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科學美國人(翻譯):COVID-19尸檢揭示了什么 2020.04.21

COVID-19: What the Autopsies Reveal

COVID-19:尸檢揭示了什么

Steve Mirsky: This is another in our series of coronavirus episodes of Scientific American’s Science Talk, posted on April 23, 2020. I’m Steve Mirsky.

史蒂夫·米爾斯基:這是《科學美國人》在2020年4月23日的《科學談話》中關于冠狀病毒的系列報道中的另一篇。我是史蒂夫·米爾斯基。

In this episode, we hear again from our contributing editor W. Wayt Gibbs in Washington state, a region that now seems to have passed the peak of this first wave of the pandemic. Gibbs reports on how pathologists are starting to get a much closer look at the damage that COVID-19 does to the body by carefully examining the lungs, hearts, kidneys, and other organs of people who have died while infected with the novel coronavirus.

在這期節目中,我們再次聽到特約編輯W. Wayt Gibbs在華盛頓州的講話,該地區現在似乎已經度過了第一波流感大流行的高峰期。Gibbs報告了病理學家如何開始更仔細地檢查死于這種新型冠狀病毒的患者的肺、心臟、腎臟和其他器官,從而更深入地了解covid19對人體造成的損害。

Wayt spoke with experts at the Cleveland Clinic and the University of Washington who have performed these high-risk autopsies, very few of which have been done so far in the United States.]

WWG: COVID-19 is a new disease, and doctors have been struggling to figure out how best to treat it. Putting people on ventilators is always a last resort: for other diseases, typically about half of the patients who go onto a ventilator do not survive. But COVID-19 patients seem to do even worse on mechanical ventilation. A study in the U.K. found that only about a third of coronavirus patients survived that experience. And in a report published on April 22 in the Journal of the American Medical Association, researchers found even more alarming outcomes recently in New York City. Analyzing data from 12 large New York hospitals during March, they found that out of 320 patients put onto ventilators, 282 died. So only about one in nine survived mechanical ventilation.

韋特與克利夫蘭診所(Cleveland Clinic)和華盛頓大學(University of Washington)的專家進行了交談,他們進行了這些高風險的尸檢,但迄今為止在美國進行的此類尸檢很少。

WWG: COVID-19是一種新的疾病,醫生們一直在努力尋找最好的治療方法。讓人們使用呼吸機一直是最后的選擇:對于其他疾病,通常有一半使用呼吸機的病人不能存活。但COVID-19患者在機械通氣時表現更差。英國的一項研究發現,只有大約三分之一的冠狀病毒患者能夠存活下來。4月22日發表在《美國醫學會雜志》(Journal of the American Medical Association)上的一份報告顯示,研究人員最近在紐約市發現了更令人擔憂的結果。他們分析了3月份紐約12家大型醫院的數據,發現320名患者中有282人使用了呼吸機。所以只有1 / 9的人通過機械通氣幸存下來。

We know this new coronavirus damages the lungs, but how exactly? Does it differ in important ways from influenza and other viral lung infections? Some experts have suggested that the virus can infect and damage the heart as well, and maybe the kidneys, or even the brain. When people are seriously ill with COVID-19, they seem to be at higher risk of blood clots.

我們知道這種新型冠狀病毒會損害肺部,但具體是如何損害的呢?它與流感和其他病毒性肺部感染有重要區別嗎?一些專家認為,這種病毒也會感染并損害心臟,甚至腎臟,甚至大腦。當COVID-19患者病情嚴重時,他們出現血栓的風險似乎更高。

But it’s really hard to determine from lab tests and fuzzy medical images whether it’s the virus damaging these other organs—or whether the body’s own immune system is fouling up the works, as it generates a massive inflammatory response to combat the coronavirus.

但是很難從實驗室測試和模糊的醫學圖像中確定是病毒破壞了其他器官,還是人體自身的免疫系統破壞了這些器官,因為它會產生大量的炎癥反應來對抗冠狀病毒。

Desiree Marshall: “Any kind of lung injury can result in acute respiratory distress syndrome.”

