2022年5月27日 星期五

新冠病毒的第二波發展與台灣的部署:人類如何與新冠病毒共存?

 

新冠病毒的第二波發展與台灣的部署:人類如何與新冠病毒共存?[1]

The Second Wave of Covid-19 Virus and Taiwan’s ResponsesHow could we Co-exist with Covid-19

 

李瑞全

中國哲學研究中心研究員

 

2020年新冠病毒從武漢肆虐開始,不但武漢封城,大陸不斷在各地有零星的爆發,而意大利與西班牙相繼淪陷,由於感染和死亡人數急升,醫療體系崩潰。繼而傳到美國,大都會的紐約也感染和死亡急升,日以數千人感染,以至上剒萬人死亡。後來傳到南美、非洲與印度,確診與死亡突破了千萬,死亡人數更高達百萬。病毒也經歷多次的變異,而傳播與殺傷力日強。雖然在2020年底開始有疫苗,但只能起到初步的減緩感染,但不久即由於變異株的不斷進化,突破性感染不斷發生和擴張,疫苗並無法抵禦。到2021年底,歐美與日本韓國等國家,由每日從數千到數萬,以至數十萬確診,美國更有一天有一百萬人確診的最高紀錄。依WHO統計,從2020年初到2021年底,全球有紀錄的死亡人數為450萬人,至於不少地區發生過嚴重感染而沒有明確醫療紀錄和死亡公告的人數的尚未計算在內。因此,其中有黑數,即第三第四世界國家中的確診人數和死亡人數超出明確紀錄甚多,WHO專家算,若依這兩年超額死亡人數計算,因新冠疫情病殁的應有1500萬人!。因此,有學者估計這次疫情已超過二十世紀初的西班牙流感所感染了的五億人以上。新冠肺炎可說是人類歷史上最嚴重的流行疫症,而且是尚未見其終局的一次全球性的流行病。

而在2021年底,歐美等醫療體制先進地區已開始放棄對抗,因為,在防疫與治療方面,已不足以應付快速變異和傳染的病毒變異株,已不能阻斷它的傳播,更遑論把它消滅,因此,只能採取與病毒共存的方式,只求盡量減低病毒的傳播與傷害。一方面減低確診人數和死亡人數,一方面保住醫療體系的運作,避免傷害其他疾病的病人所必須得到的照護,避免不必要的死亡。幸而最新而又成為主流的病毒奧密克戎(Omicron)雖然傳播力極強,因而淘汰了之前的變異株,受感染的人數仍然急劇上升,但殺傷力卻似乎大減。根據各國的數字,打了疫苗(以西方使用的mDNA疫苗為準)的確診者從約3%的死亡率降到打了一針劑約為0.1%,打了兩針劑的為0.02%,打了三針劑的再降為0.01%(由於各國各有差異,此只是根據2022年英國由1月至3月公告的各項數字所統計出來的估計數字),即打了疫苗仍然會死亡,但打了三針劑的一萬名確診中只有一人死亡。由於全球尚未打疫苗的人數仍有數十億之多,而地球村與全球化的情況不容許任何地區自外於與其他國家或地區的交流商貿,而疫苗的效力仍然有限,也不能根絕感染(即突破感染),故全球式的不斷的感染無可避免,這是全人類所必須共同面對的疫情,因而也不可能有獨自成為「零感染」的地區。台灣社會現在正面臨如何從全力防堵疫情擴散而轉換為與病毒共存的階段。此中有幾個因素必須考量的。

首先是新冠病毒的傳播特色。最重要的是受感染者最初幾天會無症狀,但已開始感染他人,因此,當感染者出現確診症狀時,它已在第一時間感染了許多接觸的人,因此,除非是發現感染者即全力追踪並隔離感染的病人和接觸者,繼而追踪其第二圈和第三圈的感染者,或可能截住它不斷傳染開去,否則它必溢出已知的感染範圍,而成為追踪不到的黑數,此即表示社區已有潛在的感染者。但如果繼續全面而有效的追踪,則仍有機會可消除此中的黑數,不斷收縮其感染圈,而使大規模的社區感染不出現。這是台灣在2021年的桃園市感染的情況,但由於指揮中心與醫護人員傾力追踪,基本上成功地消除了這次危機,並無擴散的情況。但此必須之前沒有社區感染,而追踪得力,否則清除和防止社區式感染是無法成功的。在2020年中所見,美國、歐盟、印度與日、韓等地區,基本上都已淪陷,已成巨大的社區感染,也就是說全球性的社區感染已形成,已無法截斷感染源和堵住疫情的擴散。雖然2021年年底已有疫苗研發成功和進行接種,但病毒的變異和打疫苗的數量不足之下,這些先進的地區也無法防堵疫情的繼續擴展。由此回顧武漢和大陸最初的「清零」,實只是把確診或有接觸而可能受感染的人封鎖在社區之中,只是讓感染者在方艙醫院或社區隔離之中不斷互相感染,結果病人或是死亡,或是由自身的自然免疫力康復,轉而成為具有免疫力的人。在沒有疫苗和醫療藥物研發成功之前,這一病毒的死亡率(可稱為自然死亡率)約為3%,即會有約97%的人靠自身的免疫能力抵抭病毒的入侵而存活。若以為這是強力清零政策的成功,實是貪天之功以為己力的政治宣傳。當然,由於感染力強,感染者數量巨大,3%的死亡人數仍會成千上萬。如以武漢2000萬人口計算,即以最低的感染率(3%)和死亡率(3%)計算,約有60萬人確診,18,000人死亡。在最初大半年,沒有疫苗和有效的治療藥物之下,如美國在最初的一年內即有超過50萬人死亡。因此,在經歷了病毒傳播的地區,即使以強力的封區封城的方式來抵禦,只可能成功低感染的傳播,實無法阻截仍然在傳播中或已傳播到其他地區的感染者,形成日後小火處處,偶一爆發即須大力封鎖,否則仍然不免全面感染。而此種防堵方法,在感染力特強之變異株Omicron之下,雖然採取封樓封區封城的硬隔離方式,都無法有效地堵截得住。此即是今年四月發生在上海的情況。不但無法真正清零,只能靠核酸檢測的方式確定一個社區中人是否已康復,故必須日日複檢。也由於如此硬性隔絕,必然做成許多因為疫情而受傷害與死亡的情況。但由於全面消息的封鎖,外界完全沒有明確的數字可據。但病毒的性質如此,而全球的疫情已是全面流行,人類現代社會的結構又如是緊密,目前並沒有足夠的醫療科技可以消滅和堵截它的存在,妄顧疫情的實情,所謂逆天而行,只能擴大它的傷害,和對社會產生更強逼性的壓力和暴力。目前實只有採取與病毒共存的方式,盡量保住醫療體系的有效運作,減低受感染的人數和變成重症的死亡。

