全球疫情需要全球性的解决办法 Larry Brilliant: A global pandemic calls for global solutions

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演员: Larry Brilliant


台词
Helen Walters: So, Chris, who's up first?
海伦 · 沃特斯(Helen Walters): 克里斯,第一位嘉宾是谁?
Chris Anderson: Well, we have a man who's worried about pandemics
克里斯 · 安德森(Chris Anderson): 有一个人一辈子
pretty much his whole life.
都在担心传染病大流行。
He played an absolutely key role, more than 40 years ago,
四十多年前,他在帮助全世界 扑灭天花病毒的过程中,
in helping the world get rid of the scourge of smallpox.
起到了绝对关键的作用。
And in 2006,
在 2006 年,
he came to TED to warn the world
他来到 TED,提醒全世界
of the dire risk of a global pandemic,
全球传染病大流行的严峻风险,
and what we might do about it.
以及我们该如何应对。
So please welcome here Dr. Larry Brilliant.
那么,让我们欢迎拉里·布里恩特博士 (Dr. Larry Brilliant)。
Larry, so good to see you.
拉里,很高兴见到你。
Larry Brilliant: Thank you, nice to see you.
拉里 · 布里恩特: 谢谢,我也很高兴见到你。
CA: Larry, in that talk,
克里斯: 拉里,在那次演讲中,
you showed a video clip that was a simulation
你给我们看了一段
of what a pandemic might look like.
模拟传染病大流行的视频。
I would like to play it -- this gave me chills.
我想在这里播放一下 —— 它让我浑身起鸡皮疙瘩。
Larry Brilliant (TED2006): Let me show you a simulation
拉里 · 布里恩特(TED2006): 我想给大家看一段
of what a pandemic looks like,
模拟传染病大流行的视频,
so we know what we're talking about.
这样比较直观。
Let's assume, for example, that the first case occurs in South Asia.
比如说,假设第一个病例发生在南亚,
It initially goes quite slowly,
一开始它传播得比较慢,
you get two or three discrete locations.
你能看到两三个离散的地点。
Then there will be secondary outbreaks.
接着会有二次爆发。
And the disease will spread from country to country so fast
然后疫情会在国与国之间传播, 速度如此之快,
that you won't know what hit you.
让你完全摸不清状况。
Within three weeks, it will be everywhere in the world.
在三周之内, 病毒就会遍布全世界。
Now if we had an undo button,
如果有一个 “撤销” 键,
and we could go back
能让我们回到 疫情刚开始的时候,
and isolate it and grab it when it first started,
马上进行隔离与遏制,
if we could find it early and we had early detection
如果我们能尽早发现、尽早排查、
and early response,
尽早响应,
and we could put each one of those viruses in jail,
我们就能把每一个病毒都“关”起来。
that's the only way to deal with something like a pandemic.
这就是应对全球传染病大流行 唯一的办法。
CA: Larry, that phrase you mentioned there,
克里斯: 拉里,你在视频里说的那句话,
"early detection," "early response,"
“尽早发现”、“尽早响应”,
that was a key theme of that talk,
这是那场演讲的核心主题,
you made us all repeat it several times.
你当时让我们都复述了几遍。
Is that still the key to preventing a pandemic?
这到现在仍然是 预防传染病大流行的关键吗?
LB: Oh, surely.
拉里:噢,当然了。
You know, when you have a pandemic,
当你面对一场以指数级速度发展的
something moving at exponential speed,
大流行病的时候,
if you miss the first two weeks, if you're late the first two weeks,
如果你错失了头两个星期, 如果你晚了两个星期应对,
it's not the deaths and the illness from the first two weeks you lose,
那么我们失去的就不只是 前两个星期的发病和死亡,
it's the two weeks at the peak.
而是疫情高峰期的两周。
Those are prevented if you act early.
只要你尽早行动, 这些是可以避免的。
Early response is critical,
尽早响应是至关重要的,
early detection is a condition precedent.
而尽早发现是先决条件。
CA: And how would you grade the world
克里斯:那么在这两个方面,
on its early detection, early response to COVID-19?
你会给全球 对新冠的响应打几分呢?
LB: Of course, you gave me this question earlier,
拉里:你之前问过我这个问题,
so I've been thinking a lot about it.
