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哪些人群最容易感染冠状病毒?

  The new coronavirus is not an equal-opportunity killer:Being elderly and having other illnesses,for instance,greatly increases the risk of dying from the disease the virus causes,Covid-19.It's also possible being male could put you at increased risk.

  新的冠状病毒对各类人群的致命效果并不相同:比如老年人和患有其他疾病会有更大风险。男性相较于女性也会面临更大的风险。

  For both medical and public health reasons,researchers want to figure out who's most at risk of being infected and who's most at risk of developing severe or even lethal illness.With that kind of information,clinicians would know whom to treat more aggressively,government officials would have a better idea of steps to take,and everyone would know whether they need to take special,additional precautions.

  出于医学和公共卫生方面的原因,研究人员希望找出谁最容易受到感染,以及谁最容易患上严重甚至致命的并发症。有了这些信息,临床医生将知道应该给谁更积极的治疗,政府官员该采取什么措施有更好的了解,每个人也清楚自己该做什么额外措施。

  Here's what research has shown three months into the outbreak:

  这是爆发三个月后的研究结果:

  Old and young

  老人与年轻人的比较


  The vast majority of cases in China—87%—were in people ages 30 to 79,the China Center for Disease Control reported last month based on data from all 72,314 of those diagnosed with Covid-19 as of Feb.11.That probably reflects something about biology more than lifestyle,such as being in frequent contact with other people.Teens and people in their 20s also encounter many others,at school and work and on public transit,yet they don't seem to be contracting the disease at significant rates:Only 8.1%of cases were 20-somethings,1.2%were teens,and 0.9%were 9 or younger.The World Health Organization mission to China found that 78%of the cases reported as of Feb.20 were in people ages 30 to 69.

  中国疾病控制中心上个月根据截至2月11日被诊断出患有新冠肺炎的所有72,314名患者的数据,报告了中国绝大多数病例(87%),年龄在30至79岁之间。与此相关的不只是生活方式,例如与他人经常接触。十几岁和20多岁的人在学校,工作场所和公共交通上也接触了很多其他人,但他们似乎并没有以很高的比率感染这种疾病:只有8.1%的病例是20多岁的年轻人,1.2%是十几岁,9岁以下的占0.9%。世界卫生组织驻中国代表团发现,截至2月20日,报告的病例中有78%的患者年龄在30至69岁之间。

  The death toll skews old even more strongly.Overall,China CDC found,2.3%of confirmed cases died.But the fatality rate was 14.8%in people 80 or older,likely reflecting the presence of other diseases,a weaker immune system,or simply worse overall health.By contrast,the fatality rate was 1.3%in 50-somethings,0.4%in 40-somethings,and 0.2%in people 10 to 39.

  死亡人数更严重地倾斜于老年人。总体而言,中国疾控中心发现,确诊病例中有2.3%死亡。但是,在80岁或80岁以上的人群中,死亡率为14.8%,这可能反映出存在其他疾病,免疫系统较弱或整体健康状况较差的原因。相比之下,死亡率在50岁以下人群中为1.3%,在40岁以上人群中为0.4%,在10至39岁的人群中为0.2%。

  The age-related death risk probably reflects the strength,or weakness,of the respiratory system.About half of the 109 Covid-19 patients(ages 22 to 94)treated at Central Hospital of Wuhan,researchers there reported,developed acute respiratory distress syndrome(ARDS),in which fluid builds up in the small air sacs of the lungs.That restricts how much air the lungs can take in,reducing the oxygen supply to vital organs,sometimes fatally;half of the ARDS patients died,compared to 9%of patients who did not develop the syndrome.

  与年龄有关的死亡风险可能反映了呼吸系统的强弱。在武汉市中心医院接受治疗的109名患者(22至94岁)中,约有一半发展为急性呼吸窘迫综合症(ARDS),液体积聚在肺小气囊中。这就限制了肺吸收氧气,从而减少了对重要器官的供氧,有时甚至致命。一半的ARDS患者死亡,而没有发展为ARDS的患者占9%。

  The ARDS patients had an average age of 61,compared to an average age of 49 for those who did not develop ARDS.Elderly patients“were more likely to develop ARDS,”the researchers wrote,suggesting how age can make Covid-19 more severe and even fatal:age increases the risk that the respiratory system will basically shut down under viral assault.