從客觀的數據所見,台灣在過去兩年的感染人數只在15,000名確診,死亡人數在800人左右,新冠疫情對於台灣的經濟和社會的活動自然有嚴重的衝擊,但基本上完全不影響其他疾病的病人的醫療,也沒有發生物資、醫療藥物與糧食的缺乏,這是非常突出的公共衛生的政策和調控成績,全世界實難出其右。這一成績也是由台灣民眾自願配合方能成功的,即,民眾在生活上自行做足各種保護自己、保護家人和保護他人的公共衛生行動,如帶口罩、勤洗手、常消毒、減少大小型的聚會活動,等等。但面對不可能再強行堵截得了的新變異株,或以後更凶猛的新株,台灣的醫療對策也必須進行轉型,而這一過轉過程,最重要的預防是不能讓醫療體系像其他先進地區在鬆綁後即陷於崩潰或爆量的感染和死亡。指揮中心可以說從今年(2022)三月初正式開始部署,諸如擴大醫療建設和相關的藥物儲備,如訂購快篩試劑、不斷推銷和縮短感染者的居家隔離日期、放寬確診輕症者居家隔離之條款、催促民眾特別是完全沒接種疫苗的人和老年人加快打疫苗,等等。在推高接種疫苗的比率上,雖然不能說極為成功,但基本上,除了幼兒和老年人之外,中青年的社會總體都已打了一至三針劑,全體的接種率已接近90%,打了第三針劑的也超過60%。從41日的每日確診數104人發展到430日為17000多人,總確診人數為88,880人,(約略的估計是五天左右翻一翻);而重症死亡者只有11位,多為70歲以上的老人。(確診數字在5月後自然會繼續急升。最新的數字在55日為3萬多人,但確診人數常有上落不定的表現)。這比諸前述各國在所謂第二波的疫情中急速升至數十萬,台灣的調控可謂相當成功。由於Omicron的傳染力強勁,近日的確診數字急升,民眾為自保而開始貯藏一定數量的快篩試劑備用,讓人感覺政府提供的快篩試劑略為緩慢不足,因而有巨大的壓力,但尚不致引起社會恐慌。由於台灣民眾相當自發自主地執行預防疫情的各種公共衛生行動,群眾聚會仍然很有節制,民間保持一定的居隔和隔離的措施,以及相當嚴緊的邊境疫控,因此,確診人數雖有增加,但仍在預估和控制的範圍之內,死亡人數約在0.0124%(11/88880即約10萬人有12位死亡)。若以台灣的良好防疫和接種疫苗的高比率,估計在這一波疫情中約有150萬人確診,社區的免疫力(近乎95%)會使病毒的傳播率漸遠低於1(RO<1)時,死亡人數應不超過3000人。之後的感染率和死亡率都會平穩定在與流感相若的情況,中華民國即可安心進入與病毒共存的發展。(但如果染疫人數更高,或新的變異株又再傳入,死亡人數再升高,即死亡率可能要重寫,則確診人數會再升高,難以預測。)

但是,我們不要以為能與病毒共存即可以無憂。因為,不但由於疫情實難以預估,疫苗與醫療藥物研發的困難,而各國又不真能和衷共濟,有一致的策略和資源共享,疫情發展到現在已超出任何一個國家的控制能力之外,甚致已超過全球唯一能協調跨國合作的聯合國的WHO能力之外。此因病毒感染已在全球範圍內不斷密集的感染與重覆感染,病毒的變異株層出不窮,疫苗的研發追不上變異株的速度,無法以疫苗的推廣堵截疫情的擴張。最理想只能夠是每年都有新的疫苗改進以適應新的變種。但因病毒感染而死亡的人數將無法減低。至於病毒的後續發展(所謂長新冠Long covid-19)即後遺症為何或有多大的傷害,目前實難以估算。因此,我們不能簡單以為病毒已成為流感式的感染,即可以安枕無憂。由於新冠肺炎的傳播力遠高於流感,受感染的人數龐大,實際的死亡人數每年可能仍然會以10萬計的。我們仍然需要全球性的合作,方可減免減低此病毒的傷害。而這正是全球性的流行病最難以掌控的一環。

