{"articleList":{"__iterable":"Map","data":[["state",{"__iterable":"Map","data":[["isLoading",false]]}],["edges",null],["firstCursor",null],["lastCursor",null],["totalCount",null],["authFields",{"__iterable":"Map","data":[]}],["stats",{"__iterable":"Map","data":[["repliedCount",0],["notRepliedCount",0]]}]]},"replyList":{"__iterable":"Map","data":[["state",{"__iterable":"Map","data":[["isLoading",true]]}],["edges",null],["firstCursor",null],["lastCursor",null],["totalCount",null]]},"articleDetail":{"__iterable":"Map","data":[["state",{"__iterable":"Map","data":[["isLoading",false],["isAuthLoading",false],["isReplyLoading",false]]}],["data",{"__iterable":"Map","data":[["article",{"__iterable":"Map","data":[["replyCount",0],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",4],["user",{"__iterable":"Map","data":[["id","PbpLS_NNY10PtIuCrYbsQOHYeaSNgeJWF0vVr0Kj6r870D-BQ"],["name","Cofacts 批次上傳"],["avatarUrl","https://www.gravatar.com/avatar/25712bb1397b458d03f656fefbfd14eb?s=100&d=identicon&r=g"],["level",0]]}],["hyperlinks",null],["text","讓世衛來告訴你接種疫苗的好處\n五月\n95%有效率\n70%有效率\n六月\n七月\n八月\n九月\n十月\n十一月\n十二月\n50%有效率\n沒有保護性,但會減少\n傳播\n不能減少傳播,但會減\n低徵狀嚴重性\n不會減低嚴重性,但會\n減少入院數字\n不會減少入院數字,但\n你不會死\n你會死,但你會上天堂\n"],["replyRequests",{"__iterable":"List","data":[{"__iterable":"Map","data":[["id","f_4eAD_wHAA-AD_wHAA__gmAPf4N8C_wHf494D-yGAA__PbpLS_NNY10PtIuCrYbsQOHYeaSNgeJWF0vVr0Kj6r870D-BQ-0__BATCH"],["reason",""],["positiveFeedbackCount",0],["negativeFeedbackCount",0]]},{"__iterable":"Map","data":[["id","f_4eAD_wHAA-AD_wHAA__gmAPf4N8C_wHf494D-yGAA__PbpLS_NNY10PtIuCrYbsQOHYeaSNgeJWF0vVr0Kj6r870D-BQ-1__BATCH"],["reason",""],["positiveFeedbackCount",0],["negativeFeedbackCount",0]]},{"__iterable":"Map","data":[["id","f_4eAD_wHAA-AD_wHAA__gmAPf4N8C_wHf494D-yGAA__PbpLS_NNY10PtIuCrYbsQOHYeaSNgeJWF0vVr0Kj6r870D-BQ-2__BATCH"],["reason",""],["positiveFeedbackCount",0],["negativeFeedbackCount",0]]},{"__iterable":"Map","data":[["id","f_4eAD_wHAA-AD_wHAA__gmAPf4N8C_wHf494D-yGAA__PbpLS_NNY10PtIuCrYbsQOHYeaSNgeJWF0vVr0Kj6r870D-BQ-3__BATCH"],["reason",""],["positiveFeedbackCount",0],["negativeFeedbackCount",0]]}]}],["id","f_4eAD_wHAA-AD_wHAA__gmAPf4N8C_wHf494D-yGAA"],["createdAt","2022-01-24T01:55:54.209Z"]]}],["replyConnections",{"__iterable":"List","data":[]}],["relatedArticles",{"__iterable":"List","data":[{"__iterable":"Map","data":[["replyCount",1],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",10],["user",{"__iterable":"Map","data":[["id","j4S8C_radM0R0lg3ej61cFs2ShTKmTlJUjaHe8l2AYO2rsEyE"],["name","寬厚的新市韋恩"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","非常非常重要！\n\n COVID-19\n\n去年我們近乎兒子或侄子的年青胸腔專科大夫被醫院調去Dallas專治Covid病人一年。以下是他剛回家的報導\n\n去年在美國醫院擔任加護病房，一般病房和診所醫師。加起來大概看了近1000多個新冠病毒的病人。\n\n回想我不知這段時間如何撐過來的。生理疲憊可以復原，但是內心煎熬常揮之不去。我看到許多病人被病痛折磨。生離死別家人卻不能在身邊，因為隔離。其中我醫學啟蒙導師因爲新冠肺炎，過世。\n\n現在台灣的疫情讓我非常憂心。在此跟台灣的朋友和家人提醒跟分享我們一路走來的經驗。\n\n新冠肺炎對身體的影響\n\n- 新冠病毒是非常複雜和難治的病毒。有些人完全沒有症狀，但是有些人喪命。沒有辦法預測和判斷。至今我們不知為何有些人沒事，但是有些人的症狀很嚴重。\n\n- 一般大眾認識的新冠病毒是肺部感染。新冠病毒破壞肺部組織。剛開始肺充滿水，因為強烈免疫系統對抗病毒的反應。然後肺慢慢纖維化。部分病人因為嚴重的纖維化，造成氣胸。\n\n這些過程不可逆，所以很多即使從新冠肺炎康復的病人一輩子活在缺氧和呼吸困難(病人形容跟溺水的感覺一樣)。他們需要長期大量的氧氣治療。有些病人形容生不如死。如此大量的氧氣只有醫院和照顧中心可提供，所以一部分康復的病人至今無法回家。必須在醫院或長期照顧中心。還有一部分人需要氣切，靠呼吸器維生。\n\n一些年青人即使新冠病毒康復，但是他們的肺已受損(根據他們的肺臟功能測試)。現在他們或許不覺得有症狀，但是他們50或60歲的時候，他們的呼吸症狀就出現。\n \n- 新冠病毒常引起血栓。血栓的位置不僅在肺，任何一部分都可能發生。這是為何新冠病毒的病人發生心臟病和中風。即使用抗凝血劑無法完全避免，甚至造成出血的副作用。這些無數小的血栓在肺部造成更進一步地缺氧。\n\n- 新冠病毒對腎臟有很大的損害。至今沒有一個好的醫學解釋。這造成腎功能下降，身體鹽分過高。一部分的人需要洗腎。\n\n- 新冠病毒還有對其他器官造成嚴重的影響。至今沒有好的科學解釋，例如很多人的腦功能受到嚴重影響。我們需要更多的臨床研究\n\n可能的對新冠病毒治療\n\n- 雖然過去這一年研究各種新冠病毒的治療法包含Remdesivir, IL-6 antagonist Actemra, IVIG, convalescent plasma, monoclonal antibody , etc…但是真正有用的藥或許只有類固醇。以上的藥很多被W H O認證沒有很有效。通常這些藥只對初期病發的病人有效。最有效的方式還是預防。\n\n- 目前沒有有效的治療方法。預防，預防，再預防，是唯一的方法。\n\n 建議採取的方法\n\n- 新冠病毒的傳播速度非常快，如野火燎原。若不早點撲滅，馬上會來不及。應該用盡所有資源阻止病毒傳播 (台灣已錯失先機，所以不在這細談)\n\n- 大量篩檢，提早知道感染，提早隔離，避免傳下一個人。美國深深受到這個教訓。當初沒有大量篩檢或普篩造成社區感染一發不可收拾。美國30,000,000病例和500,000犧牲生命，這是最主要原因。\n\n- 社交距離和口罩是美國降低感染率和死亡率的主因。疫苗發展之前- 遠端上課，上班 (這對台灣社會非常大的影響，畢竟台灣產業結構跟美國不一樣，但是我建議能遠端上課或上班，能做的盡量做)\n \n- 小孩及年青人雖然對新冠病毒的影響不會太大(很多是無症狀患者)，但是他們可以傳病毒給長者。美國當初用正確方法，強調年青人不回去看望他們祖父母。顧慮把病毒傳染給老人們。這就是在家上課和上班的重要性。減少傳遞病毒。通常美國很少三代同堂。實行起來比台灣容易。\n\n- 疫苗，疫苗，還是疫苗，科學發現以色列跟美國即使疫苗接種只有15 -20%，新冠病毒的病例大量下降。一般科學需要70 %的接種才有如此效果。這值得進一步研究。這是非常好的消息，代表只要我們馬上開始接受疫苗，不久將來新冠病毒的病例就會在台灣減低。\n\n現在美國疫情轉好，生活慢慢恢復正常。有時午夜夢回的時候，我夢到跟病人一樣躺在病床呼吸不過來。希望台灣醫護人員不用經歷到我的經驗。\n\n希望以上資訊可以幫助我台灣的同胞，朋友和家人。一起努力對抗新冠病毒，期待光明的明天。\n\n以上我簡短的經驗報告，還有非常多的資訊和經驗沒有提到。應家父要求，我匆匆寫此文。有機會再寫詳細的一篇。\n\n敬請原諒錯別字和不流利的中文。\n\nLeon Tung"],["id","31n3fon914j71"],["createdAt","2021-05-26T06:54:08.758Z"]]},{"__iterable":"Map","data":[["replyCount",1],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",38],["user",{"__iterable":"Map","data":[["id","j4S8C_3WKC9KPW2pJr1iEx-vaIYoQJJ8rLGCy5PGYhlQQT44o"],["name","辦事仔細的✿杉林✿拜爾德"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","COVID-19\n過去這一年在美國醫院擔任加護病房，一般病房，和診所醫師。種種加一起大概也看了將近1000多個新冠病毒的病人。回想起來，我不知道這段時間是如何撐過來的。生理的疲憊可以復原，但是內心的煎熬常常揮之不去。我看到許多病人被病痛折磨，生離死別家人卻不能在身邊因為隔離的因素。其中一個我醫學啟蒙導師，也過世於新冠肺炎。現在台灣的疫情讓我非常憂心。在此跟台灣的朋友和家人提醒跟分享我們一路走來的經驗。\n\n新冠肺炎對身體的影響\n- 新冠病毒是一種非常複雜和難治療的病毒。有些人完全沒有症狀，但有些人失去生命。沒有辦法去預測和判斷。至今我們也不知道為什麼有些人沒事但有些人有很嚴重的症狀。\n- 一般大眾對新冠病毒的認知是肺部感染。新冠病毒會破壞肺部組織。剛開始的時候肺部充滿水分因為強烈免疫系統對抗病毒的反應，然後肺部會慢慢纖維化。部分的病人會因為嚴重的纖維化造成氣胸，這些過程是不可逆的。所以很多即使從新冠肺炎康復的病人一輩子都生活在缺氧和呼吸困難的狀況(病人形容跟溺水的感覺一樣），需要長期大量的氧氣治療。有些病人形容生不如死。如此大量的氧氣，只有醫院和照顧中心可提供。所以有一部分康復的病人，至今無法回家，必須要在醫院或長期照顧中心。還有一部分人需要氣切，靠呼吸器維生。一些年輕人即使從新冠病毒康復但是他們的肺臟已受損（根據他們的肺臟功能測試）。現在他們或許不覺得有症狀。但是到他們50或60歲以上的年紀，他們的呼吸症狀就會出現。 \n- 新冠病毒常常引起血栓。血栓的位置不僅與肺部，身體的任何一部分都可能發生。這就是為什麼新冠病毒的病人會有心臟病和中風的原因。即使使用抗凝血劑也無法完全避免，甚至造成身體出血的副作用。這些無數的小的血拴在肺部造成更進一步地缺氧。\n- 新冠病毒對腎臟有很大的損害。至今沒有一個好的醫學解釋。他會造成你腎功能下降，身體鹽分過高。一部分的人需要洗腎。\n- 新冠病毒還有對其他器官造成嚴重的影響。至今沒有一個好的科學解釋，例如很多人的腦功能受到嚴重影響。我們需要更多的臨床研究\n\n可能的對新冠病毒治療\n- 雖然過去這一年，人類去研究各種新冠病毒的治療方法包含Remdesivir, IL-6 antagonist Actemra, IVIG, convalescent plasma, monoclonal antibody , etc….. 但是真正有用的藥, 或許只有類固醇。以上的藥有很多被W H O認證沒有很有效。通常這些藥只對初期病發的病人有效。最有效的方式還是預防。\n- 目前沒有有效的治療方法。預防，預防，再預防，是唯一的方法。\n\n建議採取的方法\n- 新冠病毒的傳播速度非常快，如野火燎原，不早點撲滅的話，就馬上會來不及。應該用盡所有資源阻止病毒傳播（台灣已錯失先機，所以不在這細談）\n- 大量篩檢，提早知道感染，提早隔離，避免傳給下一個人。美國深深受到這個教訓。當初沒有大量篩檢或是普篩，造成社區感染一發不可收拾。美國有30,000,000病例和500,000犧牲生命，這是最主要原因。\n- 社交距離和口罩是讓美國感染率和死亡率降低的主要原因，在疫苗發展之前。\n- 遠端上課，上班（這對台灣社會非常大的影響，畢竟台灣產業結構跟美國不一樣，但是我會建議能遠端上課或上班，能做的盡量做） \n- 小孩及年輕人雖然對新冠病毒的影響不會太大。很多是無症狀患者。但是他們依然可以傳遞病毒給長者。美國當初使用正確方法，強調年輕人不要回去看他們的祖父母，怕會把病毒傳染給他們。這就是在家上課和上班的重要性。減少傳遞病毒。（通常在美國，很少三代同堂。實行起來比台灣容易）\n- 疫苗，疫苗，還是疫苗，科學上發現一個現象，在以色列跟美國，即使疫苗接種只有15 -20%，新冠病毒的病例大量下降，一般科學上需要70 %的接種才有如此效果。這值得我們進一步研究。這是非常好的消息，代表說只要我們馬上開始接受疫苗，不久將來新冠病毒的病例就會在台灣減低。\n\n現在美國疫情轉好，生活也慢慢恢復正常了。但是有時午夜夢回的時候，我夢到自己跟病人一樣躺在病床上呼吸不過來，從夢中驚醒過來。希望台灣醫護人員，不用經歷到我的經驗。\n\n希望以上資訊可以幫助我台灣的同胞，朋友，和家人。一起努力對抗新冠病毒，期待光明的明天。\n\n\n以上是我的簡短經驗報告，還有非常多的資訊和經驗沒有在此提到。應家父的要求，我匆匆寫了此文。有機會再另外寫詳細的一篇。敬請原諒錯別字和不流利的中文。\n\n\nLeon Tung "],["id","11ces4fac3u0y"],["createdAt","2021-05-19T10:38:56.342Z"]]},{"__iterable":"Map","data":[["replyCount",1],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",34],["user",{"__iterable":"Map","data":[["id","j4S8C_RbLZGXqaz3tzNLpVzDq90lcUKHvPVYIJSmpo-Ml6BeY"],["name","興趣廣泛的林口托比"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","如果想打疫苗的參考一下\n\n\n國際四大醫學期刊之一的《新英格蘭醫學雜誌》（The New England Journal of Medicine）整理了關於疫苗的Q&A，讀者可以參考後，與自己的醫師根據自身狀況討論，再決定是否要/是否可以施打疫苗。\n\n首先要知道，目前市面上可以施打的疫苗大致上可以分成兩個種類，mRNA疫苗跟腺病毒載體疫苗。\n\n輝瑞/BioNtech與莫德納疫苗屬於mRNA疫苗，注射後，mRNA被注射部位的巨噬細胞吸收，並指示這些細胞製造棘蛋白，棘蛋白就會出現在巨噬細胞表面，誘導身體起免疫反應。\n\nAZ疫苗跟嬌生疫苗則屬於腺病毒載體疫苗，是由實驗室中提取新冠病毒的DNA序列，讓其穩定後由腺病毒攜帶，注射疫苗後，腺病毒無法複製，但其遺傳物質可以進入宿主細胞轉換成mRNA，製造出棘蛋白抗原，引起宿主反應，過程模擬Covid-19的自然感染機制，抗體跟細胞免疫都會被誘發。\n\nQ: 疫苗能持續多久？需要補打嗎？\n由於疫苗測試從2020年夏天才開始，疫苗保護力可以持續多久尚沒有明確的資訊。\n\n以莫德納疫苗的第一期試驗為例，試驗結果表明抗體大約能持續四個月左右，滴度會隨時間過去輕微下降。（注射時間愈長，免疫效果愈弱）由於尚未確定疫苗可持續的時間，目前不建議增加劑量或補打。不過各大藥廠的確正在研發加強劑量的疫苗，以及針對變種病毒進行防護的疫苗。\n\nQ: 接種了疫苗，就不會把病毒傳給別人了嗎？\n新興證據表明，已接種疫苗者「較不容易」把病毒傳染給別人。\n\n在以色列進行的大型研究中發現，已接種者無症狀感染病毒的機率比未接種者減少了90%。此外，在接種疫苗後仍被感染的人群中，病毒量似乎也比未接種者來得低。嬌生疫苗的研究發現接種後第29天，接種疫苗組出現18例無症狀感染，而安慰劑組則是50例，也就是疫苗組少了66%。\n\n可以合理假設，無症狀感染數少，病毒傳播的機率就會降低（無症狀者會到處跑，所以傳播機率高）。這讓人看到疫苗抵禦病毒感染跟減少傳播的希望，而疫苗政策背後的動機，也多是為了控制傳染數。\n\n即使疫苗降低了病毒傳播的可能性，我們不能說「打了疫苗就不會傳給別人」，因為保護效果永遠不會達到100%。\n\n因此，在新病例減少，而且大部分人都接種疫苗以前，政府單位有責任繼續向大眾強調，接種了疫苗不代表其他的防護措施就不需要了，在公共室內空間仍應繼續戴口罩，保持社交距離、不去人多的地方仍是重要且必須遵循的政策。\n\nQ: 疫苗真的安全嗎？過了幾年會不會有後遺症啊？\n無奈的是，由於疫苗發展進行時間很短，目前只有幾個月的時間研究後續，而不是好幾年。\n\n輝瑞跟莫德納的疫苗試驗都是從2020年夏天開始，嬌生則是2020年9月才開始。不過以過往其他病毒的疫苗為例，嚴重的不良反應通常會在幾天或幾週內就發生。\n\n幸運地是，根據長期研究的結果，目前世界上大部分疾病的疫苗長期副作用非常少見，當然新冠疫苗的長期副作用要等到數年後才能確定。接種疫苗後病人的資訊都會被蒐集並集中分析。\n\nQ: 針對不同族群，是否有建議施打的疫苗品牌？\n目前輝瑞疫苗可以讓16歲以上人群施打，而AZ、莫德納和嬌生則是18歲以上人群才能施打。\n\n一開始疫苗很少的時候，醫界呼籲所有成人都可以施打各牌疫苗，不過現在已經開始有比較明確的建議，尤其是AZ和嬌生疫苗施打者，都有部分被誘發血栓性血小板減少症（TTS）的症狀，尤其年輕女性出現此狀況的機率特別高，因此臨床醫師建議50歲以下的女性最好使用輝瑞或莫德納等mRNA疫苗。\n\n而對於施打mRNA疫苗者，一旦施打了第一劑，就應該按照醫生給予的第二劑預約時間施打「相同品牌」的第二劑疫苗。現在完全沒有關於第一劑和第二劑使用不同廠牌疫苗的安全報告。\n\n不過CDC表示若真的無法獲得第一劑使用的廠牌時，只要與第一劑施打時間間隔28天以上，就可以使用不同廠牌的mRNA疫苗。雖然仍應該「盡可能」不要使用不同廠牌的疫苗，但如果同是mRNA疫苗「理論上」是可行的。而對第一劑mRNA疫苗有嚴重過敏反應者，CDC建議在醫生監控下給予嬌生疫苗進行第二劑施打。\n\n\n\nQ: 打疫苗有禁忌嗎？\n目前施打Covid-19疫苗唯一的禁忌，是已經知道自己對疫苗成分有超敏反應的人不能打。CDC明確指出禁打疫苗的族群如下：\n\n先前施打Covid-19疫苗或曾服用任何疫苗成分後，出現嚴重過敏反應者\n先前施打Covid-19疫苗時，出現立即性的過敏反應（不管嚴重程度），或對任何疫苗成分有過敏史者\n對任何其他疫苗/注射療法曾有過過敏史者，則不在禁打疫苗之列，但有過敏史者應該由醫療人員在施打Covid-19疫苗後密切觀察至少30分鐘。如果有人在施打第一劑mRNA疫苗後出現嚴重過敏反應，則不應該再施打第二劑mRNA疫苗。不過，建議四週後可以在嚴密監控下施打嬌生疫苗。\n\n而如果在施打第一劑mRNA疫苗後，出現嚴重疼痛，或其他非過敏性症狀，則必須自己決定是否要施打第二劑。醫生不會禁止，但第二劑的副作用可能會更嚴重。（不過要注意，曾經感染Covid-19的人通常會回報第一劑的副作用比第二劑更嚴重，這很可能是因為他們的免疫系統已經準備好要對付Covid-19疫苗）。\n\n如果擔心第二劑疫苗的副作用很嚴重，一種解決方法是在施打完第二劑，疼痛開始發作時就馬上服用布洛芬（ibuprofen）或醋氨酚（acetaminophen）等止痛藥。不過不建議在施打疫苗前就進行投藥，因為理論上它們會減弱疫苗引發的抗體反應，讓產生抗體的效果變差。\n\n用於治療Covid-19的單克隆抗體（monoclonal antibodies）或恢復期血漿（convalescent plasma）可能會降低疫苗的效用。任何曾經接受這些療法的人必須至少等90天以上再進行疫苗施打，考慮到這段時間這些療法會進入半衰期，而已得過Covid-19的人三個月內再度被感染的機率也極低。這一建議已被加到CDC指南的臨床考量中。\n\nQ: 孕婦或哺乳婦女可以施打疫苗嗎？\n孕婦和哺乳者出於安全考量都沒有被包含在Covid-19疫苗試驗中，因此沒有相關的安全數據。然而CDC建議醫療系統可以提供孕婦和哺乳者施打疫苗的機會，而這兩個群體可以自己決定是否要施打。美國婦產科醫學會（American College of Obstetricians and Gynecologist）和母嬰醫學會（Society for Maternal-Fetal Medicine）都同意這個觀點，而這兩個學會都是婦產科界的權威。目前輝瑞針對孕婦研發的疫苗已經在試驗階段。\n\n而嬌生在疫苗試驗階段同樣排除了孕婦、哺乳婦女，以及近期有懷孕計畫的婦女。在研究過程中，有8名婦女懷孕，疫苗組跟安慰劑組各4名，兩組都有出現少數妊娠不良反應，但是樣本實在太少，很難說是由於疫苗或研究引起的。\n\n不過由於年輕婦女較可能出現血栓反應，而且懷孕期間發生血栓的機率本來就很高，歐美醫界目前偏向給予懷孕跟哺乳婦女mRNA疫苗，而非AZ或嬌生疫苗。\n\n理論上，mRNA疫苗不會對懷孕婦女、發展中的胎兒或者哺乳中的嬰兒造成傷害。\n\n懷孕的大鼠在接受莫德納疫苗後，也沒有出現與胎兒或胚胎發育有關的隱憂。而懷孕期間接種疫苗的一項潛在好處，是抗體可以經由胎盤傳給胎兒，這也是建議孕婦可以接種百日咳疫苗的主因，最新的病例也表明Covid-19抗體確實可以透過胎盤傳給肚子裡的胎兒，理論上也能保護新生兒免於被感染。\n\n孕婦必須知道懷孕期間感染Covid-19或流感，重症的機率特別高。孕婦可以根據這項事實，自己感染Covid-19的機率（例如工作性質），以及目前已知的疫苗風險（雖然資料很少）自己判斷是否想要接種。不過，接種疫苗仍應是孕婦的選項之一，畢竟過去也未曾限制孕婦施打流感疫苗，孕婦應該跟婦產科醫師充分討論所有有關問題與疑慮再下決定。\n\nQ: 如果我已經出現相關症狀，或病得很重，還可以接種疫苗嗎？\n如果你已經出現Covid-19相關症狀，或病得很重，則不能接種疫苗，需要推遲到康復以後再進行接種。不管懷疑是Covid-19感染，或者跟Covid-19無關，只要有疾病症狀，都最好先不要接種。不過，患有慢性病且症狀穩定的人則可以接種。例如患有慢性阻塞性肺病（COPD）、長期呼吸困難或發炎性腸道疾病（IBD），以及有腸胃道症狀的人，是可以施打Covid-19疫苗的。當然，在施打疫苗之前必須跟醫師進一步討論可能的疑慮。\n\nQ: 我很害怕疫苗的副作用，怎麼辦？\n止痛藥跟退燒藥，例如布洛芬跟醋氨酚可以有效控制疫苗接種後的副作用，包括注射部位疼痛、肌肉痛跟發燒等。\n\n但是這些藥物建議在注射結束後出現症狀時再使用，不要在注射前「預防性投藥」，以免使抗體效果下降。由於仍有少數的過敏風險，疫苗施打的場所必須嚴格注意並有辦法評估及治療可能造成生命威脅的過敏反應。\n\nQ: 我曾經跟確診人士近距離接觸，趕快打疫苗可以避免感染嗎？\n很遺憾，目前沒有任何證據表明與確診個案接觸的人，緊急接種疫苗可以預防感染。由於Covid-19的平均潛伏期為5天，疫苗反應速度不太可能快到可以產生抗體。因此，曾經接觸過確診個案的人，應該好好完成14天的隔離，再施打疫苗。\n\nQ: 我已經得過Covid-19又康復了，還需要打疫苗嗎？\n是的，你還是應該接種疫苗。臨床試驗中有一部分人已經有Covid-19的抗體，而疫苗試驗在這群人當中是安全有效的。\n\n由於得到Covid-19再康復後，90天內再次被感染的機率非常低，有些Covid-19康復者可能希望推遲施打疫苗的時間，不過就算你希望可以早點打，這也不是禁止的。不過曾經接受單克隆抗體或恢復期血漿治療的患者則一定要等90天以上才能施打疫苗，因為這些治療方式可能會讓疫苗失效。\n\n須注意的是，曾經得過Covid-19的康復者，在施打第一劑疫苗時，可能伴隨更明顯的全身性副作用，因為身體的免疫系統對此病毒並不陌生。這也表明曾經得過Covid-19的患者自身的免疫抗體是「主要的」，而疫苗則是「增強用」，因此有些學者認為曾得過Covid-19的康復者不需注射第二劑疫苗，但並非所有免疫學家都認同。目前，CDC仍然建議兩劑疫苗都要施打。\n\n對於要不要打疫苗這件事，只能說避免大規模傳染需要一定人口接種，但由於疫苗上市後後續研究時間還不長，每個人應該根據本身的風險與身體因素，與醫師充分討論後再決定是否施打。\n奧\n（參考資料：The New England Journal of 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Protocols | FLCCC | Front Line COVID-19 Critical Care Alliance"],["url","https://covid19criticalcare.com/covid-19-protocols/"],["summary","The MATH+ Hospital Treatment Protocol for Covid-19 is a physiologic-based combination treatment regimen created by leaders in critical care medicine."],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","http://ivmmeta.com."],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title"," - YouTube"],["url","https://www.youtube.com/watch?v=MN3CSKMTXBG."],["summary","YouTube でお気に入りの動画や音楽を楽しみ、オリジナルのコンテンツをアップロードして友だちや家族、世界中の人たちと共有しましょう。"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title"," - YouTube"],["url","https://www.youtube.com/watch?v=RWGECBWCMK4."],["summary","YouTube でお気に入りの動画や音楽を楽しみ、オリジナルのコンテンツをアップロードして友だちや家族、世界中の人たちと共有しましょう。"],["topImageUrl",null],["error",null]]}]}],["text","(翻譯)\n我希望接種疫苗不會冒犯。\n但這些信息可以拯救你所愛的人。\n這是官方的：與敘述相反, 接种疫苗的人死亡比未接种疫苗的人多6倍\n, 根據阿根廷衛生部的一項研究.\n\nCOVID+ deaths:\nSputnik: 11%\nAstraZeneca: 14%\nSinopharm: 14%\n未接種: 2%\n\n有100％有效和安全的治療，為什麼使用實驗和致命的疫苗？ (看下文 “如何治愈COVID”)\n\n讓我們小心：分享這條消息來拯救生命.\n\n接種疫苗就是自殺: 解釋在下面(400科學引文)\n\nFederico Nazar\n+5491141662100\n\n資料來源：\n衛生部（阿根廷）。研究全國疫苗接種運動在降低 60 歲及以上人群 COVID-19 死亡率方面的有效性. 2021 年 6 月 30 日. 表格1：疫苗分析中包含的記錄頻率。主辦單位：阿根廷疫苗接種和流行病學學會 (SAVE)。https://save.org.ar/wp-content/uploads/2021/07/Resultados-preliminares-Efectividad.pdf\n\n如果他們審查、更改或刪除上述網站：https://web.archive.org/web/20210701200320/https://save.org.ar/wp-content/uploads/2021/07/Resultados-preliminares-Efectividad.pdf\n\n阿根廷官方統計數據截至 2021 年 05 月 07 日\n確認的COVID +: 4,535,473\nCOVID +死亡人數: 95,904\nhttps://www.argentina.gob.ar/salud/coronavirus-COVID-19/sala-situacion\n\n注意低死亡率, 儘管有疫苗, 由於更多地使用有效藥物(下面詳述)和由於那些具有更多危險因素的人死亡。\n-------------------------------------------------- -------------------------\n\n接種疫苗後的投訴，根據歐洲官方數據(EuraVigilance)和美國(VAERS):\n\n- 20,000死亡\n\n- 1,000,000住院\n\n- 3%住院(FDA)\n\n兩地衛生機構公開承認疫苗會導致血栓形成(這是由激素避孕藥引起的血栓形成加強的).\n\n傷殘率和死亡率高到丹麥、挪威和芬蘭已經停, 例如, Oxford / AstraZeneca疫苗.\n\n所有 COVID 疫苗都是實驗性的: 他們只有緊急使用的臨時授權. 沒有一種疫苗被批准。\n\n在其緊急批准中, 從來沒有對不孕症和流產進行隨訪. 不使用 ivermectin (伊維菌素) 治療 COVID 會影響男性生育能力. 類似 COVID 的刺突蛋白或反應, 疫苗產生的, 通過相同的機制會影響男性生育能力. 接種疫苗後有數百人流產.\n\n數以千計的月經量過多的投訴(血小板生成問題).\n\n所有 COVID 疫苗都與嘗試流產有關, 通過流產嬰兒的細胞系, 無論是在開發、生產還是質量控制方面。\n以上, 疫苗效力低：根據阿根廷的官方數據，儘管接種了疫苗，仍有 43,000 人死於 COVID。\n\n儘管據稱疫苗短缺, 他們正在為從 COVID 中康復的人打疫苗: 這是禁忌的如果他們在不到 3 個月前感染了COVID並且有更高的嚴重不良反應和死亡率.\n\n給康復的人接種疫苗是沒有用的: 他們比接種兩個劑量的疫苗的人具有更好的免疫力. 不要被愚弄, 免疫力不是通過抗體來衡量的, 其水平在 3 至 6 個月之間自然下降, 但通過長期免疫, 例如, in B和T淋巴細胞.\n\n必須明白:\n\na) 如果你之前得過了COVID, 疫苗不會提供任何好處但會確實帶來死亡的風險.\n\nb) 如果你之前沒有得過了COVID, 疫苗也不會提供任何好處, 100% 有效和安全的治療方法已經可用了. 以及 43,000人死於 COVID, 接種疫苗後, 顯示, 即使你接種了疫苗, 你還是需要治療:\n證據：英語, 400科學任命解釋如何治愈 Covid和為什麼不要接種疫苗:\nhttps://doi.org/10.6084/m9.figshare.13550030.\n\n西班牙語，雖然沒有那麼完整和更新：\nhttps://figshare.com/s/71288d0d1686f368da0f.\n\n如果您接種了一劑疫苗, 不要接種第二個. 你正在用你的健康和生命玩俄羅斯輪盤賭，卻沒有機會贏: 接種疫苗沒有任何好處, 別的安全的治療方法已經有了.\n沒有先說明疫苗的風險和並且已經存在有效且無風險的治療方法就侵犯了知情同意權, 這使得完全沒有必要接種實驗疫苗。\n伊維菌素(Ivermectin) (COVID的現有治療方法之一)將摧毀腐敗政府(所有國家都一樣)和製藥行業已經談判過的每年1700億美元的生意. 因此，自2020年6月對其有效性進行科學驗證以來，伊維菌素的傳播被阻止(是的，Covid 造成的所有死亡本來都可以避免的).\n\n如何治愈COVID?\n\n協議Dr. Héctor Carvallo, 全球先鋒:\nhttps://drive.google.com/file/d/1fymghdkfzmbdxrzzbmne0hytg70jscxw/view?usp=sharing.\n\nFLCCC 協議, 地球上最新最專業的團體 (英語):\nhttps://covid19criticalcare.com/covid-19-protocols/\n\n家庭治療信息:\n\n伊維菌素(Ivermectin).\n\n它是最有效的藥物，據 WHO, PAHO, FDA, FLCCC, BIRD UK, 2歐洲國家，幾十個省，幾千個直轄市，幾十萬醫生，幾百萬病人。\n\n它是一種廣譜抗病毒藥物 (20 種 RNA 和 DNA 菌株，包括登革熱和寨卡病毒), 避免病毒錨定在紅細胞的 CD147 受體中和 ACE2 受體.\n\n科學測試:\nhttp://ivmmeta.com.\n\n如果您懷疑患有 COVID或者您與患有 COVID 的人有密切接觸: 1滴/1公斤 (看你的體重. 例如:體重:50公斤, 服用50滴). 與傳單所指示的不同對於 Covid，最好在食用含脂肪食物（披薩、肉、巧克力）後立即服用伊維菌素. 提高生物利用度. 酒(服用伊維菌素時不要喝超過一杯的葡萄酒或啤酒).\n\n如果您有兩個 COVID 症狀或嗅覺或味覺完全喪失: 2滴/1公斤.\n\n如果您發燒或咳嗽, 3滴/1公斤.\n\n如果您呼吸困難或在 90附近飽和, 4滴/1公斤.\n\n24小時後重複, 但如果症狀沒有改善, 每12小時重複一次. 然後，每天一次，持續 5 天或更長時間, 只要COVID症狀持續. 血漿濃度不應超過相當於每公斤 10 滴.\n\n6毫克(mg)丸: 每滴/公斤更換每30公斤一粒.\n阿奇黴素(Azithromycin) 500 mg每天, 繼續5天: 它為伊維菌素提供動力通過避免將病毒錨定在 ace2 受體上.\n\n如果您感到咳嗽或缺氧, 布地奈德(budesonide)和霧化布洛芬酸鈉(sodium ibuprofenate) (看腳註) 並根據症狀的嚴重程度每天服用阿司匹林. 與食物或胃保護劑一起服用. 如果病人患有胃潰瘍，則未指明: 那麼應該使用另一種藥物.\n\n維他命D: 你需要至少 15 分鐘的陽光照射.\n\n維他命A, 最重要的是維他命D: 每天, 容器中指示的劑量.\n\n網上搜索含鋅(zinc)食物: 會減少病毒的細胞複製.\n\n維他命C: 柑橘類水果.\n\n不要使用撲熱息痛(paracetamol). 布洛芬(Ibuprofen)可以慎用, 但是在退燒的時候, 始終檢查您的健康狀況及其對藥物的反應(有一打... 例如, 褪黑激素, 看上面的英文研究).\n\n在整個疾病只去提供伊維菌素的醫院: 曾經在住醫院, 一些醫生/護士不讓病人服用伊維菌素, 因不良醫療行為導致病人死亡(必須被送上法庭，以免他們繼續因疏忽而殺人?). 服用Dr. Carvallo的IDEA協議, 沒有一個病人死於 Covid (伊維菌素ivermectin +地塞米松dexamethasone +依諾肝素enoxaparin +阿司匹林aspirin). Youtube上搜索Lanata Carvallo.\n\nCall: +5491141662100\nFederico Nazar.\n\nCovid Rescue (Covid救援).\n\n科學進步的基礎\n你的時間捐贈(分享此信息) 或金錢可以讓您接觸更多人以挽救生命和經濟。\n分享救人。.\n\n重要的\n這不是醫學適應症，而是參考期刊中科學研究的總結。\n伊維菌素是安全的，但應始終諮詢醫生以避免自我用藥錯誤並防止其他拮抗藥物或某些可能使既往疾病惡化的藥物.\n\n不應該給孕婦吃或體重低於 15 公斤的兒童.或 3歲以下的兒童. 有其他替代品，如布諾洛芬酸鈉(sodium ibunoprofenate).\n\n不幸的是，有些醫生沒有在這方面更新, 主要是因為他們不能或沒有時間閱讀英文的科學參考書目.\n\n如果您附近沒有免費提供布洛芬酸鈉(sodium ibunoprofenate)的藥房, 聯繫我們尋求幫助(布洛芬酸鈉sodium ibunoprofenate簡單又便宜, 是用布洛芬和碳酸氫鈉做的).\n\nIbuprofenosoluble.org\n可霧化布洛芬酸鈉sodium ibunoprofenate的效果不如伊維菌素ivermectin, 但它可以加速清除呼吸道中的病毒並有助於消炎.\n\n口服給藥標準\n\n-風險病人: 感染初期症狀\n-其他病人在持續發燒和呼吸困難的最初症狀之前.\n\n配方准備\n病人姓名\n身份证\n診斷\nRP /布洛芬ibuprofen (作為鈉鹽sodium salt) 50 mg / 1 ml.\n滴劑\n15 ml滴管容器, 20 ml (或根據患者需要 x 數量)\n\n簽名和醫生印章\n免費提供布洛芬酸鈉sodium ibunoprofenate的藥店(阿根廷):\n1.Carlina Tommasi: San Antonio de Areco bs as.\n2. Leticia Robles: Concordia Entre Ríos\n3. Ingrid Zubiri: La Paz Entre Ríos.\n4. Gustavo Pousset: Castelar Zona Oeste\n5. Fabián Troina: San Miguel del Monte. Prov de Bs As.\n6. Laura Laborde: Vicuña Mackenna Cba.\n7. Alejandra Berlari: Tandil, Buenos Aires\n8. Ana Krieger: Tandil, Buenos Aires.\n9. Farmacia Vignolo indiana: Santa Fe Capital\n10. María Gabriela Jovanovich, Cañuelas, Bs As\n11. Farmacia Rasetto - San Nicolás bs as\n12. Farmacia prieto quilmes Buenos aires\n13. Farmacia Peiró, Santa Fe\n14 Franco Aguilar, San Miguel de Tucuman\n15 Farmacia SeSeVi, Paraná, Entre Ríos\n16 Mariela Loiza, Rosario Santa Fe\n17 Cintia Verkuyl, Tres arroyos, Buenos Aires\n18. Paliza Ángel José, Ushuaia TDF\n19. Silvina Cardoso, Casilda Santa Fe\n20. Farmacia Mónica Asinari, Santa Fe capital\n21. Sandra Chiesa, Junín.\n22. Octavio Cirelli, Santo Tomé, Santa Fe.\n23. Farmacia Grial, Bella Vista, Corrientes\n24. Farmacia Colla Daniel, San Carlos Centro, santa fe.\n25. Farmacia Mainero Héctor ( Rafaela.Santa fe)\n26. Farmacia Estuardo Romero. Fernando Romero. General Roca. Río Negro\n27. Silvia Julián. La Rioja\n28. Carolina Pizarro Funes sur de Santa Fe\n29. Silvana Busilacchi. Chabas. Santa Fe\n30. Marcelo Salatino. ROSARIO\n31. Patricia Nieto, Farmacia Nieto, Bahía Blanca\n32. Farmacia Lavie, La Plata\n33. Farmacia Melgar, La Plata\n34. Farmacia Yuln, La Plata\n35. Farmacia de la Cruz, Junín de los Andes, Neuquén\n36. Farmacia Carlos Paz - Carlos Paz, Córdoba \n37. Farmacia Dosis - Villa Angela, Chaco\n38. Farmacia Mondino- Porteña, Córdoba \n39. Farmacia Magistral Rodríguez. Comodoro Rivadavia.Chubut\nProtocolo de uso\n40 .Farmacia Gómez .La Plata \n41. Silvina Resta Farmacia Fialco Quilmes \n42. Farmacia VaninBa Timofiejuk. Villa Minetti. Santa Fe. \n43. Farmacia De Cristófano, Albarellos, Santa Fe\n44. Farmacia Farmathenea. CABA\n45. Farmacia Martinez. Tres Arroyos. Bs. As\n46- Farmacia Rosa Mistica La plata ( lo entrego gratuitamente ). \n47 farmacia scozziero Funes Santa fe.\n48.Farmacia Martoglio Villa María Cba\n49. Farmacia Fiorilli, Castelar\n50. Farmacia Berola, San Antonio de Areco, Bs As\n\n-預防: 1 ml霧化布洛芬50 mg (或滴的等價物)每12小時. 在不超過 2.5 ml 的等滲生理溶液中稀釋.\n-輕度肺炎病人: 1 ml霧化布洛芬50 mg (或滴的等價物)每8小時. 在不超過 2.5 ml 的等滲生理溶液中稀釋.\n- 急性雙側肺病病人: 1 ml霧化布洛芬50 mg (或滴的等價物)每6小時. 在不超過 2.5 ml 的等滲生理溶液中稀釋.\n\n可溶性布洛芬(soluble ibuprofen)的性質:\n\n-抗炎抑制(可逆抑制COX1和COX2), (促聚合體的血栓素部分抑制, 血管收縮劑和促炎劑), (維持 PGI2 的合成和釋放).\n-降低ROS的濃度(氧反應性物種).\n-鹼化軟肺介質.\n-有利於在肺部快速釋放一氧化氮。\n-殺病毒特性。.\n-殺菌特性\n- Ca ++ 螯合劑和粘蛋白流化劑。\n-減少 LTB4.\n-通過霧化直接引入肺部。\n\n科學和培訓信息\n-培訓法律方面和掌握配方(配方與技術) 在College of Pharmacéutics of CABA\nhttps://www.youtube.com/watch?v=MN3CSKMTXBG.\n\n-證據臨床病人 SR JESUS\nhttps://www.youtube.com/watch?v=RWGECBWCMK4.\n"],["id","2tjpknzmbkkqf"],["createdAt","2021-07-21T11:58:09.635Z"]]},{"__iterable":"Map","data":[["replyCount",2],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",5],["user",{"__iterable":"Map","data":[["id","j4S8C_6hI7sX-8Sh1trBhPXBBvSR5c6RYc2wQCmkxKhtITBuQ"],["name","富創造力的新埤克萊斯特"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","【轉發】加州大學舊金山 BioHub 小組關於 COVID-19 的討論會小結，2020 年 3 月 10 日\n\n與會者：\n\n• 喬·德里西：UCSF的頂級傳染病研究員。陳扎克伯格生物中心（涉及UCSF/伯克利/斯坦福的合資企業）聯席總裁。在非典疫情中使用的芯片的共同發明者。\n• 艾米莉·克勞福德：新肺特別工作組主任，診斷專家\n• 克里斯蒂娜·塔托：快速反應總監，免疫學家\n• 帕特里克·艾斯庫：領導疫情應對和監測，流行病學家\n• 查茲·蘭格利爾：UCSF傳染病醫生\n\n下面基本上是小組成員發言原汁原味的記錄。少數不是原話會寫在括號中。\n\n• 主要觀點：\n\n在目前時點，美國已經錯過了遏制期，遏制基本上已是徒勞的了。我們的遏制努力不會減少在美國感染的人數。\n現在，我們只能努力減緩傳播速度，幫助醫生們應對需求高峰。換句話說，遏制的目標是平緩曲線，以降低需求激增的峰值，減弱對醫院的衝擊程度。並爭取時間，希望藥物可以盡快開發出來。\n目前社區中有多少人已經感染了病毒？沒人知道，我們正在從遏制階段轉到醫護階段。\n\n美國目前處於意大利一周前的時點，我們沒有任何理由可以說我們將能避免發展到像意大利那樣。\n\n在未來12-18個月中，40%-70%的美國人口將感染COVID-19。達到這個水平後，你可以開始獲得一些抗體。與流感不同，這病毒對人類是全新的，因此全球人口沒有潛在的免疫力。 [貝克實驗室在3月1日晚餐上也告訴我感染率估計為30-70％]\n\n[我們用這個的數字來估計死亡人數——表明大約150萬美國人可能會死亡，小組成員並不反對我們的估計。相比之下，季節性流感平均每年有5萬美國人死亡。假設50%的美國人口，即1.6億人感染新肺, 在未來12-18個月中，160萬美國人將死亡，死亡率為1%。約10倍於流感死亡率。這個估計是基於未來沒有開發出有效治療藥物的假設。\n死亡率因年齡而異， 80歲以上死亡率可能為10-15%。\n我們不知道COVID-19是否是季節性的，但即使夏天能消退，它可能會像1918年的流感那樣在秋天又復發。\n\n我只能明確地告訴你兩件事，一，在情況好轉之前情況肯定會變得更糟；二，我們至少明年還會面對此病毒，明年我們的生活會和以前很不一樣。\n\n• 我們現在該怎麼辦？你能為你的家人做什麼？我們知道在潛伏期也可能是有傳染性的，但不知道在症狀出現之前傳染性有多強，但症狀最強時病毒傳染性也最強。我們目前認為，在症狀出現前2天到出現後14天（T-2至T+14），感染者俱有傳染性。\n\n病毒能在體外存活多長時間？在物體表面上，根據不同表麵類型，目前認為能存活 4-20 小時（也可是能幾天），對此仍沒有共識。\n該病毒非常容易被常見的抗菌清潔劑消滅：漂白劑、過氧化氫、酒精。\n\n要避免去音樂會、電影院、任何擁擠的場所。我們已經取消了商務旅行。\n\n要做好基本的衛生，如洗手和避免觸摸臉。\n\n提前儲存好你的常用處方藥，許多連鎖藥店的供應鏈在中國，製藥公司通常儲備有2-3個月的原材料，因此，若中國製造業中斷，可能儲備會耗盡。\n\n注射常規肺炎疫苗可能會有所幫助，不預防COVID-19，但降低你身體變弱的機率，降低得COVID-19後惡化的可能性。\n\n明年秋天請一定要接種流感疫苗，雖然不能預防COVID-19，但同樣能減少你身體變弱的機率，降低得COVID-19後惡化的可能性。\n\n我們會建議任何60歲以上的人都呆在家裡，除非萬不得已請不要出門。美國CDC內部也一直在在討論是否應規定60歲以上的人不得乘坐商業航空飛機出行。\n\nUCSF同仁們正在將自己的高齡父母從養老院等遷回到自己的家裡，不讓他們走出家門，家裡的其他成員一進家門必須先洗手。\n\n新肺病毒感染的三條途徑：手到嘴/臉；唾沫/氣溶膠傳播；糞便到嘴的傳播。\n\n• 如果有人生病怎麼辦？如果有人生病，讓他們呆在家裡並避免與任何人接觸。任何在醫院裡能做到事，你在家裡也都能做到。大多數人病狀是溫和的，但是，如果他們病情變重，或者是70歲以上的老年人，或本來就有肺或心血管問題，必須帶他們去看急診。\n迄今為止，COVID-19沒有辦法治療。醫院能提供的只是支持性護理（如靜脈輸液、吸氧氣），幫助你維持生命，靠自己的免疫力戰勝病毒，預防敗血症。\n如果病人到了危重症期，你可以嘗試讓他們申請服用Remdesivir作為“同情用藥”，該藥物目前同時在舊金山總醫院、UCSF、和中國做臨床試驗。你需要聯繫在那兩個醫院裡的醫生，申請加入臨床試驗。 Remdesivir 是一種來自 Gilead 的抗病毒藥物，在靈長類動物中表現出對中東呼吸綜合徵的有效性，目前正在做針對 COVID-19 的人體試驗。如果試驗成功，明年冬天可能上市，因為擴大藥物的生產規模比開發疫苗要快得多。\n\n為什麼老年人的死亡率要高得多？你的免疫系統在50歲以後會下降，\n死亡率與病人之前是否有基礎疾病密切相關，尤其是呼吸道或心肺疾病。這些基礎疾病在老年人中概率較高，老年人患肺炎的風險也較高。\n\n• 能否對所有人都做 COVID-19 檢測？不現實，因為沒有足夠的測試能力。原因如下，目前除了 PCR 測試之外，沒有其他測試可以區分COVID-19與流感或其他十幾個正在傳播的呼吸道病菌。聚合酶鏈反應（PCR）測試可以檢測 COVID-19 的 RNA。然而，我們仍然對測試的準確性沒有信心，即我們不知道假陰性的發生率。\n\nPCR 測試需要帶試劑的套件，並且需要臨床實驗室來處理試劑盒。\n雖然可以迅速擴大試劑套件生產規模，但實驗室處理能力不能很快增加。領先的臨床實驗室公司Quest和Labcore每天能為全美國處理1000個試劑盒，擴大實驗室處理能力需要時間、建築空間和設備、還要通過認證，很難在短期內建好。 UCSF 和加州大學伯克利分校已將其研究實驗室捐贈出來處理試劑盒，但每個實驗室每天只能處理 20-40 個試劑盒，並且尚未獲得臨床認證。其他新的測試方法也在嘗試中，但目前還沒成熟，測試能力也都很小。\n\n• 美國社會對這個疾病的衝擊做好準備了嗎？\n醫院正在增加收治能力， UCSF的帕納蘇斯校區在停車場搭起了帳篷，他們把病房改造成負壓的，這是控制病毒所必需的。他們正在考慮重新開放關閉的錫安山的設施。\n關閉學校是最大的社會衝擊之一，在關閉學校（特別是小學）之前，我們需要認真權衡得失，因為會有連鎖反應。如果小學生不上學，那麼一些醫院工作人員要照看子女而不能來上班，這降低了病人激增時醫院的救治能力。\n\n美國的公共衛生系統具有應對持續數週的短期疫情的能力，如腦膜炎的爆發。但沒有能力應對持續數月的疫情，必須找到其他解決辦法。"],["id","1iui5yyxkww1a"],["createdAt","2020-03-17T18:16:54.254Z"]]},{"__iterable":"Map","data":[["replyCount",1],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",1],["user",{"__iterable":"Map","data":[["id","j4S8C_fCy3uWoyyvKfTMxskp_205H-RJ2KhxSkhk1JtvyYz2w"],["name","獨立的坪林特麗莎"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title",""],["url","www.methodsman.com上託管了他的交流工作的資料庫。"],["summary",""],["topImageUrl",null],["error","UNKNOWN_UNFURL_ERROR"]]},{"__iterable":"Map","data":[["title",""],["url","https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Expression of Concern: Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection"],["url","https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240965"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Clinical trial to investigate whether vitamin D protects against COVID-19"],["url","https://www.eurekalert.org/pub_releases/2020-10/qmuo-ctt101320.php"],["summary","Researchers from Queen Mary University of London, funded by Barts Charity, have launched a new clinical trial to investigate whether taking vitamin D could protect people from COVID-19."],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Home - ClinicalTrials.gov"],["url","https://clinicaltrials.gov/"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Vitamins & Supplements Center – Nutritional, Herbal, Dietary, and More - WebMD"],["url","https://www.webmd.com/vitamins/index"],["summary","WebMD provides information on popular vitamins and supplements including side effects, drug interactions, user ratings and reviews, medication over dose, warnings, and uses."],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","https://www.researchsquare.com/article/rs-21211/v1"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients"],["url","https://www.medrxiv.org/content/10.1101/2020.04.08.20058578v4"],["summary","Abstract Objectives To investigate the possible role of Vitamin D (Vit D) deficiency via unregulated inflammation in COVID-19 complications and associated mortality. Design The time-adjusted case mortality ratio (T-CMR) was estimated as the number of deceased patients on day N divided by the number of confirmed cases on day N-8. The adaptive average of T-CMR (A-CMR) was further calculated as a metric of COVID-19 associated mortality in different countries. A model based on positivity change (PC) and an estimated prevalence of COVID-19 was developed to determine countries with similar screening strategies. Mean concentration of 25-hydroxyvitamin D (25(OH)D) in elderly individuals in countries with similar screening strategies were compared to investigate the potential impact of Vit D on A-CMR. We analyzed data showing a possible association between high C-Reactive Protein (CRP) concentration (CRP greater than or equal to 1 mg/dL) and severe COVID-19. We estimated a link between Vit D status and high CRP in healthy subjects (CRP greater than or equal to 0.2 mg/dL) with an adjustment for age and income to explore the possible role of Vit D in reducing complications attributed to unregulated inflammation and cytokine production. Data Sources Daily admission, recovery, and deceased rate data for patients with COVID-19 were collected from Kaggle as of April 20, 2020. Screening data were collected from Our World in Data and official statements from public authorities. The mean concentration of 25(OH)D among the elderly for comparison with A-CMR was collected from previously published studies from different countries. Chronic factor data used in regression analysis was obtained from published articles. The correlation between Vit D and CRP was calculated based on 9,212 subject-level data from NHANES, 2009-2010. Results A link between 25(OH)D and A-CMR in the US, France, Iran and the UK (countries with similar screening status) may exist. We observed an inverse correlation (correlation coefficient ranging from -0.84 to -1) between high CRP and 25(OH)D. Age and the family income status also correlated to high CRP and subjects with higher age and lower family income presented more incidences of high CRP. Our analysis determined a possible link between high CRP and Vit D deficiency and calculated an OR of 1.8 with 95%CI (1.2 to 2.6) among the elderly (age greater than or equal to 60 yo) in low-income families and an OR of 1.9 with 95%CI (1.4 to 2.7) among the elderly (age greater than or equal to 60 yo) in high-income families. COVID-19 patient-level data shows a notable OR of 3.4 with 95%CI (2.15 to 5.4) for high CRP in severe COVID-19 patients. Conclusion Given that CRP is a surrogate marker for cytokine storm and is associated with Vit D deficiency, based on retrospective data and indirect evidence we see a possible role of Vit D in reducing complications attributed to unregulated inflammation and cytokine storm. Further research is needed to account for other factors through direct measurement of Vit D levels in COVID-19 patients.\n\n### Competing Interest Statement\n\nThe authors have declared no competing interest.\n\n### Funding Statement\n\nThe authors would like to thank Benjamin D Keane for his assistance in preparing the manuscript. The authors would also like to acknowledge generous support from the Carinato Charitable Foundation, Mark and Ingeborg Holliday, Kristin Hudson & Rob Goldman, and Ms. Susan Brice & Mr. Jordi Esteve.\n\n### Author Declarations\n\nAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.\n\nYes\n\nAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.\n\nYes\n\nI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).\n\nYes\n\nI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.\n\nYes\n\nData regarding the number of affected cases, deaths, and recoveries from COVID-19 was obtained from Kaggle[24] as of April 20, 2020. Data regarding cases that have undergone testing were obtained from Our World in Data[25]. Age distribution of confirmed cases, those admitted to ICU, and deceased patients in Spain was based on data available from the Spanish Ministry of Health[26]. The concentration of 25(OH)D among the elderly population in each country was obtained from prior studies[2732]. CRP data, Vit D, data and demographic variables of the subjects were pooled the cross-sectional data from 2009-2010 NHANES, conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC) [22]. Data regarding the risk factors including blood pressure[33], body to mass ratio[34], and diabetes[35], were obtained from published articles. Data on coronary heart disease (CHD) death rates across different countries was used based on the calculation of World Life Expectancy on data reported by the World Health Organization (WHO) [36]. The link between high CRP and severe COVID-19 was examined based on data from a study investigating the characteristics of COVID-19 patients in China[23]. References: 22 NHANES 2009-2010 Laboratory Data. https://wwwn.cdc.gov/nchs/nhanes/search/datapage.aspx?Component=Laboratory&CycleBeginYear=2009 (accessed 13 May 2020). 23 Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;0:null. doi:10.1056/NEJMoa2002032 24 Novel Corona Virus 2019 Dataset. https://kaggle.com/sudalairajkumar/novel-corona-virus-2019-dataset (accessed 1 Apr 2020). 25 To understand the global pandemic, we need global testing the Our World in Data COVID-19 Testing dataset. Our World Data. https://ourworldindata.org/covid-testing (accessed 13 Apr 2020). 26 Informes COVID-19. https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Paginas/InformesCOVID-19.aspx (accessed 4 Apr 2020). 27 Basile M, Ciardi L, Crespi I, et al. Assessing serum concentrations of 25-hydroxy-vitamin d in north-western Italy. J Frailty Aging 2013;2:1748. doi:10.14283/jfa.2013.25 28 Toffanello ED, Perissinotto E, Sergi G, et al. Vitamin D and Physical Performance in Elderly Subjects: The Pro.V.A Study. PLOS ONE 2012;7:e34950. doi:10.1371/journal.pone.0034950 29 Adami S, Viapiana O, Gatti D, et al. Relationship between serum parathyroid hormone, vitamin D sufficiency, age, and calcium intake. Bone 2008;42:26770. doi:10.1016/j.bone.2007.10.003 30 González-Molero I, Morcillo S, Valdés S, et al. Vitamin D deficiency in Spain: a population-based cohort study. Eur J Clin Nutr 2011;65:3218. doi:10.1038/ejcn.2010.265 31 Rabenberg M, Scheidt-Nave C, Busch MA, et al. Vitamin D status among adults in Germany results from the German Health Interview and Examination Survey for Adults (DEGS1). BMC Public Health 2015;15. doi:10.1186/s12889-015-2016-7 32 Park J-H, Hong IY, Chung JW, et al. Vitamin D status in South Korean population. Medicine (Baltimore) 2018;97. doi:10.1097/MD.0000000000011032 33 Zhou B, Bentham J, Cesare MD, et al. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. The Lancet 2017;389:3755. doi:10.1016/S0140-6736(16)31919-5 34 Abarca-Gómez L, Abdeen ZA, Hamid ZA, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. The Lancet 2017;390:262742. doi:10.1016/S0140-6736(17)32129-3 35 Zhou B, Lu Y, Hajifathalian K, et al. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. The Lancet 2016;387:151330. doi:10.1016/S0140-6736(16)00618-8 36 Coronary heart disease death rate by country. World Life Expect. https://www.worldlifeexpectancy.com/cause-of-death/coronary-heart-disease/by-country/ (accessed 13 May 2020). \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n[https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment\\_data/file/551352/NDNS\\_Y5\\_6\\_UK\\_Main\\_Text.pdf][1]\n\n\n\n [1]: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/551352/NDNS_Y5_6_UK_Main_Text.pdf"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Vitamin D Deficiency: Symptoms, Causes, and Health Risks"],["url","https://www.webmd.com/diet/guide/vitamin-d-deficiency"],["summary","Vitamin D is essential for healthy bones, and a lack of it can lead to health problems, including cardiovascular disease. Learn more from WebMD about how to get plenty of vitamin D, and how to treat a vitamin D deficiency."],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","https://imj.ie/vitamin-d-and-inflammation-potential-implications-for-severity-of-covid-19/"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title",""],["url","https://www.bmj.com/content/356/bmj.i6583"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title","The possible roles of solar ultraviolet-B radiation and vitamin D in reducing case-fatality rates from the 1918-1919 influenza pandemic in the United States - PubMed"],["url","https://pubmed.ncbi.nlm.nih.gov/20592793/"],["summary","Deaths during the 1918-1919 influenza pandemic have been linked to both the influenza virus and secondary bacterial lung infections. Case fatality rates and percentage of influenza cases complicated by pneumonia were available from survey data for twelve United States locations in the 1918-1919 pand 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D與COVID-19的關係：\n\n一.WebMD.\n\n更多維生素D，降低嚴重COVID-19的風險？\n\n這個故事於2020年10月27日更新，其中包含有關維生素D和COVID-19的新研究。\n2020年5月18日-如果您感染了COVID-19 ，那麼健康的血液中維生素D的含量是否可以幫助您避免重症監護病房和死亡？\n更多研究表明，“陽光維生素”可能在您的病情嚴重程度中起作用。\n芝加哥西北大學生物醫學工程和醫學教授瓦迪姆•貝克曼（Vadim Backman）博士說，儘管這些研究並不能證明因果關係，但“這些研究支持維生素D可能預防COVID並發症的觀點。”維生素D缺乏與不同國家死亡率差異之間的聯繫。\n最新研究中：\n．在住院的200例COVID-19患者中，有80％以上患有維生素D缺乏症。維生素D水平較低的患者血液中的炎症標誌物水平也較高。但是研究人員發現低D水平與疾病嚴重程度之間沒有聯繫。\n．西班牙研究人員測試了維生素D處方藥如何影響COVID住院患者。在接受該治療的50名患者中，只有一名需要重症監護病房（ICU），並且沒有人死亡。在26位未服用維生素的患者中，有13位需要加護病房，其中2例死亡。\n．美國研究人員評估了235例因COVID入院的患者的血液樣本，然後對其進行跟踪以了解其進展情況。維生素D水平適當的患者不太可能失去知覺或死於COVID。（該研究發表後，期刊編輯發表了“擔憂的表情”，質疑樣本量是否足夠大以及如何對數據進行分析。該研究的作者，波士頓大學維生素D研究人員Michael Holick，醫學博士以促進維生素而聞名，並確認需要進行更大的研究。） \n將會有更多的研究。倫敦瑪麗皇后大學的研究人員正在啟動Coronavit（為期6個月的研究），該研究將招募5,000人，看看高劑量維生素D是否可以減少冬季呼吸道感染，包括COVID-19。\n臨床試驗Trial.gov上列出了其他31項研究。並不是所有人都在招募。\n專家說，當免疫系統反應過度並開始攻擊人體自身的細胞和組織時，健康的血液中維生素D的水平可以通過幫助COVID-19的人避免細胞因子風暴來提供生存優勢。\n同時，有人說服用維生素作為預防措施沒有害處。\n波士頓附近的馬薩諸塞州紐伯里波特市38歲的傑基•威爾科克斯（Jackie Wilcox）說：“我覺得如果現在有什麼事情可以支持我們的身體，我將全力以赴。” 她的家人，包括她的丈夫和兩個孩子，每天都在補充營養。\n\n研究人員如何開始研究維生素D？\n當陽光照射到您的皮膚時產生的維生素D具有許多其他好處，例如骨骼健康。在某些食品和補品中也可以找到它。\n當COVID-19大流行開始升級時，西北研究人員Backman說他想提供幫助，但不確定如何做。他說：“還有幾個謎團尚未解決。” 一個是國家之間死亡率的差異。\n因此，他的團隊在研究了COVID死亡率差異的可能解釋後，對中國，法國，德國，意大利，伊朗，韓國，西班牙，瑞士，英國和美國的醫院和診所的數據進行了統計分析。 -19，例如衛生保健質量，人口年齡，測試率和不同病毒株的變化，沒有任何變化。\n維生素D在調節免疫系統中的作用，包括其抑制危險的細胞因子產生的潛在能力，是眾所周知的。在1918-1919年的流感大流行中，陽光和維生素D與降低死亡率有關。\n因此，當有關細胞因子風暴在COVID-19中的作用的研究出現時，Backman的研究小組將更多精力集中在維生素D水平的作用上。\n他們根據維生素D缺乏症與C反應蛋白或CRP（嚴重COVID-19的替代標誌物）之間的潛在聯繫，估算了維生素D與嚴重COVID-19之間的關聯。他說，這些蛋白質是肝臟響應炎症而產生的，以減輕感染的損害。\n他們估計，維生素D缺乏的患者中約有17％會感染嚴重的COVID-19，但維生素D水平健康的患者中只有約14％。Backman說，差異具有統計意義。他說：“實際上多少會降低死亡率，我們不知道。”因為這些數字是基於統計模型得出的。\n\n尋找維生素D鏈接的其他研究\n在最近的研究中，發現維生素D水平與COVID-19的嚴重程度之間存在聯繫：\n．英國的研究人員評估了20個歐洲國家的平均維生素D水平和COVID-19病例數以及死亡率。英國國王伊麗莎白女王醫院基金會信託基金研究和創新負責人彼得•克里斯蒂安•伊利醫學博士說，人口中平均維生素D血液平均水平較低的國家的COVID-19病例和死亡人數更高。\n．在西北大學，研究人員使用建模方法估算出，維生素D缺乏者中有17％會發展為嚴重的COVID-19感染，而維生素D水平卻只有14％。他們根據維生素D缺乏症與C反應蛋白或CRP（嚴重COVID-19的替代標誌物）之間的潛在聯繫，估算了維生素D與嚴重COVID-19之間的關聯\n．在一項小型研究中，路易斯安那州和得克薩斯州的研究人員評估了20例因COVID-19住院的患者，發現入住ICU的患者中有11名維生素D缺乏，但是只有4名不需要ICU的患者。\n．印尼研究人員評估了780例記錄在案的COVID-19病例，發現大多數死亡的患者維生素D水平低於正常水平。\n．愛爾蘭研究人員分析了歐洲人口研究和維生素D含量，發現維生素D缺乏症高發國家的COVID-19死亡率也更高。這些研究人員要求政府提高維生素D的建議。\n\nCOVID-19之前研究\n維生素D的益處\n儘管關於維生素D和COVID-19的早期研究才剛剛開始，但其他研究發現維生素D補充劑可以幫助降低呼吸道感染的風險。研究人員回顧了1918-1919年的流感大流行後，發現具有健康維生素D血液水平的患者死亡的可能性較小。\n加利福尼亞杜阿特癌症中心希望之城糖尿病免疫學系主任巴特•羅普博士說，將維生素D水平與COVID-19細胞因子風暴聯繫起來的研究尚處於初期階段，但這並不令人驚訝。他說，維生素D是“談判者”，因為“它不抑制免疫系統，而是調節免疫系統。維生素D使免疫細胞的炎症減少。”\n雖然研究發現低維生素D可能會影響COVID-19的嚴重程度，但尚不知道將維生素D恢復至正常水平是否會有助於治療。沒有人可以肯定地說擁有健康的維生素D水平可以幫助您避免這種病毒。\n菲律賓東南大學的一位研究人員評估了212名被診斷為COVID-19的人的維生素D血液水平，發現處於危急狀況的人維生素D最低，而感染較輕的人維生素D最高。他的論文的結論（未經同行評審）是，補充劑“可能會改善感染COVID-19的患者的臨床結局”。\n英國研究員Ilie說：“我們已經知道，骨骼健康需要它。” “正在等待有關維生素D和COVID-19的證據-我怎麼說-證據來不及提供幫助可能太遲了。”\n但是並非所有人都同意維生素D可能對馴服COVID-19有用。循證醫學中心的研究人員於5月1日對證據進行了“快速審查”，得出結論：“沒有證據表明維生素D缺乏會誘發COVID-19，也沒有補充預防或預防維生素的研究。治療COVID-19。”\n研究人員還說，儘管某些人群中維生素D含量低的風險與高風險人群中獲得COVID-19的風險存在“重疊”，包括老年人，有色人種和慢性病患者，但這些關聯沒有證明。\n在最近的一項同行評審研究中，研究人員對超過348,000人（包括449名確診COVID-19的人）進行了評估，他們發現維生素D水平與感染風險之間沒有聯繫，也沒有解釋種族感染差異的聯繫。\n\n有關維生素D的更多信息\n簡單的驗血可以檢測您的維生素D水平是否健康或不足。甲水平需要的每毫升20納克或以上，以保持骨健康; 低於12毫微克/毫升稱為缺陷。\n維生素D還有助於調節細胞生長和減輕炎症。一些研究表明它可以幫助預防和治療糖尿病，高血壓和血糖問題，但美國國立衛生研究院認為這項研究並不明確。\n為了維持健康的血液中維生素D水平，醫學研究所建議1歲以下的兒童每天攝入400國際單位（IU）的維生素D，1至70歲的人們則攝入600 IU。70歲以上的人每天應獲得800 IU。\n很少有食物中天然存在維生素D ，但可以將其添加到其他食物中，也可以作為補充食品。三盎司煮熟的鮭魚有570 IUs，而三盎司虹鱒魚有645 IU。一杯2％維生素D強化的牛奶有120 IU。\n但是，在大流行期間，採取更多措施可能是明智的選擇，馬里蘭大學醫學院教授，布萊根婦女醫院預防醫學科主任喬安•曼森（JoAnn Manson）博士說。她在今年早些時候告訴Medscape： “建議的維生素D的飲食津貼為每天600-800 IU，但在此期間，每天含有1,000-2,000 IU的維生素或多種維生素的補充是合理的。”