So the first question is, why do we need to even worry about a pandemic threat? What is it that we're concerned about? When I say "we," I'm at the Council on Foreign Relations. We're concerned in the national security community, and of course in the biology community and the public health community. While globalization has increased travel, it's made it necessary that everybody be everywhere, all the time, all over the world. And that means that your microbial hitchhikers are moving with you. So a plague outbreak in Surat, India becomes not an obscure event, but a globalized event -- a globalized concern that has changed the risk equation. Katrina showed us that we cannot completely depend on government to have readiness in hand, to be capable of handling things. Indeed, an outbreak would be multiple Katrinas at once.
今天要談的第一個問題是 我們何必擔心全球大流行的問題? 我們到底在擔心些什麼? 我說的「我們」,是指「外交關係委員會」 我們關心國家安全的課題 生物的課題,還有公共衛生的課題 全球化的結果導致 交通量大增,許多人隨時隨地 在全世界大量的移動 病原體也搭著便車跟著一起到處移動 所以一個在印度Surat市爆發的瘟疫 不再只是個默默無名的事件,而是一個全球化的事件 一個改變風險計算式的全球課題 卡崔娜颶風給我們的教訓是 我們不能完全依賴政府 得隨時作好準備,有能力處理事件 如果爆發全球大流行,其嚴重性等於好幾個卡崔娜同時發生
Our big concern at the moment is a virus called H5N1 flu -- some of you call it bird flu -- which first emerged in southern China, in the mid-1990s, but we didn't know about it until 1997. At the end of last Christmas only 13 countries had seen H5N1. But we're now up to 55 countries in the world, have had this virus emerge, in either birds, or people or both. In the bird outbreaks we now can see that pretty much the whole world has seen this virus except the Americas. And I'll get into why we've so far been spared in a moment.
我們目前關注的問題是一個叫作H5N1的流感病毒 有些人把他叫作禽流感 這個疾病1990年代中期在中國南部第一次出現 但是我們直到1997年才知道有這個疾病 到去年耶誕節為止只有13個國家有H5N1的案例 但目前已經竄升到55個 有些國家是在禽鳥身上出現 有些在人身上出現,有些兩者都有 以禽鳥身上的傳染狀況而言 幾乎全世界都已經出現了這種病毒 除了美洲地區 我待會兒會談到我們為何還沒被波及
In domestic birds, especially chickens, it's 100 percent lethal. It's one of the most lethal things we've seen in circulation in the world in any recent centuries. And we've dealt with it by killing off lots and lots and lots of chickens, and unfortunately often not reimbursing the peasant farmers with the result that there's cover-up. It's also carried on migration patterns of wild migratory aquatic birds. There has been this centralized event in a place called Lake Chenghai, China. Two years ago the migrating birds had a multiple event where thousands died because of a mutation occurring in the virus, which made the species range broaden dramatically. So that birds going to Siberia, to Europe, and to Africa carried the virus, which had not previously been possible.
對已馴化的禽鳥,尤其是雞而言 這種疾病的致死率高達100% 可說是我們最近幾世紀 全世界流通的疾病之中 致死率最高的疾病之一 我們靠大量屠殺受感染雞隻來應付此問題 不幸的,雞農通常沒有得到補償 結果是雞農能夠掩藏就掩藏 這個病毒也會跟著季節性遷移的水鳥 隨著他們的遷徙路徑移動 中國境內的程海 就曾經發生過一次集體感染事件 兩年前在此處聚集了許多水鳥 適逢病毒發生突變 造成上千隻候鳥死亡 突變讓病毒產生戲劇性的變化 結果是遠赴西伯利亞、歐洲、 和非洲的候鳥身上都帶著這個病毒 在這之前,這隻病毒未曾到過這些地方
We're now seeing outbreaks in human populations -- so far, fortunately, small events, tiny outbreaks, occasional clusters. The virus has mutated dramatically in the last two years to form two distinct families, if you will, of the H5N1 viral tree with branches in them, and with different attributes that are worrying. So what's concerning us? Well, first of all, at no time in history have we succeeded in making in a timely fashion, a specific vaccine for more than 260 million people. It's not going to do us very much good in a global pandemic. You've heard about the vaccine we're stockpiling. But nobody believes it will actually be particularly effective if we have a real outbreak.
