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GENEVA — Around the world and around the clock, scientists are trying to figure out what must be done to end the global health emergency unleashed by the new coronavirus. As the outbreak accelerates and spreads, dozens of countries have deployed increasingly stringent measures to try to contain the epidemic. Almost as quickly, in a herculean effort, an international network of researchers at data and wet laboratories has started gathering and analyzing data to unmask and disarm this perplexing new disease.
日内瓦——全球各地的科学家正在日以继夜寻找办法,以求终结由新型冠状病毒引发的国际卫生突发事件。随着疫情的暴发和蔓延,20多个国家已采取了越来越严格的措施来遏制该流行病。在此同时,数据和湿实验室的研究人员组成的国际网络在奋力收集和分析数据,以揭开这种新疾病的神秘面纱,并解除它的危害。
In magnitude, scale and velocity, this coronavirus, known as 2019-nCoV, is too big a problem for any one team to solve. On Monday, China reported its largest single-day death toll, 97, pushing the total reported dead worldwide to 910, with more than 40,500 people infected on four continents.
就数量、规模和速度而言,这种被称为2019-nCoV的冠状病毒并不是某一个单独的团队可以解决的问题。周一,中国报告了最高的单日死亡人数97人,使全世界报告的死亡总数达到910人,四大洲有超过4.05万人被感染。
On Tuesday, I’m joining my fellow scientists at the World Health Organization headquarters for an urgent meeting to piece together, like a giant jigsaw puzzle, our findings so far. We need to get a clear view of the contagion and plug the holes in our understanding of the disease to inform public health decisions that affect hundreds of millions of lives. Science has a critical role to play in restoring calm.
周二,我将与同行科学家们在世界卫生组织总部参加一个紧急会议,将我们迄今为止的发现像拼一个巨大拼图一样串连在一起。我们需要对传染病有一个清晰的认识,并完善我们认识中的不足,以便为影响亿万生命的公共卫生决策提供依据。科学对于恢复冷静起着至关重要的作用。
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Let’s start with what we know. The new coronavirus is a close cousin of viruses that infect bats. It jumped from an unconfirmed wild source (most likely bats) to an intermediate host, possibly pangolins or other small mammals, being sold as food at a market in Wuhan, a transportation and commercial hub in central China. The infected people unknowingly spread it to others, setting off the outbreak’s deadly journey. We now estimate that it takes about five to six days — possibly upward of 14 days — for someone to show symptoms after becoming infected.
让我们从我们已知的开始。新型冠状病毒是感染了蝙蝠的病毒的近亲。它从一种未经证实的野生来源(很可能是蝙蝠)转移到中间宿主,可能是穿山甲或其他小型哺乳动物,这种动物在中国中部的交通和商业枢纽武汉的一个市场上以食品的形式出售。受感染的人无意中将其传染给其他人,从而造成致命疫情的暴发。我们现在估计一个人从被感染后到显现症状大约需要五到六天,有可能长达14天。
What do we most need to know next? For epidemiologists who track infectious diseases, the most pressing concerns are how to estimate the lethality of the disease and who is susceptible; getting detailed information on how it spreads; and evaluating the success of control measures so far.
什么是我们接下来最需要知道的?对于追踪传染病的流行病学家而言,最紧迫的问题是如何估算疾病的致死性以及谁是易感人群;获得有关其传播方式的详细信息;并评估到目前为止控制措施的有效程度。
No. 1 is the “clinical iceberg” question: How much of it is hidden below the surface? Because the outbreak is still evolving, we can’t yet see the totality of those infected. Out of view is some proportion of mildly infected people, with minor symptoms or no symptoms, who no one knows are infected.
首先是“临床冰山”问题:有多少疫情隐藏在表层之下?由于疫情仍在发展,我们仍无法看到所有受感染者。未进入视野的是一定比例的轻度感染者,他们有轻微症状或没有症状,他们的感染不为人知。
A fleet of invisible carriers sounds ominous; but in fact, an enormous hidden figure would mean many fewer of the infected are dying. Usually, simple math would determine this “case fatality” ratio: divide the total number of deaths by the total number of people infected. In an emerging epidemic, however, both numbers keep changing, and sometimes at different speeds. This makes simple division impossible; you will invariably get it wrong.
