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.
大衛 · 比爾羅(大): 我很榮幸向大家介紹 喬治 · 本傑明博士, 他是美國公共衛生協會的執行董事, 在醫療和公衛這兩個職業領域中 都有很長的經歷和卓越的職涯。 請歡迎喬治 · 本傑明博士。
Georges Benjamin: Hey, David, how are you?
喬治 · 本傑明(喬): 嘿,大衛,你好嗎?
DB: I am good, how are you, Dr. Benjamin?
大:我很好。本傑明博士你好嗎?
GB: I'm here. (Laughs)
喬:我還在。(笑聲)
DB: Hanging in there. Good.
大:要撐住。很好。
GB: Hanging in.
喬:在撐著。
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?
大:我們知道目前的關注焦點 是重新開放,至少我會這麼說。 我們剛剛才聽到了可能會。 但很顯然, 很多國家已經以某種 形式開始開放了, 且我相信,目前為止, 美國這裡的五十州 都以某種形式開放了。 我們要如何以明智、 安全的方式做好重新開放?
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.
喬:我們確實需要以明智、 安全的方式來重新開放, 那就表示,首先我們不能忘記 把疫情曲線拉下來的那些公衛措施。 那些措施包括像是 在咳嗽或打噴嚏時要遮住口鼻, 戴口罩、洗手、 和他人盡可能保持實體距離。 想想看我們所做的一切, 早上我們出門工作之前所做的, 在職場做的。 而且我們要一直十分小心 跟過去兩個月很多人一樣, 在接下來的三個月也要延續, 因為這疫情尚未結束。
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?
大:是的。 有可能像烏里(艾隆)提到的, 會有更多波疫情。 看起來,我們所有人都有責任 要把公衛當作另一份工作。 對嗎?
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.
喬:我時常主張, 現在大家都真確知道公衛是什麼了, 那麼大家也應該持續將公衛 視為他們的另一份工作, 不論你是收垃圾的人、 在雜貨店工作的人、 或者公車司機, 或者像我一樣, 從事公衛方面的工作, 比如醫生或護士, 大家都應該把公衛 融入到他們的日常生活當中。
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?
大:就你看來—— 所以我們大家都是公衛專業人士, 就你看來,當國家重新開放, 我們要預期什麼樣的新常態? 那會是怎樣的情況? 或者,身為公衛專業人士, 你希望是怎樣的情況?
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.
喬:如果我能揮一揮魔杖, 我會清楚認知 大家會做更多公衛的事, 比如洗手 和思考在公共場所時 要怎麼做才安全。 不久前, 你進到車內, 還沒有繫上安全帶的習慣。 現今大家都會繫, 且完全不假思索。 我們大部分人不抽菸 是因為我們知道抽菸對我們不好。 我們大部分人在過馬路時 會先看左右兩邊。 我們大部分人 在我們的房子裡 會做防止摔倒的措施。 當我們在這疫情向前邁進時, 我希望大家會更加注意 可能會讓我們受到感染的事物。 所以,東西要清洗、要消毒。 更重要的是,如果生病就不要去工作。 我希望僱主會提供所有人帶薪的病假, 大家才能夠待在家裡。 是的,那是額外的成本, 但我可以告訴各位, 我們現在已經學到 不這麼做的成本更高, 是數十億,數十億,數十億美金。 相較之下有薪的病假就便宜多了。
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?
大:我想,在美國,我們很羨慕 所有那些健康照護系統 比我們更完整、全面的國家。 你是否認同,戴口罩就是象徵了 「視公衛職業為另一份工作」的心態?
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.
喬:這很有趣。 我們在亞洲的同事有口罩—— 戴口罩是種多年的文化。 我們一直竊笑這件事。 當我到海外, 當我看到有人戴口罩,我總會竊笑。 當然,這次疫情剛開始時, 我們呼籲的是,需要 戴口罩的是被感染的人, 當然還有健康照護工作者, 因為我們認為他們 身處在高風險環境中。 但我認為,戴口罩 很可能會變成我們文化的一部分。 我們已經看到,它可能無法 成為我們海灘文化的一部分, 雖然現在應該要這麼做。 但我確實認為,我們會在各種地方 看到更多人戴口罩。 我認為這是合理的。
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?
大:是的,戴口罩表示你關心其他人, 且你具有公衛的精神。 說到亞洲, 哪個國家做得很好? 你已經觀察全世界 並和你的同儕交流好一陣子了, 哪個國家做得好? 我們能從這些好典範身上學到什麼?
