關於 american long-term care ，我們在網路上蒐集到這些相關的討論、資訊與評價

美國婦產科學會發表了一篇關於新型冠狀病毒疫苗的聲明，建議這些RNA疫苗施打對象不要排除懷孕的婦女，並提供給所有正在哺乳的媽媽們。他們鼓勵懷孕的婦女與自己的醫生討論疫苗的施打，畢竟這是新的疫苗，還沒有產生長期副作用的資料。但因人不同的情況有些人的受益大於風險 ，當與醫生討論時，可思考的問題如受疫苗者所在區域感染的情況，疫苗的效力與安全性和若感染對媽媽與寶寶的風險。

這些疫苗不久將抵達台灣，應該開始思考，媽媽們施打疫苗的益處與風險。

＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝
The American College of Obstetrics and Gynaecology (ACOG) has issued a statement on COVID-19 vaccination during pregnancy. It has recommended that the COVID-19 vaccines not be withheld from pregnant women and be offered to all lactating women. It encourages pregnant women to discuss the personalised benefits and risks of the FDA-approved vaccines with her clinical team. Although long-term safety data is lacking, the FDA and ACOG still are supportive for women to seek individualised conversation about COVID-19 vaccination during pregnancy. Questions to ask include:

-Level of the epidemic in the community
-Potential efficacy of the vaccine
-Risk of severe disease in mothers or babies
-Safety of the vaccine

The vaccines will likely become available in Taiwan soon so I hope this timely information will help you make decisions when the time comes. The level of epidemic is low (if any) in Taiwan currently, the vaccines will likely benefit the most for those who work in health care settings or those prepared to travel to endemic areas.

【澄清唬爆米花教室：被大內宣淹沒的美國總統署名投書】

先說這篇沒有圖，因為太重要不能亂放圖

在歷史上，從沒有美國總統親自投書到中華民國的報紙。但是在109年10月22日，美國總統參選人拜登以「More Prosperous Future For Our Families」(定稿中文標題：為我們家庭更繁榮的未來)，以華人為主體，台灣人為核心訴求，投書聯合報系的世界日報，強調他願意與中國合作而非對抗，鄙棄川普的仇中獵巫，願意與華人聯手，但更重視台灣人的健保經驗，不願台灣人為美國火中取栗而是共同繁榮。

但在一片大奇特的大內宣中，美國總統參選人的投書竟然在台灣地區被忽視。且不說拜登明明在聲譽卓著的 IBD/TIPP民調持續領先，比起川普根本鼓吹台灣人火中取栗(你對抗，我賺軍火，去跟大陸人死嗑來增加我談判勒索本錢)。

拜登不只親自署名投書，還誠懇說明他對台灣/兩岸的四大重點，根本是史上最誠懇與重要的待遇。既然親綠親川普主流媒體不報，那福編來報。

★
一、拜登堅持稱台灣是 leading democracy (領導性的民主政體)，表示其無意支持台獨立場(不稱國家)

二、拜登大篇幅強調川普仇中、卸責不科學的推卸問題給中國，造成亞裔的困擾與災難，而這不是美國總統應為。(打了那些整天喊支那賤畜以為自己就會成為高等美國人的台灣地區背祖中國人的臉)

三、拜登大談健保對一般百姓重要性，表示他珍視台灣的健保經驗，也是未來與台灣的合作重心。

四、與其獵巫與仇中，他更重視與中國的合作，希望聯盟對世界更有幫助(雖然舉例醫療與氣候，但也只是舉例) 表示願意以兩大強權的合作，謀取更多世界利益。

其他我 不多說，請看原文與譯文。

#拜登給中華民國台灣與聯合報系的面子真的太大了
#聯合報系真正展現實力
#美國總統投書首中華民國系報紙
#大內宣只在意把我們當馬前卒的喇叭川普

為我們家庭更繁榮的未來／前副總統喬瑟夫．拜登

時局多艱，我們國家處在十字路口，正面臨疾病大流行、經濟大衰退，和一場將決定我們未來很長一段時間的選舉。

今年 我們看到美國最好的一面

今年，我們看到美國最好的一面引領我們向前：英勇的醫師、護士、日常雜貨商、餐館業主、必要行業工作者 — 而其中，包括許許多多的亞裔美國人。

今年 我們也看到美國最糟情況

但我們也看到最糟的情況：亞裔美國人誤因新冠病毒遭仇視的行為比比皆是，某種程度上，是因為川普總統發布的仇恨言論所致。亞裔美國人被責備、被唾罵、被攻擊；家園、商家和汽車被侮辱性標記破壞；年幼的孩童被刺傷，還有一名89歲的奶奶，在不斷升級的仇恨文化中遭人火焚。