由於公共衛生的政策需要有宏觀的構想和預估,而其中在國內涉及個人自由自主與社會整體之利益與安全,而在國際上則涉及各國之間的利益與負擔之分配,而此中實有許多公義與公平性的問題。在國內方面,西方式的自由個人主義常不滿於國家在這種公共政策上的權力的擴張,嚴重侵害公民的生活自由與權利。而在集權國家中,強大的國家力量卻使民眾的生活與生命被置於任人宰割的困境之中,以致常由於疫情而飽受不必要的痛苦,以致死亡。因此,如何在國內取得個人自由與社會安全的平衡,是公共衛生倫理的最重要也是最難得到共識的課題。在公共衛生倫理方面,學者所支持的一個基本原則是所謂「警慎原則」(principle of prudence,一般譯為「審慎原則」,常視為一種工具性的運作,缺少了在此應有的嚴重的道德性)。此原則要求在公共衛生政策上必須遵守五個條件:有效性、必要性、符合比例要求、最少違反人權的行動、 具備公共透明和道德上可辯護的條件。此中即要求任何相關的政策或行動都要根據合理的醫藥研究成果和照顧每個人的生命與生存的道德理由,而且要高度發揮人民的自覺參與,民主和客觀監督的社會力量。因為,政府常以這種集體的安全利益為藉口,常更進一步剝奪人民的獨立自主權利。在一個意義之下,此原則所指示的政策與行動,可說是中國傳統文化中對公共事務的處事原則和態度[2],即,以公開說理爭取民眾的支持,接受民眾的監督和參與,最大限度地避免人民受到傷害,符合醫學與生命科學對病毒的了解,採用取合理而有效的方式達成最優的結果。在疫情中,我們必須有「人人為我,我為人人」的「中國一人」的生命共同體的精神,不能只自利為己,也同時要為他人的利害與權益來考量,要有一夫之不得治,猶如自己之生命的傷害的同情共感。警慎原則所規範的基本要求正是公共衛生政策必須減少和避免人民受到的傷害,不能有任何欺騙和暴力的宰制,絕不能假公共利益之名而罔顧人民的需求和痛苦,更要重視和保護每個人的生命與價值。西方的公共倫理原則也以救活最多人為基本政策,而非空談政府或政黨的權力與利害。各國面臨如此重大的民生事件,都不免有政府與政黨的私利滲雜其中,唯有讓人民發揮自主自願的參與,支持專業的決策,方能真正做好防疫與消除疫症、減輕傷害的政策與行動。台灣的指揮中心在隨變化而作滾動式的修訂,方真能符合警慎原則之有效性與必要性的要求。

在國際上,由於全球性的傳染病是沒有國家能獨立處理得了的事,因此,國家必須打破以自己國家民族的利益為至上的原則,方可有望成功地對抗人類的共同敵人。此實需要各國的政府和民眾,站在世界公民的角度,共同體認全體人類的安全和利益。在國際間的防疫政策上,猶如在一國之內,個別國家的利益與全體人類的利益必須和衷共濟,求取雙贏,才有望減低疫情的傷害。各國與每個民族中人必須認知到在這種全人類的災難之下,「為人即是為己,為己即是為人」的一體觀,才真能減低疫情對自己、家人和所有人的傷害。此即儒家之「天下一人」,即天下一體,必須和衷共濟、共度此災難,方有助我們和後代子孫的最佳利益。此時,警慎原則五個條件,可以運用到跨國的公共衛生政策上,成為跨國合作上必須遵守的原則,務求以最合理的方式和行動,以達到盡量減除病毒的傷害,最終或可戰勝此一病毒,讓世界各族人民與我們的後代子孫得以健康成長。

(2022526日校訂)

 

補充說明幾點:

自本文以上所已探討和分的基本情況以來,台灣回應疫情的表現與所產生的一些錯解與誤解,值得加以進一步的分析與說明。自20225月以來,台灣採取「與病毒共存的策略」以來,一如所料,確診與死亡人數開始上升,至5月底已發展到徘徊於每天約有6-9萬人的確診,死亡人數在50(平均數)之間。偶而或有人們需求的藥物不足之處,但基本上都沒有真正嚴重的短缺。而確診人數與死亡人數亦比諸各先進國家在「不得不共存」之下更能調控,更沒有引發醫療系統的全面崩潰,以及由此產生許多的「由於新冠病毒而有的相關的病人的死亡」。唯一值得我們反思和說明的是,這兩個月間的死亡數字不尋常地高於一般的比率。香港在過去數月間的感染確診的病人的死亡率也偏高。其中一個重要的因素是打了疫苗的比率似乎不算太低---實質上香港人對政府的不信任,不願去接種政府所提供的疫苗是民間的一種抗拒表現,而所接種的疫苗的免疫效力是否夠高與能否持續得夠長時間,都是很有疑問的,而且普遍認為隔離的方艙不但條件甚差,更增加互相感染的風險。因而自行篩檢為陽性也不去報備,只自找各種藥物自療,而相信絕大部分都是輕症,因而稍休息幾天和自我居隔都自行痊癒。這種情況是目前最流行的奧密克戎變異株的特性。因此,香港的黑數確是高的。但黑數中嚴重感染的會變成重症和死亡,這種案例則難以隱藏,因此,相對的死亡率自然升高。台灣目前的情況也相類似。而且,由於病毒的感染最容易在家中發難,因而,之前由於可以不外出而避過感染的老弱群眾,這一波會成為最容易受攻擊的族群,因此,近期台灣的死亡病人基本上是未有打過疫苗的人,如幼童和部份老年人,以及許多因有各種長期疾病(如高血壓、糖尿病、血管病等使病人免疫力受損的疾病和各種罕見的隱疾)而卧床的,此中老年人口特多。而台灣與香港一樣,屬高齡社會,老年人的人口比例較高,因而逃不過家庭中的感染,由是成重症而死亡(死者中多有不予復甦DNR的同意書)。死亡數字顯示,70歲以上的死亡人數佔居榜首,近乎3/4。西方國家老年人的人口比率較低,而在第一波和繼後之新變株(alpha, delta)疫情之後,或已多已死亡,或已得到免疫力保護,因而到第二波之奧密克戎(omicron)的巨大感染率的後期,死亡率大減,這第二波的死亡率到目前總體已降到0.001%左右(即一萬病人中只有一人死亡)。依疫症發展的合理評估,台灣在近期較高的感染和死亡期(最樂觀估計是兩星期)過去之後,群體免疫力達到較高的比率時,確診和死亡人數會逐步下降。依台灣過去兩年的防疫表現,由於民眾的高度自主自律,保護自己,保護家人,與保護他人的同理心之下,保持高度的公共衛生防疫意識與習慣,在與病毒共存的發展上,台灣仍然會跑贏絕大部份的西方先進國家。

