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えはら医院Ehara Clinic

Ehara Clinic

Our
Mission

私たちのミッションは、世の中に元気を拡散させること。

そのために、皆様が病気を治すお手伝いをすること。
元気がない時、ここでの小さな出会いとふれあいが回復への起点になること。
そして、前向きな気持ちと充実した時間を取り戻してもらうこと。

これらを通して、私たちの存在が皆様の安心の拠り所になることができれば幸いです。

【お知らせ】
※新型コロナウイルス唾液PCR健診25,000円(税別)はじめました。英文陰性証明書5,000円(税別)です。
※ 新型コロナウイルス抗体検査(ロシュ社製)2,500円(税込)やっています。採血時に抑制の必要のない小児も承ります。
二つの検査とも、健診当日を含めて2週間以内に、発熱、咳、のどの痛み、嗅覚障害があった場合、または濃厚接触者に該当する場合は、検査を延期させていただきます。

※【COVID-19 Updates】の5月24日付で、今後1年間の流行予測を発表しました。
“2020年中は小さなクラスター散発の可能性はあるが、ほぼ流行拡大がないか、または夏から秋にかけて小規模の流行がみられる。年末以降または2021年の春から夏にかけて比較的大きい第2波がやってくるか、または流行がみられない。”
となります。(解説は本文参照)

※《ウイルス拡散地図》ゲノム疫学サイト地図のPLAYで、ウイルス拡散の様子がご覧になれます。Genomic epidemiology of novel coronavirus – Global subsampling

