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接种疫苗能否避免感染“慢性新冠”?

接种疫苗能否避免感染“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体后的一个月或更长时间之后才出现相关症状。

在新冠的魔盒中,没有什么比“长期新冠”(long COVID)更令人困惑的了。根据美国疾病控制中心(CDC)的说法,这也被称为远程新冠(long-haul COVID)、急性后新冠(post-acute COVID-19)、慢性新冠(chronic COVID)以及新冠的长期影响(long-term effects of COVID),这些均是指感染新冠的人可能在首次感染病原体后的一个月或更长时间之后才出现相关症状。你可能不禁要问,全面接种新冠疫苗,是否能够预防或至少减轻长时间患一种或多种疾病症状的可能性?

所谓长期新冠并不意味着每个感染新菌株或再次感染的人都会出现严重症状,疫苗接种仍然是预防新冠住院和死亡的唯一的最有效工具。但是,长期新冠相当奇怪,它可以在首次感染时没有症状的患者身上表现出来。

“即使是在感染后几天或几周内没有出现新冠症状的人,也可能出现‘后期症状’。这些情况在不同的时间段内会有不同类型和组合的健康问题。”CDC表示。这意味着患者可能会经历慢性疲劳(最常见的长期新冠症状)、呼吸问题、皮肤问题、胃肠道不适,或一系列与新冠相关的疾病,但是不会出现更严重的症状。

关于长期新冠的数据并不十分可靠,特别是当涉及到突破性新冠疫苗接种者时。一些研究表明,大约四分之一的新冠病毒患者(并非所有患者都必须接种疫苗)在最初诊断30天或更长时间内,报告了至少一种持续症状。但是,这些数据高度不一致。

例如,英国政府最近的一项分析发现:“SARS-CoV-2感染后12周内的新冠症状患病率是不确定的。根据研究设计的不同,估计在感染者中占2.3%到37%不等。”这个范围很大,取决于你在看哪个研究。理由很充分:长期新冠的最高风险因素似乎是患有严重的新冠病例、女性、高胆固醇或免疫系统受损,或在感染前就患有呼吸道疾病等。但是,即便如此,在不同年龄的人口统计数据以及不同的患者内在生理结构中,这些数据呈现出不一致、不可预测的结果。弄清楚谁可能感染长期新冠,并准确记录某些东西是否真的是长期新冠症状——这些在很大程度上仍然是一门“正在进行的科学”。

这就把我们带回了一个问题——完全接种疫苗的人,是否仍受到这一医学谜团的影响。目前,医生、学者和公共卫生专家仍在寻找最好的方法,记录长期接种疫苗者中的新冠流行率。加州大学旧金山分校(UCSF)医学系主任兼内科医生鲍勃•瓦赫特指出,以色列在《新英格兰医学杂志》(The New England Journal of Medicine)上发表的数据显示,在接种疫苗的突破性病例中,有20%的症状在感染后持续了六周。

但是,美国卫生和公众服务部(U.S. Department of Health and Human Services,HHS)前国家卫生信息技术协调员法尔扎德•莫斯塔沙瑞并不相信近20%的接种过疫苗的人会在感染了德尔塔病毒这样的病毒变种后,仍长期感染新冠病毒。

莫斯塔沙瑞指出,许多被问及是否正在经历与他们已经患过的疾病相关的症状的患者可能会说,他们仍然有症状,但需要指出,这是出于“回忆偏见”——即他们最初生病时关于的症状的记忆。紧接着,他建议进行一项更为有力的研究,纳入从一开始就从未被诊断出患有新冠病毒,且接种过疫苗的人的随机样本,询问他们是否出现了某些症状,以及这些症状是从何时开始的。后续的血液检测可能会确认新冠病例,然后只需确定时间线,看看这是最近的感染还是长期新冠。

但是,到目前为止,仍然没有足够的信息来明确宣布或预测谁最可能受到新冠这种变化的影响。唯一确定的是,新冠疫苗以及在德尔塔变种病例激增的地区采取的隔离措施,仍是预防新冠病毒传播的最有效的已知方法。(财富中文网)