1.     社區黑數已不重要

有謂社區中仍然有不少「黑數」,即,有更多沒有被紀錄的病例和在不斷擴大傳播中,等等。這些所謂「黑數」是指沒有報告的沒有症狀和輕症的病人人數,因中重症病人是難以隱匿的。在「與病毒共存」的環境中,基本上已接受病毒在社區中的傳播,已不再去圍堵或追踪,而是由社區的群體免疫力作基本的防禦,主要的醫療對策是統計已有症狀的病人和提供相應的治療,以居家防疫為主,避免發展成為中重症,而醫療體系基本上只治療中重症,以免病人死亡。因此,已無所謂「黑數」的問題。由於我們的自然免疫力和注射疫苗後有相當高的免疫能力可以抵禦最新的變異株奧密克戎而自行痊癒。不積極對這類病人予以治療是合理的政策。所以這些沒有被報告出來的病例,許多人根本尚不知道自己已感染了,若能自我約束,實質上不會做成嚴重的擴散。若這類病人發展成為中重症,則必被現發現和進行治療。但因為要確定和全數知曉誰是染疾者,在實質上也不能也沒有必要提供任何治療,所以不必要投入巨量以至 無限量的醫藥資源和人力去處理。這些如果這些黑數被計算出來(最確定的自是全民式的核酸檢定)反而可以在數字上減低相對的死亡率,但這種數字對疫情的降低完全沒有作用。而在如是追求數字的了解上,所產生的由全體居隔和不斷檢測的大量工作與硬性的隔離所做成的更嚴重的傷害、民眾的恐懼、生活資源的不公平分配、感染風險的增加和死亡等,只會更惡化疫情和整體社會的健康。但由於疫情已進到社區之中,對於免疫力有損的幼童和80歲以上的老人家和有長期疾病的病人,家庭內的衛生防疫工作必須更嚴謹,也要更加留意病情的癥狀了。

2.     新冠病毒與流感不同類

在過去大半年的全球疫情中,我們知道「與病毒共存」已不可避免,而在疫苗的支援下,病毒的死亡率已與流感相差不多,所以許多已經歷了第二波的新冠病毒疫情大流行之後的國家,基本上採取視新冠病毒如流感,不再也不能全力去消滅這種全球性的疫情和病毒,而只能尋求共存。但把這種全球性的疫情(pandemic)等同流感式的流行病(endemic),仍有不足的條件,目前來說實是一誤區。因為,新冠病毒的傳染力遠強於流感,雖然死亡率相差不多,但確診人數遠高於流感,因而總體的死亡人數實遠超於後者!而且,由於新冠病毒的後遺症仍然有許多未知數,很可以嚴重影響確診者的後續健康、工作、生活和長期治療的需求。因此,我們目前沒有任何理由視之為如流感一樣,讓自己或家人受到嚴重的不可知的傷害。換言之,目前我們對防疫的公共衛生工作仍然不可以鬆懈。

3.     不可誤認人人最終都不免感染病毒

也有認為由於新冠病毒傳播力如此強,我們已不能不採取「與病毒共存」,而專家估計要達到總體具有95%的人都有免疫力,才會產生社區免疫。因而有人認為社區中人最終都不免受到感染,不必要再費神費力去做任何的防禦,甚致愈早得病愈好,云云。這亦是一嚴重的誤解。我們之能與病毒共存是因為當我們的社區的總體免疫力達到一個足夠高的程度時,它的傳播力才會日減,才真能共存。而此一免疫力是打了疫苗而產生的免疫力與因感染而產生的免疫力的總和要高到超過95%的人都有免疫力,社區感染才會降低或停止,群體免疫成功,這時候才真能與病毒共存。專家估計若有超過80%以上的人打了疫苗,則配以15%20%的感染後的痊癒率,方可以達到群體免疫。其中實有超過80%的人不曾感染過病毒,不是人人都必然受到感染的。因此,為避免任何不良的病毒感染所產生的傷害,我們仍然人人都要多打疫苗和做好防疫的公共衛生行動,如此方能真正達到與病毒共存而不致有更多不良後遺症和不應有的死亡。

4.     與病毒共存必須有全球性的公共衛生行動

但要達到長久的與病毒共存,是不能只限在一家一國之內的。我們必須追求全球性的與病毒共存的情況,否則,病毒必然會捲土重來。因此,我們不但在自己的社區內與病毒共存,也必須促成全球範圍內的共同的與病毒共存的情況。因此,我們必須全力支援醫療藥物不足的地區和人民,以減低病毒之傳播力度和廣度,防止病毒的不斷變異,支持研發和加快研發疫苗的生產,以合理的價格分配疫苗和協助貧窮國家的同胞取得免疫力。在這種全球性的疫情中,大國要出錢出力,發揮和生產最先進的疫苗和治療藥物,以減低病毒的傳播,和最終消滅病毒,才可能真正減低感染和徹底消除病毒的傷害。而弱小國家,也得採取自愛自律的公共衛生行動,遵行必要的防疫措施,以共同減低病毒的傳播以至消滅之。

5.     由與病毒共存到天下一家的永久和平

正如許多不斷在發生和惡化的全球性的災難,不但是任何個人或國家民族所不能自保或置身事外,也不可能獨自面對和解決的共業。這次全球性疫情再一次印證了人類最終仍然是地球上生命的共同體,我們必須分享共同的資源與共渡這一災難。由互助以促進國家與民族之間的互助互諒,走向真正的天下一人,友愛合作,達到永遠的和平。這將是人類藉危機而走向和平共存的機會。事實上,我們除了疫情之外,已經存在和不斷惡化的全球性的環境危機實已不斷在加深之中,我們實有更迫切的義務與責任,為自己與為後代子孫的共同未來,盡我們的努力。

