TED2007
Laurie Garrett: Lessons from the 1918 flu
Laurie Garrett o poukama iz gripe iz 1918.
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2007. godine, dok se svijet brinuo o epidemiji ptičje gripe, Laurie Garrett, autorica knjige „Nadolazeća pošast“ održala je ovaj značajan govor maloj publici TED sveučilišta. Njezin uvid u prošle pandemije iznenadno je puno važniji nego ikad.
Laurie Garrett - Science journalist
Pulitzer winner Laurie Garrett studies global health and disease prevention. Her books include "The Coming Plague" and "Betrayal of Trust," about the crisis in global public health. Full bio
Pulitzer winner Laurie Garrett studies global health and disease prevention. Her books include "The Coming Plague" and "Betrayal of Trust," about the crisis in global public health. Full bio
Double-click the English transcript below to play the video.
00:12
So the first question is, why do we need to
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Prvo pitanje je, zašto se uopće moramo
00:14
even worry about a pandemic threat?
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brinuti o opasnosti od pandemije?
00:17
What is it that we're concerned about?
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Što nas to zabrinjava?
00:19
When I say "we," I'm at the Council on Foreign Relations.
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Kad kažem „mi“, ja sam u vijeću za vanjske odnose.
00:22
We're concerned in the national security community,
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Mi smo uključeni u nacionalnu sigurnost zajednice,
00:24
and of course in the biology community and the public health community.
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i, naravno, u biologiju zajednice i javno zdravstvo zajednice.
00:27
While globalization has increased travel,
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Kako je globalizacija povećala putovanje,
00:29
it's made it necessary that everybody be everywhere,
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učinila je potrebnim da svatko bude svagdje,
00:32
all the time, all over the world.
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stalno i diljem svijeta.
00:34
And that means that your microbial hitchhikers are moving with you.
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I to znači da se vaši bakterijski autostoperi pokreću s vama.
00:37
So a plague outbreak in Surat, India
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Stoga početak kuge u Suratu u Indiji
00:39
becomes not an obscure event, but a globalized event --
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ne postaje neprimjetan slučaj, nego globalni slučaj –
00:42
a globalized concern that has changed the risk equation.
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globalna briga koja je promijenila jednadžbu rizika.
00:45
Katrina showed us
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Katrina nam je pokazala
00:47
that we cannot completely depend on government
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da ne možemo u potpunosti ovisiti o vladinoj spremnosti
00:49
to have readiness in hand, to be capable of handling things.
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na rješavanje stvari.
00:52
Indeed, an outbreak would be multiple Katrinas at once.
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Zaista, pojava pandemije bila bi višestruka Katrina.
00:56
Our big concern at the moment is a virus called H5N1 flu --
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Trenutno je naša velika briga virus nazvan H5N1 gripa.
00:59
some of you call it bird flu --
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Neki je od vas zovu ptičja gripa.
01:01
which first emerged in southern China, in the mid-1990s,
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Ona je prvo izbila u južnoj Kini, sredinom devedesetih.
01:04
but we didn't know about it until 1997.
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Ali nismo znali za nju do 1997.
01:07
At the end of last Christmas only 13 countries had seen H5N1.
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Krajem prošlog Božića samo je trinaest zemalja vidjelo H5N1.
01:11
But we're now up to 55 countries in the world,
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Ali sada imamo 55 zemalja diljem svijeta
01:13
have had this virus emerge,
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gdje je virus izbio
01:15
in either birds, or people or both.
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ili u ptica, ili u ljudi, ili oboje.
01:18
In the bird outbreaks we now can see
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U izbijanjima kod ptica, možemo vidjeti
01:20
that pretty much the whole world has seen this virus
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da je gotovo cijeli svijet vidio ovaj virus,
01:23
except the Americas.
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osim Amerika.
01:25
And I'll get into why we've so far been spared in a moment.
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I doći ću do toga zašto smo dosada bili pošteđeni.
01:29
In domestic birds, especially chickens,
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Kod domaćih ptica, pogotovo kokoši,
01:31
it's 100 percent lethal.
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virus je 100 posto smrtonosan.
01:33
It's one of the most lethal things we've seen
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To je jedna od najsmrtonosnijih stvari koje smo vidjeli
01:35
in circulation in the world
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na djelu u svijetu
01:37
in any recent centuries.
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posljednjih stoljeća.
01:39
And we've dealt with it by killing off lots and lots and lots of chickens,
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I suočavali smo se s time tako što smo ubijali strahovito puno pilića
01:42
and unfortunately often not reimbursing the peasant farmers
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i nažalost, često bez naknade seljacima
01:45
with the result that there's cover-up.
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koja bi pokrila te troškove.
01:47
It's also carried on migration patterns
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Ubijanje je također provođeno na migracijskim uzorcima
01:49
of wild migratory aquatic birds.
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divljih vodenih ptica selica.
01:52
There has been this centralized event
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Bio je centralizirani slučaj u mjestu
01:54
in a place called Lake Chenghai, China.
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po imenu jezero Chenghai u Kini.
01:56
Two years ago the migrating birds
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Prije dvije godine ptice selice
01:58
had a multiple event
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su doživjele višestruki slučaj
02:00
where thousands died because of a mutation occurring
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kada su tisuće umrle zbog mutacija
02:02
in the virus,
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u virusu,
02:04
which made the species range broaden dramatically.
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što je drastično proširilo raspon vrsta.
02:07
So that birds going to Siberia, to Europe, and to Africa
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Te ptice koje idu u Sibir, Europu i Afriku
02:10
carried the virus, which had not previously been possible.
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prenijele su virus, što prije nije bilo moguće.
02:13
We're now seeing outbreaks in human populations --
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Sada vidimo izbijanja u ljudskoj populaciji.
02:17
so far, fortunately, small events,
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Dosad, srećom, mali slučajevi,
02:20
tiny outbreaks, occasional clusters.
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sitna izbijanja, povremeno grupe.
02:23
The virus has mutated dramatically in the last two years
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Virus je dramatično mutirao u zadnje dvije godine
02:26
to form two distinct families, if you will,
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i oblikovao dvije posebne „obitelji“, može se reći,
02:29
of the H5N1 viral tree
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H5N1 virusnog drveta
02:31
with branches in them,
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s granama na njemu
02:33
and with different attributes that are worrying.
