地平线系列：冠状病毒特别节目（2020）（2）

Remdesivir seems to have reduced the average length
从十五天缩短到十一天
of time that people will have symptoms from 15 to 11 days.
瑞德西韦最初被研发用于丙肝
Remdesivir was developed for hepatitis C
也被试用于埃博拉
and tried against Ebola.
研发者开展的临床试验表明
Clinical trials run by its maker showed
它能缩短COVID-19病人的康复时间
it reduces recovery time in COVID-19 patients,
或许是通过破坏
perhaps by disrupting an enzyme
病毒复♥制♥所需的一种酶
that the virus uses to replicate.
这些结果尚未得到独♥立♥的证实
These results have not been independently verified
但美国食品药品监督管理局已批准
but the FDA in America has authorised
该药紧急用于治疗COVID-19
the emergency use of the drug to treat COVID-19.
在英国国家医疗服务体系的试验中
In the NHS trial, every two weeks the data
数据每两周由独♥立♥委员会评估一次
is assessed by an independent committee.
他们要研究
They are looking to see
以下治疗可用吗
表格完成后请签名
洛匹那韦-利托那韦
地♥塞♥米♥松♥
羟氯喹
阿奇霉素
这些治疗是否能减少死亡
whether the treatments reduce deaths
或缩短重症监护时间
or time spent in intensive care.
我不会挑选数据
So, I am not picking up the data
因为这是不允许的
because I am not allowed to.
所以你作为主要研究者
So you as the principal investigator,
你其实并不知道自己的试验发生了什么
you actually don't know what is happening in your own trial?
是的 这很困难 因为你真的很想知道
Yes and it is difficult because you really want to know.
但这也能防止我们因为急于看到获益
But it also protects us from making a statistical mistake
而出现统计学错误
in our eagerness to see a benefit.
彼得的试验只是六十四个
Peter's trial is one of nearly 1000
不同国家里近千项试验中的一项
taking place in 6♥4♥ different countries.
失败在所难免
There will be dead ends
但只要有一种药物能降低死亡率
but if just one drug reduces the death rate
哪怕稍有降低 也有重大意义
by even a modest amount, it would make a difference.
因为这么多人感染这种病毒
Because so many people are infected with this virus,
哪怕任何一种药物有很小的疗效
even a small effect of any of these drugs
都将挽救众多人的生命
would translate into a massive saving of human life.
是否对该参与者进行过COVID-19测试
没错 全球可能已有成千上万的人死亡
That is right. There have been hundreds and thousands of deaths probably globally
病人的生命状况如何
即使只是减少一点点
and even a small reduction
病人的生命状况如何
存活
死亡
也意味着很多生命得救
and that would be a lot of lives saved.
最成功的治疗方法始于
The most successful treatments come from a deep understanding
深入了解它对人体究竟做了什么
of what a disease actually does to the body
对于COVID-19 我们才刚刚开始
and with COVID-19 we are only just beginning
看到冰山一角
to get a glimpse of what is going on.
我们知道这种疾病
We know that this is a disease
会影响肺部的呼吸道
that affects the respiratory tract in the lungs
而对重症患者最有效的治疗
and the most effective treatment for severe cases
还是上呼吸机支持肺功能
is still ventilation to support those lungs.
但也有越来越多的证据表明
But there is also growing evidence that
这种病毒会攻击
this is a virus that can attack
身体的许许多多部位
many many more parts of the body,
妮基·隆莉医生是位传染病顾问
Doctor Nikki Longley is an infectious diseases consultant
也是这个课题研究的
and one of the leaders of the study
主要负责人之一
looking at this very issue.
妮基 我们知道COVID-19影响肺部
Nikki, we know that COVID-19 affects the lungs
但有没有证据证明它的伤害不止于此
but is there evidence that can do more?
当然 越来越多证据表明
Absolutely. I think there's growing evidence
妮基·隆莉医生
伦敦大学医院 热带病医院
这是一种多系统疾病
that this is a multisystem disease,
所以我们一直与神经科医生
so we have been working together closely
风湿病医生 肾科医生
with the neurologists and rheumatologists
重症监护医生
with the kidney doctors,
还有心脏科医生
with the intensive care doctors,
进行密切合作
with the cardiologists,
来试图更好地理解这种疾病
to try and get a better understanding of exactly how
是如何影响身体内的不同器官
this disease is affecting all the different organs in the body.