  ARDS患者的平均年龄为61岁,而未患ARDS的患者的平均年龄为49岁。研究人员写道,老年患者“更有可能患ARDS,”这表明年龄如何使新冠肺炎更严重甚至致命:年龄增加了在病毒袭击下呼吸系统瘫痪的风险。

  Youth,in contrast,seems to be protective.The WHO mission reported a relatively low incidence in people under 18,who made up only 2.4%of all reported cases.In fact,through mid-January,zero children in Wuhan,the epicenter of the outbreak,had contracted Covid-19.It's not clear whether that's because children do not show signs of illness even if infected.

  相反,年轻人似乎是受到保护的。世卫组织访问团报告说,18岁以下人群的发病率相对较低,仅占所有报告病例的2.4%。实际上,到1月中旬为止,在武汉(暴发中心)没有儿童感染了Covid-19。尚不清楚这是否是因为儿童即使被感染也没有表现出疾病迹象。

  Even cases among children and teens aged 10 to 19 are rare.As of Feb.11 there were 549 cases in that age group,1.2%of the total,China CDC found.Only one had died.

  甚至10至19岁的儿童和青少年中的病例也很少见。中国疾病预防控制中心发现,截至2月11日,该年龄组有549例,占总数的1.2%。只有一个人死亡。<-->纽约时报中英文网 http://www.qqenglish.com<-->

  One intriguing explanation for the apparent resilience of youth:in regions near Hubei province,young children seem especially likely to be exposed to other coronaviruses,scientists in China reported in 2018.That might have given them at least partial immunity to this one.

  据中国科学家在2018年报道:年轻人的抵抗力的一个有趣的解释是:在湖北省附近的地区,年幼的孩子似乎特别有可能暴露于其他冠状病毒。这可能使他们已经免疫了部分的冠状病毒。

  Men and women

  男性女性之间的比较


  The effect of sex on susceptibility to Covid-19 is less clear than the age effect,but preliminary data suggest men might be more susceptible.China CDC found that 106 men had the disease for every 100 women,while the WHO mission found that men make up 51%of cases.A study of 1,099 Covid-19 patients in Wuhan through Jan.29 found a greater imbalance:58%were male,the China Medical Treatment Expert Group for Covid-19 reported last week in the New England Journal of Medicine.

  性别对Covid-19易感性的影响尚不及年龄影响明确,但初步数据表明,男性可能更易感。中国疾病预防控制中心发现,每100名女性就有对应106名男性患该病,而世界卫生组织的访问发现,男性占该病的51%。截至1月29日,对武汉地区1,099名Covid-19患者的研究发现了更大的失衡:58%是男性,来源于上周《新英格兰医学杂志》Covid-19中国医学治疗专家组。

  It's possible the apparent sex imbalance reflects patterns of travel and contacts that make men more likely to be exposed to carriers of the virus,not any inherent biological differences.It's also possible the apparent worse disease severity in men could skew the data.Among hospitalized patients,there is“a slight predominance of men,”U.S.researchers wrote last week in JAMA.If the virus hits men harder than women,health care systems will see,test,and count more men.

  这种明显的性别失衡可能反映了出行和接触的模式,这些模式使男性更容易接触到病毒携带者,而不是任何内在的生物学差异。男性明显的疾病严重程度也有可能扭曲数据。美国研究人员上周在《美国医学会杂志》(JAMA)上写道,在住院病人中,“男性略多于女性”。如果该病毒对男性的感染影响大于女性,那么卫生保健系统将对更多的男性进行观察、检测和统计。

  To determine if there are sex differences in susceptibility to infection would require an unethical experiment:expose 1,000 otherwise similar men and women to the virus and see who gets sick.

