冠状病毒病大流行:公共卫生视角

G. Rao
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引用次数: 0

摘要

1964年,一位苏格兰病毒学家在伦敦发现了这种新型冠状病毒。就像通常的新发现一样,她写的关于这一发现的文章似乎被同行评议的期刊拒绝了。阿尔梅达博士写信给著名的《自然》杂志(Nature 220, 1968),概述了她的发现,并建议将这种新病毒命名为“冠状病毒”。这个名字指的是“冠状”的外观,她首先通过电子显微镜观察到这些病毒。虽然SARS - CoV-2感染在其发源地中国(人口超过10亿,但不到10万人)似乎得到了控制,但这一流行病已迅速蔓延到世界其他地区。实施和执行严格的人员隔离,这似乎是不可能实现的,现在在大多数国家已经成为现实。预防工作的成功与如何最好地遵循预防战略的关键原则有关;检测感染、追踪接触者、保持社交距离、戴口罩和隔离感染者。2019年12月,中国武汉的几个人出现了肺炎和呼吸衰竭,就像2003年SARS流行期间发生的那样。这种病毒很容易在有症状和无症状的个体之间传播。早在2020年1月,SARS - CoV-2病毒就被发现在车间、公司会议期间传播。医院似乎为冠状病毒病(Covid-19)的传播提供了有利的环境。长期护理设施是呼吸道疾病感染的高风险场所。在长期护理设施中,大多数老年人似乎已经患有高血压、肥胖、2型糖尿病或心血管疾病等疾病,这使他们处于与Covid-19严重程度相关的高风险状态。包括政治集会、抗议、体育和娱乐活动在内的几次大规模集会与2019冠状病毒病的爆炸性爆发有关。儿童在冠状病毒传播中的可能作用尚不清楚。几名从COVID-19中康复的人在晚些时候再次检测呈阳性,这表明感染已经重新激活。这些观察结果引发了对covid-19患者对未来感染的免疫力以及我们都希望的“群体免疫”的质疑。在缺乏循证治疗的情况下,我们预防感染的唯一选择是保持社交距离、必要时戴口罩、洗手、接触者追踪和控制。SARS CoV-2病毒通过一种叫做血管紧张素(ACE 2)的受体传播,这种受体在包括鼻咽上皮细胞在内的许多细胞上表达,通过其刺突状的外部突起附着在这些受体上。鉴于这一观察结果,人们对包括疫苗在内的可能防止这些相互作用的干预措施非常感兴趣。mRNA-1273小组成员在NEJM(2020年7月14日)上发表了他们的初步报告,成功完成了45名健康成年人的1期研究,他们接受了两种含有稳定灌注SARS CoV-2刺突蛋白的疫苗。疫苗似乎在所有参与者中诱导了SARS - CoV-2免疫反应。这些初步发现支持并鼓励开发这种新型疫苗,以及干扰宿主受体和病毒相互作用的药物
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Coronavirus Disease Pandemic: A Public Health Perspective
The new novel coronavirus was discovered by a Scottish virologist in London in 1964. As is usual with new discoveries, it seems the article she wrote about this discovery, was rejected by a peer reviewed journal. Dr Almeida wrote to the prestigious journal Nature (Nature 220, 1968), outlining her findings and proposed the name “coronavirus” for the new family of viruses. The name referred to the “crown like” appearance, she first observed on these viruses by electron microscopy. While SARS CoV-2 infection seems to be in control in China (less than 100,000 for a population of over billion), where it originated, the epidemic has moved briskly to the rest of the world. What seemed to be impossible to achieve, - imposing and enforcing strict quarantine of people, -is now a reality in majority of the countries. Success of preventive efforts is related, to how best the key principles of prevention strategies are followed; testing for infection, contact tracing, social distancing, wearing masks, and containment of the infected individuals. In December of 2019, several people in Wuhan, China, developed pneumonia and respiratory failure, like what happened during SARS epidemic of 2003. This virus is easily transmissible by symptomatic as well as asymptomatic individuals. As early as January 2020, SARS CoV-2 virus was found to spread during workshops, company meetings. Hospitals seem to provide a favorable environment for the propagation of coronavirus disease(Covid-19). Long-term care facilities are high-risk settings for infections of respiratory diseases. In the long-term care facilities, majority of the senior citizens, seem to have pre-existing conditions, such as hypertension, obesity, type-2 diabetes or cardiovascular diseases, which puts them at high-risk associated with Covid-19 severity. Several mass gatherings have been associated with explosive outbreaks of Covid-19, including political rallies, protests, sports and entertainment events. The possible role of children in transmission of the coronavirus is still not clear. Several individuals who had recovered from the COVID-19 have tested positive again at a later date, suggesting that the infection has been reactivated. These observations raise question about immunity in covid-19 patients for future infections, as well as the ‘herd immunity’ that we all are hoping for. In the absence of an evidence-based cure, the only choice we have of preventing infection is social distancing, wearing masks where needed, hand washing, contact tracing, and containment. SARS CoV-2 virus spreads through a receptor called angiotensin(ACE 2), which is expressed on many cells including the nasopharyngeal epithelial cells, by attaching to these receptors via its spike like external projections.In view of this observation, there is considerable interest in interventions, that may prevent these interactions including vaccines. The mRNA-1273 Group members have published their preliminary report in NEJM (July 14, 2020) about the successful completion of a phase-1 study of 45 healthy adults, who received two vaccines containing stabilized perfusion of SARS CoV-2 spike protein. The vaccines seem to have induced the SARS CoV-2 immune response in all participants. These preliminary findings, support and encourage the development of such novel vaccines, as well as drugs that interfere with the host receptor and virus interaction
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