David Biello: It's now my great honor and privilege to introduce Dr. Georges Benjamin, who's the executive director of the American Public Health Association, who has a long and distinguished career, both as a medical professional and as a public health professional. Please give a warm welcome to Dr. Georges Benjamin.
戴维 · 比耶洛(David Biello): 接下来,我非常荣幸 为大家介绍乔治斯 · 本杰明博士 (Dr. Georges Benjamin)。 他是美国公共卫生常务理事, 作为医学专家以及 公共卫生领域专家, 他有着多年丰富而卓越的职业生涯, 请热烈欢迎, 乔治斯 · 本杰明博士。
Georges Benjamin: Hey, David, how are you?
乔治斯 · 本杰明(Georges Benjamin): 嗨,戴维,最近如何?
DB: I am good, how are you, Dr. Benjamin?
DB:我很好,您呢?
GB: I'm here. (Laughs)
GB:至少还能毫发无损的坐在这里。 (笑声)
DB: Hanging in there. Good.
DB:一切安好吗? 听上去不错。
GB: Hanging in.
GB:没错,还算坚持得住。
DB: We know that the theme of the moment is reopening, I would say. We just heard one possibility for that, but obviously, a lot of countries have already reopened in one form or another, and I believe, as of today, all 50 states here in the US have reopened in one form or another. How do we do that smartly, how do we do that safely?
DB:我们知道当前的 一大主题是复学复工复产。 我们只听到了这一种可能性, 但显然, 很多国家已经利用这样 或那样的形式重新开放了, 而且我相信,截至今日, 美国所有 50 个州 也已经在不同形式下重开了。 但我们能如何做到 明智且安全的重新开放?
GB: Yeah, we really do need to reopen safely and carefully, and it means that we have not got to forget these public health measures that really brought down the curve to begin with. And that means thing such as covering up your nose and mouth when you cough or sneeze, wearing a mask, washing your hands, physically distancing yourself to the extent possible from others. Thinking about everything we do, you know, before we go to work in the morning, while we're at work. And being as careful as many of us have been in the last two months, as we go into the next three months, because this thing is not over.
GB:没错,我们确实需要 安全小心的重开。 而这意味着我们还未忘记 能帮助拉平曲线的公共卫生措施。 这意味着 诸如咳嗽或打喷嚏时遮挡抠鼻、 戴口罩、洗手、 还有尽量与他人保持距离等措施。 想想我们所做的所有事情—— 在早晨去上班前, 或者在工作时。 在过去的 2 个月, 我们很多人都在 尽可能保持谨慎, 在接下来的 3 个月中依旧如此, 因为这事儿还没结束。
DB: Right. There is the chance of more waves, as Uri [Alon] mentioned. It seems like it's kind of incumbent on all of us then to take public health as kind of a second job. Is that right?
DB:没错。 就如乌里 · 艾隆(Uri Alon)所说, 可能未来还会出现几波。 看起来我们所有人似乎都有义务 需要将公共卫生 作为我们的第二份工作。 是这样吗?
GB: You know, I've been arguing a lot that now that everybody really knows what public health is, that everybody should always recognize that their second job is public health, whether you're picking up the garbage or working in a grocery store, or you are a bus driver, or you're, you know, like me, doing public health, a physician or a nurse, everybody needs to put the public health mantle into what they do each and every day.
GB:我一直在重申: 现在每个人都知道了 什么是公共卫生, 每个人应该总能意识到 他们的第二份工作是公共卫生, 不论你是保洁员, 还是在杂货店工作, 或者是公交车司机, 或者像我, 在公共卫生领域的 一名医生或是护士, 每个人都需要将公共卫生 融入他们每天都在做的事情中。
DB: What do you think -- So we're all public health professionals now, what do you think the new normal we might expect, as countries reopen? What is that going to look like, or what do you hope that looks like, as a public health professional?
DB:你认为—— 鉴于我们现在都是 公共卫生领域的一员了, 你认为在国家重新开放之时, 我们可能预期的新常态是什么? 这看起来会是怎么样, 或是你作为一个公共卫生领域专家, 希望这看起来会是如何?
GB: If I could wave a magic wand, I would clearly recognize that people are going to be doing a lot more of the public health things, in terms of handwashing and thinking about what they do around safety when they go out in public. You know, it was not too long ago when you got in your car and you didn't put your seat belt on. Today we do it, and we don't think anything about it. Most of us don't smoke, because we know that that's bad for us. Most of us look both ways before we cross a street. Most of us, you know, do things in our house, that are -- fix trip hazards. So as we go forward with this outbreak, I'm hoping that people will pay a lot more attention to things that can cause us to get an infection. So you know, cleaning things, disinfecting things. More importantly, not coming to work if you're sick. I'm hoping that employers will put in paid sick leave for everybody, so people can stay home. Yeah, it’s an additional cost, but I can tell you that we've now learned that the cost of not doing something like that is billions and billions and billions of dollars. Paid sick leave is pretty cheap when you do that.
GB:如果我有一根魔法棒, 我会很清晰的意识到 人们将会做更多与公共卫生 相关的事情, 例如洗手, 并且思考他们身处公共场合时, 怎么做才能确保安全。 就在不久之前, 你上车还不会主动系上安全带。 而如今我们都是这么做的, 而且完全是下意识的。 我们大部分人不抽烟, 因为我们知道抽烟对人体有害。 我们大部分人在过马路时 会左右观察路况。 我们大部分人 会修缮房屋,消除危险隐患。 所以随着这场 全球大流行病爆发的推进, 我希望人们能更加注意 有可能导致我们被感染的事物, 例如要注意清洗和消毒。 更重要的是, 如果你生病了就别去上班。 我希望雇主能为每个员工 提供带薪病假, 让生病的人可以安心在家休息。 没错,这里有附带成本, 但我要告诉你, 我们现在已经学到了教训—— 如果我们不那么做, 最终的代价就是 奥多支付数十亿美元。 带薪病假其实是 一个相对节约成本的方式。
DB: Yeah, we are, I think, envious in the United States of all the countries that perhaps have a more all-encompassing health care system than we do. Would you agree that masks are kind of the symbol of adopting that "public health professional as a second job" mindset?