目前我們已看到人類發病的案例 所幸都是小規模的 偶發的事件 不過這個病毒最近兩年已發生非常劇烈的突變 因此在H5N1病毒的演化樹上 產生了兩個很不同的群組 而這兩組病毒型式 各有令人擔憂的特性 所以我們究竟在擔心什麼? 首先,我們從來就沒有成功的 在短時間內,為兩億六千萬人 製作某一種疫苗的紀錄 一旦面臨全球性大流行,我們會非常危險 你們或許已經聽說我們正在囤積疫苗 但沒有人相信,一旦面臨真正的大爆發 這點疫苗會有什麼用
So one thought is: after 9/11, when the airports closed, our flu season was delayed by two weeks. So the thought is, hey, maybe what we should do is just immediately -- we hear there is H5N1 spreading from human to human, the virus has mutated to be a human-to-human transmitter -- let's shut down the airports. However, huge supercomputer analyses, done of the likely effectiveness of this, show that it won't buy us much time at all. And of course it will be hugely disruptive in preparation plans. For example, all masks are made in China. How do you get them mobilized around the world if you've shut all the airports down? How do you get the vaccines moved around the world and the drugs moved, and whatever may or not be available that would work. So it turns out that shutting down the airports is counterproductive.
曾經有人想過 說911事件之後機場關閉 使得流感季節延後了兩週 所以這個想法就是說,或許我們應該 在知道H5N1在人與人間傳染開來 即病毒已突變成人對人傳染的型式時 乾脆就直接把機場關閉 不過,依據超級電腦的分析 這樣作的效益不大 只能將爆發的時間延後一些些 而且還會阻礙我們的準備工作 舉例而言,所有的面罩都在中國製造 一旦關閉了所有的機場 我們要如何把這些面罩送到世界各地? 我們要如何將疫苗運送到世界各地? 藥品及其他防疫物資也會有同樣問題 因此,關閉機場只有反效果
We're worried because this virus, unlike any other flu we've ever studied, can be transmitted by eating raw meat of the infected animals. We've seen transmission to wild cats and domestic cats, and now also domestic pet dogs. And in experimental feedings to rodents and ferrets, we found that the animals exhibit symptoms never seen with flu: seizures, central nervous system disorders, partial paralysis. This is not your normal garden-variety flu. It mimics what we now understand about reconstructing the 1918 flu virus, the last great pandemic, in that it also jumped directly from birds to people. We had evolution over time, and this unbelievable mortality rate in human beings: 55 percent of people who have become infected with H5N1 have, in fact, succumbed. And we don't have a huge number of people who got infected and never developed disease.
我們很擔心,因為此病毒跟其他已知 流感病毒不同,可以透過食用受到感染的動物 未煮熟的肉品而感染到病毒 因此我們已見到病毒以此方式傳染給野貓、 家貓、還有家犬 在囓齒類與貂科動物的餵食實驗中 我們發現這些動物出現一些一般流感未出現的症狀 例如痙攣、中央神經系統障礙、局部麻痺等 總之,這絕非我們一般所熟悉的流感 這個禽流感跟我們 重建出的1918年流感傳染模式 即上次的全球大流行非常類似 它也是直接從禽鳥傳染給人 隨著時間演化 出現了令人難以置信的死亡率 被H5N1感染的人之中 事實上有55%已經死亡 而且被感染的人之中 大部分都會發病
In experimental feeding in monkeys you can see that it actually downregulates a specific immune system modulator. The result is that what kills you is not the virus directly, but your own immune system overreacting, saying, "Whatever this is so foreign I'm going berserk." The result: most of the deaths have been in people under 30 years of age, robustly healthy young adults. We have seen human-to-human transmission in at least three clusters -- fortunately involving very intimate contact, still not putting the world at large at any kind of risk.
在猴子的餵食實驗中 我們發現這個疾病會 減低某種特定的免疫系統調節物質 因此,導致死亡的其實不是病毒 而是免疫系統的過度反應,抗議: 「這東西太詭異,我要抓狂了。」 因此死亡者大部分 是年齡不到30歲的人 非常健康的年輕成年人 我們見過的人對人傳染 已經至少有三群 所幸都是因極親密的接觸而感染 因此還不會對世界造成立即的危險
Alright, so I've got you nervous. Now you probably assume, well the governments are going to do something. And we have spent a lot of money. Most of the spending in the Bush administration has actually been more related to the anthrax results and bio-terrorism threat. But a lot of money has been thrown out at the local level and at the federal level to look at infectious diseases. End result: only 15 states have been certified to be able to do mass distribution of vaccine and drugs in a pandemic. Half the states would run out of hospital beds in the first week, maybe two weeks. And 40 states already have an acute nursing shortage. Add on pandemic threat, you're in big trouble.