\n現在，曼森（Manson）正在啟動一項臨床試驗，以觀察每天補充4周維生素D是否會減少新診斷出COVID的患者住院和/或死亡的風險。她還在研究服用這種藥物是否會減少他們最親密的家庭接觸者的感染風險。參與者在2天之內每天需要9600 IU，然後在第3到28天要花費3200 IU。\n專家說，每天服用50,000至60,000 IU可能會發生維生素D毒性。過多會導致血液中鈣的積聚，並伴有嘔吐，虛弱，排尿頻繁和心律不齊。\n隨著COVID-19案件的增多，現年45歲的洛杉磯的Tracy A. Pearson是一名博士生和大學僱員，同時擁有法學學位，她開始研究除社交疏散和親身幫助外，還有哪些方法可以降低她的風險-洗滌。\n她患有哮喘，正在接受藥物治療。她的肺部可能很脆弱。她說：“當我感冒時，我經常會得肺炎。” 她很快找到了維生素D-COVID-19研究，並與醫生討論了一下。\n她過去的維生素D水平較低，並且每週服用50,000 IU即可恢復到健康水平，因此她的醫生在對她進行評估後，同意再次這樣做。因此，她每天開始服用比平常多的4,000 IU。她還採取其他預防措施，例如在丈夫處理外事時留在家裡。而且他每天還需要4,000 IU。\n他們在整個大流行中都繼續這樣做。\n皮爾森說：“我天生就是一個解決問題的人。” “我試圖弄清楚如何減輕[風險]。這並不是我進入研究時就想到了'維生素D'。”\n\n二.Healthline.\n\n新研究發現80％的COVID-19患者維生素D缺乏\n\n．一項針對216名COVID-19患者的新研究發現，其中80％的血液中維生素D水平不足。\n．該研究還發現，同時具有COVID-19和較低維生素D水平的人也具有較高的炎症標記物，如鐵蛋白和D-二聚體，這與較差的COVID-19結果有關。\n．另一項研究發現，維生素D水平充足的COVID-19患者死於疾病的風險降低了51.5％，並且並發症的風險顯著降低。\n．醫學專家的理論認為，儘管需要更多的測試，但對於某些人來說，維持足夠的維生素D水平可能有助於降低風險或從嚴重的COVID-19中恢復。\n最近的研究可信來源發現維生素D缺乏與較高的COVID-19風險之間存在相關性。現在，另一項新研究發現了相同的現象-指出超過80％的COVID-19患者血液中沒有足夠的“陽光維生素”水平。\n作為《臨床內分泌與代謝雜誌》上這項新研究的一部分，研究人員對西班牙一家醫院的216名COVID-19患者進行了研究。科學家將患者與另一個數據集的對照進行匹配。\n所有的患者中，82.2％的人維生素d缺乏。\n在這項研究中，男性的維生素D水平低於女性。\nCOVID-19和維生素D含量較低的人也具有較高的炎症標記，例如鐵蛋白和D-二聚體。那些已經已連結可信來源 COVID-19結果差。\n維生素D缺乏者的高血壓和心血管疾病患病率更高。研究表明，他們還因COVID-19而住院時間更長。\n霍恩海姆大學教授Hans Konrad Biesalski博士說，高血壓，糖尿病和肥胖症等合併症與低維生素D狀態有關，他評估了維生素D和COVID-19。\n他告訴Healthline：“看來維生素D狀況不佳的患者可能患有更嚴重的COVID-19”。但是新的研究沒有發現這種關係。\n\n維生素D和COVID-19的恢復\n但是，除了維生素D水平與COVID-19風險之間的相關性外，許多人還在研究它如何保護人們或幫助他們從疾病中康復。\n該研究的共同作者說：“一種方法是識別和治療維生素D缺乏症，尤其是在老年人，合併症患者和療養院居民等高危人群中，這些人群是COVID-19的主要目標人群。”西班牙桑坦德坎塔布里亞大學的何塞•埃爾南德斯（JoséL.Hernández）博士。\n他說，患有COVID-19的高風險人群-老年人，患有潛在疾病的人群以及療養院的人們-可以使用維生素D治療。\n‘’在血液中循環的維生素D水平低的COVID-19患者中，建議維生素D治療，因為這種方法可能對肌肉骨骼和免疫系統都有有益的作用，”埃爾南德斯在一份聲明中說。\n\n保護自己\n許多美國人維生素d缺乏，根據以前的研究。這是全球性的健康問題，其他研究可信來源筆記。\n您是否應該檢查維生素D水平？服用補充劑是否足以保護自己，或者至少降低您獲得COVID-19的機會？\n研究維生素D並領導波士頓大學骨骼保健診所的Michael F. Holick博士說，《內分泌學會實踐指南》不建議對所有人進行篩查。\nHolick告訴Healthline，合理地控制那些患有脂肪吸收不良綜合徵，肥胖症患者或其他醫療問題的人的維生素D水平。\n內分泌學會建議，嬰兒每天應攝入400-1,000 IU，兒童每天應攝入600-1,000 IU，成人每天應攝入600-2,000 IU。所需的數量取決於您當前的水平或您是否嘗試提高它們。\nHolick指出，肥胖的成年人可能需要增加2至3倍。\nBiesalski同意，如果維生素D含量低，補充可能會有所幫助。\nHolick解釋說，有幾篇出版物建議維生素D缺乏與上呼吸道感染（包括流感和冠狀病毒）的風險增加有關。\n他的團隊的研究可信來源在191,000名COVID-19陽性患者中，維生素D缺乏症使罹患該疾病的風險增加了54.5％。\nHolick說：“在所有50個州和所有種族中都觀察到了這種情況。”\n在另一個小書房可信來源 Holick指出，維生素D水平足夠的COVID-19患者死於疾病的風險降低了51.5％，並發症的風險也大大降低了。\n對於患有COVID-19的人，霍里克說，除非一個人患有罕見的疾病，例如結節病和其他肉芽腫性疾病，否則增加維生素D的攝入就沒有任何弊端。\n根據文獻和他自己的經驗，按照內分泌學會的建議，兒童和成人合理攝取足夠量的維生素D有助於降低感染病毒的風險，並降低兒童或成人的發病率和死亡率。他說，它開發了COVID-19。\n得克薩斯大學奧斯汀分校的兒科學教授史蒂文•艾布拉姆斯（Steven Abrams）博士指出，我們不知道維生素D對身體有預防作用。\n他告訴健康熱線說：“非常低的維生素D狀態會帶來很多負面後果，COVID-19可能就是這種情況，但這與說常規補充維生素D可以預防嚴重感染並不相同。”\n\n展望未來\n需要更多的研究來更好地了解維生素D和COVID-19之間的聯繫。\n已經有證據表明攝取足夠的維生素D可以調節免疫系統，從而實現最佳健康。霍利克說，知道與疫苗一起服用維生素D是否會提高疫苗的有效性將是很有趣的。\n他說，比薩爾斯基想知道維生素A和D的平衡將如何影響疫苗的成功，正如針對流感和麻疹所顯示的那樣。\n\n三.Medscape.\n\n維生素D可以預防COVID嗎？我們之前被燒死了\n\n2020年10月28日\n\n在Medscape的冠狀病毒資源中心中找到最新的COVID-19新聞和指南。\n為了清楚起見，此成績單已經過編輯。\n歡迎使用影響因子，這是您對新醫學研究的每週評論。我是耶魯大學醫學院的F. Perry Wilson博士。\n我和維生素D有點愛恨交織的關係。\n簡短搜索我的博客將顯示我如何質疑維生素D與多發性硬化症，腎臟疾病，精神分裂症，跌倒和童年受教育程度之間的關係。\n因此，在COVID時代，維生素D再次出現也就不足為奇了。安東尼•福西博士（Anthony Fauci博士）在這次大流行期間曾有過清醒而負責任的聲音，報告了他個人使用維生素D的情況，這讓我很感興趣。維生素D也是特朗普在沃爾特•里德（Walter Reed）逗留期間收到的總統雞尾酒的一部分。\n我決定在這裡研究數據。但是在我們這樣做之前，我想告訴你為什麼我天生對維生素D研究持懷疑態度。有兩個主要問題：\n1.維生素D含量低與許多因素有關。維生素C缺乏會引起壞血病-很好。但是，低維生素D與從阿爾茨海默氏症到百日咳的一切因素都有關係。它既是世界上最重要的維生素，又是其他重要事物的替代品。\n2.當我們通過隨機試驗測試了所有這些引人入勝的聯繫時，給了一些人維生素D和一些安慰劑，它們幾乎總是沒有效果。\n我有點喜歡查理•布朗（Charlie Brown）在這裡踢足球。維生素D曾經燒過我們。幾個例子：\n多項觀察性研究發現，維生素D含量較低的人更容易患上癌症和心血管疾病。這些都是不錯的研究，適合於適當的混雜因素-整個交易。\n然後，我們進行了26,000名患者的隨機臨床試驗。兩種結果均無影響。\n觀察性研究表明，低維生素D水平與糖尿病的發展有關。然後，我們進行了2400例糖尿病前期患者的試驗。補充維生素D無效。\n觀察性研究發現，維生素D含量低與摔倒有關。在隨機試驗發現沒有這樣的效果。（不過，運動確實可以防止摔倒。）\n維生素D是否能拯救生命？並不是的。該婦女健康倡議試驗隨機36000絕經後婦女維生素D與安慰劑並沒有看到生存利益。\n我並不是說維生素D沒有用途，或者它的益處有限。隨機試驗很少像觀察數據那樣具有戲劇性。但是我想不出另一種在觀察數據和隨機數據之間有如此大的脫節的情況。\n這是為什麼？\n因為您的維生素D水平是您生活類型的標誌，因此很難，真的很難適應。當然，您可以詢問人們獲得了多少陽光和運動，飲食有多變化，賺了多少錢，但是這些都是很鈍的工具。\n好的。牢記所有這些，我們對COVID中的維生素D了解多少？\n就在本週，在《臨床內分泌與代謝雜誌》上，我們從西班牙進行了這項研究，發現在216名住院的COVID-19患者中，有80％缺乏維生素D。僅有40％的對照品缺乏。當然，這些控件沒有住院。實際上，還是生病了。\n但是，好的，更好地學習。早在9月份，即截至10年前的記錄時，我們就從芝加哥進行了這項研究，結果表明，在489位接受過維生素D測試的患者中，維生素D缺乏症的患者患COVID-19的風險高1.77倍。\n在PLOS One中進行的這項研究發現，在235名住院患者中，維生素D含量低於30 ng / mL的患者死亡率為20％，而維生素D含量較高的患者為9.7％。我應該指出，對於某些數據怪異，本文標記為“關注表達”。\n好吧，所以我們進行了多次觀察性研究-安東尼•富奇（Anthony Fauci）大聲喊叫-說我們應該考慮維生素D。\n為什麼不呢？很便宜它具有相當不錯的副作用（儘管我的腎髒病專家擔心腎結石）。\n但是當涉及到COVID時，與低維生素D水平相關的多種因素也與COVID-19感染和嚴重程度有關：年齡較大，BMI，黑人，貧困，合併症。從統計上適當地考慮所有這些東西真的很困難。\n所以我對維生素D不太滿意。我希望進行一次隨機試驗。現在，我們有一個。二，如果你斜視。\n來自西班牙的一項隨機試驗是該試驗。\n一項小型研究（76例住院了COVID-19的患者）被隨機分配為2：1的維生素D +阿奇黴素+羥氯喹（不讓我開始服用）與阿奇黴素+羥氯喹的比例。維生素D組的50人中只有1人去了ICU。將其與非維生素D組的26種藥物中的13種進行比較。\n維生素D組的死亡人數為零，非維生素D組的死亡人數為2。我應該注意，非維生素D組在基線時風險較高，患有糖尿病和高血壓的人群更多。但老實說，正是這種效果的大小令我感到驚訝。我的意思是將入ICU的風險從50％降低到2％？這只是一個驚人的數字。因此，我們處於以下情況：這是一種奇蹟藥物，還是我們不知道的研究存在問題？如今，奇蹟供不應求。\n只是為了給該研究加些冷水，我們有一個仍在預印本中的研究，該研究使用孟德爾隨機法研究了維生素D是否可能與400,000多人的COVID嚴重性有因果關係。\n在本研究設計中，您將遺傳上傾向於維生素D水平較低的人與非維生素D較低的人進行比較。這將生活方式的東西排除在外。有趣的是，遺傳上註定維生素D水平低的人不太可能因COVID-19住院或發生嚴重疾病。尚未經過同行評審，鹽粒等。\n底線？我們知道維生素D水平低的人在COVID-19中有不良結果的高風險。我們仍然不知道補充維生素D是否會改變這種風險。這裡有一些希望，但是生活方式維生素早已燒傷了我們，因此請繼續謹慎使用400個國際單位。\nF. Perry Wilson，醫學博士，MSCE，醫學副教授，耶魯大學應用翻譯研究計劃主任。他的科學傳播工作可以在《赫芬頓郵報》，NPR和Medscape上找到。他發了@methodsmanmd的推文，並在www.methodsman.com上託管了他的交流工作的資料庫。\n參考文獻與資料：\n1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/\n2.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240965\n3.https://www.eurekalert.org/pub_releases/2020-10/qmuo-ctt101320.php\n4.https://clinicaltrials.gov/\n5.https://www.webmd.com/vitamins/index\n6.https://www.researchsquare.com/article/rs-21211/v1\n7.https://www.medrxiv.org/content/10.1101/2020.04.08.20058578v4\n8.https://www.webmd.com/diet/guide/vitamin-d-deficiency\n9.https://imj.ie/vitamin-d-and-inflammation-potential-implications-for-severity-of-covid-19/\n10.https://www.bmj.com/content/356/bmj.i6583\n11.https://pubmed.ncbi.nlm.nih.gov/20592793/\n12.https://www.sciencedirect.com/science/article/pii/S1871402120301156?via%3Dihub\n13.https://clinicaltrials.gov/ct2/show/NCT04536298\n14.https://www.webmd.com/lung/news/20200518/more-vitamin-d-lower-risk-of-severe-covid-19?ecd=wnl_cvd_102820&ctr=wnl-cvd-102820_nsl-LeadModule_cta&mb=hxEvbwELBF19ah1Iz%2fe9viGBU564IW3UVodLxPg2KGo%3d\n15.https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770157\n16.https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa733/5934827\n17.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068797/\n18.https://www.healthline.com/health-new\n19.https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa733/5934827\n20.https://www.medscape.com/viewarticle/939759"],["id","1svz6qt220uu1"],["createdAt","2020-10-30T00:18:55.911Z"]]},{"__iterable":"Map","data":[["replyCount",2],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",1],["user",{"__iterable":"Map","data":[["id","j4S8C_rTHK0CH_t8uT8ZpD6JsxFEKIzr0ilq-rZ0PrQRQTdQI"],["name","耿直的楊梅強尼"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","人類體溫37℃已成為歷史：人類體溫普遍降低意味著什麼？\n\n最近，因為疫情的關係，擔心自己有接觸史或者進行保護性隔離的人，每天都要測三次體溫，很多人都會發現每次測量結果都在36.3-36.7℃左右，夜晚略高。\n\n記得小時候生物課上講過，人的正常體溫大約是37℃，但為什麼身邊所有人的體溫都不到37℃呢？\n\n就在一個月前的1月7日，斯坦福大學醫學院教授朱莉·帕森內特（Julie Parsonnet）和她的團隊剛剛發佈了一項研究成果，發現自19世紀以來，成年人的平均體溫在持續下降，不到200年間下降了0.4℃，從37℃降到36.6℃。\n\n37℃已經成為歷史，而體溫下降並非好事！\n\n1851 年，一位名叫卡爾·溫德利希（Carl Wunderlich）的德國內科醫生，收集了25000 名病人的腋下體溫資料，首次確定了人體正常體溫為37 ℃，這種說法一直延續至今。\n\n但是，近年來，許多科學家認為人類體溫在不斷下降，37℃已經成為歷史。\n\n/ 體溫降低的影響 /\n\n病毒學解密：蝙蝠為何能把上百種病毒封印在體內？根本原因很簡單：蝙蝠免疫系統強大，很大程度上是因為他們體溫能保持較高的40℃。研究顯示，體溫每降低1℃，免疫力就會下降30以上；體溫每升高1℃，免疫力就會提升5~6倍，這麼看的話，蝙蝠的免疫力大概比人類高幾百倍——怪不得蝙蝠百毒不侵，還不會得癌症......\n\n為什麼體溫降低，免疫力也會隨之降低呢？\n\n眾所周知，體溫是和基礎代謝率掛鉤的，體溫每上升1℃，基礎代謝會提高13。體溫過低，可能意味著代謝不好。\n\n反之，基礎代謝率低，體溫下降，血液流速放緩，白細胞的工作效率也隨之變低。慢慢悠悠的白細胞很難在第一時間發現異物，即使發現異物了，也很難迅速召集其他白細胞來消滅異物，導致機體容易感染病毒和細菌，引發疾病。\n\n此外，白細胞不僅能抵禦外部病毒和細菌的攻擊，還能監測到體內的癌細胞，及時把癌變細胞殺死。\n\n其實，即使是健康人，每天體內也會產生約 5000個癌細胞。如果其中一個躲過了免疫系統的監視，倖存下來，很快就會1變2、2變4、4變8...... 最終演化成腫瘤。\n\n據科學家推算，如果體溫下降1℃，免疫力降低30％，則每天免疫系統可能會漏掉近1500個癌細胞，任其瘋狂繁殖。\n\n/ 體溫降低的原因 /\n\n現代人類的體溫為什麼會降低呢？\n\n1、最主要的原因——缺乏運動\n\n科學家分析，人類體溫在170年間下降了0.4℃，近20年的下降幅度尤其大，最主要的原因是缺乏運動。在離我們並不遙遠的50年前，人們每天都要做很多運動：\n\n農村的人要種莊稼或者放牧，即使是城市人群，也會每天手洗衣服、自己做飯、清掃房間；大家出門會優先考慮步行或自行車，閒暇時靠戶外運動打發時間。\n\n然而，隨著科技的發展，人們好像越來越「懶」了——吃飯靠外賣，出門就打車，洗衣服有洗衣機，洗碗有洗碗機，掃地有機器人，隨時可以躺在床上打遊戲，男生打籃球、女生踢毽子的校園場景一去不復返。\n\n基礎代謝與任何外在活動無關，是一個人什麼都不幹的時候的自然消耗，而肌肉是人體內最大的發熱器官。較少的肌肉，意味著較低的體溫和較低的基礎代謝。一個肌肉含量高的人，即使什麼也不做也仍然在消耗能量。現代人運動量的減少，導致肌肉含量普遍偏低。\n\n基礎代謝下降，能量消耗就會減少，內臟脂肪就會增加。而內臟脂肪組織會分泌出超過20種不良激素（或者脂肪細胞因數），會引起血管炎，還會削弱胰島素的功能，從而導致癌症、高血壓、糖尿病等一系列疾病。\n\n2、無處不在的空調，使體溫調節中樞不再敏感\n\n專家認為，除了肌肉品質下降外，空調導致的出汗困難也是現代人體溫下降的一大原因。人們長期在空調屋工作和生活，大腦下丘腦的體溫調節中樞失去了接收刺激的機會，久而久之，體溫調節中樞將對外界溫度不再敏感，從而導致體溫降低。\n\n3、現代人生活壓力大，皮質醇過量分泌導致肌肉分解\n\n此外，越來越複雜的人際關係、財務問題和家庭問題等生活壓力，也和體溫降低有關。在壓力狀態下，人體處於應激狀態，身體會分泌一種叫「皮質醇」的激素來維持正常的生理功能。\n\n但是，皮質醇是一種分解代謝激素，不僅會分解肌肉，還會促進脂肪儲存，優先把脂肪存儲于內臟。生活壓力導致皮質醇長期過量分泌，一邊分解肌肉，一邊儲存脂肪，基礎代謝率一降再降，體溫也就隨之降低。\n\n體溫每降低1℃，免疫力就會下降30以上。人類體溫在170年間下降了0.4℃，意味著我們免疫力下降，大大提高了病毒、細菌感染和癌症的發生率。\n\n我們能做的，就是通過調節日常飲食、加強體育鍛煉、不濫用空調、放鬆心態緩解壓力等方式，從一點一滴的小細節中，適當提升體溫。\n\n/ 通過飲食提高體溫 /\n\n在日常飲食中加入胡椒粉或者辣椒粉。如果你是個「重口味」的人，那麼對於辣椒粉一定非常親切，這種能產熱的調味料能夠迅速提高人體的溫度，它含有一種叫辣椒素的化學物質，不僅能讓你的味覺產生反應，更能在你的消化系統中發揮作用，是一種能讓你急劇升溫的物質。 \n\n吃花生。花生長久以來都是以提高新陳代謝而著名的食物，因此對於減肥的人來說是最佳的小零食。花生中富含碳水化合物，可以當作身體的燃料，當體內碳水化合物增加了之後，身體自然會覺得更加熱一些。\n\n多吃糙米。糙米可以作為很棒的主食來吃，並且還能有效提高身體溫度。糙米中含有很多健康的碳水化合物，能讓你在有飽腹感的同時燃燒多餘的熱量，從而產生溫暖的感覺。\n\n生吃生薑。你可以在餐點中加入生薑，也可以直接生吃，在你用力咀嚼生薑時會有立竿見影的效果——你會感到體內迅速變熱。生薑中含有一種稱為姜辣素的物質，能收縮血管，從而產生熱量。 \n\n喝熱飲或熱湯。任何溫熱的液體都能提高你的體溫。熱飲中的熱量會迅速貫穿全身，讓你的身體在一段時間內處於非常溫暖的狀態\n\n/ 通過運動提高體溫 /\n\n進行日常基礎訓練。鍛煉可以有效提高身體溫度，不過也要小心，在出過汗後身體會重新冷卻下來。規律的鍛煉能提高新陳代謝的速度，進而讓身體增溫，不妨每天早上進行鍛煉，因為在早上提高了新陳代謝後能説明你維持一整天較高的新陳代謝率，也就是說，即便你已經鍛煉完了，你的身體還會持續處於較高的溫度中。\n\n深蹲。所謂深蹲就是將雙腳打開與肩同寬，將雙手搭于腰間，然後彎曲膝蓋、緩慢下蹲，就好像你要坐下來的姿勢一樣，在空中停頓兩秒後回到起始位置。一次做3組，每組20個。\n\n每天運動。每天運動30分鐘就能有效增加身體的熱量，當你在動用繩肌腱和股四頭肌等大肌肉群時，身體自然會燃燒更多熱量，從而提升身體溫度。如果你不喜歡跑步，還可以改成游泳或騎單車，同樣能達到燃脂和提高體溫的效果。\n\n盡可能地多活動身體。抓住一切可以活動身體的機會，即便當你手頭有事在忙也不要放棄。比如增加做家務活的頻率，比如掃地或拖地等等。\n\n/ 保持身體的熱度 /\n\n穿著適宜。能讓你保持身體熱度的衣服種類有很多，如果你感覺出門可能會冷，就多穿一件或者帶一件在身上以防萬一。\n\n和朋友家人們待在一起。不同身體間的熱量傳輸會提高房間的溫度，人類是熱血動物，換句話說，人體自然會釋放熱量，這也解釋了為什麼人多的房間比人少的房間溫度更高。多和其他人待在一起可以説明你從每個人身上傳輸熱量和能量，相互取暖。\n\n讓身體保持乾燥狀態。在洗完澡或者剛淋過雨後，一定要及時擦乾身體來維持體溫，溫度較低的水會迅速吸走你的熱量，讓體溫降低。\n\n如果你淋濕了，儘快換上幹衣服。如果你一直捂在濕衣服裡，體溫會急劇下降。\n\n用吹風機吹幹頭髮的同時給身體增溫。頭部溫度增加後，身體其他部分的溫度也會提高。\n\n/ 讓身體自然地增溫 /\n\n增肌。肌肉會消耗相當多的熱量，即使是在你休息的時候依然不例外，因此，增加肌肉也意味著你對於熱量的需求也在增加。記住這一點，增肌就可以增溫。\n\n不要刻意阻止身體打顫發抖。這些本能性的動作是身體自發調節體溫的方式，當你打顫和發抖時肌肉就會參與進來，繼而提高你的體溫。\n\n增重。這個辦法並不是人人適用的，尤其當你已經屬於超重狀態時。不過話說回來，增加一點體重確實能讓你保持溫暖，那些額外的脂肪能夠起到隔離作用，讓你的身體維持在一個相對較高的溫度。增重最好的方法就是攝入更多的熱量，你需要一個卡路里計算機來計算你需要攝入多少熱量來增加體重。\n\n/ 提升體溫的好處 /\n\n減輕肝腎負擔，微循環系統若得到改善，新陳代謝所產生的廢物便可迅速排除體外，從而減輕肝臟及腎臟的負擔。\n\n增強免疫力，體溫每上升1攝氏度，人體的自然治癒率會增6倍左右，若體溫上升2度，自然治癒率更會增強36倍之高。通過升溫排汗有助於健康。\n\n促進排汗及皮下脂肪的排除，提升人體的新陳代謝功能，將皮脂腺的脂肪排出體外，達到健康與美容，輕鬆變苗條的效果(要注意補充水分)。\n\n排出體內的老舊廢物，主要是體內的代謝廢物。重金屬與致癌物，提高體溫將體內累積的致癌成分”重金屬”排出體外，徹底去除癌症根源。\n\n增強活力，活化新陳代謝、強化營養成分的充分利用、消除疲勞。\n\n改善微循環系統，皮下深層的溫度微升，血流速度加快，微血管擴張。\n\n呼吸的皮膚，使得皮膚呼吸更加旺盛,血液循環順暢，常保健康美麗，光滑細緻。\n\n有效改善睡眠——助眠,睡到自然醒。\n\n在日常生活中，要儘量避免會降低你體溫的活動，比如在寒冷的冬夜外出或者有可能打溼衣服的活動。\n\n瞭解你體溫過低的原因。體溫過低有很多不同的原因，你必須清楚你是否患有某些疾病，才導致你的體溫比正常低。\n\n當你的體溫持續過低、無法提高時，不妨諮詢下醫生，你的新陳代謝方面應該出現了一些問題，需要特別的注意。"],["id","24gc50p30npm4"],["createdAt","2020-03-04T17:56:16.877Z"]]},{"__iterable":"Map","data":[["replyCount",1],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",1],["user",{"__iterable":"Map","data":[["id","j4S8C_XyVBG6ipdIbSfoARU3Ma52A5Tsy8Y3HwtuhlomGXHXY"],["name","↖寬已待人的民雄雪麗↗"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title","Squarespace - Website Expired"],["url","www.americasfrontlinedoctors.com"],["summary","Website ExpiredThis account has expired. If you are the site owner, click below to login."],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","医生做证，推特脸书油管联手封杀为哪般？"],["url","https://mp.weixin.qq.com/s/fbVO06Ldg0Gege7bub7Hzw"],["summary","这三大媒体平台都自称使“公众平台”，人们可以在这些平台上自由发表意见和观点。然而现在，他们居然向专制国家看齐，联起手来封杀与他们不同的观点。这是对美国宪法第一修正案“言论自由”原则的公然践踏！是任何一个生活在这块土地上的人们所不能接受的！"],["topImageUrl",null],["error",null]]}]}],["text","昨天,2020年7月27日,星期一,美國三大社交媒體平臺臉書(Facebook)、推特(Twitter)、油管(YouTube)聯手與線民展開了一場空前激烈的發帖-封貼大戰,帖子的內容不是兇殺,不是暴力,不是色情,不是謠言,而是一群來自全美各地有良心的臨床第一線醫生,站立在首都最高法院大門前,憑著自己親身的臨床實踐, 向美國人民來證明:一個已經被使用了60年的老藥,可以用來有效地醫治去年12月以來令人聞風喪膽、幾乎摧毀了全球經濟的新冠病毒。\n\n這個藥品就是川普總統親自服用並曾經大力推薦的Hydroxychloroquine --- 羥氯喹。\n\n來自南卡羅萊納州的共和黨籍眾議員拉爾夫·諾爾曼(Ralph Norman)參加了醫生的發佈會。\n\n川普總統昨晚與他的8400萬推特關注者分享了該視頻的多個版本。該視頻被刪除之前,在臉書上的觀看次數超過了1400萬,被分享了60萬次;在油管上的觀看次數也超過了4萬次。川普總統發的推特同樣遭到刪除。\n\n根據各地疫情統計,新冠病毒已經造成近15萬美國人死亡。然而這批醫生卻斬釘截鐵地告訴大家:這款廉價的老藥羥氯喹可以有效地使幾乎所有新冠病毒感染者完全恢復健康。\n\n來自加州Santa Monica的兒科醫生羅伯特·漢密爾頓(Bob Hamilton)說:\"總體而言,兒童能夠比較好地應對這個病毒。很少有兒童被感染,那些被感染而需要住院治療的是極低的數位,而且幸運的是病亡率大約在0.2%。 \"\n\n他還指出:「兒童不會傳染給父母,也不會傳染給老師。 \" 他援引蘇格蘭的一位兒童傳染病專家馬克·伍爾豪斯(Mark Woolhouse)醫生的話說:\"全世界還沒有發現到任何一個由學生把新冠病毒傳給老師的病例。 \"\n\n氯喹和羥氯喹均已獲得美國食物藥品管理局(FDA)批准用於治療或預防瘧疾。羥氯喹還被批准用於治療自身免疫疾病,例如慢性盤狀紅斑狼瘡,成人系統性紅斑狼瘡和類風濕關節炎。兩種藥物都已開處方多年。 2020年3月28日FDA曾經頒發了硫酸羥氯喹HCQ和磷酸氯喹CQ的緊急使用授權書(EUA)。\n\n但是6月15日,FDA撤銷了EUA。 FDA表示:根據對EUA的持續分析和新興的科學數據,FDA確定氯喹和羥基氯喹不太可能有效治療EUA中授權用途的COVID-19。另外,鑒於持續的嚴重心臟不良事件和其他潛在的嚴重副作用,氯喹和羥氯喹的已知和潛在益處不再超過授權使用的已知和潛在風險。\n\n臉書發言人向CNN表示:「我們已刪除了該視頻,因為它們分享有關COVID-19的治療方法的虛假資訊,\"他補充說,該平臺正在\"在新聞摘要中向那些對有害,已發表評論或分享有害資訊的人顯示消息我們已刪除了與COVID-19相關的錯誤資訊,將其與WHO揭穿的神話聯繫起來。 \"\n\n醫生們無非是在證明:第一,少年兒童幾乎不會感染新冠病毒,更不會傳染給成人。第二,羥氯喹可以有效治療新冠病毒感人者。如果這些醫生說得不對,你們可以用相反的證據來駁斥。作為媒體平台,你們既沒有一線臨床經驗,又沒有第一手科研數據和疾病統計數據,憑什麼刪掉一線醫生敘述親身經驗的視頻? 你們到底是FDA或WHO的官媒,還是某些利益集團的代言人?\n\n這三大媒體平臺都自稱是\"公眾平臺\",人們可以在這些平臺上自由發表意見和觀點,只要這些意見和觀點不是鼓勵暴力兇殺、宣揚色情、傳播謠言。然而現在,他們居然向專制國家看齊,聯起手來封殺與他們不同的觀點。這是對美國憲法第一修正案「言論自由」原則的公然踐踏! 是任何一個生活在這塊土地上的人們所不能接受的!\n\n下面是記者會醫生講話和與聽眾問答的全部內容:\n\n漢密爾頓醫生:新冠對兒童的致死率是0.2%,而且通常無癥狀。孩子不是這個病毒的傳輸者。蘇格蘭兒科傳染病專家和流行病學家伍爾豪斯(Mark Woolhouse)醫生指出全世界目前沒有一例學生把新冠傳給教師的記錄,全世界! ... 阻礙孩子們去學校的不是科學,是教師工會和美國教育協會,他們就是想要錢。要些錢添加個人防護用品和設施是可以的,但有些要求太荒唐。我從加州來,洛杉磯教師工會(UTLA -United Teachers Los Angeles)要求解散員警! 這和教育有什麼關係?! 他們還要關閉所有的私立學校,而這些學校才是真的在教育孩子。所以,阻止開學的不是科學,也不是為了孩子,而是為了某些成人,教師,和工會。\n\n伊曼紐爾醫生(Stella Emanuel):我在德州休斯頓做內科醫生。我在奈及利亞讀的醫學院,在那裡我用羥氯喹治療過瘧疾病人,所以很了解這個葯。我來這裡是因為過去幾個月我自己治療了350多位新冠病人。他們當中有的有糖尿病,有的有高血壓,有的有哮喘。年紀最大的是92歲,還有87歲,但結果是一樣的。我給他們用羥氯喹,用鋅,用阿奇黴素,現在他們都很好,沒有一個去世。而且,我給自己和我的職工,以及很多我認識的醫生用羥氯喹作為預防,因為早期效果最好。我們每天要看10-15個新冠病人,要給他們輸氧,我們只戴著外科口罩,卻沒有一個染病的。羥氯喹是有效的!\n\n我在治療一個不停呃逆的病人時,查了些資料。我發現國家衛生院(NIH - National Institute of Health)最近就有研究。他們不僅在2005年研究了氯喹的有效性,最近還研究了打嗝和新冠的關係。你可以自己去看,搜索'打嗝和新冠(hiccups and COVID)'你就看到了。他們用羥氯喹治療了打嗝的病人,還證明瞭不停打嗝是新冠的癥狀之一。所以國家衛生院知道羥氯喹對新冠是有效的。我很生氣,因為看到病人痛苦地不能呼吸,認為自己快死了。我擁抱他們,告訴他們一切都會好起來。他們一個都沒死去。\n\n所以如果一些偽科學,一些藥物公司資助的人跑出來說,我們做了研究,羥氯喹無效,我可以明確地告訴你那是偽科學。我想知道是誰資助的研究,誰是後台。如果無效我治療的350多位不可能一個都沒死,而他們都好轉了。我跑到華盛頓DC這裡來,就是要告訴美國人民,這個病毒可以治好,用羥氯喹+鋅+阿奇黴素。可以預防,可以治癒!\n\n那些偽醫生們,別跟我說什麼雙盲試驗,雙盲雙盲,你們聽起來像個機械出了故障。但我是真正的醫生。你們這些放射科醫師,外科整形醫師,還有CNN的神經外科醫師古普塔(Sanjay Gupta),說什麼羥氯喹無效,會導致心臟病。我問你古普塔醫生,你聽著,你治療過一個新冠病人嗎? 你給誰用了羥氯喹導致了他死於心臟病嗎? 當你有了再來跟我說。\n\n每天我在診所里,看到驚恐萬分的病人,有的開車兩三個小時來找我,因為他們那裡的急診醫生很懼怕或不給他們開藥。我告訴你們這些醫生,你們就坐在那裡看著美國人死去,你們就像是那些'好'納粹,所謂的'好'是指那些'好'德國人看著猶太人被殺而不發一聲。\n\n我收到了各種威脅。他們威脅我,還說要向醫學委員會舉報我(以取消其行醫資格),我說我不怕! 我不會讓美國人死去。如果我要被釘在這座山上那就釘吧,我不在乎,你可以舉報我,你可以殺了我,但我不會讓美國人死去。我要告訴美國人民,可以治癒,可以治癒! 所有這些愚蠢的決定和事,都不應該發生。\n\n人一旦死去就回不來了。等著數據的醫生們,如果6個月後數據證明這些藥物是有效的,那死去的人們呢? 該怎麼說? 當人們馬上要死去時,你還在要雙盲試驗? 這是不道德的!\n\n主持醫生:我希望所有在聽的醫生都對自己的病人像伊曼紐爾醫生那麼熱情。另外她談到的國家衛生院的研究,是在病毒學上對當年中國SARS的研究。研究顯示了氯喹的有效性。 15年前當福奇(Anthony Fauci)是國家衛生院院長時發表的。我們現在用的羥氯喹有同樣效果但更安全。新冠與SARS有78%的相似度。\n\n艾瑞克森醫生(Dr. Dan Erickson):我來講講關閉隔離,除了對經濟的影響之外其它方面的影響。它導致一些公共健康問題,有關自殺的熱線電話增加了600%,家暴,酗酒都在上升,不止是人們失去工作。我們應該有一個能長期持續下去的辦法,比如社交距離,口罩等,同時也要開學,要經營業務。我這兒不是沒根據的瞎說,瑞典的死亡率是每一百萬有564人,英國完全關閉隔離,死亡率是每一百萬有600人,說明關閉隔離並沒有大量減低死亡。 \"\n\n主持醫生:大家有問題嗎?\n\n聽眾中有人提到南達科他州。\n\n主持醫生:是的,南達科他州長沒有限制人們獲取羥氯喹,應該是美國唯一的一個州。有些研究說羥氯喹無效,那是不準確的,因為羥氯喹被他們用在了錯誤的時間,以錯誤的劑量給了錯誤的病人。南達科他州疫情很輕,因為人們可以很容易買到羥氯喹。\n\n聽眾中有人說要找政府。\n\n另一位女主持:對。你們需要打四個電話:給你們的州長,你們的兩位參議員,和你們的國會議員。問他們為什麼你們得不到羥氯喹,醫生說這葯可以減低住院率和死亡率,敦促他們讀一讀耶魯大學的傳染病教授瑞實(Harvey Risch)的研究。\n\n聽眾中有人問各種數據到底該信哪個。\n\n主持醫生:新冠病例數幾乎是無關緊要的,因為很多測試並不准確,還有很多是無癥狀或輕微癥狀的。只有死亡數值得關注。如果你在60歲以下,沒有其他疾病,這個病的致死率低於流感。\n\n聽眾:如果你們有資訊給福奇醫生,你們要說什麼?\n\n另一位女主持:聽取前線醫生的意見,和他們見面開會。還有很多醫生不是急診科的,他們在做預防,預防病人進急診。如果你只聽急診和ICU的醫生,而那都是不幸發展成了重症的患者,這樣你並沒有得到資訊的全貌。你應該聽一聽早期的部分。你還應該明白,關閉隔離和恐懼對民眾產生了什麼影響。\n\n伊曼紐爾醫生:我要對福奇醫生說的是,上一次你把聽診器放在一個病人身上是什麼時候? 當你像我們一樣每天面對病人時,你就會明白我們的煩惱。你需要有對美國人民的同情和憐悯之心,就像我們這些前線醫生一樣。他們聽你的,那你就應該給他們希望,你應該給我你已經知道的資訊,就是羥氯喹是有效的。\n\n聽眾:請問伊曼紐爾醫生,你打算發表你治療新冠的顯著效果嗎?\n\n伊曼紐爾醫生:是的我們在做發表數據的事。但我要對醫生們說,是數據讓你去看病人的嗎? 現在病人正在死去,有數據當然好,但別整天數據數據數據。\n\n主持醫生:已經有很多數據了,但主流媒體不報。我們的網站www.americasfrontlinedoctors.com(譯者注:這個網站在我們翻譯時已經和本視頻一起被封殺。 )上有很多數據。所有羥氯喹的治療結果,死亡率,在7月4日那個星期在底特律發表的。重症病患死亡率降低一半,早期用了羥氯喹的估計有一半到3/4的病人不會死。如果都用了這個策略。可以挽救多少生命!\n\n伊曼紐爾醫生:瑞實教授最近發表了數據。他們不需要我的數據做決定。\n\n同一聽眾:幾天前有個9歲女孩死於新冠,據說她沒有其他疾病。你認為這個女孩是死於其他原因嗎? 是不是錯的宣傳?\n\n伊曼紐爾醫生:我無法猜測。我沒見過她,沒看過她的病歷所以說不好。每個人的情況都不同 ...\n\n漢密爾頓醫生:在15歲及15歲以下的年齡段死於covid19的人,他們常常是患有心臟病、哮喘、其他肺部疾病等合併症,所以我不知道,我們不知道這個不幸過世的九歲女孩,她不再和我們在一起,但是可能 ...... 如果你深入研究,背後可能有一個原因。\n\n聽眾 :漢密爾頓醫生,你有見過任何因學校關閉而引發的副作用如抑鬱或自殺的嗎?\n\n漢密爾頓醫生:我的意思是我認為這是常識,當學校不開放時,回憶高中的經歷,你想到聚會,足球賽、社交 ... ... 想想這些,這些都被關閉了。所有的快樂都不見了, 這至關重要的幾年,無法與其他孩子,其他人一起,因為全部關閉了, 隨之引發很多併發問題,我們在談論焦慮,我們在談論沮喪、孤獨、虐待正在發生,以及有特殊情緒的孩子, 孩子也做得不好, 隔離關閉會引發一長串的併發症的。\n\n。\n\n聽眾: 你知道我們聽到的所有這些研究 ... 母親也不能回去上班了因為不敢讓孩子上學,孩子本來就不應該留在家裡,但如果母親回去上班,那麼年老的祖父母就要 ...\n\n漢密爾頓醫生: 是的,這是個大問題,因為人們害怕。並不是說他們的孩子會特別容易染病,因為我認為他們正在瞭解真相。孩子們對感染的耐受性很好。但他們肯定也會考慮到他們的環境,他們獨特的家庭,我認為在某些情況下,這是一種正當擔心的理由。但是作為常規,國家的常規,孩子們應該回到學校。也許有些孩子由於各自的居住環境可能帶來潛在的問題,但對於年幼的孩子,他們並不是將疾病傳染給成人的根源。至於羥氯喹,這是可以使用的。\n\n伊曼紐爾醫生: 好吧,我們談論的是我們不能開門經營我們的企業,我們不能去上學,父母害怕接受治療,我個人已經讓一百多人接受羥氯喹預防治療了,醫生、老師、普通人、醫療工作者、我的員工、還有我自己 ! 我有時一天接待超過15到20個病人,或一天20、15、10位病人,我戴一個醫療口罩,我周圍沒有一個人被感染。這個就是答案。你要重開學校的話,用羥氯喹預防covid-19,每隔一周用一粒葯就足夠了。這就是我們需要讓美國人民瞭解的。我們可以預防,也可以治療的。我們不需要關閉學校,我們不需要關閉我們的生意。\n\n有預防,可治療,與其去談論口罩,與其去談論封閉,與其去談論這些東西,倒不如讓老師用羥氯喹。讓那些高風險的、願意用羥氯喹的人用吧。如果你想染上病毒,很酷呀,但是你應該被允許得到這種藥物來預防的權利。所有我們正在經歷的本都是不必要的,因為羥氯喹有預防作用,它叫做羥氯喹,可以預防covid-19。\n\n聽眾:較早之前,我聽你說藥物是使用過的,但是他們以錯誤的劑量使用了藥物,所以我一直在聽,但是,什麼是正確的劑量?\n\n伊曼紐爾醫生: 是的,您要去問您的醫生,我再請一位醫生也談一下。\n\n爾佐醫生(Dr Urzo) :這個問題問得好。因為對這種藥物的恐懼已經影響了整個政治局勢,這種恐懼已經影響到了這種藥物,所以讓我們重申一點,這種藥物是超級安全的。它比阿司匹林、布洛芬、泰諾更安全。它是超級安全的! 問題是,在這些研究中,他們在全國範圍內用了非常高的劑量, 用的劑量非常大。他們做了重新定義式的研究,一致性的試驗,也就是世界衛生組織的試驗。還有康復試驗,第一天他們就使用2400毫克的劑量,其實預防性你只需要200毫克,每周兩次。而他們使用了過量的中毒式的劑量,猜猜他們發現了什麼? 當你使用過量的中毒式的劑量,那你必然會得到中毒式的結果,當你使用引發中毒式劑量時,藥物當然不會起作用,好吧!\n\n這是一種非常安全的藥物。它集中在肺部,在肺部的濃度是其他部位的200到700倍。它是一種神奇的藥物,在血液中不會去到那個高水準,但肺部會,所以你會發現自己獲得了預防性,一旦病毒到達那裡它將很難通過,因為羥氯喹阻止它了。一旦病毒進入,它就不會會讓病毒複製。實際上,當服用鋅時,鋅就會攪亂被稱為RDRP的複印機制所以結合藥物,它本身在早期疾病中非常有效。它在預防方面非常有效。所以我希望這回答了你的問題。\n\n戈爾德醫生(Dr Gold):是的,我想強調爾佐醫生所說的,因為我喜歡這個問題。這是一種非常簡單的治療方案,它應該讓美國人使用。目前困難的就是因為政治,醫生不能給它開處方,藥劑師也不能釋放它。他們有權否決醫生的意見,這就是為什麼你在櫃臺上買不到它。你可以在世界幾乎所有的地方買到,在拉丁美洲、伊朗、印尼、撒哈拉以及南非,你都可以自己去買。我的朋友,用量是200毫克,一星期兩次,然後每天服用鋅,就是這個劑量! 我贊成在櫃臺上就可以買到(非處方),把它給人民,把它給人民!\n\n聽眾:再問兩個問題,誰可以將訊息準確回答我?\n\n詹姆斯醫生(Dr. James):我是詹姆斯醫生,我想對戈爾德醫生剛才說的做一些補充:似乎有一種針對羥氯喹的精心策劃的攻擊。你什麼時候聽說過一種藥物會引起如此大的爭議? 一種有65年歷史的藥物,多年來一直屬世界衛生組織安全基本藥物的清單,是的,這在許多國家/地區遇到了麻煩,我們看到的是很多錯誤資訊。所以我與人合作撰寫了第一份關於羥基氯喹作為冠狀動脈潛在療法的檔。這是在3月份,這在某種程度上引發了一系列的風暴。從那以後,對像我們這樣的醫生進行了大量的審查。我說的是,我們中的一些人已經被審查了。我們共同撰寫的那個google文檔,實際上,是被google刪除的。現在很多研究已經表明它是有效的,安全的,但你還是看不到那篇文章。\n\n還有一個錯誤的資訊,不幸的是這已經達到了醫學的最高等級。在五月,有一篇文章發表在《柳葉刀》上,這是世界上最負盛名的醫學雜誌之一。\n\n因為這項研究,世界衛生組織停止了所有羥氯喹的臨床試驗。只有像我們這樣的獨立研究人員才會關心病人,關心真相,深入研究並確定,實際上那些數據是偽造的,不真實的。所以我們做得非常有說服力,以至於這項研究在發表后不到兩周就被《柳葉刀》撤銷了。這幾乎是聞所未聞的! 尤其是對於這麼大規模的研究,所以我向所有人道歉,因為那裡存在著太多的錯誤資訊, 不幸的是,尋找真相困難重重,我們需要在其他地方尋找真相。 \n\n這就是為什麼我們在這裡組建一線醫生組織,以設法幫助獲得真實資訊的原因。我是詹姆斯·塔塔羅博士。是的,我大部分的想法都是在推特上發表的,這個推特最近很不錯,但我也有一個網站。\n\nmedicineuncensored.com 它包含了很多關於羥氯喹的資訊,我認為比其他媒體管道的報導更加客觀。\n\n聽眾:這很重要,因為我不僅從醫生那裡瞭解到,而且從其他媒體人士那裡得知,YouTube實際上是遮罩了許多特別是關於羥氯喹的資訊的。\n\n詹姆士醫生:讓我簡明地重申這個問題,我要說的是Facebook和YouTube採取了最嚴厲的措施來壓制和審查人們。這是來自YouTube的首席執行官和馬克·紮克伯格,發表任何與世界衛生組織言論相悖的言論都會受到審查,我們都知道世界衛生組織在這次大流行中犯了很多錯誤。無論如何,他們都不是完美的。 Twitter雖然有一些缺陷和缺陷,並也標記某些內容,但仍是最自由的對話平臺之一,我們對這些資訊進行了明智的討論,今天在座的許多人實際上通過這樣的社交平台媒體聯繫在一起的。\n\n聽眾:您能談談您之前提到的藥物治療嗎? 它已經存在有多久了?\n\n喬-拉塔坡醫生(Dr. Joe Latapo):當然,我是喬-拉塔坡醫生。我是加州大學洛杉磯分校的一名內科醫生,同時也是一名臨床研究人員。我只是代表我自己,而不是代表加州大學洛杉磯分校。所以我想說的是,我想到的是那些正在幕後看此廣播的人們,我想與大家分享。因為存在著太多爭議,氣氛充滿了衝突。現在,這群醫生正在嘗試做的事情, 從根本上講,是為了讓大家更清楚地了解我們是如何應對covid19這個巨大的挑戰,這就是我們的最終目標,併為事物帶來亮光,意味著更多地考慮取捨。 \n\n我的一個同事說意外後果,實際上我認為那甚至不是正確的詞,正確的詞是\"未預料的後果\"。真的,想想我們在這個特殊的時代所做的決定的影響,我相信人們聽到了一些關於羥氯喹的討論並好奇這些醫生在說些什麼? 他們是照顧病人的醫生,有醫學認證,醫學院,很棒的醫學院。所有這些,他們怎麼可能這麼說? 我可是收看CNN和NBC的,這些媒體對此隻字未提啊。這就是問題的關鍵,有些問題是道德問題,那真的應該有一個單一的聲音,你知道! 所以對我來說,關於人們是否因性別、種族或性取向而受到不同對待的問題,我認為這些都是道德問題,在這些問題上只有一種立場。但Covid-19不是一個道德問題,Covid 19是一個具有挑戰性的複雜問題,我們可以從多角度來看待它。所以,當每個人都只能從一個渠道聽到一種觀點時,這對美國人民是不好的。這樣做毫無預警,大多數人聽到的觀點是羥基氯喹不起作用。是的,這是大多數人在主流電視上聽到的觀點。\n\n聽眾:所以我的問題 ... 我仍然沒有得到明確的答案,我想知道關於您的同事所說的,由於學校關閉和政府關閉而導致自殺性上升、焦慮、濫用和其他各種問題的增加。我想知道是否應該將聯邦資金分配給一線工人、社會工作者、心理健康治療師。\n\n醫生:問題的答案是:傷害已經來臨,我們應該如何處理這種傷害,我不知道政府的內部運作方式,但實際上傷害已經來臨了,我們必須要做些有意義的事,所以對我來說,作為一名醫生,如果你和我都知道我們已經被車碾過了,當然是要先去醫院,所以以我的職業來說 ...\n\n聽眾:是的,能夠幫助這些孩子,我認為這很有意義。\n\n記者:大家好,這裡是《布萊特巴特新聞(Breitbart News)》,我們將繼續為您帶來\"醫生小組\"的發言。感謝你收看。請繼續關注,我們遲點回來。抱歉有點過度曝光,扯掉我的麥克風了。但是我們將回來。\n\n請關注Facebook上的《Breitbart News》,關注我們的Facebook, Instagram,Twitter,當然還有我們的網站 Breitbart.com,當然還有YouTube,請繼續關注。我們很快就會回來。祝大家好。\n\nhttps://mp.weixin.qq.com/s/fbVO06Ldg0Gege7bub7Hzw"],["id","muysjqeduq56"],["createdAt","2020-08-01T23:53:02.262Z"]]}]}],["relatedReplies",{"__iterable":"List","data":[{"__iterable":"Map","data":[["article",{"__iterable":"Map","data":[["replyCount",1],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",10],["user",{"__iterable":"Map","data":[["id","j4S8C_radM0R0lg3ej61cFs2ShTKmTlJUjaHe8l2AYO2rsEyE"],["name","寬厚的新市韋恩"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","非常非常重要！\n\n COVID-19\n\n去年我們近乎兒子或侄子的年青胸腔專科大夫被醫院調去Dallas專治Covid病人一年。以下是他剛回家的報導\n\n去年在美國醫院擔任加護病房，一般病房和診所醫師。加起來大概看了近1000多個新冠病毒的病人。\n\n回想我不知這段時間如何撐過來的。生理疲憊可以復原，但是內心煎熬常揮之不去。我看到許多病人被病痛折磨。生離死別家人卻不能在身邊，因為隔離。其中我醫學啟蒙導師因爲新冠肺炎，過世。\n\n現在台灣的疫情讓我非常憂心。在此跟台灣的朋友和家人提醒跟分享我們一路走來的經驗。\n\n新冠肺炎對身體的影響\n\n- 新冠病毒是非常複雜和難治的病毒。有些人完全沒有症狀，但是有些人喪命。沒有辦法預測和判斷。至今我們不知為何有些人沒事，但是有些人的症狀很嚴重。\n\n- 一般大眾認識的新冠病毒是肺部感染。新冠病毒破壞肺部組織。剛開始肺充滿水，因為強烈免疫系統對抗病毒的反應。然後肺慢慢纖維化。部分病人因為嚴重的纖維化，造成氣胸。\n\n這些過程不可逆，所以很多即使從新冠肺炎康復的病人一輩子活在缺氧和呼吸困難(病人形容跟溺水的感覺一樣)。他們需要長期大量的氧氣治療。有些病人形容生不如死。如此大量的氧氣只有醫院和照顧中心可提供，所以一部分康復的病人至今無法回家。必須在醫院或長期照顧中心。還有一部分人需要氣切，靠呼吸器維生。\n\n一些年青人即使新冠病毒康復，但是他們的肺已受損(根據他們的肺臟功能測試)。現在他們或許不覺得有症狀，但是他們50或60歲的時候，他們的呼吸症狀就出現。\n \n- 新冠病毒常引起血栓。血栓的位置不僅在肺，任何一部分都可能發生。這是為何新冠病毒的病人發生心臟病和中風。即使用抗凝血劑無法完全避免，甚至造成出血的副作用。這些無數小的血栓在肺部造成更進一步地缺氧。\n\n- 新冠病毒對腎臟有很大的損害。至今沒有一個好的醫學解釋。這造成腎功能下降，身體鹽分過高。一部分的人需要洗腎。\n\n- 新冠病毒還有對其他器官造成嚴重的影響。至今沒有好的科學解釋，例如很多人的腦功能受到嚴重影響。我們需要更多的臨床研究\n\n可能的對新冠病毒治療\n\n- 雖然過去這一年研究各種新冠病毒的治療法包含Remdesivir, IL-6 antagonist Actemra, IVIG, convalescent plasma, monoclonal antibody , etc…但是真正有用的藥或許只有類固醇。以上的藥很多被W H O認證沒有很有效。通常這些藥只對初期病發的病人有效。最有效的方式還是預防。\n\n- 目前沒有有效的治療方法。預防，預防，再預防，是唯一的方法。\n\n 建議採取的方法\n\n- 新冠病毒的傳播速度非常快，如野火燎原。若不早點撲滅，馬上會來不及。應該用盡所有資源阻止病毒傳播 (台灣已錯失先機，所以不在這細談)\n\n- 大量篩檢，提早知道感染，提早隔離，避免傳下一個人。美國深深受到這個教訓。當初沒有大量篩檢或普篩造成社區感染一發不可收拾。美國30,000,000病例和500,000犧牲生命，這是最主要原因。\n\n- 社交距離和口罩是美國降低感染率和死亡率的主因。疫苗發展之前- 遠端上課，上班 (這對台灣社會非常大的影響，畢竟台灣產業結構跟美國不一樣，但是我建議能遠端上課或上班，能做的盡量做)\n \n- 小孩及年青人雖然對新冠病毒的影響不會太大(很多是無症狀患者)，但是他們可以傳病毒給長者。美國當初用正確方法，強調年青人不回去看望他們祖父母。顧慮把病毒傳染給老人們。這就是在家上課和上班的重要性。減少傳遞病毒。通常美國很少三代同堂。實行起來比台灣容易。\n\n- 疫苗，疫苗，還是疫苗，科學發現以色列跟美國即使疫苗接種只有15 -20%，新冠病毒的病例大量下降。一般科學需要70 %的接種才有如此效果。這值得進一步研究。這是非常好的消息，代表只要我們馬上開始接受疫苗，不久將來新冠病毒的病例就會在台灣減低。\n\n現在美國疫情轉好，生活慢慢恢復正常。有時午夜夢回的時候，我夢到跟病人一樣躺在病床呼吸不過來。希望台灣醫護人員不用經歷到我的經驗。\n\n希望以上資訊可以幫助我台灣的同胞，朋友和家人。一起努力對抗新冠病毒，期待光明的明天。\n\n以上我簡短的經驗報告，還有非常多的資訊和經驗沒有提到。應家父要求，我匆匆寫此文。有機會再寫詳細的一篇。\n\n敬請原諒錯別字和不流利的中文。\n\nLeon Tung"],["id","31n3fon914j71"],["createdAt","2021-05-26T06:54:08.758Z"]]}],["reply",{"__iterable":"Map","data":[["id","tUL0rXoBgBgcuemXI6IW"],["user",{"__iterable":"Map","data":[["id","AVriAlOoyrDaTqlmmqhC"],["name","Lin"],["avatarUrl",null],["level",22]]}],["type","OPINIONATED"],["text","此為投書，新冠肺炎確實有可能造成血栓以及凝血功能障礙。"],["reference"," \nhttps://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(21)00105-8/fulltext?utm_campaign=lancetcovid21&utm_content=166785715&utm_medium=social&utm_source=facebook&hss_channel=fbp-374651963469&fbclid=IwAR3q3e6oCu7ur13JZoSqumqoteCGTYelrJxlAvLtTtH7fOqVRVKnRiT5pG0#.YKIfqCVJvbw.facebook\n\nhttps://www.storm.mg/article/3689095?page=2"],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title","DEFINE_ME"],["url","https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(21)00105-8/fulltext?utm_campaign=lancetcovid21&utm_content=166785715&utm_medium=social&utm_source=facebook&hss_channel=fbp-374651963469&fbclid=IwAR3q3e6oCu7ur13JZoSqumqoteCGTYelrJxlAvLtTtH7fOqVRVKnRiT5pG0#.YKIfqCVJvbw.facebook"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","觀點投書：美國台裔醫生給COVID-19醫護人員的經驗分享及鼓勵-風傳媒"],["url","https://www.storm.mg/article/3689095?page=2"],["summary","過去這一年在美國醫院加護病房，一般病房，和診所，種種加一起大概也看了將近1000多個新冠病毒的病人。回想起來，我不知道這段時間是如何撐過來的。生理的疲憊可以復原，但是內心的煎熬常常揮之不去。我看到許多病人被病痛折磨，生離死別家人卻不能在身邊因為隔離的因素。其中一個我醫學啟蒙導師，"],["topImageUrl",null],["error",null]]}]}],["createdAt","2021-07-16T06:14:56.025Z"]]}]]},{"__iterable":"Map","data":[["article",{"__iterable":"Map","data":[["replyCount",1],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",38],["user",{"__iterable":"Map","data":[["id","j4S8C_3WKC9KPW2pJr1iEx-vaIYoQJJ8rLGCy5PGYhlQQT44o"],["name","辦事仔細的✿杉林✿拜爾德"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","COVID-19\n過去這一年在美國醫院擔任加護病房，一般病房，和診所醫師。種種加一起大概也看了將近1000多個新冠病毒的病人。回想起來，我不知道這段時間是如何撐過來的。生理的疲憊可以復原，但是內心的煎熬常常揮之不去。我看到許多病人被病痛折磨，生離死別家人卻不能在身邊因為隔離的因素。其中一個我醫學啟蒙導師，也過世於新冠肺炎。現在台灣的疫情讓我非常憂心。在此跟台灣的朋友和家人提醒跟分享我們一路走來的經驗。\n\n新冠肺炎對身體的影響\n- 新冠病毒是一種非常複雜和難治療的病毒。有些人完全沒有症狀，但有些人失去生命。沒有辦法去預測和判斷。至今我們也不知道為什麼有些人沒事但有些人有很嚴重的症狀。\n- 一般大眾對新冠病毒的認知是肺部感染。新冠病毒會破壞肺部組織。剛開始的時候肺部充滿水分因為強烈免疫系統對抗病毒的反應，然後肺部會慢慢纖維化。部分的病人會因為嚴重的纖維化造成氣胸，這些過程是不可逆的。所以很多即使從新冠肺炎康復的病人一輩子都生活在缺氧和呼吸困難的狀況(病人形容跟溺水的感覺一樣），需要長期大量的氧氣治療。有些病人形容生不如死。如此大量的氧氣，只有醫院和照顧中心可提供。所以有一部分康復的病人，至今無法回家，必須要在醫院或長期照顧中心。還有一部分人需要氣切，靠呼吸器維生。一些年輕人即使從新冠病毒康復但是他們的肺臟已受損（根據他們的肺臟功能測試）。現在他們或許不覺得有症狀。但是到他們50或60歲以上的年紀，他們的呼吸症狀就會出現。 \n- 新冠病毒常常引起血栓。血栓的位置不僅與肺部，身體的任何一部分都可能發生。這就是為什麼新冠病毒的病人會有心臟病和中風的原因。即使使用抗凝血劑也無法完全避免，甚至造成身體出血的副作用。這些無數的小的血拴在肺部造成更進一步地缺氧。\n- 新冠病毒對腎臟有很大的損害。至今沒有一個好的醫學解釋。他會造成你腎功能下降，身體鹽分過高。一部分的人需要洗腎。\n- 新冠病毒還有對其他器官造成嚴重的影響。至今沒有一個好的科學解釋，例如很多人的腦功能受到嚴重影響。我們需要更多的臨床研究\n\n可能的對新冠病毒治療\n- 雖然過去這一年，人類去研究各種新冠病毒的治療方法包含Remdesivir, IL-6 antagonist Actemra, IVIG, convalescent plasma, monoclonal antibody , etc….. 但是真正有用的藥, 或許只有類固醇。以上的藥有很多被W H O認證沒有很有效。通常這些藥只對初期病發的病人有效。最有效的方式還是預防。\n- 目前沒有有效的治療方法。預防，預防，再預防，是唯一的方法。\n\n建議採取的方法\n- 新冠病毒的傳播速度非常快，如野火燎原，不早點撲滅的話，就馬上會來不及。應該用盡所有資源阻止病毒傳播（台灣已錯失先機，所以不在這細談）\n- 大量篩檢，提早知道感染，提早隔離，避免傳給下一個人。美國深深受到這個教訓。當初沒有大量篩檢或是普篩，造成社區感染一發不可收拾。美國有30,000,000病例和500,000犧牲生命，這是最主要原因。\n- 社交距離和口罩是讓美國感染率和死亡率降低的主要原因，在疫苗發展之前。\n- 遠端上課，上班（這對台灣社會非常大的影響，畢竟台灣產業結構跟美國不一樣，但是我會建議能遠端上課或上班，能做的盡量做） \n- 小孩及年輕人雖然對新冠病毒的影響不會太大。很多是無症狀患者。但是他們依然可以傳遞病毒給長者。美國當初使用正確方法，強調年輕人不要回去看他們的祖父母，怕會把病毒傳染給他們。這就是在家上課和上班的重要性。減少傳遞病毒。（通常在美國，很少三代同堂。實行起來比台灣容易）\n- 疫苗，疫苗，還是疫苗，科學上發現一個現象，在以色列跟美國，即使疫苗接種只有15 -20%，新冠病毒的病例大量下降，一般科學上需要70 %的接種才有如此效果。這值得我們進一步研究。這是非常好的消息，代表說只要我們馬上開始接受疫苗，不久將來新冠病毒的病例就會在台灣減低。\n\n現在美國疫情轉好，生活也慢慢恢復正常了。但是有時午夜夢回的時候，我夢到自己跟病人一樣躺在病床上呼吸不過來，從夢中驚醒過來。希望台灣醫護人員，不用經歷到我的經驗。\n\n希望以上資訊可以幫助我台灣的同胞，朋友，和家人。一起努力對抗新冠病毒，期待光明的明天。\n\n\n以上是我的簡短經驗報告，還有非常多的資訊和經驗沒有在此提到。應家父的要求，我匆匆寫了此文。有機會再另外寫詳細的一篇。敬請原諒錯別字和不流利的中文。\n\n\nLeon Tung "],["id","11ces4fac3u0y"],["createdAt","2021-05-19T10:38:56.342Z"]]}],["reply",{"__iterable":"Map","data":[["id","rKk4k3kB9w1KR1IkOcY1"],["user",{"__iterable":"Map","data":[["id","m6nNh3kB9w1KR1Ik_7so"],["name","Seal Liu"],["avatarUrl","https://www.gravatar.com/avatar/3c65b8e6e3f17be73902cdf35b46c928?s=100&d=identicon&r=g"],["level",3]]}],["type","NOT_RUMOR"],["text","The lancet 今年四月的一篇review，新冠肺炎確實有可能造成血栓以及凝血功能障礙哦！"],["reference","https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(21)00105-8/fulltext?utm_campaign=lancetcovid21&utm_content=166785715&utm_medium=social&utm_source=facebook&hss_channel=fbp-374651963469&fbclid=IwAR3q3e6oCu7ur13JZoSqumqoteCGTYelrJxlAvLtTtH7fOqVRVKnRiT5pG0#.YKIfqCVJvbw.facebook"],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title","DEFINE_ME"],["url","https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(21)00105-8/fulltext?utm_campaign=lancetcovid21&utm_content=166785715&utm_medium=social&utm_source=facebook&hss_channel=fbp-374651963469&fbclid=IwAR3q3e6oCu7ur13JZoSqumqoteCGTYelrJxlAvLtTtH7fOqVRVKnRiT5pG0#.YKIfqCVJvbw.facebook"],["summary",""],["topImageUrl",null],["error",null]]}]}],["createdAt","2021-05-22T08:36:46.009Z"]]}]]},{"__iterable":"Map","data":[["article",{"__iterable":"Map","data":[["replyCount",1],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",34],["user",{"__iterable":"Map","data":[["id","j4S8C_RbLZGXqaz3tzNLpVzDq90lcUKHvPVYIJSmpo-Ml6BeY"],["name","興趣廣泛的林口托比"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","如果想打疫苗的參考一下\n\n\n國際四大醫學期刊之一的《新英格蘭醫學雜誌》（The New England Journal of Medicine）整理了關於疫苗的Q&A，讀者可以參考後，與自己的醫師根據自身狀況討論，再決定是否要/是否可以施打疫苗。\n\n首先要知道，目前市面上可以施打的疫苗大致上可以分成兩個種類，mRNA疫苗跟腺病毒載體疫苗。\n\n輝瑞/BioNtech與莫德納疫苗屬於mRNA疫苗，注射後，mRNA被注射部位的巨噬細胞吸收，並指示這些細胞製造棘蛋白，棘蛋白就會出現在巨噬細胞表面，誘導身體起免疫反應。\n\nAZ疫苗跟嬌生疫苗則屬於腺病毒載體疫苗，是由實驗室中提取新冠病毒的DNA序列，讓其穩定後由腺病毒攜帶，注射疫苗後，腺病毒無法複製，但其遺傳物質可以進入宿主細胞轉換成mRNA，製造出棘蛋白抗原，引起宿主反應，過程模擬Covid-19的自然感染機制，抗體跟細胞免疫都會被誘發。\n\nQ: 疫苗能持續多久？需要補打嗎？\n由於疫苗測試從2020年夏天才開始，疫苗保護力可以持續多久尚沒有明確的資訊。\n\n以莫德納疫苗的第一期試驗為例，試驗結果表明抗體大約能持續四個月左右，滴度會隨時間過去輕微下降。（注射時間愈長，免疫效果愈弱）由於尚未確定疫苗可持續的時間，目前不建議增加劑量或補打。不過各大藥廠的確正在研發加強劑量的疫苗，以及針對變種病毒進行防護的疫苗。\n\nQ: 接種了疫苗，就不會把病毒傳給別人了嗎？\n新興證據表明，已接種疫苗者「較不容易」把病毒傳染給別人。\n\n在以色列進行的大型研究中發現，已接種者無症狀感染病毒的機率比未接種者減少了90%。此外，在接種疫苗後仍被感染的人群中，病毒量似乎也比未接種者來得低。嬌生疫苗的研究發現接種後第29天，接種疫苗組出現18例無症狀感染，而安慰劑組則是50例，也就是疫苗組少了66%。\n\n可以合理假設，無症狀感染數少，病毒傳播的機率就會降低（無症狀者會到處跑，所以傳播機率高）。這讓人看到疫苗抵禦病毒感染跟減少傳播的希望，而疫苗政策背後的動機，也多是為了控制傳染數。\n\n即使疫苗降低了病毒傳播的可能性，我們不能說「打了疫苗就不會傳給別人」，因為保護效果永遠不會達到100%。\n\n因此，在新病例減少，而且大部分人都接種疫苗以前，政府單位有責任繼續向大眾強調，接種了疫苗不代表其他的防護措施就不需要了，在公共室內空間仍應繼續戴口罩，保持社交距離、不去人多的地方仍是重要且必須遵循的政策。\n\nQ: 疫苗真的安全嗎？過了幾年會不會有後遺症啊？\n無奈的是，由於疫苗發展進行時間很短，目前只有幾個月的時間研究後續，而不是好幾年。\n\n輝瑞跟莫德納的疫苗試驗都是從2020年夏天開始，嬌生則是2020年9月才開始。不過以過往其他病毒的疫苗為例，嚴重的不良反應通常會在幾天或幾週內就發生。\n\n幸運地是，根據長期研究的結果，目前世界上大部分疾病的疫苗長期副作用非常少見，當然新冠疫苗的長期副作用要等到數年後才能確定。接種疫苗後病人的資訊都會被蒐集並集中分析。\n\nQ: 針對不同族群，是否有建議施打的疫苗品牌？\n目前輝瑞疫苗可以讓16歲以上人群施打，而AZ、莫德納和嬌生則是18歲以上人群才能施打。\n\n一開始疫苗很少的時候，醫界呼籲所有成人都可以施打各牌疫苗，不過現在已經開始有比較明確的建議，尤其是AZ和嬌生疫苗施打者，都有部分被誘發血栓性血小板減少症（TTS）的症狀，尤其年輕女性出現此狀況的機率特別高，因此臨床醫師建議50歲以下的女性最好使用輝瑞或莫德納等mRNA疫苗。\n\n而對於施打mRNA疫苗者，一旦施打了第一劑，就應該按照醫生給予的第二劑預約時間施打「相同品牌」的第二劑疫苗。現在完全沒有關於第一劑和第二劑使用不同廠牌疫苗的安全報告。\n\n不過CDC表示若真的無法獲得第一劑使用的廠牌時，只要與第一劑施打時間間隔28天以上，就可以使用不同廠牌的mRNA疫苗。雖然仍應該「盡可能」不要使用不同廠牌的疫苗，但如果同是mRNA疫苗「理論上」是可行的。而對第一劑mRNA疫苗有嚴重過敏反應者，CDC建議在醫生監控下給予嬌生疫苗進行第二劑施打。\n\n\n\nQ: 打疫苗有禁忌嗎？\n目前施打Covid-19疫苗唯一的禁忌，是已經知道自己對疫苗成分有超敏反應的人不能打。CDC明確指出禁打疫苗的族群如下：\n\n先前施打Covid-19疫苗或曾服用任何疫苗成分後，出現嚴重過敏反應者\n先前施打Covid-19疫苗時，出現立即性的過敏反應（不管嚴重程度），或對任何疫苗成分有過敏史者\n對任何其他疫苗/注射療法曾有過過敏史者，則不在禁打疫苗之列，但有過敏史者應該由醫療人員在施打Covid-19疫苗後密切觀察至少30分鐘。如果有人在施打第一劑mRNA疫苗後出現嚴重過敏反應，則不應該再施打第二劑mRNA疫苗。不過，建議四週後可以在嚴密監控下施打嬌生疫苗。\n\n而如果在施打第一劑mRNA疫苗後，出現嚴重疼痛，或其他非過敏性症狀，則必須自己決定是否要施打第二劑。醫生不會禁止，但第二劑的副作用可能會更嚴重。（不過要注意，曾經感染Covid-19的人通常會回報第一劑的副作用比第二劑更嚴重，這很可能是因為他們的免疫系統已經準備好要對付Covid-19疫苗）。\n\n如果擔心第二劑疫苗的副作用很嚴重，一種解決方法是在施打完第二劑，疼痛開始發作時就馬上服用布洛芬（ibuprofen）或醋氨酚（acetaminophen）等止痛藥。不過不建議在施打疫苗前就進行投藥，因為理論上它們會減弱疫苗引發的抗體反應，讓產生抗體的效果變差。\n\n用於治療Covid-19的單克隆抗體（monoclonal antibodies）或恢復期血漿（convalescent plasma）可能會降低疫苗的效用。任何曾經接受這些療法的人必須至少等90天以上再進行疫苗施打，考慮到這段時間這些療法會進入半衰期，而已得過Covid-19的人三個月內再度被感染的機率也極低。這一建議已被加到CDC指南的臨床考量中。\n\nQ: 孕婦或哺乳婦女可以施打疫苗嗎？\n孕婦和哺乳者出於安全考量都沒有被包含在Covid-19疫苗試驗中，因此沒有相關的安全數據。然而CDC建議醫療系統可以提供孕婦和哺乳者施打疫苗的機會，而這兩個群體可以自己決定是否要施打。美國婦產科醫學會（American College of Obstetricians and Gynecologist）和母嬰醫學會（Society for Maternal-Fetal Medicine）都同意這個觀點，而這兩個學會都是婦產科界的權威。目前輝瑞針對孕婦研發的疫苗已經在試驗階段。\n\n而嬌生在疫苗試驗階段同樣排除了孕婦、哺乳婦女，以及近期有懷孕計畫的婦女。在研究過程中，有8名婦女懷孕，疫苗組跟安慰劑組各4名，兩組都有出現少數妊娠不良反應，但是樣本實在太少，很難說是由於疫苗或研究引起的。\n\n不過由於年輕婦女較可能出現血栓反應，而且懷孕期間發生血栓的機率本來就很高，歐美醫界目前偏向給予懷孕跟哺乳婦女mRNA疫苗，而非AZ或嬌生疫苗。\n\n理論上，mRNA疫苗不會對懷孕婦女、發展中的胎兒或者哺乳中的嬰兒造成傷害。\n\n懷孕的大鼠在接受莫德納疫苗後，也沒有出現與胎兒或胚胎發育有關的隱憂。而懷孕期間接種疫苗的一項潛在好處，是抗體可以經由胎盤傳給胎兒，這也是建議孕婦可以接種百日咳疫苗的主因，最新的病例也表明Covid-19抗體確實可以透過胎盤傳給肚子裡的胎兒，理論上也能保護新生兒免於被感染。\n\n孕婦必須知道懷孕期間感染Covid-19或流感，重症的機率特別高。孕婦可以根據這項事實，自己感染Covid-19的機率（例如工作性質），以及目前已知的疫苗風險（雖然資料很少）自己判斷是否想要接種。不過，接種疫苗仍應是孕婦的選項之一，畢竟過去也未曾限制孕婦施打流感疫苗，孕婦應該跟婦產科醫師充分討論所有有關問題與疑慮再下決定。\n\nQ: 如果我已經出現相關症狀，或病得很重，還可以接種疫苗嗎？\n如果你已經出現Covid-19相關症狀，或病得很重，則不能接種疫苗，需要推遲到康復以後再進行接種。不管懷疑是Covid-19感染，或者跟Covid-19無關，只要有疾病症狀，都最好先不要接種。不過，患有慢性病且症狀穩定的人則可以接種。例如患有慢性阻塞性肺病（COPD）、長期呼吸困難或發炎性腸道疾病（IBD），以及有腸胃道症狀的人，是可以施打Covid-19疫苗的。當然，在施打疫苗之前必須跟醫師進一步討論可能的疑慮。\n\nQ: 我很害怕疫苗的副作用，怎麼辦？\n止痛藥跟退燒藥，例如布洛芬跟醋氨酚可以有效控制疫苗接種後的副作用，包括注射部位疼痛、肌肉痛跟發燒等。\n\n但是這些藥物建議在注射結束後出現症狀時再使用，不要在注射前「預防性投藥」，以免使抗體效果下降。由於仍有少數的過敏風險，疫苗施打的場所必須嚴格注意並有辦法評估及治療可能造成生命威脅的過敏反應。\n\nQ: 我曾經跟確診人士近距離接觸，趕快打疫苗可以避免感染嗎？\n很遺憾，目前沒有任何證據表明與確診個案接觸的人，緊急接種疫苗可以預防感染。由於Covid-19的平均潛伏期為5天，疫苗反應速度不太可能快到可以產生抗體。因此，曾經接觸過確診個案的人，應該好好完成14天的隔離，再施打疫苗。\n\nQ: 我已經得過Covid-19又康復了，還需要打疫苗嗎？\n是的，你還是應該接種疫苗。臨床試驗中有一部分人已經有Covid-19的抗體，而疫苗試驗在這群人當中是安全有效的。\n\n由於得到Covid-19再康復後，90天內再次被感染的機率非常低，有些Covid-19康復者可能希望推遲施打疫苗的時間，不過就算你希望可以早點打，這也不是禁止的。不過曾經接受單克隆抗體或恢復期血漿治療的患者則一定要等90天以上才能施打疫苗，因為這些治療方式可能會讓疫苗失效。\n\n須注意的是，曾經得過Covid-19的康復者，在施打第一劑疫苗時，可能伴隨更明顯的全身性副作用，因為身體的免疫系統對此病毒並不陌生。這也表明曾經得過Covid-19的患者自身的免疫抗體是「主要的」，而疫苗則是「增強用」，因此有些學者認為曾得過Covid-19的康復者不需注射第二劑疫苗，但並非所有免疫學家都認同。目前，CDC仍然建議兩劑疫苗都要施打。\n\n對於要不要打疫苗這件事，只能說避免大規模傳染需要一定人口接種，但由於疫苗上市後後續研究時間還不長，每個人應該根據本身的風險與身體因素，與醫師充分討論後再決定是否施打。\n奧\n（參考資料：The New England Journal of Medicine、CDC）"],["id","x4w5aa29720"],["createdAt","2021-05-24T12:58:07.066Z"]]}],["reply",{"__iterable":"Map","data":[["id","GUIxRnoBgBgcuemXQ1K7"],["user",{"__iterable":"Map","data":[["id","AVriAlOoyrDaTqlmmqhC"],["name","Lin"],["avatarUrl",null],["level",22]]}],["type","NOT_RUMOR"],["text","對任何其他疫苗/注射療法曾有過過敏史者，不在禁打疫苗之列，但有過敏史者應該由醫療人員在施打Covid-19疫苗後密切觀察至少30分鐘。"],["reference","https://www.cw.com.tw/article/5114811"],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title","Attention Required! | Cloudflare"],["url","https://www.cw.com.tw/article/5114811"],["summary",""],["topImageUrl",null],["error",null]]}]}],["createdAt","2021-06-26T02:41:11.618Z"]]}]]},{"__iterable":"Map","data":[["article",{"__iterable":"Map","data":[["replyCount",1],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",4],["user",{"__iterable":"Map","data":[["id","j4S8C_SZoPJHAzjGKZjRMsWgBJp90jB7hc_m9ogOFmsBu60SY"],["name","生動的小港迪夫"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title",""],["url","https://save.org.ar/wp-content/uploads/2021/07/Resultados-preliminares-Efectividad.pdf"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title",""],["url","https://web.archive.org/web/20210701200320/https://save.org.ar/wp-content/uploads/2021/07/Resultados-preliminares-Efectividad.pdf"],["summary",""],["topImageUrl",null],["error","UNKNOWN_UNFURL_ERROR"]]},{"__iterable":"Map","data":[["title",""],["url","https://www.argentina.gob.ar/salud/coronavirus-COVID-19/sala-situacion"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title",""],["url","https://doi.org/10.6084/m9.figshare.13550030."],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title",""],["url","https://figshare.com/s/71288d0d1686f368da0f."],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title","ページが見つかりません"],["url","https://drive.google.com/file/d/1fymghdkfzmbdxrzzbmne0hytg70jscxw/view?usp=sharing."],["summary","ウェブワープロ、プレゼンテーション、スプレッドシート"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","COVID-19 Protocols | FLCCC | Front Line COVID-19 Critical Care Alliance"],["url","https://covid19criticalcare.com/covid-19-protocols/"],["summary","The MATH+ Hospital Treatment Protocol for Covid-19 is a physiologic-based combination treatment regimen created by leaders in critical care medicine."],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","http://ivmmeta.com."],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title"," - YouTube"],["url","https://www.youtube.com/watch?v=MN3CSKMTXBG."],["summary","YouTube でお気に入りの動画や音楽を楽しみ、オリジナルのコンテンツをアップロードして友だちや家族、世界中の人たちと共有しましょう。"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title"," - YouTube"],["url","https://www.youtube.com/watch?v=RWGECBWCMK4."],["summary","YouTube でお気に入りの動画や音楽を楽しみ、オリジナルのコンテンツをアップロードして友だちや家族、世界中の人たちと共有しましょう。"],["topImageUrl",null],["error",null]]}]}],["text","(翻譯)\n我希望接種疫苗不會冒犯。\n但這些信息可以拯救你所愛的人。\n這是官方的：與敘述相反, 接种疫苗的人死亡比未接种疫苗的人多6倍\n, 根據阿根廷衛生部的一項研究.\n\nCOVID+ deaths:\nSputnik: 11%\nAstraZeneca: 14%\nSinopharm: 14%\n未接種: 2%\n\n有100％有效和安全的治療，為什麼使用實驗和致命的疫苗？ (看下文 “如何治愈COVID”)\n\n讓我們小心：分享這條消息來拯救生命.\n\n接種疫苗就是自殺: 解釋在下面(400科學引文)\n\nFederico Nazar\n+5491141662100\n\n資料來源：\n衛生部（阿根廷）。研究全國疫苗接種運動在降低 60 歲及以上人群 COVID-19 死亡率方面的有效性. 2021 年 6 月 30 日. 表格1：疫苗分析中包含的記錄頻率。主辦單位：阿根廷疫苗接種和流行病學學會 (SAVE)。https://save.org.ar/wp-content/uploads/2021/07/Resultados-preliminares-Efectividad.pdf\n\n如果他們審查、更改或刪除上述網站：https://web.archive.org/web/20210701200320/https://save.org.ar/wp-content/uploads/2021/07/Resultados-preliminares-Efectividad.pdf\n\n阿根廷官方統計數據截至 2021 年 05 月 07 日\n確認的COVID +: 4,535,473\nCOVID +死亡人數: 95,904\nhttps://www.argentina.gob.ar/salud/coronavirus-COVID-19/sala-situacion\n\n注意低死亡率, 儘管有疫苗, 由於更多地使用有效藥物(下面詳述)和由於那些具有更多危險因素的人死亡。\n-------------------------------------------------- -------------------------\n\n接種疫苗後的投訴，根據歐洲官方數據(EuraVigilance)和美國(VAERS):\n\n- 20,000死亡\n\n- 1,000,000住院\n\n- 3%住院(FDA)\n\n兩地衛生機構公開承認疫苗會導致血栓形成(這是由激素避孕藥引起的血栓形成加強的).\n\n傷殘率和死亡率高到丹麥、挪威和芬蘭已經停, 例如, Oxford / AstraZeneca疫苗.\n\n所有 COVID 疫苗都是實驗性的: 他們只有緊急使用的臨時授權. 沒有一種疫苗被批准。\n\n在其緊急批准中, 從來沒有對不孕症和流產進行隨訪. 不使用 ivermectin (伊維菌素) 治療 COVID 會影響男性生育能力. 類似 COVID 的刺突蛋白或反應, 疫苗產生的, 通過相同的機制會影響男性生育能力. 接種疫苗後有數百人流產.\n\n數以千計的月經量過多的投訴(血小板生成問題).\n\n所有 COVID 疫苗都與嘗試流產有關, 通過流產嬰兒的細胞系, 無論是在開發、生產還是質量控制方面。\n以上, 疫苗效力低：根據阿根廷的官方數據，儘管接種了疫苗，仍有 43,000 人死於 COVID。\n\n儘管據稱疫苗短缺, 他們正在為從 COVID 中康復的人打疫苗: 這是禁忌的如果他們在不到 3 個月前感染了COVID並且有更高的嚴重不良反應和死亡率.\n\n給康復的人接種疫苗是沒有用的: 他們比接種兩個劑量的疫苗的人具有更好的免疫力. 不要被愚弄, 免疫力不是通過抗體來衡量的, 其水平在 3 至 6 個月之間自然下降, 但通過長期免疫, 例如, in B和T淋巴細胞.\n\n必須明白:\n\na) 如果你之前得過了COVID, 疫苗不會提供任何好處但會確實帶來死亡的風險.\n\nb) 如果你之前沒有得過了COVID, 疫苗也不會提供任何好處, 100% 有效和安全的治療方法已經可用了. 以及 43,000人死於 COVID, 接種疫苗後, 顯示, 即使你接種了疫苗, 你還是需要治療:\n證據：英語, 400科學任命解釋如何治愈 Covid和為什麼不要接種疫苗:\nhttps://doi.org/10.6084/m9.figshare.13550030.\n\n西班牙語，雖然沒有那麼完整和更新：\nhttps://figshare.com/s/71288d0d1686f368da0f.