“This is a disease process that we've known about for a long time. It's a stereotypical pattern of injury that we see in the lungs when they're injured for many, many different kinds of reasons.”

Desiree Marshall:“任何類型的肺損傷都可能導致急性呼吸窘迫綜合征?!?/p>

“這是一個我們已經了解了很長時間的疾病過程。這是我們在肺部看到的一種典型的損傷模式,當他們因為很多很多不同的原因受傷時?!?/p>

WWG: That’s Desiree Marshall, a pathologist at the University of Washington. She says that it’s often the cascading organ failure triggered by acute respiratory distress syndrome—or ARDS—that causes elderly people to die from influenza, and firefighters to die from smoke inhalation, and cancer patients to die from reactions to chemotherapy.

WWG:這位是華盛頓大學的病理學家德西蕾·馬歇爾。她說,導致老年人死于流感、消防員死于煙塵吸入、癌癥患者死于化療反應的往往是急性呼吸窘迫綜合征(即ards)引發的級聯性器官衰竭。

The pressing question we need to answer for COVID-19 is whether it’s just ARDS that makes the disease deadly, or whether this new disease is different and even more complicated to treat than what doctors have seen before.

對于COVID-19,我們需要回答的緊迫問題是,究竟是ARDS導致了這種疾病的死亡,還是這種新疾病與以往的醫生所見不同,治療起來更加復雜。

Well, if you watch TV, you know what medical examiners do when they want to figure out what killed somebody. There’s just no substitute for a thorough and detailed autopsy. Earlier this month, researchers published the first English-language autopsy results on people who died after becoming infected with the novel coronavirus. The paper appeared in the American Journal of Clinical Pathology on April 10. It describes two interesting cases, both from Oklahoma.

如果你看電視,你就會知道當法醫想要找出是什么致死的時候他們會怎么做。沒有什么能代替徹底而詳細的尸檢。本月早些時候,研究人員公布了首例英語尸檢結果,這些人是在感染新型冠狀病毒后死亡的。這篇論文發表在4月10日的《美國臨床病理學雜志》上。它描述了兩個有趣的案例,都來自俄克拉荷馬州。

Case 1 was a 77-year-old man who had cycled between fever and chills for six days before finally calling for an ambulance on March 20. He had high blood pressure and some other health issues, but no cough. On the trip to the hospital, he was gasping for air, and his heart stopped. By the time they arrived at the emergency room, it was too late.

病例1是一名77歲的男子,他在發燒和發冷之間騎了6天,最后在3月20日叫了救護車。他有高血壓和其他健康問題,但沒有咳嗽。在去醫院的路上,他氣喘吁吁,心臟停止了跳動。當他們趕到急診室時,已經太晚了。

The gentleman had not seen a doctor for his fever. He had not been tested for COVID-19. So it wasn’t clear what had caused the heart attack and taken his life.

這位先生發燒沒有去看醫生。他沒有接受COVID-19的檢測。所以目前還不清楚是什么導致了心臟病發作并奪走了他的生命。

The medical examiner’s team in Oklahoma City decided that it was important to find out. They swabbed the man’s nasal passages and also his lungs. Both swabs tested positive for the SARS-CoV-2 virus. And chest x-rays showed what they described as “complete whiteout” in what would normally be dark, empty lung cavities.

俄克拉荷馬城的法醫團隊認為,找到這個問題的答案很重要。他們擦洗了這名男子的鼻腔和肺部。兩份棉簽檢測結果均為SARS-CoV-2病毒陽性。胸部x光片顯示,他們所謂的“完全白了”,原本應該是漆黑的空洞的肺部。

Doing an autopsy on a COVID-positive body is risky, but they had the special protective equipment and high-containment room they needed to do it. And maybe they could learn something that would help save some of the hundreds of thousands of people around the world who will fight COVID-19 for their lives in the months to come.

