由世界針灸學會聯合會、中華中醫藥學會、中國針灸學會主辦的「國際抗疫專家大講堂系列講座」第四講，我們邀請到了國家衛健委新冠肺炎專家組成員、中國中醫科學院廣安門醫院呼吸科主任李光熙舉行英文專場，以“治療要點——預防急性肺損傷(Preventing Acute Lung Injury-Essentials of Treatment)”為題。為發揮世界針聯的多語種優勢，本場講座還特別開通了中英雙語通道，得到了來自20多個國家的2867人參與。在答疑環節，李光熙教授解答了國內外醫生關切的問題，匯總如下：
Q1-Dr. Deng（Medical Director of the BendheimIntegrative Medicine Center at MSKCC）: What are the criteria specifically for initiating IPPV (Intermittent Positive Pressure Ventilation)?
Dr. Li : Depends on the patient’s saturation, according to our experience, once a patient basically gets a good saturation with a high flow of nasal oxygen support, that’s very important. Usually we give the patients about 65% or 70% FiO2, the device is high nasal flow of oxygen support. But if it still did not work, after three hours, the patient is still in bad situation, never reach 93%. Also the patient usually has a very strong cough, as you know, plus the fever. We must consider to interfere the patient as early as possible. We need to pay attention to the frequency of cough when the patient rests. I believe this is strong indicator for using ventilation. After strong cough, patients usually have very bad saturation, usually maybe decrease to 75% even.
Q2-Dr. Deng: The second question is because in the United States, there is a shortage of hospital beds, so a lot of patients has mild symptoms, were discharged to home for quarantine, even though when they have symptoms, such as low grade fever, some cough, some fatigue. You mentioned the key factors are to watch for high fever, dry cough and dyspnea. Unfortunately a lot people do not have the ability to monitor their ox-meter at home. So when you say high fever, is there any specific number? 38, 39 or 39,5 degree Celsius, anything like that？
Dr. Li: Yes, so the criteria for high fever is more than 39 Celsius, which is very bad. That’s because of disease is usually like that—on the first 1 or second day, patients only have low degree fever, for example it’s usually less than 38.3 Celsius, but maybe after 3 to 5 days, the fever suddenly goes up. The temperature can be up more than 39.5 Celsius. So this stage is very dangerous. During that stage we need (to treat) the patient as early as possible. In China, most patients have the ox meter, maybe in New York they don’t have. In that case, you need to ask the patients to watch how much they can walk? How much distance they walk? And how is the movement? How is the activity related with cough? This correlation it’s usually tightly correlated, the patients usually walk, and then they cough, so that means some very strong indicator for the crucial disease.
Q3-Dr. Deng: Very few people in the United States have home-oxygen- monitoring ox-meter. There was a saying about the patients: if you can take a deep breath, and hold the breath for 5 seconds, or 10 seconds, you are alright. If you cannot hold your breath for 5 seconds or 10 seconds, you have probably desaturation or dyspnea, then you may go to the hospital. Is there any adaptability like any of that?
Dr. Li: I think that the problem is at that stage, it’s little bit late. I still think you need to ask patients to do some activities, for example, to go to the restroom, if they go to restroom, and cough will increase, that’s the dangerous sign.
Dr. Deng: That’s very helpful. To summarize high temperature of people in home quarantine is about 37.3 Celsius.
Dr. Deng: Dry cough especially when induced activities, or in short time dyspnea upon light activities, these are indications for acute phase and they should go to the hospital, are they all correct?
Dr. Li: I think so, correct.
Q4-Dr. Deng: The last question I have is about protection of medical personnel both in the intervention setting and more importantly in the regular care of the patients. I know in China, all these COVID-19 patients are coordinated into the hospital or floor. While here we are unable to do that, so patients still stay in the rooms, so they exercise droplet precaution basically mask, face shield and very light gown. And I see in China, people wear health mask like overall from top to the bottom, from head to shoes. Do you think that kind of protection is overdo or appropriate, or should be done?
Dr.Li: I think you know regarding intervention situation is very dangerous procedure, and you must protect yourself very strictly, even though you know whereas in China, we still have physicians in Tianjin, he’s got infected right after the intervention. After intervention of 30 patients, he’s got infected. So that’s right now, probably we still need some kind of positive air, you know some of devices with mask like some small pipe machine. That’s very important for dangerous procedure like intervention bronchoscope，you need to be really careful. And you know regarding the regular people, when you do regular care of patients , you still need to wears the gowns, wear the masks, and also the face shield, to protect yourself from the droplet, and probably from the aerosol. Nobody confirm the aerosol for these patients, but I still think is very dangerous too. In China, all the nurses and physicians in Wuhan, nobody’s got infected, it’s zero. So that means all protection is appropriate, but I’m not sure in New York and other city in the United States, what’s percentage of the infection of health worker? I think if don’t do this kind of protection, the infection rate is still high. Because right now, as we are not sure what’s kind of transmission exactly? So in that case, we need to more be prepared, that’s better than unprepared.
Q5-Dr. Deng: Thank you, I think that it’s too early to know, right now in New York and the States, we are still in the early stage, in care of regular COVID-19 patients, not doing invasive procedures, do we need N95 mask or just a regular surgical mask, face shield and gown will be in enough?
Dr. Li：In China, a lot of physicians initially just wear like that with surgical mask, but actually quite a lot of physicians and nurses have got infected, so I think N95 is very necessary for health workers, and face shield. It’s very very very important.
Dr.Deng: Thank you. Right now there is a shortage of N95 mask, so we try to strike fight the use of them in the efficient way.
