US.

美國。

now has the most reported COVID-19 cases of any country in the world.

現在是世界上報告COVID-19病例最多的國家。

This is like having a hurricane hit every single city across the United States all at the exact same time.

這就像颶風完全在同一時間襲擊全美國的每一個城市。

To find out what it's like the health care workers on the ground and to learn more about the hospitalization timeline of a patient with Covid 19.

瞭解現場醫護人員的情況，並進一步瞭解科維德19號病人的住院時間線。

I called up Dr cedric dark.

我打電話給cedric dark醫生。

He's an er physician in Houston texas.

他是休斯頓德克薩斯州的一名醫生。

So you have a waiting room full of people in the er who coughing who have fever.

所以你有一個候診室，裡面有很多人在咳嗽，有發燒。

How does triage work in the er from the beginning of this we have literally separated anybody with cough and fever from everybody else in the hospital.

從一開始，我們就把任何有咳嗽和發燒的人與醫院裡的其他人分開，分流工作是如何進行的。

Other hospitals have tent set up outside to screen people.

其他醫院在外面搭起了帳篷，對人們進行篩查。

Initially it was we're going to ask have you been to any of the countries where it's present?

最初是我們要問你是否去過任何一個存在這種情況的國家？

Have you been around somebody that's known to be diagnosed?

你身邊是否有已知的被診斷的人？

And are you having a fever?

那你是否發燒了？

If you screened in for any of those, you're definitely thrown into this separate area then symptoms?

如果你因任何這些而被篩選，你肯定會被扔到這個獨立的區域，然後症狀？

Are you feeling short of breath?

你是否感到呼吸短促？

Are you having cough?

你是否有咳嗽？

If you have any of those issues going on, you're put in this special area where we can screen you where we can keep that part of the er and the providers there give them the maximum amount of personal protective equipment, keep them safe and then also keep everybody else in the er safe.

如果你有任何這些問題，你就會被放在這個特殊的區域，在那裡我們可以對你進行篩選，在那裡我們可以保持ER的那一部分，那裡的提供者給他們提供最大數量的個人防護設備，保持他們的安全，然後也保持ER中其他人的安全。

Because still we're going to get heart attacks, we're gonna get strokes.

因為我們仍然會有心臟病發作，我們會有中風。

We're going to get people that have been in car wrecks and we need to keep those folks safe from catching communicable disease as well.

我們會有發生過車禍的人，我們也需要保證這些人的安全，以免感染傳染病。

If I see somebody that does have a fever or that does have some abnormal sounds when I listen to their lungs, that person I think warrants getting a chest X.

如果我看到有人發燒，或者當我聽他們的肺部時確實有一些異常的聲音，我認為這個人值得做胸部X光檢查。

Right as the disease progresses there are these things called infiltrates or little white spots that form in the lungs.

隨著疾病的發展，在肺部會出現這些叫做浸潤或小白點的東西。

When you look microscopically inside the lungs.

當你從顯微鏡下觀察肺部內部時。

Think of it as like little bits of fluid or plus or something that sits inside the lungs which normally are like a nice little sponge and that makes the exchange of oxygen with the air harder to happen.

可以把它看作是坐在肺部的一點液體或其他東西，而肺部通常就像一塊漂亮的小海綿，這使得氧氣與空氣的交換更難發生。

And so therefore that's why people start feeling short of breath to talk us through a bit about what the chest X rays er look like as somebody maybe first has covid 19 and then as they get sicker and sicker that one that you're looking at right there um That X ray looks fairly decent.

是以，這就是為什麼人們開始感到呼吸短促的原因，請告訴我們，當一個人可能第一次得了19號癌症，然後隨著他們的病情越來越重，胸部X射線看起來是什麼樣子的，你正在看的那張X射線看起來相當體面。

I don't see a ton of haziness or white spots.

我沒有看到大量的朦朧感或白點。

What about this X ray?

這個X射線是怎麼回事？

Yeah that was bad.

是的，這很糟糕。

Not only can I see on the X ray that the person is ventilated, they have a breathing tube in their in their trachea or their windpipe.

我不僅可以在X光片上看到這個人在通氣，他們的氣管或氣管裡有一根呼吸管。

Um You see a lot of these little patchy spots, like the little white spots all over the lungs and it's on both sides of the lungs so that you know tells you that all that nice airfield sponge, spongy nous of the lung has been filled in with fluid and gunk in this particular person.

你會看到很多這樣的小斑點，就像遍佈肺部的小白點，而且是在肺的兩側，所以你知道告訴你，在這個特定的人身上，所有漂亮的氣場海綿，肺部的海綿體已經被液體和垃圾填滿了。

It's probably so bad that they couldn't be maintained just with like oxygen through the nose that they had to put in a breathing tube to give them additional oxygen.

