Helen Walters: So, Chris, who's up first?
海倫.沃爾特斯: 好的,克里斯,誰是第一位講者?
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:我們請到一位一生 都在擔心流行病的男人。 40 年前,當我們在嘗試 擺脫天花的折磨時, 他至關重要。 2006 年時, 他來 TED 演講,並警告我們 全球性流行病發生的可怕風險。 以及我們能就此做些什麼。 讓我們熱烈歡迎 賴瑞.布萊恩特博士! 賴瑞,很高興見到您。
Larry Brilliant: Thank you, nice to see you.
賴瑞.布萊恩特:謝謝,我也是。
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:賴瑞,在你的那次演講中, 你撥放了一段影片, 來模擬全球性流行病發生後 它可能的模樣。 我想重播一次—— 這是一個讓我背脊發涼的影片。
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.
賴瑞.布萊恩特(TED2006): 各位,請看這個模型, 它展示一場全球性流行病的 樣貌和規模, 我們才可以瞭解到 我正在談的究竟是什麼。 舉例來說,我們假設首個病例在南亞。 一開始,傳播非常緩慢。 有兩三個離散的爆發區。 然後,就會有二次爆發的疫情。 疾病就會飛速地在國家間傳播, 快到你都不會知道 什麼時候來到你身邊。 在三週之內,病毒就會遍佈全球。 如果我們可以讓時光倒流, 我們可以回到過去, 然後採取隔離措施, 抓住病毒的源頭, 我們可以快速的識別病毒, 快速做出應對, 然後把病毒「關進監獄」, 這才是應對全球性疫情的唯一方法。
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:賴瑞, 你剛剛說的這些詞組, 「快速識別」、「快速應對」, 這就是當時演講的主題, 這些詞語重複地出現。 如今,這還是控制疫情的要點嗎?
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.
賴瑞:喔,當然了。 當疫情發生, 病毒指數性的傳播, 如果沒有抓住前十四天 控制病毒的機會, 我們失去的不是僅僅是 這兩週的傷亡, 更是高峰期的兩個星期。 如果我們當時快速行動, 病毒就可以被消滅。 快速的反應極其重要, 快速的識別是首要條件。
CA: And how would you grade the world on its early detection, early response to COVID-19?
克里斯:你會如何就世界 對新冠病毒的快速反應及識別 來給世界做出的反應評分?
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.
賴瑞:當然了, 你之前就問過我這件事, 所以我一直在思考這個問題。 我覺得應該按國家來評分, 而我做了一個清單。 我認為,島嶼國家如台灣、 冰島、當然還有紐西蘭, 可以拿到 A 級評分。 英國各島和美國—— 不管我們可能會怎麼想, 美國並不是一個島—— 會拿到「不及格」。 我會給南韓和德國打 B 級。 在這之間⋯⋯ 我覺得,各國對病毒的反應都不相同。 我們的世界正在顫抖, 狀況不斷惡化。 我們不應對現在發生的一切 感到得意洋洋。
CA: I mean, we got the detection pretty early, or at least some doctors in China got the detection pretty early.
克里斯:我們還是 挺迅速地識別了病毒, 或者說,中國的醫生 很早就檢測到了病毒。
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.
賴瑞:這比 2002 年的 SARS 檢測更及時,當時花了六個月。 這次疫情的識別花了六周。 識別的意思並不只是找到病毒, 而更是了解它、知道它是什麼。 我會在那一項上, 給我們一個不錯的成績。 而信息的透明度和傳播—— 這些是其他的問題。
CA: So what was the key mistake that you think the countries you gave an F to made?
克里斯:所以,你認為不及格的國家 犯下的重要錯誤是什麼?
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.
賴瑞:我認為是恐懼、 政治上的無能、從中干涉、 馬虎的態度—— 確實都是人性中會犯的錯誤。 我覺得在歷史上, 每一場大流行 大概最初都被否認和懷疑過。 但做出快速反應的國家, 包括反應較晚的,比如韓國, 他們還是可以作出彌補, 而且做得很棒。 我們大概丟失了兩個月。 我們給了一個傳播迅速的病毒 兩個月的搶先傳播機會。 克里斯,這可不是好事啊。
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:嗯,確實不是。 在網路媒體上, 還有那麼多令人費解的信息 與新冠病毒相關。 您認為,科學家最後對 這兩個關鍵信息, 也就是病毒的傳染性和致死率 會達成什麼樣的共識?
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.