這不該是我們原本的樣子。

亞裔美國人 使我們國家變強大

近兩個世紀以來，亞裔美國人使我們的國家變得強大 — 從掘金礦工，到加速我們崛起的鐵路和工廠工人，再到推動我們向前邁進的科學家、建築師、藝術家和企業家們。多年來，他們的勇氣、犧牲和成功，為美國夢注入動力，也讓美國穩為自由的燈塔與世界的希望。

川普卻不懂 傷了移民國價值觀

川普總統不懂這些。他帶頭攻擊我們作為移民之國的價值觀，甚至在我們的邊境，拆散成千上萬的孩童與父母。即便在這場大流行到來之前，我們的仇恨犯罪就已達到16年以來的新高。而如今，為了轉移自己抗疫失敗、未能保護我們國家的過失，無論是否因此導致上千反亞裔的種族歧視事件，他仍堅持把新冠病毒稱作「中國病毒」。

作為總統 我捍衛每人的美國夢

措辭很重要，總統措辭更為重要。作為總統，我將捍衛每個人的美國夢，讓每一勤奮努力的家庭，享有通向繁榮和美好未來的公平機會。我將反對任何形式的種族歧視，指示司法部優先處理仇恨犯罪，以彌合仇恨與分裂的傷口，而非煽風點火。

川普失敗 他讓我們的經濟崩盤

唐納德·川普早在今年1月就已知道新冠病毒的致命性，卻未採取任何行動。現在，超過22萬美國人因此失去生命，約3000萬人失去工作、工時和薪水，五分之一的小商家關門。川普失敗的領導力讓我們的經濟崩盤 — 他總統當得愈久，得以完全回歸正軌的時間也愈久。

我會控制疫情 讓我們重回生機

八個月過去了，川普仍然沒有(抗疫)計畫。而我有。

首先要擔起責任，努力控制疫情，讓我們重回生機。我將執行早在3月就擬定的計畫，擊敗新冠病毒。我將聽取科學家、專家的意見；保護我們的家庭；讓新冠檢測、治療， #以及最終的疫苗免費，並對所有人開放。

我會重建經濟 實質救助小商家

我將馬上開始重建更好的經濟，為數百萬遭受重創的小商家提供實質救助。他們是我們社區的生命線 — 但川普腐敗的復甦作法棄他們於不顧，只把紓困資金匯集到大公司手中。75%的亞裔小企業主，未能獲得任何首輪紓困金。這是錯誤的，我已要求確保員工在50人以下的小企業獲得紓困金，我也將增加他們獲得優惠和資金的長遠渠道，減輕阻礙移民業主的語言障礙。

我不會對年收40萬元以下者加稅

質言之，我的經濟復甦計畫將回報以工作，而不只是財富，將創造未來數百萬優薪工作。(信評機構)穆迪的獨立經濟學者發現，比起川普總統的作法，我的計畫會創造多出700萬的工作，以及超過1兆元的經濟增長。我也不會對任何年收入40萬元以下者加稅 —別懷疑。相反地，我還將確保超級富豪和大公司最終支付本應承擔的份額。

讓父母能付學費 讓醫保更平價

我一路走來，都在為工薪和中產家庭而戰；他們之中有許多勤勉奮鬥的移民，來到美國是為更好的生活。我將幫助父母有能力支付子女的優質教育、提高教師薪酬，並讓絕大多數家庭免費就讀公立學院。我將讓照顧年邁父母變得更容易，讓醫療保險更平價。川普現在要通過法院，廢除「可負擔健保法」，在一場致命大流行之中，剝奪數千萬人的醫療保險，這毫無道理。

與盟友並肩 深化與台灣的關係

同時，新冠病毒證明美國不能自外於世界。從重建我們最親近夥伴的關係開始，我們必須與其他國家攜手合作，應對影響我們所有人的國際挑戰。我們是一個太平洋強國，將與盟友並肩，增進我們在亞太地區共享的繁榮、安全與價值。這其中就包括深化與台灣這個居領先地位的民主政體、主要經濟體，以及科技重鎮的關係。台灣也是開放社會可以有效控制新冠病毒的閃亮典範。