\n\n如果您接種了一劑疫苗, 不要接種第二個. 你正在用你的健康和生命玩俄羅斯輪盤賭，卻沒有機會贏: 接種疫苗沒有任何好處, 別的安全的治療方法已經有了.\n沒有先說明疫苗的風險和並且已經存在有效且無風險的治療方法就侵犯了知情同意權, 這使得完全沒有必要接種實驗疫苗。\n伊維菌素(Ivermectin) (COVID的現有治療方法之一)將摧毀腐敗政府(所有國家都一樣)和製藥行業已經談判過的每年1700億美元的生意. 因此，自2020年6月對其有效性進行科學驗證以來，伊維菌素的傳播被阻止(是的，Covid 造成的所有死亡本來都可以避免的).\n\n如何治愈COVID?\n\n協議Dr. Héctor Carvallo, 全球先鋒:\nhttps://drive.google.com/file/d/1fymghdkfzmbdxrzzbmne0hytg70jscxw/view?usp=sharing.\n\nFLCCC 協議, 地球上最新最專業的團體 (英語):\nhttps://covid19criticalcare.com/covid-19-protocols/\n\n家庭治療信息:\n\n伊維菌素(Ivermectin).\n\n它是最有效的藥物，據 WHO, PAHO, FDA, FLCCC, BIRD UK, 2歐洲國家，幾十個省，幾千個直轄市，幾十萬醫生，幾百萬病人。\n\n它是一種廣譜抗病毒藥物 (20 種 RNA 和 DNA 菌株，包括登革熱和寨卡病毒), 避免病毒錨定在紅細胞的 CD147 受體中和 ACE2 受體.\n\n科學測試:\nhttp://ivmmeta.com.\n\n如果您懷疑患有 COVID或者您與患有 COVID 的人有密切接觸: 1滴/1公斤 (看你的體重. 例如:體重:50公斤, 服用50滴). 與傳單所指示的不同對於 Covid，最好在食用含脂肪食物（披薩、肉、巧克力）後立即服用伊維菌素. 提高生物利用度. 酒(服用伊維菌素時不要喝超過一杯的葡萄酒或啤酒).\n\n如果您有兩個 COVID 症狀或嗅覺或味覺完全喪失: 2滴/1公斤.\n\n如果您發燒或咳嗽, 3滴/1公斤.\n\n如果您呼吸困難或在 90附近飽和, 4滴/1公斤.\n\n24小時後重複, 但如果症狀沒有改善, 每12小時重複一次. 然後，每天一次，持續 5 天或更長時間, 只要COVID症狀持續. 血漿濃度不應超過相當於每公斤 10 滴.\n\n6毫克(mg)丸: 每滴/公斤更換每30公斤一粒.\n阿奇黴素(Azithromycin) 500 mg每天, 繼續5天: 它為伊維菌素提供動力通過避免將病毒錨定在 ace2 受體上.\n\n如果您感到咳嗽或缺氧, 布地奈德(budesonide)和霧化布洛芬酸鈉(sodium ibuprofenate) (看腳註) 並根據症狀的嚴重程度每天服用阿司匹林. 與食物或胃保護劑一起服用. 如果病人患有胃潰瘍，則未指明: 那麼應該使用另一種藥物.\n\n維他命D: 你需要至少 15 分鐘的陽光照射.\n\n維他命A, 最重要的是維他命D: 每天, 容器中指示的劑量.\n\n網上搜索含鋅(zinc)食物: 會減少病毒的細胞複製.\n\n維他命C: 柑橘類水果.\n\n不要使用撲熱息痛(paracetamol). 布洛芬(Ibuprofen)可以慎用, 但是在退燒的時候, 始終檢查您的健康狀況及其對藥物的反應(有一打... 例如, 褪黑激素, 看上面的英文研究).\n\n在整個疾病只去提供伊維菌素的醫院: 曾經在住醫院, 一些醫生/護士不讓病人服用伊維菌素, 因不良醫療行為導致病人死亡(必須被送上法庭，以免他們繼續因疏忽而殺人?). 服用Dr. Carvallo的IDEA協議, 沒有一個病人死於 Covid (伊維菌素ivermectin +地塞米松dexamethasone +依諾肝素enoxaparin +阿司匹林aspirin). Youtube上搜索Lanata Carvallo.\n\nCall: +5491141662100\nFederico Nazar.\n\nCovid Rescue (Covid救援).\n\n科學進步的基礎\n你的時間捐贈(分享此信息) 或金錢可以讓您接觸更多人以挽救生命和經濟。\n分享救人。.\n\n重要的\n這不是醫學適應症，而是參考期刊中科學研究的總結。\n伊維菌素是安全的，但應始終諮詢醫生以避免自我用藥錯誤並防止其他拮抗藥物或某些可能使既往疾病惡化的藥物.\n\n不應該給孕婦吃或體重低於 15 公斤的兒童.或 3歲以下的兒童. 有其他替代品，如布諾洛芬酸鈉(sodium ibunoprofenate).\n\n不幸的是，有些醫生沒有在這方面更新, 主要是因為他們不能或沒有時間閱讀英文的科學參考書目.\n\n如果您附近沒有免費提供布洛芬酸鈉(sodium ibunoprofenate)的藥房, 聯繫我們尋求幫助(布洛芬酸鈉sodium ibunoprofenate簡單又便宜, 是用布洛芬和碳酸氫鈉做的).\n\nIbuprofenosoluble.org\n可霧化布洛芬酸鈉sodium ibunoprofenate的效果不如伊維菌素ivermectin, 但它可以加速清除呼吸道中的病毒並有助於消炎.\n\n口服給藥標準\n\n-風險病人: 感染初期症狀\n-其他病人在持續發燒和呼吸困難的最初症狀之前.\n\n配方准備\n病人姓名\n身份证\n診斷\nRP /布洛芬ibuprofen (作為鈉鹽sodium salt) 50 mg / 1 ml.\n滴劑\n15 ml滴管容器, 20 ml (或根據患者需要 x 數量)\n\n簽名和醫生印章\n免費提供布洛芬酸鈉sodium ibunoprofenate的藥店(阿根廷):\n1.Carlina Tommasi: San Antonio de Areco bs as.\n2. Leticia Robles: Concordia Entre Ríos\n3. Ingrid Zubiri: La Paz Entre Ríos.\n4. Gustavo Pousset: Castelar Zona Oeste\n5. Fabián Troina: San Miguel del Monte. Prov de Bs As.\n6. Laura Laborde: Vicuña Mackenna Cba.\n7. Alejandra Berlari: Tandil, Buenos Aires\n8. Ana Krieger: Tandil, Buenos Aires.\n9. Farmacia Vignolo indiana: Santa Fe Capital\n10. María Gabriela Jovanovich, Cañuelas, Bs As\n11. Farmacia Rasetto - San Nicolás bs as\n12. Farmacia prieto quilmes Buenos aires\n13. Farmacia Peiró, Santa Fe\n14 Franco Aguilar, San Miguel de Tucuman\n15 Farmacia SeSeVi, Paraná, Entre Ríos\n16 Mariela Loiza, Rosario Santa Fe\n17 Cintia Verkuyl, Tres arroyos, Buenos Aires\n18. Paliza Ángel José, Ushuaia TDF\n19. Silvina Cardoso, Casilda Santa Fe\n20. Farmacia Mónica Asinari, Santa Fe capital\n21. Sandra Chiesa, Junín.\n22. Octavio Cirelli, Santo Tomé, Santa Fe.\n23. Farmacia Grial, Bella Vista, Corrientes\n24. Farmacia Colla Daniel, San Carlos Centro, santa fe.\n25. Farmacia Mainero Héctor ( Rafaela.Santa fe)\n26. Farmacia Estuardo Romero. Fernando Romero. General Roca. Río Negro\n27. Silvia Julián. La Rioja\n28. Carolina Pizarro Funes sur de Santa Fe\n29. Silvana Busilacchi. Chabas. Santa Fe\n30. Marcelo Salatino. ROSARIO\n31. Patricia Nieto, Farmacia Nieto, Bahía Blanca\n32. Farmacia Lavie, La Plata\n33. Farmacia Melgar, La Plata\n34. Farmacia Yuln, La Plata\n35. Farmacia de la Cruz, Junín de los Andes, Neuquén\n36. Farmacia Carlos Paz - Carlos Paz, Córdoba \n37. Farmacia Dosis - Villa Angela, Chaco\n38. Farmacia Mondino- Porteña, Córdoba \n39. Farmacia Magistral Rodríguez. Comodoro Rivadavia.Chubut\nProtocolo de uso\n40 .Farmacia Gómez .La Plata \n41. Silvina Resta Farmacia Fialco Quilmes \n42. Farmacia VaninBa Timofiejuk. Villa Minetti. Santa Fe. \n43. Farmacia De Cristófano, Albarellos, Santa Fe\n44. Farmacia Farmathenea. CABA\n45. Farmacia Martinez. Tres Arroyos. Bs. As\n46- Farmacia Rosa Mistica La plata ( lo entrego gratuitamente ). \n47 farmacia scozziero Funes Santa fe.\n48.Farmacia Martoglio Villa María Cba\n49. Farmacia Fiorilli, Castelar\n50. Farmacia Berola, San Antonio de Areco, Bs As\n\n-預防: 1 ml霧化布洛芬50 mg (或滴的等價物)每12小時. 在不超過 2.5 ml 的等滲生理溶液中稀釋.\n-輕度肺炎病人: 1 ml霧化布洛芬50 mg (或滴的等價物)每8小時. 在不超過 2.5 ml 的等滲生理溶液中稀釋.\n- 急性雙側肺病病人: 1 ml霧化布洛芬50 mg (或滴的等價物)每6小時. 在不超過 2.5 ml 的等滲生理溶液中稀釋.\n\n可溶性布洛芬(soluble ibuprofen)的性質:\n\n-抗炎抑制(可逆抑制COX1和COX2), (促聚合體的血栓素部分抑制, 血管收縮劑和促炎劑), (維持 PGI2 的合成和釋放).\n-降低ROS的濃度(氧反應性物種).\n-鹼化軟肺介質.\n-有利於在肺部快速釋放一氧化氮。\n-殺病毒特性。.\n-殺菌特性\n- Ca ++ 螯合劑和粘蛋白流化劑。\n-減少 LTB4.\n-通過霧化直接引入肺部。\n\n科學和培訓信息\n-培訓法律方面和掌握配方(配方與技術) 在College of Pharmacéutics of CABA\nhttps://www.youtube.com/watch?v=MN3CSKMTXBG.\n\n-證據臨床病人 SR JESUS\nhttps://www.youtube.com/watch?v=RWGECBWCMK4.\n"],["id","2tjpknzmbkkqf"],["createdAt","2021-07-21T11:58:09.635Z"]]}],["reply",{"__iterable":"Map","data":[["id","h4sHVYQBv5it-Cx_Jsh3"],["user",{"__iterable":"Map","data":[["id","AVriAlOoyrDaTqlmmqhC"],["name","Lin"],["avatarUrl",null],["level",22]]}],["type","RUMOR"],["text","指揮中心專家諮詢小組召集人張上淳說，經專家會議討論，認為整體證據不足，不建議常規使用治療。\n\n雖然伊維菌素在體外試驗的時候，似乎對於病毒有些效果，但仔細去看，它需要的濃度非常高，並不是體內可以達到的濃度。許多人都希望老藥新用可以在治療中扮演一些角色，但目前為止只有少數研究，樣本數不大，且統合分析研究還沒有證據顯示伊維菌素可以降低新冠並還死亡率、插管率，也沒有可以加速病毒的清除，縮短住院天數等，所以包括WHO、歐盟都沒有建議要常規使用這藥物，用於治療武漢肺炎感染。\n美國FDA也明白告訴民眾，不應該自行購買伊維菌素治療新冠肺炎。"],["reference","https://newtalk.tw/news/view/2021-06-17/590233\nhttps://www.storm.mg/article/3749403\nhttps://www.cna.com.tw/news/ahel/202106140122.aspx\nhttps://newtalk.tw/news/view/2021-06-14/588928"],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title","mRNA疫苗技術發明者｢後悔打莫德納｣：萬一未來證明有安全問題？ | 國際 | 新頭殼 Newtalk"],["url","https://newtalk.tw/news/view/2021-06-17/590233"],["summary","全球武漢肺炎疫情未歇，美國正大規模施打疫苗，然而，mRNA疫苗技術發明者之一的馬龍博士（Dr. Robert Malone）卻質疑美國官方FDA等機構強推施打卻未考量mRNA疫苗的副作用，而日前馬龍在Podcast談話中曾說「我後悔打了疫苗」，他提到自己和妻子都曾非常信任並注射了莫德納mRNA疫苗，"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","這款老藥能醫新冠肺炎？張上淳：美國FDA籲不要買來治療-風傳媒"],["url","https://www.storm.mg/article/3749403"],["summary","對於新冠肺炎（武漢肺炎）患者治療，中央流行疫情中心指揮官陳時中表示，抗寄生蟲藥物伊維菌素Ivermectin經過專家會議討論後，將不建議使用。針對近日國外有研究指出，使用抗寄生蟲藥物伊維菌素Ivermectin用來治療新冠肺炎，中央流行疫情指揮中心專家諮詢小組召集人張上淳表示，專"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","伊維菌素治療武漢肺炎？專家會議否決常規使用 | 生活 | 中央社 CNA"],["url","https://www.cna.com.tw/news/ahel/202106140122.aspx"],["summary","近期有國際期刊指出，抗寄生蟲老藥「伊維菌素」可治療武漢肺炎。指揮中心專家諮詢小組召集人張上淳今天說，經專家會議討論，認為整體證據不足，不建議常規使用治療。"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","抗寄生蟲藥「伊維菌素」不納治療指引！張上淳：自行服用恐有副作用 | 生活 | 新頭殼 Newtalk"],["url","https://newtalk.tw/news/view/2021-06-14/588928"],["summary","本土疫情嚴峻，近日在網路上掀起討論，關於抗寄生蟲藥物伊維菌素（ivermectin）治療武漢肺炎是否有好的成效，各界專家學者也建議可將有用的新藥納入治療指引。對此，指揮中心專家諮詢小組召集人張上淳表示，經專家會議討論，不建議使用該藥物治療武漢肺炎，民眾也不應自行購買藥物服用，以免造成傷害。張上淳表示"],["topImageUrl",null],["error",null]]}]}],["createdAt","2022-11-08T02:17:22.810Z"]]}]]},{"__iterable":"Map","data":[["article",{"__iterable":"Map","data":[["replyCount",2],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",5],["user",{"__iterable":"Map","data":[["id","j4S8C_6hI7sX-8Sh1trBhPXBBvSR5c6RYc2wQCmkxKhtITBuQ"],["name","富創造力的新埤克萊斯特"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","【轉發】加州大學舊金山 BioHub 小組關於 COVID-19 的討論會小結，2020 年 3 月 10 日\n\n與會者：\n\n• 喬·德里西：UCSF的頂級傳染病研究員。陳扎克伯格生物中心（涉及UCSF/伯克利/斯坦福的合資企業）聯席總裁。在非典疫情中使用的芯片的共同發明者。\n• 艾米莉·克勞福德：新肺特別工作組主任，診斷專家\n• 克里斯蒂娜·塔托：快速反應總監，免疫學家\n• 帕特里克·艾斯庫：領導疫情應對和監測，流行病學家\n• 查茲·蘭格利爾：UCSF傳染病醫生\n\n下面基本上是小組成員發言原汁原味的記錄。少數不是原話會寫在括號中。\n\n• 主要觀點：\n\n在目前時點，美國已經錯過了遏制期，遏制基本上已是徒勞的了。我們的遏制努力不會減少在美國感染的人數。\n現在，我們只能努力減緩傳播速度，幫助醫生們應對需求高峰。換句話說，遏制的目標是平緩曲線，以降低需求激增的峰值，減弱對醫院的衝擊程度。並爭取時間，希望藥物可以盡快開發出來。\n目前社區中有多少人已經感染了病毒？沒人知道，我們正在從遏制階段轉到醫護階段。\n\n美國目前處於意大利一周前的時點，我們沒有任何理由可以說我們將能避免發展到像意大利那樣。\n\n在未來12-18個月中，40%-70%的美國人口將感染COVID-19。達到這個水平後，你可以開始獲得一些抗體。與流感不同，這病毒對人類是全新的，因此全球人口沒有潛在的免疫力。 [貝克實驗室在3月1日晚餐上也告訴我感染率估計為30-70％]\n\n[我們用這個的數字來估計死亡人數——表明大約150萬美國人可能會死亡，小組成員並不反對我們的估計。相比之下，季節性流感平均每年有5萬美國人死亡。假設50%的美國人口，即1.6億人感染新肺, 在未來12-18個月中，160萬美國人將死亡，死亡率為1%。約10倍於流感死亡率。這個估計是基於未來沒有開發出有效治療藥物的假設。\n死亡率因年齡而異， 80歲以上死亡率可能為10-15%。\n我們不知道COVID-19是否是季節性的，但即使夏天能消退，它可能會像1918年的流感那樣在秋天又復發。\n\n我只能明確地告訴你兩件事，一，在情況好轉之前情況肯定會變得更糟；二，我們至少明年還會面對此病毒，明年我們的生活會和以前很不一樣。\n\n• 我們現在該怎麼辦？你能為你的家人做什麼？我們知道在潛伏期也可能是有傳染性的，但不知道在症狀出現之前傳染性有多強，但症狀最強時病毒傳染性也最強。我們目前認為，在症狀出現前2天到出現後14天（T-2至T+14），感染者俱有傳染性。\n\n病毒能在體外存活多長時間？在物體表面上，根據不同表麵類型，目前認為能存活 4-20 小時（也可是能幾天），對此仍沒有共識。\n該病毒非常容易被常見的抗菌清潔劑消滅：漂白劑、過氧化氫、酒精。\n\n要避免去音樂會、電影院、任何擁擠的場所。我們已經取消了商務旅行。\n\n要做好基本的衛生，如洗手和避免觸摸臉。\n\n提前儲存好你的常用處方藥，許多連鎖藥店的供應鏈在中國，製藥公司通常儲備有2-3個月的原材料，因此，若中國製造業中斷，可能儲備會耗盡。\n\n注射常規肺炎疫苗可能會有所幫助，不預防COVID-19，但降低你身體變弱的機率，降低得COVID-19後惡化的可能性。\n\n明年秋天請一定要接種流感疫苗，雖然不能預防COVID-19，但同樣能減少你身體變弱的機率，降低得COVID-19後惡化的可能性。\n\n我們會建議任何60歲以上的人都呆在家裡，除非萬不得已請不要出門。美國CDC內部也一直在在討論是否應規定60歲以上的人不得乘坐商業航空飛機出行。\n\nUCSF同仁們正在將自己的高齡父母從養老院等遷回到自己的家裡，不讓他們走出家門，家裡的其他成員一進家門必須先洗手。\n\n新肺病毒感染的三條途徑：手到嘴/臉；唾沫/氣溶膠傳播；糞便到嘴的傳播。\n\n• 如果有人生病怎麼辦？如果有人生病，讓他們呆在家裡並避免與任何人接觸。任何在醫院裡能做到事，你在家裡也都能做到。大多數人病狀是溫和的，但是，如果他們病情變重，或者是70歲以上的老年人，或本來就有肺或心血管問題，必須帶他們去看急診。\n迄今為止，COVID-19沒有辦法治療。醫院能提供的只是支持性護理（如靜脈輸液、吸氧氣），幫助你維持生命，靠自己的免疫力戰勝病毒，預防敗血症。\n如果病人到了危重症期，你可以嘗試讓他們申請服用Remdesivir作為“同情用藥”，該藥物目前同時在舊金山總醫院、UCSF、和中國做臨床試驗。你需要聯繫在那兩個醫院裡的醫生，申請加入臨床試驗。 Remdesivir 是一種來自 Gilead 的抗病毒藥物，在靈長類動物中表現出對中東呼吸綜合徵的有效性，目前正在做針對 COVID-19 的人體試驗。如果試驗成功，明年冬天可能上市，因為擴大藥物的生產規模比開發疫苗要快得多。\n\n為什麼老年人的死亡率要高得多？你的免疫系統在50歲以後會下降，\n死亡率與病人之前是否有基礎疾病密切相關，尤其是呼吸道或心肺疾病。這些基礎疾病在老年人中概率較高，老年人患肺炎的風險也較高。\n\n• 能否對所有人都做 COVID-19 檢測？不現實，因為沒有足夠的測試能力。原因如下，目前除了 PCR 測試之外，沒有其他測試可以區分COVID-19與流感或其他十幾個正在傳播的呼吸道病菌。聚合酶鏈反應（PCR）測試可以檢測 COVID-19 的 RNA。然而，我們仍然對測試的準確性沒有信心，即我們不知道假陰性的發生率。\n\nPCR 測試需要帶試劑的套件，並且需要臨床實驗室來處理試劑盒。\n雖然可以迅速擴大試劑套件生產規模，但實驗室處理能力不能很快增加。領先的臨床實驗室公司Quest和Labcore每天能為全美國處理1000個試劑盒，擴大實驗室處理能力需要時間、建築空間和設備、還要通過認證，很難在短期內建好。 UCSF 和加州大學伯克利分校已將其研究實驗室捐贈出來處理試劑盒，但每個實驗室每天只能處理 20-40 個試劑盒，並且尚未獲得臨床認證。其他新的測試方法也在嘗試中，但目前還沒成熟，測試能力也都很小。\n\n• 美國社會對這個疾病的衝擊做好準備了嗎？\n醫院正在增加收治能力， UCSF的帕納蘇斯校區在停車場搭起了帳篷，他們把病房改造成負壓的，這是控制病毒所必需的。他們正在考慮重新開放關閉的錫安山的設施。\n關閉學校是最大的社會衝擊之一，在關閉學校（特別是小學）之前，我們需要認真權衡得失，因為會有連鎖反應。如果小學生不上學，那麼一些醫院工作人員要照看子女而不能來上班，這降低了病人激增時醫院的救治能力。\n\n美國的公共衛生系統具有應對持續數週的短期疫情的能力，如腦膜炎的爆發。但沒有能力應對持續數月的疫情，必須找到其他解決辦法。"],["id","1iui5yyxkww1a"],["createdAt","2020-03-17T18:16:54.254Z"]]}],["reply",{"__iterable":"Map","data":[["id","jwSk7HABrhVJn3LN-mhW"],["user",{"__iterable":"Map","data":[["id","r_6F7mcBP8WrztivFgAI"],["name","Pei-Chi Lo"],["avatarUrl",null],["level",14]]}],["type","OPINIONATED"],["text","■加州大學舊金山分校(UCSF)已發聲明，這是私人小組的討論筆記，雖有UCSF專家參加但UCSF【不是】活動主辦或贊助方，筆記內容【沒有】經過正確性等審查，建議民眾仍應以美國CDC等官方資訊為準。\n　\n■至於筆記內容本身：\n　\n1.PCR測試、預防方式、高齡者為高風險族群、Remdesivir同情用藥(恩慈用途)等敘述大抵正確。\n　\n2.「症狀出現前2天有傳染性」、「可透過氣融膠/糞口傳播」的可能性的確存在，但依WHO與中國聯合任務專家組報告，這些情況可能不是主要傳播途徑，僅發生在特定情境下，仍需進一步研究才能確認。\n　\n3.「150萬美國人可能會死亡」、「明年還會面對此病毒」、「美國遏制策略是徒勞」則屬個人評論意見，在這些議題上如哈佛大學Lipsitch、國家過敏和傳染病研究所Fauci所長等皆有多元意見。"],["reference","2020年3月15日加州大學舊金山分校(UCSF)聲明原文：\nhttps://www.ucsf.edu/news/2020/03/416916/statement-covid-19-panel-discussion-notes-were-attributed-ucsf\n　\n2020年3月17日白宮記者會，Fauci所長回應記者對疫情曲線、政府遏止與減災政策有效性的提問：(請見「A question for Dr. Fauci」段)\nhttps://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-4/\n　\n哈佛公衛學院Marc Lipsitch教授對疫情是否長存的看法，認為須多方考量環境、人類行為、宿主狀況等：\nhttps://ccdd.hsph.harvard.edu/will-covid-19-go-away-on-its-own-in-warmer-weather/　\n\n2020年2月WHO與中國聯合任務專家組報告：\nhttps://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf\n　\n(P8說明病毒應非空氣傳播但特定情況下氣融膠傳播可能發生，糞口傳播應不是傳播主要動力但仍須進一步研究：P12說明無症狀傳染罕見，應不是傳染的主要模式)"],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title",""],["url","https://www.ucsf.edu/news/2020/03/416916/statement-covid-19-panel-discussion-notes-were-attributed-ucsf"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title","Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in Press Briefing | The White House"],["url","https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-4/"],["summary","James S. Brady Press Briefing Room\n11:39 A.M. EDT\nTHE PRESIDENT: Thank you very much, everyone. Thank you. Progress being made. And I appreciate you all joining us.\nLast night, the FDA announced groundbreaking new policies to further increase testing very substantially so. All states can now authorize tests developed and used within their borders, in addition to the FDA. So the states are very much involved. They have been involved from the beginning. But we’re stepping it up as much as we can, and the testing procedures are going well.\nAnd within a short period of time, all other private labs will kick in. This has never been done before, and it’s going to be something very — I think it’s going to be incredible if it’s done properly. And these are great companies. These are among the greatest companies in the world, actually.\nSo the states are going to be dealing through themselves and with local government, local physicians, local everybody. They’re also dealing with us. But we have a tremendous testing capacity.\nToday, we’re also announcing a dramatic expansion of our Medicare telehealth services. Medicare patients can now visit any doctor by phone or video conference at no additional cost, including with commonly used services like FaceTime and Skype — a historic breakthrough. This has not been done before either. In addition, states have the authority to cover telehealth services for their medical patients. And by doing this, the patient is not seeing the doctor, per se, but they’re seeing the doctor. So there’s no getting close.\nDuring this time, we will not enforce applicable HIPAA penalties so that doctors can greatly expand care for their patients using telehealth. So the penalties won’t be enforced. We encourage everyone to maximize use of telehealth to limit exposure to the virus. It’s been a very successful method of communication but never used on a scale like we’re going to use on telehealth. And you’ll be able to also better maintain hospital capacity by doing this.\nEarlier this morning, I spoke with executives from America’s fast-food industry — Wendy’s, McDonald’s, all of the big ones, Burger King — and they were great. We were talking about the pick-ups in light of yesterday’s guidance, you heard, to avoid eating or drinking at bars, restaurants, or public food courts. We discussed the important role that the drive-through, pick-up, and delivery service can play in the weeks ahead.\nSo that’s happening, and they have been fantastic. They have been absolutely fantastic. And they’ve been doing it already. But they’re keeping it open and smaller staffs. They’re very capable people and very capable companies, and they’re doing it, the pick-ups.\nOur guidance yesterday urges Americans to take action for 15 days to help stem the outbreak. So it’s a 15-day period. I guess, now I would say it’s a 14-day period. It was 15 days from yesterday, and we’re asking everyone to work at home, if possible, postpone unnecessary travel, and limit social gatherings to no more than 10 people. By making shared sacrifices and temporary changes, we can protect the health of our people and we can protect our economy, because I think our economy will come back very rapidly. So it’s 15 days from yesterday. We’ll see what happens after that. If we do this right, our country — and the world, frankly — but our country can be rolling again pretty quickly. Pretty quickly.\nWe have to fight that invisible enemy that, I guess, unknown but we’re getting to know it a lot better.\nToday, the Senate is taking up coronavirus legislation that includes free testing for those who need it, as well as paid sick leave and family medical leave for workers affected by the virus. We’re also committed to getting small businesses the support that they need. In fact, one of the things we talked about with the fast food operations — we spoke to the chairmen and CEOs of all of the companies — but one of the things we discussed is exactly that: getting small businesses support and flexibility that they need for themselves and for their workers, and that’s being worked on right now.\nAt my direction, Secretary Mnuchin is meeting today with senators on additional stimulus packages. I can tell you he was meeting with them late until the night, last night, and for a big part of the day yesterday, and tremendous things are happening. There’s great spirit. Tremendous spirit. And I can say that for Republicans and Democrats.\nI can say that, with respect to Governor Cuomo, we had a great talk this morning. We’re both doing a really good job, and we’re coordinating it. And we agree — you know, different states need different things. And we — we agree on that 100 percent. But we had a very good talk, and I think we’re right down the same track, and it’s going to be very successful.\nNew York has a pretty big problem. I guess, would be the number one hotspot. It’s no fault of anybody. It’s just the way it is. But we’re working very closely together. We’re also getting FEMA very much involved. They’ve been involved, but now we’re getting them to a different level, and we’ll have everything ready. We’re dealing with the Army Corps of Engineers should that be necessary. We have them working, in some cases; on standby, in other cases.\nBut my conversation with Andrew Cuomo was a very, very productive one and a very good one. And I appreciate that.\nWe’re giving relief to affected industries and small businesses, and we’re ensuring that we emerge from this challenge with a prosperous and growing economy because that’s what’s going to happen. It’s going to pop. One day, we’ll be standing, possibly up here, and we’ll say, “Well, we won.” And we’re going to say that. As sure as you’re sitting there, we’re going to say that. And we’re going to win, and I think we’re going to win faster than people think, I hope.\nLater today, I’ll meet with the leaders from the tourism industry, as well as industrial supply retailers and wholesalers, to discuss their critical roles. As you know, I met with the department store people, all of the retailers — the big ones, including Walmart and others — and it was a great meeting. They’re stocking up their stores like they’ve never stocked them before. We’re trying to get people to actually buy less if that’s possible. Buy less. Don’t take everything. Just buy what you need for a while. It’s — they’re going to stay open all hours of the day. And they’ve really been — they’ve been fantastic.\nWe’re taking aggressive action now as one nation and one family so that America can rebound stronger — frankly, stronger than ever before. And we recognize that while many American workers can work from home, many others cannot. Many of our healthcare providers, first responders, and men and women in the food service and manufacturing are showing at — they’re showing up and standing up to provide us with the goods and services we need.\nSo we want people to stay home where they can, but in many cases, when you talk about food service and manufacturing, certain items in particular, they are — they’re going in and they’re practicing all of the safety rules and regulations that we talk about.\nSo with that, I’d like to just introduce our great Vice President, Mike Pence. He’ll say a few words, and then I’ll make some other introductions.\nThank you very much.\nTHE VICE PRESIDENT: Thank you, Mr. President. Good morning. It should be very clear to the American people that President Trump has initiated not only a whole-of-government approach, but a whole-of-America approach. And the President’s interaction, even today and through the course of this day, with leaders in industry around the country, reflects that we’re not only bringing the full weight of the federal government to bear, but the full weight of the American economy.\nAnd I know I speak on behalf of the President when I say how inspired we are at the way the American people have stepped up and the way that American businesses, large and small, have stepped up. It’s truly been inspiring.\nOur task force met this morning. We continue to focus on President Trump’s priorities of testing, prevention, and supplies. And in that category, I’m pleased to report that while testing is available in all 50 states, as the President just indicated, through the swift action of the FDA, at the encouragement of governors around the country, now state health authorities can authorize labs in their state and expand existing testing capabilities.\nBut also in connection with the FDA’s action, which you’ll hear more about in a moment, we now have continued to expand the public and private partnership that the President forged with vast commercial laboratories around the country, increasing access to the high volume of high-throughput coronavirus testing that is greatly expanding access even as we speak.\nAlso, our task force received a report this morning on the progress that the U.S. Public Health Service and FEMA are making, working closely with state governments and also partners in the private sector like CVS, Target, Walgreen, and Walmart, to expand remote testing sites around the country. And we’ll have a full report later this week as those come online.\nIt’s important the American people understand that testing is happening all over the country. But all of our health experts wanted me to tell the American people you don’t need the results of testing to know what you should do. And President Trump’s 15-day coronavirus guidelines are advice for every American in every community. They’re the result of the best guidance of CDC and our health experts.\nAnd, as the President said, we continue to urge every American over the next 15 days to put into practice the principles in the President’s coronavirus guidelines. By every American practicing these principles, we believe that we can slow the spread of the coronavirus. In fact, our experts have told our taskforce that if every American acts on the President’s coronavirus guidelines, we could see a substantial reduction in the spread of the coronavirus.\nBut as the President said, it will take all of us to do it. And so, if you feel sick, stay home. If someone in your house tests positive, keep the entire household home. Especially if you’re a person with an underlying health condition, we urge you to stay home and practice social distancing from people. No social gatherings of more than 10 people. Use drive-through, as the President discussed with leaders in the industry today. And every American, especially practicing common sense and good hygiene.\nFor the American people as a whole, the risk of serious illness remains low, but we’re asking every American to partner with us in this effort to slow the spread of the virus and especially to be mindful of seniors or others with serious underlying health conditions for whom the threat of the coronavirus can be very significant and very real.\nAs I said, the President has continued to push our task force to bring a whole-of-government, a whole-of-America approach. And we continue to be inspired the way our nation’s governors, the nation’s businesses are responding.\nWe spoke just yesterday with the leaders of every broadcast network in America that will soon be unveiling a public service campaign using CDC guidelines. And specifically, as we work on the issue of supplies — meetings yesterday with Department of Defense officials about excess supplies; the President and I will be meeting today to speak about the supply chain for hospitals — we would make one specific request, and that is: We would urge construction companies to donate their inventory of N95 masks to your local hospital and forego additional orders of those industrial masks.\nBecause of what the President asked to be included in legislation moving through the Congress today, those industrial masks that they use on construction sites are perfectly acceptable for healthcare workers to be protected from a respiratory disease.\nBut we’re asking construction companies that our President knows very well from his background — we’re asking them to donate their N95 masks to their local hospitals and also forego making additional orders.\nAt the President’s direction, we will — we will continue to do whatever it takes. We’ll continue to marshal the best of the American people, the best of all the people behind me, the people behind them, our state and local officials. And we will get through this, and we will get through this together.\nThank you, Mr. President.\nTHE PRESIDENT: Thank you, Mike, very much. Thank you.\nTHE PRESIDENT: I want to thank Chad Wolf and Homeland Security. The job they did at the airports was really incredible. They screened thousands and thousands of people. O’Hare got backed up, but — a little bit, but they got them out. But everybody was screened and screened very carefully. They didn’t want to rush it. I think it was 13 airports. And it was — it was an incredible thing. Then they had a big surge also from the UK and Ireland, and that went very smoothly. But they did a fantastic job. They worked long hours and they did a fantastic job.\nI’d like to introduce Steve Mnuchin, and then I’m going to ask Steve to leave because he’s going to the Hill. He’s been working very hard with the Senate and with — actually, with the House on a very, very big, bold package. It’s going to be big and it’s going to be bold. And the level, again, of enthusiasm to get something done, I don’t think I’ve ever seen anything quite like it.\nSo, Steve Mnuchin, please.\nSECRETARY MNUCHIN: Thank you, Mr. President. I’d like to announce some very significant actions that the President has approved today. The first, I would say, is: Earlier today, I sent a letter to Fed Chairman Powell approving his request to use 13(3). And what that will do is, the Fed will be setting up a special purpose vehicle, which the Treasury will invest $10 billion in from one of our funds. That will enable the Fed to guarantee the purchase of A1/P1 commercial paper going forward. That is a 1-trillion-dollar market and it is critical to American workers, it’s critical to American business, and it’s critical to American savers who have a lot of that money in money market funds.\nSo we heard, loud and clear, there were liquidity issues. This is very significant. And we’ll create — I don’t think we’ll need to use it all, but we have the ability to have the Fed purchase up to $1 trillion of commercial paper, as needed. That has already created significant stability in the market today.\nThe second thing I would say is, you know, we’ve previously talked about deferring IRS payments. The President, earlier this morning, authorized me to announce this program. I have previously announced we would defer $200 billion. The President suggested we increase that to $300 billion, which we will be doing.\nNow, let me just be clear on the specifics: We encourage those Americans who can file their taxes to continue to file their taxes on April 15, because for many Americans, you will get tax refunds and we don’t want you to lose out on those tax refunds. We want you to make sure you get them. Many people do this electronically, which is easy for them and easy for the IRS.\nIf you owe a payment to the IRS, you can defer up to a million dollars as an individual. And the reason why we’re doing a million dollars is that covers lots of pass-throughs and small businesses, and $10 million to corporations, interest-free and penalty-free for 90 days. All you have to do is file your taxes. You’ll automatically not get charged interest in penalties.\nNow, of course, any American has the right to extend their taxes. We’re not taking that right. But the President has asked us to go up to $300 billion. That’s also an enormous amount of liquidity in the system.\nThe third thing is the President and I worked on a very significant economic stimulus plan. Thank you for being available last night and throughout this morning. And I will be presenting that to the Republicans in the Senate this morning and also discussing that with the House.\nWe look forward to having bipartisan support. We’re now working with the Senate to pass this legislation very quickly. And these will be payments to small businesses. We’ve talked about loan guarantees to critical industries such as airlines and hotels. And we’ve also talked about a stimulus package to the American worker. You can think of this as something like business interruption payments for the American workers.\nThank you.\nTHE PRESIDENT: Do you have any questions for the Secretary of the Treasury?\nQ When you say a stimulus package for American workers, do you mean direct payments to Americans, or are you talking about a payroll tax holiday?\nSECRETARY MNUCHIN: Although the President likes the idea of the payroll tax holiday, I will tell you, what we’ve heard from many people — and the President has said we can consider this — the payroll tax holiday would get people money over the next six to eight months. We’re looking at sending checks to Americans immediately. And what we’ve heard from hardworking Americans, many companies have now shut down — whether it’s bars or restaurants. Americans need cash now, and the President wants to get cash now. And I mean now, in the next two weeks.\nQ How much?\nSECRETARY MNUCHIN: I will be previewing that with the Republicans. There’s some numbers out there. They may be a little bit bigger than what’s in the press.\nTHE PRESIDENT: Go ahead. Please.\nQ Mr. Secretary —\nTHE PRESIDENT: Please. Wait. Please.\nQ Secretary Mnuchin, what help are you going to give to airlines, specifically?\nSECRETARY MNUCHIN: I’ve had discussions with all the airline CEOs this week. The airline CEOs have had conversations with the Senate and the House. As the President said, I was up with a subset of the Republican senators last night. I’ve discussed that with them.\nI think, as you know, this is worse than 9/11. For the airline industry, this is — they are almost ground to a halt. The President wants to make sure that although we don’t want people to travel unless it’s critical, we want to maintain for critical travel the right to have domestic travel.\nQ They want $60 billion dollars. Is that —\nSECRETARY MNUCHIN: I’m not going to comment on the specifics. I will tell you, we’re very focused. There’s a lot of workers. This is strategically important to us and we’ll be working with Congress on this.\nTHE PRESIDENT: The airline industry will be in good shape.\nYeah. Go ahead, please.\nQ There’s been talk about 1,000-dollar checks to every American. Increasing support among Republicans and some Democrats for that. Would you support that going to everyone? Or would you support some sort of income restriction on who gets a check?\nSECRETARY MNUCHIN: Well, I think it’s clear: We don’t need to send people who make a million dollars a year checks. Okay? But we like — that’s one of the ideas we like. We’re going to preview that today, and then we’ll be talking about details afterwards.\nTHE PRESIDENT: Well, I think — I think we’re going to do something that gets money to them as quickly as possible. That may not be an accurate way of doing it, because obviously some people shouldn’t be getting checks for $1,000. And we’ll have a pretty good idea by the end of the day, what we’re going to be doing.\nJohn, please.\nQ Can you tell — how would the mechanics of this work? I mean, we’ve been talking about a payroll tax holiday. Some $500 billion worth was floated to me today. So how would this idea of sending people a check work? Would you — would that be sort of advance on what they would pay in payroll taxes? How would it work?\nSECRETARY MNUCHIN: Again, we want to make sure Americans get money in their pockets quickly. We want to make sure small business owners have access to funds; we want to make sure that hotels, airlines. We have an entire package. We’ll be laying out those details later today.\nTHE PRESIDENT: Yeah, I have to say this: There are four different ways you can do it —\nQ (Inaudible.)\nTHE PRESIDENT: That’s okay. Four — you can hear me well enough, I imagine.\nQ I can, but it’s the people at home.\nTHE PRESIDENT: Okay. Oh, the people at home, you’re right. Those are very important people, come to think of it.\nQ More important than us.\nTHE PRESIDENT: Especially your people.\nLook, we have four or five ways we can do it — four ways in particular. I think there’s a fifth possibility. But there are some very good ways of getting the money out and getting it out quickly. A payroll tax is one way, but it does come over a period of months, many months, and we want to do something much faster than that. So I think we have ways of getting money out pretty quickly and very accurately.\nOkay?\nQ Mr. Secretary, can you talk about the timeline, please? How quickly do you think you can get this done while there is broad bipartisan support?\nSECRETARY MNUCHIN: The President has instructed me we have to do this now. So this is now. We —\nQ By the end of the week?\nSECRETARY MNUCHIN: Oh, we are going to work with the Senate, who’s in session right now, actively. We will continue to have conversations with the House. I’ve already spoken to Speaker Pelosi once today. This is stuff that needs to be done now.\nThe President has instructed me that this is no fault to American workers. For medical reasons, we are shutting down parts of this economy, and we’re going to use all the tools we have, as I’ve said. And what tools we don’t have, we’re going back to Congress.\nQ And we’ve seen the price tag as high —\nSECRETARY MNUCHIN: I got to go back to —\nQ — as $850 billion. To those who might be concerned that’s too expensive?\nTHE PRESIDENT: We don’t want to talk about it, but it’s a substantial number. We’re going big. The expression — we could do it two ways; we could keep going back every day or every week. We’re going big. And that’s where Mitch McConnell — that’s the way he wants to go. That’s the way I want to go. I think we want to get it done and have a big infusion as opposed to going through little meetings every — every couple of days. We don’t want to do it that way. We want to go big, go solid.\nThe country is very strong. We’ve never been so strong. And that’s what we’re going to be doing. We don’t want — with this invisible enemy, we don’t want airlines going out of business. We don’t want people losing their jobs or not having money to live, when they were doing very well just four weeks ago.\nSo we’re going big, and that’s the way it’ll be. And that’s the way everybody seems to like it on the Hill.\nAny other question for Steve?\nQ Mr. Secretary, in addition to airlines and hotels, you had a call with restaurants today. Was any type of emergency assistance discussed on that call? A lot restaurants have to close. Even, if they are doing delivery, they’re not making as much money as they would with a full house.\nSECRETARY MNUCHIN: Well, let me make two comments on the restaurants. And the President understands this; this was emphasized this morning.\nFirst of all, we want to make sure that the states allow the drive-through portion of these fast foods to stay open. Particularly in a time period where we’re telling people “don’t go to restaurants,” these companies feed a big part of America, and I expect they’re going to feed a bigger part of America.\nThe second thing they asked me to emphasize — I wasn’t going to do it now, but as long as you asked — many of these companies have apps. You can order ahead of time. That way, when you get there, it’s as simple as they’ll have it packed. They can give it to you with social distancing, and it’ll be very fast.\nSo we expect that they will be able to feed a large part of the population. And in regards to support, I will say a lot of these businesses are small businesses — are companies, franchisees, 500 or less — and we have a specific program we’ll be unveiling that helps all business — small- and medium-sized businesses of 500 and less.\nQ Mr. Secretary, a real quick question regarding Marriott Corporation. It announced that it is furloughing thousands of individuals because of the impacts of the coronavirus. Will your legislation help those individuals?\nSECRETARY MNUCHIN: I hope so. That’s one of the reasons why we got to act very quickly, because we understand whether it’s the airlines, hotels — for good reasons to protect the United States on medical issues, these businesses are shut down. And the President wants to make sure, as I’ve said, we will use all the powers we have. You saw this today: trillion dollars of potential liquidity into the market. And the powers we don’t have, we’re going to Congress. And I will say there’s a lot of bipartisan support for these issues.\nSo I’m going to apologize because I have to go deal with some other things, if that’s okay, Mr. President.\nQ Will you consider shutting down the stock market?