咳嗽不停，是不是感染加重？******
许多新冠病毒感染者会出现咳嗽症状。咳嗽不停，是不是感染在加重？
咳嗽是新冠病毒感染最常见的症状之一，平均持续时间2周左右。大部分奥密克戎变异株感染属于轻症，症状会逐渐减轻，“阳康”之后咳嗽也会持续一段时间，咳嗽持续并不代表感染在加重。但是，如果咳嗽症状严重或持续不缓解，尤其在出现发热反复或发热持续不退、伴有低氧（氧饱和度下降）或憋气以及活动后气短等症状，需要警惕新冠病毒导致的肺炎，及时到医院就诊和检查胸部CT。
不单是新冠病毒感染，普通感冒、流感或肺炎之后都会出现咳嗽症状，属于感染后咳嗽。新冠病毒感染可局限于上呼吸道，也可以累及肺部导致肺炎。大部分新冠病毒感染导致的咳嗽具有自限性，但如果症状持续，伴有低氧和呼吸困难等症状，需要警惕肺炎和重症，请及时到医院就诊评估。
轻微的咳嗽症状无需治疗。咳嗽症状影响生活时，建议就诊，推荐使用缓解咳嗽症状的药物，如复方甲氧那明胶囊，或美敏伪麻溶液。这两种药物都是复合制剂，含有抗组胺药、减充血剂和镇咳药，对感染后气道炎症导致的咳嗽治疗效果较好。也可考虑含有皮质激素的吸入剂治疗，如布地奈德或氟替卡松的吸入制剂或使用布地奈德做雾化治疗。如果既往有哮喘或咳嗽变异性哮喘病史，可按照哮喘使用含有激素和支气管扩张剂的复合制剂吸入治疗，或是增加平日的吸入激素剂量，待咳嗽控制后再恢复至原有剂量。如果药物治疗效果不佳，还需要到医院就诊进一步评估咳嗽的原因和调整治疗。
新冠病毒感染，无需使用抗生素。但在某些情况下，如老年患者尤其是合并新冠病毒性肺炎的老年患者，或咳痰增加或颜色变深，合并细菌感染的风险增加，可以考虑使用抗生素。
反复咳嗽的患者，需要注意以下事项：吸烟患者必须戒烟；高血压患者需要检查一下使用的降压药中是否有药名含有“普利”的药，这是一种血管紧张素转化酶抑制剂，可能会导致咳嗽症状加重；既往有呼吸疾病的患者，如哮喘、慢阻肺和肺纤维化等，需要向医生了解治疗方案是否需要调整；有心肺疾病基础的患者需要自备指氧仪，动态了解血氧饱和度的变化。
目前感染者主要是居家治疗，在出现以下情况时推荐到医院接受进一步检查：咳嗽症状持续不缓解，或出现呼吸困难、或血氧饱和度降低、或咯痰增加、或痰液颜色加深、或发热反复、或持续不缓解、或其他症状有加重；年龄大于65岁，合并慢性呼吸系统疾病、心脑血管疾病和肿瘤等基础疾病。
对于大部分新冠病毒感染者，如果咳嗽以干咳为主，痰不多，发热很快好转，咳嗽症状逐渐在改善，没有其他明显症状，可以放心观察，无需胸部CT检查。
新冠病毒感染后的咳嗽症状平均持续2周左右，有些患者咳嗽持续时间可长达4周。单纯气道炎症引起的咳嗽，一般会逐渐减轻。新冠病毒感染2周后如咳嗽症状有加重，或超过4周症状尚未缓解，需要到医院就诊，进一步评估可能的原因。
（作者为北京协和医院呼吸与危重症医学科副主任徐凯峰）
中新网评：处理核污水绝不是日本自家私事******
中新网北京1月19日电(蒋鲤)日本政府近日称，将于2023年春夏期间开始向海洋排放经过处理的福岛第一核电站核污水。日本罔顾国内民众及周边国家的屡屡反对，企图将核污水“一倒了之”，把一件关乎全球海洋生态环境和公众健康的事当成了自家私事。
资料图：日本福岛第一核电站。2011年，福岛核电站事故发生后，大量放射性物质泄漏到大气层和太平洋，对周围环境造成了难以逆转的伤害，数十万人被迫撤离该地区。时至今日，作为日本邻国之一的韩国仍未解除福岛海鲜禁令。
日本以核污水存储能力即将达到上限为由，在2021年4月13日，正式决定将福岛第一核电站核污水排入太平洋。过去一年多，日本政府和东京电力公司一直在持续推进核污水排海计划。
日本政府辩称，这些核污水经多核素处理系统(ALPS)处理后很安全，甚至“可以喝”，这样的表态无疑在愚弄大众。
事实上，经过处理的核污水仍含有多种放射性物质，核污水一旦排放入海就无法回收，长期来看，将会给海洋生态带来难以估量的潜在威胁，最终危害人类健康。
因此，核污水排海计划推出后，遭到日本民众强烈反对。日本《朝日新闻》2022年3月公布的问卷调查显示，福岛县、宫城县和岩手县受访的42个市町村长中，约六成反对东京电力公司福岛第一核电站核污水排放入海。日本全国渔业协会联合会也多次申明立场，反对该计划。
日本政府认为，核污水排海是最便宜、最省事的解决方案，但此举却将周边国家乃至全世界置于核污染风险中。太平洋非日本一家之海，核污水会随着洋流流动，其影响势必会跨越国界，危害周边国家乃至整个国际社会的公共福祉和利益。
《韩国经济新闻》发文称，相关研究认为，福岛核污水如果排放入海，约7个月后将到达济州等韩国海域，该国水产业和旅游业将遭受相当大的损失。
德国南极海洋机构也曾发出警告，若日本将所有核污水排入海中，不到半年，整个太平洋都将面临高度辐射威胁，包括远在大洋另一端的美国。太平洋地区人民更是对日本该计划持反对意见。
日本作为《联合国海洋法公约》缔约国，有义务保护海洋环境。然而，在核污水排海方案的正当性、核污水数据的可靠性、净化装置的有效性、环境影响的不确定性等问题上，日本未能作出科学、可信的说明。
国际原子能机构技术工作组虽已三次赴日实地考察评估，但尚未就日排海方案的安全性给出结论，并且对日本提出诸多澄清要求和整改意见。在此情况下，日本仍执意推进核污水排海工程建设，这是极不负责任的行为。
太平洋不是日本的下水道，日本必须正视各方合理关切，在与周边国家等相关利益方和国际原子能机构充分协商后，制定合理的核污水处理方案。日本也要着眼长远，若只顾眼前，执意将核污水排放入海，不仅其自身，周边国家乃至全世界都将为之买单，其后果必将会危害数代人。
Fukushima water disposal by no means Japan’s own business
By John Lee
(ECNS) -- Japan has announced it will release treated wastewater from the wrecked Fukushima Daiichi Nuclear Power Plant into the Pacific Ocean this year.
Although Fukushima wastewater disposal affects global marine ecological environment protection and public health, Japan has turned a deaf ear to domestic and international opposition to dumping the contaminated water into the sea, treating the "global" matter as its own business.
The Fukushima accident in 2011 had sent large quantities of radiation into the atmosphere and the Pacific Ocean, causing irreversible damage to the surrounding environment, and hundreds of thousands of people were forced to evacuate the area. South Korea still maintains its import ban on Japanese seafood from areas affected by the Fukushima nuclear disaster.