更新領導力 符合美利益與中合作

我們應對中國的方式，會聚焦增強美國競爭力，再興國內優勢，並更新我們在海外的聯盟與領導力。我們將在符合美國利益的領域與中國合作，包括公共衛生和氣候變遷。

讓家庭團聚 修復破碎的移民系統

美國向來不只靠強大的國力，而是用身為榜樣的實力領導世界。要切實重現此景，我們也必須修復破碎的移民系統，讓家庭團聚，確保美國繼續吸引全球最出色與最聰明的人。

我將會傾聽 重塑我們熱愛的國魂

我競選是為讓美國更好的重建，重建美國作為一個充滿機會，團結和有全新開始的國家；一個由數代移民讓其強大的地方；一個所有人都能發聲、每張選票都有價值的地方。我將引領這些議題，更重要的是，我會傾聽。所以，請確保你今天將選票投出。

讓我們一起，重塑我們熱愛的國魂。

(世界日報華盛頓記者羅曉媛／譯)

More Prosperous Future For Our Families
by Former Vice President Joseph Biden for World Journal

These are tough times. Our country is at a crossroads, facing a pandemic, a recession, and an election that will decide our futures for a very long time.

This year, we've seen the best of America carry us forward: heroic doctors, nurses, grocers, restaurant owners, essential workers–including so many Asian Americans.

But we've also seen the worst: acts of hate against Asian Americans wrongly blamed for COVID-19, spurred on, in part, by hateful rhetoric from President Trump. They've been screamed at, spit on, and assaulted. Homes, businesses, and cars vandalized with slurs. Small children stabbed. An 89-year-old grandmother set on fire amid this rising culture of hate.

This is not who we are.

For nearly two centuries, Asian Americans have made our country strong–from the gold miners and railroad and factory workers who helped to power our rise; to the scientists, architects, artists, and entrepreneurs who are helping to drive us forward now. For years, their courage, sacrifices, and success have powered the American Dream and helped America stand as a beacon of freedom and hope to the world.

President Trump doesn't get that. He has led an assault on our values as a nation of immigrants, even tearing thousands of children from their parents' arms at our border. Hate crimes against people are at a 16-year-high, even before this pandemic. And now, to deflect blame for his failure to protect our nation from this crisis, he insists on calling COVID-19 the "China virus," no matter how many thousands of reported racist incidents against Asian Americans it encourages.

Words matter – and a president's words matter even more. As President, I'll defend the American Dream for everyone, so every hardworking family has the same fair shot at prosperity and a better future. I'll stand against racism in every form, directing the Justice Department to prioritize hate crimes, and working to heal the wounds of hatred and division, not fan the flames.

Donald Trump knew how deadly COVID-19 was back in January and did nothing to stop it. Now, more than 220,000 Americans are dead. Some 30 million have lost jobs, hours, wages. One in five small businesses have shut down. Trump's failed leadership has tanked our economy – and the longer he's president, the longer it'll take to get it fully up and running again.

We're eight months in, but Trump still has no plan. I do.

It starts with taking responsibility and doing the hard work to control this pandemic and get our lives back. I'll implement the plan I've laid out since March to beat COVID-19. I'll listen to scientists and experts; protect our families; and make testing, treatment, and any eventual vaccine free and available to everyone.

I'll get right to work building our economy back better – getting real relief out to millions of hard-hit small businesses. They're the lifeblood of our communities – but Trump's corrupt recovery passed them by, funneling funds to big corporations instead. Some 75% of Asian-owned small businesses weren't expected to get any first-round stimulus funds at all. It's wrong. I've called for ensuring small businesses with less than 50 employees get new relief funds. And I'll boost their long-term access to credit and capital, and work to ease the language barriers that can hold back immigrant entrepreneurs.

Through it all, my economic recovery plan will reward work, not just wealth, creating millions of good paying jobs of the future. Independent economists at Moody's found that my plan creates 7 million more jobs – and $1 trillion more in economic growth – than President Trump's would. And I won't raise taxes on anyone earning less than $400,000 a year – period. Instead, I'll make sure the super wealthy and big corporations finally pay their fair share.