DB:是的,我认为美国所有人 都非常羡慕比我们国家 有着更加全面的医疗体系的国家。 有一种说法,口罩多少已经成为了 采取“公共卫生作为第二职业” 观念模式的象征,你同意吗?
GB: Well, you know, it's funny. Our colleagues in Asia have had a mask -- wearing masks as a culture for many, many years. And you know, we've always kind of chuckled at that. When I went overseas, I would always kind of chuckle when I saw people wearing masks. And of course, when this first started, you know, we only promoted masks for people that were infected or of course, health care workers, who we thought were in a higher-risk environment. But I think that wearing masks is probably going to be part of our culture. We've already seen it probably will not be part of our beach culture, although it probably should be for now. But I do think that we're going to see more and more people wearing masks in a variety of settings. And I think that makes sense.
GB:这很有趣。 我们在亚洲的同事就有口罩—— 多年来,戴口罩一直是一种文化。 我们总是对此嗤之以鼻。 当我在海外, 看到戴口罩的人,我总会暗笑。 当然,最开始的时候, 我们说口罩仅适用于 那些被感染的人, 或是那些暴露在高风险环境下的 医疗工作者。 但我认为,戴口罩 可能会成为我们文化的一部分。 我们已经发现这可能不会成为 我们沙滩文化的一部分, 尽管现在或许应该如此。 但我确实认为在不同场景下, 我们会看到越来越多的人戴口罩。 我觉得这很合乎逻辑。
DB: Yeah, wear your mask to show that you care about others. And that you have this, kind of, public health spirit. So speaking of Asia, who has done well? Looking around the world, you've been doing this for a while and communicated with your peers, who has done well and what can we learn from those good examples?
DB:是的,通过戴口罩的方式 来表达你对他人的关心。 之后你就有了一种 公共卫生精神。 那么谈到亚洲, 哪些国家做得比较好? 放眼全球, 你已经在这个部门从业很久, 并且和同事们交流不少。 哪些国家做得还不错? 有什么经验值得我们借鉴?
GB: Yeah, South Korea in many ways is the role model. You know, China actually, at the end of the day, did reasonably well. But the secret to all of those countries that have had less morbidity and mortality than we have, is they did lots of testing very early on, they did contact tracing and isolation and quarantine, which by the way, is the bedrock of public health practice. They did it early, they did a lot of it, and by the way, even though they're reopening their society, and they're beginning to see episodic surges, they then go back to those basic public health practices of testing, isolation, contact tracing and transparency to the public when they can, because it's important for the public to understand how many cases there are, where the disease is, if you're going to get compliance from the public.
GB:韩国在很多方面能成为榜样。 中国,从后续的成果上说, 实际上做得也还不错。 但发病率和死亡率 都比我们低的那些国家的秘诀就是, 他们在非常初期的时候 就做了大规模的检测, 他们做了很多接触史追踪、 分离和隔离, 顺便一提,这些其实都是 公共卫生实践的基石。 他们很早就开始实施大规模检测了, 而且即使他们马上要重启经济, 并且会开始时不时 看到病例的激增, 他们也会再次采用 那些基础的公共卫生实践—— 测试、隔离、接触史追踪, 以及在可能的情况下, 向大众公开透明。 因为对大众来说, 了解病例的总数及分布 是至关重要的, 如果你想要大众遵从你的管制。
DB: So testing, contact tracing and isolation. That doesn't seem like rocket science, to use that old cliché. Why has that been hard for some countries to implement? What's holding us back, is it electronic medical records, is it some fancy doodad, or is it just maybe overconfidence, based on maybe the public health successes of the last 100 years?
DB:所以测试、接触史追踪, 还有隔离。 使用这些传统方法 看起来十分简单,可以理解, 那为什么在有些国家, 要实行这些措施是如此困难? 是什么在阻碍我们? 是电子医疗记录吗? 或者一些花里胡哨的东西吗? 还是可能基于其过去 100 年 在公共卫生领域的成功, 所造成的过度自信?
GB: You know, we are very much a pill society. We think there's a pill for everything. If we can't give you a pill for it, then we can give you surgery and fix it. You know, prevention works. And we have totally underinvested in prevention. We've totally underinvested in a strong, robust public health system. If you look at the fact that in the America today, you can very easily know what's coming off the shelf of a grocery store, Amazon knows everything there is to know about you, but your doctor does not have the same tools. At three o'clock in the morning, it's still very difficult to get a hold of your electrocardiogram, or your medical record, or your list of allergies if you can't tell the practitioner what you have. And we just haven't invested in robust systems. One of the interesting things about this outbreak is that it has created an environment in which we're now dependent on telemedicine, which has been around for several years, but we weren't quite into it. But now, it's probably going to be the new standard.
GB:我们很像是一个“药丸社会”。 我们总认为有一种药丸 可以治愈一切。 如果我们没办法给你开药, 那我们可以进行手术, 帮你解决问题。 但是,预防起着很大的作用。 可我们完全没有在预防上 投入必需的资金, 建立一个成熟且强大的 公共卫生体系, 我们的投资完全不够。 如果你看看如今的美国, 你很容易就会发现 杂货店什么东西卖得最快, 亚马逊知道关于你的一切, 但你的医生却没有类似的工具。 比如在早上 3 点, 很难即时获得你的心电图, 或是医疗记录、过敏原清单—— 如果你无法告诉医生 你有什么问题。 而我们就是迟迟没有 投资于一个成熟稳健的医疗系统。 这场疫情大爆发中, 其中一件有趣的事 就是大爆发创造了一个环境—— 我们如今依赖的远程医疗。 这个领域 其实已经出现了好几年了, 但我们之前对此并不是很感兴趣。 但现在,这却可能成为一种新标准。
DB: But it also seems -- So, obviously, those countries with an incredibly robust health care system, like Taiwan, have done well, but it seems like even countries that perhaps would be considered to have a less robust health care system, like a Ghana in Africa, have actually done well. What has been the, I guess, the secret sauce for those kinds of countries?