我也考虑了很久。
I think I would go through the countries,
我觉得我可以逐一 给各个国家打分,
and I've actually made a list.
实际上我列了一张表。
I think the island republics of Taiwan, Iceland and certainly New Zealand
我认为一些岛屿国家(地区), 例如台湾、冰岛和新西兰,
would get an A.
可以得 “A”。
The island republic of the UK and the United States --
岛国英国, 还有并非岛国的美国——
which is not an island, no matter how much we may think we are --
不管我们自己有多么觉得 我们也是座岛——
would get a failing grade.
都 “不及格”。
I'd give a B to South Korea and to Germany.
我会给韩国和德国打 “B”,
And in between ...
然后别的国家……
So it's a very heterogeneous response, I think.
我觉得全球各国的响应情况差别很大。
The world as a whole is faltering.
整个世界呈现出了 一种犹豫、迟疑的状态。
We shouldn't be proud of what's happening right now.
我们不应该为现状感到自豪。
CA: I mean, we got the detection pretty early,
克里斯:我觉得这次病毒 其实发现得挺早的,
or at least some doctors in China got the detection pretty early.
起码中国的一些医生很早就发现了。
LB: Earlier than the 2002 SARS, which took six months.
拉里:比 2002 年的非典要早, 他们当时用了六个月才发现病毒。
This took about six weeks.
这次新冠只用了六个星期。
And detection means not only finding it,
“发现” 指的不仅仅是找到病毒,
but knowing what it is.
还要知道它到底是什么病毒。
So I would give us a pretty good score on that.
所以在这一点上, 我会打一个不错的分数。
The transparency, the communication -- those are other issues.
后来的透明性、沟通等等 —— 就是另一回事了。
CA: So what was the key mistake
克里斯: 那么你认为不及格的那些国家,
that you think the countries you gave an F to made?
他们犯的最主要的错误是什么?
LB: I think fear,
拉里:我认为是恐惧、
political incompetence, interference,
政治上的无能与干涉、
not taking it seriously soon enough --
没有尽早严肃地对待 ——
it's pretty human.
人性的本质暴露无遗。
I think throughout history,
我觉得纵观历史,
pretty much every pandemic is first viewed with denial and doubt.
几乎每次大流行病一开始, 人们都持否认和怀疑的态度。
But those countries that acted quickly,
但那些行动迅速的国家,
and even those who started slow, like South Korea,
甚至那些一开始 反应比较慢的国家,比如韩国,
they could still make up for it, and they did really well.
还能后来居上,而且弥补得很好。
We've had two months that we've lost.
我们(美国)已经浪费了两个月时间。
We've given a virus that moves exponentially
我们放任可以指数扩增的病毒
a two-month head start.
抢占了两个月的先机。
That's not a good idea, Chris.
这个做法很不好,克里斯。
CA: No, indeed.
克里斯:的确不好。
I mean, there's so much puzzling information still out there
我想说,关于这个病毒,
about this virus.
目前存在着太多令人困惑的信息。
What do you think the scientific consensus is going to likely end up being
你认为最后有可能达成 什么样的科学共识?
on, like, the two key numbers
比如说, 两个重要指标——
of its infectiousness and its fatality rate?
病毒的传染性和病死率?
LB: So I think the kind of equation to keep in mind
拉里:我认为我们要记住一个公式:
is that the virus moves dependent on three major issues.
病毒的传播取决于三个重要参数。
One is the R0,
第一个是 R0,
the first number of secondary cases that there are when the virus emerges.
这是病毒开始传播时, 最初感染的二代病例个数。
In this case,
在这次的新冠疫情中,
people talk about it being 2.2, 2.4.
人们讨论说这个数字 大概是 2.2 或 2.4。
But a really important paper three weeks ago,
但三个星期前, 在《新发传染病》期刊上
in the "Emerging Infectious Diseases" journal came out,
发表的一篇非常重要的论文中指出,
suggesting that looking back on the Wuhan data,
回看武汉早期的数据,
it's really 5.7.
这个数字实际上是 5.7。
So for argument's sake,
所以为了方便讨论,
let's say that the virus is moving at exponential speed
我们可以说病毒是以 指数级速度发展的,
and the exponent is somewhere between 2.2 and 5.7.