一个隐藏的携带病毒者的军团听起来令人不安;但是实际上,巨大的隐藏数量将意味着死亡的被感染者相对更少了。通常,简单的计算就可以确定这种“病死率”的比率:将死亡总人数除以感染总人数。但是,在新出现的流行病中,这两个数字都在不断变化,有时以不同的速度变化。这导致无法用简单的除法得到答案;你总是算错。
In 2003, during the early days of the SARS outbreak, the medical community got the math wrong. At first, we believed that case fatality hovered between 2 percent and 3 percent. It took two pages of longhand algebra, written in Oxford, England, coded into a computer in London and then applied to data from Hong Kong, to get it right. The actual case fatality for Hong Kong was staggering: 17 percent.
2003年,在SARS暴发的初期,医学界用了错误的计算。首先,我们认为病死率在2%至3%之间徘徊。在英国牛津完整手写的两页代数计算,在伦敦的一台电脑里被写成代码,再应用于香港的数据,这才得到了正确的数字。香港的实际病死率惊人:17%。
That’s not to suggest we’re facing as dire a scenario now. Several groups, including mine, are each using our own methods to calculate a preliminary estimate of the new virus’s lethality. If there’s near agreement among our findings, expected within the week, we’ll be more confident in describing the new coronavirus. Does it resemble the seasonal flu, SARS or one of the largest plagues in human history, the 1918-19 “Spanish flu” pandemic?
这并不是说我们现在正面临着危急的情况。包括我的小组在内的几个小组都在使用各自的方法来计算对新型病毒致死性的初步估计。预计我们在本周内可以拿出我们的发现,如果对一些发现能接近达成共识,我们将更有信心去描述新型冠状病毒。它到底更像季节性流感、SARS,还是人类历史上最大的瘟疫之一:1918-19年的“西班牙流感”大流行
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Knowing the number of people likely to die, or who get seriously sick or have zero symptoms, will help health authorities determine the strength of the response required. They can better estimate how many isolation beds, heart-lung machines and medicines, among other things, are needed.
了解可能会死亡、或病情危重,或没有症状者的人数,将有助于卫生当局确定所需应对措施的强度。他们可以更好地估算需要多少隔离病床、心肺机、药品,和其他用品。
Last month, to start understanding the severity of this illness, my team assisted Chinese experts in analyzing the initial 425 confirmed cases of infection. We learned that 65 percent of people had neither visited a market nor been exposed to another person showing pneumonialike symptoms, which implied, among other things, the possibility that some infected people don’t suffer from obvious symptoms — meaning the illness isn’t always severe.
上个月,为了解这种疾病的严重程度,我的团队协助中国专家分析了最初的425例确诊感染病例。我们了解到,65%的人既没有去过市场,也没有接触过其他出现类似肺炎症状的人,这表明一些受感染者可能没有明显症状,意味着这种疾病的病情不见得都很严重。
Along with getting a grasp on the level of severity is figuring out susceptibility, or who is most at risk for infection. The data so far indicates that this would include older adults, the obese and people with underlying medical conditions. There are few reports of children becoming infected. But are they not showing symptoms, or are they immune? And could they infect others as silent carriers? We must study those under 18 to find out; the answers could help us fine-tune public health measures. For example, should schools in China and Hong Kong remain closed?
了解疾病严重程度之外,还要弄清其易感性,或者说什么样的人感染风险最大。迄今为止的数据表明,易感人群包括老年人、肥胖者,和有潜在健康问题者。很少有儿童感染的报告。但他们是没有症状,还是对病毒具有免疫力?他们能作为无症状携带者感染他人吗?我们必须研究18岁以下的人来找出答案;这些答案可能有助于我们调整公共卫生措施,例如中国大陆和香港的学校是否应该继续关闭。
Returning to the big picture, we must also refine what we know about how the new coronavirus is passed between people. Even as the outbreak appears to keep escalating, we believe the rapid — sometimes necessarily draconian — response of governments and health authorities has made a dent in transmission. In another recent study, we estimated how many people could get infected if there were no drastic public health interventions. Our goal with this report was to sound the alarm over what could be, so that it wouldn’t be.
