Editor's note: On March 12, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic, and as of Thursday (May 28), about 200 countries and regions have confirmed a total over 5,491,000 cases, according to the WHO. On CGTN's live program "COVID-19 Frontline," we invited medical workers and experts from China and other parts of the world to share their experiences and take questions from social media, in the hope of providing more information for those who are battling against the pandemic.
5月27日晚，中央广播电视总台中国国际电视台（CGTN）的特别节目“全球疫情会诊室”邀请江苏省援鄂医务人员与来自坦桑尼亚的医疗专家们分享了新冠肺炎患者的救治经验，双方通过视频会议进行了近一个半小时的交流。根据约翰斯•霍普金斯大学的疫情统计数据，目前坦桑尼亚累计确诊新冠肺炎患者509例，死亡21例。而非洲整体确诊病例已经突破11万例， 所有非洲国家均已报告出现新冠确诊病例，累计死亡病例超过3500例。根据联合国5月20日发布的《新冠疫情对非洲影响》政策简报，目前非洲仍处于疫情早期阶段，高峰尚未到来。据江苏大学应对新冠肺炎疫情工作领导小组组长颜晓红介绍，在湖北疫情爆发期间，江苏省一共向湖北各地派出了来自省内多家医院的3000多名医护人员支援抗疫，是全国各个省份中派出医疗队员人数最多的。In the latest episode of CGTN's livestream program "COVID-19 Frontline" held on Wednesday, May 27, CGTN invited experts from east China's Jiangsu Province who joined frontline medics in Hubei Province during the anti-COVID-19 battle, to share their first-hand COVID-19 treatment experience with their Tanzanian peers.The COVID-19 pandemic has spread to 54 countries in Africa. As of Thursday, more than 500 confirmed cases and 21 deaths have been reported in Tanzania.Yan Xiaohong, head of the leading group of Jiangsu University on the COVID-19 control and prevention and president of Jiangsu University, said Jiangsu sent almost 3000 medical workers to support Hubei Province, which is No.1 in China. Both Yan and Kaushik Ramaiya, consultant physician and chief executive officer of Hindu Mandal Hospital, expressed withes to cooperate further to fight COVID-19 together.Clinical progression of patients with COVID-19坦桑尼亚银都曼德尔医院（Hindu Mandal Hospital）院长考希克•罗摩耶(Kaushik Ramaiya)首先问道，从中国的临床经验来看，判断轻型和普通型的新冠肺炎病人转向重症的临床指标是什么？江苏大学附属医院援鄂医疗队队长、呼吸科副主任医师黄汉鹏回答，判断依据有以下几个：一是影像学的证据，比如肺部CT显示病人的肺部阴影在短时间内急剧恶化；二是患者的生命体征，如指脉氧小于93%；三是血清分析，如果发现患者处于呼吸衰竭的状态，就确诊为重症患者。 Kaushik Ramaiya said there are mild COVID-19 cases, moderate cases, and severe cases. So he wanted to know the clinical indicators of the transition from mild to critical cases based on frontline doctors' experience.Huang Hanpeng, member of the first batch of Jiangsu's medical aid team to Huangshi, Hubei Province, said there are several key indicators such as when chest CT examination shows the shadow on the lung deteriorates dramatically in a short period; when the pulse oximeter reading is below 93 and when a patient has respiratory failure.The treatment of COVID-19 patients with underlying diseases来自凯瑞克医院（Kairuki Hospital）的穆克扎•恩格梅拉（Mukiza Ngemera）医生说，他们发现新冠肺炎病人会出现一些合并症，他想知道中国同行在临床上观察到患者出现的主要合并症有哪些，以及如何管理和治疗这些病人。江苏省第一批支援湖北武汉医疗队队员、危重症医学科主治医师孙志伟回答说，新冠肺炎病人出现的主要合并症有高血压、糖尿病、哮喘、慢阻肺等。他进一步介绍了治疗每类病人时应注意的事项。他说，新冠肺炎的死亡病例中合并有高血压的占到60%以上，所以对高血压的控制是非常重要的。根据我国多个医疗团队的前期研究成果，给新冠肺炎病人使用降压药的时候应该避免血管紧张素转换酶抑制剂和血管紧张素受剂抑制剂，因为它们会增加血管紧张素II（ACE2）的表达，而它与新冠病毒的表达和复制是有相关性的。他建议使用钙拮抗剂（CCB）以及利尿剂作为主要降压药。他还指出，如果血压控制导致病人出现了低血压的情况，应该立即停止使用降压药，避免病人发生休克引起低灌注，以及造成不必要的组织器官损伤。他介绍说，新冠肺炎病人中合并有糖尿病的也有很多，尤其是中老年病人，对这类病人的血糖控制应该更加严格，一般血糖目标值控制在8-10毫摩尔/升。日间对病人使用中短效胰岛素，每二到四小时监测一次；夜间为了保证病人的休息，可以使用长效胰岛素，每四到八小时监测一次。此外，哮喘和慢阻肺是新冠病人出现比较多的呼吸系统疾病。在对这类病人进行雾化治疗的时候，一个很严重的问题是雾化会产生气溶胶，造成气溶胶传播，因而病人和医护人员都要做好严格的防护措施。另外，这类病人如果出现轻症转重症的信号，应该尽早进行机械通气，包括无创通气、高流量氧疗和气管插管，这对降低病死率是非常有意义的。江苏省第一批支援湖北黄石医疗队队员、感染科副主任医师包泉磊补充说，对于有合并症的新冠病人，要根据病人的具体合并症把他们进行细致的分类，加强和相关专业医生，如神经科、心脏科医生等的沟通和合作，给病人提供相对个体化和精准的治疗，通过积极治疗这些合并症来改善病人的预后。 