而这个指数大约 在 2.2 到 5.7 之间。
The other two factors that matter
还有另外两个重要的参数,
are the incubation period or the generation time.
一个是病毒的潜伏期, 或者说是迭代时间。
The longer that is,
潜伏期越长,
the slower the pandemic appears to us.
疫情显现就越慢。
When it's really short, like six days, it moves like lightning.
当潜伏期很短,比如说六天, 疫情就会像闪电一样迅速发展。
And then the last, and the most important --
最后一个,也是最重要的参数——
and it's often overlooked --
而且经常被忽略的——
is the density of susceptibles.
就是易感染人群的密度。
This is a novel virus,
这是一个新型病毒,
so we want to know how many customers could it potentially have.
我们想知道 它有多少潜在感染人群。
And as it's novel, that's eight billion of us.
而因为它是新型病毒, 这个数字就是全球八十亿人口。
The world is facing a virus
我们正在面对一个
that looks at all of us like equally susceptible.
所有人都同样易受感染的病毒。
Doesn't matter our color, our race,
不论肤色、种族、
or how wealthy we are.
财富。
CA: I mean, none of the numbers that you've mentioned so far
克里斯: 目前你提到的这些数字,
are in themselves different from any other infections in recent years.
没有一个数字本身 有别于近年来的其他传染病。
What is the combination that has made this so deadly?
是什么样的组合 才让这次的病毒如此致命?
LB: Well, it is exactly the combination
拉里:它恰恰正是
of the short incubation period and the high transmissibility.
短潜伏期和高传染性的组合。
But you know, everybody on this call has known somebody who has the disease.
但这次视频对话里的每个人 都认识一些感染了这个病毒的人。
Sadly, many have lost a loved one.
令人难过的是, 许多人都失去了挚爱的人。
This is a terrible disease when it is serious.
这种疾病严重起来会非常可怕。
And I get calls from doctors in emergency rooms
我接到了世界各地 在急诊室和重症监护病房里
and treating people in ICUs all over the world,
救治病人的医生的电话,
and they all say the same thing:
他们都在说同一件事:
"How do I choose who is going to live and who is going to die?
“我该怎样决定谁能活下去, 谁要死去呢?
I have so few tools to deal with."
我能使用的工具实在太少了。”
It's a terrifying disease,
这是一个可怕的疾病,
to die alone with a ventilator in your lungs,
人们肺里插着呼吸机独自死去。
and it's a disease that affects all of our organs.
而且这是一个 会影响身体所有器官的疾病。
It's a respiratory disease --
它是一个呼吸道疾病 ——
perhaps misleading.
这么说也许存在一定的误导性,
Makes you think of a flu.
因为它让你联想到流感。
But so many of the patients have blood in their urine
但非常多的病人尿液中有血,
from kidney disease,
这是源自肾脏疾病。
they have gastroenteritis,
他们还会得肠胃炎,
they certainly have heart failure very often,
经常伴有心脏衰竭。
we know that it affects taste and smell, the olfactory nerves,
我们知道它还会影响 味觉和嗅觉、嗅神经,
we know, of course, about the lung.
当然,我们还知道它对肺部的损害。
The question I have:
而我想知道的就是:
is there any organ that it does not affect?
还有什么器官是不受它影响的?
And in that sense,
在这一点上,
it reminds me all too much of smallpox.
它让我不得不联想起天花。
CA: So we're in a mess.
克里斯: 我们现在的情况一团糟。
What's the way forward from here?
接下来的路该怎么走?
LB: Well, the way forward is still the same.
拉里:前进的方法还是一样的,
Rapid detection,
快速检测、
rapid response.
快速响应。
Finding every case,
找到每一个病例,
and then figuring out all the contacts.
然后找出所有接触者,
We've got great new technology for contact tracing,
我们有先进的高新技术 可以用于追踪接触者。
we've got amazing scientists working at the speed of light
我们有杰出的科学家 以光速在工作,
to give us test kits and antivirals and vaccines.
给我们提供试剂盒、 抗病毒药物和疫苗。
We need to slow down,
我们需要放慢疫情的发展速度,
the Buddhists say slow down time
佛教徒们说要放慢时间,
so that you can put your heart, your soul, into that space.