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.
喬:在許多層面上,南韓是個典範。 其實到頭來,中國也做得很好。 但所有這些發病率和死亡率 比我們低的國家,都有個秘密, 就是他們很早就做很多的檢測, 它們做接觸者追蹤、隔離、檢疫, 順道一提,這些都是公衛實做的基礎。 它們很早就做,且做了很多; 順道一提,雖然它們正在重新開放, 且開始出現突如其來的激增, 接又會回到基本的公衛實做: 檢測、隔離、接觸者追蹤, 以及在可能的範圍內 盡可能做到對大眾公開資訊, 因為很重要的是要讓大眾知道 有多少確診案例、在哪裡, 這樣才能得到大眾的配合。
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?
大:所以,檢測、 接觸者追蹤,以及隔離, 那些老方法都不需要複雜的技術。 為什麼有些國家卻很難實施? 是什麼在扯我們的後腿? 是電子醫療記錄? 是某種新奇的小玩意兒? 或者只是也許因為過去 一百年來在公衛上的成果 造成我們過於自信了?
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.
喬:要知道,我們 可說是個藥丸社會。 我們認為什麼都有藥丸可以治。 遇到藥丸無法解決的, 就用手術來搞定。 預防性工作, 我們在預防性工作上 所做的投資完全不足。 我們根本沒做足夠的投資, 去建個強大、穩固的公衛系統。 看看現今在美國社會的真實情況, 你非常容易就能知道 雜貨店有什麼現貨, 亞馬遜知道你的各種資訊, 但你的醫生卻沒有同樣的工具。 凌晨三點時 仍舊很難取得你的心電圖、 醫療記錄,或過敏清單, 若無法告訴醫生你有什麼,就會如此。 我們沒投資建造穩固的系統。 關於這次疫情,很有趣的一點是 它創造出了一種環境, 現在這環境得要仰賴視訊醫療, 視訊醫療已經存在許多年了, 但我們過去不怎麼用。 但現在它可能會變成新的標準。
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?
大:但,還似乎—— 很顯然, 健康照護系統超級穩固的那些國家, 比如台灣就做得很好, 但,似乎就連健康照護系統 被認為沒那麼穩固的國家, 比如非洲的迦納, 防疫也做得很好。 那些國家的秘方是什麼?
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.
喬:它們的接觸狀況還在很初期, 希望他們之後不會有一波疫情, 仍然有可能。 但到頭來, 就執行好、做完善公衛實做來說, 所有疫情控制很好的國家 都做到了。 我們是個大國,是很複雜的國家。 是的,一開始我們沒做好檢測。 但我們不應該再重犯 我們過去三個月犯過的錯誤, 因為我們還要再熬幾個月。 現在我們已經知道做錯了, 我想鼓勵大家,下次要做對。
DB: That seems smart.
大:那很明智。
GB: And the next time is tomorrow.
喬: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?
大:沒錯。 已經開始了。 在我看來, 讓我這樣比喻, 一些國家的系統已經有了抗體, 因為它們經歷過像是 伊波拉或第一波的 SARS。 過去接觸過這類公衛危機, 是否是個關鍵因子?
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.
喬:這次的病毒很不一樣。 雖然有些早期的證據顯示 對 MERS 和 SARS 冠狀病毒, 我們或有一些早期的防護, 有些早先的研究探討這些, 那並不是解決方案。 這裡的關鍵秘方在於 優良、實在的公衛實做, 那才是關鍵秘方所在。 我們不該想去尋找什麼很玄的東西, 或期待有種特別藥丸能拯救我們。 重點在於實實在在地實做公衛, 因為,順道一提, 這次是個險峻的大流行, 但它不會是最後一次大流行。 我們得要為下次大流行做好準備。 我們認為這次很慘, 想像如果換成是 伊波拉能透過空氣傳染, 或 MERS 能透過空氣傳染。 看看電視上的電影就知道了。 雖然這次的狀況很慘, 我們這次仍然是躲過了 非常糟糕的慘狀。
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?
大:是的,MERS 可不是開玩笑的, 謝天謝地它沒有像 SARS 冠狀病毒 那麼容易傳染。 不過,這是—— 這些疾病都是人畜共患病, 它們從動物身上跳到我們身上, 而那些動物外頭有的是。 很顯然,人類正在以一種 前所未有的急迫方式侵佔大自然, 不論是氣候變遷或侵入森林。 這是否只是個新常態, 我們應該預期 將來常會有疾病大流行嗎?