\nTHE PRESIDENT: Thanks, Steve.\nSECRETARY MNUCHIN: Oh, yeah, I — this —\nTHE PRESIDENT: Go ahead.\nSECRETARY MNUCHIN: I do want to comment on this. Okay? We absolutely believe in keeping the markets open. Okay? Americans need to know they have access to their money. After September 11th, the only reason why the markets were closed was because the technology was disrupted. I’ve been on the phone with the major banks, with the New York Stock Exchange. Everybody wants to keep it open. We may get to a point where we shorten the hours, if that’s something they need to do.\nBut Americans should know that we are going to do everything to make sure that they have access to their money at their banks, to the money in their 401(k)s, and to the money in stocks. So I want to just be very clear, we intend to keep the markets open.\nTHE PRESIDENT: And the banks are record-setting strong. So we have — we have that, which is a much different event than what we had not so long ago.\nJohn, go ahead, please.\nQ Mr. President, you mentioned the Army Corps of Engineers —\nTHE PRESIDENT: Right.\nQ — and that you’ve had a conversation with Governor Cuomo.\nTHE PRESIDENT: Right.\nQ He believes that New York is going to run out of hospital beds. Are you prepared to mobilize the Army Corps —\nTHE PRESIDENT: Well, we’ve been asked to, and we’re —\nQ — to increase capacity?\nTHE PRESIDENT: Yes, we’re starting to. We’re starting the process. And it’s a process — we hope it’s not going to be necessary, but it could be necessary. The state is working on it very hard themselves, but we’ll probably supplement what they’re doing.\nQ And given that many of the precursors for our pharmaceuticals come from China, and there have been disrupt- — there have been supply disruptions — that supply chain has been broken to some degree — do you expect that we could run into a shortage of prescription drugs?\nTHE PRESIDENT: No, I don’t see that at all. And I think China has every incentive to make sure that things work well. China wants to make sure that things work very well. They have every incentive to do so.\nJon?\nQ Mr. President, the governor of Ohio has called off the election that was supposed to happen today — the primary election. Do you agree with that decision? And what steps are you taking to ensure that elections going forward — if this pandemic continues — that elections will be able to happen, including, of course, the big one in the fall?\nTHE PRESIDENT: Well, the governor of Ohio is doing a great job. He called that off, and we’ll see what happens. There’s a court case, and it hasn’t been fully determined yet. But if he called it off, I could understand that because, you know, he — he’s definitely somebody that knows what he’s doing.\nWe’ll be seeing what — very soon. You know, they’re going by the rule of 10 as opposed to 50, and that’s pretty tough. I would say, probably, you could violate that if you wanted to for an election. I just think an election is a very special thing. He’s going to choose — he chose a different date. I think a date that sometime in June.\nBut that would be a decision that would be made by him. He felt it was necessary. The courts are — somebody is challenging it. So the courts will ultimately decide.\nQ But what are you doing to ensure that further elections — if we’re still in this situation a month from now, two months from now —\nTHE PRESIDENT: Yeah. What I’m doing —\nQ — do you suggest to July? What do we do?\nTHE PRESIDENT: What I’m going, Jon, is very simple. We’re getting rid of this virus. That’s what we’re doing. That’s the best thing we can do.\nBy the way, for the markets, for everything — it’s very simple, very simple solution. We want to get rid of it. We want to have very — as few deaths as possible. This is a horrible thing.\nYou look at what’s going on with Italy. We don’t want to be in a position like that. But a much larger — because we’re a much larger country. We don’t want to be there.\nAnd I think we’ve done really well. I think we’ve done well. I think the states have done well. We’re all working together. The best thing we can do is get rid of the virus. Once that’s gone, it’s going to pop back like nobody has ever seen before. That’s my opinion, but I think it’ll pop back like nobody has ever seen before.\nPlease.\nQ Mr. President, just to follow up on John’s question: Specifically, how many new hospital facilities could the Army Corps of Engineers build? And also, what specific measures are you taking to try to increase the number of ventilators in the stockpiles?\nTHE PRESIDENT: Right. We’ve ordered massive numbers of ventilators. We have — by any normal standards, we have a lot of respirators, ventilators. We have tremendous amounts of equipment. But compared to what we’re talking about here, this has never been done before.\nAnd yesterday I gave the governors the right to go order directly if they want, if they feel they can do it faster than going through the federal government.\nNow, we’ve knocked out all of the bureaucracy; it’s very direct, but it’s still always faster to order directly. And I gave them — that was totally misinterpreted by the New York Times, on purpose, unfortunately.\nBut the — but it’s very important.\nYes, Mike.\nTHE VICE PRESIDENT: If I could amplify —\nTHE PRESIDENT: Yeah, please. Yeah.\nTHE VICE PRESIDENT: Thank you. The President directed us to work with the Department of Defense. There’s two ways that DOD can be helpful, in terms of expanding medical capacity. I know the governor of New York has asked us to look at the Army Corps of Engineer, which could perhaps renovate existing buildings. But the President also has us inventorying what you all would understand as field hospitals, or MASH hospitals, that can be deployed very quickly.\nWe spoke with Governor Inslee yesterday in Washington State. We have resources in that part of the country that we can move. And as governors make these requests, we will process them, bring them to the President.\nBut there are two different lanes that DOD can provide, in addition to many medical supplies to augment our national reserves. And the President has tasked us to evaluate, make available, and to consider every — every request from governors for either field hospitals, expanding facilities, or the Army Corps of Engineer that could retrofit existing buildings.\nTHE PRESIDENT: The Army Corps is very prepared to do as we say. And we’re looking at where it’s going.\nBut — and they do call them MASH hospitals, but the field hospitals go up very quickly. They’re — we have them. We have all of this equipment in stock. And we’re looking at different sites in a few different locations.\nAnd we’re not going to need them in West Virginia where, so far, I guess they have none. Still none? Still none, right? West Virginia.\nQ No known cases.\nTHE PRESIDENT: Big Jim, the governor, is — he must be doing a good job.\nQ Or is that just reported?\nTHE PRESIDENT: That’s what’s reported. They —\nQ No, no, but is that a reporting issue or is that that they have no cases?\nTHE PRESIDENT: Well, that’s all that — I just see West Virginia is the only one that has no cases. So, obviously, that’s being treated differently than a New York or a California — different parts of California.\nI do say this, though: The Army Corps of Engineers is ready, willing, and able. We have to give them the go-ahead if we find that it’s going to be necessary. We think we can have quite a few units up very rapidly. I’m going to work with Governor Cuomo. I’m going to work with a number of the governors. Governor Newsom has been very generous in his words, and I’m being generous to him, too, because we’re all working together very well. And I think a lot of very positive things have taken place. We’re talking to California about different sites. But we can have a lot of units up fairly quickly if we think we need them.\nQ Mr. President, to follow up on —\nTHE PRESIDENT: I think what I’ll do is, I might ask Seema to say a few words on the telehealth, and then we can back to this.\nPlease. Seema?\nADMINISTRATOR VERMA: Thank you, Mr. President. And as the President announced earlier, we are doing a dramatic expansion of what’s known as telehealth for our 62 million Medicare beneficiaries who are amongst the most vulnerable to the coronavirus. And we’re acting in accord with the appropriations bill that was signed on March 6th, as well as the President’s emergency declaration last week.\nAnd this action is a part of our broader effort to ensure that government requirements, rules, and regulations don’t get in the way of patient care during an emergency. And today’s announcement builds on the significant progress that the President has already made over the past three years around telehealth services.\nAnd while we have allowed for virtual check-ins, full telehealth benefits have been restricted to those living in rural areas, established patients, and just for those brief visits. But no longer.\nMedicare beneficiaries across the nation, no matter where they live, will be able to receive a wide range of services via telehealth without ever having to leave home. And these services can also be provided in a variety of settings, including nursing homes, hospital outpatient apartments, and more.\nAnd thanks to the leadership of HHS, we’ll also be temporarily relaxing certain HIPAA requirements so that doctors can provide telehealth with their own phones. And we’ll be using enforcement discretion when it comes to collecting co-pays so that cost won’t be a barrier.\nThis a part of our larger efforts around mitigation. And as we are encouraging Americans to stay home whenever possible, we don’t want our Medicare policies getting in the way. And so consider the implications of this: Perhaps an elderly patient with diabetes needs a routine check-up, and this has nothing to do with the coronavirus. And so, with our new telehealth benefits, this person who is not really — who is at risk for the coronavirus doesn’t have to venture outside their home. They can talk to their doctor via Skype, and they don’t have to risk exposure to the virus, and they can receive that care from the safety of their own home.\nIt could be another Medicare recipient who is experiencing mild flu-like symptoms, and instead of leaving the house and sitting in a waiting room full of other vulnerable people, they can also receive advice from their doctor, from their home.\nAnd this shift is very important for clinicians and providers who, over the coming weeks, will face considerable strain on their time and resources. And now, Medicare patients who don’t absolutely need to come in to an office won’t have to. And this allows the healthcare system to prioritize for care for those that are more — that have more needs or are in dire need, and preserves protective equipment as well.\nState Medicaid agencies can also provide telehealth services without federal approval. And so we’re asking all states to make this available as well. And we’ve also asked private insurance companies to expand their telehealth benefits and make it clear to their providers and their members what they cover.\nAs our nation seeks to balance the twin imperatives of getting Americans the care that they need during this outbreak, and limiting the spread of the virus, the impact of this historic action simply cannot be overstated. In an emergency, those on the frontlines shouldn’t have to worry about federal rules and red tape hamstringing them when they need flexibility above all else. And we’re doing everything in our power to make sure that that doesn’t happen.\nI also just want to briefly mention that because of the President’s emergency declaration, we do have the ability to provide a lot of Medicaid waivers, and Florida was the first state to be approved. We were able to do that in a matter of days.\nThank you.\nTHE PRESIDENT: Any questions? Please.\nQ Yeah. Where do citizen seniors go for instructions on how to do the telehealth?\nADMINISTRATOR VERMA: They should call their doctor’s office, and their doctor’s office can tell them how to do that. Also, you know, there may be some of our Medicare members that may not have access to equipment, so we’re asking family members to help with this, but also respecting the requirements around social distancing. And if any of those family members or neighbors have symptoms, they should obviously stay away.\nTHE PRESIDENT: Will you be posting numbers also?\nADMINISTRATOR VERMA: That’s correct. Exactly.\nTHE PRESIDENT: That might be the easiest way to do it — if you post in ads, if you post some numbers.\nADMINISTRATOR VERMA: And they can also call our 1-800-MEDICARE number and they can also get information. Those phone lines are open.\nTHE PRESIDENT: Thank you. Thank you very much.\nAdmiral, if you’d say a few words about where we’re going, and then I’d like to ask Dr. Birx to say a couple of words about how the system is working.\nADMIRAL GIROIR: Well, thank you very much. As we talked about earlier this week, the commercial system is rapidly advancing in the testing capabilities. As of today, our public health laboratories — meaning the CDC and the public health labs — have reported out 31,878 tests. So almost 32,000 tests.\nThe clinical laboratories — the Association of Clinical Laboratories — have reported out about 27,000 tests. And most importantly, of those 27,000 during the cumulative period of time, 8,200 of them were yesterday. This is showing the dramatic ramp as the high-throughput comes in.\nWe don’t have the numbers this morning from the American Hospital Association, which means all of the individual hospital laboratories. We will have that upcoming in the next day or so. And then Ambassador Birx will have this whole process fixed under — with the legislation that everything will roll up into a common reporting, probably by the end of next week.\nIn terms of our drive-through laboratories, again, these are blossoming all over the country by individual states. The ones that we are heavily involved in, in really pushing equipment to, we expect over the next few days to begin setting up 47 of these in approximately 12 states. The material is already palletized and being shipped to the locations. Most cities have the specific locations, some do not, but it’s still going to a central receiving.\nAnd we know that we’ll be deploying at least 140 Commissioned Corps Officers. About half of the sites have reported their requirements. About 140 officers will be going. We expect that to go up. So this is going on the way we expected.\nWe did a trial site yesterday with a full mobile unit for drive-through, with full PPE. We had a lot of kinks in the system, as you can expect. That’s why we do a test before we go out into the field. Don’t expect these to be 100 percent perfect the moment they come. They’re going to be adapted to the state and the local situation, but we’re very confident that these will add testing to the already very robust healthcare system and commercial system.\nThank you, Mr. President.\nTHE PRESIDENT: Thank you very much. Thank you, Admiral.\nAnd this has never been done before. And it sets a great roadmap for future, should we have something like this in the future. I hope we don’t. But it’s never been done before, and they’ve done an incredible job.\nAgain, we’re working with the states and relying on the states. We have to because they — they have — it’s point of sale, it’s point of site. And we’re in, I think, just about every instance, getting along really well with the states.\nIf I could, Dr. Birx, if you could say a couple of words, please.\nDR. BIRX: Great. Thank you. Thank you, Mr. President. So I think what you’ve been hearing from us is to find solutions that are high quality and sustainable based on the frontline workers and governors’ requests. And I — those come in on the governors call. We’ve been immediately responsive to those. And that’s the level of red tape and bureaucracy that we have removed.\nI think that point about sustainability and quality is very important. Because, as the President says, we’re creating a roadmap for a different level of functionality for future pandemics. Our flu-pandemic preparedness plan was a plan. Now we’re seeing where we have to revise, where we have to create new avenues of research, new avenues of work to really ensure that the need of the American people can be reached.\nWe were adamant about having a high-quality test based on our commercial vendors. Over the next few months, you will begin to see that other tests that were utilized around the world were not of the same quality, resulting in false positives and potentially false negatives. These tests were studied, and studied by the FDA, to really ensure that they are that level of quality. And we’ve given the states the permission to ensure that same level of quality.\nNow, I wanted to say, one minute on the testing: Testing should not be used as an assessment of your risk. We are asking every single American, no matter what your generation, from Z and up to X, and millennials in between, to really ensure that you’re following these guidelines. We hear every night of people who are not in work, moving that time into bars and other areas of large gatherings.\nIf we continue with that process, we will fail in containing this virus. So every single generation has a role to play. We’re asking our older generation to stay in their homes. And we’re asking the younger generations to support them in social contacting through videos and other Skype-type functions, or just the simple telephone.\nWe’re asking the younger generations to stop going out in public places — to bars and restaurants — and spreading asymptomatic virus onto counter tops and knobs and grocery stores and grocery carts.\nI heard an innovation last night and this morning again on the news. I really want to applaud the private sector who are now creating senior-only shopping times. I think that’s extraordinary. I think that shows what America brings. And I think other countries will learn from us about how to really protect seniors in this type of way.\nI’m hoping that carries through to next year when we have our flu epidemic, where we can really have a very different profile of the amount of mortality that we have during flu that we never talk about. Anywhere from 15,000 to 45,000 individuals are lost every year. If we learn how to do this well, and sustain some of those core changes, we can change the way respiratory viruses — not only for this, but the future — affect Americans.\nTHE PRESIDENT: It’s a big thing. Right, Doctor? Maybe a couple of questions.\nYes, Jim.\nQ A question on the clinical data. So we’ve had now roughly 5,000 people test positive. We’ve had 90 deaths or so. When are we going to know the data of who those people are; who has been infected; what the ages are; what the preexisting conditions are; how serious it was, both for those who have been tested positive but also those who have died?\nDR. BIRX: Well, you’re singing my sheet of music. I’m very data oriented. So thank you for bringing up this issue of data. I really want to applaud HHS. We had a discussion about this several days ago. They’ve made calls into Seattle and California to really understand that, and also, importantly, to understand how many of their patients needed ventilators, how many of them needed oxygen support, how many of them needed and what they needed. Could we predict, early, someone who was going to have a more difficult course? These are all the questions we’re asking right — and answering right now.\nWe did get an early report back from Santa Clara and Seattle. We’re digesting it. We just got it this morning. We’re looking at that carefully because we think that roadmap is very important to other communities. We have not discussed this with New York yet.\nWe do know from other countries — and that all is available online, that profile — you can see that mortality under 30 is extraordinarily low. The mortality across the board, outside of Wuhan, is now settling somewhere around 0.7. But that should not be reassuring because it’s much higher in people with preexisting medical conditions, even if young, and people that are older with preexisting medical conditions.\nAnd so we still want every American focused on doing what they can do today to change the course of this pandemic.\nQ Will you commit to making that data public so we will all know?\nDR. BIRX: We’re committed not only to making it public but to have a website that everyone can see in real time.\nTHE PRESIDENT: Please, John. Him.\nQ Dr. Birx, if I could just follow up. You all are signaling a much more aggressive posture toward containment and mitigation now. And many states have been very aggressive, but there is a small number of states that have not issued public guidance to their residents. Is it important for the success of the effort that 100 percent of the states be forward leaning on this? And, if so, Mr. President, what would be your message to those states that have not?\nTHE PRESIDENT: Okay.\nDR. BIRX: So that’s why the Vice President and the President, yesterday, issued those critical guidelines. As I said this morning on “Fox and Friends,” you can look at them as guidelines, you can look at them as requirements, and you can look at them as the President asking every American and every state to follow those.\nThat’s why we put them out at the federal level. We wanted to make sure every American knew what they could do today to change the course of this epidemic. I think it’s empowering. I think it says all of us have a social responsibility to each other, and that’s why we believe that every mayor and every governor should be instituting these guidelines that came from the White House and the President of the United States.\nTHE PRESIDENT: And we’ve been very tough on those states. I know exactly who you’re talking about. We’ve been very tough on them. Thank you.\nPlease, go ahead.\nQ A follow-up question on the testing. You’ve been telling us for days now that millions of tests have been sent out. So why have fewer than 60,000 people actually been tested?\nDR. BIRX: I think you will see different numbers this week. You heard just of 8,000. Remember, all of these tests — the high-speed tests were approved last Friday — last Friday night and last Thursday night.\nI think if I could talk to Thermo Fisher and the other groups that have these platforms out there: Do not rely on a pull technology. Push out those tests. Because we can only make them available. Groups have to order them. So I — we’ve been talking to Thermo Fisher, one of the key platforms, to push out tests based on need, and not wait for orders.\nQ Is that where the issue is, getting the tests out? Or is it getting the test conducted?\nDR. BIRX: That’s a great question. I know part of it is getting the test out right now. I think the Admiral and others are working on getting the issues related to getting the test conducted. Obviously, that does take time. He is working on innovative solutions that are creative and sustainable that will be a game-changer in testing. But we don’t have the data yet. This is a critical comparator. Can you do it yourself? Can you actually sample yourself? These are the kinds of things we’re working on right now, and he’s getting the data for us.\nTHE VICE PRESIDENT: It’s coming online (inaudible).\nTHE PRESIDENT: And the states are actually doing a lot of this. The governors and the states are doing a lot of it with even our tests.\nYeah, go ahead. Go ahead, please.\nQ Okay, thank you. Can you give us a sense of how long these tough, new restrictions will need to be in place until we start to see the rate of this virus going down?\nAlso, can you speak to this study that as many as 2.2 million people in the United States could die if there weren’t this type of action by the government taken? To what extent did that prompt what we saw yesterday?\nDR. BIRX: So, I think, you know, models are models. And they’re based on input, and they’re based on infectiousness without any controls. I can tell you we’ve never seen that level of infections that modeled up to that 2.2 million in mortality.\nSo we are looking at that. We are having a particularly model meeting tomorrow. I think that’s really going to be important. I’ve dealt with a lot of modelers in my time. They’re wonderful people, but they all have their favorite inputs, and they all have their favorite integration functions. So we’re evaluating all of those so we can integrate and create the best model for the United States based on the best data. And that first set of recommendations you saw were based on what we could do today to prevent anything that looks like that.\nIf I could just say one other thing to the hospitals and dentists out there: Things that don’t need to be done over the next two weeks, don’t get it done. If you’re a person with an electric sur- — elective surgery, you don’t want to go into a hospital right now. There’s a lot of distraction. There’s a lot of people doing a lot of other things to save people’s lives. So let’s all be responsible and cancel things that we can cancel to really free up hospital beds and space, and then let’s do everything that we can to ensure that we don’t need the ventilators because we protected the people who would have needed to use them.\nQ And are you looking at the possibility of more actions like, for example, limiting travel within the United States? Are you looking —\nTHE PRESIDENT: It’s possible. It’s possible. We’ll see how it goes. I think a lot of — there’s been great cooperation with local governments, states. We’ll see how it goes. It’s going — it’s going, right now, pretty well.\nYeah, please go ahead.\nQ And, Mr. President, a quick follow on that, Mr. President. Very quickly.\nTHE PRESIDENT: Please. Yeah.\nQ Just very quickly.\nTHE PRESIDENT: Go ahead.\nQ Do you need to invoke the Defense Production Act to get more of those medical supplies to different hospitals across the country?\nTHE PRESIDENT: Well, we’re able to do that if we have to. Right now, we haven’t had to, but it’s certainly ready. If I want it, we can do it very quickly. We’ve studied it very closely over two weeks ago, actually. We’ll make that decision pretty quickly if we need it. We hope we don’t need it. It’s a big step.\nQ But as the states say they need more help from the federal government when it comes to those supplies, what do you say to those governors?\nTHE PRESIDENT: Well, when you say the states — in particular, three states need some help. And some states, you know, have two people, three people — no people, in the case of, again, West Virginia.\nSo we’re looking at it very closely. We’ve taken it apart 15 different ways. It’s a very difficult thing to do. It’s a very big step. And if we need that step, we’ll take it, okay?\nQ A quick follow-up to Kristen’s first question. A lot of people have got travel to places that aren’t considered hotspots — Caribbean, Mexico, that sort of thing — over the next few weeks. Would you recommend that they follow through with these plans?\nTHE PRESIDENT: I would just say: Enjoy your home. Stay. I would just say, right now, we — we have to get this problem fixed, and then we’ll get back into business really quick. We’ll open up our country, we’ll open up our society. The world will hopefully open up.\nWe see areas of the world that are — that haven’t done well, and we see areas that are doing very well. And I would put us in the category of doing very well for a country so big. I think that I would recommend that they just enjoy their living room.\nJon?\nQ Mr. President —\nYeah, go ahead. Please.\nQ What do you say to people who are not heeding these guidelines from the White House? And then, also, I have a question on asymptomatic people that Dr. Birx —\nTHE PRESIDENT: Yeah, sure. I’m not happy with those people if they’re not. But, you know, those people are being shouted down by other people. They know it. They’re being — it’s almost like self-policing. People went in, and there are couple of instances, I guess — probably more than a couple — where people are not happy when they see others doing what they’re not supposed to be doing.\nWe have to get rid of this. We have to win this war, and, ideally, quickly. Quickly. Because the longer it takes, it’s not a good situation. And I’m not even talking about the economy. I’m talking about the lives of a lot of people.\nYeah, please. Did you have one?\nQ Will the White House put any restrictions on corporate bonuses for companies that do get bailed out, like airlines?\nTHE PRESIDENT: I’m going to ask — I think I’m going to ask Mike. Answer that question, please.\nTHE VICE PRESIDENT: I think it’s all a work in progress. What President Trump has made clear to industries around the country is that we’re going to do whatever it takes. We understand this is an extraordinary moment in the life of our nation. It’s the reason why the President brought in leaders of the financial sector, the airline industry. He’ll meet with all additional industry leaders today in tourism and hospitality.\nBut he has tasked the Secretary of the Treasury to work with members of Congress in both parties to make sure that we construct the kind of economic support that will allow those industries to weather the period of the coronavirus and then to come back stronger than ever before.\nTHE PRESIDENT: We’ve had — we’ve had such incredible — I don’t know, it’s almost the word “spirit” is the best word. It’s like a spirit.\nTHE VICE PRESIDENT: That’s true.\nTHE PRESIDENT: The banks have come in and the banks are doing things that they would have never done. They’re working on extensions and lots of things that they wouldn’t have done.\nCo-pays, with regard to the insurance companies — I mean, for them to be doing what they’re doing — and you know all about the co-pays — they would have never done that, and they did it. They were in my office. They — I would say the 11 biggest in this country; I guess, probably, the 11 biggest in the world. The big ones, all the big ones. And they — they did things on co-pay that nobody would be doing, that they wouldn’t have done in a million years, but they’re doing it. There’s a great spirit going on right now in the country.\nSo you want — yes, please.\nQ A question for Dr. Fauci. Dr. Fauci, you’ve said you like being accused of overreacting because that is an indication we may be doing things necessary to beat this, bend the curve. How long do you think it will take for you to be confident that, yes, we’re bending the curve or, no, we’re not?\nDR. FAUCI: You know, I can’t give you a firm number on that because the dynamics of outbreaks, in some respects, are predictable. Historically, they do this and that. We don’t know because this is really unprecedented.\nI mean, of all the outbreaks that I’ve been involved with over the last, at least, 36 years, and then going historically back, we’ve never had a situation where the mobilization of all the different components: travel restrictions, internal containment, mitigation, financial assistance, public health assistance, testing. So we don’t really know.\nBut the one thing I do know: I do know that if you look at models, with all of their vicissitudes of models, is that when you have input into the kinds of mitigations and things that we’re doing, we’re going to see a hump instead of a peak.\nI would be really surprised if all the things that we’re doing — and this is, really, comprehensive approach. I was struck as I was listening to everyone make their — their presentations that, you know, I’m a scientist, I’m a health person, and I’m a physician who sees patients. So I look at it from one particular standpoint. But what I’m being impressed by is that this is really a comprehensive thing that has multiple components to it. All of them got to succeed if we’re going to get to that endpoint that I’ve described multiple times from this podium.\nSo I hope that if everyone does their job, we’re going to be able to give you a number and say, “You know, we’ve seen that inflection and we’re coming down.” I would hesitate to do it now, to be honest with you, because it might be misleading and I don’t want to be misleading.\nI just want to say one other thing, because I heard Dr. Birx say it, and I think we need to say it over and over again: When I was young — a long time ago — I felt that I was invulnerable the way I think many of us feel we’re invulnerable. And when we’re asking the young people to help us with this mitigation strategy by staying out of the bars, staying out of the restaurants, really trying to distance yourself, don’t get the attitude, “Well, I’m young, I’m invulnerable.” You are — well, in some respects, you’re certainly less vulnerable than I am. However, what you might inadvertently do — and I know you don’t want to do that — you don’t want to put your loved ones at risk, particularly the ones who are elderly and the ones who have compromised conditions.\nWe can’t do this without the young people cooperating. Please cooperate with us. Thank you.\nQ Dr. Fauci —\nQ Mr. President —\nTHE PRESIDENT: Go ahead.\nQ Dr. Fauci — and I’m going to use my notes so I get this right, but there’s apparently a new study out of China. It found that the vast majority of cases — 86 percent — were in untested patients with mild to no symptoms. So what does that say about the impact of testing? And does it mean that testing should actually go beyond the sickest patients?\nDR. FAUCI: You know, that question keeps coming up, and I’m not going to evade the question, but I want to make a point. We tend to think that we’re not going to be able to mitigate or contain without testing. They complement each other in some respects, but they’re separate channels. Even if we had no testing, we should be doing what we’re doing now.\nThe question you’re asking — so I won’t evade — is specifically: Would it be important, outside of a doctor, patient coming in together, of knowing what’s out there; what might be under the radar screen? The answer to your question is “yes.”\nSo let me tell you what the CDC is doing right now. They’re going out there, and part of their program is to get a feel for what is there that wasn’t initially thought to be coronavirus, that was thought to be something else. When you do that, you’re also going to get a feel of what the penetrance is in society. So we are heading with the high-throughput things that you’ve been hearing about to get an answer to your question.\nQ Dr. Fauci, Governor Cuomo said this morning he believes that we’ll see a peak in terms of infection in 45 days. Would you concur with that?\nDR. FAUCI: You know, it’s possible. I mean, I know the Governor has been really, I believe, doing a really good job of trying to stay ahead of this. Forty-five days is not unreasonable. You have to be careful. When you get a number, you own the number. And then if the number doesn’t come out, you’re in trouble.\nAnd that’s the reason why, from our standpoint, from the federal government, we’re talking about a range. So within that range — I mean, it isn’t like you want to be correct for the sake of being correct, but you don’t want to be wed to something and then have to back off.\nTHE PRESIDENT: Go ahead, please.\nQ When is the soonest that we’ll know that these new guidelines are actually bending the curve or actually working? And is there a point in time where, you know, in the next couple of weeks, where you’ll be able to tell the President more draconian measures are needed?\nDR. FAUCI: Well, okay, so what’s happening — I mean, if you look as a metaphor, it’s kind of like a race against the virus. If left to its own devices, we’ll do this. And us trying to somehow blunt that.\nNow, you could see the virus going up and up, and your effect, your work — what you’re trying to do — may actually be having an effect, but you may not see it because it’ll still be going up. And as you’re trying to implement your interference with the virus, you may not realize that you are actually interfering, and you’ll say, “Wait a minute, it’s still going up. What’s going on? You’ve done nothing.” But you don’t know whether it would do this versus that.\nSo the answer to your question: It probably would be several weeks and maybe longer before we know whether we’re having an effect.\nIt may be, at the end of the day, we’ll see a curve that would have been way, way up. But I wouldn’t, like, put us to task every few days: “Well, wait a minute, it’s going up. Is it working or not?” That would be really misleading if we do that.\nQ Dr. Fauci —\nQ I have a question —\nTHE PRESIDENT: Go ahead. Go ahead.