DB:但这看起来似乎也—— 所以显然, 那些有着非常成熟的 医疗保健体系的国家及地区, 例如台湾,他们做得不错, 但即使是那些被认为可能 没有如此成熟的医疗保健体系的国家, 例如非洲的加纳, 他们实际上也做得不错。 这类国家的秘诀 又是什么呢?
GB: Yeah, it's still pretty early in some of their exposures, and hopefully, they might not have a wave that comes later, that's still a possibility, but at the end of the day, I think, to the extent you have done good, sound public health practices, all of the countries that have done well have implemented that. Now we're a big country, we're a complex country. And yes, we didn't get the testing right to begin with. But we should not repeat the mistakes that we had over the last three months, because we've still got several months to go. And now that we know what we did wrong, I'm encouraging us to do it right the next time.
GB:他们对疫情的暴露 还处于相对早期阶段, 希望他们之后不用 再经历另一波病毒侵袭, 尽管这依旧很有可能发生。 但总的来说,我认为, 你只需要实行良好且健全的 公共卫生措施。 所有做得不错的国家 都已经实行了这些。 我们是一个庞大而复杂的国家。 而且没错,我们在一开始 就没有做好测试这项工作。 但我们不应该 重复过去三个月的错误, 因为我们眼前还有好几个月。 既然现在我们知道 自己之前做错了什么, 我希望大家下一次能做好。
DB: That seems smart.
DB:很明智的建议。
GB: And the next time is tomorrow.
GB:我说的下次就是明天。
DB: That's right. It's already started. I mean, it almost seems to me, if I can use this metaphor, that some of these countries already had the, kind of, antibodies in their system, because they had experience with maybe Ebola or the first SARS. Is that the key, previous exposure to these kind of public health crises?
DB:没错。 已经开始了。 我的感觉就是, 如果我能用这个比喻的话, 那就是有些国家 在他们的体系中, 已经有了类似“抗体”的东西, 因为他们或许有着对抗 埃博拉或是非典(SARS)的经验。 在应对公共卫生危机之时, 过往的经验是关键所在吗?
GB: Well, this is a very different virus. And while there may be some early evidence that MERS and SARS one, we may have some early protection from that, there's some early, early studies looking at that, that's not the solution. The secret sauce here is good, solid public health practice. That's the secret sauce here. We should not be looking for anything, any mysticism, or anyone to come save us with a special pill. This is all about good, solid public health practice, because, by the way, look, this one was a bad one, but it's not the last one. And so we need to prepare for the next really big one. We think this one was bad, imagine what would have happened had Ebola been aerosolized, or MERS had been aerosolized. You know, pick a TV movie. Even though this was a bad one, we still dodged a really, really bad one this time.
GB:这是一个非常不同的病毒。 尽管有些初期证据可能表明 针对中东呼吸综合征(MERS)和 SARS, 我们或许需要一些早期保护。 也有一些十分早期的研究, 而这不是解决方案。 这里的秘诀是 成熟稳健的公共卫生实践。 这才是秘诀。 我们不应该找寻任何别的东西, 期待任何神秘论, 或是某个人给我们提供 神奇药丸,拯救我们。 这完全关乎于 成熟稳健的公共卫生实践, 因为——顺便说一句—— 这是一场非常糟糕的 全球流行病大爆发, 但这肯定不是最后一场。 所以我们要为下一场 真正的疾病大爆发做准备。 我们认为这场疫情很糟糕, 想象一下如果埃博拉病毒 或是 MERS 病毒被雾化, 什么会发生? 选一个电影。 即使这场疫情很糟糕, 但我们仍旧躲避过了 这次极其糟糕的情况。
DB: Yeah, Middle East Respiratory Syndrome is no joke, and we should be thankful that it doesn't spread more easily, like SARS-CoV. Is this, though -- So all these diseases are zoonotic, that means they jumped to us from the animals that are out there. Obviously, humanity is kind of encroaching on nature in an ever more, kind of, urgent way, whether that's climate change or going into the forests, what have you. Is this just the new normal, like, we should expect pandemics every so often?
DB:没错,MERS 不是开玩笑的, 我们应该感恩, 这种病毒不像 SARS-CoV 这样 容易传播。 不过,可以说, 所有这些疾病都是人畜共患的, 也就是说,那些病毒从动物身上 传播到了人类身上。 显然,人类向来在侵占自然—— 不管是气候变化,还是滥砍滥伐—— 如今更是以前所未有的速度发生着。 这会是我们的新常态吗? 我们应该预期全球大流行病 未来会发生得如此频繁吗?
GB: Well, they do come periodically, so this is not, you know, the first pandemic, right? We've had several, 100 years ago, the 1918 influenza, SARS was a significant infection, even though it didn't get this bad, SARS one. And we had the avian flu, which was a challenge, and the swine flu. We had Zika. So no, we've had several new disease outbreaks. These emerging diseases happen a lot, and in many ways, we've been fortunate that we have been able to identify them early and contain them. But we're now in an environment where people can, by the way, make some of these things up. Now, this one did not happen, as best we can tell, it's not man-made. It did not probably come out of a leak in the lab. But we know that, when I was in school, to grow a bug, you had to be pretty sophisticated. That's not the case today. And we need to protect ourselves from both naturally occurring infections and from those that are created by humans.