【COVID-19 Updates どこへ向かっているかのヒントを提供し続けます】

【7月9日】血液型のゲノムは9番染色体上にありますが、むしろ重症化と明らかに関連性のあるゲノムは3番染色体上の特定部位にあることが指摘されています。そのゲノムタイプは4~6万年前にクロアチアのネアンデルタール人またはデニソワ人からほぼそのままの形で受け継がれていました。そして重症化するリスクが70%も高くなっていました。南アジア人の30%、特にバングラデシュ人の63%、ヨーロッパ人の8%、アメリカ人の4%が、そのタイプを持っていました。アフリカ人と東アジア人は持っていませんでした(153)。
(153)The major genetic risk factor for severe COVID-19 is inherited from Neandertals/bioRxiv
無症候感染者は感染者全体の17~30%とされています。感染者全体のうち、発症前感染者からの感染が47%、無症候感染者からの感染が6.6%、つまりサイレント感染が感染全体のうち50%以上を占めます。シュミレーションによれば、サイレント感染の30~40%を隔離しなければ、感染を鎮圧するのは困難でした(154)。検査数を徹底的に増やすことでサイレント感染を早期に発見、隔離してしまうか、または、外気との交通が遮られている作りのためにサイレント感染の原因になりうる屋内に足を入れないかが、まだまだ必要ということです(152)。
(154)The implications of silent transmission for the control of COVID-19 outbreaks/PNAS
【7月8日】感染発端者から始まる感染スポットの円の拡がり方は、ある所ではゆっくり小さく、別の所では速く大きく、不均一です。10人中9人が二次感染を起こさないのに、10人目だけが20人に感染させることで、再生産数を2にしてしまいます。インフルエンザの10人全員が2人ずつに感染させることで再生産数が2になるのとは内容が異なります。接触や飛沫だけでは説明できないほど短時間でのスーパースプレッドイベントが起きているのは、スーパースプレッダーという特別な発端者がいるからというよりも、呼吸のたびにウイルスを吐き出している発端者が、空気の出入りのない閉じた空間にいて、その空気を吸うことで二次感染が起きていると考えなければ、説明をつけることができません。イタリアにウイルスが持ち込まれた12月から感染爆発までなぜ2ヵ月もかかったのかの答えはつまり、空気感染によるスーパースプレッドイベントの連鎖期間だったからで決まりです(151)。無症状者の呼気中に排出されたウイルスが3時間は空気中に生きたまま滞留する可能性を忘れないようにしてください(152)。
(151)Most People With Coronavirus Won’t Spread It. Why Do a Few Infect Many?/NYT
(152)It is Time to Address Airborne Transmission of COVID-19/Clinical Infectious Diseases
【7月7日】ブラジルの9万2千人を対象とした調査によると、1~2か月以内にインフルエンザワクチンを接種していると、COVIDに罹っても、重症化率が8%、人工呼吸器使用率が18%、死亡率が17%低くなっていました。さらに驚くべきことに、COVID発症後に接種しても重症化を抑え、死亡率が27%下がっていました。インフルエンザワクチンはインフルエンザだけを相手にする免疫細胞以外の様々な自然免疫細胞全体をトレーニング、賦活します。これによりインフルエンザ以外のウイルスに対しても免疫効果が得られるというオフターゲット効果が期待されています。BCG、麻疹、天然痘、ポリオの生ワクチンは同様の免疫賦活効果があるといわれています(150)。
(150)Inactivated trivalent influenza vaccine is associated with lower mortality among Covid-19 patients in Brazil/medRxiv
【7月6日】RT(逆転写)-LAMP法は検査能力を4倍以上に拡大させ、今のPCR検査に置き換わっていきそうです。他のコロナウイルスや風邪ウイルスを誤って認識せずに済みます。PCRとの一致率は94%でしたが、現在精度を上げる工夫がなされています。RNAを抽出する作業が省けるので、費用が10分の1で済み、30分前後で結果が出ます(149)。国産品も発売されました。
(149)Standard operating procedures for SARS-CoV-2 detection by a clinical diagnostic RT-LAMP assay/medRxiv
【7月5日】SARS-CoV-2は腸のACE2という部位にくっついて侵入します。腸の細胞にあるACE2はアミノ酸の吸収をコントロールし、腸内環境を整えています。繊維の多い食事が作る良質の腸内細菌環境では短鎖脂肪酸が作られます。それによってインターフェロンやT細胞といった抗ウイルス免疫が促され、肺での防御力を高める可能性があります。しかし、SARS-CoV-2が腸に感染すると逆にACE2が減り、悪い腸内細菌が増えます。マウスの場合、ACE2が減少した悪い環境は、トリプトファンとニコチンアミドの投与によって改善しました。SARS-CoV-2に感染したヒトの場合でも、良い腸内細菌の移植またはそれと同じ効果を生む成分の注入が有効かもしれません(147)(148)。
(147)ACE2 links amino acid malnutrition to microbial ecology and intestinal inflammation/nature
(148)Potential causes and consequences of gastrointestinal disorders during a SARS-CoV-2 infection/Cell Reports
【7月4日】3月以降のパンデミックを起こしたのは、中国発のD型ウイルスが点突然変異して生まれたG型です。G型ウイルスはD型に比べウイルス排泄量が多く、感染力が強いため、世界中のD型を置き換えました。普通、ウイルスは免疫が作る中和抗体が効かない方向に形を変えていきます。しかし、幸いにも今ある中和抗体はG型にも有効でした。また致死力も強まっていませんでした(146)。
(146)Tracking changes in SARS-CoV-2 Spike: evidence that D614G increases infectivity of the COVID-19 virus/Cell
SARS-CoV-2は細胞内に一旦侵入すると、細胞の生存と分裂増殖に必要な、カイネースと呼ばれる酵素からなる回路をハイジャックします。そして細胞の分裂を止め、自らの増殖に必要な回路と材料を独占して増殖していきます。さらに細胞表面からたくさんのたこ足様の突起を発生させます。増殖したウイルスをその突起から無数に放出させて隣の細胞に感染させます。カイネースを抑える薬が現在8種類以上試験中です。特にシルミタゼルチブは有望視されています。レムデシビルなど他の薬とのコンビネーションカクテルとして使用することが想定されています(145)。
(145)The Global Phosphorylation Landscape of SARS-CoV-2 Infection/Cell
【7月3日】1976年のインフルエンザは1918年のパンデミック株とそっくりだったため、大急ぎでワクチンが作られました。しかし麻痺の後遺症500名と25名の死者を出す結果になりました。国民の50%が接種希望だったのですが、結局22%の接種率で終わりました(143)。まさに今、初期臨床試験の報告が相次いでいます(144)。しかし十分な有効性と安全性が担保されなければ、集団免疫を得るための信頼を得ることはできません。実際にモデルナのメッセンジャーRNAワクチンは有効性が示されたと同時に、最初の臨床試験では被検者の一人が高熱と失神に見まわれました。全国民への接種は、臨床試験とは異なり、あらゆる被検者への接種であり、結局はあらゆる人が接種してみなければ、本当の効果と安全性はわかりません(143)。
(143)Here’s how we’ll know when a COVID-19 vaccine is ready/NATIONAL GEOGRAPHIC
(144)BioNTech and Pfizer’s Covid-19 vaccine trial yields positive results/FT
無事にワクチンが市場に出てきたとしても、一方では、東海岸を襲ったヨーロッパ株でウイルスの変異が確認されています。そしてその感染力は増強しているようです。現在臨床試験中のワクチンは変異前の型を基にして作られています。基から作り直す必要に迫られます(145)。
(145)The D614G mutation in SARS-CoV-2 Spike increases transduction of multiple human cell types/bioRxiv
遺伝子ブロックが3万個つながってできているウイルスは感染するたびに、その中のブロック1個分が偶然に違うものに入れ替わったり、欠落することが普通に起こり続けます。そして結果的に自分の存続に有利になる方向に進化していくともいわれています。インド株がその方向に向かって弱毒化しているのは、ブロックの10カ所に生じている変異や欠落のせいではないかと考えられています(146)。
(146)Unique mutations could weaken Indian SARS-CoV-2 strain/NMLS
【7月2日】パンデミック、気候変動、種の絶滅という地球上で起きている自然現象は相互につながっています。それらに共通するのは、その動態にはポジティブフィードバック作用が働き、しだいにエスカレートしながら積みあがっていく現象であり、勢いが一線を越えると決して元には戻れない移行や消失が起きること、現象が明らかになるまでに長い時間差があることです。ヒトを含めてある生物の生息域がわずかに減少しているようにみえても、すでに絶滅が決定づけられていることはよくある現象です(142)。
(142)COVID-19: Analogues and lessons for tackling the extinction and climate crises/Current Biology
【7月1日】地球は1個の生命体のような存在であり、それを構成する全ての生物をはじめとする生命体的物体と全ての環境とが単一の統合体を構成している。そして、それは生き物が生きるためにその中で隅々に至ってつながっている川の流れのような流動性を維持するために、全体としての自己調節能を持っている。観察結果によれば、その中の生物は、まったくばらばらに進化しているのではなく、環境の変化に依存して、偶然性による不可逆的な変化を起こして進化している。生物の進化は、別々のゲノムの衝突によって融合する方向に起こる。人為的な環境変化に合わせて、人のゲノムと様々なウイルスゲノムがぶつかり合う現象が起きることになる(141)。
(141)Evolutions’ next major transition
【6月30日】高齢者と肥満がSARS-CoV-2の主なターゲットになり世界で1千万人が感染し、サプライチェーンの分断により子供と栄養不足の人々が主なターゲットになり8億2千万人が食料不足に陥っています。実は食料不足の主な原因は、静かに進行中で、SARS-CoV-2と同じRNAウイルス感染による食用植物の深刻な被害です。その植物を守るため、バイオ技術による植物用ウイルスワクチンが使用されています。これはヒト用の新しいタイプのワクチンと同様に、自らの体細胞にウイルスの断片を作らせて、それに対する免疫の学習をさせるのです。それを応用して今、植物にヒト用のワクチン蛋白を大量生産してもらっています。ベンサミアナタバコというタバコ属の植物は蛋白を高速で作る能力をもっていて、インフルエンザワクチンを従来の4倍速で作れます。同じようにSARS-CoV-2の蛋白を作らせて、検査試薬またはワクチンとして大量供給するように進行中です(139)(140)。
(139)Pandemics of People and Plants: Which Is the Greater Threat to Food Security?/Molecular Plant
(140)medicago
【6月29日】肥満があると、重症化しやすく死亡率が高くなる。これはまだ仮説の域を出ませんが、今後少しずつ証拠が得られていくことが予想されています。なぜなら、燃料がたっぷりあるところに、火をつければ当然、火は大きくなるからです。肥満は血栓を生じやすくするばかりでなく、脂肪細胞は炎症を強める成分をたくさん分泌します。同時に脂肪細胞の増殖は炎症を抑えるホルモンの分泌を低下させます。そして余分な脂肪が沈着していると肺で起こる炎症はひどくなります(138)。
(138)When two pandemics meet: Why is obesity associated with increased COVID-19 mortality?/Med
【6月28日】冬に入る南半球のこれからは私たちの未来にヒントを与えてくれます。当事者である南半球の親にとっては、子供が風邪症状を呈したらどうするかは、目の前の課題です(135)。子供のCOVID-19は普通の風邪と見た目では見分けられません。しかし実はその国や地域で流行がかなり抑えられていて、濃厚接触者でなければ、可能性はまずないと言えます。オーストラリアではPCR検査の陽性は1日で45000件中6~28件、つまり1600~7500件中1件の陽性率です。(日本は5000件中40~100件、50~125件中1件です。) ここまで来れば、検査結果はまず陰性であり、同時にその結果はかなり正確な答えになります。濃厚接触者でない限り、感染の可能性はまずないと言えます。さらに、SARS-CoV 2はヒトの細胞のACE2という部分にくっつくことで感染しますが、若いヒトほどACE2が少なく、幼少であればあるほど極端に少なくなるため、子供ではウイルスが感染せずに素通りしてしまっている可能性があります(136)。したがって、そばに感染者がいなければ、子供が感染している確率は著しくゼロに近いということになります(137)。保育園や学校の先生と親が感染しないことがきわめて大切ということです。
(135)Coronavirus or just a common cold? What to do when your child gets sick this winter/The Conversation
(136)Nasal ACE2 Levels and COVID-19 in Children/JAMA
(137)Yes, we’ve seen schools close. But the evidence still shows kids are unlikely to catch or spread coronavirus/The Conversation
【6月27日】ステイホームによる身体運動の低下量が大きかった人ほど、不安感、抑うつ気分、前向きな気持ち、自制心、バイタリティーといった精神面の健康状態が悪くなっていました。さらに女性においてその影響がより強かったという現象が確認されました(134)。診療現場での観察結果と一致しています。
(134)The impact of physical activity on psychological health during Covid-19 pandemic in Italy/Heliyon
【6月26日】ワクチンはもはや先端技術の結晶です。まだ開発途上ですが最新型といえる自己増幅型メッセンジャーRNAワクチンの臨床試験を英国で公的資金と寄付金を基にして始めます。菌やウイルスを丸ごと処理せずに、必要な遺伝情報だけをナノ粒子で包み込んで作ります。少量の成分で有効性が高く、副反応が少なく、単純な工程で短期間に大量生産が可能です。HIV他、多くのウイルスワクチンとして応用されています。ちょうど準備が整ってきていた新型のワクチンが実際にどれほど使えるのか、初めて行われる大々的な臨床試験になります(131)(132)。
(131)Government-funded Imperial College COVID-19 vaccine moves into first human trials/GOV.UK
(132)Self-amplifying RNA SARS-CoV-2 lipid nanoparticle vaccine induces equivalent preclinical antibody titers and viral neutralization to recovered COVID-19 patients/bioRxiv
コレステロールの薬の服用によって、感染しやすくなる可能性を上回る死亡率の低下が認められました。さらに同時に服用されていたACE阻害剤、ARBと呼ばれる血圧の薬はその結果に影響を及ぼすことはありませんでした(133)。
(133)In-hospital Use of Statins is Associated with a Reduced Risk of Mortality among Individuals with COVID-19/Cell Metabolism
【6月25日】マスク着用は基本的な人間のニーズに反する行為であるという考え方が、米国でマスク着用に対する強い抵抗感とつながっているのは至極合理的な現象です。エイズ予防の歴史からも、マスクの強制が市民的自由への侵害であるという信条や、マスク着用がかえって身の危険を高めてしまいかねないという事実に共感、配慮しなければ、抵抗感のないマスクの日常化を実現することは難しくなります(130)。このように、「みんなマスクをつけてください」という掛け声は、社会全体がその道理を理解しないままならば、いくら科学的事実であっても、あっという間に消えてなくなるでしょう。
(130)The Dudes Who Won’t Wear Masks/The Atlantic
【6月24日】ギリアード社の計画の骨格は、第一に早期治療薬として病棟外で幅広く投与してもらえるようにすることです。吸入タイプのレムデシビルの臨床試験はその手始めです。第二にレムデシビルだけでは元々効き目が充分とは言えないため、デキサメタゾンやトシリズマブなどの過剰免疫反応を抑える薬とのコンビネーション治療を確立させることです。元々ウイルスは人の細胞の中に潜伏しやすい性質を持つものも数多く、1種類の薬だけで完全排除がうまくいくのはむしろまれなことともいえます。HIV治療の歴史においても、併用療法が出てきて初めて目に見える治療の進歩がみられました。第三に投薬できる対象を拡げることです。子供の他に、妊婦や末期腎不全に対しての臨床試験も計画しています(129)。
(129)An Open Letter from Daniel O’Day, Chairman & CEO, Gilead Sciences/STORIES@Gilead
【6月23日】官民の連携が普通にいっている米国では、無症候者へスクリーニングを拡げるために、例えば4人分の唾液を一度に検査する方法を普及させていく予定です。4人分の検体が陽性反応のときだけ、一人分ずつ調べれば済みます。社会全体の感染率が低ければ低いほど、例えば日本では、よりいっそう効率的な方法になります。4人よりもさらに多くの唾液を一度に調べることができる精度を確保できれば、さらに効率を上げることができます(127)。社会的距離やマスク着用をきちんと守り続けている人が多い社会であればあるほど、この方法から得られた陰性の結果が本当に陰性である可能性が高くなります(128)。
(127)Coronavirus (COVID-19) Update: Facilitating Diagnostic Test Availability for Asymptomatic Testing and Sample Pooling/FDA
(128)What a Negative COVID-19 Test Really Means/The Atlantic
SARS-CoV 2はヒトから多くの飼育、畜産、野生動物に感染することがわかってきました。サル、フェレット、ネコ、ハムスターにうつります。実験で、ウサギ、羊、山羊、牛、馬、リスにも感染できることがわかっています。最もヒトに近い場所にいて数も多いネコとイヌ、ブタ、ヒトへの感染が実際に起こったミンクが、ウイルスのしかも無症状のリザーバーになりえます。そうなると、日本脳炎予防のためにブタを監視するのと同じように、こうした動物のサーベイランスが今後とても重要になります。
(126)Host range of SARS-CoV-2 and implications for public health/Microbe
【6月22日】12000年前に農耕が始まり、ヒトは所属する生活集団をしだいに大きくしていきました。それに並行して犬以外の哺乳類や鳥に接する機会が増えていきました。その結果、人畜共通感染症が伝染病となり、さらに交易が拡大することによってパンデミックが人類の歴史の中で繰り返されることになりました(124)。そして今回、猫のコロナウイルス治療に使うウイルス増殖抑制薬GC376の有効性が確認され、臨床治験へ向けた動きが始まりました(125)。
(124)What the archaeological record reveals about epidemics throughout history – and the human response to them/the Conversation
(125)Anivive Repurposes Veterinary Drug GC376 for COVID-19 And Submits Pre-IND to FDA/P&T community
【6月21日】新生児を含む軽度ではない小児COVID-19患児50人に対するレムデシビルの臨床試験が米国とヨーロッパで始まります。未来に同じ轍を踏まないために、必要なことを、できるときにできることを、知恵を絞りながら効率的に実行していきます。
(123)Gilead to enroll pediatric patients for late-stage remdesivir study/REUTERS
【6月20日】感染した子供のうつしやすさも、子供集団においてクラスターがどの程度起こりやすいのかもまだ正確にはわかっていませんが、手がかりになる二つの報告が出たので、とても大雑把な計算をしてみました。20歳未満のうつされやすさは大人の0.22~0.5倍(121)(122)、19歳以下の症状の出やすさは大人の0.3倍(121)、無症状者から他人へのうつしやすさは有症状者の0.2倍(101)。これらを基にすると、子供から他人へのうつしやすさは大人のそれに対して0.10~0.18倍、大人のR=0.6(122)ならば子供のR=0.06~0.10、三次感染率は大人のそれに対して0.022~0.09 倍でした。特に幼児では三次感染率が大人の0.02~0.04倍、集団保育や学校生活という条件でも0.09倍未満には収まりそうです。大人でも三次感染が生じないこともあるぐらいなので(122)、子供からの感染の可能性や子供集団のクラスター発生率は無視してもよいぐらい低い印象です。
(121)Age-dependent effects in the transmission and control of COVID-19 epidemics/nature medicine
(122)Household secondary attack rate of COVID-19 and associated determinants in Guangzhou, China: a retrospective cohort
study/Infectious Disease