\nQ Regarding the 15-day guidelines which were announced yesterday, one of those guidelines was a recommendation against gatherings of 10 or more people. And today, the governor of Alabama issued her own guidelines, and it was a recommendation against gatherings of 25 or more people. What is your recommendation for people of Alabama, people across all of the country, as far as the guidelines that were announced yesterday by the federal government?\nDR. FAUCI: Okay, so the one thing we don’t want to do is to get hung up on the difference between 10 and 25. I think you might agree with that. When we give guidelines, they’re only guidelines. We sit down, we look at the data — as Dr. Birx said, we’re data-driven — and we say, “On different models, 10 looks good.”\nIf someone wants to do 25, we’re not going to fault them, but if someone wants to come to us, ask us what we think is the best is, we stand by the numbers. It isn’t perfect. It isn’t precise math. It’s assumptions and it’s data that make you get your decision.\nQ But would it be more effective if every state and every city in the country was playing by the same rules instead of different?\nDR. FAUCI: Yes. Of course. But this is the United States of America. There’s a lot of free enterprise there. People do their own thing. And quite frankly, I don’t think there’s a big-deal difference between 10 and 25. We got many, many more important things to worry about than that difference.\nQ Mr. President, thank you. Going back to supply chains and then talking about preparedness for the future, yesterday, Larry Kudlow said that there is an idea floating around the administration to cut taxes for companies who would be bringing their supply chains back to the United States. He said he specifically liked immediate 100 percent write-offs for —\nTHE PRESIDENT: Right.\nQ — structures, equipment. But he said you hadn’t endorsed that yet. Would you endorse an idea like that?\nTHE PRESIDENT: We’re looking at many ideas. That’s one of them, frankly. And we’re looking at creating incentives for companies — not only that type of company, but other companies.\nWe’re also looking to help companies, such as the airline industry — within the airline industry. And we’ll be doing that. We will be doing that. This is not their fault. And they’ve been very understanding, actually. And we’re going to be helping them. We will have a very powerful airline industry, and it’ll start up as soon as this is over. We’ll — we’ll have those — we’ll have those planes ready to go. So we have to help them during the short term with — very important.\nYeah, please.\nQ Thank you, Mr. President. I wanted to know, have you taken a look at some of these models, such as the Imperial College London model, that kind of poses a very difficult choice, whether it’s shutting down society or overwhelming the healthcare system?\nTHE PRESIDENT: Right.\nQ Is that something that you took into consideration?\nTHE PRESIDENT: We look at every model. We’ve relied on the very talented people. And there’s no better team than the people behind me. And I will say that all of the people that have done those models are all in constant touch with Dr. Birx and Tony and everybody that you’ve been hearing so much from over the last couple of weeks.\nWe’ve looked at — we’ve looked at many different models. And the model we have is, we want to save a lot of lives. We want to save a lot of lives. If we get too steep on that curve, you’re going to lose a lot of lives, perhaps unnecessarily.\nNow, we’re going to find out. Everything has a risk. We’re going to see. But if people do what we’re telling them to do, what we’re asking them to do, you’re going to see the saving of a lot of lives.\nNow, Boris, in UK yesterday — you saw what happened — it looked like they were going a different way, but then he went a way of similar — I guess similar — I don’t know exactly. But I would say we had a conversation yesterday, similar to what we’re doing.\nSo a lot of people seem to think this is going to be — we are — we are looking to save the maximum number of lives. Everything else is going to come back. A life is never going to come back. But everything else — our economy is going to come roaring back.\nYou’re going to know, we’re going to know — we’re going all know that day. Somebody was asking about the day, “When will you know? When will you know?” We’re going to know. All of a sudden, we’re going to say, “Wow, that’s looking good. That’s looking good. That’s looking good.” And we’re going to be on the other side of the curve. And that’s a day that we look forward to. Okay?\nQ Is there something, sir, that you saw this week though that did — that made you decide that, yes, now is the time to implement these much more stringent social distancing measures? This week, sir.\nTHE PRESIDENT: No, I don’t think so. This is where we were going. I really think, from the beginning, this is where we were going. This is what we had in mind. We were just — we’re just going step by step. That was the next step — the next logical step.\nAs Dr. Fauci said — and I think very importantly — one of the most important things, when you write the history of this, was the fact that we closed it down to China and Europe, but in particular, China. We closed it down to China, the source, very, very early. Very, very early. Far earlier than even the great professionals wanted to do. And I think, in the end, that’s going to be — that will have saved a tremendous number of lives.\nQ A quick follow-up. One on the economy and the other on the broader picture here. But just to follow up on my colleague: Some people did note that your tone seemed more somber yesterday. You talked about that August timeline. Did you see a projection? Some people thought perhaps that 2 million, potentially, that could die maybe prompted part of that. Was there a shift in tone?\nTHE PRESIDENT: I didn’t think — I mean, I have seen that, where people actually liked it. But I didn’t feel different. I’ve always known this is a — this is a real — this is a pandemic. I’ve felt it was a pandemic long before it was called a pandemic. All you had to do is look at other countries. I think now it’s in almost 120 countries all over the world.\nNo, I’ve always viewed it as very serious. There was no difference yesterday from days before. I feel the tone is similar, but some people said it wasn’t.\nQ Can I ask one on the economy? Your former economic adviser said almost 100 percent chance of a recession. Do you see it that way?\nTHE PRESIDENT: It could be. I mean, I don’t think in terms of recession. I think in terms of getting it out, because when we’re finished with the virus, we will win. We will win.\nAnd when that victory takes place, our economy is going to go through the roof. It is so pent up. It is so built up. It is so ready to go in an upward direction. But we have to knock out this enemy. This is a really tough enemy, but we have to knock out — all of us. That’s all of us.\nSo I don’t think in terms of recession. Not recession. It’s words. We have to knock out this, and we will have an economy — I actually think we’ll have an economy like we’ve never had before. It’s all pent up.\nDid you have something to say, Mike? Please.\nTHE VICE PRESIDENT: So, I think the question about the actions that the President has authorized, beginning in January, when he took the unprecedented step of suspending all travel from China; the efforts to issue travel advisories for portions of Italy and South Korea and then to begin screening all the passengers; the efforts regarding suspending travel for Europe; and what went into effect at midnight last night, adding the UK and Ireland to that — have all been informed by the experts that are surrounding us.\nWhat the President has asked us to do from the very beginning, as Dr. Birx and Dr. Fauci often say, is let’s follow the data, bring the President the best options in response to what is actually happening on the ground.\nBut with regard to yesterday’s 15-day slow-the-spread plan, our team unanimously brought to the President these very strong recommendations for every American, because we truly believe we are at a point in this epidemic in our country when we can reduce the number of people that actually are exposed to or contract the coronavirus.\nBut we’ll continue to bring the best data, the best evidence, and the best recommendations, frankly, of the best health experts in the world. And the President will continue to make decisions that put the health of America first.\nTHE PRESIDENT: In other words, reduce the number of people that die. That’s what we’re trying to do. And when you do the steep curve, a lot of people are going to die. A lot of people.\nYou know, the worst ever, they say: 1918. And I don’t have to go into the numbers, but they were unbelievable numbers. Had they known and had they done what we had now, it would have been a very much different story. It would still be tragic, but it would have been a very much different. But that was — that was the one that people write about. That was an incredible — that was an incredible pandemic like we haven’t seen.\nBut we have — we have done something that I hope — hopefully, we will all have made the right moves. We’re all in this together, including you, and we want to see fair press. And I tell you what: It’s been — generally speaking, I think it’s been — it’s been a great thing to see.\nIt’s been very, very — the — getting along with Democrats, getting along with Republicans, for the Democrats themselves — there’s been a lot of spirit. There’s been a lot of things happening that I haven’t seen happen in the first almost now three and a half years. It’s been very nice to see. That’s one of the good things.\nBut, really, the good thing is we have to knock it out. We have to win. And we want to keep that slope as low as possible because that’s a lot of lives in there.\nLet’s go back there. Somebody that didn’t get one. Please, go ahead.\nQ Mr. President, this has had a huge impact on China’s economy as well. Have you received any indication from officials there that they’re going to have trouble meeting the purchase agreements — part of the phase one deal — particularly the agricultural buy?\nTHE PRESIDENT: Well, they need our product very badly and — no, I haven’t received any. We have a good relationship with China. I have not received anything to that. No, we have a signed agreement. They’re going to be buying and they have been buying a lot of product.\nYeah, please.\nQ Earlier today, Dr. Birx was talking about the possibility of our hospital system being overburdened and overtaxed, and she talked about certain options that are available to the United States if that happens, including VA hospitals —\nTHE PRESIDENT: Right.\nQ — Department of Defense medical treatment facilities, and even hospital ships. At what point do you tap into those options?\nTHE PRESIDENT: Well, I’ll know the point. And by speaking with Governor Cuomo and other governors, we’re going to know the point. It’s going to be different for New York than it’s going to be for, you know, Iowa or from Idaho or from West Virginia, frankly, or for — you know, it’s different. New York has got a big problem. The State of Washington has a big problem. California has some big problems.\nEveryone is doing a good job. But we’re going to know when it will be, and I believe it’ll be more spot than it will be — it’s not going to be the whole thing; it’s going to be spots. There are some hotspots that are in trouble — big trouble. And there are other areas that are in no trouble at all. They watch it on television. They don’t know — you know, it’s just not affecting them and that’s — they’re lucky. They’re lucky. But there are areas of the country that don’t have much of a problem and some that don’t have any problem. They’re not going to have a problem with hospitals.\nBut some areas — like New York, California, State of Washington — they’re going to have some difficulty. And when we see that coming, we’re going to be in there. We’re already making preparation for it.\nQ Senator Marco Rubio of Florida and your trade advisor Peter Navarro have been recommending an executive order that would ensure that the raw materials for pharmaceuticals and medical devices are manufactured here in the United States. We were getting some indications last week that you were close to signing this executive order. Can you tell us where you are on that?\nTHE PRESIDENT: Well, we’re looking at different things, John. I don’t want to say exactly. Right now, China has been sending us everything we need. But we are — we’re looking at some alternatives. Yes, we are looking for alternatives.\nAnd we have other places. Ireland does a lot of work for us — you know that — in that world, in the pharma world. A very tremendous producer. And we are looking to bring a lot more back home.\nAnd I’ve been — excuse me, you know me for a long time; I’ve been talking about this for many years. Long before I decided to run for President, I’ve been talking about this. And we have to be able to take care of our country. And that was one of the many things on the list. So we’ll be talking about it.\nBut we are — we are discussing it, and Marco is very much involved and Peter is very much involved. A lot of people are involved, and a lot of people feel that way. But we’ll be discussing.\nLet’s go. Please.\nQ Thank you, sir. Canada has closed its borders to non-citizens. Are you considering —\nTHE PRESIDENT: Not to the United States.\nQ Not to the United States, of course. Are you considering closing the land borders in the United States? And also, you’ve discussed —\nTHE PRESIDENT: Well, Canada has not closed it to the United States.\nQ Right.\nTHE PRESIDENT: So we’re working very closely with Canada and — but they have not closed it. They have closed it to the world, but they have not closed it to the United States.\nQ Are you considering closing the U.S. land borders?\nTHE PRESIDENT: I don’t want to say that, but we are discussing things with Canada, and we’re discussing things with Mexico, quite honestly. And, again, the relationship is outstanding with both. Outstanding. We just signed our deal — the USMCA — and the relationship is very strong.\nGo ahead, please.\nQ China and other have others have criticized you for using the phrase “Chinese virus.” How do you feel about that? Are you going to continue using that phrase?\nTHE PRESIDENT: Well, China was putting out information, which was false, that our military gave this to them. That was false. And rather than having an argument, I said I have to call it where it came from; it did come from China. So I think it’s a very accurate term. But, no, I didn’t appreciate the fact that China was saying that our military gave it to them. Our military did not give — give it to anybody.\nQ But the critics say using that phrase creates a stigma.\nTHE PRESIDENT: No, I don’t think so. No, I think saying that our military gave it to them creates a stigma.\nQ Mr. President, when you speak to —\nTHE PRESIDENT: Please.\nQ When you speak to travel and tourism executives today, what specific help are you going to offer to them, if at all? Or is it still vague?\nTHE PRESIDENT: Well, we’re going to help. They need help. Look, let’s face it. You know, they go from having record-breaking years — this is the third year of record-breaking years — travel and tourism, airlines, everything. They were doing record numbers, ordering new planes, building new hotels. Everything was really hunky-dory.\nAnd then, one day, we hear about this rumor in China. And then, we find out it’s much more than a rumor. And then, all of a sudden, we make a great decision to close it up early. It would be a whole different world. It would be a whole different world. But we make a decision to close it up to China, and all of a sudden, tourism and — and then we close it up to Europe, which, you know, people never heard of this before. I’m not sure that that’s ever been done. I know that when I made the decision to close it to China, people told me that’s never been done before, but it was a great decision.\nWe make good decisions. So, I’ll tell you my best decision: The people behind me are total pros. All over the world, they’re respected — Dr. Birx; Anthony, who has become a — where is Anthony? — become a major television star for — for all the right reasons. No, he’s just so professional. So good.\nThe people that we have working here have been incredible. And they’re totally respected. The Admiral has been incredible, having to do with the testing. Incredible. And he’s viewing this as testing also for the future. We’re building a platform.\nWhen we took over this platform, the first thing the Admiral said was, “This was not designed for what we’re talking about — millions of people.” It wasn’t. And it’s nobody’s fault. It’s not like — who could have ever predicted a thing like this? But we broke it down and it’s really going to be an incredible system. And it is now a great system.\nI just — I just want to say, these are people standing behind me. They’re the most respected in the world. Every country that you’ve mentioned today so far has called them, and they call them all of the time for advice. There is nobody better than what we have.\nQ Mr. President, why haven’t we seen Dr. Redfield in the last couple of days?\nTHE PRESIDENT: Say it.\nQ Why haven’t we seen Dr. Redfield in the last couple of days?\nTHE VICE PRESIDENT: (Inaudible.)\nTHE PRESIDENT: I don’t know. I can’t imagine —\nSECRETARY AZAR: He’s in Atlanta, running the CDC.\nTHE PRESIDENT: I can tell you he’s doing a good job. We’re very happy with him.\nPlease. You haven’t. Go ahead.\nQ Mr. President, yesterday we were being told that the payroll tax was going to comprise the lion’s share of fiscal stimulus.\nTHE PRESIDENT: Right.\nQ We also had the markets fall quite dramatically yesterday and — were you — did that inform your —\nTHE PRESIDENT: It wasn’t about the payroll tax.\nQ Did that inform your decision? What — what made you make that change? And when did you make that change?\nTHE PRESIDENT: Well, I didn’t make a change. We’re looking at payroll tax. And we’re looking at various other forms of getting money to people. And the payroll tax is something that I’ve always liked. The problem is it does take a period of time — you know, months — before they really see something. And we don’t really have months, in terms of people living. You know, a lot of these — you have people that work on tips. You have people in our — it’s a large number of people. It’s a tremendous — who would think this, right? And they do nicely. They work very hard, but they work on tips.\nWe have to take care of our people. We don’t want to have people suffering during this period. It wasn’t their fault that this thing, all of a sudden, was upon us. So we’re looking at various — we’re also looking at payroll tax. You know, it’s possible. It’s also possible we’ll do a percentage of payroll tax and then other things. But we’d like to be able to get money to people.\nYou know, we’re very lucky our country is doing so well, we can do this and we can do it easily. But we have to do it. And I have to say, Mitch McConnell — if you look at Mitch and Kevin and the whole group, it’s been — it’s been incredible how they’re reacting, how Congress is reacting, how — whether it’s the House or Senate, how they’re moving. And I’m talking about Democrats and Republicans.\nBut we’ve had tremendous leadership meetings, and they want to see it done right and they do want to go big. I think going big is important. I don’t think we want to go up there every day with a different idea, a different concept. “Oh, gee, let’s worry about the airlines. Let’s do this one.” You have a big problem with the cruise ship industry. It’s an industry that was setting all sorts of records two months ago. And then, all of a sudden, there is nobody on the ships. Okay?\nSo we have to help these. These are great industries. These are going to be taking care of people and passengers and — and for years to come. And paying tremendous taxes — tremendous taxes for years to come. So, we have to make sure this is done.\nYes, Jon.\nQ Mr. President, I want to bring up what you referred to just a short while ago about politics. In your address to the nation, you said we have to put politics aside, stop the partisanship, and unify together. But this morning, you criticized the Democratic Governor of Michigan. Yesterday, it was the Democratic Governor of New York. You’ve attacked Obama. You’ve talked — you attacked Biden. In fact, every day except one since that address, you’ve lashed out at a Democratic leader. Are you going to set the example on this?\nTHE PRESIDENT: I only do that when I have to respond. I watched her on television. She said something that was false and therefore I did do that. And I will continue to do that if they’re not going to play fair. Because, you know, they have the media on their side; I don’t. I just have me.\nAnd if they’re not going to play fair, I’m going to do that. If they are going to play fair, there’s going to be nobody —\nQ Obama never criticized you, sir. (Inaudible.)\nTHE PRESIDENT: There’s going to be nobody better than Donald Trump, in terms of bipartisanship. But if they’re going to say things that are false, like the story that was written yesterday. A lot of people — I don’t know — somebody — I think I know who — but they taped the conference call that I had with the governors. It was a good call. It was fine. I assumed somebody is going to tape it. They handed it to various people, and one of them was the New York Times and the New York Times chose to write totally inaccurately about it. It was a disgraceful thing. It was bad journalism, but, you know, they do a lot of bad journalism. But we respond to that and, actually, people get it. People get it.\nNo, I want it to be bipartisan and nobody’s going to be better than me. But when they attack me or the people — these incredible people behind me — I’m not going to let them get away with that. I can’t do that.\nOkay, how about one or two more questions? Go ahead, please. Please.\nQ To follow up on that, (inaudible) was the next natural step. So is the next natural step after that a national lockdown, similar to what San Francisco is doing?\nTHE PRESIDENT: Well, you can do a national lockdown. Hopefully, we are not going to need that. We think of everything. I mean, we have — every idea that you mentioned, we’ve thought of. And, you know, that’s a very big step. That’s a step that, I mean, in one sense would work. It’s a very big step. It’s something we talk about, but we haven’t decided to do that.\nPlease, go ahead.\nQ Mr. President, what would be the determining factors for you to take that action?\nTHE PRESIDENT: It would have to get to a level — I just don’t think it’s going to be an action that we’re going to take. I don’t think I’ll talk — but Anthony, all of the people standing behind, we’d get together in a room, plus some additionals, and we would make a decision. But I don’t think that’s a step that we’re going to be taking.\nBut one more question. You didn’t have one, did you? Come on.\nQ Will the U.S. government provide financial assistance to Boeing and airplane suppliers like GE?\nTHE PRESIDENT: We’re looking at that. We’re certainly looking at Boeing. Boeing got hit hard in many different ways. Boeing never had a problem. For — for years, they were — they were an incredible — an incre- — they were — it was unthinkable what happened, with respect to Boeing. Unthinkable. Probably, I would consider it the greatest company in the world prior to a year ago. Now they get hit in 15 different ways and they have different management. I’ve met the new people running Boeing. I think it’s going to be outstanding.\nBut, yeah, we have to protect Boeing. We have to absolutely help — help Boeing. They were doing a job. They were getting — it was coming along well. And then all of a sudden, this hits. So, obviously, when the airlines aren’t doing well, Boeing is not going to be doing well. So we’ll be helping Boeing. Yeah.\nQ Could you just respond to something, Mr. President, before you leave, on what Jon was saying? You’ve — you’ve called for people to leave politics out of this. Joe Biden said, “The World Health Organization offered testing kits that they had available to the United States and to give it to us now. We refused it. We didn’t want to buy them.” PolitiFact says the WHO never made that offer. Can you tell us what actually happened?\nTHE PRESIDENT: Well, that’s what I heard. And I’m going to let — I’m going to let Tony answer that question. Or some- — whoever is best at answering that. But I do have to say, when you talk about politics — I watched the debate. Not too exciting. But what they said about me — and we’ve done a great job. When you talk about not — not being bipartisan — what they said about me.\nAnd if you look at swine flu — the whole thing in, I guess it was 2009, and what they did and the mistakes they’ve made, they were terrible. They were horrific mistakes. Seventeen thousand people died. And I’ll be honest, they shouldn’t be criticizing because we’ve done a fantastic job.\nThe only thing we haven’t done well is to get good press. We’ve done a fantastic job, but it hasn’t been appreciated. Even the — the closing down of the borders, which had never been done — and not only did we close them, but we closed them early — the press doesn’t like writing about it.\nSo we’ve done a poor job on press relationships and, you know, I guess, I don’t know who to blame for that. I don’t know, maybe I can blame — maybe I can blame ourselves for that. I will blame ourselves. But I think we’ve done a great job. I think we’ve done a poor job, in terms of press relationship.\nBut let me have somebody answer your question.\nDR. BIRX: Yeah, so I tried to cover this in the answer when I talked about quality of kits. And our quality analysis runs through the FDA. So all of these platforms, we have asked people to submit. And we’ve asked states to quality control. So, I mean, the — anybody could submit their test to us. We don’t buy tests that haven’t been quality controlled and they show us the data. Either show us the data upfront or show us the data after they’ve been running them.\nBecause quality testing for our American people is paramount to us. It doesn’t help to put out a test where 50 percent or 47 percent are false positives. Imagine what that would mean to the American people. Imagine their level of concern now in telling people that they’re false positive.\nWe take the same approach to HIV. Imagine telling someone they were positive to HIV and they weren’t. So that is our bottom line: the customer, the American people first. And so any of these groups can submit their testing kits through our regulatory processes, but without that and without a plan, we are not going to accept tests that have not been studied by us.\nTHE PRESIDENT: Good answer. That’s a good answer. Would you have something on that?\nADMIRAL GIROIR: I’m just going to emphasize a little bit more on that. When I became involved in the testing world, I called as senior officials at the WHO as I could find to understand what the situation was. And as far as I can tell from sources that should know, no one ever offered a test that we refused.\nTHE PRESIDENT: That’s what I heard too.\nADMIRAL GIROIR: This was a — this is a research-grade test, right? Research-grade test that was never submit- —\nSECRETARY AZAR: It was not approved.\nADMIRAL GIROIR: Not approved, not submitted to the FDA, that was supplied in tens of thousands of quantities to 100 countries in the world, okay?\nSo I think there’s a lot that people are saying about this that’s just based on rumor and myth. Nothing was offered that we refused. It was a research test that was not approved. And again, there was a small number that we have greatly surpassed in a very short period of time.\nTHE PRESIDENT: So, number one, nothing was offered. Number two, it was a bad test. Otherwise, it was wonderful.\nListen, thank you very much.\nQ So Joe Biden was incorrect?\nTHE PRESIDENT: No he made a mistake. I assume — I assume that he’ll apologize. He made a mistake.\nThank you all very much. Thank you. We’ll be back. Thank you.\nTHE VICE PRESIDENT: Thank you all.\n1:03 P.M. EDT"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Seasonality of SARS-CoV-2: Will COVID-19 go away on its own in warmer weather?"],["url","https://ccdd.hsph.harvard.edu/will-covid-19-go-away-on-its-own-in-warmer-weather/"],["summary","Marc Lipsitch, DPhil\nProfessor of Epidemiology and Director, Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health\n(tl;dr) Probably not.\nSeveral people, including the US president, have suggested that the novel coronavirus SARS-CoV-2 and the disease it causes, COVID-19, will go away on its own in the warmer weather that will come in the Northern Hemisphere in coming months. Some have even suggested that the experience with SARS in 2003 provides evidence for this assertion.\nThe short answer is that while we may expect modest declines in the contagiousness of SARS-CoV-2 in warmer, wetter weather and perhaps with the closing of schools in temperate regions of the Northern Hemisphere, it is not reasonable to expect these declines alone to slow transmission enough to make a big dent.\nBefore making the positive case for my assertions, let me start by busting some myths.\n\nMyth 1: In 2003, SARS went away on its own as the weather got warmer.\nSARS did not die of natural causes. It was killed by extremely intense public health interventions in mainland Chinese cities, Hong Kong, Vietnam, Thailand, Canada and elsewhere. These involved isolating cases, quarantining their contacts, a measure of “social distancing,” and other intensive efforts. These worked well for SARS because those who were most infectious were also quite ill in a distinctive way — the sick cases were the transmitters, so isolating the sick curbed transmission. In Toronto, SARS resurged after the initial wave was controlled and precautions were discontinued. This resurgence was eventually linked to a case from the first wave. The resurgence confirms that it was control measures that stopped transmission the first time.\n\nMyth 2: The “common cold” coronaviruses are seasonal, with little transmission in the summer, so SARS-CoV-2 will be too.\nPredicting how a novel virus will behave based on how others behave is always speculative, but sometimes we have to do so when we have little else to go on. So the first problem with this myth is that we don’t know whether those coronaviruses, which go by the evocative names like OC43, HKU1, 229E, and NL63, are good analogies for this virus. Still, it is worth considering the analogy especially to OC43 and HKU1, which are SARS-CoV2’s closest relatives among the seasonal coronaviruses. The other reason this is a myth is that seasonal viruses that have been in the population for a long time (like OC43 and HKU1) behave differently from viruses that are newly introduced into the population.\nTo understand why, it helps to understand what we know about why many respiratory viruses are winter-seasonal in temperate regions like most of the USA. Scientists have identified four factors that contribute to this phenomenon. For some viruses, we have evidence for which factors are most important, for others, we have to extrapolate.\n\nFactor 1: The environment.\nIn the winter, the outdoor air is colder, and the air is dryer usually both indoors and out. For influenza, it has been elegantly shown in the lab that absolute humidity — the quantity of water vapor in the air — strongly affects flu transmission, with drier conditions being more favorable. Subsequently it has been shown that epidemiological patterns are consistent with this lab data in the US and in Vietnam, among other study sites. Notably the Vietnam study looked at influenza-like illness, without distinguishing influenza from other types of pathogens. This hints that similar mechanisms may be at work for other respiratory viruses, but to my knowledge are no specific studies of the role of humidity for coronaviruses or other respiratory viruses besides flu. Also important: there may be some very humid conditions that also favor flu transmission, especially relevant in the tropics. Still it is safe to say that in temperate countries, dry cold air = favorable conditions for flu transmission. For coronaviruses, the relevance of this factor is unknown. A recent preprint on which I collaborated suggests that transmission is possible in many different climates, and points out that Singapore, for example, which lies nearly on the equator, has had significant transmission. This is one piece of evidence, but as my colleague Dr. Eli Perencevich has pointed out there are many differences between Singapore in February and a temperate zone in summer — different day length, ultraviolet radiation, and other factors that may be important for coronavirus – we simply don’t know.\n\nFactor 2: Human behavior.\nIn the winter humans spend more time indoors with less ventilation and less personal space than outdoors in the summer. In particular, schools are a site of much infectious disease transmission. School terms have been strongly identified as periods of higher transmission for respiratory viruses including those causing chicken pox, measles, and flu (here and here). The 2009 pandemic flu in the United States was very much decreased during the summer, and then came back rapidly in September.\nThe relevance of school terms is important but unknown for the SARS-CoV-2. Few children have been identified as cases. This may mean they do not get easily infected and don’t do much transmitting. Or it may mean only that they don’t get severe symptoms when they are infected, and transmit nonetheless. Or something in between. Understanding this is key if we want to know whether school closures can help control COVID-19 spread, as well as to anticipate how much summer vacation may help reduce spread.\n\nFactor 3: The host’s immune system.\nIt is possible that the condition of the average person’s immune system is systematically worse in winter than summer. One hypothesis has focused on melatonin which has some immune effects and is modulated by the photoperiod, which varies seasonally. Another with more evidence is that vitamin D levels, which depend in part on ultraviolet light exposure (higher in summer) modulate our immune system in a positive way. The best evidence for the relevance of this hypothesis is that vitamin D supplementation reduces the incidence of acute respiratory infection, according to a meta-analysis of randomized trials. On the other hand, we found that this effect was unlikely to be a large factor in the variation in influenza incidence between summer and winter. This is a promising area for more study but at present its relevance seems uncertain.\n\nFactor 4: Depletion of susceptible hosts.\nEven without any seasonal variability, infectious disease epidemics rise exponentially, level off, and decline because when many individuals are susceptible, each case infects more than one new case (Reff > 1). Then as the proportion of susceptible contacts declines, the epidemic peaks (Reff = 1), and eventually declines (Reff < 1). When there is some factor (like any or all of #s 1-3) varying seasonally, and when new susceptibles appear in the population over time (for example through births) this process interacts with the seasonal factors to produce recurrent epidemics typically at the same time each year.\n\nThis leads us to the last point: Even seasonal infections can happen “out of season” when they are new.\nNew viruses have a temporary but important advantage – few or no individuals in the population are immune to them. Old viruses, which have been in the population for longer, operate on a thinner margin — most individuals are immune, and they have to make do with transmitting among the few who aren’t. In simple terms, viruses that have been around for a long time can make a living — spread through the population — only when the conditions are the most favorable, in this case in winter.\nThe consequence is that new viruses — like pandemic influenza — can spread outside the normal season for their longer-established cousins. For example in 2009, the pandemic started in April-May (well outside of flu season), quieted in the summer (perhaps because of the importance of children in transmission of flu), and then rebounded in September-October, before the start of normal flu season. Seasonality does not constrain pandemic viruses the way it does old ones. This pattern is common for flu pandemics.