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i s različitim zabrinjavajućim svojstvima.
02:35
So what's concerning us? Well, first of all,
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Dakle, što nas zabrinjava? Pa, kao prvo,
02:37
at no time in history have we succeeded in making
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ni u jednom vremenu u povijesti nismo uspjeli
02:40
in a timely fashion, a specific vaccine
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pravovremeno napraviti posebno cjepivo
02:42
for more than 260 million people.
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za više od 260 milijuna ljudi.
02:45
It's not going to do us very much good in a global pandemic.
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Neće nam pomoći jako puno u svjetskoj pandemiji.
02:48
You've heard about the vaccine we're stockpiling.
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Čuli ste o cjepivu koje skladištimo.
02:51
But nobody believes it will actually be particularly effective
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Ali nitko zapravo ne vjeruje da će biti osobito djelotvorno
02:53
if we have a real outbreak.
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ako budemo imali pravo izbijanje.
02:55
So one thought is:
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Zato je jedna misao:
02:57
after 9/11, when the airports closed,
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poslije 11. rujna zatvaranje je zračnih luka
02:59
our flu season was delayed by two weeks.
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odgodilo sezonu gripe za dva tjedna.
03:01
So the thought is, hey, maybe what we should do is just
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Stoga, pomisao je: hej možda ono što trebamo napraviti
03:03
immediately -- we hear there is H5N1 spreading from human to human,
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jest da samo smjesta – čuli smo da se H5N1 širi sa čovjeka na čovjeka,
03:07
the virus has mutated to be a human-to-human transmitter --
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virus je mutirao da bude prenosilac sa čovjeka na čovjeka –
03:09
let's shut down the airports.
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zatvorimo zračne luke.
03:11
However, huge supercomputer analyses,
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Međutim, ogromna analiza superračunala,
03:15
done of the likely effectiveness of this,
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načinjena prema mogućoj učinkovitosti ovoga,
03:17
show that it won't buy us much time at all.
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pokazuje da nam to uopće neće dati puno vremena.
03:19
And of course it will be hugely disruptive in preparation plans.
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I naravno, da će iznimno remetiti pripremu planova.
03:23
For example, all masks are made in China.
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Na primjer, sve maske izrađuju se u Kini.
03:26
How do you get them mobilized around the world
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Kako ćete ih dijeliti diljem svijeta
03:28
if you've shut all the airports down?
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ako ste zatvorili sve zračne luke?
03:30
How do you get the vaccines moved around the world
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Kako ćete raznijeti cjepiva diljem svijeta,
03:32
and the drugs moved, and whatever may or not be available that would work.
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i lijekove, i štogod bude ili ne bude dostupno i djelotvorno.
03:35
So it turns out that shutting down the airports is counterproductive.
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Dakle, ispada da je zatvaranje zračnih luka kontraproduktivno.
03:39
We're worried because this virus, unlike any other flu
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Zabrinuti smo zato što ovaj virus, za razliku od bilo koje gripe
03:42
we've ever studied, can be transmitted by eating raw meat
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koju smo ikada proučavali, može biti prenošen jedenjem sirovog mesa
03:46
of the infected animals.
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zaraženih životinja.
03:48
We've seen transmission to wild cats and domestic cats,
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Vidjeli smo prijenos na divlje mačke i domaće mačke,
03:51
and now also domestic pet dogs.
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a sada i na domaće pse.
03:54
And in experimental feedings to rodents and ferrets,
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I u eksperimentalnom hranjenju glodavaca i lasica
03:57
we found that the animals exhibit symptoms never seen with flu:
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otkrili smo da životinje pokazuju simptome nikad viđene kod gripe,
04:01
seizures, central nervous system disorders, partial paralysis.
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napadaje, poremećaje središnjeg živčanog sustava, djelomičnu paralizu.
04:04
This is not your normal garden-variety flu.
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Ovo nije uobičajena raznolikost gripe.
04:07
It mimics what we now understand
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To oponaša ono što danas znamo o
04:09
about reconstructing the 1918 flu virus,
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rekonstrukciji virusa gripe iz 1918. godine,
04:11
the last great pandemic,
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posljednju veliku pandemiju,
04:13
in that it also jumped directly from birds to people.
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koja je također prešla izravno s ptica na ljude.
04:15
We had evolution over time,
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Imali smo evoluciju tijekom vremena,
04:17
and this unbelievable mortality rate in human beings:
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i ova nevjerojatna stopa smrtnosti u ljudi.
04:21
55 percent of people who have become infected
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55 posto ljudi koji su bili zaraženi
04:23
with H5N1 have, in fact, succumbed.
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H5N1 su, u stvari, podlegli.
04:27
And we don't have a huge number of people
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I nemamo veliki broj ljudi
04:29
who got infected and never developed disease.
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koji se zarazio i nikad nije razvio bolest.
04:32
In experimental feeding in monkeys
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U eksperimentalnom hranjenju majmuna
04:34
you can see that it actually downregulates
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može se vidjeti da virus zapravo potpomaže razvoj
04:36
a specific immune system modulator.
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posebnog oblika imunološkog sustava.
04:38
The result is that what kills you
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Rezultat je da vas zapravo ubije,
04:40
is not the virus directly, but your own immune system overreacting, saying,
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ne virus izravno, već vlastiti imunološki sustav koje pretjerano reagira govoreći:
04:43
"Whatever this is so foreign I'm going berserk."
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„Štogod da je ovo strano, poludjet ću.“
04:46
The result: most of the deaths
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Rezultat, većina preminulih
04:48
have been in people under 30 years of age,
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imali su manje od trideset godina,
04:50
robustly healthy young adults.
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izrazito zdrave mlade odrasle osobe.
04:53
We have seen human-to-human transmission
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Vidjeli smo prijenos sa čovjeka na čovjeka
04:55
in at least three clusters --
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u barem tri slučaja – na sreću,
04:57
fortunately involving very intimate contact,
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uključivali su vrlo intiman kontakt
05:00
still not putting the world at large at any kind of risk.
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te nisu ugrozili ljudsku populaciju.
05:03
Alright, so I've got you nervous.
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Dobro, sada ste postali nervozni.
05:05
Now you probably assume, well the governments are going to do something.
