Helen Walters: So, Chris, who's up first?
海伦 · 沃特斯(Helen Walters): 克里斯,第一位嘉宾是谁?
Chris Anderson: Well, we have a man who's worried about pandemics pretty much his whole life. He played an absolutely key role, more than 40 years ago, in helping the world get rid of the scourge of smallpox. And in 2006, he came to TED to warn the world of the dire risk of a global pandemic, and what we might do about it. So please welcome here Dr. Larry Brilliant. Larry, so good to see you.
克里斯 · 安德森(Chris Anderson): 有一个人一辈子 都在担心传染病大流行。 四十多年前,他在帮助全世界 扑灭天花病毒的过程中, 起到了绝对关键的作用。 在 2006 年, 他来到 TED,提醒全世界 全球传染病大流行的严峻风险, 以及我们该如何应对。 那么,让我们欢迎拉里·布里恩特博士 (Dr. Larry Brilliant)。 拉里,很高兴见到你。
Larry Brilliant: Thank you, nice to see you.
拉里 · 布里恩特: 谢谢,我也很高兴见到你。
CA: Larry, in that talk, you showed a video clip that was a simulation of what a pandemic might look like. I would like to play it -- this gave me chills.
克里斯: 拉里,在那次演讲中, 你给我们看了一段 模拟传染病大流行的视频。 我想在这里播放一下 —— 它让我浑身起鸡皮疙瘩。
Larry Brilliant (TED2006): Let me show you a simulation of what a pandemic looks like, so we know what we're talking about. Let's assume, for example, that the first case occurs in South Asia. It initially goes quite slowly, you get two or three discrete locations. Then there will be secondary outbreaks. And the disease will spread from country to country so fast that you won't know what hit you. Within three weeks, it will be everywhere in the world. Now if we had an undo button, and we could go back and isolate it and grab it when it first started, if we could find it early and we had early detection and early response, and we could put each one of those viruses in jail, that's the only way to deal with something like a pandemic.
拉里 · 布里恩特(TED2006): 我想给大家看一段 模拟传染病大流行的视频, 这样比较直观。 比如说,假设第一个病例发生在南亚, 一开始它传播得比较慢, 你能看到两三个离散的地点。 接着会有二次爆发。 然后疫情会在国与国之间传播, 速度如此之快, 让你完全摸不清状况。 在三周之内, 病毒就会遍布全世界。 如果有一个 “撤销” 键, 能让我们回到 疫情刚开始的时候, 马上进行隔离与遏制, 如果我们能尽早发现、尽早排查、 尽早响应, 我们就能把每一个病毒都“关”起来。 这就是应对全球传染病大流行 唯一的办法。
CA: Larry, that phrase you mentioned there, "early detection," "early response," that was a key theme of that talk, you made us all repeat it several times. Is that still the key to preventing a pandemic?
克里斯: 拉里,你在视频里说的那句话, “尽早发现”、“尽早响应”, 这是那场演讲的核心主题, 你当时让我们都复述了几遍。 这到现在仍然是 预防传染病大流行的关键吗?
LB: Oh, surely. You know, when you have a pandemic, something moving at exponential speed, if you miss the first two weeks, if you're late the first two weeks, it's not the deaths and the illness from the first two weeks you lose, it's the two weeks at the peak. Those are prevented if you act early. Early response is critical, early detection is a condition precedent.
拉里:噢,当然了。 当你面对一场以指数级速度发展的 大流行病的时候, 如果你错失了头两个星期, 如果你晚了两个星期应对, 那么我们失去的就不只是 前两个星期的发病和死亡, 而是疫情高峰期的两周。 只要你尽早行动, 这些是可以避免的。 尽早响应是至关重要的, 而尽早发现是先决条件。
CA: And how would you grade the world on its early detection, early response to COVID-19?
克里斯:那么在这两个方面, 你会给全球 对新冠的响应打几分呢?