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.
喬:的確定期會出現大流行, 所以這次並非第一次大流行。 我們遇過好幾次, 一百年前,1918 年的流感, SARS 是很嚴重的感染, 雖然 SARS 冠狀病毒沒有到這麼慘。 我們也有過禽流感, 那是個困難的挑戰, 還有豬流感。 我們過過茲卡病毒。 我們已經經歷過數次新疾病大流行。 這些新出現的疾病常常發生, 在許多層面上, 我們一直很幸運, 因為我們能及早辨識它們, 將它們控制住。 但現在我們身處新環境, 在這環境裡,人可以造出這些病毒。 這次不是, 我們目前的最佳判斷是 這次病毒並非人造的。 病毒並不像是從實驗室流出來的。 但在我讀書時,我們就已知道, 培養病菌/病毒非常地複雜。 現今的狀況並非如此。 我們必須要保護我們自己, 對抗天然產生的感染, 也要對抗人類創造的感染。
DB: Plus we have other, kind of, threat multipliers, like climate change, that make pandemics like this that much worse.
大:此外,我們還有 其他會讓威脅加倍的因子, 比如氣候變遷, 會讓這類的疫情更糟糕。
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.
喬:我才說過,在這次疫情之前, 在人類已度過的威脅中, 最大的就是氣候變遷。 但,這是很難纏的氣候變遷。 讓我告訴各位, 我們目前要面對的大挑戰 就是我們遇到了疾病大流行, 且我們尚未將它控制住, 一旦進入颶風季, 還有氣候變遷, 會讓颶風的猛烈度大增。 因此我們可能會有個帶勁的夏天了。
DB: And here's Chris with, I think, a question from our audience.
大:克里斯帶來了一個觀眾的提問。
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(克): 其實是很多提問。 喬治,大家對你 所談的內容很感興趣。 開始了,第一個是 吉姆 · 楊問的問題: 「我們要如何處理 不相信疫情嚴重性的人?」
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.
喬:你得要持續將真相傳達給大眾。 這種疾病的其中一項特性就是 它不會放過任何人、 不認得黨派, 也無視地理。 有很多人,特別是在鄉村社區, 還不了解這些, 因為之前疾病還沒襲向他們, 他們不相信這疫情是真的。 現在有很多這類社區 被這疾病給蹂躪。 我們只得—— 說「我早告訴過你了」並不妥當。 妥當的說法是: 「聽著,現在你了解了, 就加入我們,盡一份心力, 一起解決這些問題吧。」 但這將會持續一陣子。 如果變成地方性流行, 意即,經常會有低度的流行發生, 那麼人人都會經歷到。
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?"
克:謝謝你。 接著是勞勃 · 波克維茲的問題。 「我們似乎忽視了公衛, 且投入的資金不足, 這病毒讓我們措手不及。」 若這問題顯示於畫面,可以看一下。 應該有某種魔法讓它顯示出來。 「若要為下次的公衛危機做準備, 我們現在最優先要做的是什麼?」
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.
喬:現在我們得要確保我們能規劃 投入資金、資源、訓練、人員。 順道一提,我們下一個公衛危機 並不是在十年、二十年後。 下一個潛在危機是與流感變成共病, 我們知道在今年秋天就會發生, 因為每年秋天都會有流感, 會在新型冠狀病毒延續下去 或達到高峰時,成為共病。 我們將會見到 特性非常相似的疾病過程呈現, 我們得想辦法把新型冠狀病毒 和流感區別開來。 因為我們有流感疫苗, 但我們還沒有 新型冠狀病毒的疫苗。 希望疫苗在一年左右會出來。 但這就要再看看了。
DB: So get your flu shots.
大:所以,要去打流感疫苗。
CA: Yeah. Indeed, in fact, David Collins asked exactly that question. "What is the likelihood of a vaccine before the next wave?"
克:是的。 的確,事實上,大衛 · 柯林斯 就問了這個問題。 「疫苗能在下一波疫情發生之前 推出的可能性有多高?」
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.
