疫情结束的三种可能|来自国际传染病专家Sue Welburn教授的分析 | “爱大在浙里”抗疫募捐公示第二期

17 2月 2020

新型冠状病毒肺炎爆发至今,进入了最吃劲的关键阶段。这场疫情到底怎样才会结束?

浙江大学爱丁堡大学联合学院执行院长、爱丁堡大学医学和分子流行病学主席、国际知名传染病专家苏·韦尔伯恩(Sue Welburn)教授写了《The Only Thing We have to Fear is Fear Itself》(我们唯一恐惧的是恐惧本身),分析了疫情最终结束的三种可能结果。

写稿于2020年2月5日,以下提供英文原文及中文翻译。

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Sue Welburn 教授

浙江大学爱丁堡大学联合学院执行院长;
爱丁堡大学医学和分子流行病学主席;
爱丁堡大学全球健康研究所院长;
中英合作办学联盟会首届主席。

 

The only thing we fear
我们唯一恐惧的
is fear itself ?
是恐惧本身 ?
As humans, we have lots of fears; fear of snakes, fear of heights, fear of spiders and of course fear of diseases. In 1933, Franklin D Roosevelt the 32nd President of the US at the lowest point of the Great Depression said “let me assert my firm belief that the only thing we have to fear is...fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance”.
These words are as important today as they were back in 1933, as China now battles an unseen enemy causing fear and heartbreak in communities. Fear can cause unjustified terror that impedes public health efforts to contain the spread of infection.

In December 2019, a new illness emerged in Wuhan, caused by a novel RNA coronavirus, 2019-nCoV – a virus that seemingly came from nowhere, unknown to science. Suddenly, everyone was working day and night to manage the impact of this tiny little pathogen, to try and stop its spread regionally and globally, and to work to develop drugs and vaccines to prevent a global pandemic. The speed at which 2019-nCoV is spreading is truly incredible and the response of the PRC (and globally) is unprecedented.

The disease is so new and there are so many unknowns. We do not know where it came from, how it spreads or how deadly it really is? We don’t know how the outbreak will end, but experience tells us that it will end. There are several possible outcomes.

Firstly, that the spread of 2019-nCoV is brought under control by extensive public health interventions (fast diagnosis, isolation and effective treatment of affected individuals, close identification of close contacts and their treatment). This is how two previous coronavirus outbreaks - SARS and MERS ended. Both viruses had made the jump from animals to humans and spread between them. SARS infected 8,096 people, and killed 774 people across 17 countries, but by 2004 SARS was no longer a public health problem. For SARS, health authorities identified cases quickly isolating and treating infected cases to prevent the infection spreading. Airports screened international travelers to establish whether they had been in contract with the virus. Today SARS may still exist in reservoir animal hosts, for example the forest civet, but it is not spreading among humans.

SARS could be contained, infected people, mostly did not spread the virus until they were showing symptoms, so when someone was sick, they were identified quickly, placed in quarantine and transmission was stopped.

2019-nCoV appears to be able to spread before any symptoms arise making it harder to contain. People do not know they are sick before they spread the virus to other people, and as they are not feeling ill, they will not seek medical care.
SARS also conveniently tended to stay within the hospital or healthcare setting with transmission fueled by a few “super-spreaders” who were disproportionately infectious.

The 2019-nCoV outbreak has outpaced SARS. A new mathematical model published in The Lancet suggests that up 75,800 people in Wuhan may have been infected by January 25 but also showed that if transmission could be reduced by a quarter, the growth rate of the outbreak would slow down.

Secondly, the virus might die out after it infects all or most of the people that are most susceptible to it. Disease outbreaks need susceptible individuals to spread and a virus outbreak will stop when there are no susceptible people left to infect. The 2015-2016 Zika virus epidemic infected >35,000 people but died out when the number of susceptible individuals reduced. People who were most at risk of coming into contact with Zika carrying mosquitoes had already been exposed to the disease. Zika is still around today but is not spreading.
If 2019-nCoV runs low on susceptible individuals to infect, for example people showing some immunity, then public health interventions can finish it off. 

Lastly, 2019-nCoV may become yet another common seasonal virus, as has been seen before for flu. In 2009, a new flu strain H1N1 emerged and became pandemic but eventually became part of the normal flu architecture each flu season. 2019-nCoV could become another one of the 4 coronavirus strains that commonly infect humans every year, in China or globally.
Ultimately, the outbreak of 2019-nCoV will likely be ended with the invention of a new vaccine(s) but development and deployment may take some time. In the mean while we need to support a strong public health response such as is being launched in China. It is important to keep fear at bay and this virus in perspective, each year globally 500,000 people die of flu and many more would die of flu if we did not have flu vaccination programmes for high-risk groups.