LB: Of course, you gave me this question earlier, so I've been thinking a lot about it. I think I would go through the countries, and I've actually made a list. I think the island republics of Taiwan, Iceland and certainly New Zealand would get an A. The island republic of the UK and the United States -- which is not an island, no matter how much we may think we are -- would get a failing grade. I'd give a B to South Korea and to Germany. And in between ... So it's a very heterogeneous response, I think. The world as a whole is faltering. We shouldn't be proud of what's happening right now.
拉里:你之前问过我这个问题, 我也考虑了很久。 我觉得我可以逐一 给各个国家打分, 实际上我列了一张表。 我认为一些岛屿国家(地区), 例如台湾、冰岛和新西兰, 可以得 “A”。 岛国英国, 还有并非岛国的美国—— 不管我们自己有多么觉得 我们也是座岛—— 都 “不及格”。 我会给韩国和德国打 “B”, 然后别的国家…… 我觉得全球各国的响应情况差别很大。 整个世界呈现出了 一种犹豫、迟疑的状态。 我们不应该为现状感到自豪。
CA: I mean, we got the detection pretty early, or at least some doctors in China got the detection pretty early.
克里斯:我觉得这次病毒 其实发现得挺早的, 起码中国的一些医生很早就发现了。
LB: Earlier than the 2002 SARS, which took six months. This took about six weeks. And detection means not only finding it, but knowing what it is. So I would give us a pretty good score on that. The transparency, the communication -- those are other issues.
拉里:比 2002 年的非典要早, 他们当时用了六个月才发现病毒。 这次新冠只用了六个星期。 “发现” 指的不仅仅是找到病毒, 还要知道它到底是什么病毒。 所以在这一点上, 我会打一个不错的分数。 后来的透明性、沟通等等 —— 就是另一回事了。
CA: So what was the key mistake that you think the countries you gave an F to made?
克里斯: 那么你认为不及格的那些国家, 他们犯的最主要的错误是什么?
LB: I think fear, political incompetence, interference, not taking it seriously soon enough -- it's pretty human. I think throughout history, pretty much every pandemic is first viewed with denial and doubt. But those countries that acted quickly, and even those who started slow, like South Korea, they could still make up for it, and they did really well. We've had two months that we've lost. We've given a virus that moves exponentially a two-month head start. That's not a good idea, Chris.
拉里:我认为是恐惧、 政治上的无能与干涉、 没有尽早严肃地对待 —— 人性的本质暴露无遗。 我觉得纵观历史, 几乎每次大流行病一开始, 人们都持否认和怀疑的态度。 但那些行动迅速的国家, 甚至那些一开始 反应比较慢的国家,比如韩国, 还能后来居上,而且弥补得很好。 我们(美国)已经浪费了两个月时间。 我们放任可以指数扩增的病毒 抢占了两个月的先机。 这个做法很不好,克里斯。
CA: No, indeed. I mean, there's so much puzzling information still out there about this virus. What do you think the scientific consensus is going to likely end up being on, like, the two key numbers of its infectiousness and its fatality rate?
克里斯:的确不好。 我想说,关于这个病毒, 目前存在着太多令人困惑的信息。 你认为最后有可能达成 什么样的科学共识? 比如说, 两个重要指标—— 病毒的传染性和病死率?
LB: So I think the kind of equation to keep in mind is that the virus moves dependent on three major issues. One is the R0, the first number of secondary cases that there are when the virus emerges. In this case, people talk about it being 2.2, 2.4. But a really important paper three weeks ago, in the "Emerging Infectious Diseases" journal came out, suggesting that looking back on the Wuhan data, it's really 5.7. So for argument's sake, let's say that the virus is moving at exponential speed and the exponent is somewhere between 2.2 and 5.7. The other two factors that matter are the incubation period or the generation time. The longer that is, the slower the pandemic appears to us. When it's really short, like six days, it moves like lightning. And then the last, and the most important -- and it's often overlooked -- is the density of susceptibles. This is a novel virus, so we want to know how many customers could it potentially have. And as it's novel, that's eight billion of us. The world is facing a virus that looks at all of us like equally susceptible. Doesn't matter our color, our race, or how wealthy we are.
