我们为什么正遭受新冠病毒重击,以及应该如何为下个疾病爆发做准备 Alanna Shaikh: Why COVID-19 is hitting us now -- and how to prepare for the next outbreak

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演员: Alanna Shaikh

I want to lead here by talking a little bit about my credentials
在开始演讲之前, 我想要申明自己的相关资历,
to bring this up with you,
because, quite honestly,
you really, really should not listen to any old person with an opinion
你在新型冠状病毒 (COVID-19)这件事上,
about COVID-19.
真的不应该倾听 任何一个长者的想法。
So I've been working in global health for about 20 years,
我从事全球卫生工作 大约有 20 年了,
and my specific technical specialty is in health systems
我的特定技术专长是 卫生系统
and what happens when health systems experience severe shocks.
以及当卫生系统遭到严重冲击时 会发生什么。
I've also worked in global health journalism;
我也一直在 全球卫生相关的新闻业工作,
I've written about global health and biosecurity
for newspapers and web outlets,
撰写过不少 关于全球卫生和生物安全的文章,
and I published a book a few years back
about the major global health threats facing us as a planet.
这本书讲述了我们星球 所面临的主要全球卫生威胁。
I have supported and led epidemiology efforts
我支持并领导了 许多流行病相关的工作——
that range from evaluating Ebola treatment centers
to looking at transmission of tuberculosis in health facilities
and doing avian influenza preparedness.
I have a master's degree in International Health.
I'm not a physician. I'm not a nurse.
My specialty isn't patient care or taking care of individual people.
我的专长 不是照顾病患,或照顾个体。
My specialty is looking at populations and health systems,
我的专长 是研究总体人口、卫生系统,
what happens when diseases move on the large level.
并研究当疾病大规模传播时 会发生什么。
If we're ranking sources of global health expertise
如果我们把 关于全球卫生的知识来源
on a scale of one to 10,
用 1 到 10 来形容其专业度,
one is some random person ranting on Facebook
1 是随意一个 在 Facebook 上肆意怒吼的人,
and 10 is the World Health Organization,
10 是世界卫生组织(WHO),
I'd say you can probably put me at like a seven or an eight.
我会说你大概 能把我放在 7 或 8 的位置上。
So keep that in mind as I talk to you.
接下来我进行演讲的时候, 请你记住这一点。
I'll start with the basics here, because I think that's gotten lost
我先从最基础的开始, 因为我觉得这在许多嘈杂的
in some of the media noise around COVID-19.
关于 COVID-19 的媒体报道中被遗漏了。
So, COVID-19 is a coronavirus.
所以,COVID-19 是一种冠状病毒(Coronavirus)。
Coronaviruses are a specific subset of virus,
冠状病毒 是病毒的一个特定子集,
and they have some unique characteristics as viruses.
They use RNA instead of DNA as their genetic material,
它们使用 RNA 而非 DNA 作为它们的遗传物质,
and they're covered in spikes on the surface of the virus.
They use those spikes to invade cells.
Those spikes are the corona in coronavirus.
这些棘突使得冠状病毒 看起来像皇冠。
COVID-19 is known as a novel coronavirus
COVID-19 被认为是一种 新型冠状病毒,
because, until December, we'd only heard of six coronaviruses.
因为在 12 月之前, 我们只知道 6 种冠状病毒。
COVID-19 is the seventh.
COVID-19 是第 7 种。
It's new to us.
It just had its gene sequencing,
it just got its name.
That's why it's novel.
If you remember SARS, Severe Acute Respiratory Syndrome,
如果你记得非典, 重症急性呼吸综合征(SARS),
or MERS,
或是 MERS 病毒,
Middle Eastern Respiratory Syndrome,
those were coronaviruses.
And they're both called respiratory syndromes,
而且它们都被称作为 呼吸综合征,
because that's what coronaviruses do --
they go for your lungs.
They don't make you puke, they don't make you bleed from the eyeballs,
它们不会让你呕吐 或是让你从眼睛里流血,
they don't make you hemorrhage.
They head for your lungs.
COVID-19 is no different.
COVID-19 也一样。
It causes a range of respiratory symptoms
that go from stuff like a dry cough and a fever
all the way out to fatal viral pneumonia.
