since the updated criteria for the diagnosis has gone to just a lung scan

由於最新的確診標準加入了肺部掃描及臨床診斷,

and a clinical history consistent with coronavirus 64,000 436 total deaths 1383

確診64436人,死亡1383人,

total recovered is six thousand eight hundred eighty six about five times the

而康復人數是死亡人數的5倍，有6886人。

total deaths is the total recovered let's take a look at the world of meter

再看一下其他國家的數據,

and we can see here total cases outside of China have kind of remained constant

中國以外感染人數維持上升,

because there hasn't been that redefinition causing a slew of new cases

這是因為他們沒有像中國一樣修改診斷方式

let's take a look at see what's going on inside China or total cases overall if

我們再看一下中國內部的情況

we look down here at new cases there's been a dramatic drop in the number of

新增病例數，這個位置可以看到一個顯著的下降

new cases probably because there was a number of cases that were reclassified

因為很多病例被重新分類。

we'll have to watch this and see how things go now remember what we're

這方面有待後續關注。

talking about these total cases is based on the number of people presenting to

請留意我們正在談論的這些數字只是基於就醫的人數

hospitals that can get work done on them based on some reports that we've been

從某些報導中,

seeing especially out in New York Times there's been a crackdown and a rounding

特別是從紐約時報,我們可以得知

up of people and holding them in quarantine and not getting the medical

中國政府采取封城,和集中隔離的措施,仍有人沒有得到所需治療,

treatment that they need some people of course too scared to go and not wanting

有些人太過害怕而沒有去醫院,諱疾忌醫,

to get treatment and so it's unclear exactly how many people are not being

因此,我們還不清楚到底有多少感染的人仍未被發現。

counted here but it's apparent that this is still being under counted in terms of

而死亡總人數是明顯被低估的。

total deaths there has been a jump and that doesn't seem to be cooling off

單日死亡個案有下降的趨勢,

anytime soon unfortunately

但不幸地,這不代表拐點已經出現。

for the same reason why the total number of cases may be underestimated the total

由於同樣的原因,總确診人數

deaths may be underestimated as well on the worldA meter latest updates for

和總死亡人數可能都被低估了。

February 14 we see that there's a report from Hebei province for yesterday that

據2月14日，湖北省發布的疫情報告

there was four thousand eight hundred and twenty three new cases including

新增病例4823人，

three thousand and ninety five that were clinically diagnosed we can see here

包括3095例臨床确診

that the testing was just kind of under estimating those chronically a hundred

我們可以看到，DNA測試長期低估感染人數

and sixteen new deaths and eight clinically diagnosed so we can see that

新增死亡116例，確診8例。

the clinical diagnosis addition to the count is greatly influencing the number

臨床确診人數的增加，大大影響了新增病例數目，

of new cases whereas it's not affecting the number of deaths as much total human

卻沒有影響總死亡人數

of cases we can see here that five thousand three hundred and eighty four

15384人臨床确診

were clinically diagnosed we talked about that what's interesting here is

有趣的是

that thirty six thousand are currently hospitalized that's an incredible amount

住院人數達36000人之多，

of people that are hospitalized and you can see here that seventy three percent

其中73%

so the vast majority of them are in mild condition whereas eight thousand are in

即大部分人癥狀較輕，8000人情況嚴重

serious condition and about four point six percent are in critical condition

約4.6%屬於危殆

there's a number of people that are undergoing medical observation because

有很多人正在接受醫學觀察,

of either their contact or other symptoms that they may have two new

這些人要麼是密切接觸者,要麼是有相關癥狀的。

cases in Japan one of them being a surgeon at a hospital who developed a

日本新增2個病例，其中一人是醫院外科醫生,他出現發熱癥狀，

fever and in still continue to work as usual and saw patients for three days so

仍繼續接診病人達三日之久。

that's probably gonna have to be followed up on as well okay I want to

此事有待跟進。

discuss three things today I want to talk about the New England Journal of

我今日想討論三件事:

Medicine article that actually we referenced back at the end of January

一是我們1月底曾引述過的來自新英格蘭醫學雜誌的一篇論文;

want to talk about cell phones in China and I also want to talk just briefly

二是中國的手機;

about sleep and circadian rhythms and some more reading so first of all let's

第三,我想略微談一下睡眠與生物鐘的關係。

talk about the New England Journal of Medicine so there was this article that

首先是，關於新英格蘭醫學雜誌上的那篇論文

was published in the New England Journal talking about a visitor from Wuhan China