各位應該開始緊張了吧 各位可能會認為政府應該會有所作為 我們也確實花費了許多金錢 不過布希政府到目前為止的花費 大部分針對炭疽病 和恐怖份子生物攻擊威脅的相關研究 聯邦政府跟地方政府也花費很多經費 探討傳染性疾病 但結果是只有15個州 被判定有能力在大流行時 大量的分送疫苗和藥品 在第一個或第二個禮拜之內 約有一半的州就會發生病床不足的問題 40個州已經有護理人員嚴重短缺的問題 加上大流行的威脅,問題就更嚴重了
So what have people been doing with this money? Exercises, drills, all over the world. Let's pretend there's a pandemic. Let's everybody run around and play your role. Main result is that there is tremendous confusion. Most of these people don't actually know what their job will be. And the bottom line, major thing that has come through in every single drill: nobody knows who's in charge. Nobody knows the chain of command. If it were Los Angeles, is it the mayor, the governor, the President of the United States, the head of Homeland Security? In fact, the federal government says it's a guy called the Principle Federal Officer, who happens to be with TSA.
所以到底錢用到哪裡去了? 全世界到處都在辦理各種演習 讓我們假裝現在正在發生全球大流行 所以大家要趕快去做該做的事 結果就是會非常的混亂 因為大部分的人不太清楚自己究竟該作什麼 追根究底來說,我們沒有重大進展 每次演習,沒人知道誰是總指揮 沒人知道指揮系統到底是怎樣 若流感發生在洛杉磯,總指揮到底是市長、州長、 美國總統、還是國土安全部部長? 其實,聯邦政府說指揮官是 一位「首席聯邦官員」 而他隸屬「運輸安全管理部」
The government says the federal responsibility will basically be about trying to keep the virus out, which we all know is impossible, and then to mitigate the impact primarily on our economy. The rest is up to your local community. Everything is about your town, where you live. Well how good a city council you have, how good a mayor you have -- that's who's going to be in charge. Most local facilities would all be competing to try and get their hands on their piece of the federal stockpile of a drug called Tamiflu, which may or may not be helpful -- I'll get into that -- of available vaccines, and any other treatments, and masks, and anything that's been stockpiled. And you'll have massive competition. Now we did purchase a vaccine, you've probably all heard about it, made by Sanofi-Aventis. Unfortunately it's made against the current form of H5N1. We know the virus will mutate. It will be a different virus. The vaccine will probably be useless. So here's where the decisions come in.
政府的說法是 聯邦政府的責任基本上是要把 病毒屏除在境外,我們都知道這是不可能的 還有就是去減緩大流行 對我國的衝擊,尤其是對經濟 剩下來的全部都要靠你的社區自己想辦法 所以要回歸到你所居住的城鎮 你的地方議會能不能幹 你的市長能不能幹─因為他要負責當指揮官 所有的地方政府將互相競爭 設法從聯邦政府庫存中取得 一種叫作「克流感」的藥物 這種藥物可能有用但也可能沒用─這個待會會談─ 還有取得疫苗或是其他任何的醫療物資 還有口罩,和所有聯邦庫存的防治物資 想想看所有地方政府在搶,這競爭有多激烈 我們確實有購買一種疫苗,你們也大概都聽過 是由賽諾菲安萬特(Sanofi-Aventis)藥廠製造的 很不幸的它是針對現在的H5N1病毒製造 我們都知道病毒會突變,突變後就會完全不同 因此這個疫苗可能會完全無效 所以決策過程就要處理這些問題
You're the mayor of your local town. Let's see, should we order that all pets be kept indoors? Germany did that when H5N1 appeared in Germany last year, in order to minimize the spread between households by household cats, dogs and so on. What do we do when we don't have any containment rooms with reverse air that will allow the healthcare workers to take care of patients? These are in Hong Kong; we have nothing like that here. What about quarantine? During the SARS epidemic in Beijing quarantine did seem to help. We have no uniform policies regarding quarantine across the United States. And some states have differential policies, county by county. But what about the no-brainer things? Should we close all the schools? Well then what about all the workers? They won't go to work if their kids aren't in school. Encouraging telecommuting? What works?
