關於Delta - COVID之我見

最近COVID嘅delta strain係世界各地爆到七彩，美國、英國同澳洲都失守，瘋狂社區感染。好多「智者」成日會話疫苗可能有長遠影響而無人知，甚至鼓勵民眾齊齊感染共享肺炎，到底由得COVID爆有咩問題？

Point form

1. 其實好有趣，「智者」們會話無人知疫苗長遠有咩影響，但其實都無人知中完COVID，幸運地康復後長遠有咩重大影響，近排都有唔少研究講long COVID syndrome，係咪真係重感冒咁簡單呢，似乎又唔係。

2. 「智者」們會用最新WHO/CDC/NEJM等嘅研究去講話打完疫苗都係可以照傳染，咁點解要打，仲笑打疫苗嘅人on9承受疫苗風險。的確，疫苗來得太遲，當初對alpha asymptomatic transmission嘅保護力的確相當高，但依加流行緊嘅係delta就變相得返symptomatic disease嘅保護力。即係點？即係可以避免你出現徵狀，但無法避免你傳染俾其他人。

有咩implication？就係如果解封、開關嘅話，打咗疫苗嘅人中招後出現徵狀、要入ICU、要插喉或用呼吸機甚至死亡嘅機會低好多，但無打嘅人就會係Baseline risk。

Delta傳染力特強，唔少國家都似乎打算唔再用以往封城封關封到2046嘅做法，而係盡量幫想打疫苗嘅人打咗先，到之後瘋狂大爆發時，起碼無咁多人要用ICU/呼吸機資源。

3. 瘋狂爆delta有咩問題？就係一些原本諗住淨係俾特定population打嘅疫苗變咗要balance risk and benefit去俾更年輕嘅人打。例如澳洲打AZ由本來限60歲以上就最近降到18歲以上就建議打。

但個問題就出現，AZ或美國J&J Adenovirus vector疫苗有好罕有嘅機會出現VITTS，通常係第一劑嘅4-42日出現，常見於年輕女性。當谷針或市民擔心感染打完AZ後，如果出現頭痛或肚痛咁點算？

無一個醫生會敢寫包單當係vaccine constitutional symptoms，你去睇家庭醫生佢會叫你去急症，你去急症佢會幫你抽Platelet +/- D-dimer +/- fibrinogen。但當個病人好擔心個頭痛或肚痛係因為打疫苗嘅VITTS，有無醫生敢唔做investigation呢？即使目前個rate大約係86/25 million = 0.000344% （Nature and European studies）

0.000344%係咪高？我諗大家中裡有數

但個問題就係，有無人敢孭飛？有無人敢唔驗血就送個病人返屋企？

如是者，每個打完AZ/J&J疫苗嘅病人去醫院，基本上都會抽血，抽完血如果個病人堅持甚至會照CT brain venogram/CTPA/CT venogram/Doppler US等等。

咁代表d咩，代表真係急症嘅病人會因此delay，其他更有需要照CT嘅人又會被delay。

當中用咗幾多醫療資源？就算發達國家都有油盡燈枯嘅一日

4. 醫療資源係有限，由得COVID爆嘅問題就係當資源用盡時，到底救邊個。現代醫療好嘅地方係好多古時會死嘅病，今時今日可以避免到。一個嚴重嘅COVID，及早使用remdesivir, dexamethasone +/- regeneron嘅monoclonal antibodies（有d國家會用Tocilizumab但evidence未太明朗）可以減低重症同死亡率。嚴重時用high flow/NIV/Ventilator又要去ICU 1:1或2:1護士比例去照顧個病人。

我當你1%要ICU support，如果你好似英美咁一日爆幾萬，你每日都會增加幾百個要用ICU資源嘅病人。呢d資源好多時候其他病人，例如COPD exacerbation/renal crisis/trauma/sepsis等等唔少嘅病人都可以靠ICU逃過鬼門關，但如果一路爆，要搶資源時，就要簡人去救。

到底簡邊個去救？邊個但得被救？我地點定義條線？

5. 繼續社區爆發嘅問題係邊？就係好多elective或non urgent嘅治療或手術會被取消。邊d係elective/non urgent？例如激光打腎石、小腸氣、割膽去膽石、前列腺增生、mental health嘅ECT/CBT、allied health嘅rehab/physio/occu/speech等等，下刪幾百種可以改善生活質素嘅手術或治療要被延後。

你可以幻想下一個中完風嘅病人，一般透過physio/occu/speech治療後係可以大大改善生活質素，但因為疫情而無得access呢d服務，甚至可能會miss咗rehab嘅最佳window