它可能是如此糟糕，以至於他們不能僅靠像鼻子吸氧來維持，他們不得不插上呼吸管來給他們提供額外的氧氣。

How would you treat this patient?

你會如何對待這個病人？

Let's say a patient comes in the short of breath.

比方說，一個病人來時氣喘吁吁的。

They get this X ray at this point in time I know I'm going to be admitting them to the hospital and that person essentially is what the CDC would call a person under investigation.

他們在這個時間點得到這個X射線，我知道我將把他們送入醫院，這個人基本上就是CDC所說的被調查的人。

Um And so that's the patient that would get tested.

所以這就是會被檢測的病人。

Once that decision is made to hospitalize them.

一旦做出這個決定，讓他們住院治療。

And so we would do the test right now.

是以，我們現在就會進行測試。

The tests are taking a long time to come back.

測試結果需要很長時間才能出來。

The testing at this point is not for therapeutic purposes, it's more for epidemiological purposes.

目前的測試不是為了治療目的，更多的是為了流行病學目的。

What help and support can you give Covid 19 patients is where it gets a little tricky because there's no defined treatment specific for covid 19.

你能給Covid 19患者提供什麼幫助和支持，這一點變得有點棘手，因為沒有明確的治療方法專門針對Covid 19。

What we need to do is what we call symptomatic treatment.

我們需要做的是我們所說的對症治療。

What that means is if someone needs oxygen, we give them oxygen, They have fever.

這意味著如果有人需要氧氣，我們就給他們氧氣，他們發燒了。

We might give them medicines to reduce their fever.

我們可能會給他們吃藥，以減少他們的發燒。

But other than that, we kind of have to wait for the virus to take its course.

但除此之外，我們還得等待病毒的發展。

If someone goes into what we call respiratory failure, where their lungs can't pull in enough oxygen, that's when we have to put them on a ventilator machine and so we do that procedure where we put the tube through the windpipe.

如果有人進入我們所說的呼吸衰竭，即他們的肺不能吸入足夠的氧氣，這時我們必須把他們放在呼吸機上，是以我們要做這個手術，把管子穿過氣管。

So all of those patients have to be put into a medically induced coma.

是以，所有這些病人都必須被置於醫學上的昏迷狀態。

They stay on the ventilator machine for the duration until they improve and get better and can come off as the disease progresses.

他們在呼吸機上停留的時間，直到他們改善和好轉，並隨著疾病的發展可以脫落。

If it gets worse, those little white spots you saw in the lungs could consolidate even more and more um into a condition called a R.

如果情況變得更糟，你在肺部看到的那些小白點可能會更加鞏固，更多的嗯成為一種叫做R的情況。

D.

D.

S.

S.

What that means is the lungs become completely useless and it's almost impossible to deliver enough oxygen to keep them alive.

這意味著肺部變得完全無用，幾乎不可能提供足夠的氧氣來維持他們的生命。

At which point, you know, someone could eventually succumb from the disease.

在這一點上，你知道，有人最終可能會因該疾病而屈服。

When would you take someone off a ventilator if someone gets really sick and they've been on that ventilator maybe for a few days.

如果有人病得很重，而且他們已經在呼吸機上呆了幾天，你會在什麼時候讓他離開呼吸機。

Hopefully the inflammatory response or the virus affecting the lungs starts to resolve and their lungs clear up and they can be taken off the ventilator and go back to living a normal life.

希望影響肺部的發炎反應或病毒開始得到解決，他們的肺部得到清理，他們可以脫離呼吸機，回到正常生活中去。

What point are you thinking about rationing ventilators?

你在考慮配給呼吸機的哪一點？

And who would get one?

那麼誰會得到一個呢？

And who wouldn't those decisions are happening right now?

誰不知道這些決定現在正在發生？

Um, and doctors are thinking about that and I'm fortunate to not have to think about that at the moment, but it may become a real thing if people don't take this seriously enough, what our hospitals in the Houston area doing to get ready for a potential surge of patients.

嗯，醫生們正在考慮這個問題，我很幸運，目前不必考慮這個問題，但如果人們不認真對待這個問題，它可能會成為一個真正的事情，我們休斯頓地區的醫院在做什麼，為潛在的病人激增做好準備。

So one of the things that they've been doing is we've been canceling elective surgeries so that we have fewer people in the hospital in the first place.

是以，他們一直在做的一件事是，我們一直在取消選擇性手術，以便我們首先在醫院裡有更少的人。

Um The other thing that we've been doing in hospitals, not only in Houston, but across the country has been trying to figure out ways that we can use one ventilator machine for more than one patient.

