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As of June 22, the world had 3.75 million active Covid-19 cases. Among those, around 2% were serious or critical, and an estimated 1.5% of those were being treated with ventilators.
Let’s rewind three months to March 22, 2020. At that time, there were 224,588 active cases around the world, 5% of which were reported to be serious or critical. More people are infected now, but a lower percentage of them need ventilation treatment. Why is that? There are a few possible explanations. What follows are the five most commonly debated suggestions.
截至6月22日,全球有375万新冠病毒的感染案例。这些患者中,大约有2%是严重或危重病例,其中约有1.5%的患者正使用呼吸机。时间退回3个月到2020年的3月22日,在那时,全球有224588例感染案例,其中5%是危重患者。为什么越来越多的人感染病毒,但需要的呼吸机却越少?这是为什么?有一些可能的解释,下面是5个最具争议的争论。

1.The virus is gradually becoming less lethal.
病毒的致命性正逐渐减弱

This hypothesis was raised in the early days of the outbreak by a minority of experts. This view is still, to this day, held by few and stands in contrast to the common convention that the virus is not mutating, at least not in a meaningful way.
这个假设在病毒爆发初期,有一小部分的专家提出。到今天,这个观点依然有人接受,并且与常理相反,他们认为病毒不会变异,至少不会变异成会造成很大影响的形式。

Professor Matteo Bassetti, head of the infectious diseases clinic at Italy’s Policlinico San Martino Hospital, has said that “coronavirus had downgraded from a tiger to a wild cat.” Bassetti says that in the last month (compared with March and April of this year), the severity of the virus has changed and that even elderly patients, aged 80–90, are now sitting up in bed and breathing without help. Again, this is a view held by a minority of experts. The optimistic belief that Covid-19 is steadily weakening and will eventually disappear is considered highly unlikely by most.
意大利Policlinico San Martino医院传染病诊所负责人Matteo Bassetti教授表示“冠状病毒已经从一只老虎降级成了一只野猫”,Bassetti在上个月(与、四月相比)说,病毒的严重性已经发生变化,现在,哪怕是80,90的老年人也可以不依赖于呼吸机坐在床上自由呼吸。再说一遍,只有少数专家持有这样的观点,大部分专家都不太相信新冠病毒会逐渐减弱以至消亡。

2.Hot weather is slowing down the virus.
炎热的天气使病毒的传播速度下降

This, too, has been a subject of speculation and debate for months. Theories on the benefits of vitamin D treatment or evidence of clusters mainly occurring in cool climates all sparked an optimistic view that the coronavirus could fade by summertime like other similar seasonal illnesses. Research is still being published asserting that hot weather and sunshine cause the virus to decay to such a degree that a higher viral load is needed to prompt a serious condition. This is, however, inconclusive.
这也是数月来被争论的主题。有关维生素D治疗和簇状主要在凉爽气候下产生都激发了这一乐观观点的产生,即冠状病毒能像其他类似的季节性病毒一样在夏季消亡。调查仍在发布高温和阳光会让病毒腐烂到一定程度,以至于需要更高的病毒载量以引发严重疾病。不过,这不是结论性的观点。

Other researchers found there is no link between the spread of the virus and weather conditions. In certain parts of the world, the Middle East, for example, a rise in cases has been reported despite the onset of summer. So is it possible that hot weather is causing the virus to be less dangerous? Possibly, but recent evidence suggests otherwise.
其他研究人员发现病毒传播和天气状况直接没有联系。在世界的某些地区,比如中东,尽管是夏季,报导的感染病例依然在增加。所以,有可能是热天气使得病毒的危害性更小?可能是如此,但最近的证据表明情况并非如此。

3.More tests are happening.
进行了更多的测试

More tests are being done, and so more asymptomatic carriers are found. Our World in Data
测试的人员越多,越多的无症状病毒携带者会被发现。 —— Our World in Data

This is quite a straightforward argument. In most of the world, more tests are being done. When you test more, you find more. Even President Donald Trump knows that. With more tests completed, the number of asymptomatic carriers also increases. More people are reported sick, many of them in a very mild state, which makes the percentage of those in critical condition drop. This must have some effect, although that by itself is unlikely to explain the whole trend.
这是个很简单的道理。在世界的大多地方,正进行更多的测试操作。当你测试的越多,你发现的病例也就越多。甚至总统川普都知道这点,随着越多的测试被完成,发现的无症状的病毒携带者也在增加。随着越多轻微病状的患者被发现,这会使得处于危急状况的人数下降,尽管它无法解释整体状态的下降,但它会造成一定的影响。

4.There are better treatments.
有更好的治疗方法

The world is learning new information about Covid-19 every day. Along with the rising number of Covid-19 daily cases are the rising number of Covid-19 daily research papers. With new knowledge comes better and more effective treatment. Just recently, Oxford University reported that treatment with the cheap, highly accessible drug dexamethasone managed to reduce mortality rates. More research is needed, but this is definitely a good start.
全球每天都在学习关于Covid-19的新资讯。新冠病毒的感染案例正每天增加,关于新冠病毒的研究论文也在增加。随着新知识的出现,更好,更有有效的治疗方法也在出现。就在最近,牛津大学报导称使用便宜、更易吸收的药物dexamethasone能成功减少死亡率。需要更多的研究报告,这绝对是个好开始。

Could it be that ventilators aren’t necessarily effective in all Covid-19 cases?
在所有的新冠病毒感染案例中,呼吸机并不是都必须的?

