3/23
Sarah 來的時候有發燒、哮喘、呼吸困難，而且她懷孕34周。她是一位護士在兒科診所上班。最開始的發燒、肌肉酸痛、渾身無力出現在一個星期之前，現在又有哮喘和呼吸困難，所以到急診室來就診。她胸片發現有雙側肺炎，常規病毒檢查都是陰性，在這種情況下理所當然要檢測新冠病毒。
可是因為沒有近期的旅遊史，接觸的人群裏也沒有確診的新冠病人，也就是說沒有接觸史。雖然Sarah 是醫務工作者也是高風險人群，但是卻不符合州裏衛生所送檢的條件，所以隻能把她的咽拭子送往LabCorp。我以前的文章提到過，在我們這個中西部城市，商業送檢四到六天才能出結果。
因為是懷疑新冠病毒，她從一開始就放在了負壓室，氣溶膠隔離。高氧治療保證她和胎兒的供氧。也上了激素，用來促進胎兒肺葉成熟，如果被迫提早分娩，能夠降低胎兒出生後的呼吸窘迫。
等待結果的過程理所當然的牽動著眾多人的心，我想知道結果，孕婦想知道結果，孕婦的家人也想知道結果，但是一直等到Sarah燒退了，呼吸症狀改善了，要出院了，我們都還是不知道結果。我隻能在出院的時候囑咐Sarah，回家了還要繼續隔離，一有結果我就會通知她。如果是陽性，至少Sarah熬過了這一關，但是也請觀察家人的症狀。如果是陰性，正好是皆大歡喜的結果。
在這個病區，還有10幾個病人因為種種原因，同樣排在等待結果的路上。由於沒有快速的診斷，待查的人積壓得越來越多，占用著負壓室的資源，同時抗新冠病毒的專用藥也上得很猶豫。
現在很多文章都在討論氯奎和阿奇黴素的聯用，在新冠病毒治療中的效果。在我看來並沒有神奇的特效藥，理論上講氯奎可以抑製病毒的濃度，減緩病症的進展，但是在臨床上，卻看不到藥到病除這樣的效果。根據醫院的治療指南，隻要是確診了新冠，沒有明顯的禁忌症，這種兩種藥物是標準治療。即便如此還是有不少病人症狀繼續惡化，上個周未有兩個病人被插管上呼吸機，今天又插了一個。
據說真正很有作用的藥物隻有人民的希望，Remdesivir, 但是這個藥物的產量有限，絕大部分人都用不上了。現在的標準是如果病人小於18歲，或者是孕婦，有可能會敲加入臨床實驗，從Gilead 拿到注射劑。其他的病人已經沒有可能了。
3月7號我們州裏診斷了第一位新冠病人，今天3月23號這個數字是216個，到目前為止，州裏還沒有一個人用上人民的希望。已經有4位病人去世，今天剛剛去世的是一位30多歲的女性病人。
帶娃是持久戰,dqdeer, 西北東南, xinn2005. Thanks for the support. 大家都保重。
抗疫伊始，病人日增，醫護人員的安全保障是第一重要的事情，希望你們那裏抗疫一線人員的防護裝備已經妥善到位。
請查悄悄話。
Desperate for Covid-19 answers, U.S. doctors turn to colleagues in China
文中也提到Some patients received the malaria drug chloroquine, which President Trump has touted and which is being tested in a World Health Organization-supported clinical trial, but the Zhejiang team did not have rigorous data on its effects. They tried tocilizumab, too, a drug that has enough potential that on Monday, Genentech announced that it had received U.S. Food and Drug Administration approval for a clinical trial in Covid-19 patients with severe pneumonia; the rheumatoid arthritis drug, which goes by the brand name Actemra, might quell the out-of-control immune reaction that has killed many Covid-19 patients.
That experience has involved everything but the kitchen sink, though informed as much as possible by science. Several antivirals, including the HIV drugs lopinavir and ritonavir, did not accelerate recovery or reduce mortality, ICU physician Xiao Lu said. Some immune system regulators — including alpha interferon, anti-IL-6 monoclonal antibodies such as tocilizumab, and immunoglobulin — showed hints of efficacy in some critical cases.
還有誰應該住院
Who should be hospitalized, the Hopkins physicians asked? Suspected cases can be isolated and observed in their homes, they were told, as doctors in overwhelmed Italy are also telling U.S. doctors. Mild and moderate cases can be treated in mobile units, away from other patients; coronavirus spread within hospitals has been disastrous in Italy. Severe and critical cases in China get hospitalized, but at a dedicated facility, to reduce spread from Covid-19 patient to hospital worker to non-Covid-19 patient.