喬:要知道,我們過去開發 最快的疫苗是麻疹疫苗, 也花了四年。 現在很多條件都不同了,對吧? 我們從 SARS 冠狀病毒疫苗著手。 已經做過了許多動物實驗, 已經開始非常早期的人體實驗。 各位都知道,不久前才宣佈, 這種疫苗在獼猴身上似乎有效, 有些證據顯示, 至少在極少數的人身上, 這種疫苗似乎是有效且安全的。 我說的是極少數的人, 非常少。 現在要進入第二、第三階段實驗。 是的,大衛用兩隻手比出人數了, 是的,沒有幾個人。 這個結果告訴你的是, 若不是這些人很幸運, 就是疫苗有效。 在給數千人施打疫苗之前, 我們不會知道答案。
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?'"
克:接著是一位 TED 研究員 問的一個重要問題。 「我們要如何訓練人民 了解公衛的意涵? 特別是當對象是不相信 自己對「公眾」有責任的人?
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.
喬:我會提醒大家, 當公衛發揮得最好時, 就是沒有事情發生。 如果沒有事情發生, 當然我們就沒有功勞。 所以,在美國之所以不需要 每個人每天早上起來 還得自己燒開水, 就是因為公衛。 之所以,如果你發生車禍, 發生撞車, 你有繫上安全帶, 車上有安全氣囊, 你沒在車禍中身亡, 就是因為公衛。 空氣之所以夠安全可以呼吸, 食物夠安全可以食用, 就是因為公衛。 你的孩子之所以沒穿著會著火的衣服, 就是因為我們有抗火的布料。 那是必要的。 你之所以在下樓梯時不會絆倒, 就是因為我們真的研究過 如何建造樓梯, 讓上下樓梯的人不會絆倒。 那其實就是公衛介入的功勞。 所以,建立好的環境、醫療, 所有這類事物、疫苗, 這些都是公衛。 那就是為什麼公衛一直都在。 你可能無法置信它有那麼重要, 但我們生活裡不能沒有它。
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?"
克:也許有一天我們能夠 一起構思個美國的醫療系統 能夠真正激勵公衛系統, 那將會是件好事。 大衛,如果可以, 我需要一直繼續提問, 因為這邊不停的有提問。 這裡有一個來自 賈桂琳 · 阿士比的提問, 一個對於每位家長 非常重要的問題: 「針對送孩子返校上課 您有什麼建議嗎?」
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.
喬:這對我也是個難題, 我自己就有三個孫子。 還好我的孫子們比我嫻熟得多。 現在他們在遠程上課。 我認為這將是一個挑戰, 考慮將孩子送回去上學。 我們真的要知道 孩子們的傳染性有多強, 以及倘若他們感染了,應對力如何。 目前看來似乎 除了一小部分得罕見疾病的孩子, 孩子相當能夠承受這個疾病。 但中心問題卻是: 多少感染過的孩子 會把病菌帶給你, 或帶給爺爺奶奶。 那很重要。 你也曉得,嘗試去告訴一個八歲小孩 不要跟他的朋友互動 是個大挑戰。 對了,不讓 17 歲的孩子跟朋友接觸 是個更大的挑戰。 所以,我們真要 好好地教育這些孩子, 必須想好如何錯開他們的行程。 烏里對於人力的想法 對於學校可能是個有趣的概念, 因為這想法減少課室裡學生的數量。 還有,小班教學的質量也會提高, 前提得要有足夠數量的老師。 因此那可能是限制感染率增長的一步。
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?"
克:好的,最後一個問題 來自史提芬 · 潘特奈克。 口罩,關於口罩的建議。 我把那個關了。行了。 關於口罩的建議似乎有所改變。 「在城市中生活和工作的美國人 戴上口罩會不會更好? 能有助於減少他們每天碰到的 空氣污染顆粒?」
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.
喬:當然這也許有幫助。 但是讓我告訴你, 我會更偏向於不做什麼: 不燒礦物燃料。 並且不再做那些可怕的事情, 那些正在毀掉我們氣候的事情。 知道嗎,大家都在講 我們現有的美妙改變: 二氧化碳減少,因為我們不開車了。 我一定要說, 那是最好的證明, 證明氣候變化是人為導致的。 所有氣候變化的質疑者, 那些不認為氣候變化是人為的人, 我們就剛有了一個全球的展示, 展示了人類做了些什麼 造成氣候變化。 因此我們需要停止, 轉成環保的經濟。
DB: Here, here.