编译:杨二一

在新冠的魔盒中,没有什么比“长期新冠”(long COVID)更令人困惑的了。根据美国疾病控制中心(CDC)的说法,这也被称为远程新冠(long-haul COVID)、急性后新冠(post-acute COVID-19)、慢性新冠(chronic COVID)以及新冠的长期影响(long-term effects of COVID),这些均是指感染新冠的人可能在首次感染病原体后的一个月或更长时间之后才出现相关症状。你可能不禁要问,全面接种新冠疫苗,是否能够预防或至少减轻长时间患一种或多种疾病症状的可能性?

所谓长期新冠并不意味着每个感染新菌株或再次感染的人都会出现严重症状,疫苗接种仍然是预防新冠住院和死亡的唯一的最有效工具。但是,长期新冠相当奇怪,它可以在首次感染时没有症状的患者身上表现出来。

“即使是在感染后几天或几周内没有出现新冠症状的人,也可能出现‘后期症状’。这些情况在不同的时间段内会有不同类型和组合的健康问题。”CDC表示。这意味着患者可能会经历慢性疲劳(最常见的长期新冠症状)、呼吸问题、皮肤问题、胃肠道不适,或一系列与新冠相关的疾病,但是不会出现更严重的症状。

关于长期新冠的数据并不十分可靠,特别是当涉及到突破性新冠疫苗接种者时。一些研究表明,大约四分之一的新冠病毒患者(并非所有患者都必须接种疫苗)在最初诊断30天或更长时间内,报告了至少一种持续症状。但是,这些数据高度不一致。

例如,英国政府最近的一项分析发现:“SARS-CoV-2感染后12周内的新冠症状患病率是不确定的。根据研究设计的不同,估计在感染者中占2.3%到37%不等。”这个范围很大,取决于你在看哪个研究。理由很充分:长期新冠的最高风险因素似乎是患有严重的新冠病例、女性、高胆固醇或免疫系统受损,或在感染前就患有呼吸道疾病等。但是,即便如此,在不同年龄的人口统计数据以及不同的患者内在生理结构中,这些数据呈现出不一致、不可预测的结果。弄清楚谁可能感染长期新冠,并准确记录某些东西是否真的是长期新冠症状——这些在很大程度上仍然是一门“正在进行的科学”。

这就把我们带回了一个问题——完全接种疫苗的人,是否仍受到这一医学谜团的影响。目前,医生、学者和公共卫生专家仍在寻找最好的方法,记录长期接种疫苗者中的新冠流行率。加州大学旧金山分校(UCSF)医学系主任兼内科医生鲍勃•瓦赫特指出,以色列在《新英格兰医学杂志》(The New England Journal of Medicine)上发表的数据显示,在接种疫苗的突破性病例中,有20%的症状在感染后持续了六周。

但是,美国卫生和公众服务部(U.S. Department of Health and Human Services,HHS)前国家卫生信息技术协调员法尔扎德•莫斯塔沙瑞并不相信近20%的接种过疫苗的人会在感染了德尔塔病毒这样的病毒变种后,仍长期感染新冠病毒。

莫斯塔沙瑞指出,许多被问及是否正在经历与他们已经患过的疾病相关的症状的患者可能会说,他们仍然有症状,但需要指出,这是出于“回忆偏见”——即他们最初生病时关于的症状的记忆。紧接着,他建议进行一项更为有力的研究,纳入从一开始就从未被诊断出患有新冠病毒,且接种过疫苗的人的随机样本,询问他们是否出现了某些症状,以及这些症状是从何时开始的。后续的血液检测可能会确认新冠病例,然后只需确定时间线,看看这是最近的感染还是长期新冠。

但是,到目前为止,仍然没有足够的信息来明确宣布或预测谁最可能受到新冠这种变化的影响。唯一确定的是,新冠疫苗以及在德尔塔变种病例激增的地区采取的隔离措施,仍是预防新冠病毒传播的最有效的已知方法。(财富中文网)

编译:杨二一

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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