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Vjerojatno pretpostavljate da će vlada nešto napraviti.
05:08
And we have spent a lot of money.
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I potrošili smo mnogo novca.
05:10
Most of the spending in the Bush administration
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Većina troškova Busheve administracije
05:12
has actually been more related to the anthrax results
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zapravo je bila vezana za proučavanje antraksa
05:16
and bio-terrorism threat.
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i prijetnje bio-terorizma.
05:18
But a lot of money has been thrown out at the local level and at the federal level
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I mnogo je novca bačeno na lokalnoj razini i na federalnoj razini
05:21
to look at infectious diseases.
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da bi se proučavalo zarazne bolesti.
05:23
End result: only 15 states
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Završni rezultat: za samo 15 država
05:25
have been certified to be able to do mass distribution
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potvrđeno je da su sposobne za masovnu distribuciju
05:27
of vaccine and drugs in a pandemic.
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cjepiva i lijekova u slučaju pandemije.
05:30
Half the states would run out of hospital beds
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Pola država ostat će bez bolničkih kreveta
05:32
in the first week, maybe two weeks.
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u prvom tjednu, možda u dva tjedna.
05:34
And 40 states already have an acute nursing shortage.
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I 40 država već ima kronični nedostatak njegovatelja.
05:37
Add on pandemic threat, you're in big trouble.
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Dodajte još i pandemijsku prijetnju i u velikoj ste nevolji.
05:39
So what have people been doing with this money?
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Što su ljudi radili s tim novcem?
05:41
Exercises, drills, all over the world.
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Vježbe, treninzi, diljem svijeta.
05:43
Let's pretend there's a pandemic.
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Pretvarajmo se da je pandemija.
05:45
Let's everybody run around and play your role.
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Neka svi trče uokolo i igraju svoju ulogu.
05:47
Main result is that there is tremendous confusion.
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Glavni rezultat je da postoji ogromna zbunjenost.
05:50
Most of these people don't actually know what their job will be.
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Većina ovih ljudi zapravo ne zna što će biti njihov posao.
05:53
And the bottom line, major thing that has come through
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Na kraju krajeva, glavna stvar koja se očitovala
05:55
in every single drill: nobody knows who's in charge.
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u svakoj vježbi jest da nitko ne zna tko je glavni zaduženi.
05:58
Nobody knows the chain of command.
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Nitko ne zna zapovjedni lanac.
06:00
If it were Los Angeles, is it the mayor, the governor,
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Ako je u Los Angelesu, je li gradonačelnik, guverner,
06:03
the President of the United States, the head of Homeland Security?
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predsjednik SAD-a, vođa Domovinske sigurnosti?
06:06
In fact, the federal government says it's a guy called
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Zapravo, savezna vlada kaže da je to momak
06:08
the Principle Federal Officer,
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s titulom Principle Federal Officer,
06:11
who happens to be with TSA.
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koji je u TSA-u.
06:13
The government says
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Vlada kaže da će
06:14
the federal responsibility will basically be
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savezna odgovornost u principu biti u pokušaju
06:17
about trying to keep the virus out, which we all know is impossible,
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da se zadrži virus vani, što svi znamo da je nemoguće,
06:20
and then to mitigate the impact
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i onda da ublaži utjecaj
06:22
primarily on our economy.
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na naše gospodarstvo.
06:25
The rest is up to your local community.
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Ostalo je mjesnoj zajednici.
06:27
Everything is about your town, where you live.
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Sve ovisi o tvom gradu, o mjestu gdje živiš.
06:30
Well how good a city council you have,
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Pa koliko je dobro gradsko vijeće koje imate?
06:32
how good a mayor you have -- that's who's going to be in charge.
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Koliko dobrog gradonačelnika imate; on će biti glavni zaduženi.
06:36
Most local facilities would all be competing
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Većina će se mjesnih postrojenja natjecati
06:38
to try and get their hands on their piece
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da dobiju dio
06:40
of the federal stockpile of a drug called Tamiflu,
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saveznih rezervi lijeka po imenu Tamiflu,
06:43
which may or may not be helpful -- I'll get into that --
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koji može a i ne mora biti od pomoći – doći ću do toga –
06:45
of available vaccines, and any other treatments,
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dostupnih cjepiva, ili bilo kojeg drugog tretmana,
06:48
and masks, and anything that's been stockpiled.
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maski, i svega što će biti uskladišteno.
06:51
And you'll have massive competition.
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I imat ćete ogromnu konkurenciju.
06:54
Now we did purchase a vaccine, you've probably all heard about it,
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Mi jesmo kupili cjepivo, sigurno ste čuli o tome,
06:56
made by Sanofi-Aventis.
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napravio ga je Sanofi-Aventis.
06:58
Unfortunately it's made against the current form of H5N1.
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Nažalost, napravljeno je protiv trenutačnog oblika H5N1.
07:01
We know the virus will mutate. It will be a different virus.
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Znamo da će virus mutirati. Bit će drugačiji virus.
07:04
The vaccine will probably be useless.
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Cjepivo će vjerojatno biti beskorisno.
07:07
So here's where the decisions come in.
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Dakle ovdje dolazi do odluke.
07:09
You're the mayor of your local town.
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Vi ste gradonačelnik vašeg grada.
07:11
Let's see, should we order that all pets be kept indoors?
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Da vidimo, da zapovjedimo da se svi ljubimci drže u zatvorenom?
07:14
Germany did that when H5N1 appeared in Germany last year,
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Njemačka je to napravila kad se H5N1 pojavio u Njemačkoj prošle godine,
07:17
in order to minimize the spread
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kako bi smanjili širenje
07:19
between households by household cats, dogs and so on.
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između kućanstava, preko kućnih mačaka, pasa i slično.
07:23
What do we do when we don't have any containment rooms
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Što radimo kada nemamo zatvorenih soba
07:27
with reverse air that will allow the healthcare workers
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s izmjenom zraka, koje će omogućiti zdravstvenim djelatnicima
07:29
to take care of patients?
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da se pobrinu za pacijente?
07:31
These are in Hong Kong; we have nothing like that here.
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One su u Hong Kongu. Nemamo ništa tome slično ovdje.
07:33
What about quarantine?
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Što s karantenama?
