长期新冠不能忽视，防疫措施不能放松
长期新冠患者的故事在社交媒体上传播，几乎从每个人的故事中都能看出他们的担忧和痛苦，比如呼吸问题、慢性痛疼、不明原因的挫伤、幻觉、脑雾等。一个人写道：“我只能说我的后背好像插了六把匕首。”一名医生在2020年因为工作感染了病毒，她表示：“与以前相比，我现在只是一个躯壳。”
新冠疫情许多方面的问题令研究人员困惑不已，政府部门迫切希望找到合理的政策，但最令人印象深刻的当属长期新冠。长期新冠的发展过程是个谜，它所引发的并发症各不相同，目前它可能比我们实际了解到的情况更值得担忧。
但可以明确的一点是，长期新冠及其虚弱效应最终会影响数以千万计的美国人，这也是与新冠有关的国家健康政策和预防措施依旧至关重要的原因之一。现在还不是叫停防疫措施的时候。
数字非常惊人。解决长期新冠倡议（Solve Long COVID Initiative）最近的报告估计，有2,200万美国人在最初感染新冠后的几个月依旧受到病毒的影响，约占美国总人口的6.7%。（这与美国政府问责署（U.S. Government Accountability Office）预测的数据接近。）美国约有700万人可能存在令人失去行动能力的长期新冠症状。换个角度来说，英国的数据显示，其约2.7%的人口受到长期新冠影响。
但我们对于长期新冠甚至还没有一个确切的定义。一般来说，长期新冠是指患者初次感染新冠病毒后几周或几个月内症状出现、复发或持续存在。这些症状可能会持续几个月甚至几年，可能造成可怕的后果。
这并不是一个之前从未有过的医疗术语。政府问责办公室的报告称，一项研究显示，上一次冠状病毒疫情（即2003年在亚洲首次发现的严重急性呼吸道综合征病毒）的幸存者中，有27%在首次感染4年后依旧存在慢性疲劳综合征。
但新冠疫情比SARS疫情更加严重，而且长期新冠（又被称为“后新冠”）的影响，对于数百万人而言极其严重并且改变了他们的生活。长期新冠的症状包括心脏异常、凝血问题、肾脏损伤、肺损伤甚至糖尿病等。超过四分之三长期新冠患者出现了认知障碍，而且专家表示抑郁和创伤后应激障碍等也是常见症状。
退伍军人管理局（Veterans Administration ）对超过15万新冠患者所做的大规模研究发现，患者在确诊至少一年后，患心脏病或约20种心血管疾病的风险大幅提高。与对照组相比，新冠康复患者中风的概率提高了52%，患心脏病的概率提高了72%。
为什么要在现在谈论这个问题？因为任何年龄的患者都可能出现长期新冠症状，即使是最初的轻症或无症状患者也难以幸免。简而言之，更多新冠患者意味着长期新冠患者增加。目前，美国不仅对病例数量的统计严重失真，还放松了疫情防控措施，尽管已经被削弱的统计系统显示随着东北部地区奥密克戎BA.2亚变异株的传播，病例数再次增加。
家用检测试剂盒无疑非常重要，但它的出现却影响了监管机构确定到底有多少人检测呈阳性，因为实验室看不到这些检测结果。前美国食品药品管理局（FDA）专员斯科特·戈特利布最近表示：“如果我们只能确定七分之一或八分之一病例，我不会感到意外。”戈特利布认为：“我们说每天新增30,000例感染者，但实际上可能更接近每天增加了25万例。”这让人觉得可怕，而且如果这些数据被真正记录在案，而不是猜测的结果，那么肯定会促使政府采取截然不同的防疫措施。
本月早些时候，人们更清楚地理解了持续病毒威胁的观点。当时，在华盛顿特区召开的年度烤架俱乐部晚宴实际上变成了一场超级传播事件，事后有超过70人被感染。这起高知名度的事件提醒我们，病毒依旧在美国肆虐，但许多州正在关闭检测点，取消口罩限制令，并停止每天公布感染病例、住院病例和死亡病例情况。
波士顿儿童医院（Boston Children’s Hospital）流行病学家、ABC News撰稿人约翰·布朗斯坦表示：“有效的公共健康响应取决于高质量的实时数据。检测行为的变化、公众缺乏兴趣和地方公共健康部门的资金严重不足等问题所导致的漏报，导致病例数和住院人数造成了误导，引发一场完美风暴。”
我们需要以充分的数据为基础制定合理的决策。首先应该在全美扩大废水监测规模，因为病毒可能通过有症状或无症状感染者的粪便传播，而污水监测可以提前预警新传播事件。
我们应该免费大规模提供快速检测，跟踪检测结果，并完善医院和各州收集和分享信息的方式。在感染人数增加之后，等到与新冠相关的住院人数增加时就会为时已晚。
公共健康的目标当然是为了预防。在疫情期间要求室内大型公共活动、餐厅等场合配戴口罩的规定，应该作为常态，而不是取消规定。口罩、疫苗、更先进的通风系统、便利的抗病毒药物获取途径、新疗法开发等，都可以帮助防御病毒，反过来可以减少长期新冠病例。