拉里:我认为我们要记住一个公式: 病毒的传播取决于三个重要参数。 第一个是 R0, 这是病毒开始传播时, 最初感染的二代病例个数。 在这次的新冠疫情中, 人们讨论说这个数字 大概是 2.2 或 2.4。 但三个星期前, 在《新发传染病》期刊上 发表的一篇非常重要的论文中指出, 回看武汉早期的数据, 这个数字实际上是 5.7。 所以为了方便讨论, 我们可以说病毒是以 指数级速度发展的, 而这个指数大约 在 2.2 到 5.7 之间。 还有另外两个重要的参数, 一个是病毒的潜伏期, 或者说是迭代时间。 潜伏期越长, 疫情显现就越慢。 当潜伏期很短,比如说六天, 疫情就会像闪电一样迅速发展。 最后一个,也是最重要的参数—— 而且经常被忽略的—— 就是易感染人群的密度。 这是一个新型病毒, 我们想知道 它有多少潜在感染人群。 而因为它是新型病毒, 这个数字就是全球八十亿人口。 我们正在面对一个 所有人都同样易受感染的病毒。 不论肤色、种族、 财富。
CA: I mean, none of the numbers that you've mentioned so far are in themselves different from any other infections in recent years. What is the combination that has made this so deadly?
克里斯: 目前你提到的这些数字, 没有一个数字本身 有别于近年来的其他传染病。 是什么样的组合 才让这次的病毒如此致命?
LB: Well, it is exactly the combination of the short incubation period and the high transmissibility. But you know, everybody on this call has known somebody who has the disease. Sadly, many have lost a loved one. This is a terrible disease when it is serious. And I get calls from doctors in emergency rooms and treating people in ICUs all over the world, and they all say the same thing: "How do I choose who is going to live and who is going to die? I have so few tools to deal with." It's a terrifying disease, to die alone with a ventilator in your lungs, and it's a disease that affects all of our organs. It's a respiratory disease -- perhaps misleading. Makes you think of a flu. But so many of the patients have blood in their urine from kidney disease, they have gastroenteritis, they certainly have heart failure very often, we know that it affects taste and smell, the olfactory nerves, we know, of course, about the lung. The question I have: is there any organ that it does not affect? And in that sense, it reminds me all too much of smallpox.
拉里:它恰恰正是 短潜伏期和高传染性的组合。 但这次视频对话里的每个人 都认识一些感染了这个病毒的人。 令人难过的是, 许多人都失去了挚爱的人。 这种疾病严重起来会非常可怕。 我接到了世界各地 在急诊室和重症监护病房里 救治病人的医生的电话, 他们都在说同一件事: “我该怎样决定谁能活下去, 谁要死去呢? 我能使用的工具实在太少了。” 这是一个可怕的疾病, 人们肺里插着呼吸机独自死去。 而且这是一个 会影响身体所有器官的疾病。 它是一个呼吸道疾病 —— 这么说也许存在一定的误导性, 因为它让你联想到流感。 但非常多的病人尿液中有血, 这是源自肾脏疾病。 他们还会得肠胃炎, 经常伴有心脏衰竭。 我们知道它还会影响 味觉和嗅觉、嗅神经, 当然,我们还知道它对肺部的损害。 而我想知道的就是: 还有什么器官是不受它影响的? 在这一点上, 它让我不得不联想起天花。
CA: So we're in a mess. What's the way forward from here?
克里斯: 我们现在的情况一团糟。 接下来的路该怎么走?
LB: Well, the way forward is still the same. Rapid detection, rapid response. Finding every case, and then figuring out all the contacts. We've got great new technology for contact tracing, we've got amazing scientists working at the speed of light to give us test kits and antivirals and vaccines. We need to slow down, the Buddhists say slow down time so that you can put your heart, your soul, into that space. We need to slow down the speed of this virus, which is why we do social distancing. Just to be clear -- flattening the curve, social distancing, it doesn't change the absolute number of cases, but it changes what could be a Mount Fuji-like peak into a pulse, and then we won't also lose people because of competition for hospital beds, people who have heart attacks, need chemotherapy, difficult births, can get into the hospital, and we can use the scarce resources we have, especially in the developing world, to treat people. So slow down, slow down the speed of the epidemic, and then in the troughs, in between waves, jump on, double down, step on it, and find every case, trace every contact, test every case, and then only quarantine the ones who need to be quarantined, and do that until we have a vaccine.
