 mRNA 疫苗的副作用有可能來自 mRNA 分子本身,更大的可能是來自脂質納米顆粒。 實驗證明,不含 mRNA 的脂質納米顆粒在動物中會引起同樣的副作用。 不含 mRNA 的脂質納米顆粒在被注射動物的肌肉中產生炎症介質,這些介質會引起疼痛,發紅,腫脹,發燒,類似流感的症狀。 另一方面,mRNA 分子本身對患有自身免疫性疾病的人可能會有更高的風險。 例如患有紅斑狼瘡的人,其病源是由針對其自身遺傳密碼的抗體引起的,有必要注意 mRNA 疫苗是否會使自身免疫疾病病情惡化。 對於絕大多數人來說,疫苗的副作用是短暫的,這種短暫的反應不應阻止人們面對大流行而接種疫苗。 手臂酸痛、發燒和疲勞是不愉快的,但沒有生命危險。而感染了病毒,對某些人來說,是要命的。 孰輕孰重? 05、熬過一個艱難的夜晚 針對疫苗的副作用,一線公共衛生工作者應該有充分的準備。事實上,所有疫苗都有程度不同的副作用。 以 2017 年獲得 FDA 批准的新型帶狀皰疹疫苗為例,在一項針對 50 歲及以上人群的大型關鍵試驗中,17%的疫苗接種者引起了嚴重的反應,包括注射部位疼痛和肌肉疼痛。 但人們知道,與帶狀皰疹所造成的傷害相比,這點付出是值得的。這種疫苗推出後,需求很大。 可以想象,在大量接種疫苗後,社會上將會有各種各樣的關於副作用的故事。 伊恩·海頓(Ian Haydon)在接受了默德納疫苗第二次注射後十二小時後,感到發冷,並出現 「頭痛,肌肉酸痛,疲勞,惡心」,發燒燒到 39.6°C。他不得不去了急診室,在症狀消失 24 小時後,他還發生了嘔吐並暈倒了。 對海頓來說,那是艱難的一天。 但是,如果與被 COVID-19 感染後住進重症監護室相比,這點副作用是微不足道的。 目前 COVID-19 已經在美國造成了 25 萬人死亡,為了避免家庭傳染,政府號召在即將來臨的感恩節也不要搞家庭團聚。 面對疫苗有可能出現的副作用,每個人都應該咬緊牙關,熬過一個艱難的夜晚。 為換取我們的正常生活,這樣的代價是值得的!  參考文獻:Fever, aches from Pfizer, Moderna jabs aren’t dangerous but may be intense for some By Meredith Wadman 《Science》Nov. 18, 2020.
    4 人回報1 則回應4 年前
  • 以下是張凱銘醫師 2021年5月14日的(經驗分享) 現在已經不是2020年3月了,對於COVID知識,我們了解更多了,很多過去錯誤的做法,都可以調整,有新的東西,也應該嘗試使用,這就是與時俱進。不要害怕病毒,我們可以克服。一年後再發一篇review。(註:本文特別是治療方法寫的很粗淺,以綱要提醒重點為主,裡面講的東西你如果搜尋多半有論文佐證,細節東西還是以有公信力的來源為主,此文非醫療建議) #傳染力: 為什麼COVID-19傳染力驚人?因為無症狀也可以開始傳染,這跟2003年的SARS不一樣,SARS原則上要病人有發燒或咳嗽症狀才會傳染,所以當年很快就可以擋下來,現在的COVID可以沒有症狀也傳染給別人,所以各大出入口體溫篩檢其實不一定很有用。因為可以無症狀感染,所以疫情才會這麼難以控制。COVID原則上出現症狀前兩天到發病後一天內傳染力最強,發病後七天內逐漸減弱傳染力。病人多久還有傳染力確切時間很難告訴你一個數字,但是大致上7-10天後就沒有什麼傳染力了,這也是美國CDC的隔離時間是訂在10天的原因,當然不是說十天後就一定不會傳染,這邊是說傳染力越來越弱,機率越來越低,一個概率的問題,醫學到最後都是統計的問題,極端值先不討論。 #什麼叫確診? 在此次疫情爆發之前,時常看到境外確診者,常常沒有症狀,也許在國外一陣子前染過病,到台灣篩檢陽性,或甚至是隔離14天後期滿然後自主申請檢驗然後被確診,那些人的通性都是CT值很高(>30),抗體早就已經產生陽性,這代表,他們早就被感染了,他們某種程度已經免疫了,PCR測出來的只是死掉的病毒片段被檢驗出來,其實沒有什麼傳染力不用太擔心。CT值代表要複製病毒片段多少次才能被檢驗出來,所以CT值如果很高,代表病毒片段實在是太少了,要一直複製到30次以上才有辦法被檢驗出來,有個小篇的NEJM韓國研究指出CT值在28.4以上病毒培養都培養不出來,所以CT>30其實根本不用擔心。這種沒有什麼臨床意義的病例,是否有需要每個人都送去負壓病房隔離,我認為是很需要商榷的,我很難想像這些人既沒有症狀,也沒有傳染力,到底是要住院做什麼治療?如果疫情不嚴重就算了,但國內疫情持續升溫,這可能占用醫療資源讓有需要的人無法住進醫院,那問題就大了。現在已經是2021年五月了,早已不是2019年12月或2020年一月,COVID已經不是神秘的病毒了,我認為需要用科學方法對待隔離這件事。然而此次境內社區感染,很多都是有症狀且CT值低(10-20幾),這些人就是剛被感染,這些才是真正有意義的確診者,這些是最要小心的族群。 #檢驗: PCR是1980年代就發展出來的一種檢驗技術,這不是什麼酷炫的科技也不是昂貴的檢查,任何一個檢驗,結果是死的,判斷是活的,如果有偽陽性或偽陰性問題,都可以再重複檢查。臨床判斷不能忽略。如果覺得重複檢驗費太貴,那問題應該是為什麼此項檢查會這麼貴,而不是懷疑其檢驗的必要。COVID都可以無症狀,如果懷疑COVID,不要用猜的,要用驗的。 #Variant (變異病毒): COVID病毒跟其他常見流感病毒一樣,越多人被感染,病毒一直複製,外膜就容易產生片段的變異,所以本質還是同一個病毒,因此我不喜歡用變種病毒這個名稱,我比較喜歡講變異。不管是英國或南非病毒,他們並不會使感染後的病人變嚴重,但是變異病毒的傳染力確實比較強,也可能讓疫苗效果比較不好,但是目前看來疫苗對英國變異病毒還是有效的。我認為未來的世界可能會需要每年都打COVID疫苗,就像流感每年都會變,每年都該打流感疫苗,任何人終究都需要打COVID疫苗,在這地球村就是不可能不打,除非你永遠關起來不要跟外界的人接觸。阻止病毒繼續傳播的最好方式就是疫苗。如果可以,我希望全世界70億人現在都注射好疫苗,一兩個月後COVID大流行就會終結。為什麼COVID一直流行,就是因為全世界疫苗施打太緩慢,太多人猶豫不決。越慢打疫苗,病毒一直在複製,一直複製的結果就是又產生變異,到時候疫苗又漸漸失去效果,大流行又要重來一輪。 #疫苗: 現在全世界有四家有效的疫苗:Pfizer和Moderna是mRNA疫苗,AZ和JNJ是腺病毒載體疫苗。這四種都非常有效,重症死亡率保護都非常的好。疫苗最重要的是防止死亡,不是打了就一定不會被感染。實際上COVID大部分的人被感染了只有輕度或無症狀,但是有些有危險因子的人(COVID特別喜歡攻擊老年人,肥胖,糖尿病者)可能產生嚴重肺部纖維化而至死亡。如果今天全世界的人都打滿疫苗,有些人也許還是會有感染或輕微症狀,但是到時候就不會有人擔心,因為跟感冒一樣,沒什麼大不了的!今天還在擔心那些輕微副作用(發燒、疲憊、肌肉痠痛這些真的是無關緊要1-3天就會消失的副作用),那你就失去了大局觀。99.99%的人都沒有出現嚴重副作用,甚至在國外都有過敏案例用漸加劑量還是把第二劑疫苗打齊的記載。