关于长期新冠，依旧有许多信息无法确定。在4月初，拜登政府公布了加快国立健康研究院（NIH）大型研究项目的患者招募和协调多个联邦政府就的计划。国立健康研究院的项目患者招募进展缓慢，令人意外。在此之前，联邦政府行动迟缓并且对潜在治疗药物的研发不够重视，引发多个团体不满，遭到公众的严厉批评。目前没有一款治疗药物面世。
毋庸置疑，人们正在承受痛苦，就连儿童也出现了可怕的症状。对Paxlovid等抗病毒药物以及抗凝血剂和抗血小板药物的大规模临床试验进行投资，可以帮助我们加快找到潜在治疗药物。现在应该加快研发进展。
与此同时，长期新冠患者的痛苦经历仍在继续，长期新冠对美国的影响不容低估。
退伍军人事务部圣路易斯医疗保健系统（Veterans Affairs St. Louis Health Care System）临床流行病学中心（Clinical Epidemiology Center）主任齐亚德·阿尔-阿里表示：“我们认为[病例数据]将演变成数以百万计需要护理的长期新冠患者，总之，我们的医疗系统需要做好准备。医疗系统或诊所经营者需要做好准备，迎接大量有心脏病或其他长期新冠症状的患者蜂拥而至。”全世界约有1亿人正承受着长期新冠的影响或之前曾经出现过长期新冠症状。
我们要面对长期新冠的事实，尽管我们仍在努力了解长期新冠综合征最有可能以哪种方式在哪些情况下出现。整个国家有责任对新冠的传播保持警惕，因为在传播过程中会诞生长期新冠。（财富中文网）
本文作者医学博士卡罗琳·巴伯担任急诊科医生已有25年。她著有《失控的药物：你不知道的事情可能会害死你》（Runaway Medicine: What You Don’t Know May Kill You）一书。她曾为《财富》和《美国科学》（Scientific American）等美国期刊撰文，详细介绍新冠疫情。巴伯是加州无家可归者工作计划“改变之轮”（Wheels of Change）的联合创始人。
译者：刘进龙
审校：汪皓
长期新冠患者的故事在社交媒体上传播，几乎从每个人的故事中都能看出他们的担忧和痛苦，比如呼吸问题、慢性痛疼、不明原因的挫伤、幻觉、脑雾等。一个人写道：“我只能说我的后背好像插了六把匕首。”一名医生在2020年因为工作感染了病毒，她表示：“与以前相比，我现在只是一个躯壳。”
新冠疫情许多方面的问题令研究人员困惑不已，政府部门迫切希望找到合理的政策，但最令人印象深刻的当属长期新冠。长期新冠的发展过程是个谜，它所引发的并发症各不相同，目前它可能比我们实际了解到的情况更值得担忧。
但可以明确的一点是，长期新冠及其虚弱效应最终会影响数以千万计的美国人，这也是与新冠有关的国家健康政策和预防措施依旧至关重要的原因之一。现在还不是叫停防疫措施的时候。
数字非常惊人。解决长期新冠倡议（Solve Long COVID Initiative）最近的报告估计，有2,200万美国人在最初感染新冠后的几个月依旧受到病毒的影响，约占美国总人口的6.7%。（这与美国政府问责署（U.S. Government Accountability Office）预测的数据接近。）美国约有700万人可能存在令人失去行动能力的长期新冠症状。换个角度来说，英国的数据显示，其约2.7%的人口受到长期新冠影响。
但我们对于长期新冠甚至还没有一个确切的定义。一般来说，长期新冠是指患者初次感染新冠病毒后几周或几个月内症状出现、复发或持续存在。这些症状可能会持续几个月甚至几年，可能造成可怕的后果。
这并不是一个之前从未有过的医疗术语。政府问责办公室的报告称，一项研究显示，上一次冠状病毒疫情（即2003年在亚洲首次发现的严重急性呼吸道综合征病毒）的幸存者中，有27%在首次感染4年后依旧存在慢性疲劳综合征。
但新冠疫情比SARS疫情更加严重，而且长期新冠（又被称为“后新冠”）的影响，对于数百万人而言极其严重并且改变了他们的生活。长期新冠的症状包括心脏异常、凝血问题、肾脏损伤、肺损伤甚至糖尿病等。超过四分之三长期新冠患者出现了认知障碍，而且专家表示抑郁和创伤后应激障碍等也是常见症状。
退伍军人管理局（Veterans Administration ）对超过15万新冠患者所做的大规模研究发现，患者在确诊至少一年后，患心脏病或约20种心血管疾病的风险大幅提高。与对照组相比，新冠康复患者中风的概率提高了52%，患心脏病的概率提高了72%。
为什么要在现在谈论这个问题？因为任何年龄的患者都可能出现长期新冠症状，即使是最初的轻症或无症状患者也难以幸免。简而言之，更多新冠患者意味着长期新冠患者增加。目前，美国不仅对病例数量的统计严重失真，还放松了疫情防控措施，尽管已经被削弱的统计系统显示随着东北部地区奥密克戎BA.2亚变异株的传播，病例数再次增加。
家用检测试剂盒无疑非常重要，但它的出现却影响了监管机构确定到底有多少人检测呈阳性，因为实验室看不到这些检测结果。前美国食品药品管理局（FDA）专员斯科特·戈特利布最近表示：“如果我们只能确定七分之一或八分之一病例，我不会感到意外。”戈特利布认为：“我们说每天新增30,000例感染者，但实际上可能更接近每天增加了25万例。”这让人觉得可怕，而且如果这些数据被真正记录在案，而不是猜测的结果，那么肯定会促使政府采取截然不同的防疫措施。