 



[1] 本文是發表在《鵝湖月刊》第563(20225)一文,完成於5月初,經近一月的最新觀察和民眾關心的議題,特別再作一些補充說明。

[2] 在此是以孔子之「民可使,由之;不可使,知之」與「以不教民戰,是謂棄之」所含之政府的公共政策須盡告知、教育與取得認可等為施政的基本原則,由此可引生警慎原則的基本要求。

2021年6月29日 星期二

 

在更毒的新冠病毒侵襲台灣之前:分析屏東Delta之傳播異象

 

李瑞全

 

有關屏東由秘魯回台祖孫二人染了傳染力最凶的Delta病毒,奋而引發一群聚的感染,不但指揮中心非常緊張,屏東更宣布進入類第4級警戒,急速匡列近二千人進行篩檢。以近月的疫情來看,我們的篩檢與防疫的空間與防線如此狼狽,因此產生不少未被偵查到的感染源出現,也因此,一直不能完全匡列和隔離陽性受感染的病人(居家隔離實是讓家人成為第一線受感染者,而且防堵不住)。如果這種新病毒進入台灣,而以台灣已接種的第一劑疫苗人數比例如此低,後果之嚴重,可想而知。但這次傳播的情況卻不象傳聞的那麼快速和發病率不高,甚致被匡列篩檢的被感染成為陽性的人居然也極低!其中實有一些可能與這對祖孫的感染情況和用藥有關。因為,據聞南美地區,包括秘魯,感染 Delta病毒的很多,盛傳他們都是用美國幾位頂尖新冠防疫和治病的醫學專家所推薦的一種安全的治療寄生虫的藥物,名為Ivermectin(伊維菌素)來治療和預防新冠病毒。因為這種藥很便宜,而且療效可以達到八到九成以上。(參見附文)這個藥物是日本醫學家大村智(Ōmura Satoshi)與Merck 藥廠的寄生虫專家威廉·塞西爾·坎貝爾William Cecil Campbell)在17年前共同發現,兩人在2015年同獲諾爾醫學獎。此藥的副作用極低,已被列為WHO基本藥物名單之內,訂價極低(約012美元),Merck每年都免費捐贈百萬劑給非洲等落後國家。此藥在20205月被澳州一群醫學組發現可以在2日內殺死新冠病毒。而在許多國家,包括美國,治療效力達到八至九成,它對高齡重症病人更非常有效,這些已近死亡的高齡病人服食一、二劑即可脫離氧氣呼吸機,康復回家。這對祖孫可能已在秘魯感染,在回來前吃了這種藥,因而病毒近於被消滅而清,但毒性和數量已減低,而其他接觸的家人或鄰居一時都沒有發病,只有接載他們的計程車司機出現病狀,而追踪到他們的鄰居和他們兩人。但此病毒似乎不如在英美等地的高度而快速的傳染發病方式!我不知道中心的疫調人員有沒有詳細追問他們的用藥,或不以為吃這種藥有療效而不予紀錄。但運用這個藥治療好末期新冠病人實有很多案例和醫學報告的支持。這推薦這個藥物是美國最早第一線有名的治療新冠病毒的一群專家專家聯盟(FLCCC),他們是設計現行標準治療新冠肺炎程式和用藥的標準之一的第一線專家,做了與Ivermectin(伊維菌素)用藥的學術研究報告超過27項研究,16個隨機測試,最少有33 篇研究報告等大量數據,基本上都證明Ivermectin(伊維菌素)是有效的,且防疫功能高達90%,且幾乎沒有任何不良的副用。他們在美國的發言人是團隊中最年輕耶魯大學的醫學副教授Pierre Kory,且在去年128日曾在美國國會的專責聆證會做了正式的報告,但當時國會的民主和共和黨委員都不出席,紐約時報且預先出了評論,認為這是非科學的言論,推銷莫名其妙的藥物等,且污衊為與川普有關,等等,其後更被各大媒體和主要的網踏大頭所共同封禁,一律視為假消息,不準發放。縱使第一線的醫師和醫學專家的相關言論,都一律被馬上刪除。一般相信這與跨國大製藥企業和電際通路商的打壓有關。但去年在美國芝加歌一大醫院發生一宗案例。一對兄妺為受感染也快死的80多歲高齡的母親要求使用這種藥物,但被醫院和醫師拒絕,他們告上法院,法官快速開庭和判決要醫院提供此藥,而病人吃了第一劑後即馬上有好轉,兩天之內就不再用氧氣機,肺部恢服功能,雖然中間也有反覆情況(受過如此嚴重病毒催殘的老人,自然可以有各種不明狀況出現),但幾天之後病情即穩定,可以出院回家!當然,由於這種是於所謂原定藥用之外的使用(off-label use),這個藥用於治療新冠肺炎仍然有許多醫學上的認證,但對於現行用了昂貴又不能治好病情的臨終病人,應可以准許病人使用這個藥物來救命。這個藥物如果真成為醫用藥物,對於跨國藥企的和受資助的科學研究者的研究,打擊自然極大,也因此,此中實有很嚴重的陰謀論在內。但在救人為先的天條之下,醫師與醫院不應拒絕讓病人最後使用Ivermectin(伊維菌素)作最後一試!