\n\nSo in summary:\nFor the novel coronavirus SARS-CoV-2, we have reason to expect that like other betacoronaviruses, it may transmit somewhat more efficiently in winter than summer, though we don’t know the mechanism(s) responsible. The size of the change is expected to be modest, and not enough to stop transmission on its own. Based on the analogy of pandemic flu, we expect that SARS-CoV-2, as a virus new to humans, will face less immunity and thus transmit more readily even outside of the winter season. Changing seasons and school vacation may help, but are unlikely to stop transmission. Urgent for effective policy is to determine if children are important transmitters, in which case school closures may help slow transmission, or not, in which case resources would be wasted in such closures. Previously it was thought children were not easily infected with SARS-CoV-2. Recent evidence from Shenzhen suggests that children may be infected and shed detectable virus at about the same rate as adults — so now the only question is whether they transmit as readily. It seems likely the answer is yes, but no data as of this writing to my knowledge."],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf"],["summary",""],["topImageUrl",null],["error","UNSUPPORTED"]]}]}],["createdAt","2020-03-18T07:56:39.906Z"]]}]]},{"__iterable":"Map","data":[["article",{"__iterable":"Map","data":[["replyCount",2],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",5],["user",{"__iterable":"Map","data":[["id","j4S8C_6hI7sX-8Sh1trBhPXBBvSR5c6RYc2wQCmkxKhtITBuQ"],["name","富創造力的新埤克萊斯特"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","【轉發】加州大學舊金山 BioHub 小組關於 COVID-19 的討論會小結，2020 年 3 月 10 日\n\n與會者：\n\n• 喬·德里西：UCSF的頂級傳染病研究員。陳扎克伯格生物中心（涉及UCSF/伯克利/斯坦福的合資企業）聯席總裁。在非典疫情中使用的芯片的共同發明者。\n• 艾米莉·克勞福德：新肺特別工作組主任，診斷專家\n• 克里斯蒂娜·塔托：快速反應總監，免疫學家\n• 帕特里克·艾斯庫：領導疫情應對和監測，流行病學家\n• 查茲·蘭格利爾：UCSF傳染病醫生\n\n下面基本上是小組成員發言原汁原味的記錄。少數不是原話會寫在括號中。\n\n• 主要觀點：\n\n在目前時點，美國已經錯過了遏制期，遏制基本上已是徒勞的了。我們的遏制努力不會減少在美國感染的人數。\n現在，我們只能努力減緩傳播速度，幫助醫生們應對需求高峰。換句話說，遏制的目標是平緩曲線，以降低需求激增的峰值，減弱對醫院的衝擊程度。並爭取時間，希望藥物可以盡快開發出來。\n目前社區中有多少人已經感染了病毒？沒人知道，我們正在從遏制階段轉到醫護階段。\n\n美國目前處於意大利一周前的時點，我們沒有任何理由可以說我們將能避免發展到像意大利那樣。\n\n在未來12-18個月中，40%-70%的美國人口將感染COVID-19。達到這個水平後，你可以開始獲得一些抗體。與流感不同，這病毒對人類是全新的，因此全球人口沒有潛在的免疫力。 [貝克實驗室在3月1日晚餐上也告訴我感染率估計為30-70％]\n\n[我們用這個的數字來估計死亡人數——表明大約150萬美國人可能會死亡，小組成員並不反對我們的估計。相比之下，季節性流感平均每年有5萬美國人死亡。假設50%的美國人口，即1.6億人感染新肺, 在未來12-18個月中，160萬美國人將死亡，死亡率為1%。約10倍於流感死亡率。這個估計是基於未來沒有開發出有效治療藥物的假設。\n死亡率因年齡而異， 80歲以上死亡率可能為10-15%。\n我們不知道COVID-19是否是季節性的，但即使夏天能消退，它可能會像1918年的流感那樣在秋天又復發。\n\n我只能明確地告訴你兩件事，一，在情況好轉之前情況肯定會變得更糟；二，我們至少明年還會面對此病毒，明年我們的生活會和以前很不一樣。\n\n• 我們現在該怎麼辦？你能為你的家人做什麼？我們知道在潛伏期也可能是有傳染性的，但不知道在症狀出現之前傳染性有多強，但症狀最強時病毒傳染性也最強。我們目前認為，在症狀出現前2天到出現後14天（T-2至T+14），感染者俱有傳染性。\n\n病毒能在體外存活多長時間？在物體表面上，根據不同表麵類型，目前認為能存活 4-20 小時（也可是能幾天），對此仍沒有共識。\n該病毒非常容易被常見的抗菌清潔劑消滅：漂白劑、過氧化氫、酒精。\n\n要避免去音樂會、電影院、任何擁擠的場所。我們已經取消了商務旅行。\n\n要做好基本的衛生，如洗手和避免觸摸臉。\n\n提前儲存好你的常用處方藥，許多連鎖藥店的供應鏈在中國，製藥公司通常儲備有2-3個月的原材料，因此，若中國製造業中斷，可能儲備會耗盡。\n\n注射常規肺炎疫苗可能會有所幫助，不預防COVID-19，但降低你身體變弱的機率，降低得COVID-19後惡化的可能性。\n\n明年秋天請一定要接種流感疫苗，雖然不能預防COVID-19，但同樣能減少你身體變弱的機率，降低得COVID-19後惡化的可能性。\n\n我們會建議任何60歲以上的人都呆在家裡，除非萬不得已請不要出門。美國CDC內部也一直在在討論是否應規定60歲以上的人不得乘坐商業航空飛機出行。\n\nUCSF同仁們正在將自己的高齡父母從養老院等遷回到自己的家裡，不讓他們走出家門，家裡的其他成員一進家門必須先洗手。\n\n新肺病毒感染的三條途徑：手到嘴/臉；唾沫/氣溶膠傳播；糞便到嘴的傳播。\n\n• 如果有人生病怎麼辦？如果有人生病，讓他們呆在家裡並避免與任何人接觸。任何在醫院裡能做到事，你在家裡也都能做到。大多數人病狀是溫和的，但是，如果他們病情變重，或者是70歲以上的老年人，或本來就有肺或心血管問題，必須帶他們去看急診。\n迄今為止，COVID-19沒有辦法治療。醫院能提供的只是支持性護理（如靜脈輸液、吸氧氣），幫助你維持生命，靠自己的免疫力戰勝病毒，預防敗血症。\n如果病人到了危重症期，你可以嘗試讓他們申請服用Remdesivir作為“同情用藥”，該藥物目前同時在舊金山總醫院、UCSF、和中國做臨床試驗。你需要聯繫在那兩個醫院裡的醫生，申請加入臨床試驗。 Remdesivir 是一種來自 Gilead 的抗病毒藥物，在靈長類動物中表現出對中東呼吸綜合徵的有效性，目前正在做針對 COVID-19 的人體試驗。如果試驗成功，明年冬天可能上市，因為擴大藥物的生產規模比開發疫苗要快得多。\n\n為什麼老年人的死亡率要高得多？你的免疫系統在50歲以後會下降，\n死亡率與病人之前是否有基礎疾病密切相關，尤其是呼吸道或心肺疾病。這些基礎疾病在老年人中概率較高，老年人患肺炎的風險也較高。\n\n• 能否對所有人都做 COVID-19 檢測？不現實，因為沒有足夠的測試能力。原因如下，目前除了 PCR 測試之外，沒有其他測試可以區分COVID-19與流感或其他十幾個正在傳播的呼吸道病菌。聚合酶鏈反應（PCR）測試可以檢測 COVID-19 的 RNA。然而，我們仍然對測試的準確性沒有信心，即我們不知道假陰性的發生率。\n\nPCR 測試需要帶試劑的套件，並且需要臨床實驗室來處理試劑盒。\n雖然可以迅速擴大試劑套件生產規模，但實驗室處理能力不能很快增加。領先的臨床實驗室公司Quest和Labcore每天能為全美國處理1000個試劑盒，擴大實驗室處理能力需要時間、建築空間和設備、還要通過認證，很難在短期內建好。 UCSF 和加州大學伯克利分校已將其研究實驗室捐贈出來處理試劑盒，但每個實驗室每天只能處理 20-40 個試劑盒，並且尚未獲得臨床認證。其他新的測試方法也在嘗試中，但目前還沒成熟，測試能力也都很小。\n\n• 美國社會對這個疾病的衝擊做好準備了嗎？\n醫院正在增加收治能力， UCSF的帕納蘇斯校區在停車場搭起了帳篷，他們把病房改造成負壓的，這是控制病毒所必需的。他們正在考慮重新開放關閉的錫安山的設施。\n關閉學校是最大的社會衝擊之一，在關閉學校（特別是小學）之前，我們需要認真權衡得失，因為會有連鎖反應。如果小學生不上學，那麼一些醫院工作人員要照看子女而不能來上班，這降低了病人激增時醫院的救治能力。\n\n美國的公共衛生系統具有應對持續數週的短期疫情的能力，如腦膜炎的爆發。但沒有能力應對持續數月的疫情，必須找到其他解決辦法。"],["id","1iui5yyxkww1a"],["createdAt","2020-03-17T18:16:54.254Z"]]}],["reply",{"__iterable":"Map","data":[["id","YgRR7HABrhVJn3LN6F9d"],["user",{"__iterable":"Map","data":[["id","AVqVwjqQyrDaTqlmmp_a"],["name","MrOrz"],["avatarUrl","https://avatars2.githubusercontent.com/u/108608?s=100"],["level",18]]}],["type","OPINIONATED"],["text","USCF 發布新聞稿表示，網傳 COVID-19 討論會小結，在精準度或重要脈絡上，都沒有透過與會科學家的 reiview；若需尋求 COVID-19 大流行的資訊，最好的方式還是參考 CDC 的資源。"],["reference","https://www.ucsf.edu/news/2020/03/416916/statement-covid-19-panel-discussion-notes-were-attributed-ucsf"],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title",""],["url","https://www.ucsf.edu/news/2020/03/416916/statement-covid-19-panel-discussion-notes-were-attributed-ucsf"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]}]}],["createdAt","2020-03-18T06:25:55.808Z"]]}]]},{"__iterable":"Map","data":[["article",{"__iterable":"Map","data":[["replyCount",1],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",1],["user",{"__iterable":"Map","data":[["id","j4S8C_fCy3uWoyyvKfTMxskp_205H-RJ2KhxSkhk1JtvyYz2w"],["name","獨立的坪林特麗莎"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title",""],["url","www.methodsman.com上託管了他的交流工作的資料庫。"],["summary",""],["topImageUrl",null],["error","UNKNOWN_UNFURL_ERROR"]]},{"__iterable":"Map","data":[["title",""],["url","https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Expression of Concern: Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection"],["url","https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240965"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Clinical trial to investigate whether vitamin D protects against COVID-19"],["url","https://www.eurekalert.org/pub_releases/2020-10/qmuo-ctt101320.php"],["summary","Researchers from Queen Mary University of London, funded by Barts Charity, have launched a new clinical trial to investigate whether taking vitamin D could protect people from COVID-19."],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Home - ClinicalTrials.gov"],["url","https://clinicaltrials.gov/"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Vitamins & Supplements Center – Nutritional, Herbal, Dietary, and More - WebMD"],["url","https://www.webmd.com/vitamins/index"],["summary","WebMD provides information on popular vitamins and supplements including side effects, drug interactions, user ratings and reviews, medication over dose, warnings, and uses."],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","https://www.researchsquare.com/article/rs-21211/v1"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients"],["url","https://www.medrxiv.org/content/10.1101/2020.04.08.20058578v4"],["summary","Abstract Objectives To investigate the possible role of Vitamin D (Vit D) deficiency via unregulated inflammation in COVID-19 complications and associated mortality. Design The time-adjusted case mortality ratio (T-CMR) was estimated as the number of deceased patients on day N divided by the number of confirmed cases on day N-8. The adaptive average of T-CMR (A-CMR) was further calculated as a metric of COVID-19 associated mortality in different countries. A model based on positivity change (PC) and an estimated prevalence of COVID-19 was developed to determine countries with similar screening strategies. Mean concentration of 25-hydroxyvitamin D (25(OH)D) in elderly individuals in countries with similar screening strategies were compared to investigate the potential impact of Vit D on A-CMR. We analyzed data showing a possible association between high C-Reactive Protein (CRP) concentration (CRP greater than or equal to 1 mg/dL) and severe COVID-19. We estimated a link between Vit D status and high CRP in healthy subjects (CRP greater than or equal to 0.2 mg/dL) with an adjustment for age and income to explore the possible role of Vit D in reducing complications attributed to unregulated inflammation and cytokine production. Data Sources Daily admission, recovery, and deceased rate data for patients with COVID-19 were collected from Kaggle as of April 20, 2020. Screening data were collected from Our World in Data and official statements from public authorities. The mean concentration of 25(OH)D among the elderly for comparison with A-CMR was collected from previously published studies from different countries. Chronic factor data used in regression analysis was obtained from published articles. The correlation between Vit D and CRP was calculated based on 9,212 subject-level data from NHANES, 2009-2010. Results A link between 25(OH)D and A-CMR in the US, France, Iran and the UK (countries with similar screening status) may exist. We observed an inverse correlation (correlation coefficient ranging from -0.84 to -1) between high CRP and 25(OH)D. Age and the family income status also correlated to high CRP and subjects with higher age and lower family income presented more incidences of high CRP. Our analysis determined a possible link between high CRP and Vit D deficiency and calculated an OR of 1.8 with 95%CI (1.2 to 2.6) among the elderly (age greater than or equal to 60 yo) in low-income families and an OR of 1.9 with 95%CI (1.4 to 2.7) among the elderly (age greater than or equal to 60 yo) in high-income families. COVID-19 patient-level data shows a notable OR of 3.4 with 95%CI (2.15 to 5.4) for high CRP in severe COVID-19 patients. Conclusion Given that CRP is a surrogate marker for cytokine storm and is associated with Vit D deficiency, based on retrospective data and indirect evidence we see a possible role of Vit D in reducing complications attributed to unregulated inflammation and cytokine storm. Further research is needed to account for other factors through direct measurement of Vit D levels in COVID-19 patients.\n\n### Competing Interest Statement\n\nThe authors have declared no competing interest.\n\n### Funding Statement\n\nThe authors would like to thank Benjamin D Keane for his assistance in preparing the manuscript. The authors would also like to acknowledge generous support from the Carinato Charitable Foundation, Mark and Ingeborg Holliday, Kristin Hudson & Rob Goldman, and Ms. Susan Brice & Mr. Jordi Esteve.\n\n### Author Declarations\n\nAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.\n\nYes\n\nAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.\n\nYes\n\nI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).\n\nYes\n\nI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.\n\nYes\n\nData regarding the number of affected cases, deaths, and recoveries from COVID-19 was obtained from Kaggle[24] as of April 20, 2020. Data regarding cases that have undergone testing were obtained from Our World in Data[25]. Age distribution of confirmed cases, those admitted to ICU, and deceased patients in Spain was based on data available from the Spanish Ministry of Health[26]. The concentration of 25(OH)D among the elderly population in each country was obtained from prior studies[2732]. CRP data, Vit D, data and demographic variables of the subjects were pooled the cross-sectional data from 2009-2010 NHANES, conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC) [22]. Data regarding the risk factors including blood pressure[33], body to mass ratio[34], and diabetes[35], were obtained from published articles. Data on coronary heart disease (CHD) death rates across different countries was used based on the calculation of World Life Expectancy on data reported by the World Health Organization (WHO) [36]. The link between high CRP and severe COVID-19 was examined based on data from a study investigating the characteristics of COVID-19 patients in China[23]. References: 22 NHANES 2009-2010 Laboratory Data. https://wwwn.cdc.gov/nchs/nhanes/search/datapage.aspx?Component=Laboratory&CycleBeginYear=2009 (accessed 13 May 2020). 23 Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;0:null. doi:10.1056/NEJMoa2002032 24 Novel Corona Virus 2019 Dataset. https://kaggle.com/sudalairajkumar/novel-corona-virus-2019-dataset (accessed 1 Apr 2020). 25 To understand the global pandemic, we need global testing the Our World in Data COVID-19 Testing dataset. Our World Data. https://ourworldindata.org/covid-testing (accessed 13 Apr 2020). 26 Informes COVID-19. https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Paginas/InformesCOVID-19.aspx (accessed 4 Apr 2020). 27 Basile M, Ciardi L, Crespi I, et al. Assessing serum concentrations of 25-hydroxy-vitamin d in north-western Italy. J Frailty Aging 2013;2:1748. doi:10.14283/jfa.2013.25 28 Toffanello ED, Perissinotto E, Sergi G, et al. Vitamin D and Physical Performance in Elderly Subjects: The Pro.V.A Study. PLOS ONE 2012;7:e34950. doi:10.1371/journal.pone.0034950 29 Adami S, Viapiana O, Gatti D, et al. Relationship between serum parathyroid hormone, vitamin D sufficiency, age, and calcium intake. Bone 2008;42:26770. doi:10.1016/j.bone.2007.10.003 30 González-Molero I, Morcillo S, Valdés S, et al. Vitamin D deficiency in Spain: a population-based cohort study. Eur J Clin Nutr 2011;65:3218. doi:10.1038/ejcn.2010.265 31 Rabenberg M, Scheidt-Nave C, Busch MA, et al. Vitamin D status among adults in Germany results from the German Health Interview and Examination Survey for Adults (DEGS1). BMC Public Health 2015;15. doi:10.1186/s12889-015-2016-7 32 Park J-H, Hong IY, Chung JW, et al. Vitamin D status in South Korean population. Medicine (Baltimore) 2018;97. doi:10.1097/MD.0000000000011032 33 Zhou B, Bentham J, Cesare MD, et al. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. The Lancet 2017;389:3755. doi:10.1016/S0140-6736(16)31919-5 34 Abarca-Gómez L, Abdeen ZA, Hamid ZA, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. The Lancet 2017;390:262742. doi:10.1016/S0140-6736(17)32129-3 35 Zhou B, Lu Y, Hajifathalian K, et al. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. The Lancet 2016;387:151330. doi:10.1016/S0140-6736(16)00618-8 36 Coronary heart disease death rate by country. World Life Expect. https://www.worldlifeexpectancy.com/cause-of-death/coronary-heart-disease/by-country/ (accessed 13 May 2020). \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n[https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment\\_data/file/551352/NDNS\\_Y5\\_6\\_UK\\_Main\\_Text.pdf][1]\n\n\n\n [1]: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/551352/NDNS_Y5_6_UK_Main_Text.pdf"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Vitamin D Deficiency: Symptoms, Causes, and Health Risks"],["url","https://www.webmd.com/diet/guide/vitamin-d-deficiency"],["summary","Vitamin D is essential for healthy bones, and a lack of it can lead to health problems, including cardiovascular disease. Learn more from WebMD about how to get plenty of vitamin D, and how to treat a vitamin D deficiency."],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","https://imj.ie/vitamin-d-and-inflammation-potential-implications-for-severity-of-covid-19/"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title",""],["url","https://www.bmj.com/content/356/bmj.i6583"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title","The possible roles of solar ultraviolet-B radiation and vitamin D in reducing case-fatality rates from the 1918-1919 influenza pandemic in the United States - PubMed"],["url","https://pubmed.ncbi.nlm.nih.gov/20592793/"],["summary","Deaths during the 1918-1919 influenza pandemic have been linked to both the influenza virus and secondary bacterial lung infections. Case fatality rates and percentage of influenza cases complicated by pneumonia were available from survey data for twelve United States locations in the 1918-1919 pand …"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","https://www.sciencedirect.com/science/article/pii/S1871402120301156?via%3Dihub"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","https://clinicaltrials.gov/ct2/show/NCT04536298"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title",""],["url","https://www.webmd.com/lung/news/20200518/more-vitamin-d-lower-risk-of-severe-covid-19?ecd=wnl_cvd_102820&ctr=wnl-cvd-102820_nsl-LeadModule_cta&mb=hxEvbwELBF19ah1Iz%2fe9viGBU564IW3UVodLxPg2KGo%3d"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770157"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title",""],["url","https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa733/5934827"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title",""],["url","https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068797/"],["summary",""],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","https://www.healthline.com/health-new"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title",""],["url","https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa733/5934827"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]},{"__iterable":"Map","data":[["title",""],["url","https://www.medscape.com/viewarticle/939759"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]}]}],["text","今天連續三篇醫療雜誌不約而同地都報導Vit D與COVID-19的關係：\n\n一.WebMD.\n\n更多維生素D，降低嚴重COVID-19的風險？\n\n這個故事於2020年10月27日更新，其中包含有關維生素D和COVID-19的新研究。\n2020年5月18日-如果您感染了COVID-19 ，那麼健康的血液中維生素D的含量是否可以幫助您避免重症監護病房和死亡？\n更多研究表明，“陽光維生素”可能在您的病情嚴重程度中起作用。\n芝加哥西北大學生物醫學工程和醫學教授瓦迪姆•貝克曼（Vadim Backman）博士說，儘管這些研究並不能證明因果關係，但“這些研究支持維生素D可能預防COVID並發症的觀點。”維生素D缺乏與不同國家死亡率差異之間的聯繫。\n最新研究中：\n．在住院的200例COVID-19患者中，有80％以上患有維生素D缺乏症。維生素D水平較低的患者血液中的炎症標誌物水平也較高。但是研究人員發現低D水平與疾病嚴重程度之間沒有聯繫。\n．西班牙研究人員測試了維生素D處方藥如何影響COVID住院患者。在接受該治療的50名患者中，只有一名需要重症監護病房（ICU），並且沒有人死亡。在26位未服用維生素的患者中，有13位需要加護病房，其中2例死亡。\n．美國研究人員評估了235例因COVID入院的患者的血液樣本，然後對其進行跟踪以了解其進展情況。維生素D水平適當的患者不太可能失去知覺或死於COVID。（該研究發表後，期刊編輯發表了“擔憂的表情”，質疑樣本量是否足夠大以及如何對數據進行分析。該研究的作者，波士頓大學維生素D研究人員Michael Holick，醫學博士以促進維生素而聞名，並確認需要進行更大的研究。） \n將會有更多的研究。倫敦瑪麗皇后大學的研究人員正在啟動Coronavit（為期6個月的研究），該研究將招募5,000人，看看高劑量維生素D是否可以減少冬季呼吸道感染，包括COVID-19。\n臨床試驗Trial.gov上列出了其他31項研究。並不是所有人都在招募。\n專家說，當免疫系統反應過度並開始攻擊人體自身的細胞和組織時，健康的血液中維生素D的水平可以通過幫助COVID-19的人避免細胞因子風暴來提供生存優勢。\n同時，有人說服用維生素作為預防措施沒有害處。\n波士頓附近的馬薩諸塞州紐伯里波特市38歲的傑基•威爾科克斯（Jackie Wilcox）說：“我覺得如果現在有什麼事情可以支持我們的身體，我將全力以赴。” 她的家人，包括她的丈夫和兩個孩子，每天都在補充營養。\n\n研究人員如何開始研究維生素D？\n當陽光照射到您的皮膚時產生的維生素D具有許多其他好處，例如骨骼健康。在某些食品和補品中也可以找到它。\n當COVID-19大流行開始升級時，西北研究人員Backman說他想提供幫助，但不確定如何做。他說：“還有幾個謎團尚未解決。” 一個是國家之間死亡率的差異。\n因此，他的團隊在研究了COVID死亡率差異的可能解釋後，對中國，法國，德國，意大利，伊朗，韓國，西班牙，瑞士，英國和美國的醫院和診所的數據進行了統計分析。 -19，例如衛生保健質量，人口年齡，測試率和不同病毒株的變化，沒有任何變化。\n維生素D在調節免疫系統中的作用，包括其抑制危險的細胞因子產生的潛在能力，是眾所周知的。在1918-1919年的流感大流行中，陽光和維生素D與降低死亡率有關。\n因此，當有關細胞因子風暴在COVID-19中的作用的研究出現時，Backman的研究小組將更多精力集中在維生素D水平的作用上。\n他們根據維生素D缺乏症與C反應蛋白或CRP（嚴重COVID-19的替代標誌物）之間的潛在聯繫，估算了維生素D與嚴重COVID-19之間的關聯。他說，這些蛋白質是肝臟響應炎症而產生的，以減輕感染的損害。\n他們估計，維生素D缺乏的患者中約有17％會感染嚴重的COVID-19，但維生素D水平健康的患者中只有約14％。Backman說，差異具有統計意義。他說：“實際上多少會降低死亡率，我們不知道。”因為這些數字是基於統計模型得出的。\n\n尋找維生素D鏈接的其他研究\n在最近的研究中，發現維生素D水平與COVID-19的嚴重程度之間存在聯繫：\n．英國的研究人員評估了20個歐洲國家的平均維生素D水平和COVID-19病例數以及死亡率。英國國王伊麗莎白女王醫院基金會信託基金研究和創新負責人彼得•克里斯蒂安•伊利醫學博士說，人口中平均維生素D血液平均水平較低的國家的COVID-19病例和死亡人數更高。\n．在西北大學，研究人員使用建模方法估算出，維生素D缺乏者中有17％會發展為嚴重的COVID-19感染，而維生素D水平卻只有14％。他們根據維生素D缺乏症與C反應蛋白或CRP（嚴重COVID-19的替代標誌物）之間的潛在聯繫，估算了維生素D與嚴重COVID-19之間的關聯\n．在一項小型研究中，路易斯安那州和得克薩斯州的研究人員評估了20例因COVID-19住院的患者，發現入住ICU的患者中有11名維生素D缺乏，但是只有4名不需要ICU的患者。\n．印尼研究人員評估了780例記錄在案的COVID-19病例，發現大多數死亡的患者維生素D水平低於正常水平。\n．愛爾蘭研究人員分析了歐洲人口研究和維生素D含量，發現維生素D缺乏症高發國家的COVID-19死亡率也更高。這些研究人員要求政府提高維生素D的建議。\n\nCOVID-19之前研究\n維生素D的益處\n儘管關於維生素D和COVID-19的早期研究才剛剛開始，但其他研究發現維生素D補充劑可以幫助降低呼吸道感染的風險。研究人員回顧了1918-1919年的流感大流行後，發現具有健康維生素D血液水平的患者死亡的可能性較小。\n加利福尼亞杜阿特癌症中心希望之城糖尿病免疫學系主任巴特•羅普博士說，將維生素D水平與COVID-19細胞因子風暴聯繫起來的研究尚處於初期階段，但這並不令人驚訝。他說，維生素D是“談判者”，因為“它不抑制免疫系統，而是調節免疫系統。維生素D使免疫細胞的炎症減少。”\n雖然研究發現低維生素D可能會影響COVID-19的嚴重程度，但尚不知道將維生素D恢復至正常水平是否會有助於治療。沒有人可以肯定地說擁有健康的維生素D水平可以幫助您避免這種病毒。\n菲律賓東南大學的一位研究人員評估了212名被診斷為COVID-19的人的維生素D血液水平，發現處於危急狀況的人維生素D最低，而感染較輕的人維生素D最高。他的論文的結論（未經同行評審）是，補充劑“可能會改善感染COVID-19的患者的臨床結局”。\n英國研究員Ilie說：“我們已經知道，骨骼健康需要它。” “正在等待有關維生素D和COVID-19的證據-我怎麼說-證據來不及提供幫助可能太遲了。”\n但是並非所有人都同意維生素D可能對馴服COVID-19有用。循證醫學中心的研究人員於5月1日對證據進行了“快速審查”，得出結論：“沒有證據表明維生素D缺乏會誘發COVID-19，也沒有補充預防或預防維生素的研究。治療COVID-19。”\n研究人員還說，儘管某些人群中維生素D含量低的風險與高風險人群中獲得COVID-19的風險存在“重疊”，包括老年人，有色人種和慢性病患者，但這些關聯沒有證明。\n在最近的一項同行評審研究中，研究人員對超過348,000人（包括449名確診COVID-19的人）進行了評估，他們發現維生素D水平與感染風險之間沒有聯繫，也沒有解釋種族感染差異的聯繫。\n\n有關維生素D的更多信息\n簡單的驗血可以檢測您的維生素D水平是否健康或不足。甲水平需要的每毫升20納克或以上，以保持骨健康; 低於12毫微克/毫升稱為缺陷。\n維生素D還有助於調節細胞生長和減輕炎症。一些研究表明它可以幫助預防和治療糖尿病，高血壓和血糖問題，但美國國立衛生研究院認為這項研究並不明確。\n為了維持健康的血液中維生素D水平，醫學研究所建議1歲以下的兒童每天攝入400國際單位（IU）的維生素D，1至70歲的人們則攝入600 IU。70歲以上的人每天應獲得800 IU。\n很少有食物中天然存在維生素D ，但可以將其添加到其他食物中，也可以作為補充食品。三盎司煮熟的鮭魚有570 IUs，而三盎司虹鱒魚有645 IU。一杯2％維生素D強化的牛奶有120 IU。\n但是，在大流行期間，採取更多措施可能是明智的選擇，馬里蘭大學醫學院教授，布萊根婦女醫院預防醫學科主任喬安•曼森（JoAnn Manson）博士說。她在今年早些時候告訴Medscape： “建議的維生素D的飲食津貼為每天600-800 IU，但在此期間，每天含有1,000-2,000 IU的維生素或多種維生素的補充是合理的。”\n現在，曼森（Manson）正在啟動一項臨床試驗，以觀察每天補充4周維生素D是否會減少新診斷出COVID的患者住院和/或死亡的風險。她還在研究服用這種藥物是否會減少他們最親密的家庭接觸者的感染風險。參與者在2天之內每天需要9600 IU，然後在第3到28天要花費3200 IU。\n專家說，每天服用50,000至60,000 IU可能會發生維生素D毒性。過多會導致血液中鈣的積聚，並伴有嘔吐，虛弱，排尿頻繁和心律不齊。\n隨著COVID-19案件的增多，現年45歲的洛杉磯的Tracy A. Pearson是一名博士生和大學僱員，同時擁有法學學位，她開始研究除社交疏散和親身幫助外，還有哪些方法可以降低她的風險-洗滌。\n她患有哮喘，正在接受藥物治療。她的肺部可能很脆弱。她說：“當我感冒時，我經常會得肺炎。” 她很快找到了維生素D-COVID-19研究，並與醫生討論了一下。\n她過去的維生素D水平較低，並且每週服用50,000 IU即可恢復到健康水平，因此她的醫生在對她進行評估後，同意再次這樣做。因此，她每天開始服用比平常多的4,000 IU。她還採取其他預防措施，例如在丈夫處理外事時留在家裡。而且他每天還需要4,000 IU。\n他們在整個大流行中都繼續這樣做。\n皮爾森說：“我天生就是一個解決問題的人。” “我試圖弄清楚如何減輕[風險]。這並不是我進入研究時就想到了'維生素D'。”\n\n二.Healthline.\n\n新研究發現80％的COVID-19患者維生素D缺乏\n\n．一項針對216名COVID-19患者的新研究發現，其中80％的血液中維生素D水平不足。\n．該研究還發現，同時具有COVID-19和較低維生素D水平的人也具有較高的炎症標記物，如鐵蛋白和D-二聚體，這與較差的COVID-19結果有關。\n．另一項研究發現，維生素D水平充足的COVID-19患者死於疾病的風險降低了51.5％，並且並發症的風險顯著降低。\n．醫學專家的理論認為，儘管需要更多的測試，但對於某些人來說，維持足夠的維生素D水平可能有助於降低風險或從嚴重的COVID-19中恢復。\n最近的研究可信來源發現維生素D缺乏與較高的COVID-19風險之間存在相關性。現在，另一項新研究發現了相同的現象-指出超過80％的COVID-19患者血液中沒有足夠的“陽光維生素”水平。\n作為《臨床內分泌與代謝雜誌》上這項新研究的一部分，研究人員對西班牙一家醫院的216名COVID-19患者進行了研究。科學家將患者與另一個數據集的對照進行匹配。\n所有的患者中，82.2％的人維生素d缺乏。\n在這項研究中，男性的維生素D水平低於女性。\nCOVID-19和維生素D含量較低的人也具有較高的炎症標記，例如鐵蛋白和D-二聚體。那些已經已連結可信來源 COVID-19結果差。\n維生素D缺乏者的高血壓和心血管疾病患病率更高。研究表明，他們還因COVID-19而住院時間更長。\n霍恩海姆大學教授Hans Konrad Biesalski博士說，高血壓，糖尿病和肥胖症等合併症與低維生素D狀態有關，他評估了維生素D和COVID-19。\n他告訴Healthline：“看來維生素D狀況不佳的患者可能患有更嚴重的COVID-19”。但是新的研究沒有發現這種關係。\n\n維生素D和COVID-19的恢復\n但是，除了維生素D水平與COVID-19風險之間的相關性外，許多人還在研究它如何保護人們或幫助他們從疾病中康復。\n該研究的共同作者說：“一種方法是識別和治療維生素D缺乏症，尤其是在老年人，合併症患者和療養院居民等高危人群中，這些人群是COVID-19的主要目標人群。”西班牙桑坦德坎塔布里亞大學的何塞•埃爾南德斯（JoséL.Hernández）博士。\n他說，患有COVID-19的高風險人群-老年人，患有潛在疾病的人群以及療養院的人們-可以使用維生素D治療。\n‘’在血液中循環的維生素D水平低的COVID-19患者中，建議維生素D治療，因為這種方法可能對肌肉骨骼和免疫系統都有有益的作用，”埃爾南德斯在一份聲明中說。\n\n保護自己\n許多美國人維生素d缺乏，根據以前的研究。這是全球性的健康問題，其他研究可信來源筆記。\n您是否應該檢查維生素D水平？服用補充劑是否足以保護自己，或者至少降低您獲得COVID-19的機會？\n研究維生素D並領導波士頓大學骨骼保健診所的Michael F. Holick博士說，《內分泌學會實踐指南》不建議對所有人進行篩查。\nHolick告訴Healthline，合理地控制那些患有脂肪吸收不良綜合徵，肥胖症患者或其他醫療問題的人的維生素D水平。\n內分泌學會建議，嬰兒每天應攝入400-1,000 IU，兒童每天應攝入600-1,000 IU，成人每天應攝入600-2,000 IU。所需的數量取決於您當前的水平或您是否嘗試提高它們。\nHolick指出，肥胖的成年人可能需要增加2至3倍。\nBiesalski同意，如果維生素D含量低，補充可能會有所幫助。\nHolick解釋說，有幾篇出版物建議維生素D缺乏與上呼吸道感染（包括流感和冠狀病毒）的風險增加有關。\n他的團隊的研究可信來源在191,000名COVID-19陽性患者中，維生素D缺乏症使罹患該疾病的風險增加了54.5％。\nHolick說：“在所有50個州和所有種族中都觀察到了這種情況。”\n在另一個小書房可信來源 Holick指出，維生素D水平足夠的COVID-19患者死於疾病的風險降低了51.5％，並發症的風險也大大降低了。\n對於患有COVID-19的人，霍里克說，除非一個人患有罕見的疾病，例如結節病和其他肉芽腫性疾病，否則增加維生素D的攝入就沒有任何弊端。\n根據文獻和他自己的經驗，按照內分泌學會的建議，兒童和成人合理攝取足夠量的維生素D有助於降低感染病毒的風險，並降低兒童或成人的發病率和死亡率。他說，它開發了COVID-19。\n得克薩斯大學奧斯汀分校的兒科學教授史蒂文•艾布拉姆斯（Steven Abrams）博士指出，我們不知道維生素D對身體有預防作用。\n他告訴健康熱線說：“非常低的維生素D狀態會帶來很多負面後果，COVID-19可能就是這種情況，但這與說常規補充維生素D可以預防嚴重感染並不相同。”\n\n展望未來\n需要更多的研究來更好地了解維生素D和COVID-19之間的聯繫。\n已經有證據表明攝取足夠的維生素D可以調節免疫系統，從而實現最佳健康。霍利克說，知道與疫苗一起服用維生素D是否會提高疫苗的有效性將是很有趣的。\n他說，比薩爾斯基想知道維生素A和D的平衡將如何影響疫苗的成功，正如針對流感和麻疹所顯示的那樣。\n\n三.Medscape.\n\n維生素D可以預防COVID嗎？我們之前被燒死了\n\n2020年10月28日\n\n在Medscape的冠狀病毒資源中心中找到最新的COVID-19新聞和指南。\n為了清楚起見，此成績單已經過編輯。\n歡迎使用影響因子，這是您對新醫學研究的每週評論。我是耶魯大學醫學院的F. Perry Wilson博士。\n我和維生素D有點愛恨交織的關係。\n簡短搜索我的博客將顯示我如何質疑維生素D與多發性硬化症，腎臟疾病，精神分裂症，跌倒和童年受教育程度之間的關係。\n因此，在COVID時代，維生素D再次出現也就不足為奇了。安東尼•福西博士（Anthony Fauci博士）在這次大流行期間曾有過清醒而負責任的聲音，報告了他個人使用維生素D的情況，這讓我很感興趣。維生素D也是特朗普在沃爾特•里德（Walter Reed）逗留期間收到的總統雞尾酒的一部分。\n我決定在這裡研究數據。但是在我們這樣做之前，我想告訴你為什麼我天生對維生素D研究持懷疑態度。有兩個主要問題：\n1.維生素D含量低與許多因素有關。維生素C缺乏會引起壞血病-很好。但是，低維生素D與從阿爾茨海默氏症到百日咳的一切因素都有關係。它既是世界上最重要的維生素，又是其他重要事物的替代品。\n2.當我們通過隨機試驗測試了所有這些引人入勝的聯繫時，給了一些人維生素D和一些安慰劑，它們幾乎總是沒有效果。\n我有點喜歡查理•布朗（Charlie Brown）在這裡踢足球。維生素D曾經燒過我們。幾個例子：\n多項觀察性研究發現，維生素D含量較低的人更容易患上癌症和心血管疾病。這些都是不錯的研究，適合於適當的混雜因素-整個交易。\n然後，我們進行了26,000名患者的隨機臨床試驗。兩種結果均無影響。\n觀察性研究表明，低維生素D水平與糖尿病的發展有關。然後，我們進行了2400例糖尿病前期患者的試驗。補充維生素D無效。\n觀察性研究發現，維生素D含量低與摔倒有關。在隨機試驗發現沒有這樣的效果。（不過，運動確實可以防止摔倒。）\n維生素D是否能拯救生命？並不是的。該婦女健康倡議試驗隨機36000絕經後婦女維生素D與安慰劑並沒有看到生存利益。\n我並不是說維生素D沒有用途，或者它的益處有限。隨機試驗很少像觀察數據那樣具有戲劇性。但是我想不出另一種在觀察數據和隨機數據之間有如此大的脫節的情況。\n這是為什麼？\n因為您的維生素D水平是您生活類型的標誌，因此很難，真的很難適應。當然，您可以詢問人們獲得了多少陽光和運動，飲食有多變化，賺了多少錢，但是這些都是很鈍的工具。\n好的。牢記所有這些，我們對COVID中的維生素D了解多少？\n就在本週，在《臨床內分泌與代謝雜誌》上，我們從西班牙進行了這項研究，發現在216名住院的COVID-19患者中，有80％缺乏維生素D。僅有40％的對照品缺乏。當然，這些控件沒有住院。實際上，還是生病了。\n但是，好的，更好地學習。早在9月份，即截至10年前的記錄時，我們就從芝加哥進行了這項研究，結果表明，在489位接受過維生素D測試的患者中，維生素D缺乏症的患者患COVID-19的風險高1.77倍。\n在PLOS One中進行的這項研究發現，在235名住院患者中，維生素D含量低於30 ng / mL的患者死亡率為20％，而維生素D含量較高的患者為9.7％。我應該指出，對於某些數據怪異，本文標記為“關注表達”。\n好吧，所以我們進行了多次觀察性研究-安東尼•富奇（Anthony Fauci）大聲喊叫-說我們應該考慮維生素D。\n為什麼不呢？很便宜它具有相當不錯的副作用（儘管我的腎髒病專家擔心腎結石）。\n但是當涉及到COVID時，與低維生素D水平相關的多種因素也與COVID-19感染和嚴重程度有關：年齡較大，BMI，黑人，貧困，合併症。從統計上適當地考慮所有這些東西真的很困難。\n所以我對維生素D不太滿意。我希望進行一次隨機試驗。現在，我們有一個。二，如果你斜視。\n來自西班牙的一項隨機試驗是該試驗。\n一項小型研究（76例住院了COVID-19的患者）被隨機分配為2：1的維生素D +阿奇黴素+羥氯喹（不讓我開始服用）與阿奇黴素+羥氯喹的比例。維生素D組的50人中只有1人去了ICU。將其與非維生素D組的26種藥物中的13種進行比較。\n維生素D組的死亡人數為零，非維生素D組的死亡人數為2。我應該注意，非維生素D組在基線時風險較高，患有糖尿病和高血壓的人群更多。但老實說，正是這種效果的大小令我感到驚訝。我的意思是將入ICU的風險從50％降低到2％？這只是一個驚人的數字。因此，我們處於以下情況：這是一種奇蹟藥物，還是我們不知道的研究存在問題？如今，奇蹟供不應求。\n只是為了給該研究加些冷水，我們有一個仍在預印本中的研究，該研究使用孟德爾隨機法研究了維生素D是否可能與400,000多人的COVID嚴重性有因果關係。\n在本研究設計中，您將遺傳上傾向於維生素D水平較低的人與非維生素D較低的人進行比較。這將生活方式的東西排除在外。有趣的是，遺傳上註定維生素D水平低的人不太可能因COVID-19住院或發生嚴重疾病。尚未經過同行評審，鹽粒等。\n底線？我們知道維生素D水平低的人在COVID-19中有不良結果的高風險。我們仍然不知道補充維生素D是否會改變這種風險。這裡有一些希望，但是生活方式維生素早已燒傷了我們，因此請繼續謹慎使用400個國際單位。\nF. Perry Wilson，醫學博士，MSCE，醫學副教授，耶魯大學應用翻譯研究計劃主任。他的科學傳播工作可以在《赫芬頓郵報》，NPR和Medscape上找到。他發了@methodsmanmd的推文，並在www.methodsman.com上託管了他的交流工作的資料庫。\n參考文獻與資料：\n1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/\n2.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240965\n3.https://www.eurekalert.org/pub_releases/2020-10/qmuo-ctt101320.php\n4.https://clinicaltrials.gov/\n5.https://www.webmd.com/vitamins/index\n6.https://www.researchsquare.com/article/rs-21211/v1\n7.https://www.medrxiv.org/content/10.1101/2020.04.08.20058578v4\n8.https://www.webmd.com/diet/guide/vitamin-d-deficiency\n9.https://imj.ie/vitamin-d-and-inflammation-potential-implications-for-severity-of-covid-19/\n10.https://www.bmj.com/content/356/bmj.i6583\n11.https://pubmed.ncbi.nlm.nih.gov/20592793/\n12.https://www.sciencedirect.com/science/article/pii/S1871402120301156?via%3Dihub\n13.https://clinicaltrials.gov/ct2/show/NCT04536298\n14.https://www.webmd.com/lung/news/20200518/more-vitamin-d-lower-risk-of-severe-covid-19?ecd=wnl_cvd_102820&ctr=wnl-cvd-102820_nsl-LeadModule_cta&mb=hxEvbwELBF19ah1Iz%2fe9viGBU564IW3UVodLxPg2KGo%3d\n15.https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770157\n16.https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa733/5934827\n17.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068797/\n18.https://www.healthline.com/health-new\n19.https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa733/5934827\n20.https://www.medscape.com/viewarticle/939759"],["id","1svz6qt220uu1"],["createdAt","2020-10-30T00:18:55.911Z"]]}],["reply",{"__iterable":"Map","data":[["id","laQceXUB9w1KR1Ikxu-g"],["user",{"__iterable":"Map","data":[["id","AVriAlOoyrDaTqlmmqhC"],["name","Lin"],["avatarUrl",null],["level",22]]}],["type","OPINIONATED"],["text","COVID- 19 跟維生素D之間的關聯仍然需要更多實驗證實，雖然有些理論認為維生素D可減低COVID-19感染風險，但英國NHS認為尚無足夠證據，各界立場不同。"],["reference","https://www.ncbi.nlm.nih.gov/pubmed/32252338\n\nhttps://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/\n\n\nhttps://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484"],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title","Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. - PubMed"],["url","https://www.ncbi.nlm.nih.gov/pubmed/32252338"],["summary","Nutrients. 2020 Apr 2;12(4). pii: E988. doi: 10.3390/nu12040988.Author information1Sunlight, Nutrition, and Health Research Center, P.O. Box 641603, San Francisco, CA 94164-1603, USA.22289 Highland Loop, Port Townsend, WA 98368, USA.3GrassrootsHealth, Encinitas, CA 92024, USA.4Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Blvd 98, H-4032 Debrecen, Hungary.AbstractThe world is in the grip of the COVID-19 pandemic. Public health measures that can reduce the risk of infection and death in addition to quarantines are desperately needed. This article reviews the roles of vitamin D in reducing the risk of respiratory tract infections, knowledge about the epidemiology of influenza and COVID-19, and how vitamin D supplementation might be a useful measure to reduce risk. Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines. Several observational studies and clinical trials reported that vitamin D supplementation reduced the risk of influenza, whereas others did not. Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration. To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40-60 ng/mL (100-150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D3 doses might be useful. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations.KEYWORDS: COVID-19; UVB; acute respiratory distress syndrome (ARDS); ascorbic acid; cathelicidin; coronavirus; cytokine storm; influenza; observational; pneumonia; prevention; respiratory tract infection; solar radiation; treatment; vitamin C; vitamin D [Indexed for MEDLINE] Free full text"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Vitamins and minerals - Vitamin D"],["url","https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/"],["summary","Vitamin D helps regulate the amount of calcium and phosphate in the body.These nutrients are needed to keep bones, teeth and muscles healthy.A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain caused by a condition called osteomalacia in adults.\n \n \n\n\n \n \n\n\n \n \n\n \n\n \n\n \n \n Coronavirus update\n Consider taking 10 micrograms of vitamin D a day to keep your bones and muscles healthy.This is because you may not be getting enough vitamin D from sunlight if you’re indoors most of the day.There have been some news reports about vitamin D reducing the risk of coronavirus. However, there is no evidence that this is the case.Do not buy more vitamin D than you need.\n\n\n \n \n\n\n \n \n\n\n \n \n \n \n \n\n \n\n \n\n \n Good sources of vitamin DFrom about late March/early April to the end of September, most people should be able to get all the vitamin D they need from sunlight.The body creates vitamin D from direct sunlight on the skin when outdoors.But between October and early March we do not get enough vitamin D from sunlight. Read more about vitamin D and sunlight.Vitamin D is also found in a small number of foods.Sources include:oily fish – such as salmon, sardines, herring and mackerelred meatliveregg yolksfortified foods – such as most fat spreads and some breakfast cerealsAnother source of vitamin D is dietary supplements.In the UK, cows' milk is generally not a good source of vitamin D because it is not fortified, as it is in some other countries.\n \n \n\n\n \n \n\n\n \n \n \n \n \n\n \n\n \n\n \n How much vitamin D do I need?Babies up to the age of 1 year need 8.5 to 10 micrograms of vitamin D a day.A microgram is 1,000 times smaller than a milligram (mg). The word microgram is sometimes written with the Greek symbol μ followed by the letter g (μg).Children from the age of 1 year and adults need 10 micrograms of vitamin D a day. This includes pregnant and breastfeeding women, and people at risk of vitamin D deficiency.From about late March/early April to the end of September, the majority of people should be able to get all the vitamin D they need from sunlight on their skin.\n \n \n\n\n \n \n\n\n \n \n \n \n \n\n \n\n \n\n \n Should I take a vitamin D supplement?Advice for infants and young childrenThe Department of Health and Social Care recommends that:breastfed babies from birth to 1 year of age should be given a daily supplement containing 8.5 to 10 micrograms of vitamin D to make sure they get enoughformula-fed babies should not be given a vitamin D supplement until they're having less than 500ml (about a pint) of infant formula a day, as infant formula is fortified with vitamin Dchildren aged 1 to 4 years old should be given a daily supplement containing 10 micrograms of vitamin DYou can buy vitamin D supplements or vitamin drops containing vitamin D (for under 5s) in many shops, including pharmacies and supermarkets.Women and children who qualify for the Healthy Start scheme can get free supplements containing the recommended amounts of vitamin D.See the Healthy Start website for more information.Advice for adults and children over 5 years oldDuring the autumn and winter, you need to get vitamin D from your diet because the sun is not strong enough for the body to make vitamin D.But since it's difficult for people to get enough vitamin D from food alone, everyone (including pregnant and breastfeeding women) should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter.Between late March/early April to the end of September, most people can get all the vitamin D they need through sunlight on their skin and from a balanced diet.You may choose not to take a vitamin D supplement during these months.People at risk of vitamin D deficiencySome people will not get enough vitamin D from sunlight because they have very little or no sunshine exposure.The Department of Health and Social Care recommends that you take a daily supplement containing 10 micrograms of vitamin D throughout the year if you:are not often outdoors – for example, if you're frail or houseboundare in an institution like a care homeusually wear clothes that cover up most of your skin when outdoorsIf you have dark skin – for example you have an African, African-Caribbean or south Asian background – you may also not get enough vitamin D from sunlight.You should consider taking a daily supplement containing 10 micrograms of vitamin D throughout the year.\n \n \n\n\n \n \n\n\n \n \n \n \n \n\n \n\n \n\n \n What happens if I take too much vitamin D?Taking too many vitamin D supplements over a long period of time can cause too much calcium to build up in the body (hypercalcaemia). This can weaken the bones and damage the kidneys and the heart.If you choose to take vitamin D supplements, 10 micrograms a day will be enough for most people.Do not take more than 100 micrograms of vitamin D a day as it could be harmful. This applies to adults, including pregnant and breastfeeding women and the elderly, and children aged 11 to 17 years.Children aged 1 to 10 years should not have more than 50 micrograms a day. Infants under 12 months should not have more than 25 micrograms a day.Some people have medical conditions that mean they may not be able to safely take as much. If in doubt, you should consult your doctor.If your doctor has recommended you take a different amount of vitamin D, you should follow their advice.You cannot overdose on vitamin D through exposure to sunlight. But always remember to cover up or protect your skin if you're out in the sun for long periods to reduce the risk of skin damage and skin cancer.\n \n \n\n\n \n \n\n\n \n \n\n \n\n \n\n \n \n\n \n\n\n\n\n \n \n\n\n \n\n \n Page last reviewed: 3 March 2017\n Next review due: 3 March 2020"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]}]}],["createdAt","2020-10-30T10:45:30.407Z"]]}]]},{"__iterable":"Map","data":[["article",{"__iterable":"Map","data":[["replyCount",2],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",1],["user",{"__iterable":"Map","data":[["id","j4S8C_rTHK0CH_t8uT8ZpD6JsxFEKIzr0ilq-rZ0PrQRQTdQI"],["name","耿直的楊梅強尼"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","人類體溫37℃已成為歷史：人類體溫普遍降低意味著什麼？\n\n最近，因為疫情的關係，擔心自己有接觸史或者進行保護性隔離的人，每天都要測三次體溫，很多人都會發現每次測量結果都在36.3-36.7℃左右，夜晚略高。\n\n記得小時候生物課上講過，人的正常體溫大約是37℃，但為什麼身邊所有人的體溫都不到37℃呢？\n\n就在一個月前的1月7日，斯坦福大學醫學院教授朱莉·帕森內特（Julie Parsonnet）和她的團隊剛剛發佈了一項研究成果，發現自19世紀以來，成年人的平均體溫在持續下降，不到200年間下降了0.4℃，從37℃降到36.6℃。\n\n37℃已經成為歷史，而體溫下降並非好事！\n\n1851 年，一位名叫卡爾·溫德利希（Carl Wunderlich）的德國內科醫生，收集了25000 名病人的腋下體溫資料，首次確定了人體正常體溫為37 ℃，這種說法一直延續至今。\n\n但是，近年來，許多科學家認為人類體溫在不斷下降，37℃已經成為歷史。\n\n/ 體溫降低的影響 /\n\n病毒學解密：蝙蝠為何能把上百種病毒封印在體內？根本原因很簡單：蝙蝠免疫系統強大，很大程度上是因為他們體溫能保持較高的40℃。研究顯示，體溫每降低1℃，免疫力就會下降30以上；體溫每升高1℃，免疫力就會提升5~6倍，這麼看的話，蝙蝠的免疫力大概比人類高幾百倍——怪不得蝙蝠百毒不侵，還不會得癌症......\n\n為什麼體溫降低，免疫力也會隨之降低呢？\n\n眾所周知，體溫是和基礎代謝率掛鉤的，體溫每上升1℃，基礎代謝會提高13。體溫過低，可能意味著代謝不好。\n\n反之，基礎代謝率低，體溫下降，血液流速放緩，白細胞的工作效率也隨之變低。慢慢悠悠的白細胞很難在第一時間發現異物，即使發現異物了，也很難迅速召集其他白細胞來消滅異物，導致機體容易感染病毒和細菌，引發疾病。\n\n此外，白細胞不僅能抵禦外部病毒和細菌的攻擊，還能監測到體內的癌細胞，及時把癌變細胞殺死。\n\n其實，即使是健康人，每天體內也會產生約 5000個癌細胞。如果其中一個躲過了免疫系統的監視，倖存下來，很快就會1變2、2變4、4變8...... 最終演化成腫瘤。\n\n據科學家推算，如果體溫下降1℃，免疫力降低30％，則每天免疫系統可能會漏掉近1500個癌細胞，任其瘋狂繁殖。\n\n/ 體溫降低的原因 /\n\n現代人類的體溫為什麼會降低呢？\n\n1、最主要的原因——缺乏運動\n\n科學家分析，人類體溫在170年間下降了0.4℃，近20年的下降幅度尤其大，最主要的原因是缺乏運動。在離我們並不遙遠的50年前，人們每天都要做很多運動：\n\n農村的人要種莊稼或者放牧，即使是城市人群，也會每天手洗衣服、自己做飯、清掃房間；大家出門會優先考慮步行或自行車，閒暇時靠戶外運動打發時間。