GB:它们确实会阶段性发生。 这不是我们经历的第一场 全球大流行病了,对吧? 我们经历过几次, 100 年前的 1918 大流感, SARS 也是一个很严重的感染, 即使 SARS 在当时 没有造成太严重的后果。 我们有过禽流感, 曾经也是一场挑战, 还有甲型流感、 寨卡病毒。 所以并不是什么新常态,我们已经 经历过几场新疾病的爆发。 这些新的疫情会通过多种方式 频繁发生。 迄今为止,我们一直非常幸运, 还有能力在早期 鉴别并控制这些疫情的传播。 但我们现在正处于 人造病毒的威胁之中。 但这并未发生,据我们所知, 这场疫情并不是人为的, 不是实验室病毒泄露导致的。 不过至少在我读书期间, 想要创造这样一种病毒, 你必须得相当老练。 今天疫情的起源而非如此。 但我们依旧要在身处 自然感染以及人造病毒的夹击之时, 学会自我保护。
DB: Plus we have other, kind of, threat multipliers, like climate change, that make pandemics like this that much worse.
DB:外加我们还有诸如气候变化的 放大效应, 这会让全球大流行病 变得更难以控制。
GB: You know, I was saying climate change was the greatest threat human survival before this one. But this is rivaling climate change. But let me tell you, the big challenge we have now is that we have a pandemic, which we have still not contained, as we enter hurricane season, and we have climate change, which is exacerbating the ferocity of the hurricanes that we're having. So, you know, we're in for an interesting summer.
GB:我曾说过 气候变化是人类生存的最大威胁。 但这种疫情的威胁 与气候变化相当。 不过我想说, 我们现在面临的一个主要挑战 就是我们尚未能控制的 全球大流行病。 当我们进入飓风季节, 外加因为气候变化, 这加剧了飓风的破坏力。 所以,我们将迎来 一个情况复杂的夏季。
DB: And here's Chris with, I think, a question from our audience.
DB:克里斯上线了, 他应该为我们带来了一个观众的问题。
Chris Anderson: Many questions, actually. People are very interested in what you're saying, Georges. Here we go, here's the first one from Jim Young: "How do we deal with people who don't believe this is serious?"
克里斯 · 安德森(Chris Anderson): 其实有很多问题。 人们对您的话很感兴趣,乔治斯。 那么第一个问题来自吉姆 · 杨: “我们该如何处理 那些不相信情况严重性的人?”
GB: You know, you just have to continue to communicate the truth to folks. One of the things about this particular disease is that it does not spare anyone. It does not recognize political parties, it does not recognize geography, and we had lots of people, particularly in rural communities, that were not seeing it, because it had not yet come to them, and they didn't believe it was real. And now many of those communities are being ravaged by this disease. And so we just have to -- You know, it's not appropriate to say "I told you so." It is appropriate to say, "Look, now that you see it, come on board and help us resolve these problems." But this is something that's going to be around for a while. And if it becomes endemic, meaning that it occurs all the time at some low level, everyone is going to have this experience.
GB:你只能继续和他们交流真相。 关于这一特定疾病的 一个真相就是, 就是它不会放过任何人。 它不分政党, 不分地理位置, 尤其在偏远的社区, 之前很多人还没看到病毒的影响, 因为病毒还没影响到那些地方, 所以他们并不相信其真实性。 现在很多那些社区 正被这个疾病侵袭。 所以我们只要—— 如果只是说“我早说过了” 可能不是很合适。 我们更应该说:“你看, 现在你看到病毒影响了, 加入我们,帮助我们 解决这些问题吧”,才更合适。 但这种情况将会持续一段时间。 如果这成为地方性疾病, 意味着它将在低层面持续发生, 最终每个人都无法幸免。
CA: Thank you. Here is one from Robert Perkowitz. "We seem to have been ignoring and underfunding public health, and we were unprepared for this virus." Look if the question is going to pop up there, I think it should, by some magic. "What should our priorities be now to prepare for the next public health crisis?"
CA:谢谢。 还有一个来自 罗伯特 · 珀科维茨的问题: “我们似乎一直都忽视了公共卫生的问题, 并且没有投入足够的资金, 所以我们未能为该病毒 做足准备。” 这个问题应该会出现在屏幕上, 稍等一下。 “我们现在的优先事项是什么? 如何更好的为下次的 公共健康危机做好充分的准备?”
GB: Well, we now need to make sure that we've put in the funding, resources, training, staffing on the table. And by the way, our next public health crisis is not 10 years from now, it's not 20 years from now, it's the potential co-occurrence of influenza, which we know is going to happen this fall, because it comes every year, with either continued COVID or a spike in COVID. And we're going to have a disease process which presents very much the same, and we're going to have to differentiate COVID from influenza. Because we have a vaccine for influenza, we don't yet have a vaccine for COVID. We hope to have one in about a year. But that still remains to be seen.
GB:我们现在需要确保 就投入的资金、资源、 训练和人员展开充分的讨论。 顺便一提,我们下一次 面临的公共卫生危机 不是 10 年之后, 更不是 20 年之后, 这是潜在的流感并发, 所以我们知道它将于今年秋天发生, 因为流感季节每年都会发生, 不论是持续伴随着新冠病毒, 或是出现新冠病毒的峰值。 我们都将经历一个 几乎相同的疾病传播过程, 而我们将不得不区分 新冠病毒和流感。 因为我们有预防流感的疫苗, 但还没有针对新冠病毒的疫苗。 我们希望在未来一年左右 能研发出新冠病毒疫苗。 但这还得看情况。
DB: So get your flu shots.
DB:所以大家去接种流感疫苗吧。
CA: Yeah. Indeed, in fact, David Collins asked exactly that question. "What is the likelihood of a vaccine before the next wave?"
CA:是啊。 没错,事实上, 戴维 · 柯林斯问了同样的问题。 “在下一波疫情来袭之前, 我们能获得疫苗的可能性有多大?”