  要确定对感染的易感性是否存在性别差异,需要进行一项不道德的实验:让1000名身体情况相似的男性和女性接触这种病毒,然后看看谁会得病。

  The difference is fatality rates,however,is real:1.7%for women and 2.8%for men,China CDC reported.

  然而,中国疾病预防控制中心的报告显示,致死率的差别是真实存在的:女性为1.7%,男性为2.8%。

  Sick or healthy

  已患其他疾病和健康者的比较


  The male-female difference in fatality rates,and perhaps in reported incidence,may arise from differences in underlying health.People with pre-existing illness are more likely to get seriously ill from Covid-19,and men have a higher incidence of such chronic illnesses as cardiovascular disease.

  死亡率和报告发病率的男女差异可能源于基本健康状况的差异。患有既往疾病的人更容易因Covid-19而发展为重症,男性罹患诸如心血管疾病等慢性疾病的重症几率更高。

  In the first large study of the effect of underlying illness,researchers in China analyzed 1,590 patients from throughout the country with laboratory-confirmed disease.They calculated how“co-morbidities”—existing illnesses—affected the risk of being admitted to intensive care,being put on a ventilator,or dying.

  在对潜在疾病影响的第一项大型研究中,中国的研究人员分析了来自全国各地的1,590名确诊的患者。他们计算了“并发症”(即现有疾病)如何影响接受重症监护,使用呼吸机或死亡的概率。

  After taking into account the patients'ages and smoking status,the researchers found that the 399 patients with at least one additional disease(including cardiovascular diseases,diabetes,hepatitis B,chronic obstructive pulmonary disease,chronic kidney diseases,and cancer)had a 79%greater chance of requiring intensive care or a respirator or both,or of dying,they reported last week in a paper posted to medRxiv,a preprint site that posts research before it has been peer-reviewed.The 130 with two or more additional diseases had 2.5 times the risk of any of those outcomes.

  在考虑了患者的年龄和吸烟情况后,研究人员上周在medRxiv网站上发表了一篇论文,称他们发现,399名至少有一种额外疾病(包括心血管疾病、糖尿病、乙型肝炎、慢性阻塞性肺病、慢性肾病和癌症)的患者需要重症监护或使用呼吸器或两者都需要,或死亡的几率要高出79%。患有两种或两种以上附加疾病的130名患者发生上述任何一种结果的风险是2.5倍。

  That fits with what's known about other respiratory viruses.People with a single co-morbidity who catch avian flu(H7N9)are 3.4 times more likely than otherwise-healthy flu patients to require ventilators and other intensive care.SARS and MERS,which are also caused by coronaviruses,are more severe in patients with underlying illnesses,too.

  这与我们对其他呼吸道病毒的了解相符。与其他健康的流感患者相比,感染H7N9的单一合并病患者需要呼吸器和其他重症护理的可能性高3.4倍。由冠状病毒引起的SARS和中东呼吸综合征(MERS)对有潜在疾病的患者也更为严重。

  Breaking down the Covid-19 risk with the most common co-morbidities,the scientists found that cancer raises the risk 3.5-fold,COPD 2.6-fold,and diabetes and hypertension by about 60%.Because it isn't unusual for someone to have an underlying disease(especially diabetes and hypertension)but not know it,the last figure is likely an underestimate.

  以最常见的并发症来分解Covid-19风险后,科学家发现癌症将风险提高了3.5倍,COPD提高了2.6倍,糖尿病和高血压的风险提高了约60%。由于某人患有其他疾病(尤其是糖尿病和高血压),但并不知道,因此最后的数字可能被低估了。

  Co-morbidities also raise the risk of dying from Covid-19.China CDC's analysis of 44,672 patients found that the fatality rate in patients who reported no other health conditions was 0.9%.It was 10.5%for those with cardiovascular disease,7.3%for those with diabetes,6.3%for people with chronic respiratory diseases such as COPD,6.0%for people with hypertension,and 5.6%for those with cancer.

