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    接種疫苗能否避免感染“慢性新冠”?

    接種疫苗能否避免感染“慢性新冠”?

    SY MUKHERJEE 2021年08月03日
    感染新冠的人可能在首次感染病原體后的一個月或更長時間之后才出現相關癥狀。

    在新冠的魔盒中,沒有什么比“長期新冠”(long COVID)更令人困惑的了。根據美國疾病控制中心(CDC)的說法,這也被稱為遠程新冠(long-haul COVID)、急性后新冠(post-acute COVID-19)、慢性新冠(chronic COVID)以及新冠的長期影響(long-term effects of COVID),這些均是指感染新冠的人可能在首次感染病原體后的一個月或更長時間之后才出現相關癥狀。你可能不禁要問,全面接種新冠疫苗,是否能夠預防或至少減輕長時間患一種或多種疾病癥狀的可能性?

    所謂長期新冠并不意味著每個感染新菌株或再次感染的人都會出現嚴重癥狀,疫苗接種仍然是預防新冠住院和死亡的唯一的最有效工具。但是,長期新冠相當奇怪,它可以在首次感染時沒有癥狀的患者身上表現出來。

    “即使是在感染后幾天或幾周內沒有出現新冠癥狀的人,也可能出現‘后期癥狀’。這些情況在不同的時間段內會有不同類型和組合的健康問題?!盋DC表示。這意味著患者可能會經歷慢性疲勞(最常見的長期新冠癥狀)、呼吸問題、皮膚問題、胃腸道不適,或一系列與新冠相關的疾病,但是不會出現更嚴重的癥狀。

    關于長期新冠的數據并不十分可靠,特別是當涉及到突破性新冠疫苗接種者時。一些研究表明,大約四分之一的新冠病毒患者(并非所有患者都必須接種疫苗)在最初診斷30天或更長時間內,報告了至少一種持續癥狀。但是,這些數據高度不一致。

    例如,英國政府最近的一項分析發現:“SARS-CoV-2感染后12周內的新冠癥狀患病率是不確定的。根據研究設計的不同,估計在感染者中占2.3%到37%不等?!边@個范圍很大,取決于你在看哪個研究。理由很充分:長期新冠的最高風險因素似乎是患有嚴重的新冠病例、女性、高膽固醇或免疫系統受損,或在感染前就患有呼吸道疾病等。但是,即便如此,在不同年齡的人口統計數據以及不同的患者內在生理結構中,這些數據呈現出不一致、不可預測的結果。弄清楚誰可能感染長期新冠,并準確記錄某些東西是否真的是長期新冠癥狀——這些在很大程度上仍然是一門“正在進行的科學”。

    這就把我們帶回了一個問題——完全接種疫苗的人,是否仍受到這一醫學謎團的影響。目前,醫生、學者和公共衛生專家仍在尋找最好的方法,記錄長期接種疫苗者中的新冠流行率。加州大學舊金山分校(UCSF)醫學系主任兼內科醫生鮑勃?瓦赫特指出,以色列在《新英格蘭醫學雜志》(The New England Journal of Medicine)上發表的數據顯示,在接種疫苗的突破性病例中,有20%的癥狀在感染后持續了六周。

    但是,美國衛生和公眾服務部(U.S. Department of Health and Human Services,HHS)前國家衛生信息技術協調員法爾扎德?莫斯塔沙瑞并不相信近20%的接種過疫苗的人會在感染了德爾塔病毒這樣的病毒變種后,仍長期感染新冠病毒。

    莫斯塔沙瑞指出,許多被問及是否正在經歷與他們已經患過的疾病相關的癥狀的患者可能會說,他們仍然有癥狀,但需要指出,這是出于“回憶偏見”——即他們最初生病時關于的癥狀的記憶。緊接著,他建議進行一項更為有力的研究,納入從一開始就從未被診斷出患有新冠病毒,且接種過疫苗的人的隨機樣本,詢問他們是否出現了某些癥狀,以及這些癥狀是從何時開始的。后續的血液檢測可能會確認新冠病例,然后只需確定時間線,看看這是最近的感染還是長期新冠。

