如何在美国迅速扩大接触者追踪的规模 Joia Mukherjee: How to quickly scale up contact tracing across the US

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演员: Joia Mukherjee


台词
Chris Anderson: Joia, both you and Partners In Health
克里斯·安德森: 乔亚, 在过去的数十年中,
have spent decades in various battlegrounds,
你和健康伙伴(Partners In Health)
battling epidemics.
一直在与不同的传染病作斗争。
Perhaps, for context, you could give us a couple examples of that work.
能不能给我们举几个 你们在这方面工作的例子?
Joia Mukherjee: Yeah, so Partners In Health
乔亚·穆克吉: 好的。健康伙伴
is a global nonprofit that is more than 30 years old.
是一个全球非盈利组织, 已有三十多年的历史。
We started famously in Haiti in a squatter settlement,
一切都是从海地的 一个棚户区开始的,
people who were displaced.
那里的人们常年流离失所。
And when we talked to them,
在与他们的谈话中我们了解到,
they wanted health care and education,
他们希望获得医疗、教育、
houses, jobs.
住房和工作。
And that has informed our work,
这就明确了我们的工作目标,
that proximity to people who are suffering.
援助那些正在经历苦难的人们。
When you think about health care and the poor,
当你想到医疗保障 和那些生活窘迫的人,
there is always disproportionate suffering
那些在历史上被边缘化的人
for people who have been historically marginalized,
所遭受的痛苦总是不成比例的,
like our communities that we serve in Haiti.
就像我们服务的海地社区。
And so we've always tried to provide health care
因此,我们一直在努力 为全球最贫困的人
for the poorest people on earth.
提供医疗服务。
And we were launched into an international dialogue
于是我们围绕着是否可能
about whether that was possible
在抗药性结核病、艾滋病、
for drug-resistant tuberculosis, for HIV.
手术、癌症、
Indeed, for surgery, for cancer,
心理健康和
for mental health,
非传染性疾病等领域提供援助
for noncommunicable diseases.
进行了全球性的对话。
And we believe it's possible,
我们相信这是可能的,
and it is part of the basic human right to care.
而且这是基本人权的一部分。
So when COVID started, we saw this immediately as a threat
当新冠病毒开始传播时, 我们立即意识到
to the health of people who were the poorest.
这会严重危险最贫困群体的生命健康。
And Partners In Health now works in 11 countries,
现在健康伙伴 跟 11 个国家展开了合作,
five on the African continent,
其中 5 个在非洲大陆、
Latin America and the Caribbean,
拉丁美洲和加勒比地区,
as well as the former Soviet Union.
以及前苏联。
And we immediately prepared to scale up testing,
我们立即准备扩大测试规模,
contact tracing, treatment, care,
进行接触者追踪,治疗和护理,
and then saw that it wasn't being done in the United States in that way.
然后我们看到,在美国, 人们并不是这样做的。
And in fact, we were just sitting, passively waiting for people to get sick
实际上,我们几乎是在坐以待毙, 被动的等待人们生病,
and treat them in hospital.
然后在医院里为他们提供治疗。
And that message got to the governor of Massachusetts,
在马萨诸塞州州长 知晓了我们的工作后,
and we started supporting the state to do contact tracing for COVID,
我们开始支持该州 对新冠病毒开展接触者追踪,
with the very idea that this would help us identify and resource
认为这样做可以帮助我们 寻找并分配资源
the communities that were most vulnerable.
给那些最脆弱的社区。
CA: So it's really quite ironic that these decades of experience
克里斯·安德森:很讽刺的是, 这几十年来在发展中国家和其他地方
in the developing world and elsewhere,
积累的经验,
that that has now really been seen as a crucial need to bring to the US.
现在看来很有必要引入美国。
And especially to bring your expertise around contact tracing.
更重要的是,需要运用你们在 接触者追踪方面的经验。
So, talk a bit about contact tracing,
下面来谈谈接触者追踪吧,
why does it matter so much,
为什么这个概念如此重要?
and what would, I don't know,
一个完美的接触者追踪流程
a perfect contact tracing setup look like?
大概是什么样子?
JM: Well, first I want to say that you want to, always,
乔亚·穆克吉: 首先我想说的是,
in any type of illness,
对于任何类型的疾病,
you want to do prevention,
我们总是希望能够做到预防、
and diagnosis and treatment and care.
