08.26｜经济学人阅读｜科技专栏 Covid and chronic illness: Lingering fog
经济学人The Economist是一份英国的英文新闻周报，分八个版本于每周五向全球发行，编辑部位于伦敦，创办于1843年9月。
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今天羚羊君（公众：aa-acad）给大家分享的是经济学人2020年8月22日期刊中科技专栏的第一篇：Covid and chronic illness: Lingering fog。
这篇文章介绍了新冠肺炎的症状、对人体产生的持续性影响、医生治疗对新冠肺炎的最新理解，以及最新的治疗手段。
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Covid and chronic illness: Lingering fog
新冠病毒和慢性病：挥之不去的雾霾
THE SYMPTOMS began in March, says Laura, a British woman in her mid-20s. At first covid-19 felt like a bad case of flu: a dry cough, fever, shortness of breath, loss of smell, “horrendous nausea” and general fatigue. After three weeks of rest, things started to improve. Five months later, she has still not recovered. Sometimes her symptoms ease for a week or two, but they inevitably return. “When it’s bad I can’t even go on work calls, because if I talk too much I can’t breathe.”
二十多岁的英国妇女劳拉说，她的症状始于三月。刚开始，新冠肺炎的感觉就像是重流感：干咳，发烧，呼吸急促，嗅觉丧失，“恶心”和全身疲劳。经过三周的休息，情况开始好转。但五个月后，她仍未康复。有时她的症状会缓解一两个星期，但会不可避免地复发。“情况不好时，我甚至无法上班，因为如果我说话太多，我就无法呼吸。”
02
In March, as covid-19 cases began their exponential rise in country after country, doctors focused on saving patients’ lives. Speedy sharing of knowledge, clinical trials and hands-on experience have made the illness less deadly. In Britain about half the patients treated in intensive-care units (ICUs) in the weeks to the middle of April died. By the end of June mortality was below 30%. Reductions were seen across all age groups, which means the fall cannot have been caused by fewer frail old people arriving in hospital (see chart 1). In places where the epidemic has subsided, calmer wards have meant better care. But improved knowledge about treatment probably accounts for much of the improvement.
3月份，随着新冠确诊病例在各个国家和地区开始呈指数级增长，医生开始专注于挽救患者的生命。快速的知识共享，临床试验和实践经验使这种疾病的致命性降低了。在英国，到四月中旬的几周内，大约有一半在重症监护病房中接受治疗的患者死亡。到6月底，死亡率低于30％。所有年龄段的死亡率都降低了，死亡率降低并非因为体弱老人更少到医院而导致的（见图1）。病房提供更好的护理，使得疫情消退。但是，治疗知识的提高才是疫情得到控制的主要原因。
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Doctors have learned a lot. They have stopped rushing covid-19 patients onto ventilators, which can cause lung damage. Oxygen supplied through small prongs in the nostrils is much less invasive and often does the job. In British ICUs the share of covid-19 patients on ventilation fell from 90% in the early days to 30% in June. Treatment protocols have improved further with the addition of dexamethasone, an immune-dampening drug that increases survival rates in patients who need oxygen.
医生学到了很多东西。他们已经不再让新冠患者上呼吸机了，因为这可能会导致肺部损伤。用小尖头往鼻孔中输入氧气也可以完成治疗。在英国的ICU中，给新冠确诊病人上呼吸机的比例从早期的90％下降到6月的30％。地塞米松是一种增强免疫力的药物，可增加需要氧气的患者的生存率，从而进一步改善了治疗方案。
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Now, though, doctors and scientists are shifting their focus to those who survive the infection—including the subset of people like Laura, who have never been ill enough to be hospitalised, but who have also never recovered sufficiently to return to normal life.
In most people, covid-19 is a brief, mild illness. Between a third and a half of those infected do not notice any symptoms. In those who do become unwell symptoms usually clear within two to three weeks with just home rest. In Europe only around 3-4% of those who become infected are admitted to hospital.