And that range of symptoms is one of the reasons
如此广泛的症状 也就是为何如此难以追踪
it's actually been so hard to track this outbreak.
Plenty of people get COVID-19 but so gently,
不少人感染了 COVID-19 , 但是非常轻度的感染。
their symptoms are so mild, they don't even go to a health care provider.
他们的症状如此轻微, 甚至不用去医疗机构,
They don't register in the system.
Children, in particular, have it very easy with COVID-19,
尤其是孩子, 能够非常轻易地抵抗 COVID-19。
which is something we should all be grateful for.
这是我们所有人 都应该感到庆幸的一个事实。
Coronaviruses are zoonotic,
which means that they transmit from animals to people.
这意味着 它们能从动物传播至人类。
Some coronaviruses, like COVID-19, also transmit person to person.
有些冠状病毒,例如 COVID-19 也能通过人与人传播。
The person-to-person ones travel faster and travel farther,
人人传播的方式 感染得更快且范围更广,
just like COVID-19.
就像 COVID-19 。
Zoonotic illnesses are really hard to get rid of,
because they have an animal reservoir.
因为它们有着 一个很大的动物储备。
One example is avian influenza,
where we can abolish it in farmed animals, in turkeys, in ducks,
我们可以在农场动物 比如火鸡和鸭子中消灭它,
but it keeps coming back every year because it's brought to us by wild birds.
但它依旧每年都会发生, 因为禽流感能通过野鸟传播到人。
You don't hear a lot about it
because avian influenza doesn't transmit person-to-person,
but we have outbreaks in poultry farms every year all over the world.
但其实世界范围的家禽农场 每年都会出现禽流感的大爆发。
COVID-19 most likely skipped from animals into people
COVID-19 很可能就是 在中国武汉的野生动物市场中
at a wild animal market in Wuhan, China.
Now for the less basic parts.
This is not the last major outbreak we're ever going to see.
这不是我们人类历史上能看到的 最后一场重大疾病爆发。
There's going to be more outbreaks, and there's going to be more epidemics.
往后将会有更多的爆发, 更多的流行病。
That's not a maybe. That's a given.
And it's a result of the way that we, as human beings,
are interacting with our planet.
Human choices are driving us into a position
where we're going to see more outbreaks.
Part of that is about climate change
and the way a warming climate makes the world more hospitable
to viruses and bacteria.
But it's also about the way we're pushing into the last wild spaces on our planet.
但这也与我们逼近地球上 最后的野外空间的方式有关。
When we burn and plow the Amazon rain forest
当我们在亚马逊雨林的土地上 焚烧并耕种,
so that we can have cheap land for ranching,
我们以此希望 低成本经营牧场,
when the last of the African bush gets converted to farms,
当最后一片非洲丛林 被转化为农场,
when wild animals in China are hunted to extinction,
human beings come into contact with wildlife populations
that they've never come into contact with before,
and those populations have new kinds of diseases:
之后那些野生动物种群 可携带各种新的疾病:
bacteria, viruses, stuff we're not ready for.
细菌、病毒, 我们毫无准备的东西。
Bats, in particular,
have a knack for hosting illnesses that can infect people,
它们能作为 可以传染给人的疾病的宿主,
but they're not the only animals that do it.
So as long as we keep making our remote places less remote,
所以只要我们继续逼近 偏远的地方,
the outbreaks are going to keep coming.
We can't stop the outbreaks with quarantine or travel restrictions.
我们无法用隔离或旅行限制 来停止疾病大爆发。
That's everybody's first impulse:
"Let's stop the people from moving. Let's stop this outbreak from happening."
“我们要禁止人口流动, 我们要阻止这场疫情的发生。”
But the fact is, it's really hard to get a good quarantine in place.
但实际上, 真的很难做到有效适当的隔离,
It's really hard to set up travel restrictions.
Even the countries that have made serious investments in public health,
即使是在公共卫生领域 投入足够预算的国家,
like the US and South Korea,
can't get that kind of restriction in place fast enough
都无法快速做到 那样有效的限制隔离
to actually stop an outbreak instantly.