才能来得及把心与灵魂 投入到那个空间中。
We need to slow down the speed of this virus,
我们需要放慢这个病毒的传播速度,
which is why we do social distancing.
这就是为什么 我们需要 “社交距离”。
Just to be clear --
要澄清的一点是 ——
flattening the curve, social distancing,
拉平疫情曲线、保持社交距离
it doesn't change the absolute number of cases,
并不会改变病例的绝对数量,
but it changes what could be a Mount Fuji-like peak
但会把原本可能 像富士山一样陡峭的峰值,
into a pulse,
变成一段平稳脉冲。
and then we won't also lose people because of competition for hospital beds,
这样我们便不会因为 医院床位不足而失去更多生命。
people who have heart attacks, need chemotherapy, difficult births,
那些有心脏病的、 需要化疗的、难产的人群
can get into the hospital,
就能及时在医院接受治疗。
and we can use the scarce resources we have,
我们可以使用紧缺的医疗资源,
especially in the developing world,
来为病人治疗——
to treat people.
特别是在发展中国家。
So slow down,
所以要放慢速度,
slow down the speed of the epidemic,
放慢大流行的速度,
and then in the troughs, in between waves,
然后在波谷里, 在下一波疫情来袭之前,
jump on, double down, step on it,
抓住时机、加大力度、脚踏实地,
and find every case,
找到每一个病例,
trace every contact,
追踪每一个接触者,
test every case,
检测每一个疑似病例,
and then only quarantine the ones who need to be quarantined,
然后只隔离那些需要隔离的人,
and do that until we have a vaccine.
一直坚持下去, 直到我们研制出疫苗。
CA: So it sounds like we have to get past the stage of just mitigation,
克里斯:听起来, 我们必须跨越这个
where we're just trying to take a general shutdown,
仅仅是在尝试整体封锁、 缓和疫情的阶段,
to the point where we can start identifying individual cases again
必须要做到重新开始 确认每一起病例,
and contact-trace for them
然后追踪接触者,
and treat them separately.
并将他们分开治疗。
I mean, to do that,
我觉得为了做到这些,
that seems like it's going to take a step up of coordination,
似乎需要进一步提高协调能力、
ambition, organization, investment,
信心、组织能力、投资,
that we're not really seeing the signs of yet in some countries.
而在一些国家, 我们还没有看到这些迹象。
Can we do this, how can we do this?
我们能做到吗?又该怎样做呢?
LB: Oh, of course we can do this.
拉里:哦,我们当然能做到。
I mean, Taiwan did it so beautifully,
我的意思是,台湾做得非常棒,
Iceland did it so beautifully, Germany,
冰岛和德国也做得非常棒,
all with different strategies,
他们都采取了不同的策略。
South Korea.
还有韩国。
It really requires competent governance,
这真的需要有能力的政府,
a sense of seriousness,
严肃的态度,
and listening to the scientists, not the politicians following the virus.
听取科学家而不是政治家 对于病毒的意见。
Of course we can do this.
我们当然可以做到。
Let me remind everybody --
我要提醒每一个人,
this is not the zombie apocalypse,
这不是什么僵尸世界末日,
it's not a mass extinction event.
也不是大灭绝事件,
You know, 98, 99 percent of us are going to get out of this alive.
要知道,我们当中 98%, 甚至 99% 的人都会活下来,
We need to deal with it the way we know we can,
关键在于,我们需要按照 我们已知可行的办法来应对它,
and we need to be the best version of ourselves.
而且我们需要拿出 自己最好的一面——
Both sitting at home
包括乖乖待在家里的普通人,
as well as in science, and certainly in leadership.
科学家,尤其是领导层。
CA: And might there be even worse pathogens out there
克里斯:未来还会出现
in the future?
更加可怕的病原体吗?
Like, can you picture or describe
比如,你能想象或者描述一下
an even worse combination of those numbers
我们现在就应该开始着手应对的
that we should start to get ready for?
更糟的传染病指标组合的情况吗?
LB: Well, smallpox had an R0 of 3.5 to 4.5,
拉里:天花病毒的 R0 在 3.5 到 4.5 之间,
so that's probably about what I think this COVID will be.