拉里:前进的方法还是一样的, 快速检测、 快速响应。 找到每一个病例, 然后找出所有接触者, 我们有先进的高新技术 可以用于追踪接触者。 我们有杰出的科学家 以光速在工作, 给我们提供试剂盒、 抗病毒药物和疫苗。 我们需要放慢疫情的发展速度, 佛教徒们说要放慢时间, 才能来得及把心与灵魂 投入到那个空间中。 我们需要放慢这个病毒的传播速度, 这就是为什么 我们需要 “社交距离”。 要澄清的一点是 —— 拉平疫情曲线、保持社交距离 并不会改变病例的绝对数量, 但会把原本可能 像富士山一样陡峭的峰值, 变成一段平稳脉冲。 这样我们便不会因为 医院床位不足而失去更多生命。 那些有心脏病的、 需要化疗的、难产的人群 就能及时在医院接受治疗。 我们可以使用紧缺的医疗资源, 来为病人治疗—— 特别是在发展中国家。 所以要放慢速度, 放慢大流行的速度, 然后在波谷里, 在下一波疫情来袭之前, 抓住时机、加大力度、脚踏实地, 找到每一个病例, 追踪每一个接触者, 检测每一个疑似病例, 然后只隔离那些需要隔离的人, 一直坚持下去, 直到我们研制出疫苗。
CA: So it sounds like we have to get past the stage of just mitigation, where we're just trying to take a general shutdown, to the point where we can start identifying individual cases again and contact-trace for them and treat them separately. I mean, to do that, that seems like it's going to take a step up of coordination, ambition, organization, investment, that we're not really seeing the signs of yet in some countries. Can we do this, how can we do this?
克里斯:听起来, 我们必须跨越这个 仅仅是在尝试整体封锁、 缓和疫情的阶段, 必须要做到重新开始 确认每一起病例, 然后追踪接触者, 并将他们分开治疗。 我觉得为了做到这些, 似乎需要进一步提高协调能力、 信心、组织能力、投资, 而在一些国家, 我们还没有看到这些迹象。 我们能做到吗?又该怎样做呢?
LB: Oh, of course we can do this. I mean, Taiwan did it so beautifully, Iceland did it so beautifully, Germany, all with different strategies, South Korea. It really requires competent governance, a sense of seriousness, and listening to the scientists, not the politicians following the virus. Of course we can do this. Let me remind everybody -- this is not the zombie apocalypse, it's not a mass extinction event. You know, 98, 99 percent of us are going to get out of this alive. We need to deal with it the way we know we can, and we need to be the best version of ourselves. Both sitting at home as well as in science, and certainly in leadership.
拉里:哦,我们当然能做到。 我的意思是,台湾做得非常棒, 冰岛和德国也做得非常棒, 他们都采取了不同的策略。 还有韩国。 这真的需要有能力的政府, 严肃的态度, 听取科学家而不是政治家 对于病毒的意见。 我们当然可以做到。 我要提醒每一个人, 这不是什么僵尸世界末日, 也不是大灭绝事件, 要知道,我们当中 98%, 甚至 99% 的人都会活下来, 关键在于,我们需要按照 我们已知可行的办法来应对它, 而且我们需要拿出 自己最好的一面—— 包括乖乖待在家里的普通人, 科学家,尤其是领导层。
CA: And might there be even worse pathogens out there in the future? Like, can you picture or describe an even worse combination of those numbers that we should start to get ready for?
克里斯:未来还会出现 更加可怕的病原体吗? 比如,你能想象或者描述一下 我们现在就应该开始着手应对的 更糟的传染病指标组合的情况吗?
LB: Well, smallpox had an R0 of 3.5 to 4.5, so that's probably about what I think this COVID will be. But it killed a third of the people. But we had a vaccine. So those are the different sets that you have. But what I'm mostly worried about, and the reason that we made "Contagion" and that was a fictional virus -- I repeat, for those of you watching, that's fiction. We created a virus that killed a lot more than this one did.