你是你們鎮的鎮長 我們該不該規定鎮民要將所有的寵物關在室內? 去年德國出現H5N1時就這麼作了 目的是要減少家戶之間因為 家貓家犬等寵物造成的病毒散播 當我們沒有隔離病房時我們該怎麼辦 醫護人員如果沒有這種負壓病房的保護 該如何去照顧病人 這些負壓病房在香港,我們這裡沒有這種東西 隔離措施呢? SARS流行期間北京實施的隔離政策好像有些效果 在美國不但沒有 全國統一的隔離政策 而且各州各郡之間也可能有不同政策 最簡單的決定呢?我們該不該停課? 如果停課是否要一起停班?小孩不上課 家長也不會來上班 鼓勵通訊上班如何?有效嗎?
Well the British government did a model of telecommuting. Six weeks they had all people in the banking industry pretend a pandemic was underway. What they found was, the core functions -- you know you still sort of had banks, but you couldn't get people to put money in the ATM machines. Nobody was processing the credit cards. Your insurance payments didn't go through. And basically the economy would be in a disaster state of affairs. And that's just office workers, bankers.
英國政府曾經作過通訊上班的實驗 六週內,他們要求銀行業者 假裝有大流行,只用通訊的方式上班 發現有些核心業務無法進行 例如還有很多銀行 還未提供ATM自動存款服務 沒有人處理信用卡的資訊 沒有行員處理保險付款以致未能按時支付 總而言之就是經濟活動會癱瘓 而且這銀行行員只是在室內辦公的人
We don't know how important hand washing is for flu -- shocking. One assumes it's a good idea to wash your hands a lot. But actually in scientific community there is great debate about what percentage of flu transmission between people is from sneezing and coughing and what percentage is on your hands. The Institute of Medicine tried to look at the masking question. Can we figure out a way, since we know we won't have enough masks because we don't make them in America anymore, they're all made in China -- do we need N95? A state-of-the-art, top-of-the-line, must-be-fitted-to-your-face mask? Or can we get away with some different kinds of masks? In the SARS epidemic, we learned in Hong Kong that most of transmission was because people were removing their masks improperly. And their hand got contaminated with the outside of the mask, and then they rubbed their nose. Bingo! They got SARS. It wasn't flying microbes. If you go online right now, you'll get so much phony-baloney information. You'll end up buying -- this is called an N95 mask. Ridiculous. We don't actually have a standard for what should be the protective gear for the first responders, the people who will actually be there on the front lines.
我們也不知道洗手對流感的防治到底效用如何 很驚人。我們都以為常洗手是好事 但事實上在科學界這還是個很大的爭議 到底人與人間的流感有多少比例 藉著打噴嚏和咳嗽傳染 而經手傳染的比例又是如何 醫學研究中心也曾研究口罩的問題 既然無法提供足夠的口罩,有無其他方法? 因為美國已經不製造口罩 所有的口罩都在中國製造 我們是不是一定要用N95?這種最新科技、最高品質 能完全貼合臉部配戴的口罩 還是我們可用其他的口罩? 在SARS流行期間,我們從香港的經驗得知 大部分的感染是因為 人們摘除口罩的方式不對 手被口罩外側汙染 就去揉鼻子,結果就中獎,得到SARS 病毒並不是到處飛散的微生物 如果你現在上網查詢可以找到非常多胡扯的訊息 你就會去買這個N95口罩。真的是太荒謬了 我們事實上並未替 第一線的工作者 訂定保護裝置的標準
And Tamiflu. You've probably heard of this drug, made by Hoffmann-La Roche, patented drug. There is some indication that it may buy you some time in the midst of an outbreak. Should you take Tamiflu for a long period of time, well, one of the side effects is suicidal ideations. A public health survey analyzed the effect that large-scale Tamiflu use would have, actually shows it counteractive to public health measures, making matters worse. And here is the other interesting thing: when a human being ingests Tamiflu, only 20 percent is metabolized appropriately to be an active compound in the human being. The rest turns into a stable compound, which survives filtration into the water systems, thereby exposing the very aquatic birds that would carry flu and providing them a chance to breed resistant strains. And we now have seen Tamiflu-resistant strains in both Vietnam in person-to-person transmission, and in Egypt in person-to-person transmission. So I personally think that our life expectancy for Tamiflu as an effective drug is very limited -- very limited indeed.