【6月19日】海外では中和抗体治療薬の開発が先を争うように進行中です。ただし、大量生産するために、その素になる抗体をどこから採ってくるかが問題になっています。マウスや回復したヒトから採れる量には限りがあります。人工合成する方法もあるのですが、牛にヒトの抗体を大量に作ってもらう方法が編み出されました(119)(120)。
(119)The Promise of Antibody Treatments for Covid-19/WIRED
(120)SAB Biotherapeutics Confirms Neutralizing Antibodies to SARS-CoV-2 and Begins Clinical Manufacturing of Novel COVID-19 Therapeutic Candidate/businesswire
【6月18日】ウイルスをやっつけるための火が大きくなりすぎると自分の体がもたないので、火の勢いを幾分弱めればよく、火力を弱める薬には重症化を抑える効き目があります(116)。しかし、ウイルスを燃やし尽くすまでにはその分時間がかかるようになります。ステロイドで火力を落とせばウイルスが消えるまで時間がかかります(117)(118)。ちょうどよい火加減にする必要がありそうです。
(116)GM-CSF blockade with mavrilimumab in severe COVID-19 pneumonia and systemic hyperinflammation: a single-centre, prospective cohort study/Rheumatology
(117)Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis/Leukemia
(118)Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients/JCV
【6月17日】重症者に対するデキサメタゾン1日6㎎10日間以下の投与によって、酸素が必要な場合の致死率が20%、人工呼吸器が必要な場合のそれが30%低下しました。重大な副作用も二次感染もありませんでした(115)。免疫系の火事ともいえる病気の治療では、火事の原因を取り除こうとする攻めの姿勢ばかりでなく、火が燃え広がらないようにする守りの治療がやはり役立つようです。
(115)Commonly used steroid reduces risk of death in sickest coronavirus patients, preliminary study results suggest/cnn
【6月17日】海外ではすでに、ワクチン接種と有効薬による治療のラリーが始まりました。
シノバックバイオテック社のワクチンの最終臨床試験が南米で始まります(112)。年間1億本供給できる生産体制を整えます。2種混合抗体カクテル療法は治療と予防の両面での効果が期待されます。ウイルスの耐性獲得が起こりにくい利点があります。リジェネロン社が臨床試験を始めます(113)。さらに、SARS-CoV 2が増殖するためになくてはならないNsp9という部品を抽出作成することができました。他のコロナウイルスと同じ構造をもつこのNsp9の働きを邪魔する薬によって、発症や重症化を抑えることが期待できます(114)。
(112)Sinovac says early data show its Covid-19 vaccine generated immune responses/STAT
(113)Studies in humanized mice and convalescent humans yield a SARS-CoV-2 antibody cocktail/Science
(114)Crystal structure of the SARS-CoV-2 non-structural protein 9, Nsp9/iScience
【6月16日】感染者数と死亡者数がともに日本の120倍の米国では(110)、今後2か月でさらに今の2倍の感染者数に膨れ上がるという試算があるにもかかわらず、「いまさらロックダウンには戻れない」という諦めの空気が漂い始めています(111)。それに対して、ゲノム編集技術検査法と治療法の開発、唾液を含めたPCR検査1日44万件以上の実施、レムデシビルの認可と抗アンドロゲン治療の実践、抗体治療薬の臨床試験、モデルナ、アストラゼネカ、J&Jのワクチンの16万件以上の臨床試験の前倒し開始といった、実質的な治療と予防を、感染再拡大の勢いと先を争うように、なんとかウイルスの勢いを止めるべく自前で実践配備中です。だから日本は安全で静かに見えるようです。
(110)CDC
(111)The Virus Will Win/The Atlantic
【6月15日】SARS-CoV 2はインフルエンザに比べると1/2~1/6程度の速さでしか遺伝子の変化を起こしていません。ウイルスも生き物と同じようにたくさん繁殖できる方向に適応進化していくので、SARS-CoV 2は、無症状者を減らし、発症前期間を長くし、重症度を下げる方向に変異していくと想定されます。しかし、すでに十分な伝染力をもちつつ、感染できる人口が十分に残っていて、ウイルスの繁殖が妨げられる圧力がかかっていない現状では、ウイルスの明らかな変化は見えていません (109)。
(109)On the evolutionary epidemiology of SARS-CoV-2/Current Biology
【6月14日】アフリカで感染者数と重症数が予想より少ない理由のひとつ目は、若年者が圧倒的に多い人口構成のせいです。二つ目は気候の影響です(107)。これは別の見方をすれば、ある環境では一方向の選択的圧力が働いていて、感染症の一方が優勢でもう一方が劣勢になるというゲームのような共生関係が起こります。アフリカはすでにいくつかの感染症で満席に近い状態になっていて、選択的圧力に適応しにくい感染症が新たに入り込むことが難しいのかもしれません。あるいは、ヒトの体には、あるばい菌が住み着くと、次のばい菌が入ってきたときに強い反応が起こりにくくなる免疫のしくみが備わっているので、新しいウイルスが入ってきても症状が目立たずにすむのかもしれません(108)。
(107)Socio-demographic and epidemiological consideration of Africa’s COVID-19 response: what is the possible pandemic course?/nature medicine
(108)Regulation of the host immune system by helminth parasites/JACI
【6月13日】実は、薬もワクチンも、効率よく新しい候補を探し出したり、効き目を確かめるためには、実験モデルが欠かせません。SARS-CoV 2がヒトと同じように感染するマウスのモデルができたことによって、新しい薬やワクチンがずっと見つけやすくなります。(106)。開発の道が大きく拡がったことを意味します。
(106)Generation of a Broadly Useful Model for COVID-19 Pathogenesis Vaccination, and Treatment/Cell
【6月12日】ウイルスの侵入に対して火をつける免疫細胞はどんどん火を起して退治しようとします。しかし大火事になると体がもたないので、火消し役の免疫細胞も同時に駆り出されます。BCGは火付け役を教育する効果が期待されていますが、実は同時に火消し役を教育する効果もあります。その結果、ウイルスが入ってきても大火事つまり重症にならずに済むのです。COVID-19でも川崎病でも火消し役の重要性がわかっています(30)(104)。風邪菌の混合物を飲むことで火消し役を教育することが知られています。その臨床試験が始まります(105)。様々な可能性を探し、すぐに臨床試験を実行できる国が世界にはあります。
(104)Transforming Growth Factor-β Signaling Pathway in Patients With Kawasaki Disease/Circulation
(105)OM85: could bacteria in a capsule protect us from coronavirus and other respiratory infections?/The Conversation
【6月11日】アカゲザルへの不活化ワクチン2回接種で、文句のつけようのない有効性と安全性とが報告されました(103)。間違いがなければ、アフリカや南米での瞬く間の臨床試験を終わらせ、秋風が吹き始める頃には中国本土でワクチン接種が進んでいく、1月のデジャブのような映像を観ることになるのかもしれません。
(103)Development of an inactivated vaccine candidate, BBIBP-CorV, with potent protection against SARS-CoV-2/Cell
【6月10日】国内抗体陽性者は約0.5%前後。おおざっぱに感染性胃腸炎流行時の感染者数と同じ程度です。1回の流行でのこの数字は十分に多いとも解釈できます。受け入れ病院がパンクしたことと一致する数字です。ニューヨーク市19%、スウェーデン7%と比べてこの結果になったのは、実は日本人のマスク着用習慣が幸いしただけなのかもしれません。
 発症者との濃厚接触の機会が多ければ多いほど、感染しやすさは極端に高くなり、離れれば離れるほど極端に低くなるという現象があります(57)。発症前の人に2日間のうちに5回以上接触した人、つまり家族などの濃厚接触者の16%が二次感染し、2日間で1回しか接触してない人に比べて感染しやすさが29倍高くなっていました。ちなみに、無症候者からの感染は、発症した人からに比べれば約1/5の危険性でした(101)。
 感染しやすさのこのような性質に対して有効なのがマスクだからです(86)。みんなが公共の場で無症状でも常にマスクをした場合は、症状がでてからマスクをした場合に比べて実行再生産数を2倍減らします。常に50%以上の人々が公共の場でマスクをしていれば、緩い制限下でも感染拡大を抑えることができる試算です(102)。
(101)Secondary Transmission of Coronavirus Disease from Presymptomatic Persons, China/EID
(102)A modelling framework to assess the likely effectiveness of facemasks in combination with ‘lock-down’ in managing the COVID-19 pandemic/The Royal Society A
【6月10日】川崎病はウイルスの先行感染によって引き起こされますが、川崎病の重症型ともいえる小児発症性多系統炎症症候群(CoV-PIMS)ではその期間がCOVID-19に罹ったあと4~5週間で起こっていました(99)。CoV-PIMSの川崎病との決定的違いは、76%もの患児が心筋炎を起こし、容易にショックに陥ることです。これはCOVID-19が重症化した病態そのものです。アフリカ系の患児に重症化リスクが高いことも、大人のCOVID-19における重症化リスクと共通していました(100)。
(99)SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020/Eurosurveillance
(100)Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study/BMJ
【6月9日】今となっては、感染者数の推移をみれば、この先に起きるかもしれない可能性を誰もが想像することができます。アウトブレイク前と違うのは、数字が読めるようになったからではなく、単に体験学習効果によって、自分なりに数値に意味づけができるようになったからです(97)。「今は何月何日ごろの状態」という発表のほうが説得力を持つ理由です。
(97)Of Viruses, Vaccines, and Variability: Qualitative Meaning Matters/Trends in Cognitive Sciences
一般のクリニックや病院の手元に唾液抗原検査か唾液PCRを配置しなければならない理由が二つあります。一つ目は、ヒトは脅威に対する心の防衛のために仲間や愛する人との社会的身体的接触を求め、提携しようとする生き物です。自分や大切な人が死ぬかもしれないという脅威の理性的認識が、かえって直接会いたいという本能を呼び起します。脅威の下で社会的接触をなくすことは不可能です。これは、科学が発達した国では、認知科学、行動科学として、何を準備すべきかの論理に組み込まれます(98)。二つ目は、保育園が再開されてすでに発熱が主症状になる夏風邪が流行し始めました。COVID-19に対する特異的な診断手段のないままでの、鑑別診断は2月と全く変わらず、一か八かのたぶん風邪だろうという危険な勘に頼らざるを得ず、またもや診察行為そのものをフリーズせざるを得なくなるからです。
(98)Pandemics and the great evolutionary mismatch/Current Biology
【6月6日】国内でも唾液PCRが今月中に普及しそうです。次に普及するのは、ワクチンよりも治療薬だと思われます。中和抗体薬の開発の勢いが増しているからです。例えば、動物のラマが作るVHHと呼ばれる小さな中和抗体が実験室で、ヒトの通常の抗体よりも効率よく、SARS-CoV 2を中和しました。安定性が高く、喘息やインフルエンザの治療で用いられる吸入式の治療も可能になりそうです (93)。
(93)Coronavirus: why we’re using llamas to help fight the pandemic/The Conversation
【6月5日】保育施設からのクラスターの報告は世界でも少なく(91)、子供集団からの感染拡大の危険性は低いと想定されています。しかし、実際に子供どうし遊ばせるとなると、どこまでなら許せるかという疑問が生じます。親の置かれた環境によって考え方が異なってきますが、各自が決めたルールを無理して変えることのないように、同時にお互いの価値観を許容するようにすべきです。自分たちの家族が、どこまで許容できるか、子供に100%を求めない現実的なルールを各家庭が随時決めていくことです(92)。
(91)16 infected north of Montreal in Quebec’s first COVID-19 outbreak in a daycare/CTVnews
(92)How Do You Decide if Children Can Play Together Again?/NYT
【6月4日】男性のほうが女性よりも2倍重症化のリスクが高いことがわかっています。しかし、義務化されてない地域ではマスクをつけない男性が明らかに多く、男性のほうが自分は大丈夫だという考えが強く、マスクをつけることに対して消極的な考え方をもっているという調査結果でした(90)。
(90)The effect of messaging and gender on intentions to wear a face covering to slow down COVID-19 transmission/PsyArXiv
【6月3日】SARS-CoV 2は、コウモリとセンザンコウとヒトのコロナウイルスの間で頻繁に起きる組換えによって生まれたようです。ヒトに感染力を持つのに必要な一部分がセンザンコウのものに完全に置き換わっていました(88)。また、SARS-CoV 2の増殖に必要な部分がコウモリよりも体温の低いヒトに適応できる作りでした(89)。
(88)Emergence of SARS-CoV-2 through recombination and strong purifying selection/ScienceAdvances
(89)Structural and biochemical characterization of nsp12-nsp7-nsp8 core polymerase complex from SARS-CoV-2/Cell Reports
【6月2日】ここで4月25日に報告した、迅速に実用化できて、確実に有効性が見込まれる中和モノクローナル抗体治療の実際の患者さんでの第一段階の試験結果がイーライリリー社から今月末には出ます。同時に、秋には大量供給できるよう生産体制を増強しています(87)。
(87)Lilly Begins World’s First Study of a Potential COVID-19 Antibody Treatment in Humans/Eli Lilly
【6月1日】Celltrion社が中和抗体治療薬の臨床試験を7月から始めると発表しました(85)。期待していた治療の安全性が確認されれば、安心が一気に拡散します。間違いなく治療薬の進歩が拡大、加速していく段階に入りました。
(85)Celltrion Announces Positive Pre-clinical Results for COVID- 19 Antiviral Antibody Treatment, Showing Improvement in Recovery Time/businesswire
【6月1日】科学の大進歩が、ある日突然1階から2階に上がるように起こるのはよくあることです。人類存続の危機にさらされた平時とは異なる今、ゲノム編集技術による治療法が意外にも驚くほど短期間のうちに商品化される確率は高まっているはずです(84)。
(84)Development of CRISPR as an Antiviral Strategy to
Combat SARS-CoV-2 and Influenza/Cell