大:這裡,這裡。
CA: Thank you so much for those, I'll dip back in at the end with maybe a couple more. Thank you for this.
克:真的非常感謝你的貢獻。 我會在最後再回來, 也許再帶回一些問題。 感謝。
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?
大:我們高舉戴口罩的大旗。 不過還有別的。 其中一樣也逐漸從中變得清晰, 就是新冠肺炎可能不是 某些人希望的那樣 能夠撥亂反正。 一些社區正在經歷 明顯比其它社區更糟糕的結果。 為什麼呢?
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.
喬:我們主要在討論 美國非洲裔和拉丁裔的社區 看起來是不成比例地被疫情影響到。 然而這主要是因為暴露程度, 這些人大都有面向大眾群體的工作, 你也知道,像巴士司機、 雜貨店店員、 長照或療養院的工作人員、 在包裝肉食工廠或養雞場工作的人。 這就是為什麼他們會 更容易接觸到這個疾病, 容易被感染。 很多慢性疾病。 我們了解到特別是美國的非洲裔 有不成比例的糖尿病、心臟病的案例, 還有肺病。 因為那些慢性疾病, 我們早就發現這個病毒 對原患有那些疾病的群體危害更大。 因此這是一個很大的問題。 這是造成不同的原因。 這也是一個真正的挑戰, 因為在很多方面, 這些人正是 我們當作必要的基礎工作人員, 他們必須要上崗上班。
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?
大衛:沒錯。 在你看來,公衛的介入 來保護那些必要的工作人員, 你對這有什麼見解嗎?
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.
喬:當然我有。 我們一開始嘗試的策略 是在症狀的基礎上。 而現在有了夠多的測試, 我們需要確保不僅測試 那些上醫療診所和有症狀的感染者, 還要優先重視那些面向大眾的人, 那些必要的工作人員。 這絕對包含那些在療養院、 醫院等地點工作的人, 還有巴士司機、保全人員、 雜貨店店員。 他們都需要被檢測, 需要週期性檢測。 這會保護他們和他們的家庭, 讓大家信任他們不會被感染, 我們也不會感染他們。 以在肉食包裝設施裡工作的人為例, 我們已經目睹這真正的悲劇 在肉食包裝廠上演著, 因為他們在肩並肩的環境裡工作。 有些其他的事情需要去做, 比如找到一個讓他們 在組裝線上相互隔離的方式, 這很重要。 但是,尤里的主意 是個值得我國考慮的好主意, 值得很多工業去思考。
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.
大:對,我們需要確保這些人, 這些被視為必要的工作人員不被犧牲。 也很明顯,這不僅限於美國。
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.
喬:當然。 我們現在所見到的不平等不僅在美國, 在其他國家也存在。 並且他們都跟種族和階級大大相關, 和你的工作型態、行業相關。 坦白來講, 我們在看到第一批數據時 應該早就想到, 數據顯示了在中國 患有慢性病的人們 處於更大的危險, 健康預後的情況更差。 我們本應立馬開始迅速行動。 因為,你看,每有新疾病 來到國內就會這樣。
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?
大:似乎很多事情能追溯到潛在—— 這不是矛盾, 公衛是每個人的職責, 我們必須採用。 在你的看法裡, 什麼看起來會是個 穩固強壯的醫療系統? 這會是什麼樣的?
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.
喬:好的, 每當新的健康威脅進到我們的社區, 我們應該要能夠立刻辨識它, 不讓它擴散; 如果辦得到的話,當然要削弱、消除它; 實施我們之前所有的防護措施。 就是要有 人手充足、訓練有素的政府公衛部門, 就像我們在警察、消防、 急救等方面做的那樣。 這也意味著他們必得有好薪水、 有充足的資源。 我們還有些追蹤接觸的人員 在使用筆和平板, 填 Excel 的表格發送信息。 不,我們需要強健的科技, 就像任何網店賣家在使用的, 不論是亞馬遜還是其他。 我們還在看落後兩年的數據 來做以數據為準的決定。 我們需要能夠立刻做決定。 對了,台灣。 你剛剛提到了他們。 我記得我在台灣的時候 看傳染病的實時數據, 來源是他們的電子醫療記錄系統。 所以我們做得到,已有這科技。
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?
大:就想像一下。 哇,實時健康信息, 這真能造成極大的差異。 你覺得科技能幫到我們嗎? 不論是谷歌與蘋果合作,還是其他?
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.