\n\n然而，隨著科技的發展，人們好像越來越「懶」了——吃飯靠外賣，出門就打車，洗衣服有洗衣機，洗碗有洗碗機，掃地有機器人，隨時可以躺在床上打遊戲，男生打籃球、女生踢毽子的校園場景一去不復返。\n\n基礎代謝與任何外在活動無關，是一個人什麼都不幹的時候的自然消耗，而肌肉是人體內最大的發熱器官。較少的肌肉，意味著較低的體溫和較低的基礎代謝。一個肌肉含量高的人，即使什麼也不做也仍然在消耗能量。現代人運動量的減少，導致肌肉含量普遍偏低。\n\n基礎代謝下降，能量消耗就會減少，內臟脂肪就會增加。而內臟脂肪組織會分泌出超過20種不良激素（或者脂肪細胞因數），會引起血管炎，還會削弱胰島素的功能，從而導致癌症、高血壓、糖尿病等一系列疾病。\n\n2、無處不在的空調，使體溫調節中樞不再敏感\n\n專家認為，除了肌肉品質下降外，空調導致的出汗困難也是現代人體溫下降的一大原因。人們長期在空調屋工作和生活，大腦下丘腦的體溫調節中樞失去了接收刺激的機會，久而久之，體溫調節中樞將對外界溫度不再敏感，從而導致體溫降低。\n\n3、現代人生活壓力大，皮質醇過量分泌導致肌肉分解\n\n此外，越來越複雜的人際關係、財務問題和家庭問題等生活壓力，也和體溫降低有關。在壓力狀態下，人體處於應激狀態，身體會分泌一種叫「皮質醇」的激素來維持正常的生理功能。\n\n但是，皮質醇是一種分解代謝激素，不僅會分解肌肉，還會促進脂肪儲存，優先把脂肪存儲于內臟。生活壓力導致皮質醇長期過量分泌，一邊分解肌肉，一邊儲存脂肪，基礎代謝率一降再降，體溫也就隨之降低。\n\n體溫每降低1℃，免疫力就會下降30以上。人類體溫在170年間下降了0.4℃，意味著我們免疫力下降，大大提高了病毒、細菌感染和癌症的發生率。\n\n我們能做的，就是通過調節日常飲食、加強體育鍛煉、不濫用空調、放鬆心態緩解壓力等方式，從一點一滴的小細節中，適當提升體溫。\n\n/ 通過飲食提高體溫 /\n\n在日常飲食中加入胡椒粉或者辣椒粉。如果你是個「重口味」的人，那麼對於辣椒粉一定非常親切，這種能產熱的調味料能夠迅速提高人體的溫度，它含有一種叫辣椒素的化學物質，不僅能讓你的味覺產生反應，更能在你的消化系統中發揮作用，是一種能讓你急劇升溫的物質。 \n\n吃花生。花生長久以來都是以提高新陳代謝而著名的食物，因此對於減肥的人來說是最佳的小零食。花生中富含碳水化合物，可以當作身體的燃料，當體內碳水化合物增加了之後，身體自然會覺得更加熱一些。\n\n多吃糙米。糙米可以作為很棒的主食來吃，並且還能有效提高身體溫度。糙米中含有很多健康的碳水化合物，能讓你在有飽腹感的同時燃燒多餘的熱量，從而產生溫暖的感覺。\n\n生吃生薑。你可以在餐點中加入生薑，也可以直接生吃，在你用力咀嚼生薑時會有立竿見影的效果——你會感到體內迅速變熱。生薑中含有一種稱為姜辣素的物質，能收縮血管，從而產生熱量。 \n\n喝熱飲或熱湯。任何溫熱的液體都能提高你的體溫。熱飲中的熱量會迅速貫穿全身，讓你的身體在一段時間內處於非常溫暖的狀態\n\n/ 通過運動提高體溫 /\n\n進行日常基礎訓練。鍛煉可以有效提高身體溫度，不過也要小心，在出過汗後身體會重新冷卻下來。規律的鍛煉能提高新陳代謝的速度，進而讓身體增溫，不妨每天早上進行鍛煉，因為在早上提高了新陳代謝後能説明你維持一整天較高的新陳代謝率，也就是說，即便你已經鍛煉完了，你的身體還會持續處於較高的溫度中。\n\n深蹲。所謂深蹲就是將雙腳打開與肩同寬，將雙手搭于腰間，然後彎曲膝蓋、緩慢下蹲，就好像你要坐下來的姿勢一樣，在空中停頓兩秒後回到起始位置。一次做3組，每組20個。\n\n每天運動。每天運動30分鐘就能有效增加身體的熱量，當你在動用繩肌腱和股四頭肌等大肌肉群時，身體自然會燃燒更多熱量，從而提升身體溫度。如果你不喜歡跑步，還可以改成游泳或騎單車，同樣能達到燃脂和提高體溫的效果。\n\n盡可能地多活動身體。抓住一切可以活動身體的機會，即便當你手頭有事在忙也不要放棄。比如增加做家務活的頻率，比如掃地或拖地等等。\n\n/ 保持身體的熱度 /\n\n穿著適宜。能讓你保持身體熱度的衣服種類有很多，如果你感覺出門可能會冷，就多穿一件或者帶一件在身上以防萬一。\n\n和朋友家人們待在一起。不同身體間的熱量傳輸會提高房間的溫度，人類是熱血動物，換句話說，人體自然會釋放熱量，這也解釋了為什麼人多的房間比人少的房間溫度更高。多和其他人待在一起可以説明你從每個人身上傳輸熱量和能量，相互取暖。\n\n讓身體保持乾燥狀態。在洗完澡或者剛淋過雨後，一定要及時擦乾身體來維持體溫，溫度較低的水會迅速吸走你的熱量，讓體溫降低。\n\n如果你淋濕了，儘快換上幹衣服。如果你一直捂在濕衣服裡，體溫會急劇下降。\n\n用吹風機吹幹頭髮的同時給身體增溫。頭部溫度增加後，身體其他部分的溫度也會提高。\n\n/ 讓身體自然地增溫 /\n\n增肌。肌肉會消耗相當多的熱量，即使是在你休息的時候依然不例外，因此，增加肌肉也意味著你對於熱量的需求也在增加。記住這一點，增肌就可以增溫。\n\n不要刻意阻止身體打顫發抖。這些本能性的動作是身體自發調節體溫的方式，當你打顫和發抖時肌肉就會參與進來，繼而提高你的體溫。\n\n增重。這個辦法並不是人人適用的，尤其當你已經屬於超重狀態時。不過話說回來，增加一點體重確實能讓你保持溫暖，那些額外的脂肪能夠起到隔離作用，讓你的身體維持在一個相對較高的溫度。增重最好的方法就是攝入更多的熱量，你需要一個卡路里計算機來計算你需要攝入多少熱量來增加體重。\n\n/ 提升體溫的好處 /\n\n減輕肝腎負擔，微循環系統若得到改善，新陳代謝所產生的廢物便可迅速排除體外，從而減輕肝臟及腎臟的負擔。\n\n增強免疫力，體溫每上升1攝氏度，人體的自然治癒率會增6倍左右，若體溫上升2度，自然治癒率更會增強36倍之高。通過升溫排汗有助於健康。\n\n促進排汗及皮下脂肪的排除，提升人體的新陳代謝功能，將皮脂腺的脂肪排出體外，達到健康與美容，輕鬆變苗條的效果(要注意補充水分)。\n\n排出體內的老舊廢物，主要是體內的代謝廢物。重金屬與致癌物，提高體溫將體內累積的致癌成分”重金屬”排出體外，徹底去除癌症根源。\n\n增強活力，活化新陳代謝、強化營養成分的充分利用、消除疲勞。\n\n改善微循環系統，皮下深層的溫度微升，血流速度加快，微血管擴張。\n\n呼吸的皮膚，使得皮膚呼吸更加旺盛,血液循環順暢，常保健康美麗，光滑細緻。\n\n有效改善睡眠——助眠,睡到自然醒。\n\n在日常生活中，要儘量避免會降低你體溫的活動，比如在寒冷的冬夜外出或者有可能打溼衣服的活動。\n\n瞭解你體溫過低的原因。體溫過低有很多不同的原因，你必須清楚你是否患有某些疾病，才導致你的體溫比正常低。\n\n當你的體溫持續過低、無法提高時，不妨諮詢下醫生，你的新陳代謝方面應該出現了一些問題，需要特別的注意。"],["id","24gc50p30npm4"],["createdAt","2020-03-04T17:56:16.877Z"]]}],["reply",{"__iterable":"Map","data":[["id","KYeyrnABWiTSPYAZhhfJ"],["user",{"__iterable":"Map","data":[["id","r_6F7mcBP8WrztivFgAI"],["name","Pei-Chi Lo"],["avatarUrl",null],["level",14]]}],["type","RUMOR"],["text","1.2020年1月史丹佛醫學院研究團隊的確有發表論文，表示工業革命以來，在美國人體體溫正在下降。\n　\n2.但通篇研究並未提及體溫降低有害人體，亦未認為「體溫降低的原因」是缺乏運動。\n　\n該研究是推論近200年有更好的衛生條件、食物供應、生活條件，因此減少人體發炎的機會；再加上恆定的環境溫度帶來的舒適生活，皆可能導致代謝率/消耗的能量降低，進而使體溫下降。\n　\n3.該研究亦未主張應透過飲食或運動方式提高體溫。"],["reference","2020年1月史丹佛醫學院研究團隊刊於eLife期刊的研究，研究的重點是得出「體溫變化反映的是真實歷史模式，而非測量誤差或偏差」結論，而不是認為體溫降低有害人體：\nhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946399/\n　\n2020年1月7日史丹佛醫學院新聞稿介紹此研究：\nhttps://med.stanford.edu/news/all-news/2020/01/human-body-temperature-has-decreased-in-united-states.html"],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title","Decreasing human body temperature in the United States since the Industrial Revolution"],["url","https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946399/"],["summary","Mark Jit, Reviewing Editor and Eduardo Franco, Senior EditorMark Jit, London School of Hygiene & Tropical Medicine, and Public Health England, United Kingdom;AbstractIn the US, the normal, oral temperature of adults is, on average, lower than the canonical 37°C established in the 19th century. We postulated that body temperature has decreased over time. Using measurements from three cohorts—the Union Army Veterans of the Civil War (N = 23,710; measurement years 1860–1940), the National Health and Nutrition Examination Survey I (N = 15,301; 1971–1975), and the Stanford Translational Research Integrated Database Environment (N = 150,280; 2007–2017)—we determined that mean body temperature in men and women, after adjusting for age, height, weight and, in some models date and time of day, has decreased monotonically by 0.03°C per birth decade. A similar decline within the Union Army cohort as between cohorts, makes measurement error an unlikely explanation. This substantive and continuing shift in body temperature—a marker for metabolic rate—provides a framework for understanding changes in human health and longevity over 157 years.Research organism: HumanIntroductionIn 1851, the German physician Carl Reinhold August Wunderlich obtained millions of axillary temperatures from 25,000 patients in Leipzig, thereby establishing the standard for normal human body temperature of 37°C or 98.6 °F (range: 36.2–37.5°C [97.2- 99.5 °F]) (Mackowiak, 1997; Wunderlich and Sequin, 1871). A compilation of 27 modern studies, however (Sund-Levander et al., 2002), reported mean temperature to be uniformly lower than Wunderlich’s estimate. Recently, an analysis of more than 35,000 British patients with almost 250,000 temperature measurements, found mean oral temperature to be 36.6°C, confirming this lower value (Obermeyer et al., 2017). Remaining unanswered is whether the observed difference between Wunderlich’s and modern averages represents true change or bias from either the method of obtaining temperature (axillary by Wunderlich vs. oral today) or the quality of thermometers and their calibration (Mackowiak, 1997). Wunderlich obtained his measurements in an era when life expectancy was 38 years and untreated chronic infections such as tuberculosis, syphilis, and periodontitis afflicted large proportions of the population (Murray et al., 2015; Tampa et al., 2014; Richmond, 2014). These infectious diseases and other causes of chronic inflammation may well have influenced the ‘normal’ body temperature of that era.The question of whether mean body temperature is changing over time is not merely a matter of idle curiosity. Human body temperature is a crude surrogate for basal metabolic rate which, in turn, has been linked to both longevity (higher metabolic rate, shorter life span) and body size (lower metabolism, greater body mass). We speculated that the differences observed in temperature between the 19th century and today are real and that the change over time provides important physiologic clues to alterations in human health and longevity since the Industrial Revolution.ResultsIn men, we analyzed: a) 83,900 measurements from the Union Army Veterans of the Civil War cohort (UAVCW) obtained between 1862 and 1930, b) 5998 measurements from the National Health and Nutrition Examination Survey I cohort (NHANES) obtained between 1971 and 1975, and c) 230,261 measurements from the Stanford Translational Research Integrated Database Environment cohort (STRIDE) obtained between 2007 and 2017 (Table 1). We also compared temperature measurements in women within the two later time periods (NHANES, 9303 measurements; and STRIDE, 348,006 measurements).Table 1.Demographic characteristics (N (%)) and mean (SD)) of cohort participants included in the analyses.Table 1—source code 1.R code for Table 1.Total, N (%)UavcwNhanes iStrideIndividuals189,338 (100%)23,710 (13%)15,301 (8%)150,280 (79%)Observations1677,423 (100%)83,699 (12%)15,301 (2%)578,222 (85%)Age (years)Overall*56.89 (8.85)46.55 (16.74)53.00 (15.62)20–40144,379 (21%)1682 (2%)6489 (42%)136,181 (24%)40–60283,059 (42%)52,117 (62%)4422 (29%)225,365 (39%)60–80249,985 (37%)28,900 (35%)4390 (29%)216,676 (37%)Weight (Kg)0 (0%)0 (0%)0 (0%)0 (0%)Overall*68.63 (10.54)70.44 (15.76)78.53 (19.75)>60123,931 (18%)16,147 (19%)4245 (28%)103,516 (18%)60–80296,244 (44%)57,475 (69%)7311 (48%)231,312 (40%)80–100175,598 (26%)9054 (11%)3115 (20%)163,402 (28%)>10081,650 (12%)1023 (1%)630 (4%)79,992 (14%)Height (cm)Overall*172.34 (6.8)166.31 (9.17)167.78 (10.46)<160145,964 (64%)2587 (3%)4077 (27%)139,295 (24%)160–180432,404 (64%)69,506 (83%)9995 (65%)352,762 (61%)180–20098,320 (15%)11,569 (14%)1227 (8%)85,470 (15%)>200735 (0%)37 (0%)2 (0%)695 (0%)SexWomen2357,309 (53%)0 (0%)9303 (61%)348,006 (60%)Men320,114 (47%)83,699 (100%)5998 (39%)230,216 (40%)EthnicityBlack68,955 (10%)20,801 (25%)2399 (16%)45,689 (8%)White381,330 (56%)62,898 (75%)12,716 (83%)305,581 (53%)Other78,277 (12%)0 (0%)186 (1%)78,091 (14%)Unknown148,861 (22%)0 (0%)0 (0%)148,861 (26%)Overall, temperature measurements were significantly higher in the UAVCW cohort than in NHANES, and higher in NHANES than in STRIDE (Figure 1; Figure 1—figure supplement 1). In each of the three cohorts, and for both men and women, we observed that temperature decreased with age with a similar magnitude of effect (between −0.003°C and −0.0043°C per year of age, Figure 1). As has been previously reported (Eriksson et al., 1985), temperature was directly related to weight and inversely related to height, although these associations were not statistically significant in the UAVCW cohort. Analysis using body mass index (BMI) and BMI adjusted for height produced similar results (Figure 1—figure supplement 2) and analyses including only white and black subjects (Figure 1—figure supplement 3) showed similar results to those including subjects of all ethnicities.Body temperature measurements by age as observed in three different time periods: 1860–1940 (UAVCW), 1971–1975 (NHANES 1), and 2007–2017 (STRIDE).(A) Unadjusted data (local regression) for temperature measurements, showing a decrease in temperature across age in white men, black men, white women, and black women, in the three cohorts. (B) Coefficients and standard errors from multivariate linear regression models for each cohort including age, weight, height, ethnicity group and time of day as available. Yellow cells are statistically significant at a p value of < 0.01, orange cells are of borderline significance (p<0.1 but>0.05), and remaining uncolored cells are not statistically significant. (C) Expected body temperature for 30 year old men and women with weight 70 kg and height 170 cm in each time period/cohort.Figure 1—source code 1.R code for Figure 1.Figure 1—figure supplement 1.Distribution of temperature measures (oF) for each cohort: UAVCW (1860–1940), NHANES I (1971–1975) and STRIDE (2007–2017).Figure 1—figure supplement 2.Analysis using BMI adjusted for height.Coefficients (and standard errors) are from multivariate linear regression models for each cohort including age, height, BMI adjusted for height and time of day (as available). NHANES I includes population weights. *, **, *** indicates significance at the 90%, 95%, and 99% level, respectively.Figure 1—figure supplement 3.Model of mean body temperature in black and white ethnicity groups in three different time periods (cohorts): 1860–1940 (UAVCW), 1971–1975 (NHANES 1), and 2007–2017 (STRIDE).(A) Coefficients (and standard errors) from multivariate linear regression models for each cohort including age, body weight, height and time of day. Separate regression models were fitted for men and women, in black and white ethnicity groups. NHANES I includes population weights. *, **, *** indicates significance at the 90%, 95%, and 99% level, respectively. (B) Expected body temperature (and associated 95% confidence interval) for 30 year old men and women with body weight 70 kg and height 170 cm in each time period/cohort. These values derive from the regression models presented in A.Figure 1—figure supplement 4.Model of mean body temperature over time in three cohorts by birth year controlling for the time of the day of the temperature measurement (white men and women).(A) Graph shows a decrease of predicted body temperature by birth year for both white men (blue line) and white women (red line) based on the linear regression coefficients displayed in B. No data for women were available for the period 1800–1890. For all measurements from UACWV, where time of the day was not available, the values of 12:00 PM (noon) were imputed. (B) Coefficients (and standard errors) from linear regression model including age, weight in kg, height in cm and birth year.Figure 1—figure supplement 5.Effect of the month of temperature measurement.Mixed effect predictions and confidence intervals of the month during which the measurement was taken on the measured temperature. (A) White men in UACWV, (B) white men in NHANES I, (C) white men in STRIDE, (D) white women in NHANES I, and (E) white women in STRIDE.Figure 1—figure supplement 6.Analysis using both month and location.Coefficients (and standard errors) are from a multivariate linear regression model for the UAVCW cohort including age, weight, height, month and state climate classification (cold, moderate-cold, moderate, warm or hot). While UAVCW provided state information, NHANES I provided general region only and STRIDE was in Northern California only. *, **, *** indicates significance at the 90%, 95%, and 99% level, respectively.In both STRIDE and a one-third subsample of NHANES, we confirmed the known relationship between later hour of the day and higher temperature: temperature increased 0.02°C per hour of the day in STRIDE compared to 0.01°C in NHANES (Figure 1, Figure 1—figure supplement 2, Figure 1—figure supplement 4). The month of the year had a relatively small, though statistically significant, effect on temperature in all three cohorts, but no consistent pattern emerged (Figure 1—figure supplement 5). Using approximated ambient temperature for the date and geographic location of the examination in UAVCW and STRIDE, a rise in ambient temperature of one degree Celsius correlated with 0.001 degree (p<0.001) and 0.0004 degree (p=0.013) increases in body temperature in UAVCW and STRIDE, respectively. Because the seasonal and climatic effects were small and the independent variables were unavailable for many measurements, we omitted month and estimated ambient temperature from further models.We explored whether chronic infectious diseases—even in the absence of a diagnosis of fever—might raise temperature in the UAVCW cohort, by assessing the temperatures of men reporting a history of malaria (N = 2,203), syphilis (N = 465), or hepatitis (N = 24), or with active tuberculosis (N = 738), pneumonia (N = 277) or cystitis (N = 1,301). Only those currently diagnosed with tuberculosis or pneumonia had elevated temperatures compared to the remainder of the UAVCW population [37.22°C (95% CI: 37.20–37.24°C) and 37.06°C (95% CI: 37.03–37.09°C), respectively compared to 37.02 (95% CI: 36.52–37.53)] (Supplementary file 1).One possible reason for the lower temperature estimates today than in the past is the difference in thermometers or methods of obtaining temperature. To minimize these biases, we examined changes in body temperature by birth decade within each cohort under the assumption that the method of thermometry would not be biased on birth year. Within the UAVCW, we observed a significant birth cohort effect, with temperatures in earlier birth decades consistently higher than those in later cohorts (Figure 2). With each birth decade, temperature decreased by −0.02°C. We then assessed change in temperature over the 197 birth-year span covered by the three cohorts. We observed a steady decrease in body temperature by birth cohort for both men (−0.59°C between birth decades from 1800 to 1997; −0.030°C per decade) and women (−0.32°C between 1890 and 1997; −0.029°C per decade). Black and white men and women demonstrated similar trends over time (Figure 3).Temperature trends within birth cohorts of the UAVCW, 1860–1940 (black and white men).(A) Smoothed unadjusted data (local regression) for temperature measurement trends within birth cohorts. The different colors represent different birth cohorts (green: 1820s, blue: 1830s, orange: 1840s). (B) Coefficients (and standard errors) from multivariate linear regression including age, body weight, height and decade of birth (1820–1840) (these coefficients do not correspond to the graph as here the trajectories are approximated by linear functions). Only the three birth cohorts with more than 8000 members are included. * and ** indicate significance at the 90%, and 99% level, respectively. (C) Expected body temperature (and associated 95% confidence interval) for 30 year old men with body weight 70 kg and height 170 cm in each birth cohort. These values derive from the regression models presented in B.Figure 2—source code 1.R code for Figure 2.Modeled body temperature over time in three cohorts by birth year (black and white ethnicity groups).(A) Body temperature decreases by birth year in white and black men and women. No data for women were available for the birth years from 1800 to 1890. (B) Coefficients (and standard errors) used for the graph from multivariate linear regression including age, body weight, height and birth year. All cells are significant at greater than 99% significance level.Figure 3—source code 1.R code for Figure 3.DiscussionIn this study, we analyzed 677,423 human body temperature measurements from three different cohort populations spanning 157 years of measurement and 197 birth years. We found that men born in the early 19th century had temperatures 0.59°C higher than men today, with a monotonic decrease of −0.03°C per birth decade. Temperature has also decreased in women by −0.32°C since the 1890s with a similar rate of decline (−0.029°C per birth decade). Although one might posit that the differences among cohorts reflect systematic measurement bias due to the varied thermometers and methods used to obtain temperatures, we believe this explanation to be unlikely. We observed similar temporal change within the UAVCW cohort—in which measurement were presumably obtained irrespective of the subject's birth decade—as we did between cohorts. Additionally, we saw a comparable magnitude of difference in temperature between two modern cohorts using thermometers that would be expected to be similarly calibrated. Moreover, biases introduced by the method of thermometry (axillary presumed in a subset of UAVCW vs. oral for other cohorts) would tend to underestimate change over time since axillary values typically average one degree Celsius lower than oral temperatures (Sund-Levander et al., 2002; Niven et al., 2015). Thus, we believe the observed drop in temperature reflects physiologic differences rather than measurement bias. Other findings in our study—for example increased temperature at younger ages, in women, with increased body mass and with later time of day—support a wealth of other studies dating back to the time of Wunderlich (Wunderlich and Sequin, 1871; Waalen and Buxbaum, 2011).Resting metabolic rate is the largest component of a typical modern human’s energy expenditure, comprising around 65% of daily energy expenditure for a sedentary individual (Heymsfield et al., 2006). Heat is a byproduct of metabolic processes, the reason nearly all warm-blooded animals have temperatures within a narrow range despite drastic differences in environmental conditions. Over several decades, studies examining whether metabolism is related to body surface area or body weight (Du Bois, 1936; Kleiber, 1972), ultimately, converged on weight-dependent models (Mifflin et al., 1990; Schofield, 1985; Nelson et al., 1992). Since US residents have increased in mass since the mid-19th century, we should have correspondingly expected increased body temperature. Thus, we interpret our finding of a decrease in body temperature as indicative of a decrease in metabolic rate independent of changes in anthropometrics. A decline in metabolic rate in recent years is supported in the literature when comparing modern experimental data to those from 1919 (Frankenfield et al., 2005).Although there are many factors that influence resting metabolic rate, change in the population-level of inflammation seems the most plausible explanation for the observed decrease in temperature over time. Economic development, improved standards of living and sanitation, decreased chronic infections from war injuries, improved dental hygiene, the waning of tuberculosis and malaria infections, and the dawn of the antibiotic age together are likely to have decreased chronic inflammation since the 19th century. For example, in the mid-19th century, 2–3% of the population would have been living with active tuberculosis (Tiemersma et al., 2011). This figure is consistent with the UAVCW Surgeons' Certificates that reported 737 cases of active tuberculosis among 23,757 subjects (3.1%). That UAVCW veterans who reported either current tuberculosis or pneumonia had a higher temperature (0.19°C and 0.03°C respectively) than those without infectious conditions supports this theory (Supplementary file 1). Although we would have liked to have compared our modern results to those from a location with a continued high risk of chronic infection, we could identify no such database that included temperature measurements. However, a small study of healthy volunteers from Pakistan—a country with a continued high incidence of tuberculosis and other chronic infections—confirms temperatures more closely approximating the values reported by Wunderlich (mean, median and mode, respectively, of 36.89°C, 36.94°C, and 37°C) (Adhi et al., 2008).Reduction in inflammation may also explain the continued drop in temperature observed between the two more modern cohorts: NHANES and STRIDE. Although many chronic infections had been conquered before the NHANES study, some—periodontitis as one example (Capilouto and Douglass, 1988)— continued to decrease over this short period. Moreover, the use of anti-inflammatory drugs including aspirin (Luepker et al., 2015), statins (Salami et al., 2017) and non-steroidal anti-inflammatory drugs (NSAIDs) (Lamont and Dias, 2008) increased over this interval, potentially reducing inflammation. NSAIDs have been specifically linked to blunting of body temperature, even in normal volunteers (Murphy et al., 1996). In support of declining inflammation in the modern era, a study of NHANES participants demonstrated a 5% decrease in abnormal C-reactive protein levels between 1999 and 2010 (Ong et al., 2013).Changes in ambient temperature may also explain some of the observed change in body temperature over time. Maintaining constant body temperature despite fluctuations in ambient temperature consumes up to 50–70% of daily energy intake (Levine, 2007). Resting metabolic rate (RMR), for which body temperature is a crude proxy, increases when the ambient temperature decreases below or rises above the thermoneutral zone, that is the temperature of the environment at which humans can maintain normal temperature with minimum energy expenditure (Erikson et al., 1956). In the 19th century, homes in the US were irregularly and inconsistently heated and never cooled. By the 1920s, however, heating systems reached a broad segment of the population with mean night-time temperature continuing to increase even in the modern era (Mavrogianni et al., 2013). Air conditioning is now found in more than 85% of US homes (US Energy Information Administration, 2011). Thus, the amount of time the population has spent at thermoneutral zones has markedly increased, potentially causing a decrease in RMR, and, by analogy, body temperature.Some factors known to influence body temperature were not included in our final model due to missing data (ambient temperature and time of day) or complete lack of information (dew point)(Obermeyer et al., 2017). Adjusting for ambient temperature, however, would likely have amplified the changes over time due to lack of heating and cooling in the earlier cohorts. Time of day at which measurement was conducted had a more significant effect on temperature (Figure 1—figure supplement 4). Based on the distribution of times of day for temperature measurement available to us in STRIDE and NHANES, we estimate that even in the worst case scenario, that is the UAVCW measurements were all were obtained late in the afternoon, adjustment for time of day would have only a small influence (<0.05°C) on the −0.59°C change over time.In summary, normal body temperature is assumed by many, including a great preponderance of physicians, to be 37°C. Those who have shown this value to be too high have concluded that Wunderlich’s 19th century measurements were simply flawed (Mackowiak, 1997; Sund-Levander et al., 2002). Our investigation indicates that humans in high-income countries have changed physiologically over the last 200 birth years with a mean body temperature 1.6% lower than in the pre-industrial era. The role that this physiologic ‘evolution’ plays in human anthropometrics and longevity is unknown.Materials and methodsCohortsWe compared body temperature measurements from three cohorts. Cohort 1: The Union Army Veterans of the Civil War, 1860–1940 (UAVCW) is a database from the ‘Early Indictors of Later Work Levels, Disease and Death Study’, initiated by the late Nobel Laureate, Robert Fogel in 1978 (Fogel and Wimmer, 1992) and continuing today. The study abstracted the Compiled Military Service Records, the Pension Records, Carded Medical Records, the Surgeons' Certificates (detailed medical records) and information from the US Federal Census for a cluster sample of Union Army companies in the US Civil War. In total, 331 companies of white and 52 companies of black Union Army veterans were included in the dataset. The Surgeons’ Certificates were obtained at locations throughout the US for veterans seeking pension benefits. These certificates include comprehensive medical histories and physical examinations. Body temperatures in Fahrenheit were hand-written on 83,900 Surgeons' Certificates from 23,710 individuals (mean: 3.53 examinations per individual; Table 1). Whether the temperatures were taken orally or in the axilla is unknown; both methods were employed in the 19th century although oral temperature was more common (Salinger and Kalteyer, 1900). Precision of the instruments is also unknown. Inspection of the distribution of reads, however, suggest that it is no better than 0.2 degrees Fahrenheit, consistent with the hashmarks on mercury thermometers (Figure 1—figure supplement 1). The UAVCW data—including birth date, temperature, height, weight, location and date of the medical visit, medical history, ongoing medical complaints and findings of physical examinations —are freely available on-line in digital format (The Colored Troops (USCT) original and expanded datasets; Fogel et al., 2000; Costa, 2019). Cohort 2: The National Health and Nutrition Examination Survey (NHANES I) is a multistage, national probability survey conducted between 1971 and 1975 in the US civilian population. A subset of subjects, aged 1 to 74 years (N = 23,710) underwent a medical examination (ICPSR study No. 8055), including 15,301 adults. The major focus of NHANES I was nutrition, and persons with low income, pregnant women and the elderly were consequently oversampled (Centers for Disease Control, National Center for Health Statistics, 1975). Data abstracted included weight, height, sex, ethnicity, and month and geographic region of examination and, as available, time of day the temperature was obtained. In NHANES, mercury thermometers were used and temperatures were taken orally. Precision, as with the UAVCW cohort, is assumed to be 0.2 °F. The medical examination was performed by a physician with the help of a nurse. Cohort 3: The Stanford Translational Research Integrated Database Environment (STRIDE) extracts electronic medical record information from patient encounters at Stanford Health Care (Stanford, CA). All adult outpatient encounters at Stanford Health Care from 2007 to 2017 with recorded temperature measurements in the electronic medical record are included in this study (N = 578,522 adult outpatient encounters). Temperature measurements were obtained orally with annually-calibrated, digital thermometers with precision of 0.1 °F and extracted from the dataset along with age, sex, weight, height, primary concern at the visit, prescribed medications, other conditions in the health record with ICD10 codes, and year and time of day the temperature was obtained (mean: 3.85 examinations per individual; Table 1).For the UAVCW and STRIDE datasets, any observations having a diagnosis of fever at the time of the medical examination were excluded. From all three datasets, any extreme values of temperature (<35°C and >39°C) were also excluded from the analysis either because they were implausible or because they indicated a diagnosis of fever and would otherwise have been excluded. Improbable values of both body weight (<30 kg and >200 kg) and height (<120 cm and >220 cm) were also removed. In the UAVCW, we also excluded veterans born after 1850, because they were unlikely to have served in the Union Army.The use of the STRIDE data was approved as an expedited protocol by the Stanford Institutional Review Board (protocol 40539) and informed consent was waived since the only personal health information abstracted was month of clinic visit. Anonymized data from NHANES and the data from UAVCW are freely available on-line for research use.Data analysisEthnicity categories were defined differently across cohorts. UAVCW included only white and black men. For comparability, we restricted analyses between the UAVCW and other cohorts to men in these two ethnicity groups. Asians were categorized as ‘Other’ in NHANES and as ‘Asian’ in STRIDE, so were considered as ‘Other ethnicity’ in combined analyses. We performed analyses stratified by sex to account for known temperature differences between men and women. The NHANES study uses sample weights to account for its design; these were incorporated into models including NHANES data (Centers for Disease Control, National Center for Health Statistics, 1975).To estimate the average body temperature during each of the three time periods, we modeled temperature within each cohort using multivariate linear regression, simultaneously assessing the effects of age, body weight, and height. Measurements in men and women were analyzed separately, by white and black ethnicity groups. We also conducted mixed effects modeling to account for the repeated temperature measurements from some individuals. Because the coefficients were almost identical to those of the linear regression models, we chose to present this more simple statistical method. We also assessed the effects of geography, that is location at which temperature was obtained, on temperature (Figure 1—figure supplement 6).To evaluate temperature changes over time, we predicted body temperature using multivariate linear regression including age, body weight, height and birth decade in the UAVCW cohort (the timeframe of NHANES and STRIDE spanned relatively few years, with insufficient variability to evaluate birth cohort effects within these datasets). To assess change in temperature over the 197 birth-year span covered by the three cohorts (between years 1800 and 1997 for men, and between 1890 and 1997 for women), we used linear regression with temperature as the outcome and age, weight, height, and birth decade as independent variables, stratifying by ethnicity and sex. The UAVCW cohort was further investigated for reported infectious conditions that might affect temperature. Diagnoses of infectious conditions, either in the medical history (malaria, syphilis, hepatitis) or active at the time of examination (tuberculosis, pneumonia or cystitis), were included in regression models if fever was not listed as part of that record.Some models included time of day, ambient temperature and month of year. Time of day at which temperature was taken was available for STRIDE and a subset of NHANES. For individuals without time of day, we imputed the time to be 12:00 PM (noon). We accounted for ambient temperature using the date and geographic location of examination (available in UAVCW and STRIDE) based on data from the National Centers for Environmental Information (NOAA National Centers for Environmental Information, 2018). We used the month of year when each measurement was taken as a random effect. To assess the robustness of our result to the chosen methodology, we repeated the analyses using linear mixed effect modeling, adjusting for multiple measurements.Within the UAVCW, minimum ages varied across birth cohorts due to the bias inherent in the cohort structure (for example, it is impossible to be younger than 30 years of age at the time of the pension visit, be born in 1820s, and be a veteran of the Civil War). To avoid instability in the analysis due to having too few people within specific age groups per birth decade, we excluded the lowest 1% of observations in each birth cohort according to age.All analyses were performed using R statistical software version 3.3.0. and packages easyGgplot2, lme4, merTools, and ggplot2 for statistical analysis and graphs (www.r-project.org).AcknowledgementsWe thank Professor Dora Costa, University of California, Los Angeles and Dr Louis Nguyen, Harvard Medical School for sharing their expertise and knowledge of the Union Army data. Thank you also to Dr. Philip Mackowiak, University of Maryland, for providing feedback on study design, analysis and interpretation. We also thank Michelle Bass, PhD, and Yelena Nazarenko for their support of the STRIDE clinical databases.Funding StatementThe funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.Contributor InformationMark Jit, London School of Hygiene & Tropical Medicine, and Public Health England, United Kingdom.Eduardo Franco, McGill University, Canada.Funding InformationThis paper was supported by the following grant:Stanford Center for Clinical and Translational Research and Education\nSPECTRUM award to Julie Parsonnet.Additional informationCompeting interests No competing interests declared.Author contributions Data curation, Software, Formal analysis, Validation, Visualization, Methodology, Writing—original draft.Formal analysis, Methodology, Writing—review and editing.Methodology, Writing—review and editing.Formal analysis, Visualization, Methodology, Writing—review and editing.Conceptualization, Resources, Supervision, Funding acquisition, Investigation, Visualization, Methodology, Project administration, Writing—review and editing.Ethics Human subjects: The use of the STRIDE data was approved as an expedited protocol by the Stanford Institutional Review Board (protocol 40539) and informed consent was waived since the only personal health information abstracted was month of clinic visit. Anonymized data from NHANEs and the data from UAVCW are freely available on-line for research use.Additional filesSource data 1.Cohort datasets for all analyses.Source code 1.R code - Data import files.Source code 2.R code - Data analysis files.Supplementary file 1.Predicted body temperature in individuals with infectious diseases in the UAVCW cohort (1860–1940). Expected body temperature (and associated 95% confidence interval) for a 30 year old white man with body weight of 70 kg and height 170 cm in the UAVCW cohort. *, **, *** indicates significance at the 90%, 95%, and 99% level, respectively.Transparent reporting formData availabilityAll data generated or analysed during this study are included in the manuscript and supporting files.The following previously published datasets were used:Fogel RW, Costa DL. 2018. Aging of Veterans of the Union Army: Surgeons' Certificates, United States, 1862-1940 (ICPSR 2877) National Archive of Computerized Data on Aging. 