GB: Well you know, the fastest vaccine that we've ever developed was measles, and that took four years. Now, a lot of things are different, right? We have started on a SARS-one vaccine. So it had gone to a lot of animal trials, it had gone to some very, very early human trials. As you know, we just got some announcement that at least it does seem to work in monkeys, in rhesus monkeys, and there's some evidence that at least it may be efficacious and safe in a very, very small number of people. When I say very, very small number of people, handful of people. So now it's got to go to phase two and phase three trials. So, yeah, [David] held up two hands, so yeah, yeah, it's a small number of people. What that tells you is either that those folks were very lucky, or it works. And we won't know until we put this into the arms of thousands of people.
GB:事实上,人类史上 研发速度最快的是寻麻疹疫苗, 花了 4 年时间。 如今,很多事情 都大有不同了对吧? 我们已经开始了 SARS 疫苗的研发, 这需要通过一系列的动物试验, 需要通过一些非常非常早期的 人体临床试验。 大家可能已经知道, 我们刚从最新的通告中得知, 说它至少对恒河猴起作用, 也有一些证据 表明至少在极少数人中, 这可能是有效且安全的。 我说的极少数人, 就是很少很少的人…… 所以现在该疫苗的研发将会进入 第二和第三阶段试验。 所以没错, 戴维举起了两只手, 没错,就是这样, 只有很少的一些人。 这意味着 要么那些人非常幸运, 要么就是 这个疫苗的确有效。 而在将其进行广泛接种之前, 我们不得而知。
CA: Here's an important question from a TED Fellow. "How do we actually train people about what public health means? Especially in the context of folks who don't believe they have a responsibility to 'the public?'"
CA:还有一个很重要的 来自 TED 会员的问题: “我们如何才能准确训练人员 认清公共卫生到底意味着什么? 尤其在人们不相信 自己对 ‘公众’ 也肩负责任的情景下?”
GB: Well, you know, I remind folks that when public health does its best job, nothing happens. And of course, when nothing happens, we don't get credit for it. So the reason that everyone in this country does not have to get up every morning and boil their own water is because of public health. The reason that, if you get into a car accident, you know, get into an automobile collision, and you wear your seat belt, and you have airbags, and you're not killed from that automobile collision, is because of public health. The reason that the air is safe to breathe, the food is safe to eat, is because of public health. The reason that your kids are not in clothing that ignites is because we have fire-retardant clothing. And that is a requirement. The reason that you don't trip walking down the stairs is because we've actually looked at how to build the stair so that people don't trip when they go up or down it. That's actually a public health intervention. So the built environment, medicines, all those kinds of things, vaccines, those are all public health, and that's why public health is there, and you may not believe that it's that important, but we couldn't live without it.
GB:我通常提醒人们 当公共卫生发挥最大作用时, 什么都不会发生。 当然,如果大家都安然无恙, 我们的贡献就根本无人知晓。 所以,这个国家每个人 早上起来不用烧水喝, 是因为公共卫生。 如果你被卷入一场车祸, 汽车相撞, 你系着安全带, 车里有安全气囊, 那么你幸存于这场车祸的原因 也是因为公共卫生。 你能安全的呼吸空气, 安全的进食, 都是因为公共卫生。 你孩子身上的衣服不会着火, 是因为制衣时 我们采用了防火材料, 而且这是一个制衣要求。 你走楼梯的时候不会被绊倒, 是因为我们已经研究过 如何设计楼梯, 能防止人们在上下台阶时 不被绊倒。 这实际也是 一种公共卫生的干预。 所以已建立的环境、 医药等等各种东西, 包括疫苗, 它们都属于公共卫生的范畴, 而这也是为何我们说 公共卫生无处不在, 你可能不会相信它们很重要, 但没有它,我们无法生存。
CA: Maybe one day we can all envision a health care system in America that actually has some incentives that point towards public health. That would be very nice. David, I've got to just keep going with some of these questions, if it's OK, because they're pouring in. There's one here from Jacqueline Ashby. Important question for every parent. "What are your recommendations about sending children back to school?"
CA:或许有一天我们所有人 都能构想出一个美国的医疗保健系统, 在公共卫生方面 确实有着一些激励机制。 这会很好。 戴维,如果可以的话, 我得继续问接下来的问题, 因为大家的问题 正源源不断的进来。 这个问题来自杰奎琳 · 阿什比, 是个对每位家长都很重要的问题: “对于把孩子们送回学校, 您有些什么建议?”
GB: Yeah, I'm struggling with this one, I've got three grandkids. And the good news is that my grandkids are more technically proficient than I am, and right now are getting their lessons remotely. I think it's going to be a challenge as we think about sending kids back to school. We're going to really need to know how infectious kids are and how well they do when they get infected. Now, right now, it seems, except for a very small number of children who get a very rare disease, that they tolerate this disease very well. But the central question is, how many of these germs will these kids bring back to you and to grandma and grandpa. So that's going to be important. And you know, trying to tell an eight-year-old not to interact with their friends, is a real challenge. By the way, trying to tell a 17-year-old not to interact with their friends is going to be a real challenge. So, we've got to properly educate these kids, we've got to figure out how we stagger their schedules. Uri's idea for the workforce might be an interesting concept for schools, because the idea is to try to decompress the number of kids in the classroom. By the way, if you get smaller class size, you get better education, anyway. So, we've got to have enough teachers, though. So that may be the rate limiting step.
GB:是的,我也在苦思这个问题, 我有 3 个孙辈小孩。 好消息是我的孙辈们 比我更精通技术, 所以他们现在正远程上课。 我认为把孩子送回学校 在目前看来会是一个挑战。 我们真的需要明确 孩子的感染力有多强, 他们被感染时的状态如何。 现在看来, 除了很少一些 患有罕见疾病的孩子们, 大部分儿童似乎 对于该疾病的耐受性很好。 但核心问题在于, 那些孩子将会带回多少病菌 给你,还有祖父和祖母。 这个问题很关键。 而且尝试告诉一个 8 岁的孩子 不要和他们的朋友互动, 算是一个挑战。 话说,尝试告诉一个 17 岁的青少年 不要和朋友互动, 绝对是个真正的挑战。 所以我们需要正确教育孩子, 需要弄清如何错开他们的时间表。 乌里针对工作场所的想法 可能对学校政策提供 一些有趣的参考—— 因为想法本身其实就旨在 减少在教室中孩子的数量。 班级人数变少,同时, 教育质量还能有所提高。 不过我们得有足够的师资, 在这点上我们可能会 面临一些问题。
CA: Alright, last question here for now from [Steven] Petranek. Masks. Advice on masks -- I switched that off, here we go. Advice on masks seems to have shifted. "Would most Americans who live and work in cities be better off wearing masks to also help reduce the air pollution particles they encounter every day?"
