新冠病毒|料冬季再掀新一波疫情重症高危族群達20類人遠超你所想

新冠病毒在過去數年為全球帶來巨大影響，隨着社會復常，不少人已脫下口罩生活一段時間，但千萬不要忘記，新冠病毒仍然存在於社區之中，高風險人士一旦受感染，更有機會出現重症，嚴重影響健康甚至威脅性命。¹感染及傳染病科專科林緯遜醫生表示：「高風險患者應把握治療黃金期，盡快接受適切治療，以預防出現重症。²」

感染及傳染病科專科林緯遜醫生

料冬季將有新一波新冠感染高峰

不同專家均指出，在天氣轉冷的季節，新冠病毒會變得更為活躍，可能引發新一波疫情。³⁴林緯遜醫生指原因有數個，包括病毒在低溫環境下存活的時間較長，且冬天有較多人在室內聚集，亦會加速呼吸道疾病的傳播。³⁴此外，經過數年新冠疫情，不論期間有否接種疫苗、有否受感染，其實抗體水平均會隨着時間下降，⁵林緯遜醫生說：「香港大約在數個月前曾出現一次感染高峰，隨着市民整體抗體水平下降，預料在冬季會有另一波新冠感染高峰。³⁵⁻⁷」

新冠與流感部分症狀相似

天氣轉涼轉冷，容易著涼，到底我們能否分辨自己是患上流感抑或感染新冠病毒？林緯遜醫生解釋，流感及新冠病毒感染有相似及相異之處，相似在於兩者均會入侵上呼吸道，因此上呼吸道感染的病徵會非常相似，例如發燒、喉嚨痛及流鼻水等。⁸⁻¹¹林緯遜醫生補充：「不過新冠病毒相比流感，可能較高機會出現下呼吸道病徵，如呼吸困難、咳嗽且帶有黃痰。¹²⁻¹⁵另外有部分病徵是感染新冠病毒獨有，如嗅覺及味覺減退。¹³¹⁴」

長者及多類慢性病患者屬重症高風險族群

經歷數年疫情，不少市民都經不同渠道，如政府宣傳、醫生及專家訪問，知道重症新冠肺炎的高危一族，包括60歲或以上長者或長期病患者等。¹⁶林緯遜醫生指出，年紀越大，出現重症的比率越高，因此年紀大（60歲或以上）是其中一個最主要的因素。¹⁶¹⁷其次，有否接種新冠疫苗亦是關鍵因素之一，雖然疫苗不能百分百預防感染，但對於預防重症及死亡的效能非常高。¹⁸¹⁹另外，患有慢性疾病，以及因其他疾病導致免疫系統受損，均會增加重症風險。¹參考美國疾控中心（CDC）的資料，有超過20種身體狀況或疾病，均會在感染新冠後較易得到重症，包括有情緒或精神障礙、缺乏運動、阿茲海默症、癌症、慢性腎病、慢性肝病、慢性肺病、糖尿病、殘障、心臟病、愛滋病毒感染、免疫系統減弱、肥胖、懷孕、地中海貧血、吸煙、曾進行器官移植、中風、酗酒等。¹

高危人士不論症狀輕重　均應考慮新冠口服抗病毒藥物

香港自第五波疫情開始，向新冠患者處方兩款新冠口服抗病毒藥物。²⁰根據政府指引，醫生可向60歲或以上，又或未滿60歲但患有慢性病的人士，免費處方新冠口服抗病毒藥物，合資格患者可向公營醫療機構如醫管局轄下普通科門診等，又或向超過660位私家醫生求診及免費獲得處方藥物。²⁰⁻²²至於其他有需要人士，經醫生診斷後，亦可選擇自費服用新冠口服抗病毒藥物。²²

林緯遜醫生強調，新冠口服抗病毒藥物的主要作用並非紓緩患者的病徵及不適，而是預防重症，因此高風險患者即使發病初期病徵輕微，亦應考慮服用此類藥物。²他解釋：「根據本地指引，患者應在病發後5天內服用。²³高風險患者應把握治療黃金期，盡快接受適切治療，因為即使初始症狀輕微，患者亦無法預視病情會否在數日後惡化。²²⁴」根據林緯遜醫生的觀察，病徵不明顯便毋須就診及服藥是不少人的謬誤，過往亦有年長患者在求診時對藥物抱懷疑態度，但只要向他們解釋清楚藥物的作用，大部分患者仍會遵循建議服藥。