I've fought my whole career for working and middle class families – so many of them hard-working immigrants who came to America in search of a better life. I'll help parents afford a quality education for their kids, boosting teacher pay and making public college free for most families. I'll make it easier to care for aging parents, and make health care more affordable. Trump is in court right now trying to repeal the Affordable Care Act, stripping tens of millions of people of health coverage in the middle of a deadly pandemic. It makes no sense.

Meanwhile, COVID-19 is proof that the United States can't isolate itself from the world. We have to work with other nations to meet global challenges that impact us all, starting by rebuilding our relationships with our closest partners. We're a Pacific power, and we'll stand with friends and allies to advance our shared prosperity, security, and values in the Asia-Pacific region. That includes deepening our ties with Taiwan, a leading democracy, major economy, technology powerhouse – and a shining example of how an open society can effectively contain COVID-19. And our approach to China will focus on boosting American competitiveness, revitalizing our strengths at home, and renewing our alliances and leadership abroad. We'll work to collaborate with China when it's in our interest, including on public health and climate change.

America has always led the world not only with the example of our power, but the power of our example. To truly do that again, we also have to fix our broken immigration system, keeping families together and ensuring the United States continues to draw the world's best and brightest.

I'm running to build America back better, as a country of opportunity, unity, and new beginnings. A place made strong by generations of immigrants. A place where everyone has a voice and every vote counts. I'll lead on these issues, and more importantly, I'll listen. So please make sure you get your vote in today. Together we'll restore the soul of this nation we love.

#福編編譯? (編譯個鬼，是世界日報了不起！ 大內宣與遍地綠媒鬼遮眼)

➥【重點摘要】：
本文提供長照機構在面對武漢肺炎疫情時一些基本策略，但因疫情隨時在改變，建議讀者隨時更新資訊。


本文作者提出面對疫情的ABCD：
▍Awareness:
老年人通常有多重慢性病，或因失智、中風等其他健康因素，使武漢肺炎的症狀不明顯。因此建議，若老人健康狀況出現異常，又無法以感染或敗血症等其他原因解釋，則必須考慮感染武漢肺炎的可能性。


▍Behavior:
因一般人，包括員工及訪客，有可能是無症狀帶原者，因此必須假設這些人皆感染病毒，並有可能傳染疾病給住民。例行生命跡象及健康狀況的監測必須加強，所有住民必須一天三次監測健康狀況的改變，並每天測量體溫。長照機構的員工須準備一但有住民被認定為武漢肺炎高風險或出現臨床症狀時之處理原則。圖一為武漢肺炎檢測標準的例子，圖二則為機構應變武漢肺炎個案之例子。會與確診或疑似感染住民接觸之員工須採取預防空氣傳染的措施並穿戴個人防護裝備，如N-95口罩、護目鏡、防護衣、及手套。與確診住民接觸之員工及住民須接受檢測並隔離14天。


(貼文表格-洛杉磯公衛部門建議)
圖一，長照機構武漢肺炎篩檢
「CDC建議」
1.住院患者出現武漢肺炎症狀，已進行相關之感染控制。
2.其他症狀，如老人、慢性病患者、及免疫功能不全者，因這些人誠為重症的機會較高。
3.過去14天內與確診者有密切接觸並出現症狀者，或發病14天內有旅遊史者。
4.詳情請見：https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html
圖二，長照機構內武漢肺炎之決策流程


▍Containment
Preparation
長照機構應清楚知道各負責單位及角色。表一提供長照機構內處理武漢肺炎爆發之主責單位及其角色。
(貼文表格-表一，武漢肺炎爆發時主責單位及其任務)


Preventive interventions
如，照顧住民或接觸可能帶有病毒之物體表面後加強洗手，加強清潔及消毒浴室、床欄、走廊把手、門把、電梯、樓梯把手等住民及員工常使用的設備。除非必要，應盡量減少會議，並限制越少人參加越好。


▍Decisions
各級主管應已清楚並誠實的態度，以社區合作解決危機，以平衡疾病的嚴重度造成的恐慌。

(「財團法人國家衛生研究院」莊淑鈞博士整理)


📋 Coronavirus Disease 2019 in Geriatrics and Long-term Care: The ABCDs of COVID-19(2020/03/25)+中文摘要轉譯

➥Author：Heather D'Adamo, Thomas Yoshikawa, Joseph G Ouslander, et al.
➥Link： Journal of the American Geriatrics Society - JAGS
https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16445


#2019COVID19Academic
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