Mukiza Ngemera, doctor of Kairuki Hospital, Tanzania, said some COVID-19 patients also have chronic obstructive pulmonary diseases or have symptoms of pulmonary fibrosis. So he wanted to learn more about the treatment of these kinds of patients.Sun Zhiwei, member of the first batch of Jiangsu's medical aid team to Wuhan, said the underlying diseases include high blood pressure, diabetes, asthma, and chronic obstructive pulmonary diseases. More than 60 percent of COVID-19 deaths are associated with hypertension, so the control of the blood pressure is critical. Based on previous studies by multiple medical teams in China, ACEI and ARBs should be avoided when treating hypertension, because they increase the level of angiotensin. Calcium Channel Blockers (CCB) and diuretics are suggested for treatment instead. If hypotension occurs in blood pressure control, antihypertensive drugs should be stopped immediately to avoid unnecessary tissue and organ injury."People with diabetes are more susceptible to COVID-19 due to their compromised immune systems," said Dr. Sun. So it's necessary to control the blood sugar. Blood glucose is typically targeted at 8 to 10 millimoles per liter. "At the same time, there are many irritating disinfectants in the hospital, which may induce or aggravate asthma and other respiratory diseases," Dr. Sun added.CGTN主持人焦旸在北京演播室主持“全球疫情会诊室”
How to predict and manage cytokine storm?休伯特•凯鲁基纪念大学校长查尔斯•莫根(Charles Mgone)想了解如何判断病人是否会出现细胞因子风暴，中国医生对此又有哪些治疗经验。黄医生回答，判断细胞因子风暴主要是通过检测患者血浆里白介素6（IL-6）的表达水平来实现的，如果病人血清中白介素6的表达水平明显升高，说明有细胞因子风暴。他介绍了以下几个治疗措施：一是采用白介素6的受体抑制剂托珠单抗进行针对性治疗；二是通过血液净化，减少患者血液中的炎症因子，从而达到控制炎症的目的；三是用干细胞进行治疗。他解释，由于新冠肺炎是一种病毒性肺炎，一些重症患者会出现肺部纤维化，用干细胞治疗一方面可以减轻和抑制炎症，另一方面可以起到抗纤维化的作用。此外，对于病情急剧恶化、出现严重炎症风暴的患者，还可以使用短疗程、低剂量的激素治疗。Charles Mgone, vice-chancellor of Hubert Kairuki Memorial University, asked about the signs of cytokine storm and if there is any treatment in this regard.Dr. Huang Hanpeng said elevated levels of IL-6 is a potential biomarker that is associated with cytokine storm. The treatment includes applying IL-6 blocking antibody tocilizumab, also known as atlizumab, or blood purification, which can reduce inflammatory mediators from the plasma of the patients. Another treatment is stem cell therapy which not only can reduce inflammation, but also plays an anti-fibrosis role. If the patient's condition deteriorates sharply, a short course and low-dose of the hormone will be used.The use of hormone treatment罗摩耶医生还想了解关于激素干预的更详细的经验，包括使用时间和剂量等。黄医生回答说，对于轻型和普通型患者，通常不使用激素。对于重症和危重症患者，如果病人病情急剧恶化，而且判断是由炎症导致的，可以使用激素干预。使用天数为3到5天，一般不超过一周，使用剂量一般是每公斤体重每天1-2毫克。Dr. Kaushik Ramaiya asked about the dose of hormones and when to start and stop using hormone interventions.Dr. Huang said for patients with mild and moderate symptoms, a hormone is not used. For patients whose condition deteriorated sharply and caused by cytokine storm, low-dose of hormone is used for about three to five days.在交流中，双方还探讨了复阳情况出现的原因和应对办法、新冠肺炎病人的护理和心理疏导等问题。坦桑尼亚专家对中国同行的专业分享深表感谢，他们表示，中国和坦桑尼亚是好兄弟、好朋友，两国医学专家携手对抗新冠肺炎疫情，将使中坦之间的友谊更加深厚。截止目前，CGTN的“全球疫情会诊室”已经举办了近60场直播节目，来自全国多个省份的一线抗疫医生与三十多个国家的医学专家分享了中国的抗疫经验。In later episodes of "COVID-19 Frontline," more frontline doctors and experts from Wuhan will join in to share their experience with their colleagues from other parts of the world. If you have any questions regarding COVID-19, you can share it with us using #MyOpinionOnCOVID19 on Facebook.