拉里:天花病毒的 R0 在 3.5 到 4.5 之间, 我认为新冠病毒可能也是这样。 但天花当时杀死了 1/3 的人口, 然而我们有了疫苗。 所以这就是能设想的 另一种情况。 但我最担心的 也是我们拍摄《传染病》 (“Contagion”)的原因, 那还是一个虚构的病毒 —— 我对看过的观众们重申一遍, 它纯属虚构。 我们创造了一个 比新冠凶残得多的病毒。
CA: You're talking about the movie "Contagion" that's been trending on Netflix. And you were an advisor for.
克里斯: 你是说电影《传染病》? 现在这部片子在 Netflix 上很流行。 你当时是该片的顾问。
LB: Absolutely, that's right. But we made that movie deliberately to show what a real pandemic looked like, but we did choose a pretty awful virus. And the reason we showed it like that, going from a bat to an apple, to a pig, to a cook, to Gwyneth Paltrow, was because that is in nature what we call spillover, as zoonotic diseases, diseases of animals, spill over to human beings. And if I look backwards three decades or forward three decades -- looking backward three decades, Ebola, SARS, Zika, swine flu, bird flu, West Nile, we can begin almost a catechism and listen to all the cacophony of these names. But there were 30 to 50 novel viruses that jumped into human beings. And I'm afraid, looking forward, we are in the age of pandemics, we have to behave like that, we need to practice One Health, we need to understand that we're living in the same world as animals, the environment, and us, and we get rid of this fiction that we are some kind of special species. To the virus, we're not.
拉里:对的,没错。 但我们是有意拍摄了那部电影, 以向人们展示一次真实的 传染病大流行会是什么样子。 但我们当时确实选了 一个非常恐怖的病毒。 我们之所以要这样呈现, 病毒从一只蝙蝠, 到一个苹果, 到一只猪,到一个厨师, 再到格温妮丝 · 帕特洛, 因为这就是我们所说的 自然界中的跨物种传播, 也就是人畜共患的疾病、 动物疾病跨物种传染到人类身上。 如果我往回看个三十年, 或者往前看三十年—— 往回看三十年, 埃博拉、非典、寨卡病毒、 猪流感、禽流感、西尼罗河病毒, 我们几乎可以开始一次教义问答, 听听这些病毒名字刺耳的混响。 但有 30 到 50 种新型病毒 是从动物传染到人类身上的。 而向前展望, 恐怕我们正身处 传染病大流行的时代, 我们必须这样做 —— 我们必须实施 “同一健康” (One Health)方针, 我们必须明白,无论是动物、 自然环境,还是人类, 我们都生活在同一个世界, 我们要摆脱 人类是某种特殊物种的幻想。 病毒只会对所有生物一视同仁。
CA: Mmm. You mentioned vaccines, though. Do you see any accelerated path to a vaccine?
克里斯:嗯。 不过你提到了疫苗, 你认为有什么 加速疫苗研发的途径吗?
LB: I do. I'm actually excited to see that we're doing something that we only get to think of in computer science, which is we're changing what should have always been, or has always been, rather, multiple sequential processes. Do safety testing, then you test for effectiveness, then for efficiency. And then you manufacture. We're doing all three or four of those steps, instead of doing it in sequence, we're doing in parallel. Bill Gates has said he's going to build seven vaccine production lines in the United States, and start preparing for production, not knowing what the end vaccine is going to be. We're simultaneously doing safety tests and efficacy tests. I think the NIH has jumped up. I'm very thrilled to see that.
拉里:确实有。 我很激动地看到, 我们正在做一些 原本只有计算机科学 能设想一下的事: 我们在改变 一直以来应当遵从的规则, 或者更确切地说, 一直以来存在的 多重循序进程。 先进行安全检测,然后检测效果, 之后检测效率, 最后投入生产。 我们现在正同时进行 三个或四个步骤, 不是循序处理,而是并行完成。 比尔 · 盖茨说他要在美国 建立七条疫苗生产线, 开始为疫苗生产做准备, 虽然现在还不知道 最终的疫苗是什么样的, 我们在同时进行 安全检测和功效检测, 我觉得美国国立卫生研究院(NIH) 已经站出来带头了。 我对此感到非常振奋。
CA: And how does that translate into a likely time line, do you think? A year, 18 months, is that possible?
