COVID-19 Vocabulary Confusion

Officials often use similar words when describing the pandemic, but they are not always talking about the same thing, making global comparisons less useful. Making sense of the coronavirus pandemic requires getting up to speed on semantics as much as epidemiology.

Government officials and health care professionals toss off mentions of mortality rates, flattening the curve and lockdowns, assuming that we know what they mean. But the terms mean different things from country to country, state to state, even city to city and person to person. (各國用同一名詞表示不同的內容）

Officials use the same phrases about mass testing, caseloads and deaths to describe very different situations. That makes it hard to give clear answers to vital questions: How bad are things? Where are they headed?

People search for insight by comparing their countries to those that are further along in the epidemic. But if the terms are misleading or used in differing ways, the comparisons are flawed. Also, the statistics and vocabulary offer a false sense of precision while in reality, the information we have shows only a fraction of what’s going on.

“The new cases or deaths each day are given as exact numbers, and we’re trained to take that at face value,” said Mark N. Lurie, an epidemiologist at Brown University’s School of Public Health. “But those are far from exact, they’re deeply flawed, and their meaning varies from place to place and from time period to time period.” The following are a few examples.

‘Confirmed Cases’(確診病例): Countries vary wildly in testing for the virus and how they report the numbers, and experts say most infections are going undetected. So the publicized national tallies are rough, incomplete pictures that may not be all that comparable.

And that’s if countries are forthcoming about their data. Officials in the United States say that China, which has reported more than 82,000 infections, has understated its epidemic. Until this week, the Chinese government excluded those patients who tested positive for the virus but had no symptoms. China also doesn’t say how many tests it has conducted. (中國確診病例直到上周，沒有將測試陽性而無症狀的人算為確診)

Few countries have done aggressive testing. And of course, the more testing there is, the more cases are found. Japan, with relatively few confirmed cases, has conducted only about 500 tests/million people, similar concerns have been aired in Britain, whose testing rate — more than 2,400 tests/million so far — is low by Western European standards. In contrast, South Korea has tested more than 8,000/million, and Norway about 17,000. (測試越多，確診越多)

‘Widespread/Mass Testing’(大規模測試): President Trump has boasted that more people have been tested in the United States than any other country, though on a per-capita basis, many developed countries have done more.

A few countries, like South Korea, Australia and Singapore, got serious about mass testing early on. They used the information to do ambitious contact-tracing — finding and testing those who had recently been near infected people, even if they had no symptoms. (南朝鮮、澳大利亞、新加坡測試比率最大)

That provided a pretty full picture of the outbreak while the numbers were still manageable, and made it possible to slow it down. Though Germany did not act on the same scale as those countries, it did more testing and contact-tracing in the early going than most of Europe. (德國比歐洲其他國家測試率高)

But most nations with large numbers of cases have done less testing, waited longer to do it in bulk, and made little attempt at contact tracing. They find themselves playing catch-up with the virus, ramping up testing after their outbreaks had already mushroomed.

A prime example is the United States, where about 90% of the tests so far were done in just the last two weeks. Doctors, patients and state and local officials report that there still isn’t enough testing available, and ailing people are routinely told that they are not sick enough to warrant a test. (美國確診雖多，許多州測試量仍不足)

‘Fatality/Mortality Rates’(病亡率): It has been stated time and again: Italy and Spain have high mortality rates among coronavirus patients, Germany’s is low, and China’s is somewhere between.

But it may not be that simple. Recent reports say that mortuaries in Wuhan, China, where the disease was first discovered, have ordered thousands more urns than usual, suggesting a much higher death toll than the city’s official count, 2,535.

The outbreaks in Wuhan, and parts of Italy and Spain, overwhelmed hospitals, forcing many sick people to ride it out at home. No one knows how many people have recovered or died without ever being tested. And if only the sickest patients are tested, then the number of infections will appear smaller and the percentage who die will seem higher. In Germany, some of those patients are not counted, because post-mortem testing for the virus is not standard in hospitals.(很多地區醫院超負荷，患者不得確診/醫治而死，沒算入病亡數)

‘The Peak’(疫情高峰): Officials often talk about when the epidemic peaks or plateaus — when a country “flattens the curve(疫情曲線升到頂峰).” But they rarely specify, the peak of what? And how can we be sure we’re past it?

When an outbreak is growing unchecked, more people become infected and more die each day than the day before. Italy went from reporting a few hundred newly detected infections per day in early March to more than 6,500 on March 21. That acceleration cannot continue indefinitely, and more important, Italy has strengthened social distancing, apparently slowing transmission of the virus. (保持社交距離顯然減緩傳染速度)

On a graph, the curve showing the daily count of new cases(每日新增變平緩) has gone from rising sharply to moving sideways — the curve has flattened — and even begun to move downward. That is one corner being turned: The rate of the spread of the virus has slowed down. It takes longer to turn another: the rate of people dying(病亡數下降). But that, too, appears to have leveled off in Italy, fluctuating around 800 a day in the last week.

But even when those curves flatten, the epidemic still has not “peaked” by another crucial measure: the number of active cases(活躍病例數量). That figure continues to rise until the number of patients who either die or recover each day is larger than the number of new infections(每日病死/康復數量大於新增病例).

‘Lockdowns’(封鎖/禁足令): More than two billion people, including most Americans, are living under something usually called a lockdown. But there is no set definition of that word — or stay-at-home mandates and social distancing (居家令和社交疏離)— so the details differ from place to place.

The lockdowns have varying exceptions for certain lines of work, personal circumstances or exercise. Some allow gatherings of up to ten people, or five, or forbid groups of any size; some exempt funerals, others do not.

The biggest differences may be in enforcement. Some places, like those in the United States with lockdowns, mostly rely on people to follow the rules without coercion. (主要是各地強制程度不同)

But Italy and others have deployed soldiers to ensure compliance, and French police have fined hundreds of thousands of people for violating restrictions. And on Wednesday, President Rodrigo Duterte of the Philippines threatened to have lockdown violators shot.

Italy’s experience shows the looseness of the term. It has gone through several phases of restrictions. A few weeks ago, a person could travel around Italy for a valid work or family reason. Now, people are fined for nonessential walking too far from their homes. --These were all called by the same name: "lock down".

本文內容取自紐約時報文章Coronavirus Vocabulary Causes Confusion。