只有症状很严重的COVID患者的
Does it only affected organs throughout the body
全身器官才会受到影响吗
in those patients who have really severe COVID?
我想有一点需要在这里强调一下
I think it is really important to highlight
感染了这种病毒
that with this virus,
大约百分之八十的人症状都很轻微
still about 80% of people have really mild disease
甚至有人完全没有症状
and some people have almost no symptoms at all.
可以细说一下对人体不同系统的影响吗
Can we drill into each of those body systems a little more deeply?
这是一位女性COVID患者的脑部扫描
This is a brain scan from a female patient with COVID,
可以大致说一下这里显示的是什么吗
can you tell me what we are seeing here and
以及对大脑有什么影响吗
about the effects on the brain more generally?
在这张扫描里箭头指向的地方
On this scan where the arrows are pointing
我们可以看到一些白色♥区♥域
you can see some white areas
说明这个区域有出血
which show areas of bleeding
和发炎的情况
and areas of inflammation around that.
虽然现在还不能简单的说
Although it‘s quite early to say that this isn't
这些绝对都是由COVID导致的
absolutely caused by COVID,
我们还能看到大脑有些地方
we are also seeing a few swelling
有肿胀的情况 或者说脑炎
of the brain or encephalitis
患者常常会表现出极度疲劳
and people will often then present with profound exhaustion,
越来越嗜睡
being much more drowsy
产生幻觉和大脑混乱的症状
and having hallucinations and confusion
当我们对越来越多
and the more we're trying to
出现在老年人以及年轻人身上的
get a better understanding of
中风症状了解得越多
an increased number of strokes in
我们发现
young people as well as older people
这可能与炎症
and that may be to do with inflammation
和血管内膜的问题有关
and problems with the lining of the blood vessels.
对心脏有什么影响呢
What about the effects on the heart?
这是一个动态核磁共振扫描
This is the scan, it's a dynamic moving MRI scan from
来自几周前发布的一份论文
a paper published a few weeks ago,
这是一位五十多岁的男性COVID患者
it‘s a male patient in his 50s with COVID.
这里我们能看到
So what you are seeing here is
整个心脏和心肌
diffuse swelling and inflammation of
都有弥漫性肿胀和发炎的情况
the whole of the heart and in the heart muscle
还有一个问题就是
and the fact that it is not
心脏收缩力不及正常情况
contracting as well as you would normally expect.
也就是说和没有感染病毒的
So it's not pushing as much blood around the circulation,
普通人的心脏相比
around the body as you would see
没办法推动足够的血液流动
in the heart of someone
进行血液循环
who wasn't affected.
对心脏还有别的什么影响吗
Are there other effects on the heart as well?
当然 还有一种常见的情况是
Definitely, so we've often seen people who might
有些人的脉搏会跳得非常快
notice that their pulse is racing very fast,
有一些非常健康的年轻人
you'll see otherwise young fit healthy people,
每次站起身动起来的时候
that every time they stand up and move,
发现他们的心脏和正常情况相比
they find their heart is racing away much more than
跳动速度要快得多
it would ordinarily have done.
很多人可能在媒体上看到这样一张
A lot of people may have seen pictures in the media of
被称为COVID脚趾的照片
so-called COVID toe,
这是怎么回事呢
what‘s going on,
为什么脚趾上会起红疹
why is there a rash on these toes?
关于这个目前还没有定论
So the jury is still slightly out there and
其中的原理还不是很清楚
people don't fully understand what‘s going on,
但我想大多人都听过
but I think lots of people have heard
这种病毒会与ACE2受体结合
that this virus will attach to or have an affinity
血管紧张素转化酶2
或者说与ACE2受体有亲和力
to this ACE2 receptor that you find
肺胸膜和上呼吸道
on the lining of the lungs and
都有这种受体
the upper respiratory tract,
但人体很多其他器官里也有这种受体
but that receptor is also present in many other organs in the body,
肠道和肾脏里有
so it‘s present in the gut and kidneys but also
血管内膜里也有
in the lining of the blood vessels.
越来越多的证据表明
And increasingly there is evidence
当血管内膜感染COVID引发炎症
that the lining of the blood vessels get inflamed with the COVID
就可能产生和这个脚趾一样的症状
and produce symptoms such as this toe
可能会在血管附近