對一具毒檢呈陽性的尸體進行尸檢是有風險的,但他們有專門的保護設備和高密封室來進行尸檢。也許他們可以從中學到一些東西,在未來的幾個月里,幫助拯救世界上成千上萬為生存而戰的人們。

So they laid his body on the dissecting table, and they opened him up.

The team contacted a well-known lung pathologist at the Cleveland Clinic to help them interpret what they saw, especially as they examined tissue samples from various organs under the microscope.

于是他們把他的尸體放在解剖臺上,把他剖開。研究小組聯系了克利夫蘭診所(Cleveland Clinic)一位著名的肺部病理學家,幫助他們解釋他們看到的情況,尤其是在顯微鏡下檢查來自不同器官的組織樣本時。

Sanjay Mukhopadhyay: “My name is Sanjay Mukhopadhyay. I'm director of pulmonary pathology at the Cleveland Clinic.”

Sanjay Mukhopadhyay: “我叫桑杰·穆科帕德哈耶。我是克利夫蘭診所的肺病理學主任?!?/p>

Mukhopadhyay: “Autopsies give you another deeper look into tissue that is actually several layers of resolution higher than what you can get from a history of physical examination, routine lab tests, even the highest-resolution CT scans. None of them even approach the resolution that you can get from an autopsy.”

Mukhopadhyay:“尸檢讓你對組織有了更深層次的了解,它的分辨率實際上比你從身體檢查、常規實驗室測試、甚至是最高分辨率的CT掃描中得到的結果要高好幾層。它們甚至都達不到你從尸檢中得出的結論?!?/p>

WWG: The medical examiners had noticed that this man’s lungs were two to three times heavier than usual—a common consequence of ARDS. Pathologists actually refer to that syndrome by a different name, one that describes the end result of the disease in lung cells. They call it diffuse alveolar damage.

WWG:醫學檢查人員注意到這個人的肺比平時重兩到三倍,這是ARDS的常見后果。病理學家實際上用另一個名字來稱呼這種綜合癥,這個名字用來描述這種疾病在肺細胞中的最終結果。他們稱之為彌漫性肺泡損傷。

Mukhopadhyay: “In that gentleman, we found…diffuse alveolar damage under the microscope…when you take a breath and it goes down your windpipe, the windpipe actually branches into two, and one goes into the left lung, and one goes into the right. And then those branches of the windpipe branch like the branches of a tree: you know, they get smaller and smaller and smaller as you go further and further away. And the endpoint of the branch is what we call an alveolus. Or colloquially you can call it an air sac.

Mukhopadhyay:“在那位先生的身上,我們在顯微鏡下發現了彌漫性肺泡損傷。當你吸氣時,它沿著你的氣管向下延伸,氣管實際上分成兩段,一段進入左肺,另一段進入右肺。然后那些氣管分支就像樹的分支:你知道,它們會隨著你走得越來越遠而變得越來越小。這個分支的端點就是我們所說的肺泡。通俗地說,你可以叫它氣囊。

“And what that is just a very tiny balloon. You need a microscope to see it. There are just thousands and thousands of those little balloons in the lung. That's what makes up the lung.

“那只是一個很小的氣球。你需要顯微鏡才能看到它。肺里有成千上萬的小氣球。這就是肺的組成。

WWG: So each time you inhale, you inflate thousands of microscopic alveoli.

Mukhopadhyay: “As the air enters into that little balloon with oxygen in it, the point of the balloon is to take that oxygen into the bloodstream. So the wall of the balloon has little blood vessels in it. In the normal lung, when you take a breath, the oxygen goes from the middle of the balloon into the wall of the balloon, and that's where the arteries are, and then the oxygen goes into your blood cells—red blood cells we call them—and then that takes it back to the heart and the heart sends the oxygen to the rest of the body.