還有你們可能聽過「克流感」這種藥物 它是由 Hoffmann - La Roche 製造的專利藥品 有一些證據顯示 在流感爆發時這個藥物可能可以拖延一點時間 但是如果長期使用克流感 它的副作用之一是產生自殺的意念 曾有一個公共衛生的調查研究 大規模使用克流感的效應 結果顯示克流感對公共衛生政策 造成反作用,讓情況更糟 還有另一件有趣的事情: 人服用克流感之後,只有20% 會被妥善代謝 轉化成人體內有效的成分 其餘的會轉化成一個穩定的化合物 通過各種過濾系統進入環境中的水 因此有機會進入帶原的水鳥體內 提供這些病毒 產生抗藥性的機會 我們已經在越南及埃及的 人對人傳染案例中觀察到 對克流感產生抗藥性的病毒 因此我個人認為克流感 能對抗流感的期限 應該是非常非常的短暫
Nevertheless most of the governments have based their whole flu policies on building stockpiles of Tamiflu. Russia has actually stockpiled enough for 95 percent of all Russians. We've stockpiled enough for 30 percent. When I say enough, that's two weeks worth. And then you're on your own because the pandemic is going to last for 18 to 24 months. Some of the poorer countries that have had the most experience with H5N1 have built up stockpiles; they're already expired. They are already out of date. What do we know from 1918, the last great pandemic? The federal government abdicated most responsibility. And so we ended up with this wild patchwork of regulations all over America. Every city, county, state did their own thing. And the rules and the belief systems were wildly disparate. In some cases all schools, all churches, all public venues were closed.
不過大部分的政府 都是把整個抗流感的政策 建立在大量儲存克流感上 俄國就已經儲存了足以 供應95%俄國人的藥品 美國已經儲存足夠供應30%人口的藥量 足夠指的是兩個禮拜的藥量 之後就要自己想辦法 因為全球大流行至少會延續18到24個月 一些經歷過H5N1流行 卻較貧困的國家,他們所囤積的藥品 已經超過保存期限, 過期了 我們從1918年大流感 得到的教訓是什麼? 聯邦政府會推託大部份的責任 因此我們只有美國各地法規的 拼湊物 每個市、郡、州各自為政 各地採用的規範 和遵循的原則都大不相同 有些地方是關閉所有的學校、教堂、 和所有公共場所
The pandemic circulated three times in 18 months in the absence of commercial air travel. The second wave was the mutated, super-killer wave. And in the first wave we had enough healthcare workers. But by the time the second wave hit it took such a toll among the healthcare workers that we lost most of our doctors and nurses that were on the front lines. Overall we lost 700,000 people. The virus was 100 percent lethal to pregnant women and we don't actually know why. Most of the death toll was 15 to 40 year-olds -- robustly healthy young adults. It was likened to the plague. We don't actually know how many people died. The low-ball estimate is 35 million. This was based on European and North American data.
1918年大流感在18個月內出現三波大流行 而且還是在缺乏商用客機的時代背景下 其中第二波是突變造成的超級殺手浪潮 第一波大流行時我們還有足夠的醫護人員 但是第二波大流行襲擊時 造成醫護人員大量的傷亡 讓我們失去了大部分的第一線醫師和護士 在美國共造成70萬人死亡 那隻病毒對於懷孕婦女100%致命 我們至今仍不知道原因 大部分的死者是15到40歲的人 也就是非常健康的年輕成人 它的嚴重性可跟鼠疫相提並論 我們並不清楚全球到底死了多少人 估計至少有3500萬人 這是依據歐洲跟北美的資料估算的
A new study by Chris Murray at Harvard shows that if you look at the databases that were kept by the Brits in India, there was a 31-fold greater death rate among the Indians. So there is a strong belief that in places of poverty the death toll was far higher. And that a more likely toll is somewhere in the neighborhood of 80 to 100 million people before we had commercial air travel. So are we ready? As a nation, no we're not. And I think even those in the leadership would say that is the case, that we still have a long ways to go.