 

對於更多更嚴重的病毒變種不幾出現的情況,而各國又躍躍在開放旅遊,而台灣在接種疫苗的比例偏低,我們實要加強快速而嚴格的篩檢和預備更充份的隔離疫所,不宜讓確診者在社區出沒。在匡列之內而又未確知是陰性的人,必須要守嚴格的居家隔離的要求。準確的快篩可以有效地減低隔離的天數。我個人支持以下的幾點防疫措施:

1.     加快篩檢的速度,應在一天之內得到結果。

2.     嚴格進行全面篩檢入境人士和採取少14日的隔離,除非己有疫苗護照和入境前三天的CPR的陰性證明

3.     所有與確診病人有接觸的人士的被匡列者都必須隔離和進行快速的CPR檢查。

4.     在治療用藥上應可以開放讓病人採用Ivermectin(伊維菌素)。


附錄:(註釋中有一研究報告列出用藥的份量和天數)

 

Top Yale Doctor/Researcher: ‘Ivermectin works,’ including for long-haul COVID

https://trialsitenews.com/wp-content/uploads/avatars/179/60609eda0e511-bpthumb.jpg.webp

Mary Beth PfeifferMarch 22, 2021

9 Comments

Top Yale DoctorResearcher ‘Ivermectin works,’ including for long-haul COVID

Note that views expressed in this opinion article are the writer’s personal views and not necessarily those of TrialSite.

A Yale University professor and renowned cancer researcher has pored over the COVID-19 literature and treated several dozen patients. He can remain silent no longer.

Dr. Alessandro Santin, a practicing oncologist and scientist who runs a large laboratory at Yale, believes firmly that ivermectin could vastly cut suffering from COVID-19. Santin joins a growing group of doctors committed to using the safe, generic drug both as an early home treatment to prevent hospitalization and alongside inpatient treatments like steroids and oxygen.

“The bottom line is that ivermectin works. I’ve seen that in my patients as well as treating my own family in Italy,” Santin said in an interview, referring to his father, 88, who recently suffered a serious bout of COVID. “We must find a way to administer it on a large scale to a lot of people.”

Santin’s statements carry the prestige of a leadership position at Yale School of Medicine and the gravitas of a top uterine cancer researcher, who has authored more than 250 science journal articles and pioneered treatment, used worldwide, for the most aggressive form of uterine cancer. At Yale, he is an OB/GYN professor, team leader in gynecologic oncology at the Smilow Comprehensive Cancer Center, and co-chief of gynecologic oncology.

Improvement Across the Board

When COVID came along, Santin began reading about how best he might help his cancer patients, 10 to 20 percent of whom were coming in infected with COVID. He began using ivermectin after the National Institutes of Health changed its advisory in January to allow the drug’s use outside of COVID trials.

Santin’s endorsement is not only important but broad. He said he has seen ivermectin work at every stage of COVID — preventing it, eliminating early infection, quelling the destructive cytokine storm in late infection, and helping about a dozen patients so far who suffered months after COVID. One of them is an athlete and mother of two, 39, who had been disabled by post-COVID chest pain, shortness of breath and fatigue; she confirmed in an email to me her joy at being able to walk up a hill again and breathing better within 72 hours of her first dose.

“When you have people that can’t breathe for five, six, eight, nine months and they tried multiple drugs and supplements with no success, and you give them ivermectin,” Dr. Santin said of long-haul patients, “and you see that they start immediately feeling better, this is not placebo. This is real.” 

The majority of patients improved within one to three days, he said, particularly those with breathing problems, debilitating fatigue and chest pain. Two draft studies from Peru have reported improvement with ivermectin in long-haul patients; several physicians, like Santin, have also had anecdotal success.

Beyond his outpatients, Santin has treated family members and friends infected with COVID in both his home community in Connecticut and in his native Italy via telemedicine. There, he prescribed ivermectin to more than 15 families, in which parents, children or others had became infected; the goal was both to treat early and prevent severe COVID, as studies have shown ivermectin does.

“I have not a single one that right now had to go to the hospital to receive oxygen,” he said. “I have no doubt ivermectin saved my 88-year-old father’s life.” His father survived COVID despite high blood pressure, cardiac disease that led previously to seven stents and open heart surgery, and lung problems. “If I can save you,” he said referring to his father, “I can tell you, I save anybody.”

Santin said he has also consulted on inpatient care with a colleague at a hospital in his native Brescia, one of the cities hardest hit by COVID in Italy.

Two Italian newspapers first reported Dr. Santin’s experience with ivermectin, on March 5 and March 18. In the first article, he told the newspaper il Fatto Quotidiano, “Ivermectin can really be the game-changer against COVID-19.” He reported seeing cancer patients “radically improve their shortness of breath and oxygenation” within 24 to 48 hours of their first dose.

In a subsequent article in Affaritaliani newspaper, he described his surprise after first reading the body of 40 positive ivermectin studies and then using the drug on patients. “I did not expect that a drug approved over 35 years ago with other indications [namely to treat parasitic worms and scabies] could really be so effective and well tolerated in COVID patients,” he said.

In both articles and in my interview, Santin pointed to the crucial advocacy of Dr. Pierre Kory, an ICU specialist and perhaps the nation’s strongest voice for ivermectin as president of Frontline COVID-19 Critical Care Alliance.

Doctors: Read the Research

Kory said Santin’s experience is typical of doctors who take time to scour the new ivermectin research. “I’m just so encouraged that other thoughtful clinicians are able to assess, to investigate, to look at the evidence and make a judgment on the risk-benefit analysis,” he said of Santin.

Both physicians faulted doctors who don’t read emerging science and instead follow rigid hospital protocols; these notably leave out ivermectin, even though the drug has now been given the same neutral NIH recommendation as monoclonal antibodies and convalescent plasma.

As a result, newly diagnosed COVID patients are typically told, as they have been for a year: Go home, take acetaminophen perhaps, and go to the hospital when breathing gets tough. In other words, get sicker before you get care.

But even hospital care has huge gaps. “When you are an inpatient with severe COVID right now, “ Santin said, “you give them a steroid, you give them heparin and remdesivir. That’s it. If they improve, great. If they get worse, you unfortunately keep on watching them die.”

“I was very disappointed, and I’m still very disappointed, about the treatment protocols that we currently are providing to patients,” he said. This is why, he told me, he has decided to speak out.