07:35
During the SARS epidemic in Beijing quarantine did seem to help.
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Tijekom epidemije SARS-a u Beijingu karantene nisu pomogle.
07:38
We have no uniform policies
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Nemamo ujednačenu politiku
07:40
regarding quarantine across the United States.
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koja se odnosi na karantene diljem SAD-a.
07:42
And some states have differential policies, county by county.
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Neke države imaju različitu politiku od okruga do okruga.
07:46
But what about the no-brainer things? Should we close all the schools?
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Što je s očitim stvarima? Trebam li zatvoriti sve škole?
07:49
Well then what about all the workers? They won't go to work
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Što sa svim radnicima? Oni neće otići na posao
07:51
if their kids aren't in school.
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ako njihova djeca nisu u školi.
07:53
Encouraging telecommuting? What works?
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Poticanje telekomunikacija? Što djeluje?
07:55
Well the British government did a model of telecommuting.
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Britanska vlada napravila je model telekomunikacija.
07:58
Six weeks they had all people in the banking industry
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Šest tjedana svi ljudi u bankarskoj industriji
08:01
pretend a pandemic was underway.
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pretvarali su se da je pandemija u tijeku.
08:03
What they found was, the core functions --
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Ono što su otkrili jesu osnovne funkcije,
08:05
you know you still sort of had banks,
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znate još uvijek ste imali banke,
08:07
but you couldn't get people to put money in the ATM machines.
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ali niste mogli dovesti ljude da stave novac u bankomate.
08:10
Nobody was processing the credit cards.
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Nitko nije obrađivao kreditne kartice.
08:12
Your insurance payments didn't go through.
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Vaše uplate za osiguranje nisu prolazile.
08:14
And basically the economy would be in a disaster state of affairs.
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I u osnovi, gospodarstvo bi bilo u katastrofalnom stanju.
08:17
And that's just office workers, bankers.
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A to je samo što se tiče uredskih radnika, bankara.
08:21
We don't know how important hand washing is for flu --
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Ne znamo koliko je pranje ruku važno za gripu –
08:24
shocking. One assumes it's a good idea to wash your hands a lot.
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šokantno. Za pretpostaviti je da je dobra zamisao često prati ruke.
08:27
But actually in scientific community there is great debate
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No zapravo, u znanstvenoj zajednici velika je debata
08:29
about what percentage of flu transmission between people
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o tome koliki postotak prijenosa gripe između ljudi
08:32
is from sneezing and coughing
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je od kihanja i kašljanja
08:34
and what percentage is on your hands.
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a koliki postotak je na vašim rukama.
08:36
The Institute of Medicine tried to look at the masking question.
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Medicinski Institut je pokušao razmotriti pitanje maski.
08:40
Can we figure out a way, since we know we won't have enough masks
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Možemo li smisliti način, s obzirom da nećemo imati dovoljno maski
08:42
because we don't make them in America anymore,
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jer ih više ne pravimo u Americi.
08:44
they're all made in China --
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Sve se prave u Kini.
08:46
do we need N95? A state-of-the-art, top-of-the-line,
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Trebamo li N95? Posljednje dostignuće, vrhunski izum,
08:49
must-be-fitted-to-your-face mask?
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maska koja mora pristajati vašem licu?
08:52
Or can we get away with some different kinds of masks?
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Ili možemo proći s nekom drugačijom vrstom maski?
08:55
In the SARS epidemic, we learned in Hong Kong
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Tijekom epidemije SARS -a, naučili smo u Hong Kongu
08:57
that most of transmission was because
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da je većina prijenosa gripe bila
08:59
people were removing their masks improperly.
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zbog nepravilnog skidanja maski.
09:01
And their hand got contaminated with the outside of the mask,
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Njihove su ruke bile kontaminirane s vanjske strane maske,
09:03
and then they rubbed their nose. Bingo! They got SARS.
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nakon čega su protrljali nos. Bingo! Dobili su SARS.
09:06
It wasn't flying microbes.
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To nije bio leteći mikrob.
09:09
If you go online right now, you'll get so much phony-baloney information.
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Ako sada odete na internet, dobit ćete mnoštvo lažnih i glupih informacija.
09:12
You'll end up buying -- this is called an N95 mask. Ridiculous.
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Na kraju ćete kupiti -- ovo se zove N95 maska. Smiješno.
09:17
We don't actually have a standard
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Zapravo nemamo standard
09:19
for what should be the protective gear for the first responders,
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o tome što bi trebala biti zaštitna oprema za one koji će se prvi suočiti s time,
09:22
the people who will actually be there on the front lines.
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ljude koji će zapravo biti na prvim linijama obrane.
09:25
And Tamiflu. You've probably heard of this drug,
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I Tamiflu. Vjerojatno ste čuli za ovaj lijek,
09:27
made by Hoffmann-La Roche, patented drug.
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napravljen od strane Hoffman – La Roche, patentiran lijek.
09:30
There is some indication
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Postoje neke naznake
09:32
that it may buy you some time in the midst of an outbreak.
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da vam može kupiti nešto vremena usred izbijanja epidemije.
09:35
Should you take Tamiflu for a long period of time,
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Ako uzimate Tamiflu duže vrijeme,
09:37
well, one of the side effects is suicidal ideations.
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jedna od nuspojava su suicidalne misli.
09:40
A public health survey analyzed the effect
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Istraživanje javnog zdravstva analiziralo je učinak
09:44
that large-scale Tamiflu use would have,
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koji bi imao uzimanje velikih količina Tamiflua,
09:46
actually shows it counteractive
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pokazujući zapravo da je suprotan
09:48
to public health measures, making matters worse.
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mjerama javnog zdravstva, pogoršava stanje.
09:51
And here is the other interesting thing:
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Također jedna zanimljiva stvar:
09:53
when a human being ingests Tamiflu, only 20 percent
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kada čovjek proguta Tamiflu, samo 20 posto je
09:55
is metabolized appropriately
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probavljeno pravilno,
09:57
to be an active compound in the human being.
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tako da bude aktivna tvar u ljudskom organizmu.
09:59
The rest turns into a stable compound,
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Ostatak se pretvara u stabilnu smjesu,
10:03
which survives filtration into the water systems,
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koja preživljava filtraciju u vodene sustave,
10:06
thereby exposing the very aquatic birds that would carry flu
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time se izlažući vodenim pticama koje će prenijeti gripu
10:09
and providing them a chance
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i pružiti im priliku da
10:11
to breed resistant strains.