【5月30日】検査はすべて唾液で済むところまできました。ゲノム編集技術を用いたRNA検出検査は唾液を検査機関に送付せずに自宅で1時間以内に結果が判明します。1回分200円前後。PCR検査の役割は終わります(77)。抗原検査も唾液でできるようになりました(78)。集団免疫を調べる抗体検査も唾液でできるようになりました(79)。あとはここでも早く普及することを願うだけです。
(77)Rapid home-based coronavirus tests are coming together in research labs — we’re working on analyzing spit using advanced CRISPR gene editing techniques/The Conversation
(78)Japan to approve quick antigen, saliva-based coronavirus tests/Xinhua
(79)COVID-19 serology at population scale: SARS-CoV-2-specific antibody responses in saliva/medRxiv
【5月24日】見通しを立てることの是非はさておき、サイエンス誌に掲載された流行モデルを基にした今後1年間の日本における流行予測です(60)。
流行曲線は、集団免疫いいかえれば感染しやすさにもっとも影響を受けることになっています(61)。7月以降に始まる米国で10万人規模のワクチンの治験がうまくいけば、集団免疫、実行再生産数が急速に変化していく可能性が高くなります(62)。
ウイルス拡散に対する気候の影響は軽微であること(61)、人の認知と行動様式の変化、および政府による介入タイミングの変化、さらにヒトの移動と人口密度とを変化させる実態経済の動態による実行再生産数つまり感染のしやすさという変数への持続的再帰的効果を考慮に入れています。また有効なワクチンと薬とが存在しない限り、ソーシャルディスタンシングが維持されることを前提としています。

“2020年中は小さなクラスター散発の可能性はあるが、ほぼ流行拡大がないか、または夏から秋にかけて小規模の流行がみられる。
年末以降または2021年の春から夏にかけて比較的大きい第2波がやってくるか、または流行がみられない。”

という現時点における予測になります。
(60)Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period/Science
(61)Susceptible supply limits the role of climate in the early SARS-CoV-2 pandemic/Science
(62)Exclusive: U.S. plans massive coronavirus vaccine testing effort to meet year-end deadline/Reuters
【5月6日】SARS-CoV2を含むRNAウイルスはヒトの遺伝子の鎖に取り込まれて、人類の多様性を拡げるのに役立ってきました(33)。エイズが治るというのは、ウイルスを排除する体の免疫反応が起きないと同時に、ウイルスをヒトの遺伝子の鎖の中に完全に取り込んでしまった状態だという説もあります(34)。
(33)Endogenous non-retroviral RNA virus elements in mammalian genomes/Nature
(34)HIV infection en route to endogenization: two cases/Clinical Microbiology and Infection

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We hope that our being could be a source of peaceful mind for everyone.

【Notice】
※COVID-19 saliva PCR test 25,000 yen (tax excluded). English negative certificate 5,000 yen (tax excluded).
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Above tests are only carried out on people without any COVID-19 symptoms (e.g. fever, cough) or who have not had contact with a person potentially infected with the COVID-19 virus. Those who already show COVID-19 symptoms or have had contact with a potentially infected person should stay at home and get in touch with the health hotline by calling 042(362)2334.