勿自行停藥　患長期病應向醫生說明

服用新冠口服抗病毒藥物有數點需要注意，首先是必須依照醫生指示服藥及完成療程。²⁵²⁶林緯遜醫生提醒：「即使快速測試呈陰性亦不應自行停藥，因為快測不一定能準確量化病毒量，陰性亦不代表體內沒有病毒。²⁶²⁷另外，過早停藥有機會增加抗藥性風險，情況並不理想。²⁸」此外，患者在求診時應向醫生說明自己有否藥物敏感、慢性疾病、長期服用其他藥物，因為部分藥物有機會與新冠口服抗病毒藥物相沖，林緯遜醫生補充：「所謂相沖並不一定屬禁忌症，不能服用新冠口服抗病毒藥物。有機會只需作出調整，患者便可非常安全地完成抗病毒藥物療程。²⁷²⁹⁻³¹」有部分市民或擔心新冠口服抗病毒藥物有副作用，又或對這類藥物的安全性有懷疑，不過林緯遜醫生指出，短期服用這類藥物的安全性甚高，基本上亦不會構成嚴重副作用。³⁰³¹

以上資訊由輝瑞香港提供

PP-C1D-HKG-0018 FEB 2024

參考資料：

1. Centers for Disease Control and Prevention. COVID-19: People with certain medical conditions. Available at: www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html[1]. Accessed Dec 2023.

2. Centers for Disease Control and Prevention. COVID-19: COVID-19 treatments and medications. Available at: www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html[2]. Accessed Dec 2023.

3. Inaida S, et al. Am J Infect Control 2022;50:1070-1076.

4. Liu X, et al. Environ Res 2021;195:110874.

5. Keshavarz B, et al. Front Immunol 2022;13:850987.

6. Centre for Health Protection. COVID-19 & Flu Express (Volume 1), number 43 (week 47, 2023). Available at: www.chp.gov.hk/files/pdf/covid_flux_week47_30_11_2023_chi.pdf[3]. Accessed Dec 2023.

7. Centre for Health Protection. Statistics on Government COVID-19 Vaccination Programme. Available at: www.chp.gov.hk/en/features/106989.html[4]. Accessed Dec 2023.

8. Centers for Disease Control and Prevention. Similarities and differences between flu and COVID-19. Available at: www.cdc.gov/flu/symptoms/flu-vs-covid19.htm[5]. Accessed Dec 2023.

9. Thomas M, et al. Upper respiratory tract infection. Available at: www.ncbi.nlm.nih.gov/books/NBK532961/[6]. Accessed Dec 2023.

10. Centers for Disease Control and Prevention. Influenza (flu): Clinical signs and symptoms of influenza. Available at: www.cdc.gov/flu/professionals/acip/clinical.htm[7]. Accessed Dec 2023.

11. Yuen E, et al. Am J Rhinol Allergy 2021;35:122-131.

12. Subbarao K, et al. Immunity 2020;52:905-909.

13. Centers for Disease Control and Prevention. Influenza (flu): Flu symptoms & complications. Available at: www.cdc.gov/flu/symptoms/symptoms.htm[8]. Accessed Dec 2023.

14. Centers for Disease Control and Prevention. COVID-19: Symptoms of COVID-19. Available at: www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html[9]. Accessed Dec 2023.

15. Dasaraju PV, et al. Medical microbiology (4th edition): Chapter 93 – Infections of the respiratory system. Available at: www.ncbi.nlm.nih.gov/books/NBK8142/[10]. Accessed Dec 2023

16. World Health Organization. Coronavirus disease (COVID-19). Available at: www.who.int/news-room/fact-sheets/detail/coronavirus-disease-(covid-19)[11]. Accessed Dec 2023.

17. Centers for Disease Control and Prevention. COVID-19: Underlying medical conditions associated with higher risk for severe COVID-19: Information for healthcare professionals. Available at: www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html[12]. Accessed Dec 2023.