WWG:所以每次你吸氣時,你就會吹起成千上萬個微小的肺泡。

Mukhopadhyay:“當空氣進入那個有氧氣的小氣球時,氣球的作用是將氧氣帶入血液。所以球囊壁上有小血管。在正常的肺換氣時,氧氣從中間的氣球氣球的墻,這就是動脈,然后氧氣進入血液cells-red血細胞我們稱之為——然后,回到心臟和心臟發送氧氣到身體的其他部位。

WWG: For this exchange of oxygen and carbon dioxide to work properly, the thin lining of the air sac has to be very close to the walls of the blood vessels.

Mukhopadhyay: “Now what happens in COVID—and in actually in any severe viral infection—is that the virus starts causing damage where it attaches first, which is the back of the throat, and then all the way down the windpipe, down the branches, to the smallest branches and then into the air sacs. And when it gets into the air sacs, we call that a viral pneumonia. The virus is damaging the walls of the air sacs.”

WWG:為了使這種氧氣和二氧化碳的交換正常工作,氣囊的薄層必須非??拷鼙?。

Mukhopadhyay:“現在發生在COVID-and實際上在任何嚴重的病毒感染,病毒開始造成損害,它高度第一,這是后面的喉嚨,然后進入氣管,樹枝,最小的分支,然后進入氣囊。當它進入肺泡時,我們稱之為病毒性肺炎。病毒正在破壞氣囊壁?!?/p>

WWG: Those little webs of capillaries that surround the walls of the air sacs start to leak. Proteins, fluids, white blood cells, and debris from destroyed lung tissue seep into the air sacs. The debris clogs the balloons, but maybe even more important, it also thickens the walls of the air sacs.

Mukhopadhyay: “Literally, it's making a barrier for the oxygen to go from the middle of the alveolus to the bloodstream. This is the reason that oxygen levels are so low in these patients who are very sick from COVID.”

WWG:那些圍繞在氣囊壁上的毛細血管開始滲漏。蛋白質、液體、白細胞和來自被破壞的肺組織的碎片滲入肺泡。碎片會堵塞氣球,但更重要的是,它還會使氣囊壁增厚。

Mukhopadhyay:“從字面上看,它為氧氣從肺泡中心進入血液制造了一個障礙。這就是為什么這些因COVID而病得很重的病人體內的氧含量如此之低的原因?!?/p>

WWG: The researchers concluded that Case 1, the 77-year-old man, had died from COVID-19, even though he had never been diagnosed with it.

Mukhopadhyay says he was struck by how similar the pattern of organ damage was to what he is used to seeing from autopsies on people who died from other viral infections.

WWG:研究人員得出結論,病例1,77歲的男子,死于COVID-19,盡管他從未被診斷出患有COVID-19。

Mukhopadhyay說,他對器官損傷的模式感到震驚,這種模式與他過去從死于其他病毒感染的尸體解剖中看到的非常相似。

Mukhopadhyay: “It's actually very similar to what happens in influenza…and just to mention a few other examples: SARS, you know, the SARS from 2000 to 2003— identical. MERS, the Middle Eastern Respiratory Syndrome: identical findings. I did autopsies and reported them on H1N1, when that happened, the swine flu: identical findings.

Mukhopadhyay:“這實際上與流感的情況非常相似……只是提到幾個其他的例子:非典,你知道,2000年到2003年的非典——完全相同。中東呼吸綜合征:相同的發現。我做了尸檢,并報告了H1N1,當它發生的時候,豬流感:相同的結果。

Mukhopadhyay: “And I'll give you one more example. You know, the when the vaping thing happened just recently, and many people were getting sick from that, the most sick patients were actually developing diffuse alveolar damage.”

Mukhopadhyay:“我再給你舉一個例子。你知道,當蒸汽的事情發生在最近,許多人因此生病,大多數病人實際上發展成彌漫性肺泡損傷?!?/p>

WWG: Case 2 was different. This man had gone to the hospital a day earlier, on March 19. He was only 42, but he had myotonic muscular dystrophy, a hereditary disease that causes the muscles to weaken or atrophy, sometimes so much that food can back up from the stomach and go down the wrong tube, into the lungs, where it causes bacterial pneumonia.