不过，现在医生和科学家们的工作重心转移到了那些感染了新冠病毒后幸存下来的人身上，包括像劳拉这样的人，他们从未病重住院，但也从未康复并恢复正常生活。
在大多数人中，新冠肺炎是一种短暂的轻度疾病。在三分之一到一半的被感染者中没有发现任何症状。对于那些确实变得不适的患者，通常仅在家休息两到三周即可清除症状。在欧洲，只有大约3-4％的感染者被送进医院。
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Yet at the same time it is becoming clear that some small but significant proportion of those infected have symptoms that persist for months. Prolonged recovery is not unusual for patients hospitalised for pneumonia, a frequent complication of covid-19. It is also common for people who have been admitted to an ICU, who are by definition seriously ill. But many clinicians say that the share of covid-19 patients with lingering problems is far higher than is seen with other viral illnesses such as influenza. The problems are also more varied, often including lung, heart and psychological symptoms, says Sally Singh of the University of Leicester, who leads the development of a covid-19 rehabilitation programme for Britain’s health service.
然而与此同时，越来越明显的是，有一小部分感染者的症状持续了数月。对于因新冠肺炎住院的患者而言，需要长时间恢复并不罕见，这是新冠肺炎的常见并发症。对于被视为为重病且进入重症监护病房的人来说，这也是很普遍的。但是许多临床医生说，有顽固性问题的新冠病毒患者所占的比例远远高于其他病毒性疾病，例如流感。莱斯特大学的萨利·辛格指出，新冠的问题也更加多样，通常包括肺、心脏和心理症状，他负责为英国的医疗服务制定新冠康复计划。
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Anecdotal reports of long-lasting illness have been around since the early days of the pandemic. But with more than 22m cases confirmed worldwide, and with infection rates having peaked several months ago in most rich countries, statistical patterns about the virus’s lingering effects are starting to emerge. A paper in the British Medical Journal on August 11th concluded that as many as 60,000 people in Britain have long-term symptoms. Yet only about 6% of Britain’s population—around 4m people—seems to have been infected with the virus so far.
自疫情初期以来，关于病情长期持续的报道就已经出现。但是，随着全世界确诊的病例超过2200万，并且大多数富裕国家的感染率在几个月前达到顶峰，有关这种病毒挥之不去的影响的统计模式开始出现。8月11日，《英国医学杂志》上的一篇论文得出结论，英国多达6万人患有长期症状。然而，到目前为止，英国只有约6％的人口（约400万人）感染了这种病毒。
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Severity of the illness is one predictor of lasting problems. Ian Hall, the director of the Biomedical Research Centre at the University of Nottingham, reckons that 30-50% of patients hospitalised with covid-19 have significant symptoms six to eight weeks after they have been discharged. That number rises further for patients who were admitted to an ICU. But even those who escaped with a mild illness, like Laura, are at risk. More than 10% of them remain unwell for more than three weeks, according to a patient-tracking study that follows mostly American and British patients. They struggle with fatigue, breathlessness, body aches and cognitive problems which many describe as “brain fog” (see chart 2).
疾病的严重程度是持久问题的一个预测因素。诺丁汉大学生物医学研究中心主任伊恩·霍尔估计，出院后六到八周，有30-50％的接受住院治疗的新冠患者会出现明显症状。对于入住ICU的患者，这一数字进一步增加。但是，即使是那些只有轻度症状而无需住院的人，例如劳拉，也面临着危险。根据一项针对大多数美国和英国患者的患者追踪研究，其中超过10％的患者在超过三周的时间内仍处于不适状态。他们因疲劳，呼吸困难，身体疼痛和认知问题而挣扎，许多人将其描述为“脑雾”（见图2）。
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Some long-term covid-19 patients may be suffering from undiagnosed conditions such as diabetes or thyroid dysfunction, which are “unmasked” by the infection, says Avindra Nath of the National Institutes of Health in America. For others, the collection of symptoms is suggestively similar to those seen in chronic fatigue syndrome (CFS). The biological causes of CFS are still poorly understood, but data from America indicate that three-quarters of cases follow viral or bacterial infections. One hypothesis is that the syndrome is caused by the immune system failing to properly stand down after being called on to battle an infection. It may be that SARS-CoV2, the virus that causes covid-19, is unusually likely to provoke such a lingering over-reaction.
