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新型冠狀病毒疫情系列之八 — 日本

2020/3/23 — 16:36

鑽石公主號

鑽石公主號

日本在3月21 日的疫症總數為1046,總死亡人數50,新症36,新死亡人數1,平均死亡率3.44%。它的處理手法好壞有評 (註1),主要針對其測試是足夠。特別在日本面對著奧運會和鑽石公主號遊輪的處理手法上 (註2),日本在過去一周平均只做約900個測試,被指責政府處事不力。但在事實,日本的被一確診個案相對較少。

日本厚生勞動省回應,檢測較少和不採用流行的PCR檢測是因為PCR檢測不是為了「醫學程序」,無助遏制疫情的蔓延。PCR檢測是製藥巨頭羅氏公司的試劑盒,它在日本未通過確認。在未有治療方法,早期發現並不一定會導致早期治療。就嚴格的醫學術語而言,測試本身的價值不如人們想像的那樣。厚生勞動省的測試目的是進行「流行病學調查」,私營公司使用PCR試劑盒進行檢測,檢測質量的差異可能影響流行病學研究 (註3)。

日本是少數國家為新型狀病毒交出官方的流行學報告之一 (註4)。報告在3月10日發表,研究了2月24日前的114個日本確認案例。

廣告

報告的個案群的性別比為1.6:1,共有69位為男性和43位為女性。 中位年齡為66.5歲(年齡範圍為15-89歲), 10-19歲佔2%, 20-29歲佔6%, 30-39歲佔7%,40-49歲佔 8%,50-59 歲佔18%,60-69歲佔12%,70 -79歲佔29%, 80-89歲佔18%。 大約60%的病例是在60歲以上的人群中發現的。

研究發現:主要症狀為發燒81/112(72%),咳嗽69/112(62%),肺炎43/66(65%),喉嚨痛23/68(34%),全身不適 20/61(33%),流鼻涕或“鼻塞感覺”17/64(27%),頭痛17/62(27%),腹瀉11/64(17%),噁心和/或嘔吐5/60(8%) ,關節或肌肉疼痛4/58(7%),急性呼吸窘迫綜合徵(ARDS)3/41(7%)和眼球結膜充血0/53例(0%)。

廣告

在COVID-19病例診斷時,有21/112例病例(19%)為無症狀病例。

當中被安排進入深切治療室(ICU)入院率為8/52(15%),(氣管插管)為11/50(22%)。

 5名患者需要動用更高級的體外膜氧合器(ECMO),其中包括40歲1人,60歲1人,70歲2人,80歲1人。 截至2月24日,已分析的112病例均無死亡。

鑽石公主號圖示

圖1顯示了從2020年1月20日至2月19日的90例的流行曲線。如圖所示,鑽石公主號遊輪引入的相關病例在2月7日達到峰值。


 

備註

註1

https://edition.cnn.com/videos/world/2020/03/10/japan-coronavirus-covid-19-no-problemism-hokkaido-snow-festival-intl-hnk-vpx.cnn

註2

Coronavirus could see the Tokyo Olympics cancelled. Is Japan's handling of the outbreak to blame?

註3

https://asia.nikkei.com/Spotlight/Coronavirus/Coronavirus-Why-Japan-tested-so-few-people?utm_source=paid.outbrain.com&utm_campaign=BA%20HK&utm_medium=referral&utm_content=M7-14&dicbo=v1-f485a19aa419f564a71332fcd85ce563-00280e9c9208103b82992e13a5e43683ac-mzsdcmrqmjrtmllggzs

Japan has run so few tests because the Ministry of Health, Labor and Welfare initially chose PCR testing not as a "medical procedure," but for an "epidemiological investigation" to curb the outbreak's spread.

But this holds only when there are cures. For diseases without them, such as COVID-19, early detection does not necessarily lead to early treatment. Testing by itself is of less value in strictly medical terms than one might think.

With the focus on epidemiological investigation, the NIID's initial response to the outbreak was to use its own testing procedures, with equipment of its choosing, rather than using kits from pharmaceutical giant Roche.

The NIID feared that if private-sector companies started conducting tests with the Roche kits, differences in the quality of testing would make it difficult to gather the accurate data vital to epidemiological research. This concern hobbled its efforts to ramp up the nation's testing capacity for the new coronavirus.

註4

https://www.niid.go.jp/niid/en/

Based on data reported as of February 24, 2020 by both NESID and MHLW’s active epidemiologic investigations, there were 112 lab-confirmed COVID-19 cases. The gender ratio was 1.6:1, with 69 males and 43 females in total. The median age was 66.5 (age range 15-89), with age distribution of 2 cases in the 10-19 range (2%), 7 cases in the 20-29 range (6%), 8 cases in the 30-39 range (7%), 9 cases in the 40-49 range (8%), 20 cases in the 50-59 range (18%), 13 cases in the 60-69 range (12%), 33 cases in the 70-79 range (29%), and 20 cases in the 80-89 range (18%). Approximately 60% of cases were identified in those over 60 years of age.

At of case report day, the main symptoms identified were fever 81/112 (72%), cough 69/112 (62%), pneumonia 43/66 (65%), sore throat 23/68 (34 %), general malaise 20/61 (33%), nasal discharge or congestion 17/64 (27%), headache 17/62 (27%), diarrhea 11/64 (17%), nausea and/or vomiting 5/60 (8%), joint or muscle pain 4/58 (7%), acute respiratory distress syndrome (ARDS) 3/41 (7%), and conjunctival congestion 0/53 cases (0%)

At the time of COVID-19 case diagnosis, 21/112 cases (19%) were reported as asymptomatic cases.

Intensive care unit (ICU) admission was 8/52 (15%) and invasive ventilation (tracheal intubation) was 11/50 (22%). Other interventions used included extracorporeal membrane oxygenator (ECMO) in 5 patients, with 1 in their 40s, 1 in their 60s, 2 in their 70s, and 1 in their 80s. As of February 24, there were no deaths reported in the 112 cases analyzed

 

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