There's logistical reasons for that, and there's medical reasons.
这其中有物流原因, 也有医学原因。
If you look at COVID-19 right now,
如果你现在看看 COVID-19,
it seems like it could have a period where you're infected and show no symptoms
看起来会有一段时间—— 你已经被感染但没有任何症状——
that's as long as 24 days.
能长达 24 天。
So people are walking around with this virus showing no signs.
所以人们携带着这个病毒 走来走去,没有任何征兆。
They're not going to get quarantined. Nobody knows they need quarantining.
他们不会被隔离, 也没人知道他们自己需要被隔离。
There's also some real costs to quarantine and to travel restrictions.
隔离和旅行限制也有 一些真实代价。
Humans are social animals,
and they resist when you try to hold them into place
当你尝试把他们限定在一个地方, 尝试把他们分隔开来,
and when you try to separate them.
We saw in the Ebola outbreak that as soon as you put a quarantine in place,
在埃博拉的时候,我们看到 只要你开始实行隔离,
people start trying to evade it.
Individual patients, if they know there's a strict quarantine protocol,
个别病人,如果知道有一个 严格的隔离处理流程的存在,
may not go for health care,
because they're afraid of the medical system or they can't afford care
因为他们害怕这样的医疗流程, 或他们担心自己经济上无法承担,
and they don't want to be separated from their family and friends.
而且,他们不想要 与自己的家人和朋友分开。
Politicians, government officials,
when they know that they're going to get quarantined
if they talk about outbreaks and cases,
may conceal real information for fear of triggering a quarantine protocol.
可能会隐藏真实信息, 从而避免触发隔离处理流程。
And, of course, these kinds of evasions and dishonesty
当然,正是这些回避的态度 与不诚实的手段
are exactly what makes it so difficult to track a disease outbreak.
We can get better at quarantines and travel restrictions, and we should,
通过隔离和旅行限制, 我们能好得更快,我们也应该这么做,
but they're not our only option, and they're not our best option
但是这不是唯二的方法, 也不是我们应对这些疾病爆发的
for dealing with these situations.
The real way for the long haul to make outbreaks less serious
能够长期预防流行病爆发的 真正方法
is to build the global health system
to support core health care functions in every country in the world
以支持世界上每个国家 核心医疗保健的职能运作,
so that all countries, even poor ones,
以让所有的国家, 乃至于贫穷国家,
are able to rapidly identify and treat new infectious diseases as they emerge.
在新的传染病萌发之时 都能够快速识别并治疗它。
China's taken a lot of criticism for its response to COVID-19.
中国应对 COVID-19 的措施 受到了很多批判。
But the fact is, what if COVID-19 had emerged in Chad,
但实际,倘若 COVID-19 出现在
which has three and a half doctors for every hundred thousand people?
在每 10 万人口 只有 3.5 名医生的乍得?
What if it had emerged in the Democratic Republic of the Congo,
要是 COVID-19 出现在 最后一名埃博拉病人刚出院的
which just released its last Ebola patient from treatment?
刚果民主共和国 ?
The truth is, countries like this don't have the resources
to respond to an infectious disease --
not to treat people and not to report on it fast enough
它们无法治疗病患 且无法快速上报该疾病的爆发
to help the rest of the world.
来帮助世界上其它国家 共同应对这场危机。
I led an evaluation of Ebola treatment centers in Sierra Leone,
我曾领导了一场在塞拉利昂 埃博拉治疗中心的评估工作,
and the fact is that local doctors in Sierra Leone
identified the Ebola crisis very quickly,
first as a dangerous, contagious hemorrhagic virus
首先,是危险的, 具有传染性的出血性病毒,
and then as Ebola itself.
But, having identified it, they didn't have the resources to respond.
但是,尽管识别到了病毒, 他们没有资源去应对。
They didn't have enough doctors, they didn't have enough hospital beds
他们没有足够的医生, 没有充足的床位,
and they didn't have enough information about how to treat Ebola
而且他们没有足够的信息去 了解如何治疗埃博拉,
or how to implement infection control.
Eleven doctors died in Sierra Leone of Ebola.
在塞拉利昂有 11 名医生 死于埃博拉。
The country only had 120 when the crisis started.
