3/23
Sarah 来的时候有发烧、哮喘、呼吸困难，而且她怀孕34周。她是一位护士在儿科诊所上班。最开始的发烧、肌肉酸痛、浑身无力出现在一个星期之前，现在又有哮喘和呼吸困难，所以到急诊室来就诊。她胸片发现有双侧肺炎，常规病毒检查都是阴性，在这种情况下理所当然要检测新冠病毒。
可是因为没有近期的旅游史，接触的人群里也没有确诊的新冠病人，也就是说没有接触史。虽然Sarah 是医务工作者也是高风险人群，但是却不符合州里卫生所送检的条件，所以只能把她的咽拭子送往LabCorp。我以前的文章提到过，在我们这个中西部城市，商业送检四到六天才能出结果。
因为是怀疑新冠病毒，她从一开始就放在了负压室，气溶胶隔离。高氧治疗保证她和胎儿的供氧。也上了激素，用来促进胎儿肺叶成熟，如果被迫提早分娩，能够降低胎儿出生后的呼吸窘迫。
等待结果的过程理所当然的牵动着众多人的心，我想知道结果，孕妇想知道结果，孕妇的家人也想知道结果，但是一直等到Sarah烧退了，呼吸症状改善了，要出院了，我们都还是不知道结果。我只能在出院的时候嘱咐Sarah，回家了还要继续隔离，一有结果我就会通知她。如果是阳性，至少Sarah熬过了这一关，但是也请观察家人的症状。如果是阴性，正好是皆大欢喜的结果。
在这个病区，还有10几个病人因为种种原因，同样排在等待结果的路上。由于没有快速的诊断，待查的人积压得越来越多，占用着负压室的资源，同时抗新冠病毒的专用药也上得很犹豫。
现在很多文章都在讨论氯奎和阿奇霉素的联用，在新冠病毒治疗中的效果。在我看来并没有神奇的特效药，理论上讲氯奎可以抑制病毒的浓度，减缓病症的进展，但是在临床上，却看不到药到病除这样的效果。根据医院的治疗指南，只要是确诊了新冠，没有明显的禁忌症，这种两种药物是标准治疗。即便如此还是有不少病人症状继续恶化，上个周未有两个病人被插管上呼吸机，今天又插了一个。
据说真正很有作用的药物只有人民的希望，Remdesivir, 但是这个药物的产量有限，绝大部分人都用不上了。现在的标准是如果病人小于18岁，或者是孕妇，有可能会敲加入临床实验，从Gilead 拿到注射剂。其他的病人已经没有可能了。
3月7号我们州里诊断了第一位新冠病人，今天3月23号这个数字是216个，到目前为止，州里还没有一个人用上人民的希望。已经有4位病人去世，今天刚刚去世的是一位30多岁的女性病人。
带娃是持久战,dqdeer, 西北东南, xinn2005. Thanks for the support. 大家都保重。
抗疫伊始，病人日增，医护人员的安全保障是第一重要的事情，希望你们那里抗疫一线人员的防护装备已经妥善到位。
请查悄悄话。
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.
还有谁应该住院
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.