※ We announced the epidemic forecast at Japan for next year on May 24 of【COVID-19 Updates】, as follows,
“There will be little or no epidemic or small outbreaks from summer to fall during 2020, although small clusters may occur. After the end of this year or during the spring and summer of 2021, there will be a relatively large second wave or no outbreak.” See text for commentary

※ << Recommended Virus Spread Map >>You can see when and where the virus expand by playing the genome epidemiology site map. Genomic epidemiology of novel coronavirus - Global subsampling

【COVID-19 Updates 】
[July 9]  Although the blood group genome is located on chromosome 9, it has been pointed out that the genome that is clearly associated with aggravation is located at a specific site on chromosome 3. Its genome type was inherited almost as it was from Neanderthals in Croatia or Denisovans 40,000 to 60,000 years ago. And the severity risk was 70% higher. Thirty % of South Asians, especially 63% of Bangladeshi, 8% of Europeans, and 4% of Americans had that type. Africans and East Asians did not (153).
(153)The major genetic risk factor for severe COVID-19 is inherited from Neandertals/bioRxiv
Asymptomatic infection accounts for 17 to 30% of all infections. Out of the total number of infected people, pre-symptomatic infections are 47%, asymptomatic infections are 6.6%, so that silent infections account for more than 50% of the total infections. According to simulations, it was difficult to control infections without isolating 30-40% of silent infections (154). It is still needed either to thoroughly increase the number of tests to detect and isolate silent infections at an early stage, or do not walk indoors that may cause silent infections due to obstruction of traffic to the outside air (152).
(154)The implications of silent transmission for the control of COVID-19 outbreaks/PNAS
[July 8] The spread of infected circle starting from the proband of infection is uneven, slow and small in one place, fast and large in another. Although 9 out of 10 people do not get a secondary infection, only the 10th person infects 20 people, so the reproduction number becomes 2. This is different from the fact that the reproduction number becomes 2 when all 10 people of flu infects 2 persons each. The reason why a super spread event occurs in a short time that cannot be explained only by contact or splash is the proband who is exhaling viruses each time he breathes, rather than the special proband as a super spreader. He is in a closed space with no air flow, so that secondary infection occurs by inhaling that air. This is the most relevant explanation. The answer to why it took as long as two months from December when the virus was brought to Italy to the outbreak was that it was a chain of super spread events due to airborne infection (151). Keep in mind that the virus excreted in exhaled breath of asymptomatic infected may stay alive in the air for up to 3 hours (152).
(151)Most People With Coronavirus Won’t Spread It. Why Do a Few Infect Many?/NYT
(152)It is Time to Address Airborne Transmission of COVID-19/Clinical Infectious Diseases
[July 7] According to a survey of 92,000 people in Brazil, if a person is vaccinated with flu vaccine within 1-2 months, even if they get COVID, severity rate is 8% lower, ventilator usage was 18% lower and mortality was 17% lower. More surprisingly, even if vaccinated after the onset of COVID, it was less severe and the mortality rate was 27% lower. Flu vaccine trains and activates various innate immune cells other than those that are only against influenza. This is called an off-target effect in which immune effects can be obtained against viruses other than influenza. BCG, measles, smallpox, and live polio vaccines are said to have similar immunostimulatory effects (150).
(150)Inactivated trivalent influenza vaccine is associated with lower mortality among Covid-19 patients in Brazil/medRxiv
[July 6]  RT (Reverse Transcription)-LAMP method is expected to replace the current PCR test by expanding the test capacity more than 4 times. It can avoid recognizing accidentally other species of coronaviruses or common cold viruses. The concordance rate with PCR test was 94%, but efforts are currently being made to improve accuracy. It eliminates the need to extract RNA, so it costs only one-tenth and results in about 30 minutes (149). Domestic products have also been released.
(149)Standard operating procedures for SARS-CoV-2 detection by a clinical diagnostic RT-LAMP assay/medRxiv
[July 5] SARS-CoV-2 attaches to and invades an area of the gut called ACE2. ACE2 on cells of the intestine controls the absorption of amino acids and regulates the intestinal environment. The high quality gut bacterial environment created by a fiber-rich diet produces short-chain fatty acids. This promotes antiviral immunity, such as interferon and T-cells, which may increase protection in the lungs. However, when SARS-CoV-2 infects the gut, it conversely reduces ACE2 and increases the amount of bad gut bacteria. For mice, the bad environment with reduced ACE2 was improved by administration of tryptophan and nicotinamide. Even for humans infected with SARS-CoV-2, transplantation of good gut bacteria or infusion of ingredients that produce the equivalent effect may be effective (147)(148).
(147)ACE2 links amino acid malnutrition to microbial ecology and intestinal inflammation/nature
(148)Potential causes and consequences of gastrointestinal disorders during a SARS-CoV-2 infection/Cell Reports
[July 4] The pandemic was caused by the G-type virus, a point mutation of the D-type virus from China. The G-type virus, which is more infectious than the D-type virus, excreted a larger amount of virus and replaced the D-type virus all over the world. Viruses usually change shape in a direction where the neutralizing antibodies made by the immune system are not effective. Fortunately, however, the neutralizing antibody we have now was effective against the G-type virus. They were also not lethal (146).
(146)Tracking changes in SARS-CoV-2 Spike: evidence that D614G increases infectivity of the COVID-19 virus/Cell
Once inside a cell, SARS-CoV-2 hijacks the circuitry made up of enzymes called kineses, which are necessary for cell survival and mitotic growth. It then stops the cells from dividing and monopolizes the circuitry and materials needed for its own growth. In addition, many octopus-like protrusions are generated from the surface of the cells. The proliferating virus is then released from these protrusions to infect neighboring cells. There are more than eight drugs currently being tested to suppress kaines. Silmitasertib in particular is showing promise. It is intended to be used as a combination cocktail with other drugs, such as Remdesivir (145).
(145)The Global Phosphorylation Landscape of SARS-CoV-2 Infection/Cell
[July 3] Since the 1976 flu was similar to the 1918 pandemic strain, a vaccine was created in a hurry. However, it resulted in 500 paralysis and 25 deaths. Fifty% of people wanted to get vaccination, but ended up with a vaccination rate of 22% (143). Right now, a series of early clinical trials are ongoing (144). However, without sufficient efficacy and safety, it is not possible to gain the confidence to obtain herd immunity. In fact, while Moderna's messenger RNA vaccine was shown to be effective, one of the subjects had high fever and fainting in the first clinical trial. Unlike clinical trials, vaccination to all people is vaccination to all subjects, and ultimately, if all people do not get vaccinated, the true effect and safety are unknown (143).
(143)Here’s how we’ll know when a COVID-19 vaccine is ready/NATIONAL GEOGRAPHIC
(144)BioNTech and Pfizer’s Covid-19 vaccine trial yields positive results/FT
Even if the vaccine came to market successfully, on the other hand, a virus mutation has been confirmed in the European strain that hit the east coast. And its infectivity seems to be increasing. The vaccine currently in clinical trials is based on the premutation type. We have to recreate it from scratch (145).
(145)The D614G mutation in SARS-CoV-2 Spike increases transduction of multiple human cell types/bioRxiv
The virus is made up of 30,000 linked gene blocks. Every time it infects cells, one block in it is usually replaced by a different one, or missing by mistake. And as a result, it is said that it will evolve in a direction that will be advantageous to its own survival. It is suspected that the Indian strains are becoming more attenuated in that direction because of mutations and deletions at 10 locations in these blocks (146).
(146)Unique mutations could weaken Indian SARS-CoV-2 strain/NMLS
[July 2]  Natural phenomena that occur on earth such as pandemics, climate change and extinction of species are interconnected. What they have in common is a phenomenon in which a positive feedback action acts on the dynamics, and they gradually build up while escalating. When the momentum exceeds some line, there must be a transition or disappearance that can never be recovered. There is a long time lag before a phenomenon becomes apparent. Even though the habitat of an organism including humans may seem to have diminished slightly, it is a common phenomenon that extinction has already been determined (142).
(142)COVID-19: Analogues and lessons for tackling the extinction and climate crises/Current Biology
[July 1] The earth is like a living organism, and all living organisms and other environments that compose it form a single integrated body. It has a total self-regulatory ability to maintain the liquidity of a living creature's stream, which flows through every corner of it for life. Observations support that the organisms in it do not evolve completely at random, but evolve with irreversible changes due to contingency, depending on changes in the environment. The evolution of organisms occurs in the direction of fusion due to the collision of separate genomes. The human genome and various viral genomes will collide with each other due to artificial changes in the environment (141).
(141)Evolutions’ next major transition
[June 30]  Elderly people and obesity are the main targets of SARS-CoV-2, which infects 10 million people worldwide, whereas the fragmentation of supply chain mainly targets children and malnourished, and 820 million people are short on food. In fact, the main cause of food insecurity is severe damage to edible plants by RNA virus infection as same as SARS-CoV-2, although being quietly ongoing. To protect the plant, bioengineered vaccines for plants are used. Similar to a new type of vaccine for humans, this causes somatic cells to make fragments of the virus and learn to immunize against it. Applying this, human vaccine proteins are now mass-produced by plants. A plant of the genus Tobacco called Nicotiana benthamiana has the ability to make proteins at high speed, and can make flu vaccine at 4 times faster than conventional. Similarly, SARS-CoV-2 protein is being produced, and it is in progress to supply it in large quantities as a test reagent or vaccine (139)(140).
(139)Pandemics of People and Plants: Which Is the Greater Threat to Food Security?/Molecular Plant
(140)medicago
[June 29]  Obesity easily causes severe COVID-19 and increases mortality. This is still a hypothesis, but it is expected that evidence will be gradually obtained in the future. The reason is that if you put a fire where there is plenty of fuel, the fire will naturally grow. Obesity not only makes blood clots more likely, but fat cells secrete many components that enhance inflammation. At the same time, the proliferation of adipocytes reduces the secretion of hormones that suppress inflammation. And when excess fat is deposited, inflammation in the lungs is exacerbated (138).
(138)When two pandemics meet: Why is obesity associated with increased COVID-19 mortality?/Med
[June 28]  The future of the Southern Hemisphere entering winter will give us a hint for our future. For the concerned Southern Hemisphere parents, what to do if a child develops a cold is the task at hand (135). Child COVID-19 is visually indistinguishable from a common cold. However, in reality, it is unlikely to be possible if epidemic is considerably suppressed in the country or region, and unless it is a close contact. In Australia, PCR test positivity is 6 to 28 out of 45,000 cases per day, or 1 out of 1600 to 7500. (Japan has 40-100 cases out of 5,000 or 1 out of 50-125 cases.) If you reach such a point, most of the result is negative, and at the same time the result is a fairly accurate answer. Unless you're a heavy contact person, you're unlikely to be infected. Furthermore, SARS-CoV 2 infects by sticking to the portion of human cells called ACE2, but younger humans have less ACE2, and younger children have extremely less, so the virus may not infect and pass by children (136). Therefore, the probability of a child being infected is extremely close to zero if there is no infected person nearby (137). It is extremely important that caregivers of nursery, school teachers and parents do not get infected.
(135)Coronavirus or just a common cold? What to do when your child gets sick this winter/The Conversation
(136)Nasal ACE2 Levels and COVID-19 in Children/JAMA
(137)Yes, we’ve seen schools close. But the evidence still shows kids are unlikely to catch or spread coronavirus/The Conversation
[June 27]  Those who showed a large decrease in physical activity due to stay home had worse mental health conditions such as anxiety, depressed mood, positive feelings, self-control, and vitality. Furthermore, it was confirmed that the effect was stronger in women (134). It is consistent with the observation in our clinical field.
(134)The impact of physical activity on psychological health during Covid-19 pandemic in Italy/Heliyon
[June 26]  Vaccines are no longer a crystal of high technology. UK are starting a clinical trial of the latest self-amplifying messenger RNA vaccine, which is still under development, based on public funds and donations. It is made by wrapping only the necessary genome in nanoparticles without treating the bacteria or viruses as a whole. It is expected to be highly effective with a small amount of components, has few adverse reactions, and can be mass-produced in a short time with a simple process. This technology is used for vaccines for many viruses such as HIV. It will be the first large-scale clinical trial to see how the new type of vaccine that has just been prepared can actually be useful (131)(132).
(131)Government-funded Imperial College COVID-19 vaccine moves into first human trials/GOV.UK
(132)Self-amplifying RNA SARS-CoV-2 lipid nanoparticle vaccine induces equivalent preclinical antibody titers and viral neutralization to recovered COVID-19 patients/bioRxiv
Cholesterol medications has been shown to reduce mortality over the risk of becoming infected. In addition, a blood pressure drug called ARB, or ACE inhibitor that was taken at the same time, did not affect this results (133).
(133)In-hospital Use of Statins is Associated with a Reduced Risk of Mortality among Individuals with COVID-19/Cell Metabolism
[June 25]  It is an extremely rational phenomenon that the idea that wearing a mask is an act contrary to the basic needs of humans is connected to a strong resistance to wearing a mask in the US. Even from the history of AIDS prevention, it is difficult to achieve the daily use of masks with no resistance, unless you have empathy and consider the belief that forcing a mask is an infringement of civil liberties, and the fact that wearing a mask can increase your physical risk (130). In this way, the shout of "Please put on a mask" will disappear in no time, even if it is a scientific fact, if the reason remains unknown to the whole society.
(130)The Dudes Who Won’t Wear Masks/The Atlantic
[June 24th] The first concept of Gilead's plan is to make remdecivir widely available outside the ward as an early treatment drug. A clinical trial of inhaled remdecivir is the beginning. Secondly, because remdecivir alone is not effective enough, it is necessary to establish a combination treatment with other drugs such as dexamethasone or tocilizumab that suppress hyperimmune reactions. Originally, many viruses have the property of being easily hidden in human cells, and it can be said that complete elimination with only one drug is rather rare. Even in the history of HIV treatment, there has been a visible improvement in treatment only after the emergence of combination therapy. The third is to expand the subjects that can be administered. In addition to children, they are planning clinical trials for pregnant women and end-stage renal disease (129).
(129)An Open Letter from Daniel O’Day, Chairman & CEO, Gilead Sciences/STORIES@Gilead
[June 23] In the US, where public-private partnerships are common, they plan to popularize, for example, a method of testing saliva for 4 people at once in order to expand screening for asymptomatic people. Only when the specimens of 4 persons have a positive reaction, it is enough to examine for 1 person in order. The lower the infection rate of the whole society, the more efficient it will be, for example in Japan. If you can ensure that you can examine more saliva than four at a time, you can be even more efficient (127). The more societies that maintain good social distances and facemasks, the more likely the negative results from this method will be true negative (128).
(127)Coronavirus (COVID-19) Update: Facilitating Diagnostic Test Availability for Asymptomatic Testing and Sample Pooling/FDA
(128)What a Negative COVID-19 Test Really Means/The Atlantic
SARS-CoV 2 has been found to infect many pet, husbandry and wild animals from humans. It goes to monkeys, ferrets, cats, and hamsters. Experiments have shown that it can also infect rabbits, sheep, goats, cows, horses and squirrels. Cats, dogs, which is the closest to humans, pigs, and mink which had actual infection to human, can be an asymptomatic reservoir. Surveillance of these animals will then be as important as one of pigs for the prevention of Japanese encephalitis.
(126)Host range of SARS-CoV-2 and implications for public health/Microbe
[June 22] Agriculture started 12000 years ago, and humans gradually expanded their living groups. At the same time, the opportunities to come in contact with mammals and birds other than dogs increased. As a result, zoonosis became an infectious disease, and with the expansion of trade, the pandemic was repeated in human history (124). This time, the effectiveness of the virus growth inhibitor GC376, which is used for coronavirus treatment in cats, was confirmed, and movement toward clinical trials has started (125).
(124)What the archaeological record reveals about epidemics throughout history – and the human response to them/the Conversation
(125)Anivive Repurposes Veterinary Drug GC376 for COVID-19 And Submits Pre-IND to FDA/P&T community
[June 21] Clinical trials of remdecivir on 50 non-mild children with COVID-19, including newborns, will begin in the US and Europe. They use their wisdom to efficiently carry out what is necessary and what they can do when they can, so as not to repeat the same mistakes in the future.
(123)Gilead to enroll pediatric patients for late-stage remdesivir study/REUTERS
[June 20] We do not yet know exactly how easily infected children will transmit or how clusters are likely to occur in a group of children, but two reports have provided clues, so we performed a very rough calculation. Susceptibility under age of 20 is 0.22 to 0.5 times that of adults (121) (122), 0.3 times more likely to develop symptoms under age of 19 than adults(121), and transmission from asymptomatic persons to others is 0.2 times higher than those with symptoms (101). Based on these, the ease of transmission from children to others is 0.10 to 0.18 times that of adults, R = 0.6 (122) for adults is R = 0.06 to 0.10 for children, and the tertiary infection rate is 0.022 to 0.09 times that of adults. Especially in infants, the tertiary infection rate is 0.02 to 0.04 times that of adults, and even under the conditions of childcare or school life, it seems to be less than 0.09. Even adults may not have a tertiary infection (122), so the infectivity from children and the cluster incidence rate in children are so low that they can be ignored.
(121)Age-dependent effects in the transmission and control of COVID-19 epidemics/nature medicine
(122)Household secondary attack rate of COVID-19 and associated determinants in Guangzhou, China: a retrospective cohort
study/Infectious Disease