在这场危机开始之前, 这个国家只有 120 名医生。
By way of contrast,
Dallas Baylor Medical Center has more than a thousand physicians on staff.
仅是达拉斯贝勒大学医学中心 就拥有超过 1 千名医生的团队。
These are the kinds of inequities that kill people.
诸如此类的不平等会 导致人们的死亡。
First, they kill the poor people when the outbreaks start,
首先,在疫情萌芽时, 最先受到死亡威胁的是穷人,
and then they kill people all over the world
when the outbreaks spread.
If we really want to slow down these outbreaks
如果我们真的想要 减少这些流行病的爆发
and minimize their impact,
we need to make sure that every country in the world
has the capacity to identify new diseases,
treat them
and report about them so they can share information.
COVID-19 is going to be a huge burden on health systems.
COVID-19 将会成为 卫生体系的一个重大负担。
COVID-19 has also revealed some real weaknesses
COVID-19 已经揭示了 我们全球卫生供应链中
in our global health supply chains.
Just-in-time-ordering, lean systems are great when things are going well,
实施准时下单和精益生产系统 在正常情况下很管用,
but in a time of crisis, what it means is we don't have any reserves.
但是在危机时刻,这意味着 我们没有足够的物资储备。
If a hospital -- or a country --
runs out of face masks or personal protective equipment,
there's no big warehouse full of boxes that we can go to to get more.
又没有一个大满仓的物资储备 供我们继续使用,
You have to order more from the supplier,
you have to wait for them to produce it and you have to wait for them to ship it,
之后你得等供应商生产, 你还得等他们发货送货,
generally from China.
That's a time lag at a time when it's most important to move quickly.
在非常需要快速行动的时候, 这是一个时间滞后。
If we'd been perfectly prepared for COVID-19,
如果我们早前已经为 COVID-19 做好了充分的准备,
China would have identified the outbreak faster.
They would have been ready to provide care to infected people
without having to build new buildings.
They would have shared honest information with citizens
他们也就能如实地 和群众分享信息,
so that we didn't see these crazy rumors spreading
on social media in China.
And they would have shared information with global health authorities
而且他们 也能和全球卫生机构分享信息,
so that they could start reporting to national health systems
这样他们就能开始 向国家卫生系统上报
and getting ready for when the virus spread.
National health systems would then have been able to stockpile
the protective equipment they needed
大量储备他们所需数量 的防护用品
and train health care providers on treatment and infection control.
以及针对治疗和感染控制, 为医疗机构进行培训。
We'd have science-based protocols for what to do when things happen,
我们也就会有基于科学的处理流程, 告诉我们事情发生的时候该怎么处理,
like cruise ships have infected patients.
And we'd have real information going out to people everywhere,
如果我们能为各地所有人 放出真实准确的信息,
so we wouldn't see embarrassing, shameful incidents of xenophobia,
我们也不会看到那么多 令人难堪且羞耻的仇外事件的发生,
like Asian-looking people getting attacked on the street in Philadelphia.
例如具有亚洲长相的人 在费城街头被攻击。
But even with all of that in place,
但即使,我们能把 所有的这些都做到位,
we would still have outbreaks.
The choices we're making about how we occupy this planet
make that inevitable.
As far as we have an expert consensus on COVID-19, it's this:
目前而言,专家们 针对 COVID-19 的一个共识是:
here in the US, and globally,
it's going to get worse before it gets better.
We're seeing cases of human transmission that aren't from returning travel,
我们看到很多人传人的病例, 这并非由旅行归来引发,
that are just happening in the community,
and we're seeing people infected with COVID-19
我们甚至 在感染源未知的情况下,
when we don't even know where the infection came from.
不断看到人们被 COVID-19 感染。
Those are signs of an outbreak that's getting worse,
not an outbreak that's under control.
It's depressing, but it's not surprising.
Global health experts,
when they talk about the scenario of new viruses,
this is one of the scenarios that they look at.
We all hoped we'd get off easy,
but when experts talk about viral planning,
this is the kind of situation and the way they expect the virus to move.
他们预判病毒会以这种情景 和这种方式继续传播。
I want to close here with some personal advice.