我认为新冠病毒可能也是这样。
But it killed a third of the people.
但天花当时杀死了 1/3 的人口,
But we had a vaccine.
然而我们有了疫苗。
So those are the different sets that you have.
所以这就是能设想的 另一种情况。
But what I'm mostly worried about,
但我最担心的
and the reason that we made "Contagion"
也是我们拍摄《传染病》 (“Contagion”)的原因,
and that was a fictional virus --
那还是一个虚构的病毒 ——
I repeat, for those of you watching,
我对看过的观众们重申一遍,
that's fiction.
它纯属虚构。
We created a virus that killed a lot more than this one did.
我们创造了一个 比新冠凶残得多的病毒。
CA: You're talking about the movie "Contagion"
克里斯: 你是说电影《传染病》?
that's been trending on Netflix.
现在这部片子在 Netflix 上很流行。
And you were an advisor for.
你当时是该片的顾问。
LB: Absolutely, that's right.
拉里:对的,没错。
But we made that movie deliberately
但我们是有意拍摄了那部电影,
to show what a real pandemic looked like,
以向人们展示一次真实的 传染病大流行会是什么样子。
but we did choose a pretty awful virus.
但我们当时确实选了 一个非常恐怖的病毒。
And the reason we showed it like that,
我们之所以要这样呈现,
going from a bat to an apple,
病毒从一只蝙蝠, 到一个苹果,
to a pig, to a cook, to Gwyneth Paltrow,
到一只猪,到一个厨师, 再到格温妮丝 · 帕特洛,
was because that is in nature what we call spillover,
因为这就是我们所说的 自然界中的跨物种传播,
as zoonotic diseases,
也就是人畜共患的疾病、
diseases of animals, spill over to human beings.
动物疾病跨物种传染到人类身上。
And if I look backwards three decades
如果我往回看个三十年,
or forward three decades --
或者往前看三十年——
looking backward three decades, Ebola, SARS, Zika,
往回看三十年, 埃博拉、非典、寨卡病毒、
swine flu, bird flu, West Nile,
猪流感、禽流感、西尼罗河病毒,
we can begin almost a catechism
我们几乎可以开始一次教义问答,
and listen to all the cacophony of these names.
听听这些病毒名字刺耳的混响。
But there were 30 to 50 novel viruses that jumped into human beings.
但有 30 到 50 种新型病毒 是从动物传染到人类身上的。
And I'm afraid, looking forward,
而向前展望,
we are in the age of pandemics,
恐怕我们正身处 传染病大流行的时代,
we have to behave like that,
我们必须这样做 ——
we need to practice One Health,
我们必须实施 “同一健康” (One Health)方针,
we need to understand that we're living in the same world
我们必须明白,无论是动物、 自然环境,还是人类,
as animals, the environment, and us,
我们都生活在同一个世界,
and we get rid of this fiction that we are some kind of special species.
我们要摆脱 人类是某种特殊物种的幻想。
To the virus, we're not.
病毒只会对所有生物一视同仁。
CA: Mmm.
克里斯:嗯。
You mentioned vaccines, though.
不过你提到了疫苗,
Do you see any accelerated path to a vaccine?
你认为有什么 加速疫苗研发的途径吗?
LB: I do.
拉里:确实有。
I'm actually excited to see that we're doing something
我很激动地看到, 我们正在做一些
that we only get to think of in computer science,
原本只有计算机科学 能设想一下的事:
which is we're changing what should have always been,
我们在改变 一直以来应当遵从的规则,
or has always been, rather,
或者更确切地说, 一直以来存在的
multiple sequential processes.
多重循序进程。
Do safety testing, then you test for effectiveness,
先进行安全检测,然后检测效果,
then for efficiency.
之后检测效率,
And then you manufacture.
最后投入生产。
We're doing all three or four of those steps,
我们现在正同时进行 三个或四个步骤,
instead of doing it in sequence, we're doing in parallel.
不是循序处理,而是并行完成。
Bill Gates has said he's going to build seven vaccine production lines
比尔 · 盖茨说他要在美国
in the United States,
建立七条疫苗生产线,
and start preparing for production,
开始为疫苗生产做准备,
not knowing what the end vaccine is going to be.