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razviju otporne vrste.
10:13
And we now have seen Tamiflu-resistant strains
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Do sada smo vidjeli vrste otporne na Tamiflu
10:16
in both Vietnam in person-to-person transmission,
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u Vijetnamu, u prijenosu sa čovjeka na čovjeka,
10:19
and in Egypt in person-to-person transmission.
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i u Egiptu u prijenosu sa čovjeku na čovjeka.
10:21
So I personally think that our life expectancy
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Tako da osobno mislim da je očekivano trajanje
10:24
for Tamiflu as an effective drug
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Tamiflua kao učinkovitog lijeka
10:27
is very limited -- very limited indeed.
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vrlo ograničeno – zaista vrlo ograničeno.
10:29
Nevertheless most of the governments
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Ipak, većina je vlada
10:31
have based their whole flu policies
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utemeljila cijelu svoju politiku borbe protiv gripe
10:33
on building stockpiles of Tamiflu.
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na nagomilavanju zaliha Tamiflua.
10:35
Russia has actually stockpiled enough
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Rusija je skupila zalihe dovoljne
10:37
for 95 percent of all Russians.
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za 95 posto ukupnog stanovništva.
10:39
We've stockpiled enough for 30 percent.
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Mi smo skupili zalihe dovoljne za 30 posto stanovništva.
10:41
When I say enough, that's two weeks worth.
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Kad kažem „dovoljne“, mislim na zalihe u trajanju od dva tjedna.
10:43
And then you're on your own because
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A nakon toga ste prepušteni sami sebi jer će
10:45
the pandemic is going to last for 18 to 24 months.
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pandemija trajati od 18 do 24 mjeseca.
10:47
Some of the poorer countries
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Neke od siromašnijih zemalja
10:49
that have had the most experience with H5N1 have built up stockpiles;
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koje su imale najviše iskustva s virusom H5N1 skupile su zalihe
10:52
they're already expired. They are already out of date.
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kojima je sada već istekao rok trajanja.
10:55
What do we know from 1918,
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Što znamo iz 1918.godine,
10:57
the last great pandemic?
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vremena zadnje velike pandemije?
10:59
The federal government abdicated most responsibility.
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Federalna se vlada odrekla većine odgovornosti.
11:02
And so we ended up with this wild patchwork of regulations
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I tako smo završili s ovom ludom mješavinom propisa
11:05
all over America.
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širom cijele Amerike.
11:07
Every city, county, state did their own thing.
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Svaki grad, okrug, svaka je država radila po svome.
11:09
And the rules
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I zakoni,
11:11
and the belief systems were wildly disparate.
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kao i sustavi vjerovanja, bili su u najvećoj mjeri različiti.
11:14
In some cases all schools, all churches,
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U nekim su slučajevima sve škole, sve crkve,
11:17
all public venues were closed.
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sva javna mjesta bila zatvorena.
11:19
The pandemic circulated three times in 18 months
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Pandemija je kružila tri puta u 18 mjeseci
11:22
in the absence of commercial air travel.
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u odsutnosti komercijalnog zračnog prijevoza.
11:24
The second wave was the mutated, super-killer wave.
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Drugi je val bio mutirani, superubojiti val.
11:27
And in the first wave we had enough healthcare workers.
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U prvom smo valu imali dovoljno zdravstvenih radnika.
11:30
But by the time the second wave hit
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Ali, do trenutka kada je došao drugi val,
11:32
it took such a toll among the healthcare workers
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uzet je toliki danak među zdravstvenim radnicima
11:35
that we lost most of our doctors and nurses that were on the front lines.
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da smo izgubili većinu naših liječnika i medicinskih sestra koji su bili na prvim linijama bojišnice.
11:39
Overall we lost 700,000 people.
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Sveukupno smo izgubili 700 tisuća ljudi.
11:41
The virus was 100 percent lethal to pregnant women
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Virus je bio 100 posto smrtonosan za trudnice.
11:44
and we don't actually know why.
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I dalje, zapravo, ne znamo zašto.
11:46
Most of the death toll was 15 to 40 year-olds --
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Većina je umrlih bila u dobi od 15 do 40 godina –
11:49
robustly healthy young adults.
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to su bile snažne, mlade osobe.
11:51
It was likened to the plague.
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Bilo je to nalik kugi.
11:53
We don't actually know how many people died.
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Mi zapravo i ne znamo koliko je točno ljudi umrlo.
11:55
The low-ball estimate is 35 million.
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Niska je procjena oko 35 milijuna.
11:58
This was based on European and North American data.
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Ovo je temeljeno na europskim i sjevernoameričkim podacima.
12:01
A new study by Chris Murray at Harvard
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Nova studija Chrisa Murraya s Harvarda
12:03
shows that if you look at the databases that were kept
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pokazuje da, ako pogledate baze podataka
12:05
by the Brits in India,
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koje su Britanci vodili u Indiji –
12:07
there was a 31-fold greater death rate among the Indians.
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tamo je bila 31 posto veća stopa smrtnosti među Indijcima.
12:11
So there is a strong belief that in places of poverty
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Zato postoji čvrsto uvjerenje da je u siromašnim mjestima
12:14
the death toll was far higher.
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broj umrlih bio znatno veći.
12:16
And that a more likely toll
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I da je vjerojatnija brojka umrlih negdje
12:18
is somewhere in the neighborhood of 80 to 100 million people
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oko 80 do 100 milijuna ljudi,
12:20
before we had commercial air travel.
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prije nego što smo imali komercijalni zračni promet.
12:23
So are we ready?
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Stoga, jesmo li spremni?
12:25
As a nation, no we're not.
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Kao nacija, ne nismo.
12:27
And I think even those in the leadership
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I mislim da bi čak i vodstvo naše zemlje
12:29
would say that is the case,
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priznalo da je, u ovom slučaju,
12:31
that we still have a long ways to go.
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pred nama još dug put.