本月早些时候，人们更清楚地理解了持续病毒威胁的观点。当时，在华盛顿特区召开的年度烤架俱乐部晚宴实际上变成了一场超级传播事件，事后有超过70人被感染。这起高知名度的事件提醒我们，病毒依旧在美国肆虐，但许多州正在关闭检测点，取消口罩限制令，并停止每天公布感染病例、住院病例和死亡病例情况。
波士顿儿童医院（Boston Children’s Hospital）流行病学家、ABC News撰稿人约翰·布朗斯坦表示：“有效的公共健康响应取决于高质量的实时数据。检测行为的变化、公众缺乏兴趣和地方公共健康部门的资金严重不足等问题所导致的漏报，导致病例数和住院人数造成了误导，引发一场完美风暴。”
我们需要以充分的数据为基础制定合理的决策。首先应该在全美扩大废水监测规模，因为病毒可能通过有症状或无症状感染者的粪便传播，而污水监测可以提前预警新传播事件。
我们应该免费大规模提供快速检测，跟踪检测结果，并完善医院和各州收集和分享信息的方式。在感染人数增加之后，等到与新冠相关的住院人数增加时就会为时已晚。
公共健康的目标当然是为了预防。在疫情期间要求室内大型公共活动、餐厅等场合配戴口罩的规定，应该作为常态，而不是取消规定。口罩、疫苗、更先进的通风系统、便利的抗病毒药物获取途径、新疗法开发等，都可以帮助防御病毒，反过来可以减少长期新冠病例。
关于长期新冠，依旧有许多信息无法确定。在4月初，拜登政府公布了加快国立健康研究院（NIH）大型研究项目的患者招募和协调多个联邦政府就的计划。国立健康研究院的项目患者招募进展缓慢，令人意外。在此之前，联邦政府行动迟缓并且对潜在治疗药物的研发不够重视，引发多个团体不满，遭到公众的严厉批评。目前没有一款治疗药物面世。
毋庸置疑，人们正在承受痛苦，就连儿童也出现了可怕的症状。对Paxlovid等抗病毒药物以及抗凝血剂和抗血小板药物的大规模临床试验进行投资，可以帮助我们加快找到潜在治疗药物。现在应该加快研发进展。
与此同时，长期新冠患者的痛苦经历仍在继续，长期新冠对美国的影响不容低估。
退伍军人事务部圣路易斯医疗保健系统（Veterans Affairs St. Louis Health Care System）临床流行病学中心（Clinical Epidemiology Center）主任齐亚德·阿尔-阿里表示：“我们认为[病例数据]将演变成数以百万计需要护理的长期新冠患者，总之，我们的医疗系统需要做好准备。医疗系统或诊所经营者需要做好准备，迎接大量有心脏病或其他长期新冠症状的患者蜂拥而至。”全世界约有1亿人正承受着长期新冠的影响或之前曾经出现过长期新冠症状。
我们要面对长期新冠的事实，尽管我们仍在努力了解长期新冠综合征最有可能以哪种方式在哪些情况下出现。整个国家有责任对新冠的传播保持警惕，因为在传播过程中会诞生长期新冠。（财富中文网）
本文作者医学博士卡罗琳·巴伯担任急诊科医生已有25年。她著有《失控的药物：你不知道的事情可能会害死你》（Runaway Medicine: What You Don’t Know May Kill You）一书。她曾为《财富》和《美国科学》（Scientific American）等美国期刊撰文，详细介绍新冠疫情。巴伯是加州无家可归者工作计划“改变之轮”（Wheels of Change）的联合创始人。
译者：刘进龙
审校：汪皓
Their stories are shared through social media, the fear and agony front and center in almost every conversation: breathing issues, chronic pain, unexplained bruising, hallucinations, brain fog. “No way to describe besides six daggers in my back,” wrote one. Added another, a doctor exposed on the job in 2020, “I am a shell of my former self.”
Of the many facets of the COVID-19 pandemic that have baffled researchers and left governing bodies grasping for sensible policies, perhaps none will leave as deep a mark as long COVID. Its path a mystery, its complications wildly varied, it remains at this point the subject of more concern than actual knowledge.