文中講述一個來自中國武漢的訪客，去德國參加一個商務會議。

who visited in Germany for a business meeting and it was reported in the New

據新英格蘭醫學雜誌所述，

England Journal of Medicine that this woman who came over was asymptomatic and

這個女士當時沒有新冠肺炎的癥狀，

when she flew back to China she developed symptoms of fever and the

她坐飛機回中國後，才出現發熱和新冠肺炎的癥狀,

symptoms of the corona virus had later tested positive and when they test heard

爾後被确診。

her friends that were at the business meeting in Germany they had already

與她同在德國開會的朋友做病毒測試時，

become sick and then got better and they tested

已經發病并好轉，被确診

positive for coronavirus and it was touted at that time that this was

當時就有消息稱

evidence that coronavirus could be spread even though the patients were

那是新冠肺炎無癥狀傳播(隱形傳播)的證據

asymptomatic well as it turns out there's been a correction on this new in

後來在新英格蘭醫學雜誌上又做了更正

Journal of Medicine case and we'll post a link in the description what they

我們將在備註欄加上一個連結

found out was that before they printed they had not actually reached out to

他們在付印前知道了這個情況，

this index case from China and discussed with her if she actually had symptoms

他們至今仍未找出中國的原發病例，再看這個案例，如果該女士實際有病癥，

they reported that she was asymptomatic but in reality she actually was

而報告說她是無癥狀，但事實上她是有癥狀的

symptomatic in fact she was taking medications to suppress a fever and was

她吃藥控制發熱的癥狀，并且只有很輕微的病癥

having very mild symptoms but was having them nevertheless so what does this mean

癥狀輕微也是有癥狀，這是什麼意思呢？

does this mean that coronavirus does not shed when the patient is asymptomatic no

難道說患者沒有癥狀，新冠肺炎就會自我去除嗎？

there's still people that believe that and they may be correct all it means is

仍有人堅持認為他們是正確的

that you can't use this New England Journal of Medicine case to support that

我覺得不能用新英格蘭醫學雜誌這個案例來支持該理論

theory so I think that's an important distinction that needs to be made and it

我認為有個界定需要釐清，

tells us that we've got to be careful in this world of rapid information that we

而且這件事告訴我們，在資訊科技發達的時代，我們必須謹慎。

get it right before we spread the information because spreading false

傳播資訊前要確保資訊正確

information can have consequences the other thing I want to mention with cell

因為不實資訊會造成不良後果。第二,我想談一個手機的運用,

phones we will link to a article also in The New York Times about what they are

關於這點,我們也會備註一條連結，

doing right now in China in terms of cell phone use of course in China they

紐約時報上的一篇相關文章,

have three cell phone providers that are run by the government and wherever you

中國有三家公營電信服務供應商

go of course that phone is GPS right so if you go to any particular province

GPS定位正確的情況下,你去過哪個特定的省份

it's gonna keep track of that on the phone well what they've currently worked

可以在手提電話上實時追蹤,操作方法是

out through these phone companies is if you text a particular number to them it

電信公司輸入某個電話號碼

will show on the phone right in front of you exactly which provinces in China you

就可以顯示出,在過去2個禮拜至一個月內,

have been in in the last two weeks one month however they want to do it and

該用戶曾經到過中國的哪些省份。

they just list it and so what's going on now is people are coming in to various

有一份列出了地點的清單。目前的情況是

places to various checkpoints the customs agents the military personnel

從各地來,去往各地的人,經過檢查點時,維持秩序的海關關員或者軍人

who are enforcing these banned are actually asking people as they come

會對他們進行核查,要求民眾在官方手帳上輸入自己的手機號碼,

off to text on their phone exactly this number and up there will pop where they

然後手帳上就會彈出這些人過去一個月曾經到過的地點,

have been in the last month or so and of course if Luhan is on there or specific

如果上面有武漢或者某些特定的省份,

province that Wuhan is in pops up there in some cases not letting them go and

他們就不會被放行,

they're redirecting them so I thought I'd make you aware of that the last

會被勸返。

thing I want to talk about real quickly is circadian rhythms now there's been a

最後我想很快地講一下生物鐘。

lot of questions and what I'm really trying to do is balance how much we talk

問題很多，但我儘量做個平衡，

about the virus and how much we talked about sleep and this is the reason why

病毒和睡眠我都想討論一下

I'm really gung-ho here about sleep number one is according to the studies

我為什麼要談睡眠呢？

that we've talked about in our last updates you can prevent getting the cold

原因一，據我們上一集所談的研究表明，

with sleeping appropriately up to five times imagine if I could tell you that

適當的睡眠能有效防止感冒達5倍之多。試想一下,

if you took this pill you could reduce the chances of you

如果我跟你說,你只要這麼做,感染冠狀病毒的機率,

getting the corona virus by 80% that would be an amazing way of curtailing

可以減少8成。這個方法有效的話，

the arnott's or the spread factor of corona virus and that's what we're

我想用它來說服別人不要吃餅乾，或者用來遏止冠狀病毒的傳播。

seeing not necessarily the corona virus but in

我們覺得對睡眠并不能預防冠狀病毒，

Rhino virus and so I think this is actually significant enough in a

預防鼻病毒還差不多。

discussion of what we can do practically so in that vein of things there's been a