虽然现在还不知道 最终的疫苗是什么样的,
We're simultaneously doing safety tests and efficacy tests.
我们在同时进行 安全检测和功效检测,
I think the NIH has jumped up.
我觉得美国国立卫生研究院(NIH) 已经站出来带头了。
I'm very thrilled to see that.
我对此感到非常振奋。
CA: And how does that translate into a likely time line, do you think?
克里斯:你觉得这样做的话, 疫苗的时间线大概是怎样的?
A year, 18 months, is that possible?
1 年,18 个月,这可能吗?
LB: You know, Tony Fauci is our guru in this,
拉里: 托尼 · 福奇(Tony Fauci) 是这一行的专家。
and he said 12 to 18 months.
他说需要 12 到 18 个月。
I think that we will do faster than that in the initial vaccine.
我觉得第一批疫苗可能更快,
But you may have heard that this virus
但你可能也听说了这个病毒
may not give us the long-term immunity --
可能并不会让我们长期免疫 ——
that something like smallpox would do.
不像天花那样。
So we're trying to make vaccines where we add adjuvants
所以我们在尝试研发 添加了佐剂的疫苗。
that actually make the vaccine create better immunity
这样疫苗能比得病本身
than the disease,
让人产生更强的免疫力。
so that we can confer immunity for many years.
这样提供的免疫力能持续许多年。
That's going to take a little longer.
这将花费更长时间研发。
CA: Last question, Larry.
克里斯:最后一个问题,拉里。
Back in 2006, as a winner of the TED Prize,
回到 2006 年, 作为 TED 大奖的获得者,
we granted you a wish,
我们让你许一个愿望,
and you wished the world would create this pandemic preparedness system
你当时希望世界能够建立起 一个大流行病的预防系统,
that would prevent something like this happening.
来防止像今天这样的事情发生。
I feel like we, the world, let you down.
我觉得我们,整个世界, 让你失望了。
If you were to make another wish now,
如果现在你能再许一个愿,
what would it be?
会是什么?
LB: Well, I don't think we're let down in terms of speed of detection.
拉里:我觉得在检测速度方面, 我们并不会觉得失望。
I'm actually pretty pleased.
我其实感到很满意。
When we met in 2006,
当我们 2006 年见面的时候,
the average one of these viruses leaping from an animal to a human,
我们平均要花六个月才能发现
it took us six months to find that --
某个从动物传到人类身上的病毒——
like the first Ebola, for example.
比如第一例埃博拉病毒。
We're now finding the first cases in two weeks.
现在我们只花了两个星期 就找到了第一例病人。
I'm not unhappy about that,
对此我没有感到不满。
I'd like to push it down to a single incubation period.
不过把这个时间缩短到 一个潜伏期的时间内会更好。
It's a bigger issue for me.
对于我来说更大的问题是,
What I found is that in the Smallpox Eradication Programme
在天花的扑灭行动中,
people of all colors, all religions, all races,
我发现所有肤色、所有宗教、 所有种族的人们,
so many countries,
那么多的国家,
came together.
都能团结起来。
And it took working as a global community
要战胜一场全球性的大流行病,
to conquer a global pandemic.
需要全球社会的共同努力。
Now, I feel that we have become victims of centrifugal forces.
现在,我觉得我们成为了 各种离心力的牺牲品。
We're in our nationalistic kind of barricades.
我们被各自的民族主义路障 绊住了脚步。
We will not be able to conquer a pandemic
除非我们相信 大家能够同心协力,
unless we believe we're all in it together.
否则我们将无法战胜 传染病大流行。
This is not some Age of Aquarius, or Kumbaya statement,
这不是跨进了“万物归一”的时代, 也不是过家家似的携手迈向大同,
this is what a pandemic forces us to realize.
而是传染病大流行 迫使我们意识到,
We are all in it together,
我们是命运的共同体。
we need a global solution to a global problem.
对于一个全球性的问题, 我们需要全球性的解决办法,
Anything less than that is unthinkable.
否则一切都是徒劳。
CA: Larry Brilliant, thank you so very much.
克里斯: 拉里 · 布瑞连特,非常感谢你。
LB: Thank you, Chris.
拉里: 谢谢你,克里斯。