[June 19]   Development of neutralizing antibody therapeutics is underway overseas. However, the problem is how to isolate from the original antibody to mass-produce. There is a limit to the amount that can be obtained from engineered mice or recovered humans. There is also a method of artificial synthesis, but a method has been devised to have engineered cows make large amounts of human antibodies (119)(120).
(119)The Promise of Antibody Treatments for Covid-19/WIRED
(120)SAB Biotherapeutics Confirms Neutralizing Antibodies to SARS-CoV-2 and Begins Clinical Manufacturing of Novel COVID-19 Therapeutic Candidate/businesswire
[June 18th] If the fire to kill the virus becomes too large, your body will not hold up, so you just have to weaken the momentum of the fire to some extent, and a drug that weaken the firepower have the effect of suppressing the severity of disease (116). However, it will take more time to burn out the virus. If you turn off the heat with steroids, it will take longer for the virus to disappear (117)(118). It seems that it is necessary to adjust the heat appropriately.
(116)GM-CSF blockade with mavrilimumab in severe COVID-19 pneumonia and systemic hyperinflammation: a single-centre, prospective cohort study/Rheumatology
(117)Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis/Leukemia
(118)Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients/JCV
[June 17] Dexamethasone 6 mg daily for 10 days or less for critically ill patients reduced the fatality rate by 20% when oxygen was needed and by 30% when ventilator was needed. Neither serious adverse events nor secondary infections (115). In treating the illness that can be called a fire of the immune system, not only an aggressive attitude to remove the cause of the fire but also a protective treatment to prevent the fire from spreading will still be effective.
(115)Commonly used steroid reduces risk of death in sickest coronavirus patients, preliminary study results suggest/cnn
[June 17]  Rally for vaccine clinical trials and therapeutic drug development has begun overseas. Final clinical trials of Sinovac Biotech vaccine begin in South America (112). Production system that can supply 100 million bottles per year is being prepared. Two antibody cocktail therapy is expected to be effective in both treatment and prevention. It has advantage that virus resistance will be unlikely to occur. Regeneron begins clinical trials (113). Furthermore, it is reported that a component called Nsp9, which is essential for the proliferation of SARS-CoV 2, were able to be extracted and created. It has the same structure as other coronaviruses. A drug that interferes with the action of Nsp9 can be expected to suppress the onset and severity (114).
(112)Sinovac says early data show its Covid-19 vaccine generated immune responses/STAT
(113)Studies in humanized mice and convalescent humans yield a SARS-CoV-2 antibody cocktail/Science
(114)Crystal structure of the SARS-CoV-2 non-structural protein 9, Nsp9/iScience
[June 16] In the US, where both the number of infection and fatalities are 120 times that of Japan (110), it is estimated that the number of infection will double to the present number in the next two months. However, air of resignation is beginning to drift, "We can't go back to lockdown now" (111). On the other hand, development of genome editing technology test and treatment method, implementation of more than 440,000 PCR tests daily including saliva PCR, approval of remdecivir and practice of antiandrogen treatment, clinical trial of antibody therapeutic drug, the start of more than 160,000 clinical trials of moderna, AstraZeneca and J&J vaccines. These substantial treatment and prevention are being put into practice in order to compete with the momentum of re-expansion of virus. So Japan seems safe and quiet.
(110)CDC
(111)The Virus Will Win/The Atlantic
[June 15] SARS-CoV 2 changes genes only around 1/2 to 1/6 as fast as influenza. It is assumed that SARS-CoV 2 will be mutated to reduce the number of asymptomatic individuals, prolong the presymptomatic period, and decrease the severity of the disease because it will adaptively evolve in a direction in which viruses can reproduce as if many creatures do so. However, with sufficient infectivity, sufficient population to be transmitted, and no pressure to prevent the virus from reproducing, no obvious changes in the virus are visible (109).
(109)On the evolutionary epidemiology of SARS-CoV-2/Current Biology
[June 14] First reason why the number of infection and severe cases in Africa is lower than expected is due to the overwhelmingly large population of young people. The second is the impact of climate (107). Another way to think of this is that there is one-way selective pressure that creates a game-like symbiotic relationship where one infection is dominant and another is inferior under some environment. Africa may be already close to being full of several infectious diseases, so that it may be difficult for new infectious diseases that are difficult to adapt to the pressure to enter. Additionally, human body, once one germ inhabits, is equipped with an immune mechanism that prevents strong reactions when the next germ enters, so the symptoms might not stand out even when a new virus comes in (108).
(107)Socio-demographic and epidemiological consideration of Africa’s COVID-19 response: what is the possible pandemic course?/nature medicine
(108)Regulation of the host immune system by helminth parasites/JACI
[June 13]   In fact, experimental models are indispensable for efficiently finding new candidates and confirming the efficacy of drugs and vaccines. With creation of a mouse model in which SARS-CoV 2 can be infected like humans, new drugs and vaccines are much easier to find. (106). The road of development has expanded greatly.
(106)Generation of a Broadly Useful Model for COVID-19 Pathogenesis Vaccination, and Treatment/Cell
[June 12]   Immune cells that set fire to invasion of viruses try to get rid of them by igniting fire. However, in the event of a big fire, body will be lean, so immune cells that extinguish fire will also be ejected. BCG is expected to educate the igniters, while actually it also has the effect of educating the fire fighters. As a result, even if the virus comes in, it does not have to be a big fire or serious illness. The importance of extinguishing fire is also known for COVID-19 and Kawasaki disease (30)(104). Mixture of bacterias is known to educate fire fighters. The clinical trial begins (105). There exist countries around the world that can explore various possibilities and carry out clinical trials immediately.
(104)Transforming Growth Factor-β Signaling Pathway in Patients With Kawasaki Disease/Circulation
(105)OM85: could bacteria in a capsule protect us from coronavirus and other respiratory infections?/The Conversation
[June 11]  It has been reported that two inoculations of rhesus monkeys with inactivated vaccine have good results in efficacy and safety with no complaints (103). If no doubt, possibly, you'll see footage of January's deja vu, ending a flash of clinical trials in Africa or South America, and getting vaccinated in mainland China by beginning of autumn breeze.
(103)Development of an inactivated vaccine candidate, BBIBP-CorV, with potent protection against SARS-CoV-2/Cell
[June 10]  Positive rate of antibody test in domestic is around 0.5%. This is roughly the same as number of people infected during an epidemic of viral gastroenteritis. This number can be interpreted as high enough in just one epidemic. It corresponds to the fact that designated hospitals became dysfunctional due to overflow of infected patients even in Japan. It may be actually due to just the luck attributed to facemask wearing habit for Japanese people, in contrast to 19% in New York City or 7% in Sweden.
It has been recognized that the more frequent the chances of getting intimate contact with an index person, the extremely higher the susceptibility to infection becomes, and the farther away it becomes extremely lower (57). 16% of persons who contacted the pre-onset index person more than 5 times in 2 days, that is, concentrated contacts such as family members, got secondarily infected. They are more likely to be infected 29 times higher than those who only contacted once in 2 days. Risk of infections were about 1/5 lower from asymptomatic patients than that from those who developed symptoms (101).
Facemask has now proven to be effective against this phenomenon of susceptibility (86). If everyone always wears a mask in public, even asymptomatic, it will reduce the effective reproduction number twice as compared to if masking only after symptoms appear. It is estimated that if more than 50% of people wear facemasks in public at all times, spread of infection can be suppressed even under loose restrictions (102).
(101)Secondary Transmission of Coronavirus Disease from Presymptomatic Persons, China/EID
(102)A modelling framework to assess the likely effectiveness of facemasks in combination with ‘lock-down’ in managing the COVID-19 pandemic/The Royal Society A
[June 10]   Kawasaki disease (KD) is a post-infectious systemic inflammatory syndrome triggered by viral infection. CoV-2-related paediatric inflammatory multisystem syndrome (CoV-PIMS), namely the severe form of KD, occured in 4~5 weeks period after COVID-19 infection(99). The crucial difference of CoV-PIMS from KD is that 76% of children have myocarditis and easily fall into shock. This is the typical severe state of COVID-19. The high risk of aggravation on having African ancestry was also common with the risk of severity for COVID-19 in adults (100).
(99)SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020/Eurosurveillance
(100)Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study/BMJ
[June 9]   Now, if you look at the trends in the number of infections, you can imagine any possible future that may happen. The difference from before the outbreak was not because the numbers became readable, but because it was possible to add meaning to the numbers just by the experiential learning effect (97). The announcement such as "Now is a situation around what month and day" is more convincing.
(97)Of Viruses, Vaccines, and Variability: Qualitative Meaning Matters/Trends in Cognitive Sciences
There are two reasons why we should prepare saliva antigen test or PCR on hand at a general clinic or hospital. First, humans are creatures that seek social and physical contact with their peers and loved ones in an effort to defend their minds against threats and seek to work together. The rational recognition of the threat that oneself or loved ones may die, rather evokes the instinct of wanting to meet directly. It is impossible to eliminate social contact under threat. This is incorporated into the logic of what to prepare as cognitive and behavioral sciences in countries with advanced science (98). Second, now is the time nursery or school is reopened, a summer cold in which fever was the main symptom, has already begun. The differential diagnosis without any specific diagnostic method for COVID-19 was completely the same as in February, we had to rely on the dangerous intuition that it was probably a cold or maybe a cold. Medical examination itself must be frozen again.
(98)Pandemics and the great evolutionary mismatch/Current Biology
[June 6]   Saliva PCR is likely to become popular in Japan this month. Next, it seems that therapeutic drugs will be popular earlier than vaccines. This is because development of neutralizing antibody drugs is gaining momentum. For example, small neutralizing antibody called VHH made by animal llama neutralized SARS-CoV 2 more efficiently than conventional antibodies in the lab. It is highly stable, and it seems that it will be possible for delivery to use inhalation therapy as used for treatment of asthma or influenza (93).
(93)Coronavirus: why we’re using llamas to help fight the pandemic/The Conversation
[June 5]    There are few reports of clusters from childcare facilities in the world (91). It is assumed that the risk of spreading infection from child population is low. However, when we actually come to where children may play with each other, a question arises as to how far we can forgive. Though the way of thinking varies depending on your environment in which parents are placed, it is necessary to allow each other's values, at the same time so as not to forcibly change rules set by each other. Each family should decide how far their families can tolerate and how realistic they can be without requiring 100% to children (92).
(91)16 infected north of Montreal in Quebec's first COVID-19 outbreak in a daycare/CTVnews
(92)How Do You Decide if Children Can Play Together Again?/NYT
[June 4]   We know that men are twice as likely to become more severe than women. However, a survey result showed that there are obviously many men who don't wear masks in areas where it is not compulsory, and men are more likely to think that they are okay and reluctant to wear masks (90).
(90)The effect of messaging and gender on intentions to wear a face covering to slow down COVID-19 transmission/PsyArXiv
[June 3] SARS-CoV 2 appears to be the result of frequent recombination between bats, pangolins and human coronaviruses. The part necessary to infect humans was completely replaced by pangolins (88). In addition, the part required for SARS-CoV 2 growth was adapted to humans whose body temperature is lower than that of bats (89).
(88)Emergence of SARS-CoV-2 through recombination and strong purifying selection/ScienceAdvances
(89)Structural and biochemical characterization of nsp12-nsp7-nsp8 core polymerase complex from SARS-CoV-2/Cell Reports
[June 2]   Results of phase 1 trial for patients of the neutralizing monoclonal antibody treatment, which was reported here on April 25 and was expected to be rapidly put into practical use and to be definitely effective, will be released by Eli Lilly in this month. At the same time, they are strengthening production system so that they can supply large quantities in this fall (87).
(87)Lilly Begins World's First Study of a Potential COVID-19 Antibody Treatment in Humans/Eli Lilly
[June 1] Celltrion announced to start clinical trials of neutralizing antibody therapeutics in July (85). Once the expected safety of the treatment is confirmed, peace of mind spreads at once. No doubt, we have entered the stage where the progress of therapeutics is expanding and accelerating.
(85)Celltrion Announces Positive Pre-clinical Results for COVID- 19 Antiviral Antibody Treatment, Showing Improvement in Recovery Time/businesswire
[June 1]   It is common for major scientific advances to happen as if rising suddenly from the first floor to the second floor one day. Now is the time humankind is in danger of survival, unlike the normal times, the chance must be increased obviously that treatment with genome editing technology will be commercialized in a surprisingly short period of time (84).
(84)Development of CRISPR as an Antiviral Strategy to
Combat SARS-CoV-2 and Influenza/Cell