打疫苗很多人當然會有不舒服反應,但是這些是可以接受的,因為打疫苗本來就不是要打舒服的,打了針會不會舒服一直都不是打疫苗的考量點,就跟你終究要買歐洲車,你這輩子終究是要打COVID疫苗的,早打就早有保護力,就不會一直擔心會不會被感染。我認為能早點打疫苗就是好事,任何上述四種疫苗都非常的好,真的不需要挑,沒有打就是沒有防護力,與其思考70-95%的差距,不如想0-70%的差距,沒有打疫苗病毒可以長驅直入,有疫苗你平常沒有太多病史或免疫問題,你要死於COVID的機率會非常非常的低。打疫苗不是大學聯考,去計較一兩分的差距,每個疫苗臨床試驗的基準點都不一樣,沒辦法拿純數字去比較。美國人做事慢,非常沒有效率,有在美國生活過一定知道這點,然而美國疫苗是在FDA星期五通過,星期一就開打,這點就非常有效率。看到很多人因為疫情爆發終於願意趕快打疫苗了,這也算好事,雖然在過去兩三個月早就可以做的事,真的是有點可惜。我真的很希望疫苗覆蓋率可以再高一點。 #疫苗副作用: 常見副作用就不說了,發燒疲憊肌肉痠痛等,這些不應該是你不打疫苗的理由。有些人可能淋巴腫大但是不嚴重且看運氣。立即過敏反應極度罕見。現在要談談血栓。AZ或JNJ腺病毒載體疫苗有一個非常罕見(約十萬到百萬分之一)但可以是嚴重的副作用就是血栓問題。這邊的血栓並非腿部因久不動而產生的靜脈栓塞(DVT)或肺栓塞(PE),而是會產生類似Heparin-induced thrombocytopenia (HIT)的原理,身體產生platelet factor 4 (PF4)抗體跟heparin結合消耗血小板導致的血栓問題,然而這些人都沒有接觸過heparin類藥物,所以因為疫苗導致的血栓病有一個新的病名叫做Vaccine-induced immune thrombotic thrombocytopenia (VITT),這比較類似自體免疫反應,常發生在年輕女性,過去可能沒有什麼明顯病史或血栓問題,在打了AZ或JNJ疫苗,一般在兩個禮拜左右發作(時間相對短,長一點可能一個月),血栓產生部位有可能是在splenic vein or cavernous venous sinus,所以病人也許會有肚子痛、頭部腦神經異常,動眼神經異常,視力異常,等問題。如果是腦內血栓影像診斷甚至要靠Magnetic Resonance Venography (MRV),血液檢查要驗HIT panel (PF4 or serotonin release assay)。相信很多台灣醫師可能根本沒有驗過HIT,因為東方人血栓問題不大,這對我們來說也是好事所以更加肯定疫苗風險是很低的。臨床醫師警覺性要很高。疫苗副作用通報系統要很完善才行。治療方式不可以用傳統heparin類的抗凝血劑,enoxaparin這些常見的都不行。可以使用argatroban,fondaparinux,或DOAC (apixaban, rivoraxaban)這類。還可以用IVIG治療。所幸國外的案例多半治療後無大礙。 #COVID的治療,現在有什麼? - 剛確診沒多久,最好前48小時內,如果屬於高危險族群(病人本身身體比較差者),打單株抗體(monoclonal antibody)效果最好,可以預防病情的進展,在美國有很多infusion center,或有些急診也可以打,抗體趕快中和病毒。美國現在有Regeneron藥廠的Casirivimab/imdevimab跟Bamlanivimab/etesevimab。 - Hydroxycholoroquine奎寧在2020年三月美國疫情剛爆發甚至世界各地都很常用,多個研究出來結果就是沒有用,希望以後不會有人再提這個了 - 慎用抗生素:在2020年三月幾乎每個人因為COVID住院都會給azithromycin等抗生素,因為臨床上病毒性肺炎跟細菌性肺炎都很類似。