On April 13, 2021, Japan announced it had decided to discharge contaminated radioactive wastewater in Fukushima Prefecture into the sea due to dwindling storage space, with the Japanese government and plant operator Tokyo Electric Power Company Holdings Inc. promoting the release plan over the past year.
The Japanese government argues that the water treated by an advanced liquid processing system, or ALPS, is safe and drinkable, which is undoubtedly fooling the public.
In fact, the treated wastewater still includes a variety of radioactive substances and can’t be recycled once discharged into the sea, which will pose a great threat to marine ecology and ultimately endanger human health in the long run.
Therefore, the discharge plan has been strongly opposed in Japan. According to a questionnaire conducted by The Asahi Shimbun, nearly 60 percent of mayors of 42 municipalities in Iwate, Miyagi and Fukushima prefectures oppose the discharge plan. The National Fisheries Cooperative Federation of Japan has also repeatedly stated its opposition in public.
The Japanese government believes that dumping Fukushima wastewater into the sea is the cheapest and most convenient solution, but neighboring countries and even the whole world will be at risk of nuclear pollution.
The Pacific Ocean doesn’t belong to Japan and the wastewater flow along oceanic currents will surely break boundaries and endanger public welfare and the interests of neighboring countries and even the international community.
The Korea Economic Daily reported that related research concluded that if contaminated water from Fukushima is released into the ocean, it would only take seven months for the contaminated water to reach the shores of Jeju Island, with the country's aquaculture and tourism suffering considerable losses.
According to the calculation of a German marine scientific research institute, radioactive materials will spread to most of the Pacific Ocean within half a year from the date of discharge, and the U.S. and Canada will be affected by nuclear pollution. People in the Pacific region also oppose the discharge plan.
As a participant of the United Nations Convention on the Law of the Sea, Japan has the obligation of protecting the marine environment.
However, it hasn’t offered a full and convincing explanation on issues like the legitimacy of the discharge plan, the reliability of data on the nuclear-contaminated water, the efficacy of the treatment system or the uncertainty of environmental impact.
Though the IAEA has yet to complete a comprehensive review after three investigations in Japan, the Japanese side has been pushing through the approval process for its discharge plan and even started building facilities for the discharge. It is rather irresponsible for Japan to act against public opinion at home and concerns abroad.
The Pacific Ocean is not a private Japanese sewer. The country must seriously heed the voices of the international community and make a reasonable plan for the Fukushima wastewater disposal after full consultation with stakeholders and international agencies.
If it only seeks instant interest and insists on discharging the contaminated water into the sea, not only itself, but also its neighboring countries and the entire world will pay for the decision and several generations will be forced to bear the consequence.
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