诊断、治疗和关爱。
That is what comprehensive approaches look like,
这就是综合方法的流程,
and that "care" piece, to us,
而那个“护理”的部分, 对我们来说,
is about the provision of social support and material support
就是提供社会和物质上的支持,
to allow people to get the care they need.
以便让人们得到 他们所需要的关爱——
So that might be transportation, it might be food.
这可能是交通,也可能是食物。
So when you look at that comprehensive approach,
因此,当你考虑到这种综合方法,
for an infectious disease,
对于一种传染病,
part of prevention is knowing where the disease is spreading
预防的一部分就是 知道疾病在哪里传播,
and how it's spreading and in whom it's spreading,
以及它如何传播, 在什么人群中传播,
so that resources can be disproportionately put
这样资源就可以更多的
to the highest-risk areas.
被分配到高风险地区。
So contact tracing is a staple of public health
因此,接触者追踪是 公共卫生最主要的内容,
and what it means is that every time a new person is diagnosed
这就意味着每次诊断出一个
with COVID or any infectious disease,
患有冠状病毒或任何传染病的新病人,
then you investigate and innumerate the people they've been in contacts with,
就需要去调查并且找到 与他们接触过的人,
and call those contacts and say, "You've been exposed,"
并打电话给那些接触者说,
or talk to them, "You've been exposed,
“你被感染的风险比较大。
these are the things you need to know.
你需要了解这样一些信息。
First of all, how are you?
首先,你现在怎么样?
Do you need care yourself?"
你需要医疗帮助吗?”
And facilitating that.
然后提供必要的援助。
"Second of all, these are the information you need to know to keep yourself safe.
”第二,这些是 你需要了解的
About quarantine, about prevention."
关于隔离和预防的信息。“
And again, this would be with any infectious disease,
再说一次,这适用于任何传染病,
from Ebola, to cholera, to a sexually transmitted disease like HIV.
从埃博拉病毒到霍乱, 再到性传播疾病,如艾滋病。
And then we say,
然后我们说,
"OK, knowing what you know,
“好,了解了这些信息之后,
do you have the means to protect yourself?"
你有办法保护自己吗?”
Because often the most vulnerable
因为通常最弱势的群体
do not have the means to protect themselves.
没有办法保护好自己。
So that is also where this resource component comes in
因此,这也是需要资源合理分配的地方,
and where equity is so critical
更是平等在阻止疾病传播、
to making this disease stop
同时将信息和资源提供给
and also getting the information and the resources
最需要他们的人群方面
to people who need them the most.
起到了重要作用的地方。
CA: And in a pandemic, the people who need them the most,
克里斯·安德森:在全球性的流行病中, 那些最需要帮助的人,
the most vulnerable, as you say,
按你的说法,那些最脆弱的群体
are probably also --
也可能正是
That's where the disease is spreading a lot.
疾病快速蔓延的地方。
It's in everyone's interest to do this.
这样做符合每个人的利益。
You're not just making this sort of, wonderful, equity moral point
你提出的不只是一个关于 我们应该帮助这些人的
that we've got to help these people.
美好的、公平的道德观点。
It's actually in all of our interest, right?
实际上,这符合所有人的利益,对吧?
JM: Yes.
乔亚·穆克吉:对。
Yes, we are one humanity,
是的,我们人类是一个整体,
and any disease, any infectious disease that is spreading
任何正在传播的传染病,
is a threat to all of us.
都是对我们所有人的威胁。
And that is one of the pieces, there's the moral imperative,
这是其中的一部分, 有道德上的一部分,
there is the epidemiologic imperative,
也有流行病学上的一部分,
that if you can't control these diseases everywhere,
如果你无法在所有地方 控制这些疾病,
that it's a threat anywhere.
那么它就会威胁到任何地方。
And so as we look to the kind of society we want to live in,
因此,当我们着眼于 构建理想社会时,
good health is something that gives us all so much return on our investment.
良好的公民健康则是 对投资最丰厚的回报。
CA: Now, some countries were able to use contact tracing
克里斯·安德森: 有些国家能够通过接触者追踪,
almost to shut down the pandemic before it took off in that country.
在传染病大规模爆发之前 就基本将其切断。
The US was unable to do that,
美国却无法做到这一点,
and some people have taken the view
因此,有些人觉得
that therefore, contact tracing became irrelevant,
接触者追踪无关紧要,
that the strategy was mitigation, shut everything down.