但是發現COVID剛發病很少有細菌感染,如果病人只是乾咳,沒有痰,CXR或CT很典型就是bilateral GGO沒有局部consolidation(局部細菌肺炎感染),其實可以不用上抗生素。一般細菌性感染多半發生在ICU病患、插管者、住院住兩三個禮拜以上者,這些再好好考慮。不應該每個人得到COVID就給抗生素。 - Remdesivir IV for 5 days(200mg*1 day, then 100mg*4 days)在美國算最常用的抗病毒藥物,如果有氧氣需求患者一般都會給,注意肝指數可能升高需要檢測,攜帶remdesivir的cyclodextrin需要靠腎臟清除所以如果eGFR<30可能不能使用,但是洗腎可以清除所以洗腎患者又可以使用 - Dexamethsone 6mg IV or PO for 10 days: nejm上大名鼎鼎的recovery trial顯示,對於重症患者(需氧或插管者)有助於降低死亡率,特別是插管者幫助最大,因為可以避免免疫風暴過度激化導致急性呼吸窘迫症(ARDS),如果病人不需要氧氣輕症患者,給dexamethasone是無用的,請勿濫用類固醇。 - 氧氣目標不一定要100%,如果病人沒有特別覺得喘,SpO2維持在92-96%左右其實也可以。跟2021年3月做法不一樣的事,避免早期插管!插管可以避免最好,一旦插管就很難拔管,俯臥(肚子貼地臉朝下)prone position對於血氧維持還是非常有效,high flow nasal cannula (HFNC)高速鼻氧氣管對於維持血氧也很有效,這些都可以避免走入插管這一途。 - Tocilizumab: 2020年3月很多人用,後來研究說沒有用,最近又捲土重來越來越多研究看似有用。Toci(這樣簡稱才不會念太長)是IL-6 inhibitor,可以抑制免疫反應也是想避免走入cytokine storm,先前研究結果會失敗可能跟使用時機最有關,因為不是每個病人都可以給,而是建議在氧氣需求量一直增加,已經到只用HFNC或BiPAP這種階段隨時要被插管這種階段可能會比較有用,而且至少給過類固醇(上述的dexamethasone)24小時還是一直惡化再給。 - 小心菌血症甚至黴菌感染:這些是指ICU重症患者,他們可能產生MRSA or MSSA bacteremia, Candidemia等,如果住院有發燒,該做的blood culture還是不能少。甚至有些病人肺部產生mucormycosis or Aspergillosis的關聯性世界各國有越來越多的paper報導 (我也有一篇相關論文)。 後記:算是一年後的一篇心得文章,在美國紐約2020年3月我們走過最可怕的多次融斷潮,紐約當時宛如空城,時代廣場空無一人,空氣中彷彿都有高濃度的病毒,ICU要擴張三倍,整間醫院只有COVID病人相比,現在怎麼樣台灣情況都好得多,而且現在有疫苗,有更多對病毒的認識,少了很多未知,我們現在更多知道什麼藥物有用,什麼沒有用,可以少走很多冤枉路。我對台灣人高水準的國民素質很有信心,多半人都很願意戴口罩也配合,疫情肯定不會太差。冷靜準備,有疫苗趕快打。看著歐美在疫苗施打後疫情逐漸散去,台灣也不可能永遠用高壓圍籬,非常”old school”的”2020年”防疫方式一直下去,最有效控制疫情還是要靠疫苗,希望全球大流行可以趕快結束。
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