這篇2010年美國全國經濟研究所 (National Bureau of Economic Research)的working paper 「PUBLIC AVOIDANCE AND THE EPIDEMIOLOGY OF NOVEL H1N1 INFLUENZA」
https://www.nber.org/papers/w15752
三位作者明白指出,在沒有疫苗的情況下,公眾之間的迴避與隔離可以有效降低nHiN1的流行感染速率(見圖一:虛線為沒有公眾迴避隔離的條件;實線為有公眾迴避隔離;數點為真實統計數字)
而我還是要重複強調,我認為在台灣疫情擴大之前,醫護資源較不吃緊的情形下,針對高風險的醫護人員實施定期普檢,並開放進口大陸、韓國或越南試劑、降低稅率、降低操作者資格要求,開放檢測服務提供自由市場與定價自由,民眾可自行決定購買檢測服務,毋須由醫生通報申請。
可以更有效獲取真實資訊,更能達到有效公眾迴避,從而達到曲線緩和成長。是的,我們可能最終會像有高達65%群眾感染從而群體免疫,但趨緩的上升曲線才可以避免「醫療資源擠兌」。
稍懂流行病學基本原理都知道,對付流行病毒只有三招:公眾隔離、疫苗與抗病毒藥劑。
WHO官網目前也只能宣傳勤洗手、勿觸摸眼鼻臉部、保持與他人距離來保護自身。
而在華爾街日報這篇長文投書「Reopening the U.S. Economy Even if the Pandemic Endures(即便疫情延續也要重新開放美國經濟)」
https://www.wsj.com/articles/reopening-the-u-s-economy-even-if-the-pandemic-endures-11587740529
該文作者提到:
1) 疫苗與藥劑的研發遙遙無期才是真相,即便現在許多所謂專家侃侃而談預計在2年內研發成功,但歷史上人類最快研發出疫苗的病毒是伊波拉病毒(Ebola),費時5年。
2) 目前COVID-19兩種檢測方式:抗體檢測或核酸檢測雖然各自有優缺點,但如要爭取重新復工,美國無論如何都應該快速拉升每日檢測量。作者悲觀的認為美國在9月之前可能才有機會把每日檢測量拉到100萬份。
目的何在?正是我主張的--有效將感染源隔離,讓未受感染或不再具備傳染力的康復者可以投入工作。
在台灣則可以更低成本有效避免走到「封城」那步,同時也有助於恢復市場信心。可能醫護人員看不到台灣重要都市的店面倒閉潮吧~
順道補充兩點:
a.經濟學研究醫療、公衛或流行病早是一門已經存在三十年的專業,那些以為「經濟學不該談公衛醫療」的人其實很外行。
b. 我們看到很多台灣所謂的「醫療專業」跟你談偽陽性問題,卻沒跟你談西醫的「誤診率」其實並不低。根據哈佛醫學院的研究,醫生在可預防診斷錯誤(preventable erros)有17%,又根據長達40年的遺體解剖回推研究得知醫生誤診率有9%,進一步看重大錯誤率中位數是23.5%,第一型錯誤率中位數是9%。
所謂「重大錯誤」是指醫生對死者的死因根本搞錯了。
所謂第一型錯誤是指醫生判定患者沒得什麼疾病,但事實上有。
(https://psnet.ahrq.gov/primer/diagnostic-errors)
台灣醫生的誤診率呢?呵呵。我們就相信是難波萬,美國比不上吧。
試劑檢驗並非確診COVID-19唯一手段,後面還有CT等其他醫療檢測手段做double-check。
我相信目前偽陽性機率與風險都遠低於「誤診率」。當某些醫療人員高舉偽陽性問題時,我看著誤診率呵呵。
同時也有10000部Youtube影片,追蹤數超過2,910的網紅コバにゃんチャンネル,也在其Youtube影片中提到,...
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#獨家 世界衛生組織將台灣問題相關聲明稿下架!
