新冠病毒|料冬季再掀新一波疫情 重症高危族群达20类人远超你所想

新冠病毒在过去数年为全球带来巨大影响，随着社会复常，不少人已脱下口罩生活一段时间，但千万不要忘记，新冠病毒仍然存在于社区之中，高风险人士一旦受感染，更有机会出现重症，严重影响健康甚至威胁性命。¹感染及传染病科专科林纬逊医生表示：“高风险患者应把握治疗黄金期，尽快接受适切治疗，以预防出现重症。²”

料冬季将有新一波新冠感染高峰

不同专家均指出，在天气转冷的季节，新冠病毒会变得更为活跃，可能引发新一波疫情。³'⁴林纬逊医生指原因有数个，包括病毒在低温环境下存活的时间较长，且冬天有较多人在室内聚集，亦会加速呼吸道疾病的传播。³'⁴此外，经过数年新冠疫情，不论期间有否接种疫苗、有否受感染，其实抗体水平均会随着时间下降，⁵林纬逊医生说：“香港大约在数个月前曾出现一次感染高峰，随着市民整体抗体水平下降，预料在冬季会有另一波新冠感染高峰。³'⁵⁻⁷”

新冠与流感部分症状相似

天气转凉转冷，容易著凉，到底我们能否分辨自己是患上流感抑或感染新冠病毒？林纬逊医生解释，流感及新冠病毒感染有相似及相异之处，相似在于两者均会入侵上呼吸道，因此上呼吸道感染的病征会非常相似，例如发烧、喉咙痛及流鼻水等。⁸⁻¹¹林纬逊医生补充：“不过新冠病毒相比流感，可能较高机会出现下呼吸道病征，如呼吸困难、咳嗽且带有黄痰。¹²⁻¹⁵另外有部分病征是感染新冠病毒独有，如嗅觉及味觉减退。¹³'¹⁴”

长者及多类慢性病患者属重症高风险族群

经历数年疫情，不少市民都经不同渠道，如政府宣传、医生及专家访问，知道重症新冠肺炎的高危一族，包括60岁或以上长者或长期病患者等。¹⁶林纬逊医生指出，年纪越大，出现重症的比率越高，因此年纪大（60岁或以上）是其中一个最主要的因素。¹⁶'¹⁷其次，有否接种新冠疫苗亦是关键因素之一，虽然疫苗不能百分百预防感染，但对于预防重症及死亡的效能非常高。¹⁸'¹⁹另外，患有慢性疾病，以及因其他疾病导致免疫系统受损，均会增加重症风险。¹参考美国疾控中心（CDC）的资料，有超过20种身体状况或疾病，均会在感染新冠后较易得到重症，包括有情绪或精神障碍、缺乏运动、阿兹海默症、癌症、慢性肾病、慢性肝病、慢性肺病、糖尿病、残障、心脏病、爱滋病毒感染、免疫系统减弱、肥胖、怀孕、地中海贫血、吸烟、曾进行器官移植、中风、酗酒等。¹

高危人士不论症状轻重　均应考虑新冠口服抗病毒药物

香港自第五波疫情开始，向新冠患者处方两款新冠口服抗病毒药物。²⁰根据政府指引，医生可向60岁或以上，又或未满60岁但患有慢性病的人士，免费处方新冠口服抗病毒药物，合资格患者可向公营医疗机构如医管局辖下普通科门诊等，又或向超过660位私家医生求诊及免费获得处方药物。²⁰⁻²²至于其他有需要人士，经医生诊断后，亦可选择自费服用新冠口服抗病毒药物。²²

林纬逊医生强调，新冠口服抗病毒药物的主要作用并非纾缓患者的病征及不适，而是预防重症，因此高风险患者即使发病初期病征轻微，亦应考虑服用此类药物。²他解释：“根据本地指引，患者应在病发后5天内服用。²³高风险患者应把握治疗黄金期，尽快接受适切治疗，因为即使初始症状轻微，患者亦无法预视病情会否在数日后恶化。²'²⁴”根据林纬逊医生的观察，病征不明显便毋须就诊及服药是不少人的谬误，过往亦有年长患者在求诊时对药物抱怀疑态度，但只要向他们解释清楚药物的作用，大部分患者仍会遵循建议服药。

勿自行停药　患长期病应向医生说明

服用新冠口服抗病毒药物有数点需要注意，首先是必须依照医生指示服药及完成疗程。²⁵'²⁶林纬逊医生提醒：“即使快速测试呈阴性亦不应自行停药，因为快测不一定能准确量化病毒量，阴性亦不代表体内没有病毒。²⁶'²⁷另外，过早停药有机会增加抗药性风险，情况并不理想。²⁸”此外，患者在求诊时应向医生说明自己有否药物敏感、慢性疾病、长期服用其他药物，因为部分药物有机会与新冠口服抗病毒药物相冲，林纬逊医生补充：“所谓相冲并不一定属禁忌症，不能服用新冠口服抗病毒药物。有机会只需作出调整，患者便可非常安全地完成抗病毒药物疗程。²⁷'²⁹⁻³¹”有部分市民或担心新冠口服抗病毒药物有副作用，又或对这类药物的安全性有怀疑，不过林纬逊医生指出，短期服用这类药物的安全性甚高，基本上亦不会构成严重副作用。³⁰'³¹

以上资讯由辉瑞香港提供

PP-C1D-HKG-0018 FEB 2024

参考资料：

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. 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. 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. 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. 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. Accessed Dec 2023.

9. Thomas M, et al. Upper respiratory tract infection. Available at: www.ncbi.nlm.nih.gov/books/NBK532961/. 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. 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. 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. 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/. 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). 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. 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. 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. 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. 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. 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?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. 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. 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/ . 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.