As there isn’t yet any proven coronavirus medication, what is definitely affecting the rate of patients needing ventilation is the evolving treatment protocol. It is quite clear that the general convention in medicine initially favored ventilation treatment, and providers believed that starting it as soon as possible was preferred. When a patient showed signs of deterioration, the protocol in many hospitals around the world was to connect an invasive respirator right away. This explains the arms race after ventilators — countries needed as many as they could get.
因为还没有通过验证的冠状病毒的治疗药物,因此不断进化的治疗方法无疑会深刻影响需要呼吸机治疗的病人比率。医学一般倾向用呼吸机辅助治疗,患者认为应尽快开气治疗。当患者出现恶化情况时,世界各地的医院都认为应立即使用呼吸机,这也解释了继军队之后——各国应尽可能地多准备呼吸机。

Over time, as new knowledge was gathered and with experience, a question started to emerge. Could it be that ventilators aren’t necessarily effective in all Covid-19 cases? Research showed that many ended up dying despite receiving treatment. Some even went so far as to say ventilators harmed patients more than they helped. Some patients developed a dependence on the ventilator and were more difficult to wean from mechanical ventilation. This could, in turn, cause chronic respiratory problems.
时间流逝,随着新知识和经验的积累,一个问题开始显现。可能并不是所有的新冠病毒感染病例都需要呼吸机?研究表明,尽管接受了治疗,许多人最后还是死了,一些人甚至说呼吸机给患者带来的的伤害超过对他们的帮助。一些患者对呼吸机产生依赖,并且更难以从机械通气中退出。反过来看,这还可能会导致慢性的呼吸问题。

In some countries, the practice has now shifted considerably to no more early ventilating and efforts being made to avoid ventilators at almost any cost. Noninvasive methods now considered, such as Vapotherm, were not used during the first wave because they might cause a splatter of droplets from the patient and put staff at risk. Mind you, at that time, many medical staff were already underprotected due to a dire shortage of personal protective equipment (PPE).
在一些国家,现在的做法已转变为不再过早使用呼吸机,并且为避免使用呼吸机几乎付出一切代价。目前考虑使用的非介入性方法,例如Vapotherm,不在最开始治疗时就使用,因为它们可能使患者身上的飞沫飞溅,使工作人员处于危险之中。请注意,当时因为个人防护设备(PPE)的短缺,许多医务人员的保护不足。

5.Younger people are getting sick.
年轻人正在得病

This claim is part chance and part very hard to measure. It is clear that in some places, the median age of those infected has dropped considerably. Florida is a very clear example: The median age for those infected in Florida now stands at 37 — in March it was 65. This trend has followed in Texas, Arizona, and other places. Does this age shift at least partially explain the lower rates of ICU admission and the drop in the use of ventilators? Yes. On measure, young people suffer less from Covid-19 and are less likely to need intensive care than older people.
这个结论部分是几率,部分又很难衡量。显然,在一些地方,被感染的中年人正在减少。佛罗里达是个很显然的例子:目前佛罗里达被感染者的中位年龄是37岁——三月的时候,这个数据是65岁。这种变化在德克萨斯、亚利桑那和和其他一些地方都有出现。这种年龄上的变化不是可以至少部分解释ICU入院率的降低和呼吸机使用率的下降吗?是的,在某种程度上,年轻人遭受新冠病毒的痛苦更少,相比老年人,年轻人需要重症监护的可能也更小。

One theory as to why the median age has gotten younger is that older people are doing a better job of protecting themselves. But how long can this continue as the disease spreads through the younger population? Probably not long. If this is the reason we’re leaning less heavily on ventilators at the moment, then we are not really fixing the problem — instead, we’re postponing it.

关于病毒感染人群年龄中位数变年轻的一种理论是,老年人在保护自己不被感染方面的工作做得更好。但随着病毒在年轻人中传播,这种理论还能持续多久?也许不会很久。如果这是我们目前不那么依赖呼吸机的原因,那么我并没有真正解决问题——相反,我们反而加重了这个问题。

英文原文:https://elemental.medium.com/more-people-are-getting-infected-with-covid-19-but-fewer-ventilators-are-needed-why-3c3cdfe50cd2

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