世界衛生組織(WHO)在台灣時間今(6)日凌晨以 "How the World Health Organization works with all people, everywhere" 為題發了一篇聲明稿,試圖為排除台灣參與 WHO 辯解。不過這篇聲明卻在不到 24 小時內就被 WHO 網站下架,直至晚間6時30分仍呈現「找不到網頁」(This page cannot be found),《沃草》透過世衛網站暫存紀錄,獨家為大家揭露該篇聲明內容。
聲明中,WHO仍稱與台灣相關的事務為「中國台灣事務」( Taiwan, China issues),針對全球的種種批評,WHO 仍稱之為誤解(misunderstandings),並聲稱是有些人將「技術性的維護全球公共健康任務」與「決定 WHO 會員資格的權限」混淆,似乎打算以此來回應國際要求讓台灣加入 WHO 的呼聲。
聲明中多處重申 WHO 在 3 月 29 日公布的聲明(https://waa.tw/Qsu21N),認為 WHO 與台灣設有聯絡點、台灣專家曾參與 WHO 會議等,並表示台灣參與世界衛生大會的觀察員資格是在一次次的會員國投票中遭到否決,以及提起讓中華人民共和國取代中華民國聯合國席位的聯合國 2758 決議文,表示世界衛生大會遵循此決議及其中的一中原則。
似乎是為回應全球對 WHO 應對流行病能力的質疑,WHO 在聲明中表示「有些人可能認為 WHO 成員組成影響我們維護世界安全的能力,但更重要的是要了解我們的治理方式和實踐方式。」
暫存檔網址:https://waa.tw/dohkIm
聲明截圖:https://drive.google.com/file/d/1VP-KMgP4wb6Oy8jQkOjoSu-DWGS3Xqkb/view
原新聞稿網址:https://waa.tw/lFKd8M
(以下為世界衛生組織聲明原文)
標題:Update: How the World Health Organization works with all people, everywhere
發表時間:5 April 2020 Statement
內文:
In recent months we have seen misunderstandings in social media and the news media about how WHO manages global public health issues. In particular, there are a lot of questions about Taiwan, China issues. Some people are confusing WHO’s technical global public health mandate, with the mandate of countries to determine WHO’s membership. Countries decide this. The WHO Secretariat focuses on keeping the world safe.
WHO works to promote the health of all people, everywhere. Indeed, one of our overarching goals is Universal Health Coverage. #healthforall. We are an organization with a staff of physicians, scientists, researchers and public health experts who are committed to serving all people regardless of nationality, race, ethnicity, religion, gender.
This includes the people of Taiwan. We serve them through regular interactions with their experts and authorities on vital public health issues. This has been the case over many years, including during the COVID-19 pandemic.
It is understandable that some people might think that the composition of WHO’s membership affects our ability to keep the world safe. But it is important to understand both how we are governed and how we operate in practice.
WHO is part of the United Nations, whose membership is the mandate of countries. In 1971, countries of the world participating in the United Nations General Assembly recognized the People’s Republic of China as “the only legitimate representative of China,” in effect, a one-China policy. That is contained in UNGA Resolution 2758. In 1972, the World Health Assembly decided in WHA Resolution 25.1 to follow that.
Every year, members have a chance to discuss important proposals during the World Health Assembly, where rules and policies governing WHO are decided. For example, at different times, some countries have proposed giving Taiwan’s authorities a special status – that of observing the annual World Health Assembly.
There have been 14 times over the last 22 years (1997-2006; and in 2008, 2017, 2018, 2019) when countries discussed whether a delegation from Taiwan could attend the World Health Assembly as an observer. Each time the countries decided against it by consensus – except in 1997 and 2004 when there were votes: (by 128 votes to 19 in 1997; and by 133 votes to 25 in 2004). In 2007, the issue wasn’t observer status, but membership, and countries decided against considering that by a vote of 148 to 17.
There have been occasions when it was clear that there was general support among WHO countries for Taiwan to take an observer seat at the World Health Assembly. Between 2009 and 2016, it did so under the name “Chinese Taipei.”
But having a seat at the WHA, or not having a seat at the WHA, does not affect, in any way, whether an area or population benefits from WHO expertise and guidance. WHO helps all people, everywhere.
WHO and Taiwan’s health experts interact throughout the year on vital public health and scientific issues, according to well-established arrangements.
During the current COVID-19 pandemic, interactions have been stepped up, both through existing channels and new ones as well.
Here are examples of WHO-Taiwan interactions around the coronavirus pandemic:
-- There is an established International Health Regulations (IHR) Point of Contact (POC) for Taiwan. Taiwan’s POC receives IHR (2005) communications, provides IHR information updates from Taiwan directly to WHO Headquarters, and has access to the IHR Event Information Site (EIS) system. The EIS system is a password-protected database and information exchange platform supporting the IHR. It is the well-established platform for all IHR communications, back and forth, between WHO and IHR contacts.
-- Health experts from Taiwan participate in two of the key WHO networks set up in January 2020 to support WHO work in the global COVID-19 response. Three experts from Taiwan are part of the WHO Infection Prevention and Control Network: two are part of the WHO Clinical Network. Every week, they join some 60 to 80 other experts from around the globe through a WHO-hosted teleconference, working to advance our knowledge and guidance in this response.
-- Two public health experts from Taiwan participated in the Global Research and Innovation Forum organized by WHO on 11-12 February 2020. They took part, alongside other world scientists, in considering critical research questions and in finding ways to work together to advance the response.
-- Taiwan’s Field Epidemiology Training Program is a member of the Training Programs in Epidemiology and Public Health Interventions Network (also known as “TEPHINET”). WHO shares Global Outbreak Alert and Response Network alerts and requests for assistance with TEPHINET, and those messages are cascaded to the TEPHINET members.
-- WHO, through its technical lead, has directly briefed health authorities from Taiwan and has offered again.
--Taiwan’s health experts and authorities have open access to developments, guidance and other materials through the WHO’s website (www.who.int) and other digital platforms.