What is clear, though, is that long COVID and its debilitating effects will ultimately affect tens of millions of Americans—and that is one reason why national health policies and preventative measures related to the disease in general remain critically important. Now is not the time to take our foot off the gas pedal.
The numbers are stark. A recent report by the Solve Long COVID Initiative estimates that some 22 million Americans, about 6.7% of our population, are already dealing with effects of the virus months after their initial infection. (The numbers are similar to those put forward by the U.S. Government Accountability Office.) Roughly 7 million in our country may be experiencing disabling long COVID symptoms. To put that in perspective, U.K. figures show that long COVID is affecting approximately 2.7% of its population.
Still, we don’t even have a precise definition of long COVID. Broadly speaking, it is the appearance, recurrence, or persistence of symptoms in patients weeks or months after they initially contracted the virus. The symptoms may then continue for months or even years, with potentially dire consequences.
This is not unprecedented, medically speaking. The GAO’s report notes a study indicating that 27% of survivors of a previous coronavirus, severe acute respiratory syndrome (SARS), which was first discovered in Asia in 2003, were still experiencing chronic fatigue syndrome four years after their initial infection.
But COVID’s scale is vastly more significant than was SARS, and the effects of long COVID (sometimes also called post-COVID) are, for millions, severe and life-changing. These may include cardiac disorders, clotting issues, kidney injury, lung damage, even diabetes. More than three-quarters of those living with long COVID have reported cognitive impairment, and depression and post-traumatic stress disorder are common, experts say.