克里斯:你觉得这样做的话, 疫苗的时间线大概是怎样的? 1 年,18 个月,这可能吗?
LB: You know, Tony Fauci is our guru in this, and he said 12 to 18 months. I think that we will do faster than that in the initial vaccine. But you may have heard that this virus may not give us the long-term immunity -- that something like smallpox would do. So we're trying to make vaccines where we add adjuvants that actually make the vaccine create better immunity than the disease, so that we can confer immunity for many years. That's going to take a little longer.
拉里: 托尼 · 福奇(Tony Fauci) 是这一行的专家。 他说需要 12 到 18 个月。 我觉得第一批疫苗可能更快, 但你可能也听说了这个病毒 可能并不会让我们长期免疫 —— 不像天花那样。 所以我们在尝试研发 添加了佐剂的疫苗。 这样疫苗能比得病本身 让人产生更强的免疫力。 这样提供的免疫力能持续许多年。 这将花费更长时间研发。
CA: Last question, Larry. Back in 2006, as a winner of the TED Prize, we granted you a wish, and you wished the world would create this pandemic preparedness system that would prevent something like this happening. I feel like we, the world, let you down. If you were to make another wish now, what would it be?
克里斯:最后一个问题,拉里。 回到 2006 年, 作为 TED 大奖的获得者, 我们让你许一个愿望, 你当时希望世界能够建立起 一个大流行病的预防系统, 来防止像今天这样的事情发生。 我觉得我们,整个世界, 让你失望了。 如果现在你能再许一个愿, 会是什么?
LB: Well, I don't think we're let down in terms of speed of detection. I'm actually pretty pleased. When we met in 2006, the average one of these viruses leaping from an animal to a human, it took us six months to find that -- like the first Ebola, for example. We're now finding the first cases in two weeks. I'm not unhappy about that, I'd like to push it down to a single incubation period. It's a bigger issue for me. What I found is that in the Smallpox Eradication Programme people of all colors, all religions, all races, so many countries, came together. And it took working as a global community to conquer a global pandemic. Now, I feel that we have become victims of centrifugal forces. We're in our nationalistic kind of barricades. We will not be able to conquer a pandemic unless we believe we're all in it together. This is not some Age of Aquarius, or Kumbaya statement, this is what a pandemic forces us to realize. We are all in it together, we need a global solution to a global problem. Anything less than that is unthinkable.
拉里:我觉得在检测速度方面, 我们并不会觉得失望。 我其实感到很满意。 当我们 2006 年见面的时候, 我们平均要花六个月才能发现 某个从动物传到人类身上的病毒—— 比如第一例埃博拉病毒。 现在我们只花了两个星期 就找到了第一例病人。 对此我没有感到不满。 不过把这个时间缩短到 一个潜伏期的时间内会更好。 对于我来说更大的问题是, 在天花的扑灭行动中, 我发现所有肤色、所有宗教、 所有种族的人们, 那么多的国家, 都能团结起来。 要战胜一场全球性的大流行病, 需要全球社会的共同努力。 现在,我觉得我们成为了 各种离心力的牺牲品。 我们被各自的民族主义路障 绊住了脚步。 除非我们相信 大家能够同心协力, 否则我们将无法战胜 传染病大流行。 这不是跨进了“万物归一”的时代, 也不是过家家似的携手迈向大同, 而是传染病大流行 迫使我们意识到, 我们是命运的共同体。 对于一个全球性的问题, 我们需要全球性的解决办法, 否则一切都是徒劳。
CA: Larry Brilliant, thank you so very much.
克里斯: 拉里 · 布瑞连特,非常感谢你。
LB: Thank you, Chris.
拉里: 谢谢你,克里斯。