12:33
So what does that mean for you? Well the first thing is,
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Što to znači za vas? Prije svega,
12:35
I wouldn't start building up personal stockpiles of anything --
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ja ne bih započela s izgradnjom osobne zalihe ičega –
12:38
for yourself, your family, or your employees --
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za sebe, svoju obitelj ili svoje zaposlenike,
12:42
unless you've really done your homework.
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osim ako niste temeljito proučili svoju zadaću.
12:45
What mask works, what mask doesn't work.
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Koja je maska djelotvorna? Koja maska nije djelotvorna.
12:47
How many masks do you need?
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Koliko maski trebate?
12:49
The Institute of Medicine study felt that
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Institut za medicinu smatra
12:51
you could not recycle masks.
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da ne biste trebali reciklirati maske.
12:53
Well if you think it's going to last 18 months,
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Pa ako mislite da će pandemija trajati 18 mjeseci,
12:56
are you going to buy 18 months worth of masks
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hoćete li kupiti maski za 18 mjeseci,
12:58
for every single person in your family?
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za svakog člana svoje obitelji?
13:01
We don't know -- again with Tamiflu,
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S Tamifluom, opet, ne znamo,
13:05
the number one side effect of Tamiflu is
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jer su prva nuspojava Tamiflua simptomi
13:07
flu-like symptoms.
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slični onima kod gripe.
13:09
So then how can you tell
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Kako onda možete znati
13:11
who in your family has the flu
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tko u vašoj obitelji ima gripu,
13:13
if everybody is taking Tamiflu?
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ako svi uzimaju Tamiflu?
13:16
If you expand that out to think of a whole community,
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Ako proširite ovo razmišljanje na cijelu zajednicu
13:19
or all your employees in your company,
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ili na sve zaposlenike u vašoj kompaniji
13:22
you begin to realize how limited
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počinjete shvaćati koliko bi zapravo opcija
13:24
the Tamiflu option might be.
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s Tamifluom mogla biti ograničena.
13:26
Everybody has come up to me and said,
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Svi su mi došli i rekli da će
13:28
well I'll stockpile water or, I'll stockpile food, or what have you.
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nakupiti zalihe vode ili zalihe hrane.
13:32
But really? Do you really have a place
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Ali, ozbiljno? Imate li, zaista, mjesta
13:35
to stockpile 18 months worth of food? Twenty-four months worth of food?
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za zalihe hrane za 18 mjeseci? Ili zalihe hrane za 24 mjeseca?
13:38
Do you want to view the pandemic threat
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Želite li pristupiti opasnosti od pandemije
13:40
the way back in the 1950s
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na isti način kao što su 1950-ih
13:42
people viewed the civil defense issue,
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ljudi pristupili problemu civilne obrane
13:44
and build your own little bomb shelter for pandemic flu?
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i izgraditi svoja malena atomska skloništa za pandemiju gripe?
13:47
I don't think that's rational.
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Ne smatram to racionalnim.
13:49
I think it's about having to be prepared
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Mislim da moramo biti spremni
13:51
as communities, not as individuals --
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kao zajednica, a ne kao pojedinci,
13:53
being prepared as nation,
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spremni kao nacija,
13:55
being prepared as state, being prepared as town.
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kao država, kao grad.
13:58
And right now most of the preparedness
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A trenutna je pripravnost najvećim dijelom
14:00
is deeply flawed.
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prilično slaba.
14:02
And I hope I've convinced you of that,
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I nadam se da sam vas sada uvjerila u to,
14:04
which means that the real job is go out and
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što znači da je sada pravi zadatak izaći van i
14:06
say to your local leaders,
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reći svojim lokalnim vođama,
14:08
and your national leaders,
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reći svojim državnim vođama,
14:10
"Why haven't you solved these problems?
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"Zašto niste riješili ove probleme?
14:12
Why are you still thinking that
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Zašto još uvijek mislite da se
14:14
the lessons of Katrina do not apply to flu?"
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lekcije dobivene od uragana Katrine ne odnose na gripu?"
14:17
And put the pressure where the pressure needs to be put.
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I vršiti pritisak tamo gdje pritisak treba biti nametnut.
14:21
But I guess the other thing to add is,
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Ali pretpostavljam da trebam dodati da
14:23
if you do have employees, and you do have a company,
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ako imate svoje zaposlenike ili kompaniju,
14:25
I think you have certain responsibilities
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tada imate određenu odgovornost
14:28
to demonstrate that you are thinking ahead for them,
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pokazati im da razmišljate unaprijed za njih
14:30
and you are trying to plan.
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i da pokušavate nešto isplanirati.
14:32
At a minimum the British banking plan showed that
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Plan britanskih banki pokazao je da rad od kuće,
14:36
telecommuting can be helpful.
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putem računala, može biti prilično koristan.
14:38
It probably does reduce exposure
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Na taj način smanjuje se izloženost gripi
14:40
because people are not coming into the office and coughing on each other,
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jer ljudi ne dolaze u ured i ne kašlju jedni po drugima,
14:43
or touching common objects
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ne diraju zajedničke predmete
14:46
and sharing things via their hands.
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i ne dijele stvari iz ruke u ruku.
14:48
But can you sustain your company that way?
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Ali možete li radom na takav način održati svoju kompaniju?
14:52
Well if you have a dot-com, maybe you can.
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Ako imate računalnu firmu, vjerojatno možete.
14:55
Otherwise you're in trouble.
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Inače ste u nevolji.
14:58
Happy to take your questions.
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Rado ću odgovoriti na vaša pitanja.
15:00
(Applause)
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(Pljesak)
15:04
Audience member: What factors determine the duration of a pandemic?
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Publika: Koji čimbenici određuju trajanje pandemije?
15:09
Laurie Garret: What factors determine the duration of a pandemic, we don't really know.
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Laurie Garret: Mi zapravo ne znamo koji čimbenici određuju trajanje pandemije.
15:13
I could give you a bunch of flip, this, that, and the other.
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Mogla bih vam dati hrpu pretpostavki.
15:16
But I would say that honestly we don't know.
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Ali, umjesto toga, reći ću vam da iskreno ne znamo.
15:19
Clearly the bottom line is
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Jasno je da virus
15:21
the virus eventually attenuates,
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s vremenom slabi
15:24
and ceases to be a lethal virus to humanity,
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i prestaje biti smrtonosan za čovječanstvo
15:29
and finds other hosts.
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te pronalazi druge domaćine.