CA:好的,最后一个问题, 来自史蒂文 · 彼得兰克。 是口罩,关于口罩的建议。 哦,我不小心把字幕关了,好了。 针对口罩的建议似乎发生了变化。 “在城市中工作生活的美国人, 戴口罩大部分会受益于戴口罩吗? 也会同时帮助他们 减少每天吸入的 空气污染颗粒吗?”
GB: It may help some, absolutely. But let me tell you what I would prefer we stopped doing: burning fossil fuels. And doing all those terrible things that we are doing to destroy our climate. You know, everyone's talking about the fact that we've had this amazing reduction in CO2 because we're not driving cars. I've got to tell you, that is the best evidence that climate change is man-made. All those climate change skeptics who don't think climate change is man-made, we have just had a worldwide demonstration on what people do to create climate change. And so what we need to do is stop and move to a green economy.
GB:在一定程度上绝对会有帮助。 但我想说的是 不建议大家去做的事: 燃烧化石燃料, 还有做那些会让我们破坏气候的 糟糕的事情。 所有人都在谈论一个事实—— 因为我们没有在开车, 所以我们极大减少了二氧化碳排放。 我得告诉你, 这是“人为因素造成了 气候变化”的最佳证据。 所有那些气候变化论怀疑者, 不认为气候变化 是人为因素造成的人, 我们刚在世界范围内 亲眼目睹了一场演示—— 人类如何创造了气候变化。 所以我们需要做的 就是停下脚步, 转向绿色经济。
DB: Here, here.
DB:说得太好了。
CA: Thank you so much for those, I'll dip back in at the end with maybe a couple more. Thank you for this.
CA:非常感谢您的回答, 我在最后可能还会带着几个问题 再次参与你们的讨论。 再次感谢。
DB: So we're waving the flag for masks. But also, one of the things that has become clear from this is that COVID-19 is not the great leveler that maybe some had hoped it was. Some communities are experiencing much worse, significantly worse outcomes than others. Why is that?
DB:所以我们正在号召口罩的使用。 但与此同时,有一种情势 也由此变得更加清晰了—— 即新冠病毒所呈现的并非是 有些人所认为的人人平等的局面。 有些社区正面临着 比其他社区要糟糕得多的情况。 为什么呢?
GB: We're talking principally about the African American and Latino communities that seem to be disproportionately impacted if they get the disease. And it's because of exposure, primarily. Those populations have more public-facing jobs. So, you know, bus drivers, grocery clerks, working in long-term care facilities, nursing homes, in meatpacking facilities, chicken farms. So that's why they're much more -- going to be exposed to the disease. Susceptibility. Lots of chronic disease. So we know that particularly African Americans have disproportionate amounts of diabetes, heart disease, lung disease, and because of those chronic diseases, we found early on that that virus is more detrimental to those populations that have those diseases. And so that's the big issue here. That is what's causing those differentiations and it's really a challenge, because in many ways, those are many of the people that we have decided are essential employees and have to go to work.
GB:我们所说的主要是非裔美国人 和拉丁裔社区, 一旦感染了这个疾病, 他们似乎会遭受不成比例的巨大影响。 这主要是因为暴露程度。 他们中更高比例的人 在从事面向公众的工作, 例如公交司机、 杂货店店员, 很多人在长期护理机构、 疗养院、 肉类包装工厂, 养鸡场等场所工作。 这也就是为何他们 更可能遭受疾病侵袭。 还有易感性, 以及许多慢性疾病。 尤其是非裔美国人, 很多人都患有糖尿病、心脏病、 肺部疾病, 因为这些慢行疾病, 我们在早期就发现, 病毒针对这类人群更为致命。 所以这是一个大问题。 这就是造成这些差异的原因。 这的确是一个挑战, 因为在许多方面, 他们中的很多人 是我们的政策所认为的 关键岗位的员工, 必须坚持上班。
DB: That's right. So what is, in your view, the public health intervention to protect these essential workers, if you have ideas on that front?
DB:没错。 那么在您看来, 怎样的公共卫生干预 可以保护这些关键岗位的员工, 如果您在这方面有任何想法的话?
GB: I absolutely do. We started this by a testing strategy based on symptoms. And now that we have enough tests, we need to make sure that not only people get those tests for clinical reasons, and people who have symptoms, but also begin to prioritize people who are public-facing, who are essential workers. So, certainly people working in nursing homes, hospitals, etc., but bus drivers, security guards, grocery store clerks. They need to be tested, and they need to have testing with the periodicity that will secure them, their families, and give everyone the trust that they're not going to be infected and we're not going to infect them. People who work in meatpacking plants, as an example. And we've seen the real tragedy of what's going on in the meatpacking plants, because they are working in an environment where they're shoulder to shoulder. There are some other things they need to do in terms of figuring out how to give them physical distancing on the assembly line, that's going to be important. But again, Uri's idea is not a bad idea for this nation to consider, for many of those industries to think about.