哈佛大學的Chris Murray所作的最新研究顯示 如果利用英國人在印度 所建立的資料來看 印度人的死亡率是其他地區的31倍 因此有人強烈相信較貧困的地區 死亡人數應該會多出很多 因此較可能的死亡人數 應該是在八千萬到一億人之間 而且是在還沒有商用航空的狀況下 所以我們準備好了嗎? 以美國來說,我們還沒準備好 而且我想即使是領導階層的人 也會同意我的說法 說我們還有很大的進步空間
So what does that mean for you? Well the first thing is, I wouldn't start building up personal stockpiles of anything -- for yourself, your family, or your employees -- unless you've really done your homework. What mask works, what mask doesn't work. How many masks do you need? The Institute of Medicine study felt that you could not recycle masks. Well if you think it's going to last 18 months, are you going to buy 18 months worth of masks for every single person in your family?
所以你們該怎麼辦?第一件事: 我不會開始囤積任何東西 不管是為你自己、你的家人、或是你的員工 除非你真正作好了你的功課 哪幾種口罩有用? 哪幾種沒有用? 你需要多少口罩? 醫學研究中心的研究結果顯示 你不可以回收口罩再利用 所以如果你想要撐過18個月 你得為家裡的每一份子 購買足夠18個月用的口罩嗎?
We don't know -- again with Tamiflu, the number one side effect of Tamiflu is flu-like symptoms. So then how can you tell who in your family has the flu if everybody is taking Tamiflu? If you expand that out to think of a whole community, or all your employees in your company, you begin to realize how limited the Tamiflu option might be. Everybody has come up to me and said, well I'll stockpile water or, I'll stockpile food, or what have you. But really? Do you really have a place to stockpile 18 months worth of food? Twenty-four months worth of food? Do you want to view the pandemic threat the way back in the 1950s people viewed the civil defense issue, and build your own little bomb shelter for pandemic flu? I don't think that's rational.
我們不知道。克流感呢? 克流感最主要的副作用 是類流感症狀 所以如果你們全家 都在服用克流感 你該如何分辨到底是誰真正得了流感? 如果你把這個概念延伸到整個社區 或是公司裡的所有員工 你會了解克流感的效用 真的很有限 很多人會跟我說 那我就儲存水、食物或是其他物資好了 真的嗎?你真的有空間 儲存18個月或是24個月的食物嗎? 你真的要用1950年代 人們看待民防的方式 看待這個全球大流行嗎? 真的要為大流感幫自己蓋一間防空洞嗎? 我不認為那叫理性
I think it's about having to be prepared as communities, not as individuals -- being prepared as nation, being prepared as state, being prepared as town. And right now most of the preparedness is deeply flawed. And I hope I've convinced you of that, which means that the real job is go out and say to your local leaders, and your national leaders, "Why haven't you solved these problems? Why are you still thinking that the lessons of Katrina do not apply to flu?" And put the pressure where the pressure needs to be put. But I guess the other thing to add is, if you do have employees, and you do have a company, I think you have certain responsibilities to demonstrate that you are thinking ahead for them, and you are trying to plan. At a minimum the British banking plan showed that telecommuting can be helpful. It probably does reduce exposure because people are not coming into the office and coughing on each other, or touching common objects and sharing things via their hands. But can you sustain your company that way? Well if you have a dot-com, maybe you can. Otherwise you're in trouble. Happy to take your questions. (Applause)
我認為重點不是以個人為單位作準備 而是要以整個社區 整個國家 整個州、整個城鎮為單位作準備 目前大部分的準備 都有很大的缺陷 我希望我已經說服各位 真正重要的工作是 去問各位的地方主管 去問國家領導人 「為什麼還沒有解決這些問題?」 「你們為何還認為,」 「卡崔娜颶風的教訓並不適用於流感的防治?」 請在該施壓的地方施壓 還有,如果你擁有一個公司 有一些員工 我認為你有責任 表現出你比他們有遠見 你有在計畫 至少英國的銀行實驗顯示 遠距通訊有一些幫助 或許可以減少疾病的暴露 因為人們不用到辦公室對彼此咳嗽 或是碰觸共通的物品 經由接觸造成病毒傳播 但是你的公司能否以這種方式持續經營一段時間? 如果你有個網站,或許你能 不然你的麻煩就大了 我很樂於回答問題 (掌聲)
Audience member: What factors determine the duration of a pandemic?