Kory and Santin differ in one respect. Kory believes long-haul syndrome is driven largely by inflammation; Santin sees a significant role for persistent infection, namely live lingering viruses.

In the scheme of things, this is a small issue. The key to halting COVID is to use the drug, both doctors agree. Instead, mainstream medicine, the press and public health officials in the U.S. and Europe ignore it, while India, Bangladesh, Peru, the Czech Republic, and other countries reap its benefits.

Put Focus On Therapies

The Western approach to long-haul COVID is a case in point. Studies at many university centers are focused in general not on treatment therapies but on defining the long-haul syndrome. As a result, Kory said, patients with cognitive issues, pain, breathing and heart problems are referred to specialists with few tools to help them.  This may be understandable given that long-haul research is scant and raw.

But for doctors like Santin and Kory, existing safety data and clinical research gives ample reason to try ivermectin at every stage, including in the 10 percent who have what the FLCCC calls “persistent, vexing, and even disabling symptoms after recovery.”

Fred Wagshul, a pulmonologist in Dayton, Ohio, tried ivermectin for five to seven days in what he called “true long-haulers.” Most reported significant improvement in days. Similarly, Peruvian researcher, Gustavo Aguirre-Chang, reported on 33 long-haul patients who were given ivermectin one to three months after resolution; 88 percent got better with two daily doses.

The Story of Sam Dann

Sam Dann is the poster boy for what COVID can do to a muscular, active 41-year-old and regular jogger. Like many other patients, he was sent home after a positive test last July with the advice to “drink Gatorade and take Tylenol.” 

Over the next months, “I went through an absolute living hell,” he told me, that was worse than three tours in Iraq.

After the initial bout of infection, he experienced crippling fatigue, anxiety, sleeplessness and nightmares, uncontrollable tremors, a racing heartbeat, and an inability to think straight or recall basic information. He could not work.

Some six months into his grueling odyssey, Dann went to Dr. Bruce Boros, a Key West, Florida, cardiologist and urgent care center owner who, after treating about 200 patients with ivermectin, is now offering it prophylactically. There, Dann got a 10-day prescription for ivermectin.

The vertigo went away almost immediately. The tremors calmed. The nights were difficult but gradually improved. The pain went from 8, on a scale of 10, to 1 to 3. “I still get weird feelings here and there,” he told me, “but I’m nowhere where I used to be.”

Despite stories like this, every day in the United States and elsewhere, we are minting new long-haul patients just like Sam Dann. Said Dann, “There are a lot of dead people because they refused to acknowledge this drug’s usage.”

Santin’s advice to doctors who unquestioningly follow COVID protocols is this:

“Use your brain. If your patient is dying, change something, try to do something more.”

Of ivermectin, he said, “It’s safe, it’s cheap and it works.”

 ***Mart Beth Pfeiffer is an investigative journalist and regular contributor to Trial Site News.  Her website can be found here. Twitter: @marybethpf.

Follow the TSN Ivermectin Channel

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 Tagged: COVID-19DoctorIvermectinLong COVIDLong HaulersResearcherYale

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Mary Beth Pfeiffer

Mary Beth Pfeiffer, author of Lyme: The First Epidemic of Climate Change, has been an award-winning investigative journalist for three decades. A reporter who has specialized in social justice, environmental and health issues, she is also author of Crazy in America: The Hidden Tragedy of Our Criminalized Mentally Ill. The book is a critically acclaimed look at treatment of the mentally ill in prisons and jails in the United States. Pfeiffer is married to Dr. Robert Miraldi, whom she met when both were reporters at the Staten Island Advance. Miraldi, a Fulbright scholar and journalism professor, is author of Seymour Hersh: Scoop Artist. They have two children, four grandchildren and a Shih Tzu named Bushwick.

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gunnarJune 10, 2021

Find below how the U.S FDA describe an EUA:
The key text to think of is : “and that there are no adequate, approved, and available alternatives”. So it is logical to assume that EUA beneficiaries will work to assure that alternatives are held back:

Q. What is an Emergency Use Authorization (EUA)?
A: Under section 564 of the Federal Food, Drug & Cosmetic Act, the FDA may, pursuant to a declaration by the HHS Secretary based on one of four types of determinations, authorize an unapproved product or unapproved uses of an approved product for emergency use. In issuing an EUA, the FDA must determine, among other things, that the product may be effective in diagnosing, treating, or preventing a serious or life-threatening disease or condition caused by a chemical, biological, radiological, or nuclear agent; that the known and potential benefits, when used to treat, diagnose or prevent such disease or condition, outweigh the known and potential risks for the product; and that there are no adequate, approved, and available alternatives. Emergency use authorization is NOT the same as FDA
approval or licensure.

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gunnarJune 10, 2021

One plausible explanation why Ivermectin is not yet widely adopted is legal regulations of the novel vaccines. Emergency Use Authorization (EUA) requires that NO OTHER ESTABLISHED treatment may exist for vaccine use to be granted. All the major vaccine suppliers operate under such EUA for the product. The European Union now operate under another construct named “Advance Purchase Agreement” https://ec.europa.eu/info/live-work-travel-eu/coronavirus-response/public-health/eu-vaccines-strategy_en
but conditions for how to treat alternative treatments seem to remain the same.
Should a drug such as Ivermectin be made widely available this would render the EUA’s and similar agreements invalid and vaccine suppliers lose revenue.
Those revenues are in the billions of dollar worldwide so EUA shutdowns would be dramatic if they occurred. So everything to gain for them by fighting/muting alternative treatments.
Which really are “tragically long overdue” to complement the treatment offerings.