Q6-Marek Kalmus: Are any special advices how to treat SARS-Cov-2 infected pregnant women?
Dr. Li: We do have several cases of pregnant women got infected, I saw one patient, one pregnant women at the age of 27, and she died from Covid-19. I think if you are pregnant, you really should be very careful. You know, nobody has immunity of this virus basically, so everyone is vulnerable to this virus, especially for the pregnant women, they may need some kind of more lung capacity, so they really need be taken care of, greatly than other people.
Q7-Marek Kalmus：How many asymptomatic COVID-19 carriers are estimated?
Dr.Li: We don’t have the exact data for those asymptomatic patients, but we know, even for people with mild symptom, they don’t think they got infected. Actually, they just have some diarrhea, some fatigue. They never think they got infected, so we don’t have the exact data for that. There is quite a large population for those people, especially for children, young persons, young adults, they really don’t have bad symptoms, you know, they even don’t have any fever, they just have very mild fatigue, mild cough and mild diarrhea. We don’t know exactly how many got it, because they didn’t do the test for that. That’s we don’t have exact data for this question.
Q8-Marek Kalmus：I have also question from medical doctors, she is TCM practitioner, she would ask could you describe the nature of corona virus according to TCM and penetration of this pathogen according to Wen Bing Lun or Shang Han Lun?
Dr. Li: I see. According to the first question, how we describe this pathogen in Chinese medicine, we think this coronavirus belongs to the cold, and belongs to the wet. So basically is the cold and wet, that means we need some medicine to expel the cold and dry the wet, so that’s how we describe the principle.
Regarding the second question, what kind of book we need to use, actually you know, both books are good for this disease, you know we have different success with Chinese doctors, they tried different combinations, some doctors used Shang Han, some physicians used Wen Bing, so they all work. But I think regarding this disease I prefer Wen Bing, because this disease changed rapidly, you can see how fast the patients can deteriorate. So just you know, you can count after 5 days they may become acute lung injury, and they die after 10 days. So it’s very dangerous disease and very rapidly changed disease. Thank you.
Q9-Reginaldo（Director of Brazilian School of Chinese Medicine）:My question is as now in Brazil the number of cases are increasing, and we are suggested to do quarantine. Actually in some states and cities, we are also enforced to quarantine right now. Do you recommend to people at home they can do something to improve their immunity, such as moxibustion, what’s your opinion on that?
Dr. Li: Regarding the early quarantine, certainly it is very important, it’s the cause of infection of the majors. I think another thing is regarding moxibustion, it’s very good. But even after you do that, it doesn’t mean that you will not have this virus. You still can get it. So there is nothing really prevent us from this virus. Only thing we can do is we try to develop the vaccination of the disease. So it will not happen soon, I think it takes probably after 18 months. Even 18 months is very early, it’s a long way to go. But nothing can really work for prevention virus. Everyone is vulnerable to that. You certainly need to use some kind of Chinese Medicine to make yourself. Even you get it, you can make your symptom very mild, you don’t fall into the very severe stage, and very severe time. We are still suggest for people who had cold and wet in their stomach, you know, according to Chinese theories, so they still need moxibustion, they need do some acupuncture, they need to take some Chinese herbs. To have some for themselves. For the obesity patients, they need lose weight, I don’t know how they can lose weight within a week, what we saw most people are really having some kind of problems for obesity, this is one most of population they can fall into the stage of danger, so these patients need to take care of themselves even now.
Q10-Reginaldo: My point is I totally agree and understand there is no such thing to avoid virus. The idea of moxibustion more to improve the health, so as be in good health could be a little bit stronger for body to fight virus, to contact with them. Right?
Dr. Li：Yes, absolutely. So you can regulate yourself to adapt while the virus comes into your body, basically you can regulate yourself to adapt to this the vulnerable situations, so you don’t get this inflammation storm triggered, that’s really helpful. Patients you know, Chinese herbs, acupuncture, they all have do that.
Reginaldo：As Brazil now it is coming into autumn from summer right now, so this year my colleague and I offered acupuncture and application of herbs, summer treatment for winter diseases. For those patients, they experienced very good health right now. So I really believe on improving quality of life, and improving the health using Chinese medicine theory, and I encourage more people from other countries to consider that even in the countries where Chinese medicine is not officially accepted, but we shall teach and expand it for our patients.
Dr. Li: Yeah, absolutely, I think this moxibustion and transdermal therapy you should use in this season, because that next pandemic will go to these countries like Brazil and Argentina. Right now the temperature will go like what we have in September or October, that’s very dangerous.
Q11-Amir Hooman Kazemi（Vice President of WFAS from Iran）：What is the syndrome differentiations of pulmonary effusion in TCM and which herbs can be useful？
Dr.Li：Pulmonary effusion for the COVID-19 is rare, but you know that if you have some other knowledge of effusion, then you certainly need to differentiate (it as) cold(寒), it’s from the weakness of qi and some other things. You can use some dongchouxiacao（冬蟲夏草）, cordyceps sinensis, it’s very helpful. Cordyceps and chaihu（柴胡）are good herbs, for this kind of symptoms.
Q12-Amir Hooma：Which herbs are useful for prevention ( specially the herbs we can find in other countries?
Dr. Li: In Iran, zanghonghua（藏紅花saffron crocus）is also very good. I think it is very popular in Iran. It is good, they already took that in every meal . I bought when I was there last year. I don’t know the what kind of herbs can be used in Iran, but maybe something is we can discuss later after they are showed to us, how are they called in your country.