問:哪些因素會決定全球大流行的時程長短?
Laurie Garret: What factors determine the duration of a pandemic, we don't really know. I could give you a bunch of flip, this, that, and the other. But I would say that honestly we don't know. Clearly the bottom line is the virus eventually attenuates, and ceases to be a lethal virus to humanity, and finds other hosts. But we don't really know how and why that happens. It's a very complicated ecology.
答:哪些因素決定全球大流行的時程,我們不太清楚 我列舉出一堆猜測的因素 但我寧願老實說我們並不清楚 很顯然的,到最後 病毒的效力終將減弱 不再是會致人於死的病毒 然後去找別的宿主 但我們不太清楚那如何發生或為什麼會發生 那是個非常複雜的生態
Audience member: What kind of triggers are you looking for? You know way more than any of us. To say ahh, if this happens then we are going to have a pandemic?
問:你的警告指標是什麼? 你在這方面比我們都懂得多很多 你認為發生了什麼情況,就會有大流行?
LG: The moment that you see any evidence of serious human-to-human to transmission. Not just intimately between family members who took care of an ailing sister or brother, but a community infected -- spread within a school, spread within a dormitory, something of that nature. Then I think that there is universal agreement now, at WHO all the way down: Send out the alert.
答:如果你看到嚴重的 人對人傳染的證據 也就是不只是互動親密的家人 因為照顧生病者而受到感染 而是社區感染 像是學校中的感染 宿舍中的感染,等等類似的狀況 如果有這種情況發生 世界衛生組織從上到下都會同意 發布警告
Audience member: Some research has indicated that statins can be helpful. Can you talk about that?
問:有些研究顯示藥物statins可能有幫助 你能不能談一下?
LG: Yeah. There is some evidence that taking Lipitor and other common statins for cholesterol control may decrease your vulnerability to influenza. But we do not completely understand why. The mechanism isn't clear. And I don't know that there is any way responsibly for someone to start medicating their children with their personal supply of Lipitor or something of that nature. We have absolutely no idea what that would do. You might be causing some very dangerous outcomes in your children, doing such a thing.
答:是的,是有一些證據顯示服用立普妥(Lipitor) 還有其它控制膽固醇用的statins類藥品 可能可降低流感病毒 對你的感染性 但是我們並不完全了解為什麼 它的機制還並不清楚 我也不知道有無方法 能讓人負責任地 將自己的Lipitor 或同類藥物給自己的小孩服用 我們完全不知道會造成什麼效果 有可能會因為讓小孩服用這個藥物 造成非常危險的結果
Audience member: How far along are we in being able to determine whether someone is actually carrying, whether somebody has this before the symptoms are full-blown?
問:我們到目前為止有沒有辦法 在一個人的症狀完全顯現之前 就知道一個人已經感染或是帶原?
LG: Right. So I have for a long time said that what we really needed was a rapid diagnostic. And our Centers for Disease Control has labeled a test they developed a rapid diagnostic. It takes 24 hours in a very highly developed laboratory, in highly skilled hands. I'm thinking dipstick. You could do it to your own kid. It changes color. It tells you if you have H5N1. In terms of where we are in science with DNA identification capacities and so on, it's not that far off. But we're not there. And there hasn't been the kind of investment to get us there.
答;好的,所以我一直都在倡導 說我們真正需要的是快速診斷的方法 美國的疾病管制局 將他們發展出來的一種檢測法 視為快速檢測 但得在高階的實驗室裡,由充分訓練的研究人員 進行24小時的分析 而我想要的是像試紙這麼簡單的東西 你可以在家裡檢查自己的小孩:如果變色 就表示得了H5N1 以我們目前在科學方面的進展 目前DNA檢定的能力等等 作到這麼方便的篩檢並不難 但是我們沒有,也沒有投資這種篩檢的發展
Audience member: In the 1918 flu I understand that they theorized that there was some attenuation of the virus when it made the leap into humans. Is that likely, do you think, here? I mean 100 percent death rate is pretty severe.