呢d全部都要考慮嘅嘢，「智者」們係唔會話你聽，因為佢地無受到呢d嘅影響同時亦唔係醫療嘅service provider，they couldn’t care less about public’s health

6. 醫護人員個個都因為疫情而心力交瘁

照顧每個COVID病人都需要著更多嘅保護衣，花更多嘅時候去做程序，特別係aerosol generating procedures，插完一次喉都定必會成身濕哂。

就算只係簡單嘅打導管同抽血等程序都比以往辛苦同費時。結果就係少咗時間花係其他病人身上。

封城封關封到2046真係會心累，但當社會上充斥著一群反疫苗、反控制疫症、甚至呼籲民眾齊來感染COVID來共享肺炎時，係咪真係幫緊件事？

其實都好明顯見到唔會contain到delta，世界各地嘅做法都開始跟英國，幫哂所有想打疫苗嘅人打之後，就齊齊解封，唔想打嘅人就面對感染同重症甚至死亡嘅風險，informed decision, can’t blame anyone

只不過好多發達國家嘅人都有一股self entitled嘅心，覺得唔打疫苗後中招而重症時，就應份咁享用珍貴嘅醫療資源。

Do you even care how much it costs for the care and treatment of a COVID patient in ICU?

Photo source: internet

We are negative!!!! And now all of us are back to work, to fight this COVID war together 💪💪

Besides home quarantine, there is a few things that you, as a community, can help us out.
👼👼
1. For those who are on medication, please be an obedient one, take your medication on time and dont missed it. Especially those on asthma medication, antihypertensive and insulin.
Don come into us for complication due to missed medication, it really helps us a lot in reduce admission.

2. Don merayau-rayau on the road unnecessarily. Reduce the accident on the road, which comprises a large portion on emergency dept admission.

3. Dear parents, it is the best time to show off your cooking skill. Cook in the house, prepare the healthy meals for the love one, so they wont come in because of food poisoning / acute gastroenteritis. 👨‍🍳👩‍🍳👨‍🌾

4. Dear smokers, we know you are bored. Damn bored, but please, don smoke for this critical moment, especially those with small children at home. Their breathing airways are sensitive, and we still receiving quite a number of child with respiratory distress in exacerbation ( and yeah mostly related to smoking).

5. It is NOT a festival for binge eating for now. Eat with your own portion, we don wish to accept any patient came in due to hyperglycemia or vomiting due to overfeeding ( yes we do!) 🤢🤮

6. For those who are on fluid restriction due to heart and kidney disease, please be self discipline. Don simply simply drink a big amount of water and came to us for fluid overload.

7. I know this is weird but please control your temper with the kiddos, we don wish to accept any abuse case at this moment. They could be naughty and misbehave, but we hope the parents behave as well 😬😬

8. For those with clinic appointment but not urgent one ( review growth and development in kids for example), you can kindly call up the hospital clinic to postpone the appointment, we are happy to help with that.

Lets reduce the admission and visit to hospital so all of us can focus on COVID war at this moment. You ARE A HERO too if you play your parts well.

Thank you!!! 💪💪💪💪💪

昨天的po文看了嗎？
今天已進入印度🇮🇳空汙篇part 2了哦！
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😷 俐媽新聞英文—空汙篇part 2:
🌫air purifier (ph.) 空氣清淨器
🌫snugly (adv.) 緊貼地
🌫emanate (v.) 發出 (氣體)有時
🌫slash-and-burn (n.) 游耕；火耕
🌫reluctant (a.) 不情願的；勉強的
🌫drastic (a.) 嚴厲的；激烈的 (常指手段)
🌫smother (v.) 使窒息；使透不過氣來；把...悶死
🌫intangible (a.) 無形的
🌫stagnant (a.) 停滯的；污濁的；發臭的
🌫hazardous (a.) 危險的；冒險的
🌫exacerbation (n.) 惡化；加劇
🌫curb (v.) 控制；約束；抑制
🌫pervasive (a.) 瀰漫的
🌫respiratory (a.) 呼吸的
🌫combustion (n.) 燃燒；氧化
🌫mitigation (n.) 緩和；減輕
cf. migration (n.) 遷徙
🌫blatant (a.) 公然的
🌫consecutive (a.) 連續不斷的
🌫stubble (n.) 殘株
🌫noxious (a.) 有毒的
🌫particulate (a.) 微粒的；(n.) 微粒狀物質
🌫fug (n.) 室內的悶熱空氣 [英式用語]
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俐媽每天出門也會關切各地空汙指數，
常常全家得戴口罩出門😷😷😷😷
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以上感謝欒為同學整理提供🙏🏼

#俐媽新聞英文 #俐媽新聞英文空汙篇 #india #indiaairpollution #airpollution #contamination