A massive study by the Veterans Administration of more than 150,000 individuals with COVID-19, meanwhile, found them to be at a substantially higher risk of heart problems or cardiovascular disorders—some 20 types in all—for at least a year after diagnosis. Those who had recovered from COVID-19 were 52% more likely to have a stroke and 72% more likely to experience heart failure, compared to a control group.
So why talk about all of this now? Because long COVID symptoms can develop in a person of any age, even after a mild or asymptomatic case of the virus. In short, more COVID means more long COVID. And not only might we be dramatically undercounting cases in our country right now, but we are relaxing the rules around the virus at a time when even our diminished counting system shows that caseloads are again on the rise, driven by the arrival in the Northeast of the BA.2 subvariant of Omicron.
The advent of home test kits for COVID, while unquestionably important, has compromised agencies’ ability to know how many people are actually testing positive, because labs never see those results. “I wouldn’t be surprised if we were only capturing one in seven or one in eight cases,” former FDA Commissioner Scott Gottlieb said recently. Gottlieb suggested that “when we say there’s 30,000 infections a day, it’s probably closer to a quarter of a million infections a day.” That’s a chilling thought, and if it were actually documented rather than guessed at, it would almost certainly prompt different decisions about the precautions we should take.
The notion of continued viral threat was driven home with some clarity earlier this month, when the annual Gridiron Dinner in Washington, D.C., effectively served as a super-spreader event, with more than 70 people subsequently infected. It was a high-profile reminder that the virus is still thriving in the U.S.—yet many states are shuttering test sites, dropping mask restrictions, and discontinuing the daily reporting of infections, hospitalizations, and deaths.
“An effective public health response depends on high-quality, real-time data,” said John Brownstein, an epidemiologist at Boston Children’s Hospital and an ABC News contributor. “Underreporting, driven by changes in testing behavior, lack of public interest, and severely underfunded local public health departments, creates a perfect storm of misleading case counts and hospitalizations.”
We need good data to make good decisions. One start would be to vastly scale up wastewater surveillance across the U.S., since virus can be shed by individuals with and without symptoms in feces, and sewage surveillance can provide an early warning of new spread.
Let’s also make rapid tests more widely available and free, with a way to track results, and improve how we gather and share information from hospital systems and states. Waiting for COVID-related hospitalizations to rise simply puts us behind the curve, after infections already have taken off.
The goal of public health, of course, is to be preventative. The idea of masking indoors at large public events, restaurants, and the like during COVID surges should be normalized, not shunned. Masks, vaccines, improved ventilation systems, easy access to antivirals, development of new therapeutics—all these things can help fend off the virus, which in turn could lower cases of long COVID.
Much remains to be determined about long COVID. In early April, the Biden administration announced plans to accelerate the shockingly slow enrollment in a major NIH research project and to coordinate efforts across a number of federal agencies. This announcement arrived in the face of bitter public criticism by groups frustrated by the slow pace of federal activity and the lack of a focus on potential cures, none of which currently exist.
Unquestionably, people are suffering; even children are contracting the dreadful condition. Investment in large-scale clinical trials of antivirals like Paxlovid, along with anticoagulants and antiplatelet therapy, among others, may get us more rapidly on the path to answers on possible treatments. It’s time to push the accelerator.
In the meantime, the difficult journey for COVID “long haulers” goes on, and the impact on the nation cannot be discounted.
“We think [the numbers] will translate into millions of people with long COVID in need of care, and broadly speaking, our health systems need to be prepared,” said Ziyad Al-Aly, director of the Clinical Epidemiology Center at the Veterans Affairs St. Louis Health Care System, in a recent podcast. “People running health systems or clinics need to start preparing for the tide of patients that are going to hit our doors with heart problems and other long COVID problems.” Worldwide estimates are that around 100 million people are suffering or have previously suffered from this.
The reality of long COVID is upon us, even as we strain to learn more about how and under what circumstances the syndrome is most likely to appear. It’s on us as a country to remain vigilant against the spread of the disease that fosters it.
Carolyn Barber, M.D., has been an emergency department physician for 25 years. Author of the book Runaway Medicine: What You Don’t Know May Kill You, she has written extensively about COVID-19 for national publications, including Fortune and Scientific American. Barber is cofounder of the California-based homeless work program Wheels of Change.