問:1918年的流感大流行 我聽說有一個理論是病毒在 傳給人體時毒性衰減 這次也會發生類似的情形嗎? 我的意思是說100%死亡率 相當嚴重呢
LG: Um yeah. So we don't actually know what the lethality was of the 1918 strain to wild birds before it jumped from birds to humans. It's curious that there is no evidence of mass die-offs of chickens or household birds across America before the human pandemic happened. That may be because those events were occurring on the other side of the world where nobody was paying attention. But the virus clearly went through one round around the world in a mild enough form that the British army in World War I actually certified that it was not a threat and would not affect the outcome of the war. And after circulating around the world came back in a form that was tremendously lethal. What percentage of infected people were killed by it? Again we don't really know for sure. It's clear that if you were malnourished to begin with, you had a weakened immune system, you lived in poverty in India or Africa, your likelihood of dying was far greater. But we don't really know.
答:嗯,其實我們並不清楚 1918年的病毒株在野鳥體內 還沒傳染給人時 對鳥類的致死率如何 奇怪的是,在流感大流行之前 在美國找不到 大量雞隻死亡 或是其他家禽大量死亡的證據 也許是因為這些事件 發生在世界其他地方 而這些地方沒有人注意 不過病毒很明顯的 以一種非常溫和的病毒型式 在世界上繞了一圈 以至於第一次世界大戰時,英國陸軍 認定它不是一個威脅 不足以影響戰爭的結果 但是在它繞行地球一周之後 變成非常致命的品種 受到感染的人中有多少百分比因此喪命? 我們真的不清楚 我們只知道如果你原本就營養不良 如果你的免疫系統減弱 如果你住在印度或非洲的貧民區 你死亡的機率就大許多 但是其他的我們真的不清楚
Audience member: One of the things I've heard is that the real death cause when you get a flu is the associated pneumonia, and that a pneumonia vaccine may offer you 50 percent better chance of survival.
問:我曾經聽說 流感真正致命的是併發的肺炎 而注射肺炎疫苗 可以增進50%的存活率
LG: For a long time, researchers in emerging diseases were kind of dismissive of the pandemic flu threat on the grounds that back in 1918 they didn't have antibiotics. And that most people who die of regular flu -- which in regular flu years is about 360,000 people worldwide, most of them senior citizens -- and they die not of the flu but because the flu gives an assault to their immune system. And along comes pneumococcus or another bacteria, streptococcus and boom, they get a bacterial pneumonia. But it turns out that in 1918 that was not the case at all. And so far in the H5N1 cases in people, similarly bacterial infection has not been an issue at all. It's this absolutely phenomenal disruption of the immune system that is the key to why people die of this virus.
答:新興疾病的研究人員長期以來 都對全球大流感這種想法 不以為然,因為 1918年我們還沒有抗生素 而且在一般流感流行期間 死亡的人 全球大約是36萬人 大部分都是老年人 這些人並不是死於流感,而是因為流感減弱了他們的免疫系統 於是他們感染肺炎雙球菌 或是其他細菌,如鏈球菌 得到細菌性肺炎 但是1918年那次並非如此 到目前為止H5N1的人類病例中 類似的細菌性感染 根本就微不足道 這個病毒的主要致死原因 是因為免疫系統的嚴重錯亂
And I would just add we saw the same thing with SARS. So what's going on here is your body says, your immune system sends out all its sentinels and says, "I don't know what the heck this is. We've never seen anything even remotely like this before." It won't do any good to bring in the sharpshooters because those antibodies aren't here. And it won't do any good to bring in the tanks and the artillery because those T-cells don't recognize it either. So we're going to have to go all-out thermonuclear response, stimulate the total cytokine cascade. The whole immune system swarms into the lungs. And yes they die, drowning in their own fluids, of pneumonia. But it's not bacterial pneumonia. And it's not a pneumonia that would respond to a vaccine. And I think my time is up. I thank you all for your attention. (Applause)
我還要補充一下 SARS的情況跟H5N1一模一樣 都是身體裡頭 免疫系統將所有的哨兵派遣出去,說 「我不知道這是什麼鬼東西,」 「我們從來沒有見過這種樣子的東西。」 派出狙擊手沒有用 因為根本就沒有適用的抗體 然後派出坦克車跟砲兵也沒有用 因為那些T細胞也不認得它 所以只好動用熱核能武器 刺激細胞激素連鎖反應 結果整個免疫系統湧入肺部 患者淹沒於體液中,死於肺炎 但是這不是細菌性肺炎 不是會對疫苗有反應的肺炎 我想我的時間到了,謝謝各位 (掌聲)