  并发症也增加了死于Covid-19的风险。中国疾病预防控制中心对44672例患者的分析发现,未报告其他健康状况的患者的死亡率为0.9%。患有心血管疾病的人占10.5%,患有糖尿病的人占7.3%,患有慢性阻塞性肺病等慢性呼吸道疾病的人占6.3%,患有高血压的人占6.0%,患有癌症的人占5.6%。

  Underlying disease might change the course of Covid-19.During the height of the epidemic in Wuhan,37 of 230 patients receiving dialysis for kidney failure at Remnin Hospital developed the disease.Even though none were sick enough to require intensive care or a mechanical ventilator,six of them died,for a very high fatality rate of 16%.Oddly,however,none of the six died of pneumonia,Remnin researchers reported.Instead,the causes of death were heart disease,stroke,and high blood levels of potassium(a result of kidney failure).The high fatality rate of Covid-19 in already-sick people might result not from the virus but from an exacerbation of existing disease.

  潜在疾病可能会改变Covid-19的病程。在武汉疫情高峰期间,武汉人民医院接受肾衰竭透析的230名患者中有37名患上了这种疾病。即使没有人病到需要重症监护或使用机械呼吸机,也有6人死亡,死亡率高达16%。不过,人民医院研究人员报告说,奇怪的是,这六人中没有一个人死于肺炎。相反,死亡原因是心脏病,中风和高血钾水平(肾衰竭的结果)。已经患病的人中Covid-19的高死亡率可能不是由于病毒引起的,而是由于现有疾病的加剧而引起的。

  About 60%of U.S.adults have at least one underlying health condition,Tom Frieden,former director of the U.S.Centers for Disease Control and Prevention,told reporters on Monday.

  美国疾病控制与预防中心前主任汤姆·弗里登(Tom Frieden)周一对记者说,大约60%的美国成年人患有至少一种潜在疾病。

  Pregnancy

  怀孕带来的影响

  In early February,Chinese state media reported that a woman infected with the virus gave birth to a baby who later tested positive for it.Newborns might become infected because of close proximity to a patient,like anyone else,but the case raised fears that a pregnant woman can transmit the virus to her fetus via the placenta.

  2月初,中国官方媒体报道说,一名感染该病毒的妇女生了一个婴儿,后来对其进行了阳性检测。新生儿可能会因为与其他患者一样靠近患者而被感染,但此案使人们担心孕妇会通过胎盘将病毒传播给胎儿。

  Only one small study has investigated such“vertical transmission.”Scientists at Wuhan University found that,of nine pregnant patients infected with the virus(all had a caesarean section)in their third trimester,none seemed to pass the virus to their babies,all of whom scored at the top of the Apgar scale of newborn health.

  只有一项小型研究调查了这种“垂直传播”。武汉大学的科学家们发现,在9名妊娠晚期感染病毒的孕妇中(所有人都进行了剖腹产),似乎没有人将病毒传给他们的婴儿,他们的新生儿健康评分都排在阿普加(Apgar)量表的前列。

  As for the mothers,“Covid-19 seems not to be especially severe in pregnant women,at least based on the small number in this study,”the scientists wrote.That was somewhat surprising because pregnancy suppresses the immune system(so it doesn't attack the fetus);pregnant women are more susceptible to respiratory pathogens than non-pregnant women.Nevertheless,none of the nine women developed severe Covid-19 pneumonia.

  至于母亲,“Covid-19似乎在孕妇中并不特别严重,至少根据这项研究中的少量数据,”科学家写道。这有点令人惊讶,因为怀孕会抑制免疫系统(所以它不会攻击胎儿);孕妇比非孕妇更容易感染呼吸道病原体。然而,这9名妇女均未出现严重的Covid-19肺炎。

  It may be that immuno-suppression is actually helpful.Some of the most serious symptoms of Covid-19 result from an immune system on the rampage rather than a lethargic one,Chinese scientists found:An extreme immune response called cytokine storm,a flood of immune cells and the biochemicals they produce,tears through lung tissue.

  也许免疫抑制实际上是有帮助的。中国科学家发现,covid-19最严重的一些症状是由免疫系统失控而非免疫失效引起的:一种被称为细胞因子风暴的极端免疫反应,大量的免疫细胞及其产生的生化物质撕裂肺组织。
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