我們在醫院裡做的另一件事，不僅是在休斯敦，而且在全國範圍內，一直在試圖找出方法，使我們可以將一臺呼吸機用於一個以上的病人。

Not only are we dealing with a deadly disease, but we're also dealing with the inadequate resources to protect ourselves from that disease.

我們不僅在處理一種致命的疾病，而且還在處理保護自己免受這種疾病影響的資源不足的問題。

We have supply chains that potentially could be disrupted.

我們的供應鏈有可能會被破壞。

We've seen people kind of hoarding things ranging from toilet paper to N- 95 masks, even when they don't necessarily need it.

我們已經看到人們有點囤積東西，從衛生紙到N-95口罩，即使他們不一定需要它。

We've had to conserve resources by reusing stuff that should only be used once and instead using it all day.

我們不得不通過重複使用那些只應使用一次的東西來節約資源，而是整天使用。

Um as long as it isn't soiled the PPE that we need for every confirmed patient, Um to be absolutely safe would be a gown gloves, face masks, either surgical mask or in 95 and eye protection with like a face shield or goggles.

只要它不被弄髒，我們為每一個確認的病人所需要的個人防護設備，為了絕對安全，將是一件長袍，手套，面罩，要麼是外科口罩，要麼是95年的，還有護眼罩或護目鏡等。

In terms of what most hospitals are experiencing shortages of.

就大多數醫院遇到的短缺問題而言。

It's the masks, sometimes the face shields, that's what we're typically having to reuse on shift.

是口罩，有時是面罩，這就是我們通常不得不在輪班時重複使用的東西。

Is this a situation you ever anticipated being a doctor in America?

這是你在美國做醫生時預料到的情況嗎？

Never.

從來沒有。

I mean, we think of the US as one of the most well resourced places in the world when it comes to health care, but it just goes to show that when there's sort of widespread panic, normal supplies can be depleted fairly quickly.

我的意思是，當涉及到醫療保健時，我們認為美國是世界上資源最豐富的地方之一，但這只是表明，當出現某種廣泛的恐慌時，正常的供應可以相當快地被耗盡。

And how do you mentally prepare for what might happen and what's happening right now?

而你如何為可能發生的事情和現在正在發生的事情做好心理準備？

Not much is different from what we're used to doing every day in an emergency department.

與我們每天在急診科所做的事情沒有什麼不同。

We're used to taking care of sick people.

我們習慣於照顧生病的人。

We are notoriously the people that think about the worst case scenario of the medicine world.

我們是出了名的會考慮醫學界最壞情況的人。

We are probably the doomsday preppers.

我們可能是末日預言家。

But the thing where we're not prepared for is making the ethical decision of once we reach our saturation point, who do I decide lives and who do I decided guys that were not ready for?

但是，我們沒有準備好的事情是做出道德決定，一旦我們達到飽和點，我應該決定誰的生命，我應該決定那些沒有準備好的人？

We don't know how big this surge is going to be when it hits, right?

我們不知道這股浪潮襲來的時候會有多大，對嗎？

If it's small and we can whether that storm great, but if it is long and sustained then it might completely flooded overwhelm the system and with it it will impact the health of the people on the front lines and you have a kid at home.

如果它是小的，我們可以是否該風暴偉大，但如果它是長期和持續的，那麼它可能完全淹沒了系統，並與它將影響到前線的人的健康，你有一個孩子在家裡。

So how are you managing that?

那麼你是如何管理的呢？

Coming home from the er and being at home, it's pretty difficult.

從洱海回家，在家裡，這是很困難的。

I think the one thing that seems a little bit reassuring is that at least Children seem to fare better at this than adults are, especially older adults.

我想有一點令人欣慰的是，至少兒童在這方面似乎比成人要好，尤其是老年人。

My message for the public three Things # one, Stay Home Save Lives.

我對公眾的資訊三件事#一，呆在家裡拯救生命。

We need to flatten the curve on this.

我們需要在這個問題上拉平曲線。

Number two, please do not come to the emergency room expecting it at a covid test.

第二，請不要到急診室來，期望它是一個ovid測試。

If you're well enough to stay home, stay home because we're not going to be testing you anyway.

如果你身體好到可以呆在家裡，那就呆在家裡，因為反正我們也不會對你進行測試。

Um, and number three, if you happen to have any of that personal protective equipment that we could use in the hospital, consider donating it to your local facility or to the doctor that might live down the street from you really grateful for your time and thank you so much for explaining the situation to us.

嗯，第三，如果你碰巧有任何我們可以在醫院使用的個人防護設備，考慮捐贈給你當地的機構或可能住在你街邊的醫生，真的很感謝你的時間，非常感謝你向我們解釋情況。

No problem.

沒問題。

Thanks.

謝謝。