--They can access the www.OpenWHO.org platform, which hosts open online courses for decisionmakers and responders around the world. During the COVID-19 pandemic, OpenWHO usage has reached more than 1 million.
--WHO has a designated contact point with their office in Geneva. Through this channel, general questions are handled and when technical concerns arise, WHO technical responses are coordinated.
--WHO also interacts with Taiwan’s health authorities through the European Centre for Disease Prevention and Control.
Importantly, the COVID-19 caseload in Taiwan is low relative to population. We continue to follow developments closely, and WHO is taking lessons learned from all areas.
Interactions with Taiwan during the response to the pandemic is not exceptional. Here are some examples of regular interactions with Taiwan’s health authorities and WHO, over many years, through well-established arrangements, and across many different global health concerns:
Over the course of 2019, Taiwan’s experts were invited to attend 9 WHO technical meetings. They attended 8 of these meetings, contributing to WHO expert processes on issues including immunization, drug-resistant TB, assistive technologies, vaccine safety and SDG targets on NCDs and Mental Health. Prior to the Covid-19 emergency, work was underway for more expert participation from Taiwan in 2020.
On influenza, Taiwan vaccine manufacturer Adimmune contributes to the WHO Pandemic Influenza Preparedness Framework (PIP Framework) and preparations are underway for concluding an agreement between WHO and Adimmune under the PIP Framework for pandemic influenza vaccine products;
In the fight against cancer, experts from Taiwan have contributed to key publications issued by the WHO International Agency for Research on Cancer;
In support of the International Health Regulations, an expert from Taiwan has been appointed to the IHR Expert Roster; and
On a range of other issues, from WHO pre-qualification practices for pharmaceutical manufacturers to malaria, there are exchanges with WHO on practical and technical issues.
It is fair to say that the contribution of Taiwan’s health experts to WHO, and their interactions with us, are well-developed and broad-based. And these interactions add value to the work of WHO and to global health.
influenza epidemiology 在 Dr 文科生 Facebook 的最佳貼文
1) 一個瘟疫, 死亡率高的話固然恐怖,但低的話,病人較高機會再傳播開去,所以可以傳染得更多人。(玩過遊戲如 Pandemic 都會見過這情境)
豬流感據說死亡率只有 0.02%, 但全球 20% 人口受感染 (1)。相比當年 SARS 死亡率約 10% ,不過「只是」感染超過 8000 人 (2)。而現今武漢病毒「200人」 中有「3 人」死亡。
本人非流行病學專家,只是讀醫科以外讀多了一年流行病學 epidemiology,不敢自作估計。 不過如果武漢病毒死亡率 (大家姑且暫當做單位數字) 是介乎豬流感和沙士之間,再遇上農曆新年/春節人流... 最後感染個案會有多少呢?
而其他地方,如香港、東南亞、甚至全球 (今時今日飛機可以短時間全球傳播,可不像 1918 年西班牙流感,慢慢「坐船過海」),如果不好好把關,又會有多少個案?
Only time will tell.
___________________
2) Yahoo 新聞: //政府相關部門昨開會後,決定加強口岸防控監察,將懷疑感染個案的法定呈報準則,由到訪過武漢及內地醫院,擴展至到訪過整個湖北省後發病的個案。//
// 填寫申報表只在武漢航班實施,陳漢儀說是考慮到操作問題,以免大量人滯留關口等待填表 //
陳漢儀貴為衞生署署長,學術背景有新加坡國立大學公共衞生醫學碩士,遇上新未知病毒的答案竟然是「申報表」? 填寫申報表只在武漢航班實施,因為「考慮到操作問題」? Wow.
郭家麒醫生議員批評得對:「疫情都已經擴散到去咁多地方,你仲只係針對武漢航班填寫健康申請表有乜用!呈報準則更是荒謬,連北京同深圳都有病例,政府仲只係話(呈報範圍)擴展到湖北。」(3)
___________________
3) 用流感 (流行性感冒,influenza) 與新未知病毒作比較,是為幼稚。"Flu season" 年年有,而真正瘟疫/大流行病則過去每數十年出現一次。
正如在某偽醫護專頁(圖),有網友留言: //流感你知咩病毒,傳播途徑,有疫苗預防,有藥醫(都算),全世界mon住,你隻肺炎連咩病毒都未知,臨床治療方法又唔知,傳染性有幾強又唔知...//
如果講武漢都要搬出美國流感,並形容為「蚊髀同牛髀」,醫學討論都要強加上臭蟲論,維穩筆者什麼質素有目共睹。
🤦♂️
___________________
As I said, 本人非流行病學專家。非常歡迎真正學者討論 🙂
1. https://www.reuters.com/…/swine-flu-infected-1-in-5-death-r…
2. https://www.nhs.uk/conditions/sars/
3. https://hk.mobi.yahoo.com/…/%E6%B8%AF%E5%BA%9C%E6%87%89%E8%…
influenza epidemiology 在 Influenza: Epidemiology and Viral Structure - YouTube 的推薦與評價
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