喬:科技可以幫到我們, 但是不能代替我們。 我們現在並不處於可以閒置的時間點, 也不能讓電子虛擬的人物 做我們的工作。 但是科技可以減少我們的工作量; 可以提供我們對情況的認知, 可以給我們實時的信息, 讓我們能夠從一個地方 到另一個地方發送信息 用來做數據分析; 讓我們可以做第二階段的思考。 我們在建造模型 以讓其他人能馬上檢查我們的數據, 加速研究的進展。 但是我們必須要持續投資, 因為科技最惡名昭彰的就是過時了。
DB: And it looks like Chris is back with more questions.
大:看來克里斯回來 要提更多問題了。
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?"
克:對的,我想我們已經 接近尾聲了, 但是提問還是源源不斷。 這裡有一個來自尼蕾 · 巴哈特。 「在你看來,公園、道路和露天表演 在協助公衛目標中擔任什麼角色?」
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.
喬:綠化的空間絕對必要。 還有,能夠出去走走、鍛鍊, 有一些人行道,可以讓你 在社區裡也能徒步行走、騎單車, 還有適合所有年齡層的綠地, 有助於我們的精神健康、身體健康。 我一直都告訴大家, 這是有人惹火你時的好去處。
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?"
克:沒錯。 這邊有一個匿名的提問。 請盡量不要匿名, 因為在所有層面上 我們這裡都是好朋友。 但是有可能......不管啦。 我們來看,這是個好問題。 「還有很多人質疑 真正專家說的話。 您有找到什麼有效的辦法 可以幫助這些質疑者 不那麼多疑嗎?」
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.
喬:其實說實話, 如果你犯了一個錯, 就承認,立馬改正它, 做個一致的人。 不要胡言亂語, 那已經太多了。 而且有一件非常有趣的事就是...... 我們已經討論過了,談口罩的時候, 傳統的想法是 只在有傳染性時才需要戴口罩, 或者在一個醫療的環境下, 那裡有非常高的感染風險。 然後我們說, 不,所有人都可以戴口罩, 這是因為我們終於學到了, 也更有證據顯示, 根據科學,無症狀感染是存在的。 但是先前未好好地溝通, 我們之前說,喔,不, 現在我們改口了, 所有人都可以戴口罩。 這是在告訴人們不要戴口罩之後, 而現在我們沒花足夠時間解釋為什麼。 因此我們失去了信任。 所以我們需要在這方面加強。 還有我們的領導人 需要非常小心言行。 並且,我犯了一個錯誤, 我曾在電視上說了一些 現在錯誤的事情, 我錯了。 我已經努力嘗試改正那些錯誤, 在我所能之內。 我們都會犯錯, 但是你要夠堅強, 有足夠堅韌的人格,承認你犯了錯, 然後改正。 因為到最後,一旦你失去了信任, 你就失去一切。
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?
克:好的,如果非要我講的話, 就是剛剛你溝通的方式, 我想說,對我而言, 那是一種可以引發信任的溝通方式。 我不知道你用了什麼魔法秘方, 但是你說的話是非常令人信服的。 非常感謝您的參與。 大衛,你有什麼最後的提示嗎?
GB: I've made lots of mistakes.
喬:我犯過很多的錯誤......
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?
大:是的,但是...... 真榮幸有你的參與。感謝你。 如果可以的話,就問最後一個問題。 你已經做這做一陣子了, 是什麼給予你向前看的希望?
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.
喬:讓我告訴你, 給我希望的是 當我看到人們照顧家人和朋友時, 像是生日派對—— 我今天在新聞上看到—— 人們跟好友通話—— 好久不見的老友來電聯繫,告訴我: 「我好久沒有聯繫你了。 你還好嗎?」 讓我們多多聯繫。 還有我們相互之間的信任, 和我們表達的愛,絕對美妙。 它們都給我希望。
DB: Humanity for the win in the end.
大:人性是最後的贏家。
GB: Yeah.
喬:對。
DB: Well, thank you so much, Dr. Benjamin, for joining us and for sharing your wisdom.
大:好,本傑明博士,太感謝您了, 感謝您能參與,和我們分享智慧。
GB: Glad to be here.
喬:很榮幸在這裡。
CA: Yes, thank you.
克:感謝。
GB: You guys be safe. Your families be safe.
喬:祝您們平安, 家人也平安。
DB: Thank you, you too.
大:謝謝,你也是。