15:31
But we don't really know how and why that happens.
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Ali mi zapravo ne znamo kako i zašto se to događa.
15:33
It's a very complicated ecology.
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To je vrlo komplicirana ekologija.
15:36
Audience member: What kind of triggers are you looking for?
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Publika: Kakvu vrstu aktivatora tražite?
15:39
You know way more than any of us.
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Vi znate puno više nego bilo tko od nas.
15:41
To say ahh, if this happens then we are going to have a pandemic?
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Zbog čega ćete reći: "Ah, ako se ovo dogodi - doći će do pandemije?"
15:45
LG: The moment that you see any evidence
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LG: Onog trenutka kad vidite ozbiljan dokaz
15:47
of serious human-to-human to transmission.
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prijenosa sa čovjeka na čovjeka.
15:50
Not just intimately between family members
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Ne samo intimno, između članova obitelji
15:52
who took care of an ailing sister or brother,
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koji su se brinuli o bolesnoj sestri ili bratu,
15:56
but a community infected --
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već kad vidite zaraženu zajednicu -
15:58
spread within a school,
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širenja unutar škola,
16:00
spread within a dormitory, something of that nature.
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unutar studentskih domova, nešto te prirode.
16:03
Then I think that there is universal agreement
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Smatram da sada postoji opće slaganje
16:06
now, at WHO all the way down:
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sada u Svjetskoj zdravstvenoj organizaciji do kraja.
16:08
Send out the alert.
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Pošaljite upozorenje.
16:12
Audience member: Some research has indicated that statins can be helpful.
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Publika: Neka su istraživanja pokazala da uzimanje lijekova za smanjenje razine lipida u krvi može biti korisno.
16:16
Can you talk about that?
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Možete li reći nešto o tome?
16:18
LG: Yeah. There is some evidence that taking Lipitor
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LG: Da. Postoje neki dokazi da uzimanje Lipitora
16:20
and other common statins for cholesterol control
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i nekih sličnih lijekova za kontrolu kolesterola
16:23
may decrease your vulnerability
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može smanjiti vašu osjetljivost
16:27
to influenza.
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na gripu.
16:29
But we do not completely understand why.
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Ali ne razumijemo, u potpunosti, zašto.
16:32
The mechanism isn't clear.
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Taj mehanizam nam nije jasan.
16:34
And I don't know that there is any way
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I smatram da, ni na koji način,
16:39
responsibly for someone to start
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nitko ne bi trebao osjećati potrebu da počne
16:42
medicating their children
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liječiti svoju djecu
16:44
with their personal supply of Lipitor or something of that nature.
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s osobnom zalihom Lipitora ili nečeg sličnog.
16:48
We have absolutely no idea what that would do.
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Nemamo ni ideje do čega bi to moglo dovesti.
16:50
You might be causing some very dangerous outcomes
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Time bi mogli prouzročiti opasne nuspojave
16:53
in your children, doing such a thing.
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kod svoje djece.
16:56
Audience member: How far along are we in being able to determine
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Publika: Koliko smo napredovali u sposobnosti da zaključimo
16:58
whether someone is actually carrying, whether somebody has this
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da netko ima gripu,
17:00
before the symptoms are full-blown?
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prije nego što su simptomi u punom cvatu?
17:02
LG: Right. So I have for a long time said
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LG: Već sam prije dugo vremena rekla
17:05
that what we really needed was a rapid diagnostic.
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da je ono što zapravo trebamo brza dijagnoza.
17:08
And our Centers for Disease Control
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I naši centri za kontrolu zaraze
17:11
has labeled a test they developed
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razvili su test
17:14
a rapid diagnostic.
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za brzu dijagnozu.
17:16
It takes 24 hours in a very highly developed laboratory,
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On traje 24 sata u visoko opremljenom laboratoriju,
17:20
in highly skilled hands.
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u vrhunski vještim rukama.
17:22
I'm thinking dipstick.
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Ja razmišljam o mjernim štapićima.
17:24
You could do it to your own kid. It changes color.
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To biste mogli napraviti svome djetetu osobno. Oni mijenjaju boju.
17:26
It tells you if you have H5N1.
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Kažu vam ako imate H5N1.
17:28
In terms of where we are in science
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U uvjetima u kojima je trenutno znanost
17:32
with DNA identification capacities and so on,
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glede identifikacije pomoću DNK kapaciteta i slično,
17:36
it's not that far off.
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to i nije tako nemoguće.
17:38
But we're not there. And there hasn't been the kind of investment to get us there.
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Ali mi to nemamo. I ne postoje ulaganja bilo koje vrste koja bi nam to omogućila.
17:43
Audience member: In the 1918 flu I understand that
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Publika: Koliko sam shvatio,
17:46
they theorized that there was some attenuation
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kod gripe iz 1918. postojale su neke teorije
17:50
of the virus when it made the leap into humans.
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da je virus oslabio u trenutku kada je prešao na ljude.
17:52
Is that likely, do you think, here?
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Smatrate li da je to moguće i sada?
17:54
I mean 100 percent death rate
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Mislim, stopostotna stopa smrtnosti
17:58
is pretty severe.
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je prilično ozbiljna.
18:00
LG: Um yeah. So we don't actually know
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LG: Umm, da. Mi zapravo ne znamo
18:04
what the lethality was
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kolika je bila smrtnost za
18:07
of the 1918 strain to wild birds
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divlje ptice 1918. godine
18:11
before it jumped from birds to humans.
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prije nego što je virus prešao s njih na ljude.
18:13
It's curious that there is no evidence
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Zagonetno je to što nema dokaza
18:15
of mass die-offs of chickens
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o masovnom ugibanju kokoši
18:17
or household birds across America
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i ptica u kućanstvima diljem Amerike
18:20
before the human pandemic happened.
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prije nego što se dogodila pandemija među ljudima.
18:22
That may be because those events
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To može biti zato što su se ti događaji
18:24
were occurring on the other side of the world
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pojavljivali na drugoj strani svijeta,
18:26
where nobody was paying attention.
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gdje nitko nije obraćao pozornost.