美国国立卫生研究院的Avindra Nath说，某些长期症状的新冠确诊病人可能患有其他未被诊断的疾病，例如糖尿病或甲状腺功能障碍，但新冠病毒并未“掩盖”这些疾病。对于其他人而言，他们的症状类似于慢性疲劳综合症的症状。人们对慢性疲劳综合症的生物学原因仍然知之甚少，但是来自美国的数据表明，四分之三的病例是病毒或细菌感染。一种假设是该综合症是由人体免疫系统在被要求与病毒作斗争后未能正确免疫而引起的。引起新冠肺炎和SARS的病毒可能引起这种异常的过度反应。
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If the root cause is not known, then the growing understanding of just what covid-19 can do to the body can at least suggest what sorts of care long-term sufferers may need. The hallmark of many covid-19 cases is damage to the lungs. Aggressive inflammation leads to the destruction of lung tissue and the formation of scars. The scarring, in turn, impedes the flow of oxygen from the lungs into the blood. That can cause breathlessness, even with light exercise. Small studies of covid-19 patients discharged from hospitals have found that 25-30% have impaired oxygen flow.
The prognosis is unclear. People treated in ICUs for other viral infections usually recover about 80% of their previous lung function fairly quickly, but the final 20% can take three to six months, says Dr Hall. And in some cases lung scarring can worsen over time, especially if combined with new health problems later in life.
如果根本原因尚不清楚，那么对新冠肺炎对身体产生的影响的日益了解至少可以知道长期患者需要什么样的护理。许多新冠病例的症状是肺部受损。严重的炎症导致肺组织的破坏和疤痕的形成。疤痕又阻碍了氧气从肺部流入血液。即使进行少量运动，也可能导致呼吸困难。对从医院出院的新冠肺炎患者的小型研究发现，有25-30％的患者氧气流量受损。
医生对病情的预测尚不清楚。霍尔博士说，在ICU中接受其他病毒感染治疗的人通常可以很快恢复其先前肺功能的约80％，但最后20％可能需要三至六个月的时间恢复。在某些情况下，肺部疤痕会随着时间的流逝而恶化，尤其在以后的生活中伴随着新的健康问题。
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Breathing problems can also arise from another effect of covid-19—its tendency to cause blood clots, which is unusual for a respiratory virus. When they form in the lungs, clots can choke off blood flow, making it even harder to absorb oxygen. And the virus may cause breathlessness in a more subtle way, too, by damaging the lining of blood vessels, which limits how much blood can flow through them.
Covid-19 can also damage the heart. It can inflame the tissues that surround the organ, as well as the blood vessels that ferry nutrients to it. That can weaken the heart muscle, and eventually lead to heart failure. Blood clots cause problems here, as well, since the heart must pump harder to push blood through partly blocked vessels. Over time, that can weaken the muscle.
新冠病毒的另一种症状是引起呼吸问题，即新冠病毒引起血液凝块的趋势，这对于呼吸道病毒是不常见的。当它们在肺中形成时，凝块会阻塞血液流动，使其更难吸收氧气。病毒也可能通过损坏血管内膜，从而以更微妙的方式引起呼吸困难，从而限制了可以流过血管的血液数量。
新冠病毒也会损害心脏。它能使器官周围的组织和向器官运送营养的血管发言。造成心肌削弱，并最终导致心力衰竭。血块也会因此引起问题，因为心脏必须更努力地抽血才能将血液推过部分阻塞的血管。随着时间的流逝，这会削弱肌肉。
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Nobody knows exactly how often such cardiac complications occur. But news from Germany is worrying, says Clyde Yancy, a cardiologist at Northwestern University, in Illinois. Using MRI scans, one study found evidence that covid-19 causes inflammation and other heart changes—including in people who had tested positive for the virus more than two months earlier and were, by the time of their scans, free from symptoms. The changes were small, and not enough by themselves to cause clinical symptoms. But even a minor injury to the heart may eventually lead to heart failure if it lingers for long enough, says Dr Yancy.