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tetech2March 24, 2021

The link within the article isn’t working but it’s only a page long so I’ll paste it here about the dosage for long haulers.
PERSISTENT OR POST-ACUTE COVID-19: IVERMECTIN TREATMENT
FOR PATIENTS WITH PERSISTENT SYMPTOMS
Gustavo Aguirre Chang; Eduardo Castillo Saavedra; Manuel Yui Cerca; Aurora
Trujillo Figueredo; José A. Córdova Masías. Reseach Gate. July 12, 2020.
English translation copy edited by Madeline Oh
SUMMARY:
INTRODUCTION: It is estimated that between 10 to 45% of people who get sick of
COVID-19 will present symptoms after the acute stage of the disease and that these will
persist for weeks, developing what is called Persistent or Post-Acute Symptoms of
COVID-19. There is no consensus or publication on a specific and effective treatment for
these cases. Therefore, an proper diagnosis and treatment for these patients is not
currently not been being carried out, and there is a lack of knowledge as to the etiology
that causes it.
MATERIAL AND METHODS: In the present study, 33 patients with the clinical diagnosis
of Persistent or Post-Acute Symptoms of COVID-19 who were between 4 to 12 weeks
from the date of symptom onset and who had 1 to 3 months of symptoms were enrolled.
Patients whose main symptoms were muscular system, such as fatigue due to muscle
weakness, diminished muscle strength and myalgia (muscle pain) were excluded from
the study.
The following protocol was followed: Ivermectin was administered at a dose of 0.2 mg
per kilogram of body weight per day was given for 2 days. If patients still had symptoms
after the 2 doses, 2 more days of treatment with Ivermectin was given at the same dose.
For cases with moderate symptoms, a dose of 0.4 mg per kilogram of body weight was
prescribed for 2 days, then continued with 0.2 mg per kilogram of body weight for 2 more
days. If a patient continued to have symptoms after the 3rd day of treatment, more
Ivermectin doses were indicated and should continue while clinical improvement was
observed and until there was no longer a clinical improvement response with treatment.
RESULTS: 33 adult patients with Persistent or Post-Acute Symptoms of COVID-19 were
treated with Ivermectin. In 94% of the 33 patients treated with Ivermectin clinical
improvement was observed to some degree (partial or total) after the 2 doses of
Ivermectin. Complete clinical improvement was observed (total, without symptoms) in
87.9% of patients after the 2 doses of Ivermectin. In the 12.1% of patients whom did not
have resolution of the symptoms with the first 2 doses, additional doses of treatment with
Ivermectin was provided per protocol, with final clinical resolution of symptoms seen in
94% of cases.
CONCLUSION: The result of the present study demonstrates that clinical improvement
is seen in a high percentage of patients with Persistent or Post-Acute Symptoms of
COVID-19 who had been treated with Ivermectin.
Given the high number of patients with Persistent Symptoms of COVID-19 and who have
not been receiving effective treatment, we recommend conducting further clinical studies
on the use of Ivermectin and other drugs to reduce the viral load for these cases.
Key Words: Long hauler, Long COVID, COVID Long term, Persistent Symptoms, Long Term
COVID, Persistent COVID-19, Post-acute COVID-19, Prolonged COVID-19, Subacute
COVID-19, Chronic COVID-19, Post-COVID Syndrome, Post-Viral Fatigue, Ivermectin.

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Neville SealyMarch 24, 2021

FACT… Ivermectin works!
 By these Covid19 options Fruit you will truly know them. If it soars like an Eagle, looks like an Eagle & acts like an Eagle calling it a group d bound Turkey no mater how qualified you are, is laughable! 

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timdolan25March 23, 2021

This is real journalism. The story of Dr Santin is an example that I wish more doctors and hospitals would follow: when the current treatment protocols are not working and many people are dying you cast about for the drugs that can be repurposed and prescribe them and find what works!

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Angemerli TeodoroMarch 23, 2021

Thank you so much! My husband had severe Covid and was hospitalized for 22 days. He didn’t need to be intubated, but he used high flow oxygen and Bipap. It has been 60 days since he left the hospital, but he still has shortness of breath when he does a flight of stairs, or when he runs. I would like to know about the dosage of Ivermectin in this post-Covid treatment. We are from Brazil.

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Andrew PearceMarch 23, 2021

Sara, I think the "after resolution" refers to the absence of the actual virus. Long haul patients get that descriptor because they have recovered from the virus (or so we think) yet suffer long lasting complications. That IVM can drastically mitigate those complications implies that they either still had the virus in them somewhere, or that other unknown pathogens were still at work, but IVM stopped them as well.
In another TSN article today, a reader hypothesizes that many many people have amoebic parasites and don’t know it. These are extremely hard to test for and actually quite common. Outside of the tropics, regular treatment for parasites is almost unknown. Whatever else it may do, IVM starts as an anti-parasitic.
https://trialsitenews.com/ivermectin-discussion-goes-into-mainstream-media-in-france-but-stops-there/

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John HainautMarch 23, 2021

Thank you for this.
This article articulates 2 issues that seem to require some additional research.
1) On disease progression: The FLCCC has presented a model of disease progression that shows viral replication lasting on the order of 14 or so days. According Dr. Paul Marik, physicians often continue to treat patients with the antiviral remdesivir at a point where (even if it were effective against SARS-COV 2), it couldn’t possibly help because all that is left is "dead virus". Is anyone researching the virus lifecycle well enough to determine if that is true? Is it testable? If so, why is it not being tested? Do we even have an assay test to see if "live virus" still exists in long haulers (not a PCR test)?
2) On hospital protocols. "doctors who don’t read emerging science and instead follow rigid hospital protocols". In short, it’s a crap shoot to get a doctor who isn’t just punching the clock.

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Sara SakumaMarch 22, 2021

"Most reported significant improvement in days. Similarly, Peruvian researcher, Gustavo Aguirre-Chang, reported on 33 long-haul patients who were given ivermectin one to three months after resolution; 88 percent got better with two daily doses." Thanks! Great news! I was a little confused about the above sentence. What is the ‘after resolution’ time? I thought they still had Covid while taking the ivermectin twice a day.

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