[May 30]   All the tests are already completed with just saliva. RNA detection kit using genome editing technology can bring results within one hour at home without sending saliva to lab. It will cost around $1~2 and replace PCR test (77). Antigen testing has also become possible with saliva (78). Antibody testing for herd immunity has become possible with saliva as well (79). These kits become available soon before we move to the next stage.
(77)Rapid home-based coronavirus tests are coming together in research labs — we’re working on analyzing spit using advanced CRISPR gene editing techniques/The Conversation
(78)Japan to approve quick antigen, saliva-based coronavirus tests/Xinhua
(79)COVID-19 serology at population scale: SARS-CoV-2-specific antibody responses in saliva/medRxiv
[May 24]  This is an epidemic forecast in Japan for the next year based on the epidemic model published in Science Journal, although there are pros and cons regarding suggesting a prospect (60).
The epidemic curve is supposed to be most affected by population immunity, or in other words, susceptibility to infection (61). Successful clinical trials of more than 100,000 vaccines in the US starting in July or later are likely to lead to rapid changes in population immunity associated directly with effective number of reproductions (62).
We takes into account many variables that have persistent recursive effect on the effective reproduction numbers or susceptibility to infection. Impact of climate on virus spread is minimal (61). Changes in human cognition and behavior, changes in timing of government intervention, and real economic dynamics that affects human migration and population density. It also assumes that social distancing measures are maintained unless there is effective vaccines or treatments.

