Tuesday, March 24, 2020

Harsh Steps Are Needed to Stop the New Virus

本文取自紐約時報登載的專家意見:Coronavirus Can Be Stopped, but Only With Harsh Steps。有些專家比較相信中國的做法報導和數據,與民間傳聞不一致。

Terrifying though the coronavirus may be, it can be turned back. China, South Korea, Singapore and Taiwan have demonstrated that, with furious efforts, the contagion can be brought to heel.

Whether they can keep it suppressed remains to be seen. But for the United States to repeat their successes will take extraordinary levels of coordination and money from the country’s leaders, and extraordinary levels of trust and cooperation from citizens. It will also require international partnerships in an interconnected world. (美國有獨特的強調個人自由的資本主義民主協商政體)

In interviews with a dozen of the world’s leading experts on fighting epidemics, there was wide agreement on the steps that must be taken immediately.

Americans must be persuaded to stay home, they said, and a system put in place to isolate the infected and care for them outside the home. Travel restrictions should be extended, they said; productions of masks and ventilators must be accelerated, and testing problems must be resolved.

But tactics like forced isolation, school closings and pervasive GPS tracking of patients brought more divided reactions.

It was not at all clear that a nation so fundamentally committed to individual liberty and distrustful of government could learn to adapt to many of these measures.

“The American way is to look for better outcomes through a voluntary system, I think you can appeal to people to do the right thing.” said Dr. Luciana Borio, who was director of medical and biodefense preparedness for the National Security Council before it was disbanded in 2018.

What follows the recommendations offered by the experts interviewed.

Scientists must be heard: Many experts, some of whom are international civil servants, declined to speak on the record for fear of offending the president. But they were united in the opinion that politicians must step aside and let scientists both lead the effort to contain the virus and explain to Americans what must be done. (必須聽從專家意見)

Stop transmission between cities: Extreme social distancing is the next priority. If all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt. The virus would die out on every contaminated surface and, because almost everyone shows symptoms within two weeks, it would be evident who was infected. So lockdowns and social distancing is to approximate such a total freeze. Travel and human interaction must be reduced to a minimum. (遏止城市之間的傳播)

On Friday March 20th, Dr. Anthony S. Fauci, chief medical adviser to the White House Coronavirus Task Force, said he advocated restrictive measures all across the country. China's rapid lockdown action had an important effect: With the virus mostly isolated in one province, the rest of China was able to save Wuhan.

Stop transmission within cities: Within cities, there are dangerous hot spots: One restaurant, one gym, one hospital, even one taxi may be more contaminated than many identical others nearby because someone had a coughing fit inside. Each day’s delay in stopping human contact, experts said, creates more hot spots. To stop the explosion, municipal activity must be curtailed. Still, some Americans must stay on the job to provide essential services. The delivery of food and medicine etc must continue. (遏止感染區域向周圍傳播)

Fix the testing mess: Testing must be done in a coordinated and safe way, experts said. The seriously ill must go first, and the testers must be protected. In the United States, people seeking tests are calling their doctors, who may not have them, or sometimes waiting in traffic jams leading to store parking lots. On Friday, New York City limited testing only to those patients requiring hospitalization, saying the system was being overwhelmed. (及時測試確診)

Isolate the infected: As soon as possible, experts said, the United States must develop an alternative to the practice of isolating infected people at home, as it endangers families. In China, 75 to 80 percent of all transmission occurred in family clusters. CDC experts now said cities should establish facilities where the mildly and moderately ill can recuperate under the care and observation of nurses. (隔離感染者)

Find the fevers: In most cities in affected Asian countries, it is commonplace before entering any bus, train or subway station, office building, theater or even a restaurant to get a temperature check. Washing your hands in chlorinated water is often also required. (在公共場所測量體溫)

Trace the contacts: Finding and testing all the contacts of every positive case is essential, experts said. China use an app that rates people's health risk; South Korean apps tell users exactly where infected people have traveled; Singapore university records where everyone sat in a class, affected contacts generally must remain home for 14 days and report their temperatures twice a day. (追蹤感染者)

Make masks ubiquitous: There is very little data showing that flat surgical masks protect healthy individuals from disease. Nonetheless, Asian countries generally encourage people wear them. The Asian approach is less about data than it is about crowd psychology, experts explained. All experts agree that the sick must wear masks to keep in their coughs. But if a mask indicates that the wearer is sick, many people will be reluctant to wear one. (為了大眾心理,都戴口罩)

Preserve vital services: Only the federal government can enforce interstate commerce laws to ensure that food, water, electricity, gas, phone lines and other basic needs keep flowing across state lines to cities and suburbs. Federal government can compel companies to prioritize making ventilators, masks and other needed goods; President can order military hospital ships to the fight. (維持人民生活的基本需要,諸如保證食品、藥物、水、電、煤氣、電訊的供應)

Produce ventilators and oxygen: The roughly 175,000 ventilators in all American hospitals and the national stockpile are expected to be far fewer than are needed to handle a surge of patients desperate for breath. The manufacturers, including a dozen in the United States, say there is no easy way to ramp up production quickly. But it is possible other manufacturers, including aerospace and automobile companies, could be enlisted to do so. The United States must also work to increase its supply of piped and tanked oxygen. (緊急生產呼吸機和氧氣)

Retrofit hospitals: Hospitals in the United States have taken some measures to handle surges of patients, such as stopping elective surgery and setting up isolation rooms. To protect bedridden long-term patients, nursing homes and hospitals also should immediately stop admitting visitors and do constant health checks on their staffs. (緊急修建醫院隔離室)

Recruit volunteers: With some training, China's volunteers were able to do some ground-level but crucial medical tasks, such as basic nursing, lab technician work or making sure that hospital rooms were correctly decontaminated. Americans can step forward to help neighbors too.(徵用志願義工)

Prioritize the treatments in new trials: Clinicians in China, Italy and France have thrown virtually everything they had in hospital pharmacies into the figh. There is not proof yet that any of those are effective against the virus. If any drug works on critical cases, it might be possible to use small doses as a prophylactic to prevent infection. A purified blood serum — called immunoglobulin — could possibly be used in small amounts to protect emergency medical workers. (治療藥物的研發和試驗現為首要任務)

Find a vaccine: Dr. Fauci has explained multiple times, testing those candidate vaccines for safety and effectiveness takes time. The process will take at least a year, even if nothing goes wrong. Because the human immune system takes weeks to produce antibodies, and some dangerous side effects can take weeks to appear. (各方疫苗研發尚未成功,人體試驗很危險)

In the past, some experimental vaccines have produced serious side effects, such as causing “immune enhancement”, i.e. making it more likely, not less, that recipients will get a disease. It is quite a risk to carry out vaccine's human testing.

Reach out to other nations: The Asian nations that have contained the virus could offer expertise — and desperately needed equipment. Jack Ma, the billionaire founder of Alibaba, recently offered large shipments of masks and testing kits to the United States. Wealthy nations ignored the daily warnings from Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, that far more aggressive efforts at isolation and contact tracing were urgently needed to stop the virus. That must change.(與其他國家互相借鑑)

In declaring the coronavirus a pandemic, Dr. Tedros called for countries to learn from one another’s successes, act with unity and help protect one another against a threat to people of every nationality. “Let’s all look out for each other,” he said. (各國彼此守護,不要像該隱:創世記4章9節)

No comments:

Post a Comment