第二種情況不同。這名男子于3月19日去了醫院。他只有42歲,但他患有肌強直性肌營養不良癥,這是一種導致肌肉變弱或萎縮的遺傳性疾病,有時嚴重到食物會從胃里出來,然后通過錯誤的管道進入肺部,導致細菌性肺炎。

He felt sharp abdominal pains and went to the hospital, where a CT scan showed fluid in his lungs. Just hours later, his heart gave out, and he passed away.

他感到腹部劇痛,去了醫院,CT掃描顯示他的肺部有液體。幾個小時后,他的心臟停止了跳動,他去世了。

Mukhopadhyay: “Although he was labeled as community-acquired pneumonia and died and was found to be COVID-positive, the microscopic examination of this patient does not support the idea that he died of COVID. So there was no diffuse alveolar damage.”

Mukhopadhyay:“盡管他被貼上了社區獲得性肺炎的標簽并死亡,經檢查發現他的COVID呈陽性,但對這位病人的顯微鏡檢查并不支持他死于COVID的觀點。所以沒有彌漫性肺泡損傷?!?/p>

WWG: Instead, they found food particles and bacterial infection in the airway, clear signs of aspiration pneumonia. So Case 2 died with COVID-19, but he did not die of COVID-19.

Mukhopadhyay: “Which now makes it very interesting because it brings up the issue of how often is this happening? How often are people who are positive for COVID on a nasal swab dying of things other than COVID?”

WWG:相反,他們在氣道中發現了食物顆粒和細菌感染,這是吸入性肺炎的明顯跡象。病例2死于COVID-19,但他沒有死于COVID-19。

Mukhopadhyay:“這讓事情變得非常有趣,因為它提出了這樣的問題:這種事情發生的頻率有多高?對科維德有陽性反應的人死于科維德以外的東西的幾率有多大?”

WWG: I put that question to Desiree Marshall, whom we heard from earlier.

DM: “I'm the director of autopsy and after death services at the University of Washington Medical Center.”

WWG:我把這個問題問給了Desiree Marshall,我們之前聽過他的演講。

DM:“我是華盛頓大學醫學中心尸檢和死后服務中心的主任?!?/p>

WWG: Since early March, Marshall has performed more than a dozen autopsies of people who died after testing positive for coronavirus infection. She says the results of those autopsies have been submitted to a medical journal for publication but are still undergoing peer review.

Marshall says that the risk of infection that this virus poses has changed how they perform all autopsies, regardless of whether the person was suspected to have COVID-19 or not.

WWG:自3月初以來,馬歇爾已對十幾例死于冠狀病毒感染的人進行了尸檢。她說,這些尸檢的結果已經提交給一家醫學雜志發表,但仍在接受同行的審查。

馬歇爾說,這種病毒造成的感染風險已經改變了他們進行所有尸檢的方式,不管這個人是否被懷疑患有COVID-19。

DM: “We've actually started to swab all of our decedents and get those results before we'll perform an autopsy in our facility that isn't the negative-pressure suite.”

WWG: So has Marshall also found that—like Case 2 in Oklahoma—some patients are dying of something else but turning out to have coronavirus infection as well?

DM:“我們實際上已經開始采集所有死者的樣本,并在我們的設備進行尸檢之前得到這些結果。我們的設備不是負壓設備?!?/p>

WWG:那么馬歇爾是否也發現了類似于俄克拉何馬州的2號病例——一些患者死于其他疾病,但最后被證明是冠狀病毒感染?

DM: “We have not. We have not had any unexpected positive results yet. It's still a limited number, but of the probably 15 that we've done, we have not had a positive come back where we weren't expecting it.”