正确的策略是 通过封城来缓解疫情传播。
You've argued against that,
对此,你提出了反对的意见,
that even in a process of lockdown
即使在全面封锁时期,
that actually contact tracing plays a key role.
接触者追踪依然扮演着 重要的角色。
Help us understand the scale,
能不能描述一下,
when there's a lot of cases,
当出现很多病例的时候
the scale of tracing, both cases
接触者追踪应该达到的规模,
and everyone they may have been in contact with
包括确诊患者以及 他们可能接触的每个人,
and their contacts.
和这些人的接触者。
It quickly gets to a huge problem.
这很快就会成为一个很大的问题。
JM: It's massive.
乔亚·穆克吉:规模十分庞大。
CA: What sort of workforce do you need to make a difference
克里斯·安德森:在美国当前所处的阶段, 你觉得需要采取哪些行动
at this moment, where the US is at?
才能产生实质性的效果?
JM: It's massive.
乔亚·穆克吉:疫情扩散的规模
I mean, the scale is massive,
非常庞大,
and we should not take that lightly.
我们不应该掉以轻心。
And we don't, at Partners In Health.
健康伙伴始终 非常严肃的对待这次疫情。
I mean, we are willing to try to figure this out,
我们愿意尝试解决这个问题,
and I always feel that if we could stop Ebola
我总觉得,既然我们能 阻止埃博拉病毒
in some of the poorest countries in the world,
在世界上一些最贫困的国家传播,
of course we ought to do it here,
我们当然应该也能在这里做到,
and was it too late when there were 28,000 deaths in Ebola?
在埃博拉造成了 28000 人死亡时, 是否为时已晚了呢?
Sure, it's always too late.
当然,我们采取行动总是太晚。
We should have started earlier,
我们应该开始得更早,
but it's not too late to have an impact.
但亡羊补牢,未为迟也。
And so there's three aspects of timing and scale.
那么,时间和规模 涉及到了三个方面。
First is, the earlier you start,
首先,开始得越早
the better, right?
就越好,对吧?
And that's what we saw in Rwanda.
这也是我们在卢旺达所看到的。
They went from early testing and contact tracing,
他们从早期测试和接触者追踪开始,
the first two cases entered into the country on March 15,
这个国家的最早两个病例是在 3 月 15 号被发现的,
and in one month,
并在接下来的一个月里
because of contact tracing, isolation and plenty of testing,
通过接触者追踪、 隔离和大量的测试,
they had held that case rate to 134 people.
他们把确诊病例控制在了 134 人。
It's remarkable, it's remarkable.
这很了不起,非常了不起。
In the state of Georgia, where is home to the CDC,
在佐治亚州, 美国疾控中心(CDC)的所在地,
similar population size, about 12 million,
相近的人口规模,大约 1200 万人,
from the first two cases in the first month,
从第一个月的两例,
those cases became 4,400 cases.
变成了 4400 例。
And in the country of Belgium,
同样的,在比利时,
a similar population,
相近的人口规模,
those two cases became 7,400.
最初的两例很快变成了 7400 例。
So you do have to make scale to stop this.
因此,你必须扩大检测规模 来阻止这种情况。
But the earlier you do it,
但是你行动得越早,
the more benefits there are to your society
对社会就越有利,
and also to the other people who need medical services --
包括需要其他医疗服务的人——
women who are pregnant,
孕妇、
people who need their fracture repaired,
需要治疗骨折的人,
because services themselves in the United States
因为美国的医疗服务本身
have been, you know, really hampered by this huge amount of COVID.
在这次新冠肺炎疫情中 也收到了的严重影响。
So the first point is,
所以第一点就是,
it's always late, but it's never too late.
总是会晚,但永远不会太晚。
Why?
为什么?
Because vulnerable populations are sitting ducks,
因为弱势群体只能坐以待毙,
and so imagine if one of your contacts was a nursing assistant
试想一下,如果你的接触者之一 是一家疗养院的
who worked in a nursing home.
护理助理。
We know that one nursing assistant can spread it throughout a nursing home.
我们知道一个护理助理可以 将疾病传播到整个疗养院。
And is it important to identify that person as a contact
确认该人是否为接触者,
and assure that he or she is able to remain quarantined?
并确保他或她能保持隔离, 很重要吗?
That is critical.
当然是很关键的。
And so it's hard to say,
所以很难下结论说,
"Well, it's not worth it if it's just one person, two persons."
“如果只是一两个人的话, 是不值得采取什么行动的。”
Every life matters,
每个生命都很宝贵,
and all of their contacts in the community of that person matters as well.