回到大局方面,我们还必须继续完善关于新冠病毒如何在人与人之间传播的认识。尽管疫情似乎在不断升级,但我们相信,各国政府和卫生当局的迅速反应——时有不得已的残酷——已在阻止传播方面取得了进展。在最近的另一项研究中,我们估计了在缺乏强力公共卫生干预情况下的感染人数。我们写这篇报告的目的是对可能的情况作出预警以避免发生。
Scientists are working toward quantifying effectiveness of the response. We need to find out if the virus’s basic reproductive number, the R0 or R-naught, has dropped. While our earliest estimates showed that typically every person infected by the new coronavirus passes it to 2 to 2.5 others, it’s still too early to know if measures have reduced the number to below the critical threshold of 1.
科学家正在努力量化这种反应的有效性。我们需要查明病毒的基本传染数即R0是否下降。虽然我们最初的估计显示,通常每个感染新冠病毒的人会传染2至2.5人,但现在就判断各种措施是否已将受传染人数降至临界阈值1以下还为时过早。
Simultaneously, we’re closely watching the rest of the world for any large, sustained outbreaks that might resemble ground zero in Wuhan. We expect more clarity within days or weeks. As of Monday, the largest concentration of infected patients in a single location outside mainland China, at more than 130 people, is on a cruise ship, the Diamond Princess, quarantined at Japan’s Yokohama port.
与此同时,我们正在密切关注世界其他地区是否会出现类似于疫情起始点武汉这样大规模、持续的暴发。我们希望在几天或几周内情况会更加明朗。截至周一,在中国大陆以外的地方,单一地点出现最多感染者的是一艘名为“钻石公主号”(Diamond Princess)的邮轮,有130多被感染病患。该邮轮已在日本横滨港被隔离。
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Finally, scientists need to appraise the control, or social distancing, measures deployed since the outbreak began. The challenge involves trying to quantify how many infections were actually prevented through measures such as wearing masks, closing schools and locking down cities. One possible approach to this assessment in China could involve using location services data from cellphones.
最后,科学家需要评估疫情暴发以来所采取的控制措施或社会隔离措施。挑战包括对通过戴口罩、关闭学校和封锁城市等措施得到预防的感染人数进行量化。在中国,手机定位服务数据可能被用于这种评估。
As we determine research priorities at the World Health Organization headquarters in Geneva this week, the hope is that the science being urgently coordinated will also fight the crisis on other fronts. It could help battle the emerging “infodemic,” the cacophony of real news, fake news and pseudoscience that feeds uncertainty and breeds panic.
本周,在日内瓦世界卫生组织总部确定研究重点时,我们希望,正在紧急协调中的科学也能在其他方面对抗危机。它可能有助于对抗正在出现的“信息传染病”,即真实新闻、假新闻和伪科学交织混杂的声音,它们助长了不确定性和恐慌。
And it could help roll back some measures seemingly fueled by populism and nativism. The travel advisories, outright travel bans, immigration controls and xenophobic treatment of people from different places are doing significant harm.
而且,这可能有助于逆转一些似乎由民粹主义和本土主义推动的措施。旅行警告、彻底的旅行禁令、移民控制以及对来自不同地域者的仇外对待都造成了重大损害。
The goal is to stay at least a couple of steps ahead of the epidemic curve. Scientists must prepare health authorities to catch any subsequent waves of infections and prepare for the possibility that this particular virus could reappear seasonally — and maybe one day it could be only as bad as the common cold.
我们的目标是至少领先于流行曲线几步。科学家们必须让卫生当局做好准备,应对任何随后的感染浪潮,并为这种特殊病毒出现季节性重现的可能做好准备——也许有一天,它的危害性可能只和普通感冒一样。
I’ve seen record-breaking outbreaks before and witnessed the world rally. If we all play our roles and remain on guard, then chances are we will defeat the new coronavirus, too. This is the best way to honor Dr. Li Wenliang, one of the first doctors in Wuhan to warn the world about the disease — the very one that killed him last week, at age 34.
我曾见过史无前例的疫情暴发,也曾见证世界的团结。如果我们都各司其职,保持警惕,那么我们同样有可能战胜新冠病毒。这是纪念李文亮医生的最好方式,他是武汉第一批警告世界警惕这种疾病的医生之一——上周,他正是因为这种疾病去世,终年34岁。