GB:肯定的。 我们从基于症状的检测策略开始。 现在我们已经进行了 足够的检测, 我们不仅需要确保 那些临床需求和出现症状的人 能获得检测, 也需要开始优先考虑 面向供众的关键岗位工作者。 例如在疗养院和医院的工作人员, 还有公交车司机、保安、 杂货店员工,等等。 他们需要被检测, 而且需要定期被检测, 这能为他们和他们的家庭 提供一定的保障, 让所有人相信 他们不会被感染, 并且我们不会让他们被感染。 拿在肉类包装加工厂的工人 举个例子。 我们已经看到了, 肉类包装厂的情况相当严峻, 因为他们的工作环境 是人群密集的,大家肩并肩站着。 围绕着在生产线上 如何保持一定的物理距离, 有很多重要的事情 需要考虑。 但我要再次重申, 乌里的想法对于这个国家的情况 也是适用的, 值得很多类似行业参考。
DB: Yeah, we have to make sure that these truly are folks who are treated as essential workers, not sacrificial workers, it seems to me. And obviously, this is not just confined to the US.
DB:是的,我们必须确保 这些人被视为关键岗位工作者, 而非可牺牲的工人。 我是这么认为的。 而且显然,这不仅限于美国。
GB: Oh, absolutely. We're seeing these disparities not just in the United States, but in other countries as well. And they have a lot to do with race and class and the types of jobs that you do, the occupations that you do. And quite frankly, we should have thought about this when we saw the first data that showed that in China people with chronic diseases were much more at risk and had worse health outcomes. We would have sped up our actions right away, because, look, that's happened with every new disease that's come into the country.
GB:哦,绝对的。 我们不仅在美国看到了这些差异, 其他国家也是。 他们有大量的相关工作要做—— 关于种族和阶级, 你的工作类别, 还有你的职业。 而且老实说, 在第一次看到中国公开的数据时, 我们本就应该想到这些: 患有慢性疾病的人 处于更大的风险之中, 并有着更严重的健康后果。 我们本能立即加快我们的行动, 毕竟这是每个新疾病进入一个国家 都会发生的情况。
DB: So it seems like a lot of this goes back to that potential -- it's not an oxymoron, public health is everybody's job, and we need to adopt that. What does, in your view, a robust public health infrastructure look like? What would that look like?
DB:好像又回到了刚才的话题—— 这不是一种矛盾说辞, 公共卫生真的是每个人的工作, 我们需要积极采用这种方法。 在您看来, 一个健全的公共卫生 基础设施看起来是怎样的? 能为我们展望一下吗?
GB: Well, you know, anytime a new health threat enters our community, we ought to be able to rapidly identify it, contain it, and if we can mitigate it, for sure, and eliminate it if possible, and then put in all the protective measures that we had before. So that means having a well-staffed, well-trained governmental public health entity, just like we have for police, fire, EMS. It means that they've got to be well-paid, it means that they've got to be well-resourced. You know, we still have some of our contact tracers out there using pen and pads. And sending things to Excel Spreadsheets. No, we need the same kind of robust technology that the folks at, you know, any of the online retailers are using, whether it's Amazon, etc. We're still looking at data that's two years in the rear to make data-driven decisions. We need to be able to make immediate decisions. By the way, Taiwan, you mentioned them earlier, I remember being in Taiwan watching data come from infectious diseases, real time, from their electronic medical record system. So, you know, we can do this, the technology exists.
GB:应该说, 不论何时,一种新的公共健康威胁 进入我们社区, 我们都应该能快速鉴别 并控制它, 而且要尽量削弱它的威胁, 甚至彻底消灭它, 并且实行我们之前所有的 保护措施。 这就意味着,我们需要有 一个有良好人员配备且训练有素的 政府公共卫生机构, 就如同我们的警察、消防 和邮政特快专递(EMS)系统一样。 这意味着这些人需要有 良好的薪资水平, 意味着他们需要有充足的资源。 我们仍旧有一些联系追踪人员 在用笔和小本子在进行记录, 之后转换成 Excel 表格。 这样不行,我们需要 同样健全的技术支持, 那种任何在线零售商 都在使用的科技, 例如亚马逊之类的。 我们还在用两年前的数据 做着数据驱动的决策。 我们需要能够做出即时决策。 顺便一提, 你之前提及了台湾, 我记得之前在台湾的时候, 看到过感染性疾病的实时数据 从他们的电子医疗记录系统 自动录入更新。 所以我们可以做到的, 这样的科技已经存在了。
DB: Imagine that. Wow, real time health information, what a difference that would make. Do you think that technology can help us here, whether that's the Google-Apple collaboration or whatever else?
DB:想象一下, 实时卫生信息, 这能做出多大的改变啊。 所以您认为科技 在这个领域能帮助我们, 不论是谷歌和苹果的合作, 还是以其他的方式?
GB: Technology can help us, but it's not going to replace us. We're nowhere near where we can sit back and have our electronic avatar do our work for us. But the technology can outstrip our work. It can give us situational awareness. It can give us real time information. It allows us to send information from point A to point B for data analysis. It allows us to do second thinking, so we're doing all this modeling, it allows others to check our numbers right away. So it could speed up research. But we have to invest in it, and we have to continue it, because obsolescence is always the evil part of technology.
GB:科技可以帮助我们, 但不会替代我们。 坐在一边,让我们的 虚拟人物为我们工作—— 我们离这样的未来还很远。 但是科技可以超前于我们的工作, 可以帮助我们了解现实情况; 提供我们实时数据; 让我们能够进行数据传送 和数据分析; 让我们能够进行二次思考, 所以我们在做 所有这些建模的工作; 他人也能够立即检查我们的数据, 所以这的确可以加速我们的研究。 但是我们需要投资于科技, 而且我们需要不断投资, 因为过时的科技有害无利。
DB: And it looks like Chris is back with more questions.
DB:看起来克里斯 带着更多问题回来了。
CA: Yeah, I guess we're getting close to the end, but the questions keep coming in. There's one here from Neelay Bhatt. "What role do you see parks, trails and open space play in assisting larger public health goals?"
CA:是的,时间快要到了, 但我们还在不断收到新的问题。 有一个来自尼莱 · 巴特的问题: “您认为公园、步道和开放空间 在协助实现更大的公共卫生目标方面 能扮演什么角色?”