DM:“我們沒有。我們還沒有取得任何意想不到的積極成果。這仍然是一個有限的數字,但我們已經做了大概15個,我們沒有一個積極的回來,我們沒有預料到它?!?/p>

WWG: And what about the finding from Case 1 in Oklahoma? Here in Washington, are most of the COVID-19 patients dying from more-or-less standard ARDS, or are the autopsies revealing evidence of the virus infecting and damaging other organs as well?

WWG:那俄克拉何馬州案例1的發現呢?在華盛頓,大多數COVID-19患者死于或多或少的標準急性呼吸窘迫綜合征,還是通過尸體解剖發現了病毒感染并損害其他器官的證據?

DM: “Hearing concerns of the clinicians and folks on the frontlines, … questions like is the virus infecting the heart? Or is it just kind of secondary effects related to the critical illness? Is there excess clotting related to this disease, different things like that…

DM:“傾聽臨床醫生和前線人員的擔憂,……像病毒是否感染心臟這樣的問題?或者它只是與危重癥相關的一種副作用?是否有過多的凝血與這種疾病相關?

“It looks like it's helping us to see that COVID is actually causing typical acute respiratory distress syndrome. Initially, there were thoughts that it was behaving a bit differently, but I think as we get more numbers of people, and there's less of the individual variability, the vast majority of these cases are showing the typical pathologic features of acute respiratory distress syndrome, which we call diffuse alveolar damage in pathology. It does look like it is that phenomenon. And there's not something sticking out pathologically that's different. And in a way that will inform them that, you know, they should probably continue to use the evidence-based, tried-and-true therapies for ARDS.

WWG: In particular, Marshall says, they aren’t seeing an unusual number of small blockages in blood vessels that would require treatment beyond the usual blood thinners such as heparin. Nor has her group or others she has heard from around the country found the coronavirus causing serious heart infections in the autopsies they have completed so far.

“看起來這有助于我們了解COVID實際上是在引起典型的急性呼吸窘迫綜合癥。最初,有思想,行為有點不同,但我認為,隨著我們越來越多的人,有更少的個體差異性,絕大多數的這些病例顯示典型的急性呼吸窘迫綜合征的病理特征,我們稱之為彌漫性肺泡損傷病理病變??雌饋泶_實是這樣的。病理上并沒有什么不同。在某種程度上,這會告訴他們,你知道,他們可能應該繼續使用循證的,可靠的治療ARDS的方法。

WWG:特別是,Marshall說,他們并沒有發現血管中有不尋常數量的小血管堵塞,因此需要在常規的血液稀釋劑(如肝素)之外進行治療。迄今為止,她所在的小組或她從全國各地聽到的其他人的尸檢也沒有發現導致嚴重心臟感染的冠狀病毒。

That’s an important finding because ICU physicians in the Netherlands, New York and other places have been reporting that 20 to 40 percent of COVID-19 patients in intensive care have blood that clots abnormally. These doctors worry that tiny clots may be interfering with blood circulation in those sickest with coronavirus. That could be one reason the mortality rate among these patients is so high.

這是一個重要的發現,因為荷蘭、紐約和其他地方的ICU醫生已經報告說,在重癥監護的covid19患者中,有20%到40%的血液凝結異常。這些醫生擔心微小的血塊可能會干擾冠狀病毒攜帶者的血液循環。這可能是這些病人死亡率如此之高的一個原因。

Mukhopadhyay and Marshall acknowledge that possibility. But they say that ARDS often damages blood vessels in ways that can cause tiny clots to form, and it is not yet clear whether this coronavirus infection is generating more clotting than happens in ARDS caused by other viruses or injuries. We need more evidence from more autopsies to know for certain, they say.