没有人确切知道这种心脏并发症多久发生一次。来自伊利诺伊州西北大学的心脏病专家克莱德·延西说，来自德国的消息令人担忧。一项研究使用MRI扫描发现了证据，证明新冠病毒会引起炎症和其他心脏变化，包括在两个多月前对该病毒测试呈阳性并且在当时没有症状的人。这些变化很小，并且不足以引起临床症状。延西博士说，如果持续时间够长，即使心脏受到轻微伤害也可能最终导致心力衰竭。
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Least understood are the long-term effects of covid-19 on the nervous system and the brain. Patients with lingering post-covid symptoms complain of headaches, tingling and numbness in the feet, and other neurological problems. Problems that suggest a dysfunction of the autonomic nervous system, such as irregular heart beat, dry mouth and gastrointestinal problems are also common, says Dr Nath. But the exact cause of such symptoms remains unclear, as does the reason why more than half of those infected suffer a temporary loss of their sense of smell. (Some, rather than losing it, have it altered instead, so that things smell different after the infection than they did beforehand.)
人类最不了解的是新冠肺炎对神经系统和大脑的长期影响。新冠症状持续存在的患者抱怨头痛，脚刺痛和麻木以及其他神经系统问题。纳斯博士说，提示自主神经系统功能异常的问题也很常见，例如心律不齐，口干和胃肠道问题。但是，目前尚不清楚此类症状的确切原因，还有一半以上的被感染者暂时失去嗅觉的原因也不清楚。（有些并非丢失了嗅觉，而是嗅觉出现了变化，感染后的闻到的气味与以前有所不同。）
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Confronted with a baffling array of symptoms and few detailed explanations about exactly what is going wrong, doctors are desperate for guidance. A third of general practitioners in Britain already have patients with lasting post-covid symptoms. For now, the best they can offer is referral to lung or cardiac rehabilitation. Such therapy may improve a patient’s quality of life with something as simple as a breathing exercise. Britain, Belgium and other countries are setting up specialised covid-19 rehabilitation programmes for those recovering from the disease. Waiting lists are already long.
面对令人困惑的症状和对问题的详细解释，医生们迫切希望获得指导。英国三分之一的全科医生的新冠病人已经患有持续性症状。目前，他们所能提供的最佳服务是转介肺或心脏康复。这种疗法可以通过简单的呼吸运动来改善患者的生活质量。英国，比利时和其他国家和地区正在为从疾病中康复的人建立专门的新冠康复计划。等待治疗的名单已经很长了。
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In the absence of understanding, doctors must fall back on lessons from other illnesses. Lingering symptoms are not the exclusive preserve of covid-19. Full recovery from other viral diseases such as influenza can occasionally take months. Data on CFS suggests chances of recovery are best in the first three months.
More specific data are on the way. Studies in America, Britain, China and Europe have enrolled thousands of patients, and should begin reporting initial results in the next few months. But for now, those suffering the lingering effects of the disease must deal not only with the physical symptoms, but with uncertainty about just how long it will take them to get better.
在缺乏理解的情况下，医生必须依靠其他疾病的经验。持续的症状并不是新冠肺炎的唯一可能。从其他病毒性疾病（例如流感）中完全康复有时可能需要几个月的时间。CFS上的数据表明，恢复的机会在前三个月中最好。
更具体的数据正在酝酿之中。在美国，英国，中国和欧洲的研究招募了成千上万的患者，并应在未来几个月内开始报告初步结果。但是就目前而言，那些遭受这种疾病挥之不去的影响的人不仅需要应对身体症状，而且还不能确定他们需要多长时间才能好起来。
经济学人一般目录大纲：
The world this week：简单梳理本周的时事Leaders：社论，对本周热点事件进行评论Briefing：简报，对一个特定热点话题深度讨论Letter：读者来信，对往期文章的评论Sections：各大洲及中美英三国的本周热点事件报道Business：商业新闻Finances and economics：财经新闻Science and technology：科技新闻Books and arts：文化书籍，书评和文化现象讨论Economic and financial indicators：商业及财经指数
Buttonwood：金融专栏Schumpeter：商业专栏Bartleby：职场专栏Bagehot：英国专栏Charlemagne：欧洲专栏Lexington：美国专栏Banyan：亚洲专栏
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