Wash your hands.
Wash your hands a lot.
I know you already wash your hands a lot because you're not disgusting,
我知道你经常洗手, 因为你是爱干净的,
but wash your hands even more.
Set up cues and routines in your life to get you to wash your hands.
在你日常生活中,设置一些 能让你洗手的小提示和常规。
Wash your hands every time you enter and leave a building.
Wash your hands when you go into a meeting and when you come out of a meeting.
Get rituals that are based around handwashing.
Sanitize your phone.
You touch that phone with your dirty, unwashed hands all the time.
I know you take it into the bathroom with you.
So sanitize your phone and consider not using it as often in public.
所以清洁你的手机, 尽量不要在公共场合过度使用。
Maybe TikTok and Instagram can be home things only.
抖音和 Instagram 在家看看 可能就够了。
Don't touch your face.
Don't rub your eyes.
Don't bite your fingernails.
Don't wipe your nose on the back of your hand.
I mean, don't do that anyway because, gross.
不管怎样别那么做, 因为有点恶心。
Don't wear a face mask.
Face masks are for sick people and health care providers.
口罩是生病的人 和医务人员使用的。
If you're sick, your face mask holds in all your coughing and sneezing
如果你生病了,你的口罩可以兜住 所有咳嗽和打喷嚏的飞沫
and protects the people around you.
And if you're a health care provider,
your face mask is one tool in a set of tools
你的口罩 是众多个人防护用品中的
called personal protective equipment
that you're trained to use so that you can give patient care
你也被训练说: 戴上口罩再治疗病患,
and not get sick yourself.
If you're a regular healthy person wearing a face mask,
it's just making your face sweaty.
Leave the face masks in stores
for the doctors and the nurses and the sick people.
If you think you have symptoms of COVID-19,
如果你认为 你有 COVID-19 的症状,
stay home, call your doctor for advice.
呆在家, 打电话给你的医生以寻求建议。
If you're diagnosed with COVID-19, remember it's generally very mild.
如果你被检测为 COVID-19 阳性, 记住普遍上说它是很轻度的。
And if you're a smoker,
right now is the best possible time to quit smoking.
I mean, if you're a smoker,
right now is always the best possible time to quit smoking,
任何时刻都可能 是你最佳戒烟时机,
but if you're a smoker and you're worried about COVID-19,
但如果你是烟民 并且担心 COVID-19 找上门,
I guarantee that quitting is absolutely the best thing you can do
我保证戒烟绝对是你能做出的 保护自己免受病毒入侵最糟影响的
to protect yourself from the worst impacts of COVID-19.
COVID-19 is scary stuff,
COVID-19 是一个恐怖的东西,
at a time when pretty much all of our news feels like scary stuff.
这段时间几乎每一条新闻 看起来都很恐怖。
And there's a lot of bad but appealing options for dealing with it:
之后也有很多不好却吸引人的方式 来应对这件事:
panic, xenophobia, agoraphobia, authoritarianism,
oversimplified lies that make us think that hate and fury and loneliness
以及过度简化的谎言 使我们认为
are the solution to outbreaks.
厌恶、愤怒和孤独 是疫情的解决方案。
But they're not.
They just make us less prepared.
There's also a boring but useful set of options
我们也可以使用一些 无聊但有用的方式
that we can use in response to outbreaks,
things like improving health care here and everywhere;
investing in health infrastructure and disease surveillance
so that we know when the new diseases come;
building health systems all over the world;
looking at strengthening our supply chains so they're ready for emergencies;
致力于加强我们的供应链 以让它们能准备好应对突发情况;
and better education,
so we're capable of talking about disease outbreaks and the mathematics of risk
以让我们能 在不建立盲目恐慌的前提下,
without just blind panic.
正常地谈论 疾病的爆发和风险的数学可能。
We need to be guided by equity here,
在这种情况下, 我们需要以公平为指导,
because in this situation, like so many,
equity is actually in our own self-interest.
So thank you so much for listening to me today,
and can I be the first one to tell you:
而且我能成为第一个人, 告诉你:
wash your hands when you leave the theater.
当你离开剧场的时候 请认真洗手。