“There will be little or no epidemic or small outbreaks from summer to fall during 2020, although small clusters may occur.
After the end of this year or during the spring and summer of 2021, there will be a relatively large second wave or no outbreak.”

Above is a prediction at this moment.
(60)Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period/Science
(61)Susceptible supply limits the role of climate in the early SARS-CoV-2 pandemic/Science
(62)Exclusive: U.S. plans massive coronavirus vaccine testing effort to meet year-end deadline/Reuters
[May 6] RNA viruses containing SARS-CoV2 have been incorporated into the chains of human genes and have helped to expand human diversity (33). There is also a theory that AIDS is cured when the body's immune reaction to eliminate the virus does not occur, and at the same time, the virus is completely incorporated into the chain of human genes (34).
(33)Endogenous non-retroviral RNA virus elements in mammalian genomes/Nature
(34)HIV infection en route to endogenization: two cases/Clinical Microbiology and Infection

Medical
Services

診療科目 Fields Offered

小児科 内科 アレルギー科 循環器内科 呼吸器内科 消化器内科

Pediatrics, Family Medicine, Primary Care

診療内容 Conditions Treated

家庭医として、乳幼児・小児・大人の初期診療、予防接種全般、乳幼児健診、生活習慣病の管理、成人健診、舌下免疫療法、各種健康相談、英語診療に応じます。
※オンラインによる保険診療できます。
オンライン診療専用アプリ「curon」をダウンロードしてアカウントを作成し、アプリからお手続きをお願いします。えはら医院の医療機関コードは【3314】です。折り返しの返信を受け取ったら、予約と問診票の入力をしてください。
料金は、保険診療の支払い分+curon利用料【¥330】+システム使用料【¥1100】(税込み) +処方箋送付切手代【¥84】 お支払いはクレジットカードのみです。
予約時間になりましたら、電波状況のよい静かな場所でお待ちください。
一人1アカウントでのご予約をお願いいたします。1アカウントで複数(家族分など)の診察はいたしかねます。

We provide primary care medicine for infants, children, and adults.
Immunization, Check-up for infants/children and Adult, Outpatient care of major chronic diseases, Sublingual immunotherapy.

予防接種 Immunization

【小児】
肺炎球菌、ヒブ、B型肝炎、ロタウィルス、四種混合、三種混合、BCG、麻疹風疹、水痘、おたふくかぜ、日本脳炎、二種混合、子宮頸がんワクチン
【成人】
50歳以上の帯状疱疹、65歳以上の肺炎球菌(13価、23価)、麻疹風疹、水痘、おたふくかぜ、B型肝炎、破傷風
【その他】
インフルエンザ(インフルエンザ予防接種予診票)、A型肝炎、髄膜炎菌

BCG、麻疹はコロナ感染予防の効果が検証中です。ワクチンには免疫賦活効果があり、インフルエンザワクチンにも新型コロナに対する有効性があると報告されています。小児も成人も、コロナ対策として、打てるワクチンはすべて接種を完了しておくことをお勧めします。

【Child】
Pneumococcal conjugate (PCV13), Haemophilus influenzae type b (Hib), Hepatitis B (HepB), Rotavirus, Diphtheria, tetanus, and pertussis (DTaP), Inactivated poliovirus (IPV), BCG, Measles, rubella (MR), Mumps (M), Varicella (VAR), Japanese encephalitis,
Tetanus, diphtheria (DT) , Human papillomavirus (HPV)

【Adult】
Zoster live (ZVL) over 50 years old, Pneumococcal conjugate (PCV13), Pneumococcal polysaccharide (PPSV23) over 65 y/o, Measles, rubella (MR), Varicella (VAR), Mumps, Hepatitis B (HepB), Tetanus
【Others】
Influenza inactivated (IIV), Hepatitis A (HepA), Meningococcal (MenACWY-D, Menactra)

BCG and measles are being tested for their effectiveness in preventing COVID-19 infection. Vaccine has an immunostimulatory effect, and flu vaccine has also been reported to be effective against COVID. It is recommended that both children and adults should be vaccinated for all possible vaccines as a preventive measure against COVID-19.

健康診断など Health
checkups, etc.

乳幼児健診、入園・入学前検診、就労検診、特定健康診査、
英文予防接種証明書、英文診療情報提供書、英文処方証明書
*府中市1歳6か月児、3歳児健診は、オンラインまたはお電話でご予約をお願いいたします。

Infant health checkup, Preschool checkup, Pre-work checkup, Checkup designated by Fuchu-shi,
English vaccination certificate, English medical information document, English prescription certificate

お願い Information

新型コロナウイルス感染症についての相談・受診の目安
当院では、新型コロナウイルスの急性期診断、治療はできません。新型コロナウイルス感染が疑われる場合は、接触者電話相談センター042(362)2334または03(5320)4592 にご相談ください。

If in doubt of COVID-19 Acute infection, i.e. persistent fever, cough, or difficulty breathing, call to public health department 042 (362) 2334 or 03(5320)4592
to follow their instructions, before seeking medical care.

Hours
and
Location

診療時間
9:00〜12:30
15:00〜17:30

オンライン予約
042-336-7676

診察、予防接種、乳幼児の健診(府中市1歳6ヵ月児、3歳児健診も含む)のいずれの予約も、
オンラインまたはお電話でご予約承ります。
診察は 9:00~12:30 15:00~17:15
予防接種は 9:00~12:00 15:00~17:00
乳幼児の健診は 9:00~12:00 15:30~16:30
インフルエンザ予防接種予診票

アクセス
東京都府中市若松町3-35-7
京王線多磨霊園駅から徒歩10分
甲州街道から浅間山通りに入って車で15秒
駐車場20台あり

Hours M T W T F S S
9:00〜12:30
15:00〜17:30

Online appointment is available for medical consultation, immunizations, and checkup for infants
Online appointment
042-336-7676

Consultation : 9:00 to 12:30 and 15:00 to 17:15
Immunization : 9:00 to 12:00 and 15:00 to 17:00
Health checkups for infants : 9:00 to 12:00 and 15:30 to 16:30

How to get to us
3-35-7 Wakamatsu-cho, Fuchu-shi, Tokyo
10 minutes walk from Tama Cemetery Station on Keio Line
15 seconds by car after entering Sengenyama Street from Koshu Kaido
20 parking lots