這個討論很詳細地說明了我們應該怎麼做。

lot of comments specifically about some things that I wanted to talk about shift

有很多評論都是關於我接下來要講的：

workers circadian rhythm lights and insomnia first of all shift workers I

輪班工作者，生物鐘，光與睡眠障礙。首先是辦班工作者

know there's a lot of health care workers that work night shift so that's

我知道很多醫務工作者要上夜班

like going in at 7 p.m. and getting home at 7 a.m. or 6 p.m. to 6 a.m. etc here's

晚上七點到班，翌日早上七點回到家；或者是晚上六點到翌日早上六點，等等

the key about shift workers if you're gonna do shift work it's better to

對輪班工作者來說，最好是長期做固定的輪班工作，

always do shift work and not go back between day and night that's number one

而不要回復日作夜休模式，這是第一

so stay at same shifts the reason why this is important is because of the

維持固定的輪班很重要,

second thing we're going to talk about and that is your circadian rhythm if you

這涉及到我們將在第二點討論的生物鐘

don't do that you confuse your body circadian rhythm

因為不這樣做的話,生物鐘就要紊亂

number two is make sure that your nights are days and that your days are nights

第二點是確保夜即日,日即夜

in other words if you're going to be up at night make sure that it is bright

換句話說,如果你晚上不睡覺,

where you work at night it's also very helpful sometimes to take naps when

就要確保你工作的環境里的燈光是明亮的,有時，小息是很有用的，

you're working if your job allows for that even a 15 to 20

如果你的工作情況允許的話，

Neb can be very restful number three if you're a shift worker and you get home

即便只有15-20分鐘的小息也能令人感到放鬆

make sure you go to sleep right away as soon as you get home don't go out

回家後馬上睡覺，不要外出購物

shopping don't do the kids laundry don't go work outside go to sleep and make

不要洗小孩衣物，不要帶工作回家，單純睡覺，

sure that the room is dark to make sure that the curtains are sealed make sure

還要确保房間是黑暗的，窗簾拉好，

the window is sealed you are working different shift from what the rest of

窗戶關好，你的上班模式跟別人不一樣

the world is doing but you still need your sleep

但你也需要睡覺

and so what you need to do is get your circadian rhythm on a completely

你所要做的就是讓你自身的生物鐘形成完全不一樣的循環

different cycle and that way you're gonna get your sleep the problem occurs

那樣你便可以有足夠的睡眠

is when you want to be one way on the weekends and the other way during the

而睡眠問題只會出現在換班前，不用上班的週末

week that doesn't work so number four continue your routine on the weekend I'm

所以，在週末也要堅持這种作息。

gonna put a link into the American Academy of Sleep Medicine website that

以下有一條網站連結，美國睡眠醫學學會

gives very very good tips on not only shift workers but people who have other

針對輪班工作者以及其他有睡眠障礙的人士，

issues with their sleep so the other thing I want to talk about affects all

作了一些建議。

of us is circadian rhythm and light so there's two cycles that have to be in

另外我想談一下影響睡眠的其他因素：生物鐘和光。

perfect harmony in your body for you to get the great night's sleep number one

兩者在人體內必須協調，人才能有良好的睡眠。

is the homeostatic and this is just a funny word that tells you basically as

一是穩態，這個詞很有趣，

you are awake more and more and more you start to become increasingly more and

它告訴你，醒的時間越長，就會感覺昏昏欲睡；

more and more sleepy as you sleep more and more you start to become more and

而睡得越久，越會感覺精力充沛。

more and more rested it's just like eating and hunger the more you eat the

這就好比進食及飢餓，吃得多就不覺得餓

less hungry you are the longer you go without eating the more hungry you are

禁食越久就越餓

and that's pretty easy to understand but there is a bedtime that we have and

這很容易理解。但我們有睡覺的時候，

there's a wake time that we have and so the other one is circadian and this is

和清醒的時候。二是生物鐘。

what happens when you go on a jet plane and go to a different time zone and you

當你坐飛機到一個不同時區的地方時，

get off there's a certain circadian rhythm that occurs and when both of

下機後會有時差。

these are combined together the perfect thing happens is you are asleep until

當以上兩者結合時，最完美的情況是，你會一覺睡到清晨，

the morning and then you wake up and then you are awake until the evening and

然後醒著一直到晚上

then you go to sleep and what makes you go to sleep all of a sudden which makes