GB: You know, green space is absolutely essential, and the ability to get out and walk and exercise, having sidewalks, so that you can have communities that are walkable, bikeable and green for utilization of all ages, it's good for our mental health, it's good for our physical health. And I always tell folks, you know, it's a great place to go when someone's gotten on your last nerve.
GB:绿色空间绝对很重要, 能够出门走路和运动, 有街边步道让你能够 在社区自由行走、骑行, 这是适合各个年龄段的 环保健身方法, 有利于我们的心理和身体健康。 我时常说, 当有人不知所措时, 这是一个理想的去处。
CA: Indeed. Here we have one anonymous question. Where possible don't go anonymous, because we're all friends here when all said and done. Probably someone ... Anyway. Let's see, but it's a good question. "There are many who are highly suspicious of what the real experts are saying. What have you found to be effective in helping the highly suspicious be less suspicious and more trusting?"
CA:确实。 我们还有一个匿名问题—— 请尽量不要匿名—— 因为这里所有人都是我们的朋友。 可能有人……无所谓了。 让我们看看, 这倒是个很好的问题。 “很多人高度怀疑专家说的话。 你知道怎样能有效帮助 那些持高度怀疑态度的人 变得不那么多疑,而是更加信任?”
GB: Tell the truth. If you make a mistake, acknowledge it and correct it right away. Be consistent. And don't say stupid stuff. And far too often that happens. And you know, one of the interesting things, we've already been through this with the mask discussion. You know, traditional wisdom was that we only had people wear the mask if they were infectious, or you're in a health care environment where there was a high risk of getting the disease. And then we said, no, it's OK for everybody to wear a mask. And that's because we learned eventually, and became much more believable, in the science that we had asymptomatic spreading. But we did not communicate it very well. We said, oh, no, no, we're changing our minds, everybody can wear a mask, after telling people not to wear a mask. And then we didn't spend enough time explaining to people why. So we lost trust. So we need to do a better job of that. And then our leaders need to be very careful what they say when you have a bullhorn. And by the way, I've made mistakes, I've said things on TV that were just wrong, because I was wrong. And I've tried very hard to try to correct those as quickly as I can. All of us do that, but you have to be strong enough and have a strong enough personality to say when you're wrong and then correct it. Because at the end of the day, once you've lost trust, you've lost everything.
GB:传递真相。 如果你犯了错,承认自己的错误, 并马上纠正过来。 说话要前后一致。 不要说蠢话。 这种事太常见了。 有意思的是, 我们已经针对口罩进行了讨论。 从传统的角度来说, 只有具有传染性的人 才需要戴口罩, 或者你是医护人员, 需要在高风险环境下工作。 之后我们说, 不,每个人都可以戴口罩。 因为我们最后了解到, 也更加确信, 有科学研究证实了 无症状传播的说法。 但我们并没有进行很好的沟通。 在我们告诉人们不要戴口罩后, 我们说:“哦不,不, 我们改变主意了。 每个人都可以戴口罩。” 之后我们没有花足够的时间 为大众解释原因, 所以我们失去了人们的信任。 所以在这方面,我们需要做得更好。 还有,我们的各位领导人, 当你手持话筒, 你需要非常小心。 我也犯过错误, 我在电视上也说过错话, 因为我当时的理解是错误的。 但我努力尝试尽快 改正那些错误。 我们所有人都犯错, 但你需要足够坚韧, 有一个坚强的个性 去承认你的错误, 并改正它。 因为到头来,一旦你失去了信任, 你就已经失去了一切。
CA: Well if I might say so, just the way in which you're communicating right now, I mean, to me, that is a means of communication that engenders trust. I don't know what magic sauce you have going there, but it's very, very compelling listening to you. Thank you so much for this. David, do you have any other last cues?
CA:也许我能这么说, 您刚才沟通的方式 对我来说, 是一种能够产生信任的 沟通方式。 我不知道您有什么小诀窍, 但听您所分享的这些, 非常扣人心弦。 非常感谢。 戴维,你还有什么要说的吗?
GB: I've made lots of mistakes.
GB:我犯过很多错误。
DB: Yeah, no, but it really has been a real pleasure to have you join us, and thank you for that. Just one final question if I may. You've been doing this for a while, what gives you hope looking forward?
DB:好的,不, 能有您加入我们今天的这场对话 真的是我们的荣幸,谢谢。 如果可以,我还有最后一个问题。 您在这行已经干很久了, 是什么让您怀揣希望继续前行?
GB: You know, let me tell you something. The one thing that gives me hope is when I see people taking care of their friends and family members. I mean, drive-by birthday parties. I saw that on the news today. People who are calling their friends. I've heard from people that I haven't talked to in years, who are just calling me to say, "I haven't talked to you for a long time. Are you OK?" So do more of that. And the trust we've had in one another, and the love we've shown, it's just been absolutely amazing, so that gives me hope.
GB:我想说, 一件给我带来希望的事是, 我看到了人们悉心照顾 他们的朋友和家人的场景。 比如“驱车经过”的生日聚会, 我今天刚在新闻上看到这件事。 人们在打电话给他们的朋友们。 我接到了好几年没联系的 朋友的电话, 他们只是打来问候我: “我好久没和你联系了, 你还好吗?” 所以多联系联系你的朋友吧。 我们所拥有的对彼此的信任, 我们之间所表达的爱, 简直太不可思议了, 所以这给我带来了希望。
DB: Humanity for the win in the end.
DB:以人性为本,我们终将取胜。
GB: Yeah.
GB:没错。
DB: Well, thank you so much, Dr. Benjamin, for joining us and for sharing your wisdom.
DB:非常感谢本杰明博士的参与, 并与我们分享您的智慧。
GB: Glad to be here.
GB:很高兴能参与这场对话。
CA: Yes, thank you.
CA:是的,谢谢您。
GB: You guys be safe. Your families be safe.
GB:请你们保重。 你们的家人也保重。
DB: Thank you, you too.
DB:谢谢,您也是。