    但是,到目前為止,仍然沒有足夠的信息來明確宣布或預測誰最可能受到新冠這種變化的影響。唯一確定的是,新冠疫苗以及在德爾塔變種病例激增的地區采取的隔離措施,仍是預防新冠病毒傳播的最有效的已知方法。(財富中文網)

    編譯:楊二一

    在新冠的魔盒中,沒有什么比“長期新冠”(long COVID)更令人困惑的了。根據美國疾病控制中心(CDC)的說法,這也被稱為遠程新冠(long-haul COVID)、急性后新冠(post-acute COVID-19)、慢性新冠(chronic COVID)以及新冠的長期影響(long-term effects of COVID),這些均是指感染新冠的人可能在首次感染病原體后的一個月或更長時間之后才出現相關癥狀。你可能不禁要問,全面接種新冠疫苗,是否能夠預防或至少減輕長時間患一種或多種疾病癥狀的可能性?

    所謂長期新冠并不意味著每個感染新菌株或再次感染的人都會出現嚴重癥狀,疫苗接種仍然是預防新冠住院和死亡的唯一的最有效工具。但是,長期新冠相當奇怪,它可以在首次感染時沒有癥狀的患者身上表現出來。

    “即使是在感染后幾天或幾周內沒有出現新冠癥狀的人,也可能出現‘后期癥狀’。這些情況在不同的時間段內會有不同類型和組合的健康問題?!盋DC表示。這意味著患者可能會經歷慢性疲勞(最常見的長期新冠癥狀)、呼吸問題、皮膚問題、胃腸道不適,或一系列與新冠相關的疾病,但是不會出現更嚴重的癥狀。

    關于長期新冠的數據并不十分可靠,特別是當涉及到突破性新冠疫苗接種者時。一些研究表明,大約四分之一的新冠病毒患者(并非所有患者都必須接種疫苗)在最初診斷30天或更長時間內,報告了至少一種持續癥狀。但是,這些數據高度不一致。

    例如,英國政府最近的一項分析發現:“SARS-CoV-2感染后12周內的新冠癥狀患病率是不確定的。根據研究設計的不同,估計在感染者中占2.3%到37%不等?!边@個范圍很大,取決于你在看哪個研究。理由很充分:長期新冠的最高風險因素似乎是患有嚴重的新冠病例、女性、高膽固醇或免疫系統受損,或在感染前就患有呼吸道疾病等。但是,即便如此,在不同年齡的人口統計數據以及不同的患者內在生理結構中,這些數據呈現出不一致、不可預測的結果。弄清楚誰可能感染長期新冠,并準確記錄某些東西是否真的是長期新冠癥狀——這些在很大程度上仍然是一門“正在進行的科學”。

    這就把我們帶回了一個問題——完全接種疫苗的人,是否仍受到這一醫學謎團的影響。目前,醫生、學者和公共衛生專家仍在尋找最好的方法,記錄長期接種疫苗者中的新冠流行率。加州大學舊金山分校(UCSF)醫學系主任兼內科醫生鮑勃?瓦赫特指出,以色列在《新英格蘭醫學雜志》(The New England Journal of Medicine)上發表的數據顯示,在接種疫苗的突破性病例中,有20%的癥狀在感染后持續了六周。

    但是,美國衛生和公眾服務部(U.S. Department of Health and Human Services,HHS)前國家衛生信息技術協調員法爾扎德?莫斯塔沙瑞并不相信近20%的接種過疫苗的人會在感染了德爾塔病毒這樣的病毒變種后,仍長期感染新冠病毒。

    莫斯塔沙瑞指出,許多被問及是否正在經歷與他們已經患過的疾病相關的癥狀的患者可能會說,他們仍然有癥狀,但需要指出,這是出于“回憶偏見”——即他們最初生病時關于的癥狀的記憶。緊接著,他建議進行一項更為有力的研究,納入從一開始就從未被診斷出患有新冠病毒,且接種過疫苗的人的隨機樣本,詢問他們是否出現了某些癥狀,以及這些癥狀是從何時開始的。后續的血液檢測可能會確認新冠病例,然后只需確定時間線,看看這是最近的感染還是長期新冠。