18:28
But the virus clearly
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No, virus je očito
18:32
went through one round around the world
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prošao jedan krug oko svijeta
18:34
in a mild enough form
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u blagom obliku,
18:36
that the British army in World War I
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dovoljno blagom da britanska vojska za vrijeme Prvog svjetskog rata
18:39
actually certified that it was not a threat
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proglasi da on nije prijetnja
18:42
and would not affect the outcome of the war.
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i da neće utjecati na ishod rata.
18:45
And after circulating around the world
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I nakon tog kruženja oko svijeta
18:47
came back in a form that was tremendously lethal.
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vratio se u obliku koji je bio strahovito smrtonosan.
18:52
What percentage of infected people were killed by it?
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Koji je postotak zaraženih ljudi umro?
18:55
Again we don't really know for sure.
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Ponovno, nismo u potpunosti sigurni.
18:58
It's clear that if you were malnourished to begin with,
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Jasno je da ako ste bili pothranjeni,
19:00
you had a weakened immune system,
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imali oslabljen imunološki sustav,
19:02
you lived in poverty in India or Africa,
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živjeli u siromaštvu u Indiji ili Africi,
19:05
your likelihood of dying was far greater.
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vaša je vjerojatnost umiranja bila znatno veća.
19:08
But we don't really know.
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Ali mi zapravo ne znamo.
19:11
Audience member: One of the things I've heard is that
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Publika: Jedna od stvari koje sam čuo je da je
19:13
the real death cause when you get a flu is the associated pneumonia,
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pravi uzrok smrti kada dobijete gripu - upala pluća koja dođe s njom.
19:16
and that a pneumonia vaccine
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I da vam cjepivo protiv upale pluća
19:18
may offer you 50 percent better chance of survival.
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može osigurati 50 posto veću šansu preživljavanja.
19:22
LG: For a long time, researchers in emerging diseases
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LG: Dugo su vremena istraživači nastanka bolesti,
19:26
were kind of dismissive of the pandemic flu threat
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na neki način, odbacivali prijetnju od pandemije gripe
19:28
on the grounds that
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na temelju toga
19:30
back in 1918 they didn't have antibiotics.
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što 1918. godine nije bilo antibiotika.
19:32
And that most people who die of regular flu --
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I da su većina ljudi koji umru od obične gripe,
19:35
which in regular flu years
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što je oko
19:37
is about 360,000 people worldwide,
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360 tisuća ljudi širom svijeta godišnje,
19:40
most of them senior citizens --
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stariji građani.
19:42
and they die not of the flu but because the flu gives an assault to their immune system.
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I da oni ne umiru od gripe, već zato što gripa daje zadnji napad njihovom imunološkom sustavu.
19:46
And along comes pneumococcus
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A usput dolazi i pneumokok,
19:48
or another bacteria, streptococcus
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ili druga bakterija, streptokok i
19:50
and boom, they get a bacterial pneumonia.
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- bum, oni dobiju bakterijsku upalu pluća.
19:52
But it turns out that in 1918 that was not the case at all.
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Ali izgleda da 1918. godine to uopće nije bio slučaj.
19:55
And so far in the H5N1 cases in people,
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Tako i sada, u slučajevima H5N1 kod ljudi,
19:58
similarly bacterial infection
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slična bakterijska infekcija
20:00
has not been an issue at all.
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nije ključan problem.
20:02
It's this absolutely phenomenal disruption of the immune system
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Radi se o apsolutnom poremećaju imunološkog sustava
20:07
that is the key to why people die of this virus.
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i to je ključna stvar zbog koje ljudi umiru od ovog virusa.
20:10
And I would just add
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I htjela bih dodati da smo
20:12
we saw the same thing with SARS.
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istu stvar imali sa SARS-om.
20:14
So what's going on here is your body says,
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Dakle, ono što se ovdje događa je da vaše tijelo kaže,
20:17
your immune system sends out all its sentinels and says,
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vaš imunološki sustav kaže:
20:21
"I don't know what the heck this is.
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„Ne znam što je ovo.
20:23
We've never seen anything even remotely like this before."
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Nikad nismo vidjeli nešto ni približno slično ovome.“
20:26
It won't do any good to bring in the sharpshooters
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Neće vam biti nimalo bolje ako uvedete „iskusne strijelce“ u organizam -
20:29
because those antibodies aren't here.
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jer tih antitijela nema ovdje.
20:31
And it won't do any good to bring in the tanks and the artillery
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Ni uvođenje „tenkova i topništva“ neće rezultirati poboljšanjem
20:34
because those T-cells don't recognize it either.
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jer ih vaši T-limfociti neće prepoznati.
20:37
So we're going to have to go all-out thermonuclear response,
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Zato ćemo morati ići sve do termonuklearne reakcije,
20:40
stimulate the total cytokine cascade.
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stimulirati potpunu kaskadu citokina.
20:43
The whole immune system swarms into the lungs.
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Cijeli imunološki sustav nahrupi u pluća.
20:46
And yes they die, drowning in their own fluids, of pneumonia.
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I da, ljudi umiru utapajući se u vlastitoj tekućini, od upale pluća.
20:49
But it's not bacterial pneumonia.
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Ali to nije bakterijska upala pluća.
20:51
And it's not a pneumonia that would respond to a vaccine.
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I to nije upala pluća koja bi reagirala na cjepivo.
20:55
And I think my time is up. I thank you all for your attention.
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Mislim da mi je vrijeme isteklo. Zahvaljujem Vam svima na pozornosti.
20:58
(Applause)
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(Pljesak)
ABOUT THE SPEAKER
Laurie Garrett - Science journalistPulitzer winner Laurie Garrett studies global health and disease prevention. Her books include "The Coming Plague" and "Betrayal of Trust," about the crisis in global public health.
Why you should listen
Laurie Garrett has made a career of uncovering science and policy news that is almost too depressing to know: emerging and re-emerging diseases, and the world's general inability to deal with them. In the process, she has uncovered gaping lapses in public health and policy.
Garrett is the author of The Coming Plague: Newly Emerging Diseases in a World Out of Balance and Betrayal of Trust: The Collapse of Global Public Health. As a science writer for Newsday, Garrett won a Pulitzer, a Peabody and two Polk awards; in 2004, she joined the Council on Foreign Relations as Senior Fellow for Global Health. She is an expert on public health -- and the fascinating ways that health policy affects foreign policy and national security.
Laurie Garrett | Speaker | TED.com