然後你又可以繼續睡覺。

you get tired around ten o'clock normally or 11 o'clock normally is the

是什麼令你在9-10點鐘就突然想睡覺呢？

combination of the drive to go to sleep and the drive to stay awake finally goes

來自以上兩者的結合，

away and both of those combined for you to go to sleep the

是驅使你睡覺和醒來的動力

is that the circadian rhythm can be shifted either to the left advanced or

但問題是，生物鐘的節奏是可以改變的。

to the right delayed and what is it that can shift

既可以提前，也可以延遲。是什麼改變了生物鐘節奏呢？

circadian rhythm it's light and this is the thing that is the bane of our

答案是光——我們人類的生存之源。

existence as people who look at electronic equipment whether it's coming

當人們看著電子光源時，

from a TV screen a cell phone whether it's coming from the lights in our house

無論是來息電視螢幕，手機，還是房屋里的燈光

all of those things at that time of the night when we should be going to bed

在晚上我們需要上床睡覺時，所有這些光

especially blue light is going to delay your circadian rhythm so that you become

會延遲生物鐘，尤其是藍光。

tired later and later and later and so what happens is you stay up later and

人會越來越晚睡，然後早上越來越遲才起床。

later and later and you don't feel tired until later and later and later but you

然後直到很晚才覺得累，

still have to get up in the morning to beat the traffic to get into work which

但是還要一早起床出發，以避免交通擁堵，

starts at 8:00 or 9:00 or whatever it starts and so that squeezes the amount

準時在8點或9點趕到上班地點。

of time that you have to go to bed and to get the sleep so by eliminating light

所以，既要消除晚上的

at night the light that causes this delay in your circadian rhythm is

那些會延遲生物鐘節奏的光，

particularly from blue light but bright light exposure at the beginning of your

尤其是藍光，還要在一日之始，將自己暴露在明光下

day when you're starting to get up in the morning has the opposite effect and

當你早上起床時，這樣做可以有一個相做的效果，

it can actually advance your circadian rhythm so what I tell my patients is

來提前你的生物鐘節奏。

that if they have a situation where they're going to bed very very late

我跟我的患者說，如果他們有晚睡的習慣，

because they don't feel sleepy until they go to bed very late and they love

因為不想睡，

to sleep until eight or nine or ten kind of like my teenager what they need to do

然後早上8，9點，甚至10點才起床，像我的孩子們一樣，

is advance their circadian rhythms so what I tell them to do make sure that

他們所要做的，就是提前生物鐘節奏。

they're exposing their eyes to nice bright lights around 7:00 or 8:00 in the

因為我建議他們，在早上7點至8點時，讓自己看到柔和的明光

morning and to avoid light exposure late in the evening let's talk really briefly

並且，避免對著光至深夜。

about insomnia so some people have an issue with going to bed and for those of

我們再略微講一下睡覺障礙。有些人很難入睡

you who have a separate room where your bed is as compared to other parts of

對於那些有獨立睡房的人來說，這是有效的。

your house this works but many many people have this situation where they

但很多很多的人即便有獨立睡房，還是會有睡覺障礙。

feel tired they're in the kitchen and as soon as they go into the bedroom now

他們在廚房里感覺很睏，但一進入睡房，

they are wide awake they can't go to sleep and they become very concerned

他們就馬上清醒，睡不著時，

about their insomnia and there's a number of issues going on here it has to

他們就一直想著自己睡不著，還有很多其他的問題

do with classical conditioning things like Pavlov's dogs that you may

這跟反應制約有關，像伊萬·巴甫洛夫的狗

have heard of in experiments and the situation is that you've got your

那個你曾聽說過的實驗一樣。

bedroom and there are things in your bedroom that you have associated with

情況是這樣的，你有一間睡房，睡房里有一些事物，會讓你聯想到自己睡不著。

insomnia and so that comes to your mind as soon as you go into the bedroom and

每當你走進睡房，就會想起那些令你睡不著的事物。

you can't sleep because you see these things that you've associated with

然後你就睡不著，因為看到這些令你睡不著的事物。

yourself in your brain for many many times that you can't sleep when you're

你在腦海時不斷提醒自己，在這個睡房裡面你睡不著。

in this bedroom and it's sort of like a performance anxiety and it's because

這就好比是”演出焦慮“

you've associated that bedroom with your inability to perform and the performance