这个社区中与这个人接触的 所有人的生命也同样宝贵。
So that's one thing.
所以这是第一点。
The second about scale is people need jobs right now.
第二个与规模有关的问题是, 人们现在需要工作。
And they want to be part of a solution,
他们想成为解决方案的一部分,
and some of the frustration we see,
我们现在看到了 一些令人不安的现象,
the antilockdown movement,
比如反封城运动,
is really out of anger and frustration
都是真正出于愤怒、沮丧,
and feeling, "What can we do?"
和“我们能做什么?”的想法。
And so this gives people this feeling that they're part of a solution
因此,接触者追踪能够让人们感觉 自己是解决方案的一部分,
and can provide thousands of jobs.
并且可以提供大量的工作。
And then third, I would say, for us to reopen our schools,
第三点我想说的是, 如果要让我们重新开放学校、
our churches, our workplaces,
教堂和工作场所,
we have to know where the virus is spreading
我们就必须知道病毒在哪里传播,
so that we don't just continue on this path.
以便我们不再继续走这条路。
And so contact tracing provides the platform to control,
因此,接触者追踪提供了控制平台,
but also to see outbreaks in real time popping up,
而且还可以实时观测到爆发的疫情,
and then respond promptly.
并及时做出响应。
So there are many reasons that we have to bring this to scale now.
因此,有很多我们现在 必须扩大规模的理由,
Even though it is tardy.
即使已经迟了。
CA: So especially as we have this pressure to go back to work,
克里斯·安德森:那么特别是 当我们有复工的压力,
like, contact tracing has to be part of that strategy,
接触者追踪必须是 该策略的一部分,
or we're just inviting another disaster in a few weeks' time.
否则我们就只能在几周的时间内 等待另一场灾难的发生,
Whatever you make of what's happened during this mitigation process.
无论你如何处理 疫情缓解过程中发生的事情。
JM: Exactly, exactly.
乔亚·穆克吉: 完全正确。
Exactly, and so that's such an important part, Chris,
没错,所以这是 非常重要的一部分,克里斯,
and something that we are just really keen
而且我们很渴望
to look at the United States in a different way.
以另一种方式来看待美国。
What are the long-term public health infrastructures
有哪些长期公共卫生基础设施
that we need to protect us for the second wave, the third wave
可以在第二波、第三波,
and in the future, for future pandemics?
以及未来的流行病中 保护我们?
CA: Whitney.
克里斯·安德森: 惠特尼。
Whitney Pennington Rodgers: You know, to that point,
惠特尼·彭宁顿·罗杰斯: 针对这一点,
there is a question out there from one of our anonymous
我们社区的一个匿名者
community members,
提出了一个问题,
about why contact tracing isn't already part of our public health system.
关于为什么接触者追踪尚未成为 我们公共卫生系统的一部分。
It seems like it does make a lot of sense
这看起来确实很有道理,
its a way to mitigate the spread of disease.
这是减缓疾病传播的一种方式。
Could you speak a little bit to that?
你可以简单分析一下吗?
JM: I think many people have said --
乔亚·穆克吉: 我想很多人都说过——
and I am not a politician --
当然我不是一个政客——
that our American health care infrastructure
我们美国的医疗保健基础设施
is built on treatment and not prevention.
是建立在治疗而非预防之上的。
It's built on procedures
它是建立在严格的程序之上,
and not keeping people well.
而不是保持人们的健康。
And some of that was driven by profit,
有一部分是被利润所驱动,
and some of that was driven by need,
还有一部分是被需求驱动的,
but I think we need to rethink how we deliver care in this environment.
但我认为我们应该重新考虑 在这种环境下如何提供护理。
WPR: "There is some fear and suspicion about privacy and contact tracing.
惠特尼:下一个问题,“人们对于隐私和 接触者追踪还存在一些恐惧和怀疑。
How can we build trust in the process?"
我们如何在这个过程中建立信任?”
JM: Yeah, that's a great question,
乔亚·穆克吉: 这是一个很好的问题,
and I think there's fear about privacy
我认为对隐私的担心,
and part of it comes from the idea of what contact tracing is.
部分来源于对接触者追踪的认知。
And I think that's why we feel strongly,
这就是为什么我们很强烈的认为,
is if you lead with the idea that it's care
如果你首先认为这是护理,
and it's trying to get resources and information
并且这是在努力获得资源和信息
and help to people,
来帮助人们,
it seems very different
这个问题
than just, oh, who's sick, and who's a threat.