       作为人类,世上有很多让我们害怕的事物,如怕蛇、恐高、怕蜘蛛,当然也包括各种疾病。1933年,美国第32任总统,富兰克林·罗斯福(Franklin D.Roosevelt)在大萧条最低谷时曾说:“我们唯一恐惧的是恐惧本身——这种难以名状、失去理智和毫无道理的恐惧,会把我们转退为进所需的种种努力化为泡影。”
       时至今日,这句话仍为箴言。此刻,中国正在与一个看不见的敌人作战,这个敌人给我们带来了恐惧和悲痛。恐惧情绪会造成不必要的恐慌并阻碍社会公共卫生体系控制疫情传播的努力。
      2019年12月,武汉出现了由一种来源不明新型冠状病毒(2019-nCoV)带来的疾病。一时之间,每个人都在夜以继日地努力,试图控制这个小小的病毒带来的冲击,试图阻止其在区域和全球范围内扩散,并努力开发药物和疫苗来预防全球流行。然而,2019-nCoV的传播速度之快令人难以置信,令中国(以及全球)措手不及。
       作为一个新发现病毒,2019-nCoV存在着许多未知数。我们不知道它来自何处?如何传播?到底有多致命?我们不知道疫情将如何结束。但经验告诉我们,它一定会以下面几种可能的方式结束。

       第一种可能的结果:公共卫生干预措施有效控制了2019-nCoV的蔓延(快速诊断,隔离和有效治疗受感染的个体;及时鉴别,密切关注亲密接触者并对其中发病者给予及时治疗),使其与SARS和MERS以相同的方式宣告结束。SARS和MERS能在动物间传播,并能通过动物传播给人类。SARS感染了8096人,令17个国家的774人丧命。但到2004年,SARS已能被有效预防,依赖的就是卫生部门能迅速识别并隔离感染的病例来防止扩散。机场针对国际旅客进行排查,以确定他们是否感染了该病毒。如今,SARS可能仍在动物宿主如麝香猫中存在,但并未在人类中传播。
      SARS之所以能得到控制,一个主要原因是大多感染者在传播病毒前就已经出现明显症状。因此病患能被迅速发现和隔离,从而阻止传播。
      然而,2019-nCoV在潜伏期时可以毫无症状,使感染者难以被鉴别和隔离,因此更具传播性,更难以控制。人们在染病后没有感到不适,就不会去看病,病毒因此有机会传播给更多人。
      由于存在一些传染性特别强的“超级传播者”,SARS更容易在医院或医疗机构内传播。
      目前,2019-nCoV的感染人数已超过SARS。《柳叶刀》上发表的数学模型模拟结果预测,截至1月25日,武汉可能已有75800人被感染。但同时它还表明,如果能通过采取有效措施将将传播速率减少四分之一,将能减慢这次疫情的增长率。

      第二种可能出现的结果:2019-nCoV的传播可能会在感染了全部或大部分易感者后减缓。即病毒通过不断感染易感者达到了扩散的目的,与此同时,如果绝大部分易感者已被感染,疫情也将得到控制。如2015-2016年的寨卡病毒,感染了超过35000人。当那些最容易接触携带寨卡病毒蚊子的人均已经接触过疾病时,易感者数量随即减少,寨卡疫情最终消失。虽然寨卡病毒今天仍然存在,但没有传播。
      若2019-nCoV的易感人数开始减少,当人群开始显示出免疫力,我们通过公共卫生的干预措施就可以给疫情画上句号。

      第三种可能出现的结果:2019-nCoV可能会成为另一种常见的季节性病毒。2009年,一种新型H1N1流感病毒出现,并成为大流行病,最终成为流感季节时常见流感病毒品系中的一员。同理,2019-nCoV也可能成为每年在中国或全球普遍感染人类的4种冠状病毒株中的另一种。
      最后,2019-nCoV有可能随着新疫苗的研发而被消灭,尽管研发和推广均需要时间。此外,我们需要支持强有力的公共卫生对策,如中国正在启动的应对措施。避免恐惧,正确看待病毒也十分重要。在全球范围内,每年有大约50万人死于流感。如果我们没有针对高风险人群的流感疫苗接种计划,这个数字将会更加庞大。
                                            

 

戴口罩、勤洗手、少聚集;
保持良好作息、增强免疫力;
面对疫情,保持积极乐观心态;
盼望早日春暖花开!

      2020年2月5日,爱大浙江校友会携手浙大爱大联合学院(ZJE)发起“爱大在浙里”抗疫专项募捐活动,得到了广大校友级其他爱心人士的积极响应,感谢大家的支持!以上内容由项目组志愿者翻译整理,与您共享。我们将持续关注疫情发展,为校友们传递更多信息。

 

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