賴瑞:我覺得, 我們應記住的一個公式就是 病毒的傳播基於三個主要因素。 一個是 R0 指數, 也就是當病毒出現時, 第一批二次傳播病例的指數。 在這個情況下, 它可以是 2.2、2.4。 但三周前,《新興傳染病期刊》中 發表了一篇極其重要的論文, 提出最初來自武漢的數據, R0 值其實是 5.7。 介於所有的爭議, 我假設病毒正在指數型的傳播, 而其 R0 值在 2.2-5.7 之間。 還有兩個因素為 病毒的潛伏期和世代時間。 這兩段時間越長, 我們觀察到的病毒傳播就越緩慢。 當這兩段時間很短,比如 6 天, 病毒就閃電般的傳播。 而最後,也是最重要的一點—— 它通常不會被注意—— 它就是易感人群的密度。 這是一個新型病毒, 所以我們要知道它能夠感染多少人。 介於它是新形的, 世界上有八十億人, 我們面對著一個 將我們「一視同仁」的病毒。 不管我們有什麼膚色,是什麼人種, 有多少財富。
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:目前為止,您所提到的數值 與近年其他病毒的數值都相差無幾。 是什麼樣的組合, 讓這場大流行如此致命?
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.
賴瑞:它就是 短潛伏期和高傳染性的組合。 大部分人都至少認識一位 新型冠狀病毒的受害者。 令人難過的是, 很多人失去了他們所愛的人。 這是一個可以造成嚴重傷害的疾病。 世界各地急診室的醫生 和重症病房的醫生都打過電話給我, 他們說的都是同一件事: 「我應如何選擇誰該救活?誰該放棄? 可用的工具太少了。」 這是一個可怕的疾病, 人的肺中插著呼吸機孤獨地死亡。 它還是一個影響我們 所有器官的疾病。 它是一個呼吸道疾病—— 這樣說可能令人誤解。 你可能會聯想到流感。 但很多病人的尿裡有血, 得了腎臟病, 得了腸胃炎, 常有心臟衰竭的現象, 這個病毒還影響味覺和嗅覺, 影響嗅覺神經, 而我們都知道,會影響肺部。 我現在的問題是: 有沒有不受它影響的器官? 從這方面來講, 它讓我想起了天花。
CA: So we're in a mess. What's the way forward from here?
克里斯:所以,我們的處境一團糟。 改善我們處境的方法是什麼?
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.
賴瑞:方法還是一樣的。 快速檢測、 快速回應。 找到每一個案例, 然後找到其接觸者。 我們掌握可追蹤接觸者的先進科技, 我們有沒日沒夜工作、 敬業的科學家, 發明測試包、抗病毒藥、和疫苗。 我們需要慢下來, 佛教徒說,把時間放慢, 然後讓你的心靈進入那個空間。 我們要讓病毒傳播的速度慢下來, 所以我們保持社交距離。 為了講清楚, 讓病毒傳播緩慢、保持距離, 也改變不了患者的數目本身。 但它會讓一個富士山般的病毒高峰期 變成一個脈搏般的小波動, 人們也不會因為 醫院床位的不足而去世。 患心臟病、需要化療、難產的人 能夠就診住院, 我們能夠使用珍貴的資源, 特別是在發展中國家, 來治療患者。 所以,慢下來吧, 讓病毒的傳播慢下來, 然後在傳播的波谷之間, 跳起來,用力踩下去, 把每一個案例都找到, 把每一個接觸者都找到, 測試每一個患者, 然後只隔離那些需要被隔離的人們, 直到我們獲得了疫苗為止。
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:所以,你是說, 我們不應只是減緩傳播, 不應只是全面停工, 我們應該找到每一個案例, 追蹤他們的接觸者, 把他們隔離起來。 我是說,要這樣做, 需要合作、 信心、管理、投資, 在某些國家中,並沒有這樣的事情。 我們能做到嗎?應如何做到?
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.
賴瑞:噢,我們當然可以做到。 台灣做得非常好, 冰島也做到了,德國也是, 這些國家都採取了不同的方案。 還有韓國。 我們需要強力治理, 嚴肅、認真的態度, 聽從科學家的話,而不是政客的。 我們當然可以做到。 我來給大家提個醒—— 這不是殭屍啟示錄, 不是生物大滅絕, 有百分之 98、99 的人 都會活著從疫情中走出來。 我們需要面對它, 用我們知道的方式, 我們需要全力以赴。 這包括著「居家抗疫」、 也包括科學研發,還有領導力。
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:你認為,未來會不會有 更加嚴重的病毒? 比如,你能想像到 一個有更糟糕的因素組合的病毒, 而我們需要為其做好準備?
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.