与单纯思考谁生病了, 谁又是威胁的情况就截然不同了。
And so fundamentally --
所以,从根本上讲——
and that's why we're so pleased to be at this TED talk today --
这也是为什么我们今天非常高兴 能够参加 TED 的原因——
is it's about communication, right?
接触者追踪与交流,好吗?
It's not about surveillance,
这不是监视,
it's about communication and care and support.
而是沟通、关怀与支持。
That's one thing.
这是一回事。
And we'll be hearing from our colleagues
我们会听取技术方面的
on the tech side.
同事的建议。
There's ways to add tech, even to care,
我们甚至有办法将技术与护理融合,
that it can be a resource for caring and communication.
打造一种关怀和沟通的资源。
But there are ways to protect people's privacy
但是也有办法 在保护人们隐私基础上
and also to provide care,
同时提供护理,
and public health has many laws attached to it.
公共卫生领域有很多相关的法律。
This is all done within the constructs of our state public health laws.
这些都是在我们州公共卫生法的 框架内完成的。
And so I think some of the communication around this is,
所以我认为围绕这件事进行的讨论
how do we take care of each other,
应该着眼于我们怎样去照顾好对方,
how do we take care of the most vulnerable.
怎样去照顾那些最脆弱的人。
And if we frame contact tracing as care,
如果我们把接触者追踪定义为护理,
I think that starts a different kind of conversation.
我认为这会开启另一种对话。
CA: Mm.
克里斯·安德森:嗯。
So, Joia, can you just talk in a bit more detail
那么乔亚, 你能更详细的介绍一下
about what it is that you are advising Massachusetts to do
你为马萨诸塞州
in terms of contact tracing.
在接触者追踪上提供的建议吗?
Give us a sense of the scale of it.
主要是规模方面。
JM: Yeah, so the scale -- thank you.
乔亚·穆克吉:好的, 说到规模——谢谢。
You know, we are able now to make about 10,000 calls a day
我们现在已经能够 一天打 1 万个电话
to contacts.
给那些接触者。
So every new case that comes in,
因此,每出现一个新病例,
the case is investigated by someone on the phone,
都会有人进行电话调查,
and then those investigations
这些调查的主要目的就是
means writing down the names and the phone numbers of the persons
记录下那些 在你生病时和生病之前
you've been in contact with for the time you were sick
接触的人的
and a couple days before.
名字和电话号码。
And with those numbers then, the contact tracers --
有了这些号码,接触追踪者——
And that's what we really redoubled the workforce and really expanded,
这就是为什么我们的员工人数
more than doubled,
增加了一倍以上——
to support the department of public health
来支持公共卫生部门
to do that contact tracing.
进行接触者追踪。
So we have 1,700 people employed full time, with benefits,
我们有 1700 名全职、 享有福利的员工,
to call those contacts and say, "Are you OK?
负责给那些接触者打电话,询问: “你们还好吗?
This is the information you need,"
这是你们所需要的信息。”
and then, and I think this is the critical piece,
接下来就是至关重要的步骤,
when someone doesn't have the information,
当有人没有这方面信息的时候,
then we have another cadre of people we call the resource care coordinators,
我们有另一群被称为 资源服务协调员的人,
who help that person, that contact,
去帮助那个人,那个接触者,
to do the things they need to do to protect themselves.
做需要保护自己的事情。
It might be food delivery,
可能是送餐,
it might be filing for unemployment benefits,
可能是申请失业救济金,
it might be trying to get them medical care or a test.
也可能是帮他们得到医疗和检测。
That piece is the care piece.
这就是护理的部分。
And that is what turns social distancing from very regressive --
这就是将被动的保持社交距离——
look at me in my beautiful house, social distancing --
比如我正在我漂亮额房子里隔离——
to something that's progressive
转变成主动的行为,
and paying attention to those who need the resources.
去关注那些需要资源的人。
So the scale is massive,
所以这种规模十分庞大,
with 1,700 employees hired to do this,
我们雇佣了 1700 名员工来完成,
but they are connected
他们与
with local community food banks and churches and facilities
当地社区的食品银行、 教堂、各种机构
and primary health care centers as well.
以及初级医疗中心 都建立了密切的联系。
CA: Thank you so much, Joia.
克里斯·安德森: 非常感谢,乔亚。