18. Martono, et al. Malays J Med Sci 2023;30:84-92.

19. Centers for Disease Control and Prevention. Provider resources for vaccine conversations with parents: Explaining how vaccines work. Available at: www.cdc.gov/vaccines/hcp/conversations/understanding-vacc-work.html[13]. Accessed Dec 2023.

20. News.gov.hk. COVID-19 oral drugs reminder issued. Available at: www.news.gov.hk/eng/2023/01/20230112/20230112_223322_571.html[14]. Accessed Dec 2023.

21. Centre for Health Protection. Private doctors registered with eHRSS who have got hold of covid-19 antivirals for managing covid-19 cases. Available at: www.coronavirus.gov.hk/pdf/tp_pd_antiviral.pdf[15]. Accessed Dec 2023.

22. The Government of the Hong Kong Special Administrative Region. Amount of COVID-19 oral drugs requested by private doctors via online platform adjusted. Available at: www.info.gov.hk/gia/general/202304/24/P2023042400650.htm[16]. Accessed Dec 2023.

23. Hospital Authority Central Committee on Infectious Diseases and Emergency Response. Interim recommendation on clinical management of adult cases in coronavirus disease 2019 (COVID-19). Available at: accessinfo.hk/en/request/1022/response/3205/attach/3/Interim%20Recommendation%20on%20Clinical%20Management%20of%20Adult%20Cases%20with%20COVID%2019%20v1.12.pdf[17]?cookie_passthrough=1. Accessed Dec 2023.

24. American College of Emergency Physicians. ACEP COVID-19 Field Guide: Severity and progression of disease. Available at: www.acep.org/corona/covid-19-field-guide/diagnosis/diagnosis-when-there-is-no-testing[18]. Accessed Dec 2023.

25. The Government of the Hong Kong Special Administrative Region. Available at: www.info.gov.hk/gia/general/202301/13/P2023011300459.htm[19]. Accessed Dec 2023.

26. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at: www.covid19treatmentguidelines.nih.gov/[20] . Accessed Dec 2023.

27. Data on file [Patient information leaflet]. Pfizer Corporation Hong Kong Limited.

28. Pillay D. BMJ 1998;317:660-662.

29. Petty LA, et al. JAMA 2022;327:2464.

30. Data on file [Product circular]. Merck Sharp & Dohme LLC Rahway.

31. Data on file [Prescribing Information]. Pfizer Corporation Hong Kong Limited.

References

www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html (www.cdc.gov) www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html (www.cdc.gov) www.chp.gov.hk/files/pdf/covid_flux_week47_30_11_2023_chi.pdf (www.chp.gov.hk) www.chp.gov.hk/en/features/106989.html (www.chp.gov.hk) www.cdc.gov/flu/symptoms/flu-vs-covid19.htm (www.cdc.gov) www.ncbi.nlm.nih.gov/books/NBK532961/ (www.ncbi.nlm.nih.gov) www.cdc.gov/flu/professionals/acip/clinical.htm (www.cdc.gov) www.cdc.gov/flu/symptoms/symptoms.htm (www.cdc.gov) www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html (www.cdc.gov) www.ncbi.nlm.nih.gov/books/NBK8142/ (www.ncbi.nlm.nih.gov) www.who.int/news-room/fact-sheets/detail/coronavirus-disease-(covid-19) (www.who.int) www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html (www.cdc.gov) www.cdc.gov/vaccines/hcp/conversations/understanding-vacc-work.html (www.cdc.gov) www.news.gov.hk/eng/2023/01/20230112/20230112_223322_571.html (www.news.gov.hk) www.coronavirus.gov.hk/pdf/tp_pd_antiviral.pdf (www.coronavirus.gov.hk) www.info.gov.hk/gia/general/202304/24/P2023042400650.htm (www.info.gov.hk) accessinfo.hk/en/request/1022/response/3205/attach/3/Interim%20Recommendation%20on%20Clinical%20Management%20of%20Adult%20Cases%20with%20COVID%2019%20v1.12.pdf (accessinfo.hk) www.acep.org/corona/covid-19-field-guide/diagnosis/diagnosis-when-there-is-no-testing (www.acep.org) www.info.gov.hk/gia/general/202301/13/P2023011300459.htm (www.info.gov.hk) www.covid19treatmentguidelines.nih.gov/ (www.covid19treatmentguidelines.nih.gov)