賴瑞:天花的 R0 指數約為 3.5-4.5, 所以我認為新型冠狀病毒的 R0 值和這差不多。 但天花的感染者中, 約有三分之一去世。 我們有天花疫苗。 這是一些不同點。 但我最擔心的事, 也就是我們拍《全境擴散》 這部電影的原因, 電影裡是一種虛構的病毒—— 我重複一遍,觀眾們, 虛構的。 我們編造了一種比新冠病毒 更致命的病毒。
CA: You're talking about the movie "Contagion" that's been trending on Netflix. And you were an advisor for.
克里斯:你是在說《全境擴散》, 那部最近在 Netflix 上很紅的電影。 您是片子的科學指導。
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.
賴瑞:對,就是這樣。 我們刻意要讓那部電影 揭露一場流行病的真面目。 但我們的確選了一種極糟糕的病毒。 我們這樣做的原因是, 從一隻蝙蝠到一個蘋果, 再到一隻豬,一位廚師, 到格溫妮絲·帕特洛, 是因為自然中的溢出效應。 人畜共患疾病, 也就是動物的疾病,會溢給人類。 如果我倒退三十年, 或快進三十年, 三十年前,伊波拉、 SARS、茲卡病毒、 豬流感、禽流感、西尼羅病毒, 我們幾乎可以開始教理, 並聽聽這些名稱有多刺耳。 但約有 30~50 個 新型的病毒感染了人類, 而恐怕,展望未來, 我們正處於「大流行時代」。 我們一定要這樣做, 我們要「健康一體化」, 我們需要了解, 我們生活在同一個世界, 動物、大自然、還有我們。 我們不應認為 我們是一類特殊的種族, 對病毒來說,我們並不是。
CA: Mmm. You mentioned vaccines, though. Do you see any accelerated path to a vaccine?
克里斯:嗯⋯⋯ 你提到了疫苗。 你知道如何才能 更快速地生產疫苗嗎?
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.
賴瑞:我知道的。 我很興奮地看到現在我們在進行的 是以往我們只能在電腦科學看到的事, 就是我們在改變, 或是說,原本一直是 多順序的流程。 做安全測試,然後測試有效性, 然後測試效率, 然後再開始生產。 我們遵循三/四個步驟, 但我們可以不再一步一步地做, 而是同時做這些事。 比爾·蓋茨說, 他要在美國建造七條疫苗生產線, 然後開始準備生產, 但並不知道最終的疫苗 會是什麼樣的。 我們同時做安全性測試和功效測試。 我認為,美國國立衛生研究院 已開始動作。 我很期待這件事。
CA: And how does that translate into a likely time line, do you think? A year, 18 months, is that possible?
克里斯:您認為,它可能 會有一個什麼樣的時間表? 一年,或者一年半, 這是可能的嗎?
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.
賴瑞:安東尼·佛奇是這方面的專家, 而他認為的耗時約為 12-18 個月。 我覺得,我們以後製造疫苗, 會比第一次更快。 但你可能聽說過,這個病毒 可能不會讓我們對它長期免疫—— 天花這樣的病毒可以長期免疫。 製作疫苗時,我們嘗試加入佐劑, 讓疫苗產生比病毒更厲害的免疫力, 我們才可以擁有長達多年的免疫性。 做這件事所需的時間較長。
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:賴瑞, 我的最後一個問題是: 在 2006 年,作為 TED 獎得主, 您許了一個願望, 您的願望是要在世上 有個流行病防禦系統, 來防範這樣的事。 恐怕我們,這個世界,讓你失望了。 現在,你如果再許一個願, 你會許什麼?
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.
賴瑞:以識別病毒的 速度來說,我並不失望。 我倒是很欣喜。 在 2006 年, 我們平均要花六個月的時間來辨別 一個普通的人畜共患病毒—— 舉個例子,第一次伊波拉疫情。 我們現在可以在兩週內 找到第一例病情。 我對這件事並沒有失望, 但我希望,在未來,我們能 用一個潛伏期的時間做到它。 對我來說,這是個更大的問題。 我在天花根除計劃中發現 擁有各個膚色、信仰各個宗教、 來自各個種族的人, 那麼多的國家, 都聯手了。 而我們必須作為 一個全球性社區來工作, 來征服一場全球性疫情。 我認為,我們成為了 挑撥離間的勢力的受害者。 我們的民族主義也會成為某種障礙。 除非我們相信,我們生死與共, 不然我們無法面對任何疫情。 這並不是新紀元運動的寶瓶座年代, 也不是祈求神降臨解救苦難的宣言, 這是一場大流行 讓我們必須意識到的事。 我們確實生死與共, 全球大流行 需要全球人民來攜手抗疫。 如果我們做不到,後果不堪設想。
CA: Larry Brilliant, thank you so very much.
克里斯:非常感謝您, 賴瑞·布萊恩特!
LB: Thank you, Chris.
賴瑞:謝謝,克里斯。