    但是,到目前為止,仍然沒有足夠的信息來明確宣布或預測誰最可能受到新冠這種變化的影響。唯一確定的是,新冠疫苗以及在德爾塔變種病例激增的地區采取的隔離措施,仍是預防新冠病毒傳播的最有效的已知方法。(財富中文網)

    編譯:楊二一

    In the pantheon of enigmas among COVID's seemingly endless box of mysteries, there are few more perplexing than the phenomenon of long COVID. Also called long-haul COVID, post-acute COVID-19, chronic COVID, or just the long-term effects of COVID, this is a condition in which someone infected with COVID may have coronavirus-related symptoms a month or longer after first contracting the pathogen, according to the Centers for Disease Control (CDC). But does being fully vaccinated against COVID prevent or at least mitigate the possibility of suffering from one or more of the disease's multitude of symptoms for an extended period?

    That doesn’t mean that everyone who gets infected with a new strain or a reinfection will show symptoms, serious or otherwise, and vaccination remains the single most effective tool at preventing hospitalizations and deaths. But long COVID is a strange creature that can manifest in patients who didn't show signs of illness when they first contracted the disease.

    "Even people who did not have COVID-19 symptoms in the days or weeks after they were infected can have post-COVID conditions. These conditions can have different types and combinations of health problems for different lengths of time," says the CDC. That means a patient may wind up experiencing chronic fatigue (the most commonly reported long COVID symptom), breathing problems, skin issues, gastrointestinal distress, or a hodgepodge of COVID-associated ailments without ever experiencing a more acute version of COVID-19.

    The data on long COVID isn't all that robust, especially when it comes to vaccinated people who have breakthrough infections of COVID-19. Some studies suggest that somewhere around one in four COVID patients (not all of whom are necessarily vaccinated) report at least one lasting symptom of the disease 30 days or more after initial diagnosis. But this data is highly inconsistent.

    For instance, a more recent analysis by the U.K. government found that "[l]ong COVID symptom prevalence at 12 weeks post SARS-CoV-2 infection is uncertain and estimates vary by study design, ranging from 2.3%–37% in those infected." That's a massive range depending on which study you're looking at. And for good reason: The highest risk factors for long COVID appear to be having a serious COVID-19 case, being female, having high cholesterol or a compromised immune system, or suffering from a pre-COVID respiratory condition, among others. But even these are inconsistent and unpredictable across various age demographics and patients' inner biology. Figuring out who may contract long COVID, and accurately recording whether or not something is actually a symptom of long COVID, is still very much a science in the works.

    Which brings us back to the issue of whether or not fully vaccinated people are susceptible to this medical mystery. We're at the point where physicians, academics, and public health experts are still figuring out the best way to record the prevalence of long COVID in those who've received their jabs. Bob Wachter, a physician and chair of UCSF's Department of Medicine, points to Israeli data published in The New England Journal of Medicine showing that 20% of breakthrough COVID cases in the vaccinated led to symptoms that lasted six weeks after infection.

    But Farzad Mostashari, the former national coordinator for health information technology at the U.S. Department of Health and Human Services (HHS), isn't quite as convinced that nearly 20% of immunized people could experience long COVID after contracting something like the Delta variant.

    Mostashari points out that many people who are asked whether or not they are experiencing symptoms related to a disease they've already had may say they still have symptoms due to "recall bias," the memory of the symptoms they had when they were initially sick. He goes on to suggest a more robust study that would also incorporate random samples of vaccinated people who had never been diagnosed with COVID in the first place to ask them whether or not they're experiencing certain symptoms and when those symptoms began. A follow-up blood test could confirm a case of COVID, and then it's just a matter of shoring up the timeline to see whether or not it's a recent infection or long-haul COVID.

    But there just still isn't enough information to date to definitively proclaim or predict who may be affected by this twist on COVID-19. The only certainty is that COVID vaccines—and masking and distancing precautions in regions with surging Delta variant cases—is the most effective known method of preventing the coronavirus’s spread.

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