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[Google Scholar]Mark Jit, Reviewing Editor, Jill Waalen, Reviewer, and Frank Rühli, ReviewerMark Jit, London School of Hygiene & Tropical Medicine, and Public Health England, United Kingdom;In the interests of transparency, eLife publishes the most substantive revision requests and the accompanying author responses.Thank you for submitting your article \"Decreasing human body temperature in the United States since the Industrial Revolution\" for consideration by eLife. Your article has been reviewed by two peer reviewers, and the evaluation has been overseen by Mark Jit as the Reviewing Editor and Eduardo Franco as the Senior Editor. The following individuals involved in review of your submission have agreed to reveal their identity: Jill Waalen (Reviewer #1); Frank Rühli (Reviewer #2).The reviewers have discussed the reviews with one another and the Reviewing Editor has drafted this decision to help you prepare a revised submission. We believe that the manuscript is basically acceptable for publication, but would like you to address some minor textual comments raised by the reviewers.We find that this is an interesting and well-written manuscript using measurements of mean body temperature among 3 US cohorts with data collected in 3 distinct time periods to support the hypothesis that mean population body temperature has decreased over the time from 1860 to 2017. We highly appreciate this work due to its relevant yet unique research topic, solid data sets and straight-forward analysis.Given the differences in measurement practices, data collection, and environmental conditions over that time period, the paper has tackled a question that is inherently unprovable in regard to cause-effect. However, the arguments are cogent enough (e.g., same known temperature trends corresponding to age seen in all cohorts) and the data supportive enough (e.g., same known temperature trends corresponding to age seen in all cohorts), that it is worth its thought-provocation.We would like the following textual changes to be made to the manuscript:1) The last sentence of the Abstract states that understanding the trend of decreasing mean population body temperature \"provides a framework for understanding changes in body habitus and human longevity over the last 200 years.\" There are two problems with this:a) The study spans 1860-2017, which is 157 years.b) Given that body temperature is defined as a biomarker for metabolic rate, discussion regarding body habitus in different parts of the manuscript are a bit difficult to reconcile: 1) lower metabolism is associated with greater body mass (Introduction, last paragraph); 2) increased body mass is associated with increased body temperature (Discussion, second paragraph).Given the above, please change the line in the Abstract to: \"provides a framework for understanding changes in human health and longevity over the last 150 years\" (or… since the Civil War….)2) Given the relative paucity of published medical research on the UAVCW cohort (there appears to be only a few PubMed listings), it would be helpful to give more detail about the medical data included for this cohort and how it was obtained:a) From the brief description in the Materials and methods section, it is not clear how many times an individual may have been examined, for example. Were they tested on a regular basis for pension benefits and disqualified based on some findings? It is stated in the first paragraph of the subsection “Cohorts”, that measures could have been obtained on multiple occasions from individual veterans, which, of course, introduces that problem of lack of independence of measures, but need to have some idea of how big a problem this would be (not likely to be big, but would be good to have numbers).b) Also, were the examinations done at one location for all veterans (relevant to correlating body temperature with ambient temperature)? This is implied in the third paragraph of the Results, but would be helpful to state explicitly in the Materials and methods.c) A \"Table 1\" with basic characteristics of the three cohorts would also be helpful in this regard, given the likely differences, for example, in ranges of height, weight, age, and other covariates. This would be helpful, for example, in understanding why height and weight were not statistically significantly associated in the UAVCW (Results, second paragraph) – perhaps a narrower range in the other cohorts?3) It is implied in the third paragraph of the subsection “Data Analysis”, that fever was recorded and that these records were excluded in at least some of the models. This raises the question of whether \"febrile\" subjects were excluded in all cohorts and, if so, what cut-offs were used to define fever in the different cohorts?4) Given that the changes in mean temperature of interest are relatively small (less than 1 degree), more information regarding the measurement is of interest:a) In what scale were the measurements in each cohort originally made (Celsius or Fahrenheit)? To what precision level were they recorded?b) Is it known how thermometers were calibrated for the measures in the respective cohorts (particularly UAVCW)?5) Please use the term \"ethnicity\" rather than \"race\" since we assume this is what is actually being recorded from the cohorts.6) Discussion, first paragraph: \"that\" should be \"than\"Contributor InformationMark Jit, London School of Hygiene & Tropical Medicine, and Public Health England, United Kingdom.Jill Waalen, The Scripps Research Institute, United States.Frank Rühli,"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title",""],["url","https://med.stanford.edu/news/all-news/2020/01/human-body-temperature-has-decreased-in-united-states.html"],["summary",""],["topImageUrl",null],["error","NOT_REACHABLE"]]}]}],["createdAt","2020-03-06T07:15:00.472Z"]]}]]},{"__iterable":"Map","data":[["article",{"__iterable":"Map","data":[["replyCount",2],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",1],["user",{"__iterable":"Map","data":[["id","j4S8C_rTHK0CH_t8uT8ZpD6JsxFEKIzr0ilq-rZ0PrQRQTdQI"],["name","耿直的楊梅強尼"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[]}],["text","人類體溫37℃已成為歷史：人類體溫普遍降低意味著什麼？\n\n最近，因為疫情的關係，擔心自己有接觸史或者進行保護性隔離的人，每天都要測三次體溫，很多人都會發現每次測量結果都在36.3-36.7℃左右，夜晚略高。\n\n記得小時候生物課上講過，人的正常體溫大約是37℃，但為什麼身邊所有人的體溫都不到37℃呢？\n\n就在一個月前的1月7日，斯坦福大學醫學院教授朱莉·帕森內特（Julie Parsonnet）和她的團隊剛剛發佈了一項研究成果，發現自19世紀以來，成年人的平均體溫在持續下降，不到200年間下降了0.4℃，從37℃降到36.6℃。\n\n37℃已經成為歷史，而體溫下降並非好事！\n\n1851 年，一位名叫卡爾·溫德利希（Carl Wunderlich）的德國內科醫生，收集了25000 名病人的腋下體溫資料，首次確定了人體正常體溫為37 ℃，這種說法一直延續至今。\n\n但是，近年來，許多科學家認為人類體溫在不斷下降，37℃已經成為歷史。\n\n/ 體溫降低的影響 /\n\n病毒學解密：蝙蝠為何能把上百種病毒封印在體內？根本原因很簡單：蝙蝠免疫系統強大，很大程度上是因為他們體溫能保持較高的40℃。研究顯示，體溫每降低1℃，免疫力就會下降30以上；體溫每升高1℃，免疫力就會提升5~6倍，這麼看的話，蝙蝠的免疫力大概比人類高幾百倍——怪不得蝙蝠百毒不侵，還不會得癌症......\n\n為什麼體溫降低，免疫力也會隨之降低呢？\n\n眾所周知，體溫是和基礎代謝率掛鉤的，體溫每上升1℃，基礎代謝會提高13。體溫過低，可能意味著代謝不好。\n\n反之，基礎代謝率低，體溫下降，血液流速放緩，白細胞的工作效率也隨之變低。慢慢悠悠的白細胞很難在第一時間發現異物，即使發現異物了，也很難迅速召集其他白細胞來消滅異物，導致機體容易感染病毒和細菌，引發疾病。\n\n此外，白細胞不僅能抵禦外部病毒和細菌的攻擊，還能監測到體內的癌細胞，及時把癌變細胞殺死。\n\n其實，即使是健康人，每天體內也會產生約 5000個癌細胞。如果其中一個躲過了免疫系統的監視，倖存下來，很快就會1變2、2變4、4變8...... 最終演化成腫瘤。\n\n據科學家推算，如果體溫下降1℃，免疫力降低30％，則每天免疫系統可能會漏掉近1500個癌細胞，任其瘋狂繁殖。\n\n/ 體溫降低的原因 /\n\n現代人類的體溫為什麼會降低呢？\n\n1、最主要的原因——缺乏運動\n\n科學家分析，人類體溫在170年間下降了0.4℃，近20年的下降幅度尤其大，最主要的原因是缺乏運動。在離我們並不遙遠的50年前，人們每天都要做很多運動：\n\n農村的人要種莊稼或者放牧，即使是城市人群，也會每天手洗衣服、自己做飯、清掃房間；大家出門會優先考慮步行或自行車，閒暇時靠戶外運動打發時間。\n\n然而，隨著科技的發展，人們好像越來越「懶」了——吃飯靠外賣，出門就打車，洗衣服有洗衣機，洗碗有洗碗機，掃地有機器人，隨時可以躺在床上打遊戲，男生打籃球、女生踢毽子的校園場景一去不復返。\n\n基礎代謝與任何外在活動無關，是一個人什麼都不幹的時候的自然消耗，而肌肉是人體內最大的發熱器官。較少的肌肉，意味著較低的體溫和較低的基礎代謝。一個肌肉含量高的人，即使什麼也不做也仍然在消耗能量。現代人運動量的減少，導致肌肉含量普遍偏低。\n\n基礎代謝下降，能量消耗就會減少，內臟脂肪就會增加。而內臟脂肪組織會分泌出超過20種不良激素（或者脂肪細胞因數），會引起血管炎，還會削弱胰島素的功能，從而導致癌症、高血壓、糖尿病等一系列疾病。\n\n2、無處不在的空調，使體溫調節中樞不再敏感\n\n專家認為，除了肌肉品質下降外，空調導致的出汗困難也是現代人體溫下降的一大原因。人們長期在空調屋工作和生活，大腦下丘腦的體溫調節中樞失去了接收刺激的機會，久而久之，體溫調節中樞將對外界溫度不再敏感，從而導致體溫降低。\n\n3、現代人生活壓力大，皮質醇過量分泌導致肌肉分解\n\n此外，越來越複雜的人際關係、財務問題和家庭問題等生活壓力，也和體溫降低有關。在壓力狀態下，人體處於應激狀態，身體會分泌一種叫「皮質醇」的激素來維持正常的生理功能。\n\n但是，皮質醇是一種分解代謝激素，不僅會分解肌肉，還會促進脂肪儲存，優先把脂肪存儲于內臟。生活壓力導致皮質醇長期過量分泌，一邊分解肌肉，一邊儲存脂肪，基礎代謝率一降再降，體溫也就隨之降低。\n\n體溫每降低1℃，免疫力就會下降30以上。人類體溫在170年間下降了0.4℃，意味著我們免疫力下降，大大提高了病毒、細菌感染和癌症的發生率。\n\n我們能做的，就是通過調節日常飲食、加強體育鍛煉、不濫用空調、放鬆心態緩解壓力等方式，從一點一滴的小細節中，適當提升體溫。\n\n/ 通過飲食提高體溫 /\n\n在日常飲食中加入胡椒粉或者辣椒粉。如果你是個「重口味」的人，那麼對於辣椒粉一定非常親切，這種能產熱的調味料能夠迅速提高人體的溫度，它含有一種叫辣椒素的化學物質，不僅能讓你的味覺產生反應，更能在你的消化系統中發揮作用，是一種能讓你急劇升溫的物質。 \n\n吃花生。花生長久以來都是以提高新陳代謝而著名的食物，因此對於減肥的人來說是最佳的小零食。花生中富含碳水化合物，可以當作身體的燃料，當體內碳水化合物增加了之後，身體自然會覺得更加熱一些。\n\n多吃糙米。糙米可以作為很棒的主食來吃，並且還能有效提高身體溫度。糙米中含有很多健康的碳水化合物，能讓你在有飽腹感的同時燃燒多餘的熱量，從而產生溫暖的感覺。\n\n生吃生薑。你可以在餐點中加入生薑，也可以直接生吃，在你用力咀嚼生薑時會有立竿見影的效果——你會感到體內迅速變熱。生薑中含有一種稱為姜辣素的物質，能收縮血管，從而產生熱量。 \n\n喝熱飲或熱湯。任何溫熱的液體都能提高你的體溫。熱飲中的熱量會迅速貫穿全身，讓你的身體在一段時間內處於非常溫暖的狀態\n\n/ 通過運動提高體溫 /\n\n進行日常基礎訓練。鍛煉可以有效提高身體溫度，不過也要小心，在出過汗後身體會重新冷卻下來。規律的鍛煉能提高新陳代謝的速度，進而讓身體增溫，不妨每天早上進行鍛煉，因為在早上提高了新陳代謝後能説明你維持一整天較高的新陳代謝率，也就是說，即便你已經鍛煉完了，你的身體還會持續處於較高的溫度中。\n\n深蹲。所謂深蹲就是將雙腳打開與肩同寬，將雙手搭于腰間，然後彎曲膝蓋、緩慢下蹲，就好像你要坐下來的姿勢一樣，在空中停頓兩秒後回到起始位置。一次做3組，每組20個。\n\n每天運動。每天運動30分鐘就能有效增加身體的熱量，當你在動用繩肌腱和股四頭肌等大肌肉群時，身體自然會燃燒更多熱量，從而提升身體溫度。如果你不喜歡跑步，還可以改成游泳或騎單車，同樣能達到燃脂和提高體溫的效果。\n\n盡可能地多活動身體。抓住一切可以活動身體的機會，即便當你手頭有事在忙也不要放棄。比如增加做家務活的頻率，比如掃地或拖地等等。\n\n/ 保持身體的熱度 /\n\n穿著適宜。能讓你保持身體熱度的衣服種類有很多，如果你感覺出門可能會冷，就多穿一件或者帶一件在身上以防萬一。\n\n和朋友家人們待在一起。不同身體間的熱量傳輸會提高房間的溫度，人類是熱血動物，換句話說，人體自然會釋放熱量，這也解釋了為什麼人多的房間比人少的房間溫度更高。多和其他人待在一起可以説明你從每個人身上傳輸熱量和能量，相互取暖。\n\n讓身體保持乾燥狀態。在洗完澡或者剛淋過雨後，一定要及時擦乾身體來維持體溫，溫度較低的水會迅速吸走你的熱量，讓體溫降低。\n\n如果你淋濕了，儘快換上幹衣服。如果你一直捂在濕衣服裡，體溫會急劇下降。\n\n用吹風機吹幹頭髮的同時給身體增溫。頭部溫度增加後，身體其他部分的溫度也會提高。\n\n/ 讓身體自然地增溫 /\n\n增肌。肌肉會消耗相當多的熱量，即使是在你休息的時候依然不例外，因此，增加肌肉也意味著你對於熱量的需求也在增加。記住這一點，增肌就可以增溫。\n\n不要刻意阻止身體打顫發抖。這些本能性的動作是身體自發調節體溫的方式，當你打顫和發抖時肌肉就會參與進來，繼而提高你的體溫。\n\n增重。這個辦法並不是人人適用的，尤其當你已經屬於超重狀態時。不過話說回來，增加一點體重確實能讓你保持溫暖，那些額外的脂肪能夠起到隔離作用，讓你的身體維持在一個相對較高的溫度。增重最好的方法就是攝入更多的熱量，你需要一個卡路里計算機來計算你需要攝入多少熱量來增加體重。\n\n/ 提升體溫的好處 /\n\n減輕肝腎負擔，微循環系統若得到改善，新陳代謝所產生的廢物便可迅速排除體外，從而減輕肝臟及腎臟的負擔。\n\n增強免疫力，體溫每上升1攝氏度，人體的自然治癒率會增6倍左右，若體溫上升2度，自然治癒率更會增強36倍之高。通過升溫排汗有助於健康。\n\n促進排汗及皮下脂肪的排除，提升人體的新陳代謝功能，將皮脂腺的脂肪排出體外，達到健康與美容，輕鬆變苗條的效果(要注意補充水分)。\n\n排出體內的老舊廢物，主要是體內的代謝廢物。重金屬與致癌物，提高體溫將體內累積的致癌成分”重金屬”排出體外，徹底去除癌症根源。\n\n增強活力，活化新陳代謝、強化營養成分的充分利用、消除疲勞。\n\n改善微循環系統，皮下深層的溫度微升，血流速度加快，微血管擴張。\n\n呼吸的皮膚，使得皮膚呼吸更加旺盛,血液循環順暢，常保健康美麗，光滑細緻。\n\n有效改善睡眠——助眠,睡到自然醒。\n\n在日常生活中，要儘量避免會降低你體溫的活動，比如在寒冷的冬夜外出或者有可能打溼衣服的活動。\n\n瞭解你體溫過低的原因。體溫過低有很多不同的原因，你必須清楚你是否患有某些疾病，才導致你的體溫比正常低。\n\n當你的體溫持續過低、無法提高時，不妨諮詢下醫生，你的新陳代謝方面應該出現了一些問題，需要特別的注意。"],["id","24gc50p30npm4"],["createdAt","2020-03-04T17:56:16.877Z"]]}],["reply",{"__iterable":"Map","data":[["id","FobAqnABWiTSPYAZftGZ"],["user",{"__iterable":"Map","data":[["id","C5pNe2IBbyB_hvRujIKX"],["name","嘎琳"],["avatarUrl","https://www.gravatar.com/avatar/6b6dc38459d1c6459478c0df2f4afa27?s=100&d=identicon&r=g"],["level",13]]}],["type","RUMOR"],["text","人體正常溫度是一個範圍值而非特定數值，不同部位的範圍值也略有差異。攝氏37度只是剛好都落在各部位的正常值域內，才被用來當正常體溫的概略數值。"],["reference","https://medicalinspire.com/web/posts/22498"],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title","【解開迷思】37℃就代表正常體溫嗎？發燒其實不會燒壞腦。"],["url","https://medicalinspire.com/web/posts/22498"],["summary","長久以來，正常體溫的定義一直承襲翁德利希（Wunderlich）於1869年測得的攝氏37度。然而，隨著生物醫學的進步，這個定義也受到挑戰，陸續有學者提出人類的正常體溫具24小時晝夜變異。同時大家總認為發燒是件壞事，一旦發燒不退就會大為慌張。事實上發燒可以有害，亦可以有用，不能一慨而論。近年醫學界對於發燒的研究，才發現我們對於發燒居然有那麼多錯誤觀念。\n何謂正常體溫？\n事實上體溫主要是由大腦中的體溫控制中樞負責管理調節，而正常的體溫並沒有一個絕對的度數。正常的體溫度數會隨著每日不同的時段、當時的活動狀況和所量度的身體部位而稍有差異；年齡及健康狀況亦會影響身體的溫度。而體溫最高在下午，最低在午夜二時至四時，相差可達攝氏半度或華氏一度。\n\n\n\n量度方法\n正常體溫\n\n\n耳探\n35.8°C – 38°C （96.4°F – 100.4°F）\n\n\n腋探\n34.7°C – 37.3°C（94.5°F – 99.1°F）\n\n\n肛探\n36.6°C – 38°C （97.9°F – 100.4°F）\n\n\n\n到底哪一種量體溫的方法比較準？\n量體溫的方法包括肛溫、口溫、腋溫、背溫、耳溫、額溫等，其中以肛溫最接近身體內部真正的溫度。耳溫與肛溫的相關性很高，必要時可取代肛溫，但必須注意三個月以下嬰兒的耳溫常不準確，所以不建議使用。\n口溫平均比肛溫低 0.5 ℃ ，腋溫平均比肛溫低 0.8 ℃ ，而且這兩種方法比較容易受到皮膚黏膜血管收縮等因素的影響而偏低。一個月以下或體重很低的新生兒，不適合量肛溫與耳溫，可考慮量腋溫或背溫。用額溫槍或紅外線測量皮膚表面，常有嚴重低估真正體溫的現象，所以不建議常規使用。\nPhoto from Google\n體溫高到幾度以上才算發燒？\n發燒的定義為身體內部的中心體溫 ≥ 38 ℃ ，介於 37.5℃與 38 ℃ 之間的體溫可能正常也可能是低度發燒，必須參考前後測量的體溫與其他症狀判斷是否有發燒現象。\n為何會發燒？\n人體腦部下視丘(Hypothalamus)有個體溫調節中樞，在這裡會設定一個體溫定位點，平時不生病的時候體溫都設在 37 ℃ 左右。人體因為感染等各種疾病出現發炎反應的時候，發炎反應所製造的一些小分子會作用在體溫調節中樞，而使體溫的定位點上升，於是人體會進行很多生理反應而使體溫上升。\n有另一種情形是身體並沒有發炎、體溫定位點也沒有上升，但因為身體熱量太多來不及散熱而使體溫上升，這種情形稱為體溫過高 (hyperthermia) ，例如在炎熱的環境下穿太多衣服、嬰兒包得太緊、運動、中暑等。\nPhoto from Google\n到底發燒對人體有什麼影響？\n很多研究顯示適度發燒可以提升免疫系統的效能，也有研究顯示退燒藥會壓抑免疫反應，所以在動物實驗中用大量退燒藥反而會增加敗血症的死亡率。人類生病的時候發燒，算是一種保護性的本能反應，目的在加強我們對於疾病的抵抗力。\n同時發燒的時候需要產生多餘的熱量，所以會增加氧氣消耗量、二氧化碳製造量與心臟輸出量，這些對於健康兒童的影響很有限，但患有嚴重心臟病、嚴重貧血、慢性肺病、糖尿病與先天代謝異常的兒童，則可能無法承受這些多餘的負擔。此外，有些兒童因為體質因素，在 3 個月至 6 歲間可能因為發燒而導致熱性痙攣。\n發燒會不會燒壞腦？\n41 ℃ 以下的發燒不會對腦神經組織直接造成傷害，極度高燒有時會使意識出現程度不等的異常，但目前沒有任何證據顯示高燒本身會對神經組織造成永久性的傷害。一般口傳發燒把小孩腦子燒壞的事例，都是因為那些小孩罹患了腦炎、腦膜炎等疾病，發燒只是這些疾病的症狀表現之一，真正影響腦部的是腦部嚴重感染病症。\nSource: 衛生署、台灣衛生福利部國民健康署\nText by Medical Inspire\n解開更多身體迷思：\n【解開謎團】你知道「啪手指」為何有聲音嗎？這個習慣會形成關節炎嗎？"],["topImageUrl",null],["error",null]]}]}],["createdAt","2020-03-05T12:51:46.975Z"]]}]]},{"__iterable":"Map","data":[["article",{"__iterable":"Map","data":[["replyCount",1],["references",{"__iterable":"List","data":[{"__iterable":"Map","data":[["type","LINE"]]}]}],["replyRequestCount",1],["user",{"__iterable":"Map","data":[["id","j4S8C_XyVBG6ipdIbSfoARU3Ma52A5Tsy8Y3HwtuhlomGXHXY"],["name","↖寬已待人的民雄雪麗↗"],["avatarUrl",null],["level",0]]}],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title","Squarespace - Website Expired"],["url","www.americasfrontlinedoctors.com"],["summary","Website ExpiredThis account has expired. If you are the site owner, click below to login."],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","医生做证，推特脸书油管联手封杀为哪般？"],["url","https://mp.weixin.qq.com/s/fbVO06Ldg0Gege7bub7Hzw"],["summary","这三大媒体平台都自称使“公众平台”，人们可以在这些平台上自由发表意见和观点。然而现在，他们居然向专制国家看齐，联起手来封杀与他们不同的观点。这是对美国宪法第一修正案“言论自由”原则的公然践踏！是任何一个生活在这块土地上的人们所不能接受的！"],["topImageUrl",null],["error",null]]}]}],["text","昨天,2020年7月27日,星期一,美國三大社交媒體平臺臉書(Facebook)、推特(Twitter)、油管(YouTube)聯手與線民展開了一場空前激烈的發帖-封貼大戰,帖子的內容不是兇殺,不是暴力,不是色情,不是謠言,而是一群來自全美各地有良心的臨床第一線醫生,站立在首都最高法院大門前,憑著自己親身的臨床實踐, 向美國人民來證明:一個已經被使用了60年的老藥,可以用來有效地醫治去年12月以來令人聞風喪膽、幾乎摧毀了全球經濟的新冠病毒。\n\n這個藥品就是川普總統親自服用並曾經大力推薦的Hydroxychloroquine --- 羥氯喹。\n\n來自南卡羅萊納州的共和黨籍眾議員拉爾夫·諾爾曼(Ralph Norman)參加了醫生的發佈會。\n\n川普總統昨晚與他的8400萬推特關注者分享了該視頻的多個版本。該視頻被刪除之前,在臉書上的觀看次數超過了1400萬,被分享了60萬次;在油管上的觀看次數也超過了4萬次。川普總統發的推特同樣遭到刪除。\n\n根據各地疫情統計,新冠病毒已經造成近15萬美國人死亡。然而這批醫生卻斬釘截鐵地告訴大家:這款廉價的老藥羥氯喹可以有效地使幾乎所有新冠病毒感染者完全恢復健康。\n\n來自加州Santa Monica的兒科醫生羅伯特·漢密爾頓(Bob Hamilton)說:\"總體而言,兒童能夠比較好地應對這個病毒。很少有兒童被感染,那些被感染而需要住院治療的是極低的數位,而且幸運的是病亡率大約在0.2%。 \"\n\n他還指出:「兒童不會傳染給父母,也不會傳染給老師。 \" 他援引蘇格蘭的一位兒童傳染病專家馬克·伍爾豪斯(Mark Woolhouse)醫生的話說:\"全世界還沒有發現到任何一個由學生把新冠病毒傳給老師的病例。 \"\n\n氯喹和羥氯喹均已獲得美國食物藥品管理局(FDA)批准用於治療或預防瘧疾。羥氯喹還被批准用於治療自身免疫疾病,例如慢性盤狀紅斑狼瘡,成人系統性紅斑狼瘡和類風濕關節炎。兩種藥物都已開處方多年。 2020年3月28日FDA曾經頒發了硫酸羥氯喹HCQ和磷酸氯喹CQ的緊急使用授權書(EUA)。\n\n但是6月15日,FDA撤銷了EUA。 FDA表示:根據對EUA的持續分析和新興的科學數據,FDA確定氯喹和羥基氯喹不太可能有效治療EUA中授權用途的COVID-19。另外,鑒於持續的嚴重心臟不良事件和其他潛在的嚴重副作用,氯喹和羥氯喹的已知和潛在益處不再超過授權使用的已知和潛在風險。\n\n臉書發言人向CNN表示:「我們已刪除了該視頻,因為它們分享有關COVID-19的治療方法的虛假資訊,\"他補充說,該平臺正在\"在新聞摘要中向那些對有害,已發表評論或分享有害資訊的人顯示消息我們已刪除了與COVID-19相關的錯誤資訊,將其與WHO揭穿的神話聯繫起來。 \"\n\n醫生們無非是在證明:第一,少年兒童幾乎不會感染新冠病毒,更不會傳染給成人。第二,羥氯喹可以有效治療新冠病毒感人者。如果這些醫生說得不對,你們可以用相反的證據來駁斥。作為媒體平台,你們既沒有一線臨床經驗,又沒有第一手科研數據和疾病統計數據,憑什麼刪掉一線醫生敘述親身經驗的視頻? 你們到底是FDA或WHO的官媒,還是某些利益集團的代言人?\n\n這三大媒體平臺都自稱是\"公眾平臺\",人們可以在這些平臺上自由發表意見和觀點,只要這些意見和觀點不是鼓勵暴力兇殺、宣揚色情、傳播謠言。然而現在,他們居然向專制國家看齊,聯起手來封殺與他們不同的觀點。這是對美國憲法第一修正案「言論自由」原則的公然踐踏! 是任何一個生活在這塊土地上的人們所不能接受的!\n\n下面是記者會醫生講話和與聽眾問答的全部內容:\n\n漢密爾頓醫生:新冠對兒童的致死率是0.2%,而且通常無癥狀。孩子不是這個病毒的傳輸者。蘇格蘭兒科傳染病專家和流行病學家伍爾豪斯(Mark Woolhouse)醫生指出全世界目前沒有一例學生把新冠傳給教師的記錄,全世界! ... 阻礙孩子們去學校的不是科學,是教師工會和美國教育協會,他們就是想要錢。要些錢添加個人防護用品和設施是可以的,但有些要求太荒唐。我從加州來,洛杉磯教師工會(UTLA -United Teachers Los Angeles)要求解散員警! 這和教育有什麼關係?! 他們還要關閉所有的私立學校,而這些學校才是真的在教育孩子。所以,阻止開學的不是科學,也不是為了孩子,而是為了某些成人,教師,和工會。\n\n伊曼紐爾醫生(Stella Emanuel):我在德州休斯頓做內科醫生。我在奈及利亞讀的醫學院,在那裡我用羥氯喹治療過瘧疾病人,所以很了解這個葯。我來這裡是因為過去幾個月我自己治療了350多位新冠病人。他們當中有的有糖尿病,有的有高血壓,有的有哮喘。年紀最大的是92歲,還有87歲,但結果是一樣的。我給他們用羥氯喹,用鋅,用阿奇黴素,現在他們都很好,沒有一個去世。而且,我給自己和我的職工,以及很多我認識的醫生用羥氯喹作為預防,因為早期效果最好。我們每天要看10-15個新冠病人,要給他們輸氧,我們只戴著外科口罩,卻沒有一個染病的。羥氯喹是有效的!\n\n我在治療一個不停呃逆的病人時,查了些資料。我發現國家衛生院(NIH - National Institute of Health)最近就有研究。他們不僅在2005年研究了氯喹的有效性,最近還研究了打嗝和新冠的關係。你可以自己去看,搜索'打嗝和新冠(hiccups and COVID)'你就看到了。他們用羥氯喹治療了打嗝的病人,還證明瞭不停打嗝是新冠的癥狀之一。所以國家衛生院知道羥氯喹對新冠是有效的。我很生氣,因為看到病人痛苦地不能呼吸,認為自己快死了。我擁抱他們,告訴他們一切都會好起來。他們一個都沒死去。\n\n所以如果一些偽科學,一些藥物公司資助的人跑出來說,我們做了研究,羥氯喹無效,我可以明確地告訴你那是偽科學。我想知道是誰資助的研究,誰是後台。如果無效我治療的350多位不可能一個都沒死,而他們都好轉了。我跑到華盛頓DC這裡來,就是要告訴美國人民,這個病毒可以治好,用羥氯喹+鋅+阿奇黴素。可以預防,可以治癒!\n\n那些偽醫生們,別跟我說什麼雙盲試驗,雙盲雙盲,你們聽起來像個機械出了故障。但我是真正的醫生。你們這些放射科醫師,外科整形醫師,還有CNN的神經外科醫師古普塔(Sanjay Gupta),說什麼羥氯喹無效,會導致心臟病。我問你古普塔醫生,你聽著,你治療過一個新冠病人嗎? 你給誰用了羥氯喹導致了他死於心臟病嗎? 當你有了再來跟我說。\n\n每天我在診所里,看到驚恐萬分的病人,有的開車兩三個小時來找我,因為他們那裡的急診醫生很懼怕或不給他們開藥。我告訴你們這些醫生,你們就坐在那裡看著美國人死去,你們就像是那些'好'納粹,所謂的'好'是指那些'好'德國人看著猶太人被殺而不發一聲。\n\n我收到了各種威脅。他們威脅我,還說要向醫學委員會舉報我(以取消其行醫資格),我說我不怕! 我不會讓美國人死去。如果我要被釘在這座山上那就釘吧,我不在乎,你可以舉報我,你可以殺了我,但我不會讓美國人死去。我要告訴美國人民,可以治癒,可以治癒! 所有這些愚蠢的決定和事,都不應該發生。\n\n人一旦死去就回不來了。等著數據的醫生們,如果6個月後數據證明這些藥物是有效的,那死去的人們呢? 該怎麼說? 當人們馬上要死去時,你還在要雙盲試驗? 這是不道德的!\n\n主持醫生:我希望所有在聽的醫生都對自己的病人像伊曼紐爾醫生那麼熱情。另外她談到的國家衛生院的研究,是在病毒學上對當年中國SARS的研究。研究顯示了氯喹的有效性。 15年前當福奇(Anthony Fauci)是國家衛生院院長時發表的。我們現在用的羥氯喹有同樣效果但更安全。新冠與SARS有78%的相似度。\n\n艾瑞克森醫生(Dr. Dan Erickson):我來講講關閉隔離,除了對經濟的影響之外其它方面的影響。它導致一些公共健康問題,有關自殺的熱線電話增加了600%,家暴,酗酒都在上升,不止是人們失去工作。我們應該有一個能長期持續下去的辦法,比如社交距離,口罩等,同時也要開學,要經營業務。我這兒不是沒根據的瞎說,瑞典的死亡率是每一百萬有564人,英國完全關閉隔離,死亡率是每一百萬有600人,說明關閉隔離並沒有大量減低死亡。 \"\n\n主持醫生:大家有問題嗎?\n\n聽眾中有人提到南達科他州。\n\n主持醫生:是的,南達科他州長沒有限制人們獲取羥氯喹,應該是美國唯一的一個州。有些研究說羥氯喹無效,那是不準確的,因為羥氯喹被他們用在了錯誤的時間,以錯誤的劑量給了錯誤的病人。南達科他州疫情很輕,因為人們可以很容易買到羥氯喹。\n\n聽眾中有人說要找政府。\n\n另一位女主持:對。你們需要打四個電話:給你們的州長,你們的兩位參議員,和你們的國會議員。問他們為什麼你們得不到羥氯喹,醫生說這葯可以減低住院率和死亡率,敦促他們讀一讀耶魯大學的傳染病教授瑞實(Harvey Risch)的研究。\n\n聽眾中有人問各種數據到底該信哪個。\n\n主持醫生:新冠病例數幾乎是無關緊要的,因為很多測試並不准確,還有很多是無癥狀或輕微癥狀的。只有死亡數值得關注。如果你在60歲以下,沒有其他疾病,這個病的致死率低於流感。\n\n聽眾:如果你們有資訊給福奇醫生,你們要說什麼?\n\n另一位女主持:聽取前線醫生的意見,和他們見面開會。還有很多醫生不是急診科的,他們在做預防,預防病人進急診。如果你只聽急診和ICU的醫生,而那都是不幸發展成了重症的患者,這樣你並沒有得到資訊的全貌。你應該聽一聽早期的部分。你還應該明白,關閉隔離和恐懼對民眾產生了什麼影響。\n\n伊曼紐爾醫生:我要對福奇醫生說的是,上一次你把聽診器放在一個病人身上是什麼時候? 當你像我們一樣每天面對病人時,你就會明白我們的煩惱。你需要有對美國人民的同情和憐悯之心,就像我們這些前線醫生一樣。他們聽你的,那你就應該給他們希望,你應該給我你已經知道的資訊,就是羥氯喹是有效的。\n\n聽眾:請問伊曼紐爾醫生,你打算發表你治療新冠的顯著效果嗎?\n\n伊曼紐爾醫生:是的我們在做發表數據的事。但我要對醫生們說,是數據讓你去看病人的嗎? 現在病人正在死去,有數據當然好,但別整天數據數據數據。\n\n主持醫生:已經有很多數據了,但主流媒體不報。我們的網站www.americasfrontlinedoctors.com(譯者注:這個網站在我們翻譯時已經和本視頻一起被封殺。 )上有很多數據。所有羥氯喹的治療結果,死亡率,在7月4日那個星期在底特律發表的。重症病患死亡率降低一半,早期用了羥氯喹的估計有一半到3/4的病人不會死。如果都用了這個策略。可以挽救多少生命!\n\n伊曼紐爾醫生:瑞實教授最近發表了數據。他們不需要我的數據做決定。\n\n同一聽眾:幾天前有個9歲女孩死於新冠,據說她沒有其他疾病。你認為這個女孩是死於其他原因嗎? 是不是錯的宣傳?\n\n伊曼紐爾醫生:我無法猜測。我沒見過她,沒看過她的病歷所以說不好。每個人的情況都不同 ...\n\n漢密爾頓醫生:在15歲及15歲以下的年齡段死於covid19的人,他們常常是患有心臟病、哮喘、其他肺部疾病等合併症,所以我不知道,我們不知道這個不幸過世的九歲女孩,她不再和我們在一起,但是可能 ...... 如果你深入研究,背後可能有一個原因。\n\n聽眾 :漢密爾頓醫生,你有見過任何因學校關閉而引發的副作用如抑鬱或自殺的嗎?\n\n漢密爾頓醫生:我的意思是我認為這是常識,當學校不開放時,回憶高中的經歷,你想到聚會,足球賽、社交 ... ... 想想這些,這些都被關閉了。所有的快樂都不見了, 這至關重要的幾年,無法與其他孩子,其他人一起,因為全部關閉了, 隨之引發很多併發問題,我們在談論焦慮,我們在談論沮喪、孤獨、虐待正在發生,以及有特殊情緒的孩子, 孩子也做得不好, 隔離關閉會引發一長串的併發症的。\n\n。\n\n聽眾: 你知道我們聽到的所有這些研究 ... 母親也不能回去上班了因為不敢讓孩子上學,孩子本來就不應該留在家裡,但如果母親回去上班,那麼年老的祖父母就要 ...\n\n漢密爾頓醫生: 是的,這是個大問題,因為人們害怕。並不是說他們的孩子會特別容易染病,因為我認為他們正在瞭解真相。孩子們對感染的耐受性很好。但他們肯定也會考慮到他們的環境,他們獨特的家庭,我認為在某些情況下,這是一種正當擔心的理由。但是作為常規,國家的常規,孩子們應該回到學校。也許有些孩子由於各自的居住環境可能帶來潛在的問題,但對於年幼的孩子,他們並不是將疾病傳染給成人的根源。至於羥氯喹,這是可以使用的。\n\n伊曼紐爾醫生: 好吧,我們談論的是我們不能開門經營我們的企業,我們不能去上學,父母害怕接受治療,我個人已經讓一百多人接受羥氯喹預防治療了,醫生、老師、普通人、醫療工作者、我的員工、還有我自己 ! 我有時一天接待超過15到20個病人,或一天20、15、10位病人,我戴一個醫療口罩,我周圍沒有一個人被感染。這個就是答案。你要重開學校的話,用羥氯喹預防covid-19,每隔一周用一粒葯就足夠了。這就是我們需要讓美國人民瞭解的。我們可以預防,也可以治療的。我們不需要關閉學校,我們不需要關閉我們的生意。\n\n有預防,可治療,與其去談論口罩,與其去談論封閉,與其去談論這些東西,倒不如讓老師用羥氯喹。讓那些高風險的、願意用羥氯喹的人用吧。如果你想染上病毒,很酷呀,但是你應該被允許得到這種藥物來預防的權利。所有我們正在經歷的本都是不必要的,因為羥氯喹有預防作用,它叫做羥氯喹,可以預防covid-19。\n\n聽眾:較早之前,我聽你說藥物是使用過的,但是他們以錯誤的劑量使用了藥物,所以我一直在聽,但是,什麼是正確的劑量?\n\n伊曼紐爾醫生: 是的,您要去問您的醫生,我再請一位醫生也談一下。\n\n爾佐醫生(Dr Urzo) :這個問題問得好。因為對這種藥物的恐懼已經影響了整個政治局勢,這種恐懼已經影響到了這種藥物,所以讓我們重申一點,這種藥物是超級安全的。它比阿司匹林、布洛芬、泰諾更安全。它是超級安全的! 問題是,在這些研究中,他們在全國範圍內用了非常高的劑量, 用的劑量非常大。他們做了重新定義式的研究,一致性的試驗,也就是世界衛生組織的試驗。還有康復試驗,第一天他們就使用2400毫克的劑量,其實預防性你只需要200毫克,每周兩次。而他們使用了過量的中毒式的劑量,猜猜他們發現了什麼? 當你使用過量的中毒式的劑量,那你必然會得到中毒式的結果,當你使用引發中毒式劑量時,藥物當然不會起作用,好吧!\n\n這是一種非常安全的藥物。它集中在肺部,在肺部的濃度是其他部位的200到700倍。它是一種神奇的藥物,在血液中不會去到那個高水準,但肺部會,所以你會發現自己獲得了預防性,一旦病毒到達那裡它將很難通過,因為羥氯喹阻止它了。一旦病毒進入,它就不會會讓病毒複製。實際上,當服用鋅時,鋅就會攪亂被稱為RDRP的複印機制所以結合藥物,它本身在早期疾病中非常有效。它在預防方面非常有效。所以我希望這回答了你的問題。\n\n戈爾德醫生(Dr Gold):是的,我想強調爾佐醫生所說的,因為我喜歡這個問題。這是一種非常簡單的治療方案,它應該讓美國人使用。目前困難的就是因為政治,醫生不能給它開處方,藥劑師也不能釋放它。他們有權否決醫生的意見,這就是為什麼你在櫃臺上買不到它。你可以在世界幾乎所有的地方買到,在拉丁美洲、伊朗、印尼、撒哈拉以及南非,你都可以自己去買。我的朋友,用量是200毫克,一星期兩次,然後每天服用鋅,就是這個劑量! 我贊成在櫃臺上就可以買到(非處方),把它給人民,把它給人民!\n\n聽眾:再問兩個問題,誰可以將訊息準確回答我?\n\n詹姆斯醫生(Dr. James):我是詹姆斯醫生,我想對戈爾德醫生剛才說的做一些補充:似乎有一種針對羥氯喹的精心策劃的攻擊。你什麼時候聽說過一種藥物會引起如此大的爭議? 一種有65年歷史的藥物,多年來一直屬世界衛生組織安全基本藥物的清單,是的,這在許多國家/地區遇到了麻煩,我們看到的是很多錯誤資訊。所以我與人合作撰寫了第一份關於羥基氯喹作為冠狀動脈潛在療法的檔。這是在3月份,這在某種程度上引發了一系列的風暴。從那以後,對像我們這樣的醫生進行了大量的審查。我說的是,我們中的一些人已經被審查了。我們共同撰寫的那個google文檔,實際上,是被google刪除的。現在很多研究已經表明它是有效的,安全的,但你還是看不到那篇文章。\n\n還有一個錯誤的資訊,不幸的是這已經達到了醫學的最高等級。在五月,有一篇文章發表在《柳葉刀》上,這是世界上最負盛名的醫學雜誌之一。\n\n因為這項研究,世界衛生組織停止了所有羥氯喹的臨床試驗。只有像我們這樣的獨立研究人員才會關心病人,關心真相,深入研究並確定,實際上那些數據是偽造的,不真實的。所以我們做得非常有說服力,以至於這項研究在發表后不到兩周就被《柳葉刀》撤銷了。這幾乎是聞所未聞的! 尤其是對於這麼大規模的研究,所以我向所有人道歉,因為那裡存在著太多的錯誤資訊, 不幸的是,尋找真相困難重重,我們需要在其他地方尋找真相。 \n\n這就是為什麼我們在這裡組建一線醫生組織,以設法幫助獲得真實資訊的原因。我是詹姆斯·塔塔羅博士。是的,我大部分的想法都是在推特上發表的,這個推特最近很不錯,但我也有一個網站。\n\nmedicineuncensored.com 它包含了很多關於羥氯喹的資訊,我認為比其他媒體管道的報導更加客觀。\n\n聽眾:這很重要,因為我不僅從醫生那裡瞭解到,而且從其他媒體人士那裡得知,YouTube實際上是遮罩了許多特別是關於羥氯喹的資訊的。\n\n詹姆士醫生:讓我簡明地重申這個問題,我要說的是Facebook和YouTube採取了最嚴厲的措施來壓制和審查人們。這是來自YouTube的首席執行官和馬克·紮克伯格,發表任何與世界衛生組織言論相悖的言論都會受到審查,我們都知道世界衛生組織在這次大流行中犯了很多錯誤。無論如何,他們都不是完美的。 Twitter雖然有一些缺陷和缺陷,並也標記某些內容,但仍是最自由的對話平臺之一,我們對這些資訊進行了明智的討論,今天在座的許多人實際上通過這樣的社交平台媒體聯繫在一起的。\n\n聽眾:您能談談您之前提到的藥物治療嗎? 它已經存在有多久了?\n\n喬-拉塔坡醫生(Dr. Joe Latapo):當然,我是喬-拉塔坡醫生。我是加州大學洛杉磯分校的一名內科醫生,同時也是一名臨床研究人員。我只是代表我自己,而不是代表加州大學洛杉磯分校。所以我想說的是,我想到的是那些正在幕後看此廣播的人們,我想與大家分享。因為存在著太多爭議,氣氛充滿了衝突。現在,這群醫生正在嘗試做的事情, 從根本上講,是為了讓大家更清楚地了解我們是如何應對covid19這個巨大的挑戰,這就是我們的最終目標,併為事物帶來亮光,意味著更多地考慮取捨。 \n\n我的一個同事說意外後果,實際上我認為那甚至不是正確的詞,正確的詞是\"未預料的後果\"。真的,想想我們在這個特殊的時代所做的決定的影響,我相信人們聽到了一些關於羥氯喹的討論並好奇這些醫生在說些什麼? 他們是照顧病人的醫生,有醫學認證,醫學院,很棒的醫學院。所有這些,他們怎麼可能這麼說? 我可是收看CNN和NBC的,這些媒體對此隻字未提啊。這就是問題的關鍵,有些問題是道德問題,那真的應該有一個單一的聲音,你知道! 所以對我來說,關於人們是否因性別、種族或性取向而受到不同對待的問題,我認為這些都是道德問題,在這些問題上只有一種立場。但Covid-19不是一個道德問題,Covid 19是一個具有挑戰性的複雜問題,我們可以從多角度來看待它。所以,當每個人都只能從一個渠道聽到一種觀點時,這對美國人民是不好的。這樣做毫無預警,大多數人聽到的觀點是羥基氯喹不起作用。是的,這是大多數人在主流電視上聽到的觀點。\n\n聽眾:所以我的問題 ... 我仍然沒有得到明確的答案,我想知道關於您的同事所說的,由於學校關閉和政府關閉而導致自殺性上升、焦慮、濫用和其他各種問題的增加。我想知道是否應該將聯邦資金分配給一線工人、社會工作者、心理健康治療師。\n\n醫生:問題的答案是:傷害已經來臨,我們應該如何處理這種傷害,我不知道政府的內部運作方式,但實際上傷害已經來臨了,我們必須要做些有意義的事,所以對我來說,作為一名醫生,如果你和我都知道我們已經被車碾過了,當然是要先去醫院,所以以我的職業來說 ...\n\n聽眾:是的,能夠幫助這些孩子,我認為這很有意義。\n\n記者:大家好,這裡是《布萊特巴特新聞(Breitbart News)》,我們將繼續為您帶來\"醫生小組\"的發言。感謝你收看。請繼續關注,我們遲點回來。抱歉有點過度曝光,扯掉我的麥克風了。但是我們將回來。\n\n請關注Facebook上的《Breitbart News》,關注我們的Facebook, Instagram,Twitter,當然還有我們的網站 Breitbart.com,當然還有YouTube,請繼續關注。我們很快就會回來。祝大家好。\n\nhttps://mp.weixin.qq.com/s/fbVO06Ldg0Gege7bub7Hzw"],["id","muysjqeduq56"],["createdAt","2020-08-01T23:53:02.262Z"]]}],["reply",{"__iterable":"Map","data":[["id","0-Ulr3MBb3SlMKoAdRUV"],["user",{"__iterable":"Map","data":[["id","HkXxOXABHjv_5zI2Qlbz"],["name","Ann"],["avatarUrl",null],["level",16]]}],["type","RUMOR"],["text","1. 此段宣揚「羥氯喹」療效並淡化口罩功效的影片，為一個新成立、名為「America's Frontline Doctors」組織的演講畫面，但影片中的醫師都不是流行病學家或免疫學家，也不是疫情中第一線的醫療工作人員，亦有醫師執照已失效者，其中許多人都有參與右翼利益集團、傳播COVID-19陰謀論的歷史。 \n\n2.該段影片由於含有諸多「誤導」及「錯誤」訊息，已被諸多社交平台下架。美國FDA及WHO均已指出，使用羥氯喹不會降低患者的死亡率，其他國家的研究，也顯示羥氯喹無顯著療效、對預防感染的表現也未比安慰劑好。\n\n台灣國內針對羥氯奎寧治療新冠肺炎的研究，結果同樣顯示：使用羥氯奎並沒有特別縮短PCR轉陰的時間。因此台灣的臨床處置指引，在6月時已不把羥氯奎寧列為建議用藥，而是以瑞德西韋為建議用藥。"],["reference","沒有證據表明影片中的醫生來自COVID-19前線—「美國前線醫生」（「America's Frontline Doctors」）背後的醫生是誰？\nNo Evidence That Doctor Group in Viral Video Got Near COVID 'Front Lines'\nhttps://www.medpagetoday.com/infectiousdisease/covid19/87797\n\n'America's Frontline Doctors' may be real doctors, but experts say they don't know what they're talking about\nhttps://www.usatoday.com/story/news/nation/2020/07/30/americas-frontline-doctors-tout-hydroxychloroquine-covid-who-they/5535096002/\n\nFox News’ Best COVID-19 Truthers Unite to Promote Trump’s Favorite Drug\nhttps://www.rollingstone.com/culture/culture-news/americas-frontline-doctors-hydroxychloroquine-breitbart-donald-trump-1034927/"],["hyperlinks",{"__iterable":"List","data":[{"__iterable":"Map","data":[["title","No Evidence That Doctor Group in Viral Video Got Near COVID 'Front Lines'"],["url","https://www.medpagetoday.com/infectiousdisease/covid19/87797"],["summary","Who are the physicians behind America's Frontline Doctors?"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","'America's Frontline Doctors' tout hydroxychloroquine: Who are they?"],["url","https://www.usatoday.com/story/news/nation/2020/07/30/americas-frontline-doctors-tout-hydroxychloroquine-covid-who-they/5535096002/"],["summary","Tech platforms scrambled this week to delete a video featuring seven doctors who claimed their front-line knowledge of the pandemic contradicts the guidance of public health experts – even as President Donald Trump, his son and other political allies sought to amplify the video.The event suggested the doctors' personal experience gave them a valuable perspective on the public health crisis that they said was not being taken seriously.And the major theme throughout the event by the group that calls itself America’s Frontline Doctors: touting the alleged benefits of hydroxychloroquine as a cure for COVID-19 and shooting down the science that has shown it does not have a clinical benefit for COVID-19 patients and even has increased risks.\"These are the doctors diagnosing, treating and helping patients beat COVID-19,\" said Jenny Beth Martin – co-founder of Tea Party Patriots, a pro-Trump conservative group that helped organize the event – during the news conference.While their name, America’s Frontline Doctors, suggests the speakers may work in hospital emergency rooms or intensive care units and have experience treating critically ill COVID-19 patients, it's unclear to what extent the doctors have such experience.USA TODAY confirmed that most are physicians with active state medical licenses, but their specialties and experience suggests they were offering little more than personal opinions rather than research experience on infectious diseases.While one is affiliated with a hospital that would treat critically ill patients and others work at urgent care or other clinics, none claim to be infectious disease experts or doctors working in a hospital emergency room or intensive care unit.Many have also been vocal critics of lockdowns and supporters of the Trump administration.Ashish Jha, director of the Harvard Global Health Institute, likened the views expressed in the video to his own opinions about foreign politics in an interview with USA TODAY on Wednesday.Jha acknowledged the power of the image contained in the video: a group of doctors standing outside the Supreme Court, donning white lab coats, boasting an introduction from a U.S. congressman and spreading a hopeful message amid a raging pandemic. It proved a convincing package to the more the 17 million people who viewed one version of the video circulating online before it was taken down earlier this week.Speaking with MSNBC, Dr. Anthony Fauci, the nation's top infectious disease specialist, called the group \"a bunch of people spouting something that isn't true.\"Dr. Joe Ladapo, a UCLA physician who appeared in the video, told USA TODAY in an email that he appeared at the event \"because I believe it’s critically important for us to have a discussion that includes different perspectives about our approach to COVID-19.\"Jha, however, said the idea that any doctor's personal experience could outweigh more rigorous studies is simply unscientific.“Experiences are trumped by scientific evidence,” he said. And in the case of the arguments made in the video, Jha says the evidence doesn't back up their experiences.Some of the allegations made in the video – including that a cure for COVID-19 exists – essentially suggest a global conspiracy to suppress an effective treatment to the coronavirus, Jha said.“It’s not science.\"Who was featured in the video?USA TODAY tried to contact all of the doctors who spoke during the controversial video filmed Monday to verify the organization's claim that they are working on the front lines of the pandemic. One responded, another declined to comment and the rest did not answer. USA TODAY also reached out to Tea Party Patriots, the group organizing the event, and did not immediately get a response.Many of the speakers have made public statements that clash with the opinion of the majority of public health experts.Dr. Simone Gold, who has identified herself as an emergency medicine specialist in Los Angeles. In May, she gained national attention for being a part of a group of Pro-Trump doctors who advocated for quickly reopening the economy. On her website, she claims she \"works as an emergency physician on the frontlines whether or not there is a pandemic.\" On LinkedIn, she says she works as a \"Concierge Physician,\" an increasingly common field of medicine where patients pay a monthly or annual fee for access to a physician, according to AARP. She is listed as having a renewed and current medical license by the Medical Board of California and self-reported to the board that she completes 30-39 hours of patient care per week.Dr. Bob Hamilton identified himself as a pediatrician from Santa Monica, California, with 36 years of practice. He's listed as a pediatrician at Pacific Ocean Pediatrics, which reports on its website he has privileges at two California hospitals. He is listed as having a renewed and current medical license by the Medical Board of California.Dr. Stella Immanuel identified herself as a primary care physician in Houston and claims to have successfully treated about 350 COVID-19 patients. She has a full medical license in Texas, according to Texas Medical Board online records. She told the board she has a primary specialty of pediatrics and a secondary specialty of emergency medicine.Dr. Dan Erickson was featured in a previous controversial video criticizing lockdowns; he co-owns California urgent care centers. The American Academy of Emergency Medicine condemned Erickson for his \"reckless and untested musings\" relating to COVID-19 in April. Erickson is listed as having a license from the Osteopathic Medical Board of California. While the training for a doctor of osteopathic medicine is slightly different, focusing on more of a hands-on and holistic approach to health, they must go through a similar licensing process as physicians, according to the Mayo Clinic. His urgent care center, Accelerated Urgent Care, does have a current license with the state medical board.Dr. Richard G. Urso is listed as an ophthalmologist with Houston Eye Associates. He has a full medical license in Texas, according to Texas Medical Board online records. He told the board he has a primary and secondary specialty of ophthalmology. An assistant for Urso declined to comment to USA TODAY.Dr. James Todaro identifies himself on LinkedIn as a Detroit-area physician, managing partner of an investment fund and former physician with an eye group. Michigan's Department of Licensing and Regulatory Affairs does not list anyone with a current medical doctor license by Todaro's name.Dr. Joe Ladapo is an associate professor of medicine in the division of General Internal Medicine and Health Services Research at David Geffen School of Medicine at UCLA. He is listed as a Hospitalist affiliated with Ronald Reagan UCLA Medical Center by UCLA health. Ladapo wrote in an email to USA TODAY that he has treated COVID-19 patients but that his primary work is in clinical research. He said that his research has not primarily focused on COVID-19 and potential treatments, but rather policy and management of the pandemic. Ladapo has written numerous opinion editorials critical of lockdowns published by national outlets, including USA TODAY.A doctor who believes in demon sperm sued for medical malpracticeImmanuel has received heightened attention among the doctors in the group after a report from the Daily Beast highlighted some of her bizarre religious and medical beliefs.The Daily Beast reported that Immanuel has stated \"that gynecological problems like cysts and endometriosis are in fact caused by people having sex in their dreams with demons and witches\" and that \"alien DNA is currently used in medical treatments.\"On Twitter, Immanuel embraced these claims, tweeting, \"Yes America! some need deliverance from demon sperm\" and said the news outlet \"did a great job summarizing our deliverance ministry.\"The address listed for Immanuel's practice is at the same strip mall where her Fire Power Ministries Christian Resource Center is located.At the event for America’s Frontline Doctors, Immanuel also said masks are not necessary, despite evidence that has shown the use of face coverings can slow the spread of the virus through respiratory droplets.In a video posted on Facebook in April, Immanuel is seen wearing full-body personal protective equipment in which she says her clinic offers screening for COVID-19 in its parking lot.According to online records, the Texas Medical Board lists no investigations into medical malpractice against Immanuel; however, the Houston Chronicle reported that Immanuel was the subject of a medical malpractice lawsuit tied to a woman's death in Louisiana, where Immanuel is also licensed to practice.According to the Chronicle, the lawsuit says that a woman treated by Immanuel complained about a needle in her arm. Immanuel prescribed medication but did not perform a closer examination or tests, the lawsuit says, per the Chronicle.The woman sought help hours later from a hospital because of the pain. A surgeon removed the needle, but days later, the woman died, the lawsuit says. Dick Knadler, an attorney for the woman's mother, told the Houston Chronicle that the woman died from an infection.Immanuel could not be reached for comment by USA TODAY or the Houston Chronicle.Who organized the the white lab coat 'press conference'?The group Tea Party Patriots hosted the event, which also featured Rep. Ralph Norman, R-S.C. On its website, Tea Party Patriots published several other videos of the same doctors speaking at a summit, billed as part of the \"Second Opinion Project.\"\"American life has fallen casualty to a massive disinformation campaign. We can speculate on how this has happened, and why it has continued, but the purpose of the American Frontline Doctor's Summit is to empower Americans to stop living in fear,\" Tea Party Patriots writes on its website.According to the Center for Responsive Politics, which tracks political fundraising, the Tea Party Patriots Citizens Fund, a super PAC, has raised more than $24 million since 2014 for Republican candidates and conservative causes.The group also operates a 501(c)3 non-profit and a 501(c)4 social welfare organization, which allows it to participate in politics and influencing legislation.On the group's website, its super PAC pushes for Trump's reelection as well as keeping Republicans in office.Martin, the group's co-founder who was also featured prominently in the video, has led the group and grown it \"to be the largest and most effective national umbrella group within the Tea Party movement,\" the group's website states.\"Jenny Beth Martin and Tea Party Patriots now use their network to reach millions of Americans every week with education and updates about fiscal responsibility, free market principles, and constitutionally limited government,\" the website says.What we know about COVID-19 and hydroxychloroquineFauci and other leading voices in public health and infectious disease research have repeatedly said that the cumulative knowledge of scientific evidence to date does not show that hydroxychloroquine has a positive effect for COVID-19 patients and that there are risk in taking the drug for COVID-19 patients.Hydroxychloroquine is an antimalarial drug, but the U.S. Food and Drug Administration has revoked its emergency authorization for the use of the drug in treating the new coronavirus.The agency said in a letter the decision is based on new evidence that made it unreasonable to believe hydroxychloroquine and chloroquine \"may be effective in diagnosing, treating or preventing\" COVID-19, the illness caused by the virus. Citing reports of heart complications, the FDA said the drugs pose a greater risk to patients than any potential benefits.The drug came to public attention after several small, anecdotal, non-peer-reviewed reports about hydroxychloroquine in China in February. None was up to the scientific gold standard of a double-blind, randomized, placebo-controlled trial that would more definitively show whether the drug worked.An analysis by the Milwaukee Journal Sentinel, part of the USA TODAY Network, found that many hydroxychloroquine trials have resembled lone-wolf research, overseen by individual hospitals and universities and have become became a frenzied hodge-podge of undertakings – an unprecedented scientific free-for-all in which research overlapped, studies were poorly designed, and patients were given drugs of unproven benefit.Contributing: Adrianna Rodriguez, John Fauber and The Associated Press"],["topImageUrl",null],["error",null]]},{"__iterable":"Map","data":[["title","Fox News’ Best COVID-19 Truthers Unite to Promote Trump’s Favorite Drug"],["url","https://www.rollingstone.com/culture/culture-news/americas-frontline-doctors-hydroxychloroquine-breitbart-donald-trump-1034927/"],["summary","Members of \"America's Frontline Doctors,\" the group behind the viral video shared by the Trumps, have been calling for the country to reopen."],["topImageUrl",null],["error",null]]}]}],["createdAt","2020-08-02T12:28:54.427Z"]]}]]}]}],["searchArticles",{"__iterable":"List","data":[]}],["searchReplies",{"__iterable":"List","data":[]}]]}]]},"replyDetail":{"__iterable":"Map","data":[["state",{"__iterable":"Map","data":[["isLoading",false],["isAuthLoading",false],["isReplyLoading",false]]}],["data",{"__iterable":"Map","data":[["reply",null],["originalReplyConnection",null]]}]]},"auth":{"__iterable":"Map","data":[["state",{"__iterable":"Map","data":[["isLoading",false],["isDialogShown",false]]}],["user",null]]}}

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