Mukhopadhyay和Marshall承認這種可能性。但是他們說,ARDS經常會破壞血管,導致微小的血栓形成,目前還不清楚這種冠狀病毒感染是否比其他病毒或損傷引起的ARDS產生更多的凝血。他們說,我們需要從更多的尸檢中獲得更多的證據才能確定。

The jury is still also out, Marshall says, on whether the virus can cause encephalitis or other brain disease. Investigators in Washington have so far examined four brains from COVID-19 patients.

DM: “One of those showed some small hemorrhages on the brain surface and then rare small hemorrhages in the brainstem. But no obvious, frank cases where there was definite inflammation or infection by the virus. So that needs to be continued to be looked at.

馬歇爾說,關于這種病毒是否會引起腦炎或其他腦部疾病,目前還沒有定論。到目前為止,華盛頓的研究人員已經檢查了19名covid患者的4個大腦。

DM:其中一個在大腦表面有小出血,然后在腦干有罕見的小出血。但沒有明顯的,坦率的病例,其中有明確的炎癥或感染的病毒。所以這需要繼續被關注。

WWG: Kidney disease is thought to be a risk factor for serious COVID-19 illness, but doctors have also reported a high rate of kidney damage among patients hospitalized for the virus. Acute kidney injury was seen in nearly one in five COVID-19 patients in those 12 New York City hospitals.

WWG:腎臟疾病被認為是嚴重的COVID-19疾病的一個危險因素,但是醫生也報告說,在因該病毒住院的病人中,腎臟損害的比例很高。在紐約市的12家醫院中,近1 / 5的COVID-19患者出現急性腎損傷。

DM: “Any time people are severely ill or may have severe infection or shock, you can have kidney injury. So I think the question was, is it related to just the general critical illness? Or is the virus impacting and infecting the kidney tissue as well? And so far we didn't see anything that looked like obvious inflammation in the kidneys.”

DM:“任何時候,只要患者病情嚴重,或者可能有嚴重感染或休克,就可能有腎臟損傷。所以我認為問題是,它是否只與一般的危重癥有關?或者病毒也會影響并感染腎臟組織嗎?到目前為止,我們沒有發現腎臟有任何明顯的炎癥?!?/p>

WWG: Nor did they see clots blocking the blood vessels in the kidneys, she says. So that’s all good news.

WWG:他們也沒有看到血栓阻塞腎臟的血管,她說。這些都是好消息。

But it’s bad news that COVID-19 appears to kill mainly by causing acute respiratory distress syndrome, because biotech and drug companies have tried for decades to find effective treatments for ARDS. And so far they have largely failed.

但COVID-19似乎主要通過引起急性呼吸窘迫綜合征而致死,這是個壞消息,因為數十年來,生物技術和制藥公司一直在努力尋找治療ARDS的有效方法。到目前為止,他們基本上都失敗了。

In the near term, our best hope for a treatment is an antiviral drug that works directly to thwart SARS-CoV-2, rather than a drug that somehow shuts down the runaway immune response it causes in the worst cases.

在短期內,我們對治療的最大希望是一種能直接阻止SARS-CoV-2的抗病毒藥物,而不是一種能在最糟糕的情況下以某種方式關閉失控的免疫反應的藥物。

Dozens of drug trials are now underway, and Marshall points out that autopsies may play a crucial role in these studies, as well.

幾十個藥物試驗正在進行中,馬歇爾指出,尸體解剖可能在這些研究中也起著至關重要的作用。

DM: “One of the other places where we think autopsy can be really helpful is patients that are getting these trial therapies. And so if unfortunately patients do die while they are receiving those, just to be able to understand if there's differences in their immune response versus others. So that's another area that we'll want to be focusing on.”

DM:“我們認為尸檢真正有幫助的另一個地方是那些正在接受試驗治療的病人。如果不幸的是病人在接受治療的過程中死亡,只是為了了解他們的免疫反應和其他人是否不同。所以這是我們想要關注的另一個領域?!?/p>

WWG: For Scientific American’s Science Talk, I